Laboratory Information System Research Articles

Indirect Reference Intervals of Serum Calcium in Pakistani Children Using KOSMIC, Bhattacharya, and Hoffman Approach.

Reference intervals (RIs) of serum calcium vary based on age, population demographics, and methods of assessment. However, conventional approaches to establish serum calcium (Ca)RIs pose ethical and practical challenges, especially in the pediatric population. Hence, the use of indirect approaches is beneficial. This study was carried out to estimate the RIs of serum Ca using three indirect approaches in the pediatric and adolescent population of Pakistan. Data mining laboratory information systems, for serum Ca results from 2013 - 2021 was done on a target population ranging from birth to 18 years of age. The population was grouped into three categories based on age (birth - 1 year, 2 - 4 years, and 5 - 18 years), as defined previously by Tahmasebi et al. in the CALIPER cohort. Pre-validated indirect algorithms, 'KOSMIC', Bhattacharya, and Hoffman, were used for analyzing the RIs. A total of non-duplicate 40,914 serum Ca tests were retrieved over a period of 6 years, including 38.7% (n = 15,830) from birth - 1 year, 16.3% (n = 6,641) from > 1 - 4 years, and 45.2% (n = 18443) from > 4 - 18 years respectively. The three methods revealed comparable performance with the direct RIs reported by Tahmasebi et al. in the CALIPER cohort. Keeping a stringent total allowable error of 1 mg/dl for Serum Ca as given by Clinical Laboratory Improvement Amendments (CLIA) the KOSMIC method outperformed the other two when compared to Tahmasebi, Houman, et al. Conclusions: The study advocates the use of the indirect approach for calculating RIs for serum calcium in the pediatric population, especially to aid clinical decision making in a low resource setting, due to its ability to reproduce results in line with the direct approach in a more economical, practical, and feasible way.

A Lean-Based Approach to Overcome Laboratory Challenges Using Process Excellence (PEx) Methods & Integrated Solutions – Experience of a Tertiary Care Laboratory from Mumbai

Background: The clinical laboratory’s goal is to provide the right service at the right time with the best quality. It was observed that a scattered and complex workflow resulted in non-value-added activities and impacted turn around time. A shorter turnaround time was always in demand & discussion. After feedback from clinicians & the internal team, the laboratory took this project as a part of its Quality Improvement programme. A team from the laboratory & Process Excellence (PEx) Consultants from Ortho Clinical Diagnostics performed a workflow assessment to identify the root causes of delayed turnaround time. The team used the concept of ‘Lean’ which is a quality improvement tool that focuses on simplifying the process by removing the “waste” or “non-value added” activities. Aim: This study aimed to use integrated solutions & Lean methodology to simplify the complex laboratory workflow. Method: A pre and post intervention study was conducted using the DMAIC principle (Define, measure, analyze, improve & control). The intervention was an integrated platform for analysis of Biochemistry and Immunology samples. Laboratory Information System statistical analysis for turn around time, Operator tracking and Valustream mapping were used to identify the bottlenecks and eliminate non-value-added tasks. The laboratory turnaround time, number of vacutainers used, staff assigned to tasks, were compared in the pre-intervention (2019) & post-intervention (2022) period. Results: The adoption of an integrated platform, helped reduce turnaround time for laboratory results by 26%. The integrated system also enhanced the capacity of the laboratory to handle the workload using lesser vacutainers saving US $ 2075 & US $ 30,000 per year from saving 43800 man-hours annually. The operator motion was reduced and 6 non-value-added steps were eliminated saving the laboratory 55 minutes per batch. Also, 100 sq.ft of space was saved which was utilized by the laboratory for other specialized testing. Conclusion: Value stream mapping an important lean tool, helped the laboratory to identify bottlenecks at the pre-analytical stage due to non-value-added activities. Specific interventions like integration of the Clinical Chemistry & Immunology analyzer with central specimen receiving station the TAT compliance score improved by 41% and 6% for Biochemistry & Immunology assays respectively. The laboratory could also optimize their space, manpower and show potential savings of USD $ 32075/- per year. These measures improved the operational efficiency of the laboratory.

Haematological indices in acute coronary syndromes: Could there be a hidden message?

