Clinical Pathology Laboratory Research Articles

Colorectal screening program implementation in primary health care, in Loures-Odivelas, Portugal

Abstract Problem In 2020, Portugal had the highest cumulative incidence of colorectal cancer (CRC) in the European Union (103 new cases/100,000 inhabitants). The Colorectal Cancer Screening Program (CRCS) is based on fecal occult blood testing (FOBT) as the primary screening method. With the delivery of the stool sample collection device; instruction on its use is provided by the Primary Health Care team. The sample is processed at the Clinical Pathology laboratory of the Hospital Center (HC). In case of a positive result, the general practitioner communicates the result and refers the individual to the Follow-up and Treatment Center. Description The general objective of this project was to implement the CRCS in the 19 Family Health Units (FHU) of Loures-Odivelas Health Center Group, between September 2022 and April 2023. The following activities were carried out: 1. Sessions to present the patient pathway, record platform, and stool sample collection device; 2. Application of a checklist of essential points for the start of screening; 3. Preparation and dissemination of monitoring reports to the FHU; 4. Follow-up visits to clarify doubts. Results By March 2023, CRCS had been implemented in 15 of the 19 FHU (79%). Between September 2022 and March 2023, 1,430 devices were delivered and 959 FOBT samples were received (67%). Among the devices received with biological samples, it was not possible to issue a result for 5%. Lessons The activities carried out allowed for the initiation of CRCS in most FHU. The involvement of professionals in these activities contributes to increased patient adherence and proper collection technique, reducing inconclusive FOBT results. It is necessary to continue this strategy of personalized support for the FHU to consolidate the implementation of CRCS in LO HCG. Ensuring that the necessary materials are available and that result issuance and referral deadlines are met are important factors for maintaining professional motivation. Key messages • The objective was to implement the Colorectal Cancer Screening Program (CRCS) in 19 Family Health Units (FHU) in Loures-Odivelas. By March 2023, CRCS had been implemented in 15 of 19 FHU (79%). • It is important to continue these activities in order to put into operation the CRCS in all FHU and to tackle the problem of colorectal cancer.

Molecular Typing of Pseudomonas aeruginosa Isolates Collected in Abidjan Hospitals (Côte d'Ivoire) Using the Multiple-Locus Variable Number of Tandem Repeats Method.

Background/objectives:Pseudomonas aeruginosa can cause community-acquired infections affecting various body sites. The present retrospective study investigated the genetic diversity of 173 isolates (166 clinical, 7 environmental) of P. aeruginosa collected from clinical pathology laboratories in Abidjan, Côte d'Ivoire (2001-2011). Methods: Multiple-Locus Variable Number of Tandem Repeats (VNTR) Analysis (MLVA) using 13 loci was applied to all isolates and compared to published MLVA data. The antibiotics status of the isolates was compiled when available and compared to published profiles. Results: Among 95 isolates analyzed for their antibiotics status, 14 displayed concerning resistance profiles: five multidrug-resistant (MDR) and nine extensively drug-resistant (XDR). MLVA typing revealed a high genetic diversity (>130 genotypes), with many genotypes represented by a single strain. Notably, thirteen clusters (≥4 related isolates) were observed. Some clusters displayed close genetic relatedness to isolates from France, Korea, and well-studied strains (ST560, LES and PA14). Comparative analysis suggested the presence of international high-risk MDR clones (CC233, CC111) in Côte d'Ivoire. Importantly, MLVA clustering revealed a close relationship of CC235-MDR strains with a locally identified cluster (group 9). Conclusions: These findings support MLVA as a reliable and cost-effective tool for low-resource settings, allowing the selection of relevant strains for future whole genome sequence analyses. This approach can improve outbreak investigations and public health interventions aimed at curbing MDR P. aeruginosa transmission within hospitals and at the national level.

