Malaysian Association of Clinical Biochemists (MACB) jointly with Association of Scientific Officers Ministry of Health (ASOMH) and Malaysian Biomedical Science Association (MyBIOMED) cordially invites the aspiring researchers and medical laboratory scientific community across asia to “Asian Conference on Biomedical Research and Laboratory Medicine”
For international participant payment can be made via PayPal.
Extended Abstract Submission Date: 7th July 2021
Registration Closing Date: 30th July 2021
Live Conference Date: 24th -25th August 2021
Workshop Date: 26th August 2021
Day 1 : 24th August 2021
Management of COVID-19 Quarantine & Low Risk Treatment Center (PKRC)Dr Mohd Azman Yacob , Director, Medical Practice Division, Ministry of Health, Malaysia
The Ministry of Health Malaysia has made significant progress in enhancing our capacity to respond to health emergencies and disasters during the last decade. As the global incidence of COVID-19 continues to accelerate, our health system’s timely response has been robust, evidence-based, and guided by strategies and learnings from other countries and the World Health Organization. Through a multisectoral and collaborative approach, we have shown that we are stronger when working together for a common purpose. While we have accomplished a lot as a team, the most challenging difficulties still lie ahead, as the fight against COVID-19 is far from over.The preparedness for the COVID-19 pandemic was powered by early planning and preparation of hospital facilities and services, including preparing for Pusat Kuarantin dan Rawatan Covid-19 Berisiko Rendah (PKRC). Among our strategies are to enhance the quality of care, reduce morbidity and mortality, protect healthcare workers, and ensure medical service continuity and health industry development through multi agency partnerships.Apart from that, effective communication with various stakeholders and the public play a vital role to ensure that verified information is delivered efficiently. Crisis management is a dynamic process and a learning curve for many. It is essential that all strategies, planning, achievements are documented and shared! The unfolding pandemic has offered us many opportunities to identify gaps, prioritise needs, and enhance capacity development to strengthen national health security further.
Healthcare Vision and Needs for The Country – Roles of Clinical Laboratory Scientist in COVID-19 PandemicProf Dr Chua Kek Heng, University Malaya, Malaysia
The COVID-19 pandemic is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Since the virus was first identified in Wuhan, China in 2019, more than 198 million confirmed cases with over 4 million deaths have been reported in July 2021 and this number keeps on increasing from day to day. This crisis has also caused a global socio-economic disorder. In order to combat this virus, clinical laboratory scientists play an important role besides the efforts and sacrifices of the frontliners. In general, clinical laboratory scientists can be considered vital healthcare detectives, their responsibility is important to uncover and provide laboratory information and further assist doctors in patient care and disease control. They also help to pinpoint the etiology of disease through the examination and analysis of human samples. For the timing, two major items that direct response to the current COVID-19 pandemic are diagnostic kits and vaccines. In this context, a crucial role of clinical laboratory scientists in the COVID-19 pandemic is to provide an accurate and rapid diagnosis of SARS-CoV-2 infection. Therefore, the development and improvement of diagnostic tests to detect SARS-CoV-2 is crucial. With the wide screening, the infected individuals can be identified and quarantined to avoid the rapid spread of the virus in the community. In terms of managing the infections, clinical laboratory scientists worldwide are racing to develop vaccines with the hope that the vaccines are effective to provide a natural defence in each individual and certainly with the ultimate aim to end this pandemic. Besides that, clinical laboratory scientists and pharmaceutical companies also work together to look for or develop an effective therapeutic agent/drug to cure the infected individuals, however the effective treatment for COVID-19 remains a challenge and more research needs to be carried out to make it a success.
