Department Of Laboratory Medicine Research Articles

Association of C- Reactive Protein and Glycated Hemoglobin among Type 2 Diabetic Adults

Background: Diabetes mellitus (DM) is a complex metabolic disorder and is a major global health problem. An increasing amount of evidence suggests that chronic subclinical inflammation is one of the triggering factors in the onset of type 2 diabetes mellitus (T2DM). Objective: The current study was designed to determine the association of C- reactive protein (CRP) and glycated hemoglobin (HbA1c) in T2DM patients. Methods: This cross-sectional study was carried out at Department of Laboratory Medicine, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh between March 2017 to February 2018. Total 80 adult patients of newly diagnosed T2DM were included in this study. A detailed clinical history was recorded and relevant physical examinations were done. The complete blood count (CBC), C-reactive protein (CRP), fasting blood glucose (FBG) and HbA1c were done accordingly. Data were analyzed and compared by statistical tests. Results: The mean age of the study patients was 45.06±11.08 years with female predominance. More than half (53.7%) of the study patients were in age group 41-59 years. Majority (65%) of the study patients was overweight/obese. It was observed that, mean(±SD) FBG, HbA1c and CRP levels were 8.97±2.41 mmol/L 8.54±2.08% and 8.98±4.85 mg/L respectively. Pearson correlation analysis revealed that CRP has a significant positive correlation with HbA1c (r= 0.457, p< 0.001). Conclusion: This study concluded that CRP has a significant positive association with HbA1c in adult T2DM patients. CRP can be used as a valuable and effective tool for monitoring T2DM.

A-147 Comparative Precision of Platelet Counting by Optical, Fluorescent, and Impedance Techniques in Thrombocytopenia and Microcytosis Patients

Abstract Background In today's era of automation driven by Artificial Intelligence, even the most efficient automated hematology analyzer may struggle to accurately determine platelet count in patients with low platelet count and microcytosis. The Sysmex XN-series analyzer (Sysmex, Kobe, Japan) uses optical density, fluorescence, and electronic impedance methods for platelet counting. This study aimed to evaluate the accuracy of optical, fluorescence, and electrical impedance methods in estimating precise platelet counts in thrombocytopenic and microcytic patient samples. Methods A cross-sectional study was conducted in the Department of Laboratory Medicine at AIIMS, New Delhi, for 30 days consecutively. A total of 200 blood samples collected, of which 100 samples were of thrombocytopenia (<100x10^9/L) and 100 samples were of microcytosis (Mean corpuscular volume <76 femtoliters). MCV<76 fl was further categorized into 2 groups- MCV 60-70 fl and MCV 71-76 fl accordingly. Males and females were categorized and analyzed distinctly for thrombocytopenia and microcytosis. Statistical analysis was performed using SPSS 16.0 for Windows (SPSS Inc., Chicago, IL, USA) and the Bland Altman plot was analyzed. Results Of the 100 patients with thrombocytopenia (platelet<1 lakh/L) females were predominantly 54% while males were 46% and the median age was 29 years (0.02-70). Of the 100 patients with low MCV (<76 fl) females were 53%, while males were 47% and the median age was 29 years (0.3-69). The findings were compared against the standard manual platelet count method in peripheral smears verified by two expert pathologists. The Bland Altman plot for Platelet <1 lakh/L and MCV <76 fl were compared with standard manual platelet count method and the following findings were obtained i) In female with PLT- <1 lakh/L, PLT-O showed least bias (9.8) followed by PLT-F (10.4) and PLT-I (12.1) ii) In males with PLT-<1 lakh/L, PLT-O showed least bias(14.1) followed by PLT-F(16.5) and PLT-I(17.0) iii) For MCV 61-70fl, PLT-O showed the least bias (4.4) followed by PLT-F (6.7) and PLT-I (28.5) iv)For MCV 71-76fl, PLT-F showed least bias (-0.2) followed by PLT-O (1.5) and PLT-I(31.2). Conclusions Platelet count by optical method (PLT-O) detects platelet count more accurately with minimum bias when compared with PLT-F and PLT-I in patients with thrombocytopenia. In patients with microcytosis, PLT-I is less reliable in comparison to PLT-O and PLT-F. A limitation of the automated hematology analyzer is the inability to detect platelet clumps which is appreciated in peripheral smears.

