Jupiter Medical Center

Low or abnormal plasma concentrations of anti-tuberculosis drugs can be a major reason for treatment failure or the emergence of drug resistance. Acetylator status, which affects drug metabolism, plays a key role in determining drug bioavailability. This study aimed to perform therapeutic drug monitoring (TDM) of rifampicin and isoniazid and to evaluate the correlation between plasma drug concentrations and acetylator status among Indian patients receiving first-line antituberculosis therapy. Plasma concentrations of rifampicin and isoniazid were measured using in-house standardized high-performance liquid chromatography methods, while acetylator status was determined by conventional PCR of NAT2 gene. Peak concentrations were estimated from 125 patients on first-line tuberculosis (TB) treatment. Among these, 56% exhibited subtherapeutic rifampicin concentrations and 28% had subtherapeutic isoniazid concentrations. Conversely, above normal (potentially toxic) concentrations were seen in 2% and 21% for rifampicin and isoniazid, respectively. Despite receiving the standard TB treatment regimen, only 62% of patients improved clinically, while 38% of patients continued harboring TB signs and symptoms, among which 6 patients (5%) developed rifampicin resistance during the treatment course. About 44% were slow acetylators, followed by 40% intermediate and 16% rapid acetylators. The acetylator status significantly influenced the plasma concentrations of both drugs. Slow acetylators had significantly higher isoniazid concentrations (p = 0.004) and lower rifampicin concentrations (p = 0.01) as compared to rapid acetylators. Abnormal concentrations of rifampicin and isoniazid are prevalent and a major concern. Acetylator status influences plasma concentrations of rifampicin and isoniazid. Hence, determining acetylator status and performing TDM could be instrumental in optimizing and improving TB outcomes.

Hypertension is a leading cause of cardiovascular morbidity and mortality globally, with particularly low control rates in India. Beyond controlling blood pressure (BP), effective management must address associated comorbidities such as cardiovascular disease (CVD), chronic kidney disease (CKD), and type 2 diabetes mellitus (T2DM). A multidisciplinary panel of experts, including cardiologists, nephrologists, and physicians, developed this consensus through six advisory board meetings. A comprehensive literature review of randomized controlled trials and systematic reviews published between 2019 and 2025 was conducted via PubMed and Google Scholar. Key topics included pharmacological and non-pharmacological management of hypertension, combination therapy, and comorbidity-focused treatment strategies. Early screening for hypertension-mediated organ damage and the use of combination therapy, specifically telmisartan and cilnidipine for their complementary benefits, were emphasized. Evidence showed improved BP control, reduced proteinuria, and organ protection in individuals with CVD, CKD, and T2DM. Non-pharmacological interventions such as dietary modification, physical activity, smoking cessation, stress management, and adherence to therapy through fixed-dose combinations were also endorsed. This expert consensus supports a comprehensive, patient-centered approach to hypertension management in India. Available evidence suggests that cilnidipine and telmisartan may offer potential benefits beyond BP reduction, largely based on pharmacologic properties and surrogate outcomes. Future large-scale, randomized, comparative outcome trials are needed to better define the relative clinical benefits of this combination.

Background: Extended platelet-rich fibrin (e-PRF) membranes are a novel 100% autologous biomaterial with a longer resorption time (4–6 months) than traditional solid-PRF membranes (two weeks). In part 1 of this 2-part publication series, four clinical variations for using these novel e-PRF membranes for socket preservation were introduced. In this randomized clinical trial (RCT), all four iterations of e-PRF membranes were compared to traditional collagen membranes in alveolar ridge preservation for hard and soft tissue dimensional changes and early wound healing outcomes. Methods: A single-center RCT was conducted, including 55 patients requiring the extraction of a single tooth with planned implant placement. All sockets were grafted with a “sticky bone” (bone allograft mixed with PRF) and secured with either a collagen membrane (control) or e-PRF membranes utilizing the four variations present in Part 1 (both formed extra-orally or intra-orally, each with or without an overlying solid PRF membrane). The time of fabrication and application of each e-PRF iteration was recorded. Cone beam computed tomography was utilized to evaluate horizontal and vertical ridge dimensions at baseline and 3 months post-operatively, and soft tissue thickness was also measured at both time intervals utilizing an endodontic reamer. Early wound healing was recorded at 2 weeks, utilizing the Landry, Turnbull, and Howley Index by three blinded clinicians. Results: The results demonstrated that, at 3 months, the e-PRF membranes fabricated utilizing all 4 treatment variations demonstrated equal improvements in horizontal and vertical ridge dimensions and soft tissue thickness when compared to collagen membranes. Additionally, the membrane (p = 0.029) and membrane w/solid (p = 0.021) groups demonstrated statistically significant superior early wound healing compared to the collagen membrane group. Notably, the Bio-Filler groups demonstrated statistically significant reduction in fabrication/application time compared to the membrane groups. Conclusions: Within the limitations of this RCT, all e-PRF iterations performed comparably to collagen membranes in maintaining both hard and soft tissue ridge dimensions when combined with sticky bone, while also significantly improving soft tissue wound healing. Future RCTs with alternative grafting materials, direct wound-margin assessment, and evaluation of patient-reported outcomes are necessary to clarify the advantages of each membrane type.

