Hospital Laboratory Research Articles

Clinical study of common bacterial, fungal and parasitic skin diseases in cats

Background: The skin is a big, metabolically active organ that has a significant need for other nutrients and protein in its body. The study pointed high significant infection with fungal, scabies, alopecia, bacterial and wounds in the white color cats more than the others because it is represented the better color choice for the families then the orange and grey colors while the black color is the less in number of domestic cats. The aim of present study was investigated of some skin disease in cats in Basrah, Iraq.Methods: The present study includes two hindered animals of both sexes with different ages, colors, weights and sizes were studied clinically in Basrah veterinary hospital and the private veterinary clinics in Basrah. The study extended from October 2022 to March 2023 during the winter season. Clinical signs were reported carefully, and the initial diagnosis of skin diseases was confirmed by apparent lesions on the skin, the skin samples of the cases were collected for laboratory diagnosis in veterinary medicine college ̸ Basrah University and Basrah veterinary hospital laboratories to confirmed diagnosis.Results: Clinical signs were reported carefully and the initial diagnosis of skin diseases. The two hindered sample cases were divided according to cases in Basrah veterinary hospital and Basrah private clinic: 60 Cases fungal infection, 40 cases scabies, 10 case alopecia, 50 cases of bacterial infection and 40 cases of wound. Conclusion: The present study shows the fungal diseases were common causes for skin diseases in Cats follow by Bacterial, Parasitic and Alopecia respectively.Keywords: Cat infection; Skin diseases in cat; Scabies; Fungal disease

Analysis of macular thickness and peripapillary retinal nerve fiber layer thickness in various ABO and Rh blood groups

PurposeTo determine the association between ABO and Rh blood groups with retinal structural indices including macular thickness and peripapillary retinal nerve fiber layer (RNFL) thickness.MethodsThis cross-sectional study was conducted using convenience sampling in a tertiary referral eye hospital in Tehran, Iran. Study participants were referred to the hospital laboratory to test their blood group. Ocular examinations were performed including measurement of visual acuity, auto-refraction, subjective refraction, and slit-lamp biomicroscopy. Retinal imaging was carried out using Spectral-domain OCT under dilated papillary conditions.ResultsThree hundred and twenty-eight individuals were recruited in this study. Of these, 219 (60.7%) were female and the mean age of the participants was 63.29 ± 5.57 years (range: 56 to 83 years). According to the multiple linear regression model, the global peripapillary RNFL thickness [coefficient: -3.05 (95% CI: -5.30 to -0.74); P = 0.010] and peripapillary RNFL thickness in the superior [coefficient: -4.65 (95% CI: -8.40 to -0.89), P < 0.001] and inferior [coefficient: -4.00 (95% CI: -7.81 to -0.19); P = 0.040] quadrants were significantly thinner in individuals with blood type B compared to those with other ABO blood groups. The average [coefficient: 12.69 (95% CI: 4.12–21.64); P = 0.004) and central [coefficient: 16.21 (95%: 6.44–25.97); P = 0.001) macular thicknesses were significantly thicker in AB group compared to other blood groups. The average macular thickness was significantly thinner in Rh + compared to the Rh- group [coefficient: -8.33 (95% CI: -15.4 to -1.25); P = 0.021].ConclusionRetinal structural indices may be related to blood groups implying a genetic linkage. Considering the lack of consistency among various studies, larger trials are needed to explore the effect of ABO and Rh grouping on peripapillary RNFL and macular thicknesses.

Analysis of clinical characteristics and causes of death in 38 patients with pneumoconiosis

