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Artykuły w czasopismach na temat "Laboratory reagent surveillance"
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Gachogo, Rachael W., Daniel N. Mwai i Frank G. Onyambu. "Cost analysis of implementing HIV drug resistance testing in Kenya: a case study of a service delivery site at a tertiary level hospital in Kenya". F1000Research 9 (29.07.2020): 793. http://dx.doi.org/10.12688/f1000research.23379.1.
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Background: HIV drug resistance (HIVDR) threatens progress achieved in response to the HIV epidemic. Understanding the costs of implementing HIVDR testing programs for patient management and surveillance in resource-limited settings is critical in optimizing resource allocation. Here, we estimate the unit cost of HIVDR testing and identify major cost drivers while documenting challenges and lessons learnt in implementation of HIVDR testing at a tertiary level hospital in Kenya. Methods: We employed a mixed costing approach to estimate the costs associated with performing a HIVDR test from the provider’s perspective. Data collection involved a time and motion study of laboratory procedures and interviewing laboratory personnel and the management personnel. Cost analysis was based on estimated 1000 HIVDR tests per year. Data entry and analysis were done using Microsoft Excel and costs converted to US dollars (2019). Results: The estimated unit cost for a HIVDR test was $271.78 per test. The main cost drivers included capital ($102.42, 37.68%) and reagents (101.50, 37.35%). Other costs included: personnel ($46.81, 17.22%), utilities ($14.69, 5.41%), equipment maintenance costs ($2.37, 0.87%) and quality assurance program ($4, 1.47%). Costs in relation to specific laboratory processes were as follows: sample collection ($2.41, 0.89%), RNA extraction ($22.79, 8.38%), amplification ($56.14, 20.66%), gel electrophoresis ($10.34, 3.80%), sequencing ($160.94, 59.22%), and sequence analysis ($19.16, 7.05%). A user-initiated modification of halving reagent volumes for some laboratory processes (amplification and sequencing) reduced the unit cost for a HIVDR test to $233.81 (13.97%) reduction. Conclusions: Capital expenditure and reagents remain the most expensive components of HIVDR testing. This cost is bound to change as the sequencing platform is utilized towards maximum capacity or leveraged for use with other tests. Cost saving in offering HIVDR testing services is also possible through reagent volume reduction without compromising on the quality of test results.
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Solsvik, Anne Elisabeth, Ann Helen Kristoffersen, Sverre Sandberg, Gro Gidske, Anne Vegard Stavelin, Joakim Eikeland i Erik Amundsen. "A national surveillance program for evaluating new reagent lots in medical laboratories". Clinical Chemistry and Laboratory Medicine (CCLM) 60, nr 3 (19.01.2022): 351–60. http://dx.doi.org/10.1515/cclm-2021-1262.
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Abstract Objectives Differences between laboratory results attributable to the use of different reagent lots can potentially affect the diagnosis and monitoring of patients. To minimize patient risks, all laboratories should verify that new reagent lots meet agreed analytical performance specifications (APS). We propose a simplified, pragmatic approach for laboratories that involves compilating results into a national surveillance program, and present the first results obtained when applying this approach to troponins, glycated hemoglobin (HbA1c), prostate-specific antigen (PSA) and D-dimer. Methods In the surveillance program we have (i) determined APS for selected analytes, (ii) implemented a simplified procedure for lot evaluation with patient samples used in laboratories across Norway and (iii) performed central processing of the results from the participating laboratories. Results Over a one-year period, 27 Norwegian laboratories returned results from 28 lot changes for troponin I, 11 for troponin T, and 29 for HbA1c, PSA and D-dimer. The mean difference between two reagent lots was 4.5% for troponin I (for a concentration interval of 20–32 ng/L), 5.1% for troponin T (10.7–17.5 ng/L), 2.2% for HbA1c (40–50 mmol/mol), 3.7% for PSA (3–5 μg/L) and 5.5% for D-dimer (0.4–1.0 mg/L FEU). Conclusions A novel procedure for reagent lot evaluation is proposed in which information about multiple lot changes from different medical laboratories can be accumulated nationally. Sharing this information allows simplification of lot evaluations in individual laboratories and provides real-world data about lot-to-lot variations.
