Inter-instrumental comparison for the measurement of electrolytes in patients admitted to the intensive care unit.

OBJECTIVE: To investigate whether benchtop auto-analyzers (AAs) and arterial blood gas (ABG) analyzers, for measuring electrolyte levels of patients admitted to intensive care units (ICU), are equal and whether they can be used interchangeably. MATERIALS AND METHOD: This study was conducted on 98 patients admitted to the ICU of the Institute of Medicine, Kathmandu, Nepal between 15 October and 15 December 2016. The sample for AA was collected from the peripheral vein through venipuncture, and that for ABG analyzer was collected from radial artery simultaneously. Electrolyte levels were measured with ABG analyzer in the ICU itself, and with benchtop AA in the central clinical biochemistry laboratory. RESULTS: The mean value for sodium by AA was 144.6 (standard deviation [SD] 7.63) and by ABG analyzer 140.1 (SD 7.58), which was significant (p-value <0.001). The mean value for potassium by AA was 3.6 (SD 0.52) and by ABG analyzer 3.58 (SD 0.66). The Bland-Altman analysis with the 95% limit of agreement between methods were -4.45 to 13.11 mmol/L for sodium and the mean difference was 4.3 mmol/L and -1.15 to 1.24 mmol/L for potassium and the mean difference was 0.04 mmol/L. The United States Clinical Laboratory Improvement Amendments accepts a 0.5 mmol/L difference in measured potassium levels and a 4 mmol/L difference in measured sodium levels, in the gold standard measure of the standard calibration solution. The passing and Bablok regression with 95% confidence interval has an intercept of zero and slope one for both sodium and potassium, and the 95% of random difference is -6.32 to 6.32 for sodium and -0.84 to 0.84 for potassium, showing no significant deviation from linearity. CONCLUSION: It can be concluded that AA and ABG analyzers may be used interchangeably for measurement of potassium in the Institute of Medicine, while the same cannot be concluded for the measurement of sodium, because of the significant difference in sodium measurement by the two instruments.

Everolimus TDM using Thermo Fisher QMS immunoassay on Indiko, Beckman DxC, AU680, and AU5800 analyzers.

OBJECTIVES: Everolimus (EVR), a mTOR inhibitor immunosuppressant approved for renal, liver and cardiac transplants. This study established the appropriate TDM performances of the Thermo Scientific QMS EVR Assay by using the Beckman DxC, followed by comparison to the Thermo Scientific Indiko and a previously published LC-MS/MS assay, and Beckman AU680 and AU5800 analyzers. DESIGN AND METHODS: The study initially established acceptable linearity, precision and accuracy of the QMS EVR turbidimetric assay. Sample preparation was initiated by mixing patient whole blood with methanol and a precipitation reagent. Supernatant was transferred to sample cups. Drug in the supernatant and drug coated on microparticle compete for the limited number of antibody binding sites. If EVR is absent in the sample supernatant, EVR coated microparticles are agglutinated in the presence of antibody reagent. If EVR is present, agglutination is partially inhibited, depending on EVR concentration. Calibrators range was from 1.5 to 20ng/mL. Comparison studies data were analyzed by Deming Regression and Bland-Altman plots. RESULTS: Precision studies showed the following mean concentrations 4.00-4.72, 7.70-8.20 and 14.80-15.56ng/mL, and CVs of 3.1-8.7%, 3.4-8.9% and 2.6-4.4% respectively. Comparison of analyses of 107 de-identified transplant samples by three analyzers - Indiko, DxC and AU680 showed: EVR concentrations from <1.5 to 13.6ng/mL, slopes 1.000 to 1.076, intercepts -0.053 to 0.462, and R 0.945 to 0.981. Another series of comparison studies (n=104) of Indiko and AU680 with LC-MS/MS showed the following: slopes 1.035 to 1.086, intercepts -0.019 to -0.265, and R 0.924 to 0.980. 2013-2016 CAP survey results were acceptable. CONCLUSIONS: Based on the experience of the past 3.5years, Thermo Scientific QMS EVR Immunoassay using four different analyzers offered adequate limit of detection and acceptable accuracy and precision, suitable for monitoring renal and liver transplant recipients.

Evaluation of the SediMax automated microscopy sediment analyzer and the Sysmex UF-1000i flow cytometer as screening tools to rule out negative urinary tract infections.

Urinary tract infections (UTI) are highly prevalent in nosocomial and community settings, and their diagnosis is costly and time-consuming. Screening methods represent an important advance towards the final UTI diagnosis, diminishing inappropriate treatment or clinical complications. Automated analyzers have been developed and commercialized to screen and rule out negative urine samples. The aim of this study was to evaluate two of these automated analyzers (SediMax, an automatic sediment analyzer and UF-1000i a flow cytometer) to predict negative urine cultures. A total of 1934 urine samples were analyzed. A very strong correlation for white blood cells (WBC) (rs: 0.928) and a strong correlation for bacteria (BAC) (rs: 0.693) were obtained. We also calculated optimal cut-off points for both autoanalyzers: 18 WBC/µL and 97 BAC/µL for SediMax (sensitivity=96.25%, specificity=63.04%, negative predictive value=97.97%), and 40 WBC/µL and 460 BAC/µL for UF-1000i (sensitivity=98.13%, specificity=79.16%, negative predictive value=99.18%). The use of SediMax and UF-1000i resulted in a 46.33% and 57.19% reduction of all samples cultured, respectively. In conclusion, both analyzers are good UTI screening tools in our setting.

Experiencia en el despliegue del piloto de galen clínicas en los laboratorios del instituto de hematología e inmunología / Experience in deploying of pilot galen clínicas laboratories in the institute of hematology and immunology

SOFTEL, es la empresa encargada por el Ministerio de las Comunicaciones de informatizar las entidades de Salud Pública. Para ello se han desarrollado varias aplicaciones, para ser desplegadas en hospitales, clínicas, policlínicos y bancos de sangre, fundamentalmente. Específicamente los laboratorios constituyen un área muy sensible debido a que en ellos se realizan todos los medios diagnósticos, que resultan de gran utilidad el almacenamiento de esta información para futuros estudios de los pacientes. Este trabajo expone la experiencia obtenida en el despliegue de dicho módulo, como una primera experiencia, conocida como despliegue de piloto o prueba beta. Esta experiencia sirve de base para las futuras instalaciones en otros clientes, reportó una serie de inconformidades que se resolvieron antes de concluir el mismo y finalmente quedo concluido el despliegue. Este tuvo complicaciones relacionadas con la existencia de laboratorios fuera del área de cobertura del Instituto y la preparación de las interfaces con los diferentes auto analizadores(AU)

SOFTEL is the enterprise commissioned by the Ministry of Communications to computerize public health institutions. For that has been developed several applications to be deployed in hospitals, clinics and blood banks, basically. Specifically, laboratories are a very sensitive area because in them all the diagnostic tools are used, so it is useful storage of this information for future studies of patients. This paper describes the experience gained in the deployment of the module, as a first experience, known as pilot or deployment of beta testing. This experience, which forms the basis for future installations on other customers, reported a series of disagrees which were resolved before the end of the same and finally the deployment was completed. This had complications related to the existence of laboratories outside the coverage area of the Institute and the preparation of the interfaces with the different analyzers(AU)