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Abbam G, Mensah K, Appiah SK, Nkansah C, Daud S, Aikins CN, Osei-Afoakwa AN, Osei-Boakye F, Derigubah CA, Mohammed S, Tandoh S, Bani SB. Complete Blood Count Reference Intervals for Children Aged Less Than 1 to 12 Years in the Northern Region of Ghana. BIOMED RESEARCH INTERNATIONAL 2024; 2024:6607281. [PMID: 38764534 PMCID: PMC11101252 DOI: 10.1155/2024/6607281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/30/2023] [Revised: 04/11/2024] [Accepted: 04/29/2024] [Indexed: 05/21/2024]
Abstract
Reliable laboratory diagnostic results are key for evaluating and improving children's health. To interpret these results, child-specific reference intervals (RIs), which account for constant biological changes and physiological development with sex and age, are required, as recommended by the Clinical and Laboratory Standards Institute (CLSI). This study presents age- and sex-specific reference intervals for complete blood count (CBC) parameters in children (<1-12 years old) in the Northern Region of Ghana. In this cross-sectional study, 600 healthy children from randomly sampled schools in Tamale (the Northern Region) were recruited and screened. Data from 388 eligible children were used to nonparametrically determine the reference intervals of CBC parameters at the 2.5th and 97.5th percentiles. The CBC reference intervals were compared for variations in sex and age groups using the Wilcoxon rank-sum test. There were no statistically significant differences in most CBC parameters by sex (RBC, Hb, HCT, MCH, RDW (CV/SD), WBC, LYM#, MON#(%) NEU#(%), EOS#(%), and BAS#(%); p > 0.05) and age group (RBC, MCV, RDW (CV/SD), WBC, LYM#, MON#(%) NEU#(%), EOS#(%), and BAS%; p > 0.05). However, there were observable differences between this locally established CBC reference interval and that used for children at Tamale Teaching Hospital (manufacturer's RIs). This study emphasises the importance of determining reference intervals representative of the local child population and incorporating them into the current reporting system of laboratories in the Northern Region to ensure the provision of effective and efficient healthcare services.
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Affiliation(s)
- Gabriel Abbam
- Department of Haematology, School of Allied Health Sciences, University for Development Studies, Tamale, Ghana
| | - Kofi Mensah
- Department of Haematology, School of Allied Health Sciences, University for Development Studies, Tamale, Ghana
- Department of Medical Laboratory Science, Faculty of Health Science and Technology, Ebonyi State University, Abakaliki, Nigeria
| | - Samuel Kwasi Appiah
- Department of Haematology, School of Allied Health Sciences, University for Development Studies, Tamale, Ghana
- Department of Medical Laboratory Science, Faculty of Health Science and Technology, Ebonyi State University, Abakaliki, Nigeria
| | - Charles Nkansah
- Department of Haematology, School of Allied Health Sciences, University for Development Studies, Tamale, Ghana
- Department of Medical Laboratory Science, Faculty of Health Science and Technology, Ebonyi State University, Abakaliki, Nigeria
| | - Samira Daud
- Department of Haematology, School of Allied Health Sciences, University for Development Studies, Tamale, Ghana
| | - Cheryl Namusoke Aikins
- Department of Biomedical Laboratory Sciences, School of Allied Health Sciences, University for Development Studies, Tamale, Ghana
| | - Akua Nyarko Osei-Afoakwa
- Department of Biomedical Laboratory Sciences, School of Allied Health Sciences, University for Development Studies, Tamale, Ghana
| | - Felix Osei-Boakye
- Department of Medical Laboratory Science, Faculty of Health Science and Technology, Ebonyi State University, Abakaliki, Nigeria
- Department of Medical Laboratory Technology, Faculty of Applied Science and Technology, Sunyani Technical University, Sunyani, Ghana
| | - Charles Angnataa Derigubah
- Department of Medical Laboratory Science, Faculty of Health Science and Technology, Ebonyi State University, Abakaliki, Nigeria
- Department of Medical Laboratory Technology, School of Applied Science and Arts, Bolgatanga Technical University, Bolgatanga, Ghana
| | - Sanda Mohammed
- Systems Solutions Geospatial Research Services, Accra, Ghana
- Research Department, SSNIT, Accra, Ghana
| | - Samuel Tandoh
- University Clinic Laboratory, University of Education, Winneba, Ghana
| | - Simon Bannison Bani
- Department of Biomedical Laboratory Sciences, School of Allied Health Sciences, University for Development Studies, Tamale, Ghana
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Doucoure M, Zeguime A, Niangaly A, Guindo MA, Doritchamou JYA, Assadou MH, Katile A, Kanoute MB, Perou S, Ouattara A, Sanogo S, Ouologuem B, Traore S, Dao B, Dembele D, Kone M, Kamate B, Sissoko K, Sankare S, Diarra S, Dolo A, Sissoko MS, Hume JCC, Cook D, Healy SA, Gorres JP, Traoré B, Gamiel J, Duffy PE, Sagara I. Normal Clinical Laboratory Ranges by Age and Sex, and Impact on Study Screening Outcomes in Rural Mali. Am J Trop Med Hyg 2024; 110:1021-1028. [PMID: 38531104 PMCID: PMC11066370 DOI: 10.4269/ajtmh.23-0719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Accepted: 01/04/2024] [Indexed: 03/28/2024] Open
Abstract
The interpretation of a laboratory test result requires an appropriate reference range established in healthy subjects, and normal ranges may vary by factors such as geographic region, sex, and age. We examined hematological and clinical chemistry parameters in healthy residents at two rural vaccine trial sites: Bancoumana and Doneguebougou in Mali, West Africa. During screening of clinical studies in 2018 and 2019, peripheral blood samples from 1,192 apparently healthy individuals age 6 months to 82 years were analyzed at a laboratory accredited by the College of American Pathologists for a complete blood count, and creatinine and/or alanine aminotransferase levels. Based on manufacturers' reference range values, which are currently used in Malian clinical laboratories, abnormal values were common in this healthy population. In fact, 30.4% of adult participants had abnormal neutrophil levels and 19.8% had abnormal hemoglobin levels. Differences by sex were observed in those who were older, but not in those younger than 10 years, for several parameters, including hemoglobin, platelet, and absolute neutrophil counts in hematology, and creatinine in biochemistry. The site-specific reference intervals we report can be used in malaria vaccine clinical trials and other interventional studies, as well as in routine clinical care, to identify abnormalities in hematological and biochemical parameters among healthy Malian trial participants.
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Affiliation(s)
- M’Bouye Doucoure
- Malaria Research and Training Center, International Center for Excellence in Research–MALI, University of Sciences, Techniques and Technologies of Bamako, Mali
| | - Amatigue Zeguime
- Malaria Research and Training Center, International Center for Excellence in Research–MALI, University of Sciences, Techniques and Technologies of Bamako, Mali
| | - Amadou Niangaly
- Malaria Research and Training Center, International Center for Excellence in Research–MALI, University of Sciences, Techniques and Technologies of Bamako, Mali
| | - Merepen A. Guindo
- Malaria Research and Training Center, International Center for Excellence in Research–MALI, University of Sciences, Techniques and Technologies of Bamako, Mali
| | - Justin Y. A. Doritchamou
- Laboratory of Malaria Immunology and Vaccinology, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland
| | - Mahamadoun H. Assadou
- Malaria Research and Training Center, International Center for Excellence in Research–MALI, University of Sciences, Techniques and Technologies of Bamako, Mali
| | - Abdoulaye Katile
- Malaria Research and Training Center, International Center for Excellence in Research–MALI, University of Sciences, Techniques and Technologies of Bamako, Mali
| | - Moussa B. Kanoute
- Malaria Research and Training Center, International Center for Excellence in Research–MALI, University of Sciences, Techniques and Technologies of Bamako, Mali
| | - Sidiki Perou
- Malaria Research and Training Center, International Center for Excellence in Research–MALI, University of Sciences, Techniques and Technologies of Bamako, Mali
| | - Adama Ouattara
- Malaria Research and Training Center, International Center for Excellence in Research–MALI, University of Sciences, Techniques and Technologies of Bamako, Mali
| | - Sintry Sanogo
- Malaria Research and Training Center, International Center for Excellence in Research–MALI, University of Sciences, Techniques and Technologies of Bamako, Mali
| | - Boucary Ouologuem
- Malaria Research and Training Center, International Center for Excellence in Research–MALI, University of Sciences, Techniques and Technologies of Bamako, Mali
| | - Souleymane Traore
- Malaria Research and Training Center, International Center for Excellence in Research–MALI, University of Sciences, Techniques and Technologies of Bamako, Mali
| | - Bakary Dao
- Malaria Research and Training Center, International Center for Excellence in Research–MALI, University of Sciences, Techniques and Technologies of Bamako, Mali
| | - Drissa Dembele
- Malaria Research and Training Center, International Center for Excellence in Research–MALI, University of Sciences, Techniques and Technologies of Bamako, Mali
| | - Mamady Kone
- Malaria Research and Training Center, International Center for Excellence in Research–MALI, University of Sciences, Techniques and Technologies of Bamako, Mali
| | - Bourama Kamate
- Malaria Research and Training Center, International Center for Excellence in Research–MALI, University of Sciences, Techniques and Technologies of Bamako, Mali
| | - Kourane Sissoko
- Malaria Research and Training Center, International Center for Excellence in Research–MALI, University of Sciences, Techniques and Technologies of Bamako, Mali
| | - Seydou Sankare
- Malaria Research and Training Center, International Center for Excellence in Research–MALI, University of Sciences, Techniques and Technologies of Bamako, Mali
| | - Sadio Diarra
- Malaria Research and Training Center, International Center for Excellence in Research–MALI, University of Sciences, Techniques and Technologies of Bamako, Mali
| | - Amagana Dolo
- Malaria Research and Training Center, International Center for Excellence in Research–MALI, University of Sciences, Techniques and Technologies of Bamako, Mali
| | - Mahamadou S. Sissoko
- Malaria Research and Training Center, International Center for Excellence in Research–MALI, University of Sciences, Techniques and Technologies of Bamako, Mali
| | - Jennifer C. C. Hume
- Laboratory of Malaria Immunology and Vaccinology, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland
| | - David Cook
- Laboratory of Malaria Immunology and Vaccinology, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland
| | - Sara A. Healy
- Laboratory of Malaria Immunology and Vaccinology, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland
| | - J. Patrick Gorres
- Laboratory of Malaria Immunology and Vaccinology, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland
| | - Boubacar Traoré
- Malaria Research and Training Center, International Center for Excellence in Research–MALI, University of Sciences, Techniques and Technologies of Bamako, Mali
| | - Jordyn Gamiel
- Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland
| | - Patrick E. Duffy
- Laboratory of Malaria Immunology and Vaccinology, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland
| | - Issaka Sagara
- Malaria Research and Training Center, International Center for Excellence in Research–MALI, University of Sciences, Techniques and Technologies of Bamako, Mali
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IgG antibody response to pneumococcal-conjugated vaccine (Prevenar®13) in children with immunodeficiency disorders. Med Microbiol Immunol 2023; 212:93-102. [PMID: 36595027 DOI: 10.1007/s00430-022-00759-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Accepted: 12/01/2022] [Indexed: 01/04/2023]
Abstract
Measurement of anti-pneumococcal capsular polysaccharides (anti-PnPs) IgG titers is an important tool in the immunologic assessment of patients with suspected immunodeficiency disorders (ID) to reduce the morbi-mortality and minimize severe infections. Retrospectively, we studied the relationship among anti-PnPs IgG response to 3 doses of Prevenar®13, levels of immune system components, leukocyte populations, and clinical data in children with ID. Serum samples were collected at least 4 weeks post vaccination. Subsequently, multi-serotype enzyme-linked immunosorbent assay (ELISA) was performed. Eighty-seven children (under 12 years) were enrolled. Primary immunodeficiency disorder (PID) was the most common disorder (45) followed by possible immunodeficiency disorder (POID) (19), secondary immunodeficiency disorder (SID) (15), and mixed immunodeficiency disorder (MID) (8). The median age was 3 (1.50-5.33) years, 65% of patients were male. Deficient production of anti-PnPs IgG (titer ≤ 50 mg/L) was detected in 47 patients (54%), especially in the MID group, all of them under immunosuppressive therapy. In PCV13 responders, the mean of leukocyte population levels was higher with statistically significance differences in CD4 + /CD8 + T lymphocytes (p = 0.372, p = 0.014) and CD56 + /CD16 + NK (p = 0.016). Patients with previous bone marrow transplantation were the worst PCV13 responders. Pneumococcal IgG antibody titers (post-vaccination) along with clinical and analytical markers represented.
