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The emergence and subsequent advancement of nanotechnology in recent years have greatly benefited the healthcare sector, particularly in the treatment of cancer. As per study, major fatalities are related to the lung cancer. For many years, oral tyrosine kinase inhibitors (TKIs) against the epidermal growth factor receptor (EGFR) family of receptors have been used in the clinic to treat human malignancies, although they observed some very serious adverse effects in the treatment of lung cancer, especially in non-small cell lung cancer (NSCLC). Despite EGFR-TKIs’ exceptional qualities as small-molecule targeted medications, their applicability is nevertheless limited by their poor solubility, inconsistent oral bioavailability, high daily dose needs, high plasma albumin binding propensity, and initial/acquired drug resistance. Article’s purpose is to investigate EGFR-TKI’s effects on lung cancer and get around some of its drawbacks, nanotechnology will be an innovative strategy. An effective tool to increase the effectiveness of these pharmaceuticals is nanotechnology by methods other than oral. This article signifies that a range of nanomedicine delivery systems have been developed to effectively distribute EGFR-TKIs with improved drug release kinetics and tissue-targeting capacity. This review article intends to present information regarding lung cancer and EGFR relation, mechanism of recently approved EGFR-TKI’s targeted therapy, an updated landscape of EGFR-TKIs and their clinical status over lung cancer, advantages and disadvantages of nanotechnology, and new breakthroughs in nano-delivery which mentioned as a significantly better over traditional drug chemotherapy and delivery.

Erythema nodosum leprosum (ENL) is an immune-mediated inflammatory reaction (antigen-antibody reaction involving complement) of leprosy. Available standard treatment in the form of steroids or thalidomide does not work in all ENL patients. Apremilast is an oral phosphodiesterase-4 inhibitor with potent immunomodulatory action. At present, apremilast is approved for chronic plaque psoriasis and psoriatic arthritis, however, not in ENL. The aim of this study was to assess the effectiveness of apremilast in chronic recalcitrant ENL. It was a case series, in which apremilast was started in 10 consecutive patients with recalcitrant ENL with 10 mg morning dose with a daily increment of 10 mg until day 6, when the recommended dose of 30 mg twice daily for adults is reached. Follow-up was done every 1 month till 6 months. Three patients showed good responses. The drug was well tolerated with few side effects. The most common adverse effect reported was headache (n = 5), followed by nausea (n = 4) and diarrhea (n = 4). Apremilast has lower cost and better safety profile compared to thalidomide and may be an option with limited effectiveness for ENL.

Abstract Decision makers consistently face the challenge of simultaneously assessing numerous attributes, determining their respective importance, and selecting an appropriate method for calculating their weights. This article addresses the problem of automatic generation control (AGC) in a two area power system (2-APS) by proposing fuzzy analytic hierarchy process (FAHP), an multi-attribute decision-making (MADM) technique, to determine weights for sub-objective functions. The integral-time-absolute-errors (ITAE) of tie-line power fluctuation, frequency deviations and area control errors, are defined as the sub-objectives. Each of these is given a weight by the FAHP method, which then combines them into an single final objective function. This objective function is then used to design a PID controller. To improve the optimization of the objective function, the Jaya optimization algorithm (JOA) is used in conjunction with other optimization techniques such as sine cosine algorithm (SCA), Luus–Jaakola algorithm (LJA), Nelder–Mead simplex algorithm (NMSA), symbiotic organism search algorithm (SOSA) and elephant herding optimization algorithm (EHOA). Six distinct experimental cases are conducted to evaluate the controller’s performance under various load conditions, with data plotted to show responses corresponding to fluctuations in frequency and tie-line exchange. Furthermore, statistical analysis is performed to gain a better understanding of the effectiveness of the JOA-based PID controller. For non-parametric evaluation, Friedman rank test is also used to validate the performance of the proposed JOA-based controller.

