Resource-limited Settings Research Articles

THE EFFECT OF MAGNESIUM SULFATE NEBULIZATION IN ACUTE EXACERBATION OF ASTHMA

Acute exacerbations of asthma are a significant public health challenge, particularly in resource-limited settings. Nebulized magnesium sulfate has shown potential as an adjunctive therapy in managing asthma exacerbations, but its effectiveness and safety in the Pakistani population remain underexplored. Objective: To evaluate the effectiveness and safety of nebulized magnesium sulfate in managing acute asthma exacerbations in a tertiary care hospital in Pakistan. Methods: A descriptive cross-sectional study was conducted among 200 participants with acute asthma exacerbations. Nebulized magnesium sulfate was administered as part of standard or adjunctive therapy. Symptom severity, including shortness of breath, wheezing, and chest tightness, was assessed before and after treatment. Data were analyzed using SPSS version 26, with descriptive statistics summarizing findings. Results: Significant symptom improvement was observed following treatment. The proportion of patients reporting mild shortness of breath increased from 0% to 40.5%, and mild wheezing from 0% to 62.0%. No adverse effects were reported, and 58.0% of participants rated the treatment as somewhat effective. Satisfaction levels were also high, with 58.5% somewhat satisfied and 21.0% very satisfied with the treatment. Conclusion: Nebulized magnesium sulfate is an effective and safe adjunctive therapy for acute asthma exacerbations. Its inclusion in treatment protocols can improve patient outcomes, particularly in resource-constrained healthcare settings. Further studies are warranted to develop standardized guidelines for its use.

Novel indigenous low cost (NICA) model for hands on training of surgical interns in incision and drainage procedure for superficial skin abscess

BackgroundSurgical education necessitates hands-on training, which poses ethical challenges when practicing on real patients. Simulation training emerges as a pivotal solution, offering a safe and effective environment for skill acquisition. However, existing simulation models often overlook common surgical conditions like superficial skin abscesses. The National Medical Commission advocates for simulation-based training in basic surgical skills, highlighting the need for accessible and cost-effective models. Thus, this study aimed to develop and evaluate a novel Indigenous Cost-effective model for Incision & Drainage (NICA) of subcutaneous abscesses, addressing the gap in surgical education.MethodologyFollowing institutional ethics clearance, the study employed Kern’s Six-step approach for curriculum development. The NICA model was conceptualized and crafted using locally available, low-cost materials, validated by expert opinion, and implemented in a simulation lab setting. A total of 155 surgical interns underwent training, consisting of didactic video sessions, hands-on practice with the NICA model, and structured assessments. Pre- and post-training evaluations were conducted to measure interns’ performance and feedback.ResultsExpert validation confirmed NICA model’s fidelity and usefulness. Training 155 surgical interns resulted in significant skill improvements. Pre-training, 33% correctly performed pre-procedural requisites, 46% executed procedural techniques, and 48% performed post-procedural steps accurately. Post-training, these percentages surged to 95%, 97%, and 98%, respectively. Post test score showed significant skill enhancements across all domains (p < 0.05). Intern feedback highlighted increased confidence, satisfaction, and interest in learning, affirming NICA model’s effectiveness.ConclusionThe development and implementation of the NICA model offer a scalable and cost-effective solution for surgical training in resource-limited settings. The model’s effectiveness in enhancing interns’ skills and confidence underscores its potential to address training needs effectively. The study highlights the significance of simulation-based training in surgical education and advocates for the widespread adoption of indigenous low-cost models to improve surgical skills acquisition.

The road to research leadership in resource-limited settings is paved with good intentions but poor outcomes.

The road to research leadership in resource-limited settings is paved with good intentions but poor outcomes.