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Mutua B, Chelangat R, Mustafa B, Were T, Makani J, Sowayi G, Okoth P. High-performance liquid chromatography local reference ranges of hemoglobin fractions (HbA, HbA2, and HbF) in detection of hemoglobinopathies in western Kenya. THE EGYPTIAN JOURNAL OF INTERNAL MEDICINE 2022. [DOI: 10.1186/s43162-022-00187-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Abstract
Background
Western Kenya, being a malaria-endemic region, has a high prevalence of hemoglobinopathies mostly sickle cell and thalassemia. The hemoglobin fractions or variants, HbA, HbA2, and HbF, serve as biomarkers for the detection of hemoglobinopathies and are commonly used in laboratory screening and diagnosis of these diseases. Diagnosis of diseases entails accurate and precise representation of a patient’s condition. This is the main aim of International Organization for Standardization (ISO) certified laboratories of offering a reliable diagnostic guide for the various diseases. For this to be realized, valid normal reference ranges are required. Such are reference values that are valid for local population of the setting where they are to be used is critical in quantitative diagnostic tests. Local normal reference ranges are necessary because research has revealed variations in the phenotypic expression of the genes for biological characteristics in humans inhabiting different geographical regions, owing to epigenetic differences imposed by physical environments, and associated sociocultural influences, even in cases of similarity in gene patterns. No local normal reference ranges for hemoglobin fractions are reported for Kenya and Africa as a whole. Laboratories therefore continue to use those found in textbooks and brochures from manufacturers of diagnostic reagents, which are derived from populations of geographical locations faraway and socioculturally different from Kenya. This could be misleading in diagnosis of hemoglobinopathies in western Kenya and indeed all of Kenya. Therefore, the present study aimed at exploring the possibility of developing local normal reference ranges for the concentrations of hemoglobin fractions, HbA, HbA2, and HbF, based on hemoglobinopathy-free, non-anemic subjects attending the Aga Khan Hospital Kisumu in western Kenya and its satellites. The hospital serves the populations inhabiting in and predominantly indigenous to western Kenya.
Objectives
To derive the 95% confidence intervals for hemoglobin fractions (HbA, HbA2, and HbF), evaluate the potential of these intervals as normal reference values for the local population by use of concentrations for non-anemic hemoglobinopathy-free subjects and compare the performance of the current HPLC normal ranges with those intervals we derived, based on receiver operating characteristic (ROC) curve.
Materials and methods
This was an analytical retrospective study using routine assay results from laboratory database for 386 non-anemic, HPLC-confirmed hemoglobinopathy-free subjects. Blood samples were obtained at the Kisumu Aga Khan Hospital and its satellite sites in western Kenya, covering January 2015 to November 9, 2021. The data for Hb fractions were nonparametric, and so confidence intervals, together with the age of subjects, were thus expressed as the median and interquartile range (IQR). Data for the gender and other characteristics of study subjects were summarized in frequencies and proportions, Kruskal-Wallis H-test was used to test the significance of differences in Hb concentrations between stations and age groups, while Mann-Whitney U-test is between males and females. The receiver operating characteristic (ROC) curve was used to evaluate the potential of the derived confidence intervals as normal reference values in comparison with the commonly used normal values for hemoglobin fractions.
Results
The potential normal reference intervals were computed as 95% confidence intervals (CI) for median percentage levels for the concentrations of the Hb fractions HbA, HbA2, and HbF for the hemoglobinopathy-free patients. The overall confidence intervals were derived first for the combined sample of all the hemoglobinopathy-free patients combined together irrespective station where blood specimens were obtained, age or gender, and then followed by those for separate groups, stratified based on station, age, and gender. The overall median values for the hemoglobin fractions were hemoglobin: A (HbA) 87.7, IQR = 5.7, 95% CI = 76.3–99.1; hemoglobin A2 (HbA2), 3.0, IQR = 0.6; 95% CI = 1.8–4.2; and hemoglobin F (HbF), 0.8, IQR = 0.8; 95% CI = 0.00–2.4, with the P window, 4.98, IQR = 0.4; 95% CI = 4.18–5.78. The commonly used normal reference ranges for the hemoglobin fractions were as follows: HbA 95–98%, had an accuracy of 57.5%, HbA2 of 1.5–3.5%, had an accuracy of 95.9% in grading the presumed healthy population as hemoglobinopathy-free, while HbF 0–2.0 was equal to that established by the present study.
Conclusion
It is important to report that the use of normal range for HbA of 95–98% published by Kratz et al. [1] in western Kenya has a potential threat of misdiagnosis of normal population and thus needs urgent review as it lacked efficacy (p = 0.795) in grading hemoglobinopathy-free subjects as normal with a poor accuracy of 57.5%, a sensitivity of 100%, specificity of 0.3%, positive predictive validity of 15.1%, negative predictive validity of 1%, and 1.03 positive likelihood ratio. However, the traditional normal range for HbA2 of 1.5–3.5% on use in western Kenya may be retained as it was effective (p < 0.0001) in grading majority of study subjects as normal with an accuracy of 95.9%, sensitivity of 98.4%, specificity of 93.3%, positive predictive validity of 99.7%, negative predictive validity of 70.0%, 14.7 positive likelihood ratio, and 0.017 negative likelihood ratio. Similarly, the existing normal range for HbF of 0–2.0 on use was almost the same as the one we derived of 0–2.4 and therefore may be retained for use in western Kenya. It is anticipated that the finding of this study will help improve the management of hemoglobinopathies in Kenya and Africa at large, by contributing to improvement in the validity of the clinical-pathologic interpretation assay results for the percentage values for the Hb fractions.
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Price MA, Fast PE, Mshai M, Lambrick M, Machira YW, Gieber L, Chetty P, Muturi-Kioi V. Region-specific laboratory reference intervals are important: A systematic review of the data from Africa. PLOS GLOBAL PUBLIC HEALTH 2022; 2:e0000783. [PMID: 36962599 PMCID: PMC10021479 DOI: 10.1371/journal.pgph.0000783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/03/2022] [Accepted: 10/06/2022] [Indexed: 11/16/2022]
Abstract
Region-specific laboratory reference intervals (RIs) are important for clinical trials and these data are often sparse in priority areas for research, including Africa. We reviewed data on RIs from Africa to identify gaps in the literature with a systematic review of PubMed for RI studies from Africa published ≥2010. Search focus included clinical analytic chemistry, hematology, immunological parameters and RIs. Data from adults, adolescents, children, pregnant women, and the elderly were included. We excluded manuscripts reporting data from persons with conditions that might preclude clinical trial participation in studies enrolling healthy volunteers. Of 179 identified manuscripts, 80 were included in this review, covering 20 countries with the largest number of studies in Ethiopia (n = 23, 29%). Most studies considered healthy, nonpregnant adults (n = 55, 69%). Nine (11%) studies included pregnant women, 13 (16%) included adolescents and 22 (28%) included children. Recruitment, screening, enrollment procedures and definition of age strata varied across studies. The most common type of RIs reported were hematology (66, 83%); 14 studies (18%) included flow cytometry and/or T cell counts. Other common tests or panels included liver function assays (32, 40%), renal function assays (30, 38%), lipid chemistries (17, 21%) and serum electrolytes (17, 21%). The number of parameters characterized ranged from only one (three studies characterized either CD4+ counts, D-dimer, or hemoglobin), to as many as 40. Statistical methods for calculating RIs varied. 56 (70%) studies compared their results to international RI databases. Though most presented their data side-by-side with international data with little accompanying analysis, nearly all reported deviation from comparator RI data, sometimes with half or more of otherwise healthy participants having an "out of range" result. We found there is limited local RI data available in sub-Saharan Africa. Studies to fill this gap are warranted, including efforts to standardize statistical methods to derive RIs, methods to compare with other RIs, and improve representative participant selection.
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Affiliation(s)
- Matt A. Price
- IAVI, New York City, New York, United States of America
- Department of Epidemiology and Biostatistics, University of California at San Francisco, San Francisco, California, United States of America
| | - Patricia E. Fast
- IAVI, New York City, New York, United States of America
- Division of Infectious Diseases, Stanford University School of Medicine, Palo Alto, California, United States of America
| | | | | | | | - Lisa Gieber
- IAVI, New York City, New York, United States of America
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Fiseha T, Alemayehu E, Mohammed Adem O, Eshetu B, Gebreweld A. Reference intervals for common clinical chemistry parameters in healthy adults of Northeast Ethiopia. PLoS One 2022; 17:e0276825. [PMID: 36322541 PMCID: PMC9629653 DOI: 10.1371/journal.pone.0276825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Accepted: 10/13/2022] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND Clinical chemistry reference intervals are important tools for health evaluation, diagnosis, prognosis and monitoring adverse events. Currently used reference intervals in most African countries including Ethiopia are mainly derived from Western populations, despite studies reporting differences that could lead to incorrect clinical decisions. The aim of this study was to establish reference intervals for commonly used clinical chemistry parameters for healthy adults in Northeast Ethiopia. METHODS A community based cross-sectional study was conducted among 328 apparently healthy adults between the ages of 18 and 57 years. Blood samples were collected for clinical chemistry analysis using Dirui CS-T240 auto-analyzer and serological testing to screen the population. Medians and 95% reference intervals were computed using non-parametric method according to the Clinical and Laboratory Standards Institute guideline. The Mann-Whitney U test was used to compare reference values between males and females. RESULTS Reference intervals established were: ALT 11.2-48.0 U/L, AST 16-60 U/L, ALP 53-342.3 U/L, total protein 5.4-8.9 mg/dL, total bilirubin 0.1-1.23 mg/dL, glucose 65-125 mg/dL, total cholesterol 69-213 mg/dL, triglycerides 46-207 mg/dL, creatinine 0.3-1.2 mg/dL and urea 9.5-46.3 mg/dL. Significant sex-differences were observed for ALT, AST, ALP, total cholesterol, triglycerides, creatinine and urea. We found that the established reference intervals substantially differ from the reference ranges currently in use. Up to 43.1% of apparently healthy adults are considered as having abnormal test values on the bases of the currently in use reference ranges. If the reference values from the United States based intervals were applied to the study population, 81.8% would have been classified as having abnormal laboratory test results. CONCLUSIONS Local population-specific reference intervals were established for commonly used clinical chemistry parameters in adult population of Northeast Ethiopia. Although further study is needed, these reference intervals may have the potential to facility the decision-making process based on laboratory test results in this population.
