Resource-limited Settings Research Articles

Filter Membrane-Based Colorimetric Approach for Point-of-Care Detection of Biomarkers Using CRISPR-Cas12a.

CRISPR-Cas-based point-of-care testing (POCT) strategies have been widely explored for the detection of diverse biomarkers. However, these methods often require complicated operations, such as careful solution transfer steps, to achieve high sensitivity and accuracy. In this study, we combine a filter membrane-based POCT method with CRISPR-Cas12a for colorimetric detection of biomarkers. For the nucleic acid target, the trans-cleavage activity of CRISPR-Cas12a is directly triggered, cutting the single-stranded DNA linkers on glucose oxidase (GOx)-modified polymer nanoparticles. Due to the size difference between GOx and the polymer nanoparticles, GOx can be separated using a filter membrane. The filtrate containing GOx reacts with the substrate to generate a colorimetric signal. For the non-nucleic acid target, the non-nucleic acid signal is converted into a nucleic acid signal that activates CRISPR-Cas12a, resulting in a colorimetric signal. The entire operation is easy to perform, and the signal can be directly observed via the naked eye, which circumvents the use of costly instruments. The developed strategy holds great promise for accurate and accessible POCT detection of disease biomarkers in resource-limited settings.

Integrated Psychiatric and surgical care in managing self-inflicted abdominal trauma: A case report in a resource-limited setting

Introduction and Importance: Self-inflicted abdominal stab wounds present rare yet critical challenges requiring urgent surgical intervention and comprehensive psychiatric evaluation. Such injuries often correlate with psychiatric disorders like schizophrenia and alcohol dependence, posing significant clinical and psychological management hurdles. Case Presentation: A 36-year-old male with a history of chronic alcohol use and schizophrenia presented with a self-inflicted stab wound to the abdomen following auditory hallucinations. Upon admission, he was hemodynamically unstable, with eviscerated bowel loops and a lacerated greater omentum. Prompt surgical exploration revealed extensive abdominal trauma necessitating meticulous repair and intensive postoperative care. Clinical Discussion: The case highlights the intricate interplay between severe psychiatric illness and self-harm, exacerbated by alcohol intoxication. Integrated psychiatric and surgical care proved pivotal in achieving stabilization and facilitating recovery. The challenges encountered in a resource-limited setting included a lack of advanced imaging modalities, limited access to specialized psychiatric care, and constraints in postoperative monitoring equipment, underscoring the importance of adaptive management strategies. Conclusion: This report emphasizes the critical need for a multidisciplinary approach in managing self-inflicted abdominal injuries. The successful outcome underscores the efficacy of timely surgical intervention and comprehensive psychiatric support. Integrated care models are essential for addressing the complex needs of patients with psychiatric comorbidities, ensuring holistic management and reducing the risk of recurrence in similar cases.

Integration and Characterization of Synthetic Biodegradable Polymer (PVA) with Graphite Oxide (GO) for Performance Assessment in Sustainable Electrochemical Devices

AbstractIn recent years, the demand for sustainable materials in electrochemical devices has driven the exploration of innovative composites. This study focuses on the integration and characterization of synthetic biodegradable polymer polyvinyl alcohol (PVA) with graphite oxide (GO) to evaluate their performance in sustainable electrochemical applications. PVA, known for its biodegradability and biocompatibility, was combined with GO to leverage its excellent electrical conductivity and large surface area. Microbial fuel cells (MFCs) represent a promising electrochemical biosynthesis technology that harnesses the enzymatic activities using microbes to produce energy from organic substrates. This renewable energy approach relies on the synergistic interaction between electrochemically active bacteria and electrode materials to facilitate electron transfer and power generation. Applications of MFCs range from wastewater treatment to sustainable power generation in remote or resource-limited settings. This study explores recent advances in MFC technology, challenges in scaling up for practical applications, and prospects for integrating MFCs into renewable energy strategies. The nano composite membrane was evaluated for structural, morphological, crystalline, and thermal properties by using Fourier Transform Infrared Spectroscopic (FTIR), Scanning Electron Microscopy (SEM), X-Ray Diffraction (XRD), and UV- visible spectroscopy. Additionally, the biodegradability of the composite was assessed, confirming that it maintains its environmental benefits while offering improved performance for potential applications in sustainable energy storage and conversion devices. This work provides a promising avenue for the development of eco-friendly electrochemical devices with optimized performance characteristics.

