MDS is in the process of converting to liquid
or spatula then after a conventional smear has
based collection for Gynecological Cytology.
been prepared. It is important that the attached
The production of a monolayer slide in the lab-
collection instructions are followed. In particu-
oratory results in a more consistent preparation,
lar, clockwise rotation of the device five (5)
enhancement in slide quality and reduction in
times will ensure that an optimal endo-cervical
the number of slides reported as unsatisfactory
or “limited by” when compared to conventional
Please note that we will be able to process only
Pap Smears. We have chosen the AutoCyte® sys-
samples submitted in the Tripath fixative pro-
tem of Tripath Imaging to prepare monolayers.
vided by MDS. Although we anticipate some
Collection in your office is simplified because
improvement in turn-around-time a significant
the collection device is submitted to MDS in
shortage of Cytotechnologists will persist into
fixative along with all the cells obtained. You no
the foreseeable future. It is essential that when
longer need to prepare and fix the slide. A bet-
expedited interpretation is required for clinical
ter and more complete sample is available to the
laboratory because the new technique results in
many more cells being collected with the brush
require treatment unless they are immunocom-
promised, when infections tend to be pro-
longed. Note that reliable curative treatment
for this infection is currently not available.
As clinicians continue to care for increasingnumbers of immunocompromised patients and
Patients infected with Entamoeba histolytica
should receive treatment regardless of sympto-
management of infections due to intestinal par-
matology. Patients with invasive infection (ie
asites continues to be a challenge. In this issue
colitis, amoebic abscess) should always receive
of LabNews, treatment regimens for common
an intraluminal agent such as iodoquinol after
pathogenic parasites are summarized in Table 1.
treatment with metronidazole.3 Please note that
Factors prompting referral to specialists for fur-
the laboratory is not able to discriminate
ther treatment advice may include: clinical and
between pathogenic E. histolytica
immune status of the patient, pathogenicity of
genic E. dispar
by microscopic techniques.
the organism, and first-line therapy “failures”.
Introduction . . . . . . . . . . . . . . . . 1
Physicians are encouraged to order specific E.
serology testing in order to delineate
In some instances, the decision to offer specific
Parasitic Infections . . . . . . . . . 1,2
treatment may depend upon the clinical status
of the patient. For example, only symptomatic
patients infected with Dientamoeba fragilis
1. Can J Infect Dis, 1998; 9(2): 69-70.
should receive treatment.1 The same principle
2. Lee et al., CID 2000; 30: 401-402.
3. The Medical Letter, January 1998; 40(1017): 1-12.
applies to patients with giardiasis, althoughfood handlers, the immunocompromised and
those infected as a result of an outbreak should
receive treatment, regardless of symptoms.2
Patients with cryptosporidiosis do not usually
Table 1: Treatment Regimen for Common Pathogenic Parasites
11 mg/kg once (max. 1 gram); 11 mg/kg once (max. 1 gram);
* These drugs must be obtained through the Special Access Programme by calling 613-941-2108.
** Contraindicated in pregnancy and children under the age of 8.
By: A. Sarabia, MD, FRCPC, Director, Medical Microbiology
A review of the MDS reference range was complet-ed prior to implementation on December 13, 2001.
Folic acid is an essential nutrient in the prevention of
The revised PTH reference interval is 1.5-6.5
neural tube defects (NTD). In November 1998,
pmol/L. Due to the important physiological
Canada implemented a program to ensure folic acid
relationship between PTH and calcium, it is
supplementation of all pasta, flour and grain products.
always important to interpret PTH results in
Following implementation of this program, a ret-
conjunction with circulating levels of serum total
rospective review of population data collected in
Ontario by MDS indicates that significantlyfewer individuals are at risk for folate deficiency.
Defined as a decrease in RBC folate concentra-tion (< 215 nM), the number of folate deficient
cases noted prior to fortification was 57 of 3200patients reviewed (1.8%). Post-implementation,
Utilization of the 4 hour or 5 hour glucose toler-
this number decreased to 17 of 4102 (0.4%) of
ance test (GTT) for diagnosis of hypoglycemia is
requests reviewed.1 In addition, the mean con-
no longer recommended. The preferred test for
centration (95 % CI) of RBC folate increased
initial investigation of suspected postprandial
from 680 (669-692 nM) to 852 (841-862 nM)
hypoglycemia is measurement of a single blood
glucose, collected 2-5 hours after a standardized
Considering this data and that presented by
mixed meal or carbohydrate load. The most
QMP-LS, measurement of this analyte will be
accurate assessment includes repeated blood glu-
cose measurements at times when the patient is
ed of having any of the following conditions may
still benefit from folate testing: malnutrition,
For the investigation of postprandial hypoglycemia,
alcoholism, anemia, gastrointestinal malabsorption.
order a 2-5 hour post meal blood glucose level. Thetime of meal ingestion must be provided to the labo-
ratory to permit correct interpretation of the results.
1. Ray JG, Vermeulen MJ, Boss SC and Cole DEC. Clin.
Biochem. 2000; 33(5): 337-343.
