Ending Post

Well everyone,

The semester has finally come to a close. I have tried to share a lot of information and in doing so, you all have shared information with and taught me a lot. I would like to thank everyone who chose to read and comment on my posts. I hope you found the information I presented informative and well as interesting, and most importantly, I hope that you can take the information you’ve learned from my blog and use it going forward. Though the course is ending and this blog is no longer a requirement, I really enjoyed working on it so in the future, from time to time, I may still post tid-bits of interesting information that I come across. 

Again, thanks for reading!

Natashia R. Reese

UAB CLS Graduate Student

Joke of the day:

Quality Control in the Microbiology Lab

Hello everyone,

This week in lecture we discussed quality in the clinical microbiology laboratory. This related directly to laboratory tour our class to of VA Medical Center. Here’s what I learned:

Laboratory quality control is designed to detect, reduce, and correct deficiencies in a laboratory's internal analytical process prior to the release of patient results, in order to improve the quality of the results reported by the laboratory. QC is associated with the internal activities that insure diagnostic accuracy as well as those external activities that ensure positive patient outcome. Positive patient outcomes are:
• Reduced length of stay
• Reduced cost of stay
• Reduced turn-around time for diagnosis of infection
• Change to appropriate antimicrobial therapy
• Customer ( physician or patients )satisfaction
The items list above are the responsibility of all laboratory personnel .

The Standard operating procedures manual (SOPM)  is considered part of QC program. The SOPM defines test performance, tolerance limits, reagent preparation, required quality control ,result reporting and references. The SPOM is available in the work area and is the definitive laboratory reference that is used often for questions relating to individual test .

Continuing education program are also apart of quality control to ensure that sufficient qualified personnel are employed for the volume and complexity of the work performed.

Also apart of quality control, the laboratories are required to participate in an external proficiency testing (PT). The laboratory must maintain an average score of 80%to maintain licensure in any subspecialty area. The laboratory's procedures, reagents, equipment and personnel are all checked in the process. PT provides an insight into the laboratories performance.

And last, the media, is also a part of quality. Sterility checks are performed of all media used in the laboratory. This done by taking a representative sample of the lot and testing it for sterility. 5% of any lot is tested when a batch of 100 or fewer unit is received   and maximum of 10 units are tested in large batches. Sterility is checked by incubating the medium for 48 hours at the temperature at which it will be used.

Of course these are just a few areas of quality control in the microbiology lab. There are many, many more but these are some that not only did we learn about in class but I also heard the microbiology supervisor mentioned that she participated in in her lab.

I have included a link to a video that I thought was interesting called, Meet the Pathologists Behind the CAP's Surveys.  This video is of members of the College of American Pathologists that attended the 2011 AACC Annual Meeting in Atlanta and explained how Board-certified pathologists shape CAP's world-renown Proficiency Testing Program. If you’re interest check it out!!!
http://www.youtube.com/watch?v=tKEJ8mgmqME

Thanks for reading!

Graduate Project - Treatment and Prognosis

Hello everyone,

So as the semester comes to a close and we look back, we have discussed and learned a lot about Systemic Lupus Erythrematosus. We’ve learned about the different types, the many and varying symptoms, the diagnosis,, we’ve even learned the many people that we know that are sufferers of the disease. Now it’s time we chat a little about treatment and prognosis.

Treatment

As we know there is no cure for SLE so the goal of treatment is to control symptoms. Treatment decisions are based on symptoms and the severity of those symptoms.

Mild disease may be treated with:

• Nonsteroidal anti-inflammatory medications (NSAIDs) treat arthritis and pleurisy


• Corticosteroid creams to treat skin rashes


• An antimalaria drug (hydroxychloroquine) and low-dose corticosteroids for skin and arthritis symptoms


• You should wear protective clothing, sunglasses, and sunscreen when in the sun.

Treatment for more severe lupus may include:

• High-dose corticosteroids or medications to decrease the immune system response


• Cytotoxic drugs (drugs that block cell growth)

Also, it is important to have preventive heart care, up-to-date immunizations, tests to screen for thinning of the bones (osteoporosis), and therapy and support groups which may help relieve depression and mood changes that may occur in patients with this disease.

