Chemistry Tests Research Articles

The Impact of Psychological and Contextual Factors on Student Achievement in Chemistry: A Quantitative Study in Sri Lankan Senior Secondary Schools

This quantitative study investigates the influence of psychological and contextual factors on chemistry achievement among senior secondary school students in Sri Lanka. The research examines teachers' teaching styles, students' understanding of concepts, subject satisfaction, and attitudes toward chemistry as psychological factors, with gender and school type as contextual characteristics. Using a sample of 302 students and 114 teachers from 13 schools in the Kegalle Education Zone, data were collected using a Likert scale- based instrument and a structured chemistry test. The validity and reliability of the instruments were confirmed by pilot testing and confirmatory factor analysis. Data analysis, performed with SPSS and Amos software, used multivariate techniques and structural equation modeling. The results indicate that attitude towards chemistry and gender significantly influence student achievement. All variables except school location have a positive effect on student achievement. Recommendations include enhancing teacher training programs to promote effective, student-centered teaching styles, developing interventions aimed at improving students' conceptual understanding and attitudes towards chemistry, ensuring that curriculum and teaching practices are engaging and relevant to student's interests and experiences, and implementing gender-sensitive strategies to support both boys and girls in achieving their full potential in chemistry. This study provides valuable insights for educators and policymakers to design targeted strategies that address the identified factors, ultimately aiming to enhance educational outcomes and student performance in chemistry.

Reported Awareness and Use of Pyridoxal-5'-Phosphate Supplementation in Alanine Aminotransferase and Aspartate Aminotransferase Assay Reagents: A Survey by the College of American Pathologists Clinical Chemistry Committee.

Alanine aminotransferase (ALT) and aspartate aminotransferase (AST) assay reagents are available both with and without supplementation with pyridoxal-5'-phosphate (P5P; the active form of vitamin B6), a catalytic cofactor required for their enzymatic reactions. Nonsupplemented assays may miss ALT or AST elevations in patients with vitamin B6 deficiency. To assess awareness and adoption of ALT and AST reagents that are supplemented with P5P. A 4-question survey about ALT and AST reagent supplementation with P5P was included in the College of American Pathologists General Chemistry and Therapeutic Drugs (C program) proficiency testing 2023 B mailing. Overall, 38% (1651 of 4304) of responding laboratories reported using ALT and/or AST reagent supplemented with P5P. P5P supplementation was more common for nonacademic hospital/medical center laboratories (44%; 713 of 1629) relative to other settings. Of the laboratories that reported not using P5P-supplemented reagents, few (5%; 141 of 2611) cited plans to convert in the future. Despite the availability of P5P-supplemented reagents from several major assay manufacturers, the most common stated barrier for adoption was that the laboratory's reagent manufacturer does not provide P5P-supplemented reagents. There is a lack of awareness of the existence and benefits of P5P-supplemented ALT and AST reagents. There is a need for ALT and AST assay manufacturers to clarify and standardize the P5P status of ALT and AST reagents.

Cu-Doping Layered Double Hydroxides Nanozyme Integrated with Nitric Oxide Donor for Enhanced Antioxidant Therapy in Retinopathy.

The prevalence of retinal neovascular diseases necessitates novel treatments beyond current therapies like laser surgery or anti-VEGF treatments, which often carry significant side effects. A novel therapeutic approach is introduced using copper-containing layered double hydroxides (Cu-LDH) nanozymes integrated with nitric oxide-releasing molecules (GSHNO), forming Cu-LDH@GSHNO aimed at combating oxidative stress within the retinal vascular system. Combination of synthetic chemistry and biological testing, Cu-LDH@GSHNO are synthesized, characterized, and assessed for curative effect in HUVECs and an oxygen-induced retinopathy (OIR) mouse model. The results indicate that Cu-LDH@GSHNO demonstrates SOD-CAT cascade catalytic ability, accompanied with GSH and nitric oxide-releasing capabilities, which significantly reduces oxidative cell damage and restores vascular function, presenting a dual-function strategy that enhances treatment efficacy and safety for retinal vascular diseases. The findings encourage further development and clinical exploration of nanozyme-based therapies, promising a new horizon in therapeutic approaches for managing retinal diseases driven by oxidative stress.

Performance evaluation and clinical application of the UA-5600 automatic dry chemistry urine analyzer in renal diseases.

