Mpox (formerly known as monkeypox) is a global public health concern, given the recent outbreaks in non-endemic countries where little scientific evidence exists on the disease epidemiology. Oral lesions among mpox cases have been poorly reported. Our aim was to estimate the overall prevalence of oral manifestations among patients with mpox globally. In this systematic review and meta-analysis, an extensive literature search in PubMed, Scopus, Web of Science, Embase, Cochrane, and preprint servers (medRxiv, arXiv, bioRxiv, BioRN, ChiRxiv, ChiRN, and SSRN) and assessment of all published articles, conducted across the world, until Nov 15 2022 as per the PROSPERO registration protocol (CRD42022371249), was undertaken. Primary studies (case series, cross-sectional, retrospective, prospective designs) that reported the oral/oropharyngeal symptoms among laboratory-confirmed mpox cases were included. The characteristics of the study, information on the number of cases, and symptomatic status were extracted from the included studies. The quality of the included studies was assessed for bias. Random-effects meta-regression with DerSimonian & Laird estimator, and subgroup analyses were conducted using STATA (v17.0). The degree of funnel plot asymmetry was assessed using Egger's test when at least 10 estimates were available. The heterogeneity between studies was assessed using the I² statistic. The primary outcome was the pooled prevalence of oral manifestations in the examined population. 19 studies were included with 4042 laboratory-confirmed patients with mpox for qualitative and quantitative synthesis. The pooled prevalence of oral manifestations in the investigated population was 36.75% (95% confidence interval [CI]: 23.77-50.65). Heterogeneity was found to be high in the current meta-analysis (I² = 98.24%; p < 0.001). Subgroup analysis revealed a pooled prevalence of 39.96% (95% CI: 21.42-59.91) of sore throat, 24.80% (95% CI: 8.14-46.32) of mouth sore, 18.24% (95% CI: 0.34-52.54) of tonsillitis and 17.99% (95% CI: 15.66-20.43) of mouth rash from the included studies. Oral manifestations are common in patients with mpox, with variations in prevalence across the sites within the oral cavity, and geography of the studies. Healthcare workers should be wary of the oral signs and symptoms of mpox in endemic and high-risk areas. None.

Recent Mucorales-mediated outbreaks of infections and an association of fungal infection with COVID-19 cases, as observed for COVID-19-associated mucormycosis (CAM), have posed new challenges for the management of patients in critical care units. Diabetes and hyperglycemia are integrally linked to the severity of COVID-19, and uncontrolled diabetes mellitus and COVID-19 have recently been (independently or in combination) associated with the emergence of aggressive mucormycosis due to attendant defects in innate immune recognition pathways. Therefore, the identification of novel global cellular stressors upregulated during diabetes to understand the contribution of diabetes-associated metabolic vulnerabilities can help build a Metabolic-Stress-Associated Interactome (MSAI). This interactome can help reshape the metabolic inflammation (meta-inflammation) underlying the clinical manifestations of COVID-19 to facilitate the rational design of effective therapies for COVID-19 and CAM. Accordingly, an important area of research in COVID-19 therapeutics is engaged with identifying diabetes-associated pan-cellular stressors to understand their role in immune deregulation during COVID-19 and CAM, including investigating the distant trans-neuro-vascular–endocrine axis’s role in coordinating cellular-stress recognition, transmission, compensation, and decompensation during inter-organ regulation of metabolic homeostasis in diabetes. We reviewed clinico-pathological and laboratory data to propose potential diabetes-linked novel neo-vulnerabilities that can reshape the olfactory mucosal immune landscape during airway infections such as COVID-19 and CAM.

Background: India faces unique challenges in tackling antimicrobial resistance (AMR) due to the high prevalence of infections, irrational antibiotic use, and varied healthcare infrastructure. Integrated stewardship practices are key to combating AMR. This study uses a questionnaire to assess the prevalence and barriers to integrated antimicrobial stewardship across tertiary healthcare settings, proposing actionable strategies for improvement. Methods: This cross-sectional Delphi survey under the Society of Antimicrobial Stewardship PractIces (SASPI) Consortium assessed integrated antimicrobial stewardship (IAS) practices across 31 Indian tertiary care institutions. Using a validated 42-item questionnaire, it evaluated stewardship programs, accountability, prescriber education, laboratory protocols, and infection control. Data were analysed using SPSS. Practices were analysed as subcategories- administrative, antimicrobial, diagnostic, and infection prevention stewardships. Results: 44 responses from 31 tertiary care institutions in India, including 67.7% of institutes of national importance (INI), were analysed. 61.4% of the respondents were members of their hospital’s infection control committee (HICC) or antimicrobial stewardship program (AMSP). The validation of 42 practice statements showed that 41 received over 75% agreement, with adjustments to Practice Statement 6 (72.4%). Key findings revealed poor compliance in a few areas: 29% for assigning pharmacists the antimicrobial utilisation responsibility, 13% for OPAT policies, and 29% for having policies dealing with local infectious diseases. INIs reported lower compliance with integrated stewardship practices than non-INIs, possibly due to the involvement of experts who were not HICC/AMSP members in non-INIs. Key barriers were limited resources, inadequate diagnostic facilities, and a workforce in 42% of the institutes. Conclusion: The study highlights the need for awareness and implementation of IAS practices in tertiary healthcare institutes in India. Addressing this requires the implementation of these practice statements, regular monitoring, resource allocation, training, and collaboration. SASPI can lead to collaboration. Policymakers and institutions must work together to integrate IAS fully, reducing AMR and improving patient outcomes across India.

The lack of effective stem cell protocols for generating personalized neurovascular niches poses a critical challenge in precision medicine. While iPSC-based methods are explored, their clinical use is hindered by high costs, long timelines, and cancer risks. Recent advancements in plasma-driven differentiation, using circulating monocytes, offer a promising solution as they can be reprogrammed into neuron-like, endothelial-like, and hematopoietic cells without genetic manipulation, by inducing growth factors mediated transdifferentiation. Vasculature is integral to neurodevelopment, with early blood supply transitioning from the perineural to intrinsic vascular plexus, driven by neuro-hematovascular signaling. The choroid plexus selectively transports proteins and growth factors from blood to CSF, supporting neural proliferation and differentiation. Building on these insights, we leveraged the innate reprograming potential of blood-derived cells to generate neuro-hematovascular niches using a novel PITTRep methodology, devoid of transgene and growth factor mediated transdifferentiation opening new avenues for regenerative and investigative neurovascular studies.