1
|
Sodi R. Commentary on Persistent Hypercalcemia: Choose Your Testing Strategy Carefully. Clin Chem 2023; 69:335. [PMID: 37011000 DOI: 10.1093/clinchem/hvad009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Accepted: 01/26/2023] [Indexed: 04/04/2023]
Affiliation(s)
- Ravinder Sodi
- Department of Clinical Biochemistry, Broomfield Hospital, Mid & South Essex NHS Trust, Chelmsford, CM1 7ET, United Kingdom
| |
Collapse
|
2
|
Pappachan JM, Lahart IM, Viswanath AK, Borumandi F, Sodi R, Metzendorf MI, Bongaerts B. Parathyroidectomy for adults with primary hyperparathyroidism. Cochrane Database Syst Rev 2023; 3:CD013035. [PMID: 36883976 PMCID: PMC9995748 DOI: 10.1002/14651858.cd013035.pub2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/09/2023]
Abstract
BACKGROUND Primary hyperparathyroidism (PHPT), a disorder in which the parathyroid glands produce excessive amounts of parathyroid hormone, is most common in older adults and postmenopausal women. While most people with PHPT are asymptomatic at diagnosis, symptomatic disease can lead to hypercalcaemia, osteoporosis, renal stones, cardiovascular abnormalities and reduced quality of life. Surgical removal of abnormal parathyroid tissue (parathyroidectomy) is the only established treatment for adults with symptomatic PHPT to prevent exacerbation of symptoms and to be cured of PHPT. However, the benefits and risks of parathyroidectomy compared to simple observation or medical therapy for asymptomatic and mild PHPT are not well established. OBJECTIVES To evaluate the benefits and harms of parathyroidectomy in adults with PHPT compared to simple observation or medical therapy. SEARCH METHODS We searched CENTRAL, MEDLINE, LILACS, ClinicalTrials.gov and WHO ICTRP from their date of inception until 26 November 2021. We applied no language restrictions. SELECTION CRITERIA We included randomised controlled trials (RCTs) comparing parathyroidectomy with simple observation or medical therapy for the treatment of adults with PHPT. DATA COLLECTION AND ANALYSIS We used standard Cochrane methods. Our primary outcomes were 1. cure of PHPT, 2. morbidity related to PHPT and 3. serious adverse events. Our secondary outcomes were 1. all-cause mortality, 2. health-related quality of life and 3. hospitalisation for hypercalcaemia, acute renal impairment or pancreatitis. We used GRADE to assess the certainty of the evidence for each outcome. MAIN RESULTS We identified eight eligible RCTs that included 447 adults with (mostly asymptomatic) PHPT; 223 participants were randomised to parathyroidectomy. Follow-up duration varied from six months to 24 months. Of the 223 participants (37 men) randomised to surgery, 164 were included in the analyses, of whom 163 were cured at six to 24 months (overall cure rate 99%). Parathyroidectomy compared to observation probably results in a large increase in cure rate at six to 24 months follow-up: 163/164 participants (99.4%) in the parathyroidectomy group and 0/169 participants in the observation or medical therapy group were cured of their PHPT (8 studies, 333 participants; moderate certainty). No studies explicitly reported intervention effects on morbidities related to PHPT, such as osteoporosis, osteopenia, kidney dysfunction, urolithiasis, cognitive dysfunction or cardiovascular disease, although some studies reported surrogate outcomes for osteoporosis and cardiovascular disease. A post-hoc analysis revealed that parathyroidectomy, compared to observation or medical therapy, may have little or no effect after one to two years on bone mineral density (BMD) at the lumbar spine (mean difference (MD) 0.03 g/cm2,95% CI -0.05 to 0.12; 5 studies, 287 participants; very low certainty). Similarly, compared to observation, parathyroidectomy may have little or no effect on femoral neck BMD after one to two years (MD -0.01 g/cm2, 95% CI -0.13 to 0.11; 3 studies, 216 participants; very low certainty). However, the evidence is very uncertain for both BMD outcomes. Furthermore, the evidence is very uncertain about the effect of parathyroidectomy on improving left ventricular ejection fraction (MD -2.38%, 95% CI -4.77 to 0.01; 3 studies, 121 participants; very low certainty). Four studies reported serious adverse events. Three of these reported zero events in both the intervention and control groups; consequently, we were unable to include data from these three studies in the pooled analysis. The evidence suggests that parathyroidectomy compared to observation may have little or no effect on serious adverse events (RR 3.35, 95% CI 0.14 to 78.60; 4 studies, 168 participants; low certainty). Only two studies reported all-cause mortality. One study could not be included in the pooled analysis as zero events were observed in both the intervention and control groups. Parathyroidectomy compared to observation may have little or no effect on all-cause mortality, but the evidence is very uncertain (RR 2.11, 95% CI 0.20 to 22.60; 2 studies, 133 participants; very low certainty). Three studies measured health-related quality of life using the 36-Item Short Form Health Survey (SF-36) and reported inconsistent differences in scores for different domains of the questionnaire between parathyroidectomy and observation. Six studies reported hospitalisations for the correction of hypercalcaemia. Two studies reported zero events in both the intervention and control groups and could not be included in the pooled analysis. Parathyroidectomy, compared to observation, may have little or no effect on hospitalisation for hypercalcaemia (RR 0.91, 95% CI 0.20 to 4.25; 6 studies, 287 participants; low certainty). There were no reported hospitalisations for renal impairment or pancreatitis. AUTHORS' CONCLUSIONS In accordance with the literature, our review findings suggest that parathyroidectomy, compared to simple observation or medical (etidronate) therapy, probably results in a large increase in cure rates of PHPT (with normalisation of serum calcium and parathyroid hormone levels to laboratory reference values). Parathyroidectomy, compared with observation, may have little or no effect on serious adverse events or hospitalisation for hypercalcaemia, and the evidence is very uncertain about the effect of parathyroidectomy on other short-term outcomes, such as BMD, all-cause mortality and quality of life. The high uncertainty of evidence limits the applicability of our findings to clinical practice; indeed, this systematic review provides no new insights with regard to treatment decisions for people with (asymptomatic) PHPT. In addition, the methodological limitations of the included studies, and the characteristics of the study populations (mainly comprising white women with asymptomatic PHPT), warrant caution when extrapolating the results to other populations with PHPT. Large-scale multi-national, multi-ethnic and long-term RCTs are needed to explore the potential short- and long-term benefits of parathyroidectomy compared to non-surgical treatment options with regard to osteoporosis or osteopenia, urolithiasis, hospitalisation for acute kidney injury, cardiovascular disease and quality of life.