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Prokhvatilova, E. V., N. N. Teteryatnikova, I. B. Zakharova, L. I. Belitskaya, D. V. Viktorov i A. V. Toporkov. "PREPARATION FOR STATE REGISTRATION OF THE REAGENT KIT FOR THE DETECTION AND DIFFERENTIATION OF THE DNA OF BURKHOLDERIA «PSEUDOMALLEI» GROUP". Russian Clinical Laboratory Diagnostics 64, nr 3 (29.04.2019): 180–85. http://dx.doi.org/10.18821/0869-2084-2019-64-3-180-185.
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The reagent kit designed to detect and simultaneously differentiate the DNA of three species of Burkholderia pseudomallei - causative agents of melioidosis (B. pseudomallei), glanders (B. mallei) and B. thailandensis by the set of genes of β-lactamases with B and D molecular classes using a multiplex polymerase chain reaction with electrophoretic detection was developed for clinical laboratory diagnosis. The functional properties of the reagent kit were evaluated, tests were carried out, the stages of examination and registration in the Federal Service for Surveillance on Consumer Rights’ Protection and Human Well-being were completed. During clinical testing the effectiveness of the reagent kits in the study of various samples of clinical material and isolated cultures of microorganisms was confirmed. It has been established that the indicator of diagnostic sensitivity of the reagent kit for the detection and differentiation of the glanders, melioidosis and B. thailandensis causative agents was less than 99 %, diagnostic specificity - not less than 99 % with a confidence probability of 90 % in the analysis of each of the indicators.
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Castilho-Pelloso, Marcela Peres, Dina Lúcia Morais Falavigna i Ana Lúcia Falavigna-Guilherme. "Suspected acute toxoplasmosis in pregnant women". Revista de Saúde Pública 41, nr 1 (luty 2007): 27–34. http://dx.doi.org/10.1590/s0034-89102007000100005.
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OBJECTIVE: To determine the prevalence of reagent serology for suspected acute toxoplasmosis in pregnant women and to describe clinical, laboratory and therapeutic profiles of mothers and their children. METHODS: A retrospective study was conducted with IgM-anti-Toxoplasma gondii-reagent pregnant women and their children who attended the public health system in the state of Paraná, Southern Brazil, from January 2001 to December 2003. Information were obtained from clinical, laboratory (ELISA IgM/IgG) and ultrasonographic data and from interviews with the mothers. To test the homogeneity of the IgM indices in relation to the treatment used, the Pearson's Chi-square test was applied. Comparisons were considered significant at a 5% level. RESULTS: Two hundred and ninety (1.0%) cases of suspected IgM-reagent infection were documented, with a prevalence of 10.7 IgM-reagent women per 1,000 births. Prenatal care started within the first 12 weeks for 214/290; 146/204 were asymptomatic. Frequent complaints included headaches, visual disturbance and myalgia. Ultrasonography revealed abnormalities in 13 of 204 pregnancies. Chemoprophylaxis was administered to 112/227; a single ELISA test supported most decisions to begin treatment. Pregnant women with IgM indices =2.000 tended to be treated more often. Among exposed children, 44/208 were serologically followed up and all were IgG-reagent, and three IgM-reagent cases showed clinical symptoms. CONCLUSIONS: The existence of pregnant women with laboratorially suspected acute toxoplasmosis who were not properly followed up, and of fetuses that were not adequately monitored, shows that basic aspects of the prenatal care are not being systematically observed. There is need of implementing a surveillance system of pregnant women and their children exposed to T. gondii.
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Sitko, John C., James Jordan Steel, Erin A. Almand, Christopher A. Cullenbine, Joseph W. Rohrer, Douglas P. Wickert i Steven CM Hasstedt. "Efficiency of pooled surveillance testing in academic labs to detect and inhibit COVID-19 outbreaks". Bioanalysis 13, nr 15 (sierpień 2021): 1177–82. http://dx.doi.org/10.4155/bio-2021-0054.
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Robust surveillance testing is a key strategic plan to prevent COVID-19 outbreaks and slow the spread of the SARS-CoV-2 pandemic; however, limited resources, facilities and time often impair the implementation of a widespread surveillance effort. To mitigate these resource limitations, we employed a strategy of pooling samples, reducing reagent cost and processing time. Through utilizing academic faculty and labs, successful pooled surveillance testing was conducted throughout Fall 2020 semester to detect positive SARS-CoV-2 infections in a population of 4400 students. During the semester, over 25,000 individual COVID status evaluations were made by pooling eight individual samples into one quantitative reverse transcription polymerase chain reaction. This pooled surveillance strategy was highly effective at detecting infection and significantly reduced financial burden and cost by $3.6 million.
