Medical laboratory practice in Malawi ­ Current status

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Evaluation of the antimicrobial susceptibility testing process in clinical microbiology laboratories at Niamey, Niger

Background: Risk assessment is the means of identifying and evaluating potential errors or problems that may occur in testing process. The aim of this study was to perform risk assessment of antimicrobial susceptibility testing (AST) process in clinical microbiology laboratories of Niamey, Niger Republic. Methodology: We conducted a descriptive cross-sectional study from October 1 to December 31, 2019, to evaluate AST performance in seven clinical microbiology laboratories at Niamey, the capital city of Niger republic. The evaluation focused on the determination of the criticality index (CI) of each critical point (frequency of occurrence of anomalies, severity of the process anomaly, and detectability of the anomaly during the process) in the AST process and the performance of the AST through an observation sheet using two reference strains; Escherichia coli ATCC 25922 and Staphylococcus aureus ATCC 29213. Results: The criticality index (CI) was greater than 6 for most of the critical points related to material, medium, equipment, method and labour for the AST process in all the laboratories. A range of 18-100% errors on the inhibition zone diameters of the reference strains were observed. Major and/or minor categorization (Sensitive S, Intermediate I and Resistance R) discrepancies were found at all the laboratories for either one or both reference strains. The antibiotics most affected by the S/I/R discrepancies were trimethoprim (100%), vancomycin (100%), amoxicillin (80%) and amoxicillin + clavulanic acid (70%). Conclusion: This study showed a deficiency in the control of critical control points that impacts the performance of the AST reported by the laboratories in Niger. Corrective actions are needed to improve the performance of AST in clinical microbiology laboratories in Niger

Juan Nicolás Dávalos Betancourt y Federico Grande Rossi: dos amigos y una profesión / Juan Nicolás Dávalos Betancourt y Federico Grande Rossi: two friends, one profession

El papel desempeñado por destacados científicos cubanos y matanceros como Juan Nicolás Dávalos Betancourt y Federico Grande Rossi fue fundamental en el desarrollo de la bacteriología en el país. Con este trabajo se pretende acercar a estos dos hombres unidos en la vida como grandes amigos y en la profesión. Juan Nicolás Dávalos Betancourt conocido como "el sabio que soñaba con las bacterias" trasciende su campo de trabajo particular y se proyecta en el desarrollo de nuestra nación. Federico Grande Rossi fue médico bacteriólogo y fecundo escritor (AU).

The role played by eminent Cuban and Matanzasan scientist like Juan Nicolas Davalos Betancourt and Federico Grandi Rossi was essential for the development of the bacteriology in the country. With this work the authors pretend to bring near these two men who were very close in life as friends and colleagues in their profession. Juan Nicolas Davalos Betancourt, known as "the scholar who dreamed with bacteria" went beyond his particular work field and entered the process of development of Cuban nation. Federico Grandi Rossi was a doctor-bacteriologist and a prolific writer (AU).

Human leukocyte antigen (HLA) diversity and clinical applications in South Africa

The major histocompatibility complex, known as the human leukocyte antigen (HLA) complex in humans, forms an integral component of adaptive T cell immunity by presenting self and non-self peptides to the T cell receptor, thereby allowing clonal expansion of responding peptide-specific CD4+ and CD8+ T cells. HLA likewise forms an integral part of the innate immune response through the binding of killer-cell immunoglobulin-like receptor (KIR) molecules, which regulate the response of natural killer (NK) cells. The HLA complex is found on the short arm of chromosome 6 and is the most polymorphic region in the human genome. Africans are genetically more diverse than other populations; however, information on HLA diversity among southern Africans, including South African populations, is limited. Paucity of African HLA data limits our understanding of disease associations, the ability to identify donor-recipient matches for transplantation and the development of disease-specific vaccines. This review discusses the importance of HLA in the clinical setting in South Africans and highlights how tools such as HLA imputation might augment standard HLA typing methods to increase our understanding of HLA diversity in our populations, which will better inform disease association studies, donor recruitment strategies into bone marrow registries and our understanding of human genetic diversity in South Africa

Evaluación entre dos tecnologías usando Técnicas de Aglutinación en Columna (TAC) para la titulación e identificación de aloanticuerpos anti-eritrocitarios (columnas de micro-esferas de cristal y columnas de gel) / Evaluation between two technologies using Column Agglutination Techniques (TAC) for the titration and identification of anti-erythrocytic alloantibodies (columns of glass microspheres and gel columns)

