Glycemic control as the main determinant factor of serum VEGF levels in type 2 diabetes mellitus patients

Introduction. Diabetes mellitus (DM) is a main endocrine disorder that may cause vascular complications as the disease progresses. Vascular endothelial growth factor (VEGF) has been linked to the development of micro and macrovascular diabetic complications. This study aimed to assess several factors including blood pressure, body mass index, lipid profile, kidney function, and glycemic control that may provide the rise of serum VEGF levels in type 2 DM subjects. Methods. This cross-sectional study was carried out among 65 type 2 DM subjects. Systole, diastole, mean arterial pressure (MAP), and body mass index (BMI) were measured. The levels of serum VEGF were measured by Enzyme-linked immunosorbent assay (ELISA), Hemoglobin A1c (HbA1c) levels were measured by latex agglutination inhibition test, while serum glucose, lipid profiles, urea, and creatinine levels were tested by enzymatic photometric method. Results. The levels of serum VEGF had a significant correlation with BMI (p = 0.001, r = 0.397), fasting plasma glucose (FPG) (p = 0.001, r = 0.418), HbA1c (p < 0.001, r = 0.600), systole (p = 0.001), r = 0.397), diastole (p = 0.021, r = 0.286), and MAP (p = 0.001, r = 0.001). Further multivariate linear regression analysis revealed that HbA1c logarithm (log) was the determinant factor of VEGF levels (p < 0.001, β = 0.631, Adjusted R2 = 38.9%) Conclusion. HbA1c is the main determinant factor of serum VEGF levels among type 2 DM patients.

Análisis del perfil hematológico de los pacientes con la enfermedad por coronavirus 2019 (COVID-19)

Objetivos

Se han propuesto varios parámetros hematológicos como marcadores de gravedad de la COVID-19. Aún no se han realizado estudios en Makassar (Indonesia), para evaluar potenciales diferencias en el perfil hematológico de los pacientes según la gravedad de la enfermedad y las comorbilidades que presentan. Así mismo, tampoco se ha estudiado la correlación entre perfil hematológico y umbral de número de ciclos (Ct). El objetivo de este estudio es investigar posibles diferencias en el perfil hematológico de los pacientes con COVID-19 según la gravedad de la enfermedad y sus comorbilidades, así como determinar la posible correlación entre el perfil hematológico y el Ct en estos pacientes.

Métodos

Se realizó un estudio retrospectivo transversal de pacientes con COVID-19 hospitalizados en el hospital del Dr. Wahidin Sudirohusodo en Makassar entre junio y agosto de 2020. Los datos sobre el perfil hematológico, niveles de Ct, comorbilidades y gravedad de la COVID-19 se extrajeron de la base de datos del hospital.

Resultados

De los 217 pacientes, 102 (47%) eran hombres, frente a 115 (53%) mujeres. El número de pacientes con enfermedad leve o moderada fue de 127 (58.5%) mientras que 90 pacientes presentaban enfermedad grave (41.5%). En total, 143 pacientes (65%) no tenían comorbilidades, mientras que 74 pacientes (35%) sí las tenían. La amplitud de la distribución eritrocitaria, el recuento leucocitario, neutrófilos y monocitos, y la relación neutrófilos-linfocitos fueron significativamente superiores en los pacientes con enfermedad grave que en los que presentaban enfermedad leve o moderada (p<0,05). Así mismo, los pacientes graves presentaron un recuento de glóbulos rojos, hemoglobina, hematocrito, linfocitos y trombocitos significativamente inferior al de los pacientes con enfermedad leve o moderada. No se observaron diferencias significativas en el perfil hematológico según las comorbilidades, ni correlación alguna entre este y los niveles de Ct, excepto para el recuento de eosinófilos (r=0,161; p=0,018).

Conclusiones

Nuestra hipótesis era que el perfil hematológico podría predecir la gravedad de la enfermedad en pacientes con COVID-19. Además, el recuento de eosinófilos debería tenerse en cuenta a la hora de predecir la infectividad de un paciente con COVID-19.

Hematology profile analysis in coronavirus disease 2019 (COVID-19) patients

Objectives

Some hematological parameters were reported as markers to assess severity of COVID-19 patients. Comorbidities were risk factors for severe COVID-19. Differences in hematology profile based on severity and comorbidity, and correlation between hematology profile and Ct value were never studied at Makassar, Indonesia. The aim of this study were to know the differences of hematology profile based on severity and comorbidity, and the correlation between hematology profile and Ct value in COVID-19 patients.

