Comparison of Three Expanded-Spectrum Cephalosporin Hydrolysis Assays and the NG-Test CTX-M Multi Assay That Detects All CTX-M-Like Enzymes

Rapid detection of expanded-spectrum cephalosporins (ESC) hydrolysing enzymes is crucial to implement infection control measures and antibiotic stewardship. Here, we have evaluated three biochemical ESC hydrolysis assays (ESBL NDP test, β-LACTA™ test, LFIA-CTX assay) and the NG-Test® CTX-M MULTI that detects CTX-M enzymes, on 93 well-characterized Gram-negative isolates, including 60 Enterobacterales, 21 Pseudomonas spp. and 12 Acinetobacter spp. The performances were good for all three hydrolysis assays, with the LFIA-CTX being slightly more sensitive and specific on the tested panel of isolates especially with Enterobacterales, without ambiguous results. This study showed that LFIA-CTX may be used for the detection of ESC hydrolysis as a competitive alternative to already available assays (β-LACTA™ test and ESBL NDP test) without any specific equipment and reduced hands-on-time. The lateral flow immunoassay NG-Test® CTX-M MULTI has proven to be a useful, easy, rapid, and reliable confirmatory test in Enterobacterales for detection of CTX-M-type ESBLs, which account for most of the resistance mechanisms leading to ESC resistance in Enterobacterales, but it misses rare ESC hydrolysing β-lactamases (AmpC, minor ESBLs, and carbapenemases). Combining it with the LFIA-CTX assay would yield an assay detecting the most frequently-encountered ESBLs (CTX-M-like β-lactamases) together with ESC hydrolysis.

Evaluation of a human urine barbiturate test to screen for pentobarbital euthanasia of dogs and cats

Pentobarbital is used commonly to euthanize animals. Occasionally during a death investigation, it is necessary to determine whether a cat or dog was euthanized via pentobarbital overdose. Screening for the detection of barbiturates including pentobarbital can be performed using commercial immunochromatographic tests. We used a commercial immunochromatographic test for barbiturates in humans to screen for barbiturates in urine collected postmortem from 20 dogs and 20 cats to determine whether they had been euthanized with pentobarbital. Additionally, we analyzed the urine for pentobarbital using liquid chromatography–mass spectrometry as a confirmatory test. Screening and confirmation testing revealed 100% agreement between the tests and with the euthanasia status of each animal. Our results support the use of the immunochromatographic test for the screening of urine collected postmortem to assess for the presence of barbiturates, specifically pentobarbital, used for euthanasia.

Antibacterial Activity of Padikara Parpam against ESBL Producing Escherichia coli and Klebsiella pneumoniae

Aims: To evaluate the antibacterial activity of Padikara Parpam against Extended-Spectrum Beta-Lactamase (ESBL) producing Escherichia Coli and Klebsiella Pneumoniae using agar well diffusion method. To identify ESBL producing bacteria by phenotypic confirmatory test using disk diffusion method. Study Design: Analysis of Antibacterial activity of Padikara Parpam using agar well diffusion method. Place and Duration of Study: Central Research Laboratory, Meenakshi Academy of higher Education and Research, Chennai, between June 2021 and November 2021. Methodology: Clinical isolates of ESBL were isolated by subculture into MacConkey agar and was identified by phenotypic confirmatory test. Padikara parpam's antibacterial activity was evaluated using the Agar well diffusion method at different concentrations of 0.5 %, 1 %, 1.5 %, and 2 % drugs. 30 µg Cefotaxime and 30 µg amoxicillin-clavulanic acid disk were used as controls to standardize the antibacterial activity test and to identify the ESBL by phenotypic confirmatory test. Results: In this study, Padikara parpam at various doses of 0.5 %, 1 %, 1.5 %, and 2 %, revealed significant antibacterial efficacy against ESBL producing bacteria. Padikara parpam was more active against ESBL Escherichia coli than ESBL Klebsiella pneumoniae. As a result, it may be recommended as an antibacterial agent against ESBL. Conclusion: Our findings suggest that Siddha Herbo mineral formulations of padikara parpam hold phenomenal antimicrobial activity against ESBL producing bacteria. Based on our findings, the drug may be prescribed successfully for urinary tract infections, which is caused by ESBL producing bacteria.

