Rapid establishment of a frontline field laboratory in response to an imported outbreak of Ebola virus disease in western Uganda, June 2019

The Democratic Republic of the Congo (DRC) declared an Ebola virus disease (EVD) outbreak in North Kivu in August 2018. By June 2019, the outbreak had spread to 26 health zones in northeastern DRC, causing >2,000 reported cases and >1,000 deaths. On June 10, 2019, three members of a Congolese family with EVD-like symptoms traveled to western Uganda’s Kasese District to seek medical care. Shortly thereafter, the Viral Hemorrhagic Fever Surveillance and Laboratory Program (VHF program) at the Uganda Virus Research Institute (UVRI) confirmed that all three patients had EVD. The Ugandan Ministry of Health declared an outbreak of EVD in Uganda’s Kasese District, notified the World Health Organization, and initiated a rapid response to contain the outbreak. As part of this response, UVRI and the United States Centers for Disease Control and Prevention, with the support of Uganda’s Public Health Emergency Operations Center, the Kasese District Health Team, the Superintendent of Bwera General Hospital, the United States Department of Defense’s Makerere University Walter Reed Project, and the United States Mission to Kampala’s Global Health Security Technical Working Group, jointly established an Ebola Field Laboratory in Kasese District at Bwera General Hospital, proximal to an Ebola Treatment Unit (ETU). The laboratory consisted of a rapid containment kit for viral inactivation of patient specimens and a GeneXpert Instrument for performing Xpert Ebola assays. Laboratory staff tested 76 specimens from alert and suspect cases of EVD; the majority were admitted to the ETU (89.3%) and reported recent travel to the DRC (58.9%). Although no EVD cases were detected by the field laboratory, it played an important role in patient management and epidemiological surveillance by providing diagnostic results in <3 hours. The integration of the field laboratory into Uganda’s National VHF Program also enabled patient specimens to be referred to Entebbe for confirmatory EBOV testing and testing for other hemorrhagic fever viruses that circulate in Uganda.

Following an imported outbreak of Ebola virus disease in Uganda’s western Kasese District, the Uganda Virus Research Institute and the United States Centers for Disease Control and Prevention jointly established a frontline field laboratory to test specimens collected from alert and suspect cases for Ebola virus disease. Using a single room equipped with a rapid containment kit to safely inactivate patient specimens and a GeneXpert to perform the Xpert Ebola Assay, the field laboratory rapidly ruled-out Ebola virus disease as the cause of illness in 76 patients during its 46 operational days. All specimens were also referred to Uganda Virus Research Institute (Entebbe) for confirmatory Ebola virus testing and testing against a panel of viruses known to cause hemorrhagic fever in Uganda, in line with the National Viral Hemorrhagic Fever Program’s testing protocol and mandate. The Ebola field laboratory served as a valuable asset in the outbreak response by supporting patient management and epidemiological surveillance.

Utility of repeat testing for COVID-19: Laboratory stewardship when the stakes are high

As the coronavirus disease 2019 (COVID-19) continues to circulate, testing strategies are of the utmost importance. Given national shortages of testing supplies, personal protective equipment, and other hospital resources, diagnostic stewardship is necessary to aid in resource management. We report the low utility of serial testing in a low-prevalence setting.

[THE ACTUAL APPROACHES TO PROBLEM OF IMPORT SUBSTITUTION IN TH FIELD OF PRODUCTION GROWTH MEDIUM]

The import substitution becomes one of strategic tasks of Russian economy as a result of imposition of economic sanctions on part of the USA, EU countries, Japan and number of other states. The development of structure and technology of production of national import substituted growth mediums permits satisfying needs of laboratory service of Russia inactive storage and to secure appropriate response to occurring challenges and new biological menaces and support bio-security of state at proper level. The presented data concerning substantiation of nomenclature of growth mediums and transport system permit satisfying in fullness the needs of clinical and sanitary microbiology in growth mediums of national production and to give up of import deliveries without decreasing of quality of microbiological studies.

