External quality assurance in Malaysia.

An activity supportive of the MOH QA Programme, the National EQAS for clinical chemistry monitors for analytical performance in core routine biochemical testing by the pathology laboratories, with unsatisfactory performance scores serving to alert against deficiencies or problems and the scores in subsequent challenges providing the feedback of effectiveness of remedial actions taken. While unacceptable individual analyte performance score (variance index score, VIS) indicated problems in instruments, reagent and calibrators, or the use of inherently poorer methods, repeated occurrence of unsatisfactory OMRVIS was traceable to generally poor laboratory management of usually inadequately-equipment small laboratories. The outcome has been one of slow but gradual improvement in the overall performance of participating laboratories, with a move towards methods upgrading and standardization to achieve greater concordance of results. Presently, the programme is limited to 61 government and 4 private hospital laboratories in the country for 12 commonly assayed clinical biochemistry analytes. It is hoped that the NEQAS could be extended to the other private laboratories and that of academic institutions. However, this is dependent to a large extent on the manpower and financial support obtainable by the organizing body of the programme in the future. Belk and Sunderman, 1947 demonstrated that laboratories participating in an quality assessment scheme could rapidly and dramatically improve their analytical performance. In some countries, participation has become mandatory, and acceptable performance is a requirement in laboratory accreditation. The need and value of the NEQAP is, therefore, evident. While there may be limitations in the national programme. efforts are being made at improving the programme within the means and resources of the organising body. The goals of the NEQAP are not just to monitor performance but also to educate. On this, matters related to and supportive of these goals have also been pursued. The annual workshop/forum on quality controls had allowed exchange of information between representatives of participating laboratories and the organising body. Recently in the 1997 MOH Quality Improvement evaluation, Quality Control has been evaluated together with the other 17 such activities. The study on knowledge, attitude and practice has provided the necessary feedback and will be used for future planning in making efforts at increasing the effectiveness and benefits of the all QC activities including this NEQAP for clinical chemistry. In addition, there is a need to look into areas such as selection of methods and test systems, and improvement of continuing education, training as well as research in quality improvement as suggested by the Quality Improvement evaluation.

Blood cadmium levels in Malaysian pregnant women.

Blood cadmium levels in Malaysian pregnant women were determined. There was no significant urban-rural difference in mean blood cadmium levels.

Filarial enzymes by the horizontal starch-gel electrophoresis technique.

In preliminary studies, on adult filarial parasites, difference in the electrophoretic pattern of glucosephosphate isomerase (GPI) of B. malayi, B. pahangi and the rat filarial worm, B. booliati, was demonstrated. There also appears to be a difference in the GPI and lactate dehydrogenase isoenzyme patterns of B. malayi (subperiodic) from different animal hosts. These observations suggest that the zymogram technique may yet prove to be a sensitive taxonomic tool for use in the characterisation of filarial helminths. At present, the contention is that the subperiodic form of B. malayi exists as a zoonoses (possibly also with B. pahangi), which is drawn from findings backed by procedures that cannot easily differentiate between closely-related species and subspecies. Thus enzyme electrophoresis could complement the parasitological methods currently used, and contribute in enhancing the validity of this contention. More work, and on a larger scale to include the microfilariae and infective larvae, would be required.