Drug-Induced QT Interval Prolongation

The correct measurement of the QT interval (using the QT correction formulas, preferably Fridericia and Framingham) as well as a correct interpretation of the causes and of the clinical consequences of a QT prolongation is very important in clinical practice. Drug-induced long QT syndrome (DILQTS) is one of the most common causes of LQTS. In the diagnosis and management of the DILQTS, it can be useful to follow the three-step rule presented in this article: detailed pharmacological anamnesis and correct ECG interpretation; database search and clinical interpretation; confirmatory test.

A Rare Case of Atypical Cogan’s Syndrome Presenting as Encephalitis

Cogan’s syndrome (CS) is a rare autoimmune vasculitis of unknown aetiology characterised by non-syphilitic interstitial keratitis, audio-vestibular symptoms, sometimes systemic symptoms and multi-organ involvement. Atypical CS has other ocular features such as scleritis, episcelritis, retinitis and optic neuritis. Diagnosis of CS is purely clinical without a confirmatory test. Hereby, we report a case of atypical CS presenting with features of encephalitis who was treated successfully with intravenous pulse methylprednisolone with cyclophosphamide. It is important to consider Cogan’s syndrome in the differential diagnosis of encephalitis with ocular and vestibular symptoms in young patients, as high morbidity and mortality rates are effectively lowered by early immunosuppressive treatment.

Determination of Cut-Off Index of Reactive HBsAg Based on Confirmatory Test at Dr. Moewardi Hospital

HBsAg confirmatory test is required to confirm false reactive HBsAg due to non-specific binding of antigen withantibody. HBsAg confirmatory test cannot be performed in every laboratory due to the high price of reagents, short reagentshelf life, prolonged turnaround time, and increasing complexity of the test. This study aimed to determine the HBsAg COI(cut-off unit) cut-off point, which requires a confirmatory HBsAg test on the COBAS e411 analyzer with the ECLIA method.An observational analytic study with a cross-sectional approach was performed on 59 patients who underwent the HBsAgtest at Dr. Moewardi Hospital, Surakarta in September-October 2020 on the Cobas e411 analyzer with the ECLIA method.The best analytical performance of cut-off index of reactive HBsAg was determined using the ROC curve and AUC. Theresults of initial HBsAg COI showed the following results: borderline with a mean: 0.975±0.0014 and reactive with a medianof 4.38 (1.03-10)). The confirmatory test showed 59.8% reactive, 22.2% non-reactive, 13.8% not valid and 4.2%indeterminate results. The cut-off value for reactive HBsAg was 4.34 with an AUC of 0.818 (95% CI: 0.713 - 0.923; p=0.054), asensitivity of 72.1% and a specificity of 87.5%. The initial cut-off of HBsAg index at 4.34 COI showed the best analyticalperformance with a sensitivity of 72.1% and specificity of 87.3%. Therefore, it can be used to determine HBsAg results thatrequire HBsAg confirmatory examination on the Cobas e411 analyzer with the ECLIA method.

Evidence of Chikungunya virus seroprevalence in Myanmar among dengue-suspected patients and healthy volunteers in 2013, 2015, and 2018

Introduction Chikungunya virus (CHIKV) is a mosquito-borne virus known to cause acute febrile illness associated with debilitating polyarthritis. In 2019, several institutions in Myanmar reported a CHIKV outbreak. There are no official reports of CHIKV cases between 2011 and 2018. Therefore, this study sought to determine the seroprevalence of CHIKV infection before the 2019 outbreak. Methods A total of 1,544 serum samples were collected from healthy volunteers and patients with febrile illnesses in Yangon, Mandalay, and the Myeik district in 2013, 2015, and 2018. Participants ranged from one month to 65 years of age. Antibody screening was performed with in-house anti-CHIKV IgG and IgM ELISA. A neutralization assay was used as a confirmatory test. Results The seroprevalence of anti-CHIKV IgM and anti-CHIKV IgG was 8.9% and 28.6%, respectively, with an overall seropositivity rate of 34.5%. A focus reduction neutralization assay confirmed 32.5% seroprevalence of CHIKV in the study population. Age, health status, and region were significantly associated with neutralizing antibodies (NAbs) and CHIKV seropositivity (p < 0.05), while gender was not (p = 0.9). Seroprevalence in 2013, 2015, and 2018 was 32.1%, 28.8%, and 37.3%, respectively. Of the clinical symptoms observed in participants with fevers, arthralgia was mainly noted in CHIKV-seropositive patients. Conclusion The findings in this study reveal the circulation of CHIKV in Myanmar’s Mandalay, Yangon, and Myeik regions before the 2019 CHIKV outbreak. As no treatment or vaccine for CHIKV exists, the virus must be monitored through systematic surveillance in Myanmar.