Determinants of Safe Behavior among Clinical Pathology Assistants at Dr. Soebandi Regional Hospital Jember, Indonesia

Introduction: Every workplace has potential hazards that can threaten work safety, including clinical pathology laboratories. Work accidents in clinical pathology at Dr. Soebandi Regional Hospital Jember have decreased every year. This study aims to examine the determinants of safety behavior among clinical pathology assistants at Dr. Soebandi Regional Hospital, Jember. Methods: This research was a quantitative descriptive study with a cross-sectional approach. The study's respondents were 32 clinical pathology assistants. We collected data using a questionnaire. We analyzed this research using frequency, crosstab, and logistic regression tests. Results: The majority of clinical pathology assistants were under 40 years old, had completed occupational health and safety training, possessed competencies suitable for their work, maintained a positive attitude, and demonstrated high motivation at work. Almost all respondents stated that supervision was good, they had good knowledge, and their most recent level of education was Diploma-III. Most clinical pathology assistants behave safely. Clinical pathology assistants who are under 40 years old, have completed occupational health and safety training, exhibit competence, a positive attitude, and high motivation, report good supervision, possess good knowledge, and hold the latest Diploma-III education level are more likely to behave safely. Conclusion: Several clinical pathology assistants have demonstrated safe behavior while working in the clinical pathology laboratory. Several factors, including superior supervision and reasonable supervision efforts in the clinical pathology laboratory, contribute to the safe behavior of clinical pathology assistants.

Optimization of Complete Blood Count Results with Variations in Specimen Handling and Whole Blood Secondary Homogenization Techniques

Specimen homogenization and the addition of anticoagulants are pre-analytical steps that influence the accuracy of the test results. Complete blood count (CBC) is a screening test that supports disease diagnosis and aids in determining the appropriate therapy for patients. Inadequate specimens are inappropriate for subsequent testing, as they can lead to inaccurate results in the CBC examination. This study aims to determine the optimization of complete blood count results with variations in specimen handling and secondary homogenization techniques for whole blood. The type of research used is quantitative analysis using laboratory experimental methods. The study was conducted in May 2024 in the Clinical Pathology Laboratory of the Diploma-4 Medical Laboratory Technology Study Program, Faculty of Health Sciences, Muhammadiyah University of Sidoarjo, using 48 blood samples. The results of the MANOVA test indicate that the type of anticoagulant has a significant effect on the erythrocyte count (p=0.041) but does not have a significant impact on the leukocyte count (p=0.844) and platelet count (p=0.920). Meanwhile, the homogenization technique does not significantly affect the erythrocyte count (p=0.959), leukocyte count (p=0.991), or platelet count (p=0.867). This study concludes that the secondary homogenization technique has no significant effect. In contrast, the type of anticoagulant significantly impacts the results of the Complete Blood Count (CBC) test. This research suggests collecting whole blood specimens using Ethylene Diamine Tetra Acetate (EDTA) vacutainers as the anticoagulant and applying a secondary homogenization technique before performing the CBC analysis.

Performance Evaluation of Commonly Used Portable Hemoglobin Sensors in Comparison to Clinical Test Results.

Telehealth systems in underserved countries leverage various low-cost portable medical sensors to transmit patients' vital information to remote doctors, facilitating timely diagnoses and interventions. However, the potential risks associated with inaccurate data pose considerable threats to the health of individuals. This study focuses on identifying high-quality portable hemoglobin sensors, employing the Japanese clinical pathology laboratory as a gold standard. Out of the eight sensors evaluated in this study, four were found to be highly erroneous.

Diagnostic utility of transfer learning by using convolutional neural network for cytological diagnosis of malignant effusions.

Cytological analysis of effusion specimens provides critical information regarding the diagnosis and staging of malignancies, thus guiding their treatment and subsequent monitoring. Keeping in view the challenges encountered in the morphological interpretation, we explored convolutional neural networks (CNNs) as an important tool for the cytological diagnosis of malignant effusions. A retrospective review of patients at our institute, over 3.5 years yielded a dataset of 342 effusion samples and 518 images with known diagnoses. Cytological examination and cell block preparation were performed to establish correlation with the gold standard, histopathology. We developed a deep learning model using PyTorch, fine-tuned it on a labelled dataset, and evaluated its diagnostic performance using test samples. The model exhibited encouraging results in the distinction of benign and malignant effusions with area under curve (AUC) of 0.8674, F-measure or F1 score which denotes the harmonic mean of precision and recall, to be 0.8678 thus, demonstrating optimal accuracy of our CNN model. The study highlights the promising potential of transfer learning in enhancing the clinical pathology laboratory efficiency when dealing with malignant effusions.

