This study assessed the performance of a portable prothrombin time (PT) analyzer called the CoaguChek-XS in dogs. Blood samples from 97 dogs were tested using both the CoaguChek-XS and an automated coagulation analyzer. The CoaguChek-XS provided results within 1 minute using a small amount of whole blood. There was moderate correlation between the two methods, with a mean difference of 2.58 seconds. 94% of results fell within limits of agreement between the methods. The CoaguChek-XS accurately identified dogs with anticoagulant rodenticide intoxication but results were inaccurate in anemic dogs. The study concluded the CoaguChek-XS is a simple
Internal quality control (IQC) in coagulation labAnkit Raiyani
In the haematology laboratory it is essential to ensure that the right test is carried out on the right specimen and that the correct results are delivered to the appropriate recipient without delay.
Quality control (QC) is defined as measures that must be included during each assay run to verify that the test is working properly.
Internal quality control (IQC) is monitoring the haematology test procedures to ensure continual evaluation of the reliability of the daily work of the laboratory with validation of tests before reports are released
Wavelength selection in measuring red.pdfbitconcepts
This study examined the effects of light wavelength on measurements of red blood cell aggregation using light transmittance. Key findings include:
1. Wavelength significantly affected parameters reflecting the extent of aggregation but not those reflecting the time course.
2. Hemoglobin oxygen saturation had a prominent influence on parameters at wavelengths below 700nm, affecting both extent and time course, but only affected time course at 800nm.
3. The ability to detect changes in aggregation depended on wavelength, generally being greater at higher wavelengths.
It is recommended that instruments for measuring red blood cell aggregation via light transmittance use light sources around 800nm wavelength.
This study establishes reference intervals for whole blood and plasma colloid osmotic pressure (COP) measurements in healthy cats. Whole blood COP was measured in 63 cats and found to have a mean of 24.4 mmHg with a reference interval of 18.9 to 30.4 mmHg. Plasma COP was measured in 52 cats and found to have a mean of 24.3 mmHg with a reference interval of 18.3 to 30.8 mmHg. There was no significant difference found between mean whole blood and plasma COP measurements. Total protein and albumin levels were found to be significantly correlated with whole blood and plasma COP levels.
This document describes a reference method recommended by the International Council for Standardization in Haematology (ICSH) and the International Society of Laboratory Hematology (ISLH) for platelet counting. The method involves labeling platelets in fresh blood samples with fluorescent antibodies and counting the labeled platelets relative to red blood cells using flow cytometry. An accurate red blood cell count is also determined on the original sample. The ratio of red blood cells to platelets obtained from the flow cytometry data is used along with the red blood cell count to calculate the platelet count. The method provides accurate and precise results needed for calibration of hematology analyzers.
This study evaluated the efficacy of refrigerated canine plasma (RP) as an alternative to fresh frozen plasma (FFP) for transfusion. The time to thaw 6 units of FFP in a warm water bath was 34.7 ± 1.38 minutes on average. RP and frozen plasma (control) were collected from 9 dogs and stored at 4°C and -20°C, respectively. Coagulation factors and clotting times were measured at various time points over 14 days. RP storage resulted in minor decreases in coagulation factors and slight prolongation of clotting times, but all values remained within normal ranges. No bacterial growth was detected in cultures of RP. The study concludes that RP maintains adequate
This document provides instructions for performing a complete blood count (CBC) with five-part differential on blood samples from NHANES 2001-2002. Key details include:
- The CBC is performed on a Beckman Coulter MAXM instrument using EDTA blood tubes collected from participants.
- The MAXM uses electrical impedance to count and measure the size of blood cells to determine various parameters like white blood cell count, hematocrit, and platelet count.
- Strict safety procedures must be followed when handling blood samples, which are potential biohazards. Quality control procedures like calibration and use of controls are specified.
The IQ-CSRC prospective study-draft protocolSasha Latypova
1. iCardiac Technologies will sponsor a prospective clinical study to evaluate whether exposure response analysis of standard clinical pharmacology studies can replace thorough QT studies in assessing QT interval prolongation risk. The study will compare the ability of thorough QT studies and "early QT assessment" using exposure response analysis to detect small QT interval changes.
2. The study will involve two cohorts of 10 healthy subjects receiving single and multiple doses of 6 marketed drugs - 5 known to prolong the QT interval and 1 negative control. Continuous ECG monitoring and exposure response modeling will be used to assess QT interval effects.
3. If the study meets pre-specified criteria showing detection of QT effects for the 5 positive drugs and exclusion of effects for the negative
Internal quality control (IQC) in coagulation labAnkit Raiyani
In the haematology laboratory it is essential to ensure that the right test is carried out on the right specimen and that the correct results are delivered to the appropriate recipient without delay.
Quality control (QC) is defined as measures that must be included during each assay run to verify that the test is working properly.
Internal quality control (IQC) is monitoring the haematology test procedures to ensure continual evaluation of the reliability of the daily work of the laboratory with validation of tests before reports are released
Wavelength selection in measuring red.pdfbitconcepts
This study examined the effects of light wavelength on measurements of red blood cell aggregation using light transmittance. Key findings include:
1. Wavelength significantly affected parameters reflecting the extent of aggregation but not those reflecting the time course.
2. Hemoglobin oxygen saturation had a prominent influence on parameters at wavelengths below 700nm, affecting both extent and time course, but only affected time course at 800nm.
3. The ability to detect changes in aggregation depended on wavelength, generally being greater at higher wavelengths.
It is recommended that instruments for measuring red blood cell aggregation via light transmittance use light sources around 800nm wavelength.
This study establishes reference intervals for whole blood and plasma colloid osmotic pressure (COP) measurements in healthy cats. Whole blood COP was measured in 63 cats and found to have a mean of 24.4 mmHg with a reference interval of 18.9 to 30.4 mmHg. Plasma COP was measured in 52 cats and found to have a mean of 24.3 mmHg with a reference interval of 18.3 to 30.8 mmHg. There was no significant difference found between mean whole blood and plasma COP measurements. Total protein and albumin levels were found to be significantly correlated with whole blood and plasma COP levels.
This document describes a reference method recommended by the International Council for Standardization in Haematology (ICSH) and the International Society of Laboratory Hematology (ISLH) for platelet counting. The method involves labeling platelets in fresh blood samples with fluorescent antibodies and counting the labeled platelets relative to red blood cells using flow cytometry. An accurate red blood cell count is also determined on the original sample. The ratio of red blood cells to platelets obtained from the flow cytometry data is used along with the red blood cell count to calculate the platelet count. The method provides accurate and precise results needed for calibration of hematology analyzers.
This study evaluated the efficacy of refrigerated canine plasma (RP) as an alternative to fresh frozen plasma (FFP) for transfusion. The time to thaw 6 units of FFP in a warm water bath was 34.7 ± 1.38 minutes on average. RP and frozen plasma (control) were collected from 9 dogs and stored at 4°C and -20°C, respectively. Coagulation factors and clotting times were measured at various time points over 14 days. RP storage resulted in minor decreases in coagulation factors and slight prolongation of clotting times, but all values remained within normal ranges. No bacterial growth was detected in cultures of RP. The study concludes that RP maintains adequate
This document provides instructions for performing a complete blood count (CBC) with five-part differential on blood samples from NHANES 2001-2002. Key details include:
- The CBC is performed on a Beckman Coulter MAXM instrument using EDTA blood tubes collected from participants.
- The MAXM uses electrical impedance to count and measure the size of blood cells to determine various parameters like white blood cell count, hematocrit, and platelet count.
- Strict safety procedures must be followed when handling blood samples, which are potential biohazards. Quality control procedures like calibration and use of controls are specified.
The IQ-CSRC prospective study-draft protocolSasha Latypova
1. iCardiac Technologies will sponsor a prospective clinical study to evaluate whether exposure response analysis of standard clinical pharmacology studies can replace thorough QT studies in assessing QT interval prolongation risk. The study will compare the ability of thorough QT studies and "early QT assessment" using exposure response analysis to detect small QT interval changes.
2. The study will involve two cohorts of 10 healthy subjects receiving single and multiple doses of 6 marketed drugs - 5 known to prolong the QT interval and 1 negative control. Continuous ECG monitoring and exposure response modeling will be used to assess QT interval effects.
