No abstract

Quality in laboratory has huge impact on diagnosis and patient management as 80-90% of all diagnosis is made on the basis of laboratory tests. Monitoring of quality indicators covering the critical areas of pre-analytical, analytical and post-analytical phases like sample misidentification, sample rejection, random and systemic errors, critical value reporting and TATs have a significant impact on performance of laboratory. This study was conducted in diagnostic laboratories receiving approximately 42,562 samples for clinical chemistry, hematology and serology. The list of quality indicators was developed for the steps of total testing process for which errors are frequent and improvements are possible. The trend was observed for all the QI before and after sensitisation of the staff over the period of 12 months. Incomplete test requisition form received in the lab was the most poor quality indicator observed (7.89%), followed by sample rejection rate (4.91%). Most significant improvement was found in pre-and post-analytical phase after sensitisation of staff but did not have much impact on analytical phase. Use of quality indicators to assess and monitor the quality system of the clinical laboratory services is extremely valuable tool in keeping the total testing process under control in a systematic and transparent way.

Dermatophytosis continues to be a worldwide problem, constituting a large bulk of cases attending the dermatology outpatient's department in tropical countries. Variable climatic conditions and multiple etiological agents, whose individual prevalence varies with time, prompted an attempt to define the current pattern and etiologic prevalence in our locality, and compare them with earlier studies from different centers. Of consenting patients clinically diagnosed to have superficial fungal infections, 1975 were investigated in the laboratory. All the specimens collected from patient skin, hair or nails were subjected to direct microscopy examination in 10% potassium hydroxide (KOH) and fungal culture. Confirmed diagnosis was made only if specimen was KOH and/or culture positive. Male : female ratio was 1.65 : 1. Tinea corporis (21.4%), onychomycoses (14.7%) and tinea capitis (6.2%) were the most common laboratory-confirmed infections. Only 909 patients (47%) out of 1035 clinically suspected patients had evidence of fungal infection by either microscopy and/or culture. Of these 909 patients, 787 (86.5%) were both KOH and culture positive, 25 (2.7%) were KOH negative and culture positive, while 97 (10.6%) were KOH positive but culture negative. In 1051 patients (53%), no evidence of fungal infection was seen. Trichophyton rubrum was the most commonly isolated dermatophyte (55.2%) followed by Trichophyton mentagrophytes (19.6%) and Trichophyton tonsurans (2.9%). Candida sp. accounted for 16% of all isolates. Non-dermatophyte moulds (NDM) were isolated only in patients with onychomycoses. Our study revealed a male preponderance, tinea corporis as the commonest clinical type, and dermatophytes as the commonest mycological isolates, which is in agreement with earlier studies. Relying on clinical diagnosis alone without laboratory confirmation may result in overestimation of the problem as evidenced in other studies as compared to our study. Rarely reported NDM appear to be important etiological agents of onychomycoses.

The present study was done to detect the antibiotic resistance in S. pneumoniae. One hundred twenty S. pneumoniae isolates from clinical specimens and 50 from nasopharyngeal sites were subjected to antimicrobial susceptibility testing by Kirby Bauer disk diffusion method and minimum inhibitory concentration (MIC) determination for penicillin and cefotaxime non-susceptible isolates. A total of 22 isolates (18.3%) from clinical sites and eight (16%) from nasopharyngeal sites showed decreased susceptibility to penicillin by oxacillin disk diffusion test. MICs of 26 of these resistant strains ranged from 0.12-1 µg/mL (intermediate resistance) by broth dilution and E test. Only four isolates, two from sputum and two from nasopharyngeal swabs, showed MIC of 2 µg/mL (complete resistance). However, MIC of two cefotaxime resistant isolates (by disk diffusion) was in the susceptible range (0.5 µg/mL). Highest antimicrobial resistance was seen to cotrimoxazole (55.2%) and tetracycline (61.2%). Antimicrobial resistance to cotrimoxazole and tetracycline was much more in clinical isolates than colonizing isolates. Multi-drug resistant phenotype was detected in 76.9% (20 of 26) of isolates that were intermediately sensitive to penicillin and 50% (2 of 4) of penicillin resistant isolates (co-resistant to tetracycline and cotrimoxazole). Routine screening for antibiotic susceptibility is recommended for clinical isolates of pneumococci. Strains with reduced susceptibility to penicillin should be subjected to MIC determination to detect relative resistance or true resistance as such strains are associated with increased virulence.The choice of antibiotics should be guided by the prevalence of local resistance patterns of pneumococci.

Shewanella soft tissue infections usually occur in immunocompromised patients with a preexisting cutaneous ulcer, mostly after exposure to a marine environment or contaminated water. A 35-year-old male presented with a non-healing ulcer over the distal end of his right leg but had no predisposing factors. Cultures of exudates from the wound grew Shewanella on repeated occasions. Recovery was uneventful following surgical debridement and antimicrobial therapy. Early suspicion, diagnosis, and treatment with potent antibiotics are needed to prevent any further complications resulting from infection by this emerging pathogen.