To navigate their environments effectively, animals frequently track time elapsed or distance traveled while seeking food and avoiding threats. The hippocampus is implicated in this process, but the neural mechanisms remain unclear. Using virtual reality tasks that require mice to integrate time or distance to collect a reward, we identified two previously unknown functional subpopulations of CA1 pyramidal neurons. Both subpopulations encode time or distance via distinct ramping dynamics. The first subpopulation exhibits a rapid, synchronous rise in activity upon movement-initiated integration. Subsequently, individual neurons ramp down at heterogeneous rates, creating progressively diverging firing rates that encode elapsed time or distance. Closed-loop optogenetic inactivation of somatostatin-positive (SST) interneurons counterintuitively reduced the ramping activity, leading mice to prematurely attempt reward collection, suggesting impaired time/distance estimation. Conversely, the second CA1 subpopulation shows opposite dynamics — an initial rapid suppression followed by a gradual ramp-up. Inactivating parvalbumin-positive (PV) interneurons diminished this initial suppression, resulting in transient attempts to collect reward near integration onset. These findings reveal parallel hippocampal circuits that initiate and maintain time or distance encoding, controlled by PV and SST interneurons, respectively, and provide insights into the neural computations supporting goal-directed navigation.

BackgroundBlood eosinophils have become an invaluable tool in the assessment, management, and prognostication of patients with asthma and chronic obstructive pulmonary disease (COPD). Historically, the understanding and application of blood eosinophil counts (BEC) have been primarily based on data from high-income countries, with limited information available from developing regions, including the Indian subcontinent.Research QuestionThis study aims to assess the distribution and clinical relevance of BEC among patients with asthma and COPD as well as healthy volunteers across India, to determine if patterns observed in Western studies hold true in an Indian setting.Study Design and MethodsA multi-centre cross-sectional study was conducted at 16 clinics across India. Participants included patients diagnosed with asthma or COPD and healthy volunteers who were identified from referrals to these clinics. Comprehensive data collection involved demographics, medication use, smoking status, and pre- and post-bronchodilator spirometry. All participants underwent a laboratory full blood count.ResultsThe study comprised 4782 adults, including 1,332 patients with asthma (571 males, 761 females), 1,001 patients with COPD (691 males, 310 females), and 2,449 healthy volunteers (1,399 males, 1,050 females). Among patients with asthma, the mean BEC was higher at geometric mean 173.9 [156.2, 193.6]; patients with COPD had a mean BEC of 198.4 [178.6, 220.4] which was significantly higher than that of healthy volunteers (144.7 [134.5, 155.5]).InterpretationThe range of eosinophils in the contemporary Indian population aligns with data from Europe, affirming the validity of using BEC as a biomarker in obstructive lung disease within the Indian demographic. This insight challenges the prevailing assumption of distinct eosinophil count profiles in different geographical regions and underscores the global applicability of eosinophil-based management strategies for asthma and COPD.

Depredation, the partial or complete removal of hooked fish by predators, poses significant challenges for fisheries worldwide. Shark depredation in recreational fisheries has become a growing concern, influencing both fisheries management and public perceptions of shark conservation. Although DNA swabbing of depredated fish has been used to identify responsible shark species, the reliability of this technique remains uncertain due to potential environmental DNA (eDNA) contamination. In this study, we evaluated the accuracy of swab-based molecular identification by comparing genetic results to video-confirmed depredation events. Four depredation events were recorded in Jupiter, Florida, involving a bull shark (Carcharhinus leucas), lemon shark (Negaprion brevirostris), great hammerhead shark (Sphyrna mokarran) and great barracuda (Sphyraena barracuda). DNA analysis of swab samples from depredated fish correctly identified the responsible shark species in all three shark cases. Barracuda depredation yielded no amplification. Our findings validate the use of swab-based molecular techniques for accurately identifying depredating shark species and confirm the absence of misleading eDNA signals. This approach provides a valuable, non-invasive tool for studying predator-prey interactions and informing fisheries management strategies.

In the original article published: Kalayjian T, McNally BJ, Calkins MW, et al. The SMHP™ position statement on therapeutic carbohydrate reduction for type 1 diabetes. J. metab. health. 2024;7(1), a100. https://doi.org/10.4102/jmh.v7i1.100, an author’s name was incorrectly spelt. Instead of: Mirian Kalamian It should be: Miriam Kalamian The authors apologise for this error. The correction does not change the study’s findings, its significance or overall interpretation of the study’s results or the scientific conclusions of the article in any way.