Abstract Multi-criteria decision-making (MCDM) presents a significant challenge in decision-making processes, aiming to ascertain optimal choice by considering multiple criteria. This paper proposes rank order centroid (ROC) method, MCDM technique, to determine weights for sub-objective functions, specifically, addressing issue of automatic generation control (AGC) within two area interconnected power system (TAIPS). The sub-objective functions include integral time absolute errors (ITAE) for frequency deviations and control errors in both areas, along with ITAE of fluctuation in tie-line power. These are integrated into an overall objective function, with ROC method systematically assigning weights to each sub-objective. Subsequently, a PID controller is designed based on this objective function. To further optimize objective function, Jaya optimization algorithm (JOA) is implemented, alongside other optimization algorithms such as teacher–learner based optimization algorithm (TLBOA), Luus–Jaakola algorithm (LJA), Nelder–Mead simplex algorithm (NMSA), elephant herding optimization algorithm (EHOA), and differential evolution algorithm (DEA). Six distinct case analyses are conducted to evaluate controller’s performance under various load conditions, plotting data to illustrate responses to frequency and tie-line exchange fluctuations. Additionally, statistical analysis is performed to provide further insights into efficacy of JOA-based PID controller. Furthermore, to prove the efficacy of JOA-based proposed controller through non-parametric test, Friedman rank test is utilized.

Abstract Many studies have used mobile device location data to model SARS-CoV-2 dynamics, yet relationships between mobility behavior and endemic respiratory pathogens are less understood. We studied the effects of population mobility on the transmission of 17 endemic viruses and SARS-CoV-2 in Seattle over a 4-year period, 2018-2022. Before 2020, visits to schools and daycares, within-city mixing, and visitor inflow preceded or coincided with seasonal outbreaks of endemic viruses. Pathogen circulation dropped substantially after the initiation of COVID-19 stay-at-home orders in March 2020. During this period, mobility was a positive, leading indicator of transmission of all endemic viruses and lagging and negatively correlated with SARS-CoV-2 activity. Mobility was briefly predictive of SARS-CoV-2 transmission when restrictions relaxed but associations weakened in subsequent waves. The rebound of endemic viruses was heterogeneously timed but exhibited stronger, longer-lasting relationships with mobility than SARS-CoV-2. Overall, mobility is most predictive of respiratory virus transmission during periods of dramatic behavioral change and at the beginning of epidemic waves.

Abstract Disabled 2 (Dab2), an adaptor protein, is up regulated in the hair follicle stem cells (HFSCs); however, its role in any tissue stem cells has not been studied. In the present study, we have reported that Dab2 conditional knockout (Dab2-cKO) mice exhibited a delay in the HF cycle due to perturbed activation of HFSCs. Further, Dab2-cKO mice showed a reduction in the number of HFSCs and reduced colony forming ability of HFSCs. Dab2-cKO mice showed extended quiescence of HFSCs concomitant with an increased expression of Nfatc1. Dab2-cKO mice showed a decreased expression of anti-aging genes such as Col17a1, decorin, Sirt2 and Sirt7. Dab2-cKO mice did not show full hair coat recovery in aged mice thereby suggesting an accelerated aging process. Overall, we unveil for the first time, the role of Dab2 that regulate activation and self-renewal of HFSCs.

Tuberculosis being endemic in country like India can affect any organ though pulmonary tuberculosis is rampant and extrapulmonary is rare. Tuberculosis affecting parotid gland is a rare occurrence, usually unilateral. However, Mycobacterium tuberculosis causing cold abscess in bilateral parotid glands is even rarer. Here, we present a case of a young female presented with bilateral slow-growing swelling in the parotid region with evening raise of temperature for two months. On clinical examination, no signs of inflammation were seen. Ultrasonography showed thick-walled hypoechoic collection with septae and internal echoes within involving both superficial and deep lobes of the parotid gland. Fine-needle aspiration cytology (FNAC) suggested a caseating granuloma and acid fast bacilli were detected on ZN staining, thereby confirming the diagnosis of cold abscess. She was put on antitubercular drugs and there was a drastic reduction in the size of swelling.

Canine babesiosis is a tick-borne hemoprotozoan disease of canines. Two main infective agents of the disease are intra-erythrocytic i.e. Babesia vogeli and Babesia gibsoni. In the present study, a total of 145 numbers of dogs (90 male and 55 female) in and around Akola, Maharashtra were screened from January 2022 to September 2022 for Babesiosis and 18 animals (12.41%) were found clinically and cytologically positive. The incidence of babesiosis was higher in females (11/145, 7.58%) than in males (07/ 145, 4.83%). Out of 18 positive samples, 14 (9.65%) and 4 (2.75%) animals were found infected with small and large forms of Babesia spp., respectively. Further small form was confirmed as B. gibsoni and the large form was confirmed as B. vogeli by employing PCR assay. All the cases with babesiosis revealed moderate to severe regenerative anemia with occasional basophilic stippling and Howell jolly bodies with hemoglobin ranging from 7 to 11 g/dL. Characteristic clinical features were observed among 18 positive clinical cases. The present investigation reports the incidence of B. vogeli and B. gibsoni in canines in and around Akola of Maharashtra state of India.

