Hospital Laboratory Research Articles

Squamous Cells in Thyroid Cytology and Their Clinical Significance: A Multi-Institutional Study.

Squamous cells are uncommon in thyroid fine needle aspirations (FNAs) presenting diagnostic challenges. We report our multi-institutional experience. The electronic data were searched for thyroid FNAs containing squamous cells at the Johns Hopkins Medicine, New York University Langone Hospital, United States, and Fimlab Laboratories, Finland (2001-2023). The patients' demographics, clinical history, and pathologic diagnosis were recorded. One hundred and seven cases (103 patients) were identified 35 males and 68 females (median age 58 years). Forty-eight cases (44.9%) were malignant, primary carcinomas with squamous features, such as anaplastic thyroid carcinoma (ATC), and metastatic or directly invasive squamous cell carcinomas (SqCC) including oral, oropharyngeal (HPV-related), esophageal, and laryngeal SqCC. Twenty-seven cases (25.2%) contained benign squamous cells with cystic background, suggestive of developmental cysts. Nineteen cases (17.8%) contained metaplastic benign squamous cells within an adenomatoid nodule. Seven cases (6.5%) contained atypical squamous cells. Four cases (3.7%) showed squamous cells with bacterial or fungal organisms, suggestive of esophageal fistula/diverticulum, and two cases (1.9%) contained benign squamous cells with unknown source. Thirty-six cases had surgical follow-up, 33 (91.7%) were concordant (23 metastatic or directly invasive SqCC, 8 undifferentiated/ATC, and 10 papillary thyroid carcinoma). Ancillary studies were used confirming HPV-related SqCC, or therapeutic targets (BRAF V600E), with highly variable staining in ATC. Squamous cells in thyroid FNAs carry a broad differential diagnosis with variable prognoses. It is crucial to interpret squamous cells in the context of clinical and radiographic findings for optimal patient care.

ASSESSMENT OF THYROID FUNCTION DISORDERS AMONG THE SUBJECTS ATTENDING CENTRAL LABORATORY OF A TERTIARY CARE HOSPITAL: AN OBSERVATIONAL, CROSS-SECTIONAL STUDY

Objective: Thyroid disorders are the most common endocrine disorders worldwide and India is not an exception. Several factors may determine the prevalence of thyroid dysfunction including age, gender, geographical and ethnic background, and most importantly iodine intake. Therefore, data related to thyroid disorders from one population cannot be extrapolated to another. In this study, we aimed to assess the disorders of thyroid function among the subjects attending the central laboratory of a tertiary care hospital. Methods: This observational, cross-sectional study was conducted in the Department of Pharmacology and the Department of Biochemistry of the same institute over a period of 3 months. All subjects of either sex attending the central laboratory of the institute for estimating thyroid function on their outpatient visit during the study period were included. Subjects who were on any medications known to alter the thyroid hormone status or diagnosed with a thyroid disorder and/or on therapy were excluded. A pre-designed and pre-tested data collection form was used for taking interviews to collect relevant data including sociodemographic characteristics, comorbid conditions, thyroid illness, and investigational reports. Results: A total of 132 subjects were included in the study. The majority of them were female (72.27%) and residents of urban areas (52.27%). The most common comorbid conditions and presenting symptoms were hypertension (25.76%) and fatigue (46.97%), respectively. The majority of the subjects were found to be euthyroid (81.81%). About 18.19% of the study subjects were having thyroid disorders, most commonly subclinical hypothyroidism (SCH) (13.64%), followed by primary hypothyroidism (2.27%), secondary hyperthyroidism (1.52%), and subclinical hyperthyroidism (0.76%). Thyroid disorders were mainly found in females, such as primary hypothyroidism (66.67%), SCH (66.67%), and subclinical hyperthyroidism (100%). The majority of the thyroid disorders were found in the age group of 26–50 years (20.27%), where females were found to have more primary hypothyroidism (3.17%), and SCH (12.70%). Conclusion: The findings of our study call for a review of current practices regarding thyroid disorders to include active screening of thyroid function among the subjects at greater risks and an emphasis on regular monitoring of the thyroid status.

Unveiling Efficiency: A Research Inquiry into Technical Staff Utilization in South Indian Clinical Laboratory using Workload Indicators Staffing Need (WSN) Analysis.