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Affiliation(s)
- Temesgen Fiseha
- Department of Clinical Laboratory Science, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
- * E-mail:
| | - Ermiyas Alemayehu
- Department of Clinical Laboratory Science, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Ousman Mohammed Adem
- Department of Clinical Laboratory Science, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Bruktawit Eshetu
- Department of Clinical Laboratory Science, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Angesom Gebreweld
- Department of Medical Laboratory Science, College of Health Sciences, Mekelle University, Mekelle, Ethiopia
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Perazzio SF, Palmeira P, Moraes-Vasconcelos D, Rangel-Santos A, de Oliveira JB, Andrade LEC, Carneiro-Sampaio M. A Critical Review on the Standardization and Quality Assessment of Nonfunctional Laboratory Tests Frequently Used to Identify Inborn Errors of Immunity. Front Immunol 2021; 12:721289. [PMID: 34858394 PMCID: PMC8630704 DOI: 10.3389/fimmu.2021.721289] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2021] [Accepted: 10/05/2021] [Indexed: 12/24/2022] Open
Abstract
Inborn errors of immunity (IEI), which were previously termed primary immunodeficiency diseases, represent a large and growing heterogeneous group of diseases that are mostly monogenic. In addition to increased susceptibility to infections, other clinical phenotypes have recently been associated with IEI, such as autoimmune disorders, severe allergies, autoinflammatory disorders, benign lymphoproliferative diseases, and malignant manifestations. The IUIS 2019 classification comprises 430 distinct defects that, although rare individually, represent a group affecting a significant number of patients, with an overall prevalence of 1:1,200-2,000 in the general population. Early IEI diagnosis is critical for appropriate therapy and genetic counseling, however, this process is deeply dependent on accurate laboratory tests. Despite the striking importance of laboratory data for clinical immunologists, several IEI-relevant immunoassays still lack standardization, including standardized protocols, reference materials, and external quality assessment programs. Moreover, well-established reference values mostly remain to be determined, especially for early ages, when the most severe conditions manifest and diagnosis is critical for patient survival. In this article, we intend to approach the issue of standardization and quality control of the nonfunctional diagnostic tests used for IEI, focusing on those frequently utilized in clinical practice. Herein, we will focus on discussing the issues of nonfunctional immunoassays (flow cytometry, enzyme-linked immunosorbent assays, and turbidimetry/nephelometry, among others), as defined by the pure quantification of proteins or cell subsets without cell activation or cell culture-based methods.
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Affiliation(s)
- Sandro Félix Perazzio
- Division of Rheumatology, Universidade Federal de São Paulo, Sao Paulo, Brazil.,Immunology Division, Fleury Medicine and Health Laboratory, Sao Paulo, Brazil
| | - Patricia Palmeira
- Laboratório de Investigação Médica (LIM-36), Hospital das Clinicas da Faculdade de Medicina da Universidade de São Paulo (FMUSP), Sao Paulo, Brazil
| | - Dewton Moraes-Vasconcelos
- Laboratório de Investigação Médica (LIM-56), Hospital das Clinicas da Faculdade de Medicina da Universidade de São Paulo (FMUSP), Sao Paulo, Brazil
| | - Andréia Rangel-Santos
- Laboratório de Investigação Médica (LIM-36), Hospital das Clinicas da Faculdade de Medicina da Universidade de São Paulo (FMUSP), Sao Paulo, Brazil
| | | | - Luis Eduardo Coelho Andrade
- Division of Rheumatology, Universidade Federal de São Paulo, Sao Paulo, Brazil.,Immunology Division, Fleury Medicine and Health Laboratory, Sao Paulo, Brazil
| | - Magda Carneiro-Sampaio
- Laboratório de Investigação Médica (LIM-36), Hospital das Clinicas da Faculdade de Medicina da Universidade de São Paulo (FMUSP), Sao Paulo, Brazil.,Department of Pediatrics, Faculdade de Medicina da Universidade de São Paulo (FMUSP), Sao Paulo, Brazil
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8
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Sing’oei V, Ochola J, Owuoth J, Otieno J, Rono E, Andagalu B, Otieno L, Nwoga C, Copeland NK, Lawlor J, Yates A, Imbach M, Crowell TA, Eller LA, Kamau E, Modjarrad K, Cowden J, Ake J, Robb ML, Polyak CS. Clinical laboratory reference values in adults in Kisumu County, Western Kenya; hematology, chemistry and CD4. PLoS One 2021; 16:e0249259. [PMID: 33784358 PMCID: PMC8009432 DOI: 10.1371/journal.pone.0249259] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Accepted: 03/15/2021] [Indexed: 12/25/2022] Open
Abstract
Background Clinical laboratory reference intervals (RIs) are essential for diagnosing and managing patients in routine clinical care as well as establishing eligibility criteria and defining adverse events in clinical trials, but may vary by age, gender, genetics, nutrition and geographic location. It is, therefore, critical to establish region-specific reference values in order to inform clinical decision-making. Methods We analyzed data from a prospective observational HIV incidence cohort study in Kombewa, Kenya. Study participants were healthy males and females, aged 18–35 years, without HIV. Median and 95% reference values (2.5th percentile to 97.5th percentile) were calculated for laboratory parameters including hematology, chemistry studies, and CD4 T cell count. Standard Deviation Ratios (SDR) and Bias Ratios (BR) are presented as measures of effect magnitude. Findings were compared with those from the United States and other Kenyan studies. Results A total of 299 participants were analyzed with a median age of 24 years (interquartile range: 21–28). Ratio of males to females was 0.9:1. Hemoglobin range (2.5th—97.5th percentiles) was 12.0–17.9 g/dL and 9.5–15.3 g/dL in men and women respectively. In the cohort, MCV range was 59-95fL, WBC 3.7–9.2×103/μL, and platelet 154–401×103/μL. Chemistry values were higher in males; the creatinine RI was 59–103 μmol/L in males vs. 46–76 μmol/L in females (BRUL>.3); and the alanine transferase range was 8.8–45.3 U/L in males vs. 7.5–36.8 U/L in females (SDR>.3). The overall CD4 T cell count RI was 491–1381 cells/μL. Some parameters including hemoglobin, neutrophil, creatinine and ALT varied with that from prior studies in Kenya and the US. Conclusion This study not only provides clinical reference intervals for a population in Kisumu County but also highlights the variations in comparable settings, accentuating the requirement for region-specific reference values to improve patient care, scientific validity, and quality of clinical trials in Africa.
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Affiliation(s)
- Valentine Sing’oei
- HJF Medical Research International, Kisumu, Kenya
- U.S. Army Medical Research Directorate–Africa, Kisumu, Kenya
| | - Jew Ochola
- HJF Medical Research International, Kisumu, Kenya
- U.S. Army Medical Research Directorate–Africa, Kisumu, Kenya
| | - John Owuoth
- HJF Medical Research International, Kisumu, Kenya
- U.S. Army Medical Research Directorate–Africa, Kisumu, Kenya
| | - June Otieno
- U.S. Army Medical Research Directorate–Africa, Kisumu, Kenya
- Kenya Medical Research Institute, Kisumu, Kenya
| | - Eric Rono
- U.S. Army Medical Research Directorate–Africa, Kisumu, Kenya
- Kenya Medical Research Institute, Kisumu, Kenya
| | - Ben Andagalu
- U.S. Army Medical Research Directorate–Africa, Kisumu, Kenya
- Kenya Medical Research Institute, Kisumu, Kenya
| | - Lucas Otieno
- U.S. Army Medical Research Directorate–Africa, Kisumu, Kenya
- Kenya Medical Research Institute, Kisumu, Kenya
| | - Chiaka Nwoga
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD, United States of America
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, United States of America
| | | | - John Lawlor
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD, United States of America
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, United States of America
| | - Adam Yates
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD, United States of America
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, United States of America
| | - Michelle Imbach
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD, United States of America
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, United States of America
| | - Trevor A. Crowell
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD, United States of America
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, United States of America
| | - Leigh Anne Eller
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD, United States of America
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, United States of America
| | - Edwin Kamau
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD, United States of America
| | - Kayvon Modjarrad
- Emerging Infectious Diseases Branch, Walter Reed Army Institute of Research, Silver Spring, MD, United States of America
| | - Jessica Cowden
- U.S. Army Medical Research Directorate–Africa, Kisumu, Kenya
| | - Julie Ake
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD, United States of America
| | - Merlin L. Robb
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, United States of America
| | - Christina S. Polyak
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD, United States of America
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, United States of America
- * E-mail:
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Mpofu R, Otwombe K, Mlisana K, Nchabeleng M, Allen M, Kublin J, McElrath MJ, Bekker LG, Churchyard G, Gray G, Laher F. Benign ethnic neutropenia in a South African population, and its association with HIV acquisition and adverse event reporting in an HIV vaccine clinical trial. PLoS One 2021; 16:e0241708. [PMID: 33481787 PMCID: PMC7822320 DOI: 10.1371/journal.pone.0241708] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Accepted: 10/18/2020] [Indexed: 11/18/2022] Open
Abstract
Benign ethnic neutropenia (BEN) is defined as a neutrophil count of <1.5×109 cells/L in healthy individuals and is more common in populations of certain ethnicities, e.g. African or Middle Eastern ethnicity. Neutrophil values are commonly included in eligibility criteria for research participation, but little is known about the relationship between BEN, HIV acquisition, and the occurrence of adverse events during clinical trials. We investigated these relationships using data from an HIV vaccine efficacy trial of healthy adults from 5 South African sites. We analysed data from the double-blind, placebo-controlled, randomized trial HVTN 503, and its follow-on study HVTN 503-S to assess the prevalence of BEN, its association with HIV infection, and adverse event reporting. These data were then compared with a time- and age-matched, non-pregnant cohort from the National Health and Nutrition Examination Survey (NHANES) conducted between 2007–2008 in the United States (US). The 739 South African participants had a median age of 22.0 years (interquartile range = 20–26) and 56% (n = 412) were male. Amongst the US cohort of 845 participants, the median age was 26 (IQR: 21–30) and the majority (54%, 457/745) were also male. BEN was present at enrolment in 7.0% (n = 52) of South African participants (6% in the placebo group versus 8% in the vaccine group); 81% (n = 42) of those with BEN were male. Pretoria North had the highest prevalence of BEN (11.6%, 5/43), while Cape Town had the lowest (0.7%, 1/152). Participants with BEN had a lower median neutrophil count (1.3 vs. 3.2x109 cells/L; p<0.001) and BMI (20.8 vs. 22.3 kg/m2; p<0.001) when compared to those without BEN. A greater proportion of Black South Africans had neutrophil counts <1.5×109 cells/L compared to US non-Hispanic Whites from the NHANES cohort (7% [52/739] vs. 0.6% [3/540]; p<0.001). BEN did not increase the odds for HIV infection (adjusted odds ratio [aOR]: 1.364, 95% confidence interval [95% CI]: 0.625–2.976; p = 0.4351). However, female gender (aOR: 1.947, 95% CI: 1.265–2.996; p = 0.0025) and cannabis use (aOR: 2.192, 95% CI: 1.126–4.266; p = 0.0209) increased the odds of HIV acquisition. The incidence rates of adverse events were similar between participants in the placebo group with BEN, and those without: 12.1 (95% CI: 7.3–20.1) vs. 16.5 (95% CI: 14.6–18.7; p = 0.06) events per 100 person-years (py) were noted in the infections and infestations system organ class, respectively. The vaccine group had an event incidence rate of 19.7 (95% CI: 13.3–29.2) vs. 14.8 (95% CI: 13.0–16.8; p = 0.07) events per 100py in the group with, and without BEN, respectively. BEN is more prevalent in Black South Africans compared to US Non-Hispanic Whites. Our data do not support excluding populations from HIV vaccine trials because of BEN. BEN was not associated with increased risk for HIV infection or Adverse events on a vaccine trial. Predictors of HIV infection risk were females and cannabis use, underlying the continued importance of prevention programmes in focusing on these populations.
