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  1. Fulltext Comparative Evaluation of Three Phenotypic Tests-Carba NP, Modified Carba NP and Rapidec Carba NP Test for Rapid Detection of Carbapenem Resistance in Blood Culture Isolates of Escherichia coli in an ICU Setting
    Kour I, Vasesi D, Singhal L, Gupta V
    Malays J Med Sci, 2022 Dec;29(6):60-66.
    PMID: 36818898 DOI: 10.21315/mjms2022.29.6.6
    BACKGROUND: To determine the antibiotic resistance pattern, the prevalence of extended-spectrum beta-lactamases (ESBLs) and carbapenem resistance in blood culture isolates of E. coli. Further, we evaluated and compared Carba NP, Modified Carba NP and a kit-based Rapidec Carba NP test to detect carbapenem resistance rapidly.

    METHODS: Twenty-six carbapenem-resistant strains and four susceptible strains were selected. The three methods mentioned above were evaluated as per Clinical Laboratory Standards Institute (CLSI). These tests are based on biochemical detection of the hydrolysis of the beta-lactam ring of a carbapenem-imipenem, followed by the colour change of a pH indicator.

    RESULTS: Carba NP test was positive in 24 out of 26 isolates; the Modified Carba NP and Rapidec Carba NP tests were positive for all the isolates (26/26). All the carbapenemase non-producers (100%, 04/04) were negative.

    CONCLUSION: Modified Carba NP is a more effortless and inexpensive alternative to the Carba NP test, allowing the detection of carbapenemase activity directly from bacterial cultures of Enterobacteriaceae. The test could be used in low-income countries with large reservoirs for carbapenemase producers and can be implemented in any laboratory worldwide.

  2. Fulltext An analysis of the short- and long-term cost-effectiveness of starting biphasic insulin aspart 30 in insulin-naïve people with poorly controlled type 2 diabetes
    Shafie AA, Gupta V, Baabbad R, Hammerby E, Home P
    Diabetes Res Clin Pract, 2014 Nov;106(2):319-27.
    PMID: 25305133 DOI: 10.1016/j.diabres.2014.08.024
    Aim: This study aimed to assess the cost-effectiveness of starting insulin therapy with biphasic insulin aspart 30 (BIAsp 30) in people with type 2 diabetes inadequately controlled on oral glucose-lowering drugs in Saudi Arabia, India, Indonesia, and Algeria.

    Methods: The IMS CORE Diabetes Model was used to evaluate economic outcomes associated with starting BIAsp 30, using baseline characteristics and treatment outcomes from the A(1)chieve study. Time horizons of 1 and 30 years were applied, with country-specific costs for complications, therapies, and background mortality. Incremental cost-effectiveness ratios (ICERs) are expressed as cost per quality-adjusted life-year (QALY) in local currencies, USD, and fractions of local GDP per capita (GDPc). Cost-effectiveness was pre-defined using the World Health Organization definition of <3.0 times GDPc. Comprehensive sensitivity analyses were performed.

    Results: In the primary 30-year analyses, starting BIAsp 30 was associated with a projected increase in life expectancy of >1 year and was highly cost-effective, with ICERs of -0.03 (Saudi Arabia), 0.25 (India), 0.48 (India), 0.47 (Indonesia), and 0.46 (Algeria) GDPc/QALY. The relative risk of developing selected complications was reduced in all countries. Sensitivity analyses including cost of self-monitoring, treatment costs, and deterioration of glucose control with time showed the results to be robust. In a 1-year analysis, ICER per QALY gained was still cost-effective or highly cost-effective.

    Conclusion: Starting BIAsp 30 in people with type 2 diabetes in the A(1)chieve study was found to be cost-effective across all country settings at 1- and 30-year time horizons, and usefully increased predicted life expectancy.