Collapse
Affiliation(s)
- Joseph M Pappachan
- Department of Endocrinology & Metabolism, Lancashire Teaching Hospitals NHS Trust, Preston, UK
- Faculty of Science, Manchester Metropolitan University, Manchester, UK
- University of Manchester Medical School, Manchester, UK
| | - Ian M Lahart
- Faculty of Education, Health and Wellbeing, University of Wolverhampton, Walsall, UK
| | | | - Farzad Borumandi
- Department of Oral and Maxillofacial Surgery, University Hospitals Sussex NHS Foundation Trust, St. Richard's Hospital, Chichester and Worthing Hospital, Worthing, UK
| | - Ravinder Sodi
- Biochemistry, Pathology Department, Broomfield Hospital, Mid & South Essex NHS Foundation Trust, Chelmsford, UK
| | - Maria-Inti Metzendorf
- Institute of General Practice, Medical Faculty of the Heinrich-Heine University Düsseldorf, Düsseldorf, Germany
| | - Brenda Bongaerts
- Institute of General Practice, Medical Faculty of the Heinrich-Heine University Düsseldorf, Düsseldorf, Germany
| |
Collapse
|
3
|
Sodi R. Finding the broken helix: The mainstreaming of genomic medicine into clinical biochemistry. Ann Clin Biochem 2022; 59:159-161. [PMID: 35224982 DOI: 10.1177/00045632221080044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Ravinder Sodi
- Department of Clinical Biochemistry, University Hospitals Dorset & Bournemouth University, Dorset, UK
| |
Collapse
|
4
|
Rohaim MA, Clayton E, Sahin I, Vilela J, Khalifa ME, Al-Natour MQ, Bayoumi M, Poirier AC, Branavan M, Tharmakulasingam M, Chaudhry NS, Sodi R, Brown A, Burkhart P, Hacking W, Botham J, Boyce J, Wilkinson H, Williams C, Whittingham-Dowd J, Shaw E, Hodges M, Butler L, Bates MD, La Ragione R, Balachandran W, Fernando A, Munir M. Artificial Intelligence-Assisted Loop Mediated Isothermal Amplification (AI-LAMP) for Rapid Detection of SARS-CoV-2. Viruses 2020; 12:v12090972. [PMID: 32883050 PMCID: PMC7552048 DOI: 10.3390/v12090972] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Revised: 08/22/2020] [Accepted: 08/24/2020] [Indexed: 01/13/2023] Open
Abstract
Until vaccines and effective therapeutics become available, the practical solution to transit safely out of the current coronavirus disease 19 (CoVID-19) lockdown may include the implementation of an effective testing, tracing and tracking system. However, this requires a reliable and clinically validated diagnostic platform for the sensitive and specific identification of SARS-CoV-2. Here, we report on the development of a de novo, high-resolution and comparative genomics guided reverse-transcribed loop-mediated isothermal amplification (LAMP) assay. To further enhance the assay performance and to remove any subjectivity associated with operator interpretation of results, we engineered a novel hand-held smart diagnostic device. The robust diagnostic device was further furnished with automated image acquisition and processing algorithms and the collated data was processed through artificial intelligence (AI) pipelines to further reduce the assay run time and the subjectivity of the colorimetric LAMP detection. This advanced AI algorithm-implemented LAMP (ai-LAMP) assay, targeting the RNA-dependent RNA polymerase gene, showed high analytical sensitivity and specificity for SARS-CoV-2. A total of ~200 coronavirus disease (CoVID-19)-suspected NHS patient samples were tested using the platform and it was shown to be reliable, highly specific and significantly more sensitive than the current gold standard qRT-PCR. Therefore, this system could provide an efficient and cost-effective platform to detect SARS-CoV-2 in resource-limited laboratories.
Collapse
Affiliation(s)
- Mohammed A. Rohaim
- Division of Biomedical and Life Sciences, Faculty of Health and Medicine, The Lancaster University, Lancaster LA1 4YW, UK; (M.A.R.); (E.C.); (I.S.); (J.V.); (M.E.K.); (M.Q.A.-N.); (M.B.); (J.W.-D.); (E.S.); (M.H.); (L.B.); (M.D.B.)
| | - Emily Clayton
- Division of Biomedical and Life Sciences, Faculty of Health and Medicine, The Lancaster University, Lancaster LA1 4YW, UK; (M.A.R.); (E.C.); (I.S.); (J.V.); (M.E.K.); (M.Q.A.-N.); (M.B.); (J.W.-D.); (E.S.); (M.H.); (L.B.); (M.D.B.)
| | - Irem Sahin
- Division of Biomedical and Life Sciences, Faculty of Health and Medicine, The Lancaster University, Lancaster LA1 4YW, UK; (M.A.R.); (E.C.); (I.S.); (J.V.); (M.E.K.); (M.Q.A.-N.); (M.B.); (J.W.-D.); (E.S.); (M.H.); (L.B.); (M.D.B.)
| | - Julianne Vilela
- Division of Biomedical and Life Sciences, Faculty of Health and Medicine, The Lancaster University, Lancaster LA1 4YW, UK; (M.A.R.); (E.C.); (I.S.); (J.V.); (M.E.K.); (M.Q.A.-N.); (M.B.); (J.W.-D.); (E.S.); (M.H.); (L.B.); (M.D.B.)
| | - Manar E. Khalifa
- Division of Biomedical and Life Sciences, Faculty of Health and Medicine, The Lancaster University, Lancaster LA1 4YW, UK; (M.A.R.); (E.C.); (I.S.); (J.V.); (M.E.K.); (M.Q.A.-N.); (M.B.); (J.W.-D.); (E.S.); (M.H.); (L.B.); (M.D.B.)
| | - Mohammad Q. Al-Natour
- Division of Biomedical and Life Sciences, Faculty of Health and Medicine, The Lancaster University, Lancaster LA1 4YW, UK; (M.A.R.); (E.C.); (I.S.); (J.V.); (M.E.K.); (M.Q.A.-N.); (M.B.); (J.W.-D.); (E.S.); (M.H.); (L.B.); (M.D.B.)
| | - Mahmoud Bayoumi
- Division of Biomedical and Life Sciences, Faculty of Health and Medicine, The Lancaster University, Lancaster LA1 4YW, UK; (M.A.R.); (E.C.); (I.S.); (J.V.); (M.E.K.); (M.Q.A.-N.); (M.B.); (J.W.-D.); (E.S.); (M.H.); (L.B.); (M.D.B.)
| | - Aurore C. Poirier
- Department of Pathology and Infectious Diseases, School of Veterinary Medicine, University of Surrey, Guildford GU2 7AL, UK; (A.C.P.); (R.L.R.)
| | - Manoharanehru Branavan
- College of Engineering, Design and Physical Sciences, Brunel University London, Kingston Lane, Uxbridge UB8 3PH, UK; (M.B.); (W.B.)
| | - Mukunthan Tharmakulasingam
- Centre for Vision, Speech and Signal Processing, University of Surrey, Guildford GU2 7XH, UK; (M.T.); (N.S.C.); (A.F.)
| | - Nouman S. Chaudhry
- Centre for Vision, Speech and Signal Processing, University of Surrey, Guildford GU2 7XH, UK; (M.T.); (N.S.C.); (A.F.)
| | - Ravinder Sodi
- Department of Biochemistry, Poole & Bournemouth Hospitals NHS Trust, Longfleet Road, Poole BH15 2JB, UK;
| | - Amy Brown
- The Royal Lancaster Infirmary, University Hospitals of Morecambe Bay NHS, Foundation Trust, Kendal LA9 7RG, UK; (A.B.); (P.B.); (W.H.); (J.B.); (J.B.); (H.W.); (C.W.)
