Diagnostic Services of Manitoba

Winnipeg, Canada

Diagnostic Services of Manitoba

Winnipeg, Canada
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Alfa M.J.,Diagnostic Services of Manitoba | Alfa M.J.,St Boniface Research Center | Alfa M.J.,University of Manitoba | Olson N.,St Boniface Research Center | And 2 more authors.
American Journal of Infection Control | Year: 2012

Background: Cleaning of flexible endoscopes is most commonly performed using manual methods that are often performed inadequately. The aim of this study was to validate the sample collection protocol and the Rapid Use Scope Test (RUST) and then assess its usefulness in clinical use. Methods: The benchmarks for adequate cleaning were protein <6.4 μg/cm2, hemoglobin <2.2 μg/cm2, and carbohydrate <1.2 μg/cm 2. Sample collection consisted of flushing 10 mL of sterile reverse osmosis water through the suction-biopsy port to the distal end. Validation of the RUST audit tool included simulated-use and in-use testing in 43 endoscopy clinics across Canada. Results: Simulated-use testing validated that improperly cleaned endoscopes that exceeded the cleaning benchmarks would be flagged by the RUST test. The clinical-use study indicated that 96.6% of 1,489 scope channels tested were RUST negative; however, 19% and 12% of elevator guide-wire channels and endoscopic retrograde colangiopancreatography channels, respectively, exceeded the benchmarks. The survey indicated that reprocessing personnel valued a rapid audit tool for assessing compliance with manual cleaning. Conclusion: The validated RUST test provides health care users with a rapid audit tool for manual cleaning that can be integrated into the quality program in endoscopy. Copyright © 2012 by the Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.

Alfa M.J.,Diagnostic Services of Manitoba | Alfa M.J.,University of Manitoba | Alfa M.J.,St Boniface Research Center | Olson N.,St Boniface Research Center | Murray B.-L.,St Boniface Research Center
American Journal of Infection Control | Year: 2014

Background The objectives of this study were to recommend sample collection method(s) based on relative soiling in patient-used gastrointestinal (GI) endoscopes and determine whether the published benchmarks for protein, bioburden, and adenosine triphosphate (ATP) remain relevant for pump-assisted manual cleaning. Methods Patient-used gastroscopes, duodenoscopes, and colonoscopes were sampled before and after manual cleaning and assessed for protein, bioburden, and ATP levels. The biopsy port (BP) to distal end (D) sample was collected using 20 mL of sterile reverse-osmosis water. After a 200-mL flush, the umbilical (UM) to BP portion was sampled by flushing 40 mL from the UM to the D. Results The BP to D portion of the suction biopsy channel contained 83% of ATP residuals. Despite cleaning with brushing and a flushing pump, 25% of gastroscopes exceeded the ATP benchmark of 200 relative light units (RLU), whereas all duodenoscopes and colonoscopes had <200 RLU after cleaning. The protein and bioburden residuals after pump-assisted cleaning were consistently lower than existing benchmarks. Conclusion Sampling the suction biopsy channel from BP to D detected the most residuals from patient-used GI endoscopes. The protein and bioburden benchmarks for pump-assisted cleaning can be lowered, but 200 RLU is still adequate for ATP. © 2014 by the Association for Professionals in Infection Control and Epidemiology, Inc.

Hatakka A.,University of Manitoba | Klein J.,Diagnostic Services of Manitoba | He R.,Public Health Agency of Canada | Piper J.,Public Health Agency of Canada | And 2 more authors.
Journal of Clinical Microbiology | Year: 2011

There are few reports in the literature of hepatitis as a manifestation of parvovirus B19 infection. We describe a case of parvovirus B19-associated acute hepatitis diagnosed based on a positive serologic test (IgM) and molecular detection of parvovirus B19 DNA in a liver biopsy specimen. Parvovirus B19 infection should be considered in the differential diagnosis of patients presenting with acute hepatitis. Copyright © 2011, American Society for Microbiology. All Rights Reserved.

PubMed | Diagnostic Services of Manitoba, University of Manitoba, University of Colorado at Denver and University of Baltimore
Type: | Journal: Diabetes | Year: 2016

Mitochondria are the nexus of energy metabolism and consequently their dysfunction has been implicated in the development of metabolic complications and the progression to insulin resistance and type II diabetes. The unique tetra-acyl phospholipid cardiolipin (CL) is located in the inner mitochondrial membrane where it maintains mitochondrial integrity. Here we show that knock-down of Tafazzin (TAZ kd), a CL transacylase, in mice results in protection against the development of obesity, insulin resistance and hepatic steatosis. We determined that hypermetabolism protected TAZ kd mice from weight gain. Unexpectedly, the large reduction of CL in the heart and skeletal muscle of TAZ kd mice was not mirrored in the liver. As a result, TAZ kd mice exhibited normal hepatic mitochondrial supercomplex formation and elevated hepatic fatty acid oxidation. Collectively, these studies identify a key role for hepatic CL remodelling in regulating susceptibility to insulin resistance and as a novel therapeutic target for diet-induced obesity.