Introducción: La presencia de anticuerpos anti eritrocitarios disminuye la sobrevida de los eritrocitos mediante la presencia de enfermedad hemolítica post transfusional en los pacientes oncológicos. La selección de la tecnología más conveniente para la determinación de los anticuerpos antieritrocitarios está directamente relacionada con la prevención de las reacciones transfusionales hemolíticas que son las responsables de la morbilidad y mortalidad relacionadas con la transfusión. El objetivo del presente estudio fue valorar la asociación estadística entre la técnica tradicional del gel versus la técnica de microesferas de cristal. Métodos: El estudio fue realizado en el laboratorio Clínico del Instituto Oncológico Nacional Dr. Juan Tanca Marengo, Solca-Guayaquil el período de estudio enero 2017 a marzo del 2017. Se realizaron técnicas de titulación a partir de muestras de sangre periférica con aloanticuerpos anti-eritrocitarios de especificidad única que habían sido detectados durante la realización de las pruebas pre-transfusionales. Las muestras fueron procesadas con la tecnología conocida usando la Técnica de Aglutinación en Columnas, columnas con gel. Posterior a realizar las pruebas pretransfusionales en los casos que presentaran positiva la prueba de escrutinio de anticuerpos o test de Coombs indirecto, inmediatamente después se llevaba a cabo la identificación del anticuerpo usando la misma técnica.Simultáneamente se realizaba las mismas pruebas usando la misma muestra con la otra tecnología de microesferas cristalizadas. Las reacciones de aglutinación se clasificaron como fuertemente positivas (4+ y 3+), moderadamente positivas (2+ y 1+) y positivo débil (w+). El análisis estadístico se utilizó correlación de Spearman. Resultados: En el período de estudio se efectuaron detección e identificación en 9 muestras. Seis muestras mostraron títulos idénticos, para ambas tecnologías, en 2 muestras se mostró títulos más altos con la tecnología en gel, y en 1 muestra se observó títulos más altos con la tecnología en micro esferas de cristal. La asociación Mediante Rho de Spearman entre las dos pruebas fue de R=0.84; r2=0.72, P=0.005. Conclusión: Existen una buena asociación entre las técnicas de gel y microesferas de cristal para la identificación de anticuerpos antieritrocitarios.

Introduction: The presence of anti-erythrocyte antibodies reduces the survival of erythrocytes by the presence of post-transfusion hemolytic disease in cancer patients. The selection of the most convenient technology for the determination of antierithrocytic antibodies is directly related to the prevention of hemolytic transfusion reactions that are responsible for the morbidity and mortality related to transfusion. The aim of the present study was to evaluate the statistical association between the traditional gel technique versus the crystal microsphere technique. Methods: The study was conducted in the Clinical Laboratory of the Dr. Juan Tanca Marengo National Oncological Institute, Solca-Guayaquil during the study period January 2017 to March 2017. Titration techniques were performed from peripheral blood samples with anti-alloantibodies-erythrocytes of unique specificity that had been detected during the pre-transfusion tests. The samples were processed with the known technology using the Agglutination Technique in Columns, columns with gel. After carrying out the pretransfusion tests in cases that presented a positive antibody test or indirect Coombs test, the antibody was immediately identified using the same technique. Simultaneously, the same tests were performed using the same sample with the other crystallized microsphere technology. The agglutination reactions were classified as strongly positive (4+ and 3+), moderately positive (2+ and 1+) and weak positive (w +). The statistical analysis was used Spearman's correlation. Results: In the study period, detection and identification were made in 9 samples. Six samples showed identical titers, for both technologies, 2 samples showed higher titers with gel technology, and in 1 sample higher titers were observed with the technology in crystal micro spheres. The association by Rho of Spearman between the two tests was R = 0.84; r2 = 0.72, P = 0.005. Conclusion: There is a good association between gel techniques and crystal microspheres for the identification of antierithrocytic antibodies.