Background Effective clinical laboratories are the need of the hour, they play a significant role in healthcare, providing tests for diagnosis, treatment monitoring. Having skilled and adequate staffing is crucial for clinical laboratories to operate efficiently, manage their workload effectively, and deliver test results in a timely manner. Despite being critical for healthcare delivery, ensuring adequate staffing levels in clinical laboratories remains a complex challenge for healthcare providers worldwide due to resource constraints and workforce shortages. Methods This study evaluates the effectiveness of clinical laboratory staff utilization by considering workload, work pressure, and staffing requirements. We utilized the Workload Indicators of Staffing Need (WISN) method to assess the staffing in the clinical laboratory of a tertiary care hospital. Annual hospital statistics were collected for two years from June 2021 to May 2023 to calculate the average number of days (234) worked annually, percentage of workload, distribution of activity time measurement units, and the ratio of needed, surplus, and existing staff. The findings aim to provide valuable insights for optimizing staffing levels and ensuring an efficient laboratory environment. Result The analysis found a significant workforce gap in the laboratory between the current staff numbers and the calculated staffing needs. The WISN ratios ranged from 0.2 to 0.7, indicating the existing 33 staff members face a high workload burden. The calculated ideal staffing level was 46.33 personnel. These results demonstrate staff shortage and excess workload pressure on the current laboratory employees. Conclusion The results highlight the importance of optimizing staffing levels in clinical laboratories to ensure quality service delivery. The WISN methodology can be a useful tool in healthcare facilities for making evidence -based decisions for staff allocation, maximizing the utilization of employee skill sets, and establishing standard staffing benchmarks tailored to the needs of clinical laboratories.

Anaemia Profile and Inflammation Markers in Stunted Children Under Two Years in Indonesia

Background: Stunting is a common issue affecting children who suffer from chronic malnutrition in Indonesia. The Indonesian government has introduced supplementary food programs for stunted children, but the results have been less satisfactory. This may be due to the presence of anaemia and comorbid diseases. Haematology tests and inflammation markers are necessary to identify these conditions. This study aimed to examine the anaemia profiles and inflammation markers in stunted children under two years old. Methods: A cross-sectional descriptive design with cluster samples and consecutive analysis was used. The study was conducted between December 2023 and March 2024 at the West Nusa Tenggara Hospital and Palabuhanratu Sukabumi Hospital laboratories. Samples were obtained from various Public Health Centres in Sukabumi, West Java, North Maluku, and West Nusa Tenggara. Data collection comprised interviews, measurements, and the assessment of haematology, biochemical, and inflammatory markers. Statistical analysis was conducted using SPSS version 20, which includes descriptive analysis, correlation, comparison, and chi-square tests. Results: Two hundred and ten stunted children were identified with various anaemias and comorbidities. These anaemias included suspected thalassemia (38.1%), iron deficiency (18.1%), and anaemia of chronic diseases (13.3%). Based on the inflammatory markers obtained, TB was suspected (21.4%), inflammatory bowel disease (18.1%) was suspected, and allergic proctocolitis was suspected (31.9%). Conclusions: Analysis of the anaemia profiles and inflammatory markers revealed various types of anaemia and suspected comorbidities in stunted children. It is recommended that anaemia profiles and inflammation markers be assessed at the primary healthcare level.

Rapid rule-out of acute myocardial infarction using the 0/1-hour algorithm for cardiac troponins in emergency primary care: the OUT-ACS implementation study