Identification and Functional Characterization of Androgen Receptor-Independent Prostate Epithelial Stem Cells or ProgenitorsProf. Dr. Chua Chee Wai, Shanghai Jiao Tong University, China
The emergence of androgen receptor (AR)-independent prostate cancers (AIPCs) has been witnessed as a result of the failure of second-generation androgen deprivation therapy in castration-resistant prostate cancer patients. Upon progressing into AR independence, prostate tumors are no longer responsive to any sort of treatment modalities. Unluckily, the cellular origin and evolution of AIPCs remain unclear. Previously, we have found that AR is not required for the survival and progenitor properties of the castration-resistant Nkx3.1-expressing cells or CARNs, thus highlighting the AR-independent nature of this luminal progenitor population. Interestingly, AR-deleted CARNs have demonstrated a gene expression profile that is highly similar to human neuroendocrine prostate cancer (NEPC), which is a subtype of AIPC, and can generate tumors with neuroendocrine differentiation foci upon Pten deletion and mutated Kras activation, implying the ability of CARNs to initiate NEPC upon oncogenic transformation. These results have highlighted the potential of AR-independent prostate epithelial stem cell or progenitor populations to serve as the cell-of-origin for AIPCs. In this study, we have identified different AR-independent prostate luminal progenitor subpopulations that are capable of forming AIPCs upon oncogenic transformation using a novel prostate epithelial AR-deleted mouse model. Interestingly, we have discovered various cancer cell subpopulations, which also express the prostate luminal progenitor markers using a genetically engineered mouse (GEM) model of AIPCs. We hypothesize that AR-independent prostate luminal progenitor subpopulations are capable of initiating tumors upon oncogenic transformation, while the resulting oncogenic-transformed cells represent the subpopulations in AIPCs that will continue to express the corresponding luminal progenitor markers and possess cancer stem cells (CSCs) property. Taken together, our study has provided novel insights into the identity of CSCs in AIPCs. Consequently, targeting the prostate luminal progenitor markers-expressing cancer cells as well as their molecular properties may serve as novel therapeutic strategies to overcome AR independence.
Testing Strategies in COVID-19 PandemicDr. July Kumalawati, Indonesia
Coronavirus disease 2019 (Covid-19) is a new disease caused by Severe Acute Respiratory Syndrome Virus-2 (SARS CoV-2) which has spread globally and resulted in a pandemic situation. The current gold standard to diagnose Covid-19 is by the detection of SARS CoV-2 RNA using real-time nucleic acid amplification methods. Then, antibodies to SARS CoV-2 and SARS CoV-2 antigen detection reagents were also developed. The usage of those different platforms of tests in Covid-19 is based on the indication of testing, either to establish a diagnosis, follow-up, active cases surveillance, exposure surveillance, or post-vaccination surveillance. The availability of different test platforms which can produce results in a timely manner is an important issue to consider when choosing the testing strategy in each region or institution. Fast determination of SARS CoV-2 infection is key to Covid-19 control. Testing strategies of Covid-19 are still evolving with new findings of different clinical presentations of cases, the development of reagents, and the emergence of new strains.
Molecular Diagnostic in ThalassemiaProf. Dr. Sakorn Pornprasert, Chiang Mai University, Thailand
Alpha- and beta-thalassemia are common genetic blood disorders worldwide. Currently, more than five hundred mutations causing those abnormalities were identified. Two percent of the world population is approximately to carry diverse genotypes of thalassemia and a quarter of these is symptomatic. Despite the fact that most of the thalassemia affected have asymptotic to moderate clinical presentation, three severe to lethal genotypes including compound heterozygous β0-thalassemia with hemoglobin E, homozygous β0-thalassemia, and hemoglobin Bart’s hydrops fetalis are considered as important health problems. DNA analysis for alpha- and beta-thalassemia diagnosis is the only reliable and essential tool for the prevention and control of new cases around the globe. Single or multiplex PCR-based approaches with specific downstream detection systems are widely used for known and common thalassemia mutation detection. However, in some cases, especially in an individual with a novel or uncommon thalassemia mutation, those methods are able to be misdiagnosed. Next-generation sequencing (NGS) has been introduced as a more accurate tool for thalassemia diagnosis. The DNA sequencing information can be analyzed with an appropriate database and be interpreted regardless of mutation types. Despite the great accuracy, NGS requires costly expenses. Therefore, the most cost-effective technique is more likely to be chosen for routine molecular diagnosis of thalassemia.
