Laboratory Services Research Articles

The effects and benefits of a latent print AFIS deferral policy

Forensic laboratories in the United States had an estimated backlog of 570,100 requests for all forensic services at the end of 2014. Latent print requests represented approximately 12% of that total backlog [1, NIJ 2019]. With ever-increasing demands and backlogs, a review of laboratory or section practices becomes vital to operations. Work process and business practice changes can increase efficiencies and result in the reduction of casework backlogs and turnaround times. The automated fingerprint identification system (AFIS) deferral policy implemented by the Latent Print Comparative Section (LPCS) of the Phoenix Police Department Laboratory Services Bureau (PPD LSB) was employed to address the latent print backlog. Five years of multiple AFIS request types were analyzed to demonstrate the positive effects and benefits of such policies, including a 26.32% decrease in turnaround time over the data collection and analysis period and a 90.96% reduction in backlogged requests for one year.

Assessment of Primary Laboratory Facilities for Rural Health Care Preparedness in Osmanabad District, India

Government of India has provided Indian Public Health Standards to improve rural health care services and health status, but still rural laboratory is a cause of concern. This study is performed to understand the laboratory facility-level gaps that need to be addressed to improve the public primary health centres (PHCs) present in rural areas. The laboratory assessment is performed for governance, financing, resources and services, and results are validated with the PHC laboratory performance. The current assessment shows critical gaps in the facilities regarding governance, services, resources and financing required for the laboratory services at the rural primary health care level. Governance and services need to be strengthened the most, followed with sustained availability of resources and financing. Poor health status in rural areas necessitates public health response based on health systems. Therefore, health system preparedness in the form of laboratory services is essential in primary health care facilities.

Evaluation of quality indicators in microbiology and infectious disease serology laboratory: A study from a tertiary cancer care centre in Gujarat, India

Introduction: Quality indicators (QIs) are important for the monitoring and evaluation of laboratory performance at pre-analytical, analytical, and post-analytical phases. Errors in the laboratory arise more frequently before and after the analysis of samples. The total testing process (TTP) therefore needs to be evaluated for good laboratory performance. A good quality indicator should give information about the performance of a process, thereby governing the quality of services.Objective: To analyse TTP and QIs for a period of six years of screening of laboratory performance.Methods: This retrospective analysis was conducted for the period 2017 to 2022. QIs at pre-analytical (12), analytical (04) and post-analytical (03) phases were defined and analysed on a monthly basis. The laboratory followed the guidelines of the International Organization for Standardization (ISO) 15189:2012 to identify errors in all sections.Results: A total of 259,694 samples were received during the study period. A total of 628,817 tests were performed. The overall error rate was 1.25/1000 tests. Error in the pre-analytic phase was 0.96/1000 tests, the commonest being haemolysed samples. Error in the analytical phase was 0.33/1000 tests. The error of postanalytical phase was 0.48/1000 tests with turn round time (TAT) outliers being the commonest.Conclusion: Amongst all phases of QIs, errors were minimum in the analytical phase. Continuous monitoring and analysis of QIs helps in identification of common errors in the laboratory. Corrective measures will help to improve quality of the laboratory services, and hence the patient outcome. Regular training, evaluation of technical staff, regular preventive maintenance and calibration of all analytical instruments helps in reducing the errors.

The clinical Spectrum of Viridans Group Streptococci infections in paediatric patients at a tertiary hospital.

Viridans Group Streptococci (VGS) are often considered organisms of low virulence; however, infection can result in clinically significant sepsis and life-threatening complications in paediatric patients. This study aimed to describe the spectrum of clinical presentation of VGS bacteraemia in paediatric patients, to analyse risk factors, and to describe the antibiotics resistance patterns of VGS. Cultures of VGS in paediatric patients admitted to Chris Hani Baragwanath Academic Hospital in 2019 were identified through National Health Laboratory Service. Data were extracted from archived clinical records and analysed. Sepsis scores were calculated at the time of bacteraemia. A total of 133 cultures were identified; 64 (48.1%) polymicrobial cultures and no records 4 (0.03%) were excluded; 65 (48.9%) were analysed. The median age was 1.5 months (range 0.03 to 168, interquartile range [IQR]: 0.3-13.25), 27/65 (42%) were neonates. The median duration of hospitalisation was 7 days (IQR: 3-21). The commonest diagnoses were neonatal sepsis 30.8% (n = 20) and pneumonia 28% (n = 18). The systemic inflammatory response syndrome (SIRS) score was ≥ 2 in 57% (16/28) patients; paediatric sequential organ failure assessment (pSOFA) score was > 2 in 10/24 (42%). Fifty-seven (88%) patients were discharged; three (5%) required ICU admission and 8/65 (12.3%) died. Malnutrition was present in 50% of patients who died. Cephalosporins and penicillin had sensitivity of 89% and 55%, respectively. Viridans Group Streptococci bacteraemia was common in neonates, and pneumonia was a common presentation in this cohort. The VGS bacteraemia was associated with morbidity and deaths in this cohort. The VGS should be considered a significant organism when cultured from sterile sites and routine antibiotic susceptibility testing should be performed. Prospective studies are recommended.

