Reference intervals (RIs) are critical for accurate clinical decision-making, yet many laboratories rely on manufacturer-provided RIs without local validation. This study assessed the knowledge, attitudes, and practices (KAP) of clinical laboratories in Nepal regarding RI utilization, highlighting challenges and opportunities for standardization in alignment with ISO 15189:2022 accreditation. A nationwide cross-sectional KAP survey was conducted among 56 laboratory professionals. Data were collected via an online questionnaire, covering demographics, RI knowledge, current practices, challenges, and attitudes toward national standardization. Descriptive and inferential statistics (chi-square, Fisher's exact tests) were used for analysis. While 71.4% of respondents correctly defined RIs as the 2.5th-97.5th percentiles, 28.6% held misconceptions. Most laboratories relied on manufacturer-provided RIs (87.5%) or published literature (67.9%). Key challenges to derive one's own RI included method variability and recruiting reference individuals. Accredited labs (ISO 15189) demonstrated better knowledge of RI (93.3% vs. 63.4%, p=0.032) and higher confidence in using current RI (26.7% vs. 7.3%, p=0.047). Strong interest existed in national RI standardization (92.9%) and training (85.7% preferred hands-on workshops). This survey of higher tier clinical laboratories in Nepal reveals that while these laboratories generally understand the importance of reference intervals, significant gaps in practice and standardization remain. The findings highlight an urgent need for inclusive strategies that also address the unique constraints of smaller, widespread laboratories, which perform a large proportion of routine testing in the country. The intense interest in a national program presents an opportunity to improve. Multicenter studies and RI validation integration into accreditation are needed to improve diagnostic accuracy.

Irritable bowel syndrome (IBS) and early ulcerative colitis (UC) share overlapping gastrointestinal symptoms, which may lead to misdiagnosis and delay in appropriate treatment. The patient presenting with abdominal pain and altered bowel habits was initially diagnosed with IBS based on symptoms, physical examination, and past medical history, in the absence of alarm features. However, despite one week of symptomatic treatment, the patient's condition worsened. Further evaluation including complete blood profile, abdominal ultrasonography, colonoscopy, and colonic biopsy was subsequently performed, which confirmed a diagnosis of inflammatory bowel disease consistent with ulcerative colitis. This case highlights the diagnostic pitfalls in differentiating IBS from early UC based solely on clinical presentation. Clinicians should maintain a high index of suspicion and pursue appropriate laboratory and endoscopic investigations when symptoms persist or worsen, to avoid misdiagnosis, treatment delay, and disease progression.

Lead exposure remains a major health concern in the Asia-Pacific, particularly affecting children. Despite its significance, lead toxicity testing is underutilized because of limited awareness, resources, and policy support. On December 16, 2024, the APFCB C-CP (Asia-Pacific Federation for Clinical Biochemistry and Laboratory Medicine -Communication and Publications Committee) conducted Webcast & eLearning Program Webinar themed as "Protecting Health in Asia-Pacific: Laboratory Advances and Lead Exposure Prevention", aimed to address these issues and acknowledge need based solutions. An online survey was conducted during webinar in real time to assess the current lead-testing practices, common exposure sources, testing challenges, and policy changes. A seven-question survey was distributed to webinar participants, covering testing frequency, methodologies, exposure sources, information sources, challenges, and policy needs. A total of 66 professionals attended the session and 22 complete surveys were collected from Nepal, India, Indonesia, Japan, and Australia. Lead testing was infrequent in the region, with 58.6% of the respondents reporting rare or no testing. Weekly testing has been reported in 20.7% of cases. The most commonly used methodology was point-of-care testing via anodic stripping voltammetry (37.5%) followed by electrothermal atomic absorption spectrometry (25%). Occupational exposure (39.1%) was the leading source of lead poisoning, followed by dietary sources (26.1%) and environmental contamination (21.7%). Academic journals (47.5%) were the primary educational resources. Key challenges included low awareness among healthcare providers (43.5%) and resource shortage (39.1%). The most recommended policy change was to increase government support (61.5%). In conclusion, lead testing remains infrequent across many settings, with limited routine implementation and heavy reliance on point-of-care methodologies. Occupational exposure emerged as the predominant source of lead poisoning, underscoring the need for targeted interventions. Strengthening government support is identified as the most critical policy change to enhance lead testing and management efforts.

Kidney diseases disproportionately affect people of African descent, yet current estimated glomerular filtration rate (eGFR) equations lack accuracy in African populations. The widely used the race-adjusted Modification of Diet in Renal Disease (MDRD) equation underestimates GFR in African individuals with kidney disease, while newer race-agnostic equations, such as the 2021 CKD-EPI and European Kidney Function Consortium (EKFC) equations, require further validation in these populations. This study evaluated five creatinine-based eGFR equations in a Ghanaian population to assess their impact on chronic kidney disease (CKD) stratification.The study utilized the MDRD, MDRD without race coefficient (MDRDnr), CKD-EPI 2009 and 2021, and EKFC equations, to compare stratification into GFR stages per KDIGO guidelines using creatinine results from adult patients seen at the University of Ghana Medical Centre (January 2021–December 2023).Among 10,864 creatinine results from 6172 females (56.8%) and 4692 males (43.2%), the MDRDnr yielded the lowest median eGFR (76.4 mL/min/1.73 m2), while MDRD had the highest. The MDRDnr identified the highest prevalence of reduced eGFR (<60 mL/min/1.73 m2) at 19.9%, followed by EKFC (14.8%), 2021 (11%), CKD-EPI 2009 (10.6%), and MDRD (8.8%). Notably, one-third of individuals with reduced eGFR (per EKFC) were under 60 years old. The EKFC equation identified more cases of reduced eGFR than both CKD-EPI equations.The MDRDnr and EKFC equations detected the highest proportion of reduced eGFR. However, the EKFC has been shown in other studies to be more accurate. Further validation and adoption of the EKFC equation are recommended for improved CKD diagnosis in Ghana.

