Sanjay Bhattacharya

Novel targets for anti-retroviral therapy

Novel targets for the management of HIV infection have become increasingly relevant in view of extensive drug resistance, side effects and high pill burden of some of the conventional anti-retroviral agents. Structure based drug design using X-ray crystallography, nuclear magnetic resonance, and mass spectrometry have lead to the identification of novel class of drugs targeting new stages of HIV life cycle. These agents include chemokine receptor antagonists and the integrase inhibitors which were recently approved for HIV treatment, as well as numerous other agents directed to previously untested targets such as the maturation inhibitors, zinc finger inhibitors, pharmacological CDK inhibitors, Tat-TAR interaction inhibitors, anti-CD4 monoclonal antibody, antisense oligonucleotides, oxidisers of the HIV lipid envelope and agents acting on the proviral DNA. Use of new agents with novel mechanism of action requires the development of new laboratory assays to detect viral tropism and new resistance mutations. Despite the new developments providing hope to patients and clinicians in the fights against HIV, eradication of the disease still remains elusive. This review discusses issues surrounding the development of these new agents.

Holiday haemodialysis and imported hepatitis C virus infection: A series of sixteen cases in two large haemodialysis units

BACKGROUND Patients in haemodialysis units are at an increased risk of blood borne virus infections. Birmingham city (West Midlands, UK) has a large number of its population from an ethnic origin other than white (30%). Recently due to the increase in number of haemodialysis centres abroad and particularly in the Indian Subcontinent, a large number of haemodialysis patients from these ethnic minorities are encouraged to take holidays in their countries of origin. OBJECTIVES To present the data on a series of cases of holiday haemodialysis acquired hepatitis C virus (HCV) infections from two large dialysis units in Birmingham. STUDY DESIGN In this retrospective study we have reviewed the case records of all patients in two large dialysis units who had holiday dialysis abroad and developed HCV infection after returning to the UK. RESULTS A total of 16 patients from two large dialysis units in Birmingham who developed HCV infection after haemodialysing abroad mainly in the Indian Subcontinent are being described. This constituted 44% of the total HCV positive patients in the two haemodialysis units (16/36). The cases occurred over a period of 9 years between 2000 and 2008. The last twelve of these fifteen cases had been diagnosed in the past 17 months. There were 10 male patients with a mean age 62.8 years (range 26-84 years) and 6 female patients with a mean age of 57 years (range 44-68 years). HCV genotypes 1, 3 and 4 were found in 9, 4 and 3 patients, respectively. CONCLUSION These cases underline the importance of enhanced surveillance and infection control procedures in haemodialysis units for patients who return after dialysing in resource poor countries. To the best of our knowledge this represents the largest series of imported HCV infection after holiday haemodialysis, and demonstrates clearly the significance of the perceived risk with increasing number of incident infections.

Extraintestinal Infections Caused by Non-toxigenic Vibrio cholerae non-O1/non-O139

Vibrio cholerae is an aerobic, sucrose fermentative Gram-negative bacterium that generally prevails in the environment. Pathogenic V. cholerae is well-known as causative agent of acute diarrhea. Apart from enteric infections, V. cholerae may also cause other diseases. However, their role in causing extraintestinal infections is not fully known as it needs proper identification and evaluation. Four cases of extraintestinal infections due to V. cholerae non-O1/non-O139 have been investigated. The isolates were screened for phenotypic and genetic characteristics with reference to their major virulence genes. Serologically distinct isolates harbored rtx, msh, and hly but lacked enteric toxin encoding genes that are generally present in toxigenic V. cholerae. Timely detection of this organism can prevent fatalities in hospital settings. The underlying virulence potential of V. cholerae needs appropriate testing and intervention.

Exploring the prescribing behaviours and the mind of antibiotic prescribers is critical for a successful antibiotic stewardship programme: Results of a survey from Eastern India

Quantitative and qualitative analysis were used to ascertain practices, perceptions and barriers about antibiotic stewardship program (ASP) in an oncology hospital in eastern India. In 2014 and 2017, 62% and 69.1% of the patients audited were found to be on anti infective medications respectively. Nearly 47% of patients in the study group (2014) who were on therapeutic antibiotics had an average cost of

Water usage in a multi-speciality hospital and its effective management

46.48 per patient per day (inter-quartile range:

Hepatitis B virus reactivation in a large haemodialysis unit: virological and infection control issues.

