BackgroundVitamin D enhances host protective immune responses to Mycobacterium tuberculosis by suppressing Interferon-gamma (IFN-g) and reducing disease associated inflammation in the host. The objectives of this study were to determine whether vitamin D supplementation to patients with tuberculosis (TB) could influence recovery.MethodsTwo hundred and fifty nine patients with pulmonary TB were randomized to receive either 600,000 IU of Intramuscular vitamin D3 or placebo for 2 doses. Assessments were performed at 4, 8 and 12 weeks. Early secreted and T cell activated 6 kDa (ESAT6) and Mycobacterium tuberculosis sonicate (MTBs) antigen induced whole blood stimulated IFN-g responses were measured at 0 and 12 weeks. Statistical comparisons between outcome variables at 0 and 12 weeks were performed using Student’s t-test and Chi2 tests.ResultsAfter 12 weeks, the vitamin D supplemented arm demonstrated significantly greater mean weight gain (kg) + 3.75, (3.16 – 4.34) versus + 2.61 (95% CI 1.99 – 3.23) p 0.009 and lesser residual disease by chest radiograph; number of zones involved 1.35 v/s 1.82 p 0.004 (95% CI 0.15, 0.79) and 50% or greater reduction in cavity size 106 (89.8%) v/s 111 (94.8%), p 0.035. Vitamin D supplementation led to significant increase in MTBs-induced IFN-g secretion in patients with baseline ‘Deficient’ 25-hydroxyvitamin D serum levels (p 0.021).ConclusionsSupplementation with high doses of vitamin D accelerated clinical, radiographic improvement in all TB patients and increased host immune activation in patients with baseline ‘Deficient’ serum vitamin D levels. These results suggest a therapeutic role for vitamin D in the treatment of TB.Trial registrationClinicalTrials.gov; No. NCT01130311; URL: clinicaltrials.gov

We report 13 cases of Naegleria fowleri primary amebic meningoencephalitis in persons in Karachi, Pakistan, who had no history of aquatic activities. Infection likely occurred through ablution with tap water. An increase in primary amebic meningoencephalitis cases may be attributed to rising temperatures, reduced levels of chlorine in potable water, or deteriorating water distribution systems.

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Purpose This study aims to examine the effect of frontline managers’ green mindfulness on their green creativity directly and through green creative process engagement (GCPE). Furthermore, perceived corporate social responsibility (CSR) moderates the link between green mindfulness and GCPE. Design/methodology/approach The data were collected from 592 frontline managers from the hospitality industry of Pakistan. The data were analyzed using Hayes’ PROCESS macro. Findings The findings indicate that green mindfulness has a positive relationship with GCPE and green creativity. Moreover, GCPE mediates the relationship between green mindfulness and green creativity. Perceived CSR also moderates the link between green mindfulness and GCPE. The moderated-mediation effect of perceived CSR is also found to be significant. Research limitations/implications The results imply that mindfully green frontline managers’ cognitive resources provide greater attention toward environmental problems and connectedness to nature, which encourages hospitality service firms’ frontline managers’ green creativity. Originality/value The novelty of the present study is the development and empirical testing of an integrated framework to investigate that when and how green mindfulness affects green creativity.

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It is not well known whether Alzheimer’s disease (AD) cerebrospinal fluid (CSF) biomarkers are associated with brain damage in cognitively normal elderly. The combined influence of CSF biomarkers and hypertension (HTN) on the gray matter (GM) is also not well described. 115 cognitively healthy subjects (mean age 62.6±9.5, 62% women) received clinical assessment, a high resolution MRI and a lumbar puncture. The CSF levels of total tau (t-tau), hyperphosphorylated tau (p-tau231), amyloid beta (Aβ42/Aβ40), p-tau231/Aβ42 and t-tau/Aβ42 were dichotomized as ‘high’ and ‘low’ based on accepted cut-off values. Statistical parametric mapping was used to examine MRI scans for regional GM density, studied as a function of the CSF markers, HTN and combination of both. Global and medial temporal lobe (MTL) GM was also assessed. Voxel based morphometry revealed that higher t-tau was associated with lower GM density in the precunei. Subjects with higher p-tau231 and p-tau231/Aβ42 had less GM in temporal lobes. Low Aβ42/Aβ40 was related to less GM in the thalami, caudate and midbrain. Subjects with hypertension showed more GM atrophy in the cerebellum, occipital and frontal regions. Simultaneous presence of elevated CSF AD biomarkers and HTN was associated with more GM atrophy than either marker individually, but no interaction effects were identified. In conclusion, in normal elderly CSF tau markers were associated predominantly with lower GM estimates in structures typically affected early in the AD process. In this presymptomatic stage when no cognitive impairment is present, AD pathology and HTN have additive effects on gray matter damage.

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Cryptococcosis is a rare infection in HIV-negative individuals. While the lungs and the central nervous system are most commonly infected, skeletal cryptococcosis is uncommon and isolated osteomyelitis due to Cryptococcus neoformans is quite rare. To our knowledge, only 47 cases of isolated cryptococcal osteomyelitis have been reported from 1974 to 2005. We report a case of isolated cryptococcal osteomyelitis in an immunocompetent patient, who received 12 weeks of fluconazole with complete recovery.