ABSTRACT
OBJECTIVE: To deliver rapid isoniazid (INH) and rifampicin (RMP) drug susceptibility testing (DST) close to the patient, we designed a decentralisation process for the microscopic observation drug susceptibility (MODS) assay in Peru and evaluated its reliability. METHODS: After 2 weeks of training, laboratory staff processed ≥ 120 consecutive sputum samples each in three regional laboratories. Samples were processed in parallel with MODS testing at an expert laboratory. Blinded paired results were independently analysed by the Instituto Nacional de Salud (INS) according to pre-determined criteria: concordance for culture, DST against INH and RMP and diagnosis of multidrug-resistant tuberculosis (MDR-TB) ≥ 95%, McNemar's P > 0.05, kappa index (κ) ≥ 0.75 and contamination 1-4%. Sensitivity and specificity for MDR-TB were calculated. RESULTS: The accreditation process for Callao (126 samples, 79.4% smear-positive), Lima Sur (n = 130, 84%) and Arequipa (n = 126, 80%) took respectively 94, 97 and 173 days. Pre-determined criteria in all regional laboratories were above expected values. The sensitivity and specificity for detecting MDR-TB in regional laboratories were >95%, except for sensitivity in Lima Sur, which was 91.7%. Contamination was 1.0-2.3%. Mean delay to positive MODS results was 9.9-12.9 days. CONCLUSION: Technology transfer of MODS was reliable, effective and fast, enabling the INS to accredit regional laboratories swiftly.
Subject(s)
Antitubercular Agents , Clinical Laboratory Techniques , Isoniazid , Microbial Sensitivity Tests , Mycobacterium tuberculosis/drug effects , Rifampin , Sputum/microbiology , Tuberculosis, Multidrug-Resistant/diagnosis , Accreditation , Clinical Laboratory Techniques/standards , Humans , Microbial Sensitivity Tests/standards , Microscopy , Mycobacterium tuberculosis/growth & development , Mycobacterium tuberculosis/isolation & purification , Observer Variation , Peru , Predictive Value of Tests , Regional Health Planning , Reproducibility of Results , Sensitivity and Specificity , Tuberculosis, Multidrug-Resistant/microbiologyABSTRACT
SETTING: Although considerable effort has been put into the development and evaluation of new diagnostics for tuberculosis (TB) and multidrug-resistant TB (MDR-TB), little attention has thus far been paid to the technical aspects of initiating quality-assured routine service use. For implementation of the microscopic-observation drug susceptibility (MODS) methodology in the Peruvian reference laboratory network, a laboratory accreditation process was devised; MODS results from an expert reference laboratory (Universidad Peruana Cayetano Heredia [UPCH]) were used as the standard against which implementing laboratory MODS results were judged to ensure that, prior to use for patient care, implementing laboratories achieved the same high performance with MODS as previously demonstrated in the research laboratory. OBJECTIVE: To evaluate the validity of MODS-based accreditation and the concordance of MODS drug susceptibility testing (DST) with molecular testing. DESIGN: Head-to-head comparison of MODS DST results from implementing Peruvian regional reference laboratories and the accrediting expert MODS laboratory (UPCH) with GenoType® MTBDRplus DST. RESULTS: The concordance of phenotypic MODS rifampicin (RMP) DST with GenoType MTBDRplus was respectively 97.4%, 97.9% and 97.1% for the two implementing regional laboratories and UPCH, and respectively 94.7%, 95.7% and 94.6% for isoniazid (INH) DST. CONCLUSION: High and consistent levels of MODS/MTBDRplus concordance for INH and RMP DST confirm the validity of the use of rapid methods as reference standards for accreditation.
Subject(s)
Accreditation/organization & administration , Laboratories/standards , Quality Assurance, Health Care , Antitubercular Agents/pharmacology , Bacteriological Techniques/methods , Bacteriological Techniques/standards , Humans , Isoniazid/pharmacology , Microbial Sensitivity Tests/methods , Microbial Sensitivity Tests/standards , Mycobacterium/drug effects , Mycobacterium/isolation & purification , Peru , Reference Standards , Rifampin/pharmacology , Tuberculosis/diagnosis , Tuberculosis/drug therapy , Tuberculosis/microbiology , Tuberculosis, Multidrug-Resistant/diagnosis , Tuberculosis, Multidrug-Resistant/drug therapy , Tuberculosis, Multidrug-Resistant/microbiologyABSTRACT
A comparative study of fish species identification was accomplished using three different electrophoretic techniques. Sarcoplasmic proteins were extracted from three related fish species and subjected to gel isoelectrofocusing (IEF), two-dimensional polyacrylamide gel electrophoresis (2D-PAGE), and capillary zone electrophoresis (CZE). The fish species--Genypterus chilensis, Genypterus blacodes, and Genypterus maculatus--were from the Ophidiidae family. The three electrophoretic techniques provided suitable fish species identification. Nevertheless, CZE demonstrated several advantages over the other two conventional techniques. Some of the benefits include the use of small amounts of reagents; short separation times, permitting fast comparative analysis; data reproducibility; and ease with which the technique is performed.
Subject(s)
Fishes/classification , Muscle Proteins/analysis , Muscle, Skeletal/chemistry , Animals , Electrophoresis, Capillary/methods , Electrophoresis, Gel, Two-Dimensional/methods , Isoelectric Focusing/methods , Muscle Proteins/isolation & purificationABSTRACT
Malnutrition and dehydration are common problems in nursing home patients. One explanation for this may be the large number of patients requiring feeding assistance. The Dysphagia Team at the Department of Veterans Affairs Medical Center in Miami, Florida served as the primary source in the expansion of a nutritionally supportive environment to assist in the prevention of malnutrition and dehydration in patients with feeding/swallowing disorders. "Silver Spoons," a program in which volunteers provide supervised feeding, "Happy Hour," a time each day during which an atmosphere is provided that encourages socialization and hydration, and "Second Seating," during which lunch is provided for patients who require modification of eating style, food texture, or timing are described. Analysis of the program's outcomes show it to be timely, pleasing to patients, and cost-effective.