Hemmelgarn B.R.,University of Calgary | Zhang J.,University of Calgary | Manns B.J.,University of Calgary | James M.T.,University of Calgary | And 8 more authors.
JAMA - Journal of the American Medical Association | Year: 2010

Context: Laboratory reporting of estimated glomerular filtration rate (GFR) has been widely implemented, with limited evaluation. Objective: To examine trends in nephrologist visits and health care resource use before and after estimated GFR reporting. Design, Setting, and Patients: Community-based cohort study (N=1 135 968) with time-series analysis. Participants were identified from a laboratory registry in Alberta, Canada, and followed up from May 15, 2003, to March 14, 2007 (with estimated GFR reporting implemented October 15, 2004). Main Outcome Measure: Nephrologist visits and patient management. Results: Following estimated GFR reporting, the rate of first outpatient visits to a nephrologist for patients with chronic kidney disease (CKD; estimated GFR <60 mL/ min/1.73 m2) increased by 17.5 (95% confidence interval [CI], 16.5-18.6) visits per 10 000 CKD patients per month, corresponding to a relative increase from baseline of 68.4% (95% CI, 65.7%-71.2%). There was no association between estimated GFR reporting and rate of first nephrologist visit among patients without CKD. Among patients with an estimated GFR of less than 30 mL/min/1.73 m2, the rate of first nephrologist visits increased by 134.4 (95% CI, 60.0-208.7) visits per 10 000 patients per month. This increase was predominantly seen in women, patients aged 46 to 65 years as well as those aged 86 years or older, and those with hypertension, diabetes, and comorbidity. Reporting of estimated GFR was not associated with increased rates of internal medicine or general practitioner visits or increased use of angiotensinconverting enzyme inhibitors/angiotensin II receptor blockers among patients with CKD and proteinuria or the subgroup limited to patients with diabetes. Conclusions: Reporting of estimated GFR was associated with an increase in first nephrologist visits, particularly among patients with more severe kidney dysfunction, women, middle-aged and very elderly patients, and those with comorbidities. Any effect on outcomes remains to be shown. ©2010 American Medical Association. All rights reserved.

Lagace-Wiens P.R.S.,University of Manitoba | Baudry P.J.,University of Manitoba | Pang P.,Diagnostic Services of Manitoba | Hammond G.,University of Manitoba
Journal of Clinical Microbiology | Year: 2010

Extended-spectrum-β-lactamase (ESBL)-producing organisms have captured the attention of clinicians and laboratorians and are agents of nosocomial and community onset infections (J. D. Pitout and K. B. Laupland,. Lancet Infect. Dis. 8:159-166, 2008). ESBLs in many enterobacteriaceae and in nonfermenting Gram-negative organisms have been described (K. Bush and G. A. Jacoby, Antimicrob. Agents Chemother. 54:969-976, 2010). We present the first case of a clinical isolate of multidrug-resistant Escherichia fergusonii expressing an extended-spectrum-β-lactamase (ESBL). Copyright © 2010, American Society for Microbiology. All Rights Reserved.

Wiebe C.,University of Manitoba | Pochinco D.,Diagnostic Services of Manitoba | Blydt-Hansen T.D.,University of Manitoba | Ho J.,University of Manitoba | And 8 more authors.
American Journal of Transplantation | Year: 2013

De novo donor-specific antibody (dnDSA) develops in 15-25% of renal transplant recipients within 5 years of transplantation and is associated with 40% lower graft survival at 10 years. HLA epitope matching is a novel strategy that may minimize dnDSA development. HLAMatchmaker software was used to characterize epitope mismatches at 395 potential HLA-DR/DQ/DP conformational epitopes for 286 donor-recipient pairs. Epitope specificities were assigned using single antigen HLA bead analysis and correlated with known monoclonal alloantibody epitope targets. Locus-specific epitope mismatches were more numerous in patients who developed HLA-DR dnDSA alone (21.4 vs. 13.2, p < 0.02) or HLA-DQ dnDSA alone (27.5 vs. 17.3, p < 0.001). An optimal threshold for epitope mismatches (10 for HLA-DR, 17 for HLA-DQ) was defined that was associated with minimal development of Class II dnDSA. Applying these thresholds, zero and 2.7% of patients developed dnDSA against HLA-DR and HLA-DQ, respectively, after a median of 6.9 years. Epitope specificity analysis revealed that 3 HLA-DR and 3 HLA-DQ epitopes were independent multivariate predictors of Class II dnDSA. HLA-DR and DQ epitope matching outperforms traditional low-resolution antigen-based matching and has the potential to minimize the risk of de novo Class II DSA development, thereby improving long-term graft outcome. This article provides a comprehensive evaluation of HLA Class II epitope mismatch load and epitope immunogenicity as predictors for de novo Class II donor-specific antibody development in renal transplant recipients. See editorial by Tambur and Claas on page 3059. © Copyright 2013 The American Society of Transplantation and the American Society of Transplant Surgeons.