Objective: To analyze the clinical characteristics and causes of death of patients with pneumoconiosis, and to provide evidence for the prevention and management of pneumoconiosis. Methods: From June 2022 to July 2023, 38 dead patients with pneumoconiosis confirmed by Shandong Academy of Occupational Health and Occupational Medicine were selected as the research objects. The clinical data of patients were collected through hospital information system (HIS) and laboratory information management system (LIS) to analyze the basic situation of patients with pneumoconiosis who died, the distribution of industry types, the course of disease, the nature of work, the type of reimbursement, complications/comorbidities, and the direct causes of death. Univariate analysis of variance was used to compare the course of pneumoconiosis death in patients with different age of exposure to dust. Results: Among the 38 patients with pneumoconiosis, there were 37 males and 1 female. The age of exposure to dust was 5-37 (19.29±8.17) years, the duration of disease was 5-41 (20.26±8.53) years, and the age of death was 27-86 (70.42±12.26) years old. There were 10 cases of stage Ⅰ pneumoconiosis, 18 cases of stage Ⅱ, 10 cases of stage Ⅲ pneumoconiosis and 32 cases (84.21%) of silicosis. There were 30 (78.95%) people aged ≥65 years and 8 (21.05%) people aged <65 years. The industry was mainly metal products (18 workers, 47.37%), and the distribution of work was mainly excavation workers (11 workers, 28.95%). The death course of pneumoconiosis patients with 10-<30 years of exposure to dust accounted for 76.32% (29/38). The average course of pneumoconiosis patients with 20-<30 years of exposure to dust was the longest[ (24.00±9.39) years], and there was no statistically significant difference in the average course of disease among different age of exposure to dust groups (F=1.81, P=0.165). The working units of the deceased patients were private enterprises or factories, and the hospitalization expenses were borne by individuals for 21 people (55.26%). The working unit was a state-owned enterprise, and 17 people (44.74%) were reimbursed for hospitalization expenses and work-related injuries. The main comorbidities/complications of pneumoconiosis patients were respiratory infection in 18 cases (47.37%) and chronic pulmonary heart disease (47.37%). The top 3 direct causes of death were pneumoconiosis in 13 cases (34.21%), pulmonary infection in 10 cases (26.32%) and lung cancer in 7 cases (18.42%) . Conclusion: Most of 38 cases of pneumoconiosis patients death diseases such as multiple combination of respiratory system, cardiovascular system, respiratory system disease is a major cause of death in pneumoconiosis patients.

Carbapenem-resistant Acinetobacter baumannii infections among diabetic and non-diabetic patients and possible effective combination treatments

BackgroundCarbapenems are one of the most noteworthy choices for treating multidrug-resistant Acinetobacter baumannii (A. baumannii). Currently, carbapenem-resistant A. baumannii (CRAB) represents a healthcare problem worldwide, particularly among diabetic patients who are more susceptible to microbial infections. The aim of this study was to investigate the differences in antibiotic susceptibility profiles, the abundance of carbapenem resistance genes across A. baumannii-infected diabetic and non-diabetic patients, and the antimicrobial activity of different antibiotic combinations on highly resistant isolates.MethodsData of 99 A. baumannii-infected patients were collected during the period from 2018 to 2022 and categorized according to patients’ diabetes status into either diabetic or non-diabetic group. A total of 45 A. baumannii isolates were collected during 2021 and 2022 from the main hospital laboratory to be reidentified and genetically confirmed. Antibiotic susceptibility, including carbapenems, was determined using disc agar diffusion and broth microdilution methods. The isolates were screened for OXA-23, GES, VIM, and NDM carbapenem-resistant genes. Five antibiotic combinations were assessed using the double-disk synergy and checkerboard methods.ResultsThe findings of the current study revealed that multidrug resistance increased gradually, from 56% in 2018 to 95.6% in 2022. Moreover, CRAB increased among diabetics and non-diabetics. Resistance rates of imipenem, meropenem, and doripenem reached 68.8%, 61.8%, and 47.4% in diabetics and 97.9%, 83.3%, and 50% in non-diabetics, respectively. The VIM gene was the most prevalent gene with prevalence rates of 100% and 96.15% in diabetics and non-diabetics, respectively. Moreover, all A. baumannii isolates carried at least two of the selected carbapenem-resistant genes. Across the different used combinations, only the tigecycline-meropenem combination showed synergistic activity in 50% of diabetic and 66.7% of non-diabetic isolates.ConclusionsAn increased carbapenem resistance was observed among A. baumannii-infected individuals, both diabetic and non-diabetic. The MEM/TCG combination was the only one that showed synergistic or additive effects against highly resistant isolates making it a viable alternative treatment option.

High drug-pathogen mismatch in the management of invasive carbapenem-resistant Enterobacteriaceae infections at a tertiary hospital in Nigeria

ObjectivesThis study aims to provide lacking data on antibiotics and treatment strategies used in the management of carbapenem-resistant Enterobacteriaceae (CRE) infections in Nigeria. MethodsA cross-sectional study was carried out at the University College Hospital in Ibadan. CRE isolated from routine culture of specimens from hospitalized patients from December 2021 to September 2022 was identified. Treatment information and other data were collected from the patients’ medical records. ResultsThe hospital laboratory isolated CRE from 55 patients during the study period and 27 (49.1%) of them had data available for the study. The most frequently isolated CRE was Klebsiella spp. (13 of 27, 48.1%). Of the 24 patients who received empiric antibiotics, only two (8.3%) of their CRE isolates were susceptible. After receiving culture results, 18 (66.7%) patients were treated with at least one antibiotic, to which resistance was documented. Only three (11.1%) patients overall commenced or remained on an antibiotic, to which their CRE isolate was susceptible. ConclusionsDespite culture data, we found a high prevalence of drug-pathogen mismatch in CRE treatment, including new or persistent use of antibiotics, to which resistance was documented. Antimicrobial stewardship efforts need to be strengthened to specifically address CRE treatment and effective antibiotics need to be made accessible.