Abstract Background The current investigation aimed to develop, optimise, and assess a mupirocin-loaded nanosponge-based topical delivery system for diabetic foot ulcer and to achieve prolonged drug release while improving drug deposition within the skin. The nanosponges carrying mupirocin were formulated using the emulsion solvent diffusion method. A 32 factorial design was utilised to investigate effect of two factors, specifically the concentration of ethyl cellulose and the stirring rate, on the physical attributes of the nanosponges. The optimised nanosponge formulation batch (F9) was subsequently incorporated into a Carbopol gel base, ensuring the desired physical attributes were achieved in the gel formulation containing nanosponges. The research included in vitro drug release evaluation, ex vivo drug deposition analysis, assessment of the antimicrobial action of the nanosponge formulation, and in vivo diabetic wound healing. Results Drug polymer compatibility analysis was conducted using FT-IR spectroscopy revealed no interactions among mupirocin and ethyl cellulose molecules. Further FT-IR spectroscopy, DSC spectroscopy, and XRD spectroscopy analysis of optimised formulation batch revealed that the drug was successfully entrapped in nanosponges. Scanning electron microscopy confirmed the spherical and porous nature of the prepared nanosponges. The drug release pattern across the cellulose dialysis membrane followed a diffusion-controlled release pattern, and the drug deposition analysis exhibited substantial retention of mupirocin in the skin from the nanosponges formulation for up to 24 h. Furthermore, the optimised nanosponges gel formulation demonstrated stability and non-irritant properties, as indicated by the HET-CAM test. In vivo evaluation of wound healing activity in a Streptozotocin-induced diabetes mellitus with excision wound model revealed significant actions pertaining to wound healing and closure after 16 days of treatment. Conclusion The mupirocin-loaded nanosponge gel contributed to remarkable and swift recovery and closure of wounds in diabetic rats. The nanosponges, acting as carriers for mupirocin, facilitated the effective delivery of the drug to the wound area, while the gel fostered an optimally humid environment conducive to wound care during the final stages of wound healing and sealing. Graphical abstract

Abstract Autonomic nervous system (ANS) activity causes acute variations in blood pressure (BP) and heart rate (HR). These systems are challenged during high intensity interval exercise (HIIE). However, BP variability (BPV) and HR variability (HRV) response to HIIE is unknown. We characterized BPV and HRV during an acute HIIE bout using spectral low frequency [LF] and high frequency [HF] domains. We hypothesized that BPV would increase and HRV would decrease during high‐intensity and active‐recovery of HIIE compared to baseline [BL] and BPV would reduce and HRV would increase during cool down, post‐HIIE, and 30 min post‐HIIE compared to BL. HIIE involved 10 min of alternating high‐intensity and active‐recovery (approximately 70% and 10% of Wattmax) on a recumbent stepper. We did a secondary analysis on 23 datasets. The participants were 25 ± 1.5 years, 48% females. Our results showed high‐intensity BPV LF was not significantly different from BL while HF increased. HRV LF and HF decreased compared to BL. During active‐recovery, LF and HF for BPV and HRV increased greater than high‐intensity. HRV LF and HF returned to BL after 30 min of recovery, whereas BPV HF was higher compared to BL. The rapid switching during HIIE uniquely modulates cardiovascular and ANS.