3. If the study meets pre-specified criteria showing detection of QT effects for the 5 positive drugs and exclusion of effects for the negative
This study compared the precision of semi-automated and high-precision QT interval measurement techniques using data from two thorough QT studies that assessed the effects of moxifloxacin on the QTc interval. Both techniques detected the QTc prolongation induced by moxifloxacin with similar accuracy. However, the high-precision technique improved the precision of QTc measurement by 31% in Study I and 15% in Study II as evidenced by the reduction in the standard deviation of the DQTcF values. More precise QTc measurement could lower the likelihood of false positive results and reduce the necessary sample size in thorough QT studies. Pairwise comparisons found close agreement between the techniques with small mean differences and narrow limits of agreement. Therefore,
This study evaluated the effects of hetastarch 670/0.75 administered as a constant rate infusion (CRI) at 1 mL/kg/h and 2 mL/kg/h for 24 hours on platelet function and bleeding in 8 healthy dogs. Platelet closure time was measured at baseline and 6, 12, and 24 hours after initiation of the CRI using a platelet function analyzer. At 1 mL/kg/h, closure time was prolonged at 12 and 24 hours compared to baseline, though remained within the normal reference range. At 2 mL/kg/h, closure time was also prolonged at 12 and 24 hours and exceeded the normal reference range at 24 hours. Despite changes in closure time, no spontaneous bleeding
The document summarizes several laboratory tests and procedures used in hematology, physiology, microbiology, and biochemistry. It describes bleeding time and coagulation time tests to assess platelet function. It also outlines the hematocrit test procedure to measure red blood cell volume percentage, and the blood grouping test to determine blood type based on antigen-antibody reactions. Procedures for blood culture collection and centrifugation to separate blood components are provided. Finally, it explains hemoglobin electrophoresis to measure different hemoglobin molecules and identify potential abnormalities.
This study compared measurements of plasma osmolality (POsm) obtained from capillary puncture blood (CAP) and venous blood (VEN) under conditions of euhydration and dehydration. In Study A, CAP and VEN measurements were similar during euhydration. Eliminating outliers, CAP was on average 1.6 mOsm/kg lower than VEN. In Study B, fluid restriction increased CAP POsm significantly and CAP detected dehydration with 89.1% sensitivity and 0.92 accuracy, validating its ability to track changes in hydration status. The results suggest CAP can serve as an adequate substitute for VEN in non-clinical settings.
In-Vivo Evaluation of Rifampicin Loaded Nanospheres: Biodistribution and Myco...Ratnakaram Venkata Nadh
Rifampicin PLGA nanospheres are
formulated with a specific goal in order to decrease
the dose, adverse effects and to enhance targeted
drug delivery. Rifampicin nanospheres were
prepared and evaluated by emulsion solvent
evaporation method. In vivo bio distribution studies
reveal that there was a long term accumulation of
rifampicin nanospheres in the lungs over other
organs. The increase in Cmax values confirmed that
inhalable PLGA nanospheres are suitable for
targeting and providing sustained release of antitubercular
drugs to lungs. So inhalation is a
selected administration route of Rifampicin PLGA
nanospheres. The in vivo screening of M.
tuberculosis showed good activity as well as its
activity against multidrug-resistant M. tuberculosis
and against M. tuberculosis isolates in a
potentially latent state, makes Rifampicin PLGA
nanospheres as an attractive drug dosage form
for the therapy of tuberculosis. It can be concluded
that there is a significant potential for effective
oral delivery as well as nasal delivery of the
Nanospheres for the treatment of tuberculosis.
This document is a report submitted by a student, Christian Chibuike Uzuh, on their six month industrial work experience at the Agege Local Government Primary Health Centre in Lagos, Nigeria under the Students’ Industrial Work Experience Scheme (SIWES). The report provides a brief history of the health centre, describes the various laboratory tests and procedures performed during the training including oral glucose tolerance tests, packed cell volume tests, blood grouping, and more. The student's training has helped bridge the gap between theoretical classroom learning and practical skills.
ACCULAB Corporation is a manufacturer and supplier of laboratory and medical instruments based in New York. It incorporates 7 companies to offer a wide range of products at different price points to meet customer demands. ACCULAB aims to provide both high quality products and competitive prices with a vision of being a one-stop shop for all laboratory equipment needs through excellent customer service.
This document proposes a policy-based runtime verification framework for hypertension monitoring using electrocardiogram (ECG) sensing. Key aspects include:
1) A decision tree model is implemented using timed ECG features to extract patterns/policies related to hypertension.
2) The extracted ECG policies are formally specified as timed automata to synthesize a runtime verification monitor.
3) The monitor continuously verifies the ECG policies and provides a verdict on whether hypertension is present or not based on ECG events.
The framework aims to provide explainable, non-invasive hypertension monitoring using a formal methods-based approach.
Can the tqt study be replaced b darpo london june 2013 (2)Sasha Latypova
1. Recent initiatives from regulatory agencies and industry groups suggest moving away from routinely requiring thorough QT studies for all new drugs. Alternative approaches using concentration-effect modeling and improved QT measurement precision may allow early QT assessment to replace thorough QT studies in some cases.
2. Achieving the same high level of confidence in excluding small QT effects as thorough QT studies is a key requirement for alternative approaches to be accepted. Demonstrating assay sensitivity without using moxifloxacin as a positive control is also important.
3. Enhanced cardiac safety assessment in early clinical studies, using high-precision QT measurement techniques, concentration-effect modeling, and achieving very high drug concentrations, has the potential to provide data sufficient to replace
This study aimed to develop a thrombelastography (TEG)-guided transfusion algorithm for managing postpartum haemorrhage. Whole blood samples from 57 healthy pregnant women were analyzed using three TEG assays: native, kaolin-activated, and kaolin/tissue factor-activated. Reference values and intervals were established for each assay. Reference values differed between activated and non-activated assays. The developed TEG-guided algorithm preferentially uses activated assays and recommends an initial baseline TEG measurement for comparison during transfusion management of postpartum haemorrhage.
Packed cell volume (PCV), also known as hematocrit, is a measure of the ratio of red blood cells to total blood volume. PCV determination provides important information about anemia and polycythemia. It can also be used as a screening test when a hemoglobin measurement is not available. The microhematocrit method is commonly used for PCV determination and involves filling a capillary tube with blood and centrifuging it to separate components. Quality control measures like running controls and testing in duplicate help ensure reliable PCV results.
Notes on sensitization workshop on recent initiatives.dpmo123
This document summarizes a new initiative in India that provides free laboratory services through public-private partnerships. Under the initiative, over 1,100 public health centers, 190 community health centers, 30 area hospitals and 8 district hospitals will offer free diagnostic testing. Tests will either be performed on-site by existing lab technicians or outsourced to 80 new labs established by a private provider. The private provider is responsible for establishing and operating the labs, sample transportation, and reporting results back to the public facilities. The initiative aims to reduce out-of-pocket healthcare expenses and improve access to diagnostics for poor populations.
This document provides information about the Tatwadarsha Multispeciality Hospital central laboratory. It details that the laboratory aims to provide quality diagnostic services under one roof through on-site clinical pathology, imaging and ICU facilities. The laboratory contains high-end automated analyzers and is staffed by qualified technicians and pathologists. Specimen collection, transport procedures, test directories, and emergency testing turnaround times are also outlined.
1. The study evaluated two point-of-care ethylene glycol (EG) tests using canine plasma samples containing known concentrations of EG ranging from 0 to 100 mg/dL, as confirmed by gas chromatography (GC).
2. The Kacey EG Test Strips had excellent sensitivity and specificity of 100% for both readers, and good agreement with GC results.
3. The VetSpec EG Qualitative Reagent Test Kit was less sensitive and specific, ranging from 65-95% sensitivity and 40-70% specificity between readers, with less agreement with GC results.
4. Of the two tests evaluated, the Kacey EG Test Strips were more accurate and
kSORTTM is a non-invasive blood test that analyzes gene expression to assess immune risk in kidney transplant patients. The analytical performance of kSORTTM was validated in an independent clinical laboratory. Accuracy was high, with 87% agreement between kSORTTM results and biopsy results. Precision studies showed 15% variability in quantitative scores and 94% consistency in qualitative results over multiple runs. Sensitivity was 100% and specificity was 96% when excluding indeterminate results. Validation demonstrates that kSORTTM is analytically sound for clinical use in monitoring transplant patients.
