Menka Kapil - Academia.edu (original) (raw)

Papers by Menka Kapil

Japanese Journal of Gastroenterology Research

Cystic tumours of pancreas with malignant potential are very rare including serous cystic tumour,... more Cystic tumours of pancreas with malignant potential are very rare including serous cystic tumour, although mucinous cystic neoplasms of pancreas possess more frequent ability to transmute into mucinous cystadenocarcinoma. Neuroendocrine Tumors (NETs) are rare tumors comprising approximately 2% of all malignancies. The most common sites are gastrointestinal tract and the lung. Most of these tumors are well-differentiated and have an indolent course therefore an incidental finding.

Hospice & Palliative Medicine International Journal

Palliative care is a health care that involve physical, emotional, mental , behavioral care to pe... more Palliative care is a health care that involve physical, emotional, mental , behavioral care to persons with debilitating illness from diagnosis till death .Obstacles of growth of palliative care in India has various factors as population density, poverty, geographical and cultural diversity, workforce scarcity at base level, limited national palliative care policy and lack of institutional interest in palliative care. For developing country like India continual efforts are needed to overcome these barriers for successful implementation of palliative care ,as now is the need of the hour.

Medical journal of clinical trials & case studies, 2020

Cerebrospinal fluid is an emergency test which requires stringent monitoring from sample collecti... more Cerebrospinal fluid is an emergency test which requires stringent monitoring from sample collection, transport, acceptance and release of report. These all must be in time framework .Our audit was regarding the turn around time of cerebrospinal fluid and found that TAT for CSF testing was actually falsely high due post analytical errors. Our study provides glaring evidence that can be used as a basis for making relevant changes in establishing laboratory TAT.

International Clinical Pathology Journal, Dec 2, 2018

Quality is simply defined as doing right things for the right people, at the right time and doing... more Quality is simply defined as doing right things for the right people, at the right time and doing them right Quality is simply for the first time. It is a process which involves patient centered care, safety, effectiveness and efficacy. Achievement and maintainance of quality needs stringent control in clinical laboratory. Lack of quality is a burden to the society that can be measured in lost lives and wasted resources. So the quality measures are urgent attention. For improvement in quality six sigma principle has to be applied in clinical laboratory. Although the cost increases a little bit but the money spent on implementation of six sigma are eventually realized by eliminating rework, reducing errors and increasing patient volume.

Annals of Advance Medical Sciecnes, 2018

The total testing process is divided into preanalytical, analytical and post analytical phase, wi... more The total testing process is divided into preanalytical, analytical and post analytical phase, with most of the errors has been suggested to occur in pre analytical phase. Pre analytical phase is the seismic zone in terms of errors as this phase has processes that are generally held outside the clinical laboratory and not under the control of the laboratory management. Therefore, active monitoring and control of all possible defects that are caused by non-laboratory personnel is essential for incorporating actions outside the laboratory in the laboratory quality assurance plan. Measures to reduce preanalytical errors include-continuous education & training, written policies, implementation of standard operating procedures, establishment of quality indicators and communication. It is the involvement of the entire health care team as a single unit that can bring improvement in total testing process and specifically pre analytical phase.

Reference intervals in clinical laboratory are defined as the sets of values use to interpret res... more Reference intervals in clinical laboratory are defined as the sets of values use to interpret results for the patients according to age, sex, and demographic conditions. Approximately 80% medical decisions are based on test results provided by laboratory. A test result by itself has little value unless resorted with appropriate information as reference interval, thus Establishment of Reference interval and its verification process is the need of hour in present scenario although back breaking.

<em>The clinical laboratory plays an increasingly important role in the patient-centered ap... more <em>The clinical laboratory plays an increasingly important role in the patient-centered approach to deliver healthcare services. Physicians rely on accurate laboratory test results for proper disease diagnosis and for guiding therapy; it is estimated that more than 70% of clinical decisions are based on information derived from laboratory test results.</em> <em> The total test process show that the pre-analytical phase accounts for 46% to 68.2% of errors. </em><em>The awareness and knowledge to recognize preanalytical errors is the goal of achieving total laboratory quality is must for patient care. </em>

International Journal of Science and Research (IJSR), 2017

We report a case of spurious elevation of platelet count on three consecutive occasions in a pedi... more We report a case of spurious elevation of platelet count on three consecutive occasions in a pediatric patient on six part Sysmex Hematology auto analyzer. Falsely low platelet counts are frequently reported in literature but falsely elevated Platelet counts are uncommon. The case emphasizes the important role of careful peripheral blood smear examination in case of high platelet counts. The blind folded reliance on 5 part analyzers in hematology should be discouraged so as to provide best patient care.

