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.

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.

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.

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.

Humic acid as a feed additive in poultry diets: a review

Many studies tested different feed additives, among these additives, humic substances (HS) have been used in livestock and poultry diets. Humic substances commonly present in nature as they are created from the organic matter decomposition, and are normally found in the soil and natural water. Active components of HS consist of humic acid (HA), humus, ulmic acid, fulvic acid, humin and certain microelements. Humic acid is widely used as an alternative growth promoter for antibiotics in improving poultry performance and health. Moreover, supplementation of a commercial substance as a source of HS through the drinking water or diet improved the feed consumption, feed efficiency and weight gain of broiler chickens, and also improved egg weight, egg mass, and egg production of laying hens. This review describes the useful applications and recent facets of HA including its modes of action and various valuable uses in improving the production and health safeguarding of livestock and poultry.

Direct observation of spin rotation in Bragg scattering due to the spin-orbit interaction in silicon

As a neutron scatters from a target nucleus, there is a small but measurable effect caused by the interaction of the neutron's magnetic dipole moment with that of the partially screened electric field of the nucleus. This spin-orbit interaction is typically referred to as Schwinger scattering and induces a small rotation of the neutron's spin on the order of 10^-4 rad for Bragg diffraction from silicon. In our experiment, neutrons undergo greater than 100 successive Bragg reflections from the walls of a slotted, perfect-silicon crystal to amplify the total spin rotation. A magnetic field is employed to insure constructive addition as the neutron undergoes this series of reflections. The strength of the spin-orbit interaction, which is directly proportional to the electric field, was determined by measuring the rotation of the neutron's spin-polarization vector. Our measurements show good agreement with the expected variation of this rotation with the applied magnetic field, while the magnitude of the rotation is ≈40 % larger than expected.

Development of a loop-mediated isothermal amplification assay for specific detection of all known subspecies of Clavibacter michiganensis

AIMS

Clavibacter michiganensis is an important bacterial plant pathogen that causes vast destruction to agriculturally important crops worldwide. Early detection is critical to evaluate disease progression and to implement efficient control measures to avoid serious epidemics. In this study, we developed a sensitive, specific and robust loop-mediated isothermal amplification (LAMP) assay for detection of all known subspecies of C. michiganensis.

METHODS AND RESULTS

Whole genome comparative genomics approach was taken to identify a unique and conserved region within all known subspecies of C. michiganensis. Primer specificity was evaluated in silico and with 64 bacterial strains included in inclusivity and exclusivity panels; no false positives or false negatives were detected. Both the sensitivity and spiked assay of the developed LAMP assay was 1 fg of the pathogen DNA per reaction. A 100% accuracy was observed when tested with infected plant samples.

CONCLUSIONS

The developed LAMP assay is simple, sensitive, robust and easy to perform using different detection platforms and chemistries.

SIGNIFICANCE AND IMPACT OF THE STUDY

The developed LAMP assay can detect all known subspecies of C. michiganensis. The LAMP process can be performed isothermally at 65°C and results can be visually assessed, which makes this technology a promising tool for monitoring the disease progression and for accurate pathogen detection at point-of-care.

Generation of a Lattice of Spin-Orbit Beams via Coherent Averaging

We describe a highly robust method, applicable to both electromagnetic and matter-wave beams, that can produce a beam consisting of a lattice of orbital angular momentum (OAM) states coupled to a two-level system. We also define efficient protocols for controlling and manipulating the lattice characteristics. These protocols are applied in an experimental realization of a lattice of optical spin-orbit beams. The novel passive devices we demonstrate here are also a natural alternative to existing methods for producing single-axis OAM and spin-orbit beams. Our techniques provide new tools for investigations of chiral and topological materials with light and particle beams.

Correlation Between Onset of Diabetes Mellitus and Nitric Oxide Levels in Patient with Type 2 Diabetes Mellitus

Type 2 diabetes mellitus (DM) is associated with increased risk of endothelial dysfunction if it lasts a long time without control. This study aims to connect the Onset of Diabetes Mellitus (DM) with Nitric Oxide levels in patients of type 2 diabetes mellitus. The study used cross-sectional study method. The samples were 86 subjects, consisting of 38 subjects of Type 2 DM controlled and 48 subjects of Type 2 DM uncontrolled. The results of the Kruskal-Wallis statistical test showed no significant difference between the Onset of DM and Nitric Oxide levels in the categories of 4-6 years (19.4 ± 10.1), 7-9 years (17.3 ± 9.3) and 10-12 years (13.3 ± 8.5) (p=0.06). Furthermore, the Spearman correlation test revealed a negative correlation between the Onset of DM and Nitric Oxide level in patients with Type 2 DM with and without control (r =-0.217). The level of Nitric Oxide (NO) can consider as a predictor of long-term complication in patients with type 2 DM.

