Medical Diagnostic Laboratory Research Articles

Frequency of bla CTX-M and bla TEM Virulence Genes and Antibiotic Resistance Profiles among Klebsiella pneumoniae Isolates in Urinary Tract Infection (UTI) Samples from Hashtgerd, Iran.

Klebsiella pneumoniae (K. pneumoniae) is an opportunistic microorganism and one of the most important causes of urinary tract infection. This study aimed to evaluate the frequency of K. pneumoniae producing broad-spectrum beta-lactamase in urinary tract infection and to determine the pattern of drug resistance. This study was performed on 50 samples of K. pneumoniae isolated from patients with urinary tract infection referred to the Medical Diagnostic Laboratory in Hashtgerd city. The isolates were first evaluated for antibiotic susceptibility by disk diffusion method according to the method proposed by the Clinical and Laboratory Standards Institute (CLSI). Then phenotypic detection of ESBLS was carried out by the DDST method. The frequency of gene bla TEM and bla CTX-M was determined by PCR. The highest resistance was observed to ampicillin (94%) and the highest sensitivity was observed to gentamicin (84%). 22 isolates (44%) were positive for ESBLs production. Of the 50 isolates studied, 34% had bla CTX-M and 28% had bla TEM and 11 (22%) had both genes simultaneously. Also, more than 77% of positive ESBLs isolates had the bla CTX-M gene and approximately 63.64% of positive ESBLs isolates had the bla TEM gene. Given the high prevalence of antibiotic-resistant and ESBL-producing isolates, early identification of these resistant isolates and their follow-up is essential to prevent further outbreaks. It is also important to use appropriate therapeutic strategies and proper and rational administration of antibiotics by physicians.

Electronic tools in clinical laboratory diagnostics: key examples, limitations, and value in laboratory medicine

Abstract Electronic tools in clinical laboratory diagnostics can assist laboratory professionals, clinicians, and patients in medical diagnostic management and laboratory test interpretation. With increasing implementation of electronic health records (EHRs) and laboratory information systems worldwide, there is increasing demand for well-designed and evidence-based electronic resources. Both complex data-driven and simple interpretative electronic healthcare tools are currently available to improve the integration of clinical and laboratory information towards a more patient-centered approach to medicine. Several studies have reported positive clinical impact of electronic healthcare tool implementation in clinical laboratory diagnostics, including in the management of neonatal bilirubinemia, cardiac disease, and nutritional status. As patients have increasing access to their medical laboratory data, it is essential that accessible electronic healthcare tools are evidence-based and user-friendly for individuals of varying digital and medical literacy. Indeed, studies suggest electronic healthcare tool development processes significantly lack the involvement of relevant healthcare professionals and often present misinformation, including erroneous calculation algorithms or inappropriate interpretative recommendations. The current review provides an overview of the utility of available electronic healthcare tools in clinical laboratory diagnostics and critically reviews potential limitations and benefits of their clinical implementation. The Canadian Laboratory Initiative on Pediatric Reference Intervals (CALIPER) online database is also detailed as an example of a pediatric diagnostic tool with widespread global impact.

PSI-8 Determining the effect of dam milk production and mastitis infection during pregnancy on blood biochemistry in dairy bull calves

Abstract Maternal programming can affect offspring health postnatally. We hypothesized that high milk production and/or mastitis infection during pregnancy will adversely affect calf blood biochemical analytes. Holstein bull calves (n = 45) were transported to the University of Rhode Island within 24 hrs of birth. Calves were classified by dam production and somatic cell counts (SCC) during pregnancy; HI (top 25% for herd M305, n = 7), MOD (lower 60% for herd M305, n = 16), HIMAST (HI with SCC ≥ 200,000 cells/mL; n = 15), and MODMAST (MOD with high SCC; n=6). Calves were sampled once a week for 8 wks. Serum was sent to the Missouri State Veterinary Medical Diagnostic Laboratory (Columbia, MO) for analyses. Results were analyzed in SAS using proc mixed. At wk 1, Calcium (Ca) concentrations were greater in HI calves (11±0.61mg/dL; P =.05) than MOD calves (10± 0.25mg/dL). At wk 3, Ca concentrations were greater in HIMAST (10± 0.13mg/dL) compared to HI (8±.048mg/dL; P<0.01) and MOD (9±0.36mg/dL; P =.02) calves respectively. MODMAST calves (10 ± 0.460 mg/dL) exhibited greater Ca concentrations than HI calves (P = 0.05). Aspartate aminotransferase concentrations were greater in HIMAST calves compared to MODMAST calves at wk 1 (36±2.49 Units (U)/L vs. 27±2.63U/L; P = .04) and wk 8 (79±7.08U/L vs. 47±5.71U/L; P<0.01). At wk 8, total protein concentrations were greater in HIMAST (6 ± .13g/dL) calves compared to MODMAST(5±0.13g/dL; P =.01) and MOD calves(5±.13g/dL; P = .03). In conclusion, maternal mastitis infection and production level during pregnancy does affect key circulating factors in the offspring. Correlation and gene expression analyses will be performed to better understand these changes.

