Corporate Health Camps

Suburban Diagnostics’ has a proven track record of conducting successful corporate health check-up camps at your facility/premises.

We have a strong Operations team that will visit your site and set up a medical check-up camp at no extra cost.

Camps conducted by us follow statutory norms set by the government bodies (FSSAI, DISH, and DG Shipping.)

Our camps for NGOs and for CSR wings of companies help us to reach out to the underprivileged and marginalized sections of society.

We conduct the Food Handler Test on-site for the hospitality sector and for employees of industrial plants as per DISH norms.

The “WHO” and “HOW” of HBV AND HCV testing: A glimpse of the latest WHO guidelines 2017

“WHO” TO TEST FOR CHRONIC HBV INFECTION?


Testing Approach and Population Recommendations
General Population Testing In settings with a = 2% or =5% HBsAg seroprevalence in the general population, it is recommended that all adults have routine access to and be offered HBsAg serological testing with linkage to prevention, care and treatment services General population testing approaches should make use of existing community/ or health facility based testing opportunities or programmes such as at antenatal clinics, HIV or TB clinics.
Routine Testing in Pregnant Women In settings with a = 2% or =5% HBsAg seroprevalence in the general population, it is recommended c that HBsAg serological testing is routinely offered to all pregnant women in antenatal clinics, with linkage to prevention, care and treatment services. Couples and partners in antenatal care settings should be offered HBV testing services.
Focused Testing in Most Affected Populations In all settings (and regardless of whether delivered through facility/ or community- based testing), it is recommended that HBsAg serological testing and linkage to care and treatment services be offered to the following individuals:

  • • Adults and adolescents from populations most affected by HBV infection (i.e. who are either part of a population with high HBV seroprevalence or who have a history of exposure and/or high-risk behaviours for HBV infection)
  • • Adults, adolescents and children with a clinical suspicion of chronic viral hepatitis
  • • Sexual partners, children and other family members, and close household contacts of those with f HBV infection
  • • Health-care workers: in all settings, it is recommended that HBsAg serological testing be offered and hepatitis B vaccination is given to all health-care workers who have not been vaccinated g previously ( adapted from existing guidance on hepatitis B vaccination)
Blood donors (WHO guidance on screening donated blood for transfusion transmissible infections) In all settings, screening of blood donors should be mandatory with linkage to care, counselling and treatment for those who test positive.

Abbreviations: HBsAg hepatitis B surface antigen, PWID people who inject drugs, MSM men who have sex with men a The GRADE system (Grading of Recommendations, Assessment, Development and Evaluation) was used to categorize the strength of recommendations as strong or conditional (based on consideration of the quality of evidence, balance of benefits and harms, acceptability, resource use and programmatic feasibility) and the quality of evidence as high, moderate, low or very low

A threshold of ≥2% or ≥5% seroprevalence was based on several published thresholds of intermediate or high seroprevalence. The threshold used will depend on other country considerations and epidemiological context

Many countries have chosen to adopt routine testing in all pregnant women, regardless of seroprevalence in the general population, and particularly where seroprevalence ≥2%. g A full vaccination schedule including birth dose should be completed in all infants, in accordance with the WHO position paper on hepatitis B vaccines 2009 d Includes those who are either part of a population with higher seroprevalence (e.g. some mobile/migrant populations from high/intermediate endemic countries, and certain indigenous populations) or who have a history of exposure or high-risk behaviours for HBV infection (e.g. PWID, people in prisons and other closed settings, MSM and sex workers, HIV-infected persons, partners, family members and children of HBV-infected persons)

Features that may indicate underlying chronic HBV infection include clinical evidence of existing liver disease, such as cirrhosis or hepatocellular carcinoma (HCC), or where there is unexplained liver disease, including abnormal liver function tests or liver ultrasound

In all settings, it is recommended that HBsAg serological testing with hepatitis B vaccination of those who are HBsAg negative and not previously vaccinated be offered to all children with parents or siblings diagnosed with HBV infection or with clinical suspicion of hepatitis, through community- or facility-based testing

WHO position paper. Hepatitis B vaccines. Weekly Epidemiological Record. 2009;4 (84):405–20

Screening donated blood for transfusion transmissible infections. Geneva: World Health Organization; 2010

“HOW” TO TEST FOR CHRONIC HBV INFECTION AND MONITOR TREATMENT RESPONSE?