Maple syrup urine disease diagnosed in a resource-limited setting in an infant in Nepal: a case report

BackgroundMaple Syrup Urine Disease (MSUD) is a rare inherited disorder of metabolism, which manifests early in life in classical forms. Recurrent illness and exertion aggravate neurotoxicity. This case highlights MSUD diagnosed in association with COVID-19 complications from Nepal.Case presentationWe present a case of a 4-month-old child with a biochemical diagnosis of flared-up MSUD. Initially presenting with chief complaints of fever, noisy breathing, chest retraction, cough along with lethargy and poor feeding since the first week of life, the child also had developmental delay with feeble neck holding and absent social smile. The child was diagnosed with COVID-19 pneumonia and admitted in the Intensive Care Unit, requiring mechanical ventilation for 12 days. Despite the clinical resolution of pneumonia, the child had multiple episodes of generalized seizures and was sickly and frail. An incessant peculiar odor emanating from the child led to strong suspicion of metabolic disorder. Qualitative screening for amino acids (FeCl3 and 2,4-dinitrophenylhdrazine/DNPH) in urine and further gas chromatography-mass spectrometry revealed increased branched-chain amino acids(valine, leucine, and isoleucine). With dietary restrictions, the child was doing well. However, unfortunately, after 10 days of discharge, the child succumbed to death.ConclusionsThis case highlights the outpouring of hidden metabolic disorders with the onset of new diseases. It could have been detected and managed earlier with expedited neonatal screening and proper intervention.

Geospatial Distribution of HIV Seroprevalence Among Blood Donors in South Asian Countries: A Systematic Review and Meta-Analysis.

The reliance on replacement blood donors in developing countries has led to an increased prevalence of transfusion-transmitted infections (TTIs), including HIV. This systematic review and meta-analysis aimed to assess the seroprevalence of HIV among blood donors in South Asian countries and disseminate the findings in choropleth maps. In addition, gender-specific prevalence or the yearly trend of HIV prevalence among blood donors was also investigated. Following the PRISMA guidelines, we searched PubMed, Scopus, CAB abstracts, CINAHL, and Google Scholar for articles published between January 2000 and December 2022. The DerSimonian-Laird effect model was used due to the high heterogeneity of the data. Data analysis was performed using R Studio version 4.1.0, ArcGIS, and GraphPad Prism 7.0. The pooled seroprevalence of HIV among blood donors in South Asian countries was found to be 0.13%, with the highest prevalence of 0.19% in India and the lowest prevalence of 0.02% in Bangladesh and Bhutan. Female blood donors had a higher seroprevalence than their male counterparts (0.24%, vs. 0.17%). In contrast to voluntary blood donors with an HIV seroprevalence of 0.13%, replacement blood donors have a higher HIV prevalence of 0.26%. The observed high heterogeneity was attributed to variations in country, gender, type of blood donors, and study year. This study demonstrates a significant burdenof HIV among blood donors in South Asia, emphasizing the need forenhanced donor screening protocols, targeted interventions and educational campaigns to ensure the safety of blood transfusionservices.Future research should explore additional risk factors and focus on expanding screening methods, particularly in resource-limited settings.

A Survey on Model Compression for Large Language Models

Abstract Large Language Models (LLMs) have transformed natural language processing tasks successfully. Yet, their large size and high computational needs pose challenges for practical use, especially in resource-limited settings. Model compression has emerged as a key research area to address these challenges. This paper presents a survey of model compression techniques for LLMs. We cover methods like quantization, pruning, and knowledge distillation, highlighting recent advancements. We also discuss benchmarking strategies and evaluation metrics crucial for assessing compressed LLMs. This survey offers valuable insights for researchers and practitioners, aiming to enhance efficiency and real-world applicability of LLMs while laying a foundation for future advancements.