Combining biosafety expert’s evaluation and workers’ perception regarding the Biological Risks in Biomedical laboratories of Public Hospitals in Athens, Greece

Objectives: The aim of the present study was by combining an expert’s evaluation and laboratory workers’ perception, to review the biological risks in biomedical laboratories of public hospitals in Athens, Greece. It was also to evaluate how they are managing the biological materials, the level of safety awareness and training of the personnel, and to propose mitigation measures according to the existing risks, based on the local legislation and the international Biosafety guidelines. Materials and Methods: A total of 36 biosafety level-2 (BSL2) biomedical laboratories in 20 public hospitals were assessed for their biosafety containment specifics and compliance with biosafety practices. The study was designed as a cross-sectional study, with a checklist and a detailed health and safety (H&amp;S) questionnaire, focused on biosafety and biorisk management. An expert biosafety officer observed and filled in a checklist for each biomedical laboratory (n=36) of the 20 hospitals. Laboratory staff (medical laboratory doctors, medical laboratory technologists, laboratory assistants, biologists and biochemists; n = 415) filled in a specific to biosafety H&amp;S question­naire in each of these laboratories. Results: Both the results from the checklists and the questionnaires showed that in a significant percentage of laboratories there are the following deficiencies: restricted access and signage at the entrance, autoclaves in the laboratory area, ability to use the washbasins hands-free, biorisk management system, written risk assessments, biosafety manuals, standard operating procedures (SOPs), assigned biosafety officers, protocols about the use of Personal Protective Equipment (PPE), insufficient biosafety training programs, accidents reporting, eyewash emergency shower system, first aid kits and emergency telephone numbers. On the positive site laboratory procedures are separated from management, sanitary and rest areas, laboratory surfaces and floors are easy to clean and disinfect, good laboratory Practices followed for all procedures, waste management is in compliance with the current Greek legislation and there are sufficient PPE available. Conclusion: In the laboratories studied there are significant shortcomings in containment and administrative controls, in the application of Greek and EU biosafety legislation, and in the proper management of biological agents and materials in general. This emphasizes the importance of closing key gaps in biosafety and emergency preparedness, in the biomedical laboratories. Using the results of this study, actions should be developed, applied and enforced, in compliance with the local and European legislation and guidelines. This could enhance the safety of these facilities, and the laboratory professionals, the community and the environment could be better protected from possible harmful biological agents and the possibility of Laboratory acquired infections (LAIs). This study also demonstrated the value of the laboratory workers participation in the risk evaluation, despite their propensity to over or under-estimate the risk level of the possible hazards. That fact should be considered in future studies when enhancing hospital staff.

Epidemiological trends in viral meningitis in England: Prospective national surveillance, 2013–2023

BackgroundIn the conjugate vaccine era, viruses are the most common cause of meningitis. Here, we evaluated epidemiological trends in laboratory-confirmed viral meningitis across all age-groups over an 11-year period in England. MethodsIn England, hospital laboratories routinely report laboratory-confirmed infections electronically to the UK Health Security Agency. Records of positive viral detections in cerebrospinal fluid during 2013-2023 were extracted. Incidence rates with confidence intervals were calculated using mid-year resident population estimates. ResultsThere were 22,114 laboratory-confirmed viral meningitis cases, including 15,299 cases during 2013-19 (pre COVID-19), with a gradual increase in incidence from 3.5/100,00 (95%CI, 3.3-3.6) to 3.9/100,000 (95%CI, 3.6-4.1). During 2020-21 when pandemic restrictions were in place, there were 2,061 cases (1.8/100,000; 1.7 - 1.9), which increased to 4,754 (4.2/100,000; 4.0-4.3) during 2022-23 (post pandemic restrictions).Infants aged <3 months accounted for 39.4% (8,702/22,048) of all cases, with a stable incidence 2013-19 (504/100,000, 95%CI: 491-517), followed by a significant decline during 2020-21 (204/100,000; 188-221) and then an increase during 2022-23 (780/100,000; 749-812), with enteroviruses being the commonest cause (84.9%, 7387/8,702; 424.74/100,000; 95%CI, 415.12-434.51), followed by parechoviruses (9.1%, 792/8702; 45.54/100,000; 95%CI, 42.42-48.82) and herpes simplex virus (4.4%, 380/8702; 21.85/100,000; 95%CI, 19.71-24.16). Pandemic restrictions were associated with significant declines in the incidence of enterovirus (77.7%) and parechoviruses (64% lower), with rebounds after societal restrictions lifted. ConclusionsRates of viral meningitis have returned to pre-pandemic levels since societal restrictions were lifted. The highest incidence of viral meningitis remains in infants aged <3 months and most commonly due to enteroviral infection.