Abstract Background Acute chest pain in primary care often results in defensive and unnecessary hospital referrals due to the limited ability to rule out an acute myocardial infarction (AMI) outside of hospital. In a previous prospective observational study (OUT-ACS; One-hoUr Troponin in a low-prevalence population of Acute Coronary Syndrome), we demonstrated that the ESC 0/1-hour algorithm for high-sensitivity cardiac troponin T (hs-cTnT) would be safe and cost-effective if implemented to assess low-risk patients with chest pain in emergency primary care. Purpose We evaluated the real-world applicability, personnel adherence, and disposition of low-risk patients with chest pain following the implementation of the ESC 0/1-hour algorithm in emergency primary care. Methods In April 2023, the ESC 0/1-hour algorithm for hs-cTnT was implemented at a large emergency primary care clinic in Norway. The clinic is located close to a hospital, enabling the patient to wait at the clinic while blood samples are analysed for hs-cTnT at the hospital laboratory. For the following six months, all patients ≥18 years with acute non-traumatic chest discomfort, offered hs-cTnT measurements at the clinic, were anonymously registered, including their discharge diagnoses and disposition from the clinic. By applying the ESC 0/1-hour algorithm, patients were assigned to rule-out, rule-in or further observation. Patients in the observation group were offered a 4-hour hs-cTnT measurement before a final decision. Results During the six-month period, 10.3% (n=3,053/29,631) of the clinic's consultations involved chest complaints. Hs-cTnT measurements were conducted in 32.6% (n=995/3,053) with a median age of 58 years (IQR 45-68), 50.6% being female. A single hs-cTnT <5 ng/L, sampled ≥3 hours since symptom onset, triaged 24.1% (n=240/995) of the patients towards the rule-out group, increasing to 63.8% after adding a 1-hour measurement. In the rule-in group (n=42/995, 4.2%), 16 patients were diagnosed with an AMI. The intermediate observation group (n=318/995, 32.0%, 4 AMIs) was reduced to 23.0 % after a 4-hour hs-cTnT measurement. Healthcare personnel adhered well to the algorithm, with a median sampling interval of 63 minutes (IQR 60-66) and 4.5 hours (IQR 4.1-5.5) for the 1- and 4-hour measurements, respectively. The algorithm was misinterpreted or overruled in 8.8% of the cases. Ultimately, only 14.8% required hospital transfer following troponin assessment at the clinic. The remaining patients were sent home or managed in the outpatient setting. Conclusions The OUT-ACS strategy, utilizing a 0/1/4-hour algorithm for hs-cTnT measurements in emergency primary care, is safe, effective and applicable, and the strategy contributes to reduced hospital referrals for low-risk patients with chest pain.0/1/4-hour algorithm for hs-cTnTDisposition

Evaluation N-terminal pro-B-type natriuretic peptide and other biochemical parameters in heart failure with or without chronic kidney disease in Kirkuk city

Backgrounds: Individuals who are diagnosed with chronic kidney disease (CKD) are at a significantly increased risk of developing cardiovascular (CV) disease. Aim of the study: This study evaluated N-terminal pro-B-type natriuretic peptide, urea, creatinin, and albumin in heart failure with or without chronic kidney disease. Materials and methods: The study was done at Amal Dialysis Centre, General Kirkuk Hospital Lab and Azadi Teaching Hospital Lab. The age range of the participants was between 18-68 years old. The study was conducted from January to Augest 2023. The current study examined 90 participants that divided in to four groups as: G1=Kidney failure patients (n:23), G2=Heart failure patients (n:22), G3=Heart and kidney failure (n:23), and G4=apparently healthy normal individuals. Results: This study show highly significant increase NT Pro- BNP in G1, G2 and G3(123.88±22.73, 107.86± 20.15, 134.85± 26.05), as compared with G4 (67.19±18.44) at p-value<0.0008. While highly decrease albumin in G1,G2 and G3(4.318±0.486, 4.028±0.991, 5.500± 0.652), as compared with G4 (7.028± 0.991) at p-value <0.01Conclusion: This study concluded increase in NTpro Pro- BNP, urea and creatinin in all three groups as compared with control group and decrease in albumin level.

Comparative Phenotypic and Genotypic Properties of Serratia marcescens Isolates from Clinical Cases from human in AL-Diwaniyah Province, Iraq

Serratia marcescens is a Gram-negative, rod-shaped bacterium. It is an opportunistic and facultative anaerobe. This study aims to determine the occurrence rates of Serratia marcescens in human clinical samples, investigate the pigM gene, sequence the isolates, and compare them with global isolates documented in the NCBI database. Fifty burn samples were collected from the specialized center for burns in AL-Diwaniyah province, along with 35 urine samples from individuals suffering from UTIs from Al-Diwaniyah Teaching Hospital and various private laboratories. These samples were transferred in a cooled container to the microbiology lab at the Veterinary Medicine College, University of Al-Qadisiyah, for bacteriological assay. The samples were then cultured using selective and differential media. Following the purification of the cultured bacteria, biochemical tests were conducted to confirm the isolates. Results showed that 10 out of 85 samples (11.76%) were positive for Serratia marcescens. Culture positivity was most frequent in urine samples (17.1%), followed by burn samples (8%). Molecular methods revealed that human isolates gave 100% positive results for 16S rRNA. The study found that ten isolates of Serratia marcescens possess the pigM gene, with the 16S rRNA gene sequenced using the BLASTN algorithm of NCBI. All isolates were recorded under accession numbers (OR835629, OR835630, OR835631, OR835632, OR835633, OR835634, OR835635, OR835636, OR835637 and OR835638, showing 97-99% identity with isolates detected in China, India, and Nigeria. It can be concluded that the isolation rates of Serratia marcescens from urine samples are higher than those from burn samples. The sequencing results showed a 97-99% similarity with global isolates from China, India, and Nigeria.

