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To celebrate the birthdays of Asterix and Obelix, the village develops an elaborate celebration with games, plays, and artworks of the two warriors, and invite their enemies, the Romans, as a sign of good faith.

Background Persistent elevation of aspartate aminotransferase (AST) is commonly indicative of liver injury or disease, but isolated AST elevation without concurrent alanine aminotransferase (ALT) increase is rare and difficult to diagnose. While AST is non‐specific and found in various tissues, its isolated elevation is due to less common conditions, such as macro‐AST, where AST binds with immunoglobulins creating a high‐molecular‐weight complex that affects serum activity. Case Description A 68‐year‐old female with a history of high‐grade serous ovarian cancer (HGSOC) who had persistent isolated AST elevation for several years. Evaluations including physical exams, imaging, and routine liver function tests showed no evidence of hepatic or muscular disease. The polyethylene glycol (PEG) precipitation significantly reduced serum AST activity, confirming the presence of the macro‐enzyme form of AST (macro‐AST). Conclusion This case highlights the rare and novel occurrence of macro‐AST in a patient with ovarian cancer. It emphasizes the importance of considering macro‐AST in the differential diagnosis of isolated AST elevation, particularly in patients without clear evidence of liver or muscular disease. Recognizing this benign condition can prevent unnecessary diagnostic procedures and anxiety.

Background: Background: Dengue virus infection is a major public health concern in tropical regions and is frequently associated with hepatic involvement. Liver dysfunction ranging from mild transaminase elevation to severe hepatic injury has been reported in dengue patients. Objective: To assess the clinical significance of liver function tests abnormalities in adult patients with dengue virus infection Methods: This was across-sectional study undertaken at the Department of Medicine, Mardan Medical Complex (MMC), Mardan, from January 2022 to December 2023. A total of 200 participants were included, comprising 88 laboratory confirmed dengue patients and 112 healthy controls. Dengue infection was confirmed using dengue IgM enzyme linked immunosorbent assay (ELISA). Venous blood samples were collected and analyzed for liver function parameters, including serum bilirubin, alanine aminotransferase (ALT), aspartate aminotransferase (AST), alkaline phosphatase (ALP) and serum albumin, using standardized automated methods. Patients with chronic liver disease, alcohol use, hepatotoxic drugs exposure, Nephrotic syndrome or other confounding conditions were excluded. Data was analyzed using SPSS version 26, applying the independent t-test, with a p value <0.05. Results: Of the 88 patients examined, 62(70.45%) were male and 26 (29.54%) were females. The patients' ages ranged from 18 to 60 years, with a mean age of 37.69 years. Most of the dengue patients were males. The highest number of dengue cases were reported among those aged between 31 to 45 years. Compare control group, LFT’s of the dengue patients showed significant elevation of S Bilirubin, ALT, AST and significantly lower level of S albumin (p <0.05)...  

PurposeThis study compared the results of the new Sysmex PA-100 AST System, a point-of-care analyser, with routine microbiology for the detection of urinary tract infections (UTI) and performance of antimicrobial susceptibility tests (AST) directly from urine.MethodsNative urine samples from 278 female patients with suspected uncomplicated UTI were tested in the Sysmex PA-100 and with reference methods of routine microbiology: urine culture for bacteriuria and disc diffusion for AST.ResultsThe analyser delivered bacteriuria results in 15 min and AST results within 45 min. Sensitivity and specificity for detection of microbiologically confirmed bacteriuria were 84.0% (89/106; 95% CI: 75.6–90.4%) and 99.4% (155/156; 95% CI: 96.5–100%), respectively, for bacterial species within the analyser specifications. These are Escherichia coli, Klebsiella pneumoniae, Proteus mirabilis, Enterococcus faecalis and Staphylococcus saprophyticus, which are common species causing uncomplicated UTI. Overall categorical agreement (OCA) for AST results for the five antimicrobials tested in the Sysmex PA-100 (amoxicillin/clavulanic acid, ciprofloxacin, fosfomycin, nitrofurantoin and trimethoprim) ranged from 85.4% (70/82; 95%CI: 75.9–92.2%) for ciprofloxacin to 96.4% (81/84; 95% CI: 89.9–99.3%) for trimethoprim. The Sysmex PA-100 provided an optimal treatment recommendation in 218/278 cases (78.4%), against 162/278 (58.3%) of clinical decisions.ConclusionThis first clinical evaluation of the Sysmex PA-100 in a near-patient setting demonstrated that the analyser delivers phenotypic AST results within 45 min, which could enable rapid initiation of the correct targeted treatment with no further adjustment needed. The Sysmex PA-100 has the potential to significantly reduce ineffective or unnecessary antibiotic prescription in patients with UTI symptoms.