A-261 Outcome of a survey on dengue lateral flow immunoassay test kit reading and interpretation by medical laboratory staff in a hospital laboratory

Abstract Background Lateral flow immunoassay (LFIA) tests, first introduced in 1959, are now the mainstay of clinical laboratories. Khoo Teck Puat Hospital (KTPH) is a 795-bed acute care general hospital located in the north of Singapore. The Department of Laboratory Medicine has been using dengue LFIA test kits for the detection of dengue NS1 antigen, IgM antibodies and IgG antibodies. While kits are cost-effective, user-friendly and provide rapid results, there is subjectivity in reading and interpretation of results. Methods We conducted a survey to assess test reading and interpretation by medical laboratory staff. Six serum and plasma specimens were analysed using Bioline™ Dengue IgG/IgM WB test device. Test kits at the end-point of sample incubation were photographed in both well-lit and dim conditions. A survey questionnaire was prepared using an online form builder tool using the photographs. Staff were invited to participate in the survey. They were allowed to report the result as ‘Positive’, ‘Negative’ or ‘Equivocal’. Results A total of sixteen responses were received. Results were 100% concordant for all 6 specimens in both well-lit and dim conditions. For one case, under a well-lit condition, 15 staff reported the result as ‘Positive’ while one staff reported ‘Equivocal’. Most of the reported results for samples with no consensus is split between ‘Positive’ and ‘Equivocal’. Conclusions Dengue viruses of all 4 known serotypes are endemic in Singapore. Positive results are tracked on a national level to identify areas of high dengue infection for intensive environmental and vector control measures. Hence, accurate reporting and identification of patients with dengue infection is important. Our survey shows that lighting conditions do not affect the interpretation of LFIA results. Reading and interpretation of dengue LFIA test kits however, remain dependent on user interpretation and newer test kits with optical readers may be useful in mitigating this.

Metabolomics in Pakistan: A Comprehensive Analysis of Availability, Practices, and Challenges in Clinical Laboratories.

To comprehensively analyse the current state of metabolomics in clinical laboratories across Pakistan. Cross-sectional survey. Place and Duration of the Study: Section of Chemical Pathology, Department of Pathology and Laboratory Medicine, The Aga Khan University, Karachi, Pakistan, from June to November 2022. This survey assessed metabolomics availability, computational methods, and resources in Pakistani clinical laboratories. The survey questionnaire was distributed within the chemical pathology community via Google Forms, and responses were garnered from 44 chemical pathologists across 17 laboratories in 10 cities. Among respondents, 11 had formal metabolomics training, with three having less than 1 year, five more than 1 year, and 33 lacking any experience. Primary clinical applications included inherited metabolic disorders, bio-informatics, microbiology, therapeutic drug monitoring, toxicology, and nutritional and environmental science. Thirty-three labs reported no omics-related technology; LC-MS and GC-MS were present in eight labs and capillary spectroscopy, direct infusion mass spectroscopy, and Fourier transform infrared-spectroscopy were predominantly used for metabolite identification. Challenges identified in implementing metabolomics included lack of awareness, limited expertise, low volume, restricted applicability, high instrument costs, and insufficient funding. Metabolomics in Pakistan faces limitations, but the chemical pathology community expresses strong interest, emphasising the need for intensified efforts in education and training in this emerging field. Metabolomics, Chemical pathology, Pakistan, Clinical laboratories, Genetics, Survey.

