Rebuilding Iraqi Laboratories
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Transcript of Rebuilding Iraqi Laboratories
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Rebuilding Iraqi Laboratories
By: Capt Tracy Harrelson
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Re-Establishing Iraqi relationships Part II Main Focus:Partnered with Iraqi Task Force and MEDCOMDeveloped Lab testing initiative proposal to be
submitted to Iraqi Ministry of Health.Wrote and translated three lab OIs and
submitted design for wall chart for Iraqi Lab techs.
Submitted EXSUM to 332nd EMDG to partner with the training and establishing of Iraqi Lab tech training.
Iraqi Physician, Nurses and Lab tech monthly CME
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Epithelial Cells: Cells lining the renal area that are deposited into the urine. Little diagnostic significance
Epithelial Cells Renal Tubular Transitional Squamous RBCs RBCs/WBCs WBCs
Bacteria (Cocci) Bacteria (Rods) Yeast (Candida) Starch (Artifact)
URINE SEDIMENT
CrystalsUric Acid Calcium Oxalate Triple Phosphate Ammonium Biurate
Renal : Larger then WBC’s
Transitional :Pear shaped
Hyaline Fine Granular Coarse Granular RBC WBC Waxy
Squamous: Can indicate improper collection.
RBC’s Large number of RBCs in urine can be due to infection, trauma, tumors or kidney stones. 1-2 RBC’s/hpf is considered normal.
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Bacteria: Can be contamination or presence of a UTI.
Cocci:
WBC’s: Presence of greater than 1 WBC /hpf in males and 5 WBC’s/hpf in females and children suggest infection.
Rods:
Yeast: Vary in size and shape. Can be contaminatate ( from skin or vaginal tract) or a UTI
Starch granules: Can be contaminate from gloves or baby powder.
Y
Uric acid crystal: Found in acidic urine. No clinical significance
Calcium oxalate: Envelope shaped appearance
Triple phosphate: Coffin lid appearance.
Ammonium Biurate crystal:yellow-brown color with spicules.
Granular cast: Rough/granular appearance. Hyaline cast:Normal urine sediment may contain 1-2 hyaline cast per low powered field
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RBC cast: Kidney injury. Granular with hemoglobin from lysed RBCs
WBC cast:Presence suggests urinary tract infection.
Waxy Cast:Smooth. The ends are squared. Found in chronic renal disease. Fine granular: May
appear grey or pale yellow in color
Coarse granular: Often appear black
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فايوليت الكرستال نسكبونترك المسحة على
واحدة دقيقة لمدة الساليد
اللون مزيل نسكب ثملمدة الساليد ثواني 5على
على اليود نسكب بعدها ) ونتركها) الساليد المسحة
واحدة دقيقة لمدة
بالماء الساليد نغسل بعدها
ثانبة. الساليد نغسل بعدهابالماء
يجف حتى جانبا الساليد نضع
بالماء الساليد نغسل بعها
1 32
54
7
6
) ( سافرانين ال نسكب ذلك بعدلمدة ونتركه الساليد على
واحدة دقيقة
6
بالماء الساليد نغسل بعدها
68 9
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IQATF EXSUMPropose a user friendly diagnostic testing for
integration into Iraqi clinics. Emphasize to the Iraqi physicians a negative
result is as important as a positive result.Importance of surveillance Decrease the incidence of unnecessary
treatment and encourage more people to see the doctors rather the local pharmacies.