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Hapsari, Rebriarina, Irfan Kesumayadi, Nani Maharani, Endang Mahati, Ferdy Kurniawan Cayami i Sutopo Patria Jati. "The efficiency of selective pooling strategy in a COVID-19 diagnostic laboratory". Journal of Infection in Developing Countries 16, nr 08 (30.08.2022): 1278–84. http://dx.doi.org/10.3855/jidc.14359.
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Introduction: Mass testing is essential in the surveillance strategy for fighting the COVID-19 pandemic. It allows early detection of suspected cases and subsequently early isolation to mitigate spread. However, the high cost and limited consumables and reagents hinder the mass testing strategy in developing countries such as Indonesia. The specimen pooling strategy is an option to perform mass screening with limited resources. This study aims to determine the positivity rate cut-off and to evaluate the efficiency of pooling strategy for the laboratory diagnosis of COVID-19.
Methodology: Between August 4th, 2020, and November 11th, 2020, a four-sample pooling strategy testing to detect SARS-CoV-2 was carried out at the Microbiology Diagnostic Laboratory of Diponegoro National Hospital, Semarang, Indonesia. Pools with positive results were subjected to individual specimen retesting. Spearman’s correlation and linear regression analysis were used to determine the best positivity rate cut-off to apply pooling strategy.
Results: A total of 15,216 individual specimens were pooled into 3,804 four-sample pools. Among these pools, 1,007 (26.47%) were positive. Five hundred and ten (50.64%) were 1/4 positive. A maximum positivity rate of 22% is needed to save at least 50% extraction and qRT-PCR reactions in a four-sample pooling strategy. CT values between individual specimens and pools showed a good interval agreement.
Conclusions: Pooling strategy could reduce personnel workload and reagent cost, and increase laboratory capacity by up to 50% when the positivity rate is less than 22%.
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Gordon, Ilyssa O., Jodi D. Sherman, Michael Leapman, Michael Overcash i Cassandra L. Thiel. "Life Cycle Greenhouse Gas Emissions of Gastrointestinal Biopsies in a Surgical Pathology Laboratory". American Journal of Clinical Pathology 156, nr 4 (5.04.2021): 540–49. http://dx.doi.org/10.1093/ajcp/aqab021.
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Abstract Objectives Given adverse health effects of climate change and contributions of the US health care sector to greenhouse gas (GHG) emissions, environmentally sustainable delivery of care is needed. We applied life cycle assessment to quantify GHGs associated with processing a gastrointestinal biopsy in order to identify emissions hotspots and guide mitigation strategies. Methods The biopsy process at a large academic pathology laboratory was grouped into steps. Each supply and reagent was catalogued and postuse treatment noted. Energy consumption was estimated for capital equipment. Two common scenarios were considered: 1 case with 1 specimen jar (scenario 1) and 1 case with 3 specimen jars (scenario 2). Results Scenario 1 generated 0.29 kg of carbon dioxide equivalents (kg CO2e), whereas scenario 2 resulted in 0.79 kg CO2e—equivalent to 0.7 and 2.0 miles driven, respectively. The largest proportion of GHGs (36%) in either scenario came from the tissue processor step. The second largest contributor (19%) was case accessioning, mostly attributable to production of single-use disposable jars. Conclusions Applied to more than 20 million biopsies performed in the US annually, emissions from biopsy processing is equivalent to yearly GHG emissions from 1,200 passenger cars. Mitigation strategies may include modification of surveillance guidelines to include the number of specimen jars.
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Mosa, Alexander I. "CRISPR-Based Diagnostics for Point-of-Care Viral Detection". International Journal of Translational Medicine 2, nr 2 (1.06.2022): 198–203. http://dx.doi.org/10.3390/ijtm2020017.