Impact of the London 2012 Olympic and Paralympic Games on demand for microbiology gastrointestinal diagnostic services at the Public Health Laboratory London

Planning for the London 2012 Olympic and Paralympic Games at the Public Health Laboratory London was based on the requirement to meet potential increased demand with scalable capacity. The aim of this study was to determine the impact on demand for microbiology gastrointestinal diagnostic services during the Games period. Retrospective cross-sectional time-series data analysis was used to assess the number of gastrointestinal specimens received in the laboratory and the number of positive results. There was no increase in the number of gastrointestinal specimens received during the Games period, thus the Games had no impact on demand for microbiology gastrointestinal diagnostic services at the laboratory. There was a decrease in the number of public health specimens received for culture [incidence rate ratio = 0.34, 95% confidence interval (CI) = 0.13-0.86, P = 0.02] and a decrease in the number of culture positive community specimens (odds ratio = 0.59, 95 % CI = 0.40-0.85, P = 0.005), suggesting a decrease in gastrointestinal illness during the Games period. As previous planning assumptions were not based on actual specimen activity, the results of this study may modify the extent of additional planning for microbiological services required for mass gatherings.

[Integrated prevention and control strategy for dengue in Mesoamerica]

Dengue in the Americas is a public health problem in ascent. The control strategies have not been effective when sustained in the intensive use of insecticides and poor community participation. The Mesoamerican Initiative for the Prevention and the Integrated Control of Dengue synthesizes the works generated by the Integrated Strategy of the Pan-American Health Organization (PAHO) and the risks stratification strategy designed by the countries of the Mesoamerican region. The objective is to progressively reduce the incidence of dengue cases until a 50% reduction is reached over a five years period. This document describes the elements for the risk stratification, the activities for prevention and control organized by levels of intensity and frequency and the indicators used to pursuit the objectives. To face the dispersion of the problem a concentration of efforts for control in the areas of greater risk is presented; the opportunity in the detection of cases is highlighted to tackle the fast dissemination of the infection; focus on the most productive breeding sites is proposed to battle against the vast dissemination of the breeding sites; and the severity of the infection must be addressed by capable clinical human resources. This strategy was designed along with the national representatives of the control programs to create master plans that provided the basis for the integrated prevention and control of dengue in the Mesoamerican region.

[Plan to improve malaria control towards its elimination in Mesoamerica]

To develop a plan to strengthen the control of malaria towards its elimination. In 2009, under the coordination of the National Public HealthInstitute ofMexico, atransdisciplinary equipment of technical and operative experts was conformed to carry out a situational analysis of malaria and control programs and for the selection of effective practices of intervention that would be incorporated to the plan, within the framework of an exercise in Theory of Change. Criteria for thestratificationof thelocalities, based ontheirtransmission characteristics were established. The structural and operative limitations of the control programs were identified. A plan of interventions was elaborated to improve the coverage of epidemiological surveillance, anti-malaria interventions and opportune diagnosis and treatment of cases. The plan delineates progressive phases of implementation: reorganization, intensification of interventions and evaluation of elimination feasibility. The adoption of a regional strategic plan will provide guidance and administrative elements to conform a system that coordinates the activities of the national control programs and facilitate the elimination of malaria in the region.

[Equipping the bacteriological laboratories of a tuberculosis service as the most important element of assurance of the quality and safety of their work]

By taking into account the present requirements for the equipping of the laboratories, the authors have drawn up the minimum standard list of equipment, as well as a list of additional equipment for the specialized bacteriological laboratory of a tuberculosis-controlling institution, which performs microbiological studies for the diagnosis and control of chemotherapy for tuberculosis. The specifications and characteristics of the baric types of equipment used to fit out the laboratories under the present conditions are described. Equipping the laboratories in accordance with the draw-up lists is shown to ensure a qualitative, effective, and safe work. Recommendations on how to supply the laboratories with equipment, to make the optimal choice, and to use consumables for tests are given.

[Laboratory of Biopolymer Compounds]

General information is presented concerning the Laboratory of Biological Polymeric Compounds at the Institute of Microbiology and Virology of the National Academy of Sciences of Ukraine; equipment, analytical and biophysical methods applied in the laboratory are listed.

