BACKGROUND:Antibiotic-resistant infections are known to pose a significant challenge to cancer patients, with increased morbidity, mortality and financial burden; however, less is known about their potential impact on health-related quality of life (HRQoL) in this population. This study aimed to assess HRQoL, its predictors, and quality-adjusted life years (QALYs) in cancer patients with antimicrobial-resistant infections (ARG) compared to those with antimicrobial-sensitive infections (ASG) and no infection. METHODS:A prospective cohort observational study was conducted among (N = 657) hospitalized adult cancer patients categorized into three groups: no infection (n = 150), ASG (n = 159), and ARG (n = 348), for 18 months. HRQoL was assessed using the EQ-5D-5L tool. RESULTS:Patients with ARG reported lower HRQoL, with a mean utility score of 0.391 and EQ-VAS score of 41.79, compared to ASG (0.468; 49.31) and no infection (0.533; 55.39) (P < 0.001). However, multidrug-resistant (MDR) and extensively drug-resistant (XDR) groups demonstrated significantly lower HRQoL scores (utility: 0.417 & 0.372; EQ-VAS: 44.3 & 40.02) than ASG. QALYs declined progressively (no infection: 0.046, sensitive: 0.036, resistant: 0.025; p < 0.001). MDR & XDR infections were associated with the lowest QALYs (0.028 & 0.022). Predictors identified that contributed to poorer HRQoL included age >60 years (β = -0.102), Length of stay (β = -0.019), Rural residence (β = -0.006), Stage IV of cancer (β = -0.014), Bloodstream infection (β = -0.038), and Urinary tract infections (β = -0.052), Use of Invasive devices (β = -0.055), Pneumonia (β = -0.137) and Sepsis (β = -0.274). CONCLUSION:Antimicrobial-resistant infections significantly impact HRQoL and QALYs in cancer patients compared with those with antimicrobial-sensitive infections and those without infections.

Problem considered: Tuberculosis (TB) remains a significant public health burden, especially in resource-limited countries. Malnutrition is a significant concern among TB patients, exacerbating symptoms and impeding recovery. Despite this, standardised nutritional screening remains underutilised in TB care programs. Accurate and routine nutritional assessment is essential to guide timely interventions and improve treatment outcomes among TB patients. This study aimed to assess malnutrition risk in TB patients using MUST and PG-SGA, evaluate disagreement between screening tools, and determine the limitations of Body Mass Index (BMI) based assessments. Methods: A cross-sectional study was conducted among 194 adult TB patients receiving anti-TB therapy in Bihar, India. Nutritional risk was evaluated using MUST and PG-SGA, along with demographic, clinical, and anthropometric data. Statistical analyses included ANOVA, Bonferroni post hoc tests, chi-square tests, and Cohen's kappa to assess agreement between tools. Results: The study revealed a high prevalence of malnutrition risk, with MUST detecting 74.2 % and PG-SGA detecting 88.1 % of the overall population. Underweight patients were disproportionately affected, with MUST identifying 96.5 % and PG-SGA identifying 88.3 % as high-risk. This study emphasises the limitations of BMI alone in assessing malnutrition risk and reveals near-random agreement (kappa = 0.010, p < 0.001), suggesting BMI alone inadequately captures malnutrition risk in TB patients. Conclusion: This study highlights a critical gap in malnutrition screening for TB patients, with MUST and PG-SGA detecting high but discordant risk levels. Given PG-SGA's higher sensitivity, policymakers in resource-limited settings should consider integrating it into TB programs for early nutritional intervention, while further research validates optimal screening approaches.

