Point-of-care biochemistry for primary healthcare in low-middle income countries: a qualitative inquiry.

BACKGROUND: Access to essential diagnostics is crucial for primary healthcare (PHC) in low-and-middle income countries (LMICs). Many LMICs have invested in equipping PHC with point-of-care (PoC) diagnostics for infectious diseases, however there has been no similar investment to improve PHC capacities for clinical chemistry. The biochemistry gap is among the deterrents to universal health coverage. METHODS: A social sciences project was conducted with the aim to understand the key PHC stakeholders' insights on the pertinence of PoC biochemistry for PHC in LMICs. Data generation was conducted between July-November 2023 in Mongolia, Nigeria and Peru. Decision-makers in healthcare delivery, healthcare professionals, and patient and community advocates were engaged using a combination of sampling techniques. Unstructured individual and group conversations, and non-participant observation were conducted. Analysis involved an inductive line-by-line coding on printed transcripts, followed by a deductive coding and theme-by-theme analysis on digitized transcripts. RESULTS: Fifteen, 51 and 20 informants from Mongolia, Nigeria and Peru, respectively, participated. Fifty-five of the 94 informants were female. Most informants considered that PoC biochemistry in PHC would be pertinent, from a clinical and a resources-saving perspective. Those households that currently bear the burden of referrals (i.e., the poor, the bedridden, the older adults) would benefit the most from the deployment of PoC biochemistry for essential biochemistry parameters. Improved access to PoC glycated hemoglobin (HbA1c), lipid, liver and kidney profile was perceived as helpful to inform clinicians' decision-taking. The value of PoC biochemistry for the management of noncommunicable diseases (diabetes, hypertension) and infectious conditions (dengue, malaria, tuberculosis), to improve child health outcomes (severe dehydration in children with diarrhea and/or malnutrition) and to reduce preventable causes of death (dengue-related renal failure) was highlighted. CONCLUSIONS: PoC biochemistry holds potential to revert the impact that the biochemistry gap has for patient care in some LMICs' PHC settings. PoC equipment for parameters such as HbA1c, urea, creatinine or electrolytes could enhance community-level management of preventable causes of mortality, improve service delivery for patients affected by locally-prevalent infectious conditions, and improve the psychosocial and economic wellbeing of patients facing the burden of referrals to remote biochemistry-equipped centers. TRIAL REGISTRATION: Not applicable.

Interferencia generada por la lipemia en la medición de constituyentes bioquímicos

Introducción. La turbidez por lipemia en las muestras para diagnóstico es una de las principales causas de la aparición de sesgos clínicamente significativos en la medición de magnitudes bioquímicas. Objetivo. Valorar la interferencia por lipemia en la medición de 25 constituyentes bioquímicos en dos analizadores con tecnología de química seca (Vitros 7600®) y química liquida (Atellica® Solution). Métodos. Estudio pre-experimental con pre y posprueba. Se añadieron cantidades crecientes de una emulsión lipídica de nutrición parenteral a siete alícuotas de una mezcla de sueros y se determinó por duplicado la influencia del interferente en 25 constituyentes. Se calculó el porcentaje relativo de desviación de la concentración del constituyente por influencia de la turbidez con respecto a una muestra sin interferente. Se establecieron límites de tolerancia para la interferencia utilizando tres criterios: del distribuidor de reactivos, del error sistemático deseable y del error máximo admisible. Resultados. Los constituyentes que presentaron los mayores sesgos para el analizador de química liquida fueron: fósforo (-84,72%), ALT (+81,25%) y AST (-75,76%), mientras que para la plataforma de química seca los constituyentes: ALT (-79,41%), CK (-28,92%) y lipasa (+24,85%). Se detectó interferencia significativa en diferente número de los constituyentes de acuerdo con el criterio de límite tolerable utilizado. Conclusiones. Los distintos resultados encontrados según la metodología y el analizador utilizado, además de la falta de replicabilidad de los ensayos para la valoración de interferencia por lipemia, origina la necesidad de armonizar los procesos e instaurar límites idénticos de interferencia tolerables entre los laboratorios y proveedores de insumos.

Introduction. Turbidity due to lipemia in diagnostic samples is one of the main causes of the appearance of clinically significant biases in the measurement of biochemical magnitudes. Objective. To assess the interference by lipemia in the measurement of 25 biochemical constituents in two analyzers with dry chemistry technology (Vitros 7600®) and liquid chemistry (Atellica® Solution). Methods. Pre-experimental study with pre and post test. Increasing amounts of a parenteral nutrition lipid emulsion were added to seven aliquots of pooled sera and the influence of the interferent on 25 constituents was determined in duplicate. The relative percentage deviation of the concentration of the constituent due to the influence of turbidity with respect to a sample without interference, was calculated. Tolerance limits for interference were established using three criteria: reagent distributor, desirable systematic error, and maximum permissible error. Results. The constituents that presented the greatest biases for the liquid chemistry analyzer were: Phosphorus (-84.72%), ALT (+81.25%) and AST (-75.76%), while for the dry chemistry platform the constituents, ALT (-79.41%), CK (-28.92%) and lipase (+24.85%). Significant interference was detected in a different number of constituents according to the tolerable limit criteria used. Conclusions. The different results found according to the methodology and the analyzer used, in addition to the lack of replicability of the tests for the evaluation of interference by lipemia, originates the need to harmonize the processes and establish identical limits of tolerable interference between the laboratories and suppliers of inputs.

Evaluation of the HealthID PSD microsampling device for the simultaneous determination of cholesterol, high-density lipoprotein, triglycerides, creatinine, and HbA1c in capillary blood.