Frequency of Hypocalcemic Seizures in Children with Afebrile Seizure: From 2 months - 2 years in a Tertiary Care Hospital

Objective: To determine the frequency of hypocalcemic seizures in children with afebrile seizure from age 2 months - 2 years. Methodology: This Descriptive Cross-Sectional study was conducted in Pediatric Department of Ayub Teaching Hospital Abbottabad for a period of six months (15th April, 2017 to 15th October, 2017). Total 130 cases fulfilling the inclusion criteria were enrolled in the study after approval from ethical committee of hospital and informed consent from the parents of children. A detailed history and examination were done and blood samples for serum calcium level were sent to the hospital laboratory along with other routine investigation to rule out the cause. All data was analyzed using SPSS version 21. Results: Out of 130 cases 48(36.9%) children had hypocalcemia while 82(63.1%) were normocalcemic. 79 (60.8%) were males and 51 (39.2%) were females. The mean age of children was 13.03 ± 6.81 months. The average calcium level was 8.23±1.51mg/dl. Conclusion: It has been concluded that afebrile seizures occur frequently in children with hypocalcemia. Thus, we got the local evidence regarding this association and recommend to screen all new afebrile seizure cases for hypocalcemia. Key words: Hypocalcemic fits, children, afebrile seizures, hypocalcemia

Epidemiology and diagnostic challenges of anti-NMDAR encephalitis: a study from the Waikato region.

Anti-NMDAR encephalitis is an increasingly recognised autoimmune disorder, with evolving diagnostic criteria. This study aims to analyse the prevalence and diagnostic patterns of anti-NMDAR encephalitis in a New Zealand hospital setting. Data from Waikato Hospital's lab database, encompassing anti-NMDAR antibody requests between August 2013 and July 2023, were examined. Cases were categorised based on age, gender and diagnostic outcomes. In all requests, 288/318 (91%) were processed and 10/288 (3.5%) anti-NMDAR antibodies were positive. Positive cases were equally frequent by sex, with an average age of 29.4 years. Only 6/10 were diagnosed with anti-NMDAR encephalitis, while others received alternative diagnoses. Māori ethnicity was overrepresented. This study indicates a low prevalence of anti-NMDAR encephalitis in the Waikato region, with adult predominance. Ethnic disparities were observed. The need for refining testing criteria to optimise cost-effectiveness is discussed. Anti-NMDAR encephalitis is relatively rare in Waikato Hospital, New Zealand, with diagnostic challenges related to testing criteria and ethnic diversity. Further research and consideration of testing protocols are warranted.

P-017 DNA fragmentation Index before and after density gradient centrifugation using flow cytometry, its reflection in sperm ultrastructure and its association with clinical outcome