This document describes a study that used continuous ECG monitoring to assess changes in the QTc interval during standing maneuvers as a potential positive control for detecting QT prolongation in early clinical drug trials. The study found that:
1) All treatment groups showed a significant increase in maximum QTc interval change (QTcF) from baseline upon standing at all time points, meeting regulatory standards for a positive control.
2) The variability in time to maximum QTcF response decreased substantially over repeated standing maneuvers, from a standard error of 6.4 milliseconds initially to 0.7 milliseconds.
3) The results support the use of standing-induced QTcF changes as a method for validating a study's
Real-time and Non-Invasive Detection of Haemoglobin level using CNNIRJET Journal
This document describes a study that aims to detect haemoglobin levels in a non-invasive and real-time manner using convolutional neural networks (CNNs). The researchers collected a dataset of finger images with varying haemoglobin levels from blood donation camps. They trained a CNN model on this dataset to classify haemoglobin levels based on image features. The CNN was tested on additional finger images and able to detect haemoglobin levels in real-time without drawing blood, providing advantages over traditional invasive methods like faster results and no patient discomfort or biohazards. The proposed non-invasive method using deep learning could help diagnose blood-related conditions earlier.
The document discusses quality assurance in haemostasis laboratory testing. It outlines the importance of accuracy and precision in test results. There are three main types of quality assurance: internal quality control, external quality control, and participation in proficiency testing programs. The document also describes pre-analytic, analytic, and post-analytic factors that can affect test results and outlines standard operating procedures to ensure quality at each stage of testing. Maintaining reliable test results requires strict control of all variables from specimen collection through analysis and reporting.
This document provides an abstract program for the 25th Annual ACVIM Forum held in Seattle, WA from June 6-9, 2007. It lists 99 oral presentations given over the four days, organized by topic area (e.g. oncology, infectious disease, cardiology, etc.). The presentations include research studies on diseases and conditions in small animals, horses, food animals, and topics related to veterinary internal medicine specialties.
This document describes a case study of a Miniature Dachshund that was diagnosed with a ventricular septal defect (VSD) and aortic regurgitation. Echocardiography revealed a defect between the ventricles and a thickened aortic valve prolapsing into the defect. Cardiac catheterization confirmed a supracristal VSD with aortic regurgitation. Despite medication, the dog's left ventricular dimensions worsened over time. The dog ultimately underwent surgery to close the VSD using cardiopulmonary bypass, which improved the condition and controlled further valve deterioration.
This study compared the precision of semi-automated and high-precision QT interval measurement techniques using data from two thorough QT studies that assessed the effects of moxifloxacin on the QTc interval. Both techniques detected the QTc prolongation induced by moxifloxacin with similar accuracy. However, the high-precision technique improved the precision of QTc measurement by 31% in Study I and 15% in Study II as evidenced by the reduction in the standard deviation of the DQTcF values. More precise QTc measurement could lower the likelihood of false positive results and reduce the necessary sample size in thorough QT studies. Pairwise comparisons found close agreement between the techniques with small mean differences and narrow limits of agreement. Therefore,
This study evaluated the effects of hetastarch 670/0.75 administered as a constant rate infusion (CRI) at 1 mL/kg/h and 2 mL/kg/h for 24 hours on platelet function and bleeding in 8 healthy dogs. Platelet closure time was measured at baseline and 6, 12, and 24 hours after initiation of the CRI using a platelet function analyzer. At 1 mL/kg/h, closure time was prolonged at 12 and 24 hours compared to baseline, though remained within the normal reference range. At 2 mL/kg/h, closure time was also prolonged at 12 and 24 hours and exceeded the normal reference range at 24 hours. Despite changes in closure time, no spontaneous bleeding
The document summarizes several laboratory tests and procedures used in hematology, physiology, microbiology, and biochemistry. It describes bleeding time and coagulation time tests to assess platelet function. It also outlines the hematocrit test procedure to measure red blood cell volume percentage, and the blood grouping test to determine blood type based on antigen-antibody reactions. Procedures for blood culture collection and centrifugation to separate blood components are provided. Finally, it explains hemoglobin electrophoresis to measure different hemoglobin molecules and identify potential abnormalities.
This study compared measurements of plasma osmolality (POsm) obtained from capillary puncture blood (CAP) and venous blood (VEN) under conditions of euhydration and dehydration. In Study A, CAP and VEN measurements were similar during euhydration. Eliminating outliers, CAP was on average 1.6 mOsm/kg lower than VEN. In Study B, fluid restriction increased CAP POsm significantly and CAP detected dehydration with 89.1% sensitivity and 0.92 accuracy, validating its ability to track changes in hydration status. The results suggest CAP can serve as an adequate substitute for VEN in non-clinical settings.
In-Vivo Evaluation of Rifampicin Loaded Nanospheres: Biodistribution and Myco...Ratnakaram Venkata Nadh
Rifampicin PLGA nanospheres are
formulated with a specific goal in order to decrease
the dose, adverse effects and to enhance targeted
drug delivery. Rifampicin nanospheres were
prepared and evaluated by emulsion solvent
evaporation method. In vivo bio distribution studies
reveal that there was a long term accumulation of
rifampicin nanospheres in the lungs over other
organs. The increase in Cmax values confirmed that
inhalable PLGA nanospheres are suitable for
targeting and providing sustained release of antitubercular
drugs to lungs. So inhalation is a
selected administration route of Rifampicin PLGA
nanospheres. The in vivo screening of M.
tuberculosis showed good activity as well as its
activity against multidrug-resistant M. tuberculosis
and against M. tuberculosis isolates in a
potentially latent state, makes Rifampicin PLGA
nanospheres as an attractive drug dosage form
for the therapy of tuberculosis. It can be concluded
that there is a significant potential for effective
oral delivery as well as nasal delivery of the
Nanospheres for the treatment of tuberculosis.
This document is a report submitted by a student, Christian Chibuike Uzuh, on their six month industrial work experience at the Agege Local Government Primary Health Centre in Lagos, Nigeria under the Students’ Industrial Work Experience Scheme (SIWES). The report provides a brief history of the health centre, describes the various laboratory tests and procedures performed during the training including oral glucose tolerance tests, packed cell volume tests, blood grouping, and more. The student's training has helped bridge the gap between theoretical classroom learning and practical skills.
ACCULAB Corporation is a manufacturer and supplier of laboratory and medical instruments based in New York. It incorporates 7 companies to offer a wide range of products at different price points to meet customer demands. ACCULAB aims to provide both high quality products and competitive prices with a vision of being a one-stop shop for all laboratory equipment needs through excellent customer service.
This document proposes a policy-based runtime verification framework for hypertension monitoring using electrocardiogram (ECG) sensing. Key aspects include:
1) A decision tree model is implemented using timed ECG features to extract patterns/policies related to hypertension.
2) The extracted ECG policies are formally specified as timed automata to synthesize a runtime verification monitor.
3) The monitor continuously verifies the ECG policies and provides a verdict on whether hypertension is present or not based on ECG events.
The framework aims to provide explainable, non-invasive hypertension monitoring using a formal methods-based approach.
Can the tqt study be replaced b darpo london june 2013 (2)Sasha Latypova
1. Recent initiatives from regulatory agencies and industry groups suggest moving away from routinely requiring thorough QT studies for all new drugs. Alternative approaches using concentration-effect modeling and improved QT measurement precision may allow early QT assessment to replace thorough QT studies in some cases.
2. Achieving the same high level of confidence in excluding small QT effects as thorough QT studies is a key requirement for alternative approaches to be accepted. Demonstrating assay sensitivity without using moxifloxacin as a positive control is also important.
3. Enhanced cardiac safety assessment in early clinical studies, using high-precision QT measurement techniques, concentration-effect modeling, and achieving very high drug concentrations, has the potential to provide data sufficient to replace
This study aimed to develop a thrombelastography (TEG)-guided transfusion algorithm for managing postpartum haemorrhage. Whole blood samples from 57 healthy pregnant women were analyzed using three TEG assays: native, kaolin-activated, and kaolin/tissue factor-activated. Reference values and intervals were established for each assay. Reference values differed between activated and non-activated assays. The developed TEG-guided algorithm preferentially uses activated assays and recommends an initial baseline TEG measurement for comparison during transfusion management of postpartum haemorrhage.