International Journal of Clinicopathological Correlation, 2017

Pre analytical errors have a major impact on diagnostic accuracy of laboratory results. There hav... more Pre analytical errors have a major impact on diagnostic accuracy of laboratory results. There have been tremendous work and established quality control criteria for analytical phase of testing but there is paucity of standards for pre analytical phase. Recommendations for sample collection, storage, processing and transport have been developed by national and international consensus. There is a dire need for all laboratories to formulate their own quality manual so that day to day pre analytical errors are curtailed. As the errors in pre analytical phase are not inevitable and should be avoided with diligent application of quality control, education dedicated to patient care. We illustrate the ability of laboratory data by case studies to reinforce the importance of vigilance in pre analytical phase of testing.

Annals of Pathology and Laboratory Medicine, 2016

Dear Sir, Postoperative acute endophthalmitis remains a serious and blinding complication even to... more Dear Sir, Postoperative acute endophthalmitis remains a serious and blinding complication even today. Microorganisms which reside in the skin around the eyelids, eyelashes, conjunctiva, or lacrimal sac are the usual source of infection. Staphylococcus epidermidis is the most common organism recovered from patients with cultureproven endophthalmitis. [1] Gram negative species are found in fewer cases. Burkholderia cepacia(previously known as Pseudomonas cepacia) is an opportunistic Gram Negative bacteria non‐fermentative bacilli widely distributed in the environment. Burkholderia cepacia does cause significant infection not only in cystic fibrosis, chronic granulomatous disease, and immunocompromised patients, but also in healthy individuals. [2] Organism able to survive on and in medical devices and disinfectants. Intrinsic resistance to multiple antimicrobials agents also contribute to the organism survival in hospitals. . [3]

Hematology & Transfusion International Journal, 2019

For some parameters the time is very important as they show diurnal variation so laboratory perso... more For some parameters the time is very important as they show diurnal variation so laboratory personnel must be aware of it for giving right values and right diagnosis .For some analytes as cortisol morning and evening levels are different so the laboratory may provide different time related normal ranges. For serum iron levels, as 30% lower in the evening as compared to morning, so the serial collections at similar times of the day will minimize differences related to diurnal variation. Thus all laboratory personnel must be aware of these parameters for giving right values and correct diagnosis which impacts the patient’s life.

Celiac disease is an immune mediated enteropathy triggered by ingestion of gluten containing cere... more Celiac disease is an immune mediated enteropathy triggered by ingestion of gluten containing cereals such as wheat, barley or rye in genetically predisposed individuals. It is also known as celiac sprue or gluten sensitive enteropathy. Affected people may develop intestinal as well as extraintestinal manifestations. Enteropathy associated with symptoms of bloating, chronic diarrhoea, anorexia, weight loss and sequalae of malabsorption while extraintestinal manifestations of disease include iron deficiency anemia, osteoporosis, arthritis, hepatitis, dermatitis herpetiformis or malignancy. The disease is thought to be underdiagnosed, owing to the fact that coeliac disease is often characterized by diarrohea or associated malabsorption conditions. The extraintestinal manifestations are not considered as a part of the disease can misdirect and impede diagnosis.