Advancing medical laboratory practice in Pakistan: insights from a focus group study on technologists’ training needs

BackgroundThe realm of medical laboratory technology (MLT) training and education is unstructured in Pakistan. The primary challenge currently confronting the workforce in MLT is the absence of standardized curricula and assessments in education and training. This was an exploratory study aiming to inquire experiences of trainees, alumni and teaching coordinators regarding the technologist training program in a single institute at Pakistan.MethodsTo gain an in depth understanding of MLT program, three focus group discussions (FGDs) were held at Department of Pathology and Laboratory Medicine, Aga Khan University, Pakistan during Feb-April 2024. A team of pathologists and educationists developed interview guides for FGDs in English. Interviews were bilingual, transcribed verbatim and coded using thematic analysis. Participants included current trainees, alumni, teaching and learning coordinators and moderators for the interview.ResultsA total of 29 participants were engaged; these included current MLT trainees (n = 10), alumni (n = 10), and teaching/learning coordinators and sectional supervisors (n = 9). Five main themes emerged from the analysis of FGDs: (Scott MG, Rifai N, Smith B, Oellerich M, Panteghini M, Apple F et al. The changing face of laboratory medicine: a more service and less academically oriented profession? 2015;61(2):322-9.) Recognition of key features of the MTT program, (Ferraro S, Braga F, Panteghini MJCC, Medicine L. Lab Med new Healthc Environ. 2016;54(4):523–33.) Evaluating curriculum design, (Waheed U, Ahmad M, Wazeer A, Saeed M, Saba N, Rasheed FJMJMS. Medical laboratory science education; shaping competent and skilled healthcare professionals. 2023;1(1):58–63.) Teaching and learning strategies, (Ned-Sykes R, Johnson C, Ridderhof JC, Perlman E, Pollock A, DeBoy JM. Competency guidelines for public health laboratory professionals. 2015.) Addressing the need to improve assessment methods, and (Linder RJJM, Education B. Educating medical laboratory technologists: revisiting our assumptions in the current economic and health-care environment. 2012;13(2):150-4.) Navigating the transition from a trainee to a competent technologist.ConclusionOur investigation demonstrated its potential as a valuable needs assessment study, highlighting key strengths, drawbacks, and challenges of the existing MTT program. Importantly, these findings at our institute can inform further research efforts to design competency-based MLT education and training programs in Pakistan.

Application of EXODUS system combined with allosteric DNA nanoswitches in the detection of miR-107 among plasma exosomes of Parkinson's disease patients

This study aimed to achieve rapid detection of Parkinson's disease (PD) plasma exosome miR-107. A case-control design was used to collect ten Parkinson's disease and ten healthy control plasma samples from the Department of Laboratory Medicine, Tongji Hospital, Tongji Medical College of Huazhong University of Science and Technology from December 2023 to January 2024. Exosome detection via the ultrafast-isolation system (EXODUS) was used to isolate plasma exosomes. The nanoparticle tracking analysis technology and electron microscopy were used to identify exosome particle size and morphology. The Qiagen miRNeasy Micro Kit was used to extract RNA. The microRNA-activated conditional looping of engineered switches (miRacles) was used to detect miR-107, and the relative expression was analyzed by agarose gel electrophoresis. Thermo Fisher RevertAid RT Reverse Transcription Kit was used to perform reverse transcription of RNA, and real-time PCR was used to detect miR-107. The independent samples t-test was used for comparison between groups. EXODUS system completed the isolation of exosomes from 500 μl plasma within 1.5 hours. The exosome concentration (mean±SD) was (4.82±2.02)×1010 particles/ml in the control group and (5.08±2.34)×1010 particles/ml in the PD group. There was no significant difference in exosome concentration between PD patients and healthy controls (t=-0.168, P=0.872). The morphology of exosomes was confirmed by electron microscopy. The miRacles nanoswitch could detect fM-level miR-107 and also effectively distinguish miR-107 from its family members, including miR-15a and miR-16. Agarose gel electrophoresis showed that the mean±SD of relative grey value content was 1.00±0.26 in the control group and 1.86±0.21 in the PD group. The miR-107 in the PD group was significantly higher than that in the control (t=-8.143, P<0.001), which was consistent with the result of real-time PCR. EXODUS combined with miRacles could achieve rapid, non-enzymatic and cheap detection of plasma exosomal miR-107 in PD patients.

Harnessing the Power of Big Data Analytics-Estimation of Reference Intervals for Neonatal Serum TSH in Pakistan Using RefineR Algorithm.

