Sigma is a metric that quantifies the performance of a process as a rate of Defects-Per-Million opportunities. In clinical laboratories, sigma metric analysis is used to assess the performance of laboratory process system. Sigma metric is also used as a quality management strategy for a laboratory process to improve the quality by addressing the errors after identification. The aim of this study is to evaluate the errors in quality control of analytical phase of laboratory system by sigma metric. For this purpose sigma metric analysis was done for analytes using the internal and external quality control as quality indicators. Results of sigma metric analysis were used to identify the gaps and need for modification in the strategy of laboratory quality control procedure. Sigma metric was calculated for quality control program of ten clinical chemistry analytes including glucose, chloride, cholesterol, triglyceride, HDL, albumin, direct bilirubin, total bilirubin, protein and creatinine, at two control levels. To calculate the sigma metric imprecision and bias was calculated with internal and external quality control data, respectively. The minimum acceptable performance was considered as 3 sigma. Westgard sigma rules were applied to customize the quality control procedure. Sigma level was found acceptable (C3) for glucose (L2), cholesterol, triglyceride, HDL, direct bilirubin and creatinine at both levels of control. For rest of the analytes sigma metric was found\3. The lowest value for sigma was found for chloride (1.1) at L2. The highest value of sigma was found for creatinine (10.1) at L3. HDL was found with the highest sigma values at both control levels (8.8 and 8.0 at L2 and L3, respectively). We conclude that analytes with the sigma value \3 are required strict monitoring and modification in quality control procedure. In this study application of sigma rules provided us the practical solution for improved and focused design of QC procedure.
Objective: To determine correlation between systolic and diastolic blood pressure levels and selected signs and symptoms among different gender and age groups of hypertensive patients.
Methods: A cross-sectional study was carried out at urban hospital after taking ethical approval, among patients with self-reported history of hypertension and on anti-hypertensive medication. After taking ethical approval, a total of 372 patients aged 18 or above were included in the study by employing convenient sampling technique. A detailed history was taken from each patient about hypertension associated symptoms with the help of a questionnaire whereas designed specifically for the study. Blood pressure was measured using sphygmomanometer with stethoscope. SPSS version 20 was used to analyse the collected data and the duration of study was 6 months.
Results: Among males older age, belonging to older age group >40 years, having more height and positive history of irregular heartbeat/palpitation were highly correlated with increase in systolic blood pressure (p<0.001 for all), among females, positive history of sleep apnoea was highly correlated with increase in systolic blood pressure (p<0.001) and having more height and positive history of sleep apnoea were highly correlated with increase in diastolic blood pressure (p<0.001 for both), among <40 years old milder change in urinary frequency was highly correlated with increase in systolic blood pressure (p<0.001) whereas among >40 years old positive history of headache, vertigo, sleep apnoea and irregular heartbeat/palpitation were highly correlated with increase in systolic blood pressure (p<0.001 for all) and having more height was highly correlated with increase in diastolic blood pressure (p<0.001).
Conclusion: Among other signs and symptoms, positive history of irregular heartbeat/palpitation was found to be significantly correlated with both high systolic and diastolic blood pressure levels in both males and females as well as in >40 years old patients.
Though illegal in the UK, in many countries novel psychoactive substances are quasi-legal synthetic compounds that are widely available online under the guise of research chemicals. These substances are relatively cheap and are often undetectable in standard drug screens. Nearly 200 such compounds are introduced yearly, and little is usually known about their metabolism or physiological effects. Consequently, managing patients in overdose situations on largely unknown substances usually involves supportive care, however anticipating and managing atypical side effects are challenging in the absence of knowledge of these compounds. In this report, we discuss our encounter with a 33-year-old unconscious man presenting with coingestion of a novel stimulant 3-fluorophenmetrazine with a rarely used benzodiazepine etizolam. This patient developed seizure-like activity and delayed widespread T-wave inversions, both of which ultimately resolved without sequelae.
RIs provided by assay manufacturers are general data and may not always be appropriate for different locations and patient demographics. Verification of an RI is necessary before use in a given patient population.
Aim: To determine the anatomical variation in mental foramen and to evaluate the anterior loop in the population of Karachi with the use of cone beam computed tomography (CBCT). Study Design: Prospective Study Place and duration: Department of Dental and Maxillofacial Surgery, Dr. Ishrat-ul-Ibad Khan Institute of Oral Health and Sciences Dow University of Health Sciences Karachi during September 2021 and February 2022. Methodology: A group of 160 subjects were included in this study and the simple convenient sampling technique was used to obtain data for the research. CBCT images of all patients were obtained. Results: 160 CBCT scans were obtained for this study, 76 females and the remaining 84 were males. Mental foramen was present below the second premolar and between the first and the second premolars most commonly, respectively. On the right side the mental foramen was 67.5% and 68.1% on the left. The most common shape of the anterior loop was Type-I, where Anterior Loop (AL) is unnoticeable and the anatomy is Y shaped as classified by solar et al. The AL was present more commonly on the left side 65% compared to the right side which was 59.4%. No correlation was found between anterior loop presentation and incisive canal of the mandibular region according to the Shapiro Wilk normality test (P≥0.05). Conclusion: It is evident in this study that the location of the anterior loop and mental foramen is variable in our study population. Therefore it is mandated that CBCT images should be used before any invasive procedure is undertaken in the MF region. Keywords: Anatomical variation, Mental foramen, Anterior loop, Mental Nerve, Cone Beam Computed Tomography (CBCT).
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