    Keywords: A(1)chieve; Biphasic insulin aspart 30; Cost-effectiveness; Type 2 diabetes mellitus.
  3. Trends in the antibiotic resistance patterns of enteric Fever isolates - a three year report from a tertiary care centre
    Gupta V, Singla N, Bansal N, Kaistha N, Chander J
    Malays J Med Sci, 2013 Jul;20(4):71-5.
    PMID: 24043999
    BACKGROUND: The incidence of multidrug resistant enteric fever is increasing alarmingly. This study was planned to determine the rate of isolation of Salmonella spp. and to compare the isolates for their epidemiological parameters and antimicrobial susceptibility patterns at our center.

    METHODS: The study was conducted over a span of three years with a total of 8142, 8134, and 8114 blood culture samples processed for the years 2008, 2009, and 2010 respectively. The minimum inhibitory concentration (MIC) for ciprofloxacin and chloramphenicol was determined using an agar dilution method. The MIC for ciprofloxacin was also confirmed by Epsilon-test (E -test) strips.

    RESULTS: Of the total 302 Salmonella spp. isolated, 257 were Salmonella enterica serotype Typhi (85.1%) and 45 (14.9%) were S. enterica serotype Paratyphi A. The majority of the isolates recovered were from the pediatric age group (54.6%) and males (60.6%). Complete susceptibility was observed to chloramphenicol, cefotaxime, ceftriaxone, and azithromycin over the last two years (2009 and 2010), with an increase in resistance to nalidixic acid (100%) and ciprofloxacin (13.6%).

    CONCLUSION: In our study, we found augmentation of resistance to nalidixic acid and fluoroquinolones and complete sensitivity to ceftriaxone along with reemergence of chloramphenicol sensitivity for Salmonella isolates. This report emphasises the necessity of continuous surveillance of antibiograms of enteric fever isolates in an area.

