1} A patient has returned from a 6 month stay in South America as they have developed chronic headaches. The patient also has a productive cough. She is admitted to hospital as there are consolidated...

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1} A patient has returned from a 6 month stay in South America as they have developed chronic headaches. The patient also has a productive cough. She is admitted to hospital as there are consolidated patches in the lung and she has vague neurological symptoms. An astute medical scientist notices some unstained round spaces in the Gram stain and decides to perform a silver stain. The scientist recommends to the infectious disease physician that a test for cryptococcal antigen be performed on CSF. The sputum culture grows Cryptococcus gattii Report Guide: Introduction must cover the conditions of Cryptococcus lung infection and cryptococcal meningitis. At least two illustrations are to be included in the introduction. Method: A description of what tests needs to be performed to both process the clinical samples (sputum and CSF) and then to examine microscopy and culture (this includes identification of cultures and susceptibility testing). Results: This will include at least two illustrations, one a typical microscopic finding and a picture of the agar culture growth. You should describe typical susceptibility findings for this organism. Discussion: This will be a very important section. It should contain numerous citations and should review the literature for typical culture findings from cryptococcosis. Outstanding reports would describe the history of this particular species of cryptococcus. References: A minimum of 10 references would be expected 2} A patient is suffering from keratitis and severe eye pain and is admitted to the Royal Victorian Eye and Ear hospital. On questioning, it is determined that the patient is a contact lens wearer and there is significant opacity in the cornea. A corneal scraping is sent to microbiology with a request for examination for Acanthamoeba spp. Report Guide: Introduction must cover the conditions of keratitis and the proceedure of corneal scraping. At least two illustrations are to be included in the introduction. Method: A description of what tests needs to be performed to both process the clinical samples and then to examine microscopy and culture (this includes identification of cultures and susceptibility testing). Note you need to include descriptions that cover examination for bacteria and amoeba. Results: This will include at least two illustrations, one a typical microscopic finding and a picture of the agar culture growth (both for amoeba). You should describe the susceptibility of this organism and treatment modalities. Discussion: This will be a very important section. It should contain numerous citations and should review the literature for typical culture findings and prognosis from amoebic keratitis. Outstanding reports would include molecular methods of testing. References: A minimum of 10 references would be expected PART ONE Access the following article: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4023033/       (Links to an external site.) doi: 10.4103/2153-3539.129450 Krasowski MD et al Autoverification in a core clinical chemistry laboratory at an academic centre J Pathol Inform 2014; 5:13   1. What does it mean by autoverification in the setting of a clinical laboratory? 2. Summarise the advantages of practising autoverification in the clinical laboratory. 3. Describe the chemistry analysers employed to conduct the autoverification studies in 2013. You should include the (i) instrument layout and (ii) tests performed in your answer. 4. The article states that “The majority of autoverification rules are in Middleware”. Define middleware. 5. (i) Summarise the autoverification rules for the studies. (ii) If the rules were violated, list the actions taken to rectify the problems. 6. What does it mean by delta check? 7. Outline the common reasons that may cause a test panel fails to autoverify. 8. Provide two examples where autoverification were successful in capturing artefactual results. 9. Describe the pitfalls associated with the use of autoverification 10. By introducing the appropriate autoverification rule, the author described that they were able to capture rare interference caused by IgM in the total bilirubin assay. Describe the mechanism of how IgM paraprotein can cause a falsely high total bilirubin result.   PART TWO A 66-year old female presented for routine biochemistry testing (liver function tests). No clinical notes were given, however the referring clinician did telephone the laboratory concerned at the marked variation in the total bilirubin results. The results were as follows: 1. The protein and globulin levels were consistently high across the three episodes. List the possible causes (hypothesis) of elevated protein / globulins. 2. Suggest further biochemical testing to confirm your hypothesis. 3. In a table format, outline all possible causes of raised (i) unconjugated bilirubin and (ii) conjugated bilirubin. 4. Describe the analytical principle for measuring total bilirubin. 5. What are serum indices? 6. Comment on the measurement of analytes that will affected by a high haemolysis index. 7. Is there sufficient evidence to say that this patient is jaundiced? 8. Further information was obtained by the clinician explaining that the patient had been previously diagnosed with Waldenström’s Macroglobulinaemia, producing IgM Type Kappa light chains. Does this explain the discrepancy in the 8-fold increase in bilirubin (166 μmol/L) and icterus index (17)? 9. Which analytical method for total bilirubin would you choose to rectify the discrepancy of bilirubin result in this case – colorimetric assay or enzymatic assay? Provide your rationale. Part 3 1.Compare and contrast the Roche Hitachi Cobas 8000 with another biochemistry analyser. Compare their panel of tests and principles of operation (max 2 pages writing plus tables/figures).