Prognosis

SLE is one of the most serious rheumatic diseases and it can affect so many organs that a cause of death in some people with SLE may not be directly attributed to the condition. In fact, a primary cause of death among patients with lupus is atherosclerosis which is a disease of the coronary blood vessels resulting from accelerated buildup of plaque. Never the less because of more effective and aggressive treatment, the prognosis for SLE has improved markedly over the past two decades. Only three drugs were FDA-approved for the treatment of lupus (Prednisone, Aspirin, Hydroxychloroquine) until the 2011 FDA approval of belimumab so advances are being made. It has been seen that treatment early in the course of the illness improves long-term progress. About 85 - 95% of people with lupus survive 10 years and most people with lupus can live normal lives as longs as the disorder is carefully monitored and treatment adjusted as necessary to prevent serious complications.

So, there has been a lot of information shared and now it’s time to put it all to the test. This blog post is what I like to call "SLE Review"!!! Below you will find a crossword puzzle that all about Lupus. If you dare try it out. Test your knowledge and see how much you’ve learned so far.

I hope that you have found this information that I shared on Lupus not only informative but interesting.

Thanks for reading and good luck!

Graduate Project - Antinuclear Antibodies (ANAs) – Diagnosing Lupus

Hello again,

After my post on diagnosing Lupus I recieved a lot of questions on using Antinuclear Antibodies (ANAs) to diagnose Lupus so that’s what we will cover in this post.

The primary test for SLE is Antinuclear Antibodies (ANAs) which checks for antinuclear antibodies that attack the cell nucleus. High levels of ANA are found in more than 98% of patients with SLE. However there are other conditions that may cause high levels of ANA, so a positive test is not a definite diagnosis for SLE. Other diseases are scleroderma, Sjögren syndrome, or rheumatoid arthritis. ANAs may also be weakly present in about 20 - 40% of healthy women. Drugs such as hydralazine, procainamide, isoniazid, and chlorpromazine can also produce positive antibody tests. A negative ANA test makes a diagnosis of SLE unlikely but not impossible. High or low concentrations of ANA also do not necessarily indicate the severity of the disease, since antibodies tend to come and go in patients with SLE.

In general, the ANA test is considered a screening test. If SLE-like symptoms are present and the ANA test is positive, other tests for SLE will be administered. If SLE-like symptoms are not present and the test is positive, the doctor will look for other causes, or the results will be ignored if the patient is feeling healthy.

Antinuclear Antibodies (ANAs) Pattern seen in SLE:

Homogeneous (Diffuse)

• Uniform fluorescence of entire nucleus with or without masking of nucleoli


• Chromosome region of metaphase mitotic cells positive with smooth or peripheral staining intensity greater than or equal to interphase nuclei

Also, additional, more specific tests, such as the anti-double strand DNA (dsDNA) and anti-smith antibodies (Sm), are used to confirm the diagnosis of lupus.

Tests used to diagnose SLE may include:

• Antibody tests, including antinuclear antibody (ANA) panel


• CBC


• Chest x-ray


• Kidney biopsy


• Urinalysis

Remember, no one test can diagnose or rule out the disease and one would have to present with at least 4 of the 11 typical.

Malar rash – a rash over the cheeks and nose, often in the shape of a butterfly

Discoid rash – a rash that appears as red, raised, disk-shaped patches

Photosensitivity – a reaction to sun or light that causes a skin rash to appear or get worse

Oral ulcers – sores appearing in the mouth

Arthritis – joint pain and swelling of two or more joints in which the bones around the joints do not become destroyed

Serositis – inflammation of the lining around the lungs (pleuritis) or inflammation of the lining around the heart that causes chest pain which is worse with deep breathing (pericarditis)

Kidney disorder – persistent protein or cellular casts in the urine

Neurological disorder – seizures or psychosis

Blood disorder – anemia (low red blood cell count), leukopenia (low white blood cell count), lymphopenia (low level of specific white blood cells), or thrombocytopenia (low platelet count)

Immunologic disorder – abnormal anti-double-stranded DNA or anti-Sm, positive antiphospholipid antibodies

Abnormal antinuclear antibody (ANA)

Hopefully this post added to your wealth of knowledge on SLE.

Thanks for reading comment and post!!!

Mycobacterium tuberculosis

Hello everyone,

This week in lecture we discussed Mycobacterium tuberculosis. Just so happen this very same week I had to renew my annual TB skin test. This made me wonder, what was the big deal that we had to get tested for TB each year. So I did some research and I found that transmission of tuberculosis, including multidrug-resistant tuberculosis, is a recognized risk for laboratory workers. Health care workers in general are considered to be apart of the high-risk infection groups for Tuberculosis. UAB state that, "Given the nature of their work, students engaged in health professional training programs could have a higher risk of contracting Rubeola, Rubella, Mumps, Tetanus, Diphtheria, Varicella, Tuberculosis, Pertussis, and Hepatitis B. All UAB students in the Joint Health Sciences programs and in the Schools of Medicine, Dentistry, Optometry, Public Health, Nursing, and Health Professions are required to be immunized."

