Laboratory Reports Research Articles

When less is more: the art of communicating clinical microbiology results.

The clinical microbiology laboratory is capable of identifying microorganisms in clinical specimens faster and more accurately than ever before. At face value, this should enable patient care providers to make better-informed decisions and target antimicrobial therapies to deliver individualized care. Ironically, more complete and specific reporting of microorganisms isolated from specimens may result in overtreatment based on the presence of a pathogen, even in the absence of clear signs of clinical infection. This conundrum calls into question the role of the laboratory in contributing to care through selective or "exception" reporting whereby some results are selectively withheld when there is a low probability that laboratory findings correlate with the clinical infection. In a recent article published in the Journal of Clinical Microbiology, Bloomfield et al. (J Clin Microbiol 62:e00342-24, 2024, https://doi.org/10.1128/jcm.00342-24) examine the impact and safety of an exception reporting strategy applied to wound swab specimens. Canonical pathogens associated with skin and soft tissue infections including S. aureus and beta-hemolytic streptococci are withheld from the laboratory report if certain patient criteria are met that would put them at low risk of adverse outcomes if untreated, or if treated with guideline-recommended empiric therapy. Their central finding was an approximately 50% reduction in post-laboratory report antibiotic initiation without adverse events or increased 30-day admission rate (indicative of infection-related complications, e.g., disseminated disease). While effectively achieving their goal, the premise of exception reporting and other modified reporting strategies raises questions about the potential risk of underreporting and how to ensure that the message is being interpreted, and acted upon, by care providers as was intended by the laboratory.

Electronic Health Record Data for Lyme Disease Surveillance, Massachusetts, USA, 2017-2018.

Lyme disease surveillance based on provider and laboratory reports underestimates incidence. We developed an algorithm for automating surveillance using electronic health record data. We identified potential Lyme disease markers in electronic health record data (laboratory tests, diagnosis codes, prescriptions) from January 2017-December 2018 in 2 large practice groups in Massachusetts, USA. We calculated their sensitivities and positive predictive values (PPV), alone and in combination, relative to medical record review. Sensitivities ranged from 57% (95% CI 47%-69%) for immunoassays to 87% (95% CI 70%-100%) for diagnosis codes. PPVs ranged from 53% (95% CI 43%-61%) for diagnosis codes to 58% (95% CI 50%-66%) for immunoassays. The combination of a diagnosis code and antibiotics within 14 days or a positive Western blot had a sensitivity of 100% (95% CI 86%-100%) and PPV of 82% (95% CI 75%-89%). This algorithm could make Lyme disease surveillance more efficient and consistent.

Communicable diseases in Ukraine during the period of 2018–2023: Impact of the COVID-19 pandemic and war

BackgroundBy examining 2018–2023 data, this study explored the intricate impact of the Russian invasion, ongoing COVID-19 pandemic, and environmental disruptions on communicable diseases in Ukraine. This conflict exacerbates challenges in disease surveillance and healthcare, compounding stress among the population. MethodsLeveraging the Centers for Disease Prevention Control's surveillance system, the study employs active and passive surveillance, utilizing medical records and laboratory reports. Notification rates gauge the incidence of communicable diseases, offering insights into trends during the study period. ResultsWhile salmonellosis, shigellosis, and rotavirus incidence are decreasing overall, there is a surge in viral hepatitis A, chronic hepatitis B, and C. This conflict hampers hepatitis C management, as evidenced by decreased numbers of treatment centers and patient enrollment. The prevalence of cough cases will increase in 2023, emphasizing the importance of sustained vaccination. The incidence of tuberculosis will increase in 2023 despite a general decrease. ConclusionThis study underscores the urgent need for sustained efforts and adequate resources, infrastructure, and international support to mitigate public health challenges in conflict-ridden Ukraine. Prioritizing vaccination programmes and enhancing healthcare accessibility in affected regions are crucial.

