Modern Medical Laboratory Journal
Volume:4 Issue: 1, Winter-Spring 2021

As a consequence of stat turnaround times (TATs) chronically exceeding 60 minutes, our laboratory was facing pressure to divert limited resources toward the implementation of an emergency department satellite laboratory. Peer-reviewed literature in clinical laboratory quality assurance and improvement indicates that between 60-70% of errors occur at the pre-analytical level.  Thus, we sought to improve overall TATs by focusing on reducing pre-analytical lag times. Lean six sigma process improvement owes its origins to industry, and may be universally applied in healthcare settings to improve outcomes. We report the application of Lean six sigma process improvement tools in the clinical laboratory specimen accession and processing area of a busy tertiary care center to improve chemistry stat TATs. 

The prospective before-and-after redesign encompassed a detailed evaluation of existing system, assessment of established monitors and historical data, formulation and implementation of a plan, and post-move data collection and analysis. Allocation of laboratory space was based on Lean six sigma quality improvement methods. Test TAT and volumes were obtained from the LIS.  Spaghetti diagrams were utilized to assess workflow in the existing space and in layout planning for the new space. An assessment of the pre-analytical steps in the receiving and processing area, in tandem with pre and post move Pareto chart data enabled the calculation of the reduction of defects per million opportunities that could be ascribed to this effort.

12 months mean ED CMP TATs before the move was 44.4 minutes with 90% of results reported in 60 minutes or less; after the move this improved to a mean of 37.1 minutes with 90% of results reported in 49 minutes or less. 12-month ED troponin mean TAT was 49.5 minutes with 83% of results reported in 60 minutes or less; after the move this improved to mean TAT of 43.4 minutes with 90% of results reported in 55 minutes or less.  Given seven touch points per result, this project enabled a 75% reduction in defects per million opportunities.

Lean-six sigma tools facilitated the identification and elimination of inefficiencies in specimen receiving to enable sustained improvements in TATs. Thus, defining and measuring problems, planning, taking necessary steps and implementing them are effective techniques to improve throughput in preanalytical specimen handling.  The one-time expenses associated with the moves were minimal, and the cost-avoidance of satellite laboratory oversight and operation is substantial.  Lean six sigma techniques can be applied in a cost-effective manner to minimize preanalytical wastes and improve patient care.

Cryptosporidium parasite is a cause of diarrhea in humans and other cold and endotherm animals that have been widely distributed throughout the world. This study aimed to determine the genetic diversity of Cryptosporidium in children with diarrhea using the GP60 gene by Polymerase Chain Reaction Restriction Fragment Length Polymorphism (PCR-RFLP) method. In this study, stool specimens were collected from 182 children with diarrhea referring to Zabol hospitals. By direct observing the direct wet smear, Sheatherchr('39')s Sugar Flotation Solution, and ZiehlNeelsen staining, examinations were conducted to identify the parasite, eventually, on DNA Extracted from isolates, PCR-RFLP was performed. From the total of samples of 182 stool specimens, 27 isolates were diagnosed infected with Cryptosporidium using the Ziehl-Neelsen staining method, of which 17 isolates were from Cryptosporidium parvum and 10 isolates from Cryptosporidium hominis using molecular examinations. Both human and cattle genotypes of Cryptosporidium can be seen in children with diarrhea. However, given that the dominant species are Cryptosporidium parvum, the zoonotic transmission is more common than human transmission, and contact with livestock is considered as the most important source of human contamination.

