Smear Examination Research Articles

Evaluation of new haematology analyser, XN-31, for malaria detection in blood donors: A single-centre study from India.

Malaria continues to be a significant public health concern in India, with several regions experiencing endemicity and sporadic outbreaks. The prevalence of malaria in blood donors, in India, varies between 0.02% and 0.07%. Common techniques to screen for malaria, in blood donors and patients, include microscopic smear examination and rapid diagnostic tests (RDTs) based on antigen detection. The aim of this study was to evaluate a new fully automated analyser, XN-31, for malaria detection, as compared with current practice of using RDT. Cross-sectional analytical study was conducted to evaluate clinical sensitivity and specificity of new automated analyser XN-31 among blood donors' samples and clinical samples (patients with suspicion of malaria) from outpatient clinic collected over between July 2021 and October 2022. No additional sample was drawn from blood donor or patient. All blood donors and patients' samples were processed by malaria rapid diagnostic test, thick-smear microscopy (MIC) and the haematology analyser XN-31. Any donor blood unit incriminated for malaria was discarded. Laboratory diagnosis using MIC was considered the 'gold standard' in the present study. Clinical sensitivity and specificity of XN-31 were compared with the gold standard. Fife thousand and five donor samples and 82 diagnostic samples were evaluated. While the clinical sensitivity and specificity for donor samples were 100%, they were 96.3% and 100% for diagnostic samples. Automated haematology analysers represent a promising solution, as they can deliver speedy and sensitive donor malaria screening assessments. This method also has the potential to be used for pre-transfusion malaria screening along with haemoglobin estimation.

Fatal coinfection of blastocystosis and intestinal trichomoniasis in a rhesus macaque (Macaca mulatta).

A 3-year-old male rhesus macaque was presented at Referral Veterinary Polyclinic-Teaching Veterinary Clinical Complex, with a chief complaint of chronic diarrhoea and swelling of dependent body parts. The patient's history indicates that the monkey had been experiencing diarrhoea for the past month, with 2-3 episodes of vomiting in the last 2days. Additionally, oedema has developed within the last 2weeks. The clinical examination findings revealed dullness and depression, the mucus membrane appeared pale, with a temperature-102.1°F, a respiration rate-28/min, and a heart rate-92/min. The capillary refill time was 4s. During the physical examination, the animal exhibited oedema on the dependent part of the body and faecal staining around the perineum along with loose yellow stool. Direct saline and iodine mount faecal smear examination revealed the presence of many motile pear-shaped flagellated protozoa and round vacuolated Blastocystis organisms. Giemsa-stained faecal smear cytology confirmed the presence of Pentatrichomonas sp. and Blastocystis sp. along with many microbes. The faecal culture was negative for all pathogenic microbes. The case was diagnosed as co-infection Blastocystosis and intestinal trichomoniasis. The treatment was initiated with a combination of sulfamethoxazole + trimethoprim @ 35mg/kg body weight and metronidazole @25mg/kg administered orally once daily for 7days. Supportive therapy includes hematinic injection (iron sorbitol, folic acid and vitamin B12) @ 1ml total dose, administered intramuscularly on alternate days for four occasions as well as intravenous infusion of crystalline amino acid @ 5ml total dose on alternate days for four occasions. To manage vomition, injection ondansetron was administered@0.5mg/kg intramuscularly, twice daily for 3days and H2 blockers, including injection ranitidine@2mg/kg intramuscularly twice daily for 3days. Electrolyte and probiotic supplementation were administered orally. After 7days of therapy, the oedema had significantly improved and episodes of vomition were stopped but there was no significant improvement in the episode of diarrhoea and consistency of faeces. Unfortunately, on the 10th day of therapy, the animal suddenly collapsed. Understanding the virulence pattern of opportunistic protozoa in primates is crucial, and identifying suitable therapeutic candidates to prevent fatal outcomes is the need of the hour, especially considering protozoal infections as an important differential diagnosis in gastrointestinal tract-related ailments. Our study successfully demonstrated the co-occurrence of blastocystosis and intestinal trichomoniasis, both uncommon infections with potential zoonotic implications.