Complete Blood Count and Biochemistry Reference Intervals for Healthy Adult Donkeys in the United States.

Previous hematologic and serum biochemistry reference interval (RI) values have been established for donkeys in various geographic regions, life-stages, or for specific donkey breeds. The last extensive investigation establishing RIs for adult donkeys in the United States (U.S.) was published over three decades ago. We aimed to establish updated robust RIs using a reference population of apparently healthy adult donkeys from across the U.S. Standard sized (n = 102), miniature (n = 17), and mammoth (n = 1) donkeys from four different states were enrolled, with 20% of the study population including donkeys captured directly from the wild in Death Valley National Park, CA. RIs were established in accordance with the American Society for Veterinary Clinical Pathology and Clinical Laboratory Standards Institute guidelines. The findings will assist practitioners with the interpretation of their complete blood count and biochemistry panel results in U.S. donkeys. This study also highlights a comparison of results for some important analytes in U.S. donkeys compared to U.S. horses and previously established donkey RIs.

Comparison of Two Automated Urine Analyzers (URiSCAN Super + YD Diagnostics and Sysmex UC-3500–UF-5000 Urine Chemistry Analyzer) with Routine Microscopy

Background and Aim: Urinalysis is one of the most commonly performed screening tests in the clinical laboratory to diagnose and monitor various urological as well as systemic conditions. Newly developed automated urine analyzers are expected to routinely screen urine in less time compared to conventional routine microscopy and provide clinicians with prompt clinical information with a lower false-negative rate. The study aimed to evaluate the diagnostic performance of the two automated urine analyzers, URiSCAN Super + YD Diagnostics and Sysmex UC-3500–UF-5000 urine analyzer and compare them with microscopy. Materials and Methods: This was a prospective study performed on 124 randomly selected samples of patients coming to the clinical pathology laboratory at a tertiary care hospital for 3 months between March 1, 2022 and May 30, 2022. Each sample was taken for both automated analyzer testing and microscopic evaluation. The results of urine examination consisting of cells, formed elements, and microorganisms were compared between both the automated urine analyzers and microscopy, and the degree of concordance was calculated utilizing Cohen’s kappa (κ) analysis to see the concordance between all three values. The statistical analyses were performed using SPSS version 25, developed by IBM Co, and P < 0.05 was considered statistically significant. Results: The degree of concordance of red blood cell (RBC), white blood cell (WBC), and epithelial cells (ECs) was good between the two automated analyzers, URiSCAN Super + YD Diagnostics and Sysmex UC-3500–UF-5000 urine analyzer and microscopy with P < 0.05. The concordance between the Sysmex UC-3500–UF-5000 urine analyzer and manual microscopy was better than between manual microscopy and URiSCAN Super + YD Diagnostics. There was no concordance between any of these methods for either crystals, cast, bacteria, and fungi with P > 0.05. Conclusion: The results from the automated analyzers for RBCs, WBCs, and ECs were similar to the result of manual microscopy, and the analyzers can be relied on for testing and can help in reducing turnaround time of routine urine examination. However, bacteria, fungi, dysmorphic red cells, casts, and crystals need to be analyzed by microscopic examination before giving a final diagnosis.

Perbedaan Derajat Aglutinasi Pemeriksaan Golongan Darah Metode Tabung Berdasarkan Konsentrasi Suspensi Sel 5% Segera Periksan Dengan Lama Penyimpanan 5 Hari

Background: ABO b;ood group examination is an examination carried out to determinate the type of blood group in humans that detects the presence of antigens on the surface of the red blood cell membrane by means of the Tube Method various consentrations of erythrocyte cell suspension,namely 5%, 10% and 15%. Research purpose: To determinate the effect of various consentrations of erythrocyte cell suspension with ready-to-use 0,9% NaCl and 0,9% table salt solvent on the degree of agglutination in blood group examination Tube method. Research method: This research is a pure experimental study with a total sample 41 people, this study was conducted on January 16-20, 2023 at the Muhammadiyah Palembang IKesT Clinical Pathology Laboratory. Results: The results showed that the blood group examination was done by the tube method with a concentration of erythrocyte cell suspension, namely 5%, 10% and 15% with 0,9% NaCl solvent ready-to-use and 0,9% NaCl, table salt solvent resulting in a degree of agglutination of +4. The Kruskal-wallis test result in the Cell Grouping method obtained 0,000 and in the Serum Grouping method obtained 0,051. Conclusion: The conclusion in this study is that there is no effect of various consentrations of erythrocyte cell suspension with ready-to-use 0,9% NaCl and 0,9% NaCl Solvent Kitchen Salt on the degree of agglutination in blood group examination Tube Method so that 0,9% NaCl solvent from table salt can be used as an alternative to ready-to-use 0,9% NaCl reagent in blood group tests by tube method. 
 Keywords: Blood type, Aglutination

