Medical laboratory support in a field medical unit during earthquake relief activities

Managing a clinical laboratory in peace time presents many challenges including supplies, instrument downtimes and personal issues. We observe the same and many more at an exaggerated scale while working in a field medical laboratory in an austere environment. Lab staff and pathologist have not only to carry out routine duty of performing lab investigations but many other tasks assigned to them in the field. Some of the requirements for a good laboratory service in the field include motivated staff, supplies including proper equipment and reagents along with their backups, power supply, adequate space, storage facilities, communication skills and a good administration. It is a unique experience. The purpose of this study is to present workload distribution along with some observations and impressions regarding medical laboratory support during earthquake disaster in Central Java, Indonesia and suggest measures for improvement of lab services in the field

High growth hormone levels in clinically short stature children

Growth Hormone [GH] is secreted from the anterior pituitary gland. It binds to receptors on the surface of target cells, stimulates production of Insulin-like growth factor-I [IGF-I] leading to growth of almost all tissues of the body capable of growing. Growth failure [height below 3rd centile] occurs in children who do not secrete sufficient amount of GH. In some children, however, short stature is present in the presence of high levels of GH in their blood and they also secrete normal to increased amounts of GH in response to stimulation tests when tested for possible deficiency of GH. This condition is known as GH resistance syndrome or Larons syndrome [LS]. All patients after a thorough clinical evaluation underwent GH evaluation protocol as follows. On arrival in the lab a blood sample was collected for basal GH level in each patient. Screening was performed by subjecting the patients to exercise stimulation test and/or L-dopa stimulation test. Patients with GH deficiency underwent insulin tolerance test [ITT] after one week for confirmation. All the basal and post-stimulation samples were analyzed for GH levels. A level below 10mIU/L indicated GH deficiency, between 10-20mIU/L as borderline and an adequate response was defined as a GH >20mIU/L. Patients with a basal GH level of >20mIU/L and/or a post-stimulation level of >40mIU/L were arbitrarily considered as having exaggerated GH levels. This article evaluates the high plasma growth hormone levels among clinically short stature children undergoing growth hormone stimulation tests. Two hundred ninty-three patients reported for GH evaluation. Twenty were excluded for various reasons. Thus 273 patients were included for GH evaluation out of which 66[24.2%] showed GH deficiency, 89[32.6%] were borderline while 118[43.2%] patients exhibited adequate response, with GH levels of >20mIU/L. A number of patients unexpectedly showed very high GH levels on screening tests. Out of 118 patients, 21 showed either very high basal levels of >20mIU/L and/or a much-exaggerated response to stimulation tests with levels more than about 40mIU/L. Close consanguinity was found in 67% of patients showing very high GH levels. Some children with idiopathic short stature may show high levels of GH during their evaluation for GH deficiency. We identified a considerable number of such patients. These patients require further investigations

Frequency of growth hormone deficiency in short statured children

To determine the frequency of growth hormone deficiency among short stature children referred for growth hormone evaluation. A cross-sectional survey. The study was conducted in the Department of Chemical Pathology and Endocrinology, Armed Forces Institute of Pathology, Rawalpindi, from June 1999 to July 2000. A total of 293 children were referred for growth hormone evaluation. All the patients underwent thorough clinical evaluation including recording of height, weight, presence of chronic diseases and malnutrition. Twenty children were excluded for various reasons. Screening for GH deficiency was carried out by exercise stimulation test and /or L-dopa stimulation test. The children with GH level < 10 mlU/L on screening tests were provisionally considered to have GH deficiency. These children underwent insulin tolerance test [ITT]. Out of 273 children, 189 were subjected to both exercise and L-dopa stimulation test, while 60 patients underwent only exercise stimulation test. The remaining 24 patients were subjected to L-dopa administration alone because of their physical weakness or inability to perform exercise. Sixty-six patients exhibited GH levels < 10 mlU/L on screening tests. The frequency of GH deficiency was found to be 24.17% on screening. Out of these 66 patients, 54 underwent an ITT, while 12 patients did not report back for the test. Thirty-eight children showed lack of response on ITT, therefore, after ITT, the frequency of GH deficiency was revealed to be 13.9%. GH deficiency is responsible for about 14% cases of short stature in a hospital setting. Screening tests showed a positive predictive value of 70.4% and a false positivity of 6.8%