Multi-Level Attention Split Network: A Novel Malaria Cell Detection Algorithm

Malaria is one of the major global health threats. Microscopic examination has been designated as the “gold standard” for malaria detection by the World Health Organization. However, it heavily relies on the experience of doctors, resulting in long diagnosis time, low efficiency, and a high risk of missed or misdiagnosed cases. To alleviate the pressure on healthcare workers and achieve automated malaria detection, numerous target detection models have been applied to the blood smear examination for malaria cells. This paper introduces the multi-level attention split network (MAS-Net) that improves the overall detection performance by addressing the issues of information loss for small targets and mismatch between the detection receptive field and target size. Therefore, we propose the split contextual attention structure (SPCot), which fully utilizes contextual information and avoids excessive channel compression operations, reducing information loss and improving the overall detection performance of malaria cells. In the shallow detection layer, we introduce the multi-scale receptive field detection head (MRFH), which better matches targets of different scales and provides a better detection receptive field, thus enhancing the performance of malaria cell detection. On the NLM—Malaria Dataset provided by the National Institutes of Health, the improved model achieves an average accuracy of 75.9% in the public dataset of Plasmodium vivax (malaria)-infected human blood smear. Considering the practical application of the model, we introduce the Performance-aware Approximation of Global Channel Pruning (PAGCP) to compress the model size while sacrificing a small amount of accuracy. Compared to other state-of-the-art (SOTA) methods, the proposed MAS-Net achieves competitive results.

Prevalence of subclinical pulmonary tuberculosis in adults in community settings: an individual participant data meta-analysis

Subclinical pulmonary tuberculosis, which presents without recognisable symptoms, is frequently detected in community screening. However, the disease category is poorly clinically defined. We explored the prevalence of subclinical pulmonary tuberculosis according to different case definitions. We did a one-stage individual participant data meta-analysis of nationally representative surveys that were conducted in countries with high incidence of tuberculosis between 2007 and 2020, that reported the prevalence of pulmonary tuberculosis based on chest x-ray and symptom screening in participants aged 15 years and older. Screening and diagnostic criteria were standardised across the surveys, and tuberculosis was defined by positive Mycobacterium tuberculosis sputum culture. We estimated proportions of subclinical tuberculosis for three case definitions: no persistent cough (ie, duration ≥2 weeks), no cough at all, and no symptoms (ie, absence of cough, fever, chest pain, night sweats, and weight loss), both unadjusted and adjusted for false-negative chest x-rays and uninterpretable culture results. We identified 34 surveys, of which 31 were eligible. Individual participant data were obtained and included for 12 surveys (620 682 participants) across eight countries in Africa and four in Asia. Data on 602 863 participants were analysed, of whom 1944 had tuberculosis. The unadjusted proportion of subclinical tuberculosis was 59·1% (n=1149/1944; 95% CI 55·8-62·3) for no persistent cough and 39·8% (773/1944; 36·6-43·0) for no cough of any duration. The adjusted proportions were 82·8% (95% CI 78·6-86·6) for no persistent cough and 62·5% (56·6-68·7) for no cough at all. In a subset of four surveys, the proportion of participants with tuberculosis but without any symptoms was 20·3% (n=111/547; 95% CI 15·5-25·1) before adjustment and 27·7% (95% CI 21·0-36·4) after adjustment. Tuberculosis without cough, irrespective of its duration, was more frequent among women (no persistent cough: adjusted odds ratio 0·79, 95% CI 0·63-0·97; no cough: adjusted odds ratio 0·76, 95% CI 0·62-0·93). Among participants with tuberculosis, 29·1% (95% CI 25·2-33·3) of those without persistent cough and 23·1% (18·8-27·4) of those without any cough had positive smear examinations. The majority of people in the community who have pulmonary tuberculosis do not report cough, a quarter report no tuberculosis-suggestive symptoms at all, and a quarter of those not reporting any cough have positive sputum smears, suggesting infectiousness. In high-incidence settings, subclinical tuberculosis could contribute considerably to the tuberculosis burden and to Mycobacterium tuberculosis transmission. Mr Willem Bakhuys Roozeboom Foundation.

Automatic classification of acute lymphoblastic leukemia cells and lymphocyte subtypes based on a novel convolutional neural network.