To estimate the population-specific reference intervals (RIs) for neonatal thyroid stimulating hormone (TSH) in Pakistani neonates, utilising the refineR algorithm. Observational study. Place and Duration of the Study: Department of Pathology and Laboratory Medicine, The Aga Khan University Hospital, Karachi, Pakistan, from 17th May to 30th November 2023. A data mining analysis was conducted on serum TSH results of neonates (≤1 month) over a period of six years, following approval from the Institutional Ethical Review Committee. Two subgroups were assessed based on the age as 0 - 5 days and 6 - 30 days. The refineR algorithm was implemented using refineR package (version 1.0.0), ensuring accurate analysis and insights. A total of non-duplicate 82,299 neonatal serum TSH tests were retrieved, including 70,788 (88%) aged 0 - 5 days and 11,511 (12%) aged ranging from 6 - 30 days. The estimated RI was from 0.67 µIU/mL (90% CI 0.641 - 0.72) to 15.0 µIU/mL (90% CI 13.2 - 17.3) for the first age group and 0.65 µIU/mL (90% CI 0.6 - 0.84) to 8.6 µIU/mL (90% CI 8.05 - 9.71) for the second age group. Reference intervals for neonatal serum TSH of the Pakistani population were estimated, considering the genetic differences of this demographic in comparison to the Western population. Results aligned with global literature, validating the refineR indirect approach's applicability. Reference intervals, Neonatal, Thyroid stimulating hormone, RefineR algorithm, Big data, Pakistan.

Clinico-Biochemical Spectrum of Pakistani Patients with Glutaric Aciduria Type 1 (GA1): Experience from a Specialised Biochemical Genetics Laboratory in Pakistan.

To evaluate the clinical, radiological, and biochemical features of glutaric aciduria Type 1 (GA1) patients identified through urine organic acid testing at a biochemical genetics laboratory (BGL) in Pakistan. Observational study. Place and Duration of the Study: Department of Pathology and Laboratory Medicine, The Aga Khan University Hospital, Karachi, Pakistan, from January 2013 to December 2022. Medical charts and urine organic acid (UOA) chromatograms of the patients presenting at the BGL from January 2013 to December 2022 were reviewed. Brain imaging was obtained where available. Variables were noted as per the objective and descriptive statistics were obtained. GA1 was found in 64 (0.4%) patients out of a total of 16,094 UOA requests for high-risk screening cases. The age of diagnosis ranged between one month and three years. The brain MRI findings revealed characteristic abnormalities such as cerebral atrophy, expanded CSF spaces, white matter abnormalities, and a distinct bat wings appearance, in cohesion with the results of biochemical testing. Sixty-four cases of GA1 from a single centre indicate a high frequency of the disorder in Pakistan. Late diagnosis emphasises the need for increased clinical awareness and preferably newborn screening to ensure optimal outcomes. Glutaric aciduria Type 1 (GA1), Brain imaging, UOA analysis, Glutaryl-CoA dehydrogenase (GCDH), Pakistan.

Correlation of Serum Magnesium Level in Type 2 Diabetes Mellitus Patient with Microalbuminuria

Diabetic nephropathy is the leading cause of end stage renal disease world wide. Approximately one third of patients with type 2 diabetes have hypomagnesemia, mainly caused by enhanced renal excretion. Magnesium deficit in the diet would induce insulin resistance in humans. If it is chronic, this may lead to macro-vascular and micro-vascular complications of diabetes. This study was designed to know the relationship of serum magnesium level in type 2 diabetic patients with microalbuminuria. This study was conducted at the Department of Laboratory Medicine in Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh. In this study, serum magnesium level and urine microalbumin level of 60 type 2 diabetic patients were measured. Both serum magnesium and urine microalbumin levels were measured by biochemical auto analyzer (Siemens Dimension RL Max). The mean serum magnesium level is lower in type 2 diabetes mellitus patient. There was a negative correlation between serum magnesium level and urinary microalbumin in hypomagnesemia diabetic patients. Identifying and treating hypomagnesemia can delay end stage renal disease in diabetic patient and reduce the clinical and economic burden of diabetic complications in future. The potential benefits of supplementing magnesium in type 2 diabetic patients with hypomagnesemia need to be evaluated further.

