G6PD deficiency in Latin America: systematic review on prevalence and variants

Plasmodium vivax radical cure requires the use of primaquine (PQ), a drug that induces haemolysis in glucose-6-phosphate dehydrogenase deficient (G6PDd) individuals, which further hampers malaria control efforts. The aim of this work was to study the G6PDd prevalence and variants in Latin America (LA) and the Caribbean region. A systematic search of the published literature was undertaken in August 2013. Bibliographies of manuscripts were also searched and additional references were identified. Low prevalence rates of G6PDd were documented in Argentina, Bolivia, Mexico, Peru and Uruguay, but studies from Curaçao, Ecuador, Jamaica, Saint Lucia, Suriname and Trinidad, as well as some surveys carried out in areas of Brazil, Colombia and Cuba, have shown a high prevalence (> 10%) of G6PDd. The G6PD A-202A mutation was the variant most broadly distributed across LA and was identified in 81.1% of the deficient individuals surveyed. G6PDd is a frequent phenomenon in LA, although certain Amerindian populations may not be affected, suggesting that PQ could be safely used in these specific populations. Population-wide use of PQ as part of malaria elimination strategies in LA cannot be supported unless a rapid, accurate and field-deployable G6PDd diagnostic test is made available

CLINICAL AND LABORATORY ASPECTS OF GLUCOSE-6-PHOSPHATE-DEHYDROGENASE (G-6-PD) DEFICIENCY IN BRAZILIAN NEWBORNS

11371772

UriSed as a screening tool for presumptive diagnosis of urinary tract infection

Background: Although a quantitative urine culture is essential for the final diagnosis of urinary tract infection, it is time-consuming and an expensive procedure. Effective screening tests would be a promising alternative to provide immediate results for the clinician and eliminate unnecessary culturing for most of the negative samples. The aim of this study was to evaluate the performance of an automated sediment analyzer (UriSed) as screening tool for presumptive diagnosis of urinary tract infection. Methods: We studied 1379 fresh midstream clean-catch urine samples from children to elderly. All samples were submitted to automated sediment analysis (UriSed) and quantitative urine culture (CLED medium agar). Results: The sediment analyzer detected leukocyturia and/or significant bacteriuria with sensitivity of 97%, specificity of 59%, positive predictive value of 27%, negative predictive value of 99%, and accuracy of 64% at cutoff values of bacteria count >= 12.6 elements/hpf and WBC >= 6 cells/hpf. These data suggest a potential 52% reduction of unnecessary urine cultures. Conclusion: The UriSed seems to be an efficient tool for screening UTI with high sensitivity and low rate of falsenegative results. (C) 2013 Elsevier B.V. All rights reserved.425777

Electrophoretic pattern of concentrated urine: Comparison between 24-hour collection and random samples:

The electrophoretic pattern of concentrated urine samples can be used to identify the type of proteins leaking into the urine and has diagnostic and prognostic value, providing information about the location (glomerular or tubular) and degree of renal injury. This test usually requires a 24-hour urine collection, which can be inconvenient because of its heavy dependence on patient compliance and frequently is unreliable because of errors in collecting a complete 24-hour urine sample. In this study, we compared the electrophoretic pattern in 24-hour urine collections and random samples among patients with glomerular diseases and a wide range of proteinuria. Forty adult patients were evaluated; 24-hour urine collections and random urine samples were analyzed. Protein concentrations were determined using the sulfosalicylic acid method standardized with human serum. Electrophoresis was performed with concentrated urine samples (Ultrafree, PF/Millipore Corporation, Bedford, MA) using Beckman Paragon Electrophoresis System (agarose gels and blue staining; Beckman Instruments, Inc, Brea, CA). Densitometric scanning of electrophoretic pattern (Appraise Clinical Densitometer; Beckman Instruments, Inc) was performed, and the results were reported in percentages of each observed fraction. Our results revealed that despite the significant difference between protein concentration in 24-hour collections and in random samples, the pattern of protein excretion, in percentage basis, remains the same. There were no differences between the albumin, alpha(1)-globulin, alpha(2)-globulin, beta-globulln, and gamma-globulin fractions in both types of specimens. This study shows that, at least in glomerular proteinuria, the electrophoretic analysis of the urine can be performed accurately in random samples, avoiding the inconveniences and errors of a 24-hour urine collection. (C) 2002 by the National Kidney Foundation, Inc.39