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Affiliation(s)
- Rephaim Mpofu
- Faculty of Health Sciences, Perinatal HIV Research Unit, University of Witwatersrand, Johannesburg, South Africa
- Division of Clinical Pharmacology, Department of Medicine, University of Cape Town, Cape Town, South Africa
- * E-mail:
| | - Kennedy Otwombe
- Faculty of Health Sciences, Perinatal HIV Research Unit, University of Witwatersrand, Johannesburg, South Africa
- Faculty of Health Sciences, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | - Koleka Mlisana
- National Health Laboratory Service (NHLS), Cape Town, South Africa
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), Johannesburg, South Africa
| | - Maphoshane Nchabeleng
- Mecru Clinical Research Unit, Sefako Makgatho Health Sciences University, Pretoria, South Africa
| | - Mary Allen
- National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, United States of America
| | - James Kublin
- Vaccine and Infectious Diseases Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, United States of America
| | - M. Juliana McElrath
- Vaccine and Infectious Diseases Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, United States of America
| | - Linda-Gail Bekker
- Desmond Tutu HIV Centre, University of Cape Town, Cape Town, South Africa
| | | | - Glenda Gray
- Faculty of Health Sciences, Perinatal HIV Research Unit, University of Witwatersrand, Johannesburg, South Africa
- South African Medical Research Council, Cape Town, South Africa
| | - Fatima Laher
- Faculty of Health Sciences, Perinatal HIV Research Unit, University of Witwatersrand, Johannesburg, South Africa
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Can systemic inflammation markers obtained from complete blood count in the first trimester play a role in predicting early pregnancy loss? JOURNAL OF SURGERY AND MEDICINE 2020. [DOI: 10.28982/josam.833018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Kieh MW, Browne SM, Grandits GA, Blie J, Doe-Anderson JW, Hoover ML, Davis B, Reilly CS, Neaton JD, Lane HC, Kennedy SB. Adult and paediatric haematology and clinical chemistry laboratory reference limits for Liberia. Afr J Lab Med 2020; 9:1080. [PMID: 33354527 PMCID: PMC7736678 DOI: 10.4102/ajlm.v9i1.1080] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Accepted: 08/12/2020] [Indexed: 01/03/2023] Open
Abstract
Background As more research is conducted in Liberia, there is a need for laboratory reference limits for common chemistry and haematology values based on a healthy population. Reference limits from the United States may not be applicable. Objective The aim of this study was to present laboratory reference ranges from a Liberian population and compare them to United States ranges. Methods Serum chemistry and haematology values from 2529 adults and 694 children and adolescents obtained from two studies conducted in Liberia between 2015 to 2017 were used to determine reference limits. After removing outliers, the reference limits defined by the 2.5th and 97.5th percentiles were determined by sex in three age groups (6–11, 12–17, and 18+ years). Results The median (interquartile range) of adults was 29 (23, 37) years; 44% were female. The median (interquartile range) for children and adolescents was 12 (9, 15) years; 53% were female. Several reference ranges determined using Liberian participants differed from those in the US. For chemistries, a high percentage of both adults and children/adolescents had high serum chloride levels based on United States ranges. For haematology, a high percentage of Liberian participants had haemoglobin and related assays below the lower limit of United States ranges. Conclusion Chemistry and haematology reference intervals determined for a Liberian population of healthy individuals should be considered for establishing eligibility criteria and monitoring of laboratory adverse events for clinical trials as well as for use in clinical settings in Liberia and perhaps for other countries in Western Africa.
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Affiliation(s)
- Mark W Kieh
- Partnership for Research on Ebola Virus in Liberia (PREVAIL), New Kru Town, Monrovia, Liberia
| | - Sarah M Browne
- Partnership for Research on Ebola Virus in Liberia (PREVAIL), New Kru Town, Monrovia, Liberia
| | - Greg A Grandits
- Division of Biostatistics, University of Minnesota, Minneapolis, Minnesota, United States
| | - Julie Blie
- Partnership for Research on Ebola Virus in Liberia (PREVAIL), New Kru Town, Monrovia, Liberia
| | | | - Marie L Hoover
- Advanced BioMedical Laboratories, Cinnaminson, New Jersey, United States
| | - Bionca Davis
- Division of Biostatistics, University of Minnesota, Minneapolis, Minnesota, United States
| | - Cavan S Reilly
- Division of Biostatistics, University of Minnesota, Minneapolis, Minnesota, United States
| | - James D Neaton
- Division of Biostatistics, University of Minnesota, Minneapolis, Minnesota, United States
| | - H Clifford Lane
- Division of Clinical Research, National Institute of Allergy and Infectious Diseases, National Institute of Health, Bethesda, Maryland, United States
| | - Stephen B Kennedy
- Partnership for Research on Ebola Virus in Liberia (PREVAIL), New Kru Town, Monrovia, Liberia.,Liberian College of Physicians and Surgeons, Monrovia, Liberia
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Establishment of reference intervals of biochemical analytes for healthy Chinese volunteers during the screening process in clinical pharmacology trials. Eur J Clin Pharmacol 2020; 76:1227-1235. [DOI: 10.1007/s00228-020-02912-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Accepted: 05/22/2020] [Indexed: 10/24/2022]
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Haematological and Biochemical Reference Values for Healthy Population of Maferinyah Rural Community in Guinea. BIOMED RESEARCH INTERNATIONAL 2020; 2020:8605485. [PMID: 32802881 PMCID: PMC7421051 DOI: 10.1155/2020/8605485] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/25/2020] [Accepted: 07/17/2020] [Indexed: 11/29/2022]
Abstract
Guinea's reference ranges for biological parameters rely on those of Caucasian values. Variability in reference ranges according to the context is well-documented. We conducted this study for the purpose of future malaria clinical trials that assess the efficacy and safety of malaria drugs. A repeated cross-sectional study was carried out, in an apparently healthy cohort population. Surveys took place in Maferinyah rural community, which is located at 75 km from the capital. The 2.5th and 97.5th percentiles were determined nonparametrically and stood for reference intervals. Reference values were determined separately for males and females according to ranges of age (6-10 years of age; 11-15 years of age; 16-45 years of age). Differences between genders were tested using the Mann-Whitney test, while the Friedman test was performed to test differences within each gender group according to the seasons. A total of 450 volunteers were enrolled. The median age was 13. Males 16-45 years of age had significantly higher hematologic and biochemical values compared to a female of the same age (for hematological parameters: Mean Cell Hemoglobin Concentration MCHC p ≤ 0.001, Platelets p ≤ 0.001, monocytes p = 0.0305, eosinophils p = 0.0225; for biochemical parameters: Aspartate aminotransferase AST p ≤ 0.001, Alanine Aminotransferase ALT p ≤ 0.001, creatinine p ≤ 0.001). We noticed significant seasonal variations for all the biochemical parameters and some hematologic parameters (Mean Corpuscular Hemoglobin MCH, MCHC, Mean Cell volume). This is the first study establishing hematologic and biochemical parameters in Guinea. These findings provide a useful guide for the clinical researchers and care providers. Studies on large scale and in different settings would be also desirable.
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Determining hematological, biochemical and immunological reference values in healthy adults with high-risk for HIV acquisition in Mozambique. PLoS One 2020; 15:e0232018. [PMID: 32352972 PMCID: PMC7192423 DOI: 10.1371/journal.pone.0232018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Accepted: 04/06/2020] [Indexed: 11/20/2022] Open
Abstract
Introduction In many African countries, laboratory reference values are not established for the local healthy adult population. In Mozambique, reference values are known for young adults (18-24yo) but not yet established for a wider age range. Our study aimed to establish hematological, biochemical and immunological reference values for vaccine trials in Mozambican healthy adults with high-risk for HIV acquisition. Methods A longitudinal cohort and site development study in Mozambique between November 2013 and 2014 enrolled 505 participants between 18 to 35 years old. Samples from these healthy participants, were analyzed to determine reference values. All volunteers included in the analysis were clinically healthy and human immunodeficiency virus (HIV), hepatitis B and C virus, and syphilis negative. Median and reference ranges were calculated for the hematological, biochemical and immunological parameters. Ranges were compared with other African countries, the USA and the US National Institute of Health (NIH) Division of AIDS (DAIDS) toxicity tables. Results A total of 505 participant samples were analyzed. Of these, 419 participants were HIV, hepatitis B and C virus and syphilis negative including 203 (48.5%) females and 216 (51.5%) males, with a mean age of 21 years. In the hematological parameters, we found significant differences between sex for erythrocytes, hemoglobin, hematocrit, MCV, MCH and MCHC as well as white blood cells, neutrophils and platelets: males had higher values than females. There were also significant differences in CD4+T cell values, 803 cells/μL in men versus 926 cells/μL in women. In biochemical parameters, men presented higher values than women for the metabolic, enzymatic and renal parameters: total and direct bilirubin, ALT and creatinine. Conclusion This study has established reference values for healthy adults with high-risk for HIV acquisition in Mozambique. These data are helpful in the context of future clinical research and patient care and treatment for the general adult population in the Mozambique and underline the importance of region-specific clinical reference ranges.
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Jorgensen JM, Crespo-Bellido M, Dewey KG. Variation in hemoglobin across the life cycle and between males and females. Ann N Y Acad Sci 2019; 1450:105-125. [PMID: 31074518 DOI: 10.1111/nyas.14096] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Revised: 03/18/2019] [Accepted: 03/21/2019] [Indexed: 01/08/2023]
Abstract
WHO recommendations for hemoglobin (Hb) cutoffs to define anemia are based on a handful of studies conducted in the 1960s that did not include participants from all life stages. To evaluate whether there is a need to update Hb cutoffs, we conducted a narrative review of the literature to identify more recent studies that have reported Hb cutoffs in males and females in various life stages. We compiled information from 60 studies conducted around the globe between 1975 and 2018. Many studies reported cutoffs that were similar to WHO recommendations, but cutoffs identified in studies of infants, young children, premenopausal women, and the elderly tended to be lower than WHO recommendations, while cutoffs identified in studies of men tended to be higher than WHO cutoffs. Few studies excluded individuals with iron deficiency or inflammation, which limits the conclusions that can be drawn regarding normal reference ranges. Further research using more stringent exclusion criteria is needed to develop revised recommendations for Hb cutoffs to define anemia.
