Analytical Considerations When Monitoring Pain Medications by LC-MS/MSDavid Masters-Moore
Laboratory urine drug testing of patients on chronic opioid therapy requires providing a large test menu of medications commonly prescribed for this population as well as metabolites and illicit substances. It has been shown that liquid chromatography-tandem mass spectrometry (LC-MS/MS) is the preferred method to analyze urine specimens for these substances.
Purpose of the study: To describe the challenges and some of the techniques to validate the analytical procedures used to identify and quantify these medications and substances.
Methods: Using data obtained from testing over one million specimens, the authors developed a proposed test menu. Potential isobaric interferences were established by using literature references. A list of potentially interfering medications was obtained by using the proposed test menu and the most commonly prescribed medications. Finally, criteria were designed to detect possible carryover.
Results: The LC-MS/MS instrumentation eliminated all potential interferences and provided quantitative data over the test range needed to monitor these patients. Carryover could be eliminated by setting the carryover thresholds for each analyte.
Conclusions: Reference laboratories utilizing LC-MS/MS technology to conduct urine drug testing for pain clinicians should employ specific techniques described in this study to develop an optimal test menu and validate procedures that include isolating retention times for isobaric compounds, identifying interfering substances including impurities in medicinal and illicit substance preparations, monitoring ion suppression, and avoiding carryover.
Population Health Approach for Diabetic Patients with Poor A1c ControlPhytel
New clinical research from The American Journal of Managed Care is available on the benefits of a population health approach for diabetes care. The peer-reviewed findings underline the importance of proactive health management for all patients, not just those with already high A1c levels.
Role of Hippophae rhamnoides L. in the Management of Depression by Regulating...BRNSS Publication Hub
Depression is one of the major health burden in almost all the societies particularly in urban community.
As per the World Health Organization, depression will be the second largest disease burden due to the
urban way of lifestyle. The modern era is full of stress and strains the people are living in the most
competitive society than the previous year. Although many antidepressant drugs have been develop
to manage anxiety, stress and depression due to adverse side reaction, most of the drug could show
satisfactory results. Considering the above fact, we have selected a drug Hippophae rhamnoides which
contain many phyto molecules showing preventing role of anxiety and depression by regulating some
of the biochemical parameters.
Improvement of bacterial estimation in urinalysis by iQ®200 ELITE®: capture i...kridsada31
Kridsada Sirisabhabhorn1 Anurak Choeymang2 Supaporn Pumpa1 Krim Kamyod1 and Palakorn Puttaruk1
1Department of Medical Technology Laboratory, Thammasat University hospital, Pathumthani, Thailand
2Pharmacology and Toxicology Unit, Faculty of Allied Health Sciences, Thammasat University, Pathumthani, Thailand
Analytical Considerations When Monitoring Pain Medications by LC-MS/MSDavid Masters-Moore
Laboratory urine drug testing of patients on chronic opioid therapy requires providing a large test menu of medications commonly prescribed for this population as well as metabolites and illicit substances. It has been shown that liquid chromatography-tandem mass spectrometry (LC-MS/MS) is the preferred method to analyze urine specimens for these substances.
Purpose of the study: To describe the challenges and some of the techniques to validate the analytical procedures used to identify and quantify these medications and substances.
Methods: Using data obtained from testing over one million specimens, the authors developed a proposed test menu. Potential isobaric interferences were established by using literature references. A list of potentially interfering medications was obtained by using the proposed test menu and the most commonly prescribed medications. Finally, criteria were designed to detect possible carryover.
Results: The LC-MS/MS instrumentation eliminated all potential interferences and provided quantitative data over the test range needed to monitor these patients. Carryover could be eliminated by setting the carryover thresholds for each analyte.
Conclusions: Reference laboratories utilizing LC-MS/MS technology to conduct urine drug testing for pain clinicians should employ specific techniques described in this study to develop an optimal test menu and validate procedures that include isolating retention times for isobaric compounds, identifying interfering substances including impurities in medicinal and illicit substance preparations, monitoring ion suppression, and avoiding carryover.
Population Health Approach for Diabetic Patients with Poor A1c ControlPhytel
New clinical research from The American Journal of Managed Care is available on the benefits of a population health approach for diabetes care. The peer-reviewed findings underline the importance of proactive health management for all patients, not just those with already high A1c levels.