IJCM_424A : User experience and attitude of end users towards Laboratory Information System at a tertiary care hospital

Background: Laboratory Information Systems like any other automated systems have been touted for their contribution in recognizing and minimizing diagnostic errors, supplementing the decision-making process and improving diagnostic outcomes Objectives: This study aimed to review LIS end users’ experiences using LIS and their attitude towards LIS, explore factors that affect LIS end users in a laboratory and locate connections between user issues and user variables if any. Methodology: A descriptive study was carried out to assess the personal and professional aspects experienced by LIS end users and to determine the usability of LIS. A purposive sampling methodology was used to interview all the laboratory personnel working at the department of Laboratory Medicine at the selected tertiary hospital. A five-point liker scale was used to find out the LIS end users’ experience. The System Usability Scale to ascertain the factors affecting usability and analyzing the associations between user issues and user variables (nine of them). Fisher’s Exact test was to analyse the responses to assess human factors and relations affecting the usability of LIS. Results: All the seventy respondents had a favourable response to the installation of LIS and viewed it as a valuable investment for the laboratory. Among the nine user variables, seven were found to have P ≤ 0.05 with issues affecting LIS end users in a laboratory setting, namely, gender, age, work experience using LIS, educational qualification, department within laboratory medicine, type of LIS training and job position, suggesting significant association. Conclusion: The LIS end users had a positive attitude towards LIS and acknowledged its role in the smooth functioning of the workflow in the laboratory.

Oxymatrine Inhibition of Hepatitis B Virus Replication Through ERK1/2 Pathway and HNF1α and HNF4α Block in vitro.

To explore the molecular mechanism of oxymatrine (OM) by increasing the phosphorylation of ERK1/2 signal factor and blocking the transcription factors HNF1α and HNF4α expression against hepatitis B virus (HBV) antigen secretion and HBV DNA replication in HepG2.2.15 cells. An experimental study. Place and Duration of the Study: Department of Laboratory Medicine,First Affiliated Hospital of Gannan Medical University, Jiangxi, China, between May 2020 and December 2022. HepG2.2.15 cells, known for stably expressing HBV particles, were utilised as a cell-based model to explore potential pathways pertaining to the OM inhibition of HBV replication. An MTT assay was utilised to measure cytotoxicity. HBsAg or HBeAg content was measured using an enzyme-linked immunosorbent assay kit. HBV DNA in cell-free culture media was examined using a fluorescent quantitative PCR kit. Real-time PCR was utilised to analyse HNF1α and HNF4α mRNA expression, whereas Western blotting was performed to evaluate HNF1α, HNF4α, and ERK1/2 protein expression. OM inhibited HBV DNA copy number in the cell supernatant, 3.5-kb RNA gene expression in cells, and HBsAg and HBeAg secretion. OM upregulated p-ERK1/2 protein and significantly downregulated HNF1α and HNF4α gene transcription and protein translation. OM may inhibit the replication of HBV by inducing the phosphorylation of ERK1/2 and blocking the transcription factors HNF1α and HNF4α expression that are essential for viral replication. Oxymatrine, ERK1/2, Hepatocyte nuclear factor, Anti-HBV.

Insights from semi-structured interviews on integrating artificial intelligence in clinical chemistry laboratory practices

BackgroundArtificial intelligence (AI) is gradually transforming the practises of healthcare providers. Over the last two decades, the advent of AI into numerous aspects of pathology has opened transformative possibilities in how we practise laboratory medicine. Objectives of this study were to explore how AI could impact the clinical practices of professionals working in Clinical Chemistry laboratories, while also identifying effective strategies in medical education to facilitate the required changes.MethodsFrom March to August 2022, an exploratory qualitative study was conducted at the Section of Clinical Chemistry, Department of Pathology and Laboratory Medicine, Aga Khan University, Karachi, Pakistan, in collaboration with Keele University, Newcastle, United Kingdom. Semi-structured interviews were conducted to collect information from diverse group of professionals working in Clinical Chemistry laboratories. All interviews were audio recorded and transcribed verbatim. They were asked what changes AI would involve in the laboratory, what resources would be necessary, and how medical education would assist them in adapting to the change. A content analysis was conducted, resulting in the development of codes and themes based on the analyzed data.ResultsThe interviews were analysed to identify three primary themes: perspectives and considerations for AI adoption, educational and curriculum adjustments, and implementation techniques. Although the use of diagnostic algorithms is currently limited in Pakistani Clinical Chemistry laboratories, the application of AI is expanding. All thirteen participants stated their reasons for being hesitant to use AI. Participants stressed the importance of critical aspects for effective AI deployment, the need of a collaborative integrative approach, and the need for constant horizon scanning to keep up with AI developments.ConclusionsThree primary themes related to AI adoption were identified: perspectives and considerations, educational and curriculum adjustments, and implementation techniques. The study’s findings give a sound foundation for making suggestions to clinical laboratories, scientific bodies, and national and international Clinical Chemistry and laboratory medicine organisations on how to manage pathologists’ shifting practises because of AI.

