Ralstonia mannitolilytica Infections: A Systematic Review of Case Reports Unveiling Clinical Patterns and Therapeutic Insights.

BACKGROUND: Ralstonia mannitolilytica is an emerging opportunistic pathogen that has been increasingly reported in clinical settings. Despite its low pathogenicity in immunocompetent individuals, it poses a significant threat to immunocompromised patients, particularly those with underlying medical conditions or invasive medical interventions. OBJECTIVES: This study aimed to evaluate the clinical impact and management strategies based on the analysis of individual case reports on Ralstonia mannitolilytica . METHODS: A comprehensive search of PubMed was conducted from inception until July 31, 2023, using the terms "Ralstonia mannitolilytica" and/or "Pseudomonas thomasii". Inclusion criteria for our systematic review included human-centered case reports of Ralstonia mannitolilytica infections, excluding case series and review articles. Data extraction followed PRISMA guidelines, including study details and patient characteristics. Case reports were systematically assessed using the JBI critical appraisal checklist, evaluating patient demographics, clinical history, diagnostic methods, interventions, post-intervention outcomes, adverse events, and lessons learned to minimize bias risk. RESULTS: A total of 17 case reports of Ralstonia mannitolilytica infections were included in our systematic review. Studies published from 2001 to 2023 revealed diverse global contributions, with 29.41% from China. Infection origins varied, with catheter-related cases being predominant. Mortality was reported in two studies. Antibiotic sensitivity analysis showed sensitivity to third-generation cephalosporins, notably Ceftazidime. Quality appraisal revealed that all studies had a low risk of bias, ensuring the overall robustness of the case reports. CONCLUSION: This study emphasizes the importance of understanding Ralstonia mannitolilytica infections, given their varied clinical presentations and antibiotic responses. The study also underscores the necessity for precise identification, customized treatments, and ongoing research to manage these infections effectively.

Vigilance Needed in Treating a Child with Disseminated TB: A Case Report.

BACKGROUND: Tuberculosis is still one of the biggest causes of infection-related death around the world. Disseminated tuberculosis is a potentially fatal disease caused by the haematogenous spread of Mycobacterium tuberculosis. First-line anti-tuberculosis drugs in-clude isoniazid, rifampicin, pyrazinamide, and ethambutol. The first three drugs are known to cause hepatotoxicity. CASE PRESENTATION: We have, herein, reported a case of Drug-induced Liver Injury (DILI) due to anti-tuberculosis therapy in a one-year-old male child with disseminated tuberculosis. He was started on a fixed-dose combination of Anti-tuberculosis Therapy (ATT; isoniazid 50 mg, rifampicin 75 mg, and pyrazinamide 150 mg) and pyridoxine 10 mg orally. Initially, liver pa-rameters were normal, but later on with the course of the treatment, there was a rapid rise in liver enzymes, suggesting liver injury. DISCUSSION: The association between liver injury and anti-tuberculosis therapy has been con-firmed by applying various causality association scales. It is obvious that proper treatment of disseminated tuberculosis can avoid the development of drug-resistant strains that can be harm-ful, worsening the prognosis as there are fewer therapeutic alternatives available. At the same time, there is a need to monitor the patient with ATT-induced DILI. CONCLUSION: The diagnosis of tuberculosis in children is difficult because of the mild, nonspe-cific clinical presentation, which usually reflects the implicated underlying organ. In addition to prompt diagnosis and treatment of disseminated TB, careful monitoring is equally important.

Sulbactam-Durlobactam, A Novel Drug for the Treatment of Multidrug-resistant Acinetobacter baumannii Infections - A Systematic Review.

BACKGROUND: Sulbactam-durlobactam (SUL-DUR) has been tested in vitro for its ability to gen- erate resistance in clinical isolates of Acinetobacter species. According to prior studies, combining durlobac- tam with sulbactam causes sulbactam-resistant isolates to become more active and revert to susceptibility. We aimed to conduct a systematic review of the in vitro activity of SUL-DUR on A. baumannii (Ab) iso- lates, including carbapenem-resistant A. baumannii (CRAb), to provide an overview for physicians dealing with Ab infections. METHODS: The following keywords were searched in the PubMed, Google Scholar, and EMBASE databases to look for eligible original works that have been published without restrictions till June 30, 2023: A. bau- mannii and sulbactam-durlobactam, SUL-DUR, durlobactam, and sulbactam-ETX2514. We also searched clinicaltrials.gov and the Clinical Trials Registry of India (CTRI) for clinical trials involving sulbactam- durlobactam and Acinetobacter. RESULTS: There were a total of 852 abstracts found. Among them, 633 articles with titles, abstracts, and key- words were reviewed, and 574 articles were removed after the initial screening. A total of 59 full-text eligi- ble articles were evaluated, and 51 of them were eliminated because they did not satisfy the criteria set for inclusion. The full texts of the final 8 in vitro studies on A. baumanii and sulbactam/durlobactam were fur- ther evaluated. There were 5 trials on A. baumanii and sulbactam/durlobactam found on clinicaltrials.gov and the Clinical Trial Registry of India (CTRI). CONCLUSION: The findings from the studies show that SUL-DUR might be a successful therapeutic option for multidrug-resistant-Ab infections. Future clinical trials will be required to validate the possibility of using this combination to treat multidrug-resistant A. baumannii infections.