Methods

This study was retrospective, cross-sectional of confirmed COVID-19 patients who had been hospitalized at Dr. Wahidin Sudirohusodo hospital, Makassar, since June to August 2020. Hematology profile, Ct value, comorbidity, and severity of COVID-19 patients were obtained from Hospital Information System Data.

Results

From 217 patients, subjects were 102 (47%) male dan 115 (53%) female, 127 mild-moderate patients (58.5%) and 90 severe patients (41.5%), 143 patients (65%) without comorbidity, 74 patients (35%) with comorbidity. White blood cells (WBC), red cell distribution width (RDW), neutrophil and monocyte count, and neutrophil lymphocyte ratio (NLR) were significantly higher in severe patients than mild-moderate patients (p<0.05), besides RBC, hemoglobin, hematocrit, lymphocyte and thrombocyte count were significantly lower in severe patients than mild-moderate patients (p<0.05). Hematology profile was not different significantly based on comorbidity and was not correlated significantly with Ct value, except eosinophil count (r=0.161; p=0.018).

Conclusions

We suggest that hematology profile could predict the severity of COVID-19 patients. Moreover, eosinophil count could be considered to predict the infectivity of patient with COVID-19.

The characteristics of bacteremia among patients with acute febrile illness requiring hospitalization in Indonesia

Blood culturing remains the "gold standard" for bloodstream infection (BSI) diagnosis, but the method is inaccessible to many developing countries due to high costs and insufficient resources. To better understand the utility of blood cultures among patients in Indonesia, a country where blood cultures are not routinely performed, we evaluated data from a previous cohort study that included blood cultures for all participants. An acute febrile illness study was conducted from July 2013 to June 2016 at eight major hospitals in seven provincial capitals in Indonesia. All participants presented with a fever, and two-sided aerobic blood cultures were performed within 48 hours of hospital admission. Positive cultures were further assessed for antimicrobial resistance (AMR) patterns. Specimens from participants with negative culture results were screened by advanced molecular and serological methods for evidence of causal pathogens. Blood cultures were performed for 1,459 of 1,464 participants, and the 70.6% (1,030) participants that were negative by dengue NS1 antigen test were included in further analysis. Bacteremia was observed in 8.9% (92) participants, with the most frequent pathogens being Salmonella enterica serovar Typhi (41) and Paratyphi A (10), Escherichia coli (14), and Staphylococcus aureus (10). Two S. Paratyphi A cases had evidence of AMR, and several E. coli cases were multidrug resistant (42.9%, 6/14) or monoresistant (14.3%, 2/14). Culture contamination was observed in 3.6% (37) cases. Molecular and serological assays identified etiological agents in participants having negative cultures, with 23.1% to 90% of cases being missed by blood cultures. Blood cultures are a valuable diagnostic tool for hospitalized patients presenting with fever. In Indonesia, pre-screening patients for the most common viral infections, such as dengue, influenza, and chikungunya viruses, would maximize the benefit to the patient while also conserving resources. Blood cultures should also be supplemented with advanced laboratory tests when available.

Safety of DW-MSC infusion in patients with low clinical risk COVID-19 infection: a randomized, double-blind, placebo-controlled trial

Background

Due to their immunomodulatory properties, mesenchymal stem cells (MSCs) have been proposed to have therapeutic potential to improve clinical outcomes in COVID-19. However, the safety and efficacy profile of MSC infusion therapy in patients with non-severe COVID-19 infection has not been completely established; there is, in particular, a substantial void in the literature on dose-dependent studies of MSC infusion in patients with low clinical risk COVID-19 infection.

Methods

This phase 1 double-blind, placebo-controlled, randomized clinical trial examines the safety, feasibility, and tolerability of 2 doses (high and low) of DW-MSC in patients with low clinical risk COVID-19. A total of 9 patients were enrolled in this study and randomized into low-dose (TL), high-dose (TH), and placebo (C) groups. Subjects in the TL and TH groups received single intravenous infusions of 5.0 × 10⁷ cells and 1.0 × 10⁸ cells, respectively. The main outcome was the occurrence of treatment-emergent adverse events (TEAE) during the 28-day study period. Vital signs and various inflammatory markers were also monitored weekly during the observation period.

