MEDICAL LABORATORY JOURNAL
Year:2021 | Volume:15 | Issue:6|Papers Count:10

Background and objectives: Coronavirus disease 2019 (COVID-19) is a pandemic caused by SARS-CoV-2 virus that has taken a toll on people all over the world. Previous studies have demonstration association of ABO blood groups with increased susceptibility to various conditions such as infection with Helicobacter pylori, Hepatitis B virus and Norwalk virus and even SARS-CoV1. In this cross-sectional study, we investigated the association between ABO blood groups and COVID-19 in a tertiary care hospital in western Uttar Pradesh, India. Methods: The study included data from 500 SARSCoV-2-positive patients who were referred to the hospital. Diagnosis of COVID-19 was made using RT-PCR. Data including demographic information, comorbidities, ABO blood group, Rh factor, clinical severity as well as the need for assisted ventilation, ICU admission and plasma therapy were collected from patients’,medical records. The Pearson’, s correlation, chi square and Fischer exact tests were used to analyze data at significance of 0. 05. Results: Frequency of COVID-19 was highest in blood group B (34. 8%) and lowest in blood group AB (11. 2%). Furthermore, patients with blood group A had significantly more severe form of COVID-19 when compared to patients with other blood groups. The frequency of ICU admission, assisted ventilation and plasma therapy was significantly higher in patients with blood group A than in patients with other blood groups. Conclusion: Our results suggest that patients with blood group A are at higher risk of developing severe COVID-19 infection that may require assisted ventilation and ICU admission. Hence, these patients might require more vigilant surveillance and aggressive treatment measures. Further studies are required to validate these findings.

Background and objectives: Coronavirus disease 2019 (COVID-19) is a global health problem. Laboratory professionals are at a higher risk of contracting the disease during the COVID19 pandemic. This study was conducted to examine lab professionals' perceptions and satisfaction with organizational processes during the COVID-19 outbreak. Methods: This cross-sectional survey was carried out on 53 medical laboratory professionals working at laboratories in Tripoli (Libya) between November 2020 and January 2021. Data were collected via face-to-face questionnaire. Responses to questions were scored based on a five-point Likert scale (1=strongly disagree, 2= disagree, 3=neutral, 4=agree and 5=strongly agree). Data were presented as frequency and percentages using the Microsoft Excel 2016. Results: Most participants were female (81. 2%) and with less than five years of work experience (39. 6%). The majority of respondents (79. 3%) had a bachelor’, s degree. Most healthcare workers (75. 5%) were unaware whether the lab would provide medical care if they were tested positive for COVID-19, while 13. 2% of them perceived that they will get free medical care. Owing to social distancing, 20 subjects (37. 7%) felt that their social activities have been altered during break time. Only 3. 7% of the participants believed that their motivation level decreased due to the COVID-19 outbreak. Conclusion: The outcomes of this study provide laboratorians’,perspective in the COVID-19 crisis as well as specific lessons for future unpredicted crises.

Background and objectives: Microscopic agglutination test is the gold standard sero-diagnostic method for detection of leptospirosis. Moreover, it helps identify serovars and their titers in serum samples. For obtaining accurate titer results, proper sampling, collection, storage, and transportation of samples are crucial while maintaining the cold chain. Since storage for long periods and the subsequent deterioration of samples may affect the final titers, we proposed an alternative method of MAT testing using filter paper-dried serum samples. We also evaluated sensitivity and specificity of the MAT test by using filtered-dried serum samples compared with the conventional MAT test. Methods: This experimental study was performed on human and animal serum samples that were sent to a reference leprospirosis laboratory in 2020. Overall, 142 positive samples (with 289 titers for different strains) and 15 negative samples were used for MAT test using filtered-dried serum. For this purpose, each sample was dried on a filter paper (Whatman 903, GE Healthcare) at room temperature (20-30 °, C) and kept for four days. On the fifth day, the filter papers were cut into small pieces, soaked in phosphate buffer saline, vortexed, and slowly mixed on shaker for two hours to elute antibodies. The MAT tests were performed simultaneously and under the same environmental conditions. Results: The new MAT test using dried serum samples showed 79% sensitivity and 100% specificity. The test also had positive predictive value of 92% and negative predictive value of 24% when compared with the gold standard MAT test. Conclusion: Filter-dried serum can be used for MAT test to overcome serum storage and transportation problems.

