Preanalytical errors and their impact on tests in clinical laboratory practice

There are pre-analytical, analytical and post analytical factors that contribute to accurate test results in clinical laboratories. Pre-analytical variables account for 32-75% of laboratory errors, and encompass the time from when the test is ordered by the physician until the sample is ready for analysis. Most mistakes often occur before the samples are analysed. There is a need for stronger coordination between clinicians and personnel working outside the laboratory for improving the test quality

Frequency of microalbuminuria in diabetic patients of Islamabad and Rawalpindi

To assess the frequency of microalbuminuria and correlate it with the risk of renal failure in diabetic patients and correlate microalbuminuria with serum Creatinine, a marker of renal damage. Type of study and Setting: This was a descriptive study done at Public Health Laboratories Division [PHLD] of National Institute of Health from May 2004 to April 2005. Two hundred known diabetic patients [both type I and type II] visiting were included in the study. Data on age, gender, family history, systolic and diastolic blood pressure, height and weight was recorded on a questionnaire. Urine and blood specimen were collected and analyzed for proteinuria, microalbuminuria, blood glucose and Creatinine, using Randox kit methods. Fasting plasma glucose level of 126 mg/dl or above was taken as diagnostic criteria for diabetes mellitus, as per standards of WHO. All patients of both genders irrespective of age who had type I or II diabetes for over 5 years and a negative urine dipstick test were selected for the study. Patients with other causes of proteinuria, recent respiratory and urinary tract infection, high grade fever and with clinical proteinuria were excluded. Out of 200 cases 56 [28%] had microalbuminuria. Thirty three patients [59%] had microalbuminuria of less than 75 mg/L. The mean age of the patients was 46.5 years and mean duration of diabetes was 7.63 years. Both in type-1 and type-II diabetes microalbuminuria positivity rate [microalbumin level 20 to 300mg/L] was almost similar i.e. 29% and 27.8%, respectively. No significant relationship was found between gender and microalbuminuria in both types of diabetics. Serum Creatinine, a marker of renal damage, was also measured in all 200 cases and out of 56 microalbuminuria positive cases, only 20 [36%] had a raised serum Creatinine. Patients with microalbuminuria of less than 75 mg/L are the candidates for therapeutic and dietary interventions as they are at the risk of nephropathy and other complications. For the early diagnosis of renal damage in diabetic patients, microalbuminuria is the better marker than serum Creatinine

Effect of environmental lead pollution on blood lead levels in traffic police constables in Islamabad, Pakistan

To determine the blood lead levels and trace elements [copper and manganese] in traffic police constables in Islamabad in order to assess the effects of environmental pollution on the levels of metals in] body fluids. 1 Methods: Blood samples were collected from 47 male traffic police constables, 21 to 45 years of age, posted in different areas of Islamabad and controlling traffic from 3 months to 18 years, 8 hours/day, 6 days/week. Adolescent males [13-19 years], residing in comparatively clean and very low traffic areas were included as / controls. Blood lead, copper, and manganese concentrations were estimated by atomic absorption pectrophotometry. The mean blood lead level among constables [27.27 microg/dl] was significantly [p<0.0001] high as compared to controls [3.22 microg/dl]. Twenty one percent constables had elevated blood lead levels [over 25 microg/dl] and 13% had levels above the safety limit [40 microg/dl]. No correlation was found between blood lead levels and length of service. No significant difference was found in the mean values for copper between traffic constables [93.49 microg/dl] and controls [71.15 microg/dl]. The mean blood manganese levels in traffic constables [21.94 microg/dl] were significantly [p<0.0001] higher than in controls [1.70 microg/dl]. The mean blood lead levels were significantly high in traffic constables of Karachi [47.7 microg/dl] as compared to Islamabad [27.2 microg/dl], which shows direct relation of rise in blood lead levels with vehicle exhaust. Environmental lead pollution is associated with an increased blood lead concentration in those who are regularly exposed to vehicle exhaust in high traffic areas. The degree of lead pollution arising from vehicle exhaust differs in Karachi and Islamabad. Exposure to air containing dust particles rich in manganese may affect blood manganese levels

Effect of environmental lead pollution on blood lead levels in traffic police constables in Islamabad, Pakistan

