An audit of requisition forms received at a histopathological laboratory: how compliant are submitting clinicians?
The laboratory test cycle comprises pre-analytic, analytic and post-analytic components. The analytic components are within the domain of the laboratory. However, the pre-analytic phase, and more specifically, the pre-pre-analytic phase, are influenced by non-laboratory professionals and consist of processes that are performed outside the laboratory making these variables difficult to regulate. Registration and processing are two aspects of the pre-analytic phase that are dependent upon a well-completed laboratory requisition form accompanying the specimen. An incomplete requisition form has an impact on patient and sample identification (pre-analytic), interpretation (analytic), turnaround time (a quality indicator) and communication of results (postanalytic). Studies have shown that more errors occur during the pre-analytic phase. This may be because previous efforts in quality management concentrated on the analytic phase (e.g. automation) to exclude “human error”. Plebani et al. proposed some indicators to objectively measure the quality of laboratory services during the pre-analytic phase.
Detection of molecular resistance patterns in N. gonorrhoeae to extended-spectrum cephalosporins, ciprofloxacin and spectinomycin from primary vaginal swabs
Neisseria gonorrhoeae is the second most prevalent bacterial sexually transmitted infection (STI) and remains a significant public health concern worldwide. The World Health Organization (WHO) estimated that there were 87 million cases of gonorrhoea among adults (16–45 years) globally in 2016, with sub-Saharan Africa (SSA) having the highest incidence. In South Africa, the prevalence estimates for N. gonorrhoeae infection among human immunodeficiency virus (HIV) positive pregnant women ranges from 0–6.9%.4-11 N. gonorrhoeae is considered the most significant etiological agent of cervicitis and may correspond to as many as 50% of cases. If left untreated, it may result in serious sequelae during pregnancy, such as pelvic inflammatory disease, infertility, ectopic pregnancy, miscarriage, preterm labour, low birth weight, stillbirth, postpartum endometritis, neonatal conjunctivitis, neonatal pneumonia and an increased risk of HIV transmission from mother to child during birth.
The dysregulation of adipokines in the synergy of diabetes and HIV infection
Diabetes mellitus (DM) is a metabolic disorder characterised by an impairment of insulin production. Resultantly, the abnormal metabolism of carbohydrates elevates blood glucose levels. DM is classified into two main types. (i) Type 1 diabetes (T1D) is a congenital form characterised by deficient insulin production, and (ii) type 2 diabetes (T2D) which is an adult-onset condition characterised by high blood glucose due to either insulin resistance (IR) or a lack of insulin. (Table I.)
Influence of age, gender, seasonal variation and geographic region on the occurrence of kidney stones and its composition: a retrospective study in a South African population
Renal calculi are solid masses varying in size, shape, colour and composition, that form as a result of pathological accumulation of minerals and organic substances in the urinary system (kidneys, ureters and bladder). Kidney stone disease (KSD) remains a common problem and can create a burden on healthcare systems in most parts of the world due to the associated pain and infections, as well as chronic kidney disease. The prevalence is increasing worldwide with a recurrence rate of approximately 10% within one year. To the best of our knowledge, KSD prevalence in South Africa has not been reported; however, there is a study that demonstrated a low incidence of the disease in black populations compared to other population groups.
Internal audit: non-conformance at non-accredited public health laboratories in Gauteng, South Africa: views of internal auditors for 2015–2019
The International Organization for Standardization (ISO) 15189 is a standard for quality management specific to medical laboratories, which provides an overarching structure to laboratory operations. Laboratories invite an external independent accreditation body to assess the effectiveness of their quality management system (QMS) and adherence to ISO 15189 standards. This external independent accreditation body is known as the South African National Accreditation System (SANAS). SANAS was founded in 1996 and is the sole national accreditation body that provides internationally effective and recognised accreditation. It also monitors good laboratory practice compliance. Public health medical laboratory services play an essential role in healthcare across the world. In South Africa, these public health laboratories are a component of the healthcare sector together with private medical laboratories. The health outcomes of patients are greatly influenced by the accuracy of testing and reporting of laboratory results. Plebani5 highlighted that 60–70% of the most important decisions on admission, discharge and medication are based on laboratory test results. It is therefore crucial for both public and private diagnostic laboratories to comply with the ISO 15189:2012 standard. This standard is used to evaluate the laboratory’s management and technical compliance to confirm the accuracy and reliability of laboratory testing.