Roles of laboratories and laboratory systems in effective tuberculosis programmes

Laboratories and laboratory networks are a fundamental component of tuberculosis (TB) control, providing testing for diagnosis, surveillance and treatment monitoring at every level of the health-care system. New initiatives and resources to strengthen laboratory capacity and implement rapid and new diagnostic tests for TB will require recognition that laboratories are systems that require quality standards, appropriate human resources, and attention to safety in addition to supplies and equipment. To prepare the laboratory networks for new diagnostics and expanded capacity, we need to focus efforts on strengthening quality management systems (QMS) through additional resources for external quality assessment programmes for microscopy, culture, drug susceptibility testing (DST) and molecular diagnostics. QMS should also promote development of accreditation programmes to ensure adherence to standards to improve both the quality and credibility of the laboratory system within TB programmes. Corresponding attention must be given to addressing human resources at every level of the laboratory, with special consideration being given to new programmes for laboratory management and leadership skills. Strengthening laboratory networks will also involve setting up partnerships between TB programmes and those seeking to control other diseases in order to pool resources and to promote advocacy for quality standards, to develop strategies to integrate laboratories functions and to extend control programme activities to the private sector. Improving the laboratory system will assure that increased resources, in the form of supplies, equipment and facilities, will be invested in networks that are capable of providing effective testing to meet the goals of the Global Plan to Stop TB.

Ten years experience with 497 cases of neuroinfections in tropic: in limited laboratory infrastructure initially treat both, cerebral malaria and meningitis

Review of 497 cases of neuroinfections in 7 tropical clinics in Ethiopia, Uganda, Burundi, Kenya, Sudan within 2000-2007 was performed. 97.5% of all cases was cerebral malaria (40.1%) and bacterial meningitis (56.4%). TB meningitis, cerebral cryptococcosis and sleeping sickness were very rare.

Roles of laboratories and laboratory systems in effective tuberculosis programmes

Laboratories and laboratory networks are a fundamental component of tuberculosis (TB) control, providing testing for diagnosis, surveillance and treatment monitoring at every level of the health-care system. New initiatives and resources to strengthen laboratory capacity and implement rapid and new diagnostic tests for TB will require recognition that laboratories are systems that require quality standards, appropriate human resources, and attention to safety in addition to supplies and equipment. To prepare the laboratory networks for new diagnostics and expanded capacity, we need to focus efforts on strengthening quality management systems (QMS) through additional resources for external quality assessment programmes for microscopy, culture, drug susceptibility testing (DST) and molecular diagnostics. QMS should also promote development of accreditation programmes to ensure adherence to standards to improve both the quality and credibility of the laboratory system within TB programmes. Corresponding attention must be given to addressing human resources at every level of the laboratory, with special consideration being given to new programmes for laboratory management and leadership skills. Strengthening laboratory networks will also involve setting up partnerships between TB programmes and those seeking to control other diseases in order to pool resources and to promote advocacy for quality standards, to develop strategies to integrate laboratories functions and to extend control programme activities to the private sector. Improving the laboratory system will assure that increased resources, in the form of supplies, equipment and facilities, will be invested in networks that are capable of providing effective testing to meet the goals of the Global Plan to Stop TB.

[Public production of medicines in Brazil: an overview]

This paper analyzes the role of government production of medicines in Brazil, based on a review of the literature and public documents. It begins by examining the main characteristics of the national and international pharmaceutical industry and market dimensions, mainly in the public sector. The government view was examined through Ministry of Health documents. The article concludes with a diagnosis of the state-owned pharmaceutical industry in Brazil, showing a variety of difficulties faced by the laboratories due to political and institutional constraints, management deficiencies, shortage of qualified human resources, and low technological capability.

Surveillance methods and case definition for extensively drug resistant TB (XDR-TB) and relevance to Europe: summary update

Following the urgent call for a response to the extensively drug resistant tuberculosis (XDR-TB) outbreak in Kwazulu-Natal

Management of myocardial infarction with ST-segment elevation in district hospitals without catheterisation laboratory--Acute Coronary Syndromes Registry of Małopolska 2002-2003

INTRODUCTION

Early reperfusion therapy significantly reduces mortality and improves outcome in ST-elevation myocardial infarction (STEMI). Primary percutaneous intervention has been proven to be a better therapeutic option than fibrinolysis when it can be performed by an experienced team of interventional cardiologists, within 90 minutes from the first medical contact. Despite the publication of guidelines of the European and American Scientific Societies (ESC and ACC/AHA), treatment of patients with STEMI is far from the optimum. The registry is an effective and reliable method to estimate the quality of treatment and demographic and epidemiologic characteristics of the population of a given region.