Risk management in a clinical pathology laboratory: Application of brainstorming and probability analysis for risk reduction.

Risk management includes identifying various risks, assessing the probability of occurrence, and evaluating the severity of their consequences. As clinical laboratories are integrally involved in patient care, risks in the laboratories could present grave consequences in some instances. This study aimed to utilize simple techniques for risk management in a clinical laboratory. All potential risks in the pathology laboratory of a tertiary-level hospital were identified and classified into natural calamity, environmental, manpower-related, pre-analytical, analytical, post-analytical, and laboratory hazard-related risks through a brainstorming session. The probability of occurrence of each risk was estimated from departmental and hospital records. The possible impact of risk (score 1-10) was categorized into catastrophic, critical, serious, minor negligible, and insignificant. The unweighted risk score was calculated by multiplying the probability of occurrence and impact score. Inadequate sample-to-anticoagulant ratio had the highest probability of occurrence (22.85%), followed by quantity insufficient for analysis (7.30%) and laboratory information system (LIS) breakdown (6.58%). The highest unweighted risk score in our study was inadequate sample-to-anticoagulant ratio (score 91.40), followed by improperly labeled samples (score 35.61), manpower competency issues (score 32.88), sample insufficient for analysis (score 29.20), and LIS breakdown (score 26.30). We found that among all the categories, risks involving the pre-analytical phase had the highest risk scores. The other important risks included manpower competency issues requiring continued on-the-job training of staff as a risk reduction strategy. Brainstorming and probability analysis could be easily used for risk management in a clinical laboratory.

Serum Interleukin-6 Levels are Positively Correlated with the Severity of Acne Vulgaris

Acne vulgaris is a chronic inflammatory disease that affects the pilosebaceous unit. This disease occurs on the skin of the face, body, back, and other areas of the body, and can leave scars on the skin which can be temporary or permanent. Recent data shows that the inflammatory process is the initial process in the pathogenesis of acne, several pro-inflammatory cytokines, one of which is interleukin 6 (IL-6), which plays a role in acne vulgaris. Analytical observational study with a cross-sectional approach. The research was carried out from February - November 2023 at the Skin and Venereology Polyclinic, RSUP Prof. Dr. I.G.N.G. Ngoerah Denpasar and the Clinical Pathology Laboratory of Prof IGNG Ngoerah Hospital. The sample consisted of 47 samples of patients with acne and 20 samples without acne aged 8 - 45 years who were selected through consecutive sampling according to inclusion and exclusion criteria. A sample of 3 milliliters of venous blood is taken which will then be checked for IL-6 with an ELISA kit. Data analysis with SPSS version 24 and p value <0.05 is significant. The mean IL-6 serum levels in the acne group was 110.2 ± 88.3 pg/ml while in the non-acne group it was 26.7 ± 23.7 pg/ml. There was a significant difference in the category of IL-6 levels in the acne and non-acne groups (95% CI 55.1 - 155.3, p<0.001). The correlation analysis of IL-6 levels with the severity of acne was strongly positive (r=0.951, p<0.001).

Lesson Learned from Mass Antibody Rapid Diagnostic Used in the Early COVID-19 Pandemic in Indonesia Contributors.

