Sonal Sekhar Miraj

Vitiligo is an acquired chronic autoimmune depigmentation disorder, and mainstream treatment options for vitiligo are non-steroidal immunosuppressants/immunomodulators (NSIs) and steroidal immunosuppressants (SIs). However, there are variations in the efficacy and safety of NSIs and SIs in the management of vitiligo. This research aimed to compare the efficacy and safety of NSIs and SIs in the management of vitiligo. A systematic literature search was conducted using various electronic databases, including PubMed, Scopus, Web of Science, and Embase, up to June 2025. All randomized controlled trials (RCTs) and quasi-experimental studies were included in our review, involving participants with vitiligo who received either NSIs or SIs. Quality assessment of all included studies was performed using standardized risk-of-bias tools. The study protocol was registered in the International Prospective Register of Systematic Reviews (PROSPERO) with the identification number CRD42023443213. A total of 14 studies were included in our review. Our study did not show a significant result for the VASI score and we could not compare the efficacy of NSIs versus SIs based on re-pigmentation and VIDA due to insufficient data. Regarding the safety profile, both NSIs and SIs were well tolerated. However, NSIs were associated with lower weight gain ( p = 0.02).

Background/Objectives: Diabetic foot infections (DFIs) are a major cause of morbidity and lower-limb amputation. Vitamin D exerts immunomodulatory effects through vitamin D receptor (VDR), which regulates the cathelicidin antimicrobial peptide (CAMP) gene that encodes cathelicidin (LL-37). However, their association with DFIs remains poorly understood. This study investigated the association between vitamin D supplementation, the vitamin D–VDR–CAMP–LL-37 pathway, and ulcer healing in DFIs involving biofilm-forming bacteria. Methods: This study (September 2022–March 2026) included 16 DFI patients in the study group (SG), 16 in the reference group (RG), and 16 healthy controls (HCs). The SG received vitamin D supplementation (60,000 IU) in addition to standard care, whereas the RG received standard care alone. Participants were followed up for 4 months. Vitamin D assessment (electrochemiluminescence immunoassay), VDR and LL-37 quantification (ELISA), biofilm formation (tissue culture plate method), and VDR and CAMP gene expression (mRNA quantitation) were all considered. Results: At baseline, serum vitamin D, VDR protein, and LL-37 levels differed significantly among the groups (p ≤ 0.002), whereas VDR and CAMP gene expressions did not. Following supplementation, the SG showed significant increases in serum vitamin D, VDR protein and LL-37 (p ≤ 0.001). At the four-month follow-up, there was no significant difference in VDR and CAMP gene expression or in ulcer healing between the groups. Although a higher proportion of participants in the SG achieved ulcer healing, the difference was not statistically significant. Conclusions: Although changes in the circulating elements of the vitamin D-VDR-LL-37 pathway were noted with physician-prescribed vitamin D supplementation, no statistically significant association with ulcer healing was observed. This finding requires validation through a thorough investigation.

Introduction: Developing competency for evidence synthesis and translation of evidence into healthcare practice is critical for evidence-based patient care. Pharmacy professionals have a substantial role in evidence generation, synthesis and translation across their professional practice in industry, academia and healthcare. This scoping review aims to explore educational approaches and strategies for building evidence synthesis skills among pharmacy students. Method and analysis: This scoping review protocol will follow the Preferred Reporting Items for Systematic Review and Meta-Analysis Extension for Scoping Reviews (PRISMA-ScR) reporting guidelines and will be conducted using the Arksey and O’Malley framework, supplemented by recommendations from the Joanna Briggs Institute. PubMed, Scopus, Embase, CINAHL Ultimate and Web of Science biomedical databases will be searched for literature from 2010. Two reviewers will screen the literature and extract data independently. Data related to the type of educational approaches being adopted to develop evidence synthesis skills, specific concepts delivered and reported effectiveness and feasibility factors will be extracted. The quantitative data will be compiled and summarised using descriptive statistics and will be presented using percentages, frequency, mean, median and SD. Qualitative evidence will be narratively described. This review will contribute to the development of an educational framework to develop evidence synthesis skills among pharmacy students. This review will also provide key insights for policymakers and regulatory authorities in the educational sector to strengthen existing curriculum and educational frameworks, to promote long-term sustainability of the acquired knowledge and skills that underpin evidence synthesis. Ethics and dissemination: The current review does not require ethical approval. The data will be disseminated at national or international conferences and will be published in a peer-reviewed journal. Trial registration number: This scoping review has been registered in the Open Science Framework with registration DOI:10.17605/OSF.IO/ZQVGY

Background: Female genital tuberculosis (FGTB) continues to be a significant problem worldwide. Endometrial biopsy (EB) is the most effective sample for detecting FGTB. However, biopsy is invasive and causes unwarranted suffering. Furthermore, a few studies have investigated non-invasively obtained menstrual blood (MB) as an alternative diagnostic sample for detecting FGTB. Hence, in this study, we are assessing MB as an alternative sample to EB for diagnosing FGTB. Method: A systematic literature search was conducted using the electronic databases PubMed, Scopus, Web of Science, and Embase until September 2024. All original studies that compared MB with samples of EB for diagnosing FGTB were included. Results: A total of nine studies were obtained. The sensitivity of tests using MB as a sample ranged from 33.3% to 91.7%, while the specificity ranged from 82.9% to 97.3%. In the EB group, the sensitivity ranged from 64.8% to 95.8%, and the specificity ranged from 84.3% to 97.5%. Conclusion: The review suggests that MB could be a potential sample for diagnosing FGTB, as the specificity of tests using this sample is comparable to that from the EB group. PROSPERO registration: The study protocol was registered in the International Prospective Register of Systematic Reviews (PROSPERO) with the identification number CRD42024509199.

