Community- vs. hospital-based management of multidrug-resistant TB in Pakistan

BACKGROUND Multidrug-resistant TB (MDR-TB) treatment takes 18-24 months and is complex, costly and isolating. We provide trial evidence on the WHO Pakistan recommendation for community-based care rather than hospital-based care.METHODS Two-arm, parallel-group, superiority trial was conducted in three programmatic management of drug-resistant TB hospitals in Punjab and Sindh Provinces, Pakistan. We enrolled 425 patients with MDR-TB aged >15 years through block randomisation in community-based care (1-week hospitalisation) or hospital-based care (2 months hospitalisation). Primary outcome was treatment success.RESULTS Among 425 patients with MDR-TB, 217 were allocated to community-based care and 208 to hospital-based care. Baseline characteristics were similar between the community and hospitalised arms, as well as in selected sites. Treatment success was 74.2% (161/217) under community-based care and 67.8% (141/208) under hospital-based care, giving a covariate-adjusted risk difference (community vs. hospital model) of 0.06 (95% CI -0.02 to 0.15; P = 0.144).CONCLUSIONS We found no clear evidence that community-based care was more or less effective than hospital-based care model. Given the other substantial advantages of community-based care over hospital based (e.g., more patient-friendly and accessible, with lower treatment costs), this supports the adoption of the community-based care model, as recommended by the WHO.

Implementation and Evaluation of a Psychoactive Substance Use Intervention for Children in Afghanistan: Differences Between Girls and Boys at Treatment Entry and in Response to Treatment

Psychoactive substance use among children in Afghanistan is an issue of concern. Somewhere around 300,000 children in the country have been exposed to opioids that either parents directly provided to them or by passive exposure. Evidence-based and culturally appropriate drug prevention and treatment programs are needed for children and families. The goals of this study were to: (1) examine lifetime psychoactive substance use in girls and boys at treatment entry; and (2) examine differential changes in substance use during and following treatment between girls and boys. Children ages 10-17 years old entering residential treatment were administered the Alcohol, Smoking and Substance Involvement Screening Test for Youth (ASSIST-Y) at pre- and post-treatment, and at three-month follow-up. Residential treatment was 45 days for children and 180 days for adolescents and consisted of a comprehensive psychosocial intervention that included education, life skills, individual and group counseling and, for older adolescents, vocational skills such as embroidery and tailoring. Girls and boys were significantly different regarding lifetime use of five substances at treatment entry, with girls less likely than boys to have used tobacco, cannabis, stimulants, and alcohol, and girls more likely than boys to have used sedatives. Differences between boys and girls were found for past-three-month use of four substances at treatment entry, with girls entering treatment with higher past-three-month use of opioids and sedatives, and boys with higher past-three-month use of tobacco, cannabis, and alcohol. Change over the course of treatment showed a general decline for both girls and boys in the use of these substances. Girls and boys in Afghanistan come to treatment with different substance use histories and differences in past-three-month use. Treatment of children for substance use problems must be sensitive to possible differences between girls and boys in substance use history.

Three new records of lichenised fungi from India

Three lichen species, namely Amandinea errata and Baculifera xylophila, belonging to family Caliciaceae, and Baeomyces rufus, of family Baeomycetaceae, are newly reported for the Indian lichen biota. A brief morphotaxonomic description of each species, along with their ecology and distribution, is also provided.

A Study on Extracellular Synthesis of Silver Nanoparticles from Endophytic Fungi, Isolated from Ethanomedicinal Plants <i>Curcuma longa</i> and <i>Catharanthus roseus</i>

Biological method is considered as eco-friendly and reliable process for the synthesis of silver nanoparticles (AgNps) in the field of nanotechnology due to its tremendous applications in various fields. In this study we have isolated a total of twelve endophytic fungi from leaves of Curcuma longa (turmeric) and Catharanthusroseus out of which six endophytic fungi showed their ability to synthesized AgNps from silver nitrate (AgNO3) solution which splits into a positive silver ion (Ag+) and a negative nitrate ion (NO3-) in order to turn the silver ions into solid silver (Ago). Of the six positive endophytic fungi VRD2 showed good and encouraging results and was identified as Penicillium spinulosum VRD2. UV-Visible Spectroscopy confirms the AgNps showing maximum peak at 425nm implying the bioreduction of AgNO3. Transmission Electron Microscopy (TEM) revealed the particle are spherical and well dispersed without agglomeration size ranging from 25-30nm.

A Study on Extracellular Synthesis of Silver Nanoparticles from Endophytic Fungi, Isolated from Ethanomedicinal Plants <i>Curcuma longa</i> and <i>Catharanthus roseus</i>

Biological method is considered as eco-friendly and reliable process for the synthesis of silver nanoparticles (AgNps) in the field of nanotechnology due to its tremendous applications in various fields. In this study we have isolated a total of twelve endophytic fungi from leaves ofCurcumalonga(turmeric) andCatharanthusroseusout of which six endophytic fungi showed their ability to synthesized AgNps from silver nitrate (AgNO3)solution which splits into a positive silver ion (Ag+) and a negative nitrate ion (NO3-) in order to turn the silver ions into solid silver (Ago). Of the six positive endophytic fungi VRD2 showed good and encouraging results and was identified asPenicillium spinulosumVRD2. UV-Visible Spectroscopy confirms the AgNps showing maximum peak at 425nm implying the bioreduction of AgNO3. Transmission Electron Microscopy (TEM) revealed the particle are spherical and well dispersed without agglomeration size ranging from 25-30nm.