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Point-of-care detection of viral infection is required for effective contact-tracing, epidemiological surveillance, and linkage to care. Traditional diagnostic platforms relying on either antigen detection or nucleic amplification are limited by sensitivity and the need for costly laboratory infrastructure, respectively. Recently, CRISPR-based diagnostics have emerged as an alternative, combining equipment light workflows with high specificity and sensitivity. However, as a nascent technology, several outstanding challenges to widespread field deployment remain. These include the need for pre-detection amplification of target molecules, the lack of standardization in sample preparation and reagent composition, and only equivocal assessments of the unit-economics relative to traditional antigen or polymerase chain reaction-based diagnostics. This review summarizes recent advances with the potential to overcome existing translational barriers, describes the events in CRISPR-based detection of target molecules, and offers perspective on how multiple approaches can be combined to decrease the limit of detection without introducing pre-amplification.
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Nov, Vandarith, Darapheak Chau, Kimsorn Pa, Keodane Hem i Sidonn Krang. "Proficiency Testing Performances Analysis of Microbiology Laboratories Participating in Cambodia Antimicrobial Resistance (AMR) Surveillance System". Infection Control & Hospital Epidemiology 41, S1 (październik 2020): s360—s361. http://dx.doi.org/10.1017/ice.2020.984.
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Background: The WHO recommends the establishment of sustainable and evidence-based surveillance systems are recommended for the prevention of microbial resistance. For these surveillance systems, all medical microbiology laboratories are required to participate an external quality assessment (EQA) program that covers antimicrobial susceptibility testing (AST). Clinical microbiology EQA panels with 3 isolates have been provided 3 times per year to antimicrobial resistance (AMR) sentinel laboratories in Cambodia since 2012. We evaluated the performance of laboratory testing implemented between 2016 and 2019, based on 4 years EQA results to highlight the main sources of unsatisfactory analytical processes and to suggest areas for improvement. Methods: We analyzed the results of microbiology EQA in 7 AMR surveillance sentinel laboratories from 2016 to 2019, which were coordinated by the National Institute of Public Health (NIPH) under the program of Pacific Paramedical Training Centre (PPTC) from New Zealand. All participating laboratories were required to identify bacteria to the species level, to verify AST results, and to answer a case study question on parasitology. Feedback results and appropriate corrective actions were reviewed to identify the root cause of nonconformity and to suggest areas for improvement. Results: Proficiency test results of participating laboratories from 9 cycles with 27 isolates were analyzed. The overall average of EQA result was 94.0%. The laboratories failed to identify the isolated pathogens in 7.0% of the tests and failed to interpret the inhibition zone of AST (ie, resistant, intermediate or susceptible) in 6.0% of tested strains. The main causes of erroneous of PT results were either preanalytical (ie, handling of the samples, timing of analysis, equipment and reagent management), analytical (ie, quality control, unsuitable methods, confusion of samples, or errors of confirmation), or postanalytical mistakes (eg, interpretation guideline, cross-checking of results, or the information management system). Followed by the root causes, internal quality control and inventory management were the highest-priority suggestions for improvement. Conclusions: All participating laboratories showed good performance on EQA for evidence-based AMR surveillance. The national antimicrobial resistance data quality is sufficiently good and the data should be shared on national and international platforms. However, the regular monitoring of national AMR surveillance system should be conducted for continued quality improvement.Funding: NoneDisclosures: None
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Votintseva, Antonina A., Phelim Bradley, Louise Pankhurst, Carlos del Ojo Elias, Matthew Loose, Kayzad Nilgiriwala, Anirvan Chatterjee i in. "Same-Day Diagnostic and Surveillance Data for Tuberculosis via Whole-Genome Sequencing of Direct Respiratory Samples". Journal of Clinical Microbiology 55, nr 5 (8.03.2017): 1285–98. http://dx.doi.org/10.1128/jcm.02483-16.
