Medical Technology SA - Volume 27, Issue 1, 2013
Volume 27, Issue 1, 2013
Source: Medical Technology SA 27, pp 5 –8 (2013)More Less
The habit of eating soil by pregnant women is an acceptable practice in some parts of Africa. We analysed the elemental concentration of some soil samples commonly consumed in South Africa. Samples of soil commonly consumed were collected and analysed for elemental concentrations using Inductively Coupled Plasma Mass Spectrometer (ICP-MS). The colours of the samples were either brick red, light red or brown. Soil pH (6.23 ± 0.14 - 6.79 ± 0.04). The soil was of more silt. The results were 60.04 - 169.3 (Aluminium), 24.78 - 87.73 mg/g (Iron), 0.36 - 3.99 mg/g (Calcium), 21.8 - 36.7 µg/g (Lead), 67.3 - 290 µg/g (Zinc), 0.52 - 3.04 µg/g (Antimony) and 0.02 - 0.22 µg/g (Cadmium). Significant differences were observed for the concentration of elements form all the samples (p<0.05). The target hazard quotient (THQ) showed that people consuming the sampled soil might be at greater risk of having serious health problems due to levels of elements such as Mn, Pb and Fe from the samples. It is therefore important to educate people on the effects of consuming soil since the level of trace elements cannot be controlled from the soil and may be present at a level that is toxic.
Author W.J. MauleSource: Medical Technology SA 27, pp 9 –16 (2013)More Less
There can be no doubt that the many biological discoveries found in the research arena no matter how imperceptible, have a profound effect on the work of the clinical laboratory. To improve human health, scientific discoveries must be translated into practical applications. Such discoveries typically begin at 'the bench' with basic research in which scientists, including biomedical scientists study disease at a cellular or molecular level, then progress to the clinical level and eventually to the patient's 'bedside'. This translational research has proven to be a powerful process that drives ultimately the clinical research engine to aid medical diagnosis and treatment. The never static repertoire of laboratory tests is forever being extended by translational research and the discovery and story of hepcidin that has triggered a virtual explosion of studies on iron metabolism and related disorders is an example of this process. The existence of this amino acid peptide hormone was unheard of a decade ago, but with its discovery in 2000 from plasma ultrafiltrate and subsequently in urine in 2001, it not only opened the way to understand iron metabolism, but also helped in elucidating the pathomechanisms of many other diseases. In recent times international interest grew exponentially as the key role of hepcidin in body iron regulation became clearer. Confirmatory studies in regard to hepcidin's role in a number of disorders in humans, associated either with its relative decrease or increase, have been carried out. Until relatively recently the methods for the laboratory assessment of hepcidin were fairly cumbersome and somewhat technically demanding and mainly used in the research domain. They were centred on two types of assays: immunoassays based on anti-hepcidin antibodies using a reference standard of synthetic hepcidin and mass spectrometric assays that can detect the characteristic mass of the active 25 amino acid hepcidin species or its fragments. The analyser then quantifies the intensity of these peak(s) and compares them to a spiked internal standard. Many inherent problems in regard to assaying hepcidin in biological fluids using traditional immunochemical methods based on the production of specific anti-hepcidin antibodies still exist. For example, the development of these types of assays has been hampered by several causes, including the following: (1) the compact structure of the peptide with few antigenic epitopes and its small size (only 25 amino acids); (2) the high degree of protection between animal genus, with subsequent problems in developing an appropriate immunogenic response in host animals, and (3) limited availability of the necessary antigen. However, with the development of the first competitive enzyme-linked immunoassays (C-ELISA) for human hepcidin in serum, plasma the block to its measurement in the clinical laboratory setting has more or less been eliminated, enabling further transitional research into this unique peptide hormone. In a recent study, the authors described a prospective observational study to assess the ability of a hepcidin ELISA to ascertain the cause of anaemia among critically ill anaemic patients. In a more recent pilot study, the measurement of urinary hepcidin was proposed as a means of evaluating the need for iron supplementation.