  4. A novel pharmacological approach of herbal mediated cerium oxide and silver nanoparticles with improved biomedical activity in comparison with Lawsonia inermis
    Kalakotla S, Jayarambabu N, Mohan GK, Mydin RBSMN, Gupta VR
    Colloids Surf B Biointerfaces, 2019 Feb 01;174:199-206.
    PMID: 30465994 DOI: 10.1016/j.colsurfb.2018.11.014
    Diabetes mellitus is one of the threatening, non-communicable and chronic ailments worldwide since ancient times to the current stage of human existence. The utilization of nanoparticles as a medicine in the treatment of diabetes is an attractive proposition. In the present study, herbal mediated cerium oxide nanoparticles (HMCeO2 NPs), herbal mediated silver nanoparticles (HMAg NPs) and Lawsonia intermix extract (LIE) was evaluated for them for in-vivo hypoglycemic effect and compared the potency. The resulting HMCeO2 NPs, HMAg NPs and Lawsonia inermis have been characterized by different analytical equipments such as X-ray Diffraction (XRD), Fourier transform infrared spectroscopy (FT-IR), Particle size analyzer (PSA), Field emission scanning electron microscope (FESEM) and High resolution transmission electron microscope (HRTEM). The synthesized NPs and Lawsonia inermis extract were assessed for toxicity by using acute oral toxicity using female albino mice (s) model by following OECD-425 guidelines. In in-vivo hypoglycemic animal model, the male wistar rats with weight varying between 180-200 gms were grouped as: normal control: did not receive any treatment, diabetic control (saline): received a single intraperitoneal dose of Streptozotocin (40 mg/kg), standard: received a single daily oral dose of 50 mg/kg body weight, HMCeO2 NPs: received single daily oral dose of 100 mg/kg, 200 mg/kg, HMAg NPs: received a single daily oral dose of 100 mg/kg, 200 mg/kg, and Lawsonia inermis: received a single daily oral dose of 100 mg/kg, 200 mg/kg. The herbal mediated NPs were considered safe as they have not shown toxic effects. From the current study results, it may conclude that, due to the advanced biological and pharmacological characters, the HMAg NPs depicted more potent hypoglycemic activity than that of LIE and CeO2 NPs.
  5. Fulltext An Emotion Care Model using Multimodal Textual Analysis on COVID-19
    Gupta V, Jain N, Katariya P, Kumar A, Mohan S, Ahmadian A, et al.
    Chaos Solitons Fractals, 2021 Mar;144:110708.
    PMID: 33519125 DOI: 10.1016/j.chaos.2021.110708
    At the dawn of the year 2020, the world was hit by a significant pandemic COVID-19, that traumatized the entire planet. The infectious spread grew in leaps and bounds and forced the policymakers and governments to move towards lockdown. The lockdown further compelled people to stay under house arrest, which further resulted in an outbreak of emotions on social media platforms. Perceiving people's emotional state during these times becomes critically and strategically important for the government and the policymakers. In this regard, a novel emotion care scheme has been proposed in this paper to analyze multimodal textual data contained in real-time tweets related to COVID-19. Moreover, this paper studies 8-scale emotions (Anger, Anticipation, Disgust, Fear, Joy, Sadness, Surprise, and Trust) over multiple categories such as nature, lockdown, health, education, market, and politics. This is the first of its kind linguistic analysis on multiple modes pertaining to the pandemic to the best of our understanding. Taking India as a case study, we inferred from this textual analysis that 'joy' has been lesser towards everything (~9-15%) but nature (~17%) due to the apparent fact of lessened pollution. The education system entailed more trust (~29%) due to teachers' fraternity's consistent efforts. The health sector witnessed sadness (~16%) and fear (~18%) as the dominant emotions among the masses as human lives were at stake. Additionally, the state-wise and emotion-wise depiction is also provided. An interactive internet application has also been developed for the same.
  6. Fulltext Socioeconomic impact due to COVID-19: An empirical assessment
    Gupta V, Santosh KC, Arora R, Ciano T, Kalid KS, Mohan S
    Inf Process Manag, 2022 Mar;59(2):102810.
    PMID: 35165495 DOI: 10.1016/j.ipm.2021.102810
    Starting from December 2019, the novel COVID-19 threatens human lives and economies across the world. It was a matter of grave concern for the governments of all the countries as the deadly virus started expanding its paws over neighboring regions of infected areas. The spread got uncontrollable, thereby leaving no choice for the nations but to impose and observe nationwide lockdown. The lockdown further sorely hit many sectors, which in turn impacted the economy. Manufacturing, agriculture, and the service sector - the three pillars of the economy - have been adversely affected giving a major slow down to the economy belonging to every nation. Several schemes and policies were introduced by different state and central governments to absorb the impact of subsequent lockdowns on individuals. In this paper, we present a then and now analysis of the economy using a socioeconomic framework focusing on factors- unemployment, industrial production, import-export trade, equity markets, currency exchange rate, and gold and silver prices. For all these, we consider India as a case study because the Indian sub-continent has a wide landscape and rich cultural heritage presenting itself as a potential hub for economic activities. A thorough assessment has been made for the period January 2020- June 2020. The assessment will be beneficial to observe the long-term impact of any infectious disease outbreak such as COVID-19 locally and globally.
  7. Fulltext Prediction modelling of COVID using machine learning methods from B-cell dataset
    Jain N, Jhunthra S, Garg H, Gupta V, Mohan S, Ahmadian A, et al.
    Results Phys, 2021 Feb;21:103813.
    PMID: 33495725 DOI: 10.1016/j.rinp.2021.103813
