New Product Friday–Alifax SPA

Using light scattering technology to identify bacteria has been around for a few years (as evidenced by this paper from 2009 and this article from 2006. The methodology described in these articles use actual bacterial colony growth on conventional media for identification. This only shaves a day off turnaround time. This is handy, but can we do any better?

Enter Alifax SPA. They claim to have an automated analyzer capable detecting the presence of pathogenic bacteria, quantifying (in CFU/ml) that bacteria, and measuring the drug resistance of that organism in a few hours by using light scattering technology. Those techs that have worked in hematology or urinalysis are no stranger to this type of analyzer, but how well does it translate to the world of microbiology?

Does anyone have any experience with the HB&L or the Alfred 60? How do you feel about these analyzer? Do you like this much automation in the microbiology laboratory? Let us know in the comments.

-Kelly Swails

 

 

 

CAP 2013 and My First Residents Forum

This past weekend, I attended my first College of American Pathologists (CAP) Residents Forum (RF) and Annual Meeting in Orlando, FL.

I had previously served as a delegate to the Student Osteopathic Medical Association (SOMA) House of Delegates (HOD) during medical school when I was my school’s chapter president. I was also the alternate delegate for the state of NJ at the American Osteopathic Association (AOA) House of Delegates when I was on the Council of Osteopathic Student Government Presidents (COSGP). And lastly, for the three years I served on the DO Advisory Board for the American Medical Students Association (AMSA), I wrote DO relevant resolutions for AMSA’s HOD.

In all three of my previous experiences with an organization’s HOD, I actively participated in some shape or form in voicing the opinion of those I represented – whether through writing resolutions or debating and voting on resolutions. In this manner, I, and other delegates like me helped to shape the final form of our organization’s constitution and by-laws. And this is the mindset with which I attended the Residents Forum and even ran for the position of alternate delegate to the CAP HOD on the Residents Forum Executive Council.

However, I must have misunderstood the purpose of the RF and I think it worked out that I did not win the position I ran for. What I had expected and wanted was to participate in a resident caucus to identify the consensus opinion on resident-relevant HOD resolutions similar to my previous experiences as an HOD delegate – to see my fellow residents empowered and engaged in the parliamentary process. Don’t get me wrong…I did enjoy meeting other residents at the RF – that was one of the highlights of my experience and I made some new friends who are also passionate about transforming the future of our profession.

The talks were also informative for many of the first-timers although most of the topics were not new to me and about content that I had heard before during my work with AMSA and my MPH studies. But that doesn’t take away from the fact that it was resident-relevant information that each delegate could take back to their programs for their co-residents. So, my experience was mixed in terms of what I had expected and what I saw as benefits for delegates who attended.

Then, I presented a poster during the CAP conference, listened to the keynote by Dr. Eric Topol (although I did not agree with everything he said, it was thought provoking and informative), attended didactics, and participated in a mock fellowship interview with one of the CAP Board of Governors. But the encounters that I enjoyed most were those when I discussed the future of our healthcare system with physicians that I met. I did end the conference on a good note as I found out that I was chosen as the resident/junior member on CAP’s Council on Education for the next 2 years.

-Betty Chung

The Importance of Global Outreach

In the wake of the September 21st shootings and hostage takings at the Nairobi Westgate Mall I have found it difficult to write about the minutiae of laboratory medicine and the details of running a laboratory in the developing world. Instead, my mind wanders to my own personal experiences in Kenya and Nairobi and the people I have encountered in my travels.

In all my times on the African continent I have only been to Nairobi twice (not counting transiting through the airport, which would take the number up to at least ten). My first time in Nairobi was for one day as I made my way to a six month volunteer position in Tanzania. I landed at the Nairobi airport, an intimidated 25-year-old, all alone. I was scared and nervous but incredibly excited. My memory of the city that time is hazy but I can still smell the distinct scent of the air upon exiting the airplane, and I can still feel the knot of nervous excitement in my stomach.