Special Collection: Implementation Research Evidence for Prevention and Treatment of Postpartum Hemorrhage in High-Burden Low- and Middle-Income Countries

Postpartum hemorrhage (PPH), defined as a blood loss of 500 mL or more within 24 hours after birth, remains the leading cause of maternal mortality globally, accounting for over 20% of all maternal deaths. The burden of mortality from PPH is predominantly in low- and middle-income countries and demands coordinated accelerated efforts from the global maternal health community to meet the Sustainable Development 3 maternal health target by 2030. The International Journal of Maternal and Child Health and AIDS and the Concept Foundation are proud to present this Special Collection demonstrating the evidence for introducing heat-stable carbetocin and tranexamic acid, showcasing the feasibility and acceptability of their utilization for PPH prevention and management in resource-limited high-burden settings.

Postpartum Hemorrhage in Humanitarian Settings: Implementation Insights from Using Heat-Stable Carbetocin and Tranexamic Acid

Background and Objective Maternal mortality, largely due to postpartum hemorrhage (PPH), remains high in resource-limited and crisis-affected settings, where heat-stable carbetocin (HSC) and tranexamic acid (TXA) offer promise for PPH prevention and treatment but lack evidence. This study, implemented in basic maternity facilities within humanitarian settings, explores healthcare providers’ perspectives on an HSC and TXA-inclusive PPH intervention package and related operational challenges and facilitators. Methods Based on semi-structured interview guides and using thematic analysis, this qualitative research, through 13 focus group discussions and individual interviews, investigated the perspectives of 64 healthcare staff (mostly midwives) from eight basic emergency obstetric care facilities in South Sudanese and Ugandan settings hosting large numbers of forcibly displaced populations. The PPH intervention package comprised refresher training, an online provider community, PPH readiness kits, alarm bells, and displayed algorithms. Results Findings from both countries converged, highlighting providers’ positive views on HSC and TXA. HSC effectiveness in preventing bleeding was acknowledged, bolstering staff’s confidence in its use. TXA was perceived as effective although providers reported having less experience with it due to the limited number of PPH cases. Enabling factors included the ease of administration, practical training, endorsement by national and local authorities, and the absence of a cold chain requirement. Appreciation was given to the WhatsApp community of practice as it facilitated knowledge exchange, quality improvement projects that enhanced PPH diagnosis, and innovative tools like wall clocks to record the timing of clinical actions and bells to call for assistance. Challenges included confusion between new and existing medications and record systems that inadequately capture HSC, TXA, and other PPH indicators. Conclusion and Global Health Implications HSC and TXA integrated into a PPH intervention package were overall positively valued by providers in humanitarian settings. Continued education and support are crucial. Addressing challenges like medication confusion underscores the need for ongoing education and clear guidelines for the use of HSC, TXA, oxytocin, and other drugs for PPH prevention and treatment. Our findings stress the importance of a comprehensive strategy to overcome health system barriers in PPH management, potentially improving maternal health outcomes in resource-limited and fragile contexts, with broader global implications.

A lifesaving improvised peritoneal dialysis on a toddler with acute kidney injury following a swarm of bees’ sting at Iringa Regional Referral Hospital, Southern Highland—Tanzania: a case report

BackgroundPeritoneal dialysis as one of the nephrology services in children with acute kidney injury is a safe and cost-effective modality of treatment in low and lower-middle income countries. Despite evidence of its effectiveness in limited resource settings, the service is still provided only in tertiary level healthcare facilities in Tanzania.Case presentationIn this case report, we narrate the survival of a 22-month-old male patient of African descent with an acute kidney injury following a swarm of bees’ stings at home. A lifesaving, although low-quality and high-risk, peritoneal dialysis was performed for 5 days at Iringa Regional Referral Hospital, a secondary level health facility in rural Tanzania with lack of standard and recommended expertise, laboratory investigations, and equipment.ConclusionLower- and middle-income countries in collaboration with stake holders should ensure that this service is available, accessible, and safe in the lower-level health facilities, given that access to the tertiary-level facilities is inadequate and time limited, hence serving a larger population.