Introduction and Aim: The routine markers of CAD show elevation after the development of acute manifestations. There exists a need for the establishment/validation of biomarkers that predict preclinical atherosclerotic changes. This study assesses the utility of haematological indices in the prediction and prognostication of CAD. Materials and Methods: This retrospective study includes 830 patient reports investigated for serum Troponin T retrieved from the laboratory information system. Reports were grouped into positive and negative categories. Relevant haematological and biochemical data were retrieved. Statistical analysis was carried out to estimate group differences, correlation, sensitivity, specificity, and AUC. Results: Troponin T positive group showed significantly elevated WBCs, neutrophils, CRP, NLR, PLR, and SII with significantly low lymphocytes, monocytes, basophils and RBC count. None of the lipid profile parameters, except serum triglyceride, showed significant differences between groups. Males showed a higher baseline but a blunter elevation CRP during acute coronary events. ROC showed maximum sensitivity (75.9%) and NPV (77.9%) for NLR, while PLR showed maximum specificity (76.4%). Conclusion: Haematological indices may have a better predictive value than conventional lipid profile and might serve as key markers in novel cardiac risk screening panels and aid in the risk stratification and management of coronary artery diseases.

Application of the Hoffmann, Bhattacharya, nonparametric test, and Q-Q plot methods for establishing reference intervals from laboratory databases

BackgroundReference intervals (RIs) are vital for interpreting laboratory biomarkers and enabling clinical decision-making. Among various RI-estimation methods, we explored the application value of Hoffmann, Bhattacharya, nonparametric test, and Q-Q plot methods for estimating the RI of urea, creatinine, and uric acid (UA). MethodThis cross-sectional study collected patient data recorded between January 2020 and April 2022 at the Chongqing University Central Hospital Laboratory Information System. The RIs of urea, creatinine, and UA levels were established using the Hoffmann, Bhattacharya, nonparametric, and Q-Q plot methods, and RI differences with different computational methods were verified using the reference change value (RCV%) of biological variability. ResultsWe included 16,474 and 123,570 patients in the physical examination and clinical groups, respectively. In the clinical group, differences in the RI upper limit of analytes with the four methods (excluding the Q-Q plot method) were within the permissible RCV% range; only the nonparametric test produced an RI of urea with the lower limit within the permissible RCV% range. In the physical examination group, the relative RI differences among the four methods (excluding the lower limit of RI obtained using the Q-Q plot) were all within the acceptable RCV% range; the relative deviation of the RI of UA with the four methods was within the acceptable RCV% range (excluding the lower RI limit obtained using the Q-Q plot and nonparametric test). ConclusionThe Hoffmann and Bhattacharya methods may provide reliable RIs for indirect estimations of urea, creatinine, and UA based on laboratory datasets.

Pretreatment Platelet Count is a Prognostic Marker in Lung Cancer: A Danish Registry-based Cohort Study

BackgroundThrombocytosis has been associated with a poor prognosis in a wide range of malignancies. However, the results have been conflicting for lung cancer. Therefore, we evaluated the prognostic value of platelet count in a large cohort of lung cancer patients. Patients and MethodsAll lung cancer patients diagnosed in The Central Denmark Region from 2009 to 2018 were included in the study. Data from the Danish Lung Cancer Registry were combined with data from the clinical laboratory information system on pretreatment platelet count. Platelet count was defined as low, normal, or high based on being below, within, or above the reference intervals. The prognostic value of platelet count was assessed by the Cox proportional hazard model. C-statistics were conducted to investigate if the platelet count added additional prognostic value to existing prognostic markers. ResultsTotally, 6,758 patients with non–small-cell lung cancer (NSCLC) and 1150 patients with small-cell lung cancer (SCLC) were included. Low and high platelet count were significantly associated with decreased overall survival (OS) in NSCLC patients (low: adjusted hazard ratio (HR)=1.75 (95% confidence interval [CI]: 1.49-2.06); high: adjusted HR=1.24 (95% CI: 1.16-1.33)). In SCLC patients, only low platelet count was significantly associated with decreased OS (adjusted HR = 2.71 [95% CI: 2.02-3.65]). C-statistics showed that the prognostic models were significantly improved by the addition of platelet count for both NSCLC and SCLC patients (P < .0001). ConclusionLow and high platelet count were adverse prognostic factors in NSCLC patients, while only low platelet count was a prognostic marker in SCLC patients.