AIM

To evaluate the therapeutic strategies of treatment of STEMI in district hospitals without a catheterisation laboratory in Małopolska.

METHODS

29 district hospitals from Cracow and Małopolska province participated in the Registry of Acute Coronary Syndromes in Małopolska. Finally, 2382 patients with an initial diagnosis of acute coronary syndrome were included. In 867 of them, STEMI was finally diagnosed.

RESULTS

In district hospitals, most patients with STEMI (63%) did not receive any reperfusion therapy (25% of them were >75 years old, in 20% chest pain lasted longer than 12 hours, in 7% cardiogenic shock was diagnosed and 12% had contraindications for thrombolysis or were at increased risk of haemorrhagic complications). Fifteen percent of all 867 patients were transferred to the interventional cardiology centre (63% for primary PCI, 20% for facilitated PCI and the remaining 17% for rescue PCI). Fibrinolysis was applied in 21% of all patients with STEMI. In-hospital mortality rate was 14.3% in patients treated with fibrinolysis as compared to 15.9% in those treated conservatively. Multivariate logistic regression revealed that younger age (OR 0.93; 95% CI 0.91-0.95; p <0.0001), lack of diabetes (OR 0.54; 95% CI 0.30-0.98; p=0.04) and higher systolic blood pressure (OR 0.93; 95% CI 1.00-1.02; p=0.006) were independent factors predicting the referral of patients with STEMI for PCI. GP IIb/IIIa inhibitors were used in 5% of all patients and in 30% of those referred for PCI.

CONCLUSIONS

Only one in every 7 patients with STEMI is qualified for PCI. Patients transferred to the centre with PCI facilities are younger, have no diabetes or hypotension. The use of GP IIb/IIIa inhibitors is limited. There is a need to establish local networks of hospitals with 24-hour catheterisation laboratory availability to increase frequency and efficacy of reperfusion therapy, especially in regions far from centres of interventional cardiology.

[Role of parasitological laboratories in sociohygienic monitoring]

The data available in the 2003-2004 statutory forms of the Russian Federation's subjects show that the parasitological laboratories of state sanitary surveillance centers in the Russian Federation make little use of sanitary-and-parasitological studies during sanitary monitoring. Studies of the parasitological indices of foodstuffs, drinking water, wastewater and their sediments are not under way in some regions. There is a poor material and technical basis in the parasitological laboratories; the work of parasitological laboratories does not meet the requirements stipulated in Sanitary Regulations 1.2.731-99 "Safety of work with microorganisms of pathogenicity groups 3-4 and with helmints". Intralaboratory monitoring is not always under way in the parasitological laboratories. Highly skilled staff is lacking. It is necessary to extend the list of sanitary-and-parasitological studies in accordance with MU 3.2.1756-03 "Epidemiological surveillance of parasitic diseases".

[Availability of molecular genetic diagnostic services in the Czech Republic. Is it too little, too much or sufficient?]

Review of diagnostic services offered by molecular genetic laboratories classified according the number of laboratories dealing with individual diagnoses is presented. Three different categories were distinguished: frequently, medium and rarely offered diagnostic service. Services that concerned trombophilic factors F2 a F5 and methylentetrahydrofolatreductase, cystic fibrosis, paternity testing, gender determination, molecular testing for hemochromatose--HFE, detection of BCR/ABL fused gene, and Y-chromosomal loci DAZ and AYF examination were most frequently offered.

Building a laparoscopic surgical skills training laboratory: resources and support

BACKGROUND

Technical skills have historically been developed and assessed in the operating room. Multiple pressures including resident work hour limitations, increasing costs of operating room time, and patient safety concerns have led to an increased interest in conducting these activities in a safe, reproducible environment. To address some of these issues, many residency programs have developed laparoscopic surgical skills training laboratories. We sought to determine the current status of laparoscopic skills laboratories across residency programs.

