A1c Gear: Laboratory quality HbA1c measurement at the point of care.

INTRODUCTION: HbA1c is an important part of assessing the diabetic control and since the use of point-of-care devices for monitoring HbA1c is increasing, it is important to determine how these devices compare to the central laboratory. METHODS: One hundred and twenty patient samples were analyzed on the Bio-Rad Variant™II and one POC analyzer (Sakae A1c Gear). Three patient sample pools containing ~5%, ~7%, and ~10% HbA1c levels were run over 20 days. Three reagent lots and three instruments were evaluated for the A1c Gear. RESULTS: The 120 patient samples showed strong correlation (R(2)>0.989) when compared to the Variant™II with means=8.06% and 7.81%, for Variant IIand A1c Gear, respectively. Changing reagent lots or instruments had no impact for the A1c Gear. The ~5%, ~7%, and ~10% pools within-run and between-run imprecision was between 0.87-1.33% and 1.03-1.32%, and 1.41-2.35% and 1.24-1.89% with total imprecision of 1.67-2.35% and 1.61-2.31% for the A1c Gear and Variant II, respectively. The A1c Gear showed a small negative bias (0.25% HbA1c) across HbA1c measurement ranges of <11.5%. This bias was, however, acceptable and not considered to be clinically significant. CONCLUSIONS: The A1c Gear meets the criteria of total CV <3% leading us to the conclusion that the A1c Gear can give results as precise as the laboratory at the POC.

Innate immune responses and antioxidant/oxidant imbalance are major determinants of human Chagas disease.

BACKGROUND: We investigated the pathological and diagnostic role of selected markers of inflammation, oxidant/antioxidant status, and cellular injury in human Chagas disease. METHODS: Seropositive/chagasic subjects characterized as clinically-symptomatic or clinically-asymptomatic (n = 116), seronegative/cardiac subjects (n = 102), and seronegative/healthy subjects (n = 45) were analyzed for peripheral blood biomarkers. RESULTS: Seropositive/chagasic subjects exhibited an increase in sera or plasma levels of myeloperoxidase (MPO, 2.8-fold), advanced oxidation protein products (AOPP, 56%), nitrite (5.7-fold), lipid peroxides (LPO, 12-17-fold) and malondialdehyde (MDA, 4-6-fold); and a decline in superoxide dismutase (SOD, 52%) and glutathione (GSH, 75%) contents. Correlation analysis identified a significant (p<0.001) linear relationship between inflammatory markers (AOPP/nitrite: r = 0.877), inflammation and antioxidant/oxidant status (AOPP/glutathione peroxidase (GPX): r = 0.902, AOPP/GSH: r = 0.806, Nitrite/GPX: 0.773, Nitrite/LPO: 0.805, MDA/MPO: 0.718), and antioxidant/oxidant levels (GPX/MDA: r = 0.768) in chagasic subjects. Of these, MPO, LPO and nitrite biomarkers were highly specific and sensitive for distinguishing seropositive/chagasic subjects from seronegative/healthy controls (p<0.001, training and fitting AUC/ROC >0.95). The MPO (r = 0.664) and LPO (r = 0.841) levels were also correlated with clinical disease state in chagasic subjects (p<0.001). Seronegative/cardiac subjects exhibited up to 77% decline in SOD, 3-5-fold increase in LPO and glutamate pyruvate transaminase (GPT) levels, and statistically insignificant change in MPO, AOPP, MDA, GPX, GSH, and creatine kinase (CK) levels. CONCLUSIONS: The interlinked effects of innate immune responses and antioxidant/oxidant imbalance are major determinants of human Chagas disease. The MPO, LPO and nitrite are excellent biomarkers for diagnosing seropositive/chagasic subjects, and MPO and LPO levels have potential utility in identifying clinical severity of Chagas disease.

Biochemical changes in chronic alcoholics in Port Harcourt: the report of a pilot survey.

AIMS AND OBJECTIVES: Alcohol abuse is a major public health problem and one of the leading causes of preventable death. Data on the frequency of biochemical abnormalities among alcoholics in the Niger Delta region is unavailable. We therefore conducted this pilot study to determine the type of biochemical abnormalities amongst a group of chronic alcoholics in Port Harcourt, Nigeria. SUBJECTS AND METHODS: Thirty (30) subjects aged 40 50 years with a daily alcohol consumption of more than 100g formed the study group. Thirty (30) aged matched controls from the same locality who were non-alcoholics were also recruited. Ten mls (10mls) of venous blood was collected from both subjects and controls from the antecubital fossa after obtaining informed consent into lithium heparin bottles. The plasma was harvested and stored at -20 degrees C until assayed. Plasma bilirubin, aspartate transaminase, alanine transaminase, alkaline phosphatase, gamma glutamyl transferase, glucose, total protein, albumin, magnesium, calcium and inorganic phosphorus were estimated using standard kit methods while plasma potassium was determined by flame photometry. Routine laboratory accuracy and precision controls were utilised. RESULTS: Alcohol abuse was associated with a significantly lower body weight, body mass index and percentage body fat. The plasma sodium, inorganic phosphate, gamma glutamyl transferase were significantly higher in chronic alcohol abuse when compared with normal subjects. On the other hand, the plasma magnesium, potassium, calcium, total protein, albumin and glucose were significantly reduced in the study subjects. CONCLUSION: Biochemical abnormalities are common among chronic alcoholics in this region. They include hypernatraemia, hypoglycaemia, hypocalcaemia, hypomagnesaemia, hypokalaemia, hypoalbuminaemia and hyperphosphataemia. Aspartate transaminase and gamma glutamyl transferase are usually elevated and suggests alcoholic liver damage. Efforts should be made to identify these abnormalities and treat them as it may go a long way towards improving morbidity and mortality of alcohol related diseases.