Intravenous doxycycline, azithromycin, or both for severe scrub typhus

BACKGROUND: The appropriate antibiotic treatment for severe scrub typhus, a neglected but widespread reemerging zoonotic infection, is unclear. METHODS: In this multicenter, double-blind, randomized, controlled trial, we compared the efficacy of intravenous doxycycline, azithromycin, or a combination of both in treating severe scrub typhus. Patients who were 15 years of age or older with severe scrub typhus with at least one organ involvement were enrolled. The patients were assigned to receive a 7-day course of intravenous doxycycline, azithromycin, or both (combination therapy). The primary outcome was a composite of death from any cause at day 28, persistent complications at day 7, and persistent fever at day 5. RESULTS: Among 794 patients (median age, 48 years) who were included in the modified intention-to-treat analysis, complications included those that were respiratory (in 62%), hepatic (in 54%), cardiovascular (in 42%), renal (in 30%), and neurologic (in 20%). The use of combination therapy resulted in a lower incidence of the composite primary outcome than the use of doxycycline (33% and 47%, respectively), for a risk difference of −13.3 percentage points (95% confidence interval [CI], (21.6 to −5.1; P=0.002). The incidence with combination therapy was also lower than that with azithromycin (48%), for a risk difference of −14.8 percentage points (95% CI, −23.1 to −6.5; P<0.001). No significant difference was seen between the azithromycin and doxycycline groups (risk difference, 1.5 percentage points; 95% CI, −7.0 to 10.0; P=0.73). The results in the per-protocol analysis were similar to those in the primary analysis. Adverse events and 28-day mortality were similar in the three groups. CONCLUSIONS: Combination therapy with intravenous doxycycline and azithromycin was a better therapeutic option for the treatment of severe scrub typhus than monotherapy with either drug alone. (Funded by the India Alliance and Wellcome Trust; INTREST Clinical Trials Registry–India number, CTRI/2018/08/015159.

Application of rotary in-vessel composting and analytical hierarchy process for the selection of a suitable combination of flower waste

The flower waste generated from different sources is either mixed with municipal solid waste or thrown into the river in India. Flower waste is rich in organic contents and can be converted into nutrient-enriched compost. The aim of the present study was to determine the changes in physico-chemical and biological changes during the composting of flower waste by using rotary drum technique. For composting the flower, waste was mixed with cow dung, sawdust, and wheat bran. Four different trials were performed, in which 0.5 wt% of sawdust and wheat bran was added in each trial. From the series of trials 1–4, the different proportions of flower waste and cow dung were 5:4, 6:3, 7:2 and 8:1, respectively. Finally, the compost produced by all the trials were found to have pH 7.23–7.51, electrical conductivity 5.5–6.12 mS/cm, reduction in the percentage of total organic carbon 22–33%, the percentage increase in total nitrogen 2.17–2.66%, C:N ratio 13–17, sodium 2.14–2.60 g/kg and calcium 13.35–15.58 g/kg. The analytical hierarchy process was used for the ranking of the trials to find the best proportions from the different combinations performed in this study

Vermicomposting of Textile Industries' Dyeing Sludge by Using Eisenia foetida

Surat City in India is famous for textile and dyeing industries which generate textile sludge in huge quantity. Textile sludge contains harmful chemicals which are poisonous and carcinogenic. The safe disposal and reuse of textile dyeing sludge are challenging for owner of textile industries and government of the state. The aim of present study was the vermicomposting of textile industries dyeing sludge with cow dung and Eisenia foetida as earthworm spices. The vermicompost reactor of 0.3 m3 capacity was used for vermicomposting. Textile dyeing sludge was mixed with cow dung in different proportion, i.e., 0:100 (C1), 10:90 (C2), 20:80 (C3), 30:70 (C4). Vermicomposting duration was 120 days. All the combinations of the feed mixture, the pH was increased to a range 7.45-7.78, percentage of total organic carbon was decreased to a range of 31-33.3%, total nitrogen was decreased to a range of 1.15-1.32%, total phosphorus was increased in the range of 6.2-7.9 (g/kg)

Biotransformation of flower waste composting: Optimization of waste combinations using response surface methodology

Flower waste (FW) is disposed off in the rivers or mixed with solid waste for landfilling that pollutes the environment and causes harmful effects on human health and aquatic life. It is rich in nutrient content and easily converted into the compost. Therefore, the objective of the present research was to optimize the combinations of flower waste and cow dung during agitated pile composting using response surface methodology. Thirteen different agitated piles were used for composting using the central composite design. The optimum combination from central composite design was 65 kg floral waste, 25 kg cattle dung and 10 kg sawdust having 7.10 pH, 3.31 mS cm−1 electrical conductivity, 32.98% total organic carbon and 14 Carbon to Nitrogen ratio during the end phase of the composting period. The nutrient concentrations into the final compost were within the acceptable limit and also found to be beneficial for the growth of plants

Survey of undergraduate medical students on their understanding and attitude towards the discipline of radiotherapy

Aim : The discipline of radiotherapy (RT) in India is considered a low priority subject. Postgraduate (PG) students rarely choose RT as a career option. The possible reasons could be: 1) limited availability of PG course training centers, 2) limited job prospects, etc. We decided to conduct a survey of undergraduate (UG) medical students to find out their awareness, understanding, and attitude toward the subject of RT. Materials and Methods : A simple 12-point questionnaire was designed to assess the level of awareness, understanding, and attitude. It was handed over personally or sent by e-mail or post to UG students of various medical colleges in India. The data provided by respondents was analyzed. Results : During the period from January to June 2008, 400 questionnaires were distributed. A total of 155 respondents sent their responses. Twenty-eight of them (18%) opined that RT is not a part of the bachelor of medicine and bachelor of surgery (MBBS) curriculum at their institute. About 84% replied that not more than 10 theory lectures/practical classes are assigned to RT during the entire UG period. About one-third of the respondents stated that there are no separate clinical postings for RT. According to 54% of the respondents, RT is still a low priority subject in the PG setting and the majority (70%) thought that inadequate exposure at the UG level and lack of awareness about the current prospects of RT are the main reasons for this. Conclusion : The results of our survey indicate that the RT is still a low priority subject in India, mainly due to the poor exposure to the discipline and low awareness of the subject of RT during the UG program. The Medical Council of India (MCI) needs to ensure that adequate importance is given to RT in the MBBS curriculum so as to enhance awareness regarding the subject and increase exposure to this specialty