Molecular Diagnostics in Medical Mycology; Better Late Than NeverAssoc. Prof. Dr. Leslie Than , Universiti Putra Malaysia, Malaysia
Fungal diseases cause 1.5 million mortalities and affect approximately one billion global populations. This high and alarming number of mortalities is the result of rapid advancements in healthcare and medicine, whereby they contribute to prolonging life, but at the same time increasing the number of immunocompromised and immunosuppressed individuals who are highly susceptible to fungal infections. The huge outbreak of ‘black fungi’ in India among post-COVID patients has thrown fungal infections in the limelight. Although the mortality and morbidity as a result of fungal diseases are high, the development of fungal diagnostics has not been able to match the trend due to several factors. Conventional methods such as direct microscopy and microbiological culture for the identification of fungal species remain the ‘gold standard’ in the diagnosis of fungal infections. These methods though economical come with multiple challenges i.e. long turnaround time (TAT), the need to have experienced mycologists in fungal morphological identification, low sensitivity in recovering viable organisms etc. In the last three decades or so, the advent of molecular methods such as polymerase chain reaction (PCR) has improved tremendously the landscape of diagnostic microbiology particularly in diagnostic virology. However, a similar fate does not befall diagnostic mycology. This presentation will give an overview of the evolution of molecular diagnostics in mycology. It will discuss the current and future molecular technologies used for fungal identification. In addition, it will also touch on the issues and challenges in the development and implementation of molecular diagnostics in current clinical microbiology laboratories. Finally, the presentation will attempt to offer some views and suggestions in making molecular diagnostics to be the technique of choice in overcoming the shortcomings and frustrations faced by laboratory personnel and clinicians alike who deal with fungal infections.
Inborn Error Metabolism: A Case StudyMdm. Chen Bee Chin
Inborn errors of the urea cycle are a genetic disorder caused by the deficiency of enzymes in the urea cycle pathway involved in ammonia removal from the blood. There are six enzymes and two transporters that are involved in the pathway required to convert ammonia to urea, which is subsequently excreted in the urine. Deficiency in this enzyme will lead to an accumulation of ammonia, which is extremely toxic to the body, particularly to the central nervous system. Newborns with severe mutations in any one of the first four enzymes of the urea cycle can become catastrophically ill within 36 to 48 hours of birth despite appearing normal at birth. Early diagnosis and treatment of hyperammonemia are necessary to improve survival and prevent long-term handicaps. Hence, hyperammonemia is the key to the diagnosis of urea cycle disorders and treatment before a definitive diagnosis is made. In this presentation, I will discuss cases of urea cycle disorders, the importance of accurate measurement of plasma ammonia, and the stepwise approach of quantitative amino acids analysis to assist in the diagnosis and management of patients with this disorder.
Zoonotic Malaria in Southeast AsiaProf. Dr. Balbir Singh, Universiti Malaysia Sarawak, Malaysia Merdeka Award Recipient 2017
Malaria in humans was previously thought to be caused by four species of Plasmodium, namely P. falciparum, P. vivax, P. malariae and P. ovale. Zoonotic malaria infections were considered rare until we described a large focus of human P. knowlesi infections in Sarawak in 2004. Knowlesi malaria cases have subsequently been detected throughout Southeast Asia and in the Andaman and Nicobar Islands of India. All the 9,944 indigenous malaria cases in Malaysia over the past 3 years have been due to P. knowlesi. Human P. knowlesi infections are often diagnosed by microscopy as P. malariae, since these two species are morphologically identical. The malaria rapid diagnostic tests (RDTs) evaluated so far have indicated a poor sensitivity for the detection of knowlesi malaria. Presenting signs and symptoms of knowlesi malaria are no different to those occurring in other malarias, and P. knowlesi infections result in a spectrum of diseases. Thrombocytopenia is a universal laboratory finding and fatal infections occur following hepatorenal dysfunction and hyperparasitaemia. Knowlesi malaria is primarily a zoonosis consisting of three subpopulations of P. knowlesi, the main reservoir hosts are long-tailed and pig-tailed macaques (Macaca fascicularis and M. nemestrina respectively) and transmission between hosts is through outdoor feeding, forest-dwelling Anopheles mosquitoes. Another malaria parasite of macaques, P. cynomolgi, has recently been found to cause malaria in humans in Malaysia and other Southeast Asian countries. P. cynomolgi is morphologically identical to P. vivax and molecular methods are necessary for correct identification. It is envisaged that studies on communities living at the forest fringes with molecular tools will indicate the widespread distribution of zoonotic malaria in Southeast Asia and uncover more newly emergent malaria parasites. The widespread distribution of human knowlesi and cynomolgi malaria cases, some resulting in fatal outcomes, underscores the public health importance of zoonotic malaria in Southeast Asia.