| | - Peter Burkhart
- The Royal Lancaster Infirmary, University Hospitals of Morecambe Bay NHS, Foundation Trust, Kendal LA9 7RG, UK; (A.B.); (P.B.); (W.H.); (J.B.); (J.B.); (H.W.); (C.W.)
| | - Wendy Hacking
- The Royal Lancaster Infirmary, University Hospitals of Morecambe Bay NHS, Foundation Trust, Kendal LA9 7RG, UK; (A.B.); (P.B.); (W.H.); (J.B.); (J.B.); (H.W.); (C.W.)
| | - Judy Botham
- The Royal Lancaster Infirmary, University Hospitals of Morecambe Bay NHS, Foundation Trust, Kendal LA9 7RG, UK; (A.B.); (P.B.); (W.H.); (J.B.); (J.B.); (H.W.); (C.W.)
| | - Joe Boyce
- The Royal Lancaster Infirmary, University Hospitals of Morecambe Bay NHS, Foundation Trust, Kendal LA9 7RG, UK; (A.B.); (P.B.); (W.H.); (J.B.); (J.B.); (H.W.); (C.W.)
| | - Hayley Wilkinson
- The Royal Lancaster Infirmary, University Hospitals of Morecambe Bay NHS, Foundation Trust, Kendal LA9 7RG, UK; (A.B.); (P.B.); (W.H.); (J.B.); (J.B.); (H.W.); (C.W.)
| | - Craig Williams
- The Royal Lancaster Infirmary, University Hospitals of Morecambe Bay NHS, Foundation Trust, Kendal LA9 7RG, UK; (A.B.); (P.B.); (W.H.); (J.B.); (J.B.); (H.W.); (C.W.)
| | - Jayde Whittingham-Dowd
- Division of Biomedical and Life Sciences, Faculty of Health and Medicine, The Lancaster University, Lancaster LA1 4YW, UK; (M.A.R.); (E.C.); (I.S.); (J.V.); (M.E.K.); (M.Q.A.-N.); (M.B.); (J.W.-D.); (E.S.); (M.H.); (L.B.); (M.D.B.)
| | - Elisabeth Shaw
- Division of Biomedical and Life Sciences, Faculty of Health and Medicine, The Lancaster University, Lancaster LA1 4YW, UK; (M.A.R.); (E.C.); (I.S.); (J.V.); (M.E.K.); (M.Q.A.-N.); (M.B.); (J.W.-D.); (E.S.); (M.H.); (L.B.); (M.D.B.)
| | - Matt Hodges
- Division of Biomedical and Life Sciences, Faculty of Health and Medicine, The Lancaster University, Lancaster LA1 4YW, UK; (M.A.R.); (E.C.); (I.S.); (J.V.); (M.E.K.); (M.Q.A.-N.); (M.B.); (J.W.-D.); (E.S.); (M.H.); (L.B.); (M.D.B.)
| | - Lisa Butler
- Division of Biomedical and Life Sciences, Faculty of Health and Medicine, The Lancaster University, Lancaster LA1 4YW, UK; (M.A.R.); (E.C.); (I.S.); (J.V.); (M.E.K.); (M.Q.A.-N.); (M.B.); (J.W.-D.); (E.S.); (M.H.); (L.B.); (M.D.B.)
| | - Michelle D. Bates
- Division of Biomedical and Life Sciences, Faculty of Health and Medicine, The Lancaster University, Lancaster LA1 4YW, UK; (M.A.R.); (E.C.); (I.S.); (J.V.); (M.E.K.); (M.Q.A.-N.); (M.B.); (J.W.-D.); (E.S.); (M.H.); (L.B.); (M.D.B.)
| | - Roberto La Ragione
- Department of Pathology and Infectious Diseases, School of Veterinary Medicine, University of Surrey, Guildford GU2 7AL, UK; (A.C.P.); (R.L.R.)
| | - Wamadeva Balachandran
- College of Engineering, Design and Physical Sciences, Brunel University London, Kingston Lane, Uxbridge UB8 3PH, UK; (M.B.); (W.B.)
| | - Anil Fernando
- Centre for Vision, Speech and Signal Processing, University of Surrey, Guildford GU2 7XH, UK; (M.T.); (N.S.C.); (A.F.)
| | - Muhammad Munir
- Division of Biomedical and Life Sciences, Faculty of Health and Medicine, The Lancaster University, Lancaster LA1 4YW, UK; (M.A.R.); (E.C.); (I.S.); (J.V.); (M.E.K.); (M.Q.A.-N.); (M.B.); (J.W.-D.); (E.S.); (M.H.); (L.B.); (M.D.B.)
- Correspondence:
| |
Collapse
|
5
|
Abstract
Acute myocardial infarction (AMI) and heart failure (HF) are two major causes of cardiovascular mortality and morbidity. Early diagnosis of these conditions is essential to instigate immediate treatment that may result in improved outcomes. Traditional biomarkers of AMI include cardiac troponins and other proteins released from the injured myocardium but there are a number of limitations with these biomarkers especially with regard to specificity. In the past few years circulating nucleic acids, notably microRNA that are small non-coding RNAs that regulate various cellular processes, have been investigated as biomarkers of disease offering improved sensitivity and specificity in the diagnosis and prognostication of various conditions. In this review, the role of microRNAs as biomarkers used in the diagnosis of AMI and HF is discussed, their advantage over traditional biomarkers is outlined and the potential for their implementation in clinical practice is critically assessed.
Collapse
Affiliation(s)
- En C Fung
- Department of Laboratory Services, Raja Isteri Pengiran Anak Saleha (RIPAS) Hospital, Bandar Seri Begawan, Brunei Darussalam
| | - Asif N Butt
- Department of Clinical Biochemistry, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Jarlath Eastwood
- Aberdeen Royal Infirmary, NHS Grampian, Aberdeen, United Kingdom
| | - Ramasamyiyer Swaminathan
- Department of Clinical Biochemistry, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Ravinder Sodi
- Department of Blood Sciences, University Hospitals of Morecambe Bay NHS Foundation Trust, Lancaster, United Kingdom; Lancaster Medical School, Lancaster University, Lancaster, United Kingdom.