Development and national scale implementation of an open-source electronic laboratory information system (OpenELIS) in Côte d’Ivoire: Sustainability lessons from the first 13 years

PurposeCôte d'Ivoire has a tiered public health laboratory system of 9 reference laboratories, 77 laboratories at regional and general hospitals, and 100 laboratories among 1,486 district health centers. Prior to 2009, nearly all of these laboratories used paper registers and reports to collect and report laboratory data to clinicians and national disease monitoring programs. ProjectSince 2009 the Ministry of Health (MOH) in Côte d'Ivoire has sought to implement a comprehensive set of activities aimed at strengthening the laboratory system. One of these activities is the sustainable development, expansion, and technical support of an open-source electronic laboratory information system (OpenELIS), with the long-term goal of Ivorian technical support and managerial sustainment of the system. This project has addressed the need for a comprehensive, customizable, low- to no-cost, open-source LIS to serve the public health systems with initial attention to HIV clients and later expansion to cover the general population. This descriptive case study presents the first published summary of original work which has been ongoing since 2009 in Côte d’Ivoire to transform the laboratory information management systems and processes nationally. ImpactOpenELIS is now in use at 106 laboratories across Côte d’Ivoire. This article describes the iterative planning, design, and implementation process of OpenELIS in Côte d'Ivoire, and the evolving leadership, ownership, and capacity of the Ivorian MOH in sustaining the system. This original work synthesizes lessons learned from this 13-year experience towards strengthening laboratory information systems in other low resource settings.

Modelling of Laboratory Information Systems in Higher Education Based on Enterprise Architecture Planning for Optimizing Monitoring and Equipment Maintenance

&lt;span lang="EN-US"&gt;It is possible to conduct scientific research, experiments, measurements, or training in a laboratory. Each department at FMIPA UNNES features several laboratories to complement class lectures for the students. Students can recognise concepts, cultivate scientific attitudes, and improve their critical thinking skills through lab practice. Utilising laboratory resources effectively and efficiently is expected of good laboratory management. Testing of lab equipment is required to ensure proper functionality and readiness for practicum use. Maintaining an eye on the equipment's condition and fixing any damage as soon as it becomes apparent is crucial for providing proof. The drawbacks of manually recording tool repairs are poor paperwork and equipment problems that are untraceable online. With the help of this study, the FMIPA UNNES environment departments will be able to monitor the upkeep of their lab equipment. The research approach starts with a literature review, followed by the first round of data collecting and observation, the design of an EAP-based system, system testing, system analysis, and system assessment. This research aims to create a product for the Monitoring Information System for the Maintenance of Laboratory Equipment using the SDLC (System Development Life Cycle) methodology. Testing involves the use of black box testing. The system's UAT grade of 88% implies that it is appropriate for use and may employ to simplify laboratory equipment management.&lt;/span&gt;

351. Epidemiology and antifungal susceptibilities of clinically significant filamentous fungi from a tertiary hospital in Singapore from 2018 – 2021

Abstract Background Filamentous fungi infections are associated with significant morbidity. Although an increase in antifungal resistance has been reported globally, no data pertaining to Singapore is available. This study investigates the species distribution and antifungal susceptibility profiles of molds isolated from a tertiary hospital in Singapore. Methods A retrospective review of fungal cultures with antifungal susceptibility results reported in the laboratory information system from 2018 to 2021 was conducted. Unique isolates per patient were included. Molds were identified primarily by morphology. Molecular studies were used as an adjunct where required. Susceptibility testing was performed via broth microdilution (Sensititre YeastOne) and gradient diffusion (Liofilchem) methods. Results 125 isolates were analyzed (Table 1). The most common molds recovered were Aspergillus, Fusarium and Mucorales. Aspergillus and Mucorales frequently involved the respiratory tract and skin and soft tissue (SSTI) whereas Fusarium was isolated from SSTI and blood. Amphotericin B had moderate activity against all molds, with only 11 out of 88 isolates (12.5%) being non-wild type (Table 2). The echinocandins exhibited good activity against Aspergillus and other hyaline molds but not Fusarium and Mucorales. The triazoles were most useful against Aspergillus, with posaconazole demonstrating the lowest geometric mean of 0.067. Fusarium had high MICs when tested against the azoles. Posaconazole was the azole of choice for Mucorales. Six Aspergillus isolates (all A. fumigatus) were non-wild type when tested against voriconazole, with a MIC &amp;gt;1. Of these six isolates, three were also non-wild type for amphotericin B, with a MIC &amp;gt;2. In particular, one Aspergillus fumigatus complex isolate demonstrated resistance across all tested azoles and sequencing revealed Cyp51 mutations. Conclusion Aspergillus species is the most prevalent clinically significant mold in our hospital. Although triazoles and echinocandins exhibit good activity, 13.33% of Aspergillus isolates were non-wild type for amphotericin B. Given the detection of these non-wild type Aspergillus species, susceptibility testing may be indicated in seriously ill patients to aid clinicians in selecting antifungal therapy. Disclosures All Authors: No reported disclosures.