Concordancia entre la medición directa y el valor estimado de colesterol de LDL en pacientes ambulatorios / Concordance between direct measurement and estimated LDL cholesterol in outpatients / Concordância entre medição direta e colesterol LDL estimado em pacientes ambulatoriais

Los laboratorios clínicos estiman la concentración del colesterol asociado a la lipoproteína de baja densidad (cLDL) mediante la ecuación de Friedewald; sin embargo, ésta presenta una notable desviación cuando la concentración sérica de triglicéridos se encuentra elevada. Se compararon 4.644 resultados de cLDL valorados en el laboratorio central del Hospital Edgardo Rebagliati Martins (Lima-Perú), mediante el ensayo directo homogéneo, con los valores estimados por las ecuaciones de Friedewald, Anandaraja, Chen, Vujovic, Córdova y de regresión múltiple. Además, se estratificaron los resultados en 5 grupos en función de las concentraciones de triglicéridos para determinar la influencia que ejerce el nivel de triglicéridos sobre dichas ecuaciones. En el total de las estimaciones, las ecuaciones de regresión y Vujovic mostraron los menores sesgos de -3,00 y -2,90 mg/dL, respectivamente. Asimismo, ambas ecuaciones presentaron un grado de acuerdo sustancial con la determinación directa y un menor error sistemático en los tres niveles de decisión clínica para el cLDL; sin embargo, la ecuación de regresión presentó una mejor performance para estimar el cLDL en concentraciones de triglicéridos ≥401 mg/dL. Se concluye que la ecuación de regresión presenta bajo error analítico, además de mostrar una buena concordancia con el método directo, incluso a concentraciones altas de triglicéridos.

Clinical laboratories estimate the concentration of low-density lipoprotein cholesterol (LDLc) associated with the Friedewald equation, but the latter shows a significant deviation when the serum triglyceride concentration is elevated. A total of 4644 LDLc values assessed at the central laboratory of the Edgardo Rebagliati Martins Lima-Perú Hospital were compared by means of the homogeneous direct assay with the values estimated by the Friedewald, Anandaraja, Chen, Vujovic, Córdova and multiple regression equations. Besides, the results were stratified into 5 groups based on triglyceride concentrations to determine the influence exerted by the triglyceride level on these equations. In the total of the estimates, the regression equations and Vujovic showed the lowest biases of -3.00 and -2.90 mg/dL respectively. Likewise, both equations presented a degree of substantial agreement with the direct determination and a smaller systematic error in the three levels of clinical decision for LDLc. However, the regression equation showed a better performance for estimating LDLc at triglyceride concentrations ≥401 mg/dL. It is concludeasdasdd that the regression equation presents low analytical error, besides showing a good concordance with the direct method even at high triglyceride concentrations.

Laboratórios clínicos calculam a concentração do colesterol associado à lipoproteína de baixa densidade (LDLc), utilizando a equação de Friedewald; no entanto ela apresenta um desvio significativo quando a concentração sérica de triglicerídeos está elevada. 4644 resultados de LDLc foram comparados avaliados no laboratório central do Hospital Edgardo Rebagliati Martins (Lima-Peru), por ensaio directo homogêneo, com os valores estimados pelas equações Friedewald, Anandaraja, Chen, Vujovic, Córdova e de regressão múltipla. Além disso, foram estratificados os resultados em cinco grupos com base nas concentrações de triglicerídeos para determinar a influência que exerce o nível de triglicerídeos sobre tais equações. No total das estimativas, as equações de regressão e Vujovic mostraram os menores vieses de -3,00 e -2,90 mg/DL, respectivamente. Também, ambas as equações apresentaram um grau substancial de acordo com a determinação direta e um menor erro sistemático nos três níveis de decisão clínica para o LDLc; contudo, a equação de regressão apresentou melhor desempenho para estimar o LDLc em concentrações de triglicerídeos ≥401 mg/dL. Conclui-se que a equação de regressão apresenta baixo erro analítico, além de mostrar boa concordância com o método direto, mesmo em altas concentrações de triglicerídeos.

