Volume 13 (2019): Edizione 6 (December 2019)

Leptospirosis, caused by pathogenic Leptospira spp., is a widespread zoonotic disease worldwide. Early diagnosis is required for proper patient management and reducing leptospirosis morbidity and mortality.

To summarize current literature regarding commonly used and new promising molecular approaches to Leptospira detection and diagnostic tests of human leptospirosis.

The relevant articles in Leptospira and leptospirosis were retrieved from MEDLINE (PubMed) and Scopus.

Several molecular techniques have been developed for diagnosis of human leptospirosis. Polymerase chain reaction-based techniques targeting on either lipL32 or 16S rRNA (rrs) gene are most commonly used to detect leptospiral DNA in various clinical specimens. Whole blood and urine are recommended specimens for suspected cases in the first (acute) and the second (immune) phases, respectively. Isothermal amplification with less expensive instrument is an alternative DNA detection technique that may be suitable for resource-limited laboratories.

Detection of leptospiral DNA in clinical specimens using molecular techniques enhances sensitivity for diagnosis of leptospirosis. The efficient and robust molecular detection especially in the early leptospiremic phase may prompt early and appropriate treatment leading to reduced morbidity and mortality of patients with leptospirosis.

Dabigatran, a direct oral anticoagulant, has been approved for the prevention of venous thromboembolism (VTE) after orthopedic surgery in many countries. The efficacy and safety of this agent were most studied in Western countries.

To assess the efficacy and safety of dabigatran in preventing venous thromboembolic diseases after total knee arthroplasty (TKA) in Asian patients.

We conducted a prospective nonrandomized controlled study in Thai patients undergoing TKA. Thirty-two patients received 220 mg of dabigatran once daily for 14 days as thromboprophylaxis and 32 patients in the control group received none. The primary efficacy outcome was deep vein thrombosis (DVT), which was identified by color Doppler ultrasonography and/or diagnosed pulmonary embolism (PE). The primary safety outcomes were major bleeding and clinically relevant nonmajor bleeding events.

There were no DVTs or PEs diagnosed in either group. The difference in the composite incidence of major and clinically relevant nonmajor bleedings between the dabigatran and control groups did not reach significant (6.2% vs. 0%, P = 0.15).

Dabigatran might have no clear benefit for the prevention of VTE after TKA in Thai patients. We do not recommend the routine use of dabigatran as a chemical thromboprophylaxis after TKA in Thai patients. To determine the safety profile, further study with larger sample sizes is required.

Staphylococcus aureus is one of the common opportunistic gram-positive pathogens which are often associated with nosocomial infections. Detection of methicillin-resistant S. aureus (MRSA) has become complicated due to the complex phenotypic and genomic pattern.

To evaluate the sensitivity and specificity pattern of various phenotypic methods used in screening mec genes harboring MRSA.

Clinical isolates of S. aureus were collected from diagnostic centers in Tamil Nadu. Phenotypic identification methods such as Minimal Inhibitory Concentration for oxacillin, oxacillin screen agar (OSA), oxacillin disk diffusion, and cefoxitin disk diffusion (CFD) tests were compared. The clinical isolates were classified into MRSA and methicillin-susceptible S. aureus (MSSA) based on the polymerase chain reaction (PCR) amplification of the mecA gene.

Out of 50 S. aureus, 21 were found to be MRSA based on the presence of the mecA gene. All 21 mecA-positive isolates were found to be resistant through minimum inhibitory concentration (MIC) and CFD test, having a sensitivity of 100% and specificity of 52% and 62%, respectively. OSA and oxacillin disk tests were found to have a sensitivity of 86% and specificity of 48% and 52%, respectively.

The combination of two phenotypic methods, CFD and oxacillin MIC, can be used for the detection of MRSA in clinical laboratories.

Atmospheric plasma jet has different medical applications due to its low temperature at room temperature. In recent years, the effect of nonthermal plasmas on cancer cells has been studied, and it has been shown that this type of plasma has anti-proliferative effects on cancer cells.

To design a plasma jet handpiece, which can be used in cutting operations in less bleeding surgery, eliminating cancer cells without damage to healthy cells and reducing the duration of wound healing.

The plasma handpiece simply consists of a nozzle body and two cathode and anode electrodes and a fully insulated body against heat and high voltage. Argon is introduced into the handpiece, and by plasma treatment, it is used for special purposes. Each piece was made according to its own manufacturing process and by assembling; the final product of the atmospheric plasma jet handpiece was ready for testing. The jet pipeline was then tested, and the effective parameters were examined.

The cold atmospheric plasma jet length depends on factors such as power supply, applied voltage, gas flow rate and the distance between the electrodes. The results showed with increasing velocity, the flame and jet lengths decreased greatly due to high losses of plasma, including ions and electrons. Also with increasing the velocity of argon gas, its concentration decreased.

It is concluded that the performance of the proposed design is successful. The advantages include low-cost manufacturing, highly stable performance, and low erosion and can be considered for future development.