Glomerular and non-glomerular haematuria: Preservation of urine sediment

361064764

Changes in Costs Over Time at a Medium-Sized Clinical Laboratory

This article aims to evaluate the changes in costs over time at a medium-sized Brazilian hospital laboratory through the use of financial and performance indicators. Retrospective and prospective data were collected from the laboratory information system (LIS) and hospital management system (HMS) and used as the basis for the indicators. During the analyzed period, there was a 37% growth in the number of tests produced. Staff numbers did not increase in the same proportion, and there was a 19% increase in general productivity. The average annual unit test cost in 2008 was 26% less than in the previous year. In light of the above, it is clear that cost and process management is essential for the stability and sustainability of the organization. The strengthening of participative management, the redesign of processes, and the appropriate use of information technology resources and quality tools play an important role in achieving satisfactory results.41314514

Accuracy of the urinary albumin to creatinine ratio as a predictor of albuminuria in adults with sickle cell disease

Aim: To test the usefulness of a random urine specimen albumin to creatinine ratio (A/C) in predicting 12 hour urinary albumin excretion (12UA) in patients with sickle cell disease. Methods: 12UA and A/C were measured in nocturnal urine collections and random morning urine samples, respectively, of 72 patients with sickle cell disease. Results: The correlation of A/C values with 12UA values did not provide support for the use of random urine specimens for predicting urinary albumin excretion (UAE) in these patients. However, values of A/C greater than or equal to 0.45 and < 0.45 were indicative of raised and normal UAE, respectively, The sensitivity, specificity, and accuracy of the test were 100.0%, 87.2%, and 91.7%, respectively. Conclusions: This method cannot be recommended for predicting 12UA in patients with sickle cell disease, but it is useful for selecting patients who should collect 12 hour urine for the estimation of UAE.551297397

Serum homocysteine and physical exercise in patients with Parkinson's disease

Background: Hyperhomocysteinemia is a major risk factor for cerebral and peripheral vascular diseases, as well as cortical and hippocampal injury, including an increased risk of dementia and cognitive impairment. Elevated serum homocysteine (Hcy) concentrations are common in patients with Parkinson's disease (PD) who have been treated with levodopa; however, physical exercises can help reduce Hcy concentrations. The aim of the present study was to compare serum Hcy levels in patients with PD who partook in regular physical exercises, sedentary PD patients, and healthy controls. Methods: Sixty individuals were enrolled in the present study across three groups: (i) 17 patients who did not partake of any type of exercise; (ii) 24 PD patients who exercised regularly; and (iii) 19 healthy individuals who did not exercise regularly. All participants were evaluated by Hoehn and Yahr scale, the Unified Parkinson's Disease Rating Scale (UPDRS) and Schwab and England scale (measure daily functionality). The serum levels of Hcy were analyzed by blood samples collected of each participant. An analysis of variance and a Tukey's post hoc test were applied to compare and to verify differences between groups. Pearson's correlation and stepwise multiple regression analyses were used to consider the association between several variables. Results: Mean plasma Hcy concentrations in individuals who exercised regularly were similar to those in the healthy controls and significantly lower than those in the group that did not exercise at all (P = 0.000). In addition, patients who did not exercise were receiving significantly higher doses of levodopa than those patients who exercised regularly (P = 0.001). A positive relationship between levodopa dose and Hcy concentrations (R(2) = 0.27; P = 0.03) was observed in patients who did not exercise, but not in those patients who exercised regularly (R(2) = 0.023; P = 0.15). Conclusions: The results of the present study suggest that, even with regular levodopa therapy, Hcy concentrations in PD patients who exercise regularly are significantly lower than in patients who do not exercise and are similar Hcy concentrations in healthy controls.11210511