Maternal and newborn health for the urban poor: the need for a new mental model and implementation strategies to accelerate progress.

BACKGROUND: Urbanization challenges the assumptions that have traditionally influenced maternal and newborn health (MNH) programs. This landscaping outlines how current mental models for MNH programs have fallen short for urban slum populations and identifies implications for the global community. We employed a three-pronged approach, including a literature review, key informant interviews with global- and national-level experts, and a case study in Bangladesh. MAIN BODY: Our findings highlight that the current mental model for MNH is inadequate to address the needs of the urban poor. Implementation challenges have arisen from using traditional methods that are not well adapted to traits inherent in slum settings. A re-thinking of implementation strategies will also need to consider a paucity of available routine data, lack of formal coordination between stakeholders and providers, and challenging municipal government structures. Innovative approaches, including with communications, outreach, and technology, will be necessary to move beyond traditional rural-centric approaches to MNH. As populations continue to urbanize, common slum dynamics will challenge conventional strategies for health service delivery. In addition, the COVID-19 pandemic has exposed weaknesses in a system that requires intersectoral collaborations to deliver quality care. CONCLUSION: Programs will need to be iterative and adaptive, reflective of sociodemographic features. Integrating the social determinants of health into evaluations, using participatory human-centered design processes, and innovative public-private partnerships may prove beneficial in slum settings. But a willingness to rethink the roles of all actors within the delivery system overall may be needed most.

Phytofabricated gold nanoparticles as modulators of salt stress responses in spinach: implications for redox homeostasis, biochemical and physiological adaptation.

Introduction: The utilization of plant material for synthesizing nanoparticles effectively triggers physiological and biochemical responses in plants to combat abiotic stresses. Salt stress, particularly caused by NaCl, significantly affects plant morphology and physiology, leading to reduced crop yields. Understanding the mechanisms of salt tolerance is crucial for maintaining crop productivity. Methods: In this study, we examined the effects of 150 µM spinach-assisted gold nanoparticles (S-AuNPs) on various parameters related to seed germination, growth attributes, photosynthetic pigments, stomatal traits, ion concentrations, stress markers, antioxidants, metabolites, and nutritional contents of spinach plants irrigated with 50 mM NaCl. Results: Results showed that S-AuNPs enhanced chlorophyll levels, leading to improved light absorption, increased photosynthates production, higher sugar content, and stimulated plant growth under NaCl stress. Stomatal traits were improved, and partially closed stomata were reopened with S-AuNPs treatment, possibly due to K+/Na+ modulation, resulting in enhanced relative water content and stomatal conductance. ABA content decreased under S-AuNPs application, possibly due to K+ ion accumulation. S-AuNPs supplementation increased proline and flavonoid contents while reducing ROS accumulation and lipid peroxidation via activation of both non-enzymatic and enzymatic antioxidants. S-AuNPs also regulated the ionic ratio of K+/Na+, leading to decreased Na+ accumulation and increased levels of essential ions in spinach plants under NaCl irrigation. Discussion: Overall, these findings suggest that S-AuNPs significantly contribute to salt stress endurance in spinach plants by modulating various physiological attributes.

The Role of Faith-Based Organizations in Improving Vaccination Confidence & Addressing Vaccination Disparities to Help Improve Vaccine Uptake: A Systematic Review.

The COVID-19 pandemic underscored the importance of vaccination to support individual health across the life-course, with vaccination playing a central strategy role in mitigating transmission and disease. This required unprecedented mobilization and coordination across all sectors to meet people where they are, enable equitable access, and build vaccination confidence. A literature search was conducted with combinations of the keywords and variations of vaccination and faith-based organizations (FBOs). Search inclusion criteria were: (1) FBO programs that supported public health emergency efforts, including vaccination efforts as the primary outcome; and (2) articles written in English language. A total of 37 articles met inclusion criteria (n = 26 focused on general public health campaigns, n = 11 focused on vaccination efforts). The findings related to public health campaigns fell into four themes: FBO's ability to (1) tailor public health campaigns; (2) mitigate barriers; (3) establish trust; and (4) disseminate and sustain efforts. The findings related to vaccine uptake efforts fell into three themes: (1) pre-pandemic influenza and HPV vaccination efforts, (2) addressing vaccine disparities in minority communities, and (3) enabling COVID-19 vaccination. This review demonstrated that FBOs have a vital role in both public health campaigns and vaccination initiatives to support high vaccine uptake and confidence.