Acute lymphoblastic leukemia (ALL) is a life-threatening disease that commonly affects children and is classified into three subtypes: L1, L2, and L3. Traditionally, ALL is diagnosed through morphological analysis, involving the examination of blood and bone marrow smears by pathologists. However, this manual process is time-consuming, laborious, and prone to errors. Moreover, the significant morphological similarity between ALL and various lymphocyte subtypes, such as normal, atypic, and reactive lymphocytes, further complicates the feature extraction and detection process. The aim of this study is to develop an accurate and efficient automatic system to distinguish ALL cells from these similar lymphocyte subtypes without the need for direct feature extraction. First, the contrast of microscopic images is enhanced using histogram equalization, which improves the visibility of important features. Next, a fuzzy C-means clustering algorithm is employed to segment cell nuclei, as they play a crucial role in ALL diagnosis. Finally, a novel convolutional neural network (CNN) with three convolutional layers is utilized to classify the segmented nuclei into six distinct classes. The CNN is trained on a labeled dataset, allowing it to learn the distinguishing features of each class. To evaluate the performance of the proposed model, quantitative metrics are employed, and a comparison is made with three well-known deep networks: VGG-16, DenseNet, and Xception. The results demonstrate that the proposed model outperforms these networks, achieving an approximate accuracy of 97%. Moreover, the model's performance surpasses that of other studies focused on 6-class classification in the context of ALL diagnosis. RESEARCH HIGHLIGHTS: Deep neural networks eliminate the requirement for feature extraction in ALL classification The proposed convolutional neural network achieves an impressive accuracy of approximately 97% in classifying six ALL and lymphocyte subtypes.

Features of the vagina microbiotope in patients with adenomyosis

The objective: to assess the composition of the vaginal microbiota in women of reproductive age with adenomyosis.Materials and methods. A comprehensive clinical-laboratory and instrumental prospective examination of 224 patients aged 30 to 50 years (average age – 42.0±1.8 years) with adenomyosis, who were included in the main study group, was conducted. The patients of the main group were divided into 2 subgroups depending on the form of adenomyosis – I group (diffuse form) included 106 women, II group (nodular form) – 118 persons. The control group included 84 healthy women of reproductive age with a regular ovulatory menstrual cycle and no history of gynecological diseases.Patients underwent microscopic examination of vaginal secretions, bacterioscopic examination of vaginal smears, stained according to Gram. Lactobacillus cultures were identified by polymerase chain reaction (PCR) and 16S ribosomal ribonucleic acid analysis.​Results. During the microscopic examination of the vaginal secretion, more than 15 leukocytes in the field of view were detected in 84 (37.5±3.2%) patients of both groups: in 40 (47.9±3.3%) patients of the I group and in 44 (52.1±3.3%) – II group. During the bacterioscopic examination of vaginal swabs, stained according to Gram, no gonococci and trichomonads were found in the main group. Candida fungi were detected microscopically in 158 patients (70.5±3.1%) of the main group: in 71 (66.9±4.6%) of the I group and in 87 (33.1±4.3%) of II group.Genotyping results showed that lactobacilli isolated from women with adenomyosis belonged to seven species: Lactobacillus fermentum, Lactobacillus iners, Lactobacillus gasseri, Lactobacillus amnionii, Lactobacillus jensenii, Lactobacillus crispatus, and Lactobacillus delbrueskii. The majority of lactobacilli strains have high inhibitory activity against all test strains, except for Candida albicans (39 cases, 46.4%). High adhesion to human erythrocytes was determined by 54.7% (46 cases) of the studied cultures.All lactobacilli strains were resistant to metronidazole, 83.3% (70 cases) to kanamycin, 57.1% (48 cases) to vancomycin, all strains were sensitive to roxithromycin, amoxiclav, and ampicillin. Moderate sensitivity to gentamicin and cefazolin was found in 51.9% (43 cases) of cultures, peroxide-forming activity in 80.9% (68 cases).The use of quantitative diagnostic thresholds has led to significant improvements in diagnostic performance. PCR showed 88% sensitivity and 95% specificity for Gardnerella vaginalis and 96% sensitivity and 97% specificity for Atopobium vaginae.Conclusions. It has been established that bacterial vaginosis and microorganisms associated with bacterial vaginosis are independently associated with adenomyosis. The results of the study confirmed that vaginal microorganisms, which are usually diagnosed in women with adenomyosis, ascend to the endometrium from the vagina vertically, which leads to infection of the upper parts of the genital tract.