METHODS

In December 2004, surveys were mailed to all 251 United States general surgery residency program directors. This brief 2-page survey consists of 9 questions regarding laparoscopic skills training laboratories.

RESULTS

Of the 251 mailed surveys, 111 completed surveys were returned (44%). Of the respondents, 81 have laparoscopic skills training laboratories in place (80%). Skills laboratories that used a defined curriculum, and general surgery programs that shared their laboratories with other training programs were determined to have significantly more resources. A wide variety of funding sources have been used to develop and support these skills laboratories.

CONCLUSIONS

Significant variability in training practices and equipment currently used exists between laboratories. A more efficient, standardized approach to skills training across residency programs is a desirable goal for the immediate future.

Detecting polio through surveillance for acute flaccid paralysis (AFP)

Accurate surveillance for polio is essential for eradication. Surveillance systems for polio has been developed under the guidance of the global polio eradication initiative. Surveillance of cases of acute flaccid paralysis among children less than 15 years of age is a key component for a well functioning polio surveillance system. The surveillance system works through a network of surveillance medical officers, the responsibility of them lies in assisting the health services departments of all states and maintaining a network of acute flaccid paralysis reporting sites and rapidly investigating the cases. Surveillance activities begin when a child comes in contact with a healthcare provider who in turn informs the officer in charge of acute flaccid paralysis surveillance. The goal of the polio network laboratories is to provide accurate and timely results of wild poliovirus detection in stool samples of cases of acute flaccid paralysis. Strong linkages have been established between the acute flaccid paralysis surveillance system and the laboratory network. Laboratories complete poliovirus isolation and if poliovirus is isolated, these are submitted for intratypic differentiations. Acute flaccid paralysis surveillance in India has demonstrated that the eradication activities implemented in India led to dramatic reduction and restriction in the number of cases and geographic spread of poliovirus transmission.

Clandestine drug laboratories in Australia and the potential for harm

The emphasis in the literature regarding illicit drugs has been overwhelmingly on the subject of harm caused by their ingestion. Little has been reported on the potential and real harm associated with the illicit manufacture of drugs. This paper describes the increasing prevalence of clandestine drug laboratories in Australia, overwhelmingly devoted to the manufacture of methamphetamine. The nature of the illicit synthetic process is reviewed together with its inherent dangers for the 'cook', first responders and bystanders including children, and the environment. We have analysed the emerging trends in manufacture and seizure in Australia, and offer suggestions to remedy significant deficiencies in knowledge and policy in the management of clandestine drug laboratories, especially with reference to clinical management issues, data collection, environmental contaminants and remediation, legislation and research. In particular, we conclude that: The problem of clandestine drug laboratories is growing in Australia, reflecting patterns world-wide. There are significant health and environmental implications of this growth. First responders should ensure that specialised expertise is available when decommissioning detected laboratories. Clinicians should familiarise themselves with the types of injuries associated with clandestine drug manufacture. Legislatures without a clandestine drug laboratory registry should establish one. Where it doesn't exist, legislation should be sought to curb the spread of this unwanted phenomenon. Significant opportunities exist for further research into the harm caused to first responders, the community, and the environment by clandestine laboratories.

[National evaluation of the diagnosis of activated protein C resistance]