Origins and History of Laboratory Medicine

Medical diagnostics plays a significant role in clinical decisions. The first medical laboratory test to be developed was urine analysis, in which urine properties were analyzed for diagnosis. Urine analysis has been long used as a routine laboratory test that was improved with the development of sampling and test methods. As the field of hematology progressed with the invention of the microscope, blood tests were developed. Demands for tests based on clinical chemistry have existed since the 17th century, and research using patient blood began in the 18th century. In the 20th century, with the development of the spectrophotometer, chemical analyses were performed for diagnostic purposes. With the appearance of cholera outbreaks, the identification of microorganisms was necessary for patient diagnosis, and the development of specific test methods contributed to microorganism detection in the laboratory. Blood transfusion, which started with blood collection in the 15th century, is currently used as a therapeutic method in medicine. Moreover, once the hypothesis of acquired immunity was proven in the 18th century, various methods for measuring immunity were developed. Molecular diagnosis, which was established during the 20th century after the presentation of Mendel's Genetic Laws in the 19th century, developed rapidly and became the predominant field in medical laboratory diagnostics. Thus, medical laboratory technology became an academic field, with foundations based on basic sciences. Modern medicine will further progress thanks to medical advancements, leading to an extension of average human lifespan up to 100 years. Laboratory medicine will provide significant support for this development.

Diplomado de ciencias del laboratorio para tecnólogos de la salud en laboratorio clínico / Diploma course on Laboratory Sciences for health technicians of Clinical Laboratory

INTRODUCCIÓN: la educación de posgrado constituye una de las direcciones principales de trabajo de la educación superior y tiene como objetivo promover la educación de los graduados universitarios. Una de sus vertientes es la superación profesional, que tiene como una de sus figuras organizativas el diplomado. OBJETIVOS: valorar el programa de estudio del diplomado de Ciencias del Laboratorio para tecnólogos de la salud en Laboratorio Clínico. MÉTODOS: se realizó una investigación cualitativa de tipo educacional en el campo del posgrado del período comprendido entre noviembre de 2013 y julio de 2015 en la Facultad de Tecnología de la Salud perteneciente a la Universidad de Ciencias Médicas "Carlos J. Finlay", en Camagüey. Se emplearon métodos teóricos como el analítico-sintético, y el inductivo-deductivo. Dentro de los métodos empíricos el análisis de documentos, la caracterización del estado actual de la superación profesional de este egresado, la valoración de la factibilidad del diseño y encuesta a los diplomantes y profesores del claustro. RESULTADOS: los resultados más significativos fueron que en los planes de estudios 2003-2004 y 2004-2005, no se diseñaron programas de las asignaturas de ciencias básicas biomédicas. La caracterización del estado actual de la superación profesional de este egresado permitió proyectar la superación profesional. Los laboratoristas clínico sienten satisfacción con la actividad que realizan y los atributos del diplomado fueron evaluados entre las categorías de muy adecuado y adecuado por los profesores de experiencias consultados. CONCLUSIONES: los diferentes instrumentos aplicados para la valoración del diplomado demuestran que es adecuado su diseño, y se identifica que los módulos de Ciencias Básicas Biomédicas y el de Gestión de la Calidad y Bioquímica Clínica se le debe realizar transformaciones con el objetivo de perfeccionar su diseño curricular para otras ediciones.

INTRODUCTION: postgraduate education is one of the main working directions of higher education, and aims to promote the education of university graduates. One of its aspects is the professional self-improvement, which has the diploma course as one of its organizational tasks. OBJECTIVES: to evaluate the studies program of the Diploma Course on Laboratory Sciences for health technicians of Clinical Laboratory. METHODS: A qualitative research of educational type was conducted at the postgraduate level in the period from November 2013 to July 2015, at the School of Health Technology belonging to Carlos J. Finlay University of Medical Sciences of Camagüey. Theoretical methods were used, such as analysis-synthesis and induction-deduction. Among the empirical methods, we used document analysis, the characterization of the current state of the graduates' professional development, the assessment of the design's feasibility, and surveys to diploma course students and faculty members. RESULTS: the most significant results were that, in the studies program of the academic years 2003-2004 and 2004-2005, syllabuses for the subjects of basic biomedical sciences were not designed. The characterization of the current state of the graduates' professional development permitted to project the profesional improvements. The clinical laboratory workers feel themselves satisfied with the activity they performed, while the experienced professors surveyed evaluated the diploma course's features within the categories of very appropriate and appropriate. CONCLUSIONS: The different instruments used for the assessment of the diploma course show that it design is appropriate. We identified that the modules of Basic Biomedical Sciences and Management of Quality and Clinical Biochemistry should be changed in order to improve their programs' design for further editions.