1399. Dramatic Increase in Invasive Group A Streptococcal Infection in Persons Who Inject Drugs in an Urban Philadelphia Hospital

Abstract Background Invasive infection from Group A streptococcus (iGAS) is rising nationally, and we report a significant increase in incidence at an urban, quaternary care health center, which serves the Kensington neighborhood, the epicenter of the opioid crisis in Philadelphia, PA. We examined iGAS infection in the Temple University Health System catchment area Methods iGAS was defined as an of streptococcus pyogenes cultured from a previously sterile site. Injection drug use (IDU) is a known risk factor for bacterial infection, including iGAS infection. All blood, sterile fluid, and/or tissue cultures that yielded S. pyogenes were identified using the laboratory information system at Temple University Hospital – Main Campus. Two cohorts were compared: January 1, 2021, to December 31, 2021, and January 1, 2019, to December 31, 2019. Electronic health records were reviewed and data pertaining to age, gender, and injection drug use were abstracted. Descriptive statistics were used to summarize findings. Results 155 cases of iGAS were identified in 2021 (105 of which involved bacteremia) compared to 69 in 2019 (42 of which involved bacteremia), representing a 224% increase overall. Of the cases in 2021, 130 (84%) were Persons Who Inject Drugs (PWID) compared to only 39 (57%) in 2019. PWID with iGAS were younger (median age 35 vs 54 in 2019, 39 vs 53 in 2021) and more likely to be male (57% vs 43% in 2019, 68% vs 32% in 2021). Male patients also had a higher incidence of PWID than female patients (56% vs 44% in 2019 and 64% vs 36% in 2021). Conclusion During this same time period, the COVID-19 pandemic added to the ongoing opioid crisis in Philadelphia. The city of Philadelphia publicly reports opioid data, which shows that hospitalizations related to non-fatal opioid overdose have exponentially risen in the past two decades. This also coincides with an increase in the presence of xylazine, an adulterant in the Philadelphia fentanyl supply. Xylazine has been implicated in worsening wounds. Our data supports a concerning association between iGAS and PWID. Disclosures All Authors: No reported disclosures.

Improving quality control in the routine practice for histopathological interpretation of gastrointestinal endoscopic biopsies using artificial intelligence.

Colorectal and gastric cancer are major causes of cancer-related deaths. In Korea, gastrointestinal (GI) endoscopic biopsy specimens account for a high percentage of histopathologic examinations. Lack of a sufficient pathologist workforce can cause an increase in human errors, threatening patient safety. Therefore, we developed a digital pathology total solution combining artificial intelligence (AI) classifier models and pathology laboratory information system for GI endoscopic biopsy specimens to establish a post-analytic daily fast quality control (QC) system, which was applied in clinical practice for a 3-month trial run by four pathologists. Our whole slide image (WSI) classification framework comprised patch-generator, patch-level classifier, and WSI-level classifier. The classifiers were both based on DenseNet (Dense Convolutional Network). In laboratory tests, the WSI classifier achieved accuracy rates of 95.8% and 96.0% in classifying histopathological WSIs of colorectal and gastric endoscopic biopsy specimens, respectively, into three classes (Negative for dysplasia, Dysplasia, and Malignant). Classification by pathologic diagnosis and AI prediction were compared and daily reviews were conducted, focusing on discordant cases for early detection of potential human errors by the pathologists, allowing immediate correction, before the pathology report error is conveyed to the patients. During the 3-month AI-assisted daily QC trial run period, approximately 7-10 times the number of slides compared to that in the conventional monthly QC (33 months) were reviewed by pathologists; nearly 100% of GI endoscopy biopsy slides were double-checked by the AI models. Further, approximately 17-30 times the number of potential human errors were detected within an average of 1.2 days. The AI-assisted daily QC system that we developed and established demonstrated notable improvements in QC, in quantitative, qualitative, and time utility aspects. Ultimately, we developed an independent AI-assisted post-analytic daily fast QC system that was clinically applicable and influential, which could enhance patient safety.

