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Fulltext Imperative: reducing the environmental impact of clinical laboratories

Gammie AJ, Lopez JB, Scott S

Clin Chem Lab Med, 2023 Mar 28;61(4):634-637.
PMID: 36343330 DOI: 10.1515/cclm-2022-1052

Clinical laboratories are significant contributors to the environmental burden of the planet. They have been slow to address the issues with a few exceptions, but it is highly encouraging to see the current impetus and ambition in this direction. This paper describes some of these initiatives and provides the rationale as to why clinical laboratories should become sustainable. It also describes the economic and intangible benefits that labs will accrue in achieving sustainability.

Matched MeSH terms: Clinical Laboratory Services*
Defining acute kidney injury in dengue viral infection by conventional and novel classification systems (AKIN and RIFLE): a comparative analysis

Mallhi TH, Khan AH, Sarriff A, Adnan AS, Khan YH, Jummaat F

Postgrad Med J, 2016 Feb;92(1084):78-86.
PMID: 26729887 DOI: 10.1136/postgradmedj-2015-133582

Several criteria have been used to stratify acute kidney injury (AKI) in dengue infection and have resulted in variations in its incidence as well as clinic-laboratory characteristics. The current study was aimed to compare three commonly used criteria of AKI among patients with dengue.

Matched MeSH terms: Clinical Laboratory Services
Fulltext How to develop a core curriculum in clinical skills for undergraduate medical teaching in the school of medical sciences at Uiversiti Sains Malaysia?

Hassan S

Malays J Med Sci, 2007 Jul;14(2):4-10.
PMID: 22993486 MyJurnal

Clinical skills program as a laboratory method is a valuable adjunct to other forms of undergraduate medical training. This article describes the process of developing a core curriculum in clinical skills based on the Dundee model for a clinical skills centre. The School of Medical Sciences, in Universiti Sains Malaysia (USM) has been provided with a well equipped skills centre. However, the PBL curriculum in the undergraduate medical program in the school needs to be integrated with a clinical skills lab program. This is to counter the general feeling that the contribution of PBL is insignificant in terms of building clinical competency in an integrated system such as that used in USM compared to the traditional curriculi of other medical teaching institutions in Malaysia. Integrating clinical skills laboratory training with the PBL curriculum will provide evidence of PBL as an effective and innovative method for teaching and learning in Malaysia.

Matched MeSH terms: Clinical Laboratory Services
Access to pathology and laboratory medicine services: a crucial gap

Wilson ML, Fleming KA, Kuti MA, Looi LM, Lago N, Ru K

Lancet, 2018 05 12;391(10133):1927-1938.
PMID: 29550029 DOI: 10.1016/S0140-6736(18)30458-6

As global efforts accelerate to implement the Sustainable Development Goals and, in particular, universal health coverage, access to high-quality and timely pathology and laboratory medicine (PALM) services will be needed to support health-care systems that are tasked with achieving these goals. This access will be most challenging to achieve in low-income and middle-income countries (LMICs), which have a disproportionately large share of the global burden of disease but a disproportionately low share of global health-care resources, particularly PALM services. In this first in a Series of three papers on PALM in LMICs, we describe the crucial and central roles of PALM services in the accurate diagnosis and detection of disease, informing prognosis and guiding treatment, contributing to disease screening, public health surveillance and disease registries, and supporting medical-legal systems. We also describe how, even though data are sparse, these services are of both insufficient scope and inadequate quality to play their key role in health-care systems in LMICs. Lastly, we identify four key barriers to the provision of optimal PALM services in resource-limited settings: insufficient human resources or workforce capacity, inadequate education and training, inadequate infrastructure, and insufficient quality, standards, and accreditation.

Matched MeSH terms: Clinical Laboratory Services/manpower*
Delivering modern, high-quality, affordable pathology and laboratory medicine to low-income and middle-income countries: a call to action

Horton S, Sullivan R, Flanigan J, Fleming KA, Kuti MA, Looi LM, et al.