Incidence and Management of Pseudocysts in Patients With Ventriculoperitoneal Shunts: A Study in Pakistan.

Ventriculoperitoneal (VP) shunts are a common medical intervention used to treat hydrocephalus, a condition characterized by the accumulation of cerebrospinal fluid (CSF) in the brain's ventricles, leading to increased intracranial pressure. While VP shunts are effective in managing hydrocephalus, they can lead to complications such as the formation of abdominal pseudocysts, which can compromise the functionality of the shunt and pose significant health risks. The primary objective of this study was to determine the incidence of pseudocyst formation in patients with VP shunts in Pakistan. The secondary objective was to evaluate the outcomes of conservative versus surgical management strategies and identify risk factors associated with pseudocyst recurrence in this population. This prospective observational study was conducted at Jinnah Teaching Hospital, Pakistan, from January 2021 to December 2022. The study included 50 patients diagnosed with pseudocysts associated with VP shunts. Participants were managed with either conservative (observation and aspiration) or surgical interventions (shunt revision, relocation, removal, or pseudocyst excision). The primary outcome measures were the resolution rates of pseudocysts and the incidence of complications. Statistical analysis was performed using chi-square tests, t-tests, and Kaplan-Meier survival analysis, with significance set at p<0.05. The study found a 3.5% incidence of pseudocysts among 1400 VP shunt patients. The median time to pseudocyst formation was 22 months (IQR 18-30). Surgical management yielded an 85% resolution rate compared to 60% for conservative management (p = 0.02). The recurrence of pseudocysts was significantly associated with advanced age (HR 1.8, 95% CI 1.1-3.2), a higher BMI (HR 2.1, 95% CI 1.3-3.7), and the presence of hydrocephalus (HR 1.6, 95% CI 1.2-2.9). Although surgical interventions had a higher complication rate (14% vs. 6% for conservative management), the difference was not statistically significant (p = 0.1). The study highlights a 3.5% incidence of pseudocysts in VP shunt patients, with surgical management proving more effective than conservative methods despite a slightly higher, non-significant risk of complications. These findings underscore the importance of tailored patient management, particularly for those at higher risk of recurrence, and suggest the need for further research to enhance surgical techniques and outcomes, especially in resource-limited settings.

Comparative Analysis of Musculoskeletal Ultrasonography Versus MRI in Diagnosing Shoulder Injuries

This study aimed to compare the diagnostic accuracy and cost-effectiveness of musculoskeletal ultrasonography (US) versus magnetic resonance imaging (MRI) in detecting shoulder injuries. Conducted at the Department of Physical Medicine and Rehabilitation, BSMMU, Dhaka, Bangladesh, from January to June 2024, the study included 120 patients with suspected shoulder pathologies. Patients were evaluated using both US and MRI, and findings for rotator cuff tears, labral injuries, and tendonitis were analyzed. MRI demonstrated higher diagnostic accuracy across all conditions, with sensitivity rates of 95%, 91%, and 92% for rotator cuff tears, labral injuries, and tendonitis, respectively, compared to 88%, 79%, and 86% for US. Inter-rater agreement between US and MRI was substantial, with Cohen's Kappa coefficients of 0.75 for rotator cuff tears, 0.70 for labral injuries, and 0.73 for tendonitis. Cost-effectiveness analysis revealed that US was significantly more affordable, with an average cost of 15,000 Tk per patient compared to 60,000 Tk for MRI. Additionally, the time to diagnosis was shorter for US (2 days) than for MRI (7 days). Although US required slightly more additional interventions (13.3% vs. 8.3%), this difference was not statistically significant. The findings suggest that while MRI is more accurate, US is a cost-effective and time-efficient alternative, particularly valuable in resource-limited settings.