INTRODUCTION: The use of dried capillary microsamples for clinical chemistry testing is an interesting alternative to conventional phlebotomy. Sampling devices capable to produce plasma from whole blood application are particularly useful. The aim of this study was to validate theHealthID PSDmicrosampling device for the determination of cholesterol (CHOL), high-density lipoprotein (HDL), triglycerides (TRIG), creatinine (CRE), and glycated hemoglobin (HbA1c) after collection of capillary blood. METHODS: Dried blood and plasma extracts were analyzed using modified methods in an open-channel biochemistry analyzer. The plasma volume in the extracts was corrected by the concentration of chloride (CL). Linearity, imprecision, bias, stability, and comparability to conventional samples were evaluated. RESULTS: Dried plasma assays presented total error (TE) within acceptable limits. The analytes were stable for up to 14 days at 40 °C. Predicted serum concentrations of CHO, HDL, TRI, and CRE and predicted whole blood levels of HbA1c, using dried extracts measurements, did not presented systematic or proportional differences to serum and whole blood levels. CONCLUSIONS: Dried sample extracts obtained with capillary blood applied to the HealthID PSD allowed the determination of CHO, HDL, TRI, CRE, and HbA1c, as well as the calculation of LDL level, using only 5 drops of blood. This sampling strategy can be useful for population screening programs, particularly in Developing Countries.

Comparison of agarose gel and capillary zone electrophoresis methods with preliminary reference interval generation using capillary zone electrophoresis in bald eagles (Haliaeetus leucocephalus).

BACKGROUND: Electrophoresis can be used to aid in the diagnosis of different diseases in avian species. Capillary zone electrophoresis (CZE) is an automated method that is proposed to be superior to the dye methods used in agarose gel electrophoresis (AGE). However, reference intervals (RIs) for CZE in avian species and comparison studies between electrophoretic methods are lacking. OBJECTIVES: The goals of the current study were to compare AGE and CZE methods and determine reference intervals for CZE using plasma from bald eagles (Haliaeetus leucocephalus). METHODS: Heparinized plasma samples from 44 bald eagles (mean age 18.7 years) under managed care were examined by AGE and CZE. Method comparison analyses were completed, as well as the generation of preliminary RIs using the CZE method and ASVCP guidelines. RESULTS: Passing-Bablok regression and Bland-Altman plots demonstrate that these methods are not equivalent. All fractions were significantly correlated between the methods except for alpha 1 globulin. Inter-assay and intra-assay CVs for CZE were lower or comparable to AGE and ranged from 2.4% to 15.4%, and 0.8% to 8.3%, respectively. CZE resolved more fractions than AGE with two fractions observed in the beta and gamma region vs one for AGE in each region. CONCLUSIONS: CZE provided improved resolution and reproducibility for the quantitation of protein fractions in the bald eagle. Although most fraction results correlated with AGE, these methods were judged as not equivalent, necessitating method-specific Rls. Reference intervals generated from a limited number of mostly aged individuals under managed care should be considered preliminary; additional studies will aid in the production of more robust intervals.

Validação de intervalos de referência de exames bioquímicos do laboratório de análises clínicas de um hospital universitário / Validation of reference intervals for biochemical tests at the clinical analysis laboratory of a university hospital

Introdução: Os intervalos de referência (IRs) disponibilizados em laudos de exames laboratoriais orientam a interpretação dos resultados, respaldando a avaliação clínica realizada por profissionais de saúde. Objetivo: Validar IRs de parâmetros bioquímicos, com base nas características da população local, bem como em informações disponíveis nas bulas dos reagentes e na literatura científica. Material e Métodos: Foi realizado um estudo observacional, descritivo e transversal para padronização de IRs de trinta e quatro parâmetros bioquímicos, executados pelo laboratório de análises clínicas de um hospital universitário. Participaram do estudo quarenta indivíduos adultos, pareados pelo sexo, que responderam um questionário sobre o estado geral de saúde. Uma amostra de sangue foi coletada de cada participante e analisada conforme os padrões do laboratório. Resultados: Os dados obtidos com os voluntários saudáveis permitiram a validação dos IRs de albumina, alanina aminotransferase, amilase, aspartato aminotransferase, bilirrubina direta, bilirrubina indireta, bilirrubina total, cálcio iônico, capacidade total e latente de fixação de ferro, creatinoquinase fração MB, cloro, ferro, fosfatase alcalina, fósforo, gama glutamiltransferase, glicose, lipoproteína de alta densidade, lactato, lactato desidrogenase, lipase, magnésio, potássio, proteínas totais, saturação da transferrina, sódio, triglicerídeos e ureia, de ambos os sexos. Ácido úrico foi validado apenas para o sexo masculino e creatinoquinase total (CK) foi validado apenas para o sexo feminino. Conclusão: Os IRs contidos nas bulas destes reagentes representam a população atendida pelo laboratório e podem continuar sendo utilizados. Em contrapartida, os IRs dos analitos colesterol total, lipoproteína de baixa densidade, cálcio, ácido úrico feminino e CK masculino não foram validados e necessitam de novos estudos para a validação dos intervalos de referência utilizados

