Reducing liver function tests for statin monitoring: an observational comparison of two clinical commissioning groups.

BACKGROUND: Current liver function testing for statin monitoring is largely unnecessary and costly. Statins do not cause liver disease. Both reduction in test frequency and use of a single alanine transaminase (ALT) rather than a full seven analyte liver function test (LFT) array would reduce cost and may benefit patients. AIM: To assess LFT testing in relation to statin use and evaluate an intervention to reduce full-array LFTs ordered by GPs for statin monitoring. DESIGN AND SETTING: Two-year cross-sectional time series in two east London clinical commissioning groups (CCGs) with 650 000 patients. One CCG received the intervention; the other did not. METHOD: The intervention comprised local guidance on LFTs for statin monitoring and access to a single ALT rather than full LFT array. RESULTS: Of the total population, 17.6% were on statins, accounting for 43.2% of total LFTs. In the population without liver disease, liver function tests were 3.6 times higher for those on statins compared with those who were not. Following intervention there was a significant reduction in the full LFT array per 1000 people on statins, from 70.3 (95% confidence interval [CI] = 66.3 to 74.6) in the pre-intervention year, to 58.1 (95% CI = 55.5 to 60.7) in the post-intervention year (P<0.001). In the final month, March 2016, the rate was 53.2, a 24.3% reduction on the pre-intervention rate. CONCLUSION: This simple and generalisable intervention, enabling ordering of a single ALT combined with information recommending prudent rather than periodic testing, reduced full LFT testing by 24.3% in people on statins. This is likely to have patient benefit at reduced cost.

HB Hillingdon [alpha46(CE4)Phe-->Val (alpha1 Or alpha2)]: a new alpha chain hemoglobin variant.

Routine antenatal hemoglobinopathy screening detected a new alpha chain variant that eluted with Hb A(2) on cation exchange high performance liquid chromatography (HPLC) in a lady of Sri Lankan origin who had normal hematological indices. The mutation was identified by electrospray ionization mass spectrometry (ESI-MS) as alpha46(CE4)Phe-->Val, inferring that the variant was due to a single base change at codon 46 (TTC>GTC) of the alpha1- or alpha2-globin genes.

Epidemiology of hepatitis B virus in Bangladeshi general population.

BACKGROUND: Hepatitis B virus (HBV) is encountered sporadically the year round in Bangladesh. It results in a wide range of liver diseases, with asymptomatic acute hepatitis at one end to hepatocellular carcinoma (HCC) at the other end of the spectrum. METHODS: All 1018 individuals of different age groups and sex with varied religious, educational and social backgrounds were tested for HBsAg by ELISA. The positive samples were further tested by ELISA for HBeAg. Before testing, blood samples were preserved at -20 degree centigrade. The study was conducted in a semi-urban location on the outskirts of Dhaka. RESULTS: Of the 1018 individuals, 5.5% tested positive for HBsAg. None were tested positive for anti-HCV. Among the HBsAg-positive population, 58.93% were HBeAg-positive and the rest 41.07% HBeAg-negative. There was a male predominance and those who were tested positive were mostly between 16 and 50 years of age. Major risk factors for exposure to HBV appeared to be injudicious use of injectable medications, treatment by unqualified, traditional practitioners, mass-vaccination against cholera and smallpox, barbers and body piercing. CONCLUSION: HBV remains a major cause of morbidity and mortality in Bangladesh and we have a long way to go before we may bid farewell to this deadly menace.