Role of Hippophae rhamnoides L. in the Management of Depression by Regulating...BRNSS Publication Hub
Depression is one of the major health burden in almost all the societies particularly in urban community.
As per the World Health Organization, depression will be the second largest disease burden due to the
urban way of lifestyle. The modern era is full of stress and strains the people are living in the most
competitive society than the previous year. Although many antidepressant drugs have been develop
to manage anxiety, stress and depression due to adverse side reaction, most of the drug could show
satisfactory results. Considering the above fact, we have selected a drug Hippophae rhamnoides which
contain many phyto molecules showing preventing role of anxiety and depression by regulating some
of the biochemical parameters.
Improvement of bacterial estimation in urinalysis by iQ®200 ELITE®: capture i...kridsada31
Kridsada Sirisabhabhorn1 Anurak Choeymang2 Supaporn Pumpa1 Krim Kamyod1 and Palakorn Puttaruk1
1Department of Medical Technology Laboratory, Thammasat University hospital, Pathumthani, Thailand
2Pharmacology and Toxicology Unit, Faculty of Allied Health Sciences, Thammasat University, Pathumthani, Thailand
Are venous and arterial blood gas analysis interchangeable in ED assessment o...kellyam18
Ever wondered if you can use a venous blood gas instead on an arterial analysis to guide management of patients with acute respiratory disease in the eemergency department? This presentation will try to answer the key questions including does my patient have acute respiratory failure, is my patient a CO2 retainer, do I need to provide additional ventilatory support and is my treatment working.
Venous and arterial blood gas analysis in the ED: What we know and what we don'tkellyam18
This presentation delivered at the International Conference on Emergency Medicine in Dublin summarises agreement between venous and arterial blood gas parameters and utility of venous blood gas analysis in emergency department clinical practice. It also highlights important gaps in our knowledge on this topic.
Kridsada Sirisabhabhorn, Supaporn Pumpa and Palakorn Puttaruk, Medical Techno...kridsada31
The comparative study of prevalence of human parasitic infection during 2014 –2015 year; the beginning year of approach to the AEC community.
Background:ParasiticinfectionsofhumanremainacauseofhealthproblemsinpartofSouthEastAsia(SEA) region.AccordingtoASEANEconomicCommunity(AEC) opening,pathogenicparasitescaneasilyspreadto10membercountriesbytravelers.
Objective:Theobjectiveinthisstudyweretoinvestigatehuman’spathogenicparasiteinfecalandbloodspecimensandcomparedprevalenceofinfectionbetween2014(beforeAECopening) and2015(AECcommunityyearopening) toinspectatrendofinfectionintoourcountry.
Materials/Methods:Datawerecollectedfrom9,608casestotalsinceJanuary2014toDecember2015.Stoolconcentrationtechniqueusingformalin‐ethylacetate,wasusedtoincreaseprobabilityoffindingparasitesinfeces.Ontheotherhand,thickandthinbloodsmearwerepreparedfromperipheralbloodsampleforinvestigatingblood‐borneparasiticinfection.Percentageofparasiticprevalenceineachyearwascalculatedandpresentedusingdescriptivestatistics.
Results:Theresultspresentedthattotalprevalencerateofparasiticinfectionswas1.24%(53/4,272) and1.42%(76/5,336) in2014and2015respectively.In2015,prevalencerateofBlastocystishominis (27/4,272) andStrongyloidesstercoralis (10/4,272) infectionsincreased1.4timeswhencomparedto2014(B.hominis (46/5,336)andS.stercoralis (16/5,336)).Inaddition,Opisthorchisviverrini (3/5,336) andMinuteegg(2/5,336) werenewemergedin2015aswellasotherparasitessuchasGiardialamblia,Taeniaspp.,EntamoebacoliandPlasmodiumspp.,buttheywerefoundinthelowinfectionrate.
Conclusions:Thisstudyrevealedthattotalparasiticinfectionratein2015wasslightlyincreasedfrom2014.OpeningofAECseemstoaffectpublichygieneprobleminthisregion.Thisstudyserveddatabaseformonitoringandpredictingthetrendofprevalencerateinthefuture.Nevertheless,continuousdatacollectionwillfulfillandimprovetherecentinformation.