Introduction: The reference intervals (RIs) provided in laboratory test reports orientate the interpretation of results, supporting the clinical evaluation performed by health professionals. Objective: Validate RIs of biochemical parameters, based on the characteristics of the local population, as well as on information available in the package inserts of the reagents and in the scientific literature. Material and Methods: An observational, descriptive, and cross-sectional study was carried out for the standardization of RIs of thirty-four biochemical parameters, performed by the Clinical Analysis laboratory of a university hospital. Forty adult individuals, matched by sex, participated in the study, who answered a questionnaire about their general health status. A blood sample was taken from each participant and analyzed according to laboratory standards. Results: Data obtained from healthy volunteers allowed the validation of the RIs of albumin, alanine aminotransferase, amylase, aspartate aminotransferase, direct bilirubin, indirect bilirubin, total bilirubin, ionic calcium, total and latent iron-binding capacity, creatine kinase MB fraction, chlorine, iron, alkaline phosphatase, phosphorus, gamma glutamyltransferase, glucose, high density lipoprotein, lactate, lactate dehydrogenase, lipase, magnesium, potassium, total proteins, transferrin saturation, sodium, triglycerides and urea, of both sexes. Uric acid has been validated for males only and total creatine kinase (CK) has been validated for females only. Conclusion: The RIs contained in the package inserts of these reagents represent the population assisted by laboratory and can continue to be used. The RIs of total cholesterol, low-density lipoprotein, calcium, female uric acid and male CK analytes were not validated and require further studies to validate the reference intervals used

Evaluación del desempeño analítico de parámetros de verificación de química seca a una gran altitud / Evaluation of analytical performance of dry chemistry verification parameters at high altitude

La instalación correcta de un analizador bioquímico depende del cumplimiento de las especificaciones del fabricante. El fabricante del analizador bioquímico Vitros 4600 (OrthoClinicalDiagnostics), que cuantifica analitos en base al método de química seca, garantiza un buen desempeño analítico de este hasta los 2438 msnm. Si la instalación se realiza a mayores altitudes, el laboratorio clínico debe aplicar protocolos experimentales que demuestren que el desempeño del analizador, tiene validez clínica. Objetivo: Evaluar el desempeño analítico de la química seca en un laboratorio clínico ubicado a gran altitud (Huancayo-Perú, 3259 msnm). Metodología: Estudio aplicativo y longitudinal. Se aplicó el protocolo EP15-A2 de CLSI como referencia de procedimientos estandarizados para calcular el SD y CV (error aleatorio) así como el sesgo (error sistemático) para dos niveles de concentración de algunos analitos de rutina tales como glucosa, úrea, creatinina, triglicéridos y AST, utilizando controles de tercera opinión de Bio Rad. A partir de los datos obtenidos se calculó la métrica sigma como indicador de desempeño analítico para cada analito, utilizando criterios de error total aceptable de CLIA. Resultados: Se obtuvieron métricas sigma, superiores a 4 para todos los analitos, encontrando desempeños: bueno para úrea, muy bueno para glucosa y excelente para creatinina, AST y triglicéridos. Conclusión: Se demostró que la química seca tiene un desempeño analítico aceptable, a pesar de ser utilizada en una altitud superior a las especificaciones del fabricante

Correct installation of a biochemical analyzer depends on compliance with the manufacturer's specifications. The manufacturer of the Vitros 4600 biochemical analyzer (OrthoClinicalDiagnostics), which quantifies analytes based on the dry chemistry method, guarantees its good analytical performance up to 2438 masl. If the installation is carried out at higher altitudes, the clinical laboratory must apply experimental protocols that demonstrate that the performance of the analyzer has clinical validity. Objective: To evaluate the analytical performance of dry chemistry in a clinical laboratory located at high altitude (Huancayo-Peru, 3259 masl). Methodology: Application and longitudinal study. The CLSI protocol EP15-A2 was applied as a reference of standardized procedures to calculate the SD and CV (random error) as well as the bias (systematic error) for two concentration levels of some routine analytes such as glucose, urea, creatinine, triglycerides and AST, using Bio Rad third part controls. From the data obtained, the sigma metric was calculated as an indicator of analytical performance for each analyte, using CLIA criteria of total acceptable error. Results: Sigma metrics were obtained, higher than 4 for all the analytes, finding performances: good for urea, very good for glucose and excellent for creatinine, AST and triglycerides. Conclusion: Dry chemistry was shown to have acceptable analytical performance, despite being used at an altitude higher than the manufacturer's specifications.

Biosensing of D-dimer, making the transition from the central hospital laboratory to bedside determination.

Since the disclosure of the fibrinogen degradation mechanism, around half a century ago, a significant number of papers have been published related to the clinical relevance of D-dimer, a molecule immune to additional enzymatic decomposition by plasmin. Due to the obliquity of regulating blood coagulation in pathological events, the number of diseases and conditions associated with abnormal levels of D-dimer includes deep vein thrombosis, pulmonary embolism, sepsis, myocardial infarction, disseminated intravascular coagulation, among many others. D-dimer not only is an important player in medical diagnosis but also its role as a prognosis biomarker is being revealed. However, the number of analytical alternative methods has not accompanied this trend, even though novel simple point-of-care devices would certainly boost the relevance of D-dimer in emergency medicine. Some reasons for that could be related to the fact that D-dimer is a challenging analyte present in complex samples like blood. In this manuscript, subsequent to a fibrinogen degradation process introduction, it is provided a historical overview of the early D-dimer assays, followed by an extended focus on innovative solutions, with a spotlight on the electrochemical bioanalytical devices. The discussion is accompanied with a critical analysis and concluding thoughts concerning future perspectives.