Microorganisms use host microRNAs (miRNAs) to evade immune responses and establish chronic infections. miRNAs, small non-coding RNAs, regulate gene expression post-transcriptionally, influencing host-pathogen interactions. Mycobacterium tuberculosis and other intracellular pathogens evade host immunity, promoting survival within macrophages. Dysregulated miRNA profiles in TB patients linked with disease progression, immune modulation, and treatment outcomes, serving as potential biomarkers. Biosensor technology emerged as a powerful tool for rapid and sensitive detection. MicroRNA-based diagnostics offers a promising approach for precision medicine in tuberculosis (TB) management. This review highlights the dual role of miRNAs in tuberculosis by elucidating their mechanistic contribution to host immune evasion and evaluating their potential as diagnostic biomarkers through emerging biosensor technologies. Despite these promising advances, challenges such as variability in miRNA expression across populations and the need for large-scale clinical validation remain, highlighting the importance of further research to translate miRNA-based diagnostics into routine clinical practice.

BACKGROUND:Polymyxins are considered last-resort agents for treating multidrug-resistant Gram-negative infections; however, resistance is increasing worldwide. Broth microdilution is the standard reference method for colistin susceptibility testing; however, its technical complexity and prolonged turnaround time have prompted the development of the rapid polymyxin test. The clinical performance of these rapid tests across different bacterial species remains unclear. OBJECTIVES:To evaluate the diagnostic accuracy of the rapid polymyxin test for detecting polymyxin resistance in Gram-negative bacteria. METHODS:Data sources: PubMed, Scopus, Web of Science, and Embase (inception to 31 August 2025). STUDY ELIGIBILITY CRITERIA:Studies evaluating rapid polymyxin tests against broth microdilution. PARTICIPANTS:Gram-negative bacterial isolates. INDEX TEST:Rapid polymyxin-based assays. REFERENCE STANDARD:Broth microdilution. ASSESSMENT OF RISK OF BIAS:Quality Assessment of Diagnostic Accuracy Studies 2 tool. METHODS OF DATA SYNTHESIS:Bivariate random-effects model for summary sensitivity and specificity; hierarchical summary receiver operating characteristic curves; subgroup analyses by organism type. PROSPERO:CRD420251140151. RESULTS:Thirty-seven studies were included. The summary sensitivity was 0.966 (95% CI, 0.92-0.98), and the specificity was 0.945 (95% CI, 0.92-0.96). The area under the curve was 0.979, indicating high diagnostic accuracy. Subgroup analyses revealed species-specific variations, particularly between Enterobacterales and nonfermenters. Substantial unexplained heterogeneity was present (I2 = 86.1%) for sensitivity. Among Enterobacterales, sensitivity and specificity were consistently high, with low very major error rates. DISCUSSION:The rapid polymyxin test demonstrates high diagnostic accuracy, particularly for Enterobacterales, but substantial heterogeneity and limited data for nonfermenters warrant caution. Implementation should be accompanied by confirmatory testing, especially in settings with a high prevalence of nonfermenting Gram-negative bacilli.

Incretin-based therapies are essential in diabetes management, with semaglutide receiving attention due to its oral formulation and benefits in cardiovascular health, renal function and weight loss. However, rodent studies have shown that long-term Glucagon-like Peptide-1 Receptor Agonists (GLP-1RAs) exposure can induce proliferative changes, including thyroid C-cell tumors and epithelial cell hyperplasia, through GLP-1R–mediated pathways, raising concerns about potential mitogenic effects in other tissues. This study evaluates the association between semaglutide and bile duct cancer using pharmacovigilance data. A disproportionality analysis was conducted using VigiBase, the WHO's global safety database. Individual Case Safety Reports from January 1, 2009, to July 31, 2023, were analyzed, focusing on neoplasms classified under System Organ Classes. Signal detection was assessed using the lower 95

This study examines the impact of antiretroviral therapy (ART) adherence on visceral leishmaniasis (VL) relapse among 90 HIV–VL co-infected patients in Bihar, India, using the Hindi version of the MMAS-8 to assess adherence. Overall, 21.1