International Journal of Clinicopathological Correlation, 2017

A 17‐year‐old male patient was referred to our hospital with complaints of fever and a provisiona... more A 17‐year‐old male patient was referred to our hospital with complaints of fever and a provisional diagnosis of thrombocytopenia under evaluation. On our workup of the patient, his blood tests showed Hb – 14.1 g/dL, red blood cell count – 5.30 × 106/uL, white blood cell (WBC) count – 5.33 × 103/uL, and platelet count – 4 × 103/uL. His creatinine was 0.7 mg/dl and serum glutamic pyruvic transaminase was 55 U/L. On examination of peripheral blood smear, numerous clumps of platelets were observed [Figure 1]. This created suspicion of ethylenediaminetetraacetic acid (EDTA)‐induced thrombocytopenia as the cause of low platelet count on automated hematology analyzer in the sample. To confirm the observation, patients’ blood sample was taken in sodium citrate‐containing vial instead of EDTA vial. The sample in sodium citrate showed Hb – 14.1 g/dL, red blood cell count – 5.30 × 106/uL, WBC count – 5.33 × 103/uL, and platelet count – 150 × 103/uL. Examination of peripheral blood smear showed...

International journal of students' research, 2016

We report an uncommon case of simultaneous presence of hemophagocytic lymphohistiocytosis (HLH) w... more We report an uncommon case of simultaneous presence of hemophagocytic lymphohistiocytosis (HLH) with Hodgkin's lymphoma and tuberculosis in an immunocompetent male. In the absence of treatment HLH is frequently associated with fatal outcome, although spontaneous partial regression is also noted. The early diagnosis of HLH is critical to prevent end organ failure. There are defined criteria for diagnosis of HLH but visualization of hemophagocytosis in bone marrow smear or biopsy along with fever, splenomegaly, elevated ferritin & triglycerides and peripheral blood cytopenias are highly suggestive of HLH. The pathologist and clinician should be aware of this uncommon entity so that early diagnosis and institution of therapy can be done to prevent poor prognostic outcome.

Introduction: A strict vegetarian diet has been associated with increased risk of cobalamin defic... more Introduction: A strict vegetarian diet has been associated with increased risk of cobalamin deficiency therefore; one would expect a high prevalence of Cobalamin deficiency in India. Erythrocyte indices have been used in the initial evaluation of anemic patients; high Mean corpuscular volume (MCV) is a traditional criterion for folate and vitamin B12 deficiencies. There is no large study of the prevalence of B12 deficiency among patients with normocytosis or microcytosis. Method: We retrospectively analyzed the records of serum vitamin B12 and MCV of both inpatients and outpatients at Santokba Durlabhji Memorial Hospital & Research Institute, Jaipur (Rajasthan) during the period from August 2010-April 2011. The study was aimed at identifying the correlation between vitamin B12 level and MCV; and prevalence of vitamin B12 deficiency in this region. Result & Conclusion: Every third person is vitamin B12 deficient in the region. There is no correlation between vitamin B12 levels and MC...

International Journal of Clinicopathological Correlation, 2018

Thrombotic thrombocytopenic purpura (TTP) is a life threatening, fulminant disease characterized ... more Thrombotic thrombocytopenic purpura (TTP) is a life threatening, fulminant disease characterized by fever, microangiopathy hemolytic anemia, thrombocytopenia, neurological signs and renal insufficiency. The real culprit is agglutinated platelets and fibrin which form micro thrombi, gets deposited in arterioles and capillaries without eliciting inflammatory response. The idiopathic cases of TTP are characterized by deficiency of ADAMTS-13 (a disintegrin and metalloprotease, with thrombospondin -1 like domains) metalloprotease activity. The use of antiplatelet drugs, the thienopyridine derivatives Clopidogrel & Ticlodipine, is associated with drug induced TTP. The literature studies indicate that most cases of thienopyridine associated TTP involve an antibody to ADAMTS-13 metalloprotease that cause thrombocytopenia and respond to therapeutic plasma exchange (TPE). We report a case of 59 year old male who was on Clopidogrel post coronary angioplasty since past five years. He presented ...

QAI Journal for Healthcare Quality and Patient Safety, 2019

The increasingly dominant role of laboratory medicine in clinical decision-making and the simulta... more The increasingly dominant role of laboratory medicine in clinical decision-making and the simultaneous pressure on cost containment have led to careful evaluation and identification of preventable causes of errors in total testing process of laboratory analyte. The patient-centric health-care delivery system mandates the need to formulate policies and procedures based on international guidelines to minimize errors of laboratory professionals or nonlaboratory operators. The paper summarizes various areas of laboratory that are prone to errors so that the laboratory can redesign the system and make it resistant to errors unknowingly committed by health-care professionals.