Results

There were no apparent differences in clinical characteristics between study groups (TL, TH, and C) at baseline. All patients did not show the progression of severity during the study period. During the course of the study, 6 episodes of TEAE were observed in 5 subjects; however, none of the TEAEs were severe. During the follow-up period, 8 subjects recovered and were discharged from the hospital without complications. A subject exhibited abnormal liver function biomarkers at the end of the study period. Changes in inflammatory markers throughout the clinical course were not vastly different across study groups.

Conclusions

Our clinical trial has provided reliable results regarding the safety of MSCs in low clinical risk COVID-19 subjects treated with MSCs. However, further confirmation of the therapeutic efficacy aspects of MSC will require large-scale randomized controlled trials in subjects with varying severity profiles for COVID-19.

Trial registration

ClinicalTrials.gov, NCT04535856. Registered 2 September 2020, https://clinicaltrials.gov/ct2/show/NCT04535856

Supplementary Information

The online version contains supplementary material available at 10.1186/s13287-022-02812-4.

Excess mortality attributable to antimicrobial-resistant bacterial bloodstream infection at a tertiary-care hospital in Indonesia

The burden of antimicrobial-resistant (AMR) infections in low and middle-income countries (LMICs) is largely unknown. Here, we evaluate attributable mortality of AMR infections in Indonesia. We used routine databases of the microbiology laboratory and hospital admission at Dr. Wahidin Sudirohusodo Hospital, a tertiary-care hospital in South Sulawesi from 2015 to 2018. Of 77,752 hospitalized patients, 8,341 (10.7%) had at least one blood culture taken. Among patients with bacteriologically confirmed bloodstream infections (BSI), the proportions of patients with AMR BSI were 78% (81/104) for third-generation cephalosporin-resistant (3GCR) Escherichia coli, 4% (4/104) for 3GCR plus carbapenem-resistant E. coli, 56% (96/171) for 3GCR Klebsiella pneumoniae, 25% (43/171) for 3GCR plus carbapenem-resistant K. pneumoniae, 51% (124/245) for methicillin-resistant Staphylococcus aureus, 48% (82/171) for carbapenem-resistant Acinetobacter spp., and 19% (13/68) for carbapenem-resistant Pseudomonas aeruginosa. Observed in-hospital mortality of patients with AMR BSI was 49.7% (220/443). Compared with patients with antimicrobial-susceptible BSI and adjusted for potential confounders, the excess mortality attributable to AMR BSI was -0.01 (95% CI: -15.4, 15.4) percentage points. Compared with patients without a BSI with a target pathogen and adjusted for potential confounders, the excess mortality attributable to AMR BSI was 29.7 (95%CI: 26.1, 33.2) percentage points. This suggests that if all the AMR BSI were replaced by no infection, 130 (95%CI: 114, 145) deaths among 443 patients with AMR BSI might have been prevented. In conclusion, the burden of AMR infections in Indonesian hospitals is likely high. Similar large-scale evaluations should be performed across LMICs to inform interventions to mitigate AMR-associated mortality.

Habitat selection by Asiatic black bear (Ursus thibetanus) in Siran and Kaghan Valleys, Pakistan

Asiatic black bear is present in variety of habitats like broad-leaves and coniferous forests, extending form sea level to 4300m elevation and change their habitat for food purpose seasonally. The present study was conducted at Kaghan and Siran Valleys, District Mansehra, Khyber Pakhtunkhwa, Pakistan to assess habitat of black bear. Line transect method was used for observation of bear signs. Twelve meter circular radius plots were selected for the concern vegetation's i.e. (trees, shrubs and herbs) and three to six plots were placed in each transect. At the result of sign survey, thirteen different categories of bear signs were recorded and encounter rate was calculated for each sign. A total of 1858 signs were observed during field surveys. Total (81%) coniferous species were recoded among trees, with the highest appearance of Pinus wallichiana (34.22%) and Spruce spp (27.76%), similarly broad leaves trees (18.56%) were also recoded from habitat plots. Most of the signs were encountered in bushy areas, whereas high number of Viburnum Spp (60.29%) was present. It is indicated that black bear prefers blend of Coniferous Trees, Viburnum and Ferns Species; probably because these plants provide enough food, protection, and meticulous shelter because more than 80% of habitat composed of these three species. Currently habitat destruction and increase in human population are the up-growing issues for wild animals (especially Asiatic black bear), which is highly sensitive to such problems. High levels of conservation efforts are recommended for the protection of black bear habitat and to avoid human interference in their territory.

