Low-cost conventional PCR techniques enable simultaneous detection of bacterial sexually transmitted infections with enhanced sensitivity and specificity.

PURPOSE: Neisseria gonorrhoeae (NG), Chlamydia trachomatis (CT) and Mycoplasma hominis (MH), the three most common treatable bacterial sexually transmitted infections (STIs) worldwide can lead to many complications if remain untreated. Screening of high-risk population with highly sensitive methods will lead to significant improvement in patient outcomes and will prevent downward transmission. The advantages of Polymerase chain reaction (PCR) based assay are not only high sensitivity and specificity, but also detection of multiple organisms in a single reaction which reduce the result turn-around time. The aim of the present study was to evaluate the feasibility of a multiplex PCR assay method targeting 16S rRNA gene for simultaneous detection of NG, CT and MH infection along with their trend and occurrence among high-risk population in Assam, Northeast India. METHODS: A cross-sectional study was undertaken, where a total of 200 randomly selected patients from high-risk population were included. After validation of singleplex PCR, Multiplex PCR (M-PCR) was performed along with the traditional culture method for NG. RESULTS & CONCLUSION: The overall agreement of M-PCR with singleplex PCR was very high (100%). The occurrence of STI was found to be very high (101/200; 50.5%). Furthermore, co-infection was detected in 10/200; 5%) individuals. Infection was more common among young individuals (p < 0.05) and males out-numbered females (p < 0.05). The most common organism detected was CT (42/200; 21%) followed by NG (41/200; 20.5%) and MH (20/200; 10%). The M-PCR assay workflow is simple, cost effective and can be used in routine diagnostic laboratories with basic molecular facilities.

Synthesis of α,α-Difluoro-ß-amino Ketones from N-Boc-α-Amidosulfones and Pentafluoro-gem-diols.

To circumvent the synthesis and isolation of imines, a method was devised to construct α,α-difluoro-ß-amino ketones from N-Boc-α-amidosulfones. The reactive nucleophiles, difluoroenolates, are generated in situ from the pentafluoro-gem-diols using cesium fluoride in pyridine. NMR studies confirm the role of the α-amidosulfones in this process. Incubation of the α,α-difluoro-ß-amino ketones in rat serum demonstrates the relative stability of this structure as well as its value as a chemical probe or lead.

Malaria outbreak along the India-Bhutan border town of Saralpara, Assam, India.

BACKGROUND & OBJECTIVES: A remarkable progress is being made in the South-East Asia region in reducing the burden of malaria. While all countries are committed to malaria elimination, continued transmission at and across international borders poses a threat to achieving this goal. METHODS: We investigated an outbreak of malaria in the India-Bhutan border area in a district of Assam state, India. A line listing of cases occurring during the outbreak period was made and a house-to-house survey was carried out to identify additional cases in the community. Entomological investigation consisted of light trap collection of vectors. Patients and health workers were interviewed to obtain information on the possible mode of transmission and ongoing inter-country collaboration across the border. RESULTS: Between October 21 to November 18 2022, 37 cases of malaria (all Plasmodium vivax), were diagnosed in Saralpara area of Kokrajhar district of Assam, bordering Bhutan. Of these four were diagnosed in Sarpang hospital, Bhutan. Median age was 20 years (range 3 to 70 years). Male to female ratio was 1:1.2. In addition, 6 individuals with asymptomatic malaria were detected in the community through an active case finding campaign. No cases were however reported on Bhutan side of the border. Anopheles culicifacies and An. annularis were identified from light trap collection. Saralpara is a remote and forested area where most of the residents are poor and engaged predominantly in farming activities. Being a harvesting season, they tend to stay overnight to protect their harvest from elephants. The health authorities in India and Bhutan exchanged information regularly at district-to-district level on the outbreak including through available and easy modes such as WhatsApp, telephone as well as electronic mail and collaborated in coherently implementing preventive measures on both sides and in managing the cases. INTERPRETATION & CONCLUSION: The outbreak of malaria in Saralpara demonstrates the risk of malaria outbreak in remote and forested areas, with possibility of spill over to the other side of the border. The fact that two countries had excellent inter-country cross-border collaboration and prior commitment thereby preventing further transmission of malaria to Bhutan can serve as a best practice for cross-border control of malaria and other communicable diseases.

Transient Formation of Hemiketals from Pentafluoro-gem-diols in the Presence of Alcohols.

