One of the primary challenges in diagnostic testing is ensuring the accuracy of results. This requires medical laboratories follow strict protocols and adhere to a code of conduct. Medical laboratory professionals must also be trained to properly collect, handle and analyze samples to avoid contamination and ensure the validity of results.

Another challenge is maintaining the confidentiality of patient information. In diagnostic testing, sensitive information about a patient’s health can be revealed and it is the responsibility of healthcare providers to ensure that this information is protected and not disclosed to unauthorized individuals.

In addition to these practical challenges, there are also important ethical considerations to keep in mind. The diagnostic process must be guided by the principles of medical ethics, which emphasize on the importance of treating patients with dignity and respect, and balancing their right to know with the need to protect their privacy. The ethical principles of autonomy, beneficretion and informed consent must be upheld, giving patients the right to make informed decisions about their health and medical treatment.

Another important ethical consideration in diagnostic testing is the principle of non-maleficence, which requires healthcare providers to avoid causing harm to patients. This is especially important in the context of diagnostic testing, as patients may experience psychological or emotional harm as a result of receiving results that are unexpected or difficult to understand.

Finally, it is important to remember that diagnostic testing is a complex process that must be carried out in a way that respects human values and ethics. Healthcare providers must work together to ensure that patients are treated with kindness and compassion and that the diagnostic process is guided by the highest standards of ethics and professionalism.

In conclusion, the challenges and ethical considerations in diagnostic testing are numerous and complex. It is the responsibility of healthcare providers, medical laboratories, hospitals and all involved parties to ensure that this important process is carried out in a way that protects the well-being of patients and upholds the highest standards of medical ethics. By doing so, we can ensure that patients receive the best possible care and that the diagnostic process contributes to their physical and emotional well-being.

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TYPES OF HAI

Many HAIs are caused by implants and in addition to infections caused by cross-contamination between patients and health staff, patients being prone to common infections due to weakened immune systems, and infections at surgery sites (SSIs). These include central line-associated bloodstream infections (CLABSIs), catheter-associated urinary tract infections (UTIs), and ventilator-associated pneumonia (VAP) 

CLABSI- Central line-associated bloodstream infections are lethal nosocomial infections, with a fatality rate ranging from 12% to 25%. Catheters are inserted into central lines to deliver fluids and medications, but extended usage can result in significant bloodstream infections, compromising health and increasing care costs.

SSI- SSI is the most common postoperative surgical complication, with major morbidity, high mortality rates and expensive strain on national budgets and individual patients. SSIs are infections that develop up to 30-90 days after surgery in individuals who have received an organ, group of cells or gadget and impact both the incisional site and deeper tissues surrounding the operated area.

UTI- UTIs are the most frequent HAIs and one of the top ranking microbial illnesses, accounting for approximately 40% of HAIs and having major morbidity and death effects. Although most CAUTIs are harmless, some people harbour potentially harmful aggressive bacteria but are asymptomatic. Prolonging the duration of the catheter, female sex, older age, diabetes mellitus, the lack of systemic antibiotics, catheter placement outside the operating theatre and a breach in the closed system of catheter drainage are all risk factors for CAUTIs.

Despite a vast variety of other microbes, including eukaryotic fungus, being identified, E. coli is the predominant pathogenic microorganism that causes infection. Bacterial resistance results from the improper, repeated administration of antibiotics. Biofilm frequently forms on the surface of catheters as a result of CAUTIs. Microbes are protected by the biofilm from both antimicrobial agents and host defence mechanisms. Even though short-term catheter use has a low risk of CAUTIs if catheters are properly inserted and cleansed.

VAP- More over a quarter of patients in ICUs have pneumonia, the second most frequent HAI. Approximately 86% of HAIs are linked to VAP and mechanised automatic ventilation. After endotracheal intubation and mechanical ventilation, the average critical period for developing VAP was 2-3 days. Patients typically experience fever, altered bronchial sounds, decreased white blood cell counts, changes in sputum and the identification of the causative organisms. With a mean interval between intubation and the onset of VAP of 3 days, the first five days of mechanical breathing are the most dangerous for the development of VAP.

NOSOCOMIAL PATHOGENS

Bacteria, viruses, and fungal parasites are pathogens that cause nosocomial infections. These bacteria varies based on the patient group, medical facility, and even the environment in which the care is provided.