Advancing maternal and perinatal health in low- and middle-income countries: A multi-country review of policies and programmes.

The Sustainable Development Goals prioritize maternal mortality reduction, with a global average target of < 70 per 100,000 live births by 2030. Current pace of reduction is far short of what is needed to achieve the global target. It is estimated that globally there are 300,000 maternal deaths, 2.4 million newborn deaths and 2 million stillbirths annually. Majority of these deaths occur in low-and-middle-income countries. Global initiatives like, Ending Preventable Maternal Mortality (EPMM) and Every Newborn Action Plan (ENAP), have outlined the broad strategies for maternal and newborn health programmes. A set of coverage targets and ten milestones were launched to support low-and-middle-income countries in accelerating progress in improving maternal, perinatal and newborn health and wellbeing. WHO, UNICEF and UNFPA, undertook a scoping review to understand how country strategies evolved in different contexts over the past two decades to improve maternal survival and wellbeing, and how countries in similar settings could accelerate progress considering the changing epidemiology and demography. Case studies were conducted to inform countries in similar settings and various global initiatives. Six countries were selected based on standard criteria-Cambodia, Democratic Republic of the Congo, Georgia, Guatemala, Pakistan and Sierra Leone representing different stages of the obstetric transition. A conceptual framework, encapsulating the interrelated factors impacting maternal health outcomes, was used to organize data collection and analysis. While all six countries made remarkable progress in improving maternal and perinatal health, the pace of progress and the factors influencing the successes and challenges varied across the countries. The context, opportunities and challenges varied from country to country. Two strategic directions were identified for next steps including the need to implement and evaluate innovative service delivery models using an updated obstetric transition as an organizing framework and expanding our vision to address equity and well-being.

Joint ESCMID, FEMS, IDSA, ISID and SSI position paper on the fair handling of career breaks among physicians and scientists when assessing eligibility for early-career awards.

BACKGROUND: Though women increasingly make up the majority of medical-school and other science graduates, they remain a minority in academic biomedical settings, where they are less likely to hold leadership positions or be awarded research funding. A major factor is the career breaks that women disproportionately take to see to familial duties. They experience a related, but overlooked, hurdle upon their return: they are often too old to be eligible for 'early-career researcher' grants and 'career-development' awards, which are stepping stones to leadership positions in many institutions and which determine the demographics of their hierarchies for decades to come. Though age limits are imposed to protect young applicants from more experienced seniors, they have an unintended side effect of excluding returning workers, still disproportionately women, from the running. METHODS: In this joint effort by the European Society of Clinical Microbiology and Infectious Diseases, the Federation of European Microbiological Societies, the Infectious Disease Society of America, the International Society for Infectious Diseases and the Swiss Society for Infectious Diseases, we invited all European Congress of Clinical Microbiology and Infectious Diseases-affiliated medical societies and funding bodies to participate in a survey on current 'early-career' application restrictions and measures taken to provide protections for career breaks. RECOMMENDATIONS: The following simple consensus recommendations are geared to funding bodies, academic societies and other organizations for the fair handling of eligibility for early-career awards: 1. Apply a professional, not physiological, age limit to applicants. 2. State clearly in the award announcement that career breaks will be factored into applicants' evaluations such that: • Time absent is time extended: for every full-time equivalent of career break taken, the same full-time equivalent will be extended to the professional age limit. • Opportunity costs will also be taken into account: people who take career breaks risk additional opportunity costs, with work that they did before the career break often being forgotten or poorly documented, particularly in bibliometric accounting. Although there is no standardized metric to measure additional opportunity costs, organizations should (a) keep in mind their existence when judging applicants' submissions, and (b) note clearly in the award announcement that opportunity costs of career breaks are also taken into account. 3. State clearly that further considerations can be undertaken, using more individualized criteria that are specific to the applicant population and the award in question. The working group welcomes feedback so that these recommendations can be improved and updated as needed.

Addressing and Inspiring Vaccine Confidence in Black, Indigenous, and People of Color During the Coronavirus Disease 2019 Pandemic.

During the coronavirus disease 2019 (COVID-19) pandemic, we have witnessed profound health inequities suffered by Black, Indigenous, and People of Color (BIPOC). These manifested as differential access to testing early in the pandemic, rates of severe disease and death 2-3 times higher than white Americans, and, now, significantly lower vaccine uptake compared with their share of the population affected by COVID-19. This article explores the impact of these COVID-19 inequities (and the underlying cause, structural racism) on vaccine acceptance in BIPOC populations, ways to establish trustworthiness of healthcare institutions, increase vaccine access for BIPOC communities, and inspire confidence in COVID-19 vaccines.