138. Description of Repeat Carbapenem-resistant Enterobacterales (CRE) Submitted to a State Laboratory from the Same Individuals, Kentucky - December 2018 - March 2022

Abstract Background CRE and carbapenemase-producing CRE (CP-CRE) can be persistently detected during screening in long-term care facilities. Re-identification of these organisms during normal care and movement through healthcare settings is less well described. Objective: To describe repeated submission of CRE to a state laboratory, including persistence of detection and progression from colonization to infection. Methods Submission of CRE isolates was requested from labs in late 2017 and became mandated by legislative regulation in December 2020. Isolates were tested at the Kentucky Division of Laboratory Services (DLS) for CP using the modified carbapenem inactivation method (mCIM), with follow-up testing for specific carbapenemases using the Cepheid Xpert Carba-R assay. Results were maintained in the DLS lab information system. Descriptive statistics were derived for testing results from repeat submissions. Results From December 2018 through March 2022, 1,822 isolates were submitted to DLS from 1,498 distinct individuals; 324 repeat submissions were obtained from 214 individuals, with 141 individuals tested &amp;gt; 14 days after the initial result (Figure). Several individuals had &amp;gt; 2 submissions and some cultures had CRE both with and without CP identified. The same CP-CRE (species and mechanism) was identified from 42 individuals (29.8%) when tested &amp;gt; 14 days after initial identification (median 71 days, IQR 40-151, max 857). The same CRE (species) without CP was identified from 66 individuals (44.1%; median 111.5 days, IQR 55-237, max 676). Urine was the most common specimen source among resubmissions (67% of resubmissions). Of 47 individuals with a discrepant result (i.e., different species or mechanism) after &amp;gt; 14 days, only four had the same species identified initially as CP-CRE and then subsequently as non-CP-CRE. Ten individuals (7%) had screening and then clinical specimens with the same CP or species. Conclusion Persistence can occur with CP-CRE and with CRE without CP and may continue for &amp;gt;500 days. The in vivo loss of CP by CRE appears to occur infrequently. Clinicians and infection preventionists should remain vigilant for persistent CRE colonization during clinical and infection control decision making. Disclosures All Authors: No reported disclosures.

Impact of age-dependent red blood cell parameters on α-globin gene genotyping in children.

When screening for α-thalassemia in children, adult cut-offs for mean corpuscular volume (MCV) and mean corpuscular hemoglobin (MCH) are generally applied to guide genetic evaluation. However, the normal ranges for MCV and MCH are lower in children than in adults, so we hypothesized that using age-matched cut-offs could lead to a more rational diagnostic strategy. The aim of this study was to evaluate if age-matched cut-offs could be applied advantageously. Data on children referred to a hemoglobin fractionation at the Department of Clinical Biochemistry, Aarhus University Hospital between 2016-2021 were identified in the laboratory information system. α-globin gene (HBA1/HBA2) genotyping was performed using multiplex gap-polymerase chain reaction. A total of 387 children were identified. HBA1/HBA2-genotyping was performed in 207 children (53%), and α-thalassemia was diagnosed in 47 children (23%) with -α3.7/αα being the predominant genotype (13%). We found that 23 children had MCV and MCH levels in the normal age-matched range, and two of these children (9%) were α+ thalassemia carriers with three functional α-globin genes. Using age-specific cut-off levels resulted in a reduction of 23 (11%) genotypes performed. In conclusion, applying age-matched cut-offs for MCV and MCH when screening children for α-thalassemia lead to 11% fewer genotypes performed while 9% carriers of α+ thalassemia (of the medically innocuous genotype -α3.7/αα) would have been overlooked.