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Affiliation(s)
- Josh M Jorgensen
- Program in International and Community Nutrition, Department of Nutrition, University of California Davis, Davis, California
| | - Mayra Crespo-Bellido
- Nutrition Program, School of Biological and Population Health Sciences, College of Public Health and Human Sciences, Oregon State University, Corvallis, Oregon
| | - Kathryn G Dewey
- Program in International and Community Nutrition, Department of Nutrition, University of California Davis, Davis, California
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Serena V, Alessandro M, Maurizio, Nadia T, Valeria S, Eleonora C, Alessandra B, Giordano D, Silvia A, Massimo C, Giancarlo C. Baseline haematological and biochemical reference values for healthy male adults from Mali. Pan Afr Med J 2019; 32:5. [PMID: 31068998 PMCID: PMC6492302 DOI: 10.11604/pamj.2019.32.5.12797] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2017] [Accepted: 11/24/2018] [Indexed: 11/11/2022] Open
Abstract
INTRODUCTION Haematological reference values are very important for diagnostic orientation and treatment decision. The aim of this study was to establish haematological reference values for Malian healthy adults. METHODS A cross-sectional study including 161 male Malians aged between 19 and 54 years old was performed. Median and reference ranges were calculated for haematological and biochemical parameters. Parametric student's t-test was used to determine any statistically significant differences by age, smoker status, body mass index (BMI) and occupation. Ranges were further compared with those reported for other African, Afro-American and Caucasian populations. RESULTS Increased levels of MCV, MCH, PLT and EOS were found in younger Malians who had abnormal BMI and altered platelets parameters. Notably, significantly lower eosinophil and monocyte counts were observed in Malians compared to Europeans The smoking status did not seem to directly affect RIs. CONCLUSION This is the first study to determine normal laboratory parameters in Malian adult males. Our results underscore the necessity of establishing region-specific clinical reference ranges that would allow clinicians and practitioners to manage laboratory tests, diagnosis and therapies. These data are useful not only for the management of patients in Mali, but also to support European and American clinicians in the health management of asylum seekers and migrants from Mali.
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Affiliation(s)
- Vita Serena
- Migrant Health Research Organisation (Mi-HeRO), Centro di Ricerca Sulla Salute delle Popolazioni Mobili e Globale, Italy; Department of Public Health and Infectious Diseases, Sapienza University of Rome, Policlinico Umberto I, Rome, Italy
- Units of Epidemiology and Preventive Medicine, Central Tuscany Health Authority, Florence, Italy
| | - Miglietta Alessandro
- Units of Epidemiology and Preventive Medicine, Central Tuscany Health Authority, Florence, Italy
| | - Maurizio
- Sanitary Bureau of Asylum Seekers Center of Castelnuovo di Porto, Rome, Italy; Auxilium Società Cooperativa Sociale, Senise (PZ), Italy
| | - Terrazzini Nadia
- School of Pharmacy and Biomolecular Sciences, University of Brighton, United Kingdom
| | - Sargentini Valeria
- Clinical Pathology, Department of Experimental Medicine, Sapienza University of Rome, Italy
| | - Cella Eleonora
- Unit of Medical Statistics and Molecular Epidemiology, University Campus Bio-Medico of Rome, Italy
| | - Bachetoni Alessandra
- Clinical Pathology, Department of Experimental Medicine, Sapienza University of Rome, Italy
| | - Dicuonzo Giordano
- Clinical Pathology and Microbiology Laboratory, University Hospital Campus Bio-Medico of Rome, Italy
| | - Angeletti Silvia
- School of Pharmacy and Biomolecular Sciences, University of Brighton, United Kingdom
| | - Ciccozzi Massimo
- Unit of Clinical Laboratory Science, University Campus Bio-Medico of Rome, Italy
| | - Ceccarelli Giancarlo
- Migrant Health Research Organisation (Mi-HeRO), Centro di Ricerca Sulla Salute delle Popolazioni Mobili e Globale, Italy; Department of Public Health and Infectious Diseases, Sapienza University of Rome, Policlinico Umberto I, Rome, Italy
- Units of Epidemiology and Preventive Medicine, Central Tuscany Health Authority, Florence, Italy
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Optimizing the immunogenicity of HIV prime-boost DNA-MVA-rgp140/GLA vaccines in a phase II randomized factorial trial design. PLoS One 2018; 13:e0206838. [PMID: 30496299 PMCID: PMC6264478 DOI: 10.1371/journal.pone.0206838] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Accepted: 10/18/2018] [Indexed: 12/16/2022] Open
Abstract
Background We evaluated the safety and immunogenicity of (i) an intradermal HIV-DNA regimen given with/without intradermal electroporation (EP) as prime and (ii) the impact of boosting with modified vaccinia virus Ankara (HIV-MVA) administered with or without subtype C CN54rgp140 envelope protein adjuvanted with Glucopyranosyl Lipid A (GLA-AF) in volunteers from Tanzania and Mozambique. Methods Healthy HIV-uninfected adults (N = 191) were randomized twice; first to one of three HIV-DNA intradermal priming regimens by needle-free ZetaJet device at weeks 0, 4 and 12 (Group I: 2x0.1mL [3mg/mL], Group II: 2x0.1mL [3mg/mL] plus EP, Group III: 1x0.1mL [6mg/mL] plus EP). Second the same volunteers received 108 pfu HIV-MVA twice, alone or combined with CN54rgp140/GLA-AF, intramuscularly by syringe, 16 weeks apart. Additionally, 20 volunteers received saline placebo. Results Vaccinations and electroporation did not raise safety concerns. After the last vaccination, the overall IFN-γ ELISpot response rate to either Gag or Env was 97%. Intradermal electroporation significantly increased ELISpot response rates to HIV-DNA-specific Gag (66% group I vs. 86% group II, p = 0.026), but not to the HIV-MVA vaccine-specific Gag or Env peptide pools nor the magnitude of responses. Co-administration of rgp140/GLA-AF with HIV-MVA did not impact the frequency of binding antibody responses against subtype B gp160, C gp140 or E gp120 antigens (95%, 99%, 79%, respectively), but significantly enhanced the magnitude against subtype B gp160 (2700 versus 300, p<0.001) and subtype C gp140 (24300 versus 2700, p<0.001) Env protein. At relatively low titers, neutralizing antibody responses using the TZM-bl assay were more frequent in vaccinees given adjuvanted protein boost. Conclusion Intradermal electroporation increased DNA-induced Gag response rates but did not show an impact on Env-specific responses nor on the magnitude of responses. Co-administration of HIV-MVA with rgp140/GLA-AF significantly enhanced antibody responses.
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Bimerew LG, Demie T, Eskinder K, Getachew A, Bekele S, Cheneke W, Sahlemariam Z, Adisu W, Asres Y, Yemane T, Tesfaye G, Tesfaw G, Gudina EK, Mekonnen Z. Reference intervals for hematology test parameters from apparently healthy individuals in southwest Ethiopia. SAGE Open Med 2018; 6:2050312118807626. [PMID: 30397473 PMCID: PMC6207960 DOI: 10.1177/2050312118807626] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2018] [Accepted: 09/21/2018] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND Clinical laboratory reference intervals are an important tool to identify abnormal laboratory test results. The generating of hematological parameters reference intervals for local population is very crucial to improve quality of health care, which otherwise may lead to unnecessary expenditure or denying care for the needy. There are no well-established reference intervals for hematological parameters in southwest Ethiopia. OBJECTIVE To generate hematological parameters reference intervals for apparently healthy individuals in southwest Ethiopia. METHODS A community-based cross-sectional study was conducted involving 883 individuals from March to May 2017. Four milliliter of blood sample was collected and transported to Jimma University Medical Center Laboratory for hematological analysis and screening tests. A hematological parameters were measured by Sysmex XS-500i hematology analyzer (Sysmex Corporation Kobe, Japan). The data were analyzed by SPSS version 20 statistical software. The non-parametric independent Kruskal-Wallis test and Wilcoxon rank-sum test (Mann-Whitney U test) were used to compare the parameters between age groups and genders. The 97.5 percentile and 2.5 percentile were the upper and lower reference limit for the population. RESULTS The reference interval of red blood cell, white blood cell, and platelet count in children were 4.99 × 1012/L (4.26-5.99 × 1012/L), 7.04 × 109/L (4.00-11.67 × 109/L), and 324.00 × 109/L (188.00-463.50 × 109/L), respectively. The reference interval of red blood cell, white blood cell, and platelet count in adults was 5.19 × 1012/L (4.08-6.33 × 1012/L), 6.35 × 109/L (3.28-11.22 × 109/L), and 282.00 × 109/L (172.50-415.25 × 109/L), respectively. The reference interval of red blood cell, white blood cell, and platelet count in geriatrics were 5.02 × 1012/L (4.21-5.87 × 1012/L), 6.21 × 109/L (3.33-10.03 × 109/L), and 265.50 × 109/L (165.53-418.80 × 109/L), respectively. Most of the hematological parameters showed significant differences across all age groups. CONCLUSION Most of the hematological parameters in this study showed differences from similar studies done in the country. This study provided population-specific hematological reference interval for southwest Ethiopians. Reference intervals should also be established in the other regions of the country.