Assessment of diagnostic accuracy of Gazelle: A point-of-care testing device for screening β-thalassemia trait.

Background & objectives Timely detection of population with β-thalassemia trait (BTT) followed by genetic counselling is an advocated method of preventing the birth of a child with β-thalassemia major. In this study we aim to assess the diagnostic accuracy of Gazelle, a point-of-care (POC) testing device, in screening for BTT in hospital laboratory setting. Methods Standards for Reporting Diagnostic Accuracy (STARD) guidelines were followed in developing study design, recruiting study participants and sample size calculation for the current research. A consecutive sample of 446 participants was recruited for this study and was tested for the reference test Gazelle as well as the gold standard cation exchange high performance liquid chromatography (CE-HPLC). Low serum ferritin levels are known to interfere with the production of HbA2 and in turn lead to false negative results. Hence, the study population was divided into two categories with respect to a cut off value of 15ng/dl of serum ferritin and the results were analyzed. Results Overall diagnostic accuracy of Gazelle for detecting BTT was found to be 95.3 per cent with a confidence interval (CI) of (92.9 - 97.1) and the sensitivity was 94.5 per cent with a 95% CI of (84.8 - 98.8). When analyzed by the serum ferritin level the diagnostic accuracy was found to be 94.7 per cent (91.1% - 97.1%) and 95.7 per cent (91.8% - 98.1%) for participants with serum ferritin level as > 15 ng/ml and < 15 ng/ml, respectively. Interpretation & conclusions This study found Gazelle to be a good screening tool for β-thalassemia trait with high sensitivity, specificity and accuracy. However, it is recommended that the final confirmation of the diagnosis done by a diagnostic test like HPLC or Capillary Zone Electrophoresis (CZE).

Detection of Toxoplasma Gondii IgG Antibody in Patients Infected with Toxoplasma by ELISA

Aim the current study to diagnosis of the IgG antibody to Toxolasma gondii, serum samples isolated from patients humans and healthy reviewers to AL-Diwaniyah hospital and different laboratories. 90 samples were collected from human infected with Toxoplasmosis including 60 samples of patients and 30 samples of healthy (control). The results of this study showed that concentration of the IgG antibody in patients infected with T.gondii were 47.43 while the concentration in control were 8.14 and the percentage of infection in patients (24/60) (40%) and in control (4/30) (13.33%). The results showed that IgG antibody found in both patients and control but its concentration in patients was higher this indicates a high concentration of IgG antibody with toxoplasmosis.

The Clinical Impact of Urinalysis Screened by Automated Microscopy Compared to Reference Manual Analysis.

Clinical laboratories have replaced conventional manual urine microscopy with automated urinalysis; however, concerns persist regarding its validity in detecting specific elements of urinary sediment crucial for evaluating kidney diseases. This study aimed to assess the accuracy of urinary sediment analysis performed by a large hospital laboratory compared to a standardized microscopic review, focusing on patients both with and without kidney disease. Urine samples were randomly selected from routine laboratory specimens at a university hospital. Laboratory analysis was performed using LabUmat 2 and Urised 3 PRO equipment (Abbott Diagnostics). In the automated analysis, technicians had the option to reclassify urinary sediment elements and, if needed, conduct manual microscopic evaluations to validate findings. The laboratory's analysis was compared with a "reference" analysis, which was double-blinded and conducted by two experienced technicians using bright-field and phase-contrast microscopy. 503 samples were selected, with 52.3% originating from nephrology outpatient clinic patients. Overall agreement between the laboratory results and the reference analysis was 42.1%. The sensitivity (SN) of the laboratory examination for detecting pathological casts, lipiduria, and renal tubular cells was low (&lt;50%), while specificity (SP) was high (&gt;98%). However, for hyaline casts (SN: 50.4%; SP: 80.9%) and dysmorphic red blood cells (SN: 62.3%; SP: 96.2%), accuracy was intermediate. Performance was better for hematuria (SN: 86.1%; SP: 82.3%; ICC: 0.703; R: 0.828) and leukocyturia (SN: 84.9%; SP: 95.1%; ICC: 0.807; R: 0.861). In patients with kidney disease (N=248) and in samples manually reviewed by the laboratory (N=115), accuracy for each urinary element was comparable to the overall sample findings. However, when assessing the ability to identify elements suggestive of nephropathy, only samples manually reviewed by the laboratory showed statistically similar results to those obtained by the reference analysis (p= 0.503, McNemar's test). Employing automated urinalysis seems to be accurate for detecting hematuria and leukocyturia, as well as for screening patients without kidney diseases. However, clinical laboratories attending complex patients should employ personalized strategies to help decide when to perform manual review, thus avoiding misleading urinalysis results.