A Comparative Evaluation of Point-of-Care and Laboratory HbA1c Testing in Diabetes Care: An Indian Perspective.

This study aimed to assess the diagnostic performance of a point-of-care (POC) glycated hemoglobin (HbA1c) device in the Indian population against the standard laboratory (high-performance liquid chromatography {HPLC}) method for the effective management of diabetes in India. This study on the diagnostic accuracy of a POC HbA1c device involved 121 participants. These participants were categorized into two groups according to their HbA1c levels - one group with HbA1c values below 6.5% and another group with HbA1c values equal to or greater than 6.5%. The HbA1c levels in enrolled participants were estimated using both the POC device (HemoCueHbA1c 501; Ängelholm, Sweden: HemoCue AB) and the standard HPLC-based method. The level of agreement and concordance between the two test results were assessed by the Bland-Altman plot and Lin's concordance correlation coefficient. Sensitivity, specificity, diagnostic accuracy, positive likelihood, and negative likelihood ratios of POC-HbA1c device were assessed with a 6.5% HbA1c cut-off. The mean HbA1c values obtained by the two methods showed no statistically significant difference with a minimum effect size (Cohen's d = 0.035), indicating there was a negligible difference between these methods. The Bland-Altman plot revealed that most values were within acceptable limits (95% CI: -0.5 to 0.7) and Lin's concordance correlation coefficient showed strong agreement (p < 0.0001).The POC-HbA1c device demonstrated an area under the curve (AUC) of 0.991 (95% CI: 0.953-1.000) with sensitivity, specificity, diagnostic accuracy, positive likelihood, and negative likelihood ratios of 93.62%, 97.30%, 95.87%, 34.64 and 0.07, respectively, compared to the standard diagnostic assay. The diagnostic accuracy, sensitivity, and specificity demonstrated by the POC-HbA1c device to the standard HPLC method offers a viable and practical solution for diabetes management in India. Its ability to provide rapid and reliable results at the point of care can improve patient outcomes, reduce healthcare costs, and enhance access to diabetes care, especially in primary care, remote areas, and resource-limited settings of developing countries like India.

Lab-on-a-chip paper-based electrochemically assisted solid-phase microextraction and ion selective sensor for determination of naproxen in biological fluid samples

BackgroundThe integration of paper-based analytical devices with lab-on-a-chip technology has opened up new possibilities for miniaturized, rapid, low cost and portable diagnostic testing in resource limited settings. This work introduces an integrated lab-on-a-chip platform coupling paper-based analytical devices (LOC-PADs) for dual usage: electrochemically controlled solid-phase microextraction (EC-SPME) and determination of naproxen (NAP) by potentiometric ion-selective electrode (ISE) in biological samples. ResultsConductive papers were successfully fabricated by a chemical procedure. Thereupon, a conducting molecularly imprinted polymer (CMIP) film based on PPy and an anionic model drug (NAP) as a template were applied to the conductive paper substrate via electrochemical methods. A microfluidic chip device was employed to assess the analytical performance of the fabricated paper-based CMIP. The designed chip is divided into two parts with a microfluidic channel between them. The first chamber is an extraction zone for EC-SPME of NAP by using the CMIP paper as a selective sorbent. The second chamber is the detection zone and consists of a paper-based NAP ion selective sensor for potentiometric detection of drug. The analytical process was investigated and optimized for each chamber. Remarkable selectivity towards NAP was achieved in the concentration range from 4.0 × 10−7 to 1.0 × 10−2 mol L−1 with determination coefficient (R2 = 0.99) and the limit of detection (LOD) was 2.0 × 10−7 mol L−1. Anionic Nernstian compliance was gained −58.5 ± 0.5 mV decade−1, and response time in the detection step was 7s for ISE. Satisfactory spiking recovery values within the acceptable range of 90–110 % with RSDs ≤7 % were achieved for the analysis of real samples with fully portable LOC device. SignificanceThe LOC-PADs were favorably used for selective extraction and determination of NAP in serum and saliva samples, respectively. EC-SPME caused sample clean-up, reduced or eliminated different interferences and enhanced selective response of ISE as detection zone of device. Integration of EC-SPME and ISE in a single chip enabled easy and fast determination of trace amounts of NAP in limited real sample volumes, and fully portable advantages.