Positive correlation of glomerular filtration rate with burr cells on peripheral blood smear examination in patients with chronic kidney disease

Positive correlation of glomerular filtration rate with burr cells on peripheral blood smear examination in patients with chronic kidney disease

Segmentation, feature extraction and classification of leukocytes leveraging neural networks, a comparative study.

The gold standard of leukocyte differentiation is a manual examination of blood smears, which is not only time and labor intensive but also susceptible to human error. As to automatic classification, there is still no comparative study of cell segmentation, feature extraction, and cell classification, where a variety of machine and deep learning models are compared with home-developed approaches. In this study, both traditional machine learning of K-means clustering versus deep learning of U-Net, U-Net + ResNet18, and U-Net + ResNet34 were used for cell segmentation, producing segmentation accuracies of 94.36% versus 99.17% for the dataset of CellaVision and 93.20% versus 98.75% for the dataset of BCCD, confirming that deep learning produces higher performance than traditional machine learning in leukocyte classification. In addition, a series of deep-learning approaches, including AlexNet, VGG16, and ResNet18, was adopted to conduct feature extraction and cell classification of leukocytes, producing classification accuracies of 91.31%, 97.83%, and 100% of CellaVision as well as 81.18%, 91.64% and 97.82% of BCCD, confirming the capability of the increased deepness of neural networks in leukocyte classification. As to the demonstrations, this study further conducted cell-type classification of ALL-IDB2 and PCB-HBC datasets, producing high accuracies of 100% and 98.49% among all literature, validating the deep learning model used in this study.

A Review of Three Cases of Primary Plasma Cell Leukemia: Incidental Finding Discovered by Blood Smear Revision

Introduction: Plasma cell leukemia (PCL) is the most aggressive variant of the monoclonal gammopathies (MG). Its diagnosis is based on standard morphological examination of peripheral blood, by finding plasma cells with an atypical morphology. The International myeloma working group (IMWG) has updated the diagnostic criteria for PCL considering that patients with newly diagnosed MG with 5% or greater plasma cells in peripheral blood should be considered as PCL. Case report: We present three cases of primary PCL that were admitted to the hospital due to the study of an anaemia and whose diagnosis was an incidental finding. All the patients had >5% of circulating plasma cells, whose clonality and aberrant phenotype was determined by peripheral and blood marrow flow cytometry immunophenotype and all of them had high-risk cytogenetics related with a poor and adverse outcomes of the disease. Discussion: This cases highlight the importance of peripheral blood smear revision, because the identification of aberrant plasma cells leaded the diagnosis of the MG and the patients were able to start treatment as soon as possible. Carefully examination and interpretation of peripheral blood smear should be always performed, with special attention in patients with a suspicion of MG, because with the new IMWG definition, it is possible that this entity is underdiagnosed.

Therapeutic management to concurrent infection of Haemoproteus columbae and Trichomonas spp. in domestic rock pigeons

Two domestic rock pigeons were presented to Veterinary Clinical Complex, VC & RI, Orathanadu, TANUVAS with the history of circling, rotating its head, complete inappetence and regurgitation. On clinical examination bird appeared dull, depressed and circling of head appreciated and also noticed the presence of Pseudolynchia canariensis. Blood smear examination revealed a characteristic halter shaped gametocytes of Haemoproteus columbae encircling the nucleus of erythrocytes and the crop fluid examination revealed the presence of Trichomonas gallinae. Faecal sample examination revealed the absence of intestinal parasites. The birds were treated with oral Chloroquine @5mg/kg body weight and Metronidazole @50 mg as total dose along with the multivitamin supplementation. The whole flock in the house hold were treated with Permethrin (0.25%) spray by external application to control vector population. After five days of the treatment the clinical condition of the birds were reviewed which showed complete recovery without any complications.