Background: Surgical site infections (SSIs) significantly challenge cancer patients' management, causing prolonged hospitalization, increased morbidity, and mortality. Antimicrobial resistance (AMR) complicates treatment and recovery. This study assessed the SSI incidence, antimicrobial sensitivity patterns, and clinical outcomes in cancer patients. Methods: This prospective study enrolled 228 cancer patients over 9 months at Mahavir Cancer Sansthan and Research Center in Patna, Bihar, India, including patients of all ages who underwent surgery, developed SSIs, and received antimicrobial therapy. Results: The study found an SSI incidence of 7.8 %, highest in head and neck surgeries (16.6 %). The average age was 46.77 years, with 50.9 % males. Multidrug resistance was found in 48.01 % of isolates, with Pseudomonas aeruginosa, Escherichia coli, and Klebsiella oxytoca as the main pathogens. High resistance to fluoroquinolones and third-generation cephalosporins was noted, while tetracycline and aminoglycosides were more effective. Mortality was significantly higher in patients with SSIs (33.9 %) compared to those without SSIs (3.0 %; p < 0.05). The highest mortality was observed in head and neck cancer surgeries (5.26 %) and gallbladder surgeries (3.5 %). Multivariate analysis identified carcinoma (OR = 5.36, 95 % CI: 1.56-18.42, p = 0.008) and history of radiation therapy (OR = 4.74, 95 % CI: 1.13-19.76, p = 0.033) as independent predictors of mortality. Conclusion: This study reveals a high SSI incidence in cancer patients, with significant AMR. Multidrug-resistant pathogens and high mortality rates emphasize the urgent need for improved infection control and antimicrobial stewardship in cancer care. Limitations include the single-center design, potential biases from surgical practices, and antibiotic use variability.

Immune response to COVID-19 vaccination in people living with HIV (PLHIV) remains unexplored, particularly from a metabolic perspective. This study used high-resolution mass spectrometry-based plasma metabolomics to investigate metabolic changes following ChAdOx1 nCoV-19 vaccination in PLHIV and HIV-negative (HN) populations. Plasma samples from 54 PLHIV and 69 HN were analyzed in a cross-sectional design and grouped by vaccination status. A validated UHPLC-MS/MS method was developed and assessed for environmental sustainability using the Analytical Eco-Scale (AES), Analytical GREEnness Metric (AGREE), and RGBfast-based whiteness assessment. The method exhibited strong analytical performance (RSD < 20 % for the internal standard, 110 % recovery) and favorable sustainability (AGREE: 0.53, AES: >81, Whiteness: 65), outperforming comparable published methods. Untargeted metabolomics revealed 213 differentially expressed metabolites (DEMs) in HN after the third dose, compared with 194 DEMs in PLHIV (log2 FC ≥ 0.25 or ≤ -0.25; p < 0.05) groups. Partial least squares-discriminant analysis (PLS-DA) revealed 53 key endogenous metabolites in HN and 70 in PLHIV (VIP >1, FDR< 0.05) groups. Pathway enrichment analysis revealed 23 key metabolites with significant immunological relevance, particularly within amino acid, butanoate, and lipid metabolism in both the HN and PLHIV groups. Arachidonic acid metabolism emerged as one of the most affected pathways, with > 2-fold upregulation (p < 0.05) of pro-inflammatory lipid mediators, including leukotriene B4 (LTB4) and prostaglandin E2 (PGE2). These results indicate that vaccination induces marked metabolic reprogramming in PLHIV, particularly within lipid-derived inflammatory pathways, providing novel insights into vaccine-induced immune regulation in the PLHIV.