Primary pancreatic hydatid cyst; typical radiological signs: A case report

Pancreatic hydatid cysts are rare, especially in pediatric populations, and their diagnosis presents a remarkable challenge because of the non-specific clinical presentation and the limitations of available diagnostic tools, particularly in resource-limited settings. Our case highlights the importance of maintaining a high index of suspicion for hydatid disease, even in pediatric patients presenting with non-specific abdominal symptoms, particularly in rural regions, where diagnostic resources may be limited. Early recognition and accurate diagnosis are crucial for guiding appropriate therapeutic interventions and preventing potential complications associated with this rare but clinically significant entity.

Abstract C016: Optical Techniques to Democratize Intravital Quantification of Metabolic Heterogeneity

Abstract Since metabolic and vascular adaptations are essential for tumor cell survival, a technique capable of tracking metabolic heterogeneity at both the bulk tumor and cellular scales over extended timelines is necessary. To address this technological need, we have developed a multi-scale optical microscope relying on exogenous fluorescent reporters for dynamic spatiotemporal imaging of major metabolic pathways in vivo. This microscope utilizes a low-cost CMOS detector and LEDs for excitation to enable fluorescence microscopy in resource-limited settings. Here, we implement our system to assess changes in bulk tumor and cellular metabolic heterogeneity as vasculature is perturbed. 4T1 breast tumor-bearing mice were treated with combretastatin A-1 (a vascular disruptor), implanted with window chambers, and temporally imaged (n=5/group). Fluorescence imaging and Gabor filter/Djikstra segmentation approaches enabled metabolic and vascular analyses, respectively. We demonstrated the system’s ability to acquire co-registered images of vasculature, morphology, and distinct metabolic endpoints reporting on glucose uptake, fatty acid uptake, and mitochondrial metabolism at both wide-field and high resolutions. At 12 hours post-treatment, the tumors’ metabolism shifted from mitochondrial respiration to glycolysis in avascular regions. Further, we report a higher average vascular density in untreated versus treated mice at 108 hours post-treatment (p&amp;lt;0.05, Kolmogorov-Smirnov test). On exploring the relationship between metabolic activity and vasculature, regions with high local tortuosity in the untreated group exhibited a higher reliance on fatty acid uptake than high tortuosity regions in the treatment group, indicating these cells’ reliance on fatty acids within a complex vascular network. Our multiplexed imaging strategy enables the quantification of tumor metabolism and vasculature over multiple length scales, which could be leveraged to study adaptations following clinical therapies. Citation Format: Enakshi Sunassee. Optical Techniques to Democratize Intravital Quantification of Metabolic Heterogeneity [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr C016.

Investigating the genetic basis of hereditary spastic paraplegia and cerebellar Ataxia in Pakistani families