RDW-SD - A more sensitive marker of anisocytosis than RDW-CV in patients with macrocytosis

Background: Anisocytosis is a variation in RBC size. This can be conventionally observed on peripheral blood smear microscopy and also by red cell distribution width, a RBC parameter obtained on automated hematology analyzers. Red cell distribution width is considered a quantitative measure of anisocytosis and does not carry subjective variation associated with microscopy and it is reported as RDW-CV % and RDW-SD. Both these values are calculated differently. Although it is one of the most frequently used hemogram parameters for anisocytosis, it is not well understood. This study aimed to compare the sensitivity of RDW-CV and RDW-SD as markers of anisocytosis in macrocytosis. Material and methods: This was a cross-sectional prospective observational study conducted in a laboratory of a tertiary care hospital in western India. The sample size of 138 was calculated at a precision 0.1 and 90% confidence interval. 138 blood samples each from patients with macrocytosis and normocytosis control group were analysed. Results: The range for RDW-CV &amp; RDW-SD was 12.59%-15.13% &amp; 40.05-47.81fl respectively in our population. Gender-wise distribution showed 72% male &amp; 28% female. The Z score value of 4.12 (&gt;1.96 is significant) reflected a significant difference in anisocytosis detection using RDW-SD compared to RDW-CV in macrocytosis. Conclusions: RDW-SD is a more sensitive marker of RBC anisocytosis than RDW-CV in macrocytosis.

Blood levels of zearalenone, thyroid-stimulating hormone, and thyroid hormones in patients with colorectal cancer

Mycotoxins are secondary metabolites produced by various species of mold fungi commonly found in plant materials. Zearalenone (ZEN) adversely affects the endocrine system. This study aimed to determine whether thyroid-stimulating hormone (TSH), procalcitonin (PCT), free triiodothyronine (fT3), and free thyroxine (fT4) levels are altered during natural zearalenone mycotoxicosis in patients diagnosed with sigmoid colon cancer (SCC) or colorectal cancer (CRC). A study was conducted on women and men diagnosed with SCC or CRC accompanied by the presence or absence (Patients Without ZEN – PWZ group) of ZEN in the blood. The PWZ group consisted of 17 patients with symptoms of SCC and CRC in whom ZEN and its metabolites were not detected in peripheral blood. The experimental (empirical) groups included a total of 16 SCC and CRC patients who tested positive for ZEN, but not its metabolites. TSH values in both sexes were within the upper limit of the reference range (0.27 – 4.2 μIU/mL) adopted by the hospital laboratory and corresponded to the upper second tertile and the lower third tertile. PCT values demonstrated that SCC and CRC were accompanied by a systemic or local bacterial infection. All mean values of fT3 were in the middle of the reference range, and the mean values of fT4 were within the upper reference limit. The fT3/fT4 prognostic marker was somewhat above the cut-off point of 0.22. These results indicate that in postmenopausal women and andropausal men who were diagnosed with SCC and CRC and were exposed to food-borne ZEN, higher values of the prognostic marker (fT3/fT4) were associated with an unfavorable prognosis. The study also revealed that the more distal the neoplastic lesions in the colon, the higher the percentage of both thyroid hormones, regardless of the patient's sex. The presence of ZEN in the diet alters thyroid activity in patients diagnosed with SCC and CRC.