| |
Collapse
|
6
|
Toosy S, Sodi R, Pappachan JM. Lean polycystic ovary syndrome (PCOS): an evidence-based practical approach. J Diabetes Metab Disord 2018; 17:277-285. [PMID: 30918863 PMCID: PMC6405408 DOI: 10.1007/s40200-018-0371-5] [Citation(s) in RCA: 57] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Accepted: 11/07/2018] [Indexed: 02/06/2023]
Abstract
BACKGROUND Polycystic ovary syndrome (PCOS) is a common endocrinopathy affecting women of reproductive age. Common features include menstrual irregularities, hyperandrogenism and polycystic ovarian morphology although the presentation can be heterogeneous. Insulin resistance is thought to be responsible for the hormonal and metabolic derangements observed. PCOS has two phenotypes, overweight/obese and lean, the latter being a much less common presentation of the syndrome. AIMS The aim of the present review is to summarise cardinal features, and to devise diagnostic and treatment algorithms for lean PCOS based on recent literature. METHODS We searched PubMed, EBSCOhost and Google Scholar using search terms such as 'lean polycystic ovary syndrome' OR 'lean polycystic ovarian syndrome' OR 'lean PCOS' OR 'lean polycystic ovary disease' OR 'lean polycystic ovarian disease' OR 'lean PCOD' OR 'hyperandrogenism' AND 'low BMI OR 'low body mass index' to identify potential articles to be included in the review. Citation searches were subsequently performed in order to find relevant literature. RESULTS Hormonal, metabolic and haematological profiles were altered in lean women with PCOS compared to healthy counterparts. However, the derangements were either comparable or less obvious compared to obese women with the syndrome. Insulin resistance seemed inherent in PCOS independent of obesity. Treatment options included weight maintenance, restoration of ovulation with insulin-sensitizers such as metformin, relief of symptoms such as hirsutism, acne and menstrual dysfunction, and assisted reproductive technologies in refractory cases, all of which showed promising results. The literature with evidence on lean PCOS is of low to moderate quality and there are still some uncertainties in the evidence base. CONCLUSION Carefully designed randomised controlled trials are required to confirm findings of previous studies in lean PCOS and to consolidate diagnostic and management algorithms proposed in this review. This paper will aid health professionals to improve their clinical approach in managing lean women with PCOS.
Collapse
Affiliation(s)
- Sehar Toosy
- 0000 0000 8190 6402grid.9835.7Lancaster University, Lancaster, LA1 4YW UK
| | - Ravinder Sodi
- 0000000404156862grid.488594.cDepartment of Biochemistry and Blood Sciences, University Hospitals of Morecambe Bay NHS Foundation Trust, Lancaster, LA1 4RP UK
| | - Joseph M. Pappachan
- 0000 0001 0642 1066grid.433807.bDepartment of Endocrinology, Diabetes & Metabolism, Pilgrim Hospital, United Lincolnshire Hospitals NHS Trust, Lincoln, PE21 9QS UK
| |
Collapse
|
7
|
Affiliation(s)
- Ravinder Sodi
- Department of Blood Sciences, Royal Lancaster Infirmary & Furness General Hospital, University Hospitals of Morecambe Bay NHS Foundation Trust, Lancaster, UK
- Lancaster Medical School, University of Lancaster, Lancaster, UK
| | | | - Srilatha Dampetla
- Department of Medicine, Royal Lancaster Infirmary, University Hospitals of Morecambe Bay NHS Foundation Trust, Lancaster, UK
| | - Joseph M Pappachan
- Department of Medicine, Royal Lancaster Infirmary, University Hospitals of Morecambe Bay NHS Foundation Trust, Lancaster, UK
| |
Collapse
|
8
|
Pappachan JM, Elnaggar MN, Sodi R, Jbeili K, Smith PR, Lahart IM. Primary hyperparathyroidism: findings from the retrospective evaluation of cases over a 6-year period from a regional UK centre. Endocrine 2018; 62:174-181. [PMID: 30019307 DOI: 10.1007/s12020-018-1676-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2018] [Accepted: 07/02/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND Although there are international guidelines on diagnosis and management of primary hyperparathyroidism (PHPT), clinical practice varies in different centres. Periodic review of diagnostic work-up, surgical treatment by parathyroidectomy (PTX) and clinical surveillance in nonsurgical treatment group among patients with PHPT is expected to improve the quality of care. We report a retrospective study of cases with PHPT managed at a regional centre in the United Kingdom. METHODS Clinical data of cases with calcium ≥2.6 mmol/L and parathyroid hormone (PTH) ≥9.0 pmol/L was procured from biochemistry database from January 2011 to December 2016. Laboratory parameters, imaging studies for renal stones, osteoporosis and localisation of parathyroid adenomas, type of treatment received (PTX or nonsurgical), complications of treatment, other medical co-morbidities and mortality during follow-up was recorded in each case to examine the outcomes of care of patients with PHPT. RESULTS The study included 160 patients: 127 (79%) females and 33 (21%) males. Median age was 70 years in females and 74 in males. Thirty cases (19% of 159) had renal stones and 47 (37.3% of 126) had osteoporosis. Eighty-one cases (51%) received PTX. Logistic regression analysis showed that higher calcium levels (odds ratio (OR) = 73.991; p < 0.001), peak PTH (OR = 1.023; p = 0.025), peak alkaline phosphatase (OR = 0.985, p < 0.001), lower age (OR = 0.985, p < 0.001) and male gender (OR = 0.209, p < 0.002) as statistically significant predictors for patients receiving PTX. Higher age at diagnosis of PHPT was associated with increased risk of co-existent hypertension (OR = 10.904, p = 0.001) and fractures (OR = 1.067, p = 0.004). Higher peak calcium concentration was an independent predictor of acute kidney injury (OR = 9.631, p = 0.011). PTX cured 76 cases (94%) with only 7 (9%) postoperative complications. Twenty-four cases (15%) died from the entire cohort (only one from PTX group) during a median follow-up period of 3.6 years (interquartile range = 1.5). CONCLUSIONS PTX treatment is associated with cure of disease in patients with PHPT with acceptable risk of complications. Improvements in diagnostic work-up and follow-up care should improve the morbidity from PHPT.
Collapse
Affiliation(s)
- Joseph M Pappachan
- Department of Endocrinology, Diabetes and Metabolism, University Hospitals of Morecambe Bay NHS Foundation Trust, Lancaster, LA1 4RP, UK.
| | - Mohamed Nabil Elnaggar
- Department of Endocrinology, Diabetes and Metabolism, University Hospitals of Morecambe Bay NHS Foundation Trust, Lancaster, LA1 4RP, UK
- Internal Medicine Department, Faculty of Medicine, Kafr El-Sheikh University, Kafr El-Sheikh, Egypt
| | - Ravinder Sodi
- Department of Biochemistry and Blood Sciences, University Hospitals of Morecambe Bay NHS Foundation Trust, Lancaster, LA1 4RP, UK
| | - Kahtan Jbeili
- Department of Endocrinology, Diabetes and Metabolism, University Hospitals of Morecambe Bay NHS Foundation Trust, Lancaster, LA1 4RP, UK
| | - Paul R Smith
- Department of Endocrinology, Diabetes and Metabolism, University Hospitals of Morecambe Bay NHS Foundation Trust, Lancaster, LA1 4RP, UK
| | - Ian M Lahart
- Faculty of Education, Health and Wellbeing, University of Wolverhampton, Walsall, UK
| |
Collapse
|
9
|
Abstract
This is a protocol for a Cochrane Review (Intervention). The objectives are as follows: To assess the effects of parathyroidectomy for adults with PHPT. We will also compare the effects of different types of parathyroidectomy on people with PHPT.
