Metrological traceable calibration of organic carbon and elemental carbon based on laboratory-generated reference materials.

Carbonaceous aerosol, including organic carbon (OC) and elemental carbon (EC), has significant influence on human health, air quality and climate change. Accurate measurement of carbonaceous aerosol is essential to reduce the uncertainty of radiative forcing estimation and source apportionment. The accurate separation of OC and EC is controversial due to the charring of OC. Therefore, the development of reference materials (RM) for the validation of OC/EC separation is an important basis for further study. Previous RMs were mainly based on ambient air sampling, which could not provide traceability of OC and EC concentration. To develop traceable RMs with known OC/EC contents, our study applied an improved aerosol generation and mixing technique, providing uniform deposition of particles on quartz filters. To generate OC aerosol with similar pyrolytic property of ambient aerosol, both water soluble organic carbon (WSOC) and water insoluble organic carbon (WIOC) were used, and amorphous carbon was selected for EC surrogate. The RMs were analyzed using different protocols. The homogeneity within the filter was validated, reaching below 2%. The long-term stability of RMs has been validated with RSD ranged from 1.7%-3.2%. Good correlation was observed between nominal concentration of RMs with measured concentration by two protocols, while the difference of EC concentration was within 20%. The results indicated that the newly developed RMs were acceptable for the calibration of OC and EC, which could improve the accuracy of carbonaceous aerosol measurement. Moreover, the laboratory-generated EC-RMs could be suitable for the calibration of equivalent BC concentration by Aethalometers.

Establishment and validation of a prognostic model based on common laboratory indicators for SARS-CoV-2 infection in Chinese population.

BACKGROUND: At the beginning of December 2022, the Chinese government made major adjustments to the epidemic prevention and control measures. The epidemic infection data and laboratory makers for infected patients based on this period may help with the management and prognostication of COVID-19 patients. METHODS: The COVID-19 patients hospitalized during December 2022 were enrolled. Logistic regression analysis was used to screen significant factors associated with mortality in patients with COVID-19. Candidate variables were screened by LASSO and stepwise logistic regression methods and were used to construct logistic regression as the prognostic model. The performance of the models was evaluated by discrimination, calibration, and net benefit. RESULTS: 888 patients were eligible, consisting of 715 survivors and 173 all-cause deaths. Factors significantly associated with mortality in COVID-19 patients were: lactate dehydrogenase (LDH), albumin (ALB), procalcitonin (PCT), age, smoking history, malignancy history, high density lipoprotein cholesterol (HDL-C), lactate, vaccine status and urea. 335 of the 888 eligible patients were defined as ICU cases. Seven predictors, including neutrophil to lymphocyte ratio, D-dimer, PCT, C-reactive protein, ALB, bicarbonate, and LDH, were finally selected to establish the prognostic model and generate a nomogram. The area under the curve of the receiver operating curve in the training and validation cohorts were respectively 0.842 and 0.853. In terms of calibration, predicted probabilities and observed proportions displayed high agreements. Decision curve analysis showed high clinical net benefit in the risk threshold of 0.10-0.85. A cutoff value of 81.220 was determined to predict the outcome of COVID-19 patients via this nomogram. CONCLUSIONS: The laboratory model established in this study showed high discrimination, calibration, and net benefit. It may be used for early identification of severe patients with COVID-19.

Quality assurance of serologic testing for Chagas disease in a primary care setting of rural Paraguay.

The diagnosis of Chagas disease mostly relies on the use of multiple serologic tests that are often unavailable in many of the remote settings where the disease is highly prevalent. In the Teniente Irala Fernández Municipality, in central Paraguay, efforts have been made to increase the diagnostic capabilities of specific rural health centres, but no quality assurance of the results produced has been performed. We comparatively analysed the results obtained with 300 samples tested using a commercial rapid diagnostic test (RDT) and enzyme linked immunosorbent assays (ELISA) at the laboratory of the Teniente Irala Fernández Health Center (CSTIF) with those generated upon repeating the tests at an independent well-equipped research laboratory (CEDIC). A subgroup of 52 samples were further tested at Paraguay's Central Public Health Laboratory (LCSP) by means of a different technique to evaluate the diagnostic performance of the tests carried out at CSTIF. We observed an excellent agreement between the ELISA results obtained at CSTIF and CEDIC (kappa coefficients between 0.85 and 0.93 for every kit evaluated), and an overall good performance of the tests carried out at CSTIF. However, the sensitivity of one kit was lower at CSTIF (81.3 %) than at CEDIC (100 %). The individual use of an RDT to detect the infection at CSTIF showed a similar sensitivity to that obtained combining it to an ELISA test (92.3% vs 88.5, p = 1). Nonetheless, the generalizability of this result is yet limited and will require of further studies.