p16 immunohistochemistry as a marker to distinguish between atypical lipomatous tumour /well-differentiated liposarcoma and benign adipocytic lesionsSource: Medical Technology SA 27, pp 17 –18 (2013)More Less
Introduction Atypical lipomatous tumour (ALT)/well-differentiated liposarcoma (WDL) is the most common subtype of liposarcoma. There are marked similarities between normal fat, lipomas and ALT/WDL, making the histological diagnosis of ALT/WDL challenging. In this study we compared the expression of p16 in specimens of ALT/WDL to its expression in other adipocytic tumours and normal adipose tissue to determine whether it is a useful ancilliary tool to distinguish between benign and malignant adipocytic tumours.
Methods Thirty liposarcomas, including four with areas of dedifferentiation, 30 lipomas, 26 unusual adipocytic tumours and 16 specimens of normal adipose tissue were included in the study. Immunohistochemistry for p16 was performed on all the specimens. p16 expression was reported as 1+ positive, 2+ positive, 3+ positive and negative.
Results Twenty of the 30 specimens of ALT/WDL were 3+ positive, four were 2+ positive and one was 1+ positive. Five specimens were negative, of which four were needle biopsies. All the lipomas and normal adipose tissue were negative. None of the unusual adipocytic lesions were 3+ positive. p16 positivity was significantly more common in ALT/WDL than in the other three groups (p < 0.0001).
Conclusions Our findings support the use of p16 immunohistochemistry as a useful marker to distinguish between benign and malignant adipocytic lesions.
Author A. NicolaidesSource: Medical Technology SA 27, pp 19 –25 (2013)More Less
The ancient Egyptians were undoubtedly one of the greatest civilizations of antiquity. They were highly innovative in the field of medical practice and in surgery in particular and developed impressive technologically advanced surgical instruments many of which are on display in the Egyptian and the Coptic Museums in Cairo. Egyptian medicine surpassed both the Greeks and Romans when it came to levels of knowledge and intricacy even though it occupied a position between empirical science and superstitious magic. Egyptian medicine is at the very foundation of modern Western medicine. This article reviews medical practice and organization in ancient Egypt and will be of interest to especially those involved in the medical field.
Trichomonas vaginalis in Sub-Saharan Africa : occurrence and diagnostic approaches for the male partnerSource: Medical Technology SA 27, pp 26 –28 (2013)More Less
The article aims to focus on trichomoniasis as to highlight the prevalence of this sexually transmitted infection (STI) within Sub-Saharan Africa, and to introduce an alternative means of diagnosing the infection. Globally, trichomoniasis is the STI with the highest burden in resource limited countries such as those in Sub-Saharan Africa; however, it is also the most common curable condition. With challenges faced particularly in the context of South Africa's public health sector, the implementation of affordable and rapid point-of-care diagnostic tests could allow for a more effective strategy in recognising asymptomatic STIs, where laboratory infrastructure is lacking.
The impact of non-conformances on patient care at a pathology tertiary care laboratory in South AfricaSource: Medical Technology SA 27, pp 29 –32 (2013)More Less
Introduction Although several studies have reported that laboratory errors may have some effect on patient care, few have studied non-conformance reports specifically. Clinical governance is a framework through which laboratories can improve the quality of their service and boost high standards of patient care. One of the measures of achieving this is by the identification and control of errors. For the purpose of this publication, non-conformances will refer to the recognition and documentation of laboratory errors. They are activities that fail to conform to specified standards.
Methods This was a retrospective study of the non-conformance reports for five accredited pathology divisions (Chemical Pathology, Haematology, Medical Microbiology, Immunology, and Virology) at an academic tertiary laboratory of the National Health Laboratory Service, Tygerberg Hospital over a three year period. The medical records of patients that were directly implicated by the non-conformances were reviewed to determine the impact to their healthcare.