Lagace-Wiens P.R.S.,University of Manitoba | Adam H.J.,University of Manitoba | Karlowsky J.A.,University of Manitoba | Nichol K.A.,Diagnostic Services of Manitoba | And 5 more authors.
Journal of Clinical Microbiology | Year: 2012

Matrix-assisted laser desorption ionization-time of flight (MALDI-TOF) mass spectrometry represents a revolution in the rapid identification of bacterial and fungal pathogens in the clinical microbiology laboratory. Recently, MALDI-TOF has been applied directly to positive blood culture bottles for the rapid identification of pathogens, leading to reductions in turnaround time and potentially beneficial patient impacts. The development of a commercially available extraction kit (Bruker Sepsityper) for use with the Bruker MALDI BioTyper has facilitated the processing required for identification of pathogens directly from positive from blood cultures. We report the results of an evaluation of the accuracy, cost, and turnaround time of this method for 61 positive monomicrobial and 2 polymicrobial cultures representing 26 species. The Bruker MALDI BioTyper with the Sepsityper gave a valid (score, >1.7) identification for 85.2% of positive blood cultures with no misidentifications. The mean reduction in turnaround time to identification was 34.3 h (P<0.0001) in the ideal situation where MALDI-TOF was used for all blood cultures and 26.5 h in a more practical setting where conventional identification or identification from subcultures was required for isolates that could not be directly identified by MALDI-TOF. Implementation of a MALDI-TOF-based identification system for direct identification of pathogens from blood cultures is expected to be associated with a marginal increase in operating costs for most laboratories. However, the use of MALDI-TOF for direct identification is accurate and should result in reduced turnaround time to identification. Copyright © 2012, American Society for Microbiology. All Rights Reserved.

Wiebe C.,University of Manitoba | Gibson I.W.,University of Manitoba | Blydt-Hansen T.D.,University of British Columbia | Pochinco D.,Diagnostic Services of Manitoba | And 7 more authors.
American Journal of Transplantation | Year: 2015

Understanding rates and determinants of clinical pathologic progression for recipients with de novo donor-specific antibody (dnDSA), especially subclinical dnDSA, may identify surrogate endpoints and inform clinical trial design. A consecutive cohort of 508 renal transplant recipients (n-=-64 with dnDSA) was studied. Recipients (n-=-388) without dnDSA or dysfunction had an eGFR decline of -0.65-mL/min/1.73-m2/year. In recipients with dnDSA, the rate eGFR decline was significantly increased prior to dnDSA onset (-2.89 vs. -0.65-mL/min/1.73-m2/year, p-<-0.0001) and accelerated post-dnDSA (-3.63 vs. -2.89-mL/min/1.73-m2/year, p-<-0.0001), suggesting that dnDSA is both a marker and contributor to ongoing alloimmunity. Time to 50% post-dnDSA graft loss was longer in recipients with subclinical versus a clinical dnDSA phenotype (8.3 vs. 3.3 years, p-<-0.0001). Analysis of 1091 allograft biopsies found that dnDSA and time independently predicted chronic glomerulopathy (cg), but not interstitial fibrosis and tubular atrophy (IFTA). Early T cell-mediated rejection, nonadherence, and time were multivariate predictors of IFTA. Independent risk factors for post-dnDSA graft survival available prior to, or at the time of, dnDSA detection were delayed graft function, nonadherence, dnDSA mean fluorescence intensity sum score, tubulitis, and cg. Ultimately, dnDSA is part of a continuum of mixed alloimmune-mediated injury, which requires solutions targeting T and B cells. In this study, the authors analyze clinical and histologic risk factors available at the time of de novo donor-specific antibody detection to determine clinical and histologic predictors of subsequent allograft failure, and their importance for clinical trial design. © Copyright 2015 The American Society of Transplantation and the American Society of Transplant Surgeons.

Alfa M.J.,University of Manitoba | Alfa M.J.,St Boniface General Hospital | Manickam K.,University of Manitoba | Manickam K.,St Boniface General Hospital | And 5 more authors.
Journal of Clinical Microbiology | Year: 2011

The reliability of the BacT/Alert 3D unit for automated detection of nontuberculous mycobacteria (NTM) that grow optimally at 30°C was assessed. This system reliably maintained a temperature of 30°C and detected 50% of the clinical NTM strains (5 Mycobacterium marinum and 3 Mycobacterium gordonae strains) faster than 37°C culture. Copyright © 2011, American Society for Microbiology. All Rights Reserved.

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