Surveillance for highly pathogenic avian influenza A (H5N1) in a raptor rehabilitation center-2022.

An ongoing, severe outbreak of highly pathogenic avian influenza virus (HPAI) A H5N1 clade 2.3.4.4b has been circulating in wild and domestic bird populations throughout the world, reaching North America in 2021. This HPAI outbreak has exhibited unique characteristics when compared to previous outbreaks. The global distribution of disease, prolonged duration, extensive number of species and individual wild birds affected, and the large impact on the global poultry industry have all exceeded historical impacts of previous outbreaks in North America. In this study, we describe the results of HPAI surveillance conducted at The Raptor Center, a wildlife rehabilitation hospital at University of Minnesota (Saint Paul, MN, U.S.A.), from March 28th-December 31, 2022. All wild raptors admitted to the facility were tested for avian influenza viruses using polymerase chain reaction (PCR) testing. All non-negative samples were submitted to the United States Department of Agriculture (USDA) Animal and Plant Health Inspection Service (APHIS) National Veterinary Services Laboratories for confirmatory HPAI testing and genetic sequencing. During the study period, 996 individual birds representing 20 different species were tested for avian influenza, and 213 birds were confirmed HPAI positive. Highly pathogenic avian influenza surveillance conducted at The Raptor Center contributed 75% of the HPAI positive raptor detections within the state of Minnesota, located within the Mississippi flyway, significantly augmenting state wildlife surveillance efforts. The viral genotypes observed in birds sampled at The Raptor Center were representative of what was seen in wild bird surveillance within the Mississippi flyway during the same time frame. Wildlife rehabilitation centers provide an opportune situation to augment disease surveillance at the human, wildlife and domestic animal interface during ongoing infectious disease outbreaks.

Optimizing Sample Warehouse Layout At PT BIJ: Comparative Study Of Dedicated And Class-Based Storage

PT. BIJ is an analytical laboratory services company, therefore PT. BIJ needs a good warehouse to be able to accommodate the samples it has PT. BIJ experienced problems with sample storage. Therefore, it is necessary to improve the sample storage system to make it easier to find samples to be analyzed. Using the Dedicated Storege and Class Base Storage methods will help provide grouping for each type of sample and place the samples in the right place so that the sample travel distance is shorter. The results of the research carried out can be obtained that the initial travel distance is 262.98 meters, while the proposed dedicated storage distance is 163.19 meters and the proposed basic class storage distance is 149.95 meters, so there is the largest percentage difference of 42.89%. So it can be concluded that using the class base storage method is better than the dedicated storage method.

Antibiotic prescribing practices in community and clinical settings during the COVID-19 pandemic in Nairobi, Kenya.