Primary Aneurysmal Bone Cyst of Sacrum: A Case Report of a 12 years old boy from Pakistan

Aneurysmal bone cysts are locally invasive, benign lesions usually found in the spine or metaphysis of long bones. They can be primary (idiopathic) or secondary to other bone pathologies. Primary aneurysmal bone cyst usually occurs in the first two decades of life. We report a 12 years old male, a known case of Type-1 diabetes mellitus, with lower back pain radiating to the right lower limb for the past two months following a fall. There were no neurological deficits, although straight leg raises and Faber’s tests were positive. Neuroimaging suggested an enhancing 7 x 8 mm lesion involving the lamina of the first sacral vertebra with protrusion into the spinal canal. Bone scan ruled out metastatic pathology. Excision of the lesion with laminectomy and foraminotomy was done. Histopathology was suggestive of aneurysmal bone cyst. The patient is living a healthy life. Upfront surgical excision without preoperative embolization and expensive medical therapies can be an option in resource-limited settings. doi: https://doi.org/10.12669/pjms.40.12(PINS).10988 How to cite this: Qadri HM, Khawaja AA, Bashir R, Bashir A. Primary Aneurysmal Bone Cyst of Sacrum: A Case Report of a 12 years old boy from Pakistan. Pak J Med Sci. 2024;40(12):S95-S98. doi: https://doi.org/10.12669/pjms.40.12(PINS).10988 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Exploring variations in the implementation of a health system level policy intervention to improve maternal and child health outcomes in resource limited settings: A qualitative multiple case study from Uganda.

Despite growing literature, few studies have explored the implementation of policy interventions to reduce maternal and perinatal mortality in low- and middle-income countries (LMICs). Even fewer studies explicitly articulate the theoretical approaches used to understand contextual influences on policy implementation. This under-use of theory may account for the limited understanding of the variations in implementation processes and outcomes. We share findings from a study exploring how a health system-level policy intervention was implemented to improve maternal and child health outcomes in a resource limited LMIC. Our qualitative multiple case study was informed by the Normalization Process Theory (NPT). It was conducted across eight districts and among ten health facilities in Uganda, with 48 purposively selected participants. These included health care workers located at each of the cases, policy makers from the Ministry of Health, and from agencies and professional associations. Data were collected using semi-structured, in-depth interviews to understand uptake and use of Uganda's maternal and perinatal death surveillance and response (MPDSR) policy and were inductively and deductively analyzed using NPT constructs and subconstructs. We identified six broad themes that may explain the observed variations in the implementation of the MPDSR policy. These include: 1) perception of the implementation of the policy, 2) leadership of the implementation process, 3) structural arrangements and coordination, 4) extent of management support and adequacy of resources, 5) variations in appraisal and reconfiguration efforts and 6) variations in barriers to implementation of the policy. The variations in sense making and relational efforts, especially perceptions of the implementation process and leadership capacity, had ripple effects across operational and appraisal efforts. Adopting theoretically informed approaches to assessing the implementation of policy interventions is crucial, especially within resource limited settings.

Rapid test for hepatitis B core-related antigen to identify people living with hepatitis B having high viral load in Cameroon

This study presents a retrospective assessment of the diagnostic performance of the newly developed hepatitis B core-related antigen rapid diagnostic test (HBcrAg-RDT) in detecting plasma samples with elevated hepatitis B virus (HBV) DNA levels (≥200,000 IU/ml) in Yaoundé, Cameroon. Samples were collected consecutively from treatment-naïve adults living with HBV between January 1, 2021, and June 30, 2023. Analyzing 146 samples from participants with a median age of 36 years, the HBcrAg-RDT exhibited a sensitivity of 97.5% (95% CI: 86.8–99.9) and a specificity of 77.4% (68.2–84.9) when compared to real-time PCR as the reference standard. These findings suggest that HBcrAg-RDT holds promise as a valuable point-of-care tool for diagnosing high HBV DNA levels, particularly in resource-limited settings. Further research will refine its practicality and effectiveness.