Value of Reticulocyte Count, Absolute Reticulocyte Count and Platelet Count for Bone Marrow Recovery Status on Remission Induction Phase

Reticulocyte count performed on a supravitally stained blood film is a initial and common laboratory method of determining early hematological recovery. This method is rapidly replaced by automated flow cytometry methods which have the advantage of much greater precision, before other test become positive after chemotherapy. A prospective observational study was carried out in the Department of Laboratory Medicine in collaboration with Paediatric Haematology and Oncology, Bangabandhu Sheikh Mujib Medical University during a period of one year to evaluate the bone marrow recovery in children with acute lymphoblastic leukemia by automated reticulocyte analysis over platelet count. Total fifty patients were enrolled in this study on remission induction phase. All patients were between 8 months to 15 years’ age range with a mean age of 5.5 ± 3.2. At the end of the study out of 50 cases, Ret% and Abs ret count showed early recovery in a median of 6 days before the platelet count recovery and concluded that reticulocyte parameter showed earlier haematopoietic recovery than the platelet count recovery.

Evaluation to Determine Antibiotic Resistance Reduction in Gram-Negative Bacteria from 2019 to 2021 by the Saudi Arabia National Plan.

The main objective of this study was to investigate the three-year evaluation of antibiotic resistance (AR) of multi-drug-resistant organisms and extended-spectrum beta-lactamase (ESBL)-resistant rate of gram-negative bacteria in one of the largest hospitals by the Saudi Arabia Nation Plan. This study was conducted in the Department of Laboratory Medicine, in a private hospital in Riyadh City, Saudi Arabia, from January 2019 to December 2021 in 120-bed private hospitals. A total of 4700 gram-negative isolated organisms were obtained from the various specimens of the patients, and antibiotic sensitivity tests were performed. According to the manufacturer's instructions, the inoculum prepared was applied to two test cards, one for the identification system VITEK 2 ID-GNB and another for susceptibility testing antimicrobial susceptibility testing (AST) No. 12. The most common gram-negative bacteria isolated was Escherichia coli (2706/4700; 57.57%), followed by Klebsiella pneumoniae (905/4700; 19.25%) and Pseudomonas aeruginosa (395/4700; 8.40%). Escherichia coli's highest AR reduction was reported for cefotaxime (CTX) of 29% (295/1018; 29%, 172/818; 21%, 0/870; 0%) for 2019, 2020, and 2021, respectively. Except for Salmonella species, which displayed enhanced AR, the ESBL and multidrug-resistant (MDR) rates decreased significantly (p 0.05) for most bacteria. This study helps to understand the maximum number of gram-negative bacteria susceptible to the Saudi National Action Plan (SNAP) to decrease the prevalence of AR, ESBL, and MDR. To comprehensively understand SNAP's effectiveness, other trials involving gram-positive bacteria should be considered.

Reporting Practices of Serum Protein Electrophoresis in Pakistan - a Multicenter Survey.

