Biomedical Laboratory Science

Saturday, August 6, 2016

Appendicitis: Warning Signs and Early Symptoms

Appendicitis is a condition in which the appendix becomes inflamed. Its symptoms can become very uncomfortable, painful, and potentially life-threatening if left untreated.

Sudden appendicitis is the most common cause of acute abdominal pain requiring surgery in the United States. Additionally, more than 5 percent of the population develops appendicitis at some point.

Though it most commonly occurs between the ages of 10 and 30, appendicitis can develop at any age.

The appendix is a tube-shaped piece of tissue attached to part of the long intestine and severe pain is
often the first symptom of appendicitis. In most cases, it will begin near the belly button and surgery
may be needed to treat a case of appendicitis.

Source: medicalnewstoday

Resolving QC Failures

Most medical technologists and technicians, responsible for outputting test results as quickly and reliably as possible, hate it when their smooth flow of work is abruptly interrupted by an out-of-control QC rule flag. Suddenly they are faced with delayed reports, the prospect of a complicated technical investigation, and a litany of questions they must ask themselves, such as:

“Is the out-of-control condition real?”
“Do I really have a problem with the analytical system?”
“If I do have a problem, when did it start and how many patient samples are affected?”
“What should I do first?”
“What should I do next?”

The laboratory would have much less of a conundrum if it were using a new QC rule proposed in a 2012 Clinical Chemistry article.1 This rule allows, as part of its process control, the possibility of a second set of QC measurements when the first results are inconclusive.

Clinical Case Study: Red Brown Urine in a Patient with Chronic HIV Infection and Quadriparesis

A 42-year-old woman with chronic HIV infection presented with sudden onset of progressive limb weakness, leading to immobility within 4 days. This was preceded by severe abdominal pain, nausea, and vomiting for 2 days and episodes of confusion and agitation.

Six weeks prior, she had commenced highly active antiretroviral therapy (HAART), consisting of efavirenz/emtricitabine/tenofovir and cotrimoxazole for opportunistic infection prophylaxis. Additional history included constipation for 4 weeks and an admission for psychiatric symptoms 1 week before starting HAART. She had declined HAART when HIV infection was diagnosed 6 years earlier, but was successfully treated for multidrug-resistant tuberculosis.

Source: clinchem

Friday, August 5, 2016

Pre-Dementia Memory Loss Improved With Acupuncture

Acupuncture appears to be effective for the mild cognitive impairment that is a precursor for dementia, when used as an alternative or in combination with other treatment, a new study finds.

The review of available published evidence and presented in Acupuncture in Medicine shows promise for clinical effectiveness and safety of acupuncture use for the pre-dementia state. However, the authors caution that further, more rigorously designed studies are needed.

Min Deng, from the Department of Neurology at Zhongnan Hospital of Wuhan University in China, and Xu-Feng Wang, from the Department of General Surgery at Renmin Hospital of Wuhan University, conducted the study.

Mild cognitive impairment (MCI) is an intermediate stage between the expected cognitive decline of normal aging and the most severe decline of dementia.

Acupuncture may assist with improving the subtle memory loss that precedes the development of
dementia.

Source: medicalnewstoday

External and Internal QC for Blood Gases

Quality Control (QC) and Quality Assurance (QA) in the clinical lab have changed. The Centers for Medicare and Medicaid Services (CMS) has embraced a voluntary QC option for meeting CLIA quality control standards called Individualized Quality Control Plan (IQCP), which was implemented in January 2016 for all labs that have been utilizing Equivalent Quality Control (EQC). CLIA QC regulations will remain the same as published in 2003. All of the pre-analytical, analytical, and post-analytical systems requirements in the CLIA regulations will remain in effect.

There are many different aspects of the IQCP for laboratories to consider. This article will cover the minimum requirements for use of external quality controls with regard to blood gas QC.

Minimum guidelines

The minimum guidelines according to CLIA 88 (2003) require laboratories to perform external quality control at least one time per eight-hour shift.1 The IQCP does not change this requirement. In addition to the daily QC requirement, the laboratory is also responsible for calibration verification for all non-waived “moderate to high-complexity” test systems.

Source: mlo-online

Throat Cancer: Get the Facts

The throat is often described as having many different parts. This article looks at two of the more common places throat cancer can occur: the pharynx and the larynx.

The pharynx is most commonly thought of as the throat. It is a tube around 5 inches long that leads from behind the nose to the food pipe.
The larynx is also known as the voicebox. It is a short passage just below the pharynx. The larynx holds the vocal cords and a small piece of tissue called the epiglottis.

The epiglottis moves to cover the top of the larynx so food cannot enter it when people breathe.

Thursday, August 4, 2016

The Continuing Case for Point-of-Care Testing for HbA1c

There is an ongoing conflict between traditional clinical laboratories and the relative new kid on the block, point-of-care testing (POCT). Of course, the laboratory system will likely always be king. But there is absolutely a place for POCT, especially as the way in which we approach healthcare, especially diagnostics, develops beyond the usual settings.

POCT ensures the rapid provision of diagnostic information, ideally during one consultation, to enable clinical decisions to be made at the earliest opportunity. Such rapid provision of information facilitates optimization of the care process. The potential for any application of POCT can, therefore, be judged in terms of its contribution to decision making and to the process of care.

In the case of the management of diabetes patients, POCT for glycated hemoglobin (HbA1c) may offer a number of advantages—as long as the performance characteristics of the analyzers used are equivalent to those employed in the central laboratory, and can be certified as such.

The use of HbA1c for management of diabetes

Glycated hemoglobin (HbA1c) is well-recognized as a reliable measure for glycemic control.

Figure 1. Glycated hemoglobin (HbA1c) explained

Source: mlo-online

Change in 'Cervical Stitch' Thread Size Could Save Infants' Lives

The cervical stitch is a common procedure used to prevent preterm birth. Breaking research concludes that the size of the thread used can make a significant difference to the outcome for the infant.

An estimated 1 in 10 American babies are born prematurely.

Being born before the 37-week mark is the greatest contributor to infant death and a leading cause of long-term neurological disabilities.

Preterm births are triggered by the cervix opening too early and allowing the baby to enter the birth canal.

Women who are considered at high risk of miscarriage or preterm birth often undergo the cervical stitch procedure, also known as cervical cerclage.

A small change in cervical stitch thread size could save lives.

Source: medicalnewstoday

SAQs 3: Gilbert's Syndrome - A 24-year old man with no significant past medical history presents with an episode of mild jaundice.

A 24-year old man with no significant past medical history presents with an episode of mild jaundice. His liver function tests are normal apart from a bilirubin of 45 µmol/L. There is no bilirubinuria. His GP wonders whether this could be due to hemolysis, but you wish to explore an alternative diagnosis of Gilbert's Syndrome.

Answer these questions:

(a) Is this patient likely to have conjugated or unconjugated hyperbilirubinaemia?

(b) State two routinely available biochemistry tests that are of use in the exclusion of hemolysis.

(d) State two factors that exacerbate the mild hyperbilirubinemia of Gilbert's syndrome.

(e) Describe the genetic cause of Gilbert's syndrome.

(f) Discuss the diagnostic performance of genetic testing for Gilbert's syndrome.

Source: rcpath/biochemistry

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