RESULTS The monthly average percent mortality from severe malaria dropped from 9% to 3.6% after the interventions which was borderline statistically significant (p 0.06, CI 95% 1.5 to 5.6). The secondary outcome, percent of malarial deaths attributable to hypoglycemia via chart reviews, reduced from 83% to 44%across the study period. There was an increase in the average number of admissions for severe malaria from 71 to 153 children per month in the second half of the year (range from 49-212 per month). CONCLUSION Implementing the WHO malaria treatment protocol with bedside tracking of protocol steps reduced malaria mortality and improved our ward's efficiency without adding any human or medical resources. Phaeohyphomycosis is a set of fungal infections caused by various dematiaceous fungi such as coelomycetes. These infections can occur either in immunocompetent or immunocompromised patients like solid organ transplants. Here we describe a nodular lesion of the right hallux that occurred in a kidney transplant patient. Microscopic examination of the biopsy revealed fungal hyphae and culture was positive to a grey to black mould that lacked characteristic elements to be identified. Nucleic acid sequencing targeting the internal transcribed spacer of the ribosomal DNA identified this mould as Medicopsis romeroi. The patient benefited of an antifungal therapy with voriconazole associated with surgical excision of the lesion. No relapse of the lesion was observed during a six-month follow-up. In solid organ transplants, phaeohyphomycosis caused by Medicopsis romeroi are very rare with only 12 cases reported. The clinical history should be well assessed since the lesion can appear several years after a cutaneous trauma that happened in a tropical region. Therapy generally combines antifungals with surgical excision of the lesion in order to avoid any relapse or dissemination of the infection. OBJECTIVE To evaluate the performance of whole genome sequencing (WGS) for predicting Mycobacterium tuberculosis (MTB) drug resistance. METHODS 276 rifampin-resistance tuberculosis (RR-TB) and 30 rifampicin-sensitive clinical isolates were randomly selected from patients with tuberculosis in Shanghai Pulmonary Hospital (SPH). Phenotypic drug susceptibility testing (DST) against 6 anti-TB drugs were performed, and WGS was performed to predict the drug resistance using an online 'TB-Profiler' tool.  https://www.selleckchem.com/products/FK-506-(Tacrolimus).html  RESULTS Using phenotypic susceptibility as the gold standard, the overall sensitivity and specificity for WGS were 94.53% and 92.00% for isoniazid, 97.10% and 100.00% for rifampicin, 97.46% and 64.36% for ethambutol, 97.14% and 95.83% or streptomycin, 93.02% and 98.87% for ofloxacin, and 75.00% and 100.00% for amikacin, respectively. The concordances of WGS-based DST and phenotypic DST were shown as follows isoniazid (94.12%), rifampicin (97.39%), ethambutol (77.12%), streptomycin (96.73%), ofloxacin (96.41%) and amikacin (97.06%). CONCLUSIONS WGS could be a promising approach to predict resistance to isoniazid, rifampicin, ethambutol, streptomycin, ofloxacin and amikacin. BACKGROUND Whole genome sequencing (WGS) has been proposed to be a powerful tool to predict drug resistance for antitubercular drugs. However, the feasibility of WGS in predicting final treatment outcomes for multidrug-resistant tuberculosis (MDR-TB) patients remains unclear. PATIENTS AND METHODS In the prospective observational study conducted from January 2014 to September 2016, MDR-TB patients were enrolled consecutively. Genotypic drug sensitivity testing was performed via WGS using the culture isolates. Patients were followed for two years to determine the treatment outcomes. Multivariate analysis was used to identify the association between information provided by WGS and the final treatment outcomes. RESULTS A total of 123 patients with MDR-TB were included in this study. The overall favorable treatment outcome rate was 60.2%. Multivariate analysis showed that independent risk factors associated with unfavorable treatment outcome including high-level moxifloxacin phenotypic resistance (OR, 4.362; 95%CI, 1.364-13.950; p=0.013), cycloserine phenotypic resistance (OR, 7.457; 95%CI, 1.644-33.819; p=0.009), mutations causing high level fluoroquinolones resistance (OR, 3.947; 95%CI, 1.195-13.034; p=0.024), and ethA mutation (OR, 3.817; 95% CI, 1.154-12.823; p=0.028). WGS costs for each patient are ¥450 ($63) and the average turnaround time was one week. CONCLUSIONS In summary, WGS showed a promising feasibility in predicting treatment outcomes for MDR-TB patients within a clinically relevant time frame. OBJECTIVE Metagenomic Next-Generation Sequencing (mNGS) has been applied as a novel method of detection pathogens for infectious diseases, but its value in the rapid diagnosis of tuberculous meningitis(TBM)had not been clarified based on large samples. METHODS A retrospective analysis was conducted on 51 inpatients with TBM suspected who underwent mNGS and other four tests in cerebrospinal fluid (CSF). RESULTS Among 51 included patients, 45 cases were diagnosed as TBM (38 definite, 5 probable, 2 possible) and 6 cases with not-TBM. Using final diagnosis as reference standard, the sensitivity, specificity, PPV (positive predictive value), NPV (negative predictive value) of mNGS in CSF for TBM were 84.44% (38/45, 69.94%-93.01%), 100%(6/6, 51.68%-100%), 100% (40/40, 88.57%-100%) and 46.15% (6/13, 20.40%-73.88%). The diagnostic sensitivity of mNGS (84.4%)was significantly higher than that of AFB (0%, P = 0.000), MGIT960 culture (22.2%, P = 0.000), MTB PCR (24.4%, P = 0.000) and Xpert MTB/RIF (40%, P = 0.000). The ROC curve showed that CSF protein quantification and CSF cells count might be valuable in the prediction of NGS positive detection of MTB (Mycobacterium tuberculosis). CONCLUSION CSF mNGS had high sensitivity, specificity and PPV in the diagnosis of TBM. Patients with significant increase in CSF cell number and protein quantification might be higher likelihood of positive MTB detection of NGS. OBJECTIVES The aim of this study was to evaluate the use of meropenem in terms of indication and continuation of treatment at Sultan Qaboos University Hospital (SQUH), Muscat, Oman. METHODS A retrospective observational study, conducted by reviewing the medical records of 400 adult admitted patients who received at least one dose of meropenem during the study period (January 2017 to September 2017). Analysis was performed using univariate statistics. RESULTS Meropenem was prescribed empirically in 382/400 (96%) of the cases. The majority (315/361 (87%)) of the patients received the proper meropenem dose. The indication for meropenem was considered appropriate in only 196/400 (49%) of the cases. The continuation of treatment was evaluated according to culture and sensitivity results in 202 cases, out of which 112 (55%) were justified. Most of the inappropriate uses were seen in oncology and hematology cases (31/42 (74%) and 61/101 (60%), respectively) and among respiratory and urinary tract infections (126/155 (81%) and 40/46 (87%), respectively).