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ABSTRACT Routine full characterization of Mycobacterium tuberculosis is culture based, taking many weeks. Whole-genome sequencing (WGS) can generate antibiotic susceptibility profiles to inform treatment, augmented with strain information for global surveillance; such data could be transformative if provided at or near the point of care. We demonstrate a low-cost method of DNA extraction directly from patient samples for M. tuberculosis WGS. We initially evaluated the method by using the Illumina MiSeq sequencer (40 smear-positive respiratory samples obtained after routine clinical testing and 27 matched liquid cultures). M. tuberculosis was identified in all 39 samples from which DNA was successfully extracted. Sufficient data for antibiotic susceptibility prediction were obtained from 24 (62%) samples; all results were concordant with reference laboratory phenotypes. Phylogenetic placement was concordant between direct and cultured samples. With Illumina MiSeq/MiniSeq, the workflow from patient sample to results can be completed in 44/16 h at a reagent cost of £96/£198 per sample. We then employed a nonspecific PCR-based library preparation method for sequencing on an Oxford Nanopore Technologies MinION sequencer. We applied this to cultured Mycobacterium bovis strain BCG DNA and to combined culture-negative sputum DNA and BCG DNA. For flow cell version R9.4, the estimated turnaround time from patient to identification of BCG, detection of pyrazinamide resistance, and phylogenetic placement was 7.5 h, with full susceptibility results 5 h later. Antibiotic susceptibility predictions were fully concordant. A critical advantage of MinION is the ability to continue sequencing until sufficient coverage is obtained, providing a potential solution to the problem of variable amounts of M. tuberculosis DNA in direct samples.
Rozprawy doktorskie na temat "Laboratory reagent surveillance"
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Chikh, Maïssane. "Réactosurveillance en santé animale en France : état des lieux et améliorations". Electronic Thesis or Diss., Lyon 1, 2024. http://www.theses.fr/2024LYO10321.
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La réactosurveillance est la surveillance des incidents et des risques d'incidents résultant de l'utilisation de réactifs de laboratoire. Cette dernière vise à détecter les défaillances potentielles des méthodes d'analyse dans les laboratoires ainsi que les défauts de performance des réactifs, qui peuvent entraîner une augmentation des faux positifs (défaut de spécificité) et faux négatifs (défaut de sensibilité), potentiellement responsables de pertes économiques ou de retard dans la détection d'une épidémie. Dans ce contexte, nous avons évalué le système de réactosurveillance en nous concentrant sur cinq maladies des ruminants en France : la rhinotrachéite infectieuse bovine (IBR), la brucellose, l'hypodermose, la diarrhée virale bovine (BVD) et la leucose bovine enzootique, à l'aide d'OASIS, un outil d'évaluation des systèmes de surveillance. Parmi les principaux atouts, on peut citer le suivi de la performance des réactifs par les laboratoires et l’expertise des différents acteurs. Les principales limites étaient l'absence d'organes formalisés avec des rôles définis pour la prise de décision et la coordination, l'absence de procédures de déclaration et de suivi et un faible retour d'information vers certains acteurs. Pour améliorer le système, une nouvelle organisation est recommandée. De plus, un tour d’horizon des pratiques de réactosurveillance en Europe a été réalisé. Afin d’appuyer le système en place, la faisabilité d'un dispositif complémentaire est en cours d’étude pour l’IBR. Il serait basé sur des algorithmes de détection d'anomalies appliqués sur les données de prophylaxie en provenance du ministère et des laboratoires d’analyses, pour identifier rapidement les défaillances de réactifs ou les épidémiesLaboratory reagent surveillance is the monitoring of incidents and risks of incidents resulting from the use of laboratory reagents. It aims to detect potential failures of analytical methods in laboratories as well as performance defects of reagents, which can lead to an increase in false positives (lack of specificity) and false negatives (lack of sensitivity), potentially responsible for economic losses or delays in epidemic detection. In this context, we evaluated the French laboratory reagent surveillance system focusing on five ruminant diseases: infectious bovine rhinotracheitis (IBR), brucellosis, hypodermosis, bovine viral diarrhea (BVD), and enzootic bovine leukosis, using OASIS, a surveillance system evaluation tool. Among the main strengths are the monitoring of reagent performance by laboratories and the expertise of various stakeholders. The main limitations were the absence of formalized bodies with defined roles for decision-making and coordination, the lack of reporting and follow-up procedures, and poor feedback to certain actors. To improve the system, a new organization is recommended. Additionally, an overview of reagent surveillance practices in Europe was conducted. To support the existing system, the feasibility of a complementary mechanism is being studied for IBR. It would be based on anomaly detection algorithms applied to prophylaxis data from the ministry and analytical laboratories to quickly identify reagent failures or outbreaks
Części książek na temat "Laboratory reagent surveillance"
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Usluca, Selma. "Malaria and Molecular Diagnosis". W Molecular Approaches in Medicine, 21–48. Istanbul: Nobel Tip Kitabevleri, 2024. http://dx.doi.org/10.69860/nobel.9786053359524.2.
