Producing a reliable, reproducible, accurate, timely, and correctly interpreted test results by clinical laboratory is very important, since physicians' decisions mostly depends on it for screening, diagnosis and monitoring diseases. To provide quality report, routinely in all clinical laboratories internal quality control (IQC) and external quality assessment (EQA) programs are done which helps to evaluate and continuously improve analytical quality. Recently new quality assessment (QA) systems, six-sigma became more popular because it offers a different approach to problems. Sigma metrics allow comparison of different processes with each other and thus improving the quality of testing processes. This study was done to evaluate clinical chemistry laboratory performance using sigma metrics.

Background: Number of cancer cases in India is rising every year and also the sufferings caused by the disease. The patients not only require physical control of disease and symptoms, but, also need help to cope up with other elements caused by the disease. Psychosocial aspect of the patient is usually left unmet.Methods: This study was done in ‘Jeevodaya Hospice Care Centre’, Chennai, India. 60 patients were included in this study. Questionnaire on problems and needs in palliative care was used. The questionnaire consists of eleven elements which deal with psychological issues and fourteen elements which deal with social problems and needs.Results: The five most common psychological problems, perceived by palliative care patients in descending order were; depressed mood (96.7%), fear of metastasis (95%), unpredictability of future (93.3%), not experiencing pleasure (91.5%), and, fear of physical suffering (85%). The five most common social problems perceived by the patients were; loneliness (93.3%), experiencing too little support from others (61.7%), difficulty in talking about the disease for not wanting to bother others (56.7%), finding others not receptive while talking about the disease (53.3%) and difficulty in finding someone confidential to talk to (46.7%).Conclusions: These psychological and social problems along with fear of death causes disruption of the sensitive balance between the body and mind. Proper communication, treatment and counselling helps in a great way to tackle such issues.

Breastfeeding is best gift for child from mother. It is safe, adequate to fulfill nutrition in early life, provides with immunity for protection from various diseases. Exclusive breastfeeding is affected due to various cultural practices which exists, or, due to lack of knowledge of mother and other family members, or, because, mother has to return to work and doesn't have enough maternity leaves or proper feeding area in the workplace. The present study is done to assess knowledge and attitude of ante-natal women towards breastfeeding. Material and Methods: 120 women who had come for routine ante-natal checkup to DM WIMS hospital, Wayanad, Kerala were included in the present study. A semi-structured questionnaire containing various aspects of breast feeding and basic information of the participants was used to assess the knowledge, attitude and find determinants of breast feeding. Results: 55.8% participant were in the age group 18-25yrs. The mean age of study participant was 25.4 years. 50% of the participants were nulliparous, 30% primiparous and 20% were multiparous. 43.3% of the study participants knew the importance of breastfeeding and only 37.5% knew about colostrum. 93.3% participants considered breast milk healthier than artificial substitute like formula milk, etc. Majority of participants received information about breastfeeding from media (54%) and doctors (41%). 77% of participants said presence of strangers affect breastfeeding and 56% said crèche should be available at all work places. A significant association was seen between age and breastfeeding (p-value 0.003), and also between, age and knowledge of colostrum (p-value 0.002), in the present study. Association between parity and breastfeeding, and, parity and colostrum was also found to be significant in our study with p-value 0.001 and 0.007 respectively. Conclusion:In the present we found that, mother's knowledge and attitude towards breastfeeding was favorable, but, still more efforts are required to reach WHO recommended prevalence of 90%.

Hypertension is the most prevalent chronic medical condition seen in primary care. It is a silent disease because of its asymptomatic nature and is usually diagnosed at advanced stage. It effects various organs like heart, kidney, etc. It is responsible for 10.8% deaths in India. Over the years many biomarkers are identified to understand the pathophysiology of hypertension. Biomarkers have unique role in prognosis as the level rises before the onset of overt hypertension. Clinically it is beneficial as it helps in identifying the high risk patients for better treatment and prognosis. In this review we have highlighted the importance of various biomarkers of hypertension in early diagnosis, before the onset of overt hypertension, which is associated with long-term end-organ diseases.

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