Keywords:AEC,Parasite,Infection,Trend,Prevalence
Kridsada Sirisabhabhorn, Supaporn Pumpa, Surapong Pornprasitseang and Palakor...kridsada31
Eosinophilia characteristic of patient with parasitic infection in fecal specimen diagnosis
Background:Eosinophiliaresponsenotonlytoparasiticinfectionbutalsoseveralotherstimulatingfactorsthatincreasesbloodcirculation.Ourteamsuspectedwhethereosinophilinbloodstreamassociatedwiththekindsofintestinalparasitesthatwerefoundinfecalspecimenornot.
Objective:Todescribepercentageofeosinophilinpatientwhohaveapositiveresultofeachintestinalparasiteinstool.
Materials/Methods:Thedatawereselectedduring2015inbothoffecesandblood.ParasiteclassificationsweredonebydirectmicroscopicstoolexaminationandpercentagesofeosinophilweremeasuredinEDTAbloodusingDXH®800BeckmanCoulter,Miami,FL,hematologyautomatedanalyzer.Total119caseswereobtainedandcategorizedinto2groups,49caseswerepositiveofintestinalparasitesand70caseswerenon‐parasiticinfection(negativecontrol).T‐testanddescriptivestatisticswasusedtoanalyzedataandexplainassociationparameters.
Results:Thestudypresentedthatpatientsinfectedwithpathogenicparasitesshowedpercentofeosinophil(meanas10.38%(95%CI;6.86‐13.89))higherthanhealthypersons(meanas1.72%(95%CI;1.35‐2.09))withstatisticalsignificance(p<0.001).Ingroupofhelminths;round,flukeandtapewormweredemonstratedtheaverageofeosinophilcountat11.08±11.92,10.62±15.95,5.12±3.70%respectively.Interestingly,Strongyloidesstercoralisshowedthehighestaverageofpercentageat10.18±10.56amongclusterofhelminths.
Conclusions:Highpercentageofeosinophilwillremindphysicianstoinvestigateparasitesbyrequestingstoolexamination.Thispreliminaryresultrevealedaneosinophiliapatterninpatientswhomwereinfectedwithhelminthsespeciallyincaseofroundandflatworm.Thedatainthisstudywaslimitedduetothelownumberofpositivecases(1year) therefore,anincreaseinthenumberofsamplesisneededformoreconfidentresultsandabsoluteeosinophilshouldbeappliedforconsideration.
Keywords:Eosinophilia,Parasite,Helminthes,Infection,Fecal
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Are venous and arterial blood gas analysis interchangeable in ED assessment o...kellyam18
Ever wondered if you can use a venous blood gas instead on an arterial analysis to guide management of patients with acute respiratory disease in the eemergency department? This presentation will try to answer the key questions including does my patient have acute respiratory failure, is my patient a CO2 retainer, do I need to provide additional ventilatory support and is my treatment working.
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Objective:Theobjectiveinthisstudyweretoinvestigatehuman’spathogenicparasiteinfecalandbloodspecimensandcomparedprevalenceofinfectionbetween2014(beforeAECopening) and2015(AECcommunityyearopening) toinspectatrendofinfectionintoourcountry.
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Increase in the prevalence of Clostridium difficileproducing toxin B in fecal...kridsada31
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Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
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Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
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The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
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Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
Waraporn Bubpha, Autcharaporn Srisuwan, Palakorn Puttaruk and Kridsada Sirisabhabhorn*, Medical Technology Laboratory, Thammasat University Hospital, Pathumtani, Thailand 12120
1. Hemoglobin A1C automatic analyzer comparisons between H50 and HA-8180v
Waraporn Bubpha, Autcharaporn Srisuwan, Palakorn Puttaruk and Kridsada Sirisabhabhorn*
*Corresponding author
Medical Technology Laboratory, Thammasat University Hospital, Pathumtani, Thailand 12120
Background: The reliability of percent glycosylated hemoglobin (HbA1C) is very significant for physician decision which useful for diabetic interpretation
due to better than glucose fasting blood. Even many machines are leaded to adding volume of efficiency but confidence available result from the new device
when compare with original instrument is still wondering.