Collapse
Affiliation(s)
- Joseph M Pappachan
- University Hospitals of Morecambe Bay NHS Foundation TrustEndocrinologyAshton RoadLancasterUKLA1 4RP
| | - Ravinder Sodi
- University Hospitals of Morecambe Bay NHS Foundation TrustClinical SciencesAshton RoadLancasterUKLA1 4RP
| | - Ananth K Viswanath
- New Cross HospitalEndocrinologyWolverhampton RoadWolverhamptonUKWV10 0QP
| | - Ian M Lahart
- University of WolverhamptonFaculty of Education, Health and WellbeingGorway RoadWalsallUKWS1 3BD
| |
Collapse
|
10
|
Affiliation(s)
- Ravinder Sodi
- Department of Biochemistry, Blood Sciences, Royal Lancaster Infirmary & Furness General Hospital, University Hospitals of Morecambe Bay NHS Foundation Trust, Lancaster, UK; .,Lancaster Medical School, University of Lancaster, Lancaster, UK
| | - David Hall
- Medwyn Medical Practice, Carnwath, Lanarkshire, UK
| |
Collapse
|
11
|
Abstract
PURPOSE OF REVIEW Pheochromocytomas and paragangliomas (PPGLs) are uncommon catecholamine-producing neuroendocrine neoplasms that usually present with secondary hypertension. This review is to update the current knowledge about these neoplasms, the pathophysiology, genetic aspects and diagnostic and therapeutic algorithms based on scientific literature mostly within the past 3 years. RECENT FINDINGS Eighty to eighty-five percent of PPGLs arise from the adrenal medulla (pheochromocytomas; PCCs) and the remainder from the autonomic neural ganglia (paragangliomas; PGLs). Catecholamine excess causes chronic or paroxysmal hypertension associated with sweating, headaches and palpitations, the presenting features of PPGLs, and increases the cardiovascular morbidity and mortality. Genetic testing should be considered in all cases as mutations are reported in 35-40% of cases; 10-15% of PCCs and 20-50% of PGLs can be malignant. Measurements of plasma-free metanephrines or 24-h urine-fractionated metanephrines help biochemical diagnosis with high sensitivity and specificity. Initial anatomical localization after biochemical confirmation is usually with computed tomography (CT) or magnetic resonance imaging (MRI). 123Iodine metaiodobenzylguanidine (123I-MIBG) scintigraphy, positron emission tomography (PET) or single-photon emission computed tomography (SPECT) is often performed for functional imaging and prognostication prior to curative or palliative surgery. Clinical and biochemical follow-up is recommended at least annually after complete tumour excision. Children, pregnant women and older people have higher morbidity and mortality risk. De-bulking surgery, chemotherapy, radiotherapy, radionuclide agents and ablation procedures are useful in the palliation of incurable disease. PPGLs are unique neuroendocrine tumours that form an important cause for endocrine hypertension. The diagnostic and therapeutic algorithms are updated in this comprehensive article.
Collapse
Affiliation(s)
- Joseph M Pappachan
- Department of Endocrinology and Metabolism, University Hospitals of Morecambe Bay NHS Foundation Trust, Lancaster, LA1 4RP, UK.
| | - Nyo Nyo Tun
- Metabolic Unit, Western General Hospital, Edinburgh, UK
| | | | - Ravinder Sodi
- Department of Biochemistry and Blood Sciences, University Hospitals of Morecambe Bay NHS Foundation Trust, Lancaster, LA1 4RP, UK
| | - Fahmy W F Hanna
- Department of Endocrinology and Metabolism, The Royal Stoke University Hospital and North Staffordshire University, Stoke-on-Trent, ST4 6QG, UK
| |
Collapse
|
12
|
Raistrick M, Holland S, Muraski P, Boyle A, Brown A, Sodi R, Walls G. Optimised intraoperative parathyroid hormone (PTH) assay for shortening the duration of parathyroid surgery. Eur J Surg Oncol 2017. [DOI: 10.1016/j.ejso.2017.10.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
|
13
|
Sodi R. Green Serum After Parathyroidectomy. Clin Chem 2017; 63:1909-1910. [PMID: 29184041 DOI: 10.1373/clinchem.2017.276352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2017] [Accepted: 06/07/2017] [Indexed: 11/06/2022]
Affiliation(s)
- Ravinder Sodi
- Department of Biochemistry, Royal Lancaster Infirmary & Furness General Hospital, University Hospitals of Morecambe Bay NHS Foundation Trust, Lancaster, UK; .,Lancaster Medical School, University of Lancaster, Lancaster, UK
| |
Collapse
|
14
|
Sodi R, Eastwood J, Caslake M, Packard CJ, Denby L. Relationship between circulating microRNA-30c with total- and LDL-cholesterol, their circulatory transportation and effect of statins. Clin Chim Acta 2017; 466:13-19. [PMID: 28062296 DOI: 10.1016/j.cca.2016.12.031] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2016] [Revised: 12/30/2016] [Accepted: 12/30/2016] [Indexed: 01/20/2023]
Abstract
BACKGROUND Small non-coding microRNAs (miR) have important regulatory roles and are used as biomarkers of disease. We investigated the relationship between lipoproteins and circulating miR-30c, evaluated how they are transported in circulation and determined whether statins altered the circulating concentration of miR-30c. METHODS To determine the relationship between lipoproteins and circulating miR-30c, serum samples from 79 subjects recruited from a lipid clinic were evaluated. Ultracentrifugation and nanoparticle tracking analysis was used to evaluate the transportation of miR-30c in the circulation by lipoproteins and extracellular vesicles in three healthy volunteers. Using archived samples from previous studies, the effects of 40mg rosuvastatin (n=22) and 40mg pravastatin (n=24) on miR-30c expression was also examined. RNA extraction, reverse transcription-quantitative real-time polymerase chain reaction was carried out using standard procedures. RESULTS When stratified according to total cholesterol concentration, there was increased miR-30c expression in the highest compared to the lowest tertile (p=0.035). There was significant positive correlation between miR-30c and total- (r=0.367; p=0.002) and LDL-cholesterol (r=0.391; p=0.001). We found that miR-30c was transported in both exosomes and on HDL3. There was a 3.8-fold increased expression of circulating miR-30c after pravastatin treatment for 1year (p=0.005) but no significant change with atorvastatin after 8weeks (p=0.145). CONCLUSIONS This study shows for the first-time in humans that circulating miR-30c is significantly, positively correlated with total- and LDL-cholesterol implicating regulatory functions in lipid homeostasis. We show miR-30c is transported in both exosomes and on HDL3 and pravastatin therapy significantly increased circulating miR-30c expression adding to the pleiotropic dimensions of statins.