Synergizing computer‐aided design, commercial software, and cutting‐edge technologies in an innovative nozzle test apparatus for an engineering laboratory course

AbstractThis study explores compressible flow, a field reliant on mathematical models for effective teaching. Using laboratory experiments as pedagogical tools, we introduce a compact nozzle test apparatus that integrates cutting‐edge technologies—additive manufacturing (AM), pressure‐sensitive paint, the Schlieren system, image processing, and computational fluid dynamics (CFD)—in a compressible flow laboratory course. Commercial software, including MATLAB, SOLIDWORKS, ANSYS Fluent, and LabVIEW, facilitates the incorporation of these technologies. The research outlines the course structure, objectives, and details of student projects. Through a comparative analysis of experimental results, analytical calculations, and CFD simulations, we showcase the successful integration of AM in pedagogical practices for compressible flow, addressing critical concerns like nozzle strength and surface roughness. Statistical data from student projects offer practical insights, ensuring accuracy in experimental applications. The laboratory's design and detailed lists of components and costs provide a meaningful comparison with a supersonic wind tunnel, considering manufacturing expenses, operational costs, spatial requirements, and noise levels. The assessment of lab report grades underscores the approach's efficacy in conveying compressible flow concepts successfully, facilitated by modern computers. In summary, our study presents a comprehensive, efficient, and technologically advanced approach to teaching compressible flow within a concise framework.

Effect of alcohol consumption on lipid profile

Now-a-days alcoholism is major complication for development of different diseases. According to our literature review chronic alcoholic consumption will cause the lot of health complications. People without any comorbidities are also diagnosed with the lot of health complications at early age because of alcohol consumption. Our aim of the study is to identify the lipid changes in chronic alcoholic patients and how it effects on their health.To monitor the lipid changes in alcoholic persons.A prospective observational study was conducted for duration of six months, the data has been collected in 456 patients over six months of period and the data was collected with informed consent from the persons. All the data was collected by interacting with persons by using data collection form and laboratory reports were studied.In our study, 456 male populations were included. Out of 456 members, 272 people were alcoholics, and 184 members were non-alcoholic. Out of 272 population 180 are chronic alcoholics and 92 are occasional alcoholics. Out of 456 members young adults (18-25) 182 (39.9%) persons and old adults (26-40) were 274 (60%) persons296 members are taking alcohol with food and 160 members are taking without food. Out of 456 population 438 (96%) persons are non-vegetarians and 18(4%) members are vegetarians. Out of 272, 104 members were drinking beer, 58 were cheap liquor, 25 were Officers' choice, 18 were royal stag, 22 were blenders pride, 15 were signature, 23 were mixed brands, and 7 were others. In our study 156 persons were drinking sweetened beverages, 52(33.3%) members are daily beverage intakes and 104(33.3%) Members are occasionally beverage intakes. According to our study most commonly used sugary beverage brands are thumps up 93(59%), 48(31%) Sting,15(10%) other sugary beverages. Out of 156, Triglycerides were elevated in 47 and LDL was elevated in 36 persons, VLDL elevated in 4 persons and T. Cholesterol elevated in 5 members, Normal lipid profile in 64 persons. Out of 456 persons, 314(69%) are undiagnosed and 142(31%) are diagnosed with lipid changes. According to our common complications associated with alcohol consumption 39 were cardiac, 56 were hepatic, 9 were renal, and 38 were others (pancreatitis, stroke, cholelithiasis).In our study, we concluded that alcohol consumption will mainly affect triglyceride levels. Elevation of triglyceride levels is associated with the quantity and duration of alcohol intake. Normal Intake of alcohol does not cause lipid changes. Excessive intake of beer and cheap liquor increases TG. Excessive alcohol intake and fat intake will increase the LDL, Triglycerides, VLDL and decrease HDL. Excessive intake of sweetened beverages may also cause dyslipidaemia. Because it contains a high number of calories. The most common complication associated with elevation of triglycerides are hypertension, cardiovascular disease. Alcohol intake with food or without food shows the same complications but the absorption of alcohol may vary with food. Alcohol consumption with fat intake will cause hyperlipidaemia.