Caregiver burden among informal caregivers of stroke survivors in Harare, Zimbabwe

Background: Stroke presents significant challenges for both survivors and caregivers, particularly in resource-limited settings like Zimbabwe. Identifying factors contributing to caregiver burden strain (CBS) is crucial to enhance support strategies.Objectives: This longitudinal study identified caregiver and stroke survivor characteristics associated with CBS among caregivers in Harare, Zimbabwe.Method: Altogether 188 stroke survivors and their caregivers participated with CBS assessed at 3 months and 12 months using the Caregivers Strain Index. Multiple linear regression was used to evaluate the association of explanatory variables with CBS. Model fit was evaluated using the Akaike’s Information Criterion and R2.Results: Caregivers experiencing anxiety or depression showed increased CBS at 3 months (β = 2.46, p 0.001) and 12 months (β = 2.73, p = 0.016). Work adjustments were associated with higher CBS at 3 months (β = 3.84, p 0.001). Caregivers feeling overwhelmed had significantly higher CBS at 3 months (β = 3.36, p 0.001). Stroke survivors’ poor physical outcomes and reliance on health insurance were associated with CBS at 12 months (β = 4.34, p = 0.006). Caring for married stroke survivors was associated with reduced CBS (β = –2.83, p 0.001).Conclusion: Caregiver anxiety, depression, work adjustments and poor physical and social outcomes in stroke survivors contributed to increased CBS. Targeted interventions addressing mental health and social support are essential to reduce CBS.Clinical implications: Multifaceted interventions that address caregiver mental health and social support are vital to reduce CBS and improve outcomes in resource-constrained settings like Zimbabwe.

Impact of inappropriate empirical antibiotic therapy on in-hospital mortality: a retrospective multicentre cohort study of patients with bloodstream infections in Chile, 2018–2022

IntroductionEmpirical antibiotic therapy is essential for treating bloodstream infections (BSI), yet there is limited evidence from resource-limited settings. We quantified the association of inappropriate empirical antibiotic therapy (IEAT) with in-hospital...

Managing Hereditary Angioedema in a Three-Generation Family: Danazol’s Promise in Resource-Limited Settings

Managing Hereditary Angioedema in a Three-Generation Family: Danazol’s Promise in Resource-Limited Settings

Therapeutic drug monitoring for antimicrobial agents for people living with HIV (TAP)

Background Antimicrobial resistance (AMR) is a growing health concern, particularly in Africa, and is predicted to be the leading cause of death after cancer by 2050. Factors like overuse or inappropriate use of antibiotics, contribute to this crisis. People living with HIV (PLWH) are particularly vulnerable to AMR with potential drug-drug interactions between antiretroviral and antimicrobial agents against common organisms like Mycobacterium tuberculosis. There is limited data on the concentrations of commonly used antimicrobial agents in people living with HIV in resource-limited settings. Therapeutic Drug Monitoring (TDM) offers a promising approach to optimize antibiotic dosing and improve treatment outcomes for those with sub-optimal drug concentrations. TDM has been recommended for PLWH on anti-tuberculosis treatment due to sub-optimal drug concentrations found in a significant proportion of those with TB. Objectives The main objectives of this study are to determine the concentrations of selected antimicrobial agents in people living with HIV requiring antimicrobial therapy and to assess the utility of therapeutic drug monitoring in achieving therapeutic targets for PLWH receiving rifampicin and isoniazid for the treatment of tuberculosis Methods This prospective observational study will enroll adult PLWH receiving amoxicillin, azithromycin, ciprofloxacin, rifampicin, isoniazid, or ceftriaxone. Concentrations of these antibiotics will be measured locally using validated liquid chromatography mass spectrometry methods and high-performance liquid chromatography with ultraviolet detection. TDM with dose adjustment will be performed in a subset of participants on TB treatment. Pharmacokinetic parameters will be estimated using non-linear mixed effects models. Results This study was reviewed and approved by the research and ethics committee in February 2024. Enrolment is projected to begin by August 2024. Conclusions We anticipate that the findings from this research will characterize pharmacokinetic and pharmacodynamics relationships to predict treatment response for optimal antimicrobial therapeutic and anti-tuberculosis dosing among people living with HIV (PLWH). Clinical registration The study is registered with Pan African Clinical Trials Registry, registration number PACTR202409710100607, registration date 07 August 2024, pactr.samrc.ac.za/TrialDisplay.aspx?TrialID=31764

