Quality assessment of malaria microscopic diagnosis at the Aristide Le Dantec University Hospital of Dakar, Senegal, in 2020.

BACKGROUND: Following WHO guidelines, microscopy is the gold standard for malaria diagnosis in endemic countries. The Parasitology-Mycology laboratory (LPM) is the National Reference Laboratory and is currently undergoing ISO 15189 accreditation. In this context, we assessed the performance of the laboratory by confirming the reliability and the accuracy of results obtained in accordance with the requirements of the ISO 15189 standards. This study aimed to verify the method of microscopic diagnosis of malaria at the LPM, in the Aristide Le Dantec hospital (HALD) in Dakar, Senegal. METHODS: This is a validation/verification study conducted from June to August 2020. Twenty (20) microscopic slides of thick/thin blood smear with known parasite densities (PD) selected from the Cheick Anta Diop University malaria slide bank in Dakar were used for this assessment. Six (6) were used to assess microscopists' ability to determine PD and fourteen (14) slides were used for detection (positive vs negative) and identification of parasites. Four (4) LPM-HALD microscopists read and recorded their results on prepared sheets. Data analysis was done with Microsoft Excel 2010 software. RESULTS: A minimum threshold of 50% concordance was used for comparison. Of the twenty (20) slides read, 100% concordance was obtained on eight (8) detection (positive vs negative) slides. Four (4) out of the six (6) parasite density evaluation slides obtained a concordance of less than 50%. Thirteen (13) out of the fourteen (14) identification slides obtained a concordance greater than 50%. Only one (1) identification slide obtained zero agreement from the microscopists. For species identification a concordance greater than 80% was noted and the microscopists obtained scores between 0.20 and 0.4 on a scale of 0 to 1 for parasite density reading. The microscopists obtained 100% precision, sensitivity, specificity and both negative and positive predictive values. CONCLUSION: This work demonstrated that the microscopic method of malaria diagnosis used in the LPM/HALD is in accordance with the requirements of WHO and ISO 15189. Further training of microscopists may be needed to maintain competency.

[Hemoperfusion with activated carbon in the treatment of exogenous acute poisoning]. / L'emoperfusione mediante carbone attivato nel trattamento delle tossicopatie esogene acute.

Reference is made to results obtained at the University of Messina Anaesthesiology and Resuscitation department with an "Emoadsorb" haemodepurator set in 18 patients with serious exogenous toxicosis. The criteria used in the indication of this treatment include the seriousness of the clinical picture and quantitative and qualitative assessment of the poison in the blood. A key feature of the system used was a highly biocompatible, hydroxyethylmetacrylate membrane coating the activated carbon, capable of subtracting toxins in a 300-5000 p.m. range. The effectiveness of the method was appraised clinically and by gas chromatography, to quantify the amount of poison in the blood before and after treatment. Rapid detoxication was obtained in 16/18 cases. It is therefore felt that extracorporeal haemodepuration with A.C. is a sound form of management in cases of acute exogenous toxicosis, and should be more widely employed in resuscitation departments.