Blood Transfusion as an Adjunct Therapy in a Foal Affected with Trypanosomiasis

Trypanosomiasis is an infectious haemo protozoan disease that affects various domestic, pet, and wild animals. A 9-month-old foal was presented to the Veterinary Clinical Complex of the College of Veterinary Science, Rajendranagar, Hyderabad with a complaint of reduced appetite, red color urine, and rapid loss of weight for a week. Upon physical examination pale conjunctival and buccal mucous membranes were noticed along with a temperature of 97.20 F Auscultation of the heart revealed high intensity heart beats with 72 bpm. A blood smear was prepared from peripheral veins and its examination revealed RBCs with pleomorphism, microcytes and a few RBCs are acanthocytes. Wet film examination revealed vigorously moving spindle-shaped intercellular parasites Further, Giemsa-stain smear examination revealed the presence of intercellular spindle-shaped organisms, which are suggestive of Trypanosoma evansi. A complete blood picture revealed severe anemia, low levels of hemoglobin, and thrombocytosis, monocytosis, and lymphocytosis. Based on these findings, the case was diagnosed as trypanosomosis and the treatment was initiated with Diminazene aceturate at 3.5mg/K, iron Folic acid, and cyanocobalamin, along with blood transfusion to manage anemia. The foal was successfully revived following a blood transfusion.

Effectiveness of Histopathological Examination of Ultrasound-guided Puncture Biopsy Samples for Diagnosis of Extrapulmonary Tuberculosis

ObjectiveTo evaluate the diagnostic value of histopathological examination of ultrasound-guided puncture biopsy samples in extrapulmonary tuberculosis (EPTB). MethodsThis study was conducted at the Shanghai Public Health Clinical Center. A total of 115 patients underwent ultrasound-guided puncture biopsy, followed by MGIT 960 culture (culture), smear, GeneXpert MTB/RIF (Xpert), and histopathological examination. These assays were performed to evaluate their effectiveness in diagnosing EPTB in comparison to two different diagnostic criteria: liquid culture and composite reference standard (CRS). ResultsWhen CRS was used as the reference standard, the sensitivity and specificity of culture, smear, Xpert, and histopathological examination were (44.83%, 89.29%), (51.72%, 89.29%), (70.11%, 96.43%), and (85.06%, 82.14%), respectively. Based on liquid culture tests, the sensitivity and specificity of smear, Xpert, and pathological examination were (66.67%, 72.60%), (83.33%, 63.01%), and (92.86%, 45.21%), respectively. Histopathological examination showed the highest sensitivity but lowest specificity. Further, we found that the combination of Xpert and histopathological examination showed a sensitivity of 90.80% and a specificity of 89.29%. ConclusionUltrasound-guided puncture sampling is safe and effective for the diagnosis of EPTB. Compared with culture, smear, and Xpert, histopathological examination showed higher sensitivity but lower specificity. The combination of histopathology with Xpert showed the best performance characteristics.

HEMATOLOGICAL DYNAMICS IN HEMODIALYSIS: A COMPREHENSIVE EXAMINATION OF PATIENTS WITH CHRONIC RENAL FAILURE IN A TERTIARY CARE HOSPITAL

Background: Chronic kidney disease (CKD) is a significant health burden in developing countries like India, leading to high morbidity and mortality rates. The study aimed to determine the incidence of anemia among patients with CKD and examine its potential association with other predictive markers. Methods: A cross-sectional observational research was undertaken within a tertiary hospital setting to examine the incidence of hematological abnormalities and explore the association between anemia and its many manifestations in patients with stages 3-5 chronic kidney disease (CKD). The markers for anemia encompassed measurements of hemoglobin percentage (Hb%), mean corpuscular volume (MCV), and examination of peripheral smears. The investigation also examined the correlation between stages of chronic kidney disease (CKD) and red cell distribution width (RDW), thrombocytopenia, leucocyte count, and differential count. Result: The study found that 96.8% of participants displayed symptoms of anemia, characterized by normocytic and normochromic observations on peripheral measures. A significant number of patients (57.3% of them) had a higher total leucocyte count (TLC), but there was no statistically significant link between a higher TLC and the worsening stages of CKD. The mean corpuscular volume (MCV) and platelet levels exhibited a predominantly normal range, with relatively few observed fluctuations. However, there is a positive link between the advancement of CKD and an increase in red cell distribution width (RDW). Conclusion: The study highlights the changes in blood parameters observed in individuals with CKD, with particular attention given to the high occurrence of anemia. The findings underscore the importance of comprehensive iron investigations and the timely identification and intervention of anemia. Adopting a comprehensive strategy that includes regular monitoring of blood parameters, specifically focusing on anemia and iron levels, is crucial for effectively managing and enhancing the overall health of individuals with CKD KEY WORDS- Anemia in CKD, Chronic kidney disease, Iron deficiency anemia