Japanese Journal of Gastroenterology Research

Cystic tumours of pancreas with malignant potential are very rare including serous cystic tumour,... more Cystic tumours of pancreas with malignant potential are very rare including serous cystic tumour, although mucinous cystic neoplasms of pancreas possess more frequent ability to transmute into mucinous cystadenocarcinoma. Neuroendocrine Tumors (NETs) are rare tumors comprising approximately 2% of all malignancies. The most common sites are gastrointestinal tract and the lung. Most of these tumors are well-differentiated and have an indolent course therefore an incidental finding.

Hospice & Palliative Medicine International Journal

Palliative care is a health care that involve physical, emotional, mental , behavioral care to pe... more Palliative care is a health care that involve physical, emotional, mental , behavioral care to persons with debilitating illness from diagnosis till death .Obstacles of growth of palliative care in India has various factors as population density, poverty, geographical and cultural diversity, workforce scarcity at base level, limited national palliative care policy and lack of institutional interest in palliative care. For developing country like India continual efforts are needed to overcome these barriers for successful implementation of palliative care ,as now is the need of the hour.

Medical journal of clinical trials & case studies, 2020

Cerebrospinal fluid is an emergency test which requires stringent monitoring from sample collecti... more Cerebrospinal fluid is an emergency test which requires stringent monitoring from sample collection, transport, acceptance and release of report. These all must be in time framework .Our audit was regarding the turn around time of cerebrospinal fluid and found that TAT for CSF testing was actually falsely high due post analytical errors. Our study provides glaring evidence that can be used as a basis for making relevant changes in establishing laboratory TAT.

International Clinical Pathology Journal, Dec 2, 2018

Quality is simply defined as doing right things for the right people, at the right time and doing... more Quality is simply defined as doing right things for the right people, at the right time and doing them right Quality is simply for the first time. It is a process which involves patient centered care, safety, effectiveness and efficacy. Achievement and maintainance of quality needs stringent control in clinical laboratory. Lack of quality is a burden to the society that can be measured in lost lives and wasted resources. So the quality measures are urgent attention. For improvement in quality six sigma principle has to be applied in clinical laboratory. Although the cost increases a little bit but the money spent on implementation of six sigma are eventually realized by eliminating rework, reducing errors and increasing patient volume.

Annals of Advance Medical Sciecnes, 2018

The total testing process is divided into preanalytical, analytical and post analytical phase, wi... more The total testing process is divided into preanalytical, analytical and post analytical phase, with most of the errors has been suggested to occur in pre analytical phase. Pre analytical phase is the seismic zone in terms of errors as this phase has processes that are generally held outside the clinical laboratory and not under the control of the laboratory management. Therefore, active monitoring and control of all possible defects that are caused by non-laboratory personnel is essential for incorporating actions outside the laboratory in the laboratory quality assurance plan. Measures to reduce preanalytical errors include-continuous education & training, written policies, implementation of standard operating procedures, establishment of quality indicators and communication. It is the involvement of the entire health care team as a single unit that can bring improvement in total testing process and specifically pre analytical phase.

Reference intervals in clinical laboratory are defined as the sets of values use to interpret res... more Reference intervals in clinical laboratory are defined as the sets of values use to interpret results for the patients according to age, sex, and demographic conditions. Approximately 80% medical decisions are based on test results provided by laboratory. A test result by itself has little value unless resorted with appropriate information as reference interval, thus Establishment of Reference interval and its verification process is the need of hour in present scenario although back breaking.

<em>The clinical laboratory plays an increasingly important role in the patient-centered ap... more <em>The clinical laboratory plays an increasingly important role in the patient-centered approach to deliver healthcare services. Physicians rely on accurate laboratory test results for proper disease diagnosis and for guiding therapy; it is estimated that more than 70% of clinical decisions are based on information derived from laboratory test results.</em> <em> The total test process show that the pre-analytical phase accounts for 46% to 68.2% of errors. </em><em>The awareness and knowledge to recognize preanalytical errors is the goal of achieving total laboratory quality is must for patient care. </em>

International Journal of Science and Research (IJSR), 2017

We report a case of spurious elevation of platelet count on three consecutive occasions in a pedi... more We report a case of spurious elevation of platelet count on three consecutive occasions in a pediatric patient on six part Sysmex Hematology auto analyzer. Falsely low platelet counts are frequently reported in literature but falsely elevated Platelet counts are uncommon. The case emphasizes the important role of careful peripheral blood smear examination in case of high platelet counts. The blind folded reliance on 5 part analyzers in hematology should be discouraged so as to provide best patient care.