Role of Thyroidinum (sarcode) as an intercurrent remedy in treating various cases of Hypothyroidism

As we all know that Hypothyroidism is going to be increased in 21st century. Homoeopathic sarcode like Thyroidinum can play an important role in treating cases of Hypothyroidism. An observational retrospective study was undertaken to study the impact of Thyroidinum as an intercurrent remedy. I have taken 40 cases for study & evaluated all cases with evidence of laboratory report at the interval of 3 months up to 1 year. In my clinical study I have seen that in various hypothyroid cases it worked very well as an intercurrent remedy with constitutional remedy from lower to higher potency. I got significant result in 31 cases, no result in 9 cases. So, I have found that we can increase our efficacy of result with use of ‘Thyroidinum’ as an intercurrent remedy.

Uncovering the connection: how do preservice teachers’ inquiry skills relate to practices of judgment and feedback regarding lower secondary school students’ laboratory reports?

ABSTRACT Recent studies have shown that preservice teachers often struggle to effectively implement formative assessment practices to support students’ inquiry skills development. Therefore, it is crucial to investigate factors related to the successful implementation of these practices by preservice teachers. In this study, the relation between the inquiry skill levels of preservice science teachers and the accuracy of their judgments and the quality and quantity of feedback given on lower secondary school students’ laboratory reports of different levels of achievement were examined. Therefore, 61 preservice science teachers evaluated laboratory reports and provided feedback using a rubric, after their inquiry skills were assessed with a paper-and-pencil test. The results show that preservice teachers’ inquiry skills significantly explained the variance in judgment accuracy for all reports. Additionally, the inquiry skill levels of preservice teachers were positively related to the amount of correct feedback they gave in all reports and the amount of prescriptive feedback they gave in the low-achieving report. Finally, there was a negative correlation between the inquiry skill levels of the preservice teachers and the amount of false feedback they gave in high-achieving reports. The results are discussed in terms of effective formative assessment practices in the context of inquiry skill.

Implementation of electronic lab notebooks (ELNs) in science laboratory classes: student response and lessons learned

As data and protocols are increasingly generated, accessed, and manipulated electronically, many labs are shifting to storing data in electronic laboratory notebooks (ELNs). ELNs provide clear advantages in readability, shareability, searchability, accessibility, and data security over their paper counterparts. Our interdisciplinary program implemented ELNs across several sections of our gateway molecular biology laboratory course and analyzed the impact on 384 students (13 sections total from Fall 2016 to Spring 2018) using surveys, focus groups, and grade data. We found that students prefer the electronic format, citing the ease of transitioning to lab reports and the longevity of their data. Course grades overall were not affected by the change. Based on our experience, we offer suggestions for smoothing the transition to an ELN system in undergraduate and graduate laboratory courses, including use during remote teaching.

Fluid administration and fluid accumulation in intensive care units-Protocol for an international inception cohort study (FLUID-ICU).

Fluid accumulation is associated with adverse outcomes in critically ill patients admitted to the intensive care unit (ICU). Fluid administration in the ICU may be a clinically relevant source of fluid accumulation in ICU patients. However, the extent is unknown, and no standard definition exists. We aim to provide epidemiological data on fluid accumulation, risk factors, use of fluid removal strategies, patient outcomes and describe current fluid administration practices in the ICU. We will conduct an international 14-day inception cohort study including a minimum of 1000 acutely admitted adult ICU patients. Data will be collected from medical records and laboratory reports at baseline and daily from ICU admission to discharge with a maximum of 28 days. Follow-up will be performed on day 90 after inclusion. The primary outcome is the number of patients with fluid accumulation. Secondary outcomes include the number of days with fluid accumulation, use of active fluid removal, days alive without life support at day 28, days alive and out of hospital day 90, and all-cause mortality at day 90. Furthermore, we will assess risk factors for fluid accumulation and its association with 90-day mortality and report on the types of fluid administration. This international inception cohort study will provide contemporary epidemiological data on fluid administration and fluid accumulation in adult ICU patients.