    Coronavirus is a pandemic that has become a concern for the whole world. This disease has stepped out to its greatest extent and is expanding day by day. Coronavirus, termed as a worldwide disease, has caused more than 8 lakh deaths worldwide. The foremost cause of the spread of coronavirus is SARS-CoV and SARS-CoV-2, which are part of the coronavirus family. Thus, predicting the patients suffering from such pandemic diseases would help to formulate the difference in inaccurate and infeasible time duration. This paper mainly focuses on the prediction of SARS-CoV and SARS-CoV-2 using the B-cells dataset. The paper also proposes different ensemble learning strategies that came out to be beneficial while making predictions. The predictions are made using various machine learning models. The numerous machine learning models, such as SVM, Naïve Bayes, K-nearest neighbors, AdaBoost, Gradient boosting, XGBoost, Random forest, ensembles, and neural networks are used in predicting and analyzing the dataset. The most accurate result was obtained using the proposed algorithm with 0.919 AUC score and 87.248% validation accuracy for predicting SARS-CoV and 0.923 AUC and 87.7934% validation accuracy for predicting SARS-CoV-2 virus.
  8. Fulltext Improved COVID-19 detection with chest x-ray images using deep learning
    Gupta V, Jain N, Sachdeva J, Gupta M, Mohan S, Bajuri MY, et al.
    Multimed Tools Appl, 2022;81(26):37657-37680.
    PMID: 35968409 DOI: 10.1007/s11042-022-13509-4
    The novel coronavirus disease, which originated in Wuhan, developed into a severe public health problem worldwide. Immense stress in the society and health department was advanced due to the multiplying numbers of COVID carriers and deaths. This stress can be lowered by performing a high-speed diagnosis for the disease, which can be a crucial stride for opposing the deadly virus. A good large amount of time is consumed in the diagnosis. Some applications that use medical images like X-Rays or CT-Scans can pace up the time used in diagnosis. Hence, this paper aims to create a computer-aided-design system that will use the chest X-Ray as input and further classify it into one of the three classes, namely COVID-19, viral Pneumonia, and healthy. Since the COVID-19 positive chest X-Rays dataset was low, we have exploited four pre-trained deep neural networks (DNNs) to find the best for this system. The dataset consisted of 2905 images with 219 COVID-19 cases, 1341 healthy cases, and 1345 viral pneumonia cases. Out of these images, the models were evaluated on 30 images of each class for the testing, while the rest of them were used for training. It is observed that AlexNet attained an accuracy of 97.6% with an average precision, recall, and F1 score of 0.98, 0.97, and 0.98, respectively.
  9. Fulltext Pulsatile stretch as a novel modulator of amyloid precursor protein processing and associated inflammatory markers in human cerebral endothelial cells
    Gangoda SVS, Avadhanam B, Jufri NF, Sohn EH, Butlin M, Gupta V, et al.
    Sci Rep, 2018 01 26;8(1):1689.
    PMID: 29374229 DOI: 10.1038/s41598-018-20117-6
    Amyloid β (Aβ) deposition is a hallmark of Alzheimer's disease (AD). Vascular modifications, including altered brain endothelial cell function and structural viability of the blood-brain barrier due to vascular pulsatility, are implicated in AD pathology. Pulsatility of phenomena in the cerebral vasculature are often not considered in in vitro models of the blood-brain barrier. We demonstrate, for the first time, that pulsatile stretch of brain vascular endothelial cells modulates amyloid precursor protein (APP) expression and the APP processing enzyme, β-secretase 1, eventuating increased-Aβ generation and secretion. Concurrent modulation of intercellular adhesion molecule 1 and endothelial nitric oxide synthase (eNOS) signaling (expression and phosphorylation of eNOS) in response to pulsatile stretch indicates parallel activation of endothelial inflammatory pathways. These findings mechanistically support vascular pulsatility contributing towards cerebral Aβ levels.
  10. Fulltext Influenza vaccination guidelines and vaccine sales in southeast Asia: 2008-2011
    Gupta V, Dawood FS, Muangchana C, Lan PT, Xeuatvongsa A, Sovann L, et al.
    PLoS One, 2012;7(12):e52842.
    PMID: 23285200 DOI: 10.1371/journal.pone.0052842
    Southeast Asia is a region with great potential for the emergence of a pandemic influenza virus. Global efforts to improve influenza surveillance in this region have documented the burden and seasonality of influenza viruses and have informed influenza prevention strategies, but little information exists about influenza vaccination guidelines and vaccine sales.
  11. Treatment of chronic airway diseases using nutraceuticals: Mechanistic insight
    Allam VSRR, Chellappan DK, Jha NK, Shastri MD, Gupta G, Shukla SD, et al.
    Crit Rev Food Sci Nutr, 2021 May 12.
    PMID: 33977840 DOI: 10.1080/10408398.2021.1915744
    Respiratory diseases, both acute and chronic, are reported to be the leading cause of morbidity and mortality, affecting millions of people globally, leading to high socio-economic burden for the society in the recent decades. Chronic inflammation and decline in lung function are the common symptoms of respiratory diseases. The current treatment strategies revolve around using appropriate anti-inflammatory agents and bronchodilators. A range of anti-inflammatory agents and bronchodilators are currently available in the market; however, the usage of such medications is limited due to the potential for various adverse effects. To cope with this issue, researchers have been exploring various novel, alternative therapeutic strategies that are safe and effective to treat respiratory diseases. Several studies have been reported on the possible links between food and food-derived products in combating various chronic inflammatory diseases. Nutraceuticals are examples of such food-derived products which are gaining much interest in terms of its usage for the well-being and better human health. As a consequence, intensive research is currently aimed at identifying novel nutraceuticals, and there is an emerging notion that nutraceuticals can have a positive impact in various respiratory diseases. In this review, we discuss the efficacy of nutraceuticals in altering the various cellular and molecular mechanisms involved in mitigating the symptoms of respiratory diseases.
  12. KESTREL and KITE: 52-week results from two Phase III pivotal trials of brolucizumab for diabetic macular edema
    Brown DM, Emanuelli A, Bandello F, Barranco JJE, Figueira J, Souied E, et al.
    Am J Ophthalmol, 2022 Jan 13.
    PMID: 35038415 DOI: 10.1016/j.ajo.2022.01.004
    PURPOSE: To compare the efficacy and safety of brolucizumab with aflibercept in patients with diabetic macular edema (DME).