Fast, robust, and affordable antimicrobial susceptibility testing (AST) is required, as roughly 50% of antibiotic treatments are started with wrong antibiotics and without a proper diagnosis of the pathogen. Validated growth-based AST according to EUCAST or CLSI (European Committee on Antimicrobial Susceptibility Testing, Clinical Laboratory Standards Institute) recommendations is currently suggested to guide the antimicrobial therapy. Any new AST should be validated against these standard methods. Many rapid diagnostic techniques can already provide pathogen identification. Some of them can additionally detect the presence of resistance genes or resistance proteins, but usually isolated pure cultures are needed for AST. We discuss the value of the technologies applying nucleic acid amplification, whole genome sequencing, and hybridization as well as immunodiagnostic and mass spectrometry-based methods and biosensor-based AST. Additionally, we evaluate the potential of integrated systems applying microfluidics to integrate cultivation, lysis, purification, and signal reading steps. We discuss technologies and commercial products with potential for Point-of-Care Testing (POCT) and their capability to analyze polymicrobial samples without pre-purification steps. The purpose of this critical review is to present the needs and drivers for AST development, to show the benefits and limitations of AST methods, to introduce promising new POCT-compatible technologies, and to discuss AST technologies that are likely to thrive in the future.

The emergence and spread of antibiotic-resistant bacteria are aggravated by incorrect prescription and use of antibiotics. A core problem is that there is no sufficiently fast diagnostic test to guide correct antibiotic prescription at the point of care. Here, we investigate if it is possible to develop a point-of-care susceptibility test for urinary tract infection, a disease that 100 million women suffer from annually and that exhibits widespread antibiotic resistance. We capture bacterial cells directly from samples with low bacterial counts (10⁴ cfu/mL) using a custom-designed microfluidic chip and monitor their individual growth rates using microscopy. By averaging the growth rate response to an antibiotic over many individual cells, we can push the detection time to the biological response time of the bacteria. We find that it is possible to detect changes in growth rate in response to each of nine antibiotics that are used to treat urinary tract infections in minutes. In a test of 49 clinical uropathogenic Escherichia coli (UPEC) isolates, all were correctly classified as susceptible or resistant to ciprofloxacin in less than 10 min. The total time for antibiotic susceptibility testing, from loading of sample to diagnostic readout, is less than 30 min, which allows the development of a point-of-care test that can guide correct treatment of urinary tract infection.

Objective This study aimed to evaluate the clinical and prognostic value of various inflammatory and metabolic indices in identifying of early-onset (EO-PE) and late-onset preeclampsia (LO-PE) and in predicting composite adverse maternal outcomes (CAMO), composite adverse perinatal outcomes (CANO), and disease severity. Methods This retrospective cohort study included 625 singleton pregnant women followed at a tertiary center between January 1, 2023, and January 1, 2025. The study group comprised 320 preeclamptic women (170 EO-PE < 34 weeks, 150 LO-PE ≥ 34 weeks), while 305 gestational age-matched healthy pregnancies served as controls (155 early controls, 150 late controls). Preeclampsia cases were further classified into 155 severe and 165 mild cases. The indices analyzed included uric acid/albumin ratio (UA/Alb), fibrinogen/uric acid ratio (Fib/UA), uric acid/creatinine ratio (UA/Cr), creatinine/body weight ratio (Cr/BW), AST/platelet ratio (AST/PLT), AST/ALT ratio, and fibrosis indices (FIB-4 and FIB-5). Composite adverse maternal outcomes (CAMO) include the presence of at least one of the following maternal outcomes: thrombocytopenia, renal dysfunction, hepatic dysfunction, HELLP syndrome (hemolysis, elevated liver enzymes, low platelet count), disseminated intravascular coagulation (DIC), pulmonary edema, eclampsia, and admission to the maternal intensive care unit (ICU). Composite adverse neonatal outcomes (CANO) include the presence of at least one of the following adverse outcomes: transient tachypnea of the newborn, respiratory distress syndrome, need for continuous positive airway pressure, need for mechanical ventilation, need for phototherapy, neonatal hypoglycemia, intraventricular hemorrhage, necrotizing enterocolitis, neonatal sepsis, 5th minute APGAR score < 7, neonatal intensive care unit (NICU) admission, placental abruption, and preterm birth. Results The UA/Alb ratio and Fib/UA ratio were the most strongly associated with EO-PE and LO-PE, with high discriminative accuracy (AUC = 0.831 and 0.888, respectively). These indices also showed strong associations with CAMO, CANO, and disease severity. In contrast, the AST/ALT ratio was not significantly associated with PE discrimination, severity, CAMO, or CANO. The AST/PLT ratio and FIB-4 were significantly associated with both EO-PE and LO-PE, while FIB-5 was only associated with EO-PE. Both FIB-4 and FIB-5 were significantly linked to CAMO and CANO in EO-PE cases, but not in LO-PE. Both indices were also associated with severe preeclampsia. Although the Cr/BW ratio was associated with disease severity, it showed limited value in distinguishing EO-PE or LO-PE from the control group and was only related to CAMO and CANO in EO-PE. Conclusion Our study identified UA/Alb and Fib/UA ratios as the most informative indices for classifying EO-PE and LO-PE, assessing CAMO and CANO risk, and evaluating disease severity. The high AUC values support their potential clinical applicability. Conversely, the AST/ALT ratio was not significantly associated with preeclampsia diagnosis, disease severity, differentiation of CAMO or CANO.