Facilitating aerospace engineering senior design: Integrating lab curriculum redesign with student project and new technologies

AbstractThis study addresses a gap in existing literature by exploring the impact of an aerodynamics laboratory course on students' readiness for senior design projects in Aerospace Engineering at North Carolina State University. The redesigned curriculum focuses on propellers, aligning with the increasing popularity of senior design projects involving fixed‐wing aircraft and multi‐rotor systems in the Mechanical and Aerospace Engineering Department. The updated course incorporates Additive Manufacturing (AM) and an anechoic chamber for the first time, outlining its structure, objectives, and pivotal concepts. The use of data acquisition codes streamlines experimentation while integrating AM accelerates practical applications of blade element theory (BET). Through an assessment of lab report grades, this initiative significantly enhances students' grasp of propeller concepts, marking a pivotal step in their preparation for senior design projects.

P017 Sweat test: different clinical questions require different lab reports

P017 Sweat test: different clinical questions require different lab reports

Immune checkpoint inhibitor-associated gastrointestinal adverse events in patients with colorectal cancer.

e14708 Background: Immune checkpoint inhibitors (ICI) are successfully used to treat microsatellite instability-high (MSI-H) tumors. While immune checkpoint inhibitor related colitis is a frequent and devastating immune related adverse event (irAE) of these agents, the incidence and characteristics of this inflammatory toxicity in patients with MSI-H colorectal cancers has not been examined. We aimed to describe the characteristics and clinical profile of patients diagnosed with luminal gastrointestinal irAE in patients treated with ICI for colorectal cancer in a tertiary cancer care center. Methods: This is a retrospective analysis that included adult cancer patients diagnosed with colorectal cancer that received ICI between 6/1/2014 and 12/31/2022. We report data on those that developed colitis as an irAE up to 3 months after the last dose of ICI confirmed by laboratory and/or imaging report. We included patients’ demographic characteristics, oncologic profile and outcomes as well as clinical course, endoscopic features as well as treatment and outcomes in terms of luminal gastrointestinal irAEs. Results: Out of 474 patients with colorectal cancer on ICI in our study period, only 18 developed a gastrointestinal irAE with an incidence of 3.8%. Patients were primarily Caucasian (88.8%) males (61.1%) with a median age of 69.5 years. The majority of these patients received combination therapy with anti-PD1/L1 and CTLA-4 (50%). 66.6 % received ICI for MSI-H colorectal cancer. 11.1% of our sample were noted to have a second cancer-melanoma. The major-ity of patients had grade 1-2 colitis (61.2%) and grade 1-2 diarrhea (88.8%). Only 5 patients underwent endoscopic evaluation of whom, 2 had ulcerative inflammation necessitating use of selective immunosuppressive therapy with biologics. 61.1% had to withhold cancer treatment due toxicity. With regards to other gastrointestinal irAEs among this population, 41.4% and 5.8% were noted to have liver and pancreas toxicity respectively, with a median CTCAE grade of severity 2. The most common treatment for these toxicities were steroids. Conclusions: Luminal gastrointestinal irAEs seem to occur less frequently and at a lower severity among patients with MSI-H colorectal cancer after checkpoint inhibitors exposure compared to the overall incidence of the same among other cancers reported in literature. Larger prospective studies are necessary to determine the role of tumor biology and the gut microbiome in the disease profile and severity of immune related adverse events of the GI organ system. [Table: see text]

Effect of real-time data-driven physician engagement on appropriate precision oncology testing.