So what does UAB require for Tuberculosis Screening?

• All international students and scholars must show proof of a non-reactive Tuberculin skin test or negative blood test (Quantiferon), or appropriate treatment if positive, within three months prior to enrollment or visiting


• PPD (skin test) screening requires a 2-step process, with PPD (skin test) placements at 1-3 weeks apart.


• Non-reactive (negative) Tuberculin skin test or chest x-ray reports done outside the United States will not be accepted.


• Individuals with a history of a reactive Tuberculin skin test or blood test must provide a current chest x-ray (taken since their last positive TB test but within three months prior to enrollment or visiting), indicating that the person is free of active tuberculosis. Individuals with a positive TB screening test should complete the TB Questionnaire, submit it to Student Health Services, and consult the UAB Student Health Services TB Testing Policy to view the required follow-up.

So what is the TB skin test:

The Mantoux tuberculin skin test (TST) is the standard method of determining whether a person is infected with Mycobacterium tuberculosis. The TST is performed by injecting 0.1 ml of tuberculin purified protein derivative (PPD) into the inner surface of the forearm. The TST is an intradermal injection and when placed correctly, the injection should produce a pale elevation of the skin 6 to 10 mm in diameter. The skin test reaction should be read between 48 and 72 hours after administration. The reaction should be measured in millimeters of the induration (palpable, raised, hardened area or swelling), making sure not to measure the erythema (redness). The diameter of the indurated area should be measured across the forearm.

How Are TST Reactions Interpreted?

Classification of the Tuberculin Skin Test Reaction:

An induration of 5 or more millimeters is considered positive in -HIV-infected persons -A recent contact of a person with TB disease -Persons with fibrotic changes on chest radiograph consistent with prior TB -Patients with organ transplants -Persons who are immunosuppressed for other reasons (e.g., taking the equivalent of >15 mg/day of prednisone for 1 month or longer, taking TNF-a antagonists)

An induration of 10 or more millimeters is considered positive in -Recent immigrants (< 5 years) from high-prevalence countries -Injection drug users -Residents and employees of high-risk congregate settings -Mycobacteriology laboratory personnel -Persons with clinical conditions that place them at high risk -Children < 4 years of age - Infants, children, and adolescents exposed to adults in high-risk categories

An induration of 15 or more millimeters is considered positive in any person, including persons with no known risk factors for TB. However, targeted skin testing programs should only be conducted among high-risk groups.

So as you can see from the chart, laboratory personnel and other adults in high-risk categories induration measurement is greater other categories to be consider positive.

So as students, we should understand our risk and take the TB screening process seriously. I know we are all busy, but we shouldn’t put it off. Make sure to get your TB screening annually and take the necessary precaution to remain TB negative.

Also, I have included a few links: two on Mycobacterium tuberculosis to provide more information on the bacteria and disease and one on the TB skin test Mantoux Method that I mention above. Also I have included a link from a journal insert on Tuberculosis in laboratory workers. If you are interested please check them out.

As always, read, comment, and post!

Thanks for reading!!!

Tuberculosis Http://www.youtube.com/watch?V=jtyx694ubio

Mycobacterium tuberculosis Http://www.youtube.com/watch?V=u7o93nmgp1e

Tuberculosis in laboratory workers http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1961675/pdf/brmedj03110-0055.pdf

Mantoux Method Http://www.youtube.com/watch?V=br86g-itrtq

Antimicrobial Resistance and Susceptibility Testing

Hello Again!!!

This week’s lecture we discussed antimicrobial susceptibility testing.

Antibiotic use has been beneficial and, when prescribed and taken correctly, their value in patient care is enormous. However, these drugs have been used so widely and for so long that the infectious organisms the antibiotics are designed to kill have adapted to them, making the drugs less effective. People infected with antimicrobial-resistant organisms are more likely to have longer, more expensive hospital stays, and may be more likely to die as a result of the infection.

What cause antimicrobial resistance?

Inappropriate and irrational use of medicines provides favourable conditions for resistant microorganisms to emerge and spread. For example, when patients do not take the full course of a prescribed antimicrobial or when poor quality antimicrobials are used, resistant microorganisms can emerge and spread.