Bacteria- The most prevalent pathogens responsible for nosocomial infections are bacteria.  Some are a part of the patient’s natural flora and only become infectious when the patient’s immune system becomes susceptible to illnesses. Example- Acinetobacter,Bacteroides fragilis, Clostridium difficile, Enterobacteriaceae(carbapenem-resistance), Methicillin-resistant S. aureus (MRSA) 

Fungus- Through environmental contamination, Aspergillus spp. can cause illnesses. Candida albicans and Cryptococcus neoformans are also responsible for hospital infection.

Virus- Hepatitis virus can be spread during the administration of medicine to both patients and staff. Unsafe injecting techniques frequently result in the transmission of Hepatitis B and C.Despite the advancement of various high-tech procedures, hand washing with soap and water or an alcohol rub is still the most important way to maintain personal hygiene and prevent HAIs.  However, due to the growth of antibiotic-resistant bacteria and the unwillingness of certain HCWs to apply best practice infection control, HAIs continue to be one of the leading causes of death in the majority of countries. As a result, it is critical that strategic, policy, and education activities continue to focus on treating and controlling such (mostly unnecessary) infections. A WHO-guided effective surveillance strategy can assist healthcare institutions in developing infection control programmes. Effective biosafety training for hospital workers, proper waste management, healthcare reforms, and making the general public aware of these endemic pathogens can all assist to reduce nosocomial infections.

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Low amount of clotting factor VIII or clotting factor IX are present in those with hemophilia.  The quantity of clotting factor in the blood determines how severe is hemophilia. In hemophilia, there is a low level of clotting factors, the bleeding is more likely to happen, which can cause major health issues. 

Hemophilia,  in extremely rare circumstances can develop later in life. In most cases, middle-aged or elderly persons are involved, as well as young women who have recently delivered a baby or are in the final stages of pregnancy. With the right care, this condition frequently gets better. 

Causes of Hemophilia

A gene that codes for the clotting factor proteins necessary to create a blood clot is altered or mutated in hemophilia which results in the disorder. A clotting protein that has undergone this alteration or mutation may not function at all or may function improperly. On the X chromosome, these genes are situated. 

There are numerous genes on the X chromosome that are absent from the Y chromosome. As a result, although females have two copies of the majority of X chromosome genes, males only have one copy. Therefore, if a male inherits an X chromosome that has a mutation in either the factor VIII or factor IX gene, they may develop a disease hemophilia. Hemophilia can also affect women, however this is less common. In these situations, either both of the X chromosomes are affected or one is affected while the other is absent or inactive. These females may experience bleeding symptoms similar to hemophiliac males. 

Types of Hemophilia

• Hemophilia A (Classic Hemophilia)
• Hemophilia B (Christmas Disease) 

Symptoms of Hemophilia 

• Bleeding joints. This can cause joint swelling, pain or tightness. It commonly affects elbows, knees and ankles. 
• Frequent nose bleeding that are difficult to control. 
• Blood in urine and stool. 
• Head bleeding in infants after dystocia
• Bruising and Hematoma
• Bleeding of the mouth and gums and bleeding that is hard to stop after losing a tooth.
• Post-circumcision bleeding

Treatment

The perfect approach to treat hemophilia is to replace the missing blood clotting factors so that the blood can clot properly. This is done by infusion (given intravenously) of commercially manufactured factor concentrates. People with hemophilia can gain knowledge of self-administering these infusions, thus stopping bleeding episodes and even prevent most bleeding episodes with regular intravenous drips (called prophylaxis). 

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Indications

Hemochromatosis, Polycythemia Vera, Porphyria Cutanea Tarda, Polycythemia related to arterio-venous fistulae, and cyanotic congenital heart disease. Iron excess, or hemochromatosis, can be inherited or acquired as a result of repeated transfusions, it is crucial that blood contain the proper levels of iron. Too much can have a negative impact on health and perhaps set the stage for future illnesses. The removal of abnormally shaped red blood cells, as in sickle cell anaemia, or the reduction of blood viscosity as a result of increased red cell mass may all be treated with therapeutic phlebotomy. 

Procedure of Therapeutic Phlebotomy

Phlebotomy is frequently carried out by a skilled phlebotomist in a blood donation facility. Phlebotomy for therapeutic purposes is carried out under medical supervision. 

