Background: Lean methodology, originally developed in the manufacturing sector, is a process management philosophy focused on maximizing value by eliminating waste. Its application in laboratory settings, particularly concerning laboratory turnaround times (TAT), involves a systematic approach to identifying inefficiencies and optimizing processes to enhance value for end customers. Methods: This systematic review was registered in PROSPERO with identification number (CRD42024552350) and reported based on the 2020 PRISMA checklist. An extensive search strategy was performed using PubMed, Scopus, and Embase databases and gray literatures. Advanced searching was used using Boolean operators (AND & OR). After articles were exported to endnote x8, duplications were removed and articles were selected based on titles, abstracts, and full texts. The illegibility of the articles was independently assessed by the three authors (NC, DMB, and BBT), and the disagreements were settled through scientific consensus. Methodological quality was assessed using JBI critical appraisal checklist. Discussion: In this review, electronic databases search yielded 1261 articles, of which 7 met the inclusion criteria. The review demonstrated, implementation of lean principle into the routine laboratory testing had an overall impact 76.1% on reducing laboratory TAT. Transportation, manual data processing, inefficient workflow, and the heavy workload were identified as the main wasteful procedures. To eliminate these non-value-added steps, several intervention techniques were implemented, including the use of a barcoding system, process redesign, workflow optimization, hiring additional staff, and relocating the sample collection room closer to the result distribution center. Lean implementation is crucial in the medical laboratory industry for optimizing processes, reducing TAT, and ultimately enhancing customer satisfaction. As a result, all clinical laboratories should adopt and implement lean principles in their routine testing processes. The medical laboratory industry should also proactively look for and apply lean tools, provide ongoing training, and foster awareness among laboratory staffs.

External quality assessment is the process of evaluating the performance of a laboratory and the competence of professionals. Participation in EQA and standardizing the quality of laboratory services are a mandatory requirements for accreditation. This review is aimed at identifying and discussing challenges that hinder the effective implementation of an EQA program in countries with resource limited setting. To obtain abundant information, articles were identified by searching the literature publishedin English using the National Library of Medicine, PubMed, Science Direct and AMC digital library databases. The articles identified in the references were manually searched and included. After the article was identified, it was imported to Endnote version 8.1 and exported to Microsoft Word for citation. Based on this review, the major identified challenges that hinder the implementation of an EQA program include the high cost of control materials, malfunction and lack of maintenance for equipment failure and breakdown, a knowledge gap among laboratory professionals, noncommutability of control samples, and difficulty in assigning target values. In addition, failing to participate in EQA and failing to take corrective action are the major challenges identified. As a result, applying to an EQA program in resource-limited counties was highly challenging. To attain high performance in the laboratory and to provide quality laboratory service for patient care, the EQA supplier and the user laboratory must pay attention to these issues and take appropriate corrective actions for ongoing quality improvement and accreditation.

Background: Thyroid neoplasms include a range of lesions, most of which are benign, though some may progress to or present as malignant. Diagnostic tools like FNAB, ultrasound, and hormone analysis are commonly used, though they have limitations. Recently, peripheral blood markers have been explored for their potential in differentiating thyroid lesions, despite controversy evidence. This review evaluates the diagnostic utility of NLR and PLR in thyroid lesions. Methods: We systematically searched all relevant articles on PubMed, Science Direct, Cochrane Library, and gray literature, including Google Scholar, for studies on the diagnostic utility of platelet-to-lymphocyte ratio (PLR) and neutrophil-to-lymphocyte ratio (NLR) in thyroid lesions. Two researchers independently screened articles, and study quality was assessed using the QUADAS 2 tool. A random-effects model calculated pooled sensitivity and specificity, while the area under the HSROC curve summarized diagnostic accuracy. Heterogeneity was evaluated with Higgins’ I² statistic, and publication bias was assessed using the MIDAS command. Subgroup analyses by sample size, gender distribution, cutoff values, and carcinoma types explored sources of heterogeneity. Results: A total of 12 studies were included in the final meta-analysis, with 9 focusing on NLR and 6 on PLR. Most of these studies were retrospective in design. The pooled sensitivity and specificity of NLR were 75% (95% CI: 65–82%) and 62% (95% CI: 42–75%), respectively. For PLR, the overall sensitivity and specificity were 70% (95% CI: 61–78%) and 57% (95% CI: 46–66%), respectively. The diagnostic accuracy, based on the area under the HSROC curve (AUC), was 0.75 (95% CI: 0.71–0.79) for NLR and 0.69 (95% CI: 0.65–0.73) for PLR. These results indicate that NLR has better diagnostic accuracy than PLR in distinguishing between benign and malignant thyroid lesions. Conclusion: While the NLR demonstrates better diagnostic utility than the PLR in distinguishing between benign and malignant thyroid lesions, its standalone diagnostic accuracy remains moderate. Therefore, we recommend using these markers as complementary tools alongside other standard diagnostic modalities until further studies provide more definitive evidence. Thyroid neoplasm is a type of cancer which arises from the thyroid parenchymal cell and affects the thyroid gland. The disease encompasses a variety of lesion, including benign adenomas to malignant carcinomas [1]. The majority of thyroid glands are noncancerous and are mostly benign. In some contexts, thyroid adenomas may transform into carcinomas as the nonfunctional adenomas possess oncogene mutations [2]. Overall, 5% of thyroid nodules are malignant. Notably, approximately 20% of follicular adenomas have the potential to progress into follicular carcinomas [3]. The common thyroid malignancies include, papillary, follicular, medullary and anaplastic types, which varies based on the aggressiveness of the cancer, which are highly variable clinical features; some may be indolent and slow progressing while others may be highly aggressive tumors with a high mortality rate [4,5]. Globally, thyroid cancer cases are increasing over time. Approximately 18.3 million thyroid cases were reported with a high prevalence rate in China and United States [6]. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline was used and performed for this systematic review and meta-analysis. This review was registered on PROSPERO with registration number of CRD42024559798.