Packed cell volume (PCV), also known as hematocrit, is a measure of the ratio of red blood cells to total blood volume. PCV determination provides important information about anemia and polycythemia. It can also be used as a screening test when a hemoglobin measurement is not available. The microhematocrit method is commonly used for PCV determination and involves filling a capillary tube with blood and centrifuging it to separate components. Quality control measures like running controls and testing in duplicate help ensure reliable PCV results.
Notes on sensitization workshop on recent initiatives.dpmo123
This document summarizes a new initiative in India that provides free laboratory services through public-private partnerships. Under the initiative, over 1,100 public health centers, 190 community health centers, 30 area hospitals and 8 district hospitals will offer free diagnostic testing. Tests will either be performed on-site by existing lab technicians or outsourced to 80 new labs established by a private provider. The private provider is responsible for establishing and operating the labs, sample transportation, and reporting results back to the public facilities. The initiative aims to reduce out-of-pocket healthcare expenses and improve access to diagnostics for poor populations.
This document provides information about the Tatwadarsha Multispeciality Hospital central laboratory. It details that the laboratory aims to provide quality diagnostic services under one roof through on-site clinical pathology, imaging and ICU facilities. The laboratory contains high-end automated analyzers and is staffed by qualified technicians and pathologists. Specimen collection, transport procedures, test directories, and emergency testing turnaround times are also outlined.
1. The study evaluated two point-of-care ethylene glycol (EG) tests using canine plasma samples containing known concentrations of EG ranging from 0 to 100 mg/dL, as confirmed by gas chromatography (GC).
2. The Kacey EG Test Strips had excellent sensitivity and specificity of 100% for both readers, and good agreement with GC results.
3. The VetSpec EG Qualitative Reagent Test Kit was less sensitive and specific, ranging from 65-95% sensitivity and 40-70% specificity between readers, with less agreement with GC results.
4. Of the two tests evaluated, the Kacey EG Test Strips were more accurate and
kSORTTM is a non-invasive blood test that analyzes gene expression to assess immune risk in kidney transplant patients. The analytical performance of kSORTTM was validated in an independent clinical laboratory. Accuracy was high, with 87% agreement between kSORTTM results and biopsy results. Precision studies showed 15% variability in quantitative scores and 94% consistency in qualitative results over multiple runs. Sensitivity was 100% and specificity was 96% when excluding indeterminate results. Validation demonstrates that kSORTTM is analytically sound for clinical use in monitoring transplant patients.
This document describes a study that used continuous ECG monitoring to assess changes in the QTc interval during standing maneuvers as a potential positive control for detecting QT prolongation in early clinical drug trials. The study found that:
1) All treatment groups showed a significant increase in maximum QTc interval change (QTcF) from baseline upon standing at all time points, meeting regulatory standards for a positive control.
2) The variability in time to maximum QTcF response decreased substantially over repeated standing maneuvers, from a standard error of 6.4 milliseconds initially to 0.7 milliseconds.
3) The results support the use of standing-induced QTcF changes as a method for validating a study's
Real-time and Non-Invasive Detection of Haemoglobin level using CNNIRJET Journal
This document describes a study that aims to detect haemoglobin levels in a non-invasive and real-time manner using convolutional neural networks (CNNs). The researchers collected a dataset of finger images with varying haemoglobin levels from blood donation camps. They trained a CNN model on this dataset to classify haemoglobin levels based on image features. The CNN was tested on additional finger images and able to detect haemoglobin levels in real-time without drawing blood, providing advantages over traditional invasive methods like faster results and no patient discomfort or biohazards. The proposed non-invasive method using deep learning could help diagnose blood-related conditions earlier.
The document discusses quality assurance in haemostasis laboratory testing. It outlines the importance of accuracy and precision in test results. There are three main types of quality assurance: internal quality control, external quality control, and participation in proficiency testing programs. The document also describes pre-analytic, analytic, and post-analytic factors that can affect test results and outlines standard operating procedures to ensure quality at each stage of testing. Maintaining reliable test results requires strict control of all variables from specimen collection through analysis and reporting.
This document provides an abstract program for the 25th Annual ACVIM Forum held in Seattle, WA from June 6-9, 2007. It lists 99 oral presentations given over the four days, organized by topic area (e.g. oncology, infectious disease, cardiology, etc.). The presentations include research studies on diseases and conditions in small animals, horses, food animals, and topics related to veterinary internal medicine specialties.
This document describes a case study of a Miniature Dachshund that was diagnosed with a ventricular septal defect (VSD) and aortic regurgitation. Echocardiography revealed a defect between the ventricles and a thickened aortic valve prolapsing into the defect. Cardiac catheterization confirmed a supracristal VSD with aortic regurgitation. Despite medication, the dog's left ventricular dimensions worsened over time. The dog ultimately underwent surgery to close the VSD using cardiopulmonary bypass, which improved the condition and controlled further valve deterioration.
Este documento proporciona información sobre anestesia y analgesia en perros y gatos. Explica los fármacos utilizados para premedicación, inducción anestésica y mantenimiento anestésico, así como analgésicos intraoperatorios. Detalla esquemas de dosis comunes para diferentes tipos de procedimientos y pacientes. Los principales fármacos discutidos incluyen opiáceos, benzodiacepinas, agonistas alfa-2, ketamina e isoflurano.
Guia Practica Analgesia y Anestesia.pdfleroleroero1
El documento presenta cuatro casos de protocolos anestésicos y analgésicos para diferentes procedimientos quirúrgicos en caninos y felinos. Divide los casos en categorías según el grado de dolor esperado y propone opciones de premedicación, inducción, mantenimiento y recuperación para cada uno, destacando la importancia de adaptar los protocolos a cada paciente.
buprenorfina y medetomidina en gatos.pdfleroleroero1
This study investigated the effects of using different combinations of medetomidine and buprenorphine as preanesthetic medications in cats undergoing ovariohysterectomy. Forty cats were divided into four groups receiving different doses of medetomidine alone or in combination with buprenorphine. The results showed that cats receiving 30 μg/kg medetomidine with 20 μg/kg buprenorphine required significantly less isoflurane to maintain anesthesia compared to cats receiving medetomidine alone. Heart rate was significantly lower and oxygen saturation was slightly lower in cats receiving the highest dose of medetomidine and buprenorphine. All groups receiving medetomidine and buprenorphine experienced significantly
This document appears to be a collection of page numbers without any accompanying text. It consists of page numbers from 2 through 11 but provides no other context or information to summarize.
complicaciones en toracotmías en ghatos.pdfleroleroero1
Lateral thoracotomy is commonly used to access the thoracic cavity in dogs and cats for surgical treatment of diseases. This study reviewed 83 cases (70 dogs and 13 cats) that underwent lateral thoracotomy. The most common indication was treatment of a vascular anomaly like a patent ductus arteriosus. Overall survival to discharge was high at 87%, though cats had lower survival than dogs. Younger animals and those undergoing vascular procedures like PDA ligation had higher survival than those undergoing lung or esophageal surgery. Post-operative complications within 2 weeks were reported in 47% of cases, but long-term complications in survivors were rare.
1) The document describes a novel axial pattern flap for nasal and facial reconstruction in dogs. The flap is based on the commissure of the lip and receives blood supply from the angularis oris artery and other arteries.
2) Cadaver studies and dye infusion showed the flap has a reliable blood supply from three direct cutaneous arteries. The flap survived with good results in four clinical cases to reconstruct large facial or nasal defects.
3) The flap provides sufficient skin to reconstruct large defects involving the nose or face. It has a reliable blood supply and versatile design that allows it to be used for various reconstruction needs in dogs.
Laboratorios Richmond División Veterinaria es una empresa argentina dedicada al desarrollo y producción de medicamentos y equipamiento veterinario. Cuenta con instalaciones de investigación, desarrollo y producción que cumplen con los estándares GMP. Exporta sus productos a varios países de América Latina, África y Asia, ofreciendo tratamientos para una variedad de especies animales.