Objective: To investigate the result of HbA1C comparison base on principle of high performance liquid chromatography (HPLC) between H50 (Mindray,
Shenzhen, China) new instrument, with HA-8180v (ARKRAY, Inc., Kyoto, Japan) for introduce useful in routine analysis.
Material and Method: Total 1,197 EDTA blood samples in daily post-analysis which were obtained from Medical Technology, Thammasat University
Hospital, Pathumtani. Using adequate volume of EDTA peripheral blood is 3 ml for measuring. Individual commercial quality control which including 2 levels
as percent of normal and variant Hb was run before analysis samples by the time. Measuring samples by parallel H50 and HA-8180v then print out the result
for comparison analysis. T-test and Pearson’s correlation analysis by Stata software were used and described statistics.
Result: This study demonstrated the average (95% CI) of HbA1C % concentration of H50 and HA-8180v as 7.02 (6.93-7.11) and 6.96 (6.88-7.05) respectively
with no difference significantly statistics (p=0.374). Pearson’s statistic analysis shown coefficient correlation (r) between 2 medical devices was 0.99, the excellent
correlation level, and decorated equation in linear is (y) = 0.909x + 0.576.
Conclusion: The new model as H50 is very high consistent with HA-8180v - using our routine investigator - with acceptable in our laboratory condition.
Interestingly, % insufficient Hb conc. from 2 devices are appear that may be defect from range limitation due to some variant Hb i.e. HbE disease, major
hemoglobinopathy in Thai’s population, should be explore further.
Key words: HbA1C, Comparison, HPLC, H50, HA-8180v
Abstract
Introduction
The glycosylated hemoglobin call as HbA1C that is a majority for
glucose monitoring in patient’s blood stream about 3 months which reason
due to regenerated program of red blood cell in their life span. [1] The
temporary of erythrocyte life cycle is beneficial useful as blood glucose
reference level, tolerance against BG level dramatic changing so, narrow
range of HbA1C percent must be careful for physician’s decision then over
6.5% of level is needed medication [2]. Even many machines are coming
using in analysis but validation method is still essential compared with
reliability machine. H50 (Mindray, Shenzhen, China) and HA-8180v
(Arkray, Inc., Japan) are ion-exchange-based high-performance liquid
chromatography (HPLC) [3] which desire to compare percent values for
confidential results
Table 1. Demographic data of comparisons 2 automatic analyzers
between H50 with HA-8180v by test
y = 0.909x + 0.576
R² = 0.993
0
2
4
6
8
10
12
14
16
18
20
0 5 10 15 20
H50
(N = 1,197)
HA-8180v
(N = 1,197)
EDTA blood
N = 1,197
Result
Analysis
Spearman’s correlation of
coefficients (r); Hinkle et.al.,
1998
Correlation levels
.90 - 1.00 Very high or Excellent
correlation
.70 - .90 High correlation
.50 - .70 Moderate correlation
.30 - .50 Low correlation
.00 - .30 Very low correlation
Discussion & Conclusion
References
Materials & Methods
The correlation data between H50 and HA-8180v in this study were demonstrated Pearson’s
coefficient correlation of (r) as 0.99 which was classified in very high or excellent correlation according
to table 2 and linear correlation graph was represented as picture 1.
This result is consist with same principle in prior studies such Yoo et al., 2014 that were
shown r = 0.9955. [4] In the principle of HPLC devices announce to distort measurement deal variant
Hb [5] especially HbE diseases [6], major type of variant Hb in Thailand [7] so, are need to investigate
further by other principle ex. turbidimetric inhibition immunoassay (TINA) but hold disadvantage in
delay releasing result and interference of some Hb variants types are remaining. In addition, HPLC
technique machines are productivity in high through put (60 tests per hour) that suitable for use in
diabetic screening before meeting physician.
Conclusion, H50 HbA1C automatic analyzer provide confidential ability in %HbA1C
measuring when compare other instrument as a same HPLC principle. Point analysis in groups of
variant Hb should be careful and recognize to study further.
1. Tahara Y, Shima K. The response of GHb to stepwise plasma glucose change over time in diabetic patients. Diabetes Care. 1993;16(9):1313–4.