Predictors of Nosocomial Infections among Geriatric Patients in the Internal Medicine Department of the University Teaching Hospital of Butare (CHUB), South, Huye, Rwanda

Purpose: Nosocomial infections pose a significant burden worldwide, particularly in resource-limited settings. This study aimed to determine predictors of nosocomial infections among geriatric patients at the University Teaching Hospital of Butare (CHUB) in Rwanda. Methodology: A quantitative cross-sectional cohort study over seven months included participants admitted to CHUB's Internal Medicine department from July 2023 to January 2024 with the aim to determine the Nosocomial infections predictors among elderly aged 61 years and above. The target sample size was 313, but a census approach with 400+ participants was used. Data collection involved physician examinations, laboratory testing, interviews, facility observations, specimen culture, antimicrobial susceptibility testing, and logistic regression analyses. Findings: The study included 206 participants who were screened infection-free at admission, predominantly from Southern Province (85%) and female (56%), with a median hospital stay of 3 days. Most were admitted from Kabutare District Hospital (22%) to Internal Medicine (90%). Age distribution peaked at 61 years and above (38.8%) and 60 years and below (61.2%). Unemployment was high (83%), especially among females (60%) and those with low education. Prior 30-day hospitalization occurred in 34%, mainly for non-communicable diseases (41%) and infections (20%). Chronic conditions were reported by 41%, commonly hypertension (37%), other non-communicable diseases (14%), and diabetes (10%). Recent antibiotic use was 23%, primarily ceftriaxone (54%). Urine samples dominated (55%), with prevalent pathogens like Escherichia coli and Staphylococcus species. But more importantly this study demonstrated a strong association between nosocomial infection level and some predictors with significant P values as follows: time of stay (P=0.002), Health Care providers following WHO 5 Moments of hand hygiene (P=0.005), disinfection of medical devices by Health Care providers (P=0.036) and hands washing before taking medicines (P=0.047). Unique Contribution to Theory, Practice and Policy: The environmental decontamination and antibiotic rotation policies should be implemented to manage Acinetobacter spp. infections. As well hand hygiene adherence and preventive measures for urinary tract infections will address Escherichia Coli infections. Efforts to mitigate the burden of nosocomial infections should prioritize the enhanced surveillance, establishing robust infection tracking systems across healthcare facilities, invest in antimicrobial stewardship and targeted interventions tailoring infection control practices to high-risk groups like geriatric patients.

Efficient and Accurate Brain Tumor Classification Using Hybrid MobileNetV2–Support Vector Machine for Magnetic Resonance Imaging Diagnostics in Neoplasms

Background/Objectives: Magnetic Resonance Imaging (MRI) plays a vital role in brain tumor diagnosis by providing clear visualization of soft tissues without the use of ionizing radiation. Given the increasing incidence of brain tumors, there is an urgent need for reliable diagnostic tools, as misdiagnoses can lead to harmful treatment decisions and poor outcomes. While machine learning has significantly advanced medical diagnostics, achieving both high accuracy and computational efficiency remains a critical challenge. Methods: This study proposes a hybrid model that integrates MobileNetV2 for feature extraction with a Support Vector Machine (SVM) classifier for the classification of brain tumors. The model was trained and validated using the Kaggle MRI brain tumor dataset, which includes 7023 images categorized into four types: glioma, meningioma, pituitary tumor, and no tumor. MobileNetV2’s efficient architecture was leveraged for feature extraction, and SVM was used to enhance classification accuracy. Results: The proposed hybrid model showed excellent results, achieving Area Under the Curve (AUC) scores of 0.99 for glioma, 0.97 for meningioma, and 1.0 for both pituitary tumors and the no tumor class. These findings highlight that the MobileNetV2-SVM hybrid not only improves classification accuracy but also reduces computational overhead, making it suitable for broader clinical use. Conclusions: The MobileNetV2-SVM hybrid model demonstrates substantial potential for enhancing brain tumor diagnostics by offering a balance of precision and computational efficiency. Its ability to maintain high accuracy while operating efficiently could lead to better outcomes in medical practice, particularly in resource limited settings.