Laboratory examination is extremely important in handling the COVID-19 pandemic. In the first era of the pandemic, the molecular and antigen tests were limited. Hence, at that time, it was necessary to carry out antibody Rapid Diagnostic Tests (RDT). However, many antibody RDTs were yet to obtain Food and Drug Authorization (FDA)'s approval. Therefore, The Indonesian Association of Clinical Pathology and Medical Laboratory (PDS PatKLIn) decided to conduct a validity test of RDT antibodies to find out the quality of SARS-CoV-2 diagnosis performance based on these RDTs used. This is a descriptive observational design with diagnostic analysis. The retrospective secondary data were collected from 34 provinces in Indonesia from May to June 2020. Data analysis was carried out on the sensitivity and specificity values of each antibody RDT brand to the RT-PCR result and analyzed descriptive data. The amount of secondary data of antibody RDT and RT-PCR results collected was 139,908, consisting of 59 RDT brands of which 44% were authorized by The Indonesian COVID-19 Response Acceleration Task Force (Gugus Tugas Percepatan Penanganan COVID-19 Indonesia). There were huge variations of SARS-CoV-2 antibody RDT performance between total antibody types (sensitivity 59.18%, specificity 62%), IgM RDT (sensitivity 16-100%, specificity 7-97%), and RDT IgG (sensitivity 33-96%, specificity 19-100%). The variations in the RDT antibodies'performance can cause errors in diagnosis leading to significant material and immaterial losses. Therefore, cooperation from various parties is needed for the pre- and post-marketing surveillance process to assess the performance and the characteristics of each RDT kit and other diagnostic methods to assist the rapid pandemic response process.

How clinical laboratories select and use Analytical Performance Specifications (APS) in Italy.

Even if the topic of the analytical quality required to provide laboratory results "fit for purpose" exists since the beginning of the modern medical laboratory, there is the suspect that the expression "Analytical Performance Specifications" (APS) is not well-known. To investigate this aspect a survey was conducted. A questionnaire with seven questions related to the knowledge about the topic, the sources of information and the criteria used by the laboratories to set the APS and their applications was prepared. It was distributed to all the clinical pathology laboratories of Lombardy Region (143) and to the members of SIBioC Laboratory Medicine (excluding Lombardy). We received 201 replies: 127 from Lombardy and 74 from the rest of Italy. Fifteen percent declared to ignore the meaning ofAPS and only 64 % of those knowing the meaning of theterm declared to use them in the daily practice. The state-of-the-art was the principle used more frequently to setAPS(about 48 %) followed by biological variation (41 %), and APS were typically applied to set goals for Internal Quality Control for selected measurands. Usually imprecision or total error APS were used, much less frequently uncertainty APS. In fact only 27 % of the laboratories declared to have calculated the measurement uncertainty for part or the majority of their measurands. Even considering the limits of a survey that relies upon self-declarations, it appears clearly that, at list in Italy, there is some work to be done to promote the concept and the use of APS.

Measuring the Level of Agreement for Lactate Measurements in Hispaniolan Amazon Parrots (Amazona ventralis) Among 2 Point-of-Care Analyzers and a Benchtop Analyzer.

Lactate is an important biochemistry analyte used in human and veterinary medicine to assess tissue perfusion and can be used as a prognostic indicator for certain disease conditions. Whereas lactate is commonly measured using "patient-side" handheld meters, these meters have not been validated for companion avian species. The purpose of this study was to measure the level of agreement between 2 commercially available point-of-care lactate meters and a laboratory benchtop blood analyzer in Hispaniolan Amazon parrots (Amazona ventralis). Blood samples were collected from 20 adult parrots at Louisiana State University by drawing 1.5 mL of blood from the right jugular vein. One drop of whole blood was used for the Lactate Plus analyzer and the remainder of the sample transferred into a lithium heparin microtainer. From the blood in the microtainer, 0.2 mL whole blood was analyzed using the epoc Blood Analysis System, and the remaining sample was centrifuged to obtain plasma that was immediately frozen at -80°C (-112°F) and submitted to the Texas A&M University Clinical Pathology Laboratory for analysis on the VITROS 4500 benchtop analyzer. Bland-Altman agreement plots and Passing-Bablok regression were used to measure the level of agreement between the methods. There was poor agreement between all 3 methods with mean percentage differences in lactate concentrations ≥22% (epoc and Lactate Plus: 33.6% [95% CI: 27-40]; epoc and VITROS 4500: 55% [95% CI:52-58]; VITROS 4500 and Lactate Plus: 22% [95% CI:16-28]). Based on these results, the point-of-care meters tested in this study are not interchangeable, and separate reference intervals were calculated for each method. Blood lactate concentrations may have more utility in tracing lactate trends over time in an individual rather than being able to utilize this information at 1 time point for disease diagnosis and prognosis.