Abstract Study question Is DNA fragmentation Index (DFI) affected by Density Gradient Centrifugation (DGC), reflected in sperm ultrastructure and associated with clinical outcome? Summary answer DFI was not affected by DGC, nor associated with clinical outcome, but it was negatively correlated with sperm concentration/motility and positively correlated with ultrastructural anomalies. What is known already Oxidative stress induces DNA fragmentation during sperm transit through the male genital tract and it is suggested to be the main mechanism causing DNA breaks after ejaculation during in vitro manipulation and sperm selection for injection/insemination. High levels of sperm DNA fragmentation have been linked to lower fertilization rates, poor embryo quality and delayed cleavage. Limited studies, have investigated in detail the effects of DGC on DFI and the reflection in sperm ultrastructure, while the predictive value of DFI on clinical outcome still remains controversial. Study design, size, duration Semen samples were collected on the day of the female partener’s oocyte collection and analysed before and after DGC for standard characteristics by light microscopy, according to World Health Organization (WHO) criteria (n = 120), for DNA Fragmentation by Flow Cytometry and for ultrastructure by Transmission Electron Microscopy (TEM). The predictive value of DFI for clinical outcome was also assessed. Participants/materials, setting, methods Standard semen analysis and DGC using the Sil-Select 40%/ 80 % layers were performed at an IVF Laboratory of an academic Hospital. Sperm DFI before and after DGC was assessed by Flow Cytometry at the Department of Immunology and Histocompatibility of the same academic Hospital. Ultrastructure analysis by TEM was carried out at an academic Histology/Embryology Laboratory following fixation in 3% glutaraldehyde, 1% osmium tetroxide, washes in PBS and staining with 1% aqueous uranyl acetate. Main results and the role of chance DGC did not alter DFI significantly (p = 0.052), but lead to a statistically significant increase in Progressive Motility (p &amp;lt; 0.001). DFI was higher in men with a male factor infertility compared to men without a male factor (p = 0.032) and Oligoasthenoteratospermia (OAT) exhibited the highest DFI levels (36.38% ± 5.36). DFI was negatively correlated with sperm concentration (rho = -0.361, p &amp;lt; 0.01) and sperm motility (rho = -0.301, p &amp;lt; 0.05). No significant association was observed between DFI and clinical outcome, but statistically significant differences were observed both in the age of men (37.54±1.33 vs 42.8±1.27 p = 0.017) and the age of women (35.77±1.25 vs 40.17±0.78 p = 0.007) in the group of patients who achieved a pregmamcy and those that did not. TEM showed that DGC did not lead to an increase in ultrastructural anomalies of spermatozoa, but DFI was positively correlated with ultrastructural anomalies. In teratozoospermic men TEM revealed head, neck and tail defects, including elongated forms, axonemal defects and premature initiation of the acrosome reaction. Limitations, reasons for caution The ultrastructure analysis was not possible to be performed in severely oligospermic samples. Wider implications of the findings This study shows that sperm ultrastructure and DFI are not adversely affected by DGC confirming the safety of the preparation method for sperm selection prior to insemination/injection. Larger-scale studies are needed, to elucidate any potential correlations between DFI and the probability of pregnancy. Trial registration number not applicable

Biomarkers In Prediction of Acute Mesenteric Ischaemia: a prospective multicentre study (BIPAMI study): a study protocol

BackgroundAcute mesenteric ischaemia (AMI) is a life-threatening disease where early diagnosis is critical to avoid morbidity and mortality from extensive irreversible bowel necrosis. Appropriate prediction of presence of bowel necrosis is currently not available but would help to choose the optimal method of treatment.The study aims to identify combinations of biomarkers that can reliably identify AMI and distinguish between potentially reversible and irreversible bowel ischaemia.MethodsThis is a prospective multicentre study. Adult patients with clinical suspicion of AMI (n = 250) will be included. Blood will be sampled on admission, at and after interventions, or during the first 48 h of suspicion of AMI if no intervention undertaken. Samples will be collected and the following serum or plasma biomarkers measured at Tartu University Hospital laboratory: intestinal fatty acid-binding protein (I-FABP), alpha-glutathione S-transferase (Alpha- GST), interleukin 6 (IL-6), procalcitonin (PCT), ischaemia-modified albumin (IMA), D-lactate, D-dimer, signal peptide-CUB-EGF domain-containing protein 1 (SCUBE-1) and lipopolysaccharide-binding protein (LBP). Additionally, more common laboratory markers will be measured in routine clinical practice at study sites.Diagnosis of AMI will be confirmed by computed tomography angiography, surgery, endoscopy or autopsy.Student’s t or Wilcoxon rank tests will be used for comparisons between transmural vs. suspected (but not confirmed) AMI (comparison A), confirmed AMI of any stage vs suspected AMI (comparison B) and non-transmural AMI vs transmural AMI (comparison C). Optimal cut-off values for each comparison will be identified based on the AUROC analysis and likelihood ratios calculated. Positive likelihood ratio > 10 (> 5) and negative likelihood ratio < 0.1 (< 0.2) indicate high (moderate) diagnostic accuracy, respectively. All biomarkers with at least moderate accuracy will be entered as binary covariates (using the best cutoffs) into the multivariable stepwise regression analysis to identify the best combination of biomarkers for all comparisons separately. The best models for each comparison will be used to construct a practical score to distinguish between no AMI, non-transmural AMI and transmural AMI.DiscussionAs a result of this study, we aim to propose a score including set of biomarkers that can be used for diagnosis and decision-making in patients with suspected AMI.Trial registrationNCT06212921 (Registration Date 19–01-2024).

