Nesher, Israel
Nesher, Israel

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Memish Z.A.,Alfaisal University | Assiri A.M.,Ministry of Health | Alshehri M.,Pediatrics Infectious Diseases | Hussain R.,Regional Laboratory | Alomar I.,Administration of Laboratories and Blood Banks
Travel Medicine and Infectious Disease | Year: 2012

Despite the high risk of acquiring respiratory infections, healthcare workers who treat pilgrims at Hajj have not been studied in previous research on respiratory diseases during Hajj. The objective of this study was to determine the prevalence of different respiratory viruses among healthcare workers who treated pilgrims during Hajj 2009, the year of the influenza A H1N1 pandemic. A cross-sectional study was performed just before and after Hajj (25-29 November, 2009). Nasal and throat swabs were tested for 18 respiratory virus types and subtypes. A total of 184 healthcare workers were examined. Most were men (85%) with an average age of 41 years. Before the Hajj, rates of seasonal influenza vaccination were higher (51%) than rates of pandemic influenza A H1N1 vaccination (22%). After the Hajj, participants reported high rates of maintaining hand hygiene (98%), cough etiquette (89%), and wearing a face mask (90%). Among all the viruses tested, only two were detected: rhinovirus was detected in 12.6% and Coronavirus 229E in 0.6%. Rhinovirus was detected in 21% of those who had respiratory symptoms during Hajj. Influenza A (including H1N1), influenza B. respiratory syncytial virus, other coronaviruses, parainfluenza viruses, human metapneumovirus, adenovirus, and human bocavirus were not detected. The finding of high rates of rhinovirus infection corresponds to their frequent occurrence in adults. None of the participants had influenza A H1N1 2009, possibly because it was also infrequent among the 2009 pilgrims. © 2011 Elsevier Ltd. All rights reserved.


Drosten C.,University of Bonn | Meyer B.,University of Bonn | Muller M.A.,University of Bonn | Corman V.M.,University of Bonn | And 16 more authors.
New England Journal of Medicine | Year: 2014

BACKGROUND: Strategies to contain the Middle East respiratory syndrome coronavirus (MERS-CoV) depend on knowledge of the rate of human-to-human transmission, including subclinical infections. A lack of serologic tools has hindered targeted studies of transmission. METHODS: We studied 26 index patients with MERS-CoV infection and their 280 household contacts. The median time from the onset of symptoms in index patients to the latest blood sampling in contact patients was 17.5 days (range, 5 to 216; mean, 34.4). Probable cases of secondary transmission were identified on the basis of reactivity in two reverse-transcriptase-polymerase-chain-reaction (RT-PCR) assays with independent RNA extraction from throat swabs or reactivity on enzyme-linked immunosorbent assay against MERS-CoV S1 antigen, supported by reactivity on recombinant S-protein immunofluorescence and demonstration of neutralization of more than 50% of the infectious virus seed dose on plaque-reduction neutralization testing. RESULTS: Among the 280 household contacts of the 26 index patients, there were 12 probable cases of secondary transmission (4%; 95% confidence interval, 2 to 7). Of these cases, 7 were identified by means of RT-PCR, all in samples obtained within 14 days after the onset of symptoms in index patients, and 5 were identified by means of serologic analysis, all in samples obtained 13 days or more after symptom onset in index patients. Probable cases of secondary transmission occurred in 6 of 26 clusters (23%). Serologic results in contacts who were sampled 13 days or more after exposure were similar to overall study results for combined RT-PCR and serologic testing. CONCLUSIONS: The rate of secondary transmission among household contacts of patients with MERS-CoV infection has been approximately 5%. Our data provide insight into the rate of subclinical transmission of MERS-CoV in the home. Copyright © 2014 Massachusetts Medical Society.


PubMed | University of Bonn, Jeddah Regional Laboratory, Saudi Aramco, United International University Dhanmondi and 6 more.
Type: Journal Article | Journal: Clinical infectious diseases : an official publication of the Infectious Diseases Society of America | Year: 2015

In spring 2014, a sudden rise in the number of notified Middle East respiratory syndrome coronavirus (MERS-CoV) infections occurred across Saudi Arabia with a focus in Jeddah. Hypotheses to explain the outbreak pattern include increased surveillance, increased zoonotic transmission, nosocomial transmission, and changes in viral transmissibility, as well as diagnostic laboratory artifacts.Diagnostic results from Jeddah Regional Laboratory were analyzed. Viruses from the Jeddah outbreak and viruses occurring during the same time in Riyadh, Al-Kharj, and Madinah were fully or partially sequenced. A set of 4 single-nucleotide polymorphisms distinctive to the Jeddah outbreak were determined from additional viruses. Viruses from Riyadh and Jeddah were isolated and studied in cell culture.Up to 481 samples were received per day for reverse transcription polymerase chain reaction (RT-PCR) testing. A laboratory proficiency assessment suggested positive and negative results to be reliable. Forty-nine percent of 168 positive-testing samples during the Jeddah outbreak stemmed from King Fahd Hospital. All viruses from Jeddah were monophyletic and similar, whereas viruses from Riyadh were paraphyletic and diverse. A hospital-associated transmission cluster, to which cases in Indiana (United States) and the Netherlands belonged, was discovered in Riyadh. One Jeddah-type virus was found in Riyadh, with matching travel history to Jeddah. Virus isolates representing outbreaks in Jeddah and Riyadh were not different from MERS-CoV EMC/2012 in replication, escape of interferon response, or serum neutralization.Virus shedding and virus functions did not change significantly during the outbreak in Jeddah. These results suggest the outbreaks to have been caused by biologically unchanged viruses in connection with nosocomial transmission.