Microflora of Secretions in a Surgical Hospital of Orthopedics and Traumatology Profile for 2021-2023 (SI “ITO NAMS of Ukraine”)

Summary. Healthcare-associated infections (HAIs), namely, surgical site infections, early postoperative and subsequent in-hospital infections, are the most common undesirable phenomenon in the world. According to statistics, at least one case of HAIs is diagnosed in every 100 hospitalized patients in hospitals of 7 developed and 15 other countries of the world at any given time. The occurrence of such complications during the treatment of a patient in a hospital leads to the need of additional diagnostic tests, additional courses of antibiotics, and unplanned surgical intervention. Worsening of the prognosis of treatment may occur due to the formation of the so-called resistant microflora in such patients, with a real probability of spreading the infection in the hospital. Prevention of HAIs in practice occurs through planned infection control in operating rooms and procedure rooms in clinical departments and qualified timely diagnostic work of certified microbiological laboratories in hospitals. Objective. The objective of the study was to determine the spectrum of microflora of secretions for three years (2021-2023) in orthopedic and trauma patients due to changes in modern injuries received more often because of military aggression and to propose the identified differences as criteria for prescribing antibacterial drugs in complex inpatient treatment. The work shows that over the past three years (2021-2023), the ratio of gram-positive and gram-negative microorganisms in the study material almost did not change and averaged 1.65. The peculiarity of the analyzed period was an increase in the number of methicillin-resistant staphylococci by 1.3 times. The spectrum of gram-negative clinical strains has changed, namely, the number of Kl.pneumoniae clinical strains with a high level of polyresistance has increased by 2.5 times. The obtained data made it possible to identify the spectrum of microflora of secretions in orthopedic and trauma patients with modern infectious complications, which prompts us to make changes in the standards of antibacterial treatment protocols, and to plan the needs for certain antibiotics in hospitals with personalization of their prescription to improve the effectiveness of treatment and reduce the risk of development of antimicrobial resistance.

News-Driven Volatility: A Deep Dive into Leading Nifty Healthcare Stocks

This study conducts a comprehensive analysis of stock price volatility within the healthcare sector, concentrating on five prominent companies: Sun Pharma, Dr. Reddy, Cipla, Apollo Hospitals, and Divis Laboratories. Leveraging annual daily data from the Nifty Healthcare Index for 2023, the research delves into the intricate relationship between stock price fluctuations and market-sensitive news events. Employing a robust methodology that integrates slope calculations, ANOVA, Tukey’s HSD tests, moving averages, and standard deviation metrics, the study evaluates the differential impact of these events on stock volatility. The findings reveal significant volatility, with Apollo Hospitals demonstrating the highest levels of price variability. The research highlights the profound influence of regulatory shifts, financial performance metrics, and macroeconomic conditions on stock behavior. These insights are pivotal for investors and financial analysts seeking to navigate the complex dynamics of the healthcare market. The application of moving averages further refines the analysis, offering a sophisticated lens through which to assess and interpret market trends, ultimately enhancing the strategic decision-making process within this critical sector.

Molecular Diagnosis and Typing of Cryptosporidium spp. Species in Human Stools with Diarrhea.

This study was conducted to molecularly identify and classify Cryptosporidium spp. in fecal samples (n=150) from patients with diarrhea received at the microbiology laboratory of a private hospital in Denizli. In this study, the positivity of Cryptosporidium spp. in fecal samples was investigated using direct microscopy, Kinyoun's acid-fast staining method, and Nested polymerase chain reaction (PCR) techniques. Positive PCR products were sequenced. In the examined fecal samples of patients with diarrhea, no parasites were detected through direct microscopic examination. Using the Kinyoun acid-fast staining method, Cryptosporidium spp. was identified in 2.7% (n=4) of the samples, while Nested PCR detected it in 4.67% (n=7) of the samples. The four positive samples were sequenced using primers that amplify the 18S rRNA gene region. The sequencing results identified the isolates as C. parvum. Cryptosporidiosis is an important public health issue as it is a zoonotic disease caused by the Cryptosporidium parasite that can be transmitted from animals to humans. This study focuses on the molecular characterization of Cryptosporidium species detected in human fecal samples, which is significant for understanding which specific strains or species are involved in human infections. According to the findings, it is recommended that control measures be implemented to reduce the risk of exposure to Cryptosporidium in both humans and animals in Türkiye.

Retrospective Evaluation of Intestinal Protozoa Parasites in Patients Presenting to Kafkas University Health Research and Application Hospital Between 2019-2022.

