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Rebuilding Iraqi Laboratories By: Capt Tracy Harrelson

Rebuilding Iraqi Laboratories

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Rebuilding Iraqi Laboratories. By: Capt Tracy Harrelson. Re-Establishing Iraqi relationships Part II Main Focus:. Partnered with Iraqi Task Force and MEDCOM Developed Lab testing initiative proposal to be submitted to Iraqi Ministry of Health. - PowerPoint PPT Presentation

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Page 1: Rebuilding Iraqi Laboratories

Rebuilding Iraqi Laboratories

By: Capt Tracy Harrelson

Page 2: Rebuilding Iraqi Laboratories

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

Page 3: Rebuilding Iraqi Laboratories

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.

-

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

-

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

Page 4: Rebuilding Iraqi Laboratories

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

Page 5: Rebuilding Iraqi Laboratories

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.

Page 6: Rebuilding Iraqi Laboratories

Gram Negative Bacilli*

Page 7: Rebuilding Iraqi Laboratories
Page 8: Rebuilding Iraqi Laboratories

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

Page 9: Rebuilding Iraqi Laboratories

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

Page 10: Rebuilding Iraqi Laboratories

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

Page 11: Rebuilding Iraqi Laboratories

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.

Page 12: Rebuilding Iraqi Laboratories

Iraqi Physician CME 12 Feb

Page 13: Rebuilding Iraqi Laboratories

SSgt Castenda demonstrating i-STAT

Page 14: Rebuilding Iraqi Laboratories

Members of Iraqi Physician CME:Capt Harrelson, MSgt VanDeGutche, SSGt Luna, SSgt Castenada, SrA Chattin, Spc Lysendrou, Mr. Guy Clark, Iraqi Task Force Advisor

Page 15: Rebuilding Iraqi Laboratories

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

Page 16: Rebuilding Iraqi Laboratories

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  

Page 17: Rebuilding Iraqi Laboratories

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

Page 18: Rebuilding Iraqi Laboratories

FEBRUARY 17, 2010

Page 19: Rebuilding Iraqi Laboratories

i-STAT Training

Page 20: Rebuilding Iraqi Laboratories

SrA Chattin teaches rapid Malaria detection

Page 21: Rebuilding Iraqi Laboratories

Sgt Totton demonstrates rapid HIV testing to Dr. Emann & Iraqi Techs

Page 22: Rebuilding Iraqi Laboratories

Ibn Firnaz Lab techs Inaugural lab CME.

Page 23: Rebuilding Iraqi Laboratories

FEEDBACKTechs expressed interest in monthly CMELearn more about anemiaParasitologyMicrobiologyChemistry

JBB established a monthly CME for Iraqi Lab techs

Page 24: Rebuilding Iraqi Laboratories

Spc Sudduth demonstrates rapid HIV testing to Iraqi Nurses

Page 25: Rebuilding Iraqi Laboratories

JBB’s progress in improving Iraqi Medicine

Established monthly Iraqi Physician CMEIraqi Nurse CMEIraqi Lab tech CMEIraqi Kids DayIraqi Training Facility

Page 26: Rebuilding Iraqi Laboratories

Iraqi Training Facility

Page 27: Rebuilding Iraqi Laboratories

Iraqi Training Facility

Page 28: Rebuilding Iraqi Laboratories

Iraqi Kids Day

Page 29: Rebuilding Iraqi Laboratories

Iraqi Girls Health Day

Page 30: Rebuilding Iraqi Laboratories

Teaching proper teeth brushing

Page 31: Rebuilding Iraqi Laboratories

Demonstrating Stop, Drop & Roll

Page 32: Rebuilding Iraqi Laboratories

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

Page 33: Rebuilding Iraqi Laboratories

Special thanks to Lt Col Fox for continuing the Iraqi Lab program