PSII-19 The Effects of Maternal Programming on Dairy Bull Calf Response to an Intravenous Glucose Tolerance Test

Abstract Calves are prone to health issues with high mortality observed during the first 3 weeks of life. We hypothesized that dam milk production levels and/or mastitis infection during gestation will lead to reduced insulin production and increased circulating glucose concentration in response to an Intravenous Glucose Tolerance Test (IVGTT) in young dairy bull calves. Calves (n = 45) were selected from dams classified has high producers (HI; Top 25% for herd M305; n = 7), high producers with high somatic cell count (SCC; HIMAST; SCC test during gestation over 200,000 cells/mL; n = 15), moderate producers (MOD; lower 60% for herd M305; n =17) or moderate producers with high SCC (MODMAST; n = 6). IVGTT were performed on the calves at 7 weeks of age. Blood samples were collected prior to (-30, -15 and 0 min) infusion of glucose. After glucose (0.15 grams /kg bw) administration, samples were collected at 2, 5, 10, 15, 30, 60, and 120-minutes post infusion. Serum insulin and glucose concentrations were determined at Cornell Veterinary Medical Diagnostic Laboratory (Ithica, NY). Data were analysed in SAS using Proc Mixed. Insulin:glucose ratio was analysed using Proc Mixed with repeated measures for treatment x time. No effect of maternal milk production and/or mastitis infection during gestation was observed on calf baseline insulin, insulin AUC, baseline glucose or glucose AUC (P ≥ 0.12). Similarly, no difference in Insulin:Glucose ratio was observed in these calves (P = 0.66). In conclusion, high maternal milk production and/or mastitis infection may not have an effect on circulating insulin production in calves in response to an IVGTT. Correlation analyses will be performed on these data, as well as additional analyses, to determine if insulin sensitivity or response (ie: phase 1 response) was altered further.

Prevalence of Cryptosporidium in Children Under 13 Years of Age With Acute Diarrhea in Tabriz, Iran

Introduction: Cryptosporidium is a coccidian parasite that causes diarrhea in animals and humans, especially children. Although several studies have been done on Cryptosporidium infection in some parts of Iran, this parasite is not examined in routine parasitological tests. Therefore, the aim of this study was to determine the frequency of Cryptosporidium infection in children with diarrhea in Tabriz, Iran. Materials and Methods: In this study, 100 fecal samples of children under 13 years of age with acute diarrhea who referred to medical diagnostic laboratories in Tabriz during 2018 were examined for Cryptosporidium infection. The samples were first concentrated by formalin-ether method and after staining with modified acid fast method, they were examined by light microscope. Results: In this study, 3 children (3%), 2 boys, 3 years old and 5 years old, and a 3-year-old girl had cryptosporidiosis. Conclusion: The results of the present study show the presence of Cryptosporidium infection in children in Tabriz. The very low percentage of infection with this parasite indicates that this parasite is not yet considered as a health problem in this area.

