Rama Prosad Goswami’s scientific contributions

Background: Using face masks is one of the possible prevention methods against respiratory pathogens. A number of studies and reviews have been performed regarding the use of medical grade masks like surgical masks, N95 respirators etc. However, the use of cloth masks has received little attention. Objectives: The purpose of this review is to analyze the available data regarding the use of cloth masks for the prevention of respiratory infections. We intended to use data from both clinical and non-clinical studies to arrive at our conclusion. Methods: We used PubMed, Cochrane Library and Google Scholar as our source databases. Both clinical and non-clinical studies, which had data regarding the efficacy of cloth masks, were selected. Articles not containing analyzable data including opinion articles, review articles etc. were excluded. After screening the search results, ten studies could be included in our review. Data relevant to our objective was extracted from each study including clinical efficacy, compliance, filtration efficacy etc. Data from some studies were simplified for the purpose of comparison. Extracted data was summarized and categorized for detailed analysis. Qualitative synthesis of the data was performed. But the heterogeneity between the studies did not allow for a meta-analysis. Discussion: The review was limited by a lack of sufficient clinical studies. Lack of standardization between studies was another limitation. Although cloth masks generally perform poorer than the medical grade masks, they may be better than no masks at all. Filtration efficacy varied greatly depending on the material used, with some materials showing a filtration efficacy above 90%. However, leakage could reduce efficacy of masks by about 50%. Standardization of cloth masks and appropriate use is essential for cloth masks to be effective. However, result of a randomized controlled trial suggest that they may be ineffective in the healthcare setting.

Objective: A tetravalent dengue vaccine (CYD-TDV) has been licensed in 2015 and is currently approved in 20 countries. We did a meta-analysis to determine whether CYD-TDV is effective in preventing dengue. Methods: We did a pubmed search to find published papers on dengue vaccine (keyword: dengue AND vaccine AND randomized controlled trial [pt]) and found 74 results. We filtered those papers first by titles, then abstracts and lastly by full text and included 6 studies which compared CYD-TDV with placebo. We used virologically confirmed dengue as our primary endpoint. We combined data for all age groups together. We used RevMan software for statistical analysis. Results: We included 6 studies which had 122,660 participants in total, 82165 in vaccine group and 40495 in control group. Virologically confirmed dengue occurrence was 865 in vaccine group and 1087 in control group. Fixed effect model was used and the heterogeneity was I2 =81%. Confidence interval was chosen as 95%. Overall effect was Z=20.69 (P<0.000001). The meta-analysis showed a risk ratio of 0.39 in favor of the tetravalent dengue vaccine. Conclusion: The meta-analysis showed a lower incidence of virologically confirmed dengue in the vaccine group which indicates that CYD-TDV vaccine is efficacious in preventing dengue. However, our study did not look into different age-groups separately. Not all studies looked into the severity of dengue in vaccine group. Most studies were in dengue endemic regions. A single large study in 2017 dominated the meta-analysis. Based on the current meta-analysis it can be said that tetravalent dengue vaccine is effective in preventing dengue and should be considered for implementation in endemic regions. Further meta-analysis may be warranted to look into dengue vaccine efficacy in specific age groups.

Objective: Infection with HIV results in progressive depletion of the CD4 T-lymphocytes and the development of multiple opportunistic infections (OI) which is serious cause of concern with regards to the outcome. Methods and Results (Case Report): A 29 year old female was admitted with drowsiness and right sided hemiparesis, inconti- nence of bladder, partial seizure and bloody diarrhea. On examina- tion: Mild pallor, GCS 8/15 (E2V2M4), BP-100/70, pulse-70, RR- 24/min, neck rigidity present, plantar bilateral flexor, pupil bilateral mid-dilated, reacting to light, muscle tone increased, power dimin- ished (3/5) and jerk brisk on the right side compared to the left. Pe- rianal vesicular lesions with satellite ulcerations and discharge were present. HIV ELISA was positive. CD4 count was 3(1%). MRI brain showed periventricular hyperintensities, focal demyelination with dif- fuse edema suggestive of encephalopathy. CSF study revealed raised pressure, lymphocytosis, borderline high ADA and high protein with negative CBNAAT. Both Toxoplasma IgG (4+ in 1:64 dilution) and serum CRAG (4+ in 1:32 titer) were positive in high titer. The same patient had evidence of five OI – CNS (toxoplasmosis, cryptococco- sis, and tuberculosis), anogenital herpes along with bloody diarrhea for longer than 1 month. She was treated with amphotericin B, co- trimoxazole, acyclovir, ciprofloxacin along with empirical ATD and corticosteroid. Patient improved partially and is now on maintenance therapy. Conclusion: Occurrence of multiple AIDS defining OIs in single HIV-infected individual in this report highlights the need for early screening to improve decisions regarding prophylaxis and appropriate therapy. Every immune-compromised patients with low CD4 count should be searched for multiple OI.