The Challenges of Medical Technologists during COVID-19 Specimen Collection

Background@#The coronavirus disease, also known as COVID-19, is a highly contagious disease caused by a new strain of the coronavirus SARS-CoV-2. Medical technologists, along with doctors and nurses, are also heroes in the fight against the virus as they risk their own health in order to collect and analyze specimens for the diagnosis of the disease. However, they face numerous challenges along the way. @*Objectives@#This study aimed to better understand the difficulties of medical technologists assigned to collect COVID-19 specimen in tertiary hospitals or laboratories in Metro Manila, Philippines. @*Methodology@#Utilizing the qualitative case study design, the researchers interviewed 14 medical technologists and examined the data according to Colaizzi's method which consisted of grouping and categorizing relevant remarks before formulating themes. @*Findings@#The researchers were able to formulate the following themes: (1) patient-related challenges, namely, attitude, age, health status, and communication; (2) physical challenges, namely, fatigue, work hours, number of patients, and the use of personal protective equipment; (3) environmental challenges, namely, collection setting, temperature, and exposure to the virus; (4) resource challenges, namely, supplies and human resources; and (5) psychological challenges, namely, fear, anxiety, and emotional fatigue. @*Conclusion@#The study was able to analyze the obstacles faced by COVID-19 specimen collectors in order to give a means of hearing from and comprehending their viewpoints. This shows the importance of performing regular reviews of healthcare workers to ensure their safety. Medical technologists and their supervisors should be able to communicate effectively in order to improve current standards and procedures.

rare variant of multiple myeloma; non-secretory myeloma with diffuse osteolytic lesions

Non-secretory myeloma is a very rare entity of plasma cell dyscrasia. It is delineated as symptomatic myeloma without detectable monoclonal immunoglobulin peak on serum or urine electrophoresis with normal immunoquantification. Due to the inability to detect monoclonality often it is difficult to ascertain an early and accurate diagnosis. Misdiagnosing results to undue delay in therapeutic intervention. Consequently extensive imaging studies, serum free light chains detection and morphological confirmation are mandatory. Lytic bone lesions are less frequently seen in this type of myeloma. Here we report the case of a patient with this rare variant having diffuse osteolytic lesions in whom we established the diagnosis by bone marrow examination and document light chain restriction by immunophenotyping. Patient is classified as stage III according to Durie and Salmon criteria in view of anemia and multiple lytic lesions observed

Survival of plant growth promoting rhizobacteria [PGPR] in soil under pesticide stress

A study was conducted to determine the effects of pesticide application at different doses on the population density of two important plant growth promoting rhizobacteria [PGPR]: Methylobacterium spp. And Bacillus spp. These bacteria play an important role in plant growth promotion and as such are associated with the soil's nutritional value. The purpose of the study was to find whether or not pesticides do affect these PGPR and ultimately lead to environmental stress. Four organophosphates and four biopesticides were used for the purpose of the study. The results revealed that pesticide applications caused a drastic reduction in the microbial population present in the soil, especially Methylobacterium sp. which was completely extinct in soil treated with Chlorpyrifos, Phorate and Dimethoate, except for [count of 0.7 x 106, 30 days, R.D. in Phorate treated soil], [106, 40 days and 0.55 x 106, 30 days, 2 R.D. in Chlorpyrifos treated soil]. The same species proliferated well in biopesticide-treated soil except for a reduction in Neem treated plates [2.4 x 106 in R.D as compared to 3.3 x 106 in control]. Increased doses of Dimethoate and Chlorpyrifos had profound effects on the Bacillus sp. population. In the case of biopesticides, only Karanj had a negative impact on its count, especially at 10 R.D., maybe as a result of its antibacterial effect. So, our present research focuses on the extensive use of biopesticides from a sustainable agriculture point of view.