11168 Background: Precision medicine is a paradigm shift in healthcare: 24% of all FDA approvals are precision medicines, with 67% of new approvals relying on companion or complementary testing or on diagnostics prior to clinical use. Yet a recent publication indicates that approximately 64% of potentially eligible patients could be lost due to various clinical practice gaps along patient journey (Sadik et al JCO 2022). Low prevalence biomarker testing is proven to be one of the critical determinants of missed therapy, potentially due to poor physician awareness. The increasingly advanced machine learning (ML) and natural language processing (NLP)-based ability to label, analyze, and segment data can be utilized to monitor and influence testing behavior in real-time. We hypothesize that a real-time data-driven physician-targeted digital engagement can increase biomarker testing rate and in turn enhance patient identification for precision therapies. Methods: Unstructured real-world, real-time biomarker testing reports were collected from 494 laboratories across the US. These testing reports were first curated, labeled and extracted via ML and NLP-based technologies to allow data analysis and reveal testing behavior. Suboptimal testing behavior was defined as no requisition of the selected novel biomarker as part of the diagnostic workups. Physicians who identified as having suboptimal testing behavior were selected as candidates to receive a personalized digital engagement over a 4-week period. The digital engagement's purpose was to raise clinical awareness towards the novel biomarker testing. The follow-up testing behavior was analyzed again over laboratory reports collected from 26-weeks’ time after the initial engagement. Results: 822 physicians were identified with suboptimal testing behavior and selected to receive 4 weeks' follow-up digital engagement. 271 out of 822 (33%) recipients were successfully engaged shown as open and read the digital communication. 42 (~15%) physicians reacted to the communications and ordered the new test at least once during this period. The initial 4 weeks' engagement was observed to be the most impactful, when 23 out of the 42 (~55%) physicians ordered the novel biomarker test for the first time.71 new therapy-eligible patients were identified via data-driven targeted physician digital engagement during the 26 weeks’ follow-up period. Conclusions: This study illustrates the value of data in influencing or reinforcing testing behaviors and emphasizes the value of data-driven physician-targeted digital engagement in addressing clinical practice gaps which in turn, drive patient identification to match potential eligible precision therapies.

Methotrexate Induced Oral Mucositis and Bone Marrow Suppression in Psoriatic Patient

Methotrexate is an antimetabolite which binds to the dihydrofolate reductase enzyme and used in the treatment of malignant disorders and autoimmune diseases. Myelosuppression is a serious complication of methotrexate toxicity. The following case describes a case of 67 year old male patient diagnosed with psoriasis and wrongly taken methotrexate 7.5 mg daily for 3 days and twice daily for 4 days. He presented with oral mucositis and his lab reports showed myelosuppression. Our case emphasizes the significance of effective patient counselling to ensure the understanding of prescription and to prevent drug toxicity. The key learning points of our case report include the importance of adhering to prescribed medication regimens, awareness of MTX toxicity, early initiation of folinic acid as an antidote, vigilant monitoring of toxicity, and effective patient education on proper medication use. Adherence to established MTX therapy guidelines in dermatological conditions is crucial to minimize the risk of patient.

#2646 Precision verification and method comparison of anti-MPO anti-hsPR3 immunoassay on Alegria2 instrument