Urine testing as a routine screening programme, abnormal test results can be suggestive to clinicians but can sometimes be overlooked, and the establishment of a diagnostic model can better assist clinicians in identifying potential problems. BLD (blood), LEU (leukocyte), PRO (protein) and GLU (glucose) are the four most important parameters in urine testing, and the accuracy of their results is a key concern for clinicians, so it is essential to verify the accuracy of their results. In this study, we evaluated the analytical and clinical performance of Mindray's automatic urine dry chemistry analyzer, the UA-5600 (Hereinafter referred to as the (UA-5600), and the test strips configured with the instrument, and developed a machine-learning (ML) model for kidney disease screening from the results of 11 parameters output from the UA-5600 with the aim of detecting abnormal urine test results. Urine samples from outpatients and inpatients at The First Affiliated Hospital of Sun Yat-sen University were collected from August to September 2022 to evaluate the performance of the Mindray UA-5600 dry chemistry analyzer and test strips. The evaluation of the UA-5600 and its test strips focused on the agreement of the urine BLD and LEU readings with the RBC (red blood cell) and WBC (white blood cell) counts obtained by the Mindray EH-2090 urine formed element analyzer. We also compared the PRO and GLU readings with the results of the Mindray BS-2800M biochemistry analyzer. Urine samples from outpatients and inpatients were retrospectively analysed and grouped according to LIS diagnosis. Additionally, eight ML models for kidney disease screening were developed using 11 parameters measured by the UA-5600. And the model was validated by the validation set. The UA-5600 had an 89.55% concordance rate for BLD and a 91.04% concordance rate for LEU compared to the EH-2090 analyzer. When benchmarked against the BS-2800M, the concordance rates for PRO and GLU were 94.14% and 95.20%, respectively. A total of 1,691 samples were used for the construction of the ML models, of which 346 patients (135 males and 211 females, age range: 18 to 98 years) diagnosed with renal disease, and 1,345 patients (397 males and 948 females, age range: 18 to 92 years) with non-renal disease diagnosed with other conditions. Notably, the Naïve Bayes (NB) model, which was built from the UA-5600 parameters, demonstrated superior predictive capabilities for renal disease, with an area under the receiver operating characteristic curve of 0.9470, a sensitivity of 0.7767, and a specificity of 0.9457. The Mindray UA-5600 demonstrates robust detection abilities for both BLD and LEU, and its results for PRO and GLU align closely with those obtained from the chemistry analyzer. The NB model has a good screening ability and shows promise as an effective screening tool.

Point-of-care blood tests using a smartphone-based colorimetric analyzer for health check-up.

A microscale colorimetric assay was designed and implemented for the simultaneous determination of clinical chemistry tests measuring six parameters, including glucose (GLU), total protein (TP), human serum albumin (HSA), uric acid (UA), total cholesterol (TC), and triglycerides (TGs) in plasma samples. The test kit was fabricated using chromogenic reagents, comprising specific enzymes and binding dyes. Multiple colors that appeared on the reaction well when it was exposed to each analyte were captured by a smartphone and processed by the homemade Check6 application, which was designed as a colorimetric analyzer and simultaneously generated a report that assessed test results against gender-dependent reference ranges. Six blood checkup parameters for four plasma samples were conducted within 12min on one capture picture. The assay achieved wide working concentration ranges of 10.45-600 mg dL-1 GLU, 1.39-10.0g dL-1 TP, 1.85-8.0g dL-1 HSA, 0.86-40.0 mg dL-1 UA, 11.28-600 mg dL-1 TC, and 11.93-400 mg dL-1 TGs. The smartphone-based assay was accurate with recoveries of 93-108% GLU, 93-107% TP, 92-107% HSA, 93-107% UA, 92-107% TC, and 99-113% TGs. The coefficient of variation for intra-assay and inter-assay precision ranged from 3.2-5.2% GLU, 4.6-5.3% TP, 4.3-5.3% HSA, 2.8-6.6% UA, 2.7-6.5% TC, and 1.1-3.9% TGs. This assay demonstrated remarkable accuracy in quantifying the concentration-dependent color intensity of the plasma, even in the presence of other suspected interferences commonly present in serum. The results of the proposed method correlated well with results determined by the microplate spectrophotometer (R2 > 0.95). Measurement of these six clinical chemistry parameters in plasma using a microscale colorimetric test kit coupled with the Check6 smartphone application showed potential for real-time point-of-care analysis, providing cost-effective and rapid assays for health checkup testing.

Multivariate anomaly detection models enhance identification of errors in routine clinical chemistry testing.

Conventional autoverification rules evaluate analytes independently, potentially missing unusual patterns of results indicative of errors such as serum contamination by collection tube additives. This study assessed whether multivariate anomaly detection algorithms could enhance the detection of such errors. Multivariate Gaussian, k-nearest neighbours (KNN) distance, and one-class support vector machine (SVM) anomaly detection models, along with conventional limit checks, were developed using a training dataset of 127,451 electrolyte, urea, and creatinine (EUC) results, with a 5 % flagging rate targeted for all approaches. The models were compared with limit checks for their ability to detect atypical EUC results from samples spiked with additives from collection tubes: EDTA, fluoride, sodium citrate, or acid citrate dextrose (n=200 per contaminant). The study additionally assessed the ability of the models to identify 127,449 single-analyte errors, a potential weakness of multivariate models. The KNN distance and SVM models outperformed limit