Introduction: Electrolyte imbalance refers to altered electrolyte levels that predominantly affect diabetic patients due to hyperglycemia which rise plasma osmolality and impaired renal function, contributing to a change in electrolyte level. Therefore, this study aimed to assess the prevalence of electrolyte imbalance and its associated factors among diabetic patients and healthy control groups attending the University of Gondar Comprehensive Specialized Hospital. Patients and Methods: A comparative cross-sectional study was conducted on 130 diabetic patients and 130 diabetes-free controls. Sociodemographic, behavioral and clinical data were collected using a structured questionnaire. After measuring anthropometric parameters, 5mL of the blood sample was collected. Electrolytes were measured based on ion-selective electrode methods. Fasting blood glucose, and creatinine were measured by spectrophotometric enzyme hexokinase, and Jaffe reaction methods, respectively. The data was entered into Epi-data version 4.6 and analyzed using STATA version 14. Mann–Whitney U-tests and independent t-tests were used for comparison. Multiple logistic regression analysis was done to determine the factors associated with electrolyte imbalances. P-value < 0.05 was considered statistically significant. Result: The overall prevalence of electrolyte imbalance among diabetic patients and controls were 83.07% and 52.31%, respectively. The mean of Na⁺ and the median level of Mg²⁺ and Ca²⁺ were significantly decreased. However, the mean level of Cl⁻ was significantly increased in diabetic patients as compared to control groups. In multivariable logistic regression: alcohol consumption AOR = 3.34 [1.02– 10.9], no formal education AOR = 5.38 [1.14– 25.4], hyperglycemia AOR = 6.32 [2.04– 19.5], and urbanization AOR = 5.6 [1.44– 22.3] showed significant association with electrolyte imbalance. Conclusion: Diabetic patients have more likely to develop electrolyte imbalance than control groups. Diabetic participants showed significantly reduced Na⁺, Mg²⁺, and Ca²⁺ levels and significantly increasing CI⁻ levels when compared to control groups. Hyperglycemia, alcohol drinking habits, urbanization, and no-formal education were statistically significantly associated with electrolyte imbalance.

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.

Introduction: Hormonal contraceptives are artificial preparations that contain artificial progestins and Ethinylestradiol; these preparations are utilized by women of reproductive age to prevent pregnancy. Roughly a billion women in the world use some form of contraceptive worldwide. Despite the utility of these preparations, they are linked with several adverse effects, including disturbances of liver functionality and integrity. However, previous studies conducted to assess the association between hormonal contraceptive utilization and liver function tests reported conflicting results, and the effects remained a matter of concern. Methods: The study enrolled a total of 264 participants, who were allocated into two groups. One group of hormonal contraceptive users who use the medication for a minimum of six months: Depot medroxyprogesterone acetate (DMPA), combined oral contraceptives (COC), Norplant, and Implant users and another age-matched non-user control group in a ratio of 1:1. A semi-structured questionnaire was used to collect socio-demographic, behavioral, and clinical data. Five ml serum blood sample was collected for liver function test analysis on a Beckman Coulter Clinical Chemistry analyzer (DXC 700 AU). Independent t-test was used to compare liver function tests of hormonal contraceptive users and non-user controls, whereas ANOVA followed by a Bonferroni post hoc test was used for intra- (between classes of contraceptives) and inter-group (between each class of contraceptives and controls) comparisons and to identify factors associated. Results: Hormonal contraceptive users were observed to have a statistically significant higher mean value of liver enzymes assessed compared to non-user control groups: aspartate aminotransferase (AST) (47.07±14.79 versus 25.92±7.37; p <0.001), alanine aminotransferase (ALT) (35.83±13.76 versus 16.56 ± 5.03; p <0.001), alkaline phosphatase (ALP) (63.34±14.74 versus 45.41±14.34, p <0.001) and for γ-glutamyl transferase (GGT) (47.37±24.32 versus 19.45 ± 6.86 p <0.001). Similarly, the mean value of total and direct bilirubin (mg/dL) among HC users showed a statistically significant elevation (0.68 ± 0.22 against 0.32 ± 0.13, p <0.001) for total bilirubin and (0.14 ± 0.06 against 0.06 ± 0.03, p <0.001) for direct bilirubin respectively. However, no statistically significant result was observed in the mean values of total protein and albumin. For total protein (6.7 ± 0.89 versus 6.5 ± 1.15, p 0.07) and for albumin (5.4 ± 0.92 versus 5.3 ± 1.08; p 0.30). The current study also indicates the level of hepatic function test alteration is related to the type of hormonal contraceptives, duration of usage, and level of adherence to a specific class of contraceptives. Conclusion and recommendation: Hormonal contraceptive use was observed to affect hepatic function. Based on this finding, we strongly recommend to closely monitor liver function tests in women using hormonal contraceptives.

Introduction: In clinical laboratory, the performance of the hematology analyzer should be checked routinely to ensure the desired quality. Therefore, the aim of the study was to assess the analytical performance of hematology analyzer using sigma metrics. Methods: The study included all daily internal quality control (IQC) data of hematology analyzer prospectively from August to October 2022. Data was collected using record formats by trained laboratory professionals. The sigma values of each CBC parameter were calculated using the formula: Sigma = (TEa – Bias) / CV. The TEa data were adopted from five different guidelines to calculate sigma value of the laboratory based on different specification. The bias of all complete blood count (CBC) parameters was calculated from the laboratory mean of the daily IQC data and the target value of the manufacturer in the insert kit. A coefficient of variations was also calculated using IQC data. Results: The current study found that sigma value of the analyzer varied based on source of TEa. Except HCT out 5 parameters included based on CLIA guideline, except MCV, MCHC, RDW, MPV and Basophil out of 15 parameters included based on EFLM 2022 minimum guideline, except Hb and PLT out of 9 parameters included based on SOTA guideline other parameters meets minimum specification (< 3 sigma value). On the other hand, all parameters included in Rilibak and Standards of Spanish guideline achieved minimum specification (> 3 sigma value). Conclusion: Sigma values of the CBC parameters have significantly varied depends on the TEa sources. So, it is recommended laboratory to use alternative sigma value based on its preference. Additionally, it is suggested that the laboratory to design local Westgard rules for each parameter based on sigma value.

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.