Froom P.,Regional Laboratory | Froom P.,Tel Aviv University | Isakov E.,Regional Laboratory | Barak M.,Regional Laboratory
Scandinavian Journal of Clinical and Laboratory Investigation | Year: 2014

Criteria for peripheral smear review are designed to include those samples with results outside the reference interval and can be more extreme based on what is considered to have clinical utility. However, we are unaware of previous studies that reported the distributions of various complete blood cell count (CBC) parameters in infants. In the following study we reviewed screening CBC results of 692 infants aged 9-15 months in order to determine the proportion of peripheral smear reviews recommended according to consensus criteria and that after adjusting for the observed distributions of the various parameters. According to consensus criteria the recommended reflex peripheral smear review rate was 39.7% (95% CI 36.1-43.4) whereas after adjustment for the observed distributions, the rate fell to 5.6% (95% CI 3.9-7.3) (p < 0.001). The major reasons for the difference in rates were the high proportion of infants with an absolute lymphocyte count > 7 × 109/L (17.5%), the presence of a plus one blast flag (4.3%), and a large unstained cell count of ≥ 5% (26.2%) (equivalent to + 1 atypical flag). We found that international consensus criteria for reflex peripheral smear review results in a very high peripheral smear review rate in well infants, and might be inappropriate. © 2014 Informa Healthcare.


Froom P.,Regional Laboratory | Henig C.,Regional Laboratory | Zalman L.,Ministry of Healths Screening Center for Hemoglobinopathies of Pregnant Women | Barak M.,Regional Laboratory
American Journal of Clinical Pathology | Year: 2012

A variant hemoglobin fraction may be an incidental finding during HbA 1c analysis using the G8 Tosoh HPLC analyzer, but it is unclear if the retention times and fraction patterns can reliably predict the findings of a high-performance liquid chromatography (HPLC) β-thalassemia program (Bio Rad Variant II analyzer). We chose 100 samples sent for HbA 1c determinations (G8 Tosoh) with an incidental finding of variant hemoglobin and did a reflex test using the Bio Rad Variant II analyzer (β-thalassemia program). Two observers attempted to predict the results with that analyzer from fraction patterns and retention times of the hemoglobin variants detected with the G8. They independently identified all hemoglobin variants (HbS, Hb Setif, HbC, and HbD) by their patterns and retention times. We conclude that HPLC confirmation of certain variant hemoglobin fractions found incidentally during HbA 1c testing on the G8 Tosoh is not necessary. Copyright© by the American Society for Clinical Pathology.


Froom P.,Regional Laboratory | Saffuri-Elias E.,Regional Laboratory | Rozenberg O.,Regional Laboratory | Barak M.,Regional Laboratory
Clinical Chemistry and Laboratory Medicine | Year: 2015

Background: A triple positive antiphospholipid (aPL) antibody profile [two positive serum IgG aPL antibodies along with one positive functional plasma lupus anticoagulant (LAC) test result] is associated with an increased risk for thrombosis, whereas patients with single positive test results may have little to no increased risk. The frequency of triple positivity in outpatients with various combinations of LAC test results is unclear. Methods: We extracted from our database all LAC test results [dilute Russell viper venom times (dRVVT) and silica clotting times (SCT)] that had concomitant serum IgG aPL testing [both serum anti β2-glycoprotein I (anti-β2GPI) and anti-cardiolipin (aCL) antibodies]. Results: There were 3195 patients without a prolonged prothrombin time. Double antibody positivity was found in 1% (31/2955) of those with normal functional LAC test results, in 16.0% (31/81) of those with a positive dRVVT, in 12.7% (10/79) of those with a positive SCT, and in 56.3% (45/80) of those with both tests positive (p<0.001). A triple positive aPL antibody profile was found in 28.3% (68/240) of those with at least one positive LAC test result. Conclusions: We conclude that 28% of patients with elevated LAC tests have a triple positive aPL antibody profile and patients with two positive LAC tests have a higher prevalence of a triple positive profile than do those with one positive LAC test result. © De Gruyter 2015.