Creating Efficient Workflows for Electron Microscopy Laboratories with Automated Specimen Preparation

Abstract Electron microscopy (EM) is essential to the biological and biomedical sciences and clinical diagnostic pathology. Electron microscopy specimen preparation is laborious and time-consuming, with transmission EM (TEM) chemical preparation typically requiring 1–3 days, while volume electron microscopy (vEM) takes 3–5 days of tedious manual reagent exchanges every few minutes or hours. This places a considerable burden on laboratory scientists with the ongoing demand for TEM, and the rapidly growing demand for vEM due to its potential to revolutionize structural biology, connectomics, and related fields. This burden is exacerbated by a shortage of trained electron microscopy scientists as current staff retire, and few enter the workforce. This report provides four case studies to illustrate how automated and faster specimen preparation workflows using mPrep™ Automated Specimen Processors (ASP-1000™ and ASP-2000™, Microscopy Innovations, LLC) free electron microscopy staff in academic and pre-clinical research labs and a clinical pathology laboratory.

Performance Evaluation of the Commonly-Used Portable Cholesterol Sensors for Telehealth Services in the Unreached Communities.

Portable medical sensors play an important role in healthcare services, especially in rural communities. Many telehealth systems use these devices for providing patients' vital information from a distance to remote doctors. Erroneous data will not only mislead the remote doctor for correct diagnosis but it will cause health threats to these unreached community people. Therefore, it is very important to identify good sensors with an acceptable level of accuracy but within the affordable price of the available sensors in the market. This study aims to identify quality portable cholesterol sensors with high accuracy with the reference of the Japanese clinical pathology laboratory as a gold standard. We have considered cholesterol sensors that measure total cholesterol for this study that are commonly used in the developing countries of Asia. We found that out of four, three of them were very much erroneous and cannot be recommended even for primary healthcare.

An evaluation of the commonly used portable medical sensors performance in comparison to clinical test results for telehealth systems

Background and ObjectiveOne of the primary challenges faced by telehealth systems is the accurate transmission of patient information to remote doctors. In this context, portable medical sensors deployed at the remote patients' end play a crucial role in measuring vital information. There are many sensors available in the market. However, the accuracy of the sensors has been always a concern. The objective of this study is to verify different sensors and create awareness for using accurate sensors to avoid misdiagnosis for the patients’ safety. MethodsThis study considered the test result of a Japanese clinical pathology laboratory as the reference gold standard. The clinical pathology laboratory uses 1) Hexokinase UV method for blood glucose, 2) Enzymatic Determination method for cholesterol, 3) Automatic Analyzer (EDTA-2 K) of Hemoglobin, and 4) Uricase POD method for uric acid. To assess the performance of a medical sensor, its test results were compared to the gold standard test results obtained from the laboratory using the same sample. A Normalized Root Mean Square Error (NRMSE) threshold of less than 0.2 was established as the criterion for determining whether the medical sensor's performance fell within an acceptable range. ResultsAmong the eight most commonly used blood glucose devices in the Asian market, only one device was deemed acceptable with NRMSE less than 0.2. However, all four devices found in the Japanese market showed their acceptability. In the case of cholesterol, hemoglobin, and uric acid devices, only a limited number of items were available in Asian markets. Some of the hemoglobin and uric acid devices were found to be somewhat acceptable, while all the cholesterol sensors were found erroneous. ConclusionsThis study has clearly shown the issues with the portable medical sensors and recommends the device approval authority of each country to approve sales of the quality sensors only for patients’ safety.

