Challenges of implementing Iranian national laboratory standards

After four years of publishing the Iranian National Laboratory Standard and following a strategic plan to implement its requirements, it was decided to review the taken actions, evaluating the achievements and the failures, as well as analyzing the gaps and planning the interventional activities to resolve the problems. A thorough evaluation revealed that the progress of implementation process varies considerably in different provinces, as well as in laboratories in different public and private sectors. Diversity and heterogeneousity of laboratories throughout the country is one of unresolvable problems. Although we encounter shortage of resources in the country, improper allocation or distribution of resources and budgets make the problems more complicated. Inadequacy of academic training in laboratory sciences has resulted in necessity of holding comprehensive post-graduate training courses. Revising academic curriculum of laboratory sciences could be mostly helpful, moreover there should be organized, training courses with pre-determined practical topics. providing specific technical guidelines, to clarify the required technical details could temporarily fill the training gaps of laboratory staff. Inadequate number of competent auditors was one of the difficulties in universities. Another important challenge returns to laboratory equipment, developing the national controlling system to manage the laboratory equipment in terms of quality and accessibility has been planned in RHL. At last cultural problems and resistance to change are main obstacles that have reduced the pace of standardization, it needs to rationalize the necessity of establishing laboratory standards for all stakeholders.

Detection of human coronavirus strain HKU1 in a 2 years old girl with asthma exacerbation caused by acute pharyngitis

Respiratory viral infections can trigger asthma attack which may lead to sever morbidity. In this report, using molecular methods, we show the chronological association between human coronavirus--HKU1 infection and asthma exacerbation in a two years and seven months old asthmatic girl who was not under treatment and was otherwise healthy.

First detected human bocavirus in a Malaysian child with pneumonia and pre-existing asthma: a case report

Human bocavirus (HBoV) is a newly discovered parvovirus associated with respiratory disease in children. There are many reports worldwide on the endemicity of this virus. Since it is relatively new, detection in clinical laboratories is not routinely performed. We describe the first detection of HBoV in Malaysia in a 13-month-old boy with pneumonia and underlying asthma. The infective agent was confirmed by molecular methods.

Cyclin B1 Is an Independent Prognostic Proliferation Marker with a High Reproducibility in a Population-Based Lymph Node Negative Breast Cancer Cohort

Purpose: A large proportion of women with lymph node negative breast cancer treated with chemotherapy do not benefit from such treatment. Proliferation markers can recognize patients at high risk for recurrence. However, no proliferation marker is generally accepted for clinical use. We investigated the independent prognostic importance of cyclin B1 in node negative breast cancer and included a study of the reproducibility.Study Design: In a population-based, case-control study, 190 women who died from breast cancer were defined as cases and 190 women alive at the time for the corresponding case's death as controls. Inclusion criteria were tumor size ≤ 50 mm, no lymph node metastases, and no adjuvant chemotherapy. Tumor tissue was immunostained for cyclin B1. Two investigators evaluated the staining independently by counting approximately 100, 200, 500, and 1000 cells.Results: Cyclin B1 was statistically significantly associated to breast cancer death, in both uni- and multivariate analyses (adjusted for tumor size, age, and endocrine therapy), with odds ratios 2-3 for both investigators. The reproducibility between the two investigators was good to very good, regardless of the number of counted cells (kappa values between 0.74 and 0.82).Conclusions: Cyclin B1 is a prognostic factor for breast cancer death in a population-based and node negative patient cohort and can identify high-risk node negative patients with a good to very good reproducibility.

Citation Information: Cancer Res 2009;69(24 Suppl):Abstract nr 6051.

The effect of increasing blood flow rate on dialysis adequacy in hemodialysis patients

Inadequacy of dialysis is one of the determinants of morbidity and mortality in patients undergoing dialysis. The aim of this study was to assess the effect of increasing blood flow rate during hemodialysis (HD) on the adequacy of dialysis. In this study, 42 patients on maintenance HD were assessed. Body weight and blood urea nitrogen (BUN) levels before and after HD sessions were recorded on all the study patients. Volume of ultrafiltration, the duration of dialysis, percentage of filter clearance and flow rate of the dialysate were collected and documented in a checklist. Both Kt/V and urea reduction ratio (URR) were determined at two different blood pump speeds, i.e. 200 and 250 mL/min. During HD, hemodynamic status and vital signs of patients were monitored and controlled. After collecting the necessary data, efficiency of dialysis was calculated using the standard formula. Descriptive and analytical statistics was carried out to analyze the data. Using blood flow rate of 200 mL/min, 16.7% of patients had Kt/V higher than 1.3 and URR higher than 65. On the other hand, with flow rate of 250 mL/min, 26.2% of patients had Kt/V higher than 1.3 and 35.7% of subjects had URR higher than 65. Paired t-test with 95% confidence showed a significant difference in dialysis efficiency between two groups. Our data further confirm that increasing the blood flow rate by 25% is effective in increasing dialysis adequacy in HD patients.