Diagnosis and Management of Intrahepatic Cholestasis of Pregnancy- A Retrospective Clinical Audit

Introduction: Pregnant women presenting with pruritus, serum bile acid (SBA) ≥10 µmol/L and/or alanine transaminase (ALT) &gt;30 U/l is diagnostic of intrahepatic cholestasis of pregnancy (ICP). A retrospective audit was performed to look at the diagnosis, management and outcomes of ICP patients in University Malaya Medical Center (UMMC). Methods: SBA requests from Obstetrics and Gynaecology Department from 1st January 2016 to 31st December 2020 were extracted from Laboratory Information System (LIS). The medical records (preexisting medical conditions, maternal and perinatal outcomes) of ICP were obtained. Mild and severe ICP were defined based on SBA 10-40µmol/L and SBA &gt;40 µmol/L, respectively. Results: SBA was requested for 202 pregnant women. The prevalence of ICP in our cohort was 0.18% (47 out of 26,697 deliveries). The average gestation at diagnosis was 35 weeks. Both SBA and liver enzymes were elevated in 25 (53.2%) whereas only SBA was elevated in 20 (42.6%) women. In two women, the diagnosis was made based on clinical symptoms and elevated liver enzyme alone. All with ICP had a livebirth and 31.9% were preterm. Severe ICP was noted in eight (17%) and all had cesarean section, whereas, in mild ICP, only 17 (44%) had a caesarean section. In those with normal SBA (n=149) at initial presentation, a repeat SBA was performed only in 12 (8.1%). Postpartum follow-up of ICP patients was observed in only 10 (21.2%). Conclusion: Despite being an uncommon diagnosis in our population, early diagnosis and timely delivery is important to reduce the major perinatal adverse outcomes. In women with persistent pruritus but without the biochemical evidence of ICP at the time of presentation should have repeat SBA and LFT done.

One health system supporting surveillance during COVID-19 epidemic in Abruzzo region, southern Italy

The Istituti Zooprofilattici Sperimentali (IZSs) are public health institutes dealing with the aetiology and pathogenesis of infectious diseases of domestic and wild animals. During Coronavirus Disease 2019 epidemic, the Italian Ministry of Health appointed the IZSs to carry out diagnostic tests for the detection of SARS-CoV-2 in human samples. In particular, the IZS of Abruzzo and Molise (IZS-Teramo) was involved in the diagnosis of SARS-CoV-2 through testing nasopharyngeal swabs by Real Time RT-PCR. Activities and infrastructures were reorganised to the new priorities, in a “One Health” framework, based on interdisciplinary, laboratory promptness, accreditation of the test for the detection of the RNA of SARS-CoV-2 in human samples, and management of confidentiality of sensitive data. The laboratory information system – SILAB – was implemented with a One Health module for managing data of human origin, with tools for the automatic registration of information improving the quality of the data. Moreover, the “National Reference Centre for Whole Genome Sequencing of microbial pathogens - database and bioinformatics analysis” – GENPAT – formally established at the IZS-Teramo, developed bioinformatics workflows and IT dashboard with ad hoc surveillance tools to support the metagenomics-based SARS-CoV-2 surveillance, providing molecular sequencing analysis to quickly intercept the variants circulating in the area. This manuscript describes the One Health system developed by adapting and integrating both SILAB and GENPAT tools for supporting surveillance during COVID-19 epidemic in the Abruzzo region, southern Italy. The developed dashboard permits the health authorities to observe the SARS-CoV-2 spread in the region, and by combining spatio-temporal information with metagenomics provides early evidence for the identification of emerging space-time clusters of variants at the municipality level. The implementation of the One Health module was designed to be easily modelled and adapted for the management of other diseases and future hypothetical events of pandemic nature.

THE COVID-19 VULNERABILITY IN ASSOCIATION WITH ABO AND RH BLOOD GROUP SYSTEM: AN ANALYTICAL STUDY WITH REVIEW OF LITERATURE

Objective: COVID-19 began on March 11, 2020, when the WHO declared a pandemic, caused by the novel coronavirus. At present, millions of COVID-positive cases are reported with an increase in mortality during the second wave. There are various studies and research chronicles available regarding hematology and biochemical criteria in COVID-19 infection. On the other hand, there is an urge to explore of ABO blood group vulnerability of COVID-19-infected patients in our study population. Our aim of this study is to scrutinize the relevance between the ABO, Rh blood types, and the susceptibility to COVID-19 and to study the capable use of the ABO blood group system for risk stratification of COVID-19. Methods: ABO and Rh grouping data available of 500 COVID-19 positive were collected from our hospital blood bank. Data about the age and gender of each patient are obtained from the Laboratory Information system. The patients who were confirmed to have SARS-CoV-2 infection by RT-PCR and ABO and Rh typing data available are included in the study. Results: The ABO blood group in 500 people in tertiary care hospital displayed a percentage distribution of 31.8%, 27.4%, 6.4%, and 34.4% for A, B, AB, and O, respectively. The proportion of non-O blood group (A, B, and AB) among patients with COVID-19 was substantially higher compared to the O blood group. Conclusion: This study reports an association between COVID-19 susceptibleness and the ABO blood group system. Categorically, non-O blood group systems have a greater risk compared to the O blood group system and have a higher risk of ICU admissions due to COVID-19-related complications.