The medical diagnostic laboratory

The coronaviruses are single-stranded RNA viruses, one of which is responsible for the current outbreak of coronavirus disease-19. COVID-19 has affected health-care workers including laboratory personnel worldwide in an alarming and unprecedented manner. In India too, the huge number of infected health-care staff has further weighed down our already over-burdened health-care system. While their protection is of paramount importance, it is also essential that these personnel adhere to the specific bio-safety practices to minimize their exposure to this disease. In this article, our objective is to provide guidelines for laboratories while working with COVID-19 samples to reduce the human and economic burden in the current pandemic. A risk assessment of all policies must be done and standard operating procedures on all ‘Safe Laboratory Practices and Procedures’ must be readily available for the staff. Dividing the laboratory functions into three broad phases, namely pre-examination, examination and post-examination, the precautions outlined for each stage must be followed stringently with the frequency defined as per the workload of the laboratory. The safety measures must cover all the laboratory processes including sample disposal. Decontamination too plays a major role and must be performed as per the standard national and international guidelines. Hence, following special precautions in the laboratory while working through the COVID-19 pandemic will not only minimize the risk of infection to the laboratory staff and but also help reduce the mortality and morbidity associated with this disease.

Role of Laboratory Medicine in SARS-CoV-2 Diagnostics. Lessons Learned from a Pandemic.

Since the 2019 novel coronavirus outbreak began in Wuhan, China, diagnostic methods in the field of molecular biology have been developing faster than ever under the vigilant eye of world’s research community. Unfortunately, the medical community was not prepared for testing such large volumes or ranges of biological materials, whether blood samples for antibody immunological testing, or salivary/swab samples for real-time PCR. For this reason, many medical diagnostic laboratories have made the switch to working in the field of molecular biology, and research undertaken to speed up the flow of samples through laboratory. The aim of this narrative review is to evaluate the current literature on laboratory techniques for the diagnosis of SARS-CoV-2 infection available on pubmed.gov, Google Scholar, and according to the writers’ knowledge and experience of the laboratory medicine. It assesses the available information in the field of molecular biology by comparing real-time PCR, LAMP technique, RNA sequencing, and immunological diagnostics, and examines the newest techniques along with their limitations for use in SARS-CoV-2 diagnostics.

Complete mitochondrial genome of Asian longhorned tick, Haemaphysalis longicornis, Neumann, 1901 (Acari: Ixodida: Ixodidae) identified in the United States

Haemaphysalis longicornis (Ixodida: Ixodidae), the Asian longhorned tick, which is native to temperate East Asia, has been recently detected in the northeastern region of the United States, drawing concerns about its potential impact on the US animal and public health sectors. Knowledge about the genetic features of H. longicornis found in the US is limited. Therefore, we sequenced the complete mitochondrial genome (mt-genome) from two H. longicornis ticks recently collected in the State of New York, USA, in 2020. These ticks were morphologically identified and tested for tick-borne pathogens at the Connecticut Veterinary Medical Diagnostic Laboratory (Storrs, CT). The mt-genome was 14,694 bp in length and encoded 37 genes, including 13 protein-coding genes, 22 transfer RNAs, and two ribosomal RNAs. Phylogenetic analysis showed that the mt-genome clustered with those of other H. longicornis identified in China. The mt-genome sequence was 99.7% identical to a H. longicornis mt-genome (GenBank: MK439888) collected in China. The cox1 gene haplotype in these ticks belonged to the H1 type, which is the dominant haplotype present in central NJ and Staten Island, NY. The complete mt-genome data are needed to provide insights into genetic changes and phylogenetic studies of H. longicornis ticks.

Measuring the performances of Medical Diagnostic Laboratories based on interval efficiencies

The classic data envelopment analysis (DEA) models have overlooked the intermediate products, internal interactions and the absence of data certainty; and deal with analyzing the network within the “Black Box” mode. This results in the loss of important information and at times a considerable modification occurs in efficiency results. In this paper, a Three-stage network model is considered with additional inputs and undesirable outputs and obtains the efficiency of the network, as interval efficiency in presence of the imprecise datum. The proposed model simulates the internal structure of a diagnostic lab (the pre-test, the test and the post-test). In this study, the criteria for evaluation are obtained by using the Fuzzy Delphi method. Due to the social, economic and environmental problems of health care organizations, the importance of sustainability criteria is evident in the case study indicators. We utilized the multiplicative DEA approach to measure the efficiency of a general system and a heuristic technique was used to convert non-linear models into linear models. Ultimately, this paper concentrates on the interval efficiency to rank the units.

Prevalence of Virulence Genes and Antibiotic Resistance Pattern in Enterococcus Faecalis Isolated from Urinary Tract Infection in Shahrekord, Iran.