Serum Protein Electrophoresis (SPE) is crucial for the diagnosis and follow-up of monoclonal gammopathy (MG), as it helps to separate and identify these paraproteins. Currently, Pakistan lacks standardized guidelines for SPE reporting and analytical performance. This survey aims to analyze reporting variations from Consultant Chemical Pathologists in Pakistani laboratories. This cross-sectional survey was conducted by the section of Chemical Pathology, Department of Pathology and Laboratory Medicine, at Aga Khan University Hospital, Karachi. A previously validated and published tool was used with some modifications to assess analytical techniques, reporting patterns, and interpretations provided with SPE by different laboratories. Frequency and percentages were calculated for each response and descriptive results were also evaluated. Differences between laboratories were also assessed qualitatively. Out of the eight laboratories contacted, seven participated in the survey, yielding a response rate of 87.5%. Immunofixation Electrophoresis (IFE) was used by all labs for serum immunotyping. All labs reported a new small abnormal band in patients with no known monoclonal gammopathy or with a known M-protein. Variations were found in terminologies used to label paraprotein, terminologies used to report normal and pathological SPE patterns, electrophoretic technique, methods for quantifying paraprotein in the gamma region on SPE and for albumin quantification. Similarly, the number of decimal places reported, reporting of multiple monoclonal proteins and small paraprotein in the beta region or monoclonal proteins less than 1 g/L, approach for screening, number of fractions reported in gamma region and reporting of interferences were also not standardized and var-iations were noticed. Our survey highlighted variations in practices of SPE reporting. These differences in laboratory practices could result in inconsistent test results, which could adversely affect patient care.

Daptomycin MICs by Broth Microdilution Method Against Staphylococcus aureus in Clinical Specimens: A Cross-Sectional Study from Pakistan.

To explore the distribution of daptomycin (DAP) minimum inhibitory concentrations (MICs) in Staphylococcus aureus isolated from complicated skin, soft tissue, and bloodstream infections collected from the Pakistani population using broth microdilution (BMD). Descriptive, cross-sectional study. Place and Duration of the Study: Department of Pathology and Laboratory Medicine, The Aga Khan University Hospital, from May to October 2021. Through consecutive sampling techniques, 169 Staphylococcus aureus (S. aureus) isolated from clinical specimens including pus, tissue, and blood were collected. Patients' data including age, gender, geographical location, specimen site, and methicillin susceptibility were collected from the laboratory data. BMD was used to determine MICs of clinical isolates and S. aureus ATCC 29213. DAP MIC ≤1.0 µg/ml was considered susceptible according to the Clinical and Laboratory Standards Institute M100. Among all the clinical isolates, 144 (85%) and 25 (15%) were from skin and soft tissue and blood, respectively. All isolates were susceptible to DAP with MIC50, MIC90, and MIC range of 0.25 µg/ml, 0.5 µg/ml, and 0.06 - 0.5 µg/ml, respectively. These study findings demonstrated low in-vitro MICs for DAP against S. aureus in tested isolates from a diverse variety of patient specimens from across Pakistan. Daptomycin, Staphylococcus aureus, Broth microdilution, Minimum inhibitory concentrations.

Association of Hematological Profile and Inflammatory Markers with Severity of Covid-19 Patients

Background: Corona virus disease 2019 (COVID-19) is an acute viral respiratory illness. It has been a global pandemic causing millions of deaths worldwide for more than one and half years. In our study, we will investigate the role of hematological parameters in predicting the prognosis of COVID-19 so that severely ill patients can be assessed early and managed accordingly. Objective: This study was designed to evaluate the role of hematological parameters in predicting the prognosis of COVID-19 patients. Methods: This study was conducted atthe Department of Laboratory Medicine, BSMMU, Shahbagh, Dhaka. In this study hematological and biochemical parameters were measured. Both levels were measured by automated hematology analyzer ‘Sysmex 4000XN’ and automated biochemistry analyzer Dimension EXL with LM. Results: The result of this research might help clinicians to predict the progression of disease and to prevent undue mortality by ensuring appropriate treatment.

Prevalence of COVID-19 antibodies in employees of St. Jacob Hospital in Bardejov.

