Publications by authors named "Sagnik Biswas"

18 Publications

  • Page 1 of 1

Molecular perspective concerning fluoride and arsenic mediated disorders on epididymal maturation of spermatozoa: A concise review.

Hum Exp Toxicol 2021 Jun 4:9603271211021474. Epub 2021 Jun 4.

568916Department of Life Sciences, Presidency University, Kolkata, West Bengal, India.

Epididymis is a complex tubular structure of male reproductive system where spermatozoa undergo maturation and gain the fertilizing ability. Epididymal pseudostratified columnar epithelium with different cell types play imperative role by their secretory properties and enrich the luminal microenvironment necessary for achieving spermatozoal motility. During epididymal transit several secretory proteins like P26h, SPAG11, HSPD1 and many others are deposited on spermatozoal surface. At the same time spermatozoal proteins are also modified in this intraluminal milieu, which include cyritestin, fertilin, CE9 and others. Natural and anthropogenic activities disclose various environmental pollutants which affect different physiological systems of animals and human being. Likewise, reproductive system is also being affected. Fluoride causes structural alterations of caput and cauda segments of epididymis. Redox homeostasis and functional integrity are also altered due to diminished activities of SOD1, GR, Crisp2, Lrp2 and other important proteins. On the contrary arsenic affects mostly on cauda segment. Redox imbalance and functional amendment in epididymis have been observed with arsenic revelation as evidenced by altered genomic appearance of SOD, GST, catalase, Ddx3Y, VEGF and VEGFR2. This review is dealt with structure-function interplay in normal epididymal spermatozoal maturation along with subsequent complications developed under fluoride and arsenic toxicities.
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http://dx.doi.org/10.1177/09603271211021474DOI Listing
June 2021

Utility of nasal application of lignocaine gel using cotton tip swab versus squirting with slip-tip syringe for transnasal fibreoptic bronchoscopy: a pilot randomised controlled trial.

Postgrad Med J 2021 May 26. Epub 2021 May 26.

Department of Medicine, All India Institute of Medical Sciences, New Delhi, India.

Background: During flexible fibreoptic bronchoscopy through the nasal route, anaesthesia of the nasal passage is achieved by lignocaine gel application by a slip-tip syringe or with the help of a cotton tip swab. No studies in existing literature have compared the two techniques in terms of efficacy.

Methods: 137 consecutive patients undergoing bronchoalveolar lavage (BAL) were recruited over a 2-year period. The patients underwent BAL after nasal anaesthesia-either by slip-tip syringe or by cotton tip swab smeared with 2% lignocaine gel. Patients were monitored for intraprocedural epistaxis, discomfort and improvement in operator visibility of nasal passage.

Results: 67 patients were randomised to cotton swab and 70 patients to the gel instillation group. There were no significant differences in terms of epistaxis, 29.9% in the cotton tip swab (95% CI 19.3% to 42.3%) versus 24.3% in the gel instillation group (95% CI 14.8% to 36%) or detection of nasal blocks, 7.5% in the cotton tip swab (95% CI 2.5% to 16.6%) versus 10% in the gel instillation group (95% CI 4.1% to 19.5%) in the two groups, although a significant difference was there in terms of visibility, 73.1% in the cotton tip swab (95% CI 60.9% to 83.2%) versus 42.9% in the gel instillation group (95% CI 31.1% to 55.3%). There was no difference in the mean pain score across the two groups either during the procedure or 1 hour after it. A short systematic review of existing literature on the topic has been provided for comparison.

Conclusion: Application of 2% lignocaine gel by slip-tip syringe and cotton tip swab are equivalent in terms of observed and narrated pain experienced by patients, frequency of epistaxis and nasal blocks. Vision was better preserved in the cotton tip swab group.
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http://dx.doi.org/10.1136/postgradmedj-2020-139626DOI Listing
May 2021

Coronavirus Disease-2019 (COVID-19) and the Liver.

J Clin Transl Hepatol 2021 Apr 22;9(2):247-255. Epub 2021 Mar 22.

Department of Gastroenterology and Human Nutrition Unit, All India Institute of Medical Sciences, New Delhi, India.