Analisis Sensitivitas Dan Spesifisitas COVID-19 Ag Rapid Test Terhadap PCR Test

SARS-Cov-2 is the newest coronavirus caused Covid-19 which can infect human and pandemic, COVID-19 parameter testing can be done with serological tests used to detect antibody or antigen and also molecular test using PCR method. This research is aimed to compare the sensitivity and specificity between COVID-19 Ag rapid test and PCR test. This research is an analytical descriptive study with 421 samples were obtained from documentation study with probability systematic random sampling and by using secondary data taken from Laboratory Information System (LIS) at Siloam Hospitals Lippo Village Tangerang and the type of observational analytical research with cross sectional design. The analysis results show the sensitivity rate was 96.64%, specificity was 93.75%, PPV was 89.44%, NPV was 98.08%, LR (+) was 15.46, and LR (-) was 0.04. The conclusion of the research result, COVID-19 Ag rapid test is valid to be used as a diagnostic test because it has high rate of sensitivity and specificity according to WHO regulations.

Prevalence and clinical characteristics of T2DM patients with OTUD3 gene rs78466831 SNP at a single academic center in China.

A novel, rare OTUD3 c.863G>A (rs78466831) in humans has been reported associated with diabetes, but the prevalence and clinical characteristics of T2DM patients with rs78466831 have not been reported before. To investigate the prevalence and clinical characteristics of T2DM patients with rs78466831 and provide a basis for clinical diagnosis and treatment. OTUD3 gene rs78466831 SNP was detected by Sanger sequencing in all the collected specimens of laboratory-confirmed T2DM patients and healthy people. Clinical characteristics indexes inconsisting of fasting blood glucose (FBG), glycosylated hemoglobin (HbA1c), high density lipoprotein cholesterol (HDL-C), low density lipoprotein cholesterol (LDL-C), total cholesterol (TC), triglyceride (TG) and a body mass index (BMI), T2DM-associated chronic complications (myocardial infarction, cerebrovascular disease, retinopathy, arterial plaque, peripheral neuropathy and nephropathy) were obtained from the clinical laboratory information systems and electronic medical record system. Clinical characteristic indicators were compared between the wild-type and variant (rs78466831) patients with T2DM. The prevalence of rs78466831 in the T2DM patients group was significantly higher than the healthy control in our academic center. The general characteristic indicators were not significantly different between the wild-type and rs78466831 patients with T2DM, except the family history of diabetes. Clinical laboratory indicators including HbA1c, FBG, OGTT, TC, HDL-C, LDL-C and CP had no significant difference between the two groups. The therapeutic drug and target achievement rates were not significantly different between the two groups. The incidence of diabetic retinopathy in the variant group was significantly higher than the wild-type group. The OTUD3 gene rs78466831 was associated with T2DM and may be a biological risk factor of diabetes retinopathy.

Hematological Profile with Peripheral Blood Smear Morphology of Admitted COVID-19 Infected Patients: A Study at a COVID Dedicated Hospital in Kashmir.