Abstract Background and Aims Antibodies to myeloperoxidase (anti-MPO) and proteinase 3 (anti-PR3) are recognized as the only clinically relevant antineutrophil cytoplasmic antibodies (ANCA) specificities so far. ANCA testing can be used in different clinical settings, especially in situations that require rapid diagnosis like renal-pulmonary syndrome that require result within 24 hours. The aim of this study was to perform analytical verification of the new automated single test ELISA based method on Alegria2 instrument to test if the reagents and analyser were acceptable for the routine use. Method For precision assessment we tested two concentration levels of commercial control material in triplicate for five days in a row. We used EASI acceptable criteria for precision for anti-MPO as well as for anti-hsPR3. For method comparison we included 50 patients with history or suspicion of vasculitis. Anti-MPO and anti-PR3 were measured using 5 different reagents: Anti-Myeloperoxidase ELISA (IgG) and anti-PR3-hn-hr ELISA (IgG) on Euroimmun Analyzer I-2P (EUROIMMUN AG, Lubeck, Germany), MPO and PR3 II chemiluminiscent immunoassay (CLIA) on IDS iSYS (IDS ISYS, Pouilly en Auxois, France), QUANTA Flash® MPO and QUANTA Flash® PR3 CLIA on BIO-FLASH® (Inova Diagnostics Inc, San Diego, USA), Anti-MPO and anti-PR3 hs on Alegria2 ELISA based method (Orgentec, Mainz, Germany), and Anti-MPO and anti-PR3 ELISA (Orgentec, Mainz, Germany). Results were categorized as positive or negative and we calculated kappa statistics as well as intraclass correlation coefficient. Complete statistical analysis was done using MedCalc statistical software (MedCalc version 14.8.1, Ostend, Belgium). Results Within-laboratory precision (CV%) for anti-MPO for normal and pathological controls were 5.73% and 15.14% respectively. For anti-PR3 hs within-laboratory precision (CV%) for normal and pathological controls were 5.46% and 18.89% respectively. Intraclass correlation coefficient showed excellent degree of consistency in average measures (0.9778 (95% CI: 0.9665-0.9862)) for anti-MPO and good reliability on single ratings (0.8981 (95% CI: 0.8522-0.9344). For anti PR3 intraclass correlation coefficient showed excellent degree of consistency in average measures (0.9257 (95% CI: 0.8873-0.9539)) but only moderate consistency in single ratings (0.7136 (95% CI: 0.6115-0.8053)). Separate Cohen`s kappa testing revealed almost perfect agreement for most reagent combination for anti- MPO (kappa from 0.825 to 0.958). For anti-PR3 we found moderate agreement between QUANTA Flash® PR3 and PR3 II IDS iSYS (kappa 0.520) but mostly substantial agreement (kappa from 0.629 to 0.865). We also found almost perfect agreement between anti-PR3 hs on Alegria2 and QUANTA Flash® PR3 (kappa = 0.901). Conclusion Our results showed a rather small relative variability and met the precision criteria defined by EASI initiative. Satisfactory agreement between methods is very reassuring but due to the lack of standardisation in autoimmune diagnostics imposes that information about methodological differences must be clearly stated on laboratory report. According to our results the new method for anti-MPO and anti-PR3 proved to be suitable for the routine use.

#873 Membranous nephropathy has higher all-cause mortality rate in comparison to focal segmental glomerulosclerosis and IgA nephropathy: a long-term study

Abstract Background and Aims Membranous nephropathy, focal segmental glomerulosclerosis (FSGS) and IgA nephropathy are the most frequent types of primary glomerulonephrites in the adulthood. Glomerulonephritides may progress into end-stage renal disease despite appropriate treatment. Both the manifestations of the glomerulonephritides and medications for treatment might yield cardiovascular events such as venous thromboembolism, coronary artery disease and stroke. The purpose of this study is to compare three different types of primary glomerulonephritides in terms of all-cause mortality, kidney-related and cardiovascular outcomes. Method All patients who underwent kidney biopsy between 01.01.2000 and 01.06.2022 in Hacettepe University Hospital were screened and cases with primary glomerulonephritis and follow-up data were enrolled. Data regarding baseline demographics, laboratory and kidney pathology reports and outcomes were obtained. The primary end-point was defined as all-cause mortality. Kidney related and cardiovascular outcomes were determined as secondary end-points. Results population was 39 (18-81) years. Membranous nephropathy was present in 36.5% (n = 172), focal segmental glomerulosclerosis was present in 25.9% (n = 122) and IgA nephropathy was present in 37.6% (n = 177) of the cases. Age (p < 0.001), frequency of diabetes (p = 0.004) and smoking history (p = 0.020) were significantly higher in patients with membranous nephropathy than both FSGS and IgA nephropathy. Serum albumin levels were lower (p < 0.001), while total cholesterol (p < 0.001), LDL cholesterol (p < 0.001) and proteinuria levels (p < 0.001) were higher both in patients with membranous nephropathy than the other two groups and in patients with FSGS than IgA nephropathy. Median duration of follow-up was 120.2 (1.7-273.3) months (Table 1). All-cause mortality rate was significantly higher in patients with membranous nephropathy than the other two groups (p = 0.005); however the type of glomerulonephritides was not found to be related to all-cause mortality (HR: 1.07; 95% CI: 0.65-1.77; p = 0.770). Age (HR: 1.079; 95% CI: 1.05-1.10; p < 0.001), serum creatinine (HR: 1.35; 95% CI: 1.10-1.66; p = 0.003) and serum albumin (HR: 0.60; 95% CI: 0.38-0.95; p = 0.030) levels were found to be associated with all-cause mortality in patients with primary glomerulonephritides. The rates of ischemic stroke, atrial fibrillation and steroid induced diabetes were similar between all of the glomerulonephritides subgroups. Acute coronary syndrome (p = 0.015), coronary revascularization (p = 0.021) and venous thromboembolic events were more frequent in patients with membranous nephropathy than IgA nephropathy. There was no difference in terms of cardiovascular outcomes between the patients with FSGS and IgA nephropathy (Table 1). Although the remission rate was significantly higher in patients with membranous nephropathy than the other two groups (p < 0.001); there was not a distinct difference in relapse rates. Progression to end-stage renal disease was prominently lower in patients with membranous nephropathy than the other groups (p = 0.003) and loss of glomerular filtration rate per year was significantly higher in cases with FSGS compared to other groups (p = 0.021). Conclusion All-cause mortality risk was higher in patients with membranous nephropathy because of higher age at diagnosis and accompanying higher burden of comorbidities including diabetes and dyslipidemia. FSGS had a worse prognosis in terms of kidney related outcomes compared to other glomerulonephritides due to higher loss of glomerular filtration rate per year and increased rates of progression to end-stage renal disease. Intensive cardiovascular risk reduction strategies should be applied especially in patients with membranous nephropathy due to increased mortality rates.