Role of skill laboratory training in medical education - students' perspective

Objective: To evaluate the perceptions of medical students regarding their training utilizing facilities provided in the skill laboratory of a public sector medical college. Study Design: Cross-sectional study. Place and Duration of Study: Army Medical College, Rawalpindi, from October to December 2014

Methodology: Students of final year MBBS who had underwent skill laboratory training were recruited through convenience purposive sampling. Students not exposed to skill laboratory training were excluded. Data collection tool was a questionnaire having 23 questions with responses on Likert Scale as strongly disagree, disagree, agree and strongly agree coded as 1, 2, 3 and 4, respectively. Data was analysed on SPSS version 22

Results: There were 78 [57%] male and 59 [43%] female students out of 137, with mean age of 22.59 +/- 0.74 years. The response rate was 68.5%. Cronbach's Alpha test was 0.84 showing high reliability. The mean of sum of all the 23 items was 63.85 +/- 8.71, whereas item means was 2.78 +/- 0.38, reflecting a high inclination of students towards skill laboratory training. Frequency of students responding in favour of skill laboratory training was significantly high [p < 0.05]

Conclusion: Medical students perceived skill laboratory training as a favoured learning strategy as compared to practising on real patients for acquisition of various aspects of clinical skills, knowledge and attitude

Implementation of a mentored professional development programme in laboratory leadership and management in the Middle East and North Africa

Laboratories need leaders who can effectively utilize the laboratories' resources, maximize the laboratories'capacity to detect disease, and advocate for laboratories in a fluctuating health care environment. To address this need, the University of Washington, USA, created the Certificate Program in Laboratory Leadership and Management in partnership with WHO Regional Office for the Eastern Mediterranean, and implemented it with 17 participants and 11 mentors from clinical and public health laboratories in 10 countries [Egypt, Iraq, Jordan, Lebanon, Morocco, Oman, Pakistan, Qatar, Saudi Arabia, and Yemen] in 2014. Designed to teach leadership and management skills to laboratory supervisors, the programme enabled participants to improve laboratory testing quality and operations. The programme was successful overall, with 80% of participants completing it and making impactful changes in their laboratories. This success is encouraging and could serve as a model to further strengthen laboratory capacity in the Region

Medical laboratory science and nursing students' perception of academic learning environment in a Philippine university using Dundee Ready Educational Environment Measure (DREEM) / 보건의료교육평가

PURPOSE: This study aimed to compare the perception of the academic learning environment between medical laboratory science students and nursing students at Saint Louis University, Baguio City, Philippines. METHODS: A cross-sectional survey research design was used to measure the perceptions of the participants. A total of 341 students from the Department of Medical Laboratory Science, School of Natural Sciences, and the School of Nursing answered the Dundee Ready Education Environment Measure (DREEM) instrument from April to May 2016. Responses were compared according to course of study, gender, and year level. RESULTS: The total mean DREEM scores of the medical laboratory science students and nursing students did not differ significantly when grouped according to course of study, gender, or year level. Medical laboratory science students had significantly lower mean scores in the sub-domains 'perception of learning' and 'perception of teaching.' Male medical laboratory science students had significantly lower mean scores in the sub-domain 'perception of learning' among second year students. Medical laboratory science students had significantly lower mean scores in the sub-domain 'perception of learning.' Nursing students identified 7 problem areas, most of which were related to their instructors. CONCLUSION: Medical laboratory science and nursing students viewed their academic learning environment as 'more positive than negative.' However, the relationship of the nursing instructors to their students needs improvement.

Erros pré-analíticos em medicina laboratorial: uma avaliação preliminar em diferentes laboratórios de análises clínicas / Pre-analytical erros in laboratory medicine: a preliminary evaluation in different clinical laboratories