Converting an HLA-B27 flow assay from the BD FACSCanto to the BD FACSLyric.

HLA-B27 is a major histocompatibility complex (MHC) class I antigen which exhibits strong association (90%) with ankylosing spondylitis. HLA-B27 detection in patients by flow cytometry is a widely used clinical test, performed on many different flow cytometer models. We sought to develop and validate a test conversion protocol for the HLA-B27 test performed on the BD FACSCanto to BD's newer FACSLyric flow cytometers. The development and validation experiments were performed using anti-HLA-B27*FITC/CD3*PE antibody-stained whole blood patient specimens. The anti-HLA-B27*FITC logarithmic median fluorescence (LMF) results on the BD FACSCanto were converted to median fluorescence intensity (MFI) values on the BD FACSLyric. Clustering of the HLA-B27 positive and negative values, using a 3rd order polynomial equation, resulted in a conversion of the BD FACSCanto cutoff values, negative (<150 LMF) and positive (≥160 LMF), to negative (<4530 MFI) and positive (≥6950 MFI) on the BD FACSLyric. Accuracy was assessed by comparing the flow results obtained on the BD FACSCanto and BD FACSLyric to a molecular PCR based assay. Additional validation parameters (compensation verification, intra- and inter-assay precision, and instrument comparison) were performed per the recommendations outlined in the Clinical and Laboratory Standards Institute (CLSI) H62 guidelines for validation of flow cytometry assays.

Estimating Lab-Quake Source Parameters: Spectral Inversion from a Calibrated Acoustic System.

Laboratory acoustic emissions (AEs) serve as small-scale analogues to earthquakes, offering fundamental insights into seismic processes. To ensure accurate physical interpretations of AEs, rigorous calibration of the acoustic system is essential. In this paper, we present an empirical calibration technique that quantifies sensor response, instrumentation effects, and path characteristics into a single entity termed instrument apparatus response. Using a controlled seismic source with different steel balls, we retrieve the instrument apparatus response in the frequency domain under typical experimental conditions for various piezoelectric sensors (PZTs) arranged to simulate a three-component seismic station. Removing these responses from the raw AE spectra allows us to obtain calibrated AE source spectra, which are then effectively used to constrain the seismic AE source parameters. We apply this calibration method to acoustic emissions (AEs) generated during unstable stick-slip behavior of a quartz gouge in double direct shear experiments. The calibrated AEs range in magnitude from -7.1 to -6.4 and exhibit stress drops between 0.075 MPa and 4.29 MPa, consistent with earthquake scaling relation. This result highlights the strong similarities between AEs generated from frictional gouge experiments and natural earthquakes. Through this acoustic emission calibration, we gain physical insights into the seismic sources of laboratory AEs, enhancing our understanding of seismic rupture processes in fault gouge experiments.

Integrating Programming into Neuroscience Courses.

Programming is a useful skill for students, both in neuroscience research and in the broader economy. Many instructors, however, may wonder how and when they should integrate it into their coursework, especially if they themselves have limited computational training. The suggestions offered here aim to help a wide range of educators - even those who have minimal coding experience - who wish to expose their students to the intersection of neuroscience and programming. Throughout, I provide examples of how I have weaved coding into various elements of neuroscience courses, even those without a computational focus. I also discuss the rich landscape of low-cost, accessible programming tools as well as how generative AI can (and should) impact the way that we are teaching programming. Ultimately, the goal is not to insist that all our students learn how to code, but rather to lower barriers and provide exposure and opportunity to any student who wishes to integrate programming into their research or careers.