Thrombophilia or prothrombotic state appears when activation of blood hemostatic mechanisms overcomes the physiological anticoagulant capacity allowing a thrombotic event. Thrombosis is the leading worldwide mortality cause and due to its high associated morbidity and mortality, it should be insisted in the opportune identification of a thrombophilic state. The study of thrombophilia identifies individuals at high risk for thrombosis. This meeting was conceived first to analyze the current status of the diagnosis of thrombophilia in Mexico and second to create the base for a national consensus for thrombophilia screening and for the establishment of a national center for laboratory reference and quality control for thrombophilia. Since searching of activated protein C resistance (APCR) and FV Leiden seem to have priority either in the clinical setting and in public health services, it was decided to start with these two abnormalities as a model to analyze the current status of thrombophilia diagnosis in the clinical laboratory. At this time, several thrombophilic abnormalities have been described however, APCR remains the most important cause of thrombophilia, accounting for as much as 20% to 60% of all venous thrombosis. APCR is a consequence of the resistance of activated FV to be inactivated by activated protein C. Procoagulant activity of activated FV increases the risk of thrombosis. Hereditary APCR is almost always due to a point mutation at the nucleotide 1691 of the FV gen inducing an Arg506Glu substitution in FV molecule. This mutation is better known as FV Leiden. Heterocygous carriers of FV Leiden have a thrombotic risk 5 to 10 times higher than general population while the risk for the homocygote state is increased 50 to 100-fold. When activated PC is added to plasma from patients with FV Leiden, this last resists the anticoagulant effect of activated PC. Therefore, thrombin production is not inhibited. This phenomenon is called APCR. The functional test evaluates the partially activated thromboplastin time (aPTT) in a plasma sample before and after adding activated PC. The result is reported as a standardized sensibility index: aPTT post-activated PC/aPTT pre-activated PC. The conclusions of this national reunion pretend to optimize the available resources in our country in order to allow a wide and less-expensive diagnosis of patients with thrombosis.

Containing and combatting bioterrorism

At 09.28 Eastern Standard Time on September 11 2001, President George W Bush stated that the US had succumbed to a serious asymmetric threat and vowed to hunt down the perpetrators. American Airlines flight 11 hit the north tower of New York's World Trade Center at 08.48 Eastern Standard Time, followed by United flight 175 at 09.18 hitting the south tower. The south tower collapsed, followed by the north tower at 10.28. In 100minutes the world had changed forever.

Standard laboratory equipment

This appendix lists standard pieces of equipment in the modern biochemistry laboratory, i.e., items used extensively in this manual and thus not included in the individual materials lists.

[Capability of health services of the city of Ouagadougou to diagnose sexually transmitted diseases]

BACKGROUND

Quantitative and qualitative shortage of both human and material resources in the diagnosis of sexually transmitted diseases (STD's) remains one of the difficulties in dealing with these diseases in developing countries. The aim of this study was to determine the capability of health and medical laboratories personnel to diagnose STD's prevailing in Ouagadougou.

METHOD

The study has been conducted in all the health centres and the medical laboratories of the town. The personnel ensuring out-patient clinics and the director of each medical laboratory have been interviewed. The interview as well as the assessment of the consulting room and the medical laboratories technical equipment were carried out.

RESULTS

The range of STD's that the staff was able to point out was limited only to classical diseases. One member of the staff out of five mentioned two probable diagnoses of STD's in a case of a genito-urinary symptom. Errors in the diagnosis of vaginal discharge were significantly more frequent in the paramedical staff than in the medical one (p < 0.01), likewise the number of erroneous diagnoses of urethral discharge was more significant among the health agents in the private sector than those in the public sector (p = 0.04). The number of medical laboratories and the range of medical tests conducted in the town were lacking. Moreover, the results of these tests were not taken into account while prescribing the treatment for STD's.

CONCLUSIONS

The above observations indicate a limited capability of the urban health services in establishing diagnoses of STD's on a rational basis. The transformation of current laboratory activities to a centralized specialized laboratory capable of a) identifying microorganisms circulating in the town and determine their magnitude and sensitivity to the main antimicrobials available, b) maintain regular surveillance of microorganism susceptibilities, and c) ensure quality control of laboratory tests conducted at a lower geographical level would contribute to the information and training of health care personnel and better acceptability of diagnosis and treatment strategies by this personnel.

A protective cabinet for the post-mortem examination of infected animals

A special cabinet was designed to protect the operator, during post-mortem examinations on animals infected with pathogenic organisms, against the risk of enhaling infected material and the surrounding area from becoming contaminated. The cabinet was suitable for small animals including mice and guinea-pigs.