This study evaluated the effect of preoperative intrathecal administration of a low dose of morphine on intraoperative fentanyl requirements in dogs undergoing spinal surgery. Eighteen dogs undergoing cervical or thoracolumbar laminectomy were randomly assigned to receive intrathecal morphine (MG group) or no treatment (CG group). The MG group had significantly lower hourly fentanyl consumption and lower predicted plasma fentanyl concentrations compared to the CG group. This suggests that a low dose of preoperative intrathecal morphine has a sparing effect on intraoperative fentanyl requirements in dogs undergoing spinal surgery. No adverse effects were observed from the intrathecal morphine administration.
This study evaluated the effects of postoperative ketamine administration on pain control and feeding behavior in dogs undergoing mastectomy. Twenty-seven dogs undergoing mastectomy were randomly assigned to receive either placebo, low-dose ketamine, or high-dose ketamine intravenously at the end of surgery and as a 6-hour infusion. Pain levels, opioid requirements, sedation, and food intake were evaluated and compared between groups. The high-dose ketamine group showed significantly improved feeding behavior 20 hours after surgery compared to the low-dose and placebo groups, but opioid requirements did not differ significantly between groups.
This study evaluated 59 cats that underwent perineal urethrostomy surgery for feline lower urinary tract disease (FLUTD) at a university veterinary clinic. Early complications within 4 weeks of surgery occurred in 25.4% of cats, most commonly urethral stricture formation. Late complications after at least 4 months included recurring urinary tract infections in 28.2% of cats. Despite frequent complications, 32.2% of cats had no long-term issues, though recurring FLUTD symptoms still occurred in 23% of cats. Overall, the surgery provided a good quality of life for most cats, according to their owners.
This study evaluated the effects of acepromazine (a sedative) on cardiovascular changes induced by dopamine in anesthetized dogs. The researchers found that:
1) Acepromazine prevented the normal return of systemic vascular resistance to baseline levels during higher dopamine doses and reduced the magnitude of arterial pressure increases from dopamine.
2) However, acepromazine did not modify dopamine's ability to increase cardiac index and oxygen delivery, which are beneficial effects.
3) Previous acepromazine administration reduces dopamine's efficacy as a vasopressor agent under isoflurane anesthesia in dogs, but does not alter its other beneficial hemodynamic effects.
recuperación en hipotermia anestesia.pdfleroleroero1
Lower core body temperatures were associated with longer recovery times from general anesthesia in dogs undergoing routine sterilization surgery. Oesophageal temperatures at the end of surgery averaged 36.8°C, with lower temperatures correlated with significantly slower recoveries. Premedication with acepromazine and morphine also significantly increased recovery times compared to dogs that were not premedicated. The choice of induction or maintenance anesthetic agent did not affect recovery time. Hypothermia during general anesthesia can slow recovery through multiple mechanisms, such as decreasing anesthetic requirements and impairing drug metabolism.
This document summarizes a study on the survival characteristics and prognostic variables of dogs with myxomatous mitral valve disease (MMVD), the most common heart disease in dogs. The study included 558 dogs of varying breeds and severity of MMVD. Clinical exams, echocardiograms, and follow-up phone interviews with owners were conducted to evaluate survival times and prognostic factors. Variables found to be associated with reduced survival in univariate analysis included older age, syncope, increased heart rate and dyspnea, higher ISACHC heart failure class, diuretic use, increased end-systolic volume, enlarged left atrium, and higher transmitral flow velocities. Multivariate analysis identified syncope, enlarged left atrium
Este documento presenta información sobre fisiología cardiovascular, respiratoria y del sistema nervioso central. En tres oraciones: 1) Detalla parámetros hemodinámicos como presiones arteriales, índice cardíaco y resistencias vasculares. 2) Explica conceptos como contenido de oxígeno arterial y venoso, transporte de oxígeno y ecuaciones relacionadas a la ventilación. 3) Describe características del flujo sanguíneo cerebral y su regulación, así como parámetros del líquido cefalorraquídeo.
This study evaluated the effects of ephedrine and dopamine on cardiovascular parameters in anesthetized dogs experiencing hypotension. Twelve healthy dogs undergoing orthopedic surgery were randomly assigned to treatment with either ephedrine or dopamine if their mean arterial pressure dropped below 60 mmHg under isoflurane anesthesia. Both drugs improved cardiac output and oxygen delivery, but ephedrine only transiently increased blood pressure while dopamine maintained blood pressure and total peripheral resistance at a higher infusion rate. The study concluded that while both drugs were effective at improving hemodynamics, dopamine provided more sustained blood pressure support.
This document provides guidelines for the recognition, assessment, and treatment of pain in cats and dogs. It discusses the physiology and pathophysiology of pain, as well as methods for assessing acute and chronic pain. Guidelines are provided for managing pain associated with various procedures and conditions through the use of analgesics like opioids, NSAIDs, alpha2 agonists, and local anesthetics. Non-pharmacological approaches like rehabilitation, nutrition, and massage are also addressed. The document aims to help veterinarians effectively recognize and minimize pain in small animal patients.
Este documento describe las bases neuroanatómicas del dolor, incluyendo las vías periféricas y centrales de la transmisión del impulso nociceptivo. También discute el reconocimiento y tratamiento farmacológico del dolor en pequeños animales.
This study compared sevoflurane and isoflurane for maintaining anesthesia in 108 dogs undergoing surgical or diagnostic procedures. Dogs were randomly assigned to receive either sevoflurane (group S) or isoflurane (group I). Both groups had similar heart rates, respiratory rates, blood pressures, temperatures, and times to recovery. However, end-tidal carbon dioxide levels were higher in group S from 30-60 minutes after induction. Sevoflurane required higher vaporizer settings throughout but no adverse events occurred. The study concluded that sevoflurane was a suitable volatile anesthetic for maintaining routine clinical anesthesia in dogs.
Section 79(A) of Maharashtra Societies act 1860ManmohanJindal1
Lot of redevelopment projects are going on, where law and procedures are not followed , causing harm to the members of the society . This PPT is useful for every citizen living in society Building
Parabolic antenna alignment system with Real-Time Angle Position FeedbackStevenPatrick17
Introduction
Parabolic antennas are a crucial component in many communication systems, including satellite communications, radio telescopes, and television broadcasting. Ensuring these antennas are properly aligned is vital for optimal performance and signal strength. A parabolic antenna alignment system, equipped with real-time angle position feedback and fault tracking, is designed to address this need. This document delves into the components, design, and implementation of such a system, highlighting its significance and applications.
Importance of Parabolic Antenna Alignment
The alignment of a parabolic antenna directly affects its performance. Even minor misalignments can lead to significant signal loss, which can degrade the quality of the received signal or cause communication failures. Proper alignment ensures that the antenna's focal point is accurately directed toward the signal source, maximizing the antenna's gain and efficiency. This precision is especially crucial in applications like satellite communications, where the antenna must track geostationary satellites with high accuracy.
Components of a Parabolic Antenna Alignment System
A parabolic antenna alignment system typically includes the following components:
Parabolic Dish: The primary reflector that collects and focuses incoming signals.
Feedhorn and Low Noise Block (LNB): Positioned at the dish's focal point to receive signals.
Stepper or Servo Motors: Adjust the azimuth (horizontal) and elevation (vertical) angles of the antenna.
Microcontroller (e.g., Arduino, Raspberry Pi): Processes sensor data and controls the motors.
Potentiometers: Provide feedback on the antenna's current angle positions.
Fault Detection Sensors: Monitor for potential faults such as cable discontinuities or LNB failures.
Control Software: Runs on the microcontroller, handling real-time processing and decision-making.
Real-Time Angle Position Feedback
Real-time feedback on the antenna's angle position is essential for maintaining precise alignment. This feedback is typically provided by potentiometers or rotary encoders, which continuously monitor the azimuth and elevation angles. The microcontroller reads this data and adjusts the motors accordingly to keep the antenna aligned with the signal source.
Fault Tracking in Antenna Alignment Systems
Fault tracking is vital for the reliability and performance of the antenna system. Common faults include cable discontinuities, LNB malfunctions, and motor failures. Sensors integrated into the system can detect these faults and either notify the user or initiate corrective actions automatically.