BACKGROUND:This study aims to identify patterns and predictors of medical device-related adverse events (MDAEs) among radiotherapy patients. Understanding MDAEs is crucial for optimizing patient safety during radiotherapy. METHODOLOGY:An observational study conducted from August to December 2023 involved 139 patients undergoing radiotherapy. Demographics, clinical characteristics, and AE reports were collected from patient datasheets and analyzed using SPSS Version 28. RESULTS:Study findings revealed that patients with head and neck cancer were significantly associated with higher rates of skin (OR: 3.56, CI: 1.59-7.96) and mucous membrane reactions. Specific dose ranges, particularly 800-2800 cGy, also predict mucous membrane reactions (OR: 11.12, CI: 3.42-36.1). Furthermore, smokeless habits significantly influenced both skin (OR: 6.04, CI: 1.99-18.3) and mucous membrane reactions (OR: 8.77, CI: 2.57-29.9). In contrast, head and neck cancer patients had reduced likelihoods of pharynx reactions (OR: 0.37, CI: 0.13-1.00), particularly with doses between 2801 and 4800 cGy (OR: 0.45, CI: 0.96-21.6). CONCLUSION:This study identified a few significant predictors for the occurrence of various types of MDAEs among patients undergoing radiotherapy. Reporting MDAEs can prevent adverse effects caused by medical devices and enhance radiotherapy safety.

Background:This study aimed to provide comprehensive information on translated versions of the 9-item shared decision-making questionnaire, widely used to measure patient involvement in shared decision-making, by combining psychometric validation information. Methods:We searched various databases such as PubMed, Scopus, Google Scholar, along with developer website to gather pertinent literature published until Feb, 2024. This psychometric validation carried out based on item characteristics, content validity, and factor analysis results of individual studies. Our evaluation was based on predetermined cut-off values for item difficulty, discrimination index, Cronbach's alpha, Kaiser Meyer Olkin factor (KMO), Bartlett's test of sphericity, and factor extraction and rotation, confirmatory factor analysis range. The European Social Research Council guidance on the conduct of narrative synthesis in systematic reviews was employed for synthesis of validation results. Results:The final analysis included nine studies with 3090 participants from various countries, and most participants had adequate literacy, and age range was 30-60 yr. Most model versions had a good fit, and all studies reported satisfactory results, except for one study's discrimination index values. The tool's validity was satisfactory. Most of the studies reported a convenient sample was the main limitation, along with recall bias in the final responses. Conclusion:The 9-item shared decision-making tool can be used to measure patient involvement in shared decision-making in validated language-respected countries, as proper evaluation procedures reported satisfactory results in the confirmatory analysis models and reliability testing.

Background: To enhance the treatment outcomes of tuberculosis (TB), it is crucial to understand the sleep quality of patients who use tobacco. This study seeks to measure the level of nicotine dependence in tuberculosis patients who use tobacco and its correlation to sleep quality. Additionally, it aims to examine the extent to which tobacco use affects the sleep quality of TB patients. Methods: A cross-sectional study was conducted at a TB centre in Patna, Bihar, India with n = 209 patients. The study used the Pittsburgh Sleep Quality Index questionnaire to measure sleep quality, and the Fagerstrom Test for Nicotine Dependence, as well as the Fagerstrom Test for Nicotine Dependence-Smokeless Tobacco questionnaires, to evaluate the level of nicotine dependence. Results: The study revealed that TB patients with tobacco use reported significantly worse sleep quality (86.1 %, 95 % CI: 80.6-91.1) compared to non-tobacco users (13.9 %, 95 % CI: 9.4-19.4). Additionally, the study identified a correlation between nicotine dependence (Smokers r = .550, p < .001 and smokeless tobacco r = .835, p < .001) and poor sleep quality. Smokers are (beta = 2.250, 95 % CI: 1.380-3.120, p < .001) more prone to experience poorer sleep quality compared to non-smokers, while users of smokeless tobacco are (beta = 5.167, 95 % CI: 4.465-5.869, p < .001) more prone to experience worse sleep quality compared to non-users of smokeless tobacco. Conclusion: The study concluded that tuberculosis patients with tobacco use experienced poorer sleep quality. Improving sleep quality could enhance the overall management and care for individuals with tobacco-associated tuberculosis, leading to better health outcomes.