Background: Oral Submucous Fibrosis, OSF is an inflammatory mucosal disorder prevalent in areca nut chewing belts of the world. Although various treatments are available for its management, none provide complete resolution.Curcumin, an indigenous product, improves burning sensation, mouth opening along with other clinical signs of OSF and is potentially viable therapeutic option for its management. Objectives: To assess the available evidence for employing curcumin in improving symptoms in patients with OSF. Methods: Systematic search was carried out in e-databases from January 2010 until July 2023 to identify relevant clinical trials comparing curcumin to active and/or nonactive controls (placebo) for the management of OSF. Results: A total of 20 studies were used for qualitative analysis out of which 11 studies were considered for quantitative synthesis.Curcumin was found to be highly effective in alleviating pain/burning sensation, improving mouth opening (MO), cheek flexibility, tongue protrusion and induces positive histological changes in patients with OSF.The standardized mean difference in mouth opening between both the Curcumin and Multivitamin group showed a statistically significant difference favouring the Curcumin group (SMD, 0.37, 95% CI = 0.18–0.56, p - 0.0001, I2- 0%). Conclusion: Statistically curcumin was noted to be as effective as Aloe vera, lycopene and steroids in relieving symptoms of OSF in stages 1 and 2 and improving MO. It is seen to improve histopathological picture of lesions thereby suggesting its active role in preventing malignant transformation. Its found to be more effective than multivitamins in improving mouth opening of patients in OSF.

IntroductionPost-ovulatory aging is a time-dependent deterioration of ovulated oocytes and a major limiting factor reducing the fitness of offspring. This process may lead to the activation of cell death pathways like apoptosis in oocytes.MethodologyWe evaluated oocyte membrane integrity, egg developmental competency, and mRNA abundance of apoptosis-related genes by RT-qPCR. Oocytes from zebrafish Danio rerio were retained in vivo at 28.5°C for 24 h post-ovulation (HPO). Viability was assessed using trypan blue (TB) staining. The consequences of in vivo oocyte aging on the developmental competence of progeny were determined by the embryo survival at 24 h post fertilization, hatching, and larval malformation rates.ResultsThe fertilization, oocyte viability, and hatching rates were 91, 97, and 65% at 0 HPO and dropped to 62, 90, and 22% at 4 HPO, respectively. The fertilizing ability was reduced to 2% at 8 HPO, while 72% of oocytes had still intact plasma membranes. Among the apoptotic genes bcl-2 (b-cell lymphoma 2), bada (bcl2-associated agonist of cell death a), cathepsin D, cathepsin Z, caspase 6a, caspase 7, caspase 8, caspase 9, apaf1, tp53 (tumor protein p53), cdk1 (cyclin-dependent kinase 1) studied, mRNA abundance of anti-apoptotic bcl-2 decreased and pro-apoptotic cathepsin D increased at 24 HPO. Furthermore, tp53 and cdk1 mRNA transcripts decreased at 24 HPO compared to 0 HPO.DiscussionThus, TB staining did not detect the loss of oocyte competency if caused by aging. TB staining, however, could be used as a simple and rapid method to evaluate the quality of zebrafish oocytes before fertilization. Taken together, our results indicate the activation of cell death pathways in the advanced stages of oocyte aging in zebrafish.

Lignocellulosic biomass is an abundant and renewable bioresource for the production of biofuels and biochemical products. The classical biorefinery process for lignocellulosic degradation and conversion comprises three stages, i.e., pretreatment, enzymatic saccharification, and fermentation. However, the complicated pretreatment process, high cost of cellulase production, and insufficient production performance of fermentation strains have restricted the industrialization of biorefinery. Consolidated bioprocessing (CBP) technology combines the process of enzyme production, enzymatic saccharification, and fermentation in a single bioreactor using a specific microorganism or a consortium of microbes and represents another approach worth exploring for the production of chemicals from lignocellulosic biomass. The present review summarizes the progress made in research of CBP technology for lignocellulosic biomass conversion. In this review, different CBP strategies in lignocellulose biorefinery are reviewed, including CBP with natural lignocellulose-degrading microorganisms as the chassis, CBP with biosynthetic microorganisms as the chassis, and CBP with microbial co-culturing systems. This review provides new perspectives and insights on the utilization of low-cost feedstock lignocellulosic biomass for production of biochemicals.