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It is an endemic vector-borne parasitic disease caused by protozoan parasites of the genus Plasmodium in tropical and subtropical regions worldwide. In each endemic area, malaria is transmitted by a specific set of Anopheles species. Plasmodium consists of over 200 species, infecting mammals, birds, and reptiles, and malaria parasites generally tend to be host-specific. Plasmodium falciparum, Plasmodium vivax, Plasmodium malariae, Plasmodium ovale, and Plasmodium knowlesi are the five known species of the genus Plasmodium that causes malaria in humans. Of the five Plasmodium species that cause malaria in humans, P. falciparum causes severe malaria. P. vivax is the most widespread malaria parasite globally. P. malariae is the least frequent and pathogenic, causing mainly asymptomatic infections with submicroscopic parasitemia, leading to low morbidity and mortality, although it can occasionally evolve with chronic renal disease. Different malaria species require distinct treatment regimens. Early and accurate diagnosis to specifically identify the infecting agent among all five malarial species is thus crucial for correct treatment and disease control. Prompt treatment is key to averting severe malaria and relies on access to accurate diagnosis and effective therapeutics. Several methods, such as microscopy-based analysis, rapid diagnostic test (RDT), serological methods, and molecular methods are available to diagnose malaria. Nucleic acid amplification tests (NAATs), which have advantages, such as high sensitivity and processivity and the capacity to identify drug-resistant strains, despite being more time consuming and expensive than microscopy and RDTs. PCR-based tests are also ideal for diagnosing mixed Plasmodium infections. However, PCR reliance on electricity, costly reagents and laboratory facilities for sample preparation have limited PCR to reference laboratories. To eliminate malaria, control and prevention efforts are necessary to reduce the prevalence of the disease and limit the development of drug resistance of the parasite. This requires a robust monitoring and surveillance system. Vector surveillance, larvae and vector control are also important. Vaccines and more recently, the use of monoclonal antibodies is needed for control of the disease. Enhanced surveillance and investigation of Plasmodium spp. genetic variations will contribute to the successful diagnosis and treatment of malaria in future.
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Phee, Lynette, i David Wareham. "Detecting Antimicrobial Resistance". W Tutorial Topics in Infection for the Combined Infection Training Programme. Oxford University Press, 2019. http://dx.doi.org/10.1093/oso/9780198801740.003.0056.
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● To optimize antimicrobial therapy for the management of individual patient’s infection. ● For surveillance purposes, which in turn inform local/national/international clinical guidelines. ● For the management of infection control and prevention. Broadly speaking, resistance is detected by observing its phenotypic expression (activity of the candidate drug(s) against the target bacterium) or detecting the underlying genotypic determinant (resistance genes). Commonly used methods in clinical diagnostic laboratories generally fall under the ‘phenotypic’ category. These share similar traits— ease of use, reproducibility, scalability, quick turnaround of results and relative low cost of materials/reagents required. Moreover, decades of experience and fine-tuning have seen them established as methods of choice in most microbiology laboratories. Most phenotypic test methods are reliant on the use of clinical breakpoints set by national and international bodies (e.g. EUCAST and CLSI) to determine susceptibility/resistance. These guidelines are regularly subject to updates with input from leading experts and latest research findings. It is important for clinical diagnostic laboratories to adhere to best practice guidance set out by these bodies and keep up-to-date with the latest guidelines. Growth characteristics (on artificial media) of the bacterium of interest are extremely important in conventional phenotypic methods. As this presents a big obstacle for slow growers and ‘unculturable’ pathogens (e.g. Mycobacterium tuberculosis, Mycoplasma spp.) it has led to the introduction of genotypic methods of resistance detection in the clinical diagnostic laboratory. meteoric rise in the world of microbiology. Compared with conventional phenotypic methods, molecular genotypic-based tests are better suited for automation and reduce dependence on skilled workers for result interpretation. They therefore deliver the rapid turnaround demanded by modern medicine. Antimicrobial susceptibility tests (ASTs) is a term used to describe a range of phenotypic methods that employ direct observation of the action of antimicrobials against a target microorganism. This is the most commonly used method in clinical diagnostic laboratories for detecting resistance in bacteria. A. Disc diffusion Growth medium: Standardized agar plates (usually unsupplemented, but addition(s) may be necessary for bacteria with specific growth requirements). Antibacterial component: Fixed dose in standard size circular paper discs or tablets.