Artificial Intelligence (AI) has transitioned from a technological concept to a foundational component of healthcare innovation. In laboratory medicine, it is no longer a question of whether AI will play a role, but rather how it will be responsibly integrated to amplify clinical value, operational efficiency, and equitable patient care. This article explores the current and future impact of AI across diagnostic workflows, clinical decision-making, personalized prevention strategies, and hospital governance. It also highlights the ethical, legal, and sustainability considerations critical to ensuring AI supports a smarter, fairer, and more sustainable healthcare system.

BackgroundDiabetes is an established risk factor for coronary artery disease (CAD), with substantial evidence linking it to a higher prevalence of multivessel disease and worse cardiovascular outcomes. This study aimed to explore the relationship between lipid profile and diabetes with severity of CAD by evaluating the degree of stenosis as assessed by Gensini Score (GS).MethodsA total of 300 participants were included: 100 CAD patients with diabetes, 100 CAD patients without diabetes, and 100 healthy controls. Serum lipoproteins were quantified using standard colorimetric methods, while HbA1c levels were determined through HPLC. GS was assessed using angiographic data obtained from the catheterization laboratory.ResultsSignificant differences in lipid profile, and HbA1c were observed between diabetic CAD patients, non-diabetic CAD patients, and healthy controls. The GS in patients with CAD was markedly elevated in the diabetic CAD cohort (32.97±22.47) in comparison to the non-diabetic CAD cohort (28.70±20.60). A positive correlation was found between HbA1c (r2=0.061), random blood sugar (r2=0.23), and TG (r2=0.00) with the GS. Conversely, HDL levels (r2= -0.074) exhibited a significant negative correlation with GS.ConclusionOur results suggest that lipoproteins and diabetic indicators have a considerable impact on the severity of CAD. This highlights the need for a more personalized approach in managing diabetes and CAD, incorporating regular monitoring of glucose and lipid levels to evaluate cardiovascular risk.

BackgroundInsulin resistance may occur in various organs, including adipose tissue, which causes increased lipolysis and blood free fatty acids (FFA). Insulin resistance in adipose tissue is commonly assessed using the Adipose Tissue Insulin Resistance (Adipo-IR) index, calculated using fasting insulin and FFA levels. This study aimed to evaluate which obesity index has the best predictive value to determine Adipo-IR.MethodsThis cross-sectional study is conducted on 80 non-diabetic adult subjects. Measurements and assessments of the relationship between obesity indices and Adipo-IR values were performed.ResultsWaist circumference (r = 0.275, p = 0.013), BMI (r = 0.318, p = 0.004), visceral fat (r = 0.334, p = 0.002), and body fat percentage (r = 0.246, p = 0.028) were all significantly correlated with Adipo-IR. The area under the curve (AUC) showed that visceral fat had the most significant predictive value of insulin resistance in adipose tissue compared to BMI, waist circumference, and body fat (AUC = 0.690 vs 0.663 vs 0.620 vs 0.570). Subjects with visceral fat values in the fourth quartile had a 6-fold risk of experiencing insulin resistance in adipose tissue compared to subjects in quartile 1 (OR = 6, p = 0.014, 95% CI 1.324-27.191).ConclusionsThe Adipo-IR index increases with the value of the obesity index. Visceral fat has the highest predictive value in determining the occurrence of adipose tissue insulin resistance.

This study aimed to explore the ethical perspectives of laboratory professionals in Nepal regarding laboratory medicine practices. A survey was conducted among participants at the annual conference of laboratory professionals in Nepal in April 2024, with a total of 32 complete responses collected. The survey consisted of questions categorized into three phases of laboratory practice: pre-examination (4 questions), examination (4 questions), and post-examination (5 questions). Each section addressed specific ethical considerations and practices within these phases, including issues related to sample collection, testing accuracy, result interpretation, and reporting. The responses were analyzed to identify trends, challenges, and areas where ethical standards in laboratory medicine could be improved. The findings highlight the need for greater awareness and training in ethical practices, with particular emphasis on improving consistency and transparency across all phases of laboratory work.

BackgroundPhotometric techniques are the most common methods for measuring serum albumin, where albumin binds with an organic dye to form a complex. These methods are popular due to their simplicity, automation potential, speed, and cost-effectiveness, with bromocresol green (BCG) and bromocresol purple (BCP) being the most frequently used dyes.Case presentationA 2-year-old boy presented with facial swelling, starting around the eyes in the morning and gradually spreading to the face, improving by evening, and accompanied by reduced urine output. He was diagnosed with nephrotic syndrome and treated with a high-calorie, high-protein diet, oral prednisolone, furosemide, and intravenous albumin. Despite treatment, his local laboratory’s serum albumin level remained consistently low. However, tests from a private lab showed levels higher than the state lab. The nephrology team was informed of this discrepancy and chose to rely on the private lab’s results.ConclusionA comparison study between BCP and BCG methods found a good correlation overall, but Bland-Altman analysis revealed that BCG had a significant positive bias compared to BCP, explaining the lab discrepancies. The study underscored the importance of clinician awareness of different serum albumin measurement methods, noting that BCP is more specific and does not overestimate albumin in kidney disease patients like BCG does.