EQA-based evaluation of metrological traceability of clinical chemistry test results in Argentina / EQA-based evaluation of metrological traceability of clinical chemistry test results in Argentina

Equivalence of results among laboratories is a major mission for medical laboratories. In the Netherlands, medical laboratories only use homogenous, commercial for general chemistry analytes, whereas in Argentina heterogenous, home brew test applications are common. The effect of this practice difference on test accuracy is studied using key features of the accuracy-based EQA program of the Netherlands. Six frozen, human-based, commutable poolsera, covering the (patho) physiological measuring range for 17 general chemistry analytes, were assayed by ~75 Argentinian labs and ~200 Dutch laboratories in 2014. After removal of outliers, harmonization status among laboratories was evaluated by calculating overall mean interlaboratory coefficients of variation (CVs, %) per analyte and per country for all 6 levels. Evenso, standardization status was evaluated after removal of outliers by calculating overall mean recoveries (%) as compared to the assigned target values per analyte per country for all 6 levels. Absolute median biases were compared to (minimal/desirable) biases derived from biological variation criteria. For serum enzymes interlaboratory CVs in the Argentinian laboratories ranged between 10 and 22%, as compared to 3-6% in the Netherlands. For serum uric acid, creatinine, glucose and total protein, interlaboratory CVs varied between 4.3 and 13.1% in Argentinian labs, as compared to <3.5% in the Netherlands. For serum electrolytes, interlaboratory CVs ranged between 1.8 and 3.8% for Na+; 2.9-5.8% for Cl-; 3.8-7.5% for K+; 9.4-10.4% for Ca2+ and 16.2-22.3% for Mg2+ as compared to ≤2% (Na+, K+, Cl-, Ca2+) and ≤3% (Mg2+) in the Netherlands. Mean recoveries in Argentinian laboratories for e.g. serum creatinine, glucose, CK, Ca2+ and Na+ were 95-119%; 95-104%; 98-102%; 98-102% and 96-100% respectively, whereas min-max recovery ranges were 65-155%; 58-126%; 47-132%; 66-132% and 85-115%. In the Netherlands, absolute mean recoveries were overall 98.9% with a SD of 2.0%. Median biases in Argentinian laboratories ranged from -2.9 to 18.2%; -3.1 - 2.6%; -3.3 - 0.5%; -1.1 - 3.8% and -4.3-0% for serum creatinine, glucose, CK, Ca2+ and Na+. In the Netherlands overall mean/median biases were 1.1% (SD=2.0%). Exchange of commutable, value- assigned EQA-materials was helpful for studying the harmonization and standardization status of medical tests in Argentina, and for revealing the future harmonization and standardization potential. The results clearly demonstrate that metrological traceability of test results in Argentina is on average in line with what is expected; yet, the spreading among laboratories is far too high and should be improved.

La equivalencia de resultados entre laboratorios es una mision importante para los laboratorios medicos. En los Paises Bajos, los laboratorios medicos solo usan aplicaciones comerciales homogeneas, regulatoriamente aprobadas (CE-IVD) para analitos quimicos, mientras que en la Argentina son comunes las aplicaciones heterogeneas caseras. El efecto de esta diferencia practica en la precision de la prueba se estudia utilizando caracteristicas clave del programa EQA, basado en la precision, de los Paises Bajos. Se ensayaron seis pools de sueros, congelados, de origen humano, conmutables, que cubrian el rango de medidas (pato)fisiologicas para 17 analitos de quimica clinica. Estos analitos de quimica clinica fueron analizados por ~75 laboratorios argentinos y ~200 laboratorios holandeses en 2014. Despues de eliminar los valores atipicos, el estado de armonizacion entre los laboratorios fue evaluado calculando los coeficientes de variacion interlaboratorios medios globales (CV%) por analito y por pais para los 6 niveles. No obstante, el estado de estandarizacion se evaluo despues de la eliminacion de valores atipicos mediante el calculo de recuperaciones medias generales (%) en comparacion con los valores asignados por analito por pais para los 6 niveles. Los sesgos medios absolutos se compararon con los sesgos (minimos / deseables) derivados de los criterios de variacion biologica. Para enzimas sericas los CV interlaboratorio en los laboratorios argentinos oscilaron entre 10 y 22%, en comparacion con 3-6% en los Paises Bajos. Para el acido urico serico, creatinina, glucosa y proteinas totales, los CV entre laboratorios variaron entre 4,3 y 13,1% en los laboratorios argentinos, en comparacion con <3,5% en los Paises Bajos. Para los electrolitos sericos, los CV interlaboratorios oscilaron entre 1,8 y 3,8% para Na+; 2,9-5,8% para Cl-; 3,8-7,5% para K+; 9,4-10,4% para Ca2+ y 16,2-22,3% para Mg2+ en comparacion a ≤2% (Na+, K+, Cl-, Ca2+) y ≤3% (Mg2+) en los Paises Bajos. Las recuperaciones medias en laboratorios argentinos para, p.ej. la creatinina serica, glucosa, CK, Ca2+ y Na+ fueron 95-119%; 95-104%; 98-102%; 98-102% y 96-100% respectivamente, mientras que los rangos de recuperacion min-max fueron 65-155%; 58-126%; 47-132%; 66-132% y 85-115%. En los Paises Bajos, las recuperaciones medias absolutas fueron en general del 98,9% con una desviacion estandar (DE) del 2,0%. La mediana de los sesgos medios de los laboratorios argentinos oscilo entre -2,9 y 18,2%; -3,1 - 2,6%; -3,3 - 0,5%; -1,1 - 3,8% y -4,3-0% para creatinina serica, glucosa, CK, Ca2+ y Na+. En los Paises Bajos, las medias / medianas en general fueron de 1,1% (DE=2,0%). El intercambio de los valores asignados a los materiales EQA, conmutables fue de gran ayuda para la armonizacion y estandarizacion de los ensayos medicos en la Argentina y para revelar el potencial futuro de armonizacion y estandarizacion. Estos resultados claramente demuestran que la trazabilidad metrologica de los resultados de las pruebas en la Argentina esta, en promedio, de acuerdo con lo esperable; sin embargo, la dispersion entre laboratorios es muy grande y deberia ser mejorada.