Pharmaceutical care integration in rural public health districts
South Africa’s healthcare system finds itself in a stage of profound revolution where changes in global health and human development as well as political and economic challenges, call for solidarity among healthcare workers to realise the 17 sustainable development goals (SDG) that were set in 2015. Additionally, citizens’ right to healthcare access is embedded in South Africa’s post-apartheid Constitution. Furthermore, efforts regarding universal health coverage (UHC) are structured around a unified health system that strives for equitable access to medicines for the entire population. The caveat was that “critical socioeconomic right” is to be realised gradually within the scarcity of accessible resources. However, equity and access for all can be achieved through a shift to a primary healthcare delivery approach. According to Chopra et al, accessibility to healthcare for all South Africans rests in addressing the rural and underserved communities through the strategic vehicle of building new primary healthcare (PHC) clinics.
Validation of the cerebrospinal fluid module of the Siemens ADVIA® 2120i for automated cell counts of cerebrospinal fluid
Analysis of cerebrospinal fluid (CSF) cell counts provides critical information required for the diagnosis of various inflammatory and infective conditions, as well as for monitoring the response to therapeutic measures. The value of CSF cell counts is underscored further by its usefulness for diagnosing central nervous system (CNS) infiltration by primary neural and extraneural malignancies.
The link between accreditation and quality laboratory services: public versus private laboratories in South Africa
The process of accreditation of a laboratory involves an assessment by an independent authorised accreditation body, and confirmation that the Quality Management System (QMS) is well implemented and conforms with the quality standard. The accreditation process allows an authorised body to give formal recognition that a laboratory is competent to perform specific tasks. The rate of medical laboratory accreditation is growing in South Africa, although this is not evenly distributed to both publicly- and privately-owned laboratories. The only authorised accreditation body in South Africa is the South African National Accreditation System (SANAS) as per the Accreditation for Conformity Assessment, Calibration and Good Laboratory Practice Act 19 of 2006 to offer an internationally recognised accreditation and monitoring system in South Africa. The publicly-owned laboratories offer non-profit healthcare services to approximately 80% of the population throughout South Africa. The remaining 20% of the population is serviced by privately-owned laboratories.
Manifestation of diabetes among different professionals in the Volta Region of Ghana
Diabetes mellitus (DM) is a metabolic disorder of several aetiology characterised by chronic hyperglycaemia with disorders of carbohydrate, fat and protein metabolism resulting from a defect in insulin secretion, insulin action or both. DM can be grouped into two broad aetiopathogenic categories, namely, type 1 and type 2. Type 1 diabetes mellitus (T1DM) occurs within all age groups and represents 10% of the diabetic cases, while type 2 diabetes mellitus (T2DM) occurs during later stages of life (> 30 years) and accounts for approximately 90% of all diabetes cases.2 Globally, 463 million people between the ages of 20 and 79 were estimated to be living with DM in 2019. This represents approximately 9.3% of the adult population and this number is expected to increase to 578 million (10.2%) in 2030 and 700 million (10.9%) in 2045.3 The International Diabetes Federation (IDF) has estimated that, globally, one in 11 adults (415 million adults) aged 20–79 years had DM in 2015 and projected this figure to rise to 642 million adults by 2040.4 In sub-Saharan Africa alone, it was estimated that roughly 15.5 million people had DM in 2017 of which 69% was undiagnosed. A vast number of DM research studies conducted among youth aged 10–19 years have established an increased incidence rate of 12.1 per 100 000 youth. T1DM is considered a public health threat because of the increasing number of patients as well as the severity of complications associated with it.
The therapeutic use of cannabis in South Africa: panacea or scourge?
The Constitutional Court of South Africa passed a bill on 18 September 2018 decriminalising the cultivation, possession and use of cannabis by private adults. In this regard, it would now not be an offence for a person to:
• be in possession of cannabis in a private setting for his or her own consumption, or
• cultivate cannabis in a private setting for his or her personal use
A laboratory case of Emergomyces africanus
Emergomyces africanus (Es. africanus) is a novel thermallydimorphic fungal pathogen, which belongs to the Ajellomycetaceae family. The fungus was first identified in 1992 and closely resembled Emmonsia pasteuriana. Es. africanus was identified as a cause of disseminated mycosis in patients with advanced human immunodeficiency virus (HIV) disease. Es. africanus was initially referred to as Emmonsia, but following a taxononomic revision of the Ajellomycetaceae, it was accommodated under a new genus called Emergomyces. Five species have now been described within the Emergomyces genus, with disease reported globally. These are Es. africanus (in Africa), Es. canadensis (in Canada and United States of America), Es. pasteurianus (in Europe), Es. orientalis (in China) and Es. europaneaus (in Germany).