Lancet, 2018 05 12;391(10133):1953-1964.
PMID: 29550030 DOI: 10.1016/S0140-6736(18)30460-4

Modern, affordable pathology and laboratory medicine (PALM) systems are essential to achieve the 2030 Sustainable Development Goals for health in low-income and middle-income countries (LMICs). In this last in a Series of three papers about PALM in LMICs, we discuss the policy environment and emphasise three crucial high-level actions that are needed to deliver universal health coverage. First, nations need national strategic laboratory plans; second, these plans require adequate financing for implementation; and last, pathologists themselves need to take on leadership roles to advocate for the centrality of PALM to achieve the Sustainable Development Goals for health. The national strategic laboratory plan should deliver a tiered, networked laboratory system as a central element. Appropriate financing should be provided, at a level of at least 4% of health expenditure. Financing of new technologies such as molecular diagnostics is challenging for LMICs, even though many of these tests are cost-effective. Point-of-care testing can substantially reduce test-reporting time, but this benefit must be balanced with higher costs. Our research analysis highlights a considerable deficiency in advocacy for PALM; pathologists have been invisible in national and international health discourse and leadership. Embedding PALM in LMICs can only be achieved if pathologists advocate for these services, and undertake leadership roles, both nationally and internationally. We articulate eight key recommendations to address the current barriers identified in this Series and issue a call to action for all stakeholders to come together in a global alliance to ensure the effective provision of PALM services in resource-limited settings.

Matched MeSH terms: Clinical Laboratory Services/legislation & jurisprudence; Clinical Laboratory Services/standards*
Fulltext Providing a laboratory diagnostic service for pandemic SARS-CoV-2 in a developing country

Sam IC, Chong J, Kamarudin R, Jafar FL, Lee LM, Bador MK, et al.

Trans R Soc Trop Med Hyg, 2020 08 01;114(8):553-555.
PMID: 32497211 DOI: 10.1093/trstmh/traa037
Matched MeSH terms: Clinical Laboratory Services/organization & administration*
Improving pathology and laboratory medicine in low-income and middle-income countries: roadmap to solutions

Sayed S, Cherniak W, Lawler M, Tan SY, El Sadr W, Wolf N, et al.

Lancet, 2018 05 12;391(10133):1939-1952.
PMID: 29550027 DOI: 10.1016/S0140-6736(18)30459-8

Insufficient awareness of the centrality of pathology and laboratory medicine (PALM) to a functioning health-care system at policy and governmental level, with the resultant inadequate investment, has meant that efforts to enhance PALM in low-income and middle-income countries have been local, fragmented, and mostly unsustainable. Responding to the four major barriers in PALM service delivery that were identified in the first paper of this Series (workforce, infrastructure, education and training, and quality assurance), this second paper identifies potential solutions that can be applied in low-income and middle-income countries (LMICs). Increasing and retaining a quality PALM workforce requires access to mentorship and continuing professional development, task sharing, and the development of short-term visitor programmes. Opportunities to enhance the training of pathologists and allied PALM personnel by increasing and improving education provision must be explored and implemented. PALM infrastructure must be strengthened by addressing supply chain barriers, and ensuring laboratory information systems are in place. New technologies, including telepathology and point-of-care testing, can have a substantial role in PALM service delivery, if used appropriately. We emphasise the crucial importance of maintaining PALM quality and posit that all laboratories in LMICs should participate in quality assurance and accreditation programmes. A potential role for public-private partnerships in filling PALM services gaps should also be investigated. Finally, to deliver these solutions and ensure equitable access to essential services in LMICs, we propose a PALM package focused on these countries, integrated within a nationally tiered laboratory system, as part of an overarching national laboratory strategic plan.

Matched MeSH terms: Clinical Laboratory Services/manpower*
Serological and molecular rapid diagnostic tests for Toxoplasma infection in humans and animals

Khan AH, Noordin R

Eur J Clin Microbiol Infect Dis, 2020 Jan;39(1):19-30.
PMID: 31428897 DOI: 10.1007/s10096-019-03680-2

Infection by Toxoplasma gondii is prevalent worldwide. The parasite can infect a broad spectrum of vertebrate hosts, but infection of fetuses and immunocompromised patients is of particular concern. Easy-to-perform, robust, and highly sensitive and specific methods to detect Toxoplasma infection are important for the treatment and management of patients. Rapid diagnostic methods that do not sacrifice the accuracy of the assay and give reproducible results in a short time are highly desirable. In this context, rapid diagnostic tests (RDTs), especially with point-of-care (POC) features, are promising diagnostic methods in clinical microbiology laboratories, especially in areas with minimal laboratory facilities. More advanced methods using microfluidics and sensor technology will be the future trend. In this review, we discuss serological and molecular-based rapid diagnostic tests for detecting Toxoplasma infection in humans as well as animals.