Results Five hundred and eighty-three non-conformance reports were recorded across the divisions with chemistry having 140 (24%), haematology 65 (11%), medical microbiology 122 (21%), virology 211 (36%) and immunology 45 (8%). Three hundred and sixty-eight (63%) non-conformances had a major impact on patient care such as: delay in treatment in 52 (20%) cases, specimen recollection in 27 (11%) cases, inappropriate or unnecessary therapy in 44 (17%) cases, and inadequate patient care in 56 (22%) cases.
Conclusion Although the data was limited by poor adherence to documentation, this could serve as a pilot study where laboratories can be encouraged to document non-conformance reports better so that the appropriate impact of non-conformances on patient care can be ascertained subsequently. With continuous quality improvement measures in the laboratory, more favourable patient outcomes are expected.
The characteristics and outcomes of patients undergoing percutaneous balloon pulmonary valvuloplasty in the paediatric populationSource: Medical Technology SA 27, pp 33 –37 (2013)More Less
Background The immediate results along with short term and medium term results of percutaneous balloon pulmonary valvuloplasty (PBPV) for the treatment of pulmonary stenosis (PS) have been well documented in literature. On the other hand the results on long term follow up are few. The purpose of this study was to document the immediate, short and long term results of PBPV and, to analyse the characteristics and outcomes of patients who have undergone PBPV at Inkosi Albert Luthuli Central Hospital (IALCH) Department of Paediatric Cardiology in Durban South Africa.
Methods The study comprised of 30 patients (20 females/67%, 10 males/33%) with isolated congenital pulmonary stenosis who underwent PBPV from June 2005 to June 2012. Their age ranged from 23 days to 11 years. Patients underwent clinical examination, angiography (Pre and post PBPV) and echocardiography on the day after the procedure, at 6 months and at one year. The difference in clinical examination and diagnostic findings were described over the above three time periods.
Results The results were categorized as "excellent" when the Peak Transvalvular systolic gradient (PTSG) was reduced by more than 50mmHg after the procedure, "good" when the PTSG was reduced by 25-50mmHg and "poor" when the PTSG was less than 25mmHg. The mean pre PBPV pullback systolic pressure between the main Pulmonary Artery (MPA) to right ventricular outflow tract (RVOT) was 20.2±7.60 mmHg to 78.1±27.78 mmHg. The mean pre PBPV systolic pullback pressure gradient between the MPA to RVOT was 60.03±32.10. The mean post PBPV pullback systolic pressure between the MPA to RVOT was 20.13±8.22 mmHg to 48.13±24.47 mmHg. The mean post PBPV pullback systolic pressure gradient between the MPA to RVOT was 28.73±23.21. The mean±SD initial echocardiographic gradient was 110.1±35.58 mmHg. The mean±SD echocardiographic gradient the day after PBPV was 54.37±26.53 mmHg (excellent), the mean±SD echocardiographic gradient at the 6 months follow-up was 54.9±28.10 mmHg (excellent) and the mean±SD echocardiographic gradient at the one year follow-up was 53.2±32.27 mmHg (excellent). Patients with Mild Pulmonary stenosis 9/30(30%) showed mean±SD reduction in the gradient between pre-procedure echocardiographic findings and at one year follow-up by 41.30±20.10 mmHg (good). Patients with moderate pulmonary stenosis 9/30(30%) showed post PBPV with a mean±SD reduction in the gradient between pre-echo and at the one year follow-up by 70.92±24.90 mmHg (excellent). Patients who presented with severe pulmonary stenosis [12/30(40%)] showed a mean±SD reduction in the gradient between pre-echo and at the one year follow-up by 81.21±35.85 mmHg (excellent). Procedural complications included pulmonary regurgitation occurring in 16/30(53%) of patients and tear of a leaflet occurring in one patient 1/30(4%). The remaining 13/30(43 %) presented with no procedural complications.
Conclusion In this study Percutaneous Balloon Pulmonary Valvuloplasty as a treatment option of pulmonary stenosis in children showed excellent immediate, short and long term results.