Respiratory System Model for Quasistatic Pulmonary Pressure-Volume (P-V) Curve: Generalized P-V Curve Analyses

A normalized P-V curve is proposed for quantitative comparisons of quasistatic P-V curves from different sources, including data from different investigators, airway pressure-volume curves versus transpulmonary pressure-volume curves, normal versus injured respiratory system, and animal tests versus clinical data. Similarities and differences among five different data groups we analyzed are shown to be quantified through the nondimensional pressure range of an individual data set, combined with the magnitudes of two nondimensional parameters of the inflation limb, derived from a respiratory system model previously reported.

Respiratory System Model for Quasistatic Pulmonary Pressure-Volume (P-V) Curve: Inflation-Deflation Loop Analyses

A respiratory system model (RSM) is developed for the deflation process of a quasistatic pressure-volume (P-V) curve, following the model for the inflation process reported earlier. In the RSM of both the inflation and the deflation limb, a respiratory system consists of a large population of basic alveolar elements, each consisting of a piston-spring-cylinder subsystem. A normal distribution of the basic elements is derived from Boltzmann statistical model with the alveolar closing (opening) pressure as the distribution parameter for the deflation (inflation) process. An error minimization by the method of least squares applied to existing P-V loop data from two different data sources confirms that a simultaneous inflation-deflation analysis is required for an accurate determination of RSM parameters. Commonly used terms such as lower inflection point, upper inflection point, and compliance are examined based on the P-V equations, on the distribution function, as well as on the geometric and physical properties of the basic alveolar element.

A Mechanistic Model for Quasistatic Pulmonary Pressure-Volume Curves for Inflation

A mechanistic model of the respiratory system is proposed to understand differences in quasistatic pressure-volume (p-V) curves of the inflation process in terms of the alveolar recruitment and the elastic distension of the wall tissues. In the model, a total respiratory system consists of a large number of elements, each of which is a subsystem of a cylindrical chamber fitted with a piston attached to a spring. The alveolar recruitment is simulated by allowing a distribution of the critical pressure at which an element opens; while the wall distension is represented by the piston displacement. Relations are derived between parameters in the error-function p-V model equation and properties of the mechanistic model. The parameters of the model-based p-V equation are determined for clinical data sets of patients with acute respiratory distress syndrome.

Kinetic spectrophotometric determination of thiocyanate based on its inhibitory effect on the oxidation of methyl red by bromate

A kinetic spectrophotometric method for measuring thiocyanate is described. The proposed method is based on the inhibitory effect of thiocyanate on the oxidation of Methyl Red by bromate in the presence of nitrite, which was monitored at 520 nm. The variables affecting the rate of the reaction were investigated and the optimum conditions were established. Thiocyanate can be measured in the range of 0.05-1.1 microg ml(-1) with a detection limit of 0.025 microg ml(-1). This method has been used to determine trace thiocyanate in urine and tap water samples.

Control of hippocampal morphogenesis and neuronal differentiation by the LIM homeobox gene Lhx5

The mammalian hippocampus contains the neural circuitry that is crucial for cognitive functions such as learning and memory. The development of such circuitry is dependent on the generation and correct placement of the appropriate number and types of neurons. Mice lacking function of the LIM homeobox gene Lhx5 showed a defect in hippocampus development. Hippocampal neural precursor cells were specified and proliferated, but many of them failed to either exit the cell cycle or to differentiate and migrate properly. Lhx5 is therefore essential for the regulation of precursor cell proliferation and the control of neuronal differentiation and migration during hippocampal development.

Serum prolactin concentrations are elevated after syncope

The distinction between syncope and epileptic seizures is a common clinical diagnostic problem. Elevated serum prolactin (PRL) concentrations are used to help differentiate epileptic from nonepileptic attacks such as pseudoseizures. Reports of PRL concentrations following syncope have been variable. To determine whether PRL rises after syncope, we measured serum PRL concentrations during a 45-minute passive 60-degree head-up tilt in 21 patients with a history of near-fainting or syncope. Head-up tilt triggered hypotension (mean arterial pressure 51 mm Hg, 95% CI = 45-57) with syncope in 11 patients. PRL concentrations were elevated ( > 19 ng/mL) and reached a maximum within the first 30 minutes after tilt-induced syncope in nine patients (PRL supine: 11 ng/mL, 95% CI = 7-15, vs. PRL after syncope: 52 ng/mL, 95% CI = 36-67; a greater than fourfold rise), while they remained unchanged in 10 patients who had a normal response to head-up tilt (PRL supine: 6 ng/mL, 95% CI = 5-8, vs. maximum PRL while upright: 8 ng/mL, 95% CI = 6-10). The findings indicate that elevated PRL concentrations are present after hypotensive syncope and are of little use in differentiating such syncope from epileptic seizures.

Heterologous enzyme function in Escherichia coli and the selection of genes encoding the catalytic RNA subunit of RNase P

The gene for the catalytic RNA subunit of RNase P has been isolated from several Enterobacteriaceae by complementation of an Escherichia coli strain that is temperature-sensitive for RNase P activity. The selection procedure relies on the ability of the heterologous gene products to function enzymatically in E. coli. This procedure obviates the need for positive results in DNA blot hybridization experiments or for the purification of holoenzyme to identify the RNA component of RNase P and its corresponding gene from organisms other than E. coli. Comparisons of the variations in sequences provide the basis for a refined two-dimensional model of the secondary structure of M1 RNA.