Dog Bite Injury: Rusk Became a Risk - A Case Report.

BACKGROUND: Dog bites are a worldwide problem that disproportionately affects children. It might be difficult to keep in mind that even a man's closest buddy can be dangerous to people. In light of the significant morbidity and mortality associated with dog bites, we report, herein, an intriguing case in which a two-year-old boy appeared with eyelid facial lacerations as a result of a dog bite. CASE PRESENTATION: A two-year-old boy presented with bleeding around the right and left eyes. Local examination of the eyes revealed laceration and disfiguration of the left orbit and abrasion around the right eye. Preoperatively, parenteral antibiotics were started and continued postoperatively. Dressing was done for the right eye. Lid reconstruction surgery for the left eye was scheduled and it was carried out under general anaesthesia. The child was monitored for a month and showed satisfactory wound healing with no visible scars or complications. DISCUSSION: The standard treatment for bites is direct suture, grafting, or local flaps, depending on the type of wound and the surgeon's preference, regardless of the time since the attack. Crush wounds are difficult to treat because the damage to the tissues is often so profound that amputation is unavoidable. CONCLUSION: The global injuries caused by dog bites are the consequence of uncommon illnesses and often manifest as peri-orbital and ocular lesions. Most rabies cases occur in underserved rural and urban areas, with a high frequency of stray dogs without immunisation.

Kisspeptin and its Current Clinical Status- A Systematic Review.

BACKGROUND: Kisspeptin was initially known as metastin for its role in suppressing metastasis in melanoma and breast cancer. Later, based on its ability to stimulate GPR54, its importance in maintaining an intact hypothalamic-pituitary-ovarian axis was recognised, which is the basis for the widespread application of the drug in several conditions such as secondary amenorrhea, regulation of puberty onset, ovarian function, trophoblast invasion, fertility regulation, parturition, and lactation. This systematic study aims to evaluate the current status of kisspentin in clinical trials. METHODS: The keywords 'kisspeptin' or 'metastin' were used in the clinicaltrials.gov website and Clinical Trial Registry of India (CTRI) to find eligible clinical trials or records carried out without time constraints until February 26, 2023. RESULTS: A total of 33 records were identified through clinical trial databases. All records were screened, and four trials were rejected as they failed to meet the inclusion criteria. Finally, 29 (87.9%) reports of interventional clinical trials with kisspeptin were reviewed. CONCLUSION: Kisspeptin can be viewed as a multipurpose drug with considerably fewer side effects due to its effects simulating normal physiological processes in our body.

Treatment Modalities for Trigeminal Neuralgia and the Need for Vigilance in Monitoring Adverse Drug Events: A Case Report.

INTRODUCTION: Trigeminal neuralgia is a rare condition characterised by paroxysms of intense pain in the distribution of the trigeminal nerve. This condition significantly diminishes the patient's quality of life, and the side effects from chronic use of medications for symptomatic relief further exacerbate their distress. CASE DESCRIPTION: The case report discusses a patient diagnosed with Trigeminal Neuralgia who commenced carbamazepine treatment. The report tracks the disease's progression, medication adjustments, and the eventual emergence of vertigo due to long-term carbamazepine use. CONCLUSION: The article covers fundamental information about trigeminal neuralgia and its management and also offers a comprehensive review of the basics of vertigo. It delves into carbamazepine's mechanism of action and its associated side effects. The paper also looks at prospective therapy changes that could improve patients' quality of life.

Antimicrobial Stewardship Program: Time to be Focused in Speciality Settings of Leprosy Institute and Related Health Care Setup.

Leprosy, often known as Hansen's disease is a contagious chronic infectious disease caused by Mycobacterium leprae (M. leprae). Our methodology is easily repeatable in tertiary care settings with diagnostic accuracy resources and staff capable of building a stewardship team. Comprehensive antimicrobial policies and programmes are required to properly alleviate the initial issue.

