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Introduction: Exposure to Bisphenol A (BPA) during early development particularly in-utero has been linked to a wide range of pathology. Over the last two decades the importance of vitamin D in maternal and child health has been highlighted. The aim of this pilot study was to examine the relationship of BPA and its naturally occurring metabolite BPA-glucuronide (BPA-g) with 25-hydoxy vitamin D (25OHD) levels in South African mother-child pairs. Methods: Third-trimester serum maternal samples and matching cord blood samples were analyzed for BPA and BPA-g using liquid chromatography tandem mass spectrometry (LC-MS/MS) and 25OHD3 and 25OHD2 using high performance liquid chromatography. A total of 58 maternal and child pairs were analyzed. Results: More than fifty percent of maternal-child pairs were noted to be vitamin D deficient or insufficient using the Endocrine Society Practice guidelines cut-off of 50 nmol/L. Spearman rank correlation and Kruskal Wallis analysis did not show statistically significant relationship between cord 25OHD (total) and maternal and cord BPA-g concentrations. Analysis of covariance after controlling for confounders showed a significant relationship between cord BPA-g levels and cord 25OHD levels (p=0.03) as well as between maternal BPA-g levels (p=0.04) and cord total 25OHD levels (p=0.04). Discussion: The findings of the current study indicate a possible relationship with BPA/BPA-g and fetal/early infant Vitamin D levels that needs to be further investigated in this population. [ABSTRACT FROM AUTHOR]

This document discusses novel and promising therapies for diabetic dyslipidemia, which is a major risk factor for atherosclerotic cardiovascular disease (ASCVD) in diabetic patients. The dyslipidemia of diabetes is characterized by high triglyceride levels, low levels of high-density lipoprotein (HDL) cholesterol, and elevated levels of apolipoprotein B (apoB). Current guidelines recommend statins as the primary therapy for lowering LDL cholesterol, but there are other therapies being explored, such as bempedoic acid, inhibitors of apolipoprotein C-III, angiopoietin-like 3 (ANGPTL3), and lipoprotein(a). These therapies show promise in reducing ASCVD events, but further clinical trials are needed to confirm their efficacy and safety. [Extracted from the article]

The editorial discusses recent advancements in laboratory testing for the diagnosis and monitoring of endocrine disorders and metabolic diseases. It highlights the use of immunoassays, mass spectrometry, chip technology, and artificial intelligence in improving diagnostic capabilities. The research topic covers various areas such as non-alcoholic fatty liver disease, diabetes mellitus, thyroid-related disorders, and reproductive endocrinology, showcasing new methods and biomarkers for disease detection and monitoring. The authors emphasize the importance of laboratory investigations in improving patient management and treatment outcomes. [Extracted from the article]

Background: Renal complications afflict up to 0.8% of non-cardiac surgery patients. Postoperative urea and electrolyte (U&E) panels, comprised of 7 biochemical analyte tests, are methods used to assess perioperative renal function. However, inappropriate testing (i.e. ordering a subsequent test when there is no indication/risk of renal impairment based on a preceding test) is financially wasteful, increases laboratory workloads and increases unnecessary phlebotomy. African studies on inappropriate U&E postoperative tests are rare. A better understanding of this would assist with improving resource utilization and patient-friendly practices around perioperative testing in this setting. This study sought to address the gap in the knowledge. Methods: This was a retrospective audit involving data from vascular, gynaecology, specialized surgery patients who attended an academic hospital in Durban, South Africa during 2012-2016. Data was collected from the hospital and laboratory administrative systems. The number/proportion of inappropriate U&E tests was computed. The laboratory costs of unnecessary testing (in South African Rands - ZAR, and US$) were also computed. Results: The study sample was comprised of 704 patients. There were 1443 U&E panels ordered, equating to 10101 individual analyte tests. Of the 10101 individual analyte tests, 5161 (51.0%) were unnecessary. The total cost of unnecessary testing was ZAR 135734.30 (US$ 9647.07) based on a currency conversion rate of US$ 1 = ZAR 14.07. Conclusion: Given the high level of unnecessary postoperative U&E testing in our setting and the additional costs incurred, surgical departments should consider implementing algorithms for postoperative renal function testing and electronic gatekeeping for laboratory orders. [ABSTRACT FROM AUTHOR]