Antimicrobial resistance (AMR) represents a substantial threat to global public health, complicating the treatment of common infections and leading to prolonged illness and escalated healthcare expenses. To effectively combat AMR, timely and accurate detection is crucial for AMR surveillance and individual-based therapy. Phenotypic antibiotic resistance testing (AST) has long been considered the gold standard in clinical applications, serving as the foundation for clinical AMR diagnosis and optimized therapy. It has significantly contributed to ensuring patients’ health and the development of novel antimicrobials. Despite advancements in automated culture-based AST technologies, inherent limitations impede the widespread use of phenotypic AST in AMR surveillance. Genotypic AST technologies offer a promising alternative option, exhibiting advantages of rapidity, high sensitivity, and specificity. With the continuous advancement and expanding applications of genotypic AST technologies, such as microfluidics, mass spectrometry, and high-resolution melting curve analysis, new vigor has been injected into the development and clinical implementation of genotypic AST technologies. In this narrative review, we discuss the principles, applications, and advancements of emerging genotypic AST methods in clinical settings. The comprehensive review aims to highlight the significant scientific potential of emerging genotypic AST technologies in clinical AMR diagnosis, providing insights to enhance existing methods and explore novel approaches.

Objective: This research was designed to examine the impact of vitamin C on valproic acid-induced hepatotoxicity.Methods: Male rabbits were separated into three groups, each with five animals. Control group: no treatment was provided. The valproic acid group received a dose of 400 mg/kg, while the valproic acid with vitamin C group received 400 mg/kg/day plus 10 mg/kg of vitamin C.Results: The results showed the extent of the effect of valproic acid alone and with vitamin C alone on the levels of the liver enzymes AST (aspartate aminotransferase) and ALT (alanine aminotransferase) compared to the control group. The results of the AST levels showed a significant increase in the valproic acid group compared with the rest of the groups, while the group treated with vitamin C with valproic acid showed a significant decrease compared with the valproic acid group alone. Microscopic examination of liver tissue from the valproic group exhibited serious vacuolar degeneration with necrosis of hepatocytes, inflammatory cell infiltration in the portal area, recent thrombus, and congestion of the central vein. Liver samples from the valproic group displayed mild vacuolar degeneration of hepatocytes. Liver sections from the valproic + Vitamin C group showed a restoration of normal hepatocyte architecture.Conclusion: Vitamin C can lessen the harmful oxidative effects of valproic acid in liver cells by acting as an antioxidant agent.

With the increase in antimicrobial resistance, fast reporting of antimicrobial susceptibility testing (AST) results is becoming increasingly important. EUCAST developed a method for rapid AST (RAST) directly from the broth of positive blood cultures (BC). Inhibition zones are read after 4, 6, and 8 h, with specific breakpoints per time point. We evaluated the RAST method based on EUCAST disk diffusion methodology with inoculation of BC broth using WASPLab ® (inclusive Colibrí ™ and Radian ® ). Forty-nine non-duplicate strains were tested: Escherichia coli n  = 17, Klebsiella pneumoniae n  = 7, Pseudomonas aeruginosa n  = 4, Acinetobacter baumannii n  = 2, Staphylococcus aureus n  = 10, Enterococcus faecalis n  = 6, and Enterococcus faecium n  = 3. Results were compared to direct AST and standardized AST. Good categorical agreement was obtained at all time points for all groups, except P. aeruginosa . RAST cut-offs for extended-spectrum β-lactamase (ESBL)-producing Enterobacterales enabled the detection of all included ESBL isolates ( n  = 5) at all time points, except for 1 E. coli ESBL after 4 h. RAST cut-offs for carbapenemase-producing Enterobacterales enabled the detection of only one carbapenemase after 6 h. However, all carbapenemases ( n  = 3) were correctly detected after 8 h. Two methicillin-resistant S. aureus were included; both were correctly categorized as cefoxitin-resistant at 6 and 8 h. At 4 h, there was insufficient growth for inhibition zone interpretation. EUCAST RAST is a fast supplementary tool for direct AST of positive BC. WASPLab ® provides a significant advantage as pictures are made automatically implicating that we are not strictly bound to the time points for inhibition zone interpretation.