Prevalence of HIV Infection and Resistance Mutations in Patients Hospitalized for Febrile Illness in Indonesia

HIV prevalence in Indonesia is increasing, and only 64% of infected individuals know their status. In a prospective cohort of 1,453 hospitalized patients with unexplained fever, 46 (3.2%) had HIV, including 15 (1.1%) patients without a prior HIV diagnosis. Among 31 subjects previously known to have HIV, 21 (68%) had been receiving combination antiretroviral therapy (cART) at the time of enrollment. Of 39 HIV cases with HIV RNA levels ≥ 100 copies/mL, sequencing for genotype analysis and resistance testing was successful in 30 (77%) subjects. The most common HIV subtypes were AE (90%) and B (10%). Five (16.7%) subjects had resistance mutations to nucleoside and non-nucleoside reverse transcriptase inhibitors, and all of them were on cART. No evidence of transmitted drug resistance was found in newly diagnosed individuals. Hospital-based screening may be an efficient method to expand HIV testing and identify a significant number of new cases. Access to care, close monitoring, expansion of anti-retroviral options, and ensuring availability of CD4 determinations, viral load testing, and genotyping are crucial to control of the epidemic in Indonesia.

Exogenous application of bio-stimulant and growth retardant improved the productivity of cotton cultivars under different planting arrangement

Optimum planting arrangement is an important attribute for efficient utilization of available resources and to obtain high yield of cotton. Application of plant growth promoter and retardant on cotton in improved planting density are the innovative techniques in the establishment of more productive cotton crop. Therefore, we planned a field study to assess the role of bio-stimulant and growth retardant in the resource utilization efficiency of cotton cultivars planted under variable row spacing at Agronomic Research Area Bahauddin Zakariya University and Usmania Agricultural Farm Shujabad during Kharif 2012. Experimental treatments consisted of cotton genotypes viz. CIM-573 and CIM-598, cultivated under conventional (75 cm), medium (50 cm) and ultra-narrow row spacing (25 cm) with foliar spray of bio-stimulant (moringa leaf extract) and growth retardant (mepiquate chloride), either sole or in combination, keeping distilled water as a control. Exogenously applied MLE alone and MLE + MC significantly enhanced the number of squares, flowers and green bolls per plant leading to higher cotton seed and lint yield of CIM 598 cultivar cultivated under conventional row spacing. While application of MC alone and MLE + MC produced maximum micronaire value, fiber strength and fiber uniformity ratio of CIM 573 cultivar cultivated under conventional row spacing. The results suggested that application of MLE is a possible approach to enhance the cotton productivity and the use of MC to enhance the fiber quality attributes under conventional row spacing.

Human neutrophil peptide (HNP) in deteriorate sepsis patients

OBJECTIVE

The objective of this study was analyzed HNP1 and HNP3 level of deteriorating sepsis patients.

METHODS

It was a cross-sectional study that observed HNP and sepsis level, samples size were 40 patients taken by consecutive random sampling. Analysis of HNP serum level use enzyme-linked immunosorbent assay (ELISA), data analyzed used independent T-test and presented in tables with mean, standard deviation, mean difference and probability value.

RESULTS

Results show that when patients become deteriorate or shock sepsis, HNP1 levels increase dramatically, which is 356.2pg/ml higher than sepsis patients and statistically significant (p=0.016, p≤0.05). It is similar to HNP3 level, which is 2.04ng/ml higher than with sepsis patients and statistically significant (p=0.021, p≤0.05).

CONCLUSION

This study reveals that HNP1 and HNP3 level increases dramatically in deteriorate sepsis patients. Level of HNP1 and HNP3 of sepsis patient is higher than nonsepsis patient, shock sepsis patient is higher than sepsis patient and both HNP1 and HNP3 level is higher in die patient compare to alive patient.

Improved multiplex TaqMan qPCR assay with universal internal control offers reliable and accurate detection of Clavibacter michiganensis

AIM

Clavibacter michiganensis (Cm) is a seed-borne plant pathogen that significantly reduces tomato production worldwide. Due to repeated outbreaks and rapid spread of the disease, seeds/transplants need to be certified free of the pathogen before planting. To this end, we developed a multiplex TaqMan qPCR assay that can accurately detect Cm in infected samples.