Day 2 : 25th August 2021
Educating 21st Century Medical Laboratory Scientists: Why, What and How Do We Have to Do Differently?Prof. Datuk Dr. Harlina Harlizah binti Siraj , Universiti Kebangsaan Malaysia, Malaysia
Educating professionals to become safe and competent future leaders of the 21st century has to become a top priority for educators today. Generic core competencies such as the 4Cs – critical thinking, communication, collaboration and creativity – should be ingrained within the curricula and assessed thoroughly before one can qualify to be a professional in this century. The didactic teacher-centred mode of teaching has to be replaced with a more interactive, learner-centred delivery, suitable to enhance self-directed learning within the Digital Native generation. Educators have to master the latest heutagogy, willing to be co-learners and enjoy the journey of learning together with their learners. The continuous need to embrace the latest digital technology of teaching and learning will put on tremendous demands on the educators to keep improving. This talk will explore the WHY, HOW and WHAT that we as educators have to do differently to facilitate our future leaders in the expertise of medical laboratory sciences.
Allied Health Professions Act 2016: Issues in the ImplementationEn. Saravanakumar a/l Maniam, Principal Assistant Director, Allied Health Sciences Division, Ministry of Health Malaysia
The Allied Health Professions Act 2016 is a unique legislation. It was designed to govern and regulate multiple professions through a single regulatory body instead of like other established regulators in a country that only regulate a single profession. The Act, which was enacted in 2016 and took effect on the 1st of July 2020, mandated the establishment of the Malaysian Allied Health Health Professions Council, whose primary role is to set the requirements, register, and regulate the Allied Health Professions listed in the Act's Second Schedule. While this Act can improve and elevate the competency and quality of service provided by Allied Health Practitioners, numerous complexities are involved in determining and applying registration standards. Such policy decisions are likely to impact the rights and interests of some practitioners. The Allied Health Professions (23) nature, such as differences in primary qualification, training, practice standards, and skills, demand careful consideration before registration begins. Steps are being taken to address the issue and challenges to determine appropriate regulatory measures and policy decisions prior to fully implementing the Act.
The Burden of Chronic Metabolic Disorders and Real Time Monitoring of Diabetes MellitusProf. Dr. Sunil Sethi, National University of Singapore (NUS), Singapore
Diabetes is currently the most significant healthcare issue in terms of resource requirements. Diabetes is becoming more common and the overall global prevalence of diabetes in adults is a staggering 8.5% of total population. Diabetes is a major cause of blindness, kidney failure, heart attacks, stroke and lower limb amputation. Healthcare providers in many third-world countries simply do not have the resources to adequately manage these multitude of complications. Because of the large numbers of patients, it is estimated that doctor-patient interactions are limited to less than 5 minutes per outpatient visit. In a typical outpatient setting, beyond the clinical examination, the diabetic patient will require review for adequacy of control, of about 12 biomarkers.
It is imperative that healthcare professionals utilize newer technologies to diagnose and manage such patients. The laboratory has always been a key player in the healthcare industry and these technologies will allow us to assume even greater importance to our clinician colleagues and our patients. This presentation will cover prevalence of diabetes in South East Asia and the solutions for laboratory management of the chronic disorder of diabetes mellitus, currently and potentially available in the city state of Singapore.