FLAMING CELLS DI MULTIPLE MYELOMA

Multiple myeloma is a type of cancer on plasma cells which are system of immune cells in bone marrow that produce antibodies. A47 years old man precented with an excruciatingly painfull bone lytic lesion acompanied with compressive fracture in his Thorakal XIIand first Lumbar vertebral body since a week ago. A complete blood count on admission showed anemia normocytic normocrom withhemoglobin content of 5.3 mg/dL. The blood smear revealed clumping of red blood cells to bound "Rouleaux formations". Serum proteinelectrophoresis showed specific evidence of a M-spike. Bence-Jones proteinuria was positive and serum kreatinin arised 2.44 mg/dL.The bone marrow aspiration contained 45% plasma cells, many of which exhibited the morphology of flaming cells with an eccentricnucleus and violaceous cytoplasm. Plasma cells varied in size and shape and included flaming cells and myeloma cells. The patient wasdiagnosed as having flaming cells in multiple myeloma stage IIIB.

Three Phase-Grating Moiré Neutron Interferometer for Large Interferometer Area Applications

We demonstrate a three phase-grating moiré neutron interferometer in a highly intense neutron beam as a robust candidate for large area interferometry applications and for the characterization of materials. This novel far-field moiré technique allows for broad wavelength acceptance and relaxed requirements related to fabrication and alignment, thus circumventing the main obstacles associated with perfect crystal neutron interferometry. We observed interference fringes with an interferometer length of 4 m and examined the effects of an aluminum 6061 alloy sample on the coherence of the system. Experiments to measure the autocorrelation length of samples and the universal gravitational constant are proposed and discussed.

Emergence of Melioidosis in Indonesia and Today's Challenges

A recent modeling study estimated that there could be as many as 20,000 human melioidosis cases per year in Indonesia, with around 10,000 potential deaths annually. Nonetheless, the true burden of melioidosis in Indonesia is still unknown. The Indonesia Melioidosis Network was formed during the first melioidosis workshop in 2017. Here, we reviewed 101 melioidosis cases (99 human and two animal cases) previously reported and described an additional 45 human melioidosis cases. All 146 culture-confirmed cases were found in Sumatra (n = 15), Java (n = 104), Kalimantan (n = 15), Sulawesi (n = 11) and Nusa Tenggara (n = 1). Misidentification of Burkholderia pseudomallei was not uncommon, and most cases were only recently identified. We also evaluated clinical manifestations and outcome of recent culture-confirmed cases between 2012 and 2017 (n = 42). Overall, 15 (36%) cases were children (age <15 years) and 27 (64%) were adults (age ≥15 years). The overall mortality was 43% (18/42). We conducted a survey and found that 57% (327/548) of healthcare workers had never heard of melioidosis. In conclusion, melioidosis is endemic throughout Indonesia and associated with high mortality. We propose that top priorities are increasing awareness of melioidosis amongst all healthcare workers, increasing the use of bacterial culture, and ensuring accurate identification of B. pseudomalleiand diagnosis of melioidosis.

Increased interference fringe visibility from the post-fabrication heat treatment of a perfect crystal silicon neutron interferometer

We find that annealing a previously chemically etched interferometer at 800 °C dramatically increased the interference fringe visibility from 23% to 90%. The Bragg plane misalignments were also measured before and after annealing using neutron rocking curves, showing that Bragg plane alignment was improved across the interferometer after annealing. This suggests that current interferometers with low fringe visibility may be salvageable and that annealing may become an important step in the fabrication process of future neutron interferometers, leading to less need for chemical etching and larger more exotic neutron interferometers.