By my second trip to Nairobi, years later, I was much more accustomed to East Africa. This time I was there with an ASCP colleague and volunteer to conduct laboratory assessments at level I and II labs throughout the city. We spent a week driving all over Nairobi and the surrounding suburbs visiting multiple labs. We saw a lab being run out of a container, and another that was inaccessible by car, it was so tucked away in one of the poorer areas of the city that the road was too narrow for anything but foot traffic. We saw labs in desperate need of basic supplies and electricity. We met lab techs who were working hard to do their best with the few available resources.

As we drove around the city we not only had the opportunity to visit these labs and conduct our assessments but, while mired in the worst traffic jams I have ever experienced, we had time to observe the city. We watched women and men working, shopping, socializing; children playing, and running to and from school. We saw an energetic city with millions of people going about their daily lives. People who I imagine are touched by this tragedy. People I have been thinking about these past couple of weeks.

While my heart breaks for those who suffered and lost loved ones, a tragedy like this reminds me why the work of global outreach is so important. With injuries (both catastrophic and not) the lab is an important part of overall health care. A situation like this reminds us of the importance of having well-run, safe, accurate blood banks to treat the wounded and sick.

-Marie Levy

The Rogue Suitcase, Part II

I’m sure you’re anxious to hear what happened to my little suitcase packed for two continents and extremes in weather—part of my “Adventures In Travel” as an ASCP Consultant. We left the little rogue somewhere in Amsterdam with several airline baggage officers giving chase in multiple languages. My hotel concierge in Kazakhstan was very sympathetic to my plight, and they sent me in a car to the city’s one shopping mall. Remember it’s about -30 degrees, and so they dropped me off to find what I needed and would pick me up in two hours. I have a very good friend I’ve worked with internationally who would call that “power shopping.”  I needed professional clothing and shoes to work in, a few essentials, and definitely a coat, hat and gloves. It should be noted that, with rare exceptions, body sizes differ across the globe….and the language of sizes is a challenge. One kind store clerk kept bringing me black pants to try on that would have fit Twiggy (and if you know who that is, well, you know the root cause of my problem!).  Finally in sign language, she convinced me that “these were the biggest sizes she had” and with no other choices available I set my goal for lighter breakfast in the weeks ahead. The coat was another matter. After looking in every store I found the ONLY one in the entire mall that actually fit me, and was warm enough, and was not a men’s musher’s parka. Of course, it was not on the bargain rack, but it was worth every KZT tenge!

My suitcase caught up with me the last two days in northern Kazakhstan just in time to board the plane for our next few days in southern Kazakhstan. One of my travel companions shared a furry lambs’ wool hat with me and I had the rest of my travel wear for the next few days. At the end of our time in Kazakhstan I was headed for Namibia for another week of work in the summer sun with our colleagues there, and en route I had a 2 day layover in Frankfurt, Germany, where I celebrated my birthday! Armed with my coat and hat and gloves and boots on my body, I boarded the plane for Frankfurt. Due to the size of the plane they would not allow me to carry on my little rogue suitcase, but I figured what could possibly happen? We’re not stopping anywhere. I reluctantly gave it to the baggage handler. It made it to Frankfurt according to the computer, but was somewhere inside the Frankfurt air terminal and they “couldn’t exactly locate it just now.” Well … it caught up with me again just as I was leaving the hotel to board the plane to Namibia. By this time I’m having fun with this little game, and happily checked it at the airport wondering where in the world it would travel without me this time! Lo and behold, it didn’t make it to Namibia either … no surprise. It probably missed the last plane from Johannesburg to Windhoek (which I’ve almost done several times myself!) You can imagine that my new coat and hat and boots are a bit overdressed for the Namibia summer climate, so I was glad I had “layered” my working outfit in the bottom of my backpack—and I was good to go, but I had quite a story to share with my ASCP colleagues and Namibia classmates about lost luggage.