Collapse
Affiliation(s)
- Ravinder Sodi
- Department of Biochemistry, Royal Lancaster Infirmary & Furness General Hospital, University Hospitals of Morecambe Bay NHS Foundation Trust, Lancaster, United Kingdom; Lancaster Medical School, University of Lancaster, Lancaster, United Kingdom.
| | - Jarlath Eastwood
- Institute of Cardiovascular and Medical Sciences, College of Medical, Veterinary and Life Sciences, University of Glasgow, United Kingdom
| | - Muriel Caslake
- Institute of Cardiovascular and Medical Sciences, College of Medical, Veterinary and Life Sciences, University of Glasgow, United Kingdom
| | - Chris J Packard
- Institute of Cardiovascular and Medical Sciences, College of Medical, Veterinary and Life Sciences, University of Glasgow, United Kingdom
| | - Laura Denby
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, United Kingdom
| |
Collapse
|
15
|
Sodi R, Eastwood J, Denby L, Godber I, Caslake M, Packard C. Relationship between circulating microRNA-30c with lipoproteins, their circulatory trafficking and effect of statins. Atherosclerosis 2016. [DOI: 10.1016/j.atherosclerosis.2016.07.503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
16
|
Abstract
Introduction: Lithium-heparin plasma is the most commonly used sample type in many hospitals, but it has been suggested that it is not suitable for protein electrophoresis due to the presence of fibrinogen, which can potentially mask a paraprotein band or be misconstrued as one. Here we aimed to demonstrate that lithium-heparin plasma samples could be used for protein electrophoresis and paraprotein typing without or with ethanol treatment to remove the fibrinogen. Method: A lithium-heparin sample from a patient with IgG λ, IgG κ, IgA λ and IgA κ myeloma, a non-specific polyclonal increase and a serum control were treated with ethanol prior to protein electrophoresis. Immunofixation electrophoresis was undertaken to investigate the effect of ethanol treatment on immunoglobulin and light chains. Nephelometry was undertaken to investigate whether ethanol treatment affected the quantification of IgG levels. Densitometric evaluation of proteins after electrophoresis was used to study whether ethanol treatment affected other serum proteins. An audit was also undertaken to ascertain the magnitude of the potential interference from the fibrinogen band in heparinized samples. Results and conclusions: Ethanol treatment significantly but incompletely removed the fibrinogen in lithium-heparin plasma samples and did not affect the integrity of any of the proteins investigated. Even without ethanol treatment, lithium-heparin plasma can be used for protein electrophoresis and paraprotein identification as the instances of interference between fibrinogen and paraproteins was low (2.3%). In rare cases where there is uncertainty or ambiguity, immuno-fixation electrophoresis is recommended. This report has implications in terms of reducing costs and turn-around time as it prevents the need for requesting another serum sample from patients. This may be one step towards a universal sample for all tests.
Collapse
Affiliation(s)
- Andrew S Davison
- Department of Clinical Biochemistry & Metabolic Medicine, Royal Liverpool & Broadgreen University Hospital, Liverpool, L7 8XP, UK
| | | | | |
Collapse
|
17
|
Abstract
Background: The pneumatic tube system (PTS) has been implicated in inducing haemolysis. It is not known whether certain sample types are more susceptible to haemolysis than others. We assessed the level of haemolysis in commonly used sample types in the clinical biochemistry department when transported through the PTS. Method: Blood was collected in pairs for different sample types and sent to the laboratory via the pneumatic tube or delivered by a porter. Haemolysis indices were measured spectrophotometrically and compared for each pair of sample type. Results: Our results suggest that plain serum samples are more susceptible to haemolysis than the other sample types when sent through our PTS ( P <0.0001). Compared with serum with gel samples, plain serum samples are more prone to haemolysis ( P <0.001). This suggests that gel may confer some protection against haemolysis. Conclusion: Different hospitals will have varying system configurations and use different sample types. We recommend that each hospital investigate their own system to assess whether haemolysis is a recurring problem in any of the sample types transported.
Collapse
Affiliation(s)
- Ravinder Sodi
- Department of Clinical Chemistry, Royal Liverpool and Broadgreen University Hospital, Liverpool L7 8XP, UK.
| | | | | |
Collapse
|
18
|
Abstract
Background: The cardiac troponins have been shown to be sensitive and specific biochemical markers of myocardial infarction and highly prognostic for future adverse events in patients with acute coronary syndromes. There have been reports suggesting that haemolysis causes a negative interference in the cardiac troponin T (cTnT) assay but the mechanism(s) involved remain unknown. Here we show the effects of haemolysis and haemoglobin per se on the cTnT assay. Methods: The effect of haemolysis was studied by the addition of prepared haemolysate to serum samples with known and clinically relevant cTnT levels. The effect of haemoglobin was studied by the addition of haemoglobin of increasing concentrations and noting its effect on the level of cTnT measured. The effect of putative proteases was determined indirectly by incubating samples with spiked cTnT with various protease inhibitors and observing the changes in the measured cTnT levels. Results: The results show that both haemolysis, which is the release of haemoglobin and corpuscular contents, and haemoglobin itself negatively interfere in the cTnT assay in a concentration-dependent manner, although the former had a greater magnitude of effect. On haemolysis, indirect evidence suggests that proteases are released which degrade the cTnT in serum, thus causing the decreased levels detected. Pepstatin A, a reversible inhibitor of aspartic proteinases, effectively inhibited the loss of cTnT in serum at 37°C and pH 7.4 over a 48-h period. We found that at a haemoglobin level of 0.75 g/L, cTnT declined by more than 10% of the initial concentration, suggesting that falsely decreased levels due to haemolysis may significantly affect the clinical utility of the assay. Conclusions: Haemolysis, haemoglobin per se and possibly proteolysis play a role in the negative interference in cTnT assays. Measures to reduce this interference must be implemented.
Collapse
Affiliation(s)
- Ravinder Sodi
- Department of Clinical Biochemistry and Metabolic Medicine, Royal Liverpool and Broadgreen University Hospital, Prescot Street, Liverpool, L7 8XP, UK.
| | | | | | | | | |
Collapse
|
19
|
Abstract
Half of all men with prolactin (PRL)-producing macroadenomas present with hypogonadism, decreased libido and impotence, and therefore require testosterone replacement. However, very little is known about the effect of testosterone on prolactinomas. We report a case of an 18-year-old obese man who presented with hypogonadism and hyperprolactinaemia and underwent a transphenoidal hypophysectomy after a computer tomography scan showed the presence of a suprasellar macroadenoma. On separate occasions, we documented a rise in PRL when testosterone replacement was started and a fall in PRL when testosterone replacement was stopped ( r=0.6090, P=0.0095). Furthermore, imaging studies suggested the possibility of tumour re-growth after testosterone therapy. We hypothesize that the exogenous testosterone was aromatized to oestradiol, which stimulated the release of PRL by the anterior pituitary. This was supported by the increase in oestradiol levels after testosterone replacement, although statistical significance was not achieved due to the availability of only a few data points. This case highlights the need to be aware of testosterone-replacement-induced hyperprolactinaemia, an under-recognized complication of androgen replacement in this setting. The use of aromatase inhibitors together with testosterone-replacement therapy or the use of non-aromatizable androgens might be indicated in such patients. Taken together, this report and previous studies show that dopamine agonists apparently do not suppress the hyperprolactinaemia induced by testosterone replacement.