COVID-19 pandemic response and Field Epidemiology and Laboratory Training Programs in ECOWAS.

The COVID-19 pandemic has been persistent with a huge demand for human health resources which is a vital component of its preparedness and response. Globally, the public health workforce through field epidemiology and laboratory training programme (FELTP) has been instrumental to global health security. We determined the status of FELTP in the region and its contributions to the COVID-19 pandemic response in the ECOWAS region. We conducted a desk review, shared a questionnaire among member states and organized a two-day online regional consultative meeting on field epidemiology training on 30th-31st March 2022 during which there were presentations, group discussions and deliberations on the status and contribution of FETP during the COVID-19 pandemic. Data collected were analyzed in themes. All countries in the ECOWAS region had established at least one tier of FELTP, 11 (73.3%) had established two tiers of FELTP and only 3 (20.0%) had established all three tiers of the program. Despite the pandemic, the cumulative number of graduates increased from 2996 to 4271 frontline, 41 to 380 intermediate, and 409 to 802 for advanced FELTP between 2019 and 2022. However, the progress has been disproportionate across countries. The key activities supported through FELTP graduates included pandemic response coordination, surveillance, data collection/management, laboratory support, case management, risk communication, infection prevention and control, COVID-19 vaccination, and research. Despite improvements in the FELTP in the Economic Community of West African States (ECOWAS) region, there is a need for continuous stakeholder engagement for its implementation, resource mobilization for sustainability, and leveraging critical partnerships.

Clinical and epidemiological profiles of pediatric COVID-19 in two private Kenyan hospitals.

Introduction: COVID-19 infection has attracted global attention with limited published data on the burden in African children. Methods: hospital-based longitudinal survey in children with COVID-19 infection, aged 0-18 years admitted between August 2020 and December 2021. The main objective of the study was to describe socio-demographic, clinical and diagnostic manifestations of COVID-19 infection in children. Results: the study enrolled 85 children. Median age was 5•1 years (IQR = 1•3 - 12•4) with equal gender distribution. Under five years were 52•9%. Average length of hospital stay among non-severe cases was three days (IQR=2•0-5•0). No deaths were reported. Fifteen patients (18•7%) were asymptomatic. The most common presenting symptoms were fever (51•8%), vomiting (36•5%), cough (27•1%), diarrhea (20•0%), nasal congestion (14•1%) and fast breathing (12•9%). Two patients presented in shock and features consistent with Multisystemic Inflammatory Syndrome in Childhood (MIS-C). Procalcitonin and C-reactive proteins were elevated in 76•9% and 45•8% respectively. Majority (n=80) had white cell counts within normal range and none had bacterial pathogens isolated from blood (n=63). Liver and Renal function tests were within the normal range in the majority of those tested (n=24 and n=64 respectively). Three of the five patients with elevated platelet count (>500 x109/L) had clinical diagnosis of MIS-C. Eight of 20 patients subjected to imaging had radiological features of bilateral ground glass opacifications while six of nine patients who presented with cardiovascular compromise had mild to moderate ventricular dysfunction on echocardiography. Conclusion: our study suggests that children in the African setting manifest a mild form of the COVID-19 infection with low mortality.

The hierarchy of needs for laboratory medicine requires a foundational care delivery model.

Under the collective weight of growing test volume, staffing constraints, and Medicare reimbursements cuts, an enhancement-based, alternative payment structure focused on rewarding the laboratory's care delivery efforts via benchmarking is appealing. However, achieving a value-based payment model requires the development of an inclusive laboratory care delivery model (LCDM) framework. Today, a holistic, practical LCDM framework for laboratory medicine does not exist. However, such creation is essential for establishing unifying tenants of practice for value-tracing by which standardized key performance and population health indicators can be derived. LAB-CARES is the first step in formulating an LCDM with the primary objective of defining and streamlining the processes and strategies necessary to deliver and articulate the value of diagnostic excellence across the healthcare system. The goal of LAB-CARES is to maximize efficiencies, enhance quality, disseminate clinical expertise, increase patient safety, and promote integrative practice. LAB-CARES is designed to improve an individual patient's quality of life (longitudinal laboratory results - beyond one test) and their surrounding communities (e.g., through surveillance and prevention - beyond one patient). Further professional conversation and efforts are paramount to integrate LAB-CARES as a formalized structure within the healthcare landscape.