SPECTRUM OF ORAL AND MAXILLOFACIAL SURGERY PATIENTS SEEN AT TRIAGE WITH SUBSEQUENT EMERGENCY TREATMENT PROVIDED – A CLINICAL STUDY AT SMBBIT

Oral and maxillofacial injuries constitute a significant portion of trauma cases in emergency departments, often resulting in life-threatening complications and sometimes death. Effective triage is crucial for prioritizing care, especially in resource-limited settings. Despite the importance of standard protocols, many institutions lack uniform guidelines for managing these complex injuries, which can lead to adverse patient outcomes. Objectives: To explore the clinical presentation patterns of oral and maxillofacial trauma patients at triage, focusing on injury types and patient demographics while documenting initial emergency interventions administered. Methods: This descriptive cross-sectional study was conducted at SMBBIT over six months, involving patients presenting with OMFS Trauma sustained at Emergency Room. Data were collected using a pre-designed pro forma and analyzed using SPSS software for descriptive statistics. Results: A total of 73 patients were included, predominantly male (84.94%), with a mean age of 35.2 years. Road traffic accidents were the leading cause of injury (68.5%). Most patients were self-referred (37%), and 82.2% had no significant co-morbidities. Imaging revealed comminuted pan-facial fractures (37.5%) as the most common diagnosis. Following triage assessment, 80.8% required hospitalization, with 32.2% undergoing immediate surgical interventions, including open reduction internal fixation, closed reduction and soft tissue closure. Conclusion: This study underscores the importance of effective triage in managing oral and maxillofacial surgical patients, particularly in polytrauma cases, with a focus on a multidisciplinary team (MDT) approach. Our findings suggest that incorporating oral and maxillofacial surgical emergency care into triage protocols and resource allocation can improve care quality and reduce patients’ complications. Inclusion of oral and maxillofacial surgeons in Emergency Trauma teams in Pakistan is essential for enhancing collaboration and improving patient survival outcomes.

Addressing the Continuing Challenges of Developing and Implementing Clinical Practice Guidelines.

This editorial examines the ongoing challenges associated with developing and implementing clinical practice guidelines (CPGs), sparked by Ng et al.'s analysis of pre-participation physical evaluations (PPE) for youth athletes. The authors reveal that only a third of the PPE evaluation they reviewed documented all essential patient history elements. They suggest that the limited efficacy of PPEs in predicting serious cardiac events may lead practitioners to deprioritize comprehensive history-taking, and point to the stronger evidence for electrocardiograms (ECG) as a more effective diagnostic tool. Practitioners should reflect more broadly on the inherent tension between CPG standardization and the need for clinical flexibility. While standardized guidelines are crucial for consistent, high-quality care in acute and chronic settings, social determinants of health (SDH) can affect patient adherence and outcomes, necessitating tailored approaches, which can account for the disparities in CPG application across different populations and healthcare environments. Complex guidelines can be overwhelming, particularly in under-resourced settings, where they may be impractical or difficult to follow. For these areas, CPGs should account for local infrastructure and healthcare capabilities, potentially substituting advanced diagnostics with enhanced clinical skills. There are additional concerns about CPG development processes, including the variability in expert opinions, the influence of industry funding, and conflicts of interest that may erode trust and compliance. While industry contributions can enhance guideline robustness, transparency and accountability are vital to maintaining the integrity of CPGs. In conclusion, we call for a pragmatic approach to CPG development that balances scientific rigor with adaptability to diverse clinical and resource-limited settings. Addressing these challenges is essential for fostering equitable and effective patient care and enhancing the trustworthiness of CPGs in the global healthcare landscape.

