Lipodystrophy syndrome among HIV infected children on highly active antiretroviral therapy in northern India.

BACKGROUND: It is estimated that about 2.5 million people are living with HIV infection in India. Although antiretroviral drugs have been able to reduce the mortality, these drugs have serious side effects one of which is lipodystrophy syndrome. Most of the drugs used in HAART viz, protease inhibitors, stavudine and nevirapine are associated with lipodystrophy. Hence we conducted this study to assess the prevalence of lipodystrophy in HIV infected children on HAART and its associated risk factors. MATERIALS AND METHODS: A cross sectional study was conducted on 80 HIV infected children aged 2-18 years of age who were on stavudine based HAART for ≥ 2 years. These children were assessed for presence of lipodystrophy, its metabolic complications and associated risk factors. RESULTS: Lipodystrophy was observed in 33.7% of children with lipoatrophy being the commonest subtype followed by lipohypertrophy. Older age, increased duration of treatment and dyslipidaemia were found to be associated in patients with lipodystrophy than those without. On further multivariate analysis of independent risk factors only increased duration of treatment was significantly associated with lipodystrophy. No association was found with insulin resistance. CONCLUSION: We observed that lipodystrophy is a common finding in HIV patients treated with HAART for long duration.

Preanalytical quality in clinical chemistry laboratory.

BACKGROUND: Haemolysis is usually caused by inadequate specimen collection or preanalytical handling and is suggested to be a suitable indicator of preanalytical quality. We investigated the prevalence of detectable haemolysis in all routine venous blood samples in OPDs and IPDs to identify differences in preanalytical quality. METHODS: Haemolysis index (HI) values were obtained from a Vitros 5,1 in the routine clinical chemistry laboratory for samples collected in the outpatient department (OPD) collection centres, a hospital, and inpatient departments (IPD). Haemolysis was defined as a HI > or = 15 (detection limit). RESULTS: Samples from the OPD with the highest prevalence of haemolysis were 6.1 times (95% confidence interval (CI) 4.0 - 9.2) more often haemolysed compared to the center with the lowest prevalence. Of the samples collected in primary health care, 10.4% were haemolysed compared to 31.1% in the IPDs (p = 0.001). A notable difference in haemolysed samples was found between the IPDs section staffed by emergency medicine physicians and the section staffed by primary health care physicians (34.8% vs. 11.3%, p = 0.001). CONCLUSIONS: The significant variation in haemolysis indices among the investigated units is likely to reflect varying preanalytical conditions. The HI is a valuable tool for estimation and follow-up of preanalytical quality in the health care laboratory.

Delay in specimen processing-major source of preanalytical variation in serum electrolytes.

OBJECTIVE: To evaluate the stability of electrolytes in serum samples due to delay in analysis in a tertiary care government hospital in India, and the maximum time delay acceptable between sample centrifugation and analysis. MATERIALS AND METHODS: We estimated serum electrolytes of 400 samples with different time intervals between centrifugation and sample analysis on automated analyser. RESULTS: Values were compared using repeated measure ANNOVA and acceptable limit change using in house QC values of 6 months. During the time interval between centrifugation and sample analysis, the samples were kept uncovered in sample cups in the laboratory. Potassium values show significant changes within 1 h (T1, p<0.01) but sodium (T2, p <0.01) and chloride (T2, p <0.001) values are acceptable up to a time delay of 3 h between sample centrifugation and analysis. CONCLUSION: Samples for electrolytes should be analysed within 1-2 h of centrifugation and if there is any delay in analysis, the samples should be stored under proper conditions.