Phillip Bwititi

Association of abnormal erythrocyte morphology with oxidative stress and inflammation in metabolic syndrome.

In carrying out their role of free radical scavenging, erythrocytes become damaged due to oxidation of membrane lipids and proteins. Such damage may change the morphology of the erythrocytes. The present study aims to demonstrate change in erythrocyte morphology in MetS and associate the changes with increased oxidative stress and inflammation that were shown in our recent study. One hundred participants were recruited from a rural town of Australia. Whole blood viscosity, erythrocyte aggregation, erythrocyte deformability, lipid profile and blood sugar level, oxidative stress markers (erythrocyte reduced glutathione, superoxide dismutase, urinary isoprostanes) and inflammatory markers (high sensitivity C-reactive protein) were measured. Erythrocyte morphological study was performed by scanning electron microscopy. Recruited participants were classified into MetS and non-MetS following the National Cholesterol Education Program Adult Treatment Panel III definition. Data were analyzed by IBM SPSS 20 software. The mean percentages of biconcave cells were decreased whereas acanthocytes, stomatocytes and echinocytes were increased in MetS group compared to healthy controls. Morphologically abnormal erythrocytes were significantly correlated with oxidative stress and chronic inflammation markers. Free radicals generated in increased concentration in MetS seem to damage erythrocyte changing its morphology which possibly could affect other hemorheological parameters.

Early renal failure detection by cystatin C in Type 2 diabetes mellitus: varying patterns of renal analyte expression.

Aim: The early stages of renal failure are poorly diagnosed by current routine tests. We studied cystatin C and routine renal analyte patterns in Type 2 diabetes mellitus. Methods: Type 2 diabetes mellitus patients (n = 48) were tested for serum cystatin C, urine albumin, haemoglobin A1c, serum creatinine, serum urea, urine creatinine, glucose, triglycerides and low density lipoproteins (LDL). Glomerular filtration rate (GFR) estimates were made using Cockroft‐Gault and Modification of Diet in Renal Disease formulae. Results: The cystatin C (95%CI) reference range was 0.78–0.86 mg/L. While serum cystatin C showed general correlation with routine renal tests, a plateau was observed in analytes measured against cystatin C. Cystatin C improved sensitivity led to detection of renal abnormality in 19% of patients not diagnosed by routine tests. Conclusions: Cystatin C is a more sensitive marker of renal disease in Type 2 diabetes mellitus where estimated GFR is unreported at >60 mL/min and where antihypertensive medications render microalbuminuria detection unreliable. Its incorporation into a panel of renal function tests is highly recommended.

New guidelines for diagnosis of gestational diabetes: pathology based impact assessment

Background: A recent study indicated an average of 19.5% abnormal oral glucose tolerance in antenatal clients per year. Aim: The purpose of this study was to determine the impact on gestational diabetes cases due to new guidelines for diagnosis and classification of hyperglycaemia in pregnancy. Materials and Methods: This study reviewed the archived clinical pathology data on oral glucose tolerance tests performed between January 1999 and December 2008 on antenatal clients (N = 615). The cases were reviewed to determine changes if any in percentage of gestational diabetes due to new guidelines. Results: Over the 10 years period, a yearly average of additional 10.8% antenatal cases suggestive of gestational diabetes was observed due to the new recommended thresholds. Further, the average yearly incidence would have increased from 8.8 cases to 16.2 cases, which translates to almost 46% increase in the prospective numbers of gestational diabetes. Conclusions: This report presents the extent of how the new recommended guidelines for diagnosis and classification of hyperglycaemia in pregnancy could increase the prevalence of gestational diabetes. It also provides pathology-based evidence for the epidemiology of gestational diabetes mellitus and allows for planning the costs that would be attendant to the full implementation of the new guidelines.

Automation and Expert Systems in a Core Clinical Chemistry Laboratory

Clinical pathology has a major influence on clinical decisions and the past 60 years have seen an evolution brought about by advances in information technology and automation. The impact of the ever-changing technology in regard to responsibilities and training therefore needs continual appraisal. In this article, the authors have drawn on their experience on automation in clinical chemistry and the experience at Monash Medical Centre in Melbourne, Australia where one of the authors is based. Automation in other industries has also been reviewed, since the reasons to automate and the impact of automation have similarities and these include reduction in errors, increase in productivity, and improvement in safety. Advances in technology in clinical chemistry that have included total laboratory automation call for changes in job responsibilities to include skills in information technology, data management, instrumentation, patient preparation for diagnostic analysis, interpretation of pathology results, dissemination of knowledge and information to patients and other health staff, as well as skills in research. Research in clinical chemistry should not only emphasize evaluation of performance of automation but also should include pre- and postanalytical phases and training also needs to reflect this.

Whole Blood Viscosity and Metabolic Syndrome

Abstract Whole-blood viscosity (WBV) depends on vascular geometry and blood physiological constituents. Diabetes mellitus, hypertension, dyslipidemia and obesity – the major components of metabolic syndrome (MetS) – can independently affect blood vessels and microcirculation. MetS is the state of oxidative stress and systemic inflammation. Pro-oxidant and inflammatory cytokines induce endothelial dysfunction. Morphological alterations of erythrocytes could be a consequence of decreased erythrocytes deformability, oxidative stress and systemic inflammation. These events altogether lead to increased WBV. In this review, the effect of WBV in different components of the MetS and WBV with regard to oxidative stress and inflammation – common states in chronic disease – are discussed.