Topic Recommendations
Which Serological Assays to Use? For the diagnosis of chronic HBV infection in adults, adolescents and children (>12 months of b c d age ), a serological assay that meets minimum quality, safety and performance standards (with regard to both analytical and clinical sensitivity and specificity) is recommended to detect hepatitis B surface antigen (HBsAg).

  • • In settings where existing laboratory testing is already available and accessible, laboratory based immunoassays are recommended as the preferred assay format
Serological Testing Strategies
  • • In settings or populations with an HBsAg seroprevalence of ≥0.4%, a single serological assay for detection of HBsAg is recommended, prior to further evaluation for HBV DNA and staging of liver disease
  • • In settings or populations with a low HBsAg seroprevalence of
Detection of HBV DNA: Assessment for treatment (WHO HBV 2015 guidelines )
  • • Directly following a positive HBsAg serological test, the use of quantitative or qualitative nucleic acid testing (NAT) for detection of HBV DNA is recommended as the preferred strategy and to guide who to treat or not treat
Monitoring for HBV Treatment Response and Disease Progression (WHO HBV 2015 Guidelines ) It is recommended that the following be monitored at least annually:

  • • ALT levels (and AST for APRI), HBsAg, HBeAg, & HBV DNA levels (where HBV DNA testing is available)
  • • Non-invasive tests (APRI score or transient elastography) to assess for the presence of cirrhosis in those without cirrhosis at baseline
  • • If on treatment, adherence should be monitored regularly and at each visit More frequent monitoring is recommended:
  • • In persons on treatment or following treatment discontinuation: more frequent on- treatment monitoring (at least every 3 months for the first year) is indicated
  • • In persons with more advanced disease (compensated or decompensated cirrhosisj)
  • • During the first year of treatment to assess treatment response and adherence
  • • Where treatment adherence is a concern;
  • • In HIV-coinfected persons
  • • In persons after discontinuation of treatment
  • • In persons who do not yet meet the criteria for antiviral therapy: i.e. persons who have intermittently abnormal ALT levels or HBV DNA levels that fluctuate between 2000 IU/mL h and 20,000 IU/mL (where HBV DNA testing is available) and in HIV coinfected persons

Abbreviations: ALT alanine aminotransferase, AST aspartate aminotransferase, APRI aspartate-to-platelet ratio index, HBeAg HBV e antigen, HBsAg HBV surface antigen, NAT nucleic acid test, RDT rapid diagnostic test

The GRADE system (Grading of Recommendations, Assessment, Development and Evaluation) was used to categorize the strength of recommendations as strong or conditional (based on consideration of the quality of evidence, balance of benefits and harms, acceptability, resource use and programmatic feasibility) and the quality of evidence as high, moderate, low or very low

 A full vaccination schedule including birth dose should be completed in all infants in accordance with the WHO position paper on Hepatitis B vaccines, 2009. Testing of exposed infants is problematic within the first six months of life as HBsAg and hepatitis B DNA may be inconsistently detectable in infected infants. Exposed infants should be tested for HBsAg between 6 and 12 months of age to screen for evidence of hepatitis B infection. In all age groups, acute HBV infection can be confirmed by the presence of HBsAg and IgM anti-HBc. CHB is diagnosed if there is persistence of HBsAg for six months or more

Laboratory-based immunoassays include enzyme immunoassay (EIA), chemoluminescence immunoassay (CLIA), and electrochemoluminescence assay (ECL)

Assays should meet minimum acceptance criteria of either WHO prequalification of in vitro diagnostics (IVDs) or a stringent regulatory review for IVDs. All IVDs should be used in accordance with manufacturers’ instructions for use and where possible at testing sites enrolled in a national or international external quality assessment scheme e Based on results of predictive modelling of positive predictive values according to different thresholds of seroprevalence in populations to be tested, and assay diagnostic performance

A repeat HBsAg assay after 6 months is also a common approach used to confirm chronicity of HBV infection g For further details, see Chapter 5: Who to treat and who not to treat. Guidelines for the prevention, care and treatment of persons with chronic hepatitis B infection: World Health Organization; 2015

In persons on treatment, monitor for HBsAg loss (although this occurs rarely), and for seroreversion to HBsAg positivity after discontinuation of treatment

Monitoring of HBeAg/anti-HBe mainly applies to those who are initially HBeAg positive. However, those who have already achieved HBeAg seroconversion and are HBeAg negative and anti-HBe positive may serorevert

Decompensated cirrhosis is defined by the development of portal hypertension (ascites, variceal haemorrhage and hepatic encephalopathy), coagulopathy, or liver insufficiency (jaundice). Other clinical features of advanced liver disease/cirrhosis may include: hepatomegaly, splenomegaly, pruritus, fatigue, arthralgia, palmar erythema and oedema

“WHO” TO TEST FOR CHRONIC HCV INFECTION?