Evaluation of Acute Leukaemias by Flow Cytometry and Its Correlation With Diagnosis Using Morphological and Special Staining Techniques.

Leukaemia can be reliably diagnosed and classified by the simultaneous application of multiple techniques. Cytochemical stains that are cheap and do not require any special instruments are very important in developing countries for the diagnosis of acute leukaemia (AL). To diagnose AL in all suspected cases by flow cytometry and to correlate the diagnosis with morphological and special staininglike myeloperoxidase (MPO) and periodic acid-Sciff (PAS)techniques. Methods and materials: The study participants' peripheral blood smear details and bone marrow aspirate smear morphologic findings, as well as socio-demographic information, were taken from the patients' medical files. In total, 57 newly diagnosed instances of acute leukaemia confirmed by flow cytometry were incorporated into the study, which underwentcytochemical labeling and morphological diagnosis. All patients who gave previous consent had their bone marrow aspirated, and a Wright-stained smear was produced for microscopic inspection, cytochemical staining, and immunophenotyping. In an ethylenediaminetetraacetic acid (EDTA) container, peripheral blood was also drawn for the same purpose. During the entire bone marrow smear examination, we used both MPO and PAS staining techniques. The study was carried out between July 2019 and June 2020. Out of 57 cases in the study, 29 (50.9%) cases on cytochemical analysis of leukaemia using PAS and MPO were diagnosed with acute myeloid leukaemia (AML) and 28 (49.1%) were diagnosed as acute lymphoid leukaemia (ALL).Cytochemical analysis of leukaemia using PAS and MPO rendered the diagnosis in 92.9% of acute leukaemia cases in our study. A total of 25 out of 25 AML cases and28 out of 32 cases of ALLwere correctly diagnosed based on morphology and cytochemical staining. Morphology and cytochemical analysis alone were unable to correctly diagnose a total of four ALL cases. All AML cases that were wrongly diagnosed as ALL were mostly M0 and M1-AML. Morphological staining diagnosis by itself is capable of correctly identifying a large proportion of cases of AL, which comprised 92.98% of total cases. There was also a favorable relationship between findings of diagnosis by flow cytometry and findings of diagnosis by morphology assessment in determining acute leukaemias.

Diagnosis and treatment of Ehrlichiosis in a Pug dog

In addition to damaging the skin and causing inflammatory reactions and anemia, dog tick infestations are vectors for blood parasites such as Ehrlichia spp., known as Ehrlichiosis. This article reports the case of a five-year-old female Pug dog whose body was covered with ticks. The clinical examination found tick infestation on the face, ears, back, abdomen, legs, and interdigital areas. Supporting examinations included a complete blood count (CBC), buffy coat smear, and a test kit. CBC examination showed that the dog had leukocytosis, neutrophilia, hypochromic microcytic anemia, and thrombocytopenia. A buffy coat smear examination showed the presence of Ehrlichia morulae in the cytoplasm of the dog's monocytes, and the test kit results were positive for Ehrlichia antibodies; therefore, the dog was diagnosed with Ehrlichiosis. Treatment is done by administering Doxycycline, Intervetta Dr. Choice Ferro-B, and Fu Fang Ejiao Jiang orally for 21 days. After treatment, hematological parameters in leukocytes, neutrophils, erythrocytes, and platelets returned to normal ranges.

Effectiveness of artemether-lumefantrine for treating uncomplicated malaria in low- and high-transmission areas of Ghana.

