BackgroundThe absence of rapid tests evaluating antibiotic susceptibility results in the empirical prescription of antibiotics. This can lead to treatment failures due to escalating antibiotic resistance, and also furthers the emergence of drug-resistant bacteria. This study reports a rapid optical method to detect β-lactamase and thereby assess activity of β-lactam antibiotics, which could provide an approach for targeted prescription of antibiotics. The methodology is centred on a fluorescence quenching based probe (β-LEAF – β-Lactamase Enzyme Activated Fluorophore) that mimics the structure of β-lactam antibiotics.ResultsThe β-LEAF assay was performed for rapid determination of β-lactamase production and activity of β-lactam antibiotic (cefazolin) on a panel of Staphylococcus aureus ATCC strains and clinical isolates. Four of the clinical isolates were determined to be lactamase producers, with the capacity to inactivate cefazolin, out of the twenty-five isolates tested. These results were compared against gold standard methods, nitrocefin disk test for β-lactamase detection and disk diffusion for antibiotic susceptibility, showing results to be largely consistent. Furthermore, in the sub-set of β-lactamase producers, it was demonstrated and validated that multiple antibiotics (cefazolin, cefoxitin, cefepime) could be assessed simultaneously to predict the antibiotic that would be most active for a given bacterial isolate.ConclusionsThe study establishes the rapid β-LEAF assay for β-lactamase detection and prediction of antibiotic activity using S. aureus clinical isolates. Although the focus in the current study is β-lactamase-based resistance, the overall approach represents a broad diagnostic platform. In the long-term, these studies form the basis for the development of assays utilizing a broader variety of targets, pathogens and drugs.

Objective:Gestational diabetes mellitus (GDM) is defined as any degree of glucose intolerance that is diagnosed for the first time during pregnancy. This prospective study was undertaken to validate the single-step non-fasting 75 gm Diabetes in Pregnancy Study Group of India (DIPSI) criteria of GDM in Indian patients in comparison with the two-step fasting 100 gm glucose challenge through the Carpenter Coustan criteria (CCC).Materials and Methods:Two hundred patients underwent comparative testing using the DIPSI criteria and CCC. Plasma venous blood glucose levels were estimated using the hexokinase method; values ≥140 mg/dL at 2 hours were considered positive according to the DIPSI criteria. Any two values from ≥95 mg/dL for fasting, ≥180 mg/dL at 1 hour, ≥155 mg/dL at 2 hours, and ≥140 mg/dL at 3 hours were considered positive with the CCC.Results:The mean age and body mass index were 24.26±3.75 years and 20.7±3.07 kg/m2. The sensitivity, specificity, and positive and negative predictive values of the DIPSI guidelines were found as 100%, 97.14%, 83.87%, and 100%, respectively. The positive and negative likelihood ratios were 35.8 and zero. Diagnostic accuracy was found as 97.56%.Conclusion:DIPSI having high sensitivity, specificity, negative predictive value and diagnostic accuracy. DIPSI offers simplicity, feasibility, convenience, and repeatability while economizing universal screening and diagnosis of GDM on a mass-scale. The DIPSI procedure has the potential to be applied to the entire obstetric population, in the implementation of public health programs to diagnose GDM in the community, thus reaching the needs of the developing world.

Antibiotic resistance (AR) is increasingly prevalent in low and middle income countries (LMICs), but the extent of the problem is poorly understood. This lack of knowledge is a critical deficiency, leaving local health authorities essentially blind to AR outbreaks and crippling their ability to provide effective treatment guidelines. The crux of the problem is the lack of microbiology laboratory capacity available in LMICs. To address this unmet need, we demonstrate a rapid and simple test of β -lactamase resistance (the most common form of AR) that uses a modified β -lactam structure decorated with two fluorophores quenched due to their close proximity. When the β -lactam core is cleaved by β -lactamase, the fluorophores dequench, allowing assay speeds of 20 min to be obtained with a simple, streamlined protocol. Furthermore, by testing in competition with antibiotics, the β -lactamase-associated antibiotic susceptibility can also be extracted. This assay can be easily implemented into standard lab work flows to provide near real-time information of β -lactamase resistance, both for epidemiological purposes as well as individualized patient care.

IntroductionHajj is an annual mass gathering of over 3.5 million pilgrims from 200 countries who congregate in densities of 9 people/ m2 and endure strenuous rituals, compromised living standards, and a harsh desert climate in an alien ethnocultural and sociolinguist milieu for spiritual enlightenment. Mass gathering medicine at Hajj is challenged by issues of healthcare accessibility, infection control, on-site treatment, referral, evacuation, and response to disasters and public health emergencies in addition to challenges to providing support such as shelter, food and water, transportation, mass communication, interpersonal communication, sanitation, overcrowding, and human security. 1,2Hajj has historically experienced high morbidity and mortality owing to pre-existing comorbidities, outbreaks, accidents, and disasters such as such as stampedes, fires, AbstractIntroduction: Hajj is an annual mass gathering of over 3.5 million pilgrims congregating from 200 countries in the desert climate of Saudi Arabia. Mass gathering medicine at Hajj is challenged by issues of healthcare accessibility, infection control, on-site treatment, referral, evacuation, and response to disasters and public health emergencies. The Indian Medical Mission at Hajj 2016 established, operated, and coordinated a strategic network of mass gathering medical operations, the proceeds of which are discussed herein. Methods:The mission was designed to provide holistic health security through health intelligence for pre-existing chronic diseases, epidemic intelligence for endemic and exotic diseases, public-health and disaster-health preparedness, and tiered healthcare through mobile medical task forces, static clinics, tent clinics, secondary care hospitals, and evacuation capabilities. Results: Primary care, secondary care, and tertiary care treated 374 475, 930, and 523 patients, respectively. Patients exhibited limited compliance with pre-instituted treatments and precautionary protocols. Respiratory and gastrointestinal infections, cardiorespiratory, trauma, and heat illnesses were seen. Epidemic intelligence revealed an outbreak of food poisoning. Respiratory infections were reported by 90% of the healthcare personnel. Surge capacity was overwhelmed with patient throughput and ambulance transfers. Crude unadjusted mortality was 11.99/10 000. Conclusion:The Indian Medical Mission at Hajj 2016 yielded solutions to the challenges faced during the 2016 Hajj pilgrimage. The mission posture of the Indian Medical Mission in Hajj presents a modus operandi for handling crisis scenarios in mass gathering. The situational analysis of the Hajj health mission calls for dynamic interventions in preparedness, clientele, and health systems.