A equivalencia de resultados entre laboratorios e uma missao importante para os laboratorios medicos. Nos Paises Baixos, os laboratorios medicos so utilizam aplicacoes comerciais homogeneas, aprovadas por regulacoes (CE-IVD) para analitos quimicos, ao passo que na Argentina sao comuns as aplicacoes heterogeneas caseiras. O efeito desta diferenca pratica na exatidao do teste e estudado utilizando caracteristicas essenciais do programa EQA, dos Paises Baixos, baseado na exatidao. Foram ensaiados seis pools de soros, congelados, de origem humana, comutaveis, que abrangiam a faixa de medidas (pato)fisiologicas para 17 analitos quimicos gerais. Esses analitos quimicos foram analisados por ~75 laboratorios argentinos e ~200 laboratorios holandeses em 2014. Apos eliminar os valores atipicos, o estado de harmonizacao entre os laboratorios foi avaliado atraves do calculo dos coeficientes de variacao interlaboratorio meios globais (CV%) por analito e por pais para os 6 niveis. Nao obstante, o estado de padronizacao foi avaliado depois da eliminacao de valores atipicos pelo calculo de recuperacoes medias gerais (%) se comparados com os valores atribuidos por analito por pais para os 6 niveis. Os vieses medios absolutos foram comparados com os vieses (minimos / desejaveis) decorrentes dos criterios de variacao biologica. Para enzimas sericas, os CV interlaboratorio nos laboratorios argentinos oscilaram entre 10 e 22%, em comparacao com 3-6% nos Paises Baixos. Para o acido urico serico, creatinina, glicose e proteinas totais, os CV entre laboratorios variaram entre 4,3 e 13,1% nos laboratorios argentinos, em comparacao com <3,5% nos Paises Baixos para os eletrolitos sericos, os CV interlaboratorios oscilaram entre 1,8 e 3,8% para Na+; 2,9-5,8% para Cl-; 3,8-7,5% para K+; 9,4-10,4% para Ca2+ e 16,2-22,3% para Mg2+ em comparacao com ≤2% (Na+, K+, Cl-, Ca2+) e ≤3% (Mg2+) nos Paises Baixos. As recuperacoes medias em laboratorios argentinos para, p.ex. a creatinina serica, glicose, CK, Ca2+ e Na+ foram 95-119%; 95-104%; 98-102%; 98-102% e 96-100% respectivamente, enquanto que os intervalos de recuperacao min-max. foram 65-155%; 58-126%; 47-132%; 66-132% e 85-115%. Nos Paises Baixos, as recuperacoes medias absolutas foram em geral de 98,9% com um desvio padrao (DE) de 2,0%. A mediana dos vieses medios dos laboratorios argentinos oscilou entre -2,9 e 18,2%; -3,1 - 2,6%; -3,3 - 0,5%; -1,1 - 3,8% e -4,3-0% para creatinina serica, glicose, CK, Ca2+ e Na+. Nos Paises Baixos, as medias / medianas em geral foram de 1,1% (DE=2,0%). O intercambio dos valores atribuidos aos materiais EQA, comutaveis, foi de grande ajuda para a harmonizacao e padronizacao dos ensaios medicos na Argentina e para revelar o potencial futuro de harmonizacao e padronizacao. Esses resultados demonstram as claras que a rastreabilidade metrologica dos resultados dos testes na Argentina esta de acordo com o esperavel; a dispersao entre laboratorios ainda e muito grande e deveria ser melhorada.

Clinical biochemistry profile of American Quarter Horse broodmares fed Tifton-85 (Cynodon spp. ) hay and haylage / Perfil bioquímico clínico de matrizes Quarto de Milha alimentadas com feno e haylage Tifton 85 (Cynodon spp. )

The conservation of haylage (a pre-dried feed) can be challenging, since there is an increased risk of mould growth, which can contaminate this foodstuff with mycotoxins. However, when the hygienic quality is secured, haylage enhances grass palatability and provide enough supply of dry matter throughout the year. Due to the lack of information regarding its effect on blood parameters in horses fed exclusively with this foodstuff, the aim of this study is to provide information regarding its use in comparison to hay and ensure that it does not affect horses' biochemical profile. Twelve Quarter Horse broodmares were distributed into two groups, each fed with Tifton-85 (Cynodon spp.) hay or haylage for a period of 28 days, and the biochemical profile was done in five different times (T0 before the experiment started and, chronologically, seven days apart - T1, T2, T3 and T4), It was analyzed total protein (TP) and its fractioning; enzymes alanine aminotransferase, aspartate aminotransferase and γ-glutamyl-transferase; endogenous catabolism products urea and creatinine; and ions calcium and phosphorus. Mycotoxins in haylage were also investigated and remained below the legislation thresholds. Only TP was higher in the last sampling (T4) of the haylage group, which may be related to the foodstuff's higher protein digestibility. No differences were observed between serum enzymes, urea, creatinine and Ca/P from both experimental groups. Haylage has proven to be safe, when well prepared for horses, without causing impairing side effects, as shown by the normal serum biochemistry parameters presented in this study.(AU)