The COVID-19 disease caused by the SARS-CoV-2 virus belongs to the group of highly infectious diseases with increased mortality and morbidity in the population. Finding the presence of antibodies plays an important role while finding the number of individuals who overcame the disease or were vaccinated. A total of 250 employees of St. Jacob Hospital with Polyclinic, Bardejov, participated in our study, the blood samples were drawn from the index finger and processed with the help of the rapid Ag test for the detection of antibodies and venous blood using the ELISA method. The health workers (doctors, nurses, medical laboratory technicians, laboratory diagnosticians) tested during September and October 2022 participated in our study. Our experimental study shows the presence of IgG antibodies in 215 (86%) of employees, who get them from overcoming the COVID-19 disease or getting vaccinated. In 17 (6.8%) of employees were detected IgG and IgM antibodies. The biggest number of IgG antibodies was found in 36 (78%) employees of the Surgical Department, 28 (84%) employees of Rehabilitation Department and 25 (89%) employees of the Internal Department, when compared with the Department of Laboratory Medicine 9 (30%) employees and Radiology Department 4 (44%) employees. Multiple prevalence of COVID-19 disease were found in employees of the internal, surgical and rehabilitation departments in whom we detected a higher presence of IgG antibodies. In department of laboratory medicine workers were proven lower levels of IgG antibodies, mainly for the limited contact with the positive covid patients and working with only their biological material, compared to the first-line employees exposed to direct contact with the patients.

Low Serum Magnesium Level is Associated with Severity of Acute Stroke

Background: Incidence of stroke is increasingly prevalent around the world. It is necessary to assess the severity of acute stroke early for better patient management and also to predict treatment option and disease outcome. Serum magnesium (Mg) remarkably associated with vascular risk factor and has a neuro-protective role in stroke. Objective: To assess the correlation between serum magnesium level with severity of acute stroke. Methods: This cross-sectional study was conducted at Department of Laboratory Medicine, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh, from March 2021 to February 2022. A total of 60 diagnosed patients of acute stroke were enrolled. A through neurological examination of the study patients were done, the severity of acute stroke was leveled by the National Institutes of Health Stroke Scale (NIHSS) score. Then, their serum magnesium levels were measured following standard procedure. Data were analyzed and compared by statistical tests. Results: The mean (±SD) age of the study patients was 61.7 (±12.2) years, with a range of 28-95 years. A male to female ratio was 1.6:1. Of them; 75% study patients had low level of serum magnesium, mean serum magnesium level was 1.52±0.30 (mg/dl) in acute stroke patients and it was significantly decreased with increasing severity of acute stroke (p= 0.048). A significant negative correlation was observed between serum magnesium level and stroke severity (r= -0.374, p= 0.003). Conclusion: Majority of the patients with acute stroke has low serum magnesium level and serum magnesium is negatively related with severity of the acute stroke.

Assessing the knowledge, attitude and practice of osteoporosis among Pakistani women: A national social-media based survey.

There are numerous risk factors for osteoporosis and understanding and recognizing these risk factors is critical when deciding whether to take preventive measures. It is critical to reduce the healthcare expenditure burden of the Pakistani population by raising awareness and implementing osteoporosis-preventable measures. This survey aims to assess the knowledge, attitudes, and practices (KAP) of Pakistani women as well as their misconceptions about osteoporosis. A cross-sectional survey was conducted from August 2021 to January 2022 by the Bone & Mineral Disease research group at Section of Chemical Pathology, Department of Pathology and Laboratory Medicine, Aga Khan University, Karachi, with exemption from the ethical review committee. Using snowball sampling, a validated Osteoporosis Prevention and Awareness Tool (OPAAT) was disseminated online via social media. With informed consent, 400 Pakistani women aged ≥ 18 years were included in the study. SPSS Statistics version 25.0 was used for data analysis. Chi-square test for association and Fisher-exact test were applied, and significance level was α<0.05. Based on the OPAAT scores of all (n = 400) participants, 22% (n = 88) had low knowledge, 44% (n = 176) had average knowledge, while 34% (n = 136) had good knowledge of osteoporosis. The most common misconceptions were about age-related risk, presentation of symptoms, radiation risk, associated risk factors like tooth loss, osteoarthritis, and knowledge about predictors of bone health. Adult Pakistani women have a fair understanding of osteoporosis, but the OPAAT tool clarifies some common misconceptions. There is a need to develop educational strategies to increase the knowledge of osteoporosis among Pakistani adults and to promote a bone-healthy lifestyle.