Evolution of Laboratory Diagnostics for Cryptococcosis and Missing Links to Optimize Diagnosis and Outcomes in Resource-Constrained Settings.

Cryptococcal meningitis is one of the leading causes of death in sub-Saharan Africa among patients with advanced HIV disease. Early diagnosis is crucial in improving treatment outcomes. Despite advances and the availability of modern and point-of-care diagnostics for cryptococcosis, gaps still exist in resource-constrained settings, leading to unfavorable treatment outcomes. Here, we review the current outstanding issues or missing links that need to be filled to optimize the diagnosis of cryptococcosis in resource-constrained settings to improve treatment outcomes. We highlight the evolution of cryptococcosis diagnostics; the roles of early fungicidal activity, cryptococcal antigen titers, antifungal susceptibility testing, and therapeutic drug monitoring; and the missing links to optimize diagnosis and outcomes, including practical recommendations.

Laboratory variables-based artificial neural network models for predicting fatty liver disease: A retrospective study.

Background: The efficacy of artificial neural network (ANN) models employing laboratory variables for predicting fatty liver disease (FLD) remains inadequately established. The study aimed to develop ANN models to precisely predict FLD. Methods: Of 12,058 participants undergoing the initial FLD screening, 7,990 eligible participants were included. A total of 6,309 participants were divided randomly into the training (4,415 participants, 70%) and validation (1,894 participants, 30%) sets for developing prediction models. The performance of ANNs was additionally tested in the testing set (1,681 participants). The area under the receiver operating characteristic curve (AUROC) was employed to assess the models' performance. Results: The 18-variable, 11-variable, 3-variable, and 2-variable models each achieved robust FLD prediction performance, with AUROCs over 0.92, 0.91, and 0.89 in the training, validation, and testing, respectively. Although slightly inferior to the other three models in performance (AUROC ranges: 0.89-0.92 vs 0.91-0.95), the 2-variable model showed 80.3% accuracy and 89.7% positive predictive value in the testing. Incorporating age and gender increased the AUROCs of the resulting 20-variable, 13-variable, 5-variable, and 4-variable models each to over 0.93, 0.92, and 0.91 in the training, validation, and testing, respectively. Conclusions: Implementation of the ANN models could effectively predict FLD, with enhanced predictive performance via the inclusion of age and gender.

Pneumatic tube transport-induced pseudohyperkalemia in patients with extreme leukocytosis: a retrospective study from a single medical center.

BACKGROUND: Pseudohyperkalemia (falsely elevated serum potassium) must be distinguished from true hyperkalemia to avoid unnecessary treatment. Some case reports suggest that pneumatic tube transportation may increase the risk of pseudohyperkalemia, but comprehensive research on the topic is lacking. Here, we aimed to assess the association between WBC levels, pneumatic tube transport, and pseudohyperkalemia prevalence. METHODS: We analyzed 1188 samples collected from 240 patients between 2019 and 2022. Samples with elevated WBC counts (≥ 100 × 103/µL) and potassium levels were included in this study. The method of specimen transportation was documented. RESULTS: Pseudohyperkalemia was observed (7/390) in specimens transported using pneumatic tubes. No pseudohyperkalemia was identified with manually transported specimens (0/132). Every increase in WBC count by 100 × 103/µL in the specimens multiplied the odds ratio of pseudohyperkalemia by 3.75 when delivered with pneumatic tube. The prevalence of pseudohyperkalemia increased as WBC count increased, especially at WBC counts greater than 200 × 103/µL. CONCLUSION: Pneumatic tube transport poses a risk for pseudohyperkalemia in patients with extreme leukocytosis. Physicians should anticipate odd potassium levels when interpreting blood test results. Redrawing of blood samples, manual specimen transportation, or point-of-care testing are suggested to prevent further misdiagnosis.

Virtual Reality Cognitive Remediation in Older Adults with Bipolar Disorder: The Effects on Cognitive Performance and Depression in a Feasibility Randomized Controlled Trial.

