IMPROVING DIAGNOSTIC MICROBIOLOGY
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Dr. Rao discusses the issues with diagnostic microbiology in developing countries. He notes that many medical colleges are producing underqualified microbiologists, bringing the profession into disrepute. Misdiagnoses are common due to a lack of regulatory controls over diagnostic tests, which are often sold and used without evidence of effectiveness. This leads to failure to treat serious infections or unnecessary expensive treatments. Good quality diagnostic tests with accurate results are important for reducing the burden of infectious diseases. However, many laboratories compromise quality for cost, using tests without proper regulatory approval, leading to false positive and negative results. National regulatory processes are needed to ensure the safety and effectiveness of diagnostic kits.
IMPROVING DIAGNOSTIC MICROBIOLOGY
- 1. Dr.T.V.Rao MD IMPROVING DIAGNOSTIC MICROBIOLOGY If you are sincere to your profession and have a passion for learning, we cannot improve unless we think how much we are committed to the laboratory work we cannot improve the services, Many join Medical Microbiology including MD’s as a subject without much responsibility and many say it is technicians responsibility and the qualified report the matters without much basics. With emerging mushrooming of Medical colleges it is nice to have a degree MD which has brought bad reputation to the profession, it is not just the individuals many private managements neglect due to lack of awareness, Today many do not join MD Microbiology with shrinking opportunities for faculty placements it is certain ill qualified people will handle the profession bring more dangers in lacking effective treatments to infected patients. However one should not forget accurate diagnostic tests have a key role in patient management and the control of most infectious diseases. Unfortunately, in many developing countries, clinical care is often critically compromised by the lack of regulatory controls on the quality of these tests. As a result, diagnostic tests are sold and used in much of the developing world without evidence of effectiveness. Misdiagnoses leading to failure to treat a serious infection or wasting expensive treatment on people who are not infected remains a serious obstacle to health. Do not forget Infection kills faster than Cancer. Why need efficient Microbiology laboratories The lack of access to good quality diagnostic tests for infectious diseases contributes to the enormous burden of ill health in the developing world, where infectious diseases are the major causes of death and account for more than half of all deaths in children. Each year, more than 2 million people die of malaria, approximately 4 million of acute respiratory infections and almost 3 million of enteric infections. HIV and tuberculosis together are estimated to kill some 5.8 million people each year More than 95% of these deaths are in developing countries. Early diagnosis and treatment not only reduces the risk of the patient developing long-term complications but for diseases such as tuberculosis, sexually transmitted infections (STIs) and HIV, prompt treatment also reduces further transmission of the disease to other members of the community. We have no proper regulatory authority to control the matters, Good quality diagnostic tests that are fit for purpose and provide accurate results are therefore of paramount importance in reducing the burden of infectious diseases . The choice of which diagnostic test to use depends on which tests have been approved for use by regulatory authorities in a particular country, Many laboratories runs on compromise for economy, rate contract in many public institutes a grave threat to patients influence in cheaper practices to save the money and bring many false positive and negative tests in turn brining a bad medical care, Many people approach us for selling many things, however the young generation of Medical microbiologists should know about the value of sensitivity specificity and predictive value of the test. The practicing microbiologist should be familiar with how is test is performing when we evaluate the specimen Test sensitivity and specificity, and the positive and negative predictive values of a test, are important considerations. *High sensitivity is important for a screening test for diseases such as syphilis where a missed diagnosis has serious consequences. Poor specificity might matter less if over-treatment rarely results in adverse side effects, as in the treatment for syphilis, but might be a serious disadvantage in cases of HCV, HBV Dengue HIV screening tests done with just with DOT methods. In India there is real danger grave threat from many substandard rapid method kits sold many offer a good kickbacks for people ordering the kits will be tempted , In India we have no regulatory
- 2. authority to check all the vagaries. To best of knowledge my knowledge law rarely punishes the culprits who are selling the substandard materials National regulatory processes should provide safeguards for the safety and effectiveness laboratory kits used in a country. The tightening of governmental regulatory requirements for drugs in developing countries has done much to improve the standardization and quality of drug trials, in which efficacy and adverse effects are assessed and compared. Unfortunately, regulatory standards are often lacking for diagnostic tests, especially those targeting diseases that are uncommon in industrialized countries. As a result, diagnostic tests are often sold in the developing world without any formal evaluation of their performance and effectiveness. An exception to this is tests used for blood banking, for which rigorous international standards exist. The main problems remain when we screen asymptomatic patients with or without purpose are counterproductive, however it is inappropriate purpose. Diagnostic trials should be designed and conducted for a specific purpose to yield meaningful results. The clinician’s should realize that the Laboratories are not places for fishing for diagnosis it only can support if they are wise in paying clinical attention AND making a provisional diagnosis, Improving Medical Microbiology is a great concern to medical establishments HOWEVER TODAY THE PATIENTS PAYS THE PRICE AND BECOME VICTIMS IN THE SYSTEM OF OUR MEDICAL CARE. TODAY MANY PATIENTS KNOW WHY MANY DIAGNOSTIC TESTS ARE WRITTEN MAY BE FOR INADEQUATE KNOWLEDGE IN CLINICAL ASSESSMENT , KICKBACKS, CONFLICTS OF INTERESTS AND NEXUS BETWEEN THE LABORATORY AND TREATING PHYSICIAN, Ref *The Article is adopted from A guide for diagnostic evaluations Rosanna W. Peelingetal Nature reviews Medical microbiology I wish all the new generation of Microbiologists to read the* Article, Dr.T.V.Rao MD Professor of Microbiology Freelance writer