A post meal glucose level of less than 2.5 mmol/L,
2. QMP-LS Endocrinology Committee Comments,
Folate patterns of practice survey
on more than one occasion, is suggestive of reac-
R-9908-PP, Endocrinology 2000; 3(2.2): 49-56.
tive hypoglycemia. To rule out true fasting hypo-glycemia, individuals should, subsequently, beevaluated using a supervised 72 hour fastingtest. For further assistance, please consult the
MDS Clinical Biochemist at extension 2363.
C-PeptideDue to a manufacturers change in the calibrationof the C-peptide kit, physicians may observe asignificant decrease of up to 40% in reported
serum C-peptide concentrations. A review and
validation of the manufacturers stated referencerange is in progress. Implementation of the
Deep insertion of a collection device into the cer-
reformulated kit is scheduled for March 4, 2002.
vical canal is inadvisable in pregnancy. In orderto obtain a sample in pregnant women, the Cervex®
broom provided by MDS can be used in a man-
The PTH assay utilized by MDS has been refor-
ner similar to the spatula which was included in
mulated to include the use of a new pair of mono-
the kits for conventional smears. The central bris-
clonal and polyclonal antibodies. This change in
tles of the Cervex® brush should not be inserted
format has resulted in an assay of increased sensitiv-
deep into the canal but by firm pressure and rota-
ity and specificity to the intact PTH molecule.
tion in a clockwise direction, the device may be
Note that reported concentrations of serum PTH
used to sample the external os and ectocervix. A
may be up to 28% lower than previous values.
vaginal pool sample may also be obtained.
(continued from page 3 - Lab Notes)
This type of analysis may also be useful in
the investigation of patients with isoen-
CK activity. A relative index greater than
Creatine Kinase, CK, exists in five molecu-
zyme secreting tumours, heterophilic anti-
bodies or persistent asymptomatic elevated
infarction, (AMI), while, indices between
variants. The three CK isoenzymes are CK-
total CK activities. Analysis is not auto-
2-4% are “borderline high” and warrant
mated and is labour intensive, hence pro-
derived from brain, myocardial and skeletal
isoenzymes analysis precludes its use as a
muscle, respectively, while CK variants are
routine test for investigating acute myocar-
dial infarction. CK isoenzyme analysis or
appropriate medical response is to direct
fractionation does not provide added value
the patient to a near-by hospital with emer-
in patients suspected of muscle disorders.
gency services so that immediate care can
other isoenzymes or fractions appear as a
monitored with quantitation of total CK.
If further assistance is required, please con-
healthy older women, often associated with
normal or slightly elevated total CK but are
(U/L) is used in the investigation of sus-
1. Moss DW et al. Enzymes: In Tietz Textbook of
Clinical Chemistry, 2nd ed., Burtis C. A. &
Ashwood E. R. eds., W. B. Saunders Co. 1994,
797 – 809.
assays are preferred due to improved preci-
2. Lee KN, Csako G, Bernhardt P and Elin RJ.
tionation is used to investigate patients
sion, rapid analysis capabilities, enhanced
Clin Chem 1994; 40: 1278 – 1283.
with unexplained total CK results or pres-
sensitivity and specificity. Results of CK-
3. Thompson RJ, Jackson AP and Langlois N. Clin
Chem 1986; 32: 476 – 481.
MB assays are usually expressed in absolute
patients receiving animal derived therapies.
concentration (ug/L) and as the “relative
Published byMDS Laboratory Services a division of MDS Inc.
Your comments and suggestions are welcomed. Please contact us at:
Medical Support Department100 International Blvd.,Toronto, OntarioM9W 6J6
F O U R S I M P L E S T E P S
disconnect the entire brush from requisition form with patient
O N E C L E A R R E S U L T
In clinical trial studies, cervical samples were taken and first smeared onto slides. Residual cells from the conventional smear
were used in the AutoCyte PREP process. In each case, the same patient sample, with very different results.
The conventional smear, although diagnosed
as “within normal limits” can be considered
an unsatisfactory specimen, and the patient
“limited” with the cells hidden by excessive
is called back in for another sample.
diagnosed as “within normal limits.”
C a n c e r D e t e c t i o n a n d P r e v e n t i o n
100 International Blvd., Toronto, Ontario M9W 6J6
Handling Precautions and Guideline for Lithium Ion (LO) batteries General 1. The customer is strongly advised to contact DYNAMIS in advance in case the application or operating conditions of the battery will differ from those specified in the specification sheet. Additional testing may be necessary to verify the suitability of the particular cell type for the intended use. 2. DYN
October 2007 Published in hard copy and on the web at www.saltmatters.org The business address of the Salt Skip Program is Queensland Hypertension Association PO Box 193, Holland Park, QLD 4121, phone (07) 3899 1659, FAX (07) 3394 7815. Use the academic address when writing about salt control —see the panel on page 4. rather grandiose title Salt Matters— ‘Tick’, and co