METHODS AND RESULTS

A specific region of Cm (clvG gene) was selected for primer design using comparative genomics approach. A fully synthetic universal internal control (UIC) was also designed to detect PCR inhibitors and false-negative results in qPCRs. The Cm primers can be used alone or in a triplex TaqMan qPCR assay with UIC and previously described Clavibacter primers. The assay was specific for Cm and detected up to 10 fg of Cm DNA in sensitivity and spiked assays. Addition of the UIC did not change the specificity or sensitivity of the multiplex TaqMan qPCR assay.

CONCLUSION

The triplex TaqMan qPCR provides a specific and sensitive diagnostic assay for Cm.

SIGNIFICANCE AND IMPACT OF THE STUDY

This assay can be used for biosecurity surveillance, routine diagnostics, estimating bacterial titres in infected material and for epidemiological studies. The UIC is fully synthetic, efficiently amplified and multiplex compatible with any other qPCR assay.

Resource use efficiency of cotton in improved vs conventional planting geometry with exogenous application of bio-stimulant and synthetic growth retardant

Plant growth regulators and improved planting density are the innovative techniques in the establishment of more productive cotton crop. A field study was planned to assess the role of growth regulators in the resource utilization efficiency of cotton cultivars under different row spacing at Agronomic Research Area, Bahauddin Zakariya University Multan and Usmania Agricultural Farm, Shujaabad during Kharif 2012. The study was comprised of cotton cultivars viz. CIM-573 and CIM-598, cultivated under conventional (75 cm), medium (50 cm) and improved ultra-narrow row spacing (25 cm) and foliar spray of growth regulators viz. moringa leaf extract (MLE) and mepiquat chloride (MC), either alone or in combination, distilled water as a control. The application of MLE alone and in combination (MLE + MC) showed the promoting effect on crop growth rate, net assimilation rate, leaf area index, leaf area duration, sympodial branches and number of bolls leading to higher seed cotton yield of both cotton cultivars grown under conventional row spacing. While application of MC averts the plant growth without considerably improving the productivity. MLE being rich source of growth promoting hormone and nutrients showed its potential to a far greater extent under conventional row spacing in efficient utilization of available resources compared to MC and distilled water.

Dietary effect of probiotics and prebiotics on broiler performance, carcass, and immunity

This experiment was carried out to evaluate the effects of dietary addition of probiotics (Protexin) and prebiotics (active MOS, mannan oligosaccharides) on growth performance, carcasses, and antibody titer in broilers. A total number of 360-day-old Ross broiler chicks were randomly divided into 9 groups in a 3 × 3 factorial arrangement. Nine broiler starter (0-21 d) and finisher (21-35 d) diets were formulated by using 3 levels of probiotics (0, 1, and 2 g/kg of feed) and 3 levels of MOS (0, 1, and 1.5 g/kg of feed) and were randomly allotted to 9 groups. Feed intake was not affected by interaction of treatments during all phases (P > 0.05). Feed intake was improved due to the main effect of probiotic (P = 0.0001) or MOS (P = 0.005). No interaction (P > 0.05) was observed for weight gain in the starter, finisher, and overall phases. While, during the starter and finisher phases, weight gain was increased by probiotics (P = 0.028 or 0.04, respectively). Dietary supplementation of MOS improved weight gain (P = 0.01) and feed conversion ratio (FCR) (P = 0.03) during the overall period, but during starter and finisher periods, weight gain and FCR were not affected by prebiotics. Apart from dressing percentage, no interaction or individual effect of probiotics and prebiotics was observed for carcass, breast, thigh, heart, liver, and gizzard weight. Antibody titer for infectious bursal disease (IBD) was improved (P = 0.026) by the interaction effect between probiotics and prebiotics, when compared with the control group. Antibody titer against Newcastle disease (ND) was not affected by probiotics or prebiotics or their interactions (P > 0.05). It could be concluded that supplementation of prebiotics or probiotics can improve the growth performance of broilers. It may also be helpful in improving the antibody titer against IBD in broilers fed antibiotic-free diets.

Etiologies of severe acute respiratory infection (SARI) and misdiagnosis of influenza in Indonesia, 2013-2016

Background

Severe acute respiratory infection (SARI) accounts for a large burden of illness in Indonesia. However, epidemiology of SARI in tertiary hospitals in Indonesia is unknown. This study sought to assess the burden, clinical characteristics, and etiologies of SARI and concordance of clinical diagnosis with confirmed etiology.