Uptake of Revised CLSI Breakpoints and Potential Impact among Hospitals Reporting to The NHSN AR Option, 2022

Background: Antimicrobial susceptibility testing (AST) is critical for detecting antimicrobial resistance (AR) and guiding antimicrobial treatment. The Clinical and Laboratory Standards Institute (CLSI) regularly publishes and revises breakpoints to guide the interpretation of AST results. In 2010–2019, CLSI has lowered many breakpoints for Enterobacterales and Pseudomonas aeruginosa. Timely implementation of updated breakpoints can vary across hospital laboratories, leading to shifts in the interpretation of AST results. This issue is a potential threat to the estimation of national prevalence estimates for AR and limits the comparability of AR data across hospitals. Hospitals submit AST data with clinical laboratory interpretations to the AR Option of CDC’s National Healthcare Safety Network (NHSN). NHSN tracks whether a hospital adopted the revised CLSI breakpoints for six organism-antimicrobial combinations involving AR phenotypes commonly associated with healthcare associated infections through hospital self-reporting status into a structured survey — 2022 NHSN Annual Hospital Survey (Table). For this analysis, we describe the uptake of revised CLSI breakpoints and compare cumulative antibiograms among hospitals that used various breakpoints. Methods: We included hospitals that completed the 2022 NHSN annual survey and submitted data to the NHSN AR Option for at least 9 months in 2022 by November 1, 2023. The percentage of hospitals that implemented CLSI breakpoints, published during 2010–2019, were determined for combinations of antibiotic class, organism, and CLSI revision year (Table). We calculated percent resistance (%R) as the number of isolates meeting AR phenotype definitions divided by the total number of Isolates tested for the following phenotypes: carbapenem-resistant Enterobacterales (CRE) which included E. coli, Klebsiella, and Enterobacter species; extended-spectrum cephalosporin-resistant Enterobacterales (ESC); carbapenem-non-susceptible P. aeruginosa; fluoroquinolone-resistant P. aeruginosa; and fluoroquinolone-resistant Enterobacterales. Results: Among the 741 hospitals included, 75%–93% implemented any of the six revised CLSI breakpoints (Table). The %R was higher among isolates from hospitals that adopted revised breakpoints compared to those that did not (p &lt; 0 .0001). The largest difference was observed for carbapenem-non-susceptible P. aeruginosa (14.91% vs 10.11%). Conclusions: The uptake of revised CLSI breakpoints varied across hospitals, organism-antimicrobial combinations, and CLSI versions. This analysis indicates that the prevalence of AR for corresponding phenotypes could be underestimated if data from hospitals using higher, outdated breakpoints are included. It is important for NHSN to continue tracking breakpoints used in individual hospitals and encourage hospitals to report complete data on the original AST results, such as MIC, to optimize the accuracy of national AR surveillance.

Antimicrobial resistance, biofilm formation, and molecular detection of efflux pump and biofilm genes among Klebsiella pneumoniae clinical isolates from Northern Jordan

The current study aimed to investigate the antimicrobial susceptibility profiles, biofilm production capabilities, and the prevalence of efflux pump and biofilm-associated genes among Klebsiella pneumoniae clinical isolates. One hundred sixty-seven K. pneumoniae isolates were collected from microbiology laboratories in Northern Jordan hospitals. Antimicrobial susceptibility was tested using the Kirby-Bauer method. The double-disk synergy test was used to detect the extended-spectrum beta-lactamase (ESBL) phenotype. PCR was used to detect the frequency of acrAB,tolC, and mdtk efflux pump genes and fimH-1,mrkA, and mrkD biofilm-associated genes among the isolates. The highest nonsusceptibility was observed against azithromycin (87.4 %) and nitrofurantoin (85.0 %). Among the isolates, 75.4 % and 92.2 % were multidrug resistant and produced biofilms, respectively. Efflux pump genes acrAB, tolC, and mdtK were found in 96.4 %, 95.2 %, and 90.4 % of the isolates, respectively. Biofilm-associated genes mrkD, mrkA, and fimH-1 were found in 92.2 %, 89.2 %, and 88.6 % of the isolates, respectively. The presence of the mrkA was significantly associated with biofilm formation. Overall, high percentages of multi-drug resistance, efflux pump, and biofilm-associated genes were observed among the isolates. Subsequent studies are recommended to monitor changes in the prevalence of resistance phenotypes and genotypes of isolates.

Unlocking Precise Lung Cancer Detection Through Minimal Panel Immunostaining in Small Biopsy Samples.