Background: Pulmonary tuberculosis, caused by the bacillus Mycobacterium tuberculosis , remains a major global health challenge, particularly in developing countries. In this study, we analyzed publicly available 16S amplicon sequencing datasets from four geographical locations using a single workflow. Methods: We employed Quantitative Insights Into Microbial Ecology v.2 for microbial diversity analysis and Phylogenetic Investigation of Communities by Reconstruction of Unobserved States v.2 for functional pathway predictions of the gut microbiota in patients with PTB and antitubercular therapy. Results: Our analysis revealed statistically significant alpha diversity differences in West Africa with decreased microbial diversity in pulmonary tuberculosis patients after two months of antitubercular therapy. Additionally, there were no statistically significant differences observed in pairwise comparisons within the same location or in the aggregate beta diversity of the datasets. The predicted microbial metabolic pathways related to vitamin biosynthesis, amino acid synthesis, and energy production were depleted in pulmonary tuberculosis patients following antitubercular therapy. Conclusions: The observed alterations of gut microbial diversity and predicted functional profile underscores the influence of antitubercular therapy on gut health, suggesting that longer treatment durations may aggravate these alterations in gut microbial function. Moreover, geographical location exerts a more significant impact on microbial diversity than the disease state in a specific location, highlighting the potential for precision medicine to tailor interventions based on individual or regional microbiome characteristics.

Aims/Introduction: Vitamin D deficiency is prevalent among individuals with diabetic foot infections (DFIs) and can influence a range of patient-related parameters. Hence, we aimed to find the association of serum vitamin D levels with various clinical, biochemical, and inflammatory parameters, as well as the microbial environment in the wounds of DFI patients. Materials and Methods: From September 2022 to March 2024, 169 DFI patients participated in cross-sectional research at the hospital. Utilising an electrochemiluminescence immunoassay, vitamin D levels were determined. Vitamin D receptor (VDR) and Cathelicidin (LL-37) were estimated using ELISA Kits. The tissue culture plate technique was used to analyze biofilm formation. Patient-related parameters were obtained from medical records. Results: The vitamin D status of DFI patients indicated that 70.4% were deficient, 19.5% were insufficient, and 10.1% were sufficient. The median vitamin D, VDR protein, and LL-37 values were 15.3 ng/mL, 0.832 ng/mL, and 1.54 ng/mL, respectively. Biofilm formation was seen in 84.36% of bacteria from vitamin D-deficient DFI patients ( P < .001). Vitamin D levels were negatively correlated with ulcer duration, hospital stay, white blood cell count, neutrophil-lymphocyte ratio, C-reactive protein, and systemic inflammation index (r = −0.787, −0.849, −0.6, −0.475, −0.402, and −0.521, respectively; P < .001). However, vitamin D levels were positively correlated with VDR and LL-37 levels (r = 0.988 and 0.944, respectively; P < .001). Conclusions: The majority of DFI patients exhibited vitamin D deficiency, which was significantly associated with most of the clinical, biochemical, and inflammatory parameters, in addition to the microbial environment within the wound.

Emerging evidence suggests the link between pulmonary tuberculosis (PTB) and gut microbiota dysbiosis. This is the first study from the southern Indian population that characterized the gut microbiota of PTB patients using 16 S amplicon sequencing. The analysis revealed a significant reduction in gut microbial diversity among PTB patients, with particularly lower alpha diversity (Chao1 index, p ≤ 0.0001) than healthy controls (HC). This was further depleted during antitubercular therapy (ATT). Beta diversity indicated distinct clustering in all the groups (p < 0.05). Subgroup analyses showed that supplementation of probiotics with ATT improved microbial richness and diversity. However, broader shifts in composition were not observed. At the genus level, specific taxa were upregulated or downregulated in PTB patients compared to HC. Functional analysis showed a depletion in biosynthesis pathways in PTB patients. Short-term probiotic supplementation had a partial effect on microbial recovery but did not fully restore gut microbial diversity. These findings highlight persistent dysbiosis in PTB patients, even after ATT. Large-scale studies are needed to evaluate the role of microbiome-targeted therapies to address this dysbiosis.

This study aimed to assess the effect of probiotic supplementation on multiple dimensions of tuberculosis (TB) care, including clinical, humanistic, and safety outcomes. This study is a prospective cohort study. Data were collected for TB treatment outcome, hematologic inflammatory indices, anti-tuberculosis treatment (ATT)-induced adverse drug reactions (ADRs), and health-related quality of life (HRQoL) using EuroQol 5-Dimension 5-level questionnaire to evaluate the effect of probiotics supplementation. In all, 177 patients with drug-sensitive pulmonary TB were enrolled. TB treatment success rates in the study group (SG) and the reference group (RG) were 85.1% and 84.6%, respectively (p = 1.000). Among hematologic inflammatory indices, only the systemic inflammation response index (SIRI) showed a statistically significant reduction after probiotic supplementation (p = 0.048). No significant changes were observed in HRQoL scores at various time points. ATT-induced ADRs were significantly lower in the SG than the RG (14.8% vs 61.3%; p < 0.001). Probiotic supplementation did not significantly influence TB treatment success or HRQoL outcomes. However, it showed a favorable impact on systemic inflammation and a significant reduction in the incidence of ATT-induced ADRs, especially gastrointestinal side effects. These findings suggest a potential role for probiotics as a supportive adjunct to ameliorate ATT-induced ADRs. Future studies should focus on assessing long-term supplementation effects to investigate humanistic outcomes.