Chemotherapy, a primary cancer treatment, often leads to debilitating gastrointestinal (GI) side effects, significantly impacting health-related quality of life (HRQoL). This study investigates the prevalence and impact of gastrointestinal (GI) symptoms on HRQoL in cancer patients undergoing chemotherapy in Bihar, India. This prospective observational study enrolled 246 chemotherapy patients (≥ 18 years) over 9 months. GI symptoms and HRQoL were assessed using the Gastrointestinal Symptom Rating Scale (GSRS) and Short Form-36 (SF-36) questionnaires. Data analysis employed SPSS v.27, with t-tests determining significant associations. Mild GI symptoms were prevalent (72.8

Background: Carbapenem-resistant Enterobacteriaceae (CRE) infections pose a significant threat owing to their high mortality rates and limited treatment options, exacerbated by antibiotic misuse and the spread of resistance genes. Objective: This study aimed to compare the effectiveness, safety, and outcomes of tigecycline and colistin in the treatment of CRE infections in cancer patients. Methods: A 9-month prospective observational study was conducted at a tertiary-care cancer hospital in Bihar, India. The study included 150 patients with CRE infections divided into tigecycline (n = 90) and colistin (n = 60) groups. Results: Patients receiving tigecycline had higher levels of direct bilirubin, alkaline phosphatase, and creatinine. However, tigecycline was associated with shorter hospital stays (13.73 vs 17.45 days, p = 0.016) and therapy durations (5.7 vs 7.3 days, p = 0.04). Infection recurrence rates (3.3 % vs. 5 %) and 30-day mortality rates (17.6 % vs. 18.9 %, p = 0.663) were similar between the two groups. Conclusion: Both tigecycline and colistin were effective in treating CRE infections in patients with cancer. Although tigecycline was associated with improved hospital stay and therapy duration, it also showed potential liver and kidney function adverse effects. These findings highlight the need for careful consideration of treatment options for CRE infections in patients with cancer.

In recent years, groundwater uranium [U238] poisoning has posed serious health hazards in the exposed population. In India, an estimated 151 districts and 18 states are reported with groundwater uranium contamination, and about 1.7% of groundwater sources are affected in the state of Bihar (India). The objective of the study is to evaluate the uranium contamination in the breastmilk of lactating mothers and their breastfed infants. To evaluate the uranium exposure in the infants exposed through their mother’s breastmilk, n = 40 lactating women were selected randomly from different districts of Bihar. After obtaining the written informed consent, their breast milk was collected and analysed for quantification of U238. The infants and their mother’s carcinogenic risk (CR) and hazard quotient (HQ) were also studied to know the potential health hazard effects of uranium. The uranium exposure to the infants through their mother’s breastmilk is at a hazardous level. All the analysed breastmilk samples had U238 contents, which could pose health impacts to infants. The infants are highly vulnerable to potential non-carcinogenic risk in comparison to their mothers due to the real-time uranium elimination from their bodies. The study reveals that the uranium content in the breast milk was significantly high. The 70% of the infant population had the potential to cause non-carcinogenic health effects. From the studied districts, Katihar breastmilk samples had the highest U238 content. The exposure of uranium to the infant’s body through breast milk is significantly high, which may impact their health. Furthermore, there is also a need for biomonitoring of U238 in these regions at a broader level.

BACKGROUND:Despite global advancements in tuberculosis (TB) management, significant patient safety gaps remain, particularly affecting vulnerable populations in resource-limited settings. Aligning with calls for solution-oriented research, this study addresses systemic safety challenges in TB management and suggests targeted interventions to improve equity and care quality gaps. METHODS:A mixed-methods study was conducted at ICMR-RMRIMS in Patna, India, involving TB patients (n = 100), healthcare professionals (n = 30), and caregivers (n = 30). Data from treatment charts, surveys, interviews, and focus groups were analyzed using descriptive statistics, regression models (quantitative), and thematic analysis (qualitative). RESULTS:The results of the study revealed critical safety gaps with 43 % of patients had experienced diagnostic delays (p = 0.005), 32 % had adverse drug reactions (p = 0.028), and 15 % showed medication non-adherence (p = 0.002). Regression analysis identified illiteracy (β = 0.334, p < 0.001) and delayed diagnosis (β = 0.304, p < 0.001) emerging as key risk predictors, with mask usage (β = -0.173, p = 0.036) and hygiene education (β = -0.234, p = 0.013) as significant protective measures. A striking know-do-gap existed among providers with 93 % knowing WHO guidelines, but only 63 % consistently used PPE reflecting trade-off between safety protocols and real-world constraints. Qualitative findings revealed financial constraints (43 % delayed diagnosis) and GI ADRs as key adherence barriers, compounded by medication access issues (11 % unavailability). Healthcare providers reported 3.7 day isolation delays due to infrastructure limitations, advocating for community-based solutions like mobile clinics and family screening to strengthen safety. CONCLUSION:This study identifies critical, modifiable gaps in TB patient safety, including diagnostic delays, medication risks, and PPE non-compliance. Findings emphasize the integration of health literacy, decentralized diagnostics, adverse event management, socioeconomic support for vulnerable populations, and specialized provider training to strengthen safety in high-burden settings.