Influences of dietary supplementation of peanut skin powder (Arachis Hypogaea) on growth performance, carcass traits, blood chemistry, antioxidant activity and meat quality of broilers

The present study aimed to investigate the effects of dietary supplementation with powdered peanut skin (PS) as natural antioxidant and growth promoter on growth performance, carcass characteristics, serum metabolites and meat quality of Cobb broiler chickens. A total of 240 unsexed Cobb 500 1-week-old broiler chicks were randomly assigned to four treatment groups with six replicates. The dietary treatments consisted of the basal diet as control and PS groups (1.0, 2.0, and 3.0 PS g/kg). Results showed that the highest values (P < 0.01) of live bodyweight and bodyweight gain were observed in the control group at 3 weeks of age and during the period of 1–3 weeks of age, respectively compared with all levels of PS. During 1–3 weeks of age, feed intake per day chicks fed the diet containing PS levels decreased numerically (P > 0.01) with increased levels of PS compared with the control. Supplementing 1.0 or 3.0 g/kg of PS insignificantly enhanced feed conversion ratio at 1–6 weeks of age. Dietary treatments significantly depressed giblets (P = 0.002), thigh (P = 0.0.027) and abdominal fat percentages (P > 0.0.1), however, increased (P = 0.004) breast percentage of broiler chicks at 6 weeks of age. The lowest value of serum creatinine and urea achieved by chicks fed diet contained 3.0 PS g/kg diet. Also, high density lipoprotein cholesterol in addition to triglycerides were significantly (P < 0.05 and P < 0.01) decreased with increasing level of PS supplementation. It can be concluded that PS as a phytogenic additive could be used as a supplementation to broiler diets to lower abdominal fat in carcass and cholesterol, creatinin and urea in blood. Sensory characteristics were not affected except that appearance was improved. Water-holding capacity was also improved.

The impacts of dietary Nigella sativa meal and Avizyme on growth, nutrient digestibility and blood metabolites of meat-type quail

The present study was performed to evaluate the effect of varying proportion of Nigella sativa meal (NSM) in the diets with or without Avizyme supplementation on growing Japanese quail performance. A 4 × 2 factorial experiment was conducted including four levels of NSM (0%, 10%, 15% and 20% of the diet) and two levels of dietary Avizyme supplementation (0 or 0.5 g/kg diet) through the growing period (1–6 weeks of age). A total number of 600 unsexed 1-week-old Japanese quail chicks were randomly distributed into eight treatment groups. The effects of NSM inclusion levels were highly significant (P < 0.01) on the values of live bodyweight, daily bodyweight gain and daily feed intake at all periods studied. The incorporation of 10% NSM of the diet recorded the best values of live bodyweight and daily bodyweight gain compared with the Control and other NSM levels. Quail fed diets contained 10% or 15% NSM had higher (P < 0.01) daily feed intake than those in the Control, but feed conversion ratio was not statistically affected at all studied ages. All carcass traits studied were significantly (P < 0.01) affected by feeding the NSM diet. The digestion coefficients of dry matter, organic matter, crude protein, ether extract and nitrogen-free extract were significantly (P < 0.01 or P < 0.05) increased in chicks fed diets containing 10% NSM as compared with the Control. Quail fed diets including 10% or 15% NSM had increased serum concentrations of total protein, albumin and a higher A : G ratio. All serum lipid constituents except high density lipoprotein were at lower (P < 0.01) concentrations in blood serum of quail fed diets containing NSM. Using NSM at level of 20% of the diet had a negative impact on growth, carcass characteristics, and nutrient digestibility. Neither Avizyme supplementation alone nor the interaction between NSM and Avizyme had any statistically impact on all studied parameters. It can be concluded that NSM could be included in growing quail diets up to 15% without any Avizyme supplementation to support growth performance and feed utilisation, however higher NSM levels negatively affected performance, carcass traits and nutrient digestibility.

Methods for preparation and detection of neutron spin-orbit states

The generation and control of neutron orbital angular momentum (OAM) states and spin correlated OAM (spin-orbit) states provides a powerful probe of materials with unique penetrating abilities and magnetic sensitivity. We describe techniques to prepare and characterize neutron spin-orbit states, and provide a quantitative comparison to known procedures. The proposed detection method directly measures the correlations of spin state and transverse momentum, and overcomes the major challenges associated with neutrons, which are low flux and small spatial coherence length. Our preparation techniques, utilizing special geometries of magnetic fields, are based on coherent averaging and spatial control methods borrowed from nuclear magnetic resonance. The described procedures may be extended to other probes such as electrons and electromagnetic waves.