Background: Sigma metrics is a quantitative management tool. This study assessed the Six Sigma score for 26 chemistry analytes, compared scores with different total allowable errors (TEa) and use of scores for internal quality control (IQC) rules in 4 Laboratories in Kwa-Zulu Natal, South Africa. Methods: Utilizing 6 months of IQC SD, CV, and bias data on albumin, alkaline phosphatase, alanine aminotransferase, amylase, aspartate aminotransferase, bicarbonate, calcium, total cholesterol, creatine kinase, chloride, creatinine, gamma glutamyl transferase, glucose, HDL-cholesterol, potassium, lactate dehydrogenase, magnesium, sodium, inorganic phosphate, direct bilirubin, total bilirubin, triglycerides, total protein, urea nitrogen, uric acid, and C-reactive protein (CRP) Six Sigma scores were calculated using Microsoft Excel 2016 and ideal IQC rules were determined. Six Sigma scores using Ricos et al. 2014, Royal College of Pathologists Australasia, and Clinical Laboratory Improvement Amendments TEas were compared. Results: For levels 1, 2, and 3 respectively, analytes scoring >3 sigma was 9 (35%), 12 (46%), and 14 (54%) in Laboratory A; Laboratory B had 15 (58%), 19 (73%), and 17 (65%); Laboratory C had 12 (46%), 13 (50%), and 15 (58%); and Laboratory D had 13 (50%), 18 (69%), and 18 (69%). Albumin, calcium, sodium, magnesium, bicarbonate, and chloride scored <3; CRP scored >6 for all. In Laboratories A, B, C, and D, 7 (27%), 7 (27%), 6 (23%), and 8 (31%) analytes, respectively, required only 1 IQC rule. One of 21 analytes for Laboratories C and D, 3 for Laboratory A, and 0 for Laboratory B had the same sigma score with all 3 databases. Conclusion: Despite South Africa being a developing nation, many analytes are able to achieve >3 sigma. [ABSTRACT FROM AUTHOR]

Abstract Background The 516G > T polymorphism in exon 4 of the CYP2B6 gene has been associated with increased plasma Efavirenz (EFV) concentrations. EFV concentrations greater than the recommended therapeutic range have been associated with the increased likelihood of developing adverse CNS effects. The aims of this study were to a) determine the presence of the 516G > T and other CYP2B6 exon 4 polymorphisms in a South African group of HIV-infected individuals b) investigate the relationship between the EFV plasma concentrations, the CYP2B6 516G > T polymorphism and the occurrence of CNS related side effects in this group of patients and c) develop and validate a rapid method for determination of EFV in plasma. Method Data from 80 patients is presented. Genetic polymorphisms in exon 4 of the CYP2B6 gene were identified using PCR amplification of this region followed by sequencing of the amplification products. EFV concentrations were analysed by UPLC-MS/MS. Assessment of the presence of CNS related side effects following EFV initiation were elicited with the use of a questionnaire together with physical examination. Results Plasma EFV concentrations displayed high inter-individual variability amongst subjects with concentrations ranging from 94 μg/l to 23227 μg/l at 2 weeks post initiation of treatment. For the 516G > T polymorphism the following frequencies were observed 23% of patients were TT homozygous, 36% GG and 41% GT. The TT homozygous patients had significantly higher EFV concentrations vs. those with the wild (GG) genotype (p < 0.05). Patients who experienced no side effects had significantly lower EFV plasma concentrations vs. the group of patients which experienced the most severe side effects (p < 0.05). Conclusion The significant association between the 516G > T polymorphism and plasma EFV concentrations has been demonstrated in this study. A rapid and sensitive method for the measurement of plasma EFV concentration was developed and validated.