My little rogue suitcase finally caught up with me in Ondangwa the next day, so I was now well dressed for the remainder of my trip; I actually had too many clothes, and had to purchase a small duffle to get things home. Oddly enough, that little suitcase made it all the way back to San Diego without incident through intricate travel on the home stretch—I fully expected it to end up in Brazil, but it must have been tired of the game by then!

Lessons learned? 1) Never trust your luggage to make it to your destination—even if it’s your carry-on; 2) Always have one change of clothing with you at all times, even if you have to wear it; and 3) You can actually live and work for three weeks out of a backpack, on two continents and extremes in weather with both professional and casual attire—but you’ll have to trust me on that one!

Next time I’ll share a little about “Adventures in Travel” that involve passports … stay tuned. And, if you are ever in Frankfurt celebrating your birthday, I highly recommend the Marriott Hotel restaurant. They treated me like royalty and were very attentive since I was celebrating all by my self—and served me a very fine birthday dinner with a complimentary glass of champagne!  I had a lovely day actually, and if you would like to know how to spend your birthday in Frankfurt, contact me at bsumwalt@pacbell.net. I’ve got some ideas for you!

Cheers, Beverly Sumwalt

Cystic Fibrosis Related Diabetes

Cystic fibrosis-related diabetes (CFRD) is a type of diabetes that affects individuals who have Cystic Fibrosis. CFRD is an entity unto itself, having several aspects that make it different from other forms of diabetes.

Cystic Fibrosis (CF) is one of the most common genetic defects among the Caucasian population, and it is a devastating, systemic disease. When CF was first being diagnosed, children with this disorder rarely lived to reach their teens]; now the average life expectancy  of an individual with CF is around 36 years. Still horrifically short, but better. The fact that people with CF are living longer means they acquire other disorders, including a type of diabetes. It has been shown that with increasing age in the CF population there is increasing incidence of diabetes mellitus.  Roughly 20% of adolescents with CF have diabetes and about 50% of adults with CF have CFRD (1).

CFRD is not as straight-forward to diagnose as type 1 and type 2 diabetes, so it’s important for laboratory professionals to be aware of this disease. People with CF who have diabetes may not always have hyperglycemia. Also hemoglobin A1c (Hgb A1c) values, which is a test recommended by the ADA for diagnosing diabetes, may not be elevated in these patients. The oral glucose tolerance test (OGTT) is recommended for diagnosis of CFRD, and yet even these results may be equivocal in CFRD patients (2). Nonetheless, the ADA/CFF guidelines suggest that all CF patients over 10 years of age should be screened yearly for CFRD using the OGTT. In addition, at least one study in the literature has found that when performing an OGTT on CFRD patients, a glucose level at the 1 hr time point correlates best with the patient’s lung function (3). Thus, if your lab performs OGTT on individuals with suspected CFRD, the physician requesting the test may want the glucose value on a one hour time point as well as the standard 2 hour OGTT.

Individuals with CF who get CFRD tend to have weight loss, protein catabolism, worsened lung function and significantly increased mortality compared to CF individuals without diabetes. The increased mortality is directly related to decreased pulmonary function, rather than to the atherosclerotic vascular disease seen in other types of diabetes. Insulin therapy is the recommended therapy for CFRD.

-Patti Jones

References:

  1. Moran A, Brunzell C, Cohen RC, Katz M, Marshall BC, Onady G, Robinson KA, Sabadosa KA, Stecenko A, Slovis B. Clinical care guidelines for cystic fibrosis-related diabetes.  Diabetes care 33(12):2697-2708. 2010.
  2. Rana M, Munns CF, Selvadurai H, Donaghue KC, Craig ME. Cystic fibrosis-related diabetes in children – gaps in the evidence? Nature Reviews: Endocrinology, 6:371-378. July 2010.
  3. Brodsky J, Dougherty S, Makani R, Rubenstein RC, Kelly A. Elevation of 1-hour plasma glucose during oral glucose tolerance testing is associated with worse pulmonary function in cystic fibrosis. Diabetes Care, 34:292-205. 2011.