Automation in Clinical Biochemistry: Core, Peripheral, STAT, and Specialist Laboratories in Australia

Pathology has developed substantially since the 1990s with the introduction of total laboratory automation (TLA), in response to workloads and the need to improve quality. TLA has enhanced core laboratories, which evolved from discipline-based laboratories. Work practices have changed, with central reception now loading samples onto the Inlet module of the TLA. It is important to continually appraise technology. This study looked at the impact of technology using a self-administered survey to seniors in clinical biochemistry in NATA GX/GY–classified laboratories in Australia. The responses were yes, no, or not applicable and are expressed as percentages of responses. Some of the questions sourced for descriptive answers. Eighty-one laboratories responded, and the locations were 63%, 33%, and 4% in capital cities, regional cities, and country towns, respectively. Forty-two percent were public and 58% private. Clinical biochemistry was in all core laboratories of various sizes, and most performed up to 20 tests per sample. Thirty percent of the 121 surveyed laboratories had plans to install an automated line. Fifty-eight percent had hematology and biochemistry instrumentations in their peripheral laboratory, and 16% had a STAT laboratory on the same site as the core laboratory. There were varied instruments in specialist laboratories, and analyzers with embedded computers were in all laboratories. Medium and large laboratories had workstations with integrated instruments, and some large laboratories had TLA. Technology evolution and rising demand for pathology services make it imperative for laboratories to embrace such changes and reorganize the laboratories to take into account point-of-care testing and the efficiencies of core laboratories and TLA.

Cardiovascular risks in prediabetes: Preliminary data on "vasculopathy triad"

Background: Subclinical cardiovascular disease is inherent in complications of diabetes mellitus. It occurs before the obvert manifestation of cardiovascular disease complication in diabetes, and involves vasculopathy triad or three major vascular events comprising stasis, endothelial dysfunction, and atherothrombosis. Aim: This study was to examine evidence of vasculopathy triad in prediabetes, biomarkers of stasis, endothelial dysfunction, and atherothrombosis in prediabetes were compared with apparently healthy group. Materials and Methods: Eighty-one participants with results for plasma D-dimer, homocysteine, and whole blood viscosity were selected from a research database. The participants consisted of control (n = 44) and prediabetes (n = 37) based on clinical history and laboratory results. Results: Multivariate analysis shows a significantly higher level of vasculopathy in prediabetes than in the control group (P > 0.0001). Blood viscosity (P < 0.04) and homocysteine (P < 0.03) are significantly higher in prediabetes than in controls. Average levels for plasma D-dimer are also higher in prediabetes than in control, but not statistically significant in this particular analysis. Conclusion: This study suggests a novel application of known idea, vasculopathy triad that could be used for assessment of subclinical cardiovascular disease in prediabetes.

Outpatient cardiac rehabilitation: Effects on patient improvement outcomes

OBJECTIVE To determine if the Cardiac rehabilitation (CR) program had positive effects on the patient medically as well as effects on pathological risk factors, functional capacity, and mental health; and the extent to which targets for blood pressure (BP) control in patients with hypertension (HT) and diabetes mellitus (DM) are achieved. METHODOLOGY CR participant data was collected from 1st June 2014 until 31st December 2015 (19 months), which included: demographics, medical history, social history, medications, lipid profiles and anthropometric measurements. Additional data was collected on The Patient Health Questionnaire (PHQ-9) factors, and on the participants 6min walk test (6MWT). Study participants were eligible to participate in the study if they attended 10 or more CR program sessions out of 12 at the Calvary Public Hospital Canberra. RESULTS Seventy nine (79) participants participated in the study. Significant reductions in BP (n=79) (p=<0.05), blood LDL cholesterol levels (n=26) (p=<0.05), and improvements in participants PHQ-9 scores (n=79) (p=<0.001), and their 6MWT (n=78) (p=<0.001) were noted. Participants were also able to better manage their medication (p=<0.05). Importantly, results indicated that significant improvements (p=<0.05) were made in DM patients (n=18) diastolic BP, physical ability and depression and anxiety. CONCLUSION A CR program can reduce risk factors associated with CVD, and improves mental health and physical fitness of participants. RESULTS Indicated that the CR program reduces DM patient risk factors through improved physical fitness and reductions in depression and anxiety, leading to reduced risk of future cardiovascular and renal disease.

Screening of Cardiovascular Disease Risk in Diabetes: Questions Concerning Prediabetes and Low-Mid Income Countries

Background: The prevalence of prediabetes is increasing world-wide and this condition predisposes to substantially increased risk of cardiovascular disease in addition to developing diabetes mellitus (DM). This article debates screening for early identification and intervention of cardiovascular risk in prediabetes. Discussion: Screening methods exist for cardiovascular disease, but the models have diabetes and smoking status as dichotomous variables. A [Yes or No] response in regards to diabetes then ignores dysglycemia in prediabetes individuals who may nevertheless have hyperglycemia-induced oxidative stress. Therefore, the sufferers are treated like healthy persons in such screening models. The problem is worse especially in the low - mid income countries where diagnostic services are either inaccessible or unaffordable for comprehensive testing. Conclusion: To improve early intervention of cardiovascular risk in subclinical diabetes, a model that employs a combination of blood glucose level and an index of oxidative damage is imperative to cater for prediabetes.

Toxic and hypericaemic effects of Opuntia megacantha extract in rats

The effect of O. megacantha extract on blood uric acid levels and other biochemical profiles were investigated over a 5 week period of giving rats an oral dose of 20 mg/100 g body weight of the extract daily. The results show that O. megacantha extract significantly lowered (p <0.01) serum uric acid and increased renal excretion of uric acid by comparison with controls. Serum creatinine, AST (aspartate aminotransferase) and phosphate levels were significantly raised (p <0.05) in the experimental group. However serum magnesium, calcium and ALP (alkaline phosphatase) were lowered (p <0.05) in the same group by comparison with control rats. An increase (p <0.05) in total water intake, an increase (p <0.05) in total urinary uric acid excretion as well as a slight increase in total urine voided over the 5 week period were observed.