INTRODUCTION: Dementia, depression, and cardiovascular disease are major public health concerns for older adults, requiring early intervention. This study investigates whether a virtual reality cognitive remediation program (VR-CR) can improve cognitive function and depressive symptoms in older adults, and determines the necessary sample size for future studies. Integrated VR and CR interventions have shown promising outcomes in older adults with neurodegenerative and mental health disorders. METHODS: This secondary analysis of a randomized controlled trial involves adults aged 58-75 years with bipolar disorder, excluding those with acute episodes, epilepsy, or severe eye diseases. The experimental group received standard treatment plus VR-CR, while the control group received only standard treatment. RESULTS: No baseline differences were found between the experimental and control groups. No significant improvement was observed in the overall cognitive function test (p = 0.897) or in depressive symptoms (p = 0.322). A phase III efficacy study requires a sample size of 28 participants (alpha = 0.05, beta = 0.20). CONCLUSIONS: VR-CR can potentially treat depressive symptoms in adults and older adults, but the results support conducting phase III studies to further investigate these outcomes. However, the improvement in cognitive performance in the elderly is less pronounced than in younger individuals.

Gender Reassignment and the Role of the Laboratory in Monitoring Gender-Affirming Hormone Therapy.

Transgender people experience distress due to gender incongruence (i.e., a discrepancy between their gender identity and sex assigned at birth). Gender-affirming hormone treatment (GAHT) is a part of gender reassignment treatment. The therapeutic goals of the treatment are to develop the physical characteristics of the affirmed gender as far as possible. Guidelines have been developed for GAHT, which recommend dosage as well as different formulations of oestrogen and testosterone for treatment. Questions arise about the metabolic side effects of hormone treatment. Establishing reference ranges for common analytes in transgender individuals remains a task for laboratory medicine. It has been suggested once GAHT is commenced, the reference ranges for affirmed gender are reported for red blood cells, haemoglobin and haematocrit. For transgender assigned-female-at-birth (AFAB) people, testosterone concentrations are recommended to be within the reference interval established for cisgender men and for transgender assigned-male-at-birth (AMAB) people, estradiol concentrations are within the reference range for cisgender women. Sex-specific reference ranges are available for certain laboratory tests, and these may be organ (e.g., heart)-specific. Transgender-specific reference ranges may be a requirement for such tests. Laboratories may need to make decisions on how to report other tests in the transgender population, e.g., eGFR. Interpretation of further tests (e.g., reproductive hormones) can be individualized depending on clinical information. Electronic medical record systems require fields for gender identity/biological sex at birth so that laboratory results can be flagged appropriately. In this review, we aim to summarise the current position of the role of the laboratory in the clinical care of the transgender individual. Prior to the review, we will summarise the genetics of sex determination, the aetiology of gender incongruence, and the recommendations for GAHT and monitoring for the transgender population.

Identification of severe fever with thrombocytopenia syndrome virus isolates in the northwest of Hubei Province, China.

Severe fever with thrombocytopenia syndrome (SFTS) is a tick-borne viral disease that is increasingly affecting human being worldwide. The clinical manifestations and mortality rates of SFTS can vary depending on the geographic region and the specific genotype of the severe fever with thrombocytopenia syndrome virus (SFTSV). From July 2022 to August 2023, we collected serum samples from 83 patients with suspected SFTSV infection in the northwest of Hubei Province, China. From which, 13 patients tested positive for SFTSV. Phylogenetic analysis of the SFTSV L, M, and S gene segments was performed using the maximum likelihood method to determine the genetic diversity of the isolates. At least 2 SFTSV genotypes (A and F) were identified in the northwest of Hubei Province. The clinical manifestations and laboratory findings on the first day of admission were investigated. Results showed that bleeding and disturbance of consciousness, and significant elevated AST and APTT, are valuable for assessing the prognosis for SFTS patients. This study disclosed the genomic sequences and genotypes of SFTSV spreading in the northwest of Hubei Province for the first time, providing information of genetically etiology for SFTS in the local district. Furthermore, certain symptoms and/or laboratory findings may indicate adverse clinical outcomes, highlighting the importance of identifying the symptoms and monitoring specific laboratory markers. Future research is needed to investigate the threshold values of these markers and to closely observe the indicative symptoms in order to early identify and timely management of critically ill patients within clinical settings.