Mercury is a persistent, bio-accumulative, and hazardous contaminant. When released into the environment, it accumulates in water sediments, converting it to poisonous methylmercury that enters the food chain. The present study was carried out in habitations from the 11 districts of Bihar (India). In the study, n = 224 lactating women and their infants n = 172 infants participated. After obtaining the written informed consent, their breast milk, urine, and blood were collected for mercury estimation. The breastmilk content was measured in n = 181 subjects, in which 74% women had their breastmilk higher than the WHO permissible limit (< 1.7 μg/L), while 26% of the women had their breast milk below the permissible limit. The blood mercury content showed that 19% subjects had mercury content above the permissible limit [20 μg/L]. In urine mercury estimation, 49% women had mercury content above the permissible limit [10 μg/L], while, 51% women had the mercury content below the permissible limit. In the child’s urine, 54% infants had their mercury content in urine above the permissible limit [10 μg/L] while 46% infants had content below the permissible limit. The study indicates that 20% of infants had the complete accumulation of mercury in their body which is highly toxic for them. However, the mercury content in the food (wheat) had the contamination with in the permissible limit [100 μg/kg]. There was a significant correlation found between the breastmilk and child’s urine and mother’s urine. The HQ study also correlates the mercury poisoning effect with 100% of the mother’s and 66% of the infants exceeding the limit of non-carcinogenic risk. The Monte Carlo and multivariate study correlates the high health risk in the studied population due to mercury poisoning. The entire study concludes that population inhabitation in the Gangetic plains of Bihar are exposed to mercury poisoning which may be due to geogenic or anthropogenic sources. But, the levels of mercury contamination above the permissible limit could lead to neurogenerative changes in the lactating mothers and their infants. To control the present problem medical intervention is immediately required.

Patient involvement in shared decision-making (SDM) is known to improve patient-reported outcomes. However, the patient-perceived level of SDM varies, and this experience is crucial for enacting policies. Evidence suggests that suitable measurement tools are lacking in low- and middle-income countries (LMICs). This study aimed to develop and validate a tool for measuring patient involvement in SDM in LMICs. The study was conducted among cancer patients undergoing chemotherapy. Item generation involved a literature review and focus group discussions, followed by content validation with experts. Item characteristics were initially evaluated, and the tool’s validity was assessed using factor analysis. Scientific rigor was ensured through the Bartlett test of sphericity (p < 0.05) and the Kaiser–Meyer–Olkin (KMO) test for sample adequacy. Exploratory factor analysis (EFA) with varimax rotation was used for factor extraction, considering factor loadings above 0.5. Confirmatory factor analysis (CFA) was used to assess model fit, with data analysis performed using IBM SPSS v.29 and AMOS v.29 software. Six items were included in the final tool, validated with 73 cancer patients. The tool showed excellent content validity (scale content validity index [S-CVI] = 1.00, universal agreement [UA] = 1.00), a Bartlett sphericity test result of p < 0.01, and a KMO score of 0.76. EFA identified a single construct explaining 55.4