Collapse
Affiliation(s)
- R Sodi
- Department of Clinical Biochemistry, Royal Liverpool & Broadgreen University Hospital, Liverpool L7 8XP, UK.
| | | | | | | | | |
Collapse
|
20
|
Sodi R, Godber IM. Effect of refrigeration, centrifugation, acidification, heat treatment and storage on urine calcium, magnesium and phosphate. ACTA ACUST UNITED AC 2016; 54:e379-e381. [DOI: 10.1515/cclm-2016-0064] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2016] [Accepted: 03/28/2016] [Indexed: 11/15/2022]
|
21
|
Abstract
Recent studies of inherited disorders of phosphate metabolism have shed new light on the understanding of phosphate metabolism. Phosphate has important functions in the body and several mechanisms have evolved to regulate phosphate balance including vitamin D, parathyroid hormone and phosphatonins such as fibroblast growth factor-23 (FGF23). Disorders of phosphate homeostasis leading to hypo- and hyperphosphataemia are common and have clinical and biochemical consequences. Notably, recent studies have linked hyperphosphataemia with an increased risk of cardiovascular disease. This review outlines the recent advances in the understanding of phosphate homeostasis and describes the causes, investigation and management of hypo- and hyperphosphataemia.
Collapse
Affiliation(s)
- P Manghat
- Department of Chemical Pathology, Darent Valley Hospital, Dartford, UK
| | - R Sodi
- Department of Biochemistry, NHS Lanarkshire, East Kilbride, UK
| | - R Swaminathan
- Department of Chemical Pathology, St. Thomas Hospital, London, UK
| |
Collapse
|
22
|
Sodi R, Bailey LB, Marks EM, Roberts NB, Fraser WD. Response to letter by Gerald A. Maguire. Ann Clin Biochem 2010. [DOI: 10.1258/acb.2009.201001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- R Sodi
- Department of Clinical Biochemistry and Metabolic Medicine, Royal Liverpool & Broadgreen University Hospital, Liverpool L7 8XP, UK
| | - L B Bailey
- Department of Clinical Biochemistry and Metabolic Medicine, Royal Liverpool & Broadgreen University Hospital, Liverpool L7 8XP, UK
| | - E M Marks
- Department of Clinical Biochemistry and Metabolic Medicine, Royal Liverpool & Broadgreen University Hospital, Liverpool L7 8XP, UK
| | - N B Roberts
- Department of Clinical Biochemistry and Metabolic Medicine, Royal Liverpool & Broadgreen University Hospital, Liverpool L7 8XP, UK
| | - W D Fraser
- Department of Clinical Biochemistry and Metabolic Medicine, Royal Liverpool & Broadgreen University Hospital, Liverpool L7 8XP, UK
| |
Collapse
|
23
|
Sodi R, Bailey LB, Glaysher J, Allars L, Roberts NB, Marks EM, Fraser WD. Acidification and urine calcium: is it a preanalytical necessity? Ann Clin Biochem 2009; 46:484-7. [DOI: 10.1258/acb.2009.009027] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Background It has been suggested that for the accurate measurement of calcium in urine, samples must be collected into bottles containing acid. Acidification poses risks to both patients and laboratory staff. Here we reappraise whether acidification is a preanalytical necessity. Methods Twenty-four-hour urine samples were collected from 133 patients into bottles without acid or preservatives. In a subset of 29 patients, 10 mL aliquots were prepared to test the effect on urine calcium of 0.1, 1.0 and 5.0 mol/L hydrochloric acid (HCl). Calcium was then measured immediately after acidification, after 12 h and seven days storage at 4°C. In a separate study, urine calcium concentrations in paired control (non-acidified) and acidified (with 5 mol/L HCl) samples were compared in 133 patients. When available, we recorded the time from start of urine collection to time of analysis. Calcium was measured using the cresolphthalein complexone colorimetric endpoint assay on the Roche Modular system. Results There was no significant difference in the calcium concentration in the 29 cases studied between the varying acid concentrations tested compared with non-acidified urine ( P = 0.987). Overall, in 133 patients there was no difference between control and acidified samples ( P = 0.888). We found no correlation between basal urine pH and urine calcium at all time points studied. Conclusions Our results suggest that the acidification of urine samples is not a preanalytical necessity for the measurement of urine calcium.
Collapse
Affiliation(s)
- R Sodi
- Department of Clinical Biochemistry & Metabolic Medicine, Royal Liverpool & Broadgreen University Hospital, Prescot Street, Liverpool L7 8XP
| | - L B Bailey
- Department of Clinical Biochemistry & Metabolic Medicine, Royal Liverpool & Broadgreen University Hospital, Prescot Street, Liverpool L7 8XP
| | - J Glaysher
- Department of Clinical Biochemistry, Booth Hall Children's Hospital, Charlestown Road, Manchester M9 7AA, UK
| | - L Allars
- Department of Clinical Biochemistry & Metabolic Medicine, Royal Liverpool & Broadgreen University Hospital, Prescot Street, Liverpool L7 8XP
| | - N B Roberts
- Department of Clinical Biochemistry & Metabolic Medicine, Royal Liverpool & Broadgreen University Hospital, Prescot Street, Liverpool L7 8XP
| | - E M Marks
- Department of Clinical Biochemistry & Metabolic Medicine, Royal Liverpool & Broadgreen University Hospital, Prescot Street, Liverpool L7 8XP
| | - W D Fraser
- Department of Clinical Biochemistry & Metabolic Medicine, Royal Liverpool & Broadgreen University Hospital, Prescot Street, Liverpool L7 8XP
| |
Collapse
|
24
|
Sodi R, Hazell M, Durham B, Rees C, Ranganath L, Fraser W. The circulating concentration and ratio of total and high molecular weight adiponectin in post-menopausal women with and without osteoporosis and its association with body mass index and biochemical markers of bone metabolism. Clin Biochem 2009; 42:1375-80. [DOI: 10.1016/j.clinbiochem.2009.06.003] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2009] [Revised: 05/24/2009] [Accepted: 06/01/2009] [Indexed: 01/17/2023]
|
25
|
Monaghan PJ, Leonard MB, Neithercut WD, Raraty MGT, Sodi R. False positive carbohydrate antigen 19-9 (CA19-9) results due to a low-molecular weight interference in an apparently healthy male. Clin Chim Acta 2009; 406:41-4. [PMID: 19463797 DOI: 10.1016/j.cca.2009.05.012] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2009] [Revised: 05/08/2009] [Accepted: 05/08/2009] [Indexed: 11/19/2022]
Abstract
BACKGROUND We investigated the presence of interference in a patient who had an elevated CA19-9 concentration using the ADVIA Centaur but results within reference limits with ROCHE Modular Analytics E170 and Brahms KRYPTOR analysers. METHODS We performed repeat analyses using the same (ADVIA Centaur) and alternate immunossays (Roche Modular Analytics E170 and Brahms KRYPTOR) on the patient's sample and investigated for known interferences. To determine the nature of the interference, we measured CA19-9 on the ADVIA Centaur after dilution experiments and after incubation with non-immune animal sera and in heterophilic blocking tubes (HBT). We also undertook polyethylene glycol precipitation, lectin inhibition experiments and gel filtration chromatography. RESULTS A curvilinear response to dilution was observed with the ADVIA Centaur. Other known interferences were excluded. Treatment with HBT or non-immune animal sera did not give clinically different results from untreated samples. There was only 0.59% recovery after PEG precipitation in the sample from the case patient. Lectin reduced the assay signal in four patient samples (recovery=1.9-14.1%) but not in the case patient (recovery=106.2%). Gel filtration studies suggested the presence of a low molecular weight (approximately 100 kDa) interference in the case patient's serum. CONCLUSIONS We report a novel mode of interference and show a non-CA19-9, low molecular-weight interference affecting the ADVIA Centaur CA19-9 immunoassay.