Non-pancreatic hyperlipasemia: A puzzling clinical entity.

Increased lipase level is a serological hallmark of the diagnosis of acute pancreatitis (AP) but can be detected in various other diseases associated with lipase leakage due to inflammation of organs surrounding the pancreas or reduced renal clearance and/or hepatic metabolism. This non-pancreatic hyperlipasemia (NPHL) is puzzling for attending physicians during the diagnostic procedure for AP. It would be clinically beneficial to identify the clinical and laboratory variables that hinder the accuracy of lipase diagnosis with the aim of improve it. A more precise description of the NPHL condition could potentially provide prognostic factors for adverse outcomes which is currently lacking. To perform a detailed clinical and laboratory characterization of NPHL in a large prospective patient cohort with an assessment of parameters determining disease outcomes. A Hungarian patient cohort with serum lipase levels at least three times higher than the upper limit of normal (ULN) was prospectively evaluated over 31 months. Patients were identified using daily electronic laboratory reports developed to support an ongoing observational, multicenter, prospective cohort study called the EASY trial (ISRCTN10525246) to establish a simple, easy, and accurate clinical scoring system for early prognostication of AP. Diagnosis of NPHL was established based on ≥ 3 × ULN serum lipase level in the absence of abdominal pain or abdominal imaging results characteristic of pancreatitis. A total of 808 patients [male, n = 420 (52%); median age (IQR): 65 (51-75) years] were diagnosed with ≥ 3 × ULN serum lipase levels. A total of 392 patients had AP, whereas 401 had NPHL with more than 20 different etiologies. Sepsis and acute kidney injury (AKI) were the most prevalent etiologies of NPHL (27.7% and 33.2%, respectively). The best discriminative cut-off value for lipase was ≥ 666 U/L (sensitivity, 71.4%; specificity, 88.8%). The presence of AKI or sepsis negatively affected the diagnostic performance of lipase. NPHL was associated with a higher in-hospital mortality than AP (22.4% vs 5.1%, P < 0.001). In multivariate binary logistic regression, not lipase but increased amylase level (> 244 U/L) and neutrophil-to-lymphocyte ratio (NLR) (> 10.37, OR: 3.71, 95%CI: 2.006-6.863, P < 0.001), decreased albumin level, age, and presence of sepsis were independent risk factors for in-hospital mortality in NPHL. NPHL is a common cause of lipase elevation and is associated with high mortality rates. Increased NLR value was associated with the highest mortality risk. The presence of sepsis/AKI significantly deteriorates the serological differentiation of AP from NPHL.