Paravertebral block can attenuate cytokine response when it replaces general anesthesia for cancer breast surgeries

Cytokine release is a well-known response to surgery especially when it is linked to cancer. Paravertebral block [PVB] is the suitable regional anesthesia for breast surgery. We tested the effect of replacing general anesthesia [GA] with PVB on cytokine response during and after surgeries for cancer breast. Controlled randomized study. Forty cancer breast patients were divided in two groups; Group 1 received PVB and Group 2 received GA during performance of unilateral breast surgery without axillary clearance. Plasma concentrations of interleukin [IL]-6, IL-10, IL-12 and interferon-gamma [IFN-gamma] were measured and IL-10/IFN-gamma were estimated in the following points; before starting PVB in Group 1 or induction of GA in Group 2 [Sample A], before skin incision [Sample B], at the end of procedure before shifting out of operating room [Sample C], 4-h post-operatively [Sample D] and 24-h post-operatively [Sample E]. unpaired Student t-test. IL-6 increased progressively in both groups with statistically significant lower levels in samples C and D in Group 1. IL-10 levels showed progressive increasing in both groups without differences between groups. IL-12 showed progressive decrease in both groups with statistically significant higher levels in samples C and D in Group 1. IFN-levels showed significantly higher levels in samples C and D in Group 1. IL-10/IFN-gamma ratio was significantly lower in Group 2 in samples C and D. Replacing GA with PVB can attenuate cytokines response to cancer breast surgeries

Assessment of role of perioperative melatonin in prevention and treatment of postoperative delirium after hip arthroplasty under spinal anesthesia in the elderly

Little is known about the relationship between sedative drugs used preoperatively and postoperative delirium. Melatonin is a drug used to sedate patients preoperatively and is hypothesized by recent works to have a curative effect on postoperative delirium. The incidence of postoperative delirium will be tested if affected by three different sedative drugs including melatonin. Controlled randomized double-blind study. Three-hundred patients aged>65 years scheduled for hip arthroplasty under spinal anesthesia were randomly distributed to one of the four groups. Group 1 [control] received nothing for sedation. Group 2 [melatonin] received 5 mg melatonin. Group 3 [midazolam] received 7.5 mg midazolam. Group 4 [clonidine] received 100 microg clonidine. These medications were given orally at sleep time at night of operation and another dose 90 min before operative time. Patients who developed postoperative delirium received 5 mg of melatonin 9 pm for three successive days in a trial to treat delirium. Statistical analysis was done using the SPSS Software [version 13]. Total of 222 patients completed the study. Percentage of postoperative delirium in the control group was 32.65% [16/49 patients]. The melatonin group showed a statistically significant decrease in the percentage of postoperative delirium to 9.43% [5/53 patients]. Melatonin was successful in treating 58.06% of patients suffered postoperative delirium [36/62 patients] with no difference between different groups. Postoperative delirium is affected with the drug used for preoperative sedation. Melatonin was successful in decreasing postoperative delirium when used preoperatively and in treating more than half of patients developed postoperative delirium when used for three postoperative nights

Safety and efficacy of pentastarch 6% versus albumin 5% for acute normovolemic hemodilution in patients undergoing major abdominal surgeries