    DESIGN: Double-masked, 100-week, multicenter, active-controlled, randomized trials.

    METHODS: Subjects were randomized 1:1:1 to brolucizumab 3mg/6mg or aflibercept 2mg in KESTREL (N=566) or 1:1 to brolucizumab 6mg or aflibercept 2mg in KITE (N=360). Brolucizumab groups received 5 loading doses every 6 weeks (q6w) followed by q12w dosing, with optional adjustment to q8w if disease activity was identified at pre-defined assessment visits; aflibercept groups received 5xq4w followed by fixed q8w dosing. The primary endpoint was best-corrected visual acuity (BCVA) change from baseline at Week 52; secondary endpoints included the proportion of subjects maintained on q12w dosing, change in DRSS score and anatomical and safety outcomes.

    RESULTS: At Week 52, brolucizumab 6mg was noninferior (NI margin 4 letters) to aflibercept in mean change in BCVA from baseline (KESTREL: +9.2 letters versus +10.5 letters; KITE: +10.6 letters versus +9.4 letters; p<0.001), more subjects achieved central subfield thickness (CSFT) <280µm and fewer had persisting subretinal and/or intraretinal fluid versus aflibercept, with >50% of brolucizumab 6mg subjects maintained on q12w dosing after loading. In KITE, brolucizumab 6mg showed superior improvements in change of CSFT from baseline over Week 40-Week 52 versus aflibercept (p=0.001). The incidence of ocular serious adverse events was 3.7% (brolucizumab 3mg), 1.1% (brolucizumab 6mg), 2.1% (aflibercept) in KESTREL; 2.2% (brolucizumab 6mg), 1.7% (aflibercept) in KITE.

    CONCLUSION: Brolucizumab 6mg showed robust visual gains and anatomical improvements with an overall favorable benefit/risk profile in patients with DME.