Matched MeSH terms: Clinical Laboratory Services
Fulltext Mobile Phones: A Possible Vehicle of Bacterial Transmission in a Higher Learning Institution in Malaysia

Hikmah N', Anuar TS

Malays J Med Sci, 2020 Mar;27(2):151-158.
PMID: 32788850 MyJurnal DOI: 10.21315/mjms2020.27.2.15

Background: Mobile phones (MPs) have become one of the most indispensable accessories in social and professional life. Though they offer plenty of benefits, MPs are prolific breeding grounds for infectious pathogens in communities. Thus, the aim of this study was to identify the prevalence of bacterial contamination and determine antimicrobial susceptibility pattern of Staphylococcus aureus (S. aureus) from MPs.
Methods: A cross-sectional study was conducted from March to July 2019 on 126 students and 37 laboratory staff/clinical instructors' MPs from the Faculty of Health Sciences, Universiti Teknologi MARA, Malaysia by a simple random sampling technique. Along with the questionnaire, a swab sample from each participant's MPs was collected and transported to the microbiology laboratory for bacterial culture as per standard microbiological procedures and antimicrobial susceptibility test by the disc diffusion technique. Data were analysed by the Statistical Package for Social Sciences Programme version 24.
Results: All of the tested MPs were contaminated with either single or mix bacterial agents. Bacillus spp. (74.8%), coagulase-negative staphylococci (CoNS; 47.9%) and S. aureus (20.9%) were the most predominant bacterial isolates, whilst the least isolate was Proteus vulgaris (P. vulgaris) (2.5%). Oxacillin resistance was seen in 5.9% of S. aureus isolate. A comparison of bacteria type and frequency among gender showed a significant difference with P. vulgaris (P = 0.003) and among profession showed a significant difference with S. aureus (P = 0.004).
Conclusion: The present study indicates that MPs can serve as a vector for both pathogenic and non-pathogenic organisms. Therefore, full guidelines about restricting the use of MPs in laboratory environments, hand hygiene and frequent decontamination of MPs are recommended to limit the risk of cross-contamination and healthcare-associated infections caused by MPs.

Matched MeSH terms: Clinical Laboratory Services
Fulltext The antibacterial effects of vitamin D3 against mutans streptococci: an in vitro study

Almoudi MMM, Hussein AS, Abu Hassan MI, Al-Talib H, Khan HBSG, Nazli SAB, et al.

Eur Oral Res, 2021 Jan 04;55(1):8-15.
PMID: 33937756 DOI: 10.26650/eor.20210119

Purpose: This study aims to evaluate the antimicrobial effects of the cholecalciferol vitamin D3 against Streptococcus sobrinus (Strep. sobrinus) and Streptococcus mutans (Strep. mutans) bacteria in vitro that is considered the main causative bacteria in dental caries development.
Materials and methods: The antimicrobial effects of vitamin D3 were evaluated against Strep. sobrinus and Strep mutans using the agar disc diffusion method. The minimum inhibitory concentration (MIC) and minimum bactericidal concentration (MBC) of vitamin D3 were determined using a microdilution method following the guidelines by the Clinical Laboratory Standards Institute (CLSI). Scanning electron microscope (SEM) was used to evaluate the morphological changes of bacterial cells following exposure to vitamin D3.
Results: Strep. sobrinus was more sensitive to vitamin D3 compared to Strep. mutans bacteria. The MIC values of vitamin D3 against Strep. sobrinus and Strep. mutans were 60 μg/ mL and 250 μg/mL respectively whereas the MBC values were 120 μg/mL and 500 μg/mL, respectively. Moreover, significant changes in the bacterial morphology were observed in treated bacterial cells with vitamin D3 as compared to the untreated control bacteria using SEM.
Conclusion: These findings suggested that vitamin D3 has excellent antimicrobial effects against Strep. sobrinus and Strep. mutans and may be considered as a promising compound in the prevention of dental caries in the future. Further research is recommended to elucidate the mechanism of vitamin D3 on these bacteria.

Matched MeSH terms: Clinical Laboratory Services