Unnecessary repetitions of C-reactive protein and leukocyte count at the emergency department observation unit contribute to higher hospital admission rates.

OBJECTIVES: The aim of the present study was to assess the effect of repeated laboratory measurement of C-reactive protein (CRP) and leukocyte count on the decision whether to admit or dicharge the patient with localized infections who received antibiotics at the Emergency Department (ED) observation unit. METHODS: Adult patients with respiratory, urinary tract and abdominal infections, observed at the ED after antibiotic administration, in whom repeated measurements of CRP and leukocyte count were performed within 24 h, were included. They were initially grouped as planned discharge, planned admission and unclear attitude towards admission. Initial and repeated CRP and leukocyte count results, clinical dynamics (improvement, worsening, unchanged) and clinical decision about discharge or admission, were recorded. RESULTS: A total of 1,038 patients were eligible for inclusion. No significant differences in initial CRP and leukocyte count values were observed, nor any association of CRP and leukocyte count changes with clinical dynamics. Among 504 patients eligible for discharge at second laboratory sampling according to clinical dynamics, 54.4 % were further observed or admitted. Discharged patients had an average negative absolute (p<0.001) and relative CRP change (p=0.002). Clinical dynamics, first and second CRP results and absolute CRP change were independently associated with the decision to discharge or further observe/admit. CONCLUSIONS: Schematic repetitions of CRP and leukocyte count at the ED observation unit are common, regardless of patients' clinical condition. Clinical judgment remains the main guiding factor to admit or discharge the patient, but repeated CRP testing influences the final decision, contributing to higher admission rates.

Engineering Escherichia coli for utilization of PET degraded ethylene glycol as sole feedstock.

From both economic and environmental perspectives, ethylene glycol, the principal constituent in the degradation of PET, emerges as an optimal feedstock for microbial cell factories. Traditional methods for constructing Escherichia coli chassis cells capable of utilizing ethylene glycol as a non-sugar feedstock typically involve overexpressing the genes fucO and aldA. However, these approaches have not succeeded in enabling the exclusive use of ethylene glycol as the sole source of carbon and energy for growth. Through ultraviolet radiation-induced mutagenesis and subsequent laboratory adaptive evolution, an EG02 strain emerged from E. coli MG1655 capable of utilizing ethylene glycol as its sole carbon and energy source, demonstrating an uptake rate of 8.1 ± 1.3 mmol/gDW h. Comparative transcriptome analysis guided reverse metabolic engineering, successfully enabling four wild-type E. coli strains to metabolize ethylene glycol exclusively. This was achieved through overexpression of the gcl, hyi, glxR, and glxK genes. Notably, the engineered E. coli chassis cells efficiently metabolized the 87 mM ethylene glycol found in PET enzymatic degradation products following 72 h of fermentation. This work presents a practical solution for recycling ethylene glycol from PET waste degradation products, demonstrating that simply adding M9 salts can effectively convert them into viable raw materials for E. coli cell factories. Our findings also emphasize the significant roles of genes associated with the glycolate and glyoxylate degradation I pathway in the metabolic utilization of ethylene glycol, an aspect frequently overlooked in previous research.

Evaluation of Pathology Resources for Cervical Cancer Detection Between 2018 & 2022: a Retrospective Study at Moi Teaching and Referral Hospital, Western Kenya.