Within a year of its emergence, coronavirus disease-2019 (COVID-19) has evolved into a pandemic. What has emerged during the past 1 year is that, apart from its potentially fatal respiratory presentation from which the severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) derives its name, it presents with a myriad of gastrointestinal (GI) and liver manifestations. Expression of the angiotensin-converting enzyme-2 (ACE-2) receptor throughout the GI tract and liver, which is the receptor for the SARS-CoV-2, may be responsible for the GI and liver manifestations. Besides acting directly via the ACE-2 receptor, the virus triggers a potent immune response, which might have a role in pathogenesis. The virus leads to derangement in liver function tests in close to 50% of the patients. The impact of these derangements in patients with a normal underlying liver seems to be innocuous. Severe clinical presentations include acute decompensation and acute-on-chronic liver failure in a patient with chronic liver disease, leading to high mortality. Evolving data suggests that, contrary to intuition, liver transplant recipients and patients with autoimmune liver disease on immunosuppression do not have increased mortality. The exact mechanism underlying why immunosuppressed patients fare well as compared to other patients remains to be deciphered. With newer variants of COVID-19, which can spread faster than the original strain, the data on hepatic manifestations needs to be updated to keep a step ahead of the virus.
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http://dx.doi.org/10.14218/JCTH.2021.00006DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8111098PMC
April 2021

Pulmonary tuberculosis presenting as acute respiratory distress syndrome.

BMJ Case Rep 2021 Jan 25;14(1). Epub 2021 Jan 25.

Department of Medicine, All India Institute of Medical Sciences, New Delhi, India

Pulmonary tuberculosis (TB) may present in the form of parenchymal disease or extraparenchymal disease. Patients with TB as a primary cause of respiratory failure requiring mechanical ventilation have been reported to have mortality rates ranging between 47% and 80%. However, acute respiratory distress syndrome (ARDS) as a presentation of TB is rarely reported. We describe two cases of immunocompetent women presenting with ARDS. They were initially worked up for viral aetiologies in view of the ongoing COVID-19 pandemic but were later diagnosed to have microbiologically proven parenchymal pulmonary TB. One of our patients succumbed to nosocomial pneumonia, while the other was discharged to follow-up.
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http://dx.doi.org/10.1136/bcr-2020-237664DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7839906PMC
January 2021

Lymphoma versus thymoma: A diagnostic challenge.

Drug Discov Ther 2020 Nov 29;14(5):249-251. Epub 2020 Oct 29.

Department of Pathology, All India Institute of Medical Sciences, New Delhi, India.

T-cell acute lymphoblastic lymphoma is a common hematological malignancy of childhood. It can involve the bone marrow, blood, or tissues like the thymus, lymph nodes as well as extra-nodal sites. Two aspects of the disease make early diagnosis critical - the clinically aggressive nature of the neoplasm, and availability of effective chemotherapy against the disease. Diagnosis is largely based on clinical suspicion and confirmation by histopathological examination of the affected tissue. However, biopsy results may not always be helpful in establishing the diagnosis. We describe the case of an 18-year old patient presenting with fever and an anterior mediastinal mass suspected to have a T-cell lymphoma where an initial biopsy from the mass had features of a thymoma. The patient was kept in close follow up for 2 months when there was a recurrence of symptoms and a repeat bone marrow evaluation revealed a T-cell lymphoma.
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http://dx.doi.org/10.5582/ddt.2020.03025DOI Listing
November 2020

Casein- and pea-enriched high-protein diet can take care of the reprotoxic effects of arsenic in male rats.

Andrologia 2020 Jun 20;52(5):e13560. Epub 2020 Mar 20.

Department of Life Sciences, Presidency University, Kolkata, India.

Arsenic toxicity is a significant health problem featured with several incidents of male reproductive dysfunctions. We studied the protective effects of a casein- and pea-enriched formulated high-protein diet (FHPD) on arsenic-mediated testicular dysfunctions in rats. Adult male rats sustained on either a benchmark diet (n = 8) or an isocaloric FHPD (n = 8) were gavaged with arsenic trioxide (3mg/kg body wt/rat/day) for 30 consecutive days. A vehicle-fed group (n = 8) maintained on the standard diet served as control. The arsenic-treated group continued on the standard diet had a significantly reduced testicular and accessory sex organs weights. They exhibited decreased count, motility, viability and disrupted plasma membrane integrity of caudal spermatozoa with a higher incidence of gross morphological anomalies and DNA damage. Attenuated steroidogenic enzyme activities and low serum testosterone level vouched for a compromised state of testicular steroidogenesis. An increased testicular malondialdehyde and protein carbonyl contents coupled with impaired activities of antioxidant enzymes and free radical scavengers mirrored a situation of exacerbated testicular oxidative imbalance and disrupted redox homeostasis. FHPD, by and large, countermanded testicular steroidogenesis and antioxidant defence system and revoked the ill effects of arsenic. We conclude that specific protein-enriched diet may serve as prospective weaponry in encountering the arsenic-threatened testicular functions.
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http://dx.doi.org/10.1111/and.13560DOI Listing
June 2020

Role of routine use of ultrasonographic guidance for performing lumbar punctures.