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection started in Wuhan, China, and spread to the rest of the world to become a pandemic affecting over 385 million people throughout the world to date. Coronavirus disease 2019 (COVID-19) is primarily started as a respiratory tract infection. Recent studies indicate that it should be regarded as a systemic disease involving multiple systems including the hematopoietic system. Complete blood count and its parameters are important investigative tools in its prognosis. However, very few studies highlight the importance of peripheral blood cell morphology in this disease. To study the hematological parameters (complete blood count and peripheral blood film) of COVID-19-positive patients and to compare the hematological parameters of those admitted in intensive care units (ICUs) with those admitted in non-ICUs of the hospitals. This retrospective study was carried out at a COVID-19 dedicated tertiary care center over a period of 3 months from July 2020 to September 2020. In our study, all 79 patients had complete blood counts performed at the time of admission. Complete blood count was repeated during the hospital stay for all severe cases. The data which provided information on the age and gender of each patient were obtained from the Laboratory Information System (LIS) of the hospital. The mean age of our study group was 46.05 years. Out of 79 cases, lymphopenia was seen in 16.5% with five patients presenting with severe lymphopenia (&lt;0.5 × 109 /L). All the patients that required ICU care presented with moderate to severe lymphopenia. The patients in the ICU setting showed significant neutrophilia (mean 14.16 × 109 /L) on follow-up complete blood count. Thrombocytopenia was observed in 35.3% of cases. It was observed that the mean neutrophil- lymphocyte ratio was higher in ICU admitted patients as compared to the non-ICU admitted patients. Among the ICU patients, 80% showed a neutrophil-lymphocyte ratio above the baseline cutoff (3.1). A wide array of morphological changes were observed in the peripheral blood smear including toxic-like granules in neutrophils, fetus-like C-shaped nucleus, lymphoplasmacytoid cells, bizarre cells, and apoptotic cells. The study highlights that at the time of admission older age, decreased lymphocyte count, and raised neutrophil-lymphocyte ratio were closely associated with ICU admissions. Also, the morphological changes in peripheral blood film reveal atypical changes predominantly in the white blood cell (WBC) lineage.

Diffuse Large B-Cell Lymphoma in the Public-Sector of Johannesburg, South Africa, in the Era of Widescale Antiretroviral Therapy Use.

Diffuse large B-cell lymphoma (DLBCL) is a high-grade non-Hodgkin lymphoma with increased incidence among people living with HIV-infection (PLWH). Although its frequency is reportedly attenuated by antiretroviral therapy (ART), we have previously shown a similar rate of DLBCL in the post-ART era (2017) in Johannesburg, South Africa compared with that observed when ART had only limited availability in the South Africa state-sector (2007). Here, we present a more detailed analysis of DLBCL in the pre-and post-ART eras in Johannesburg. All cases of DLBCL diagnosed in the state-sector hospitals of Johannesburg in 2007 and 2017 were extracted from the laboratory information system, and factors of interest compared. Most (&gt;85%) were observed among PLWH at both time-points; ART-coverage was significantly higher in 2017 compared with 2007, but with failed immunological recovery in 50% of cases. The immunohistochemically-defined cell of origin differed according to HIV-status; the germinal center (GC) and non-GC subtypes predominating in the PLWH and the HIV-negative group, respectively. MYC-gene rearrangement was more common than is reported elsewhere (22.1%), whereas BCL6 and BCL2 gene rearrangements were less so (14.6% and 0%, respectively). Slight improvement in survival was noted in the post-ART era, but remained poor, with bone marrow involvement and albumin levels ≤30 g/L independently associated with mortality. Although the frequency of DLBCL in Johannesburg has not dropped significantly in the post-ART era, a slight improvement in survival is observed. However, outcomes remain poor, indicating a need for further improvements in care.

An Audit on Transfusion error in 16 years of blood transfusion practice at a Teaching Hospital in North Eastern Malaysia

Clinical demand for blood transfusion is endless, and patients are exposed to the risk of transfusion error at any point along the transfusion chain which lead to incorrect blood component transfused (IBCT) if the standard transfusion practices have not complied. This study aimed to determine the prevalence, sources, and causes of error among IBCT in Hospital USM. This retrospective study involved all packed red cell (PC) transfusion and reported IBCT in Transfusion Medicine Units, Hospital USM from January 2005 to December 2020. The recipient and transfusion data of IBCT were collected from the medical record and laboratory information system (MyTransfusi). A total of 193 697 PC transfusions were documented, and 14 IBCT were reported within 16 years of transfusion services. The incidence of IBCT was 1 in 13 836 of PC transfusion. Most of the IBCT contributed by ward error (64.3%). The major cause of error was patient miss identification (85.7%) either in patient sampling, blood component issuing and administration. Most ABO incompatibility IBCT (3 out of 5) end up with severe morbidity or mortality related to an acute haemolytic transfusion reaction. Most of the errors occurred in the wards. Patient misidentification is a major cause of IBCT, and it is preventable. Thus, preventive measures should emphasize on positive patient identification at every step of transfusion chain.