This study aimed to retrospectively evaluate the prevalence of protozoan parasites in stool samples collected from patients presenting with various gastrointestinal complaints to the Medical Parasitology Laboratory of Kafkas University Research and Application Hospital between 2019 and 2022. Stool samples were initially examined using the native-Lugol method for the detection of protozoan parasites, followed by the formol-ethyl acetate sedimentation method, Giemsa, and carbol fuchsin staining methods. Specific immunochromatographic card tests were used for the diagnosis of Entamoeba histolytica, Cryptosporidium spp., and Giardia intestinalis. Of the 2.267 stool samples examined over the four-year period from January 2019 to December 2022, 7.63% were found to contain one or more protozoan parasites. Among these parasites, Entamoeba histolytica was detected at the highest rate of 4.06%. The other parasite species were identified as follows: Blastocystis spp. 1.15%, Entamoeba spp. and Entamoeba coli each 0.52%, Giardia intestinalis 0.48%, Endolimax nana 0.17%, and Entamoeba histolytica/dispar 0.08%. This study indicates that despite a decrease in the prevalence of intestinal protozoan infections in the Kars region, these infections remain a significant public health issue. Therefore, improvements in hygiene and sanitation conditions, increased public health education, and the widespread implementation of early diagnosis and treatment methods are necessary. Special measures should be taken to protect vulnerable groups, particularly children and the elderly.

Epidemiology of Infections Caused by ESBL-Producing Enterobacteriaceae and Antibiotic Resistance Profile of Strains Isolated at Meknes-Based Moulay Ismail Military Hospital: A Retrospective Study from January 2018 to December 2020

Introduction: Infections caused by ESBL-producing Enterobacteriaceae (ESBL-PE) pose a major public health challenge. In addition to their widespread presence and growing resistance to several categories of antibiotics, the medical management of these bacteria becomes intricate, potentially resulting in a therapeutic impasse. Our study's goal is to examine the regional epidemiological characteristics of ESBL-PE infections and present a current assessment of their antibiotic resistance. Methods: The retrospective investigation undertaken at the bacteriology laboratory of the Meknes-based Moulay Ismail Military Hospital, covering a period of three years (January 2018 to March 2021), specifically examines the isolates of ESBL-PE. Results: Among the 2596 strains of Enterobacteriaceae described, 16.4% were found to produce ESBL, with E. coli being accountable for 63.6% of these strains. 85.1% of these ESBL-PE were isolated from urine samples. Surgical services were the largest source of these ESBL-PE (54.3%), followed by the emergency department (22%), medical services (14.5%), and intensive care unit (9.2%). The antibiotic resistance of these ESBL-PE has been studied and found to be high for gentamicin (63%), tobramycin (66%), cotrimoxazole (85%), and ciprofloxacin (91%). Only 7% exhibited good sensitivity to amikacin, 4% to imipenem, and 5% to fosfomycin. Conclusion: The advent of ESBL-PE in our institution is a big challenge. To limit the use of carbapenems and prevent the spread of strains causing carbapenemases, other kinds of antibiotics can be utilized. The partnership between clinicians and the bacteriology laboratory is vital for efficiently preventing and monitoring the spread of these multidrug-resistant bacteria.

12208 Impact Of Transition From The IDS-iSYS To The Roche Elecsys® Immunoassays On A Clinical Study Assessing Strict IGF-1 Control (I-Con) In Patients With Acromegaly