This study aims to specify the antimicrobial resistance pattern and virulence genes of Enterococcus faecalis isolated from urinary tract infections in Shahrekord, Iran. Urine samples of 1000 people suspected of having urinary tract infections referred to Shahrekord medical diagnostic laboratories were examined. Biofilm assays were performed by microtiter plate test through reading the OD490. Polymerase Chain Reaction (PCR) was applied to study the virulence factors. Enterococcus faecalis was detected in 60 samples. After performing microbiological tests, all samples were positive in the molecular analysis. Strong, moderate and weak biofilm reactions reported 66.67%, 25%, and 8.33% respectively. The most resistance reported to cotrimoxazole, vancomycin and amikacin and the lowest resistance to nitrofurantoin (8.33%) was reported. Statistical analysis with Fisher's exact test showed a statistically significant relationship between biofilm production and resistance to cotrimoxazole, vancomycin and cefotaxime. Prevalence of efe A, ace, gel E, esp, cyl M, agg, cyl A and cyl B in strong biofilm formation isolates was reported 100%, 87.5%, 82%, 62.5%, 55%, 37.5% 25% and 22.5% respectively. There was a significant relationship between the frequency of efa A and strong biofilm reaction. The presence of E. faecalis strains resistant to co-trimoxazole and vancomycin and present of some virulence factors is alarming the researchers. Since antibiotic resistance genes are probably transmitted among enterococci, and Staphylococci, controlling infections made by enterococci as well as the appropriate administration of antibiotics could treat the nosocomial infections effectively.

Stray Mexico origin cattle captured crossing into Southern Texas carry Babesia bovis and other tick-borne pathogens

Cattle fever ticks, Rhipicephalus microplus and R. annulatus have been eradicated from the United States and inspectors from the U.S. Department of Agriculture (USDA), Animal Plant Health Inspection Service (APHIS), Cattle Fever Tick Eradication Program (CFTEP) monitor the quarantine zone along the Texas border to prevent the introduction of livestock carrying cattle fever ticks from Mexico. Stray livestock apprehended by CFTEP in the zone are checked for ticks and tested for infectious disease-causing pathogens but are not evaluated for evidence of infection with tick-borne pathogens. We tested blood samples collected from stray cattle by CFTEP inspectors for evidence of infection with tick-borne pathogens. As a comparison group representing U.S. resident cattle, we tested blood samples that had been sent to the Texas A&M Veterinary Medical Diagnostic Laboratory (TVMDL) for unrelated testing. Both sets of blood samples were evaluated using the same specific and broad-spectrum PCR assays. For the border cattle the overall prevalence of infection with one or more tick-borne pathogen was 58.5 % (79/135) with many co-infections, including 30 cattle positive for Babesia bovis and/or Babesia bigemina (22.2 %) and 77 cattle positive for Anaplasma marginale (57 %), three of these animals were also positive for Borrelia theileri. No resident cattle represented by the TVMDL samples were infected with either of the Babesia spp., or with Borrelia theileri, but three were positive for Theileria orientalis and 7.3 % (7/96) were positive for A. marginale. These data show that cattle originating in Mexico have a higher prevalence of infection with tick-borne pathogens relative to resident U.S. cattle and specifically, a proportion are infected with bovine Babesia, which is absent from U.S. cattle populations. Consequently, these stray cattle may be a reservoir of tick-borne pathogens and if populations of Boophilus ticks become reestablished in areas where they had previously been eradicated, could pose a significant risk to the U.S. Cattle industry.

Modern Trends and Prospects for the Development of Russian Healthcare: The Role of Digital Technologies