Testing Approach and Population Recommendations
Focused Testing in Most Affected Populations In all settings (and regardless of whether delivered through facility/ or community- based testing), b it is recommended that serological testing for HCV antibody (anti- HCV) be offered with linkage to prevention, care and treatment services to the following individuals:

  • • Adults and adolescents from populations most affected by HCV infection (i.e. who are either part of a population with high HCV seroprevalence or who have a history of exposure and/or high-risk behaviours for HCV infection)
  • • Adults, adolescents and children with a clinical suspicion of chronic viral hepatitis
    Note: Periodic re-testing using HCV NAT should be considered for those with an ongoing risk of acquisition or reinfection
General population Testing
  • • In settings with a ≥ 2% or ≥5% HCV antibody seroprevalence in the general population, it is recommended that all adults have access to and be offered HCV serological testing with linkage to prevention, care and treatment services
  • • General population testing approaches should make use of existing community/ or facility-based testing opportunities or programmes such as HIV or TB clinics, drug treatment services and f antenatal clinics
Birth Cohort Testing
  • • This approach may be applied to specific identified birth cohorts of older persons at higher risk of g infection and morbidity within populations that have an overall lower general prevalence

Abbreviations: NAT nucleic acid test, anti-HCV HCV antibody, PWID people who inject drugs, MSM men who have sex with men

The GRADE system (Grading of Recommendations, Assessment, Development and Evaluation) was used to categorize the strength of recommendations as strong or conditional (based on consideration of the quality of evidence, balance of benefits and harms, acceptability, resource use and programmatic feasibility) and the quality of evidence as high, moderate, low or very low

This may include fourth-generation combined antibody/antigen assays c Includes those who are either part of a population with higher seroprevalence (e.g. some mobile/migrant populations from high/intermediate endemic countries, and certain indigenous populations) or who have a history of exposure or high-risk behaviours for HCV infection (e.g. PWID, people in prisons and other closed settings, MSM and sex workers, and HIV-infected persons, children of mothers with chronic HCV infection especially if HIV-coinfected)

Features that may indicate underlying chronic HCV infection include clinical evidence of existing liver disease, such as cirrhosis or hepatocellular carcinoma (HCC), or where there is unexplained liver disease, including abnormal liver function tests or liver ultrasound

A threshold of ≥2% or ≥5% seroprevalence was based on several published thresholds of intermediate and high seroprevalence. The threshold used will depend on other country considerations and epidemiological context Routine testing of pregnant women for HCV infection is currently not recommended

Because of historical exposure to unscreened or inadequately screened blood products and/or poor injection safety

“HOW” TO TEST FOR CHRONIC HCV INFECTION AND MONITOR TREATMENT RESPONSE?


Testing Approach and Population Recommendations
Which serological Assays to Use?
  • • To test for serological evidence of past or present infection in adults, adolescents and children b c (>18 months of age ), an HCV serological assay (antibody or antibody/ antigen) that meets d minimum safety, quality and performance standards (with regard to both analytical and clinical sensitivity and specificity) is recommended
  • • In settings where there is limited access to laboratory infrastructure and testing, and/or in populations where access to rapid testing would facilitate linkage to care and treatment, RDTs are recommended
Serological Testing Strategies
  • • In adults and children older than 18 months, a single serological assay for initial detection of serological evidence of past or present infection is recommended prior to supplementary nucleic acid testing (NAT) for evidence of viremic infection
Detection of Viremic Infection
  • • Directly following a reactive HCV antibody serological test result, the use of quantitative or qualitative NAT for detection of HCV RNA is recommended as the preferred strategy to diagnose viremic infection
Assessment of HCV Treatment Response
  • • Nucleic acid testing for qualitative or quantitative detection of HCV RNA should be used as a test of cure at 12 or 24 weeks (i.e. sustained virological response (SVR12 or SVR24)) after completion of antiviral treatment