Temperature 

Blood pressure

Heart rate (pulse)

Arm examination

Respiration 

A technician will extract a certain amount of blood during a therapeutic phlebotomy treatment using a needle attached to a blood collection bag. The technician will withdraw the needle and apply a pressure bandage to the needle site when the appropriate amount of blood has been extracted. Place the needle in a sharps biohazard container after removing it from the transfer bag. Place the bag in the biohazard waste for disposal.

Check for reactions from the patient. Inform your primary doctor if any reaction occurs. Keep track of the reaction type and how symptoms went away. Give patient refreshment and advise  to wait for at least 15 minutes before getting back to their regular routines.

Conclusion 

Therapeutic phlebotomy is beneficial for treating individuals with hemochromatosis, polycythemia vera, and associated disorders because it is reasonably safe and successful at reducing iron storage in the body.

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 Liver function tests include the following:

Alanine Transaminase (ALT) or Serum glutamic pyruvate transaminase (SGPT) 

ALT is an enzyme mainly found in liver. High levels of ALT or SGPT in the blood may indicate liver damage. ALT is normally present in the liver and hence it is a specific enzyme for indicating liver injury than AST.

Aspartate Transaminase (AST) or Serum glutamic oxaloacetate transaminase (SGOT) 

AST is an enzyme found in quite large amounts in the liver and other parts of the body like muscles.

High levels of AST may be a sign of liver damage.  AST levels in blood are also elevated during muscle injury, heart disease such as congestive heart failure and hemolysis.

Alkaline phosphatase (ALP)

ALP is an enzyme mainly present in the liver and bone and is responsible for the breakdown of proteins. High levels of ALP in the blood may indicate liver damage or hepatobiliary disease such as a blocked bile duct, cholangitis or bone diseases.

Gamma-glutamyl transpeptidase (GGT) 

GGT is an enzyme found in liver, bile ducts and pancreas. High levels of GGT may be a sign of hepatic or bile duct damage.

Total Protein 

Total Protein measures the amount of protein present in the blood. Albumin and Globulin are the two main proteins present in the blood. Albumin and Globulin are produced in the liver.  Low albumin and globulin levels can be a sign of liver damage. 

Prothrombin 

Prothrombin is a protein made in the liver and helps in clotting of blood. A high prothrombin time due to lower prothrombin levels can be a sign of liver damage.

Bilirubin

Bilirubin is a yellowish pigment present in bile. It is produced during the breakdown of red blood cells. Bilirubin passes through the liver, gets conjugated and is excreted in stool. High levels of bilirubin (jaundice) may be a sign of liver damage or anemia.

Diagnosis based on LFT:

• Hepatitis, fatty liver disease, ischemic hepatitis, autoimmune disorder of liver, hemochromatosis(iron overload), side effect of medications/toxins, Wilson disease(excess copper deposition in the liver, brain and other tissues). 

Submitted By:

Ms. Yashica Adlakha

Faculty of Biochemistry

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Biomarkers are produced by cancerous cell or are secreted in response to cancers. These biomarkers are usually detected in blood or urine. The markers can be used for predicting risk of primary or secondary tumor. Occasionally, non-cancerous situations may also show increased level of some tumor markers than in normal conditions. In addition, some cancer patients does not have elevated level of tumor marker. Tumor markers are not the main parameters for diagnosis of cancer but may be employed as laboratory test as supportive to the diagnosis.

Types of Cancer Markers

The cancer markers can be hormones, oncofetal antigens, isoenzyme, proteins, mitochondrial markers, mucin, glycoproteins and molecular markers. Some of the biomarkers are calcitonin, human chorionic gonadotrophin, α fetoproteins, carcino-embryonic antigen, prostatic acid phosphatase, Immunoglobulins, catalase, mtDNA, cancer 125, p53, adenomatous polyposis coli etc.

Uses of Tumor Marker Detection

Though tumor markers are generally unsatisfactory for screening tests of occult cancers, when a specific tumor was diagnosed by means of a marker, the biomarker can be used as follow up of the treatment. Their level may also show the progression of the disease. Increased levels of tumor markers on detection results can be, but are not at all times bothersome. Though alteration of tumor marker levels can be the reason to alert, other noncancerous conditions may show variation in test result. The laboratory conditions for performing the tests can also change the results.