Health care as an open system is affected by external fluctuations: the processes of globalization, digitalization and informatization; modernization and virtualization; increasing complexity of problems and volumes of information; increasing share of qualified, creative work; challenges and threats of the future, increasing social tension and devaluation of values. All this leads to a change in the management paradigm, which is based on future management, advanced development, self-education and self-development. Data analysis of VTSIOM secondary sociological studies and author’s analysis of the content of discussions from August 2018- to February 2019 of medical professionals ’online communities were conducted. The study has identified the following current trends: the growth of informatization, virtualization, the emergence of new medical technologies, the formation of the global medical market, the change in the management paradigm of public and non-profit health organizations, the formation of new requirements for managers and staff of medical organizations. Global trends are linked to the growing popularity of digital healthcare. Medical institutions, diagnostic laboratories and insurance companies are gradually getting involved in the digitalization process and creating a single electronic system. This task is included in the National strategy for the development of artificial intelligence in Russia. The study has fixed that the problem of accessibility and quality of medical care in the country remains relevant, which is confirmed by the data of independent sociological studies. The main risks of digital medicine development are data security and insufficient professional competence of medical personnel in the field of information technology. It is important to support the processes the of users number of medical relevant social networks: iVrach.com, imedicina.ru, vrachirf.ru, doctocnarabote.ru, novmed.net, medtusovka.ru, doctornet.ru as well as consolidation of Russian technology companies in developing their own up-to-date software products for digital medicine.
 Keywords: Digital Healthcare; digital technologies; quality of medical services, telemedicine, Russian healthcare, risks of digitalization Introduction

Editorial – A new year and a new editor team

Editorial – A new year and a new editor team

Subtypes identification and frequency of Blastocystis isolated from patients in Kashan, Central Iran

Aims: Blastocystis species are one of the most common enteric protist infections in humans and some animals worldwide. Molecular studies have shown that there is a high level of genetic variation among Blastocystis isolates. The aim of this study was to identify the subtypes and frequency of Blastocystis isolates in patients who referred to the medical diagnostic laboratories in Kashan, Central Iran. Materials and Methods: This cross-sectional study was conducted on 1118 patients, from December 2017 to June 2018. Fecal specimens were evaluated by the microscopic examination. Positive samples were cultivated in Robinson media. After massive growth and DNA extraction, a 550 bp from the small subunit ribosomal RNA gene was amplified by the polymerase chain reaction (PCR) for subtype identification. The PCR products have been sequenced, identified, and compared at the NCBI site. The results were analyzed using the SPSS software version 16. Results: The frequency of Blastocystis sp. was 8.58%, (confidence interval = 6.94%–10.22%) from which 76% were men and 24% were women. Of the 51 PCR positive samples, ST3 (41.2%), ST1 (39.2%), ST2 (11.8%), and 7.8% isolates were identified as mixed. ST3 and ST1 have been more common. The highest levels of infection were observed in the food-handlers, the age group of 31–40, and people with high school education. Conclusion: The results showed that the frequency of Blastocystis was lower than other studies and the most common Blastocystis subtype was subtype 3, followed by subtype 1, and subtype 2.

An overview of medical diagnostic laboratories in South Africa that meet the international standard of accreditation: ISO 15189

Accreditation is an official recognition that a facility or laboratory is competent to perform specific tasks and has a documented manual on a Quality Management System (QMS) in place. According to the Accreditation Act 19 of 2006, South African National Accreditation Systems (SANAS) is the only internationally recognised accreditation body in South Africa. The International Organization for Standardization (ISO) standard specifically for medical laboratory accreditation is ISO 15189:2012. This review is designed to bring awareness of accredited and unaccredited medical diagnostic laboratories in SA; to look at the number of accredited, unaccredited laboratories and the rate of accreditation growth; to examine the state of accreditation in South Africa with regard to how many are accredited, suspended or withdrawn; and to highlight the advantages of being an accredited laboratory. It also examines the nonconformances commonly raised during assessment and an overview of accreditation around the world. Upon accreditation, the laboratory is given the right to use the SANAS symbol on patient request forms or results as a confirmation of competency. This has motivated more and more laboratories to be accredited. Diagnostic laboratories contribute much toward the final decisions taken by clinicians to diagnose the patients or treatment; this may be from an accredited or non-accredited laboratory. Since patient care is inextricably linked to pathology testing, every laboratory should engage a premium QMS and be evaluated by an accreditation body to ensure that patients receive a trustworthy report. Accreditation is a voluntary process in South Africa but mandatory in some Western countries. Although some laboratories might lose accreditation along the way, the ratio compared to those accredited is still very small. The fact that a majority remain accredited is a good indication of a well-implemented QMS. The challenges faced by the medical technologist-owned laboratories remain, as they are still not accredited.