Background: Anemia due to living condition disproportionally affects the global refugee children. Nutritional deficiency particularly iron deficiency is the primary causes of anemia. Hence, we conducted a systemic review and meta-analysis on the prevalence of anemia among refugee children. Methods: We searched systematically all relevant studies on the prevalence of anemia among refugee children including under the age of 18 years, which were conducted between 2009 and 2023 in English from PubMed, Embase, Scopus, Cochran library and other gray literatures such as google scholar. Two researchers independently screened articles based on their title and The Joana Brigg’s Institute (JBI) checklist was used to assess the quality of studies. Random effect model was utilized to calculate the pooled estimate of anemia. Higgins I² statistics and Egger’s test were analyzed to check heterogeneity and publication bias, respectively. Subgroup analysis by continent, age group of the children and year of study was employed to identify the source of heterogeneity. Result: A total of 14 studies were included in the final meta-analysis. Most of the studies were from Asian countries followed by African countries. The pooled prevalence of anemia among global refugee children was 36.54 with (95% CI: 23.79, 49.28). There was moderate level of heterogeneity between the studies (I² = 68.91, P<0.001). The highest pooled prevalence of anemia in refugee children was reported in African, it was 56.1%, whereas the lowest pooled prevalence of anemia was in N. America, it was 12.66%. The prevalence of anemia was highest (53.88) in studies done among under-five refugee children. Conclusion: The global prevalence of anemia among refugee children is found to be moderate public health problem. Anemia prevalence is more common in African refugee children. Intervention and prevention for should be focused especially for refugees found in low- and middle-income countries.

Proficiency testing (PT) is an impartial laboratory performance-evaluating system using an independent body. It is a mandatory accreditation requirement and means for improving the laboratory’s performance. The study aimed to evaluate the performance of PT, with a focus on identifying and discussing determinants that influence PT performance at comprehensive specialized hospitals in northwest Ethiopia. A retrospective cross-sectional study was carried out from 2020 to 2022. Using a convenient sampling technique, laboratory tests with recorded PT results in each hospital laboratory were included. A data collection template and customized checklists were used to collect the data. Epi Data Version 3.1 for data entry and STATA Version 14.1 for cleaning and analysis were used. Binary logistic regression analyses were used. Variables with p < 0.05 in the multivariable logistic regression were considered to be statistically significant. Over nine cycles, 3807 PT challenges were distributed. The total failure rate of the laboratories was 32.4%, with a peak failure rate of 40.3% in 2020, after which the failure rate was decline to 20.6% in 2022. Among the five laboratory sections, molecular biology had the lowest failure rate (22.2%), while microbiology had the highest failure rate (56.5%). Multivariate logistic regression revealed that PT results reported without appropriate unit of measurement (AOR 7.5), lack of corrective action for PT nonconformance (AOR 7.1), and reagent unavailability (AOR 6.1) had significant effects on PT performance (p < 0.001). The results of this study showed that the overall performance of the laboratory was lower. Reporting PT results without appropriate units of measurement and not taking corrective action for PT nonconformance were the major aggravating factors for high failure rates.

Objective Vitamin D deficiency during pregnancy is a global health concern, contributing to adverse maternal and fetal outcomes. Despite its importance, limited data exist on vitamin D status and its determinants among pregnant women in Ethiopia. This study aimed to assess the prevalence and determinants of vitamin D deficiency among pregnant women in their first and second trimesters in Gondar Town, Ethiopia, 2024. Design and setting A facility-based cross-sectional study was conducted at the antenatal care unit of University of Gondar Comprehensive Specialized Hospital from January to March 2024. Methods Eligible participants were selected using a simple random sampling technique. Sociodemographic, behavioural and clinical data were collected through structured questionnaires and medical record reviews. Serum levels of vitamin D, calcium and alkaline phosphatase were analysed using the Beckman Coulter clinical chemistry analyser. Statistical comparisons between pregnant women in the first and second trimesters were performed using the independent t-test. Determinants of vitamin D deficiency were identified using multivariate logistic regression analysis. Participants 384 pregnant women in their first or second trimester. Results The prevalence of vitamin D deficiency (<20 ng/mL) was 41.41%, while 84.11% of pregnant women had vitamin D insufficiency (90 mm Hg) (AOR 0.28, 95% CI 0.11 to 0.70), lower dietary diversity (AOR 3.17, 95% CI 1.13 to 8.89), lower fish and fish oil consumption habit (AOR 3.01, 95% CI 1.03 to 8.77; AOR 12.27, 95% CI 1.50 to 100.42) were the key predictors associated with serum vitamin D defiency. Conclusion and recommendation Nearly half of the pregnant women in Gondar Town exhibit vitamin D deficiency, showing a challenging public health concern. Thus, targeted interventions, such as dietary supplementation and lifestyle modifications, are urgently needed to address the problem and improve maternal and neonatal health outcomes.