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Affiliation(s)
- Lealem Gedefaw Bimerew
- Department of Medical Laboratory Sciences and Pathology, Faculty of Health Sciences and Institute of Health, Jimma University, Jimma, Ethiopia
| | - Tesfaye Demie
- Department of Medical Laboratory Sciences and Pathology, Faculty of Health Sciences and Institute of Health, Jimma University, Jimma, Ethiopia
| | - Kaleab Eskinder
- Department of Medical Laboratory Sciences and Pathology, Faculty of Health Sciences and Institute of Health, Jimma University, Jimma, Ethiopia
| | - Aklilu Getachew
- Department of Medical Laboratory Sciences and Pathology, Faculty of Health Sciences and Institute of Health, Jimma University, Jimma, Ethiopia
| | - Shiferaw Bekele
- Department of Medical Laboratory Sciences and Pathology, Faculty of Health Sciences and Institute of Health, Jimma University, Jimma, Ethiopia
| | - Waqtola Cheneke
- Department of Medical Laboratory Sciences and Pathology, Faculty of Health Sciences and Institute of Health, Jimma University, Jimma, Ethiopia
| | - Zewdineh Sahlemariam
- Department of Medical Laboratory Sciences and Pathology, Faculty of Health Sciences and Institute of Health, Jimma University, Jimma, Ethiopia
| | - Wondimagegn Adisu
- Department of Medical Laboratory Sciences and Pathology, Faculty of Health Sciences and Institute of Health, Jimma University, Jimma, Ethiopia
| | - Yaregal Asres
- Department of Medical Laboratory Sciences and Pathology, Faculty of Health Sciences and Institute of Health, Jimma University, Jimma, Ethiopia
| | - Tilahun Yemane
- Department of Medical Laboratory Sciences and Pathology, Faculty of Health Sciences and Institute of Health, Jimma University, Jimma, Ethiopia
| | - Girum Tesfaye
- Department of Medical Laboratory Sciences and Pathology, Faculty of Health Sciences and Institute of Health, Jimma University, Jimma, Ethiopia
| | - Getnet Tesfaw
- Department of Medical Laboratory Sciences and Pathology, Faculty of Health Sciences and Institute of Health, Jimma University, Jimma, Ethiopia
| | - Esayas Kebede Gudina
- Department of Internal Medicine, Faculty of Medical Sciences and Institute of Health, Jimma University, Jimma, Ethiopia
| | - Zeleke Mekonnen
- Department of Medical Laboratory Sciences and Pathology, Faculty of Health Sciences and Institute of Health, Jimma University, Jimma, Ethiopia
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Abebe M, Melku M, Enawgaw B, Birhan W, Deressa T, Terefe B, Baynes HW. Reference intervals of routine clinical chemistry parameters among apparently healthy young adults in Amhara National Regional State, Ethiopia. PLoS One 2018; 13:e0201782. [PMID: 30071088 PMCID: PMC6072122 DOI: 10.1371/journal.pone.0201782] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2017] [Accepted: 07/23/2018] [Indexed: 11/18/2022] Open
Abstract
Background Clinical laboratory reference intervals (RIs) are essential for clinical diagnosis, treatment and therapeutic monitoring. Locally established RIs are required to correctly interpret clinical laboratory results. In Ethiopia, clinical laboratory test results are interpreted based on RIs derived from a western population. Methods A multicenter cross-sectional study was conducted among blood donors in Amhara National Regional State, Ethiopia from March 2016 to May 2017. A total of 1,175 apparently healthy study participants were included in the study from four blood banks in the region. All clinical chemistry parameters were analyzed using Mindray BS-200E full automated clinical chemistry analyzer. The 95% RIs were estimated using reference limits at 2.5th percentile for the lower reference limit and 97.5th percentile for the upper reference limit. Kolmogorov–Sminorv and Wilcoxon rank-sum tests were used to check data distribution normality and whether partitions were needed between variables, respectively. Results RIs established include: ALT 5.13–42.88 U/L for males and 4.3–37 U/L for females; AST 12.13–46.88 for males and 10–43.8 U/L for females; ALP 77.2–475.8 U/L for males and 89–381 U/L for females; amylase 29–309.8 U/L for males and 29–287.9 U/L for females; GGT 7–69.8 U/L for males and 6–39.1 U/L for females; total bilirubin 0.11–1.18 mg/dl for males and 0.08–0.91 mg/dl for females; creatinine 0.48–1.13 mg/dl for males and 0.47–1.09 mg/dl for females; total cholesterol 78.13–211.75 mg/dl for males and 83.6–202.7 mg/dl for females; total protein 5.7–9.7 g/dl for males and 5.6–9.47 for females; triglycerides 36–221.9 mg/dl for males and 35.3–201.5 mg/dl for females; urea 12–43 mg/dl for males and 10–38.7 mg/dl for females; and uric acid 2.7–6.9 mg/dl for males and 2.1–5.9 mg/dl for females. Conclusion This study has established RIs for routine clinical chemistry parameters. These RIs are important as they support the interpretation of clinical laboratory results for medical decision making and other health-related activities.
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Affiliation(s)
- Molla Abebe
- Department of Clinical Chemistry, School of Biomedical and Laboratory Sciences, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
- * E-mail:
| | - Mulugeta Melku
- Department of Hematology and Immunohematology, School of Biomedical and Laboratory Sciences, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Bamlaku Enawgaw
- Department of Hematology and Immunohematology, School of Biomedical and Laboratory Sciences, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Wubet Birhan
- Department of Immunology and Molecular Biology, School of Biomedical and Laboratory Sciences, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Tekalign Deressa
- Department of Immunology and Molecular Biology, School of Biomedical and Laboratory Sciences, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Betelihem Terefe
- Department of Hematology and Immunohematology, School of Biomedical and Laboratory Sciences, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Habtamu Wondifraw Baynes
- Department of Clinical Chemistry, School of Biomedical and Laboratory Sciences, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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Bakrim S, Motiaa Y, Benajiba M, Ouarour A, Masrar A. Establishment of the hematology reference intervals in a healthy population of adults in the Northwest of Morocco (Tangier-Tetouan region). Pan Afr Med J 2018; 29:169. [PMID: 30050633 PMCID: PMC6057597 DOI: 10.11604/pamj.2018.29.169.13042] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2017] [Accepted: 03/02/2018] [Indexed: 11/11/2022] Open
Abstract
Introduction Among the most useful biological examinations in common medical practice, blood count is the most prescribed. The reference intervals of the hematological parameters of this examination are of major importance for clinical orientations and therapeutic decisions. In Morocco, the reference values used by the laboratories of medical biology and used by doctors are ones collected from Caucasian and European individuals. These values could be different in the Moroccan population. Besides, reference intervals of the blood count specific to the various Moroccan regions are missing. We decided to determine the reference intervals from a population of healthy adults of the Tangier-Tetouan region by following the procedures recommended by the IFCC-CLSI guidelines in 2008 and comparing them to those of the literature. Methods Blood samples were taken from 15840 adult volunteers (8402 men from 18 to 55 years old and 7438 women from 18 to 50 years old) from the regional transfusion center of Tangier and Tetouan during a period between November 2014 and May 2016. The complete blood count was measured by the Sysmex KX21N® analyzer. For each sample a systematic blood smear was done to determine the leukocyte differential. The data analysis was made by the software SPSS 20.0 by using percentiles 2.5th and 97.5th. Results A significant difference between both sexes was noted (p<0,001) for all the hematological parameters (red blood cells, hematocrit, hemoglobin, mean corpuscular volume, mean corpuscular hemoglobin, mean corpuscular hemoglobin concentration, leukocytes, neutrophils, basophils, eosinophils, monocytes, platelets and mean platelet volume) except for the numeration of lymphocytes (p = 0.552). The values of this study were compared with those reported in Arabic, Caucasian and African populations. Said comparisons showed the existence of significant differences. Conclusion This study tries to accentuate the necessity of proceeding with the establishment of reference intervals specific to the blood count of the Moroccan population to avoid errors of diagnosis, allow clinicians to interpret with greater specificity the hematological examinations and to improve the quality of medical care distributed to patients.
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Affiliation(s)
- Saad Bakrim
- Laboratory of Biology and Health, Abdelmalek Essaâdi University, Faculty of Science, BP 2121, Tetouan, Morocco.,Hematology Laboratory, Provincial Hospital Center, Mohammed VI hospital, M'diq, Morocco.,Hematology Laboratory, Faculty of Medicine and Pharmacy, Mohammed V University, Rabat, Morocco; Central Hematology Laboratory, Ibn Sina University Hospital, Rabat, Morocco
| | - Youssef Motiaa
- Anesthesia Reanimation Department, Ibn Sina University Hospital, Rabat, Faculty of Medicine and Pharmacy, Mohammed V University, Rabat, Morocco
| | - Mohamed Benajiba
- National Center of Blood transfusion and Hematology, Rabat, Morocco
| | - Ali Ouarour
- Laboratory of Biology and Health, Abdelmalek Essaâdi University, Faculty of Science, BP 2121, Tetouan, Morocco
| | - Azlarab Masrar
- Hematology Laboratory, Faculty of Medicine and Pharmacy, Mohammed V University, Rabat, Morocco; Central Hematology Laboratory, Ibn Sina University Hospital, Rabat, Morocco
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Peck MJ, Sanders EB, Scherer G, Lüdicke F, Weitkunat R. Review of biomarkers to assess the effects of switching from cigarettes to modified risk tobacco products. Biomarkers 2018; 23:213-244. [PMID: 29297706 DOI: 10.1080/1354750x.2017.1419284] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Context: One approach to reducing the harm caused by cigarette smoking, at both individual and population level, is to develop, assess and commercialize modified risk alternatives that adult smokers can switch to. Studies to demonstrate the exposure and risk reduction potential of such products generally involve the measuring of biomarkers, of both exposure and effect, sampled in various biological matrices.Objective: In this review, we detail the pros and cons for using several biomarkers as indicators of effects of changing from conventional cigarettes to modified risk products.Materials and methods: English language publications between 2008 and 2017 were retrieved from PubMed using the same search criteria for each of the 25 assessed biomarkers. Nine exclusion criteria were applied to exclude non-relevant publications.Results: A total of 8876 articles were retrieved (of which 7476 were excluded according to the exclusion criteria). The literature indicates that not all assessed biomarkers return to baseline levels following smoking cessation during the study periods but that nine had potential for use in medium to long-term studies.Discussion and conclusion: In clinical studies, it is important to choose biomarkers that show the biological effect of cessation within the duration of the study.
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Affiliation(s)
| | | | | | - Frank Lüdicke
- Research & Development, Philip Morris International, Neuchâtel, Switzerland
| | - Rolf Weitkunat
- Research & Development, Philip Morris International, Neuchâtel, Switzerland
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Achila OO, Semere P, Andemichael D, Gherezgihier H, Mehari S, Amanuel A, Yohannes T, Yohaness E, Goje T. Biochemistry reference intervals for healthy elderly population in Asmara, Eritrea. BMC Res Notes 2017; 10:748. [PMID: 29258577 PMCID: PMC5735951 DOI: 10.1186/s13104-017-3087-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2017] [Accepted: 12/13/2017] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE There is a scarcity of reference interval studies on the elderly in Africa. This study establishes reference interval for the elderly for some commonly used biochemical parameters. In this study, 255 conveniently sampled, healthy elderly, participants meeting Clinical and Laboratory Standards Institute (CLSI C28-A3) guidelines were enrolled. The results obtained may have utility in clinical diagnosis, patient management and research. RESULTS In general, the consensus reference interval established in this study tended to be higher than reference interval from Caucasian populations; but lower than those obtained from reference interval studies in several African countries. This pattern was observed in a number of analytes including Alanine aminotransferase; aspartate aminotransferase; alkaline phosphatase; sodium; potassium among others. Significant sex-related variations were also observed in total bilirubin; direct bilirubin; indirect bilirubin; albumin; sodium; chloride; plasma carbon dioxide, creatinine and anion gap. The results demonstrate that reference interval for Eritrean urban population differs from those derived from other African or North American populations. In this regard, the use of reference interval values obtained from Caucasian populations may result in misdiagnosis.