Advantages Of Tumor Marker Detection

• Tumor markers help in screening and early detection of cancer. Screening of tumor markers means to search for tumor markers in asymptomatic persons, whereas early detection means to detect markers at early stage of cancer.
• They help in the diagnosis of cancer. Both biopsy and tumor markers are employed to diagnose cancer. It is also capable to detect the origin of cancer in patients who are in advanced stages.
• They are also used to monitor the response to therapy. The originally elevated tumor marker level reduces on treatment indicating that the treatment is effective in reducing the cancer. Whereas if the level of tumor marker does not reduce on treatment, then the treatment is not efficient and should be changed.
• It can be used as prognosis of disease progression. Types of tumor marker aid in assessing the type of cancer and even the types of drugs to be used for treatment. 
• They indicate relapse of cancer in the course of follow-up period. Markers have also been employed for detecting cancers which recur subsequently initial treatment. Few tumor markers are useful in indicating the complete cure of cancer.

Disadvantages of Tumor Marker Detection

• As there is biological variability in patient’s sample, tumor markers are unable to predict specific cancer states.

• Variation in sample collection, handling or storage and reporting techniques can result into alteration in the protein profile of a given sample. Therefore, the methods of sample processing should be standardised before analysing the test results.
• The amount of cancer biomarkers is very less in early stage of cancer which makes it difficult to detect.

Methods for detection of tumor markers

Tumor markers are detected by antigen-antibody based techniques such as spectrophotometry, chromatographic techniques, radio-immunoassay (RIA), enzyme linked immunosorbent assay (ELISA), precipitin tests, flow-cytometry, immunohistochemistry and molecular genetic methods. Molecular genetic markers can be detected by polymerase chain reaction (PCR), reverse transcriptase- polymerase chain reaction (RT-PCR), southern blot hybridization (SB) and fluorescent in-situ hybridization (FISH).

Submitted by

Dr Pratyusha Kar

Faculty of Paramedical Sciences

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As mentioned above, the most common and familiar are the medical lab technicians. Why do we say that they are the most familiar? Well, you can easily find them in all Clinic, Diagnostic Centres, Primary Healthcare Centre’s, Hospitals, Labs, and other establishments where a lot of patients go for medical analysis, diagnosis, and treatment. Medical technologists usually do analysis for blood, urine and feces that come from humans. The body fluid analysis results help doctors in detecting and diagnosing health ailments and diseases that affect the health of their patients. The role and responsibility of such professionals are considered highly responsible as they help in making diagnoses for various health issues.

Lab technologists do different kinds of jobs. Some of them also get a job as Forensic lab technicians and they are responsible for handling, preserving, and analysing hair, blood, tissues, and materials that can be considered evidence for the crimes. Dental lab technologists, on the other hand, aid the dentists and have the skills needed for creating materials that are used in treating dental issues. 

As far as employment opportunities are considered, there are plenty of them. All that matters is having the right training and skills. Though candidates from different backgrounds can apply for medical lab technician training programs, those having a science background are given more importance. Also, you do not have to spend years to become a medical lab technologist. You simply have to look for a short-duration diploma course that provides you a platform where you can study and understand diverse aspects of the medical lab. One thing you should keep in mind is that it is one of the most demanding and responsible professions. Having an eye for detail is an added advantage. 

You can carve out a niche in this field by enrolling in a medical lab technician course. You can browse through the internet and look for institutes providing the course. Be careful while choosing the one. Do not make any decision in haste. Compare different institutes, eligibility criteria, kind of training and exposure they provide, and placement opportunities before making any decision. Being a medical lab technician course can open plenty of job opportunities for you provided you have the right skills and training. Read More

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Who exactly are Medical Lab Technicians (MLT) ?

Medical laboratory technicians help physicians and doctors in the diagnosis and treatment of multiple diseases like Cancer, Diabetes, AIDS, etc by performing tests on tissue, blood and other body fluids. Medical lab technicians usually work in hospitals, clinics, pathology labs and offices of doctors.
Along with such a wonderful job description there are 6 benefits of pursuing a career as a Medical Lab Technician. Read on to know more:

• Multiple Work Opportunities
  

  
  Once you get a degree in Lab Tech Sciences, you expose yourself to a vast ocean of opportunities. A MLT can work in Hospitals, Pathology Labs, Diagnostic Labs, Blood and Organ Banks, Research Facilities, Medical Equipment Sales Companies and many more such fields.