Diabetic striatopathy (hyperglycemic hemichorea-hemiballismus syndrome) in a young patient with type 1 diabetes mellitus in Dar es Salaam, Tanzania: a case report

Introduction: Diabetic striatopathy, or nonketotic hyperglycemic hemichorea-hemiballismus syndrome, is a rare movement disorder linked to poorly controlled diabetes mellitus. It predominantly affects older women with type 2 diabetes mellitus and presents with characteristic basal ganglia abnormalities on CT and MRI. Even rarer is the presentation in a young patient, which may pose diagnostic and management challenges. Case Presentation: We report a 17-year-old male with poorly controlled type 1 diabetes mellitus presenting with left-sided hemichorea-hemiballismus of acute onset associated with hyperglycemia without ketoacidosis. Brain imaging revealed increased attenuation in the right caudate and putamen on CT and hyperintensity on T1-weighted MRI, consistent with diabetic striatopathy. The abnormal movements abated after one month through dietary counseling, increased insulin dosage, and anti-chorea therapy. Conclusion: Diabetic striatopathy may occur in young patients with type 1 diabetes mellitus. In resource-limited settings, its management can be challenging. There is a need for increased awareness among physicians of this potentially reversible condition, especially when seeing atypical patient populations. Strict glycemic control is an essential part of treatment.

REASSURED Test System for Food Control—Preparation of LAMP Reaction Mixtures for In-Field Identification of Plant and Animal Species

The potential of loop-mediated isothermal amplification (LAMP) assays for species identification in medical diagnostics, food safety, and authentication is indisputable. The challenge in commercialization of such DNA-based rapid test methods for resource-limited settings is the on-site availability of the required reagents and an intuitive read-out system. In this work, reaction mixtures for LAMP assays for the detection of animal (plaice) and plant food (safflower) were lyophilized and stored at room temperature for up to 24 weeks, demonstrating that refrigeration of reagents after lyophilization is not absolutely necessary. During this period, reaction mixtures were stable and the polymerase showed no loss of activity. In addition, mobile testing, including DNA isolation, using the lyophilized LAMP reaction mixtures and a handheld fluorescence detection read-out system (Doctor Vida Pocket test) was successfully performed outside of the laboratory environment in less than 40 min using a proposed standard operation procedure. The results highlight that the use of the lyophilized LAMP reaction for food control purposes has the potential to meet the WHO-proposed REASSURED criteria.

Automation for lateral flow rapid tests: Protocol for an open-source fluid handler and applications to dengue and African swine fever tests.

Lateral flow rapid diagnostic tests (RDTs, RTs) are cost-effective with low infrastructure requirements for limited-resource settings, and in any setting can represent a bridge between early disease monitoring at outbreak onset and fully-scaled molecular testing for human or animal diseases. However, the potential of RTs to handle higher throughput testing is hampered by the need for manual processing. Here we review dengue virus and African swine fever virus rapid tests, and present a novel protocol that employs an open-source fluid handler to automate the execution of up to 42 RTs per run. A publicly accessible website, rtWIZARD.lji.org, provides printouts for correctly spacing cassettes, worksheets for sample organization, and test-specific fluid handler protocols to accurately deliver samples from a 48-tube rack to each cassette's sample and running buffer wells. An optional QR-coded sheet allows for de-identified sample-to-result traceability by producing a unique printable label for each cassette, enabling results to be entered via a scanner. This work describes a highly cost-effective model for increasing outbreak diagnostic efficiency and of increasing RT throughput for other applications including workplace testing, food safety, environmental testing, and defense applications.