Introduction Lung cancer diagnosis faces challenges due to morphological heterogeneity and limited biopsy tissue. This study evaluates the efficacy of a minimal panel immunostaining technique using immunohistochemical markers like napsin A, thyroid transcription factor 1 (TTF-1), p63, and synaptophysin to improve the precision of lung carcinoma subclassification. Methods A retrospective analytical study was conducted at the Histopathology Laboratory of Saveetha Medical College and Hospital, Chennai, from January 2018 to February 2024. A total of 64 lung carcinoma cases were analyzed. Inclusion criteria included biopsy samples from lung lesions with a confirmed diagnosis of lung carcinoma based on histomorphological examination, covering all age groups and both genders. Non-carcinomatous lung lesions were excluded. Clinical data were obtained from the Medical Information Archiving Software (MIAS) database and histopathological examination request forms. Under a light microscope, tissue samples were examined after beingfixed in formalin, processed, and stained with hematoxylin and eosin (H&E). Additionally, a minimal panel of immunohistochemical markers, including napsin A, TTF-1, p63, and synaptophysin, was used to subclassify lung carcinomas. Results The age group older than 50 years was the most affected, with a higher incidence in males. Histologically, 49% of cases were adenocarcinoma, 42% were squamous cell carcinoma, and 9% were small cell carcinoma. Immunohistochemistry (IHC) results adjusted these proportions to 54.6% adenocarcinoma, 31.2% squamous cell carcinoma, and 14% small cell carcinoma, showing a 5.6% increase in adenocarcinoma cases. The most common adenocarcinoma pattern was mixed, followed by acinar. TTF-1 and napsin A were crucial for identifying adenocarcinoma, while p63 was key for squamous cell carcinoma. Synaptophysin confirmed neuroendocrine differentiation in small cell carcinoma. Conclusion Incorporating a minimal panel of IHC markers significantly enhances the accuracy of lung carcinoma subclassification, addressing diagnostic challenges posed by morphological heterogeneity and limited sample size. This approach supports more precise and efficient clinical care for patients with lung cancer. Further validation in diverse clinical settings is recommended.

Study of Antibiotic Resistance of &lt;i&gt;Bacillus&lt;/i&gt; Bacteria Isolated from the International Space Station and a Hospital Laboratory

Study of Antibiotic Resistance of &lt;i&gt;Bacillus&lt;/i&gt; Bacteria Isolated from the International Space Station and a Hospital Laboratory

Peningkatan Performa Model Hard Voting Classifier dengan Teknik Oversampling ADASYN pada Penyakit Diabetes

Diabetes is a chronic disease that arises from excess sugar levels in the body and lack of exercise intensity resulting in a buildup in the blood. Indonesia ranks fifth as the country with the largest number of people with diabetes based on a report from the International Diabetes Federation (IDF). The reason is that people with diabetes do not realize that they have diabetes, so there is a need for early detection in knowing this. The purpose of this research is to improve the performance of the Hard Voting Classifier model combining the Decision Tree, Random Forest, and XGBoost algorithms with the ADASYN oversampling technique that handles data imbalance in diabetes prediction. This study uses patient information data with a total of 1000 data and 14 features from the Medical City Hospital laboratory, Iraq. The results of this study show an increase in the performance of the prediction model with an accuracy value of 99.0%, precision 99.1%, recall 99.0%, and f1-score 98.98% without using ADASYN. Then get an accuracy value of 99.8%, precision 99.8%, recall 99.8%, and f1-score 99.8% by using ADASYN as an oversampling technique. This shows that there is an increase in the performance of the Hard Voting Classifier model so that it produces accurate predictions of diabetes, where the correctness of diabetes prediction is very good.

Benchmarking medical laboratory performance on a global scale.

Laboratory performance as a relative concept needs repetitive benchmarking for continuous improvement of laboratory procedures and medical processes. Benchmarking as such establishes reference levels as a basis for improvements efforts for healthcare institutions along the diagnosis cycle, with the patient at its center. But while this concept seems to be generally acknowledged in laboratory medicine, a lack of practical implementation hinders progress at a global level. The aim of this study was to examine the utility of a specific combination of indicators and survey-based data collection approach, and to establish a global benchmarking dataset of laboratory performance for decision makers in healthcare institutions. The survey consisted of 44 items relating to laboratory operations in general and three subscales identified in previous studies. A global sample of laboratories was approached by trained professionals. Results were analyzed with standard descriptive statistics and exploratory factor analysis. Dimensional reduction of specific items was performed using confirmatory factor analysis, resulting in individual laboratory scores for the three subscales of "Operational performance," "Integrated clinical care performance," and "Financial sustainability" for the high-level concept of laboratory performance. In total, 920 laboratories from 55 countries across the globe participated in the survey, of which 401 were government hospital laboratories, 296 private hospital laboratories, and 223 commercial laboratories. Relevant results include the need for digitalization and automation along the diagnosis cycle. Formal quality management systems (ISO 9001, ISO 15189 etc.) need to be adapted more broadly to increase patient safety. Monitoring of key performance indicators (KPIs) relating to healthcare performance was generally low (in the range of 10-30% of laboratories overall), and as a particularly salient result, only 19% of laboratories monitored KPIs relating to speeding up diagnosis and treatment. Altogether, this benchmark elucidates current practice and has the potential to guide improvement efforts and standardization in quality & safety for patients and employees alike as well as sustainability of healthcare systems around the globe.