Rejections of clinical chemistry specimens delays the availability of results, which may impact patient management. The study aims to measure sample rejection rate, identify reasons for sample rejection, evaluate the effect of a campaign to reduce rejection rates and discover which clinical units produced the most insufficient specimen. The study measured specimen rejection rates and the contributions of different rejection reasons in calendar 2016 and April 2018–March 2019. The study undertook a 7-intervention campaign to reduce specimen rejection during the 2018–2019 intervention period. It compared rejections rates, number of months with rejection rates ≤1.2%, and distribution of rejection reasons between the two year-long intervals. The study also determined the origin for specimens rejected for the most common rejection reason during one month in the second period. The overall rejection rate fell significantly from 1.4% in pre-intervention period to 1.2% in the intervention period. The number of months with rejection rates within the target range increased significantly from 2 in the post-intervention period to 6 in the intervention period. Insufficient, hemolysed, and 'too-old' specimen decreased significantly, however, insufficient specimen remained the most frequent rejection reason. In February 2019, one-third of all insufficient specimen came from neonatal units and 24% from the pediatric units. Interventions decreased significantly both overall and monthly rejection rates above target levels. Insufficient, hemolysed, 'too-old' specimen, became significantly less frequent, however, insufficient specimen remained the most frequent rejection reason. Over a month, most insufficient specimen came from neonatal and pediatric sites. [ABSTRACT FROM AUTHOR]

The pituitary gland is responsible for the production and/or secretion of various hormones that play a vital role in regulating endocrine function within the body. Secretory tumors of the anterior pituitary predominantly, pituitary adenomas, collectively account for 10%–25% of central nervous system tumors requiring surgical treatment. The most common secretory tumors are prolactinomas, which can be diagnosed by basal prolactin levels. Acromegaly can be diagnosed by basal insulin growth-like factor 1 levels and the failure of growth hormone (GH) to suppress during an oral glucose tolerance test. Cushing disease can be diagnosed by demonstrating hypercortisolemia evidenced by increased salivary cortisol levels in the evening, increased urine free cortisol excretion and failure of plasma cortisol to suppress following oral dexamethasone given overnight (1.0 mg). We also discuss the diagnosis of the rarer thyroid-stimulating hormone and gonadotrophin secretory tumors. Morbidity is associated with tumor occurrence, clinical sequelae as well as the related medical, surgical and radiological management. This review focuses on the pathogenesis of secretory tumors of the anterior pituitary with emphasis on molecular mechanisms associated with tumorigenesis and the major role of the clinical chemistry laboratory in diagnosis and management of these tumors. [ABSTRACT FROM AUTHOR]

Background The use of serum creatinine equations for estimating glomerular filtration rate is well known in adults and children. We evaluated the revised Schwartz creatinine-based estimated glomerular filtration rate prediction equation in Black African children in KwaZulu-Natal, South Africa. Methods Review of medical records of all Black African patients aged 2-18 years old who have had glomerular filtration rate determined by intravenous Technetium-99 m-diethylene-triamine-pentaacetate, for the period 1 January 2010 to 31 December 2014 at the Inkosi Albert Luthuli Central Hospital, Durban, South Africa was performed. Estimated glomerular filtration rate result obtained using the revised Schwartz equation was compared to Technetium-99 m-diethylene-triamine-pentaacetate plasma clearance measured glomerular filtration rate. Accuracy of the estimated glomerular filtration rate equations within 10% (P10) and 30% (P30) of the measured glomerular filtration rate, sensitivity and specificity for predicting glomerular filtration rate < 60 mL/min/1.73 m2 and < 30 mL/min/1.73 m2 was determined. Results Results from 148 African children between 2 and 18 years old were analysed. P10 and P30 values were 16 and 49%, respectively. Sensitivity of 92.9% (95% CI: 80.5-85), specificity of 95.3 (95% CI: 89.3-98.5) and AUC of 0.96 (95% CI 0.92-0.99) were obtained for measured estimated glomerular filtration rate < 60 mL/min/1.73 m2. Sensitivity of 88.2% (95% CI: 63.6-98.5), specificity of 90.8 (95% CI: 84.5-95.2) and area under the curve of 0.93 (95% CI 0.88-0.96) were obtained for measured estimated glomerular filtration rate < 30 mL/min/1.73 m2. Conclusions The revised Schwartz equation did not meet the National Kidney Foundation Kidney Disease Outcomes Quality Initiative guidelines of 90% of estimated glomerular filtration rate results within 30% of measured glomerular filtration rate. [ABSTRACT FROM AUTHOR]