Precision Health in ToxicologyProf. Dr. Michael Fenech, University of Adelaide, Australia Distinguished Professor, Faculty of Health Sciences, Universiti Kebangsaan Malaysia
Inter-individual variation in the response to toxin exposure can vary greatly due to a number of factors including differences in (i) the copy number and sequence of genes involved in absorption, distribution, metabolism and excretion of xenobiotic agents; (ii) epigenetic modifications that alter transcription and translation of relevant regions of the genetic code; (iii) dietary intake of cofactors required for the function of detoxification and repair proteins and (iv) in the exposome profile which varies depending on dietary and/or lifestyle choices and man-made or natural noxious agents in the environment. My presentation will focus on recent technological and conceptual advances aimed at (a) obtaining a more comprehensive assessment of toxicity at the cellular and molecular level using human in vitro models; (b) improving human toxicogenomic epidemiological studies by more detailed measurement of the exposome profile and its metabolic impacts in different organs; and (c) improving biological dosimetry techniques that can be used to more accurately measure inter-individual differences in susceptibility to different toxins and toxin combinations. Ultimately, this knowledge and capability are critical to developing sustainable ecosystems and services that are beneficial to the wellbeing of all humans and the organisms with whom we share our habitats.
Biomedical Research and Innovation in a Doughnut WorldDatuk Prof. Dr. Looi Lai Meng, National Distinguished Professor University Malaya, Malaysia
In spite of the impressive advancements of the 20th century which have resulted in a doubling of the human lifespan, today’s world is far from well. We continue to live in an unequal world. Many under-resourced countries where the burden of disease is greatest have yet to benefit from 20th century advances, and in the R&D World, much catching-up is still required to address the 10/90 gap. To tackle the challenges of the 21st Century, biomedical research and innovation face many critical paradigm shifts in the healthcare and global ecosystems. To appreciate this, I would like to adapt the concept of a doughnut world from “doughnut economics” (Kate Raworth, 2017). Researchers need to be cognizant that a healthy and thriving society lies between the two circles of the “doughnut”. The outer circle borders the health of our planet. Wide-ranging issues such as climate change, one health, planetary health, urbanization, ocean and forest management which breach this outer circle, have a serious deleterious impact on health and disease in Society (e.g. emerging infections, cancer, heart disease, diabetes and other non-communicable diseases). The individual’s health is bordered by the inner circle of the doughnut. Tackling breaches of the inner circle require focused individualized healthcare and research, such as drug discovery, precision medicine, understanding disease pathways and efficient diagnostics. This lecture emphasizes the need to preserve both circles and calls for more enlightened and enhanced collaboration between Science and Society for building resilience to crises and sustaining health for future generations.
Updates in Laboratory Diagnosis of LeptospirosisProf. Dr. Zamberi Sekawi, Universiti Putra Malaysia, Malaysia
Leptospirosis is caused by pathogenic bacteria called leptospires that are transmitted directly or indirectly from animals to humans. It occurs worldwide but is most common in tropical and subtropical areas. A significant proportion of individuals will be asymptomatic but this disease can potentially cause serious illness involving multi organs and deaths. More often than not, the clinical presentations are not typical and can mimic other common infectious diseases such as influenza, hepatitis, dengue, meningitis or other viral hemorrhagic fevers. Though it is a treatable infection using the common antibiotics, clinically suspecting and confirming the infection remains a major challenge. The most common tests conducted in most clinical laboratories are using serology platforms, typically enzyme-linked immunosorbent assay and microscopic agglutination tests. There are numerous limitations of these tests. In recent years, molecular techniques have improved the detection and confirmation of this pathogen using different target genes and biomarkers. Using the correct laboratory technique is also important and therefore, it is vital to know the pathogenesis of leptospirosis. Suitable laboratory diagnostic tests vary depending on the stage of the disease, requiring the combination of diagnostic tests using appropriate specimens at each disease stage.
Targeting Signalling Pathways in Oral Squamous Cell CarcinomaProf. Dr. Cheong Sok Ching, Cancer Research Malaysia, Malaysia
Oral squamous cell carcinoma (OSCC) is a cancer that is predominantly diagnosed in Asia and currently, treatment options are limited for this cancer. I will describe the strategies we have taken to identify candidate therapeutic targets and their corresponding anti-cancer drugs. I will present our work on identifying genetic vulnerabilities in OSCC using the CRISPR/Cas essential screens and our approach in following up on candidate genes. I will share our experience in targeting specific pathways that are implicated in OSCC development including the cell cycle pathway and mitogenic signaling. Finally, I will talk about the development of resources including unique OSCC models that have enabled this work.