Objetivo: Este trabalho teve como objetivo avaliar os conhecimentos sobre erros pré-analíticos em medicina laboratorial de profissionais que atuam nesta área. Métodos: O presente estudo foi realizado por meio de um questionário para avaliar a ocorrência de erros laboratoriais pré-analíticos em dez laboratórios de análises clínicas privados e de pequeno porte nas zonas norte, sul e oeste da cidade do Rio de Janeiro. Resultados: A média de idade dos entrevistados foi de 35-55 anos, que trabalham como flebotomistas, técnicos de laboratório e analistas com formação superior. Duas das nove perguntas doquestionário de erros pré-analíticos apresentaram um elevado índice de respostas incorretas, a primeira relacionada ao tempo máximo de aplicação do torniquete/garrote ea segunda sobre as fases da etapa pré-analítica, ambas com 74% de respostas incorretas. A pergunta que apresentou um percentual de 100% de acertos estava relacionada à hemólise como causa de erros pré-analíticos. Conclusão: A melhoria da fase pré-analítica permanece um desafio para muitos laboratórios clínicos, visto quetodos os laboratórios avaliados apresentaram elevada frequência de procedimentos incorretos. É provável que este fato ocorra pela dificuldade dos laboratórios em relatar e registrar os erros provenientes da fase pré-analítica, bem como pelo despreparo dos profissionais envolvidos. Portanto, é de extrema importância a implantação de um programa para capacitação dos profissionais, a fim de minimizar a ocorrência de tais erros.

Aportes para la historia del médico laboratorista y los laboratorios clínicos de la ciudad de Cuenca / Contributions for the History of the Laboratory Technician and the clinical laboratories of the City of Cuenca

La formación del Patólogo Clínico o Médico Laboratorista se inició en nuestro medio a partir de la primera década del siglo anterior como un aprendizaje práctico junto a un maestro, para luego independizarse, salir al exterior, realizar cursos de actualización y mantenerse al día en sus conocimientos sobre las modernas técnicas y procedimientos. Los primeros patólogos clínicos se iniciaron en el centenario Hospital "San Vicente de Paúl". Los primeros exámenes de Laboratorio se realizaron a partir de 1912, luego del retorno de Europa de los primeros médicos que salieron al exterior. Fue el Dr. Emiliano J. Crespo A. quien inició estudios de parasitología y bacteriología. El Primer Laboratorio Clínico se fundó en el Hospital "San Vicente de Paúl" confiado al Profesor Dr. Manuel Malo Crespo, luego de su temprana muerte (1933), le sucedió desde 1937 el Dr. Timoleón Carrera Cobos que formó una escuela de Médicos Laboratoristas que ejercieron esta especialidad en la segunda mitad del siglo XX y que a su vez han continuado formando a muchos de los actuales Laboratoristas Clínicos de la ciudad de Cuenca. Termina el artículo destacando la importancia del Médico de Laboratorio en la actualidad, no solo en la medicina general, sino en la mayor parte de las especialidades, en el diagnóstico, evolución, pronóstico y seguimiento de la enfermedad.

The preparation academic of Clinical Pathologists or Clinical Laboratory Physicians started from the first decade of the previous century in Ecuador. First as a practical learning experience with a mentor, then independently by going to a foreign country to study, taking actualization courses and keeping knowledge abreast of modern techniques and procedures. Early Clinical Pathologists began working in the ancient Hospital "San Vicente de Paul". The first laboratory tests were conducted from 1912, after the return of Dr. Emiliano J. Crespo A., from Europe, who initiated studies of parasitology and bacteriology. The first Clinical Laboratory was founded en Hospital "San Vicente de Paul" assigned to Professor Manuel MaloCrespo, after his early death, succeeded by Dr. Juan Cuesta y Cuesta and since 1933 Dr. Timoleón Carrera Cobos formed a prestigious School of Clinical Laboratory Physicians. Its graduates exercised this specialty in the second half of the twentieth century and have also continued forming many current Clinical Laboratory Technicians city of Cuenca. The article finishes by highlighting the importance of Clinical Pathology Physicians today, not only in general medicine, but in most specialties, diagnosis, progression, prognosis and disease monitoring.

Epidemiological Markers of Fungi and its Clinical Application.

The risk factors for opportunistic fungal infections are progressive HIV infection, Diabetes mellitus or patient on antibiotics, steroid or antimalignant therapy. Though with the development of Medical sciences, fungal infections are gaining importance, the field of epidemiology of fungal infection has not expanded that much. The different epidemiological markers for fungal infection have been discussed in this article. Ideally epidemiological marker should be standardized, reproducible, sensitive, easy to perform and inexpensive.

Determination of a reference interval in a population.

The reference interval is the most widely used medical decisionmaking tool that separates healthy from diseased individuals. We briefly discuss the methods used to determine reference interval and its limitations.