Artemisinin-based combination therapy (ACT) has been effective in the supervised treatment of uncomplicated malaria in Ghana. Since ACT usage is primarily unsupervised, this study aimed to determine the effectiveness of artemether-lumefantrine (AL) for treating malaria patients in two transmission settings in Ghana. Eighty-four individuals with uncomplicated Plasmodium falciparum malaria were recruited from Lekma Hospital (LH) in Accra (low-transmission area; N = 28), southern Ghana, and King's Medical Centre (KMC) in Kumbungu (high-transmission area; N = 56), northern Ghana. Participants were followed up for 28days after unsupervised treatment with AL. The presence of asexual parasites was determined by microscopic examination of Giemsa-stained blood smears. Plasmodium species identification was confirmed using species-specific primers targeting the 18S rRNA gene. Parasite recrudescence or reinfection was determined by genotyping the Pfmsp 1 and Pfmsp 2 genes. After AL treatment, 3.6% (2/56) of the patients from KMC were parasitaemic on day 3 compared to none from the LH patients. One patient from KMC with delayed parasite clearance on day 3 remained parasite-positive by microscopy on day 7 but was parasite-free by day 14. While none of the patients from LH experienced parasite recurrence during the 28-day follow-up, three and two patients from KMC had recurrent parasitaemia on days 21 and 28, respectively. Percentage reduction in parasite densities from day 1, 2, and 3 for participants from the KMC was 63.2%, 89.5%, and 84.5%. Parasite densities for participants from the LH reduced from 98.2%, 99.8% on day 1, and 2 to 100% on day 3. The 28-day cumulative incidence rate of treatment failure for KMC was 12.8% (95% confidence interval: 1.9-23.7%), while the per-protocol effectiveness of AL in KMC was 89.47%. All recurrent cases were assigned to recrudescence after parasite genotyping by Pfmsp 1 and Pfmsp 2. While AL is efficacious in treating uncomplicated malaria in Ghana, when taken under unsupervised conditions, it showed an 89.4% PCR-corrected cure rate in northern Ghana, which is slightly below the WHO-defined threshold.

EHRLICHIOSIS AND DEMODICOSIS IN BALI LOCAL DOG

Ehrlichiosis is a zoonotic disease caused by infection with intracellular bacteria Ehrlichia sp. which can be transmitted by ticks. Demodicosis is a parasitic disease caused by the mite Demodex sp. which has a predilection for the dermis, hair follicles, and sebaceous glands. A male local breed dog aged approximately 2 years with a body weight of 8 kg came with complaints of hair loss and high intensity itching with a scale of 8/10. The results of clinical examination showed alopecia, scale, and erythema almost all over the body accompanied by tick infestations found on the back, anemic mucosa, left prescapularis lymph nodes and left popliteus experienced swelling. Hematological examination showed macrocytic hypochromic anemia, leukocytosis, lymphocytosis, granulocytosis, and thrombocytopenia. Blood smear and serology examination showed Ehrlichia sp.. infection while deep skin scrapping examination showed Demodex sp. infection. Based on the anamnesis, physical examination and laboratory examination, the case of the dog suffering from ehrlichiosis accompanied by demodecosis. The therapy given was in the form of doxycycline, ivermectin, diphenydramine, vitamin B complex, and bath therapy with sulfur soap. Observation of therapy on the 14th day provided clinical improvement in terms of reducing itching intensity, Demodex sp. infection intensity, and hematological parameters. On the 28th day of the last treatment, the dog's body condition was getting better, new hair started to grow and the body condition score increased. Dogs should be given food rich in nutrients such as liver, meat and egg yolks, as well as providing nutritional supplements to speed up the dog's recovery.