BackgroundHereditary Spastic Paraplegias (HSPs) and Hereditary Cerebellar Ataxias (HCAs) are progressive neurodegenerative disorders encompassing a spectrum of neurogenetic conditions with significant overlaps of clinical features. Spastic ataxias are a group of conditions that have features of both cerebellar ataxia and spasticity, and these conditions are frequently clinically challenging to distinguish. Accurate genetic diagnosis is crucial but challenging, particularly in resource-limited settings. This study aims to investigate the genetic basis of HSPs and HCAs in Pakistani families.MethodsFamilies from Khyber Pakhtunkhwa with at least two members showing HSP or HCA phenotypes, and who had not previously been analyzed genetically, were included. Families were referred for genetic analysis by local neurologists based on the proband’s clinical features and signs of a potential genetic neurodegenerative disorder. Whole Exome Sequencing (WES) and Sanger sequencing were then used to identify and validate genetic variants, and to analyze variant segregation within families to determine inheritance patterns. The mean age of onset and standard deviation were calculated to assess variability among affected individuals, and the success rate was compared with literature reports using differences in proportions and Cohen’s h.ResultsPathogenic variants associated with these conditions were identified in five of eight families, segregating according to autosomal recessive inheritance. These variants included previously reported SACS c.2182 C > T, p.(Arg728*), FA2H c.159_176del, p.(Arg53_Ile58del) and SPG11 c.2146 C > T, p.(Gln716*) variants, and two previously unreported variants in SACS c.2229del, p.(Phe743Leufs*8) and ZFYVE26 c.1926_1941del, p.(Tyr643Metfs*2). Additionally, FA2H and SPG11 variants were found to have recurrent occurrences, suggesting a potential founder effect within the Pakistani population. Onset age among affected individuals ranged from 1 to 14 years (M = 6.23, SD = 3.96). The diagnostic success rate was 62.5%, with moderate effect sizes compared to previous studies.ConclusionsThe findings of this study expand the genotypic and phenotypic spectrum of HSPs and HCAs in Pakistan and emphasize the importance of utilizing exome/genome sequencing for accurate diagnosis or support accurate differential diagnosis. This approach can improve genetic counseling and clinical management, addressing the challenges of diagnosing neurodegenerative disorders in resource-limited settings.

Evaluation of molecular and bacteriological detection methods performed on the formalin-fixed paraffin-embedded biopsy samples collected from endometrial and lymph node tuberculosis suspected patients

BackgroundEndometrial Tuberculosis is one of the most common gynecological problems known to have serious implications for the quality of life like infertility. The commonly practiced histopathology solely relies on the suggestive feature of Tuberculosis (TB) with low specificity. Regarding the alternative bacteriological and molecular detection tools, little evidence was generated on their utility in the diagnosis of endometrial tuberculosis in Ethiopia. Therefore, we aim to investigate the detection rate of molecular and bacteriological detection methods on formalin-fixed paraffin-embedded biopsy samples for the diagnosis of endometrial and lymph node TB.MethodsA retrospective cross-sectional study was conducted on 90 formalin fixed paraffin embedded biopsy samples from patients with gynecologic and lymph problems collected between 2018 and 2022 at St. Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia. SPSS version 26 was used for statistical analysis. The diagnostic performance was calculated using the histopathology method as the reference standard. Cohen’s Kappa value was used to measure the level of agreement. A test with a P-value of < 0.05 was considered statistically significant.ResultsA total of 90 samples were analyzed in the current study. Auramine O, GeneXpert MTB/RIF assay, and Real-Time PCR tests have shown a detection rate of 32/90 (36%), 43/90 (47.8%), and 54/90 (60%) respectively (P ≤ 0.01). The sensitivity and specificity of AO were 38.1% and 95% respectively. RT PCR showed superior sensitivity followed by GeneXpert MTB/RIF assay, 70% and 58.6%. AO and molecular methods have shown a similarly low level of agreement with histopathology (Kappa value = 0.2).ConclusionsIn a resource-limited setting, the selection of diagnostic tools needs careful attention. Putting the patients on anti-TB treatments based solely on histopathological findings may lead to undesired and adverse complications. Therefore, applying molecular and bacteriological detection methods along with histopathology, could help minimize inappropriate antimicrobial use.

Mobile Critical Care in Resource-Limited Settings: An Unmet Need.