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Affiliation(s)
- Oliver Okoth Achila
- Department of Clinical Laboratory Services, Asmara College of Health Sciences (ACHS), P.O. Box 9540, Asmara, Eritrea.
| | - Paulos Semere
- Department of Clinical Laboratory Services, Asmara College of Health Sciences (ACHS), P.O. Box 9540, Asmara, Eritrea
| | - Danait Andemichael
- Department of Clinical Laboratory Services, Asmara College of Health Sciences (ACHS), P.O. Box 9540, Asmara, Eritrea
| | - Harerta Gherezgihier
- Department of Clinical Laboratory Services, Asmara College of Health Sciences (ACHS), P.O. Box 9540, Asmara, Eritrea
| | - Senait Mehari
- Department of Clinical Laboratory Services, Asmara College of Health Sciences (ACHS), P.O. Box 9540, Asmara, Eritrea
| | - Adiam Amanuel
- Department of Clinical Laboratory Services, Asmara College of Health Sciences (ACHS), P.O. Box 9540, Asmara, Eritrea
| | - Tedalo Yohannes
- Department of Clinical Laboratory Services, Asmara College of Health Sciences (ACHS), P.O. Box 9540, Asmara, Eritrea
| | - Eyob Yohaness
- Department of Clinical Laboratory Services, Asmara College of Health Sciences (ACHS), P.O. Box 9540, Asmara, Eritrea
| | - Tzegezeab Goje
- Department of Clinical Laboratory Services, Asmara College of Health Sciences (ACHS), P.O. Box 9540, Asmara, Eritrea
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Model based population PK-PD analysis of furosemide for BP lowering effect: A comparative study in primary and secondary hypertension. Eur J Pharm Sci 2017; 109:253-261. [PMID: 28821435 DOI: 10.1016/j.ejps.2017.08.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2017] [Revised: 07/05/2017] [Accepted: 08/14/2017] [Indexed: 11/20/2022]
Abstract
Though numerous reports have demonstrated multiple mechanisms by which furosemide can exert its anti-hypertensive response. However, lack of studies describing PK-PD relationship for furosemide featuring its anti-hypertensive property has limited its usage as a blood pressure (BP) lowering agent. Serum concentrations and mean arterial BP were monitored following 40 and 80mgkg-1 multiple oral dose of furosemide in spontaneously hypertensive rats (SHR) and DOCA-salt induced hypertensive (DOCA-salt) rats. A simultaneous population PK-PD relationship using Emax model with effect compartment was developed to compare the anti-hypertensive efficacy of furosemide in these rat models. A two-compartment PK model with Weibull-type absorption and first-order elimination best described the serum concentration-time profile of furosemide. In the present study, post dose serum concentrations of furosemide were found to be lower than the EC50. The EC50 predicted in DOCA-salt rats was found to be lower (4.5-fold), whereas the tolerance development was higher than that in SHR model. The PK-PD parameter estimates, particularly lower values of EC50, Ke and Q in DOCA-salt rats as compared to SHR, pinpointed the higher BP lowering efficacy of furosemide in volume overload induced hypertensive conditions. Insignificantly altered serum creatinine and electrolyte levels indicated a favorable side effect profile of furosemide. In conclusion, the final PK-PD model described the data well and provides detailed insights into the use of furosemide as an anti-hypertensive agent.
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Thakar M, Angira F, Pattanapanyasat K, Wu AHB, O'Gorman M, Zeng H, Qu C, Mahajan B, Sukapirom K, Chen D, Hao Y, Gong Y, Indig MDA, Graminske S, Orta D, d'Empaire N, Lu B, Omana-Zapata I, Zeh C. CD4 Lymphocyte Enumeration and Hemoglobin Assessment Aid for Priority Decisions: A Multisite Evaluation of the BD FACSPresto ™ System. Open AIDS J 2017; 11:76-90. [PMID: 29290885 PMCID: PMC5730955 DOI: 10.2174/1874613601711010076] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2017] [Revised: 09/19/2017] [Accepted: 09/21/2017] [Indexed: 12/17/2022] Open
Abstract
Background: The BD FACSPresto™ system uses capillary and venous blood to measure CD4 absolute counts (CD4), %CD4 in lymphocytes, and hemoglobin (Hb) in approximately 25 minutes. CD4 cell count is used with portable CD4 counters in resource-limited settings to manage HIV/AIDS patients. A method comparison was performed using capillary and venous samples from seven clinical laboratories in five countries. The BD FACSPresto system was assessed for variability between laboratory, instrument/operators, cartridge lots and within-run at four sites. Methods: Samples were collected under approved voluntary consent. EDTA-anticoagulated venous samples were tested for CD4 and %CD4 T cells using the gold-standard BD FACSCalibur™ system, and for Hb, using the Sysmex® KX-21N™ analyzer. Venous and capillary samples were tested on the BD FACSPresto system. Matched data was analyzed for bias (Deming linear regression and Bland-Altman methods), and for concordance around the clinical decision point. The coefficient of variation was estimated per site, instrument/operator, cartridge-lot and between-runs. Results: For method comparison, 93% of the 720 samples were from HIV-positive and 7% from HIV-negative or normal subjects. CD4 and %CD4 T cells venous and capillary results gave slopes within 0.96–1.05 and R2 ≥0.96; Hb slopes were ≥1.00 and R2 ≥0.89. Variability across sites/operators gave %CV <5.8% for CD4 counts, <1.9% for %CD4 and <3.2% for Hb. The total %CV was <7.7% across instrument/cartridge lot. Conclusion: The BD FACSPresto system provides accurate, reliable, precise CD4/%CD4/Hb results compared to gold-standard methods, irrespective of venous or capillary blood sampling. The data showed good agreement between the BD FACSPresto, BD FACSCalibur and Sysmex systems.
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Affiliation(s)
| | - Francis Angira
- Kenya Medical Research Institute/US CDC Research and Public Health Collaboration, Kisumu, Kenya
| | | | - Alan H B Wu
- San Francisco General Hospital, San Francisco, CA, USA
| | - Maurice O'Gorman
- Children's Hospital Los Angeles, Los Angeles, and The Keck School of Medicine, University of Southern California, CA, USA
| | - Hui Zeng
- Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Chenxue Qu
- Peking University First Hospital, Beijing, China
| | | | - Kasama Sukapirom
- Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Danying Chen
- Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Yu Hao
- Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Yan Gong
- Peking University First Hospital, Beijing, China
| | | | | | - Diana Orta
- BioCollection Worldwide Incorporated, Miami, Florida, USA
| | | | - Beverly Lu
- BD Biosciences, San Jose, California, USA
| | | | - Clement Zeh
- US Centers for Disease Control and Prevention (CDC-Kenya), Kisumu, Kenya
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Indrayan A. Statistical medicine: An emerging medical specialty. J Postgrad Med 2017; 63:252-256. [PMID: 29022563 PMCID: PMC5664870 DOI: 10.4103/jpgm.jpgm_189_17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2017] [Revised: 07/08/2017] [Accepted: 08/12/2017] [Indexed: 12/02/2022] Open
Abstract
A large number of statistical tools are now used for medical decision in the core activities of diagnosis, treatment and prognosis. These tools provide undeniable help in improving medical outcomes. Prominent among them are uncertainty measurement by probability, medical indicators and indexes, reference ranges, and scoring systems. In addition are tools such as odds ratio, sensitivity, specificity and predictivities, area under the ROC curve, likelihood ratios, and cost-benefit analysis that are commonly applied in medical research but have implications for day-to-day clinical activities. These tools have so completely integrated into medical practice that statistical medicine by itself can stand alone as a medical specialty. Time has arrived to recognize statistical medicine as a medical specialty.
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Affiliation(s)
- A Indrayan
- Former Professor & Head, Department of Biostatistics and Medical Informatics, University College of Medical Sciences, Delhi, India
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Kone B, Maiga M, Baya B, Sarro YDS, Coulibaly N, Kone A, Diarra B, Sanogo M, Togo ACG, Goita D, Dembele M, Polis MA, Warfield J, Belson M, Dao S, Orsega S, Murphy RL, Diallo S, Siddiqui S. Establishing Reference Ranges of Hematological Parameters from Malian Healthy Adults. JOURNAL OF BLOOD & LYMPH 2017; 7:154. [PMID: 29423342 PMCID: PMC5800422 DOI: 10.4172/2165-7831.1000154] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
INTRODUCTION Measurement of immuno-hematological parameters has been historically helpful in the diagnosis and treatment monitoring of many infectious diseases and cancers. However, these parameters have not yet been established in many developing countries where patient care strongly relies on such low-cost tests. This study describes the immuno-hematological parameter ranges for Malian healthy adults. METHODS A cross sectional study was conducted from August 2004 to May 2013. We included 213 healthy volunteers (173 male and 40 female), aged between 18-59 years. Median, 2.5 and 97.5 percentile ranges for each immuno-hematological parameter are presented. RESULTS In our study population, the hematological parameters' ranges were mostly different to the universal established ranges. We found in our population a Median white blood cell (WBC) count of 5200 cells/μL [3237.5-11900], Red Blood Cell (RBC) count of 4.94 10^6 [3.56-6.17], hemoglobin (Hb) of 14.2 g/dL [12.2-17.38], platelet count (Plt) of 275 10^3/μL [145.4-614.4], lymphocytes 2050/μL [1200-3800], neutrophils 2200/μL [1040-6220]; monocytes 200/μL [100-660]; eosinophils 131/μL [0-1026]; CD4 902 cells/μL [444-1669] and CD8 485 cells/μL [0-1272]. We found significant gender differences in RBC, Hb level and MPV. However, RBC and Hb were higher in males median values compared to females (median values) (p<0.001), whereas the Mean platelet volume lower values (MPV) in males than females (P<0.047). The hemoglobin level for some West African countries (Mali, Burkina Faso, Togo, and Nigeria) ranged from 13.5 to 15.1 g/dL for males and 12 to 13 g/dL for females. However in East and Southern Africa, the values were anywhere from 14.1 to 16.1 for males and 11.2 to 14.4 for females. CONCLUSION Our data may help physicians to better define hematological abnormalities in patients. They may also be used to define new "normal hematological values" in Malian population or in the whole West African population.
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Affiliation(s)
- B Kone
- University of Sciences, Techniques and Technologies of Bamako, Mali
| | - M Maiga
- University of Sciences, Techniques and Technologies of Bamako, Mali
- Leidos Biomedical Research, Inc., in support to NIAID, Bethesda, Maryland, USA
- Northwestern University, Chicago, Illinois, USA
| | - B Baya
- University of Sciences, Techniques and Technologies of Bamako, Mali
| | - YDS Sarro
- University of Sciences, Techniques and Technologies of Bamako, Mali
| | - N Coulibaly
- University of Sciences, Techniques and Technologies of Bamako, Mali
| | - A Kone
- University of Sciences, Techniques and Technologies of Bamako, Mali
| | - B Diarra
- University of Sciences, Techniques and Technologies of Bamako, Mali
| | - M Sanogo
- University of Sciences, Techniques and Technologies of Bamako, Mali
| | - ACG Togo
- University of Sciences, Techniques and Technologies of Bamako, Mali
| | - D Goita
- University of Sciences, Techniques and Technologies of Bamako, Mali
| | - M Dembele
- University of Sciences, Techniques and Technologies of Bamako, Mali
| | - MA Polis
- National Institute of Allergic and Infectious Diseases (NIAID), Bethesda, Maryland, USA
| | - J Warfield
- Leidos Biomedical Research, Inc., in support to NIAID, Bethesda, Maryland, USA
| | - M Belson
- National Institute of Allergic and Infectious Diseases (NIAID), Bethesda, Maryland, USA
| | - S Dao
- University of Sciences, Techniques and Technologies of Bamako, Mali
| | - S Orsega
- National Institute of Allergic and Infectious Diseases (NIAID), Bethesda, Maryland, USA
| | - RL Murphy
- Northwestern University, Chicago, Illinois, USA
| | - S Diallo
- University of Sciences, Techniques and Technologies of Bamako, Mali
| | - S Siddiqui
- National Institute of Allergic and Infectious Diseases (NIAID), Bethesda, Maryland, USA
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Genetu M, Damtie D, Workineh M, Mathewos Tebeje B, Enawgaw B, Deressa T. Immunological and hematological reference intervals among HIV-seronegative pregnant women in northwest Ethiopia. Int J Womens Health 2017; 9:145-150. [PMID: 28424562 PMCID: PMC5344411 DOI: 10.2147/ijwh.s126916] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Background Pregnancy is a state characterized by profound physiological hematological changes. However, hematological reference intervals being used in clinical practice in Ethiopia are derived from nonlocal general populations, despite the significant variations reported previously. The aim of this study was to determine the immunological and hematological reference intervals in healthy pregnancy among HIV-seronegative pregnant women in northwest Ethiopia. Materials and methods A total of 200 healthy, HIV-seronegative pregnant women were enrolled from February 2015 to June 2015 in a cross-sectional study setting at Gondar University Hospital. Sociodemographic and obstetric data were collected using a structured questionnaire. Blood samples collected from each participant were used to define the immunological and hematological parameters. The mean, median, and 95% interval values were calculated for the immunological and hematological parameters. P-value <0.05 was considered statistically significant for all variables. Results This study found that there were changes in CD4+ T-cell count, platelet count, and hematocrit (HCT) values as pregnancy advances. The calculated combined reference intervals for the absolute CD4+ T-cell count and platelet count were 712.47–760.67 and 221.25–240.14, respectively. A progressive decline in the platelet count was observed as pregnancy advanced, with 95% intervals of 224.53–253.21, 209.50–237.38, and 213.70–247.86 in the first, second, and third trimesters, respectively (P=0.27). There was a statistically significant increase in mean (±standard deviation [SD]) HCT with gestational age, being 39.18±6.70, 41.96±3.70, and 40.53±3.77 in the first, second, and third trimesters, respectively (P=0.03). The overall 95% interval for hemoglobin (HB) concentration was 12.99–13.36 g/dL, HCT 40.19%–41.49%, mean corpuscular volume (MCV) 93.33–94.63 fL, and mean corpuscular hemoglobin (MCH) 28.88–34.81 pg. Compared with the reference ranges derived from other studies, we found considerable variations in CD4+T-cell count, HB, HCT, and MCV values. Conclusion The findings of this study highlight the differences in immunohematological profile among pregnant women and nonpregnant women from Ethiopia and other countries, in addition to suggesting the need for such establishment of local reference values for different populations.