Design and Implementation
1. Parabolic Dish and Feedhorn
The parabolic dish is designed to reflect incoming signals to a focal point where the feedhorn and LNB are located. The dish's size and shape depend on the specific application and frequency range.
2. Motors and Position Control
Stepper motors or servo motors are used to control the azimuth and elevation of
We recently hosted the much-anticipated Community Skill Builders Workshop during our June online meeting. This event was a culmination of six months of listening to your feedback and crafting solutions to better support your PMI journey. Here’s a look back at what happened and the exciting developments that emerged from our collaborative efforts.
A Gathering of Minds
We were thrilled to see a diverse group of attendees, including local certified PMI trainers and both new and experienced members eager to contribute their perspectives. The workshop was structured into three dynamic discussion sessions, each led by our dedicated membership advocates.
Key Takeaways and Future Directions
The insights and feedback gathered from these discussions were invaluable. Here are some of the key takeaways and the steps we are taking to address them:
• Enhanced Resource Accessibility: We are working on a new, user-friendly resource page that will make it easier for members to access training materials and real-world application guides.
• Structured Mentorship Program: Plans are underway to launch a mentorship program that will connect members with experienced professionals for guidance and support.
• Increased Networking Opportunities: Expect to see more frequent and varied networking events, both virtual and in-person, to help you build connections and foster a sense of community.
Moving Forward
We are committed to turning your feedback into actionable solutions that enhance your PMI journey. This workshop was just the beginning. By actively participating and sharing your experiences, you have helped shape the future of our Chapter’s offerings.
Thank you to everyone who attended and contributed to the success of the Community Skill Builders Workshop. Your engagement and enthusiasm are what make our Chapter strong and vibrant. Stay tuned for updates on the new initiatives and opportunities to get involved. Together, we are building a community that supports and empowers each other on our PMI journeys.
Stay connected, stay engaged, and let’s continue to grow together!
About PMI Silver Spring Chapter
We are a branch of the Project Management Institute. We offer a platform for project management professionals in Silver Spring, MD, and the DC/Baltimore metro area. Monthly meetings facilitate networking, knowledge sharing, and professional development. For more, visit pmissc.org.
1. Brief Clinical Communication Journal of Veterinary Emergency and Critical Care 24(4) 2014, pp 455–460
doi: 10.1111/vec.12200
Assessment of a portable prothrombin time
analyzer (CoaguChek-XS) in dogs
Efrat Kelmer, DVM, MS, DACVECC; Gilad Segev, DVM, DECVIM; Carolina Codner, DVM;
Yaron Bruchim, DVM, DACVECC; Sigal Klainbart, DVM, DACVECC and
Itamar Aroch, DVM, DECVIM
Abstract
Objectives – To assess the performance of a portable prothrombin time (PT) analyzer (CoaguChek-XS) in dogs.
Animals – Ninety-seven dogs composed of 20 healthy dogs, 45 ill dogs, and 32 ill dogs with altered coagulation.
Procedures – Samples were concurrently obtained and PT was measured using the CoaguChek-XS and an
automated coagulation analyzer. Agreement between methods was assessed using Spearman’s correlation and
Bland–Altman analysis.
Results – The reference interval for PT using the CoaguChek-XS was 9.6–11.5 s. The CoaguChek-XS was easy to
use, required a small volume of whole blood, and gave results within 1 min. The mean difference in PT between
the 2 methods was 2.58 s (SD 3.10), and 94% of the samples fell within limits of agreement. The correlation was
moderate, but significant (r = 0.35, P < 0.001). Sensitivity and specificity of the CoaguCheck-XS PT compared
to analyzer PT were 92% and 56%, respectively, and increased to 95% and 77% on intent to treat basis. The
coefficient of variance was 0.72%.
The CoaguChek-XS identified all 8 dogs with anticoagulant rodenticide intoxication, although a discrepancy
was noted from the analyzer results. In anemic dogs (PCVࣘ25%), the CoaguChek-XS did not display accurate
results.
Conclusions – The CoaguChek-XS is a simple, user-friendly, highly precise PT analyzer. Results had moderate
correlation and good agreement with a standard method. It can be used reliably for screening dogs when the
PT is normal. However, when the CoaguChek-XS PT is prolonged or when the PCV is ࣘ25%, results should be
confirmed using a standard method.
(J Vet Emerg Crit Care 2014; 24(4): 455–460) doi: 10.1111/vec.12200
Keywords: coagulation testing, coagulopathy, point-of-care testing
Introduction
The use of portable, point-of-care (POC) coagulation
analyzers for prothrombin time (PT) and international
normalized ratio (INR) testing has recently gained
popularity in human medicine. These analyzers allow
convenient, simple, at-home monitoring of warfarin
therapy, and improved management of anticoagulation.
Portable analyzers have several advantages over tradi-
tional methods, including ease of use, low maintenance,
From the Department of Small Animal Emergency and Critical Care, the
Hebrew University Veterinary Teaching Hospital, Koret School of Veterinary
Medicine, Rehovot, Israel.
The CoaguChek-XS test strips, and some of the reagents used for ACA-
PT, were provided by DYN Diagnostics LTD, Caesarea, Israel. The authors
declare no other conflict of interests.
Address correspondence and reprint requests to
Dr. Kelmer, Hebrew University Veterinary Teaching Hospital, Koret
School of Veterinary Medicine, PO Box 12, Rehovot 76100, Israel. Email:
kelmere1@gmail.com
Submitted September 21, 2012; Accepted May 25, 2014.
Abbreviations
ACA automated coagulation analyzer
ACA-PT prothrombin time measured by the ACA
CCX-PT Prothrombin time measured by the
CoaguChek-XS
INR international normalized ratio
ISI international sensitivity index
POC point-of-care
PT prothrombin time
RI reference interval
immediate results, and requirement for a small volume
of whole blood for testing.1
Automated coagulation analyzers (ACA) generally
measure PT by adding a mixture of calcium and throm-
boplastin to citrated plasma, and recording the time un-
til a clot has formed.2
Results differ among laboratories
C
Veterinary Emergency and Critical Care Society 2014 455
2. E. Kelmer et al.
Figure 1: The CoaguChek-XS portable PT analyzer. Once the
strip is inserted and internally calibrated, 180 s are allowed to
place a blood drop on the strip (A). The CoaguChek-XS PT ana-
lyzer is shown, displaying a PT of 10.6 s (B).
because of differences in the sensitivity of commercially
available thromboplastins in the particular analyzer and
the clot detection method.2
The international sensitiv-
ity index (ISI) measures the thromboplastin respon-
siveness, compared with a World Health Organization
reference preparation. A lower ISI reflects a more sensi-
tive reagent.3
The PT ratio is calculated by dividing the
patient’s measured PT by the mean PT obtained from
at least 20 normal individuals using the same reagent
and equipment. The INR was instituted by the World
Health Organization in an attempt to standardize PT re-
sults obtained by different laboratories, and is calculated
as the (PT ratio)ISI
.3
The INR is routinely used in human
medicine but not in veterinary medicine.
Several POC coagulation analyzers are commercially
available for use in human medicine, and data regard-
ing their accuracy and precision have been reported.4–10
Such devices are also penetrating the veterinary market,
and 2 POC coagulation analyzers have been evaluated
in dogs.11,12
The CoaguChek-XSa
is a second-generation,
portable, battery-powered, laser photometer, weighing
175 g (batteries included) and fits in a human hand
(Figure 1). It uses a thromboplastin and iron particle-
containing test cartridge, which is inserted into a slot in
the analyzer. A drop of fresh whole blood is placed on
the test area, and is then drawn through capillary force
into a rabbit brain thromboplastin-containing chamber,
where it mixes with the reagent, initiating coagulation. A
pulsating magnetic field is activated, and induces move-
ment of the paramagnetic iron-oxide particles contained
within the cartridge. When the blood sample clots, iron-
oxide particle movement ceases, leading to decreased
laser light reflectance detected by a photosensor. This
time result is recorded as the PT, and is displayed in
seconds and INR units. The analyzer is internally cali-
brated to a mean PT of 12.6 s. The reported CoaguChek-
XS PT (CCX-PT) RI in people is 12–15 s, and thus, the
INR equals PT/12.6. Thromboplastin-specific calibra-
tion information, read by the analyzer, for each lot of
strips, is coded on a lot-specific chip. The thromboplas-
tin reagent’s ISI reported by the manufacturer is 1.01.13
Chronic first generation anti-coagulant (ie, warfarin)
therapy in dogs is uncommon; however, it has been used
for long-term management of dogs who have received
tricuspid and mitral valve replacements.14,15
Anticoagu-
lant rodenticide intoxication is frequently diagnosed in
dogs, and was the 3rd and 2nd most common intoxica-
tion in dogs reported by the US Animal Poison Control,
and the UK Veterinary Poisons Information Service web-
site in year 2010, respectively.16,17
In-house coagulation
tests are often unavailable in private veterinary prac-
tices, and testing by reference laboratories may delay
the reporting of results and is limited by the laboratory
working hours.