Background and objectives: Voluntary blood donation is the main source of blood and its components globally. Blood transfusion is essential for management of various diseases but remains as one of the most important causes of disease transmission. In this study, we screened donated blood samplesfor haemoparasites in the University of Calabar Teaching Hospital, Nigeria. Methods: This cross-sectional study was performed on 200 blood samples taken from donors who had been asymptomatic for haemoparasite infections. The blood samples were analyzed microscopically for the presence of malaria parasites using Giemsa stained thin smears and thick smears. The Knott concentration technique was used to detect microfilaria. To evaluate presence of trypanosomes, triple centrifugation was carried out and the resulting sediment was used to prepare wet and smears stained with 10% Giemsa solution. Results: The prevalence of malaria parasites, microfilaria, and trypanosome was 38% (76/200), 5% (10/200), and nil (0/200), respectively. The prevalence of malaria infection was highest among females, individuals aged 18–, 25 years and those with O+ blood type. Most donors had malaria parasite density of 200–, 4000/µ, l. Microfilaria was only found in males and more common among subjects between 26 and 33 years of age as well as those with O+ blood type. Conclusion: The findings revealed the presence of malaria and microfilaria infections and the absence of trypanosomes among blood donors in Calabar, Nigeria. This accentuates the need to screen all blood donors for haemoparasites in order to reduce the spread of the parasites and minimize its effects on the recipients.

Background and objectives: Differential diagnosis between clonal lymphocytosis (CL) and reactive lymphocytosis (RL) is often established through blood smear examination but with some limitations. We aimed to evaluate ability of clinical data and extended-cells blood count (CBC) parameters to discriminate CL from RL and to establish a decision-making algorithm for moderate lymphocytosis in adults. Methods: A total of 85 samples were collected from adults with absolute lymphocytescount of >5G/l. The samples were divided into RL group (n=34) and newly diagnosed CL group (n=51). Demographic data, CBC parameters including high fluorescence lymphocytes cells percentage (HFLC%) and abnormal lymphocytes or blasts (’, AbnLym/BL’, ’, ) morphological flag were evaluated for each study group. New threshold for discriminating parameters were determined using receiver operating characteristic (ROC) curves and used in an algorithm for moderate lymphocytosis. Results: Age, high lymphocytes count and the presence of the ’, AbnLym/BL’, ’,flag and low HFLC% were predictor of malignant lymphocytosis. Age threshold of 62. 5 years and absolute lymphocytes count of > 10. 47 G/l were highly effective in CL detection with area under the ROC curve of 0. 9 and 0. 99, respectively. In addition, HFLC% showed an area under the ROC curve of 0. 71. Considering ALC threshold of 10. 47 G/l alone, a sensitivity of 96. 7% and a specificity of 100 % were achieved. For moderate lymphocytosis ranging between 5 and 10. 47G/l, no false positive or negative result was detected when we considered both the proposed ALC and age cut-offs. Conclusion: A combination threshold for ALC and age appears to be helpful for screening CL, especially in moderate lymphocytosis for both laboratory and clinical routine practice.

Background and objectives: Antibiotic resistance is a global health challenge that affects both individuals and the health system in many ways. The aim of this study was to evaluate the antibiotic resistance pattern in isolates from patients admitted to the intensive care unit (ICU) of a hospital in Qazvin, Iran. Methods: This descriptive and retrospective study was performed on urine and blood samples collected from 1318 ICU patients in the Velayat Hospital of Qazvin (Iran) during 20172019. Data were collected from patients’,medical records. All statistical analyses were performed using SPSS software (version 25). Results: Based on the findings, 65. 2% of the samples were related to urinary tract infections and 34. 7% to bloodstream infections. Escherichia coli (68. 6%) and Stenotrophomonas (41. 0%) were the most common bacteria isolated from urinary tract infections and bloodstream infections, respectively. Moreover, the rate of antibiotic resistance was higher among Acinetobacter, Escherichia coli, Stenotrophomonas, Enterococcus and Pseudomonas isolates. Conclusion: The rate of drug resistance in isolates from ICU patients is alarmingly high and requires immediate attention. It is recommended to modify antibiotic prescriptions in the hospital based on the results of antibiotic resistance pattern, particularly for treatment of infections caused by E. coli and Stenotrophomonas.

Background and objectives: In recent years, analytical error rates in medical laboratories have decreased significantly. It has been demonstrated that the majority of errors occur outside of the laboratory in the pre-analytical and post-analytical phases. Our study aimed to evaluate the specimen rejections that occur for various reasons in the central clinical laboratory of a teaching hospital. Methods: The study included all specimens (emergency and routine) that were sent from different units of the hospital to the central laboratory between January and December 2019. Results: Based on the results, 3483 (0. 27%) out of 1, 307, 013 specimens were rejected. The rejection rate was highest for specimens from the intensive care unit (0. 69%) and lowest for specimens from the outpatient clinic (0. 18%). The specimen rejection rate was 0. 42% and 0. 22% for specimens from the service unit and emergency department, respectively. The rejection rate for specimens from the intensive care unit was significantly higher than that for specimens from the emergency department (p<0. 001), outpatient clinic (p<0. 001), and service unit (p=0. 010). Although the number of specimens from the intensive care unit was lowest, it had the highest rate of specimen rejection. In our study, most analysis requests were from the outpatient clinic. However, the specimen rejection rate was lowest in this unit. Conclusion: The results indicate that the reasons for specimen rejection may be influenced by the health status of the patient rather than the patient population.

Background and objectives: Turnaround time (TAT) is an important quality indicator for benchmarking laboratory performance. Delay in TAT may affect patient safety,thus, continuous monitoring and analysis of laboratory workflow is mandatory. This study was designed to improve the TAT of two biochemistry laboratories serving in tertiary care teaching hospitals (multispecialty and super-specialty) through the application of quality tools namely quality failure reporting, the Fishbone model, and process mapping. Methods: First, TAT was defined for routine (four hours) and urgent samples (two hours). Then, TAT failureincidents in 2018-2019 were analyzed using the Fishbone model. The process map of TAT was studied and made more value streamed and lean after removal of waste steps. Corrective action plans were prioritized and implemented for potential causes with more adverse outcomes. Pilot solutions were implemented for six months and TAT failures incidents were reanalyzed. Results: The quality failure in TAT reporting was reduced by 22% (from 34% to 12%) for urgent samples and by 19% (from 27% to 8%) for routine samples after the implementation of quality tools in multispecialty hospital laboratory. In the super-specialty hospital laboratory, the improvement was more profound and the TAT percentage achieved after the corrective actions was 96. 57% and 98% for urgent and routine samples, respectively. Conclusion: Implementation of quality failure reporting culture along with quality tools led to significant improvement in TAT and higher quality laboratory performance in terms of efficiency, reliability, and increased patient safety.

Background and objectives: Bacterial contamination of wounds is a serious problem, particularly in burn patients. Gram-positive bacteria are the predominant cause of infection in newly hospitalized burn cases. This study aimed to survey the prevalence and antibiotic resistance pattern of gram-positive bacterial isolates among burn patients in Rasht, North of Iran. Methods: This cross-sectional study was conducted on burn patients with a positive culture for gram-positive isolates who were hospitalized in the Velayat Burn Center in Rasht, North of Iran, during 2017-2020. The isolates were identified using standard microbiological methods. Moreover, the antibiotic resistance pattern was determined by the disk diffusion method. Results: During the study period, 671 bacterial cultures were obtained, of which a total of 16 gram-positive isolates were taken from the patients. The frequency of coagulase-negative staphylococci (CoNS), Staphylococcus aureus, and Enterococcus spp. was 68. 7%, 18. 8%, and 12. 5%, respectively. In addition, the highest rate of resistance in CoNS isolates was against trimethoprim/sulfamethoxazole. The highest rate of resistant among S. aureus isolates was recorded against penicillin. Moreover, Enterococcus faecalis isolates showed a high level of resistance to ampicillin, erythromycin, tetracycline, gentamicin, and ciprofloxacin. All isolates were susceptible to teicoplanin. Moreover, the frequency of methicillin-resistant S. aureus isolates was 66. 7%. Conclusion: Given the increasing prevalence of drugresistant strains, especially in susceptible burn patients, it is imperative to analyze the bacterial etiology of nosocomial infections periodically and epidemiologically.

Infective endocarditis is rare in children but can cause significant morbidity and mortality. Streptococcus and Staphylococcus species are the leading causes of this disease. Staphylococcus is more common in people with underlying heart disease, and Streptococcus viridans is more common in people who have had a dental procedure. In general, any fever of unknown origin in children with an underlying heart problem should be carefully evaluated for endocarditis, and empiric therapy should be performed. The main symptoms of the disease include fever, new murmur, deterioration of the previous murmur, hematuria, embolic events, splenomegaly, bleeding splinter, Osler's nodes, Janeway lesion, and Roth spots. One of the important complications of infective endocarditis is cerebrovascular event and stroke. Herein, we describe a 6-yearold girl presented with fever and skin lesions and no history of underlying heart problem or dental procedure. The patient expired after three days of mitral valve infection with S. aureus.