Abbreviations: DBS dried blood spot, IVD in vitro diagnostics, NAT nucleic acid test, RDT rapid diagnostic test

The GRADE system (Grading of Recommendations, Assessment, Development and Evaluation) was used to categorize the strength of recommendations as strong or conditional (based on consideration of the quality of evidence, balance of benefits and harms, acceptability, resource use and programmatic feasibility) and the quality of evidence as high, moderate, low or very low

HCV infection can be confirmed in children under 18 months only by virological assays to detect HCV RNA, because transplacental maternal antibodies remain in the child’s bloodstream up until 18 months of age, making test results from serology assays ambiguous  

Laboratory-based immunoassays include enzyme immunoassay (EIA), chemoluminescence immunoassay (CLIA), and electrochemoluminescence assay (ECL) Assays should meet minimum acceptance criteria of either WHO prequalification of IVDs or a stringent regulatory review for IVDs. All IVDs should be used in accordance with manufacturers’ instructions, and where possible at testing sites enrolled in a national or international external quality assessment scheme

Unique Double Multiplex PCR – Diagnosing 5 fevers in 1 test

SETTING A NEW STANDARD WITH HIGH-END INFECTIOUS MOLECULAR TESTS FOR EARLY AND CONFIRMATORY DIAGNOSIS OF SYDROMIC FEVER

Suburban Diagnostics Introduces

A Unique Double Multiplex PCR to Diagnose 5 Syndromic Fevers

Recommended to test:

Within 1-5 days of onset of signs and symptoms

*Analytical sensitivity of PCRs – 100 copies/ µl

Analytical sensitivity of Malaria PCR – 2 parasites/µl

  • The

    5
  • 0
  • 5
  • 0

    Advantage

  • 5

    Sydromic fevers in 1 test

  • 0

    Days delay in treatment initiation

  • 5

    Results in 5 hours*

  • 0

    Incremental cost over serology

We offer,

Test Name Sample Required Cut-off
Double Multiplex PCR: Dengue-Chikungunya RT PCR, Typhoid-Leptospira-Malaria PCR 2 ml serum & 2 ml EDTA – 0 Whole blood at 2-8 °C Daily 10 AM, 3 PM
CLINICAL FINDINGS FROM A RESEARCH STUDY SHOW THAT,

One- third patients of Chikungunya were falsely negative by serological tests (IgM Antibodies) but were found to be positive by RT-PCR.

10% patients were diagnosed with Dengue and Chikungunya co-infection.

Adopt a superior diagnostic approach: ‘Co-test Dengue and Chikungunya by RT-PCR’

We offer,

Test Name Sample Required Cut-off
Dengue-Chikungunya Multiplex RT PCR 2 ml serum at 2-8 °C Daily 10 AM, 3 PM

When unsure about the onset of signs and symptoms within 5 days or beyond

For conclusive diagnosis, we offer:

Comprehensive Fever Panel – A Combination of PCR + IgM + Smear

Test Name Sample Required Cut-off
Comprehensive Fever Panel: (Dengue-Chikungunya RT-PCR, Typhoid-Leptospira-Malaria PCR, Dengue IgM, Chikungunya IgM, Leptospira IgM, MP smear) 2 tubes of 2 ml serum & 2 tubes of 2 ml EDTA 0 Whole blood at 2-8 °C Daily 10 AM, 3 PM

Co-testing for screening of cervical cancer

In INDIA

  • Cervical cancer is the 2nd most common cancer in women aged 15 to 44 years
  • About 122,844 new cervical cancer cases are diagnosed annually
  • • 5% of women in general population harbour HPV-16/18 infection

Therefore for women aged 30 to 65, Leading Health Organisations such as ACOG, ACS2 , ASCP3 & ASCCP4 recommend LBC+HPV together (co-testing) as the preferred approach for cervical cancer screening.