Care of the critically ill in resource-limited areas, inside or outside the intensive care unit (ICU), is indispensable. Murthy and Adhikari noted that about 70% of patients in low-middle income (LMIC) areas could benefit from good critical care. Many patients in resource-limited settings still die before getting to the hospital. Investing in capacity building by strengthening and expanding ICU capability and training intensivists, critical care nurses, respiratory therapists, and other ICU staff is essential, but this process will take years. Also, having advanced healthcare facilities that are still far from remote areas will not do much to alleviate distance and mode of transportation as barriers to achieving good critical care. This paper discusses the importance of mobile critical care units (MCCUs) in supporting and enhancing existing emergency medical systems. MCCUs will be crucial in addressing critical delays in transportation and time to receive appropriate lifesaving critical care in remote areas. They are incredibly versatile and could be used to transfer severely ill patients to a higher level of care from the field, safely transfer critically ill patients between hospitals, and, sometimes, almost more importantly, provide standalone short-term critical care in regions where ICUs might be absent or immediately inaccessible. MCCUs should not be used as a substitute for primary care or to bypass readily available services at local healthcare centers. It is essential to rethink the traditional paradigm of 'prehospital care' and 'hospital care' and focus on improving the care of critically ill patients from the field to the hospital.

Explainable Deep Learning Approach for Mpox Skin Lesion Detection with Grad-CAM

Mpox is a viral zoonotic disease that presents with skin lesions similar to other conditions like chickenpox, measles, and hand-foot-mouth disease, making accurate diagnosis challenging. Early and precise detection of mpox is critical for effective treatment and outbreak control, particularly in resource-limited settings where traditional diagnostic methods are often unavailable. While deep learning models have been applied successfully in medical imaging, their use in mpox detection remains underexplored. To address this gap, we developed a deep learning-based approach using the ResNet50v2 model to classify mpox lesions alongside five other skin conditions. We also incorporated Grad-CAM (Gradient-weighted Class Activation Mapping) to enhance model interpretability. The results show that the ResNet50v2 model achieved an accuracy of 99.33%, precision of 99.34%, sensitivity of 99.33%, and an F1-score of 99.32% on a dataset of 1,594 images. Grad-CAM visualizations confirmed that the model focused on relevant lesion areas for its predictions. While the model performed exceptionally well overall, it struggled with misclassifications between visually similar diseases, such as chickenpox and mpox. These results demonstrate that AI-based diagnostic tools can provide reliable, interpretable support for clinicians, particularly in settings with limited access to specialized diagnostics. However, future work should focus on expanding datasets and improving the model's capacity to distinguish between similar conditions.

Innovative Bedaquiline-Based Delivery Systems for Multidrug-Resistant Tuberculosis Treatment

Abstract: The increasing incidence of multidrug-resistant tuberculosis (MDR-TB) is one of the most challenging tasks in tuberculosis treatment. Conventional TB treatment regimens have proven ineffective in treating MDR-TB, thus demanding the development of new drugs followed by delivery systems. Bedaquiline, a novel anti-TB drug, has been reported to inhibit the ATP synthase required for the growth and replication of TB bacteria. Bedaquiline is able to target the persistent or latent form of TB, which remains difficult to treat with conventional drugs. This makes bedaquiline an important drug in the fight against MDR-TB. The drug has been approved by the US FDA as well as European Medicines Agency and is now widely used as part of combination therapy for the treatment of MDR-TB. Bedaquiline and its ad-vanced drug delivery system play a key role in tackling MDR-TB, providing a much-needed boost to control and eventually eliminate the disease. However, the cost of the drug remains a concern, and efforts are underway to make bedaquiline more accessible and affordable to patients in resource-limited settings. Nevertheless, the development of bedaquiline nanofor-mulations represents a significant step forward in the fight against TB and offers hope to millions of patients across the globe.

Comparison of Copper (II) Sulphate to Hemocue Analyser in the Estimation of Haemoglobin among Voluntary and Replacement Blood Donors at Bugando Medical Centre

