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.

More intensive versus conservative blood pressure lowering after endovascular therapy in stroke: a meta-analysis of randomised controlled trials

The optimum systolic blood pressure (BP) after endovascular thrombectomy for acute ischaemic stroke is uncertain. We aimed to perform an updated meta-analysis of randomised controlled trials (RCTs) to evaluate the safety and efficacy of more intensive BP management compared to less intensive BP management. We searched various electronic databases to retrieve relevant RCTs on the clinical effects of more intensive BP management after endovascular thrombectomy compared to the less intensive management. We calculated odds ratios (ORs) with 95% confidence intervals (CIs) for dichotomous outcomes. Our meta-analysis included four RCTs with a total of 1560 patients. More intensive BP management (<140 mmHg) was associated with a statistically significant decrease in the number of patients showing functional independence (modified Rankin scale [mRS] score = 0-2) at 90 days (OR 0.69; CI = 0.51-0.94). Regarding 90-day mortality, our pooled results showed no statistically significant difference between the two groups (OR 1.21; CI = 0.89-1.65). There was no statistically significant difference between the two groups regarding the incidence of intracerebral haemorrhage (ICH) (OR 1.09; CI = 0.85-1.39) and the incidence of symptomatic intracerebral haemorrhage (sICH) (OR 1.11; CI = 0.75-1.65). According to our meta-analysis, the intensive BP lowering group decreased the number of patients showing functional independence at 90 days. We found no benefit of the intensive lowering of BP on mortality rates and incidence of ICH compared to the conservative BP management. Future large-scale trials should focus on other interventions to improve prognosis in these patients

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)