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) emerged in December 2019 and rapidly spread worldwide. Since then, scientists have searched to find an effective treatment for coronavirus disease 2019 (COVID-19). In this regard, several antiviral drugs are currently undergoing clinical trial studies to evaluate their safety and efficacy in the treatment of COVID-19. Some of these drugs have been designed based on this fact that SARS-CoV-2 is a positive-sense single-stranded RNA virus and previous studies showed the efficacy of anti-RNA virus, single strand RNA inhibiting antisense RNAs (asRNAs), for silencing virus replication, in vitro. Exosomes can be suggested as a promising candidate to transfer the anti-SARS-CoV-2 asRNAs to human respiratory epithelium. Exosomes are secreted by mesenchymal stem cells (MSCs) and can be loaded by asRNAs of an anti-RNA virus. MSCs-secreted exosomes as a nano-cargo of asRNAs of anti-SARS-CoV-2 have other therapeutic potentials such as immunomodulatory effects of their cytokine contents, affinity to respiratory epithelial attachment, anti-fibrotic activity in lung, non-toxicity for normal cells, and not triggering an immune response. Moreover, inhalation of anti-SARS-CoV-2 asRNAs may stop SARS-CoV-2 replication. Producing specific anti-SARS-CoV-2 asRNAs by targeting the genome of virus and their delivery by MSCs exosomes are suggested and discussed. This approach will potentially shed light on gene therapy of the other human lung diseases via inhalational delivery using exosomes in future.

During 2019, the number of patients suffering from cough, fever and reduction of WBC’s count increased. At the beginning, this mysterious illness was called “fever with unknown origin” but now, it is known as the 2019 novel coronavirus (2019-nCoV) or the severe acute respiratory syndrome corona virus 2 (SARS-CoV-2). The SARS-CoV-2 is one member of great family of coronaviruses. Coronaviruses are enveloped positive-stranded RNA viruses. The SARS-CoV-2 has some particular structures for infecting, reproducing and causing damage. The SARS-CoV-2 can bind angiotensin-converting enzyme 2 (ACE‐2) receptors and cause various difficulties for human. The SARS-CoV-2 can cause both serious and not-serious issues for mankind. Malayan pangolin and bat are the most suspicious candidate for being sources of the SARS-CoV-2. The SARS-CoV-2 can be transmitted by various ways such as transmitting from infected human to healthy human and can make severe pneumonia, which can lead to death. The SARS-CoV-2 can infect different kind of people with different ages, races, and social and economic levels. The SARS‐CoV‐2 infection can cause various sorts of clinical manifestations like cough and fever and intensity of signs and symptoms depends on sufferer conditions. Clinicians use all of available documents and tests for diagnosing new cases and curing patients with high accuracy. At the present time, there is no particular way for treating SARS-CoV-2 infection. It seems that the best way for standing against the SARS-CoV-2 infection is preventing from it by social distancing and vaccination. This review tries to prepare an essential brief update about SARS-CoV-2 infection.

Up to now, enormous smart materials have been engineered with physical stimulators such as temperature, electric field, magnetic field, light, ultrasound, mechanical stimuli, chemical stimulators such as pH and reduction, or biological stimulators such as antigen glucose and enzyme in regenerative medicine. Smart materials have numerous properties, such as responding to controlled drug release, “ON-OFF” switch activities, prolonged blood circulation, ability to specific triggers, enhanced diagnostic accuracy, increased tumor accumulation, and therapeutic efficacy. In this review, notable research achievements of smart materials responsive to various stimuli involving responsive mechanisms and applications are summarized and discussed separately.

Over the recent years, studies in the area of cancer microenvironment and the cellular groups existing in this environment have indicated the significant role of them in progression of cancer studies. Among the mentioned cellular groups, as the main inflammatory components of stroma, Tumor associate macrophage (TAM) cells have the capacity of affecting the cancer tissue in different aspects. With their plasticity capacity, macrophages can change into M1 (classic) or M2 (alternative) macrophage reacting to different signals.  In the tumor environment, they usually change into the M2 phenotype, and this phenotype can create a precancerous role in the macrophage and facilitate the invasion of tumor cells and metastasis, angiogenesis, remodeling of the extracellular matrix, and suppression of the immune system. The various roles of these cells and their reversibility have made the TAMs a potential target of the cancer treatment. This process takes place by different mechanisms such as Interference with TAMs survival, Inhibition of macrophage recruitment, repolarization of M2-like TAMs towards an M1-like phenotype, nano particle and liposome-based drug delivery system. This review study investigates the markers and the function of M1, M2, and tumor-associated macrophages, and finally, it proposes the latest clinical and laboratory approach for targeting the TAMs.