J Assoc Physicians India 2020 Jan;68(1):105

All India Institute of Medical Sciences, New Delhi.

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January 2020

N-Terminal pro-BNP is an independent predictor of mortality in patients with sepsis.

J Assoc Physicians India 2020 Jan;68(1):87

All India Institute of Medical Sciences, New Delhi.

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January 2020

Role of routine use of ultrasonographic guidance for performing lumbar punctures.

Postgrad Med J 2021 Jan 5;97(1143):23-28. Epub 2019 Dec 5.

Department of Medicine, All India Institute of Medical Sciencess, New Delhi, India.

Purpose Of Study: Ultrasound (US) for lumbar puncture has seen the most success in obese patients and in patients with difficult to palpate landmarks. We aimed to elucidate the advantage of the use of routine US for performing lumbar punctures over the traditional landmark method.

Study Design: This was a prospective study with consecutive sampling with a sample size of convenience. Three residents were chosen to perform the lumbar punctures after a training session. Patients were assigned to either the US group or the landmark group. The outcomes studied were number of attempts at needle insertion, patient and physician anxiety, pain experienced, time to procedure, number of traumatic attempts and the difficulties faced during the procedure.

Results: A total of 77 patients were included in this study, of which 36 patients (46.8%) underwent landmark-based lumbar puncture and 41 (53.2%) underwent US-guided lumbar puncture. There was no statistically significant difference between the two groups among the following characteristics: number of attempts to a successful procedure, number of traumatic punctures, procedure time, preprocedure anxiety of the participants and physicians and pain score rating of the procedure.

Conclusion: There was no significant difference between the landmark method and US-guided method for performing lumbar puncture in the number of successful attempts, number of traumatic punctures, procedure time and pain during the procedure. Further studies are required to elucidate the advantage of the use of ultrasonography in subsets of the population such as the low body mass index population.
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http://dx.doi.org/10.1136/postgradmedj-2019-137058DOI Listing
January 2021

An Unusual Case of Intractable Vomiting: Unravelling the Present, Through the Past!

J Assoc Physicians India 2018 Jun;66(6):88-91

Professor, Department of Medicine, All India Institute of Medical Sciences, New Delhi.

A 54 year old lady presented to our institute with a history of low grade fever for one week associated with occasional loose stools, vomiting and severe malaise. Initial evaluation revealed low serum sodium. An initial diagnosis of acute gastroenteritis with secondary hyponatremia was made. Work up for infective causes of gastroenteritis was however negative. ENT evaluation and review of drug history did not contribute towards a diagnosis. The patient's symptoms persisted and did not respond to symptomatic treatment. Ultrasound of abdomen revealed cholelithiasis with no evidence of cholecystitis. Further evaluation revealed hypotonic hyponatremia with normal levels of urinary sodium excretion. With other causes of hyponatremia ruled out, an endocrinopathy was suspected as the likely culprit. Follow up hormonal studies revealed hypopituitarism and MRI of brain revealed a partially empty sella. On reviewing the case, a past history of amenorrhea immediately after the birth of her third child (almost 20 years ago!) was elicited. Intractable vomiting is quite an unusual presentation for Sheehan's syndrome, but a thorough case history coupled with a high index of suspicion can contribute towards identifying the cause among a series of confounding clinical and radiological findings, as in our case.
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June 2018

Case Report: Cardiac Tamponade in Dengue Hemorrhagic Fever: An Unusual Manifestation of a Common Disease.

Am J Trop Med Hyg 2019 08;101(2):448-450

Department of Medicine, All India Institute of Medical Sciences, New Delhi, India.

Dengue hemorrhagic fever is one of the most commonly encountered mosquito-borne viral infections of humans worldwide with multiple reported outbreaks. Cardiac involvement is a known manifestation of the disease usually presenting as rhythm abnormalities, myocarditis, or pericardial effusion, which may be clinically asymptomatic. We describe a case of a 30-year-old woman who presented to us with high-grade fever, headache, retro-orbital pain, generalized maculopapular rash with bilateral pleural effusion, and hypotension. Dengue non-structural protein 1 (NS1) antigen and IgM antibodies were positive on admission, supporting a diagnosis of dengue hemorrhagic fever. Cardiac troponin-I was elevated on admission (65 ng/L) with diffuse convex ST segment elevations on electrocardiogram, suggestive of possible myopericarditis. Echocardiogram on admission revealed minimal pericardial effusion with preserved ejection fraction. Despite administration of fluids and inotrope use, the patient's hypotension progressively deteriorated over the next 6 hours, associated with decreased urine output and worsening sensorium. Clinical examination revealed muffled heart sounds and raised jugular venous pressure. A repeat echocardiogram confirmed an increase in the pericardial effusion manifesting as cardiac tamponade. Ultrasound-guided pigtail catheter insertion led to a prompt removal of the excessive pericardial fluid and correction of hypotension. Early identification of this uncommon but important complication of dengue hemorrhagic fever led to a good outcome in our case.
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http://dx.doi.org/10.4269/ajtmh.19-0153DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6685585PMC
August 2019

Dextrocardia with pulmonary hypoplasia: an unusual cause of unilateral lung white-out.