Determining chromosomal arms 1p/19q co-deletion status in low graded glioma by cross correlation-periodogram pattern analysis

Prediction of mutational status of different graded glioma is extremely crucial for its diagnosis and treatment planning. Currently FISH and the surgical biopsy techniques are the ‘gold standard’ in the field of diagnostics; the analyses of which helps to decide appropriate treatment regime. In this study we proposed a novel approach to analyze structural MRI image signature pattern for predicting 1p/19q co-deletion status non-invasively. A total of 159 patients with grade-II and grade-III glioma were included in the analysis. These patients earlier underwent biopsy; the report of which confirmed 57 cases with no 1p/19q co-deletion and 102 cases with 1p/19q co-deletion. Tumor tissue heterogeneity was investigated by variance of cross correlation (VoCC). Significant differences in the pattern of VoCC between two classes was quantified using Lomb-Scargle (LS) periodogram. Energy and the cut-off frequency of LS power spectral density were derived and utilized as the features for classification. RUSBoost classifier was used that yield highest classification accuracy of 84% for G-II and 87% for G-III glioma respectively in classifying 1p/19q co-deleted and 1p/19q non-deleted glioma. In clinical practice the proposed technique can be utilized as a non-invasive pre-confirmatory test of glioma mutation, before wet-lab validation.

Parametric Investigation of Photochemical Machining of SS- 430 for Manufacturing of Micromesh

Photochemical machining (PCM) is an emerging method for machining of very thin and difficult-to-cut material with complex geometrical profile. PCM is one of recommended method for machining of aerospace components, biomedical appliances, electronics part and decorative items. High corrosion resistance, better life, good appearance and strength recommend SS-430 as suitable material for various applications. In the current investigation, the parametric investigations of process parameters in photochemical machining for concentration and temperature of etchant, time of etching is done through ANOVA analysis. Grey Relational Analysis is performed to estimate the optimum machining parameters during PCM of SS-430. Formulation of mathematical model is done for prediction of results. Taguchi (L27) experimental array is used for Design of Experiments (DoE). The significance process parameters are estimated to govern the process with F-Values. Confirmatory test is conducted to observe the improvement in the responses. ANN predictive model is built up for investigation of error between predictive and experimental values. The obtained optimum set is used for manufacturing of micromesh typically used in smoke detector to safeguard human life.

Efficacy of Influenza Like Illness (ILI) Screening OPD for COVID-19 at a High-Volume Centre: Unlocking Routine OPD

Background: The Impact of COVID-19 pandemic over non-essential health services has been massive. We initiated Influenza Like Illness (ILI) screening for resumption of out-patient services at a tertiary care centre and this study attempted to gauge its efficacy in effectively pruning out COVID-19. Methods: We included all the patients who had visited for an OPD appointment during the study period. Patient details and ILI symptoms were noted. Patients were then followed up telephonically after 2 weeks. The telephonic follow up was to ensure RT-PCR status and complaints of any newly developed ILI post OPD visit (within the last 14 days). Results: Out of the 957 patients who were enrolled, 929 patients were successfully followed up telephonically after 14 days. Only 13 who were screened out as ‘possible ILI’, were either RT-PCR negative or did not follow up with a confirmatory test. The telephonic follow up to ensure RT-PCR status and complaints of any newly developed ILI post OPD visit (within the last 14 days) was noted in the rest of the patients. Only 1 participant out of 957 screened, tested positive for COVID-19. Conclusion:The period in which the study was held the national positivity rate was low (around 3%). Therefore, in a resource limited country such as India it is astute to restart the OPD services in the pre-existing setup using basic precautions and a verbal questionnaire during the slope of the pandemic.