Acute normovolemic hemodilution [ANH] has been used to decrease allogenic blood transfusion. ANH has different systemic effects that may include hemodynamic, oxygen transport variables, renal, hematological and acid base status. The effect of pentastarch [6% hydroxyethyl starch, MW: 200 kDa] versus human serum albumin [5%, MW: 69 kDa] as volume replacement solution after induction of anesthesia for major abdominnal surgery was assessed in this study. Eighty patients were divided into two groups; HES group [no = 40] received pentasarch and ALB group [no = 40] received albumin. Fifteen m1/kg of blood was removed and replaced simultaneously with the tested solutions to keep central venous pressure between 12-15 mmHg. Blood was reinfused before the end of operations. Total blood loss at 1st postoperative day was significantly higher in HES group [1198.5 +/- 354.3 vs. 1044.2 +/- 288.3 m1 in ALB group]. Significantly Higher amounts of the tested colloid [2084.7 +/- 408.6 in HES group vs. 1766.6 +/- 574.3 ml in ALB groups, 4 hrs postoperatively], crystalloids [5748.8 +/- 1165.3 in HES group vs. 5116.8 +/- 1309.8 ml in ALB group at 1 st postoperative day], FFP [243.6 +/- 29.7 in HES group vs. 123.5 +/- 25.3 ml in ALB group, at the end of surgery] and packed RBC [988.8 +/- 47.8 in HES group vs. 645.9 +/- 44.8 ml in ALB group, at the end of surgery] were used in HES group. HES group showed significantly higher cardiac index [3.9 +/- 0.9 in HES group vs. 3.4 +/- 1.0 1/min.m 2 in ALB group, at the completion of ANH], better preservation of SVRI [2052.3 +/- 251.5 in 5HES2 group vs. 1729.6 +/- 159.4 dyne.sec/cm5. m 2 in ALB group, at the completion of ANH]. Renal functions were better preserved in ALB group. Serum creatinine was significantly higher HES group [1.41 +/- 0.35 vs. 0.98 +/- 0.31 mg% in ALB group, at 3rd postoperative day]. Urinary N-acetyl-beta-glucosaminidase [beta-NAG] was significantly higher in HES group [1.38 +/- 0.52] compared with ALB group [0.97 +/- 0.52] u/mmol creatinine] at the 3rd posstoperative day. alpha-1-microglobulin was significantly higher in HES group [19.7 +/- 9.3] compared with ALB group [15.2 +/- 9.3 mg/1] at the 3rd postoperative day. Activated PTT was significantly higher in HES group [44.8 +/- 4.4] compared with ALB group [40.5 +/- 4.7 sec] 4 hrs postoperatively. D-dimer was significantly higher in HES group [2.4 +/- 0.2] compared with ALB group [3.0 +/- 0.6 ng/1] at the 1st postoperative day. Thrombin/antithrombin III [TAT] was statistically higher in HES group [2.2 +/- 0.7] compared with ALB group [1.9 +/- 0.6 micro g/1] at the 1st postperative day. There was a state of metabolic acidosis in both groups with a significant difference in base-excess results [-3.2 +/- 1.5 in HES group vs. -4.1 +/- 1.3 mmo1/1 in ALB group] at the completion of ANH. We can conclude that both solution were safe and effective for performing ANH before major abdominal operations with the superiority of albumin over pentastarch

Anesthetic management of cardiac patient for cataract surgery

A 6-year-old boy, weighing 11 kg, came to us with diagnosis of TOF for the cataract extraction. TOF was diagnosed on echocardiograph showing ventricular septal defect, pulmonary stenosis, transposition of great vessels and right to left shunt. ECG was showing right axis deviation and right ventricular hypertrophy. X-ray chest was normal. Hemotocrit was high [49.3]. On examination patient was cyanosed, had clubbing of fingers and toes, wasted thenar muscles, deformed left thumb and protruded sternum. On palpation systolic thrill was present at lower left sternal border. On auscultation chest was clear and systolic ejection murmur was identified. Syrup cephradine [velocef] 250 mg, six hourly, was given prior to the surgery. Patient was kept nil per oral after 12 am and intravenous line was maintained with 20 gauge cannula. Hartmann solution [Lactated ringer's], 40 ml per hour was given during that period to avoid dehydration. After taking the informed consent, precordial stethoscope and pulse oximeter were applied. Pre-operative pulse, oxygen saturation, blood pressure and respiratory rate were recorded [heart rate 120/min, saturation 70%, blood pressure 100/60 mmHg, respiratory rate 20/min]. Child was pre-oxygenated for 5 minutes. Anesthesia was induced with 1 mg of midazolam and 20 mg [2 mg/kg] of Ketamine and laryngeal masks size 2 1/2 was inserted. Anesthesia was maintained throughout the surgery with 100% oxygen and 10 mg of Ketamine boluses. A total of 70 mg of Ketamine was used during surgery. Ventilation was manually assisted; heart rate, oxygen saturation and blood pressure were closely monitored. No significant changes in heart rate, blood pressure and oxygen saturation were noted. Heart rate remained between 120-130/min, blood pressure 100/70 mmHg and oxygen saturation between 90-93%. Total duration of surgery was about 35 minutes. Laryngeal masks was successfully removed after gentle suction and drying mouth without any complication. Patient was covered and room temperature controlled to avoid hypothermia. He was closely monitored in recovery room for an hour. Blood pressure [100/60mmHg], heart rate [122/min], respiratory rate [20/min] and GCS [Glasgow coma scale] 15/15 were recorded. He was shifted to ward for uneventful recovery