Effect of dietary supplementation of organic zinc on laying performance, egg quality and some biochemical parameters of laying hens

This study was conducted to evaluate the effects of zinc methionine (Zn-Met) supplementation on the performance, egg quality, antioxidant status and some biochemical parameters of blood serum in laying hens from 22 to 34 weeks of age. A total of 120 Hisex Brown laying hens of 22-week-old were randomly allocated into five treatments with six cage replicates for each (four hens/replicate). Dietary treatments consisted of the basal diet with no Zn-Met supplementation (control group) and basal diet supplemented with 25, 50, 75 or 100 mg Zn-Met/kg diet. No significant differences were observed on body weight, body weight gain or feed conversion ratio due to dietary Zn-Met supplementation. However, highly significant impact was observed on daily feed intake. Egg number, egg weight and egg mass were increased in the group fed diet supplemented with the highest level of Zn-Met (100 mg/kg of diet) as compared to other groups. All egg quality traits were statistically (p > .05 or .01) affected as a response to dietary Zn-Met supplementation except egg shape index, shell percentage and yolk index. In comparison with the control group, dietary supplementation of 25, 50, 75 or 100 mg Zn-Met/kg decreased serum triglyceride and LDL-cholesterol levels. Serum cholesterol level was increased with all dietary levels of Zn-Met in comparison with the control group. Dietary Zn-Met supplementation increased the serum content of zinc, where the highest values were recorded with 50 and 100 mg Zn-Met/kg diet. Dietary Zn-Met levels did not affect the antioxidant indices in blood serum except for the activity of copper-zinc superoxide dismutase (Cu-Zn-SOD). The activity of Cu-Zn-SOD was increased with Zn-Met supplementations with no differences among supplemental zinc levels. It is concluded that dietary Zn-Met supplementation reduced serum triglyceride, LDL-cholesterol and increased Zn status and resulted in promoting antioxidant ability of laying hens, and the addition of 100 mg Zn-Met/kg to layer diet was appropriate for improving the above parameters in addition to egg production indices and Haugh unit score.

The Etiologies and Clinical Characteristics of Patients Hospitalized with an Acute Febrile Illness and Central Nervous System Sydromes in Indonesia

Background

Acute febrile illness is a common reason for hospitalization in many developing countries, including Indonesia. While patients can often be categorized and managed based on clinical presentations, diagnostic capacity in these countries remains limited, leading to poor patient outcomes. For patients with central nervous system (CNS) infections, identifying the underlying etiologies is particularly important to prevent lifelong neurological complications and death.

Methods

As part of a study conducted at 8 top-referral hospitals across Indonesia from 2013 to 2016, 114 of 1,486 enrolled subjects presented with an acute fever and a CNS syndrome. To identify the etiologies and clinical manifestations of these infections, as well as the management of febrile patients at the hospitals, demographic and clinical data were collected at enrollment, and blood samples were collected for diagnostic testing at enrollment, once during days 14–28, and at 3 months after enrollment.

Results

Subject ages ranged from 1 to 63.2 years old (median of 4.9 years old), and underlying diseases were reported in 35 (30.7%) subjects. Standard-of-care, molecular, and serological testing identified pathogens in 56 (49.1%) cases, as detailed in the table. Of the 19 subjects who died, 18 presented with decreased consciousness and 5 were infected with Rickettsia typhi, which was clinically misdiagnosed in each case.

Conclusion

The findings from this study will improve the diagnosis and treatment of patients presenting with CNS syndromes in Indonesia. Additionally, the discovery of misdiagnosed, fatal etiologies highlights the general need for greater diagnostic testing capacity to aid clinicians and inform public health policy makers.

Disclosures

All authors: No reported disclosures.

Introducing leprosy post-exposure prophylaxis into the health systems of India, Nepal and Indonesia: a case study

Background

Leprosy has a wide range of clinical and socio-economic consequences. India, Indonesia and Nepal contribute significantly to the global leprosy burden. After integration, the health systems are pivotal in leprosy service delivery. The Leprosy Post Exposure Prophylaxis (LPEP) program is ongoing to investigate the feasibility of providing single dose rifampicin (SDR) as post-exposure prophylaxis (PEP) to the contacts of leprosy cases in various health systems. We aim to compare national leprosy control programs, and adapted LPEP strategies in India, Nepal and Indonesia. The purpose is to establish a baseline of the health system’s situation and document the subsequent adjustment of LPEP, which will provide the context for interpreting the LPEP results in future.