A conservação do haylage (alimento pré-seco) pode ser desafiadora, considerando o aumento do risco de crescimento de fungos, com consequente produção de micotoxinas. Entretanto, quando a qualidade da higiene e armazenamento é assegurada, o haylage aumenta a palatabilidade da forragem e fornece suplemento de matéria seca suficiente ao longo do ano. Devido à falta de informação relativa aos efeitos dessa alimentação nos parâmetros sanguíneos de equinos alimentados exclusivamente com essa dieta, o objetivo do presente estudo é avaliar o perfil bioquímico sanguíneo dos equinos após administração da haylage em comparação com feno. Doze matrizes Quarto de Milha foram distribuídas em dois grupos, cada um recebendo feno ou haylage de Tifton 85 (Cynodon spp.) por um período de 28 dias. O perfil bioquímico foi realizado em cinco tempos (T) diferentes (T0, antes do início do experimento e cronologicamente, a cada sete dias após o fornecimento das dietas - T1, T2, T3 e T4) para análise de proteína total (PT) e seu perfil fracionado, das enzimas alanina aminotransferase, aspartato aminotransferase, γ-glutamil-transferase, dos produtos de catabolismo creatinina e ureia e, dos íons cálcio e fósforo. Micotoxinas no haylage foram investigadas e mantiveram-se abaixo dos limites determinados pela legislação brasileira. O perfil bioquímico revelou, somente, elevação da PT em T4 no grupo que recebeu haylage, o que pode estar relacionado à sua maior digestibilidade proteica. Nenhuma diferença foi observada nos outros parâmetros estudados em ambos os grupos experimentais. Conclui-se que Haylage é comprovadamente seguro, quando bem preparado para equinos, sem causar efeitos na saúde geral, conforme demonstrado pelos exames bioquímicos no presente estudo.(AU)

Clinical biochemistry profile of American Quarter Horse broodmares fed Tifton-85 (Cynodon spp. ) hay and haylage / Perfil bioquímico clínico de matrizes Quarto de Milha alimentadas com feno e haylage Tifton 85 (Cynodon spp. )

The conservation of haylage (a pre-dried feed) can be challenging, since there is an increased risk of mould growth, which can contaminate this foodstuff with mycotoxins. However, when the hygienic quality is secured, haylage enhances grass palatability and provide enough supply of dry matter throughout the year. Due to the lack of information regarding its effect on blood parameters in horses fed exclusively with this foodstuff, the aim of this study is to provide information regarding its use in comparison to hay and ensure that it does not affect horses' biochemical profile. Twelve Quarter Horse broodmares were distributed into two groups, each fed with Tifton-85 (Cynodon spp.) hay or haylage for a period of 28 days, and the biochemical profile was done in five different times (T0 before the experiment started and, chronologically, seven days apart - T1, T2, T3 and T4), It was analyzed total protein (TP) and its fractioning; enzymes alanine aminotransferase, aspartate aminotransferase and γ-glutamyl-transferase; endogenous catabolism products urea and creatinine; and ions calcium and phosphorus. Mycotoxins in haylage were also investigated and remained below the legislation thresholds. Only TP was higher in the last sampling (T4) of the haylage group, which may be related to the foodstuff's higher protein digestibility. No differences were observed between serum enzymes, urea, creatinine and Ca/P from both experimental groups. Haylage has proven to be safe, when well prepared for horses, without causing impairing side effects, as shown by the normal serum biochemistry parameters presented in this study.(AU)

A conservação do haylage (alimento pré-seco) pode ser desafiadora, considerando o aumento do risco de crescimento de fungos, com consequente produção de micotoxinas. Entretanto, quando a qualidade da higiene e armazenamento é assegurada, o haylage aumenta a palatabilidade da forragem e fornece suplemento de matéria seca suficiente ao longo do ano. Devido à falta de informação relativa aos efeitos dessa alimentação nos parâmetros sanguíneos de equinos alimentados exclusivamente com essa dieta, o objetivo do presente estudo é avaliar o perfil bioquímico sanguíneo dos equinos após administração da haylage em comparação com feno. Doze matrizes Quarto de Milha foram distribuídas em dois grupos, cada um recebendo feno ou haylage de Tifton 85 (Cynodon spp.) por um período de 28 dias. O perfil bioquímico foi realizado em cinco tempos (T) diferentes (T0, antes do início do experimento e cronologicamente, a cada sete dias após o fornecimento das dietas - T1, T2, T3 e T4) para análise de proteína total (PT) e seu perfil fracionado, das enzimas alanina aminotransferase, aspartato aminotransferase, γ-glutamil-transferase, dos produtos de catabolismo creatinina e ureia e, dos íons cálcio e fósforo. Micotoxinas no haylage foram investigadas e mantiveram-se abaixo dos limites determinados pela legislação brasileira. O perfil bioquímico revelou, somente, elevação da PT em T4 no grupo que recebeu haylage, o que pode estar relacionado à sua maior digestibilidade proteica. Nenhuma diferença foi observada nos outros parâmetros estudados em ambos os grupos experimentais. Conclui-se que Haylage é comprovadamente seguro, quando bem preparado para equinos, sem causar efeitos na saúde geral, conforme demonstrado pelos exames bioquímicos no presente estudo.(AU)

Relative quantification of plasma N-glycans in type II congenital disorder of glycosylation patients by mass spectrometry.

BACKGROUND: Type II Congenital Disorders of Glycosylation (CDG-II) are a group of diseases with challenging diagnostics characterized by defects in the processing of glycans in the Golgi apparatus. Mass Spectrometry (MS) has been a valuable tool in the definition of CDG-II subtypes. While some CDG-II subtypes are associated with specific N-glycan structures, others only produce changes in relative levels, reinforcing the demand for quantification methods. METHODS: Plasma samples from control individuals were pooled, derivatized with deuterated iodomethane (I-CD3), and used as internal standards for controls and patients whose glycans were derivatized with iodomethane (I-CH3), followed by MALDI MS, LC-MS and -MS/MS analyses. RESULTS: Total N-glycans from fifteen CDG-II patients were evaluated, and 4 cases with molecular diagnosis were considered in detail: 2ATP6V0A2-CDG siblings, and 2 MAN1B1-CDG patients, one of them carrying a previously undescribed p.Gly536Val mutation. CONCLUSIONS: Our methodology offers a feasible alternative to the current methods for CDG-II diagnosis by MS, which quantify glycan structures as fractions of the total summed signal across a mass spectrum, a strategy that lowers the variability of minor components. Moreover, given its sensitivity for less concentrated yet biologically relevant structures, it might assist the uncovering of novel diagnostic glycans in other CDG-II subtypes.