The COVID-19 pandemic has significantly impacted healthcare systems, including antibiotic use practices. We present data on patterns of antibiotic dispensing and use in community and hospital settings respectively in Nairobi, Kenya during the pandemic. We conducted interviews with 243 pharmacies in Nairobi using a standardised questionnaire from November to December 2021. The data collected included demographic characteristics, antibiotic customers, types of antibiotics sold, and antibiotic prescribing practices. Additionally, we retrospectively reviewed health records for 992 and 738 patients admitted in COVID-19 and general wards at two large inpatient hospitals between April 2020 and May 2021, and January 2019 to October 2021, respectively. Demographic, utilisation of laboratory services, treatment, clinical, and outcome data were collected using a modified Global WHO Point Prevalence Surveys (Global-PPS) tool. Almost all pharmacies (91.4%) served customers suspected of having COVID-19 with a mean weekly number of 15.6 customers. All pharmacies dispensed antibiotics, mainly azithromycin and beta lactams to suspected COVID-19 infected customers. 83.4% of hospitalised COVID-19 patients received at least one antibiotic at some point during their hospitalisation, which was significantly higher than the 53.8% in general ward patients (p<0.001). Similarly, the average number of antibiotics administered to COVID-19 patients was higher than that of patients in the general ward (1.74 vs 0.9). Azithromycin and ceftriaxone were the most commonly used antibiotics in COVID-19 patients compared to ceftriaxone and metronidazole in the general wards. Only 2% of antibiotic prescriptions for COVID-19 patients were supported by microbiological investigations, which was consistent with the proportion of 6.8% among the general ward population. Antibiotics were commonly prescribed to customers and patients suspected of having COVID-19 either in community pharmacies or in hospital, without a prescription or laboratory diagnosis. These findings emphasize the crucial role of antibiotic stewardship, particularly in community pharmacies, in the context of COVID-19.

Association of Vitiligo with ABO/Rh System and its Influence on Thyroid Stimulating Hormone and Vitamin D

This study was conducted to determine if there is a relationship between vitiligo and ABO blood groups, the Rhesus (Rh) factor, thyroid stimulating hormone (TSH) and vitamin D. For vitiligo analysis, two hundred subjects participated in this study, 100 vitiligo patients and 100 control cases (without vitiligo). ABO blood grouping and Rh typing were tested by a slide method. TSH testing involved 80 vitiligo patients and 80 controls (without vitiligo) and the hormone was analyzed by separating the serum in a centrifuge for two minutes and the results were obtained by Beckman fully automatic analyzer. For vitamin D, 50 vitiligo patients and 50 healthy people (without vitiligo) were included. The data on vitamin D were obtained from private laboratory services. Statistical analysis was performed using IBM SPSS version 26. P&lt;0.05 was considered significant. Most patients with vitiligo had a significantly lower level of serum vitamin D compared with controls (p-value &lt; 0.05), while no statistically significant difference in TSH serum levels between vitiligo cases and controls, was found (p-value &gt; 0.05). Furthermore, despite showing that subjects with blood group O are more susceptible to vitiligo as compared to other groups, there was no significant association of vitiligo with ABO blood groups (p-value &gt; 0.05). Similarly, the incidence of Rh positive and Rh negative was not statistically different between the two groups (p-value &gt; 0.05). This study showed that vitiligo patients are often vitamin D deficient. This study highlights the need to evaluate vitamin D status in vitiligo patients to improve the level of skin pigment loss. It remains unknown whether vitamin D deficiency causes vitiligo. However, a collection of larger sample sizes of different ethnicities should be required to achieve a precise conclusion.

Quality Control in Regional Blood Center QC Laboratory

Implementing comprehensive quality control measures in Regional Blood Center (RBC) laboratory services is indispensable for ensuring the accuracy, reliability, and consistency of transfusion-transmitted infectious screening results. These measures not only identify and address potential issues but also uphold the highest standards in analysis and testing. Below, we explore deeper into the critical aspects of quality control in laboratory services especially in the Regional Blood Center laboratory followed by American association of blood banking.

Trends in decision-making by primary care physicians regarding common infectious complaints

Background Primary care physicians played an important role in the global response during the COVID-19 pandemic, but with the absence of laboratory and diagnostics services, the move to telehealth and the focus on respiratory assessment, they faced increased uncertainty when making clinical decisions. Objectives This paper aims to examine the impact of the pandemic on decisions made by primary care physicians, as measured by referrals to chest X-ray and laboratory tests and by prescriptions of antibiotics. Methods We conducted a retrospective study of all visits recorded with fever or cough, presenting to 209 community clinics in Southern Israel during the years 2018–2022. We describe changes in outcome rates across time and use multivariate generalised linear mixed effects model to compare the odds of referrals and prescriptions between periods, while accounting for gender, age, clinic sector, visit type, diagnosis, and season. Results In total, 609,823 visits to primary care physicians complied with the cohort definitions. Social restrictions were associated with a decline in all measured outcomes for primary care physician decisions, most prominently among ages 20-59, for throat culture referral during the first lockdown (OR = 0.46) and for cephalosporine prescription during the second lockdown (OR = 0.55). This trend persisted following the cancellation of the restrictions. Conclusions Despite higher uncertainty during the COVID-19 social restrictions, the overall course of clinical decision-making processes was maintained, and was associated with a reduction in the use of auxiliary resources, which can improve the quality of patient care by lowering costs and supporting prevention of future antibiotics resistance.