International Journal of Clinicopathological Correlation, 2017

Pre analytical errors have a major impact on diagnostic accuracy of laboratory results. There hav... more Pre analytical errors have a major impact on diagnostic accuracy of laboratory results. There have been tremendous work and established quality control criteria for analytical phase of testing but there is paucity of standards for pre analytical phase. Recommendations for sample collection, storage, processing and transport have been developed by national and international consensus. There is a dire need for all laboratories to formulate their own quality manual so that day to day pre analytical errors are curtailed. As the errors in pre analytical phase are not inevitable and should be avoided with diligent application of quality control, education dedicated to patient care. We illustrate the ability of laboratory data by case studies to reinforce the importance of vigilance in pre analytical phase of testing.

Annals of Pathology and Laboratory Medicine, 2016

Dear Sir, Postoperative acute endophthalmitis remains a serious and blinding complication even to... more Dear Sir, Postoperative acute endophthalmitis remains a serious and blinding complication even today. Microorganisms which reside in the skin around the eyelids, eyelashes, conjunctiva, or lacrimal sac are the usual source of infection. Staphylococcus epidermidis is the most common organism recovered from patients with cultureproven endophthalmitis. [1] Gram negative species are found in fewer cases. Burkholderia cepacia(previously known as Pseudomonas cepacia) is an opportunistic Gram Negative bacteria non‐fermentative bacilli widely distributed in the environment. Burkholderia cepacia does cause significant infection not only in cystic fibrosis, chronic granulomatous disease, and immunocompromised patients, but also in healthy individuals. [2] Organism able to survive on and in medical devices and disinfectants. Intrinsic resistance to multiple antimicrobials agents also contribute to the organism survival in hospitals. . [3]

Hematology & Transfusion International Journal, 2019

For some parameters the time is very important as they show diurnal variation so laboratory perso... more For some parameters the time is very important as they show diurnal variation so laboratory personnel must be aware of it for giving right values and right diagnosis .For some analytes as cortisol morning and evening levels are different so the laboratory may provide different time related normal ranges. For serum iron levels, as 30% lower in the evening as compared to morning, so the serial collections at similar times of the day will minimize differences related to diurnal variation. Thus all laboratory personnel must be aware of these parameters for giving right values and correct diagnosis which impacts the patient’s life.

Celiac disease is an immune mediated enteropathy triggered by ingestion of gluten containing cere... more Celiac disease is an immune mediated enteropathy triggered by ingestion of gluten containing cereals such as wheat, barley or rye in genetically predisposed individuals. It is also known as celiac sprue or gluten sensitive enteropathy. Affected people may develop intestinal as well as extraintestinal manifestations. Enteropathy associated with symptoms of bloating, chronic diarrhoea, anorexia, weight loss and sequalae of malabsorption while extraintestinal manifestations of disease include iron deficiency anemia, osteoporosis, arthritis, hepatitis, dermatitis herpetiformis or malignancy. The disease is thought to be underdiagnosed, owing to the fact that coeliac disease is often characterized by diarrohea or associated malabsorption conditions. The extraintestinal manifestations are not considered as a part of the disease can misdirect and impede diagnosis.