Froom P.,Regional Laboratory | Saffuri-Elias E.,Regional Laboratory | Barak M.,Regional Laboratory
International Journal of Laboratory Hematology | Year: 2015

Introduction: To determine the rates of autovalidation in our outpatient coagulation laboratory. Methods: We retrospectively identified all coagulation tests analyzed during the month of January 2014 from our laboratory information system (LIS) (N = 16 116), from around 800 000 active members of Clalit Health Services (a health maintenance organization). The integrated system includes a single centrifugation of all collection tubes, analyzers that rerun or reflex tests according to the test results, and a laboratory information system that sends orders to the analyzer, autovalidates test results, and automatically sends critical value results to a list for immediate physician communication. Reasons for technician validation are tests rerun for confirmation or because of analyzer errors and test results that require reflex testing. All other test results are sent automatically to the laboratory information system without the need for technician review. Results: There were 362 test results with analyzer errors, 91 results rerun for confirmation (thrombophilia test results outside the reference interval), and 50 tests with mixing studies and reflex testing for factor XI activity levels (total = 3.1%, 503/16116), resulting in an autovalidation rate of 96.9% (95% confidence interval - 96.6-97.2%). Conclusions: We conclude that an integrated system can result in a high autovalidation rate in a high-volume outpatient coagulation laboratory. © 2015 John Wiley & Sons Ltd.


Froom P.,Regional Laboratory | Barak M.,Regional Laboratory
Clinical Chemistry and Laboratory Medicine | Year: 2015

Background: The rate of auto-validation is dependent on the ability of the laboratory information system (LIS) to integrate historical data, on the frequency and methods for identifying analyzer errors, and on the criteria for reflex testing, including the need for peripheral smear review. The rate of auto-validation in outpatient laboratories, however, is unclear. Methods: We examined 45,925 consecutive complete blood count (CBC) test results (1 January, 2014-31 January, 2014) from patients aged 50±24 years. The LIS auto-validates all samples according to set criteria. Technicians validated test results when previous CBC test results were required to determine: 1) the need for peripheral slide review and/or sample rerun or 2) the need for reflex testing to detect autoimmune hemolytic anemia or β-thalassemia minor. Results: The auto-validation rates were 97.6% after rejecting results requiring validation to determine the need for a peripheral smear review and/or sample rerun. This decreased to 92.9% after including reflex testing to determine the reasons for normocytic and microcytic anemia. We estimated that auto-validation decreased the workload by 7.7-11.6 h per 3000 test results. Conclusions: We conclude that very high auto-validation rates are possible in outpatient general laboratories, leading to conformity in the validation process and a considerable estimated savings in technician time. Further studies are needed in other settings. © 2015 by De Gruyter 2015.


Froom P.,Regional Laboratory | Saffuri-Elias E.,Regional Laboratory | Rozenberg O.,Regional Laboratory | Barak M.,Regional Laboratory
Journal of Clinical Pathology | Year: 2014

Aims: We hypothesised that there is a threshold value for the association of dilute Russell's viper venom times (dRVVT) with positive immunoglobin G antiphospholipid antibody (IgG-APLA) test results. Methods: We tested 120 controls and a cohort of 2412 outpatients who had concomitant test results for dRVVT and IgG-APLA (IgG antibodies to cardiolipins and ß2-glycoprotein I). We also selected a subgroup who had repeated IgG-APLA tests at least 12 weeks apart (1398 patients with multiple ß2-glycoprotein I tests and 672 with multiple aCL tests). We cross tabulated the proportion of IgG-APLA single positive, double positive and persistently positive antibodies with dRVVT values. Results: The distribution of the dRVVT results from the reference population was consistent with an upper limit of the reference interval of 1.22 to >1.48. A consistent increase in the proportion of IgG-APLA single, double positive and persistently positive antibody tests occurred in the group with a normalised dRVVT ratio of 1.40-1.49. IgG-APLA double positivity was found in 12.5% (4 of 32) patients with a ratio of dRVVT 1.40-1.49 compared with 3.3% (6/181) of those with a ratio of dRVVT 1.20-1.39 ( p=0.045). Conclusions: We conclude that there is an association between dRVVT positivity and elevated proportions of single, double and persistently positive IgG-APLA test results with an apparent threshold effect. These findings may provide a general guide to risk and suggest a way to choose from a wide range of possible upper limits of the reference interval.


PubMed | Regional Laboratory
Type: Journal Article | Journal: International journal of laboratory hematology | Year: 2015

To determine the rates of autovalidation in our outpatient coagulation laboratory.We retrospectively identified all coagulation tests analyzed during the month of January 2014 from our laboratory information system (LIS) (N = 16 116), from around 800 000 active members of Clalit Health Services (a health maintenance organization). The integrated system includes a single centrifugation of all collection tubes, analyzers that rerun or reflex tests according to the test results, and a laboratory information system that sends orders to the analyzer, autovalidates test results, and automatically sends critical value results to a list for immediate physician communication. Reasons for technician validation are tests rerun for confirmation or because of analyzer errors and test results that require reflex testing. All other test results are sent automatically to the laboratory information system without the need for technician review.There were 362 test results with analyzer errors, 91 results rerun for confirmation (thrombophilia test results outside the reference interval), and 50 tests with mixing studies and reflex testing for factor XI activity levels (total = 3.1%, 503/16116), resulting in an autovalidation rate of 96.9% (95% confidence interval - 96.6-97.2%).We conclude that an integrated system can result in a high autovalidation rate in a high-volume outpatient coagulation laboratory.

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