The impact of COVID-19 on healthcare booking and cancellation patterns: time series analysis of private healthcare service utilisation in Finland

BackgroundCOVID-19 has had wide-reaching effects on healthcare services beyond the direct treatment of the pandemic. Most current studies have reported changes in realised service usage, but the dynamics of how patients engage with healthcare services are less well understood. We analysed the effects of COVID-19 on healthcare bookings and cancellations for various service channels between January 2020 and July 2021.MethodsOur data includes 7.3 million bookings, 11.0 million available appointments, and 405.1 thousand cancellations by 900.6 thousand individual patients between the ages of 18 and 65 years. The data were collected from electronic health record data, including laboratory and imaging services as well as inpatient stays, between January 2017 and July 2021. The patients were Finnish private and occupational healthcare customers in the capital region of Finland. We fitted an autoregressive moving average (ARIMA) model on data between 2017 and 2019 to predict the expected numbers of bookings, available appointments, and cancellations, which were compared to observed time series data between 2020 and 2021.ResultsUtilisation of physical, in-person primary care physician appointments decreased by up to 50% during the first 18 months of the pandemic. At the same time, digital care channels experienced a rapid, multi-fold increase in service usage. Simultaneously, the number of bookings for laboratory and imaging services decreased by 50% below the pre-pandemic projections. The number of specialist and hospital service bookings remained at the predicted level during the study period. Cancellations for most health services increased sharply by up to three times the pre-COVID levels during the first weeks of the pandemic but returned to the pre-pandemic levels for the rest of the study period.ConclusionsThe reduction in in-person appointments and the increase in the utilisation of digital services was likely a contributing factor in the decrease of the utilisation of diagnostic and imaging services throughout the study period. Utilisation of specialist care and hospital services were not affected. Cancellations contributed to the changes in service utilisation only during the first weeks of the pandemic.

Distribution and Antifungal Resistance Profile of &amp;lt;i&amp;gt;Candida&amp;lt;/i&amp;gt; spp. Isolated from Patients Living with HIV at the Yaoundé Central Hospital

Background and Purpose: Candidiasis are the most frequent fungal infection, especially in immunocompromised people such as patients living with the human immunodeficiency virus (PLHIV). Data on the fungal prevalence and antifungal resistance rate particularly in PLHIV in Cameroon are scarce. This study aimed to determine the distribution and the antifungal resistance profile of&amp;lt;i&amp;gt; Candida &amp;lt;/i&amp;gt;spp. isolated from clinical samples of PLHIV visiting the laboratory service of the Yaoundé Central Hospital. Materials and Methods: A cross-sectional study was carried out on the PLHIV visiting the Central Hospital of Yaoundé laboratory service. Samples were collected according to the signs and symptoms recorded by the patient and inoculated onto Sabouraud + Chloramphenicol agar medium for 24 hours incubation at 35°C ± 2°C. Typical &amp;lt;i&amp;gt;Candida&amp;lt;/i&amp;gt; colonies were subjected to a germ tube test to identify &amp;lt;i&amp;gt;Candida albicans&amp;lt;/i&amp;gt; and the other species were identified biochemically using API Candida (BioMérieux). The antifungal susceptibility testing was carried out by the disk diffusion method and seven antifungal discs (Bioanalyse) were tested. Results: Overall, 106 unique samples were obtained from participants. The positivity rate of &amp;lt;i&amp;gt;Candida &amp;lt;/i&amp;gt;spp. was 37.7%. &amp;lt;i&amp;gt;Candida&amp;lt;/i&amp;gt; isolates were mostly recovered from sputum (n=15/40) followed by the oral swabs (n=10/40) and the vaginal swabs (n=08/40). Out of the 40 isolates, &amp;lt;i&amp;gt;Candida albicans&amp;lt;/i&amp;gt; was the predominant species 57.5% followed by &amp;lt;i&amp;gt;Candida krusei &amp;lt;/i&amp;gt;15%, &amp;lt;i&amp;gt;Candida glabrata &amp;lt;/i&amp;gt;and &amp;lt;i&amp;gt;Candida guilliermondii&amp;lt;/i&amp;gt; 10% each and &amp;lt;i&amp;gt;Candida famata &amp;lt;/i&amp;gt;7.5%. The antifungal drug resistance profile of &amp;lt;i&amp;gt;Candida&amp;lt;/i&amp;gt; spp. revealed the highest resistance rates to Amphotericin B (95.0%), Fluconazole (57.5%) and Nystatin (42.5%). Conversely, Clotrimazole, Miconazole and Econazole were the most effective against &amp;lt;i&amp;gt;Candida&amp;lt;/i&amp;gt; spp. Conclusion: The high frequency of &amp;lt;i&amp;gt;Candida &amp;lt;/i&amp;gt;spp. isolation, resistant to several commonly used antifungals among PLHIV in a hospital setting is a direct call for stakeholders, policymakers and clinicians about antifungal therapy awareness in this vulnerable population.