Implementation of pharmacogenetics for treatment of patients with acute lymphoblastic leukemia

Introduction: Acute lymphoblastic leukemia (ALL) is the most frequent pediatric leukemia; it can be defined according to chromosomic and genomic data. Cytogenetic analyses and determination of chromosomal numbers (such as hypo- or hyperdiploidy) and/or specific chromosomal rearrangements are basic for ALL classification and treatment. Even though cure rates of childhood ALL are at ~95%, pharmacogenetic aspects are of raising importance. Material and Methods: We have analyzed the literature for ALL subtypes, corresponding therapy options, and pharmacogenetic implications. Results: Data for ALL subtypes such as B-ALL, T-ALL, Ph-like ALL, DS-ALL, ETP-ALL, BCR-ABL1-like ALL are presented here. The gene polymorphism which lead to metabolizability of 6-MP are ITPA variants (94C&gt;A) and IVS2+21A&gt;C, in conjunction with TPMT (238G&gt;C, TPMT*3B 460G&gt;A and *3C 719A&gt;G and NUDT15 (415C&gt;T). For methotrexate metabolism gene polymorphisms are found for gene MTHFR as C677T and A1298C. Conclusion: In the last decade in many hospital laboratories, pharmacogenetic aspects gain more and more importance. Application of many molecular biology methods provided progress in treatment and diagnosis of ALL patients. Combination therapy is proposed as an alternative to single drug treatments.

Association Between Thyroid Dysfunction Among Pregnant Women with Bad Obstetric History A Comprehensive Study

Background: Thyroid dysfunction is increasingly prevalent globally, particularly in developing countries where dietary and hygiene practices during pregnancy contribute to its incidence. This condition significantly affects maternal and fetal health, necessitating closer examination, especially in populations with adverse obstetric histories. Objective: To evaluate the prevalence of thyroid dysfunction among pregnant women with a history of adverse obstetric outcomes and to underscore the necessity for targeted screening and management strategies. Methods: A cross-sectional study involved 260 pregnant women aged 18 to 40 with a history of poor obstetric outcomes. Participants were selected through non-probability consecutive sampling. After obtaining informed consent, demographic data were collected, and thyroid function was assessed by measuring TSH, T3, and T4 levels in a hospital laboratory. Data analysis was performed using SPSS version 16.0, utilizing means and standard deviations for quantitative data and frequencies and percentages for qualitative data. Results: The average age of participants was 30.31 ± 3.11 years. Mean thyroid hormone levels were recorded at T4: 1.84 ± 1.12 and TSH: 4.32 ± 0.91. Thyroid dysfunction was identified in 45.4% of the women, with 65.2% having subclinical hypothyroidism and 34.7% exhibiting subclinical hyperthyroidism among those diagnosed. Conclusion: The study highlights a significant prevalence of thyroid dysfunction in pregnant women with poor obstetric histories, indicating a critical need for comprehensive screening and tailored management to improve maternal and fetal health outcomes.

The band count imprecision - a Croatian multicentric pilot study.

Due to high inter-observer variability the 2015 International Council for Standardization in Haematology (ICSH) recommendations state to count band neutrophils as segmented neutrophils in the white blood cell (WBC) differential. However, the inclusion of bands as a separate cell entity within the WBC differential is still widely used in hematology laboratories in Croatia. The aim of this multicentric study was to assess the degree of inter-observer variability in enumerating band neutrophils within the WBC differential among Croatian laboratories. Seven large Croatian hospital laboratories from different parts of the country participated in the study. In each of 7 participating laboratories, one blood smear, that was flagged by the analyzer as possibly having bands, was evaluated by all personnel participating in the analysis of hematology samples. Between-observer manual smear reproducibility was expressed as coefficient of variation (CV) and calculated using the following formula: CV (%) = (standard deviation (SD)/mean value) x 100%. The CVs (%) and relative band neutrophil counts in participating laboratories were as follows: 15.4% (16-24), 19.2% (16-32), 19.5% (17-40), 21.1% (17-44), 35.0% (8-26), 51.9% (3-29), and remarkably high 62.4% (12-59). For segmented neutrophils CVs were lower, ranging from 7.4% to 32.2%. The CVs did not correlate with the number of staff members in each hospital (P = 0.293). This study revealed very high variability in enumerating band neutrophil count in the blood smear differential among all participants, thus prompting a need for action on a national level.