Methods

Data and samples were collected from subjects presenting with SARI as part of the acute febrile Illness requiring hospitalization study (AFIRE). In tertiary hospitals, clinical diagnosis was ascertained from chart review. Samples were analyzed to determine the “true” etiology of SARI at hospitals and Indonesia Research Partnership on Infectious Diseases (INA‐RESPOND) laboratory. Distribution and characteristics of SARI by true etiology and accuracy of clinical diagnosis were assessed.

Results

Four hundred and twenty of 1464 AFIRE subjects presented with SARI; etiology was identified in 242 (57.6%), including 121 (28.8%) viruses and bacteria associated with systemic infections, 70 (16.7%) respiratory bacteria and viruses other than influenza virus, and 51 (12.1%) influenza virus cases. None of these influenza patients were accurately diagnosed as having influenza during hospitalization.

Conclusions

Influenza was misdiagnosed among all patients presenting with SARI to Indonesian tertiary hospitals in the AFIRE study. Diagnostic approaches and empiric management should be guided by known epidemiology. Public health strategies to address the high burden of influenza should include broad implementation of SARI screening, vaccination programs, clinician education and awareness campaigns, improved diagnostic capacity, and support for effective point‐of‐care tests.

Chikungunya in Indonesia: Epidemiology and diagnostic challenges

BACKGROUND

Chikungunya virus (CHIKV) is often overlooked as an etiology of fever in tropical and sub-tropical regions. Lack of diagnostic testing capacity in these areas combined with co-circulation of clinically similar pathogens such as dengue virus (DENV), hinders CHIKV diagnosis. To better address CHIKV in Indonesia, an improved understanding of epidemiology, clinical presentation, and diagnostic approaches is needed.

METHODOLOGY/PRINCIPAL FINDINGS

Acutely hospitalized febrile patients ≥1-year-old were enrolled in a multi-site observational cohort study conducted in Indonesia from 2013 to 2016. Demographic and clinical data were collected at enrollment; blood specimens were collected at enrollment, once during days 14 to 28, and three months after enrollment. Plasma samples negative for DENV by serology and/or molecular assays were screened for evidence of acute CHIKV infection (ACI) by serology and molecular assays. To address the co-infection of DENV and CHIKV, DENV cases were selected randomly to be screened for evidence of ACI. ACI was confirmed in 40/1,089 (3.7%) screened subjects, all of whom were DENV negative. All 40 cases initially received other diagnoses, most commonly dengue fever, typhoid fever, and leptospirosis. ACI was found at five of the seven study cities, though evidence of prior CHIKV exposure was observed in 25.2% to 45.9% of subjects across sites. All subjects were assessed during hospitalization as mildly or moderately ill, consistent with the Asian genotype of CHIKV. Subjects with ACI had clinical presentations that overlapped with other common syndromes, atypical manifestations of disease, or persistent or false-positive IgM against Salmonella Typhi. Two of the 40 cases were possibly secondary ACI.

CONCLUSIONS/SIGNIFICANCE

CHIKV remains an underdiagnosed acute febrile illness in Indonesia. Public health measures should support development of CHIKV diagnostic capacity. Improved access to point-of-care diagnostic tests and clinical training on presentations of ACI will facilitate appropriate case management such as avoiding unneccessary treatments or antibiotics, early response to control mosquito population and eventually reducing disease transmission.

Leptospirosis in Indonesia: diagnostic challenges associated with atypical clinical manifestations and limited laboratory capacity

BACKGROUND

The burden of leptospirosis in Indonesia is poorly understood. Data from an observational study conducted from 2013 to 2016 in seven cities across Indonesia was used to estimate the incidence of leptospirosis and document its clinical manifestations in patients requiring hospitalization.

METHODS

Specimens from patients hospitalized with acute fever were collected at enrollment, 14-28 days, and 3 months. Demographic and clinical information were collected during study visits and/or retrieved from medical records and double-entered into clinical report forms. After initially screening for dengue virus and other pathogens, specimens were tested at a central Reference Laboratory for anti-Leptospira IgM using commercial ELISA kits and for Leptospira DNA using an in-house quantitative real-time PCR assay.