Collapse
Affiliation(s)
- P J Monaghan
- Department of Clinical Biochemistry, Wirral University Teaching Hospital, Arrowe Park Road, Upton, Wirral, CH49 5PE, UK
| | | | | | | | | |
Collapse
|
26
|
Sodi R, Davison AS, Holmes E, Hine TJ, Roberts NB. The phenomenon of seasonal pseudohypokalemia: effects of ambient temperature, plasma glucose and role for sodium-potassium-exchanging-ATPase. Clin Biochem 2009; 42:813-8. [PMID: 19232334 DOI: 10.1016/j.clinbiochem.2009.01.024] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2008] [Revised: 01/23/2009] [Accepted: 01/31/2009] [Indexed: 11/29/2022]
Abstract
OBJECTIVES There is limited data regarding the phenomenon of seasonal pseudohypokalemia. We aimed to demonstrate the incidence of spurious hypokalemia during the summer months and to investigate the mechanism of cause. DESIGN AND METHODS Potassium and glucose results from primary care and hospital patients were collected retrospectively for a period of 1 year to assess the incidence of pseudohypokalemia. Experiments were undertaken to confirm that this was a reversible in vitro phenomenon due to increased temperature mediated by sodium-potassium-exchanging-ATPase. RESULTS Our data show an increased incidence of hypokalemia associated with increasing ambient temperature during June-August in samples from primary care but not in hospital samples. In a subset of patients, we showed that the repeat results were within or at the lower limit of the reference range. Experiments showed that this phenomenon was mediated by the sodium-potassium-exchanging-ATPase. CONCLUSIONS There is an increased incidence of pseudohypokalemia during the summer (seasonal pseudohypokalemia) in samples from primary care and this is an in vitro pseudo-phenomenon mediated by sodium-potassium-exchanging-ATPase.
Collapse
Affiliation(s)
- Ravinder Sodi
- Department of Clinical Biochemistry and Metabolic Medicine, Royal Liverpool and Broadgreen University Hospital, Duncan Building, Prescot Street, Liverpool, L7 8XP, UK.
| | | | | | | | | |
Collapse
|
27
|
Sodi R, Dubuis E, Shenkin A, Hart G. B-type natriuretic peptide (BNP) attenuates the L-type calcium current and regulates ventricular myocyte function. ACTA ACUST UNITED AC 2008; 151:95-105. [PMID: 18616964 DOI: 10.1016/j.regpep.2008.06.006] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2008] [Revised: 05/22/2008] [Accepted: 06/15/2008] [Indexed: 10/21/2022]
Abstract
A fundamental question in physiology is how hormones regulate the functioning of a cell or organ. It was therefore the aim of this study to investigate the effect(s) of BNP-32 on calcium handling by ventricular myocytes obtained from the rat left ventricle. We specifically tested the hypothesis that BNP-32 decreased the L-type calcium current (I(Ca,L)). Perforated patch clamp technique was used to record I(Ca,L) and action potential (AP) in voltage and current clamp mode, respectively. Myocyte shortening was measured using a photodiode array edge-detection system and intracellular calcium transients were measured by fluorescence photometry. Western blotting was used to determine the relative change in the expression of proteins. At the concentrations tested, BNP-32 significantly decreased cell shortening in a dose-dependent manner; increased the phase II slope of the AP by 53.0%; increased the APD(50) by 16.9%; reduced the I(Ca,L) amplitude with a 22.9% decrease in the peak amplitude and reduced Ca(2+)-dependent inactivation; increased the V(1/2) activation of the L-type calcium channel by 51.1% and decreased V(1/2) inactivation by 31.8%; and, intracellular calcium transient amplitude was significantly decreased by 32.0%, whereas the time to peak amplitude and T(1/2) were both significantly increased by 38.7% and 89.4% respectively. Sarcoplasmic reticulum Ca(2+)-ATPase (SERCA2a) protein expression was reduced by BNP-32. These data suggest that BNP-32 regulates ventricular myocyte function by attenuating I(Ca,L), altering the AP and reducing SERCA2a activity and/or expression. This study suggests a novel constitutive mechanism for the autocrine action of BNP on the L-type calcium channel in ventricular myocytes.
Collapse
Affiliation(s)
- R Sodi
- Department of Clinical Biochemistry & Metabolic Medicine, Royal Liverpool & Broadgreen University Hospital, Prescot street, Liverpool L7 8XP, United Kingdom.
| | | | | | | |
Collapse
|
28
|
Abstract
BACKGROUND There is limited data and literature on the issue of cardiac troponin test requesting by general practitioners (GPs). It was therefore our aim to audit the cardiac troponin test requests made by GPs in our community with a view to develop an informed strategy for assay provision and reporting of results. METHODS A retrospective audit was undertaken of data in our laboratory database for all cardiac troponin T (cTnT) tests requested by GPs between January and June 2005. A prospective audit was then carried out between July and December 2005 using the telephone interview method. The number and distribution of tests, the reasons for the request and the intended action by the GPs were quantified. RESULTS Forty-five of 46 of the results of both the retrospective and prospective audits were negative based on the 99th percentile level with less than 10% imprecision (cTnT <0.03 microg/L). During the one-year study period, we had requests from 24 general practices with a mean and mode of two and one requests per general practice respectively. The most common reason for the request was found to be chest pain that had occurred more than 24 h ago. CONCLUSION Bearing in mind the limitations of an audit study, our findings obviate the use of cTnT in general practice. We suggest that the laboratory should liase with the GP and advise referral for specialist care if clinical suspicion of acute coronary syndrome is high.
Collapse
Affiliation(s)
- Ravinder Sodi
- Department of Clinical Biochemistry and Metabolic Medicine, Royal Liverpool & Broadgreen University Hospital, Liverpool L7 8XP, UK.
| | | | | |
Collapse
|
29
|
Darn SM, Sodi R, Ranganath LR, Roberts NB, Duffield JR. Experimental and computer modelling speciation studies of the effect of pH and phosphate on the precipitation of calcium and magnesium salts in urine. Clin Chem Lab Med 2006; 44:185-91. [PMID: 16475905 DOI: 10.1515/cclm.2006.034] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Abstract
Collapse
Affiliation(s)
- Simon M Darn
- Department of Clinical Biochemistry & Metabolic Medicine, Royal Liverpool & Broadgreen University Hospital, Liverpool, UK
| | | | | | | | | |
Collapse
|
30
|
|