OVERVIEW OF BACTERIAL PATTERNS IN TABANAN GENERAL HOSPITAL

AbstractBackground: Resistant bacterial infections will affect the results of therapy, costs, spread of disease, and duration of illness. To minimize the losses incurred, it is necessary to monitor resistant bacterial and the use of antibiotics. Objective: To be able to identify, monitor, map and overcome antibiotic resistance and restrict bacterial transmission in hospitals, especially at the Tabanan General Hospital. Method: This research was conducted using a cross-sectional method using samples of inpatients and outpatients sent by clinicians to the Clinical Pathology Laboratory, Microbiology Sub Lab in period of January to December 2022. Results: Of the 590 positive culture samples in 2022, the majority were caused by Escherichia coli (15.25%) and 62.22% were ESBL. Apart from that, 8.31% were found to be Staphylococcus aureus and 53.06% were MRSA. Conclusion: The percentage of Escherichia coli bacteria that produce the ESBL enzyme is still high (62.22%). The percentage of Staphylococcus aureus bacteria that produce the MRSA enzyme is still high (53.06%). The antibiotics Meropenem, Amikacin, and Tigecycline are the antibiotics with the highest sensitivity to ESBL. The antibiotics Nitrofurantoin, Linezolid, and Quinupristin/Dalfopristin are the antibiotics with the highest sensitivity to MRSA. Keywords: bacterial patterns, description of bacterial distribution, antibiotic resistance

Korelasi Kadar HbA1c Dengan Kadar Kreatinin Pada Pasien Diabetes Melitus Kronis

Uncontrolled diabetes mellitus will lead to various chronic complications, both microvascular and macrovascular complications. HbA1c examination is effective for long-term monitoring of blood glucose for people with diabetes mellitus. A high HbA1c value is used as a measure of the development of complications of diabetes mellitus. Diabetic nephropathy is the most common complication of diabetes mellitus which can end in kidney failure resulting in damage to the glomeruli. Indications to determine kidney function impairment is creatinine examination. This study aims to determine the correlation between HbA1c levels and creatinine levels in patients with chronic diabetes mellitus at the Clinical Pathology Laboratory of the Bajawa Regional General Hospital. Analytical observational research with an approach cros- sectional using techniques purposive sampling 35 chronic DM patients. Test results who squares shows that the value of p = (0.687) > α (0.05), thus it can be concluded that there is no relationship between HbA1c levels and Creatinine levels in patients with chronic diabetes mellitus.
 
 Keywords: HbA1c, Creatinine, Diabetes Mellitus.

Development of a targeted proteomic assay for the quantitation of neurofilament light in cerebrospinal fluid: Correlation with Simoa‐based quantitation across neurodegenerative diseases and centres

AbstractBackgroundCerebrospinal fluid (CSF) neurofilament light (NfL) is a dynamic biomarker of neurodegeneration that is used for supporting clinical diagnosis and monitoring disease‐modifying therapies. Development of new analytical tests has been limited, with quantitation of NfL in biomarker studies largely restricted to immunoassay methods. Targeted mass spectrometry is a highly specific technique that can be easily translated into existing proteomic and clinical pathology laboratories. In this multi‐centre study, we have developed two targeted mass spectrometry assays which were compared to Simoa, the gold standard method for NfL quantitation. The developed methods included immunocapture of intact NfL protein or specific peptides (immune‐peptide capture) prior to targeted proteomic analyses. We discuss the development, validation and merits of each technology to quantitate NfL in CSF from healthy controls and several neurodegenerative diseases.MethodCSF was collected from patients with a range of neurological diseases at the National Hospital for Neurology and Neurosurgery (London, UK). Clinical diagnosis was determined by their treating clinician according to consensus clinical criteria. NfL concentrations were measured by Simoa (Quanterix, USA) and two immunoprecipitation‐targeted mass spectrometry (IP‐MS) assays developed by a collaboration between UCL and Washington University in St Louis. To evaluate replication of results across centres and mass spectrometry approaches, results were compared using Spearman’s correlation analysis and Bland‐Altman testing.ResultsA high correlation was observed for CSF NfL levels between Simoa and both IP‐MS assays (immune‐peptide capture, r = 0.90, P<0.0001 and immune‐protein capture, r = 0.88, P<0.0001). Relative differences in mean NfL concentration between clinical groups remained the same across the analytical methods, with the highest and lowest NfL concentrations observed in the Huntington’s disease and the healthy control groups respectively. Interestingly, differences in the extent of correlation between Simoa and IP‐MS were observed between the different clinical groups (r = 0.37 ‐ 0.94).ConclusionImmunoprecipitation‐targeted mass spectrometry quantitation of NfL correlates highly with NfL Simoa measures across a range of neurodegenerative and neuroinflammatory diseases, and is replicable between laboratories using different immunoprecipitation‐targeted mass spectrometry approaches.