Background: Cervical cancer cases are increasing in sub-Saharan Africa, particularly in Kenya, exacerbated by inadequate histopathology resources, posing a significant barrier to timely diagnosis and treatment. There has been little research on the availability and evolution of histopathology resources for diagnosing cervical cancer over the years. This retrospective study evaluated this evolution at Moi Teaching and Referral Hospital in Kenya between 2018 and 2022. Methods: We used a mixed-methods approach. An in-depth interview was conducted with one of MTRH's pathology laboratory staff to assess the equipment, personnel, and quality control trends between 2018 and 2022. A thematic analysis was conducted in NVivo. We also retrospectively conducted a comprehensive inventory review of laboratory resources from 2018-2022 via purposive sampling. Microsoft Excel and Stata version 17 were utilized for descriptive statistical analysis. Turnaround time (TAT) was assessed against the UK's National Health Service Cervical Screening Program guidelines. Results: The number of histopathology laboratory personnel at MTRH increased from 2018 to 2022, during which the facility included two pathologists, one records person, and one office administrator. Patient annual visits increased from approximately 350,000 in 2018 to approximately 500,000 in 2022. However, the histopathology personnel-to-population ratio decreased from 1.5 pathologists and 2.7 histo-technicians per 100,000 in 2018 to 1.4 pathologists and 1.8 histo-technicians per 100,000 in 2022. Despite this decrease, lab equipment, automatic tissue processors and embedding machines were added, and an average 14-day turnaround time was maintained for pathology reports. Conclusions: Despite a decreased personnel-to-patient ratio, the addition of crucial histopathology equipment mirrors the operational commitment of the Moi Teaching and Referral Hospital. The 14-day TAT is commendable, contributes to operational effectiveness and significantly contributes to timely detection. The hospital's dedication to upgrading its infrastructure underscores a proactive approach to addressing growing healthcare demands and improving patient outcomes, even with limited human resources. The decline in the personnel-to-patient ratio underscores challenges in diagnosis, emphasizing the need to address workforce and infrastructure gaps to improve patient care within similar low-resource settings.

Impact of Isotretinoin on Blood Lipids and Liver Enzymes: A Retrospective Cohort Study in Saudi Arabia.

Background: Isotretinoin is an effective treatment for acne but can cause side effects such as changes in blood lipids and liver enzymes. Laboratory monitoring is essential during treatment, but there is variation in monitoring practices. Aim: This study aims to investigate the relationship between isotretinoin therapy and its effects on complete blood count in Saudi Arabia to improve patient outcomes. Methods: The study was a retrospective cohort study conducted at King Khalid University Hospital in Riyadh, Saudi Arabia, between January 2016 and December 2020. Following the inclusion and exclusion criteria, 515 patients were randomly selected for the study. The data was analyzed using SPSS, and descriptive statistics and paired samples t-tests were employed to analyze the data. Results: In this study, 515 patients were enrolled. Of these participants, 76.7% (n=395) were females and 23.3% (n=120) were males. The mean age of the study participants was 23.98±7.4 years and ranged between 16 and 65 years. The mean dose of Isotretinoin administered was 27.65±9.6 mg/day, with a range of 10-60 mg/day. The mean BMI of the study participants was 24.3±4.1 kg/m2, ranging from 14.3 to 44.8 kg/m2. Regarding the effect of Isotretinoin on laboratory measures, significant statistical differences were found in hemoglobin measurements (t=-3.379, p=0.001), platelets (t=-3.169, p=0.002), neutrophils (%) (t=3.107, p=0.002), total cholesterol (t=-13.017, p=0.000), AST (t=-6.353, p=0.000), ALT (t=-4.352, p=0.000), HDL (t=2.446, p=0.015), and LDL (t=-12.943, p=0.000). However, there were no significant statistical differences in the measurements of WBC, neutrophils (count), or triglycerides. In the Chi-square analysis and Fisher's Exact test to identify the interaction between BMI, dose, and gender on abnormal lab results, significant interaction was found between participants' BMI and abnormal HDL measurements (p=0.006). Furthermore, there were significant interactions between Isotretinoin dose (either less than 30 mg/day or 30 mg/day or more) and abnormal neutrophil count (p=0.04), abnormal HDL measurements (p=0.010), and abnormal triglycerides measurements (p=0.020). Moreover, a statistically significant interaction was found between participants' gender and abnormal hemoglobin measurements (p=0.006), abnormal total cholesterol (p=0.016), abnormal AST measurements (p=0.001), abnormal ALT measurements (p=0.000), abnormal HDL measurements (p=0.000), and abnormal triglycerides measurements (p=0.007). Conclusion: In conclusion, the study found that isotretinoin therapy has significant effects on several laboratory measures, including hemoglobin, platelets, neutrophils, total cholesterol, AST, ALT, HDL, and LDL. The study also revealed significant interactions between BMI, dose, gender, and abnormal lab results.