17.23–

Antibiotic Prophylaxis for Breast Oncosurgery in a Setting With a High Prevalence of Multidrug-Resistant Bacteria: Common Sense Infection Control Measures Are More Important Than Prolonged Antibiotics

94.76). Antibiotic related consultations from clinical microbiologists, was found to be in demand, and education of prescribers and policymakers was identified as critical to the success of ASP.

Blood stream infections as a predictor of length of hospital stay and cost of care in patients with cancer

Context: Water is an important resource for hospitals. There are few studies about the quality, quantity and cost of water that is required for health care. Aims: To study the quality, quantity, cost and applications of water in a hospital. Settings and Design: Observational study. The study was done in a cancer hospital in eastern India. Methods and Material: Water generation and consumption patterns and costing were assessed after: Discussion with the engineers; analysis of documented records; observation of patient/visitor/staff behaviours; measurement of flow rates and metered readings; Individual water consumption surveys. Statistical Analysis Used: None. Results: The total filtered reverse osmosis (RO) water used by the hospital per day was 200,000 L. This equated to 1093 L/patient/day. The volume of filtered reversed osmosis water consumed showed that the total water usage for drinking was 1%, water usage for hand-washing was 18%, water usage for showering was 6%, kitchen water consumption was 2%, housekeeping activities usage was 4%, central sterile supply department usage was 4%, heating, ventilation, and air conditioning systems usage was 36%, hot water consumption was 5% and toilet flush usage was 24%. Cost was Rs. 1119/- for 10,000 liters of RO water and about Rs. 31/- for 10,000 liters of raw water. Conclusions: The economics of hospital water both in terms of consumption and cost is a valuable source of information for hospital planners, administrators and hospital engineers.

How to develop an in-house real-time quantitative cytomegalovirus polymerase chain reaction: Insights from a cancer centre in Eastern India

A 60-year-old Asian man, originally from Pakistan but presently UK resident had been on long-term haemodialysis for end stage enal disease secondary to diabetic nephropathy.Hewasbeingdialsed three times a week at the various dialysis units at the Heart of ngland NHS Trust and was not on any immunosuppressive treatent. He had no history of recent travel. He was “negative” for BV, HCV and HIV by routine screening. In late September 2007 BsAgwasweaklypositive (signal/cut-off ratio3.337)by theMonoisa Ultra assay (Bio-Rad Laboratories) and strongly positive (s/co 37.77) by the Vidas Ultra assay (BioMerieux). The results of the idas assay were confirmed by a specific HBsAg neutralisation test Vidas Ultra assay). He was also found to be weakly reactive for epatitis B e antigen (HBeAg), antibody to HBeAg (anti-HBe) postive, anti-HBc positive, and anti-HBc IgM negative. His HBV viral oad reached a peak of 1,667,360 IU/ml (Roche Cobas Taqman HBV ssay). The patient had mild transaminitis (peak aspartate aminoransferase 124 IU/ml). Retrospective testing of stored sera showed hat 4 months previously he was anti-HBc positive and HBV DNA ositive but HBsAg negative (HBV viral load 848 IU/ml) (Fig. 1).

Viral myocarditis in a patient following allogenic stem cell transplant: Diagnostic dilemma and management considerations

isolated KPC-3-Kp ST395. For these isolates, cluster analysis based on MLST genes indicated a unique sublineage (or clonal group) of K. pneumoniae. This is not the first report of an outbreak of colonization by KPC-producing K. pneumoniae (KPC-Kp) in a NICU in Palermo; the pandemic ST258 clone has already been reported in another NICU here. Furthermore, in our area, the monoclonal spread of the successful pandemic ST258 clone is apparently being replaced by a simultaneous dissemination of multiple clones of KPC-Kp. In other recent surveillance studies from Italy, multifocal dissemination of KPC-3–producing K. pneumoniae (KPC-3-Kp) clones have been observed, showing the rapid emergence of the KPC-3-Kp ST307 clone, also coproducing the CTX-M-15 ESBL. Our observation of ST395 and ST307 clones (both coproducing KPC-3 and CTX-M-15 ESBL) suggests the changing epidemiology of KPC-Kp even in specific settings such as NICUs. In conclusion, we emphasize the need for active surveillance programs focused on CR-Kp in high-risk patients and wards, such as critical infants in NICUs. Surveillance data from colonization cases could be crucial to revealing the circulation of CR-Kp in the wards, to evaluating local epidemiology, and to improving control and prevention measures.