Prevalence of non-communicable chronic diseases in rural India amongst peri- and post-menopausal women: Can artificial intelligence help in early identification?

AimsTo identify peri- and post-menopausal women at risk of non-communicable diseases in rural India and to assess their prevalence amongst these groups via the use of artificial intelligence. Settings and designAn observational study conducted by the Indian Menopause Society in collaboration with the Government of Maharashtra. The study included rural women residents of three villages in the Latur district of Maharashtra, India. Materials and methodsAccredited social health activist workers identified 400 peri- and post-menopausal women aged 45–60 years. Specific symptoms able to predict the presence of a non-communicable disease were identified through the use of artificial intelligence. Statistical analysis usedDescriptive statistics and predictive network charts analysis. ResultsThe mean age of 316 women included in the analysis was 50.4 years and the majority of them were illiterate (68 %). The prevalence of dyslipidaemia, osteopenia, diabetes mellitus, obesity and hypertension were 58 %, 50 %, 25 %, 25 %, and 20 % respectively. None of their symptoms or laboratory reports could be significantly correlated directly with any of these non-communicable diseases. Hence, we used a cluster of symptoms to suggest the presence of hypertension, diabetes mellitus, osteoporosis and hypothyroidism via predictive network analysis charts. ConclusionsScreening of at-risk women can be done using an artificial intelligence-based screening tool for early diagnosis, timely referral and treatment of non-communicable diseases with the support of community health workers.

E-Health Care System

Within the Admin module, healthcare facility administrators have robust tools at their disposal to manage users, including doctors, staff, and patients. They can effortlessly organize departments and allocate doctors and staff members accordingly, ensuring a streamlined workflow. Additionally, administrators can efficiently oversee doctor appointments, maintain financial records through transaction reports, and monitor lab reports, guaranteeing the accuracy and timeliness of crucial medical information. The Patient module empowers individuals to actively engage with their healthcare services. Patients can seamlessly access their appointment schedules, check the availability and status of their appointed doctors, and book or modify appointments as needed. Furthermore, they can review their prescription history, ensuring they adhere to their recommended treatments, and manage their personal profiles for comprehensive healthcare management. Key Words: — User management ,Doctor allocation Department ,organization Workflow optimization, Appointment scheduling

Impact of removing ESBL status labelling from culture reports on the use of carbapenems for non-bacteraemic patients diagnosed with ESBL-positive urinary tract infections.

To evaluate carbapenem prescribing rates for initial definitive treatment of urinary tract infections and clinical outcomes before and after removing ESBL status labels on antibiotic susceptibility reports. This was a retrospective cohort study of adult patients treated for at least 48 h for an ESBL-producing/ceftriaxone-resistant Enterobacterales urinary tract infection. ESBL status reporting ceased in September 2022 for a network of seven community hospitals within the USA. The primary endpoint was the rate of carbapenem prescribing for initial definitive treatment of urinary tract infections. Secondary endpoints included total days of therapy for initial definitive treatment with carbapenems, clinical cure rates, time to transition to oral antibiotic therapy for initial definitive treatment, rate of guideline-compliant therapy, rate of relapsed infection within 30 days, 30 day readmission rate, and 30 day all-cause in-hospital mortality. Of 3055 patients screened, 199 were included in the pre group and 153 were included in the post group. The rate of carbapenem prescribing for initial definitive treatment was 156 patients (78%) in the pre group, compared with 93 patients (61%) in the post group (P = <0.01). Days of therapy for initial definitive therapy with carbapenem was 620 in the pre group compared with 372 in the post group (P < 0.01). There was no difference between other secondary outcomes. Removing ESBL status labels from laboratory reports reduced carbapenem use for initial definitive treatment of urinary tract infections from 78% to 61% (P < 0.01) without impacting clinical outcomes.