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Gram Negative Bacilli*
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APPENDIX I
Reference Texts and Charts Fundamentals of Urine
1Tiezt Fundmental Lab (reference book) 1Bialy’s & Scott Diagnostic Microbiology
1 Lab Test Handbook 1Micro chart I 1Micro chart II 1Para chart I
1Para chart II 1Hemato chartQuery Baghdad General Hospital - their reference material? What are Gold Standard Iraqi references & Other Arabic texts? Iraqi university microbiology texts; Annals of Saudi Medicine texts
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APPENDIX III Name of Test # Manufacturer HCG Qualitative* 50 QuickVue Cardiac Enzymes - CK-MB, Troponin 20 Nanogen Flu A/B 50 Binax Rapid Strep 50 Quidel H. Pylori QuickVue Tiphidot 200 TyphiDot Parsite Panel - Giardia, E. histolitica, C. parvum 200 BIOSITE Hepatitis Panel - HBV/HCV 200 Oraquick HIV1&2 ( HBV/HIV/HCV by Medmira vs. HIV alone) OraQuick CHEM8+ 30 Abbott(i-STAT) Urinalysis dip-sticks 500
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Lab Supply Items
Gloves 2000
Urine collection cups 1000 Sharps container, 5 qt 10 Bag/red biohazard 200 Sani Cloth wipe, 100 container 2000 Purell hand sanitizer 20
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Iraqi Lab trainingCultural issues experienced in December.Requested permission for 332nd Lab to
present an hour “show and tell” to the Iraqi Physician CME on 12 Feb.
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Iraqi Physician CME 12 Feb
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SSgt Castenda demonstrating i-STAT
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Members of Iraqi Physician CME:Capt Harrelson, MSgt VanDeGutche, SSGt Luna, SSgt Castenada, SrA Chattin, Spc Lysendrou, Mr. Guy Clark, Iraqi Task Force Advisor
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AFTER ACTION REPORTIraqi Physicians Continuing Medical Education –
Intensive Care Purpose: To improve the medical knowledge and standards of intensive care management
The afternoon was session was set for skills training and the main focus of the class was on the lab
Trainees:Medical College: Dr. Haqqi Ismael (General
Medicine) Yethrib Clinic: Dr. Salah Mahdi Ahmad Ibn Firnas Clinic: Mr. Faez (Nurse
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PHYSICIANS EVALUATIONS What did you like about the conference today? - The lab tests hands-on section - Very good - Conclusive, nice 2. What would you like to see changed about the
conferences? How can we improve? - None - Lectures were informative 3. Would you plan to attend another conference again next
month? - Yes 5. Would you recommend this conference to others? - Yes 6. What topic(s) would you like to discuss in future
conferences? - Multiple subjects - Infective (parasites/helminthic) dz - Mineral & vitamin deficiencies - Adult & pediatric anemia
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Positive Results: Mr. Faez, Ibn Firnaz Nurse Administrator requested all of his lab techs attend the Nurse CME and
spend time working with JBB lab techs
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FEBRUARY 17, 2010
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i-STAT Training
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SrA Chattin teaches rapid Malaria detection
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Sgt Totton demonstrates rapid HIV testing to Dr. Emann & Iraqi Techs
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Ibn Firnaz Lab techs Inaugural lab CME.
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FEEDBACKTechs expressed interest in monthly CMELearn more about anemiaParasitologyMicrobiologyChemistry
JBB established a monthly CME for Iraqi Lab techs
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Spc Sudduth demonstrates rapid HIV testing to Iraqi Nurses
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JBB’s progress in improving Iraqi Medicine
Established monthly Iraqi Physician CMEIraqi Nurse CMEIraqi Lab tech CMEIraqi Kids DayIraqi Training Facility
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Iraqi Training Facility
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Iraqi Training Facility
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Iraqi Kids Day
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Iraqi Girls Health Day
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Teaching proper teeth brushing
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Demonstrating Stop, Drop & Roll
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Iraqi Medical FutureContinuing work with Iraqi Task Force Advisor
and MEDCOM in order to gain approval and funding for lab diagnostic from Iraqi Ministry of Health
Submitting proposals to US government agencies for improving Iraqi lab and Diagnostic conditions
Partnering with Various civilian agencies to gain permission for lab testing trials
JBB continues to train/teach Iraqi medical community
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Special thanks to Lt Col Fox for continuing the Iraqi Lab program