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Affiliation(s)
- Meaza Genetu
- Department of Immunology and Molecular Biology, School of Biomedical and Laboratory Sciences, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia
| | - Debasu Damtie
- Department of Immunology and Molecular Biology, School of Biomedical and Laboratory Sciences, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia
| | - Meseret Workineh
- Department of Immunology and Molecular Biology, School of Biomedical and Laboratory Sciences, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia
| | - Biniam Mathewos Tebeje
- Department of Immunology and Molecular Biology, School of Biomedical and Laboratory Sciences, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia.,Molecular Parasitology Laboratory, Queensland Institute of Medical Research, Brisbane, Australia
| | - Bamlaku Enawgaw
- Department of Hematology and Immunohematology, School of Biomedical and Laboratory Sciences, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia
| | - Tekalign Deressa
- Department of Immunology and Molecular Biology, School of Biomedical and Laboratory Sciences, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia
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Lim E, Miyamura J, Chen JJ. Racial/Ethnic-Specific Reference Intervals for Common Laboratory Tests: A Comparison among Asians, Blacks, Hispanics, and White. HAWAI'I JOURNAL OF MEDICINE & PUBLIC HEALTH : A JOURNAL OF ASIA PACIFIC MEDICINE & PUBLIC HEALTH 2015; 74:302-310. [PMID: 26468426 PMCID: PMC4578165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Reference intervals (RIs) for common clinical laboratory tests are usually not developed separately for different subpopulations. The aim of this study was to investigate racial/ethnic differences in RIs of common biochemical and hematological laboratory tests using the National Health and Nutrition Examination Survey (NHANES) 2011-2012 data. This current study included 3,077 participants aged 18-65 years who reported their health status as "Excellent," "Very good," or "Good," with known race/ethnicity as white, black, Hispanic, or Asian. Quantile regression analyses adjusted for sex were conducted to evaluate racial/ethnic differences in the normal ranges of 38 laboratory tests. Significant racial/ethnic differences were found in almost all laboratory tests. Compared to whites, the normal range for Asians significantly shifted to higher values in globulin and total protein and to lower values in creatinine, hematocrit, hemoglobin, mean cell hemoglobin, mean cell hemoglobin concentration, and mean platelet volume. These results indicate that racial/ethnic subpopulations have unique distributions in the labortoary tests and race/ethnicity may need to be incorporated in the development of their RIs. Establishment of racial/ethnic-specific RIs may have significant clinical and public health implication for more accurate disease diagnosis and appropriate treatment to improve quality of patient care, especially for a state with diverse racial/ethnic subpopuations such as Hawai'i.
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Affiliation(s)
- Eunjung Lim
- Office of Biostatistics and Quantitative Health Sciences, John A. Burns School of Medicine, University of Hawai'i, Honolulu, HI (EL, JJC)
| | - Jill Miyamura
- Office of Biostatistics and Quantitative Health Sciences, John A. Burns School of Medicine, University of Hawai'i, Honolulu, HI (EL, JJC)
| | - John J Chen
- Office of Biostatistics and Quantitative Health Sciences, John A. Burns School of Medicine, University of Hawai'i, Honolulu, HI (EL, JJC)
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Simoncini GM, Megill M, van den Berg-Wolf M. Reducing False-Positive HIV Diagnosis in Niger: A Women's Issue. J Int Assoc Provid AIDS Care 2015; 15:15-8. [PMID: 25979258 DOI: 10.1177/2325957415586260] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
The entry into both HIV care and secondary prevention is first through the knowledge of one's own HIV status. Testing for HIV remains challenging in countries where clinicians rely on rapid testing algorithms because the routine use of confirmatory Western blot technology is unavailable. In this case report, we describe the case of a pregnant woman in Niger, who was falsely labeled as HIV positive during prenatal visits. We also describe our clinical algorithm that was developed to facilitate retesting in patients who initially tested HIV positive or indeterminant with rapid diagnostic tests. Vigilance is necessary to ensure that appropriate identification and treatment of HIV is provided to reduce mother-to-child transmission of HIV, to appropriately allocate resources, and to avoid falsely labeling patients with HIV.
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Affiliation(s)
- Gina M Simoncini
- Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA, USA
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Incidence of HIV and the prevalence of HIV, hepatitis B and syphilis among youths in Maputo, Mozambique: a cohort study. PLoS One 2015; 10:e0121452. [PMID: 25798607 PMCID: PMC4370560 DOI: 10.1371/journal.pone.0121452] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2014] [Accepted: 02/01/2015] [Indexed: 01/03/2023] Open
Abstract
Background Prevalence of HIV in Mozambique among individuals aged 15–49 years is 11.5%. The HIV prevalence is higher in women than in men across the country, peaking at ages 25–29 years and 35–39 years, respectively. In this study, we aimed at determining the prevalence and incidence of HIV, prevalence of Hepatitis B (HBV), and prevalence of syphilis in youths. We also characterized a cohort of youths for future participation in phase I/II HIV vaccine trials. Methods The study was conducted at a youth clinic in Maputo Central Hospital from August 2009 to October 2011. Youths of both genders aged 18–24 years (n = 1380) were screened for HIV using a sequential algorithm of two immunochromatographic assays, HBV using an enzyme linked immunosorbant test, and syphilis using a treponemal immunochromatographic strip test. The HIV seronegative participants (n = 1309) were followed-up for 12 months with quarterly study visits. The clinical and behavioral data were collected using structured questionnaires. The HIV seroconversions were confirmed by a molecular assay. Results The study population was female dominant (76.8%). All participants had a formal education, with 44.6% studying for technical or higher education degrees. The mean age at sexual debut was 16.6 years (SD: ±1.74), with 85.6% reporting more than one sexual partner in life. The screening showed the prevalence of HIV, HBV, and syphilis at 5.1% (95% CI: 3.97–6.31), 12.2% (95% CI 10.5%–14.0%), and 0.36% (95% CI 0.15%–0.84%), respectively. The HIV incidence rate was found to be 1.14/100 person years (95% CI: 0.67–1.92). Retention rates were stable throughout the study being 85.1% at the last visit. Conclusion Incidence of HIV in this cohort of youths in Maputo was relatively low. Also, the prevalence of HIV and syphilis was lower than the national values in this age group. However, the HBV prevalence was higher than in previous reports in the country.
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Koumaré ATCRK, Sakandé LPL, Kabré E, Sondé I, Simporé J, Sakandé J. Reference ranges of cholesterol sub-fractions in random healthy adults in Ouagadougou, Burkina Faso. PLoS One 2015; 10:e0116420. [PMID: 25611320 PMCID: PMC4303323 DOI: 10.1371/journal.pone.0116420] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2014] [Accepted: 12/09/2014] [Indexed: 11/30/2022] Open
Abstract
In Burkina Faso, the values that serve as clinical chemistry reference ranges are those provided by European manufacturers' insert sheets based on reference of the Western population. However, studies conducted so far in some African countries reported significant differences in normal laboratory ranges compared with those of the industrialized world. The aim of this study was to determine reference values of cholesterol fractions in apparently normal adults in Burkina Faso that could be used to better assess the risks related to cardiovascular diseases. Study population was 279 healthy subjects aged from 15 to 50 years including 139 men and 140 women recruited at the Regional Center of Blood Transfusion of Ouagadougou, capital city of Burkina Faso (West Africa). Exclusion criteria based on history and clinical examination were used for defining reference individuals. The dual-step precipitation of HDL cholesterol sub-fractions using dextran sulfate was performed according to the procedure described by Hirano. The medians were calculated and reference values were determined at 2.5th and 97.5th percentiles. The median and upper ranges for total cholesterol, LDL cholesterol, total HDL cholesterol and HDL2 cholesterol were observed to be higher in women in comparison to men (p <0.05). These reference ranges were similar to those derived from other African countries but lower than those recorded in France and in USA. This underscores the need for such comprehensible establishment of reference values for limited resources countries. Our study provides the first cholesterol sub-fractions (HDL2 and HDL3) reference ranges for interpretation of laboratory results for cardiovascular risk management in Burkina Faso.
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Affiliation(s)
- Alice T. C. R. Kiba Koumaré
- Health Department, Laboratory of Biochemistry, University of Ouagadougou, Ouagadougou, Burkina Faso
- Regional Blood Transfusion Center of Ouagadougou, Ouagadougou, Burkina Faso
| | - Linda P. L. Sakandé
- Clinic Philadelphie of Ouagadougou, Clinical Laboratory, Ouagadougou, Burkina Faso
| | - Elie Kabré
- Health Department, Laboratory of Biochemistry, University of Ouagadougou, Ouagadougou, Burkina Faso
| | - Issaka Sondé
- Health Department, Laboratory of Biochemistry, University of Ouagadougou, Ouagadougou, Burkina Faso
| | - Jacques Simporé
- Centre de Recherche Biomoléculaire Pietro Annigoni (CERBA), Laboratoire de Biologie et Génétique (LABIOGENE), Centre Médical Saint Camille, Ouagadougou, Université de Ouagadougou, Ouagadougou, Burkina Faso
| | - Jean Sakandé
- Health Department, Laboratory of Biochemistry, University of Ouagadougou, Ouagadougou, Burkina Faso
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