Effect of community-based newborn-care intervention package implemented through two service-delivery strategies in Sylhet district, Bangladesh: a cluster-randomised controlled trial.

BACKGROUND: Neonatal mortality accounts for a high proportion of deaths in children under the age of 5 years in Bangladesh. Therefore the project for advancing the health of newborns and mothers (Projahnmo) implemented a community-based intervention package through government and non-government organisation infrastructures to reduce neonatal mortality. METHODS: In Sylhet district, 24 clusters (with a population of about 20 000 each) were randomly assigned in equal numbers to one of two intervention arms or to the comparison arm. Because of the study design, masking was not feasible. All married women of reproductive age (15-49 years) were eligible to participate. In the home-care arm, female community health workers (one per 4000 population) identified pregnant women, made two antenatal home visits to promote birth and newborn-care preparedness, made postnatal home visits to assess newborns on the first, third, and seventh days of birth, and referred or treated sick neonates. In the community-care arm, birth and newborn-care preparedness and careseeking from qualified providers were promoted solely through group sessions held by female and male community mobilisers. The primary outcome was reduction in neonatal mortality. Analysis was by intention to treat. The study is registered with ClinicalTrials.gov, number 00198705. FINDINGS: The number of clusters per arm was eight. The number of participants was 36059, 40159, and 37598 in the home-care, community-care, and comparison arms, respectively, with 14 769, 16 325, and 15 350 livebirths, respectively. In the last 6 months of the 30-month intervention, neonatal mortality rates were 29.2 per 1000, 45.2 per 1000, and 43.5 per 1000 in the home-care, community-care, and comparison arms, respectively. Neonatal mortality was reduced in the home-care arm by 34% (adjusted relative risk 0.66; 95% CI 0.47-0.93) during the last 6 months versus that in the comparison arm. No mortality reduction was noted in the community-care arm (0.95; 0.69-1.31). INTERPRETATION: A home-care strategy to promote an integrated package of preventive and curative newborn care is effective in reducing neonatal mortality in communities with a weak health system, low health-care use, and high neonatal mortality.

Biochemical synthesis of gold nanoparticles from leaf protein of Nicotiana tabacum L. cv. xanthi and their physiological, developmental, and ROS scavenging responses on tobacco plant under stress conditions.

The stress conditions imposed by the impact of metal and non-metal oxide nanoparticles over plant systems enhances the synthesis of reactive oxygen species (ROS), resulting in oxidative damage at cellular level. The objective of this study was to synthesise the gold nanoparticles (GNps) from the leaves protein of Nicotiana tabacum L. cv. xanthi, its characterisation, and response on plant physiology and ROS scavenging activity on plants after exposure to different stresses. The authors have treated N. tabacum L. cv. xanthi plants with 100, 200, 300, 400, and 500 ppm biochemically synthesised GNps and examined physiological as well as biochemical changes. Results showed that biochemically synthesised GNps exposure significantly increased the seed germination (P < 0.001), root (P < 0.001), shoot growth (P < 0.001), and antioxidant ability (P < 0.05) of plants depending on bioengineered GNPs concentrations. Low concentrations (200-300 ppm) of GNps boosted growth by ∼50% and significantly increase in photosynthetic parameters such as total chlorophyll content (P < 0.05), membrane ion leakage (P < 0.05) as well as malondialdehyde (P < 0.05) content with respect to untreated plants under stress conditions. The high concentration (400-500 ppm) of GNps affected these parameters in a negative manner. The total antioxidant activity was also elevated in the exposed plants in a dose-dependent manner.

Intermittent interatrial block after electrical cardioversion for atrial fibrillation.

A 67-year-old woman with persistent atrial fibrillation presented for elective electrical cardioversion. The patient was cardioverted to normal sinus rhythm with a synchronized 150 joules (J) biphasic shock. Varying P-wave morphology suggesting intermittent interatrial block (IAB) was noted after the cardioversion on the rhythm strip. Three minutes later the patient developed early recurrence of atrial fibrillation and a second successful 150 J biphasic shock was delivered; IAB was still evident on a single lead II monitoring. However, the patient remained in sinus rhythm. The patient was discharged in normal sinus rhythm with electrocardiographic evidence of intermittent interatrial block. This case report examines the occurrence of IAB postcardioversion for atrial fibrillation and speculates on its prognostic significance.