Insects as Evidence in Forensic Science Investigation to Determine Post-Mortem IntervalProf Dr Baharudin Omar Profesor Emeritus Universiti Kebangsaan Malaysia
The field of forensic entomology which uses insects as evidence is increasingly being recognised by academicians and crime-laboratory personnel. Insects, especially blowflies are often the first “witnesses” to reach a dead body, particularly if a murder has been committed. Insects and other arthropods descend on the corpse following an ecological phenomenon called succession. The succession pattern whereby one group of insects replacing another at a dead body is rather constant and predictable and more often than not is affected by the stage of decomposition of the corpse. The validity of estimation of the interval of death is strengthened by using animal models. Various carcasses placed at different habitats in Malaysia had accumulated data on the life cycles of major insects associated with carrions and dead human bodies. Such studies enrich our understanding of insects especially blowflies, bionomic and systematic, in addition to the discoveries of new records and species of blowflies in Malaysia. Findings acquired from those simulation studies are being translated as the baseline or reference data to estimate the age and speciation of insect specimens sent by forensic pathologists and the police. Such information is then used to estimate the post-mortem interval of the victim under investigation. Knowledge of the life cycle of flies is the key to forensic entomology scrutiny. The use of insects is not merely confined to estimation of time of death, but may include the determination of victim’s DNA, finding the cause of death, especially one due to poisoning (entomotoxicology), implicating drug traffickers, and investigating neglect and abuse of children and the elderlies. This field is still in its infancy in Malaysia and has great potential to contribute to criminal investigations that are based on sound scientific methodology and merit.
Liquid Biopsy and its application in medicine: Sharing an experienceDr. Bhuwnesh Agrawa
Liquid Biopsy is tumor-derived material circulating in the blood. It consists of several types of material such as circulating tumor cells, circulating tumor DNA (ctDNA), etc. In this presentation, the focus will be on ctDNA, as it has gained significant interest recently due to both ease of sampling and good correlation to tumor samples. Recently there has been an increase in data on clinical applications. Benefits include, besides the minimally invasive nature of a blood test, the faster results and repeatability of sampling, allowing monitoring of the course of the disease. ctDNA also gives a holistic view of the disease and avoids sampling errors (as compared to tissue) and gives real-time information. Liquid Biopsy (ctDNA) can be used for screening, diagnosis, prognosis, therapy selection and monitoring in cancer patients. It has shown usefulness in the most common cancers such as NSCLC, CRC, melanoma, breast cancer and AML, amongst others. Specific examples will also be given using ultra-high sensitive NGA methods, as these allow for a more precise understanding of the disease. The current presentation will also try to highlight key challenges and future directions and needs for liquid biopsy to become standard practice in cancer management, including the importance of sensitivity, short turnaround time, automation, regulatory approvals, inclusion in guidelines and reimbursement. It is expected that in the future liquid biopsy will be a key part of patient management of cancer patients and will find its way into guidelines across the world.
Trend and Challenges in Drug Abuse TestingDr Raja Elina, MACB
Drug abuse is a global health problem and it is no different in Malaysia. Drug testing provides objective evidence that can be used not only in the prevention and legal actions against drug abuse but also to assess adherence to prescribed regimen in drug rehabilitation programs and in the management and treatment of drug intoxication. However, there are many challenges in drug testing. Although sophisticated drug testing methods are available today, many factors contribute to the correct interpretation of a drug test result. The factors that need to be considered include the type of sample tested, the purpose of the test request, the drug panel that is being tested, route of drug intake, metabolism of the drugs in question and the physiological condition of the donor. In addition, time of sample collection as well as sample handling can also affect the results obtained.
