Case report of Candida parapsilosis sepsis detected in peripheral blood smear

Introduction During long periods of hospitalization, debilitated and immunosuppressed patients are prone to contracting nosocomial fungal infections, such as Candida parapsilosis, which can cause sepsis. Candida parapsilosis, indeed, is able to form firm and persistent biofilms in central venous catheters (CVC) in addition to other medical devices, thus threatening patients undergoing invasive medical procedures [1]. We report a case of Candida parapsilosis sepsis detected in the peripheral blood smear and by the change of the cytograms of the hematology analyzer before to blood culture positivization. Case presentation An 89-year-old woman, positive for the Sars-Cov2 virus, was admitted at the San Donato hospital (Arezzo) for 40 days for Covid symptoms. Laboratory tests show an increase in C reactive protein (10.6 mg/dL), gamma GT (76 U/L), total bilirubin (2.31 mg/dL) and direct (1.46 mg/ dL), creatinine (1.00 mg/dL ) and reduction of glomerular filtrate (50.4 mL/min /1.73 mq). In addition, at the CBC anemia is detected with hemoglobin of 102 (g/L) and thrombocytopenia (32 x 10

Implementation of a Poct (Point-Ofcare) System for the Detection of the Antigen of the Sars-Cov2 Virus in Emergency Department and for the Prehospitalization of the Hospitals of the Company Usl Toscana Sud Est

Introduction Following the release of the regional circulars recommending the execution of antigen tests for the diagnosis of Sars-Cov2 infection for all patients entering the emergency Department and in case of pre-hospitalization, it was decided to implement a system of POCT (Point-Of-Care) instruments in hospitals throughout the South-East USL area. Materials and methods The managers of the POCT network have provided each hospital with third generation tests capable of guaranteeing a sensitivity of over 95% and a specificity of 100%.The necessary skills for the staff were then determined and training sessions were planned to cover all the staff concerned thanks to the involvement of the specialized staff of the supplier company and the previously trained laboratory staff.Following the training of over 300 operators, its effectiveness was verified through online self-assessment questionnaires and each user was enabled to use the tool with their own identification. The insertion of the identification code for the individual operators, it was possible to monitor the correct performance of the pre-analytical procedures and to implement any corrective measures where necessary. Results All this has ensured, in addition to an optimal collaboration between the laboratory, the supplier company and the emergency room, a high level of data security related to a very low rate of invalid or discordant results. This resulted in a considerable time and cost saving when compared with the need to carry out repeated tests or confirmations with molecular tests. Conclusions This organization has allowed not only a supply of tests with superior performances, but to have a complete traceability of the results following the connection of the instruments to the systems of the hospitals and in the ability to apply the criteria necessary for an aware training of the operators, in accordance with what is reported in the ISO 9001/2015 standard.

The Lean methodology applied to risk assessment in the Blood Gas Analysis process

INTRODUCTION The BGA (Blood Gas Analysis) is a bedside testing that ensure results in a short time, usually performed in Emergency-Urgency for time-dependent clinical condition. Lean Thinking for 'KAIZEN' or rather, continuous improvement in services provision increasing the value perceived by the user reducing of waste. The aim of the present analysis has been to assess, applying Lean methods, the likelihood of risk in the BGA testing, related to the increase in their use during the COVID19 pandemic. MATERIALS AND METHODS To carry out the risk assessment, the context was studied through the use of distribution maps of the BGA analyzers in the Covid19 and non-Covid19 wards of the San Donato Hospital in Arezzo. Data was collected on the entire BGA process: activities, hours of greatest use, instrumental stops and maintenance, in the year 2020. The spaghetti chart, Lean mapping method, was used to calculate the distances between the instruments (used and backup) and patient beds. In addition, Lean methods were used: the Hishikawa Diagram with the cause-effect matrix, the HFMECA, the Swot, the monitoring indicators of the entire process and the A3 report. RESULTS The analysis carried out using the Lean methodology has shown that the entire ABG process is well governed within the wards. However, there remain the risks associated with the new staff employed and their training on the which much of the implementation plan was focused. The risk is mainly linked to the high turnover, to the reorganization of human resources that had to be used to deal the pandemic. CONCLUSIONS For optimal governance of BGA analyzers and reduce the risk in entire process, it is essential to maintain adequate and continuous training of personnel.

HCV (Genotype) distribution in the area of Arezzo: Epidemiological data in the eradication strategy

INTRODUCTION Infection with hepatitis C virus (HCV) is a major cause of chronic liver disease worldwide. HCV is enveloped, small circular, positive-sense and single stranded ribonucleic acid (RNA) virus from genus Hepacivirus, family Flaviviridae. The ability of the HCV to mutate has resulted in the existence seven main genotypes (1-7) with multiple subtypes. Genotyping is most significant for planning of HCV treatment and helps to cure HCV infection. The Tuscany region has declared its intention to proceed with the eradication of the Hepatitis C virus in the population. The aim of this retrospective study is to investigate the incidence of HCV in a population screened in the area of Arezzo from 2016-2020. Furthermore, genotype distribution in those subjects positive for screening was studied. MATERIALS AND METHODS The subjects included in the study 5012(31.3%) were positive for HCV-RNA quantification, so they were enrolled for viral genotyping. Blood sample collected in BD Vacutainer® PPT™ Plasma Preparation Tube were used to perform the viral load quantification of the HCV and for genotyping analyses. RESULTS In the patients examined from 2016 to 2020 years we have been note a reduction in positive cases of HCV: 1250(35.4%) in 2016 respect 521(25.4%) in 2020. Among the patients examined from 2016 to 2020 years have been seen a major incidence for genotype 1(55.8%), comparable fraction for type 2(19.2%) and 3(19.1%) and lower incidence for genotype 4(0.05%). The distribution of the HCV genotypes in the years showed that genotype 1a reach the peak of incidence in the 2018 year, while the trend of 1b genotype was almost constant in the period 2016-2020. The genotype 2a/2c reach a peak in the years 2018 and 2019, the genotype 3a were observed an increase in the 2017, then a reduction. The genotype 4 was constant in the years. Conclusion The data from the present study seem to suggest that there has been a slight change in the epidemiology of HCV genotypes in the Arezzo, although the genotype 1b remain the most prevalent in Italy, the genotype 3a in surprisingly increased in the area of Arezzo. This study show a reduction of positive cases during the years, as a result of the Tuscany's new eradication strategy, despite the reduced requests during covid emergency.