Methods

The study followed the multiple-case study design with single units of analysis. The data collection methods were direct observation, in-depth interviews and desk review. The study was divided into two phases, i.e. review of national leprosy programs and description of the LPEP program. The comparative analysis was performed using the WHO health system frameworks (2007).

Results

In all countries leprosy services including contact tracing is integrated into the health systems. The LPEP program is fully integrated into the established national leprosy programs, with SDR and increased documentation, which need major additions to standard procedures. PEP administration was widely perceived as well manageable, but the additional LPEP data collection was reported to increase workload in the first year.

Conclusions

The findings of our study led to the recommendation that field-based leprosy research programs should keep health systems in focus. The national leprosy programs are diverse in terms of organizational hierarchy, human resource quantity and capacity. We conclude that PEP can be integrated into different health systems without major structural and personal changes, but provisions are necessary for the additional monitoring requirements.

Electronic supplementary material

The online version of this article (10.1186/s12913-017-2611-7) contains supplementary material, which is available to authorized users.

Capacity and Utilization of Blood Culture in Two Referral Hospitals in Indonesia and Thailand

It is generally recommended that sepsis patients should have at least two blood cultures obtained before antimicrobial therapy. From 1995 to 2015, the number of blood cultures taken each year in a 1,100-bed public referral hospital in Ubon Ratchathani northeast Thailand rose from 5,235 to 56,719, whereas the number received in an 840-bed referral public hospital in South Sulawesi, Indonesia, in 2015 was 2,779. The proportion of patients sampled for blood cultures out of all inpatients in South Sulawesi in 2015 (9%; 2,779/30,593) was lower than that in Ubon Ratchathani in 2003 (13%; 8,707/66,515), at a time when health expenditure per capita in the two countries was comparable. Under-use of bacterial cultures may lead to an underestimate and underreporting of the incidence of antimicrobial-resistant infections. Raising capacity and utilization of clinical microbiology laboratories in developing countries, at least at sentinel hospitals, to monitor the antimicrobial resistance situation should be prioritized.

Neutron interferometer crystallographic imperfections and gravitationally induced quantum interference measurements

Dynamical diffraction leads to an interesting, unavoidable set of interference effects for neutron interferometers. This experiment studies the interference signal from two and three successive Bragg diffractions in the Laue geometry. We find that intrinsic Bragg-plane misalignment in monolithic, "perfect" silicon neutron interferometers is relevant between successive diffracting crystals, as well as within the Borrmann fan for typical interferometer geometries. We show that the dynamical phase correction employed in the Colella, Overhauser, and Werner gravitationally induced quantum interference experiments is attenuated by slight, intrinsic misalignments between diffracting crystals, potentially explaining the long-standing 1% discrepancy between theory and experiment. This systematic may also impact precision measurements of the silicon structure factor, affecting previous and future measurements of the Debye-Waller factor and neutron-electron scattering length as well as potential fifth-force searches. For the interferometers used in this experiment, Bragg planes of different diffracting crystals were found to be misaligned by 10 to 40 nrad.

Noise refocusing in a five-blade neutron interferometer

We provide a quantum information description of a proposed five-blade neutron interferometer geometry and show that it is robust against low-frequency mechanical vibrations and dephasing due to the dynamical phase. The extent to which the dynamical phase affects the contrast in a neutron interferometer is experimentally shown. In our model, we consider the coherent evolution of a neutron wavepacket in an interferometer crystal blade and simulate the effect of mechanical vibrations and momentum spread of the neutron through the interferometer. The standard three-blade neutron interferometer is shown to be immune to dynamical phase noise but prone to noise from mechanical vibrations, and the decoherence free subspace four-blade neutron interferometer is shown to be immune to mechanical vibration noise but prone to noise from the dynamical phase. Here, we propose a five-blade neutron interferometer and show that it is immune to both low-frequency mechanical vibration noise and dynamical phase noise.