The choice of method used in drug testing is another important factor that needs to be taken into consideration. Immunoassays which are regarded as the initial or screening test have the advantage of being easy to perform and can provide fast results. However, immunoassays are manufacturer dependent and are available only for a limited number of drugs. Immunoassays are also not specific to the drug being tested. Thus, interpretation of drug screening results should be done with caution. To confirm the presence of drugs in a specimen, a more confirmative method is required. Gas Chromatography mass spectrometry (GC-MS) has long been regarded as the gold standard in toxicology testing. However, the emergence of new drugs of abuse poses new challenges for clinical toxicology laboratories. There is limited information about the emerging drugs and their metabolism, and an untargeted drug screening by mass spectrometry may be required. Due to this, Liquid Chromatography-Tandem Mass Spectrometry (LC-MS/MS) and even newer liquid chromatography–high resolution mass spectrometry (LC-HR-MS) are gaining popularity and will become new gold standards of toxicology testing. These mass spectrometry methods require the use of expensive and complex analytical instruments, vigorous method validation and specially trained
The Era of a Clinical Laboratories with Fully Automated MALDI SystemDr. Patrick Murray
MALDI-TOF (Matrix-Assisted Laser Desorption/Ionization Time-of-flight) mass spectrometry has revolutionized the identification of bacteria, mycobacteria, yeasts, moulds, and parasites. It is important to understand the value of microbial classification: (1) associates microbial identification with pathogenic potential, (2) frequently identifies the source of infection, and (3) provides predictive antimicrobial susceptibility (pAST). The history of microbial identification is founded on utilizing biochemical properties to classify organisms into hierarchical groupings of increasing refinement (i.e., orders, families, genera, species). This classification technology initially used manual interpretation of groups of biochemical tests and evolved to first manual interpretations of commercial test strips and panels and then to automated interpretation of biochemical tests. The accuracy of all biochemical test methods is defined by the number of tests that can be performed, selection of tests to minimize the variable reactivity for organisms with individual tests, and subjective interpretation of the manual tests. As the technology for gene sequencing developed, the limitations of biochemical classification were realized and, although biochemical testing was widely available and continues to be commonly used, whole genome sequencing or targeted gene sequencing (e.g., ribosomal RNA genes) was accepted as the gold standard. Sequencing is accurate but time consuming and proportionately expensive. An alternative approach is the use of nonamplified or PCR-amplified probe technology. This can identify if the isolate is a specific organism but cannot broadly identify an unknown organism. In contrast, MALDI-TOF MS can identify a broad array of microbes in minutes at a nominal cost of commercial reagents. The technology can be integrated into clinical laboratory workflow with minimal training needed and, as adoption expands, is limited only by the comprehensive nature of the database. The technology has also been used for strain typing clinical isolates for epidemiologic purposes, as well as determining antimicrobial resistance for selected antibiotics.
Powerful Tool for Resolving Antibody Problems in Transfusion Lab Practice.Dr. Rozi Hanisa Musa
Pre-transfusion tests are critical elements in transfusion safety and prevention of hemolytic transfusion reactions. Several methods are available for indirect antiglobulin test (IAT) to identify red cell antibodies and their titration including tube IAT with enhancement reagents, tubeless methods such as solid phase red cell adherence (SPRCA) tests, column agglutination test (CAT), microtiter – plate technique, and not routinely performed molecular tests. Identifying the specificity of antibodies in a patient’s plasma can be as straightforward as testing selected reagent red cells on the basis of the antibody detection results. Many investigations, however, require the use of additional methods or supplemental tests for resolution. Column Agglutination Techniques (CAT) or tube methods, or low‐ionic strength saline enhancement media or unenhanced tests have appropriate uses for detecting or avoiding antibody reactivity. Useful red cell treatments include enzymes or thiol compounds to destroy antigens or enhance the antigen–antibody interaction and EDTA–glycine acid or chloroquine diphosphate to remove bound IgG from autologous cells. Separating autologous red cells from transfused donor cells for phenotyping or testing with plasma or eluate is critical. Alloantibodies or autoantibodies can be removed or separated by appropriate adsorption tests. Combined into a logical investigation, these additional tests will aid in resolution of most antibodies‐containing samples.