The escalating discharge of noxious gases resulting from unmitigated anthropogenic activities has emerged as a pivotal concern, presenting imminent threats to global ecosystems. In response to this pressing challenge, the development of cutting-edge materials within gas sensor systems emerges as a promising avenue for the precise detection of hazardous gaseous pollutants. This investigation delves into the synthesis and characterization of a novel composite material: reduced graphene oxide (rGO) modified with ruthenium Octaethyl porphyrin (Ru OEP), with a primary focus on its chemiresistive sensing properties. The meticulously deposited rGO-modified Ru OEP material onto gold microelectrodes, featuring a 3 µm gap on a silicon Si/SiO2 substrate, resulted in an intricate two-terminal chemiresistive sensor device. Comprehensive structural, spectroscopic, and morphological analyses were conducted to elucidate the intricacies of the composite material. The electrical characterization, evaluated through I-V measurements, provided nuanced insights into the device's resistance properties. Notably, the chemiresistive sensor demonstrated exceptional responsiveness to Carbon monoxide (CO) gas, exhibiting an impressively low limit of detection (LOD) at 2.5 ppm. The fabricated sensor showcased rapid response and recovery times, registering at 43 s and 65 s, respectively, underscoring its efficiency in real-time applications. Furthermore, the sensor maintained linearity and stability across a broad spectrum of conditions, ensuring prolonged reliability and consistent performance. This research underscores the potential of advanced materials, specifically the rGO-modified Ru OEP composite, in crafting highly effective gas sensors to address urgent environmental and safety concerns. The presented findings contribute invaluable insights to the burgeoning field of gas sensor technology, paving the way for innovative solutions to mitigate the adverse impacts of anthropogenic activities on our delicate ecosystems.

Worldwide population growth and consumerism have elevated the water pollution problem to the top of the environmental priority list, with severe consequences for public health, particularly in agricultural countries such as India, where water scarcity is a big challenge. Hence, greywater has the potential to be one of the most sustainable options to meet the growing need for freshwater with satisfying treatment options. This study focused on the assessment of electrocoagulation coupled with the filtration and adsorption processes in continuous modes and different electrode arrangements including (Al-Fe-Al-Fe), (Fe-Al-Fe-Al), (Al-Al-Al-Al) and (Fe-Fe-Fe-Fe) to investigate the effect of specific flow rates (i.e., 0.05 and 0.1 liters per minute) on the removal efficiency. The findings show that a 0.05 lit/min flow rate produces a higher removal efficiency approximately between 85 to 90% with an energy consumption of between 0.5 to 4.75 KWh/m3 as compared to the 75 to 85% removal efficiency and 0.4 to 4 KWh/m3 energy consumption at a flow rate of 0.1 lit/min. The operational cost is variable and mainly depends upon the energy consumption; moreover, it was found that the optimal results and economy variation shown by the electrode assembly of Al-Fe-Al-Fe was between 20 to 22 Indian rupees at a 24 volt current density and in each combination of electrodes.

Abstract India is the world’s largest cotton producer and the only country that grows all four cultivated cotton species. There have been very few studies on the diversity and abundance of natural enemies of cotton insect pests in these cultivated cotton species. Therefore, the current study (2016–2018) was conducted to assess the diversity and abundance of natural enemies that cultivated cotton species harbour. Phule Dhanwantari, Suraj, Suvin, RCH-2, and DCH-32 were the five genotypes used in the study, each with a distinct genetic background. Using the adiv 2.0.1 and vegan R packages, we identified significant differences in natural enemies in terms of species diversity, richness, evenness, and abundance. Analysis of Similarity (ANOSIM) and Non-metric Multidimensional Scaling (NMDS) indicated substantial differences in the natural enemy community structure among the examined genotypes. A total of 17,279 natural enemies were collected and identified across genotypes from seven predatory families and five parasitoid families. The percentage share of these natural enemy families across genotypes and years, in descending order, is Coccinellidae (28.23%)

Introduction: The use of chemical agents has dramatically increased and holds a great promise for the prevention of dental plaque, of which chlorhexidine is considered the gold standard. New novel probiotic mouthrinses are being developed to combat the adverse effects of chlorhexidine mouthrinse. Objective: The objective of this study was to compare the effectiveness of probiotic mouthrinse with chlorhexidine mouthrinse for the treatment of chronic periodontitis as an adjunct to scaling and root planing. Materials and Methods: The patients were randomly divided into two groups of 7 subjects each. Group A (Control) and Group B (Test) had scaling and root planing along with chlorhexidine mouthrinse and probiotic mouthrinse, respectively. Clinical parameters measured at baseline and 45 days were gingival index, plaque index, probing pocket depth, and clinical attachment loss. Microbial analysis was done by collecting plaque samples at baseline and 45 days. Paired t-test was used for intragroup and intergroup comparisons, whereas independent t-test was used for intergroup comparisons. Keeping the level of significance at 5%, the significant difference was adjusted at P ≤ 0.05. Results: The mean clinical parameters were significantly reduced for both treatment groups posttherapy. The microbiological data analysis (colony-forming units/ml) showed that after the therapy, there was a significant reduction in both the groups with Group B > Group A. Conclusion: Probiotics can in the near future and with more research serve to be as natural candidates to substitute antibiotics and their derivatives.