International Journal of Clinicopathological Correlation, 2017

A 17‐year‐old male patient was referred to our hospital with complaints of fever and a provisiona... more A 17‐year‐old male patient was referred to our hospital with complaints of fever and a provisional diagnosis of thrombocytopenia under evaluation. On our workup of the patient, his blood tests showed Hb – 14.1 g/dL, red blood cell count – 5.30 × 106/uL, white blood cell (WBC) count – 5.33 × 103/uL, and platelet count – 4 × 103/uL. His creatinine was 0.7 mg/dl and serum glutamic pyruvic transaminase was 55 U/L. On examination of peripheral blood smear, numerous clumps of platelets were observed [Figure 1]. This created suspicion of ethylenediaminetetraacetic acid (EDTA)‐induced thrombocytopenia as the cause of low platelet count on automated hematology analyzer in the sample. To confirm the observation, patients’ blood sample was taken in sodium citrate‐containing vial instead of EDTA vial. The sample in sodium citrate showed Hb – 14.1 g/dL, red blood cell count – 5.30 × 106/uL, WBC count – 5.33 × 103/uL, and platelet count – 150 × 103/uL. Examination of peripheral blood smear showed...

International journal of students' research, 2016

We report an uncommon case of simultaneous presence of hemophagocytic lymphohistiocytosis (HLH) w... more We report an uncommon case of simultaneous presence of hemophagocytic lymphohistiocytosis (HLH) with Hodgkin's lymphoma and tuberculosis in an immunocompetent male. In the absence of treatment HLH is frequently associated with fatal outcome, although spontaneous partial regression is also noted. The early diagnosis of HLH is critical to prevent end organ failure. There are defined criteria for diagnosis of HLH but visualization of hemophagocytosis in bone marrow smear or biopsy along with fever, splenomegaly, elevated ferritin & triglycerides and peripheral blood cytopenias are highly suggestive of HLH. The pathologist and clinician should be aware of this uncommon entity so that early diagnosis and institution of therapy can be done to prevent poor prognostic outcome.

Introduction: A strict vegetarian diet has been associated with increased risk of cobalamin defic... more Introduction: A strict vegetarian diet has been associated with increased risk of cobalamin deficiency therefore; one would expect a high prevalence of Cobalamin deficiency in India. Erythrocyte indices have been used in the initial evaluation of anemic patients; high Mean corpuscular volume (MCV) is a traditional criterion for folate and vitamin B12 deficiencies. There is no large study of the prevalence of B12 deficiency among patients with normocytosis or microcytosis. Method: We retrospectively analyzed the records of serum vitamin B12 and MCV of both inpatients and outpatients at Santokba Durlabhji Memorial Hospital & Research Institute, Jaipur (Rajasthan) during the period from August 2010-April 2011. The study was aimed at identifying the correlation between vitamin B12 level and MCV; and prevalence of vitamin B12 deficiency in this region. Result & Conclusion: Every third person is vitamin B12 deficient in the region. There is no correlation between vitamin B12 levels and MC...

International Journal of Clinicopathological Correlation, 2018

Thrombotic thrombocytopenic purpura (TTP) is a life threatening, fulminant disease characterized ... more Thrombotic thrombocytopenic purpura (TTP) is a life threatening, fulminant disease characterized by fever, microangiopathy hemolytic anemia, thrombocytopenia, neurological signs and renal insufficiency. The real culprit is agglutinated platelets and fibrin which form micro thrombi, gets deposited in arterioles and capillaries without eliciting inflammatory response. The idiopathic cases of TTP are characterized by deficiency of ADAMTS-13 (a disintegrin and metalloprotease, with thrombospondin -1 like domains) metalloprotease activity. The use of antiplatelet drugs, the thienopyridine derivatives Clopidogrel & Ticlodipine, is associated with drug induced TTP. The literature studies indicate that most cases of thienopyridine associated TTP involve an antibody to ADAMTS-13 metalloprotease that cause thrombocytopenia and respond to therapeutic plasma exchange (TPE). We report a case of 59 year old male who was on Clopidogrel post coronary angioplasty since past five years. He presented ...

QAI Journal for Healthcare Quality and Patient Safety, 2019

The increasingly dominant role of laboratory medicine in clinical decision-making and the simulta... more The increasingly dominant role of laboratory medicine in clinical decision-making and the simultaneous pressure on cost containment have led to careful evaluation and identification of preventable causes of errors in total testing process of laboratory analyte. The patient-centric health-care delivery system mandates the need to formulate policies and procedures based on international guidelines to minimize errors of laboratory professionals or nonlaboratory operators. The paper summarizes various areas of laboratory that are prone to errors so that the laboratory can redesign the system and make it resistant to errors unknowingly committed by health-care professionals.