Selecting an Antimicrobial Drug

Before antimicrobial therapy can begin three factors must be known:

• Overall medical conditions of patient

• Nature of microorganism causing infection

• Degree of microorganism susceptibility (sensitivity to various drugs

Antimicrobial Susceptibility Testing

The purpose of performing antimicrobial susceptibility testing is to assist clinicians with the selection of appropriate targeted antibiotic therapy in order to optimize clinical outcomes. Infection-related and overall mortality is reduced when patients are treated expeditiously with an antibiotic to which the organism is susceptible.

Methods

The methods of antimicrobial susceptibility testing we learned about are qualitative and quantitative. The disk diffusion method, also known as the Kirby-Bauer method, is a qualitative method of susceptibility testing . Broth microdilution and agar dilution methodologies are considered quantitative because they can measure the minimum inhibitory concentration (MIC). The MIC is defined as the lowest concentration of an antibiotic that inhibits visible growth of a microorganism. Both quantitative methods are considered the reference methods for susceptibility testing because of their high levels of reproducibility.

How do we prevent antimicrobial resistance?

• Limit drug use - less selective pressure

• Proper drug use - viruses are not affected, use full dose to ensure elimination of pathogens

• Narrow range antibiotics - kill only the targeted microbes; less likely complications

• Multiple drug treatments - drugs can work synergistically; much less likely to get drug resistances

Also, for more prevention methods and to learn what initiatives the Center for Disease Control and Prevent are taking to combat this problem, I have included a link to their "Get Smart for Healthcare" page so check it out.

http://www.cdc.gov/getsmart/healthcare/

Also, for those of you who are interested, I’ve included links to journal articles on "Antimicrobial‐Resistant Pathogens Associated With Healthcare‐Associated Infections" as well as "Frequent Acquisition of Multiple Strains of Methicillin-Resistant Staphylococcus aureus by Healthcare Workers in an Endemic Hospital Environment." I found them very interesting so check them out.

http://www.jstor.org/stable/10.2307/30146980

http://www.jstor.org/stable/full/10.1086/591861

Until next time, read, comment, and post!

Thanks for reading!!! 

Joke of the day:

Diagnosing Lupus - Graduate Project

Hello Everyone,

In weeks prior I’ve discussed different aspects of Lupus. Now I want to discuss in detail how Lupus is diagnosed.

As we’ve learned Lupus is chronic and complex, as well as unpredictable and varies greatly from one individual to the next making it often difficult to diagnose. Because of this, there is no single laboratory test that can determine if a person has lupus. To complicate matters even more, many symptoms of lupus are similar to those of other diseases, and symptoms can develop gradually as well as come and go over weeks and months. It can often take years for a diagnosis to be made. To diagnose lupus, a doctor should be able to find physical or laboratory evidence of the condition, such as swelling of joints, protein in the urine, fluid around the lungs or heart, or a skin biopsy that shows evidence of the disease. The doctor also will look at a person’s medical history and special tests to rule out other diseases.

Doctors use the American College of Rheumatology's “Eleven Criteria of Lupus” to help make—or exclude—a diagnosis of lupus.

Typically, four or more of the following criteria must be present to make a diagnosis of systemic lupus.

So what happens after you diagnosed with Lupus?
Though there is no cure for lupus, in the past several years, treatment has improved considerably and currently there are medications that are proving effective. Only three drugs were FDA-approved for the treatment of lupus (Prednisone, Aspirin, Hydroxychloroquine) until the 2011 FDA approval of Belimumab so advances are being made. Suprising to some, most people with lupus can live normal lives as longs as the disorder is carefully monitored and treatment adjusted as necessary to prevent serious complications. Also, it is recommended that those that have been recently diagnosed with Lupus educate themselve as much as possible about the disease as well as seek support as apart of treatment. I've included a link below that I found very informative titled, "Living with Lupus".

Also, I've included and interactive link, "Could I have Lupus", which is a checklist/quiz that anyone can take if they suspect they may be suffering from Lupus.
http://www.lupus.org/newsite/pages/lupusChecklist.aspx

Until next time, check out the criteria chart above, the links above and below, comment, and post!
Thanks for reading!!!

Living With Lupus:
http://www.lupus.org/webmodules/webarticlesnet/templates/new_learnliving.aspx?articleid=2252&zoneid=527

Diagnosing Lupus:
http://www.lupus.org/webmodules/webarticlesnet/templates/new_learndiagnosing.aspx?articleid=2239&zoneid=524