  13. Fulltext Secondary Prevention of Cervical Cancer: ASCO Resource-Stratified Guideline Update
    Shastri SS, Temin S, Almonte M, Basu P, Campos NG, Gravitt PE, et al.
    JCO Glob Oncol, 2022 Sep;8:e2200217.
    PMID: 36162041 DOI: 10.1200/GO.22.00217
    PURPOSE: To update resource-stratified, evidence-based recommendations on secondary prevention of cervical cancer globally.

    METHODS: American Society of Clinical Oncology convened a multidisciplinary, multinational Expert Panel to produce recommendations reflecting four resource-tiered settings. A review of existing guidelines, formal consensus-based process, and modified ADAPTE process to adapt existing guidelines was conducted. Other experts participated in formal consensus.

    RESULTS: This guideline update reflects changes in evidence since the previous update. Five existing guidelines were identified and reviewed, and adapted recommendations form the evidence base. Cost-effectiveness analyses provided indirect evidence to inform consensus, which resulted in ≥ 75% agreement.

    RECOMMENDATIONS: Human papillomavirus (HPV) DNA testing is recommended in all resource settings; visual inspection with acetic acid may be used in basic settings. Recommended age ranges and frequencies vary by the following setting: maximal: age 25-65 years, every 5 years; enhanced: age 30-65 years, if two consecutive negative tests at 5-year intervals, then every 10 years; limited: age 30-49 years, every 10 years; basic: age 30-49 years, one to three times per lifetime. For basic settings, visual assessment is used to determine treatment eligibility; in other settings, genotyping with cytology or cytology alone is used to determine treatment. For basic settings, treatment is recommended if abnormal triage results are obtained; in other settings, abnormal triage results followed by colposcopy is recommended. For basic settings, treatment options are thermal ablation or loop electrosurgical excision procedure; for other settings, loop electrosurgical excision procedure or ablation is recommended; with a 12-month follow-up in all settings. Women who are HIV-positive should be screened with HPV testing after diagnosis, twice as many times per lifetime as the general population. Screening is recommended at 6 weeks postpartum in basic settings; in other settings, screening is recommended at 6 months. In basic settings without mass screening, infrastructure for HPV testing, diagnosis, and treatment should be developed.Additional information is available at www.asco.org/resource-stratified-guidelines.

  14. Identification of chronic obstructive pulmonary disease subgroups in 13 Asian cities
    Kim WJ, Gupta V, Nishimura M, Makita H, Idolor L, Roa C, et al.
    Int J Tuberc Lung Dis, 2018 07 01;22(7):820-826.
    PMID: 29914609 DOI: 10.5588/ijtld.17.0524
    BACKGROUND: Chronic obstructive pulmonary disease (COPD) is a heterogeneous condition that can differ in its clinical manifestation, structural changes and response to treatment.

    OBJECTIVE: To identify subgroups of COPD with distinct phenotypes, evaluate the distribution of phenotypes in four related regions and calculate the 1-year change in lung function and quality of life according to subgroup.

    METHODS: Using clinical characteristics, we performed factor analysis and hierarchical cluster analysis in a cohort of 1676 COPD patients from 13 Asian cities. We compared the 1-year change in forced expiratory volume in one second (FEV1), modified Medical Research Council dyspnoea scale score, St George's Respiratory Questionnaire (SGRQ) score and exacerbations according to subgroup derived from cluster analysis.

    RESULTS: Factor analysis revealed that body mass index, Charlson comorbidity index, SGRQ total score and FEV1 were principal factors. Using these four factors, cluster analysis identified three distinct subgroups with differing disease severity and symptoms. Among the three subgroups, patients in subgroup 2 (severe disease and more symptoms) had the most frequent exacerbations, most rapid FEV1 decline and greatest decline in SGRQ total score.

    CONCLUSION: Three subgroups with differing severities and symptoms were identified in Asian COPD subjects.