To determine the blood lead levels and trace elements [copper and manganese] in traffic police constables in Islamabad in order to assess the effects of environmental pollution on the levels of metals in body fluids. Blood samples were collected from 47 male traffic police constables, 21 to 45 years of age, posted in different areas of Islamabad and controlling traffic from 3 months to 18 years, 8 hours/day, 6 days/week. Adolescent males [13-19 years], residing in comparatively clean and very low traffic areas were included as controls. Blood lead, copper, and manganese concentrations were estimated by atomic absorption spectrophotometry. The mean blood lead level among constables [27.27 micro g/dl] was significantly [p<0.0001] high as compared to controls [3.22 micro g/dl]. Twenty one percent constables had elevated blood lead levels [over 25 micro g/dl] and 13% had levels above the safety limit [40 micro g/dl]. No correlation was found between blood lead levels and length of service. No significant difference was found in the mean values for copper between traffic constables [93.49 micro g/dl] and controls [71.15 micro g/dl]. The mean blood manganese levels in traffic constables [21.94 micro g/dl] were significantly [p<0.0001] higher than in controls [1.70 micro g/dl]. The mean blood lead levels were significantly high in traffic constables of Karachi [47.7 micro g/dl] as compared to Islamabad [27.2 micro g/dl], which shows direct relation of rise in blood lead levels with vehicle exhaust. Environmental lead pollution is associated with an increased blood lead concentration in those who are regularly exposed to vehicle exhaust in high traffic areas. The degree of lead pollution arising from vehicle exhaust differs in Karachi and Islamabad. Exposure to air containing dust particles rich in manganese may affect blood manganese levels

Measles mortality among Afghan refugee children

Measles outbreak was investigated in Afghan refugees camp, Haripur, NWFP where around 80 cases of measles had occurred among children of age 1-7 years during a period of two months from December 2000 to January 2001. All the 12 children who died out of the 80 measles cases were residing in a camp served by the Basic Health Unit-3 of the camp. This specific camp had high influx of refugees with low immunization coverage and high malnutrition rate

Blood zinc, copper and manganese levels healthy adolescents in Islamabad

Blood zinc, copper and, manganese levels were studied in 170 healthy school children, aged 13 to 19 years, belonging to Chakshahzad area of Islamabad. The analyses were made by graphite furnace atomic absorption spectrophotometer Shimadizu Model AA 670. The mean blood zinc level was 818 micro g/dl in boys, and 608 micro g/dl in girls. For copper, the mean blood level in boys was 89.8 micro g/dl in girls 81.9 micro g/dl. The mean blood managanese level in boys was 2.23 micro g/dl in girls 1.09 micro g/dl. The mean levels of zinc and manganese were significantly higher [P <0.001] in boys than in girls. No significant difference was found in the mean copper level between the two sexes. No significant correlation was found between any of the pair of trace elements studied

Blood lead levels in young children in Chakshahzad, Islamabad

Blood lead levels were estimated in one hundred and seventy school children, aged 13 to 19 years, residing in Chakshahzad area of Islamabad. The overall mean blood lead level was 2.38 ug/dl [range 0.2 to 8.6 ug/dl], 3.22 ug/dl in boys and 1.49 ug/dl in girls. A significant difference [p<0.01] was found in mean blood lead concentrations between the two sexes. The highest mean levels for lead were found at the age of 13 years. Blood lead levels in adolescents reported here were relatively low. They reflect very little or no risk to the health of children in Chakshahzad and it also indicated that area of Chakshahzad is relatively free from any lead pollution

Immunoglobulins and serum proteins in toxoplasmosis

Immunoglobulin levels in 47 children [age 13-20 years] with toxoplasmosis were compared with 46 age and sex matched controls. No significant difference was observed in mean serum immunoglobulin [IgG, IgA, IgM] levels between patients and controls but mean IgM levels were significantly [P] higher in children with acute toxoplasma infection. Total proteins were higher in patients while mean albumin and globulin levels were similar between the two groups. Estimation of serum immunoglobulins in young children with toxoplasmosis has no significance and should not be considered as an immunodiagnostic tool

Seroepidemiology of toxoplasma gondii infection in young school children in Islamabad

Sera, from 270 school children [age 13 to 20 years] residing in suburbs of Islamabad, were investigated for the presence of toxoplasma gondii, IgG antibodies using the enzyme linked immunosorbent assay [ELISA]. The overall prevalence was 17.4%. There was no significant difference between the two sexes. Since a positive test result for IgG antibodies at any level does not eliminate the possibility of a current infection, the toxoplasma IgG antibody positive children were further tested for the presence of toxoplasma IgM antibodies by the same technique. An acute infection was indicated in 12.7% [6/47] IgG positive children. This study shows that toxoplasmosis is prevalent in adolescence in Islamabad. The presence of cats and the degree of soil contact appeared compatible with hypothesis of transmission by oocysts. Poor sanitary habits and conditions and water shortage in schools may cause parasitic infection through contact between the children. An improvement in general hygienic conditions is important in reducing the rate of transmission by oocysts. Further studies are needed to assess the possible age of exposure to this parasite in the paediatric group

Serum calcium, urea and uric acid levels in pre-eclampsia

Serum calcium, urea and uric acid levels were determined in 100 normal pregnant women and 50 patients with pre-eclampsia. Serum calcium levels were significantly lower and urea and uric acid levels higher in pre-eclampsia. Low levels of calcium were found as early as 28 weeks and can therefore be used for early diagnosis of pre-eclampsia