BMJ Case Rep 2019 May 28;12(5). Epub 2019 May 28.

Internal Medicine, All India Institute of Medical Sciences, New Delhi, Delhi, India.

Pulmonary agenesis is a rare developmental disorder with many syndromic associations. Type III agenesis presents with variable amounts of bronchial tree, pulmonary parenchyma and supporting vasculature. It is also reported to be associated with dextrocardia due to shifting of the heart to occupy the space left by the underdeveloped lung, which occurs as early as the fourth week of gestation. Right lung agenesis is considered rarer than its left-sided counterpart and also has a poorer prognosis due to increased chances of respiratory infections. We report a case of isolated right-sided lung hypoplasia with dextrocardia without situs inversus or heterotaxy.
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http://dx.doi.org/10.1136/bcr-2019-229413DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6557338PMC
May 2019

A study on factors determining dose of topical lignocaine during broncho-alveolar lavage by spray-as-you-go technique: A single centre observational study.

Drug Discov Ther 2019 ;13(2):89-95

Department of Medicine, All India Institute of Medical Sciences.

Basic bronchoscopic diagnostic procedures like Broncho-alveolar lavage (BAL) are often performed without sedation, using lignocaine administered via the working channel of bronchoscope (spray-as-you-go technique) and other routes. Our aim was to evaluate the factors responsible for variation in the total dose of lignocaine administered in individual subjects. We prospectively included consecutive subjects undergoing BAL in an outpatient setting from August 2016 to November 2017 at our centre. The subjects were administered lignocaine via nebulization, nasal gel, oropharyngeal spray before and during bronchoscopy ("spray-as-you-go") as per a predefined protocol. The demographic details, high resolution computerized tomography (HRCT) characteristics, procedural details, doses of lignocaine administered and a visual analogue scale (VAS) for satisfaction with the procedure were recorded. Using lignocaine dose as outcome, variables were assessed for effect by univariate and multivariate regression analysis. 96 subjects were included with a mean age of 40 years and male predominance (60.4%). Cough was the most common presenting symptom (64.6%). Predisposing factors included tuberculosis (47.9%) and smoking (23.2%). Maximum variation in lignocaine dose occurred prior to intubating vocal cords using "spray-as-you-go", which was significantly related to history of past tuberculosis (p = 0.031), obstructive airway disease (p = 0.009), fibrotic sequelae (p = 0.011) and bronchiectasis (p = 0.049). Obstructive airway disease and fibrotic sequelae were also significant on multivariate analysis (p = 0.01 and 0.005 respectively). Obstructive airway disease and architectural distortion due to fibrotic sequelae leads to higher dose requirement for lignocaine during BAL by fibre-optic bronchoscopy. Caution must be maintained during bronchoscopic procedures to avoid exceeding recommended maximum doses in such patients.
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http://dx.doi.org/10.5582/ddt.2019.01012DOI Listing
September 2019

Hydropneumothorax following diagnostic bronchoalveolar lavage: A rarest of rare complication.

Lung India 2019 May-Jun;36(3):270-271

Department of Medicine, All India Institute of Medical Sciences, New Delhi, India.

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http://dx.doi.org/10.4103/lungindia.lungindia_423_18DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6503703PMC
April 2019

Expansile cough impulse: a useful clinical sign for empyema necessitans.

BMJ Case Rep 2019 Mar 31;12(3). Epub 2019 Mar 31.

Department of Internal Medicine, All India Institute of Medical Sciences, New Delhi, Delhi, India.

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http://dx.doi.org/10.1136/bcr-2019-229696DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6453375PMC
March 2019

Toxic shock syndrome: the great masquerader.

BMJ Case Rep 2018 Nov 28;11(1). Epub 2018 Nov 28.

Department of Pathology, All India Institute of Medical Sciences, New Delhi, India.