SNI ISO/IEC 17025:2017 IMPLEMENTATION IMPACT ON TESTING LABORATORY

&lt;p&gt;A globally recognized standard for ensuring the competence of testing and calibration laboratories is SNI ISO/IEC 17025:2017. Many testing laboratories are currently using SNI ISO/IEC 17025:2017, and many have already received accreditation. The laboratory serves a variety of objectives, which is beneficial to enhancing the lab's performance. A laboratory's performance could be measured by how well it serves its customers and their satisfaction. This study aims to examine the impact of applying SNI ISO/IEC 17025:2017 on the number of services provided and the level of customer satisfaction in laboratories that have been accredited by KAN for the scope of CNC vertical-type milling machines and CNC lathes for position accuracy test, cutting result accuracy test, and circular movement accuracy test. This study uses a qualitative, descriptive research design and conducts elementary analysis to characterize the overall state of the data. Information on the number of services provided and the degree of customer satisfaction during 2016–2021 were compared, allowing for a comparison of the trends in service quantity and customer satisfaction. The findings indicate that the rise in laboratory services is influenced by the implementation of SNI ISO/IEC 17025:2017. Furthermore, as evidenced by a strong customer satisfaction score, the performance of the offered service has no bearing on the quantity of technological services falling under the purview of SNI ISO/IEC 17025:2017 accreditation.&lt;/p&gt;

Plasma lipids paediatric reference intervals: Indirect estimation using a large 14-year database.

Establishing direct reference intervals (RIs) for paediatric patients is a very challenging endeavour. Indirect RIs can address this problem, using existing clinical laboratory databases from real-world data research. Compared to the traditional direct method, the indirect approach is highly practical, widely applicable, and low-cost. Considering the relevance of dyslipidemia in the paediatric age, to provide better laboratory services to the local paediatric population, we established population-specific lipid RIs via data mining. Our laboratory information system was searched for cholesterol (TC), triglycerides (TG), low-density lipoprotein (LDL) and high-density lipoprotein (HDL) of patients aged less than 18 years, performed from January 2009 until December 2022. RIs were estimated using RefineR algorithm. Values from 215,594 patients were initially collected. After refining data on the basis of specific exclusion criteria that left 17,933 patients, we determined the RIs for each analyte, including corresponding 95% confidence interval (95% CI). Age and sex partitions were required for proper stratification of the heterogenous subpopulations. Age-related variations in TC and TG values were observed mainly in children until 5 years. RIs were defined for children less than 3 years and for those of 3-18 years. In our population, the obtained RIs were comparable with those of the literature, but the upper TG limit in subjects under the age of 3 (2.03 mmol/L with 95% CI: 1.45-2.86) was lower than that previously reported. Our RIs, necessary for paediatric lipid monitoring, are tailored to the serviced patient population as should be done whenever possible.

Effect of storage temperature on the change of microbiological indicators of fresh soft cheese