Fever of unknown origin caused by late-onset rheumatoid arthritis.

Fever of unknown origin (FUO) is always a diagnostic challenge. The causes of FUO are legion and may be due to malignancy, infection, collagen vascular disease, and a variety of other unusual disorders. Currently, malignancies-followed by infectious etiologies-are the most common cause of FUO. We present an elderly female patient with an FUO who was thought to have subacute bacterial endocarditis because of an antecedent history of recent dental work. Subacute bacterial endocarditis was ruled out on the basis of negative cultures and negative transesophageal echocardiography. No evidence for an infectious disease or neoplastic etiology could be demonstrated in this patient. The diagnosis of FUO is most difficult when there is a paucity of clues from the history and physical examination, as was the case in this patient. Nonspecific laboratory tests included highly increased erythrocyte sedimentation rate (>or=100 mm/h), highly increased C-reactive protein, relative lymphocytopenia, and chronic thrombocytosis. These findings are compatible with a variety of infectious and inflammatory disorders. No evidence could be found for vasculitis. The only laboratory diagnostic findings present in her case were a highly increased rheumatoid factor titer and perinuclear antineutrophilic cytoplasmic antibody level. Polymyalgia rheumatica/temporal arteritis, systemic lupus erythematosus, and adult Still's disease were ruled out. The patient's FUO was best explained by the finding of late-onset rheumatoid arthritis (LORA), which is characterized by acute onset in elderly patients without the usual musculoskeletal manifestations of rheumatoid arthritis. Both the highly increased rheumatoid factor titer and perinuclear antineutrophilic cytoplasmic antibody level in the absence of an alternate explanation indicate that the FUO in this patient was caused by LORA.

Review of domiciliary newborn-care practices in Bangladesh.

In Bangladesh, high proportions of infant deaths (two-thirds) and deaths among children aged less than five years (38%) occur in the neonatal period. Although most of these deaths occur at home due to preventable causes, little is known about routine domiciliary newborn-care practices and care-seeking for neonatal illness. As an initial step in strategic planning for the implementation of interventions in Bangladesh to improve neonatal outcomes, a review of the literature of antenatal, intrapartum, and postpartum care practices for mothers and newborns in Bangladeshi communities and homes was conducted. A dearth of information was found and summarized, and priority areas for future formative research were identified. The information gained from this review was used for informing development of a guide to formative research on maternal and neonatal care practices in developing-country communities and forms a cornerstone for formulation of behaviour change-communication strategies and messages to advance neonatal health and survival in Bangladesh.

Immediate and early postnatal care for mothers and newborns in rural Bangladesh.

The study evaluated the impact of essential newborn-care interventions at the household level in the Saving Newborn Lives project areas. Two household surveys were conducted following the 30-cluster sampling method using a structured questionnaire in 2002 (baseline) and 2004 (endline) respectively. In total, 3,325 mothers with children aged less than one year in baseline and 3,110 mothers in endline from 10 sub-districts were interviewed during each survey. The proportion of newborns dried and wrapped immediately after birth increased from 14% in 2002 to 55% in 2004; 76.2% of the newborns were put to the mother's breast within one hour of birth compared to 38.6% in baseline. Newborn check-up within 24 hours of delivery increased from 14.4% in 2002 to 27.3% in 2004. Postnatal check-up of mothers by trained providers within three days of delivery rose from 2.4% in 2002 to 27.3% in 2004. Knowledge of the mothers on at least two postnatal danger signs increased by 17.2%, i.e. from 47.1% in 2002 to 64.3% in 2004. Knowledge of mothers on at least three postnatal danger signs also showed an increase of 16%. Essential newborn-care practices, such as drying and wrapping the baby immediately after birth, initiation of breastmilk within one hour of birth, and early postnatal newborn check-up, improved in the intervention areas. Increased community awareness helped improve maternal and newborn-care practices at the household level. Lessons learnt from implementation revealed that door-to-door visits by community health workers, using community registers as job-aids, were effective in identifying pregnant women and following them through pregnancy to the postnatal periods.

Citric acid based durable and sustainable flame retardant treatment for lyocell fabric.