Infection prevention and control status of medical diagnostic laboratories in western Kenya

Background: Infection prevention and control in medical diagnostic laboratories is becoming increasingly important subject as a result of emergence of highly infectious viral diseases such as Marburg, Zika, Hepatitis and HIV. A growing numbers of personnel are employed in laboratories that range in size and complexity, equally the number of patients and health care workers who visit laboratories for test results and consultation need to be protected against laboratory related risks that threatens safety and health. Methods and materials: Across sectional study was conducted to evaluate IPC measures employed in private and public medical diagnostic laboratories in western part of Kenya using the Kenyan biosafety and biosecurity policy guideline questionnaire and observation checklist. Study approval was obtained from NACOSTI and data analyzed using STATA v 13. Results: A total of one hundred and thirteen medical diagnostic laboratories were visited and evaluated for the presence of infection prevention and control measures employed, of which 77 (68.1%) were located in rural areas and 78 (69%) were private. Males were the majority 72 (63.7%). Mean year of service of the staff in the laboratory was 3.22 with majority 96 (85%) having active service of less than five years. Mean number of laboratory staff per facility was 1.63 with majority 99 (88%) having one. Laboratory that had staff with appropriate vaccination were 68 (60.2%) of with 23 (33.8%) were private and 45 (66.2%) were public. Appropriate Vaccination record available 34 (30.1%), aware of laboratory accident SOP 107 (94.7%), training on laboratory incident and accident handling 109 (96.5%), designated biosafety officer 98 (86.7%) availability of post exposure prophylaxis policy and SOP 11 (9.7%), SOP posted in areas where all staff can see 20 (17.7%). Presence of Hand washing sinks (71.7%). Conclusion: Laboratory personnel are trained on IPC however; there is a gap in implementation of the knowledge learnt. Regular monitoring and assessment of diagnostic laboratories for compliance with IPC measures will not only promote a safer working environment, but could also impact greatly on service delivery. Therefore more strategies on the “know-do gap” that translates training into practice with proper documentation need to be employed to close identifiable gaps.

A Perusal of Managers' Optimism Pursuant to the Rate of Hormones in Blood

The objective of the current survey was to excavate the effect of the rate of hormones in the blood, age, and gender on the financial behavior of managers. Also, preparing and propounding the neurofinance model of financial behaviors that have generated anomalies such as optimism in the market is other intentions of this study. This research has been operated with an inductive approach and experimentally in a one-time period in a statistical population consisting of 37 male and female managers with an average age of 25-60 years. The amounts of the testosterone, free testosterone, cortisol T3, T4, and TSH were deliberate in a medical diagnostic laboratory with a blood test. Managers' optimism data were accumulated with a standardized questionnaire straight away afterward receiving the blood sample. The prepared data were analyzed with SPSS and LISREL and RSM software. The outcomes demonstrated that age has a significant inverse relationship with optimism. Free Testosterone; T4 and testosterone play an inverse role in optimism augmenting. Cortisol and T3 are straightly related to optimism. Also, financial behavior is further related to the dimension of optimism in women than men, and with growing older, optimism decreases. The significant effect of testosterone and cortisol, age and gender on optimism, confirmed the effect of these hormones on the financial behavior in other studies. The effect of testosterone and thyroid hormones on optimism was considered in this survey for the first time.