Nutritional Status in Leprosy Patients: A Systematic Review and Meta-analysis.

BACKGROUND: Leprosy, a chronic mycobacterial disease, is frequently accompanied by malnutrition. However, it is important to regularly assess the nutritional state of leprosy patients in a resource-poor nation like India, where undernutrition is widespread. OBJECTIVES: This study aimed to compare the nutritional status of leprosy patients to that of normal individuals using the body mass index. METHODS: The electronic databases PubMed, Google Scholar, and Embase were used to conduct an open literature search. From 1st January 2000 to 31st January 2023, all articles were screened using the following MeSH terms: (nutrition OR body mass index OR body weight) AND (leprosy OR lepra) to find possibly relevant articles. RESULTS: This meta-analysis includes five research studies with a total of 1173 individuals (363 patients in the leprosy group and 810 patients in the non-leprosy group). The weighted mean difference (WMD) for BMI studies was -17.88 (95% CI -27.65 to -8.12), showing that there was a significant difference in BMI < 18.5 between leprosy patients and non-leprosy patients. There was a significant difference in DDS score and HFIAS score between patients with leprosy and non-leprosy. In a total of 342 leprosy patients, 206 developed deformities. CONCLUSION: This research increases our understanding of nutrition and leprosy. The results found that people with leprosy are nutritionally at a distinct disadvantage when compared to non-leprosy patients. It emphasises the several ways in which diet may generate circumstances that increase the risk of leprosy.

Analysis of Research Publications on Pharmacogenomics of Sulphonylurea - A Scientometric Study.

This study analysed pharmacogenomics studies on sulfonylurea research publications using the Pubmed and Scopus databases. In the end, 65 publications from the years 2015 to 2021 were noticed. The objective of this study was to analyse these studies using scientometric tools, such as frequency counts, percentages, relative growth rates, doubling times, and collectively. A maximum of 19 (29.23%) research publications were contributed during the 2020 research period. The relative growth rate tends to decrease from 2015 to 2020 and the doubling time tends to increase and decrease after 2020. Up to 2 (3.08%) research publications were contributed by Ewan R. Pearson and Chen each. The top authors have an average degree of collaboration of 0.90 and 41 (63.83%) of their research publications are articles. The United States is the major contributor with 19 (29.23%) pharmacogenomics research publications on sulfonylureas. Although the United States is the most prolific country in sulfonylurea pharmacogenomics research, there are few Indian institutions that are not listed among the most prolific institutions.

Hybrid CNN-LSTM model with efficient hyperparameter tuning for prediction of Parkinson's disease.

The patients' vocal Parkinson's disease (PD) changes could be identified early on, allowing for management before physically incapacitating symptoms appear. In this work, static as well as dynamic speech characteristics that are relevant to PD identification are examined. Speech changes or communication issues are among the challenges that Parkinson's individuals may encounter. As a result, avoiding the potential consequences of speech difficulties brought on by the condition depends on getting the appropriate diagnosis early. PD patients' speech signals change significantly from those of healthy individuals. This research presents a hybrid model utilizing improved speech signals with dynamic feature breakdown using CNN and LSTM. The proposed hybrid model employs a new, pre-trained CNN with LSTM to recognize PD in linguistic features utilizing Mel-spectrograms derived from normalized voice signal and dynamic mode decomposition. The proposed Hybrid model works in various phases, which include Noise removal, extraction of Mel-spectrograms, feature extraction using pre-trained CNN model ResNet-50, and the final stage is applied for classification. An experimental analysis was performed using the PC-GITA disease dataset. The proposed hybrid model is compared with traditional NN and well-known machine learning-based CART and SVM & XGBoost models. The accuracy level achieved in Neural Network, CART, SVM, and XGBoost models is 72.69%, 84.21%, 73.51%, and 90.81%. The results show that under these four machine approaches of tenfold cross-validation and dataset splitting without samples overlapping one individual, the proposed hybrid model achieves an accuracy of 93.51%, significantly outperforming traditional ML models utilizing static features in detecting Parkinson's disease.

A Change in the Trend of Quality Reporting in Leprosy Trials: A Systematic Review.