In Ukraine, there is a tendency to increase the production of soft, fresh cheeses due to their technological features. The advantages of producing this product include efficient use of raw materials; the ability to sell the product without ripening or with a short ripening period (no more than 14 days); and high quality indicators. In general, cheese is considered a complete food product that covers part of a person's daily needs for nutrients and biologically active substances. Due to martial law in the country, loyalty in the sale of products plays a unique role, but the temperature regime of storage affects the safety of cheese. Therefore, the study aimed to determine the sanitary quality of soft, fresh cheese and to justify the parameters of product storage at a temperature of 6 °C. The research was conducted at the Regional State Laboratory of the State Service of Ukraine for Food Safety and Consumer Protection in Poltava Oblast and at the Department of Livestock Products Processing Technology laboratory of Poltava State Agrarian University. The research objects were samples of soft, fresh cheese without fillers produced at the Milk Local Product Expert Center of the Faculty of Animal Production and Food Technology. The indicators stipulated by the regulatory document for soft cheeses 4395:2005 “Soft cheeses. General technical conditions”. It was established that the investigated cheese (sample No. 6) met the requirements of the current standard in terms of organoleptic (appearance, taste and smell, consistency, dough color, pattern, shape), physicochemical (mass fraction of fat, table salt, water) and physicochemical parameters. Specific physicochemical characteristics (mass fraction of moisture, table salt, and fat in dry matter) of the cheese, according to the tests, were within the limits specified by SSTC. The studied samples of fresh soft cheese regarding microbiological parameters (pathogenic microorganisms, particularly Salmonella, Listeria monocytogenes, and Staphylococcus aureus) complied with regulatory documents when they were stored at +6 °C for two days. At the same time, it has been proven that storage of fresh soft cheese without fillers at a temperature of +20 ± 0.5 °C leads to the growth and presence of coliform bacteria in the E. coli group. As early as 48 hours later, the products did not meet the regulated norms of the current national standards.

Assessment of quality and safety of red caviar of salmon fish

The health of the body largely depends on the necessary goods in the human diet. Therefore, quality and safety indicators are essential in monitoring their suitability. Red salmon caviar is no exception; it is considered a valuable food product and, due to its high price – a delicacy. Typically, this type of product must meet all regulatory requirements, which allows it to be safely used in the human diet. In terms of nutritional value, red caviar contains complete proteins, easily digestible fats, minerals, and vitamins, and its content is superior to that of some types of food products, even fish meat. The article presents the results of studies of organoleptic, physico-chemical, and microbiological indicators and the content of preservatives in salmon red granular salted caviar of 1st and 2nd grades sold in retail chains and markets in the Kyiv region. The study was carried out in laboratory conditions at the Research Institute of Food Technologies and Technologies for processing livestock products of the BNAU and the central testing state laboratory of the State Consumer Service (Vishnevoe). All indicators were determined using different methods intended for each indicator. Therefore, it was found that the organoleptic indicators of red caviar in both varieties corresponded to standard values. The mass fraction of sodium chloride and hexamine was within the normal range and did not exceed the standard indicators: sodium chloride – 8,57 % and 7,14 %, respectively (grades 1 and 2); methenamine – 70 % and 60 %, respectively (grades 1 and 2). According to microbiological indicators, the experimental samples showed that the number of MAFAnM did not exceed 1×102 CFU/g in both varieties, and the presence of yeast and mold fungi was detected no more than 10 CFU 1,0 g, which is 3 times less than the norm. The content of preservatives E200 1st and 2nd grades of red caviar was 0,07 % and 0,04 %, and E210 (1st and 2nd grades) 0,05 % and 0,03 %. Thus, all studied samples of red granular salmon caviar meet standard values for all indicators of quality and food safety.

Should tularemia be considered a particularly dangerous infection?

Tularemia is a widespread bacterial zoonotic infection in the world, the causative agent of it in our country is classified as pathogenicity group 2, which corresponds to group 3 according to the international classification for laboratory services. F. tularensis is considered a potential agent of category A bioterrorism. The review presents current information about the causative agent of tularemia, the features of the clinical course of the infection and the incidence rate associated with its different subtypes. The possibilities of treatment and prevention of the disease are highlighted. The material is presented from the point of view of whether the infection meets the criteria for a particularly dangerous disease. The species includes 4 subspecies, of which only one, present only in some states of the United States and probably the evolutionarily oldest, is assessed as highly virulent. The subspecies most widespread on the European continent is classified as moderately virulent and causes diseases that do not meet the criteria for a particularly dangerous disease in terms of severe and mortality rate. There is a list of drugs that are quite effective against the causative agent of tularemia, provided they are prescribed in a timely manner. The incidence of tularemia in countries where it is registered does not exceed sporadic levels. However, a feature of the pathogen is plasticity in the external environment which determines the long-term preservation of the epizootic potential of natural foci. In some years large outbreaks of infection occur, often in the absence of visible risk factors. The possibilities of specific and nonspecific prevention are limited and can reduce the risk of infection of the population only with a timely, quick and adequate response to changing situations. In various countries work is underway to create vaccines on different technological platforms, but currently only Russia, Belarus and Kazakhstan use the live attenuated vaccine. Although by wild strains is not a particularly dangerous disease, it requires close surveillance.