2. Hoelzel W, Weykamp C, Jeppsson JO, et al; for the IFCC Working Group on HbA1c Standardization. IFCC reference system for measurement of hemoglobin A1c in human blood and the national
standardization schemes in the United States, Japan, and Sweden: a method-comparison study. Clin Chem. 2004;50:166-174.
3. Haliassos, A, Drakopoulos I, Katristis D, Chiotinis N, Korovesis S, Makaris K. Measurement of glycated hemoglobin (HbA1c) with an automated POCT instrument in comparison with HPLC and
automated immunochemistry method: evaluation of the influence of hemoglobin variants. Clin Chem Lab Med 2006; 44:223–227.
4. Yoo EH, Kim B-I, Cho H-J. Performance Evaluation of the ARKRAY ADAMS A1c HA-8180. Lab Med Online. 2014 Jul;4(3):164-167.
5. Effects of hemoglobin (Hb) E and HbD traits on measurements of glycated Hb (HbA1c) by 23 methods.
6. Diabetes Association Clinical Practice Recommendations. Diabetes Care 2014;37,suppl.1:S5-13.
7.Bachir D, Galacteros F. Hemoglobin E [Internet]. Paris (France): Orphanet Encyclopedia; 2004. Available from: http://www.orpha.net/data/patho/GB/uk-HbE.pdf
%HbA1C (N=1,197) P-value*
H50 HA-8180v
Average
(95%CI)
7.02
(6.93-7.11)
6.96
(6.88-7.05)
0.374
* P-value > 0.05 is defined that no different significant statistic
Picture 1. Illustrated linear correlation graph of %HbA1C
comparison of 2 devices between H50 and HA-8180v
automatic analyzers
%HbA1C
%HbA1C
This study declared no conflicts and interest.
![Hemoglobin A1C automatic analyzer comparisons between H50 and HA-8180v
Waraporn Bubpha, Autcharaporn Srisuwan, Palakorn Puttaruk and Kridsada Sirisabhabhorn*
*Corresponding author
Medical Technology Laboratory, Thammasat University Hospital, Pathumtani, Thailand 12120
Background: The reliability of percent glycosylated hemoglobin (HbA1C) is very significant for physician decision which useful for diabetic interpretation
due to better than glucose fasting blood. Even many machines are leaded to adding volume of efficiency but confidence available result from the new device
when compare with original instrument is still wondering.
Objective: To investigate the result of HbA1C comparison base on principle of high performance liquid chromatography (HPLC) between H50 (Mindray,
Shenzhen, China) new instrument, with HA-8180v (ARKRAY, Inc., Kyoto, Japan) for introduce useful in routine analysis.
Material and Method: Total 1,197 EDTA blood samples in daily post-analysis which were obtained from Medical Technology, Thammasat University
Hospital, Pathumtani. Using adequate volume of EDTA peripheral blood is 3 ml for measuring. Individual commercial quality control which including 2 levels
as percent of normal and variant Hb was run before analysis samples by the time. Measuring samples by parallel H50 and HA-8180v then print out the result
for comparison analysis. T-test and Pearson’s correlation analysis by Stata software were used and described statistics.
Result: This study demonstrated the average (95% CI) of HbA1C % concentration of H50 and HA-8180v as 7.02 (6.93-7.11) and 6.96 (6.88-7.05) respectively
with no difference significantly statistics (p=0.374). Pearson’s statistic analysis shown coefficient correlation (r) between 2 medical devices was 0.99, the excellent
correlation level, and decorated equation in linear is (y) = 0.909x + 0.576.
Conclusion: The new model as H50 is very high consistent with HA-8180v - using our routine investigator - with acceptable in our laboratory condition.
Interestingly, % insufficient Hb conc. from 2 devices are appear that may be defect from range limitation due to some variant Hb i.e. HbE disease, major
hemoglobinopathy in Thai’s population, should be explore further.