  15. Standardization of Nomenclature for Ocular Tuberculosis - Results of Collaborative Ocular Tuberculosis Study (COTS) Workshop
    Agrawal R, Agarwal A, Jabs DA, Kee A, Testi I, Mahajan S, et al.
    Ocul Immunol Inflamm, 2019 Dec 10.
    PMID: 31821096 DOI: 10.1080/09273948.2019.1653933
    Purpose: To standardize a nomenclature system for defining clinical phenotypes, and outcome measures for reporting clinical and research data in patients with ocular tuberculosis (OTB).Methods: Uveitis experts initially administered and further deliberated the survey in an open meeting to determine and propose the preferred nomenclature for terms related to the OTB, terms describing the clinical phenotypes and treatment and reporting outcomes.Results: The group of experts reached a consensus on terming uveitis attributable to tuberculosis (TB) as tubercular uveitis. The working group introduced a SUN-compatible nomenclature that also defines disease "remission" and "cure", both of which are relevant for reporting treatment outcomes.Conclusion: A consensus nomenclature system has been adopted by a large group of international uveitis experts for OTB. The working group recommends the use of standardized nomenclature to prevent ambiguity in communication and to achieve the goal of spreading awareness of this blinding uveitis entity.
  16. The Collaborative Ocular Tuberculosis Study (COTS) Consensus (CON) Group Meeting Proceedings
    Agrawal R, Testi I, Mahajan S, Yuen YS, Agarwal A, Rousselot A, et al.
    Ocul Immunol Inflamm, 2020 Apr 06.
    PMID: 32250731 DOI: 10.1080/09273948.2020.1716025
    An international, expert led consensus initiative was set up by the Collaborative Ocular Tuberculosis Study (COTS) group to develop systematic, evidence, and experience-based recommendations for the treatment of ocular TB using a modified Delphi technique process. In the first round of Delphi, the group identified clinical scenarios pertinent to ocular TB based on five clinical phenotypes (anterior uveitis, intermediate uveitis, choroiditis, retinal vasculitis, and panuveitis). Using an interactive online questionnaires, guided by background knowledge from published literature, 486 consensus statements for initiating ATT were generated and deliberated amongst 81 global uveitis experts. The median score of five was considered reaching consensus for initiating ATT. The median score of four was tabled for deliberation through Delphi round 2 in a face-to-face meeting. This report describes the methodology adopted and followed through the consensus process, which help elucidate the guidelines for initiating ATT in patients with choroidal TB.
  17. Fulltext Guidelines for the use and interpretation of assays for monitoring autophagy (4th edition)1
    Klionsky DJ, Abdel-Aziz AK, Abdelfatah S, Abdellatif M, Abdoli A, Abel S, et al.
    Autophagy, 2021 Jan;17(1):1-382.
    PMID: 33634751 DOI: 10.1080/15548627.2020.1797280
    In 2008, we published the first set of guidelines for standardizing research in autophagy. Since then, this topic has received increasing attention, and many scientists have entered the field. Our knowledge base and relevant new technologies have also been expanding. Thus, it is important to formulate on a regular basis updated guidelines for monitoring autophagy in different organisms. Despite numerous reviews, there continues to be confusion regarding acceptable methods to evaluate autophagy, especially in multicellular eukaryotes. Here, we present a set of guidelines for investigators to select and interpret methods to examine autophagy and related processes, and for reviewers to provide realistic and reasonable critiques of reports that are focused on these processes. These guidelines are not meant to be a dogmatic set of rules, because the appropriateness of any assay largely depends on the question being asked and the system being used. Moreover, no individual assay is perfect for every situation, calling for the use of multiple techniques to properly monitor autophagy in each experimental setting. Finally, several core components of the autophagy machinery have been implicated in distinct autophagic processes (canonical and noncanonical autophagy), implying that genetic approaches to block autophagy should rely on targeting two or more autophagy-related genes that ideally participate in distinct steps of the pathway. Along similar lines, because multiple proteins involved in autophagy also regulate other cellular pathways including apoptosis, not all of them can be used as a specific marker for bona fide autophagic responses. Here, we critically discuss current methods of assessing autophagy and the information they can, or cannot, provide. Our ultimate goal is to encourage intellectual and technical innovation in the field.
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