Clinically Applicable LJ Control Chart Achieved High Quality Medical Testing Laboratory (Experience Sharing)Ms Vanessa Lo
Levey-Jennings (LJ) control chart is one of the daily "mandatory" internal quality control (IQC) tools adopted in the medical testing laboratory which issues reports with numerical results. Analytical standard deviation (SD) and coefficient of variation (CVA) determine the strength of the LJ control chart to identify analytical imprecision appropriately with minimal false rejection and false acceptance rates. SD and CVA are not "isolated" figures but clinically related to analyte dependent within-subject or intra-individual biological variation (CVi). Incorporating the concept of CVi to the internal quality control system enabled the author to establish clinically applicable LJ control charts for most analytes. Together with the sigma metric quality framework the author was able to achieve further: (1) identify bad performing analyte(s) reasonably, (2) relate analyte required performance clinically, (3) set clear & achievable target sensibly, and (4) allocate resources wisely. After a year of implementation due to attainment of high scoring in the key performance indicator, the author supervised laboratory (laboratory) was categorized by the Royal College Pathologists of Australasian Quality Assurance Program (RCPAQAP) as GOOD performing laboratory. In subsequent years because of past record and well-documented evidence of good analytical performance in the RCPAQAP, the laboratory was selected to be one of the reference institutes worldwide for target value setting of FIVE analytes in the following year. To the degree that the author knows, as of now, the laboratory achievement is still the local record.
Identification of Yeast: Current Practice and ChallengesAssoc. Prof. Dr Tzar Mohd Nizam bin Khaithir
Current practice in yeast identification can be divided into culture-based and non-culture-based methods. Examples of culture-based methods include cultures on non-differential media such as Sabouraud dextrose agar, cornmeal agar, potato dextrose agar, nutrient agar, brain-heart infusion agar; and on differential media such chromogenic agar and caffeic acid or birdseed agar. Apart from agar media, some culture-based methods can also be performed in test tubes such as germ tube test and urease test. However, these tests only give presumptive identification at best, and may be prone to subjectivity. Hence, culture-based methods that rely on carbohydrate assimilation were developed to give a more objective yeast identification. Still, these methods rely upon cultures that may take a few days to get results. In addition, these methods often misidentify newly emerging yeast such as Candida auris. Non-culture-based methods include staining, serology, molecular and mass spectrometry. Staining methods are rapid and easy to do but may lack specificity and sensitivity. Serological tests that were developed to detect either fungal antigens or antibodies in human body fluids have variable performances. Nucleic acid detection methods such as polymerase chain reaction and sequencing are the gold standards in confirmation of fungal identity. However, they require high technical skills and are not standardized. MALDI-TOF is promising in giving fast and reliable results but is very expensive and requires pure cultures for best results. In conclusion, current practices in yeast identification have improved over the years but are still far from desirable. We need fungal identification tests that are accurate, reproducible, rapid, cheap and that can be performed directly on clinical specimens.
Sample Size Calculation in Quantitative StudyDr. Wan Amir Nizam Wan Ahmad
One of the most difficult conundrums for the researcher is the sample size. The act of determining the number of observations or replicates to include in a statistical sample is known as sample size determination. In practice, the sample size for a study is frequently determined by the cost, time, or convenience of collecting the data, as well as the necessity for statistical power. Sample sizes in quantitative studies should be sufficient enough to identify a minimal significant difference between groups. Good sample size will also be able to establish the study's validity. The various approaches for calculating the sample size for the pilot or exploratory study design in quantitative research will be explored in this workshop.
New Methods in Forensic Anatomical ResearchDr Helmi Mohd Hadi Pritam
Current trends of forensic anatomical research require the researcher to be resourceful and technology savvy. The talk is targeted at a broad audience who are just beginning or interested in researching anatomical and forensic anatomical fields. The talk will cover the general anatomical tools of conventional and techniques, sampling methods and ethics and issues relating to conducting research in forensic anatomy.
New-born Screening Workflow Changes, Improved Outcomes for Tennessee InfantsDr Christine Dorley Assistant Director of the New-born Screening Laboratory for the Tennessee Department of Health, Division of Laboratory Services
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