Building effective R&D capabilities abroad

In the past, companies kept most of their research and development activities in their home country because they thought it important to have R&D close to where strategic decisions were being made. But today many companies choose to establish R&D networks in foreign countries in order to tap the knowledge there or to commercialize products for those markets at a competitive speed. Adopting a global approach entails new, complex managerial challenges. It means linking R&D strategy to a company's overall business strategy. The first step in adopting such an approach is to build a team to lead the initiative--a team whose members are sufficiently senior to be able to mobilize resources at short notice. Second, companies must determine whether an R&D site's primary objective is to augment the expertise that the home base has the offer or to exploit that knowledge for use in the foreign country. That determination affects the choice of location and staff. For example, to augment the home base laboratory, a company would want to be near a foreign university; to exploit the home base laboratory it would need to be near large markets and manufacturing facilities. The best individual for managing both types of site combines the qualities of good scientist and good manager, knows how to integrate the new site with existing sites, understand technology trends, and is good at gaining access to foreign scientific communities. As more pockets of knowledge emerge around the globe and competition in foreign markets mounts, only those companies that embrace an informed approach to global R&D will be able to meet the new challenges.

Availability of laboratory testing services for identification of periodontal pathogens in dental plaque

Microbiologic monitoring of key subgingival plaque organisms has been proposed to enhance management of some patients with destructive forms of periodontal disease. However, isolation and identification of many of these species is available only through selected microbiology laboratories possessing special expertise with periodontal microorganisms. The purpose of this study was to determine the availability of periodontal microbiology laboratory services in the U.S. and Canada that identify suspected periodontal pathogens for dentists in clinical practice. A survey questionnaire was mailed to all U.S. and Canadian dental schools. Six laboratories that process plaque samples for dentists in private clinical practice were identified. All of the testing services examine plaque specimens for Actinobacillus actinomycetemcomitans and Bacteroides gingivalis. Four of the laboratories used bacterial culturing to characterize a wide range of plaque species and to determine antibiotic sensitivity of isolates. Two other laboratories use indirect immunofluorescence microscopy or DNA probes to screen for three putative periodontal pathogens. All but one of the testing services analyze plaque samples that are collected by private practitioners in their offices and forwarded to the laboratory through next-day delivery services or regular mail. The availability of these adjunctive diagnostic services may enhance the ability of dentists in clinical practice to apply recent advances in knowledge on periodontal microbiology into routine preventive and therapeutic patient care.

Laboratory support for poliomyelitis eradication: memorandum from a WHO meeting

This Memorandum summarizes the conclusions and recommendations of the participants at the Consultation on Strategy for Isolation and Characterization of Poliovirus Strains and Surveillance of Wild Polioviruses held in Geneva, 28-30 November 1988.

The effect of changing technology on manpower in pathology and laboratory medicine

This article reviews changes in technology, the economics of reimbursement, and the health care delivery system and describes the cumulative impact of these trends on pathologists, pathologists-in-training, and pathology laboratories. While an increase in the number of pathologists-in-training is not anticipated, their training will be influenced by the new biology of medicine and emerging new technologies. Specialized preparation of graduate medical education trainees will create new opportunities for pathologists, enabling them to respond to new challenges associated with change. Those who also hold degrees in management will be prepared to assume leadership roles.

The growth of physician office laboratories. Will it continue? What does it mean for hospitals?

The increase in both the numbers of physician office laboratories (POLs) and the range of tests they offer may have significant impact on hospital laboratories. Their profitability already weakened by prospective payment systems, hospital laboratories face a serious competitor in physicians' offices. Concerns about the quality of testing performed in POLs do not seem to be impeding their growth, but are stimulating various regulatory or legislative proposals, which would remove some of their economic incentives. Physicians will always need referral laboratories, and hospitals will need to cultivate this market by improving services to physicians. One such service--consultation by hospitals' clinical laboratory staffs--has the added feature of helping to improve the quality of POLs.

[Identification of proposed laboratories for leptospirosis surveillance at the regional and multiregional levels]

A geographic emplacement of reference Centres for the epidemiological control is proposed here according to recommendation by the Istituto Superiore di Sanità and the instructions of the WHO. While the ordinary laboratories make serodiagnosis for clinical use only, the reference Centres must carry out the epidemiological control by typing of leptospires strains in order to establish the prevalence of the serotypes in the different territories. For these more complex epidemiological techniques, closer relations between the Centres and the Istituto Superiore di Sanità are necessary. The national map proposed, object of discussion at the meeting, refers to reference Centres (location and person) that have made themselves available for this duty.