The CoaguChek-XS analyzer has been evaluated in
dogs in a recent report.18
The aim of the current
study was to assess the accuracy and precision of the
CoaguChek-XS compared to a routine automated coag-
ulometric method of PT measurement in dogs.
Materials and Methods
Selection of dogs
The study was approved by the Institutional Animal
Care and Use Committee. Control dogs were recruited
from staff-owned dogs or those presented for routine cas-
tration. Staff-owned dogs were determined to be healthy
based on a thorough history and physical examination,
and a normal CBC was recorded for all dogs undergo-
ing castration. The remaining dogs that supplied sam-
ples for the study were clinical patients presented to the
hospital’s emergency service for evaluation of various
medical conditions. Selection of clinical cases was con-
secutive and depended on presence in the clinic of 1 of
the 2 authors qualified to perform the CoaguChek-XS
measurements at the time when blood samples were ob-
tained. Patients were divided into 2 groups based on the
likelihood of the presence of a coagulopathy.
Collection of blood
Whole blood samples were collected by direct venipunc-
ture or from an IV catheter immediately upon inser-
tion. Following the blood draw, 1.8 mL of blood was
placed in a 3.2% 2 mL trisodium-citrate tube,b
while the
remaining blood was immediately used for the CCX-
PT measurement, performed according to the manu-
facturer’s instructions. Samples for PT testing by the
automated coagulation analyzer were centrifuged
456 C
Veterinary Emergency and Critical Care Society 2014, doi: 10.1111/vec.12200
3. Assessment of the CoaguChek-XS PT analyzer
within 15 min from collection (1,500 ×g for 5 min, at
room temperature) and harvested plasma was either an-
alyzed immediately (n = 65), or immediately stored at –
80°C, pending analysis, and performed within 3 months
of collection (n = 32). Collection of all blood samples
and measurement of the CCX-PT were performed by
1 of 2 authors. For the CCX-PT precision assessment,
fresh whole blood samples from 10 healthy dogs were
collected by 3 separate venipunctures within 10 min us-
ing a 25 Ga needle and a 1 mL syringe, and analyzed
immediately.
Routine PT testing
Routine PT was measured at the institutional diagnostic
laboratory using an ACAc
calibrated for canine plasma
(ACA-PT). The laboratory PT reference interval (RI) for
dogs is 6.0–8.5 s. The CCX-PT RI for dogs was based
on 20 healthy dogs whose PT, tested by the ACA, was
within the laboratory’s RI. As the CoaguChek-XS is not
designed to measure shorter than normal PT, results
lower than 9.6 s are displayed as 9.6 s.
Statistical analysis
The distribution pattern of continuous variables was
assessed by the Shapiro–Wilk test. The correlation be-
tween paired PT results, generated by the CoaguChek-
XS and the ACA, was assessed using a Spearman rank
correlation test. Bland–Altman analysis was used to fur-
ther assess the agreement between the 2 PT testing
methods.19
The bias (mean bias, average of the differ-
ences between the 2 measurements) represents the sys-
tematic error between the 2 testing methods, and the
SD of the bias represents the random error, or variabil-
ity, between different testing methods. In the Bland–
Altman plot, points in complete agreement would fall
on the zero axis. For a strong indication of agreement,
roughly 95% of the data points should fall within the 95%
limits of agreement (plus and minus 2 standard devia-
tions from the mean) and should appear random in their
distribution.
To measure CoaguChek-XS precision, the mean and
the SD was calculated of each set of 3 measurements ob-
tained from the healthy dogs. For each of these dogs,
the SD was divided by the mean to calculate the co-
efficient of variation of each sample. Finally, all the
above-calculated coefficients of variation were averaged
to calculate the mean coefficient of variation, which was
used as a measure of precision. Statistical analyses were
performed using a commercial software package.d
For
all tests, a P value 0.05 was considered statistically
significant.
Results
Signalment and diagnoses
The study included 97 dogs of various breeds. Thirty-
nine were male (19 neutered) and 58 were female (27
neutered), with a median age and body weight of 7
years (range 0.25–16) and 24.5 kg (range 4–70), respec-
tively. There were 20 healthy dogs, 45 dogs diagnosed
with various diseases deemed unlikely to affect coag-
ulation, and 32 dogs diagnosed with conditions poten-
tially affecting coagulation. The latter group included
dogs with anticoagulant rodenticide intoxication (8 dogs,
8%), gastric dilatation and volvulus (5 dogs, 5%), sep-
tic peritonitis (4 dogs, 4%), hemoperitoneum secondary
to splenic hemangiosarcoma (4 dogs, 4%), immune-
mediated thrombocytopenia (3 dogs, 3%) and immune-
mediated hemolytic anemia, pyometra with pancreati-
tis, parvovirus enteritis, spinal-cord bleeding, Vipera
palaestinae snakebite, suspected brown recluse enveno-
mation, icterus and disseminated intravascular coagula-
tion (of undetermined cause), and hyperadrenocorticism
(1 each, 1%).
The ACA-PT was below RI in 17 dogs (17.5%), within
RI in 41 dogs (42.3%) and above RI in 39 dogs (40.2%).
Of the dogs with ACA-PT above RI, in 16 (16.5%) the PT
was at least 1.5-fold the upper RI.
CoaguChek-XS performance and PT results
The CoaguChek-XS analyzer required less than 0.05 mL
of whole blood and provided results within 1 min from
application of the blood sample on the strip. The CCX-PT
RI was 9.6–11.5 s. In all dogs in which the ACA PT was
below RI (n = 17), the CCX-PT was within RI. Because the
CoaguChek-XS does not report results below its lower
limit of detection, for the statistical analyses, these results
were considered to have agreement between the 2 PT
measurement methods.
A total of 14/97 (14.5%) samples were excluded from
statistical analyses. In 7 of these, the CoaguChek-XS did
not display the PT in seconds, but displayed only the
calculated INR. All 7 of these dogs were severely anemic
(PCV ࣘ 25%), and 2 of them had markedly prolonged
ACA-PT due to anticoagulant rodenticide intoxication.
Based on the information provided by the manufacturer,
the CoaguChek-XS is inaccurate in PCV ranges of 25%
or 55%. In 4 additional dogs with anticoagulant roden-
ticide intoxication, both the ACA and the CoaguChek-XS
displayed error messages, indicating PT prolonged be-
yond the test range. In 1 additional dog with splenic
hemangiosarcoma, the CoaguChek-XS reported an “er-
ror 6” message (measurement error), while the ACA re-
ported a mildly prolonged PT (10.4 s). This dog was not
anemic. In the remaining 2 dogs, there was a discrepancy
C
Veterinary Emergency and Critical Care Society 2014, doi: 10.1111/vec.12200 457
4. E. Kelmer et al.
Figure 2: Bland–Altman (B–A) plot for assessment of the agree-
ment between the CoaguChek-XS and the automated coagulo-
metric analyzer PTs in 83 dogs. Ninety-four percent of the results
fell within the limits of agreement. In a B–A plot, points in full
agreement fall on the zero axis. For a strong indication of agree-
ment, roughly 95% of the results should fall within the limits
of agreement (ie, the mean difference ± 2 SD) and should be
distributed randomly.19
between methods, such that the ACA-PT was within RI,
whereas the CCX-PT was markedly prolonged.