Key words: HbA1C, Comparison, HPLC, H50, HA-8180v
Abstract
Introduction
The glycosylated hemoglobin call as HbA1C that is a majority for
glucose monitoring in patient’s blood stream about 3 months which reason
due to regenerated program of red blood cell in their life span. [1] The
temporary of erythrocyte life cycle is beneficial useful as blood glucose
reference level, tolerance against BG level dramatic changing so, narrow
range of HbA1C percent must be careful for physician’s decision then over
6.5% of level is needed medication [2]. Even many machines are coming
using in analysis but validation method is still essential compared with
reliability machine. H50 (Mindray, Shenzhen, China) and HA-8180v
(Arkray, Inc., Japan) are ion-exchange-based high-performance liquid
chromatography (HPLC) [3] which desire to compare percent values for
confidential results
Table 1. Demographic data of comparisons 2 automatic analyzers
between H50 with HA-8180v by test
y = 0.909x + 0.576
R² = 0.993
0
2
4
6
8
10
12
14
16
18
20
0 5 10 15 20
H50
(N = 1,197)
HA-8180v
(N = 1,197)
EDTA blood
N = 1,197
Result
Analysis
Spearman’s correlation of
coefficients (r); Hinkle et.al.,
1998
Correlation levels
.90 - 1.00 Very high or Excellent
correlation
.70 - .90 High correlation
.50 - .70 Moderate correlation
.30 - .50 Low correlation
.00 - .30 Very low correlation
Discussion & Conclusion
References
Materials & Methods
The correlation data between H50 and HA-8180v in this study were demonstrated Pearson’s
coefficient correlation of (r) as 0.99 which was classified in very high or excellent correlation according
to table 2 and linear correlation graph was represented as picture 1.
This result is consist with same principle in prior studies such Yoo et al., 2014 that were
shown r = 0.9955. [4] In the principle of HPLC devices announce to distort measurement deal variant
Hb [5] especially HbE diseases [6], major type of variant Hb in Thailand [7] so, are need to investigate
further by other principle ex. turbidimetric inhibition immunoassay (TINA) but hold disadvantage in
delay releasing result and interference of some Hb variants types are remaining. In addition, HPLC
technique machines are productivity in high through put (60 tests per hour) that suitable for use in
diabetic screening before meeting physician.
Conclusion, H50 HbA1C automatic analyzer provide confidential ability in %HbA1C
measuring when compare other instrument as a same HPLC principle. Point analysis in groups of
variant Hb should be careful and recognize to study further.
1. Tahara Y, Shima K. The response of GHb to stepwise plasma glucose change over time in diabetic patients. Diabetes Care. 1993;16(9):1313–4.
2. Hoelzel W, Weykamp C, Jeppsson JO, et al; for the IFCC Working Group on HbA1c Standardization. IFCC reference system for measurement of hemoglobin A1c in human blood and the national
standardization schemes in the United States, Japan, and Sweden: a method-comparison study. Clin Chem. 2004;50:166-174.
3. Haliassos, A, Drakopoulos I, Katristis D, Chiotinis N, Korovesis S, Makaris K. Measurement of glycated hemoglobin (HbA1c) with an automated POCT instrument in comparison with HPLC and
automated immunochemistry method: evaluation of the influence of hemoglobin variants. Clin Chem Lab Med 2006; 44:223–227.
4. Yoo EH, Kim B-I, Cho H-J. Performance Evaluation of the ARKRAY ADAMS A1c HA-8180. Lab Med Online. 2014 Jul;4(3):164-167.
5. Effects of hemoglobin (Hb) E and HbD traits on measurements of glycated Hb (HbA1c) by 23 methods.
6. Diabetes Association Clinical Practice Recommendations. Diabetes Care 2014;37,suppl.1:S5-13.
7.Bachir D, Galacteros F. Hemoglobin E [Internet]. Paris (France): Orphanet Encyclopedia; 2004. Available from: http://www.orpha.net/data/patho/GB/uk-HbE.pdf
%HbA1C (N=1,197) P-value*
H50 HA-8180v
Average
(95%CI)
7.02
(6.93-7.11)
6.96
(6.88-7.05)
0.374
* P-value > 0.05 is defined that no different significant statistic
Picture 1. Illustrated linear correlation graph of %HbA1C
comparison of 2 devices between H50 and HA-8180v
automatic analyzers
%HbA1C
%HbA1C
This study declared no conflicts and interest.](https://image.slidesharecdn.com/hba1c1-160806070654/85/Waraporn-Bubpha-Autcharaporn-Srisuwan-Palakorn-Puttaruk-and-Kridsada-Sirisabhabhorn-Medical-Technology-Laboratory-Thammasat-University-Hospital-Pathumtani-Thailand-12120-1-320.jpg)
