Comparision between bed side testing of blood glucose by glucometer vs centralized testing in a tertiary care hospital.

BACKGROUND: To determine the accuracy, turnaround time and cost effectiveness of bedside monitoring of blood glucose levels by non-laboratory health care workers and centralized testing of blood glucose by automated analyzer in a tertiary care hospital. METHODS: The study was conducted in Section of Chemical Pathology, Department of Pathology and Microbiology and Section of Endocrinology Department of Medicine, Aga Khan University and Hospital Karachi, from April 2005 to March 2006. One hundred and ten patients were included in the study. The blood glucose levels were analyzed on glucometer (Precision Abbott) by finger stick, using Biosensor Technology. At the same time venous blood was obtained to analyze glucose in clinical laboratory on automated analyzer (SYNCHRON CX7) by glucose oxidase method. RESULTS: We observed good correlation between bed side glucometer and laboratory automated analyzer for glucose values between 3.3 mmol/L (60 mg/dl) and 16.7 (300 mg/dl). A significant difference was observed for glucose values less than 3.3 mmol/L (p = 0.002) and glucose values more than 16.67 mmol/l (p = 0.049). Mean Turnaround time for glucometer and automated analyzer were 0.08 hours and 2.49 hours respectively. The cost of glucose testing with glucometer was 48.8% lower than centralized lab based testing. CONCLUSION: Bedside glucometer testing, though less expensive does not have good accuracy in acutely ill patient with either very high or very low blood glucose levels.

Correlation of serum cortisol levels and stress among medical doctors working in emergency departments.

OBJECTIVE: To assess and correlate serum cortisol levels and self-perceived work-related stress among medical doctors working in emergency departments in different tertiary care hospitals of Karachi. DESIGN: Cohort study. PLACE AND DURATION OF STUDY: The study was conducted in Section of Chemical Pathology, Department of Pathology and Microbiology, AKUH, from December 2004 to August 2005. SUBJECTS AND METHODS: A total of 64 doctors participated from one private and two public tertiary care hospitals of Karachi. Thirty-four doctors were from emergency departments and 30 from non-emergency departments. Serum cortisol levels were measured in the morning (between 8.00-8.30 am) and in the evening (between 8.00-8.30 pm). Cortisol was measured by Florescence Polarization Immunoassay (FPIA) technique. Two questionnaires, modified mental Professional Stress Scale (PSS) and Aga Khan University Anxiety and Depression Scale (AKUADS) were used to assess stress levels. RESULTS: Emergency room physicians (ERP) were 1.2-year younger than non-emergency room physicians (NERP). Mean evening cortisol of emergency physicians was 60.72nmol/L higher than non-emergency physicians. The difference between morning and evening cortisol was marginally significant (p = 0.051). Morning diastolic blood pressure was 3mmHg higher in emergency physicians. Forty-one percent of emergency physicians and 20% of non-emergency physicians had AKUADS more than or equal to 20, the difference was borderline significant (p = 0.068). Mean value of professional stress scale for emergency physicians was significantly higher than non-emergency physicians. Evening serum cortisol concentration was significantly associated with PSS (p = 0.011). The sub-scales such as work-load (p = 0.007) and lack of resources were highly significant with evening cortisol (p = 0.005). CONCLUSION: In this study, evening serum cortisol levels significantly correlated with work overload and lack of resources, however, there was marginally significant correlation between morning and evening serum cortisol difference. Study suggests that emergency physicians perceive more stress than non-emergency physicians. Work overload and lack of resources are major contributing factors for stress in these doctors.

To compare the total cholesterol and HDL-cholesterol before and after ultra-centrifugation in lipemic samples.

OBJECTIVE: It is an everyday routine in laboratories to encounter interference in the analysis of lipids. These likely interferences (hemolysis, icterus and lipemia) are countered by asking physicians and patients to send fresh and properly collected samples. At the Aga Khan University (AKU) Laboratory, we receive 2-3 lipemic/turbid samples per day. Previously it was our departmental policy to advise these patients to go for lipoprotein electrophoresis, which though accurate was time consuming and not cost effective. We therefore studied ultra centrifugation/airfuge as an alternate method to clear lipid interference and provide accurate, reliable and cost effective results. METHODS: Daily 2-3 grossly turbid samples are identified on the lipid bench, 48 samples were received in 4 months (February to May 2004). These samples were analyzed for total cholesterol (TC) and High Density Lipoprotein-Cholesterol (HDL-C) before and after ultra centrifugation/airfuge. RESULTS: There was a positive correlation between the lipemia and the false high TC and HDL-C. The mean TC and HDL-C before ultra centrifugation were 263.06 mg/dl and 39.42 mg/dl respectively and after centrifugation these became 191.77 mg/dl and 33.06 mg/dl. P value showed a significant difference in both results. CONCLUSION: This study suggests that the removal of turbidity by ultra centrifugation/airfuge is cost effective, less time consuming and provides accurate reliable results of TC and HDL-C in patients with lipemia interference.