A CASE OF ANAPLASMOSIS IN DOG

Anasplasmosis is a disease caused by gram-negative intracellular microorganisms. A Kintamani mix dog was examined at the Veterinary Hospital, Faculty of Veterinary Medicine, Udayana University with complaints; itching, tick infestation, alopecia and erythema all over the dog's body. A case study has been carried out aiming to detect the presence of Anaplasma sp. infection. in dogs infested with ticks in Denpasar City. The results of the clinical examination showed focal mucous membranes of the eyes and mouth, a weak dog, and Rhiphicephalus Sanguenus tick infestation. Routine hematological examination showed leukocytosis, hypochromic normocytic anemia, thrombocytopenia. Blood smear examination showed positive results for the discovery of Anasplasma sp. The blood test with the test kit (E.canis/Anaplasma Ab Test Kit, BioNote, Inc., Republic of Korea) showed positive results for Anasplasma sp. So the case of a dog diagnosed with Anaplasmosis. The treatment used was Doxycycline® (10 mg/kg BW PO) given twice a day for fourteen days, Ivermectin® (0.4 mg/kg BW SC) once a week with twice repetition, and Sangobion® 1/6 tablet per day given for ten days. This treatment gave good results for case dogs in terms of appetite and drinking, animal activity, animals free of ticks and routine hematology results showed no anemia and normal platelet values. To avoid re-infection, it is advisable to eradicate fleas from the environment, isolate animals during therapy, pay attention to good and healthy animal management, and maintain a tick-free environment.

TREATMENT OF BABESIOSIS AND ECTOPARASITIC INFESTATION IN TERRIER CROSSBREED DOG

Babesiosis is an infectious disease caused by Babesia sp. distributed in the circulatory system. A 5-month-old male Terrier mix with a body weight of 6.20 kg had complaints of weakness and many ticks all over the dog's body. The results of the physical examination found ticks almost all over the body, pale eye mucosa, erythema on the right ear, and the inside of the ear was dirty. Laboratory examination results include routine haematological examination showing hypochromic normocytic anaemia followed by leucocytosis and lymphocytosis; blood smear examination showing Babesia sp erythoparasites; microscopic examination found Rhipicephalus sanguineus ticks and Ctenocephalides canis larvae on the skin and nails of dogs and the results of earwax swabs found Otodectes cynotis. Based on the results of history taking, physical examination, and laboratory examination, the case dog was diagnosed with babesiosis with a prognosis of fausta. The therapy given was imidocarb dipropionate 6.6mg/kg BW every 2 weeks for 3 repetitions; doxycycline 10 mg/kg BW twice a day for 21 days; and ivermectin 0.2 mg/kg BW given once a week for 3 repetitions; and herbal oabat Fufang E'jiao Jiang 1 ml/kg given once a day for 7 days. Observation on the 14th day of therapy showed clinical improvement such as lethargy that disappeared, decreased intensity of nausea, and reduced tick infestation.

Allium ampeloprasum var. Porrum (Alliaceae) Improves Metabolic and Reproductive Disorders Associated with Polycystic Ovary Syndrome in Wistar Rats.

To provide scientific evidence of the efficacy of Allium ampeloprasum against female infertility, the effects of the aqueous extract of the said plant (AE) were evaluated in rats with letrozole-induced polycystic ovary syndrome (PCOS). AE was administered orally to PCOS rats at doses of 192, 384, and 768 mg/kg. The positive control was co-treated with clomiphene citrate (1 mg/kg) and metformin (200 mg/kg). Normal and negative controls received distilled water. The vaginal contents of rats were examined daily under a microscope before (7 days) and during treatment. Treatments were administered orally for 15 days, and then, 6 rats from each group were sacrificed for biochemical and histological analyses. The remaining rats were mated with males of proven fertility for 5 days. The daily examination of vaginal smears allowed the evaluation of fertility index. After parturition, additional fertility parameters were determined. Results showed that in PCOS rats, AE decreased body weight (p < 0.001), abdominal fat weight (p < 0.001), serum levels of LH (p < 0.001), testosterone (p < 0.001), total cholesterol (p < 0.05), and LDL cholesterol (p < 0.01). HDL cholesterol increased and atherogenic indices decreased (p < 0.001). The number of Graafian follicles and corpora lutea increased, while cystic (p < 0.001) and atretic (p < 0.05) follicles decreased. AE also decreased oxidative stress in the ovaries, restored the estrous cycle, induced uterine epithelial cell hypertrophy, and improved fertility. These effects were attributed to phenols, flavonoids, terpenoids, and anthocyanins present in AE. The overall results justify the traditional use of A. ampeloprasum against female infertility and suggest its potential use as a dietary supplement for PCOS patients.