Pentafluoro-gem-diols have emerged as a source of reactive intermediates for synthesizing fluorinated molecules. When pentafluoro-gem-diols were exposed to alcohols as solvents, the formation of transient hemiketals was detected by 19F NMR. The conversion rates to hemiketals were found to be higher with primary alcohols than with secondary or fluorinated alcohols. These findings provide valuable insight for developing novel techniques to construct intricate fluorinated structures using pentafluoro-gem-diols.

Generation of formaldehyde and formaldehyde-d2 for hydroxymethylations and hydroxydeuteromethylations of difluoroenolates and difluorobenzyl carbanions.

A method for the in situ production of formaldehyde from dimethylsulfoxide, bromine, and cesium carbonate is reported for reactions with difluoroenolates and difluorobenzyl carbanions. This process also generates formaldehyde-d2 for the production of 2,2-difluoro-1,1-deuteroethanols. Mechanistic and computational studies further characterize the production of hydroxymethylated and hydroxydeuteromethylated difluorinated organic molecules.

Abdominal tuberculosis and spontaneous miscarriage.

We present a case report of a 23-year-old Pakistani woman who had a second trimester spontaneous miscarriage while visiting her family in the Kingdom of Saudi Arabia. A dilatation and curettage (D&C) was done after the miscarriage. She developed sepsis and acute respiratory distress syndrome, requiring intensive care unit admission a few days after the D&C. An exploratory laparotomy was done and she was found to have a pelvic abscess. Despite adequate broad spectrum antimicrobial cover, she continued to drain a copious amount of serous fluid from the peritoneal cavity, with persistent fever and a stiff lung with difficult weaning off mechanical ventilation. Tuberculosis PCR of the peritoneal fluid came back positive. A histological finding of necrotising granuloma from the postoperative omental specimen and a positive culture from the ascitic fluid confirmed the diagnosis of Mycobacterium tuberculosis Antituberculous treatment was started and she made a speedy recovery.

Difference between continuous positive airway pressure via mask therapy and incentive spirometry to treat or prevent post-surgical atelectasis.

OBJECTIVE: To assess the effect of early use of continuous positive airway pressure (CPAP) therapy to treat or prevent acute atelectasis in post-operative cardiac patients particularly smokers and elderly patients. METHODS: A pilot study suggested enrolling at least 32 participants in each group to be significant. One hundred and eight patients from King Fahd Armed Forces Hospital, Jeddah, Kingdom of Saudi Arabia who met the inclusion criteria participated in this study conducted between March 2010 and March 2011. The participants were divided randomly into 3 groups, incentive spirometry (IS) therapy, and CPAP therapy every 2 (CPAP 2 hrs), or 4 hours (CPAP 4 hrs). Inspiratory capacity (IC) was used to compare the 3 therapy regimes. Simultaneously, respiratory rate (RR), heart rate (HR) and oxygen saturation (SpO2) were measured for all groups. Failure was defined as requiring intubation, bi-level positive airway pressure, or added chest physiotherapy. RESULTS: Thirty-six patients participated in each group (98 male and 10 female, with a mean age of 62+/-9.3 years). The IC increased significantly in the CPAP 2 hrs group when compared with the control group or the CPAP 4hrs group. The SpO2 decreased significantly in the control group and the CPAP 4 hrs groups when compared with the CPAP 2 hrs group. Also, there were no significant differences in RR and HR between all groups. CONCLUSION: Early use of CPAP via mask therapy for half an hour every 2 hours had better outcomes to re-open collapsed alveoli after cardiac surgery.

Guanylyl cyclases, nitric oxide, natriuretic peptides, and airway smooth muscle function.

Airway smooth muscle (ASM) plays an important role in asthma pathophysiology through its contractile and proliferative functions. The cyclic nucleotides adenosine 3',5'-cyclic monophosphate (cAMP) and guanosine 3',5'-cyclic monophosphate (cGMP) are second messengers capable of mediating the effects of a variety of drugs and hormones. There is a large body of evidence to support the hypothesis that cAMP is a mediator of the ASM's relaxant effects of drugs, such as beta2-adrenoceptor agonists, in human airways. Although most attention has been paid to this second messenger and the signal transduction pathways it activates, recent evidence suggests that cGMP is also an important second messenger in ASM with important relaxant and antiproliferative effects. Here, we review the regulation and function of cGMP in ASM and discuss the implications for asthma pathophysiology and therapeutics. Recent studies suggest that activators of soluble and particulate guanylyl cyclases, such as nitric oxide donors and natriuretic peptides, have both relaxant and antiproliferative effects that are mediated through cGMP-dependent and cGMP-independent pathways. Abnormalities in these pathways may contribute to asthma pathophysiology, and therapeutic manipulation may complement the effects of beta2-adrenoceptor agonists.