Thai clinical laboratory responsible to economic crisis.

Nowadays, Thailand encounters a serious economic crisis. A clear consensus has been made that a cost-saving system must be the important tool. Both private and government organizations are engaged in this situation. We studied the cost-saving in the clinical laboratory. A questionnaire was distributed to 45 hospital laboratories located in Bangkok. Results showed that efforts to control the cost are the essential policy. There was a variety of factors contributing to the cost-saving process. The usage of public utility, non-recycle material and unnecessary utility were reconsidered. Besides, capital cost (wages and salary) personnel incentive are assessed. Forty three of the 45 respondents had attempted to reduce the cost via curtailing the unnecessary electricity. Eliminating the needless usage of telephone-call. water and unnecessary material was also an effective strategy. A reduction of 86.9%, 80 % and 80.0% of the mentioned factors respectively, was reported. An inventory system of the reagent, chemical and supplies was focused. Most of the laboratories have a policy on cost-saving by decreased the storage. Twenty eight of the 45 laboratories considered to purchase the cheaper with similar quality reagents instead. And some one would purchase a bulky pack when it is the best bargain. A specific system "contact reagent with a free rent instrument" has been used widely (33.3%). Finally, a new personnel management system has been chosen. Workload has rearranged and unnecessary extra-hour work was abandoned.

A diversity of blood smear examination system of Thai public hospital.

A good laboratory practice is the heart of clinical laboratory quality. One must establish a standard system in order to achieve the quality. However, standard system is not only the technical but also a state of the art. The socioeconomic and culture are the influence factors. At present, technique of reporting the blood smear examination is still a nation controversy. We surveyed the blood smear examination reporting system of the public hospital in Thailand. There were 77 hospitals participated in this study. A questionnaire comprised of 23 questions was distributed to 105 clinical laboratory staffs of the public health hospitals. Results showed that there was a diversity of blood smear examination reporting system. Generally, there were 2 ways of blood smear review. Every smeared slide and only abnormal slides were re-examined by the conventional technique. When an abnormal white blood cell blood picture was observed. The presence of either blast cell or atypical lymphocyte has clinical significance. A majority of laboratory would report in form "counting number of abnormal cell within 100% of the differential count". For other abnormalities of white blood cell; i.e. the neutrophils with toxic granules, most of laboratory reported as "presence". Interestingly, the red blood cell reporting system varied from laboratory to laboratory. There was a total of nine reporting patterns. Results indicated that pattern 4 (few or some, 1+,2+,3+,4+ are 5-10%, 11-25%, 26-50%, 51-75% and 51-100% cell/oil field, respectively) was the most popular one in reporting anisocytosis and poikilocytosis. However, the reporting pattern on red blood cell staining was difference. Pattern 4 and pattern 7 (grading by the size of central pallor) obtained a same popularity on the consideration of hypochromia. But the pattern 9 (few or some, 1+,2+,3+ are 0-1, 1-3, 4-6 and >6 cell/oil field, respectively) was the most frequently used in reporting of polychromasia. Fortunately we found that the reporting system for platelet was not complicated. A majority of laboratory chose the qualitative pattern (reporting as adequate, increased and decreased). Our study indicated that Thai clinical laboratory encounter a diversity of blood smear reporting system. Every clinical laboratory should pay a great attention to this circumstance. Since a good laboratory practice is a knot of the knot-bolt system of healthcare service, therefore, a nation standard system must be established in the near future.

Analysis of RNA polymerase gene mutation in three isolates of rifampicin resistant Mycobacterium tuberculosis.

Drug resistance in tuberculosis (TB) has become a major public health threat, particularly when the disease cannot be 100% controlled by BCG vaccination. In Thailand, resistance to rifampicin, a major component of multidrug regimens of treatment, is the common cause of tuberculosis recurrence. The mechanism of rifampicin resistance involves alterations of the RNA polymerase subunit beta (rpo B) gene. Mutations in rpo B gene were often found to cluster within a region of 23 amino acids starting from amino acid residue 511 to residue 533. Direct PCR sequencing was utilized to compare base changes in rpo B gene in three rifampicin resistant phenotypes of M. tuberculosis isolated from Thai patients. The sequences showed one base substitution at codon 531 resulting in an amino acid change from serine (TCG) to leucine (TTG) in a multidrug resistant isolate compared to that of a sensitive isolate, whereas a point mutation at codon 516 causing a change from aspartic acid (GAC) to tyrosine (TAC) was detected in a multidrug resistant isolate from a HIV positive patient. In an isolate resistant only to rifampicin a double mutation at codon 531 changing serine (TCG) to phenylalanine (TTT) was found. No mutations were observed in the same region in streptomycin, ethambutol or isoniazid resistant isolates. This finding reports two new types of mutation (GAC to TAC at codon 516 and TCG to TTT at codon 531) and confirms a direct correlation between rpo B gene alteration and rifampicin resistant phenotype in M. tuberculosis.

A simple method for protein electrophoresis of unconcentrated urine.

Thirty-two unconcentrated urines were electrophoresed on cellogels in 0.05 M barbital buffer, pH 8.6, at 280 volts for 35 minutes. Instead of concentrating 100 fold, the urine samples were directly applied on the gel in volumes from 1.2 to 3.6 microliters and Coomassie dye was used for staining. This makes it possible to observe the protein patterns at trace concentration by reagent strips (about 0.05-0.2 g/l). This method is simple, convenient and suited for routine services.