RESULTS

Of 1464 patients enrolled, 45 (3.1%) confirmed cases (by PCR and/or sero-coversion or four-fold increase of IgM) and 6 (0.4%) probable cases (by high titer IgM) of leptospirosis were identified by the Reference Laboratory. Disease incidence at sites ranged from 0 (0%) cases in Denpasar to 17 (8.9%) cases in Semarang. The median age of patients was 41.2 years (range of 5.3 to 85.0 years), and 67% of patients were male. Twenty-two patients (43.1%) were accurately diagnosed at sites, and 29 patients (56.9%) were clinically misdiagnosed as having another infection, most commonly dengue fever (11, 37.9%). Clinically, 20 patients (39.2%) did not present with hyperbilirubinemia or increased creatinine levels. Two patients (3.9%) died, both from respiratory failure. Fifteen patients (29.4%) clinically diagnosed with leptospirosis at sites were negative based on IgM ELISA and/or PCR at the Reference Laboratory.

CONCLUSIONS

Leptospirosis remains an important cause of hospitalization in Indonesia. It can have diverse clinical presentations, making it difficult to differentiate from other common tropical infections. PCR combined with ELISA is a powerful alternative to the cumbersome gold-standard microscopic agglutination test, particularly in resource-limited settings.

Comparative genomics reveals signature regions used to develop a robust and sensitive multiplex TaqMan real-time qPCR assay to detect the genus Dickeya and Dickeya dianthicola

AIMS

Dickeya species are high consequence plant pathogenic bacteria; associated with potato disease outbreaks and subsequent economic losses worldwide. Early, accurate and reliable detection of Dickeya spp. is needed to prevent establishment and further dissemination of this pathogen. Therefore, a multiplex TaqMan qPCR was developed for sensitive detection of Dickeya spp. and specifically, Dickeya dianthicola.

METHODS AND RESULTS

A signature genomic region for the genus Dickeya (mglA/mglC) and unique genomic region for D. dianthicola (alcohol dehydrogenase) were identified using a whole genome-based comparative genomics approach. The developed multiplex TaqMan qPCR was validated using extensive inclusivity and exclusivity panels, and naturally/artificially infected samples to confirm broad range detection capability and specificity. Both sensitivity and spiked assays showed a detection limit of 10 fg DNA.

CONCLUSION

The developed multiplex assay is sensitive and reliable to detect Dickeya spp. and D. dianthicola with no false positives or false negatives. It was able to detect mixed infection from naturally and artificially infected plant materials.

SIGNIFICANCE AND IMPACT OF THE STUDY

The developed assay will serve as a practical tool for screening of propagative material, monitoring the presence and distribution, and quantification of target pathogens in a breeding programme. The assay also has applications in routine diagnostics, biosecurity and microbial forensics.

Comparison of Commercial Enzyme-Linked Immunosorbent Assay and Immunofluorescence Assay for Diagnosis of Acute Rickettsia typhi Infections

Murine typhus is a tropical disease caused by Rickettsia typhi and is endemic in resource-limited settings such as Southeast Asian countries. Early diagnosis of R. typhi infection facilitates appropriate management and reduces the risk of severe disease. However, molecular detection of R. typhi in blood is insensitive due to low rickettsemia. Furthermore, the gold standard of sero-diagnosis by immunofluorescence assay (IFA) is cumbersome, subjective, impractical, and unavailable in many endemic areas. In an attempt to identify a practical diagnostic approach that can be applied in Indonesia, we evaluated the performance of commercial R. typhi IgM and IgG enzyme-linked immunosorbent assay (ELISA) and IFA using paired plasma from previously studied R. typhi PCR-positive cases and controls with other known infections. Sensitivity and specificity of combined ELISA IgM and IgG anti-R. typhi using paired specimens were excellent (95.0% and 98.3%, respectively), comparable to combined IFA IgM and IgG (97.5% and 100%, respectively); sensitivity of ELISA IgM from acute specimens only was poor (45.0%), but specificity was excellent (98.3%). IFA IgM was more sensitive (77.5%), but less specific (89.7%) for single specimens.

Precision Measurement of the Neutron Scattering Length of ^{4}He Using Neutron Interferometry

We report a 0.08% measurement of the bound neutron scattering length of ^{4}He using neutron interferometry. The result is b=(3.0982±0.0021[stat]±0.0014[syst])  fm. The corresponding free atomic scattering length is a=(2.4746±0.0017[stat]±0.0011[syst])  fm. With this result the world average becomes b=(3.0993±0.0025)  fm, a 2% downward shift and a reduction in uncertainty by more than a factor of six. Our result is in disagreement with a previous neutron interferometric measurement but is in good agreement with earlier measurements using neutron transmission.