Abstract Disclosure: C.L. Chik: Advisory Board Member; Self; Ipsen, Novo Nordisk, Novartis Pharmaceuticals. Grant Recipient; Self; Pfizer, Inc.. C. Gandhi: None. J.A. Rivera: None. M. Denis: None. S. Van Uum: Advisory Board Member; Self; Ipsen, Pfizer, Inc., Novo Nordisk, Spruce. S.Z. Ezzat: Advisory Board Member; Self; Bayer, Inc., Eli Lilly &amp; Company, Ipsen, Novartis Pharmaceuticals, Merck, Eisai. D.T. Holmes: Other; Self; Roche Diagnostics. Objective: IGF-1 measurements were transitioned from the IDS-iSYS to the Roche Elecsys® immunoassays by the central laboratory during our clinical study that assessed strict IGF-1 control (I-Con) and quality-of-life scores in patients with acromegaly. Given the known variabilities of the IGF-1 measurements and the critical nature of IGF-1 results to the validity of the study, a retrospective analysis of the stored samples was completed using both methods. Methods: IGF-1 was measured in available stored samples (n=38) using IDS-iSYS at one of the hospital laboratories and the Roche Elecsys® at the central laboratory. In addition, the end-of-study (EOS) IGF-1 results were compared with IGF-1 measurements during the study (DTS) at the central and the local laboratory of the two sites with more than 10 stored samples, with one site using IDS-iSYS and the second site using IGF-1-RIACT. Bland-Altman plot, regression analysis and intra-class correlation were used to assess the reliability of the IGF-1 measurements. Results: Ten acromegaly patients from four sites in Canada participated in the clinical study. After six months of addition of pegvisomant to a somatostatin analog (n=6) or dose escalation of pegvisomant (n=4), IGF-1 decreased from 258.5 ± 59.2 µg/L [121.8 ± 14.4 % upper limit of normal (%ULN)] to 184.1 ± 41.1 µg/L (86.7 ± 20.0 %ULN) (p=0.001). Two to five stored samples were available from the 10 patients (n=38) and the mean difference of IGF-1 between the IDS-iSYS and Roche Elecsys® was 10.8 µg/L or 4.6% when expressed as %ULN, with a trend to a higher value at the central laboratory. Linear regression of the difference between IGF-1 measurements against their average showed a slope of 0.1 (p&amp;lt;0.001) or 0.15 (p=0.01) when expressed as %ULN. Intra-class correlations between the central laboratory DTS and EOS measurements were compared with those by the local laboratory. In the site that used IDS-iSYS for IGF-1 measurements, the intra-class correlations with the Roche Elecsys® was 0.99 (n=11) for DTS measurements and 0.98 (n=13) for EOS measurements. In the second site that used IGF-1-RIACT, the intra-class correlations with the IDS-iSYS was 0.38 (n=13) for DTS results, and with the Roche Elecsys® was 0.64 (n=15) for EOS results. Conclusion: Although there were variabilities between the IDS-iSYS and the Roche Elecsys® IGF-1 measurements, the small difference between the two IGF-1 assays confirmed that the transition from the IDS-iSYS to the Roche Elecsys® by the central laboratory had little impact on the IGF-1 results of our study. Using intra-class correlations to assess reliability of the IGF-1 measurements, the reliability of the IGF-1 results appeared dependent on the IGF-1 method used in the individual site. Presentation: 6/2/2024

The environmental microbial retrieving assessment of cell-processing facilities for cell therapy in a hospital laboratory.

Cell therapy represents a promising treatment modality. A critical component in the production of cell therapy products is maintaining the sterility of cell therapy clean rooms (CTCRs). This study aimed to evaluate the environmental microbial load within CTCRs. We systematically monitored microbial load in CTCRs, following established guidelines. Cultured microbial samples underwent metagenomic sequencing, and alpha and beta diversity analyses, functional annotation, and resistance gene profiling were performed using various bioinformatics tools to assess microbial diversity and function. From November 2023 to January 2024, we collected 42 environmental microbial colony samples from various sources within the CTCR and performed metagenomic sequencing on 39 samples. Alpha diversity analysis revealed no significant differences among surface, settle_plate, and airborne categories, but significant disparities within surface subgroups were revealed. Beta diversity analysis showed notable differences between surface and airborne categories and among surface subgroups. Species distribution analysis identified Bacillus as the predominant genus on surfaces. Functional annotation and resistance gene analysis indicated distinct resistance patterns, with significant variations between subgroups, such as microscopes and transfer windows, and hands and other Grade_B environments. Resistance to hydrogen peroxide was notably higher in the transfer window group. These findings highlight the importance of stringent disinfection protocols and enhanced hand hygiene to maintain sterility in CTCRs. These findings provide valuable insights for implementing effective measures to maintain cleanliness throughout CTCRs. The annotation and study of resistance genes can help rapidly identify methods to control cellular contamination under circumstances of environmental microbial pollution.IMPORTANCEMaintaining the sterility of cell therapy clean rooms (CTCRs) is crucial for the production of safe and effective cell therapy products. Our study systematically evaluated the environmental microbial load within CTCRs, revealing significant microbial diversity and distinct resistance patterns to disinfection methods. These findings underscore the need for stringent disinfection protocols and enhanced hand hygiene practices to ensure CTCR sterility. By identifying key microbial species and their resistance genes, our research provides essential insights into controlling contamination and safeguarding the production environment, ultimately contributing to the reliability and success of cell therapy treatments.

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.