Comprehensive evaluation of the internal and external quality control to redefine analytical quality goals.

INTRODUCTION: The aim of this work is to design a selection algorithm for total allowable error (TEa) source using a graphic tool that, by integrating internal (IQC) and external (EQC) quality control performances, enables the laboratory to evaluate which TEa source better fits the test analytical performance. MATERIALS AND METHODS: Two analytical performance indicators (bias and Sigma metrics) were estimated for 23 biochemistry tests during 2016. Bias was estimated on the EQC, and Sigma metrics was calculated through the results obtained in the IQC. The Sigma metrics was charted as a function of the bias (TEa%). Following the proposed algorithm (considering the hierarchy in the Milan 2014 consensus), the TEa was evaluated depending on two areas. One area in the chart was defined as the objective area in which the used TEa is the appropriate one for the analytical performance of the test under evaluation. For any test located outside this area, a performance re-evaluation was required using another source of TEa. RESULTS: In 19 out of 23 evaluated tests, the resulting analytical performance allowed for the selection of biologic variability as TEa source. In the four remaining cases, TEa sources of lesser hierarchy were selected. CONCLUSION: The graphic tool designed together with the proposed algorithm enabled the laboratory to standardize the selection procedure of the most appropriate TEa for the test analytical performance.

Determination of inorganic cations in biological fluids using a hybrid capillary electrophoresis device coupled with contactless conductivity detection.

We describe the assembly of a hybrid electrophoresis device that contains fused silica capillaries interconnected to a microfabricated interface in a cross format for the determination of inorganic cations in biological samples. The sample transport in the proposed hybrid device was performed under gated injection mode and the separations were monitored with a capacitively coupled contactless conductivity detector. The capillary extremities were inserted into polypropylene tubes to create solution reservoirs. Sensing electrodes were produced using stainless-steel hypodermic needles previously cut with 2.0 mm length. The running composition and injection time were optimized and the best results were found using 50 mmol/L lactic acid, 20 mmol/L histidine and 3 mmol/L 18-crown-6 ether, and an electrokinetic injection time of 15 s. The separation of six inorganic cations was achieved with baseline resolution, and efficiencies were between 9.1 × 103 and 5.4 × 104 plates/m. The proposed hybrid device was explored for determining the concentration levels of inorganic cations in urine, saliva, and tear samples, employing Li+ as an internal standard. The achieved results were in good agreement with the data reported in the literature. The reliability of the proposed method ranged from 93 to 98%, thus suggesting satisfactory accuracy for bioanalytical applications.

The Importance of Medicinal Chemistry Knowledge in the Clinical Pharmacist's Education.

Objective. To show why medicinal chemistry must be a key component of the education of pharmacy students, as well as in the pharmacist's practice. Findings. Five case reports were selected by their clinically relevant elements of medicinal chemistry and were explained using structure-activity relationship data of the drugs involved in the case easily obtained from primary literature and in medicinal chemistry textbooks. Summary. This paper demonstrates how critical clinical decisions can be addressed using medicinal chemistry knowledge. While such knowledge may not explain all clinical decisions, medicinal chemistry concepts are essential for the education of pharmacy students to explain drug action in general and clinical decisions.

Newly Emerging Drugs of Abuse and Their Detection Methods: An ACLPS Critical Review.

OBJECTIVES: Illicit drug abuse has reached an epidemic level in the United States. Drug overdose has become the leading cause of injury-related deaths since 2008 due to the recent surge of opioid overdose by heroin, controlled prescription drugs, and nonmethadone synthetic opioids. Synthetic designer drugs such as synthetic cathinones ("bath salts") and synthetic cannabinoids ("Spice" and "K2") continue to emerge and attract recreational users. METHODS: The emergence of new drugs of abuse poses a steep challenge for clinical toxicology laboratories. Limited information about the emerging drugs and their metabolism, "rebranding" of the illicit drugs, and a lack of Food and Drug Administration-approved screening methods for these drugs contribute to this difficulty. Here we review detection methods that can aid in identifying emerging drugs of abuse. RESULTS: One promising approach is the utilization of untargeted drug screening by mass spectrometry. Historically, gas chromatography-mass spectrometry has been the gold standard. CONCLUSIONS: Liquid chromatography-tandem mass spectrometry and liquid chromatography-high-resolution mass spectrometry offer improved detection capability of new drugs with simplified sample preparation, making it the new standard.

Fasting conditions: Influence of water intake on clinical chemistry analytes.