Artificial intelligence (AI) is a technological breakthrough that is rapidly progressing all over the world. AI has a variety of uses in medicine and dentistry, ranging from data analysis to using neural networks for diagnosis. AI has received enormous attention and has gone through a transition stage from being a pure statistical tool to being one of the main drivers of modern medicine. We are at the dawn of a new era, and AI is undoubtedly the future of dental practice management. This aim article is to review the various applications of AI in all the specialties of dentistry.

Background: Anemia among adolescent girls is a worldwide public health problem. Although anemia has several causes, the most common and significant is iron deficiency. Treatment of anemia with iron alone may result in reduced compliance on account of adverse effects. Various studies have revealed that use of vitamin C in addition to iron improves its absorption and reduces the ill effects of the therapy. However, a concrete evidence of adding vitamin C to iron for treating iron deficiency anemia is lacking. Aims: Protocol for current systematic review was prepared and registered with the aim to generate evidence on role of vitamin C in addition to iron for treatment of anemia. Materials and Methods: Present protocol has been prepared based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and registered with International Prospective Register of Systematic Reviews. Data extraction will be done by the reviewers independently. Cochrane risk of bias assessment tool will be used for risk of bias assessment. Results: For primary outcome and each of the other outcomes pairwise random effects meta-analysis and network meta-analysis will be performed. Sensitivity analysis will be performed in case of any heterogeneity is detected to find out the difference of the effect estimation between subsets. Conclusions: The evidence for role of vitamin C as an adjunct in iron and folic acid for treatment of anemia in adolescent girls will be generated once the systematic review and meta-analysis is completed.

Automatic generation control (AGC) is employed in power systems to maintain balance between generation and load by adjusting output of generators in real time. Controller continuously monitors system frequency and tie-line power flow by responding to fluctuations in electricity demand and supply and optimizes generator dispatch, reduces power imbalances, and enhances grid stability. This work proposes and solves the issues of the AGC in two-area interconnected power systems by proposing a new approach based on both Jaya algorithm and the rank exponent method. In particular, we design a proportional-integral-derivative controller with derivative filtering (PIDm), where the effect of the noise is mitigated by the use of a filter with derivative gain. We propose to build the objective function, to tune the controller’s parameters, as the linear combination of three sub-objectives, namely integral of time multiplied absolute error (ITAE) for frequency deviations, tie-line power deviation, and area-control errors (ACEs). The rank method is exploited to evaluate the weights of these sub-objectives, while the final overall objective function is minimized exploiting the Jaya algorithm. The proposed controller’s performance is assessed in six different scenarios with load disturbances, and its effectiveness is compared to state-of-art controllers tuned using salp swarm algorithm (SSA), Nelder-Mead simplex (NMS), symbiotic organisms search (SOS), elephant herding optimization (EHO), and Luus-Jaakola (LJ) optimization algorithms. To illustrate the frequency and tie-line power changes, results are also shown, and a statistical study is finally carried out to evaluate the recommended controller’s overall effectiveness. Additionally, Friedman rank test as no-parametric statistical analysis is also done in order to evaluate the significance level of optimization algorithms. Our numerical findings evidence that the proposed PIDm controller outperforms other existing optimization-based controllers in terms of performance and utility, thus proving to be very effective for handling AGC issues in two-are interconnected power systems.

Abstract Limited understanding of the immunopathogenesis of human herpesvirus 6B (HHV-6B) has prevented its acceptance as a pulmonary pathogen after hematopoietic cell transplant (HCT). In this prospective multicenter study of patients undergoing bronchoalveolar lavage (BAL) for pneumonia after allogeneic HCT, we test blood and BAL fluid (BALF) for HHV-6B DNA and mRNA transcripts associated with lytic infection and perform RNA-seq on paired blood. Among 116 participants, HHV-6B DNA is detected in 37% of BALs, 49% of which also have HHV-6B mRNA detection. We establish HHV-6B DNA viral load thresholds in BALF that are highly predictive of HHV-6B mRNA detection and associated with increased risk for overall mortality and death from respiratory failure. Participants with HHV-6B DNA in BALF exhibit distinct host gene expression signatures, notable for enriched interferon signaling pathways in participants clinically diagnosed with idiopathic pneumonia. These data implicate HHV-6B as a pulmonary pathogen after allogeneic HCT.