The mean difference between the CCX-PT and ACA-
PT was 2.58 s (SD 3.10). The Bland–Altman plot showed
that 78/83 of the samples (94%) fell within limits of agree-
ment (Figure 2). There was a significant, albeit moderate,
overall linear correlation between the 2 PT measurement
methods (r = 0.35, P 0.001). The sensitivity and speci-
ficity for the CCX-PT, using the ACA-PT as the gold
standard, were 92% and 56%, respectively. The mean co-
efficient of variation was 0.72%
For analysis of the results on an intent to treat ba-
sis, we assumed that therapeutic interventions would be
considered if the PT is prolonged to at least 1.5 times the
upper end of the RI. Based on this PT cutoff, in 11/97
dogs (11%), therapeutic intervention, when based on the
CCX-PT, would differ from a decision made based on
ACA-PT. These 11 cases included the 2 dogs (2%) that
were considered outliers as their ACA-PT was within RI,
whereas the CCX-PT was markedly prolonged, 2 dogs
with markedly prolonged CCX-PT that had moderately
prolonged ACA-PT, and 7 dogs (7%) with markedly pro-
longed ACA-PT, but with only moderately prolonged
CCX-PT. Sensitivity and specificity of the CoaguChek-
XS in correctly detecting normal or abnormal PT when
compared to the ACA were 93% and 77%, respectively.
The CCX-PT results of the 8 dogs with anti-coagulant
rodenticide intoxication were all markedly prolonged. In
4 of these, both the CCX-PT and the ACA-PT were not
displayed as numeric values, but rather results above
test range were displayed. In 3 of these latter 4 dogs,
the CoaguChek-XS displayed an error 6 message, in-
dicating a measurement error, and in 1 dog, an error
7 message, referring to inability of the sample to form
a clot. In the 4 remaining dogs, the CoaguChek-XS re-
ported an abnormally prolonged PT; however, there was
a significant discrepancy between these measures and
the ACA PT. In 2 of these dogs, the PCV was 25%.
Discussion
This study assessed the precision of the portable, bed-
side, CoaguChek-XS PT analyzer in dogs. In addition, the
accuracy, as measured by statistical agreement and the
clinical implications of its results compared to standard
ACA PT measurement, was evaluated. The CoaguChek-
XS can be used reliably for PT screening in dogs. If the
CCX-PT is within RI, its expected agreement with a ref-
erence ACA method is 93%, and in 98% of the cases
such result will not lead to an inappropriate therapeutic
decision. However, if a prolonged CoaguCheck-XS PT
result is obtained, the agreement with the ACA method
substantially decreases, and in 9% of the cases, results
might lead to incorrect therapeutic decisions. Therefore,
when a prolonged PT is obtained using the CoaguChek-
XS in dogs, citrated blood samples should be submitted
to a reference laboratory for confirmation of the PT using
standard methods.
The Bland–Altman analysis showed that CCX-PT had
very good agreement with the reference ACA method,
although the Spearman rank correlation coefficient was
suggestive of only a moderate agreement. Nonethe-
less, the correlation between methods provides only one
aspect of the evaluation. A tested method may have
high correlation with the reference method, but it could
also concurrently display a consistent, large error com-
pared to the reference method.19
Although the corre-
lation between CoaguCheck-XS and ACA-PT measure-
ments was only moderate, most PTs were within or
slightly above or below the corresponding values and
in most dogs these differences were deemed clinically
insignificant.
The CoaguChek-XS is designed for home PT monitor-
ing by human patients. As such, it is a portable, easy to
operate, low maintenance analyzer, requiring minimum
quality control, and a very small blood sample volume.
These advantages were also apparent in our study. This
portable PT analyzer may provide a viable, affordable
screening method for coagulopathies characterized by a
prolonged PT (eg, anti-coagulant rodenticide intoxica-
tion) unless the initial PT is substantially prolonged or
the dog is anemic.
A recent study that evaluated the accuracy of the
CoaguChek-XS in 54 dogs (40 healthy dogs and 13
with coagulopathies) showed that the analyzer had ex-
cellent agreement with a reference PT measurement
method.18
As in the current study, the accuracy of the
458 C
Veterinary Emergency and Critical Care Society 2014, doi: 10.1111/vec.12200
5. Assessment of the CoaguChek-XS PT analyzer
CoaguChek-XS decreased in samples in which the refer-
ence method PTs were prolonged, and in hemolyzed or
anemic samples.18
In addition, and similar to the results
reported here, in 4 of 53 samples (7.5%) the CoaguChek-
XS was unable to display the PT results, and displayed
only the calculated INR result. In that report and the
present one, this occurred in samples in which the stan-
dard ACA-PTs were abnormally prolonged or when an-
imals were anemic. According to the manufacturer, the
analyzer reports only an INR result when the sample
is interpreted by the device as a quality control sam-
ple (indicated by a lowercase “c” in the display).18
In
addition, based on the manufacturer’s package insert,
the CoaguChek-XS provides accurate results only when
sample hematocrit is between 25% and 55%. As all the re-
sults that were displayed only as INR in our study were
from dogs with PCV ࣘ25%, we suspect that the analyzer
interpreted these as quality control samples, and only
displayed the results as INR.
To the authors’ knowledge, 2 other POC coagulation
analyzers have been assessed and validated in veteri-
nary medicine, including the SCA-2000 Veterinary Coag-
ulation Analyzere,12
and the Abaxis VSPro Coagulation
Analyzer.f,11
The i-stat ACTg
methodology to measure
activated clotting time has been validated in people,7,10,20
but not in animals. The CoaguChek-XS had a higher sen-
sitivity, but lower specificity compared to the SCA-2000,
and a lower correlation to reference method compared
to the Abaxis (r = 0.35 versus 0.578).11,12
Routine oral anti-coagulant treatment is uncommonly
practiced in dogs, although in certain cases (eg, treat-
ment for aortic thromboembolism21
and following heart
valve replacement surgery14,15
) long-term warfarin ther-
apy may be indicated in dogs. In such instances, home
PT monitoring using the device may be considered. The
CoaguChek-XS can be reliably used for exclusion of anti-
coagulant rodenticide intoxication, because PT is invari-
ably prolonged in such intoxications.22
The use of the
CoaguChek-XS is limited to samples with hematocrits
between 25% and 55%, which may limit its diagnostic
utility in patients who are anemic because of hemorrhage
of unknown origin.
This study has 2 major limitations. First, the blood
collection site and technique might have affected results,
and might have introduced variance. Several different
large veins were used in this study and ideally, collec-
tion of all blood samples should have been made us-
ing the same vessel, preferably the jugular vein. In this
clinical study, ethical limitations for avoiding unneces-
sary venipunctures in client-owned dogs dictated this
decision. Second, the number of dogs in this study was
small, especially the number of dogs with significantly
prolonged PT values (n = 16), thereby limiting the power
of the statistical analyses.
The CoaguChek-XS was simple to operate, required a
very small blood sample volume, provided very quick
results, and had excellent precision. In dogs with PTs
within the RI, the CoaguChek-XS had a small mean dif-
ference, excellent limits of agreement, and significant,
albeit moderate correlation with a standard reference
method. The CoaguChek-XS can be used for PT screen-
ing of patients with hypocoagulable states; however, in
dogs with abnormally prolonged PT and in anemic dogs,
the CoaguChek-XS had difficulty displaying a measur-
able PT. In such cases, reference PT measurement meth-
ods should be employed.
Acknowledgments
The authors thank Ms. Maria Griber and Dr. Tamara
Shapiro of the HUVTH Diagnostic Laboratory for their
technical assistance.
Footnotes
a
CoaguChek-XS, Roche, Mannheim, Germany.
b
Vacuette, Grainer Bio-One, VWR International, Milano,
Italy.
c
ACL 200, Instrumentation Laboratory, Milano, Italy; reagent HemosIL PT-
fibrinogen recombinant 0020005000, ISI – 1.0, Instrumentation Laboratory,
Milano, Italy.
d
SPSS 17.0, SPSS Inc., Chicago, IL.
e
SCA-2000, Synbiotics, San Diego, CA.
f
Abaxis, Arrow International, Raleigh, NC.
g
i-stat, Abbott Laboratories, Abbott Park, IL.
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