Toxic shock syndrome is a rare but potentially lethal toxin-mediated illness that can be caused by streptococcal and staphylococcal species. It initially presents as a febrile illness that rapidly progresses to multiorgan dysfunction, hence a high index of suspicion coupled with rapid verification of the diagnosis and aggressive treatment is required to improve the outcome of the disease. A 23-year-old man presented with high-grade fever associated with headache, retro-orbital pain, gastroenteritis and gum bleeds. Treatment was initiated keeping in mind the possibility of dengue haemorrhagic fever. However, further clinical deterioration led us to re-examine our patient, revealing an old neglected wound. Microbiological confirmation of methicillin-resistant from the wound swab and prompt institution of appropriate treatment led to a favourable outcome in a case known to be associated with serious morbidity and mortality.
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http://dx.doi.org/10.1136/bcr-2018-226123DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6301640PMC
November 2018

α-Lipoic Acid Mitigates Arsenic-Induced Hematological Abnormalities in Adult Male Rats.

Iran J Med Sci 2017 May;42(3):242-250

Department of Biological Sciences, Presidency University, Kolkata, India.

Background: Arsenic toxicity is a major global health problem and exposure via contaminated drinking water has been associated with hematological and other systemic disorders. The present investigation has been conducted in adult male rats to evaluate the protective ability of α-lipoic acid (ALA) against such hematological disorders.

Methods: Twenty-four adult male Wister rats (b.wt.130±10g) were grouped and accordingly group I (control) received the normal diet, group II (treated) was given arsenic orally for 28 consecutive days as arsenic trioxide (3 mg/kgbw/rat/day) whereas group III (supplemented) received the same dose of arsenic along with ALA (25 mg/kgbw/rat/day) as oral supplement. Hematological profile, plasma oxidant/antioxidant status, and erythrocyte morphology were assessed. Statistical analysis was done by one-way ANOVA using SPSS software (version 16.0).

Results: Arsenic exposure caused reduction of erythrocyte (P=0.021), leucocyte (P<0.001), and hemoglobin (P=0.031) associated with echinocytic transformation as evidenced by light and scanning electron microscopic studies. The other significantly altered parameters include increased mean corpuscular volume (P=0.041) and lymphocytopenia (P<0.001) with insignificant neutropenia and eosinophilia. Altered serum oxidative balance as evidenced by decreased TAS (P<0.001) and increased TOS (P<0.001) with OSI (P<0.001) was also noted. The dietary supplementation of ALA has a beneficial effect against the observed (P<0.05) arsenic toxicities. It brings about the protection by restoring the hematological redox and inflammatory status near normal in treated rats. Arsenic-induced morphological alteration of erythrocytes was also partially attenuated by ALA supplementation.

Conclusion: It is concluded that arsenicosis is associated with hematological alterations and ALA co-supplementation can partially alleviate these changes in an experimental male rat model.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5429492PMC
May 2017

Protection against arsenic-induced hematological and hepatic anomalies by supplementation of vitamin C and vitamin E in adult male rats.

J Basic Clin Physiol Pharmacol 2016 Nov;27(6):643-652

Background: Chronic arsenic exposure via contaminated drinking water is a global environmental health problem associated with hematological, hepatic and many serious systemic disorders. This study on adult male rats evaluated the protective effects of vitamin E (VE) and vitamin C (VC) against arsenic-mediated hematological and hepatic toxicities.

Methods: Arsenic was administered orally as arsenic trioxide (3 mg/kg body weight/day), as a single dose for 30 consecutive days or along with VC/ascorbic acid (200 mg/kg body weight/day dissolved in water) and VE/α-tocopherol (400 mg/kg body weight/day dissolved in olive oil) as supplements. Multiple hematological and hepatic parameters were assessed.

Results: Arsenic exposure caused significant reduction of erythrocyte counts (p<0.05), leukocyte counts (p<0.01) and hemoglobin (Hb) levels (p<0.01). Arsenic exposure also led to marked echinocytic transformation of erythrocytes resulting in increased morphological index (p<0.001). Altered serum oxidative balance was observed with a higher oxidative stress index (p<0.001). The results also showed a significant increase of serum cholesterol (p<0.05), low-density lipoprotein (p<0.001) and triglycerides (p<0.01), and decreased high-density lipoprotein (p<0.01) along with total protein (p<0.01). A marked elevation of hepatic thiobarbituric acid reactive substance (p<0.05) along with decreased reduced glutathione (p<0.001) levels were also observed. Interestingly, co-administration of VC and VE significantly prevented all the arsenic-induced alterations (p<0.05) except Hb content and serum protein.

Conclusions: The present investigation offers strong evidence regarding the protective efficacy of co-administration of VC and VE against hematotoxicity and hepatotoxicity in adult male rats caused by chronic arsenic exposure.
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http://dx.doi.org/10.1515/jbcpp-2016-0020DOI Listing
November 2016