Active tracking of rejected dried blood samples in a large program in Nigeria

AIM: To study the impact of rejection at different levels of health care by retrospectively reviewing records of dried blood spot samples received at the molecular laboratory for human immunodeficiency virus(HIV) early infant diagnosis(EID) between January 2008 and December 2012.METHODS: The specimen rejection rate, reasons for rejection and the impact of rejection at different levels of health care was examined. The extracted data were cleaned and checked for consistency and then deduplicated using the unique patient and clinic identifiers. The cleaned data were ciphered and exported to SPSS version 19(SPSS 2010 IBM Corp, New York, United States) for statistical analyses.RESULTS: Sample rejection rate of 2.4%(n = 786/32552) and repeat rate of 8.8%(n = 69/786) were established. The mean age of infants presenting for first HIV molecular test among accepted valid samples was 17.83 wk(95%CI: 17.65-18.01) vs 20.30 wk(95%CI: 16.53-24.06) for repeated samples. HIV infection rate was 9.8% vs 15.9% for accepted and repeated samples. Compared to tertiary healthcare clinics, secondary and primary clinics had twofold and three-fold higher likelihood of sample rejection, respectively(P < 0.05). We observed a significant increase in sample rejection rate with increasing number of EID clinics(r = 0.893, P = 0.041). The major reasons for rejection were improper sample collection(26.3%), improper labeling(16.4%) and insufficient blood(14.8%). CONCLUSION: Programs should monitor pre-analytical variables and incorporate continuous quality improvement interventions to reduce errors associated with sample rejection and improve patient retention.

One image is worth more than a thousand words:producing an atlas of medical signs for teaching clinical and forensic toxicology

Clinical and forensic toxicology are critically involved in the acquisition of basic skills to correctly suspect intoxication,collect biological and non-biological materials for toxicological analysis,comprehend the complexities inherent to laboratory activity,and understand the fundamentals of toxicokinetics and toxicodynamics that underlie the interpretation of results.This works presents a pedagogical innovation proposal for the teaching of clinical and forensic toxicology based on a compilation of more than 3000 cases where the image was fulcra for suspicion.The experience in this article follows the model practiced in bachelors,masters,and PhD degrees,as well as in other continuing training courses,where we are teaching toxicology for more than 15 years.All these levels of education are considered fundamental to the sound development of this science.This approach aims also to offer strength to the intervention of the true toxicologist in all the toxicological phases,besides the classic analytical chemistry.Indeed,it is impossible to provide effective clinical and forensic toxicological interpretations without a proper and broad education,and not thinking exclusively in terms of laboratory techniques.In the future,it will be interesting to evaluate knowledge retention and to propose a database of videos of signs related to intoxications.