Background and Aim: Human antibiotic formulations in animal feed for therapeutic and non-therapeutic purposes have contributed to antimicrobial resistance worldwide; however, little evidence is available in low- and middle-income countries. We aimed to generate evidence of antibiotic use across the human and animal health sectors by investigating the overlap in antibiotic use in community settings in rural blocks of Pune District, India, following the World Health Organization’s (WHO) Access, Watch, Reserve (AWaRe) classification. Materials and Methods: An exploratory pilot study using a cross-sectional design in two randomly selected rural blocks of the Pune district included 138 interviews with general physicians (GPs, n = 62), pharmacists (n = 60), and veterinary practitioners (n = 16) using semi-structured interview schedules and the WHO AWaRe classification. IBM-Statistical Package for the Social Sciences, Version 21.0 software was used for descriptive statistics and to calculate the proportions of the different antibiotic groups. The WHO AWaRe classification was used to describe antibiotic use by the study participants and to assess the overlap in antibiotic use. Results: Our study provides evidence of an overlap in human and animal antibiotic use in rural community settings across the human and animal health sectors. Amoxicillin (access group), penicillin (access group), and ofloxacin (watch group) were used in both human and animal health. Amoxicillin and penicillin were used to treat common bacterial infections, ofloxacin was used to treat skin infections in humans and animals, and ofloxacin was used to treat pneumonia in animals and urinary bladder infections in humans. In contrast, azithromycin (watch group), cefixime (watch group), and amoxicillin (Access Group), with or without other antibiotics, were the most commonly used antibiotics by GPs in humans. Conclusion: We confirmed the overlap in antibiotic use across the human and animal health sectors in rural community settings, suggesting the need for interventions following the One Health approach. Further, research is required to assess the patterns of this overlap, as well as behavior, knowledge, and potential solutions to help avoid this overlap and prevent the rampant use of antibiotics in the animal and human health sectors in rural community settings.

BACKGROUND: There are few rigorous studies comparing quality of tuberculosis (TB) care in public versus private sectors. METHODS: We used standardised patients (SPs) to measure technical quality and patient experience in a sample of private and public facilities in Mumbai. RESULTS: SPs presented a classic, suspected TB scenario and a recurrence or drug-resistance scenario. In the private sector, SPs completed 643 interactions. In the public sector, 164 interactions. Outcomes included indicators of correct management, medication use and client experience. Public providers used microbiological testing (typically, microscopy) more frequently, in 123 of 164 (75%; 95% CI 68% to 81%) vs 223 of 644 interactions (35%; 95% CI 31% to 38%) in the private sector. Private providers were more likely to order chest X-rays, in 556 of 639 interactions (86%; 95% CI 84% to 89%). According to national TB guidelines, we found higher proportions of correct management in the public sector (75% vs 35%; (adjusted) difference 35 percentage points (pp); 95% CI 25 to 46). If X-rays were considered acceptable for the first case but drug-susceptibility testing was required for the second case, the private sector correctly managed a slightly higher proportion of interactions (67% vs 51%; adjusted difference 16 pp; 95% CI 7 to 25). Broad-spectrum antibiotics were used in 76% (95% CI 66% to 84%) of the interactions in public hospitals, and 61% (95% CI 58% to 65%) in private facilities. Costs in the private clinics averaged rupees INR 512 (95% CI 485 to 539); public facilities charged INR 10. Private providers spent more time with patients (4.4 min vs 2.4 min; adjusted difference 2.0 min; 95% CI 1.2 to 2.9) and asked a greater share of relevant questions (29% vs 43%; adjusted difference 13.7 pp; 95% CI 8.2 to 19.3). CONCLUSIONS: While the public providers did a better job of adhering to national TB guidelines (especially microbiological testing) and offered less expensive care, private sector providers did better on client experience.