Cardiac Amyloidosis: Everywhere, but Nowhere

Clinical pathways in the evaluation and management of cardiac amyloidosis (CA) are haphazard in Malaysia. Presented here are two cases that serve as examples of how diagnosis of CA can often be missed or delayed, leading to serious consequences. A complex interplay between various factors contributes to this, including lack of expertise and facilities to support early recognition and confirmation of CA affecting laboratory services, radiological services, and expertise in the disease. A lack of coordinated care involving various disciplines and subspecialties has been a barrier in establishing a national-level clinical pathway for CA. Additionally, there is poor awareness among clinicians surrounding CA, where limited experience in managing the disease is concentrated in major centres. Building an amyloidosis network may be the way forward, as the onus is on clinicians to improve the way they communicate with each other.

Linkage to HIV care and early retention in HIV care among men in the ‘universal test-and-treat’ era in a high HIV-burdened district, KwaZulu-Natal, South Africa

IntroductionDespite the numerous efforts and initiatives, males with HIV are still less likely than women to receive HIV treatment. Across Sub-Saharan Africa, men are tested, linked, and retained in HIV care at lower rates than women, and South Africa is no exception. This is despite the introduction of the universal test-and-treat (UTT) prevention strategy anticipated to improve the uptake of HIV services. The aim of this study was to investigate linkage to and retention in care rates of an HIV-positive cohort of men in a high HIV prevalence rural district in KwaZulu-Natal province, South Africa.MethodsFrom January 2018 to July 2019, we conducted an observational cohort study in 18 primary health care institutions in the uThukela district. Patient-level survey and clinical data were collected at baseline, 4-months and 12-months, using isiZulu and English REDCap-based questionnaires. We verified data through TIER.Net, Rapid mortality survey (RMS), and the National Health Laboratory Service (NHLS) databases. Data were analyzed using STATA version 15.1, with confidence intervals and p-value of ≤0.05 considered statistically significant.ResultsThe study sample consisted of 343 male participants diagnosed with HIV and who reside in uThukela District. The median age was 33 years (interquartile range (IQR): 29–40), and more than half (56%; n = 193) were aged 18–34 years. Almost all participants (99.7%; n = 342) were Black African, with 84.5% (n = 290) being in a romantic relationship. The majority of participants (85%; n = 292) were linked to care within three months of follow-up. Short-term retention in care (≤ 12 months) was 46% (n = 132) among men who were linked to care within three months.ConclusionWhile the implementation of the UTT strategy has had positive influence on improving linkage to care, men’s access of HIV treatment remains inconsistent and may require additional innovative strategies.

Performances and determinants of proficiency testing in clinical laboratory services at comprehensive specialized hospitals, northwest Ethiopia

Proficiency testing (PT) is an impartial laboratory performance-evaluating system using an independent body. It is a mandatory accreditation requirement and means for improving the laboratory’s performance. The study aimed to evaluate the performance of PT, with a focus on identifying and discussing determinants that influence PT performance at comprehensive specialized hospitals in northwest Ethiopia. A retrospective cross-sectional study was carried out from 2020 to 2022. Using a convenient sampling technique, laboratory tests with recorded PT results in each hospital laboratory were included. A data collection template and customized checklists were used to collect the data. Epi Data Version 3.1 for data entry and STATA Version 14.1 for cleaning and analysis were used. Binary logistic regression analyses were used. Variables with p < 0.05 in the multivariable logistic regression were considered to be statistically significant. Over nine cycles, 3807 PT challenges were distributed. The total failure rate of the laboratories was 32.4%, with a peak failure rate of 40.3% in 2020, after which the failure rate was decline to 20.6% in 2022. Among the five laboratory sections, molecular biology had the lowest failure rate (22.2%), while microbiology had the highest failure rate (56.5%). Multivariate logistic regression revealed that PT results reported without appropriate unit of measurement (AOR 7.5), lack of corrective action for PT nonconformance (AOR 7.1), and reagent unavailability (AOR 6.1) had significant effects on PT performance (p < 0.001). The results of this study showed that the overall performance of the laboratory was lower. Reporting PT results without appropriate units of measurement and not taking corrective action for PT nonconformance were the major aggravating factors for high failure rates.