Background Pre-donation haemoglobin (Hb) screening is among the foremost test done on blood donors to determine whether an individual is fit to donate with the intention of preventing inadvertent donation from an anaemic donor. The National Blood Transfusion Service (NBTS) in Tanzania uses the Copper II Sulphate (CuSO4) gravimetric method to estimate haemoglobin (Hb) in blood donors. The accuracy of the copper II sulphate method for the rapid screening of prospective blood donors has been questioned because this rapid screening method may lead to false deferral of truly eligible prospective blood donors. However, this and other point-of-care method may provide false results. Methods This was a cross-sectional study conducted among 236 eligible blood donors attending BMC transfusion centre at Mwanza, Tanzania. The blood donors were asked for their consent to participate in this study from 1st May to 1st August 2024. Capillary blood samples were obtained for Hb estimation by CuSO4 and HemoCue methods, and 3mls of venous blood were also collected for Hb quantification by AHA (gold standard). Descriptive statistics were used to analyse the demographic details of the donor. Kappa statistics were used to determine the level of agreement between the two methods of Hb estimation. Results The median age of the study participants was 30 years (IQR: 25-36). The proportion of false eligible donors was 5.5%, and false deferral donors were 2.3% using the CuSO4 gravimetric method. The specificity, sensitivity, positive and negative predictive values, and Kappa agreement for CuSO4 were 53.8%, 94.7%, 93.8%, 58.3%, and 0.51, respectively. In contrast, the specificity, sensitivity, positive and negative predictive values, and Kappa agreement for HemoCue were 63.6%, 97.9%, 96%, 77.7%, and 0.67, respectively. Conclusion. The current study revealed that, the performance of the CuSO4 gravimetric method is relatively poor, with a high proportion of false eligible donors than the HemoCue method. These findings warrant further studies to evaluate the quality control measures for CuSO4 gravimetric method and explore alternative point-of-care methods for Hb estimation among blood donors in similar resource limited-settings.

Metabolic engineering-enabled dual-color biosensor for discriminative and sensitive detection of toxic lead and mercury in environmental waters

The ubiquity of toxic heavy metals, particularly lead (Pb) and mercury (Hg), in environmental waters severely threatens ecosystems and human health. We developed a metabolic engineering-based dual-color bacterial biosensor for the sensitive and discriminative detection of Pb(II) and Hg(II) at nanomolar levels. The biosensor leverages the synthetic biology approach to integrate two pigments, prodeoxyviolacein (PDV) and deoxyviolacein (DV), into a single construct that responds distinctly to Pb(II) and Hg(II), respectively. The engineered E. coli biosensor exhibits a detection range of 0.732–3000 nM for Pb(II) and 0.183–750 nM for Hg(II), with low detection limits of 0.732 nM for Pb(II) and 0.183 nM for Hg(II). The biosensor demonstrated high sensitivity, selectivity, and accuracy with a recovery rate close to 1 in freshwater and seawater matrices. Notably, the biosensor's visual readout allows for rapid, equipment-free assessment. It is a practical tool for real-world monitoring of heavy metal pollution, especially in remote or resource-limited settings. This study underscores the potential of whole-cell biosensors as a sustainable and effective alternative to traditional heavy metal detection methods.

Amlodipine-Induced gingival hyperplasia in a nepalese patient experiencing high dosages: a case report

Introduction and Importance: Amlodipine is a third-generation calcium channel blocker used in the treatment of Hypertension. One of the side effects associated with amlodipine is gingival hyperplasia mostly occurring at a higher dose (10 mg). There are very few cases of gingival hyperplasia associated with amlodipine at a lower dose (5 mg) or short-term administration. Case presentation: A 51-year-old male patient with diagnosed hypertension sought medical attention for gingival swelling and bleeding from the gums while brushing. He had been under amlodipine 5 mg for 12 months, which was increased to 10 mg for the last 2 months. The history and physical examination were consistent with amlodipine-induced gingival hyperplasia. The first line of treatment consisted of discontinuation of amlodipine and substitution with another class of anti-hypertensive. Clinical discussion and conclusion: The presented case highlights the challenge of balancing economic considerations with potential side effects in the use of amlodipine for hypertension in low-income countries like Nepal. Given its availability at no cost or minimal expense, amlodipine is often initiated as a first-line therapy. However, the decision to increase the dosage to 10 mg/day, influenced by economic constraints and the drug’s affordability, raises the risk of gingival hyperplasia. This case emphasizes the importance of physicians being mindful of potential adverse effects when prescribing higher doses of amlodipine and underscores the need for continued vigilance in managing hypertension in resource-limited settings.