Pyrovatex CP New, is a commonly used organophosphorus based flame retardant (FR) reagent for cellulosic materials. However, it has a drawback of high formaldehyde release when used with methylated melamine (MM) based cross-linker, a known carcinogenous compound. In the present approach, a durable and sustainable flame retarding recipe formulation for lyocell fabrics is developed using citric acid (CA) as a cross-linker. The FR finish was applied by pad-dry-cure process. The treated fabrics were characterized for surface morphology, elemental analysis, TG analysis, char study and FT-IR spectroscopy. Furthermore, flame retardancy, washing durability, formaldehyde release and breaking strength were also assessed, and compared with the conventional MM based FR recipe. The fabric samples treated with 400gL(-1) of FR with either 40 or 80gL(-1) of CA demonstrate flame retardancy even after 10 washing cycles. Furthermore, a 75% reduction in formaldehyde release is achieved. Higher char yield and lower decomposition temperature are found compared to untreated and FR+ MM treated lyocell. Such an improved sustainable recipe formulation can be used for lyocell fabric without any health risk in apparel wear.

Equity improvements in maternal and newborn care indicators: results from the Bardiya district of Nepal.

Community-based maternal and newborn care interventions have been shown to improve neonatal survival and other key health indicators. It is important to evaluate whether the improvement in health indicators is accompanied by a parallel increase in the equitable distribution of the intervention activities, and the uptake of healthy newborn care practices. We present an analysis of equity improvements after the implementation of a Community Based Newborn Care Package (CB-NCP) in the Bardiya district of Nepal. The package was implemented alongside other programs that were already in place within the district. We present changes in concentration indices (CIndices) as measures of changes in equity, as well as percentage changes in coverage, between baseline and endline. The CIndices were derived from wealth scores that were based on household assets, and they were compared usingt-tests. We observed statistically significant improvements in equity for facility delivery [CIndex: -0.15 (-0.24, -0.06)], knowledge of at least three newborn danger signs [-0.026(-0.06, -0.003)], breastfeeding within 1 h [-0.05(-0.11, -0.0001)], at least one antenatal visit with a skilled provider [-0.25(-0.04, -0.01)], at least four antenatal visits from any provider [-0.15(-0.19, -0.10)] and birth preparedness [-0.09(-0.12, -0.06)]. The largest increases in practices were observed for facility delivery (50%), immediate drying (34%) and delayed bathing (29%). These results and those of similar studies are evidence that community-based interventions delivered by female community health volunteers can be instrumental in improving equity in levels of facility delivery and other newborn care behaviours. We recommend that equity be evaluated in other similar settings within Nepal in order to determine if similar results are observed.

RNAi down-regulation of cinnamate-4-hydroxylase increases artemisinin biosynthesis in Artemisia annua.

Cinnamate-4-hydroxylase (C4H) converts trans-cinnamic acid (CA) to p-coumaric acid (COA) in the phenylpropanoid/lignin biosynthesis pathway. Earlier we reported increased expression of AaCYP71AV1 (an important gene of artemisinin biosynthesis pathway) caused by CA treatment in Artemisia annua. Hence, AaC4H gene was identified, cloned, characterized and silenced in A. annua with the assumption that the elevated internal CA due to knock down may increase the artemisinin yield. Accumulation of trans-cinnamic acid in the plant due to AaC4H knockdown was accompanied with the reduction of p-coumaric acid, total phenolics, anthocyanin, cinnamate-4-hydroxylase (C4H) and phenylalanine ammonia lyase (PAL) activities but increase in salicylic acid (SA) and artemisinin. Interestingly, feeding trans-cinnamic acid to the RNAi line increased the level of artemisinin along with benzoic (BA) and SA with no effect on the downstream metabolites p-coumaric acid, coniferylaldehyde and sinapaldehyde, whereas p-coumaric acid feeding increased the content of downstream coniferylaldehyde and sinapaldehyde with no effect on BA, SA, trans-cinnamic acid or artemisinin. SA is reported earlier to be inducing the artemisinin yield. This report demonstrates the link between the phenylpropanoid/lignin pathway with artemisinin pathway through SA, triggered by accumulation of trans-cinnamic acid because of the blockage at C4H.

Mapping the functional anatomy of sentence comprehension and application to presurgical evaluation of patients with brain tumor.