PSI-26 The Effects of Probiotics on Growth and Metabolism in Ram Lambs

Abstract Probiotic treatment can improve feed efficiency, increase growth, and alter blood components in small ruminants. Several commercial probiotics are available, but they vary in microorganisms resulting in different effects on growth and health. We hypothesized that Probios (Menomonie, Wisconsin) powder would increase growth, feed efficiency, and alter blood metabolites in ram lambs from 2 to 6 months of age. Twenty individually housed Shropshire ram lambs (average age 59.85 ± 2.74 days) were randomly assigned to a control or probiotic treatment group. Lambs were fed lamb concentrate (17.2% CP, 3.56 Mcal/kg) at 3.6% of their body weight and ad libitum hay (16.2% CP, 2.53 Mcal/Kg). Probios (10g) was fed once daily in concentrate of the probiotic group. Feed intake (FI) was determined daily and body weight (BW), body condition score (BCS), feed:gain (F:G), and average daily gain (ADG) were determined weekly. At weeks 0 and 16, heart girth (HG) and crown-rump length (CRL) were measured and ultrasonography of back fat (BF) and loin-eye area (LEA) was performed. Blood samples were collected biweekly. Week 16 blood metabolites were determined using Food Animal Maxi Panel (Missouri Veterinary Medical Diagnostic Laboratory). Plasma concentration of malondialdehyde (MDA) was determined at weeks 0, 6, and 16. Data were analyzed using SAS. Statistical significance was considered at P≤ 0.05. As a result of time, BW, BCS, ADG, FI, and F:G increased for all animals (P < 0.0001). No effect of treatment was observed for growth, feed efficiency, or oxidative stress measurements (P ≥ 0.33). Plasma albumin concentration increased by 12.66% (P = 0.02) and magnesium concentration increased by 5.83% (P = 0.01) as a result of treatment. Treatment had no effect on other measured blood metabolites. Probios powder did not alter growth but did alter blood metabolites in these lambs. Future studies should examine more effects of Probios on metabolism in growing lambs.

External quality assessment programs of laboratory test results conducted by the Central Center for Quality Research in Laboratory Diagnostics in 2019

In 2019, the Central Center for Quality Research in Laboratory Diagnostics conducted 24 editions as part of eight external quality assessment programs. Four programs (in the field of clinical chemistry, hematology, parameters of acid-base balance and ISE electrolytes, and coagulatory) were conducted with the frequency of four editions a year, which gradually adjusts the implementation of the programs to the requirements of the Regulation of the Minister of Health of December 15, 2017 (Journal of Laws No. U. 2017, item 2394). The other four programs, for financial reasons, were conducted with the frequency of two editions a year. In 2019, the Central Center also maintained a procedure for transporting control material samples to laboratories by courier. In total, 558.947 control test results from 1542 polish medical diagnostic laboratories were assessed in 2019. In seven programs carried out in 2019, the percentage of correct results according to the adopted group criteria was slightly higher compared to 2018. Only in the hematology program, the percentage of correct results according to group means was lower due to the applied limits of the acceptable error limits. It is worth emphasizing thatthe annual regularity assessments obtained in 2019 are comparable to those obtained in 2018.

Antimicrobial Resistance among Community-Acquired Uropathogens in Mashhad, Iran.

Background Antimicrobial resistance among community-acquired uropathogens is an emerging concern over the past decades that warrants a continuing reevaluation of the appropriateness of recommended empiric antimicrobial regimens for treatment of urinary tract infections (UTIs). Aims To describe the microbial spectrum and resistance profile of community-acquired uropathogens and predictors of isolation of resistant strains. Methods Between October 2017 and June 2019, individuals who visited the outpatient clinics for diagnosis of UTIs or screening of asymptomatic bacteriuria were included in the study if they were tested for urine culture in one of the three main medical diagnostic laboratories of Mashhad, Iran. The standard disk diffusion antimicrobial susceptibility testing was used, with the Clinical and Laboratory Standards Institute (CLSI) threshold cutoffs for susceptibility of isolated uropathogens. Results Three hundred thirty cases were included with a median age of 47 years. Two hundred seventy-six (83.6%) were female. The most common isolated uropathogens were Escherichia coli in 201 (60.9%) cases and Klebsiella species in 46 (13.9%) cases. E. coli isolates showed the highest rates of susceptibility to nitrofurantoin (89.3%), cefixime (75%), and gentamicin (72.4%). Exposure to antibiotics in the past 3 months was a predictor of resistance to ciprofloxacin (OR: 2.8, 95% CI: 1.33–6.28), and older age was a predictor of resistance to TMP-SMX (OR: 2.1, 95% CI: 1.07–3.97) among E. coli isolates. Conclusion. E. coli and Klebsiella species accounted for about two-thirds of community-acquired uropathogens. In regard to the high susceptibility rates, nitrofurantoin was identified as the first-choice agent for empiric treatment of community-acquired cystitis, while cefixime and gentamicin might be the second-choice alternatives. Ciprofloxacin and TMP-SMX, on the other hand, cannot be considered appropriate agents for empiric therapy of community-acquired UTIs, particularly in those who had exposure to antibiotics in the past 3 months and the elderly.