INTRODUCTION: Currently available recommendations regarding fasting requirements before phlebotomy do not specify any maximum water intake volume permitted during the fasting period. The aim was to study the effects of 300 mL water intake 1 h before phlebotomy on specific analytes. MATERIALS AND METHODS: Blood was collected from 20 women (median age (min-max): 24 (22 - 50) years) in basal state (T0) and 1 h after 300 mL water intake (T1). Glucose, total proteins (TP), urea, creatinine, cystatin C, total bilirubin (BT), total cholesterol, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, triglycerides (Tg), uric acid (UA), high-sensitivity C-reactive protein, gamma-glutamyl transferase (GGT), aspartate-aminotransferase (AST), alanine-aminotransferase and lactate-dehydrogenase (LD) were studied. Results were analyzed using Wilcoxon test. Mean difference (%) was calculated for each analyte and was further compared with reference change value (RCV). Only mean differences (%) higher than RCV were considered clinically significant. RESULTS: Significant differences (median T0vs median T1, P) were observed for TP (73 vs 74 g/L, 0.001); urea (4.08 vs 4.16 mmol/L, 0.010); BT (12 vs 13 µmol/L, 0.021); total cholesterol (4.9 vs 4.9 mmol/L, 0.042); Tg (1.05 vs 1.06 mmol/L, 0.002); UA (260 vs 270 µmol/L, 0.006); GGT (12 vs 12 U/L, 0.046); AST (22 vs 24 U/L, 0.001); and LD (364 vs 386 U/L, 0.001). Although the differences observed were statistically significant, they were not indicative of clinically significant changes. CONCLUSIONS: A water intake of 300 mL 1 h prior to phlebotomy does not interfere with the analytes studied in the present work.

SERUM CHEMISTRY OF FREE-RANGING NAZCA BOOBIES ( SULA GRANTI).

This study reports body mass and serum chemistry reference values of 121 male and 57 female Nazca boobies (Sulidae: Sula granti) from a colony on Isla Española, Galápagos Islands, Ecuador. Circulating aspartate aminotransferase, creatine kinase, lactate dehydrogenase, total protein, immunoglobulin Y, uric acid, blood urea nitrogen, triglycerides, cholesterol, and creatinine were quantified and analyzed by sex. Sex explained little variance in all examined variables except mass; females were heavier than males, as expected for sulids. Uric acid values had a bimodal distribution, likely reflecting differences in recent foraging success. Aspartate aminotransferase and creatine kinase values were similar to those reported in other sulids. Clinical health reference values are critical for practitioners investigating responses of seabirds to oil spills, coastal restoration efforts, or emerging diseases. These data from a species living in a relatively isolated and pristine area provide a valuable baseline for future health evaluations.

Reference intervals for biochemical analytes of captive Black-Fronted Piping-Guan (Aburria jacutinga).

BACKGROUND: Black-Fronted Piping-Guan (Aburria jacutinga) is considered one of the most threatened bird species on the American continent. Ex situ conservation efforts have been developed in Brazil, and monitoring the health status of these populations is essential to ensure reproductive success in captivity. Reference intervals (RI) for biochemistry analytes from a larger population of Black-Fronted Piping-Guan are unavailable. OBJECTIVES: This study was aimed at establishing RI for biochemical analytes of captive Black-Fronted Piping-Guan for future improved health assessments in these animals. METHODS: Blood samples were collected from 32 adult Black-Fronted Piping-Guans for serum and plasma separation. Liver and kidney function markers, and concentration of protein and lipids were measured. Reference intervals were determined using an Excel program with Reference Value Adviser (version 2.0). RESULTS: The RI of the analytes were: AST 20.7-188.0 U/L; CK 713.7-4741.4 U/L; LDH 360.7-1173.7 U/L; γ Glutamyl Transferase 1.1-5.4 U/L; total plasma protein 3.5-6.2 g/dL; total serum protein 1.7-4.7 g/dL; uric acid 0.9-19.2 mg/dL; urea 7.0-25.3 mg/dL; cholesterol 71.8-232.2 mg/dL; triglycerides 25.6-183.4 mg/dL. CONCLUSIONS: The RI are similar to the ones published for other avian species. Only CK and uric acid values were in discordance with the usually reported avian ranges. This could be due to different methods of capture and physical restraint. Alternatively, some differences could be species-specific. In general, physical restraint should be limited to a minimum and without stress to prevent capture myopathy and death.

Portable lactate analyzer for measuring lactate in cerebrospinal fluid (CSF) and plasma ? method-comparison evaluations / Analisador portátil para dosar lactato no líquido cefalorraquidiano e plasma ? comparação de método

Increased plasma lactate levels can indicate the presence of metabolic disorders in HIV infected individuals. Objective: To determine whether a portable analyzer is valid for measuring cerebrospinal fluid (CSF) and plasma lactate levels in HIV infected individuals. Method: CSF and plasma were collected from 178 subjects. Samples tested by the Accutrend® portable analyzer were compared to those tested by a reference device (SYNCHRON LX® 20). Results: The portable analyzer had in plasma sensitivity of 0.95 and specificity 0.87. For CSF the specificity was 0.95; the sensitivity 0.33; the negative predictive value was 95% and the positive predictive value 33%. Conclusions: These findings support the validity of the portable analyzer in measuring lactate concentrations in CSF that fall within the normal range. The relatively poor positive predictive value indicates that a result above the reference range may represent a “false positive test”, and should be confirmed by the reference device before concluding abnormality. .

O aumento da concentração plasmática dos níveis de lactato pode indicar a presença de distúrbios metabólicos em indivíduos infectados pelo HIV. Objetivo: Determinar a validade do analisador portátil para quantificar os níveis de lactato no líquido cefalorraquidiano (LCR) e plasma em indivíduos infectados. Método: LCR e plasma foram coletados de 178 participantes. As amostras testadas com o analisador portátil Accutrend® e os resultados comparados com aqueles obtidos com o equipamento de referência (SYNCHRON LX® 20). Resultados: O analisador portátil teve, no plasma, sensibilidade de 0,95 e especificidade 0,87. No LCR a especificidade foi 0,95; a sensibilidade 0,33; o valor preditivo negativo foi de 95% e o valor preditivo positivo 33%. Conclusões: Estes dados suportam a validade dos resultados do analisador portátil em concentrações de lactato dentro da faixa normal. Os valores preditivos positivos relativamente baixos indicam que um resultado acima da faixa de referência pode representar um resultado “falso positivo”. .