Suburban Diagnostics offers the universally recommended approach of co-testing LBC+HPV with a Difference

PAPSURE (Liquid Based Cytology)

  • Screening test to detect cervical cancer and precancerous conditions
  • Cell enrichment process separates and removes blood, mucus and other cells, reducing the risk of missed diagnosis
  • Faster turnaround time
  • Unsatisfactory rates have decreased from 0.98% in conventional smears to 0.24% in Sure Path Laboratories. (Multicentre large studies by various laboratories)
  • Same sample can be used for HPV test

HPV DNA Detection & Genotype

  • Detect 40 HPV types involved in causing precancerous lesions and cervical cancer
  • Detects all 14 High Risk (HR) types and other Low Risk (LR) types
  • HR types: 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 66 or 68 HPV 16/18 is the most carcinogenic
  • HPV genotype and accounts for 75 – 85% of all cervical cancers
  • Approximately 10 other HR HPV genotypes cause the remaining 15 – 25% of cervical cancers

Test Code Test Name Sample Required
CY005 Liquid Based Cytology (PAPSURE) LBC samples in BD Sure Path vials
PATH007131 HPV Detection (LBC Sample) LBC samples in BD Sure Path vials
PATH007133 HPV Detection (Other Specimen) Cervical/ Vaginal/ Genital swabs/ Tissue in viral transport medium (VTM)/ Paraffin Block
MB007 HPV Detection and Typing (LBC Sample) LBC samples in BD Sure Path vials
PATH007134 HPV Detection and Typing (Other Specimen) Cervical/ Vaginal/ Genital swabs/ Tissue in viral transport medium (VTM)/ Paraffin Block
PR161 Cervical Cancer Screening Panel (LBC + HPV) LBC samples in BD Sure Path vials

Test Range for Monsoon Infections

  • The

    5
  • 0
  • 5
  • 0

    Advantage

  • 5

    Sydromic fevers in 1 test

  • 0

    Days delay in treatment initiation

  • 5

    Results in 5 hours*

  • 0

    Incremental cost over serology


A comprehensive test range to diagnose common fevers
  • DENGUE
    • IgG
    • IgM
    • NS1
    • Real Time PCR
  • CHIKUNGUNYA
    • IgG
    • IgM
    • Real Time PCR
  • MALARIA
    • Malaria Smear
    • Malaria Antigen
    • Real Time PCR
  • LEPTOSPIROSIS
    • IgG
    • IgM
    • Real Time PCR
  • TYPHOID
    • IgM
    • Blood Culture
    • Real Time PCR
Typhoid
  • Blood Culture
    • Blood culture or paired blood culture is accurate and precise and is therefore the gold standard in the diagnosis of typhoid fever
  • Vitek Susceptibility
    • Antimicrobial susceptibility of 16 antibiotics with MIC values
    • Identification based on 64 biochemical values and hence gives better precision and accuracy
Test Name Sample Required Cut-off TAT
Blood Culture & Sensitivity – Paired Adult (Bact Alert/Automated paired blood culture, 1 bottles from each arm) Whole Blood in Blood culture Bottle [Above 12 yrs use Green bottle for aerobic & Orange bottle for anaerobic with minimum 10 ml blood] Sample by 4 PM Interim report 24 hrs, Final Report 6th Day
Urine Culture
  • Urinary isolate is identified and susceptibility is done using Vitek 2 Compact
  • The susceptibility to various groups of antibiotics is deduced using MIC and breakpoint MIC values
  • We use special boric acid (a urinary preservative) containers which maintain the colony count of bacteria and avoid over growth

At Suburban Diagnostics, we retrospectively studied around 25000 samples of urine culture over a period of 3 years. The study concluded the following:

  • 71%

    of patients are females

  • 60 Years

    Majority of the cases confirmed by urine culture belong to this age

  • 93%

    of causative organisms detected by urine culture are Gram negative

  • ALMOST 60%

    of the Gram negative isolates are ESBL producers

Test Name Sample Required Cut-off TAT
Urine Culture & Sensitivity Urine in Boric acid container Sample by 4 PM 48-72 hrs
Hepatitis
  • Serological tests for Hepatitis A and Hepatits E also available
Test Name Sample Required Cut-off TAT
Anti HAV IgM 2 ml serum Sample by 7 PM Same Day
Anti HEV IgM 2 ml serum Sample by 7 PM Same Day

H1N1 and Influenza Testing

Test Name Sample Required Cut-off TAT
H1N1 (Influenza) Screening Throat Swab & Nasal Swab in viral Transport media at 2-8 °C Sample by 9 PM Same Day 6 PM
H1N1 (by RT PCR) Throat Swab & Nasal Swab in viral Transport media at 2-8 °C Sample by 9 PM Same Day 6 PM


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