BACKGROUND AND PURPOSE: The main clinical indication for functional MR imaging (fMRI) has been to preoperatively map the cortex. Motor paradigms to activate the cortex are simple and robust; however, language tasks show greater variability and difficulty. The aim of this study was to develop a language task with an adequate control task to engage the areas of the posterior temporal lobe responsible for sentence comprehension. METHODS: We performed a cloze paradigm requiring silent reading of a visually presented sentence-completion task based on semantic meaning versus a letter-scanning epoch requiring the completion of nonlinguistic strings or a rest period. Before this task was clinically used in two patients epilepsy and cavernous angioma, its feasibility and accuracy were tested in 14 healthy right-handed participants. RESULTS: Results showed significant activation of the posterior temporal cortex, including a broad area across the posterior left temporal cortex extending into the inferior parietal lobule. When the sentence completion-minus-letter string task was compared with the sentence completion-minus-rest task, increased activation was present in the posterior temporal lobe. CONCLUSION: Decreased significant activation during the sentence completion-minus-rest contrast may be attributed to increased noise from intersubject variability in the rest period. Our results suggest that this task elucidates areas important to reading comprehension in the posterior and inferior temporal regions that verbal fluency and auditory discrimination tasks do not. Data from two cases are summarized to exemplify the input of this task for neurosurgery.

Leaf Senescence and GABA Shunt.

Leaf senescence is highly regulated and complex developmental process that involves degradation of macromolecules as well as its recycling. Senescence process involves loss of chlorophyll, degradation of proteins, nucleic acid, lipid and mobilization of nutrients through its transport to the growing parts, developing fruits and seeds. Nitrogen is the most important nutrient to be recycled in senescence process. GABA-transaminase (γ-aminobutyric acid) is found to play very important role in nitrogen recycling process through GABA-shunt. Therefore, it is of interest to review the significance of GABA shunt in leaf senescence.

Renal transplant with bronchiolitis obliterans organizing pneumonia (BOOP) attributable to tacrolimus and herpes simplex virus (HSV) pneumonia.

BACKGROUND: Solid organ transplants (SOTs) may be complicated by a wide variety of infectious and noninfectious pulmonary disorders. Transplant patients receive immunosuppressive drugs to prevent rejection, but these drugs also predispose them to infection. Because immunosuppressive therapy impairs T-lymphocyte function, ie, cell-mediated immunity, such therapy, not surprisingly, predisposes patients to intracellular pulmonary pathogens. Community-acquired pneumonia (CAP) in patients with SOT usually involves one of the common typical or atypical bacterial CAP pathogens infecting immunocompetent hosts. The most frequent intracellular CAP pathogens in SOTs during immunosuppressive therapy are viral, eg, cytomegalovirus (CMV), respiratory syncytial virus (RSV), and herpes simplex virus (HSV). In addition, intracellular fungal pathogens are also common in patients with SOTs during immunosuppressive therapy, eg, Pneumocystis (carinii) jiroveci pneumonia (PCP). In addition, a variety of noninfectious disorders are not uncommon in patients with SOTs, including bronchiolitis obliterans organizing pneumonia (BOOP). Bronchiolitis obliterans organizing pneumonia may be associated with a variety of infectious agents, or may be attributable to drugs, including some immunosuppressive agents. METHODS: The clinical approach to CAP in patients with SOTs may be based on the appearance of the chest x-ray (CXR) or chest computed tomography scan, combined with the degree of hypoxemia (ie, the A-a gradient). Patients with SOTs and with a normal or nearly normal CXR and a high degree of hypoxemia (A-a gradient, >35) most often have an early viral pneumonia, eg, CMV or early PCP. If the CXR reveals bilateral patchy interstitial infiltrates and severe hypoxemia, the differential diagnosis is limited to moderate or severe viral pneumonia or PCP. Patients with SOTs and presenting with diffuse infiltrates and mild to moderate hypoxemia (A-a gradient, <35) are usually prone to noninfectious disorders, eg, congestive heart failure, pulmonary embolism, or drug-induced pneumonias. In patients with SOTs and CAP with focal or lobar infiltrates, the distribution of pathogens is the same as in immunocompetent hosts, ie, either a bacterial or atypical CAP pathogen. CASE REPORT AND CONCLUSION: A renal transplant patient developed bilateral patchy interstitial infiltrates with severe hypoxemia during hospitalization. The most likely differential diagnostic possibilities included PCP and BOOP. Bronchoalveolar lavage was performed to rule out PCP, and indicated cytopathic effects diagnostic of HSV pneumonia. Lung biopsy pathology confirmed the diagnosis of BOOP. In reviewing the patient's medications, we surmised that tacrolimus may have caused BOOP. The tacrolimus was discontinued, and the patient received acyclovir for HSV pneumonia.