• Scope For Future Specialization

Once a person becomes a MLT, it doesn’t stop for him/her there itself. They can further specialise in specific various fields to open up many opportunities for them on the professional front. Some of the fields to specialise in are:
a) Microbiology
b) Blood Banking
c) Immunology
d) Clinical Chemistry
e) Molecular Biology

• Growing Need in the Industry

  With the onset of multiple and complicated diseases growing in the world, there is a constant need of trained paramedics like MLT. All over the world, trained technicians are needed throughout the industry.The industry is growing almost at a rate of 18% annually. There is an annual demand of almost 35 Lakh trained personnels. 

• Handsome Salary Package

  As stated before, with the increasing demand of skilled professionals in the medical industry, the salary package available to moderately skilled people is also pretty decent. Once a person gets his qualification as a Medical Lab Technician, he/she can easily expect a starting salary anywhere between Rs 18000 – 22000. 

• Opportunity to work Abroad

  
  A person, once trained as a MLT can easily find career opportunities abroad as well. The international medical industry also has a huge demand for paramedical personnels like Medical Lab Technicians. The upside is that abroad, the salary package is even better and the work environment can be considered better. 

• You’re Doing GoodwillLastly, if you’re pursuing a career as a MLT, you are automatically doing a good deed for the society as you’re helping people to be happy. The diagnosis and treatments that MLTs assist in are often beneficial for the patient. So you feel good because what you are doing for the society is something that needs constant appreciation.

DPMI is one such institute which trains students in various Paramedical Programs, out of which MLT is one such program. DPMI has various branches all over the country.

So, if you’re considering a career option, do keep this in mind while deciding what you do with your life. You should eventually love what you do.

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Hitachi Life Limited’s Executive Managing Director, Yuaaz Nassu said- there is a high demand for paramedical staff, not only in Japan but all over the world, But the proportion of the demand is not met Under this, we are searching for the capable Paramedic students in India, which has been completed in the DPMI.

On this occasion principle of DPMI Aruna Singh said- that it is a matter of great pleasure for us that the selection of our students is being conducted in abroad. She explained that paramedics can diagnose patients and can do the therapy much better.  According to the report of Planning Commission of India, more than 1 million nurses are needed and apart from this, more than 90 million paramedics will be required by 2020. However, at the moment only one nurse is available for 10 patients.

Also Read: Shine your Career in MLT – Medical Lab Technician with DPMI

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Delhi Paramedical and Management Institute has emerged as one of the best paramedical colleges in Delhi/NCR. As mentioned earlier, a paramedical career includes a lot more than rushing at the time of emergency. It includes various technology programs such as medical lab technology, operation theatre technology, radio imaging technology, electrocardiogram technology and much more. These four technologies are different from each other to a large extent. Let’s have a quick overview of these courses and technologies.

1. Medical Lab Technology: Medical Laboratory Technology involves the diagnosis, treatment, and prevention of diseases through the clinical laboratory tests. This course offers a career in a hospital, minor emergency centers, private laboratory, blood donor centers and doctor’s clinics. DPMI provides an adequate number of well-equipped laboratories with modern equipment that makes the training process under the guidance of highly qualified professionals with modern techniques.

2. Operation Theatre Technology: Operating theatre technicians are an essential part of the operation unit and work with surgeons, anesthetists, and nurses to ensure the safest operation procedure. The successful outcome of the surgical process relies not only on the doctors and nurses but also on technical capacity and alertness of operation theatre technicians. DPMI prepares the students mentally to support the patients emotionally and make the process of surgery-free from any added stress.

3. Radio Imaging Technology: Radiography is fully concerned with operating radio imaging machines like X-ray and interpreting the results. It also involves treatment of major ailments like cancers and tumors with radiation. Radiographers are required in huge numbers in nursing homes, hospitals, diagnostic centers and super specialty hospitals. DPMI offers highly sophisticated equipment, experienced and talented educators and world-class laboratories to ensure comprehensive teaching with a safe environment.

4. Electrocardiogram Technology: Electrocardiogram Technicians monitor and further test a patient’s heart using ECG equipment. DPMI provides a course that not only combines theory but also a comprehensive practice on the anatomy and physiology of the heart and chest. There is a lot of scope in the field of paramedical science. DPMI provides world-class classrooms and equipment to impart the best theoretical and practical knowledge to the students.

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