BACKGROUND: Leprosy is a communicable disease caused by bacteria Mycobacterium leprae. Despite all attempts, it has not been eradicated in several underdeveloped nations since the start of the antibiotic age. It's a social issue as well as a stigmatised disease. Due to these restrictions, randomised controlled trials in leprosy confront numerous obstacles, which are reflected in the quality of study reporting. OBJECTIVES: The objective of this study is to use the Consolidated Standard for Reporting Trials (CONSORT) 2010 checklist to assess the quality of leprosy trial reporting. METHODS: We assess the quality of reporting of randomised control trials on leprosy conducted after 2010 in the PubMed database, using the CONSORT checklist 2010. Second, we compare the quality of RCT reporting before and after the release of the CONSORT guidelines in 2010. RESULTS: A total of 19 full-text eligible articles were examined and included in the final list of articles, which were then evaluated further. 4 out of 19 trials had a compliance percentage of more than 75%. 6 out of 19 trials had compliance percentage of 50% to 75%. 9 trials had a compliance percentage of below 50%. Highest compliance was 86.48% and the lowest compliance was 32.43%. When compared with trials before 2010, we could see an improvement in some criteria showing a statistically significant rise in comparison with trials conducted before 2010. CONCLUSION: Leprosy is still a concern in developing countries, which have failed to eradicate the disease despite their best efforts and resources. The compliance of leprosy related RCTs has improved since the introduction of the CONSORT guidelines, but the quality of reporting still remains on the lower side.

Capecitabine and Hand-foot Syndrome: A Case Report.

Capecitabine, a prodrug of 5-fluorouracil, is an FDA-approved drug for adjuvant treatment of colon, metastatic colorectal, and breast cancer. A variety of mucocutaneous adverse effects has been recognized with capecitabine. The pathogenesis of such manifestations still remains an enigma though various theories have been proposed. Here, we report two such cases. A 59-year-old female with carcinoma of the sigmoid colon on palliative therapy developed localized cutaneous hyperpigmentation of the palms and soles secondary to capecitabine in her 2nd cycle. Another case was of a 42-year-old female with stomach adenocarcinoma, who developed similar adverse effects after administration of capecitabine in her 4th cycle. Since these drugs have been widely used in recent years due to their relative ease in administration, the relative unawareness of Hand-foot syndrome (HFS) caused due to this drug makes it a prudent topic to be reported.

Leprosy Reactions: Clinical Pharmacologist Perspective with Repurposed Medications.

The elimination of leprosy has been possible with the available anti-leprotic drugs. However, the lepra reactions usually occur months or years after multi-drug therapy completion, and continue to be a formidable challenge mainly owing to its role in causing nerve damage and disability. Corticosteroids are commonly used but they lead to systemic complications, and hence require dose reduction and adjunct therapy with a different target. Various drugs with different targets have been identified and are in practice to treat lepra reactions. The newer targets can include genetic and tissue targets in the skin and nerve. Thalidomide treatment reducing pentraxin-3, toll-like receptor antagonists, minocycline, apremilast, immunomodulators, and tenidap can be helpful in lepra reaction. Other modalities to manage lepra reactions include plasma exchange, intravenous immunoglobulins, and immunotherapy. Most of these treatments are based only on the pathological process of the reaction and tend to be incomplete leading to recurrence. Newer multimodal approaches are required based on various biomarkers (genetic, tissue, serological), which can be monitored to prevent the recurrence of reactions. Hence, there is a need for newer targets and drugs to be identified for the management of lepra reactions.

Current Status of Pharmacokinetic Research in Children: A Systematic Review of Clinical Trial Records.

BACKGROUND: Many medications have different pharmacokinetics in children than in adults. Knowledge about the safety and efficacy of medications in children requires research into the pharmacokinetic profiles of children's medicines. By analysing registered clinical trial records, this study determined how frequently pharmacokinetic data is gathered in paediatric drug trials. METHODS: We searched for the pharmacokinetic data from clinical trial records for preterm infants and children up to the age of 16 from January 2011 to April 2022. The records of trials involving one or more drugs in preterm infants and children up to the age of 16 were examined for evidence that pharmacokinetic data would be collected. RESULTS: In a total of 1483 records of interventional clinical trials, 136 (9.17%) pharmacokinetic data involved adults. Of those 136 records, 60 (44.1%) records were pharmacokinetics trials involving one or more medicines in children up to the age of 16. 20 (33.3 %) in America, followed by 19 (31.6 %) in Europe. Most trials researched medicines in the field of infection or parasitic diseases 20 (33.3%). 27 (48.2%) and 26 (46.4%) trials investigated medicines that were indicated as essential medicine. CONCLUSION: The pharmacokinetic characteristics of children's drugs need to be better understood. The current state of pharmacokinetic research appears to address the knowledge gap in this area adequately. Despite slow progress, paediatric clinical trials have experienced a renaissance as the significance of paediatric trials has gained international attention. The outcome of paediatric trials will have an impact on children's health in the future. In recent years, the need for greater availability and access to safe child-size pharmaceuticals has received a lot of attention.