Evaluating laboratory key performance using quality indicators in alexandria university hospital clinical chemistry laboratories

The performance of clinical laboratories plays a fundamental role in the quality and effectiveness of healthcare. To evaluate the laboratory performance in Alexandria University Hospital Clinical Laboratories using key quality indicators and to compare the performance before and after an improvement plan based on ISO 15189 standards. The study was carried out on inpatient samples for a period of 7 months that was divided into three phases: phase I included data collection for evaluation of the existing process before improvement [March-May 2012]; an intermediate phase, which included corrective, preventive action, quality initiative and steps for improvement [June 2012]; and phase II, which included data collection for evaluation of the process after improvement [July 2012-September 2012]. In terms of the preanalytical indicators, incomplete request forms in phase I showed that the total number of received requests were 31 944, with a percentage of defected request of 33.66%; whereas in phase II, there was a significant reduction in all defected request items [P< 0.001] with a percentage of defected requests of 9.64%. As for the analytical indicators, the proficiency testing accuracy score in phase I showed poor performance of 10 analytes in which total error [TE] exceeded total error allowable [Tea], with a corresponding sigma value of less than 3, which indicates test problems and an unreliable method. The remaining analytes showed an acceptable performance in which TE did not exceed the TEa, with a sigma value of more than 6. Following an intervention of 3 months, the performance showed marked improvement. Error tracking in phase I showed a TE of [5.11%], whereas in phase II it was reduced to 2.48% [P<0.001]. For the postanalytical indicators, our results in phase I showed that the percentage of nonreported critical results was 26.07%. In phase II, there was a significant improvement [P< 0,001]. The percentage of nonreported results was 11.37%, the reasons were either inability to contact the authorized doctor [8.24%], wrong patient identification [1.0%], lack of reporting by lab doctor [1.11%], and finally, lack of reporting by the lab technician [1.03%]. Standardization and monitoring of each step in the total testing process is very important and is associated with the most efficient and well-organized laboratories

study on a cercarial assay for detection of praziquantel-resistance in Alexandria [Egypt]

Praziquantel [PZQ] has been used extensively and successfully in national schistosomiasis control programs in Egypt and there are reports of emerging PZQ resistance. The aim of this work was to use an in vitro assay for detection of PZQ resistance in Egyptian field and laboratory strains of Schistosoma mansoni cercariae. The assay was performed on ordinary glass slides. Cercariae were exposed to a final concentration of 0.5x10[-7] M or 5x10[-6] M PZQ. They were examined and counted at 0, 20, 40 and 60 minutes. In some samples the assay was coupled with scanning electron microscopy to detect any PZQ-induced tegumental changes in cercariae. After exposure to 5x 10[-7] M or 5x 10[-6] M of PZQ, there was a gradual decrease in the proportion of unaffected cercariae. The effect of the exposure time on the percentage of unaffected cercariae of the laboratory and field strains was significant in the two concentrations of PZQ. The low concentration of the drug did not succeed to cause significant differences between the two isolates of cercariae throughout a 60-minute exposure time. Surprisingly, the high concentration of PZQ showed a significant difference in the response of the two isolates where the field strain was more affected after exposure to PZQ for 60 minutes. The results of the SEM showed that all cercariae exposed to PZQ for 30 or 60 minutes were influenced, as blebs appeared in the body tegument, unlike the unexposed cercariae. The in vitro assay results indicated that PZQ resistance may not constitute a real problem in the field isolates of S. mansoni cercariae in Alexandria. However, why the field isolates showed significantly higher susceptibility to PZQ needs further investigations

Monitoring and stratification of renal functions in patients with chronic hepatitis c virus infection: an immunohistochemical study

Hepatitis C virus [HCV] infects more than 170 million people worldwide and around 20% of blood donors are seropositive by ELIZA to HCV Ab in Egypt. Renal manifestations may be the presenting features of chronic HCV infection. This work was carried out on 200 patients with chronic HCV in order to study the relationship between HCV and chronic kidney Disease and to stratify HCV patients according to the degree of albuminuria and to know the histopathological changes in kidney and liver by immunohistochemical study. II showed that screening for proteinuria in patients with chronic HCV is necessary due to high prevalence of renal affection in these patients. Assessment of microalbuminuria should be done in these patients as an early indicator for renal affection. Albumin creatinine ratio ACR] had a good reliability as a surrogate measure for routine screening of urine albumin excretion. Awareness of chronic kidney disease [CKD] stage in patients with HCV and renal affection help prediction and early management of renal disease. There was a documented link between cryoglobulinemic and non-cryoglobulinemic membrano-proliferative glomerulonephritis and HCV infection

Pro- brain natriuretic peptide [pro-BNP] in cirrhotic patients as a marker of cirrhotic cardiomyopathy

This study was conducted to determine the significance of Pro-brain natriuretic pepitde [Pro-BNP] measurement as a marker of cirrhotic cardiomyopathy in cirrhotic patients. Thirty patients with liver cirrhosis were enrolled in this study. Diagnosis depended on history taking, clinical examination, laboratory testing, abdominal ultrasonography and liver biopsy when applicable. Echocardiography was done to all patients and depending on its results, patients were divided into 2 groups. The first group included 15 patients with liver cirrhosis with no cardiomyopathy and the second group included 15 patients with liver cirrhosis and cardiomyopathy proved by echocardiography. In addition to a control group consisted of 15 age and gender matched healthy individuals. Blood samples were taken for laboratory investigations other samples were taken heparinized of 2m1 to detect level of pro-BNP in blood. Pro-BNP was significantly elevated in patients with cirrhotic cardiomyopathic when compared with group of cirrhotic non cardiomyopathic arid with control group [p<0.01]. Also, pro-BNP is related with severity of liver cirrhosis [Significantly related with Child scoring. serum albumin, serum bilirubin]. Pro-BNP was significantly related to SWT, PWT, left atrial diameter and fractional shortening. In conclusion, markedly-elevated pro-BNP is considered a reliable marker for cirrhotic cardiomyopathy and not hyperdynamic circulation that occurs in liver cirrhosis. Upon its clinical significance SWT may be used as a marker for detection of cardiac dysfunction in advanced cirrhotic patients

Efficacy of long acting theophylline as a single therapy in the management of mild persistent asthma

Medications for management of asthma in pediatrics include both relieves and controllers. Controllers are medications taken daily on a long term basis to achieve and maintain control of asthma. Theophylline has anti-inflammatory, immunomodulatory and bronchoprotective effects that contribute to its efficacy as preventive therapy for chronic asthma. The present study aimed to evaluate the pattern of prophylactic asthma medications used in asthmatic children in Fawzy Moaz allergy, Ministry of health, Alexandria and to spotlight on the role of long acting theophylline in the chronic management of asthma. In the present study, most cases of mild persistent asthma [96.2%], received long acting theophylline only for prophylaxis. In patient with moderate persistent asthma, [67.8%] were on low dose inhaled steroid and long acting theophylline while, [32.2%] were receiving moderate dose inhaled steroid only as a prophylactic therapy. Throughout the follow up period, the frequency of exacerbation was reduced to less than once month in 96.1%, 94% of asthmatics receiving long acting theophylline only and inhaled steroid only respectively with no statistically significant difference. Regarding asthmatic children who required shifting up in prophylactic therapy, 21.1% and 31.6% of those on long acting theophylline only and inhaled steroid only respectively required stepping up in prophylactic medications

Morbidity of Schistosomiasis mansoni in rural Alexandria, Egypt

A parasitological survey of stool and urine of 2577 from 3281 individuals living in Abis village, Alexandria, was undertaken in 1998 in order to investigate the prevalence of schistosomiasis in this area and the risk factors for hepatic morbidity. A random sample of 1082 individuals was interviewed using a questionnaire regarding the risk factors for liver morbidity. All interviewed adults [total 728] were clinically examined for an evidence of organomegaly [hepatomegaly and/or splenomegaly]. Individuals with clinically detected organomegaly were referred for detailed investigations [total 65]. The criteria for severe hepatic morbidity were AST/ALT ratio higher than 1, prothrombin activity <70% and an evidence of portal hypertension

Treatment of nasopharyngeal stenoosis following unulopatopharyngoplasty with the CO2 laser

Sixteen patients who had uvulopalatopharyngoplasty [UPPP] for obstructive sleep apnea [OSA] all of whom developed stenosis in variable degrees [I, II and III] were included in this study. The carbon dioxide laser was used to treat these patients in the office under local anesthesia in a staged manner in type I and under GA for type II and III. The patients were followed up for an average follow up period of 3-12 months and had stenosis treated successfully. It was suggested that the postoperative complication of nasopharyngeal stenosis after UPPP can be treated in a safe and cost-effective manner with the use of this technique

Thyroid cancer in Alexandria [Part I]: Incidence and potential risk factors

All cases of thyroid cancer registered in Alexandria Cancer Registry during the period 1979 to 1988 were included. Data were collected from available records and by interviewing patients. Age and sex specific incidence rates were calculated. Tests for trends were applied to incidence rates of cancer thyroid [papillary and follicular carcinoma]. Odds ratios were determined to estimate the significance of suggested risk factors. Papillary carcinoma was the commonest pathologic type of cancer thyroid [51.3%], followed by follicular carcinoma [36.0%], mixed type [10.3%], medullary carcinoma [0.67%] and anaplastic carcinoma [1.67%]. The average incidence rate of cancer thyroid during the period 1979-1988 in Alexandria was 1.67/100.000. The incidence of papillary carcinoma increased in the last 10 years, while the incidence of follicular carcinoma showed linear decrease. The history of non-toxic goiter and thyrotoxicosis was found to be significant risk factors for the occurrence of cancer thyroid. A high percentage of cases with papillary and mixed pathology was associated with high iodine diet, while follicular carcinoma was commonest in patients on low iodine diet

Childhood leukemia in Alexandria, [Egypt]: incidence, risk factors and survival

All cases with confirmed childhood leukemia registered by Alexandria Cancer Registry [ACR] during the period Jan. 1982 to Dec. 1991 were included. During the last 10 years, 348 cases of leukemia in the children were registered in ACR. The average incidence rate was 30.3 per million in males and 21.8 per million in females. No significant variations were detected in incidence rates over the last 10 years. Among studied risk factors, the following were shown as statistically significant [P <0.05]: parental consanguinity [OR = 1.76, XMH2 = 4.48], maternal smoking during pregnancy of the index child [OR = 8.39, XMH2 = 5.59], maternal exposure to X-ray radiation [OR = 7.29, XMH2= 4.61], and residence near a high voltage cables during pregnancy [OR = 3.75, XMH2 = 5.89]. Five years survival rates in these cases were 32.2% and 0% for acute lymphocytic and acute non- lymphocytic leukemia respectively [XMH2 = 10.1, P <0.05]. These survival rates were strikingly lower than those reported by USA and many other developed countries

Acute phase reactant CRP and ESR versus cardiac enzymes in evaluation of the extent of active coronary artery disease [unstable angina and acute myocardial infarction]

Acute phase reactant C-reactive protein [CRP] and the erythrocyte sedimentation rate [ESR] are expected to rise during the course of active coronary artery disease [CAD] [unstable angina [UA] and acute myocardial infarction [M.I.] as an inflammatory process has been proposed to be involved in the pathogenesis of both conditions. Our aim of this study was to evaluate the kinetics of rise of CRP and ESR and their correlation with the pattern of changes of cardiac enzymes [creation phospokinase [CPK], lactic dehydrognase [LDH] and serum glumatic oxalacetic transferase [SGOT] in active CAD. 50 patients [pts] with active CAD were studied [17 pts with UA [gp. I]; including 12 males and 5 females with a mean age of 53.4 +/- 7y and 33 pts with acute M.I. [gp. II]; including 24 males and 4 females with a mean age of 54.2 +/- 11y. The mean CRP and ESR were elevated in gpi [2.12 +/- 1.12 mg/dl and 58.7 +/- 33 mm/h respectively with the serial cardiac enzymes [CPK, LDH and SGOT] were within normal limits. Gp II revealed marked elevations of the cardiac enzymes [CPK ranged from 202-1800 IU/L with a mean of 774 +/- 448 while the mean peak LDH was 1093 +/- 400 IU/L [315-2080 IU/L] mean SGOT was 157 +/- 98 U/L [20-400 U/L]. Serum CRP was significantly elevated ranged 6-24 mg/dl with a mean of 18 +/- 5.6 mg/dl and the mean ESR was 83 +/- 33 mm/h ranged from 25-140 mm/h]. For CRP the mean time to peak was 3.15 +/- 0.69 and mean time to disappear was 8.53 +/- 0.91 d after the onset of chest pain. Strong correlation was found between mean CRP and Mean CPK [r=0.5]. Also, Significant difference was found between peak CPK in pts with anterior and inferior M.I. [p> 0.05]. We conclude that: The concentration of CRP rapidly in response to tissue injury [acute M.I.] with a peak level at a mean time of 60 hours after chest pain, falls to normal after 7 days in uncomplicated cases. A significant correlation was found between CPK, CRP and ESR as indices of severity in pts suffering from acute M.I. A positive CRP test is a valuable aid in establishing the presence of irreversible injury and the more the area of myocardial necrosis, the more prolonged the production and the persistence of the postulated mediato

Factors affecting the allergic reaction to cockroaches antigen in two different environments

A sample of 281 pupils were randomly chosen from two schools of different sectors: El-Shatby school representing humid area and King Maryout school representing dry area. They were tested intradermally with crude cockroaches antigen [German and American cockroaches]. Using logistic analysis, it has been proved that environmental factors and the history of atopy are the most effective causes of positive reaction. Age, sex, socioeconomic status and consanguinity are of no relevant effect on the cockroach antigen antibody reaction

Re-evaluation of the hypotensive effect of diazoxide

To evaluate further the effectiveness and some of the factors that might influence the hypotensive action of diazoxide, the drug was given [300 mg] by rapid i.v. injection as a single bolus to 28 patients with hypertensive emergencies. Twenty measurements of BP were made in each patient over 24-hours period. The reduction in the mean arterial pressure [MAP] ranged from 13 to 102 mm [Hg] and the duration of the duration of the hypotensive action ranged from one minute to 24-hours. A [hypotension index] derived by multiplying the fall in MAP by the duration of hypotensive action was used to judge effectiveness. Patients with an index of 60 mm Hg. Hours or greater were classified as responders, those of less than 60 mm Hg. Hours were non-responders. Fifteen patients [54%] were responders with an effective single diazoxide injection. Heart failure, ECC-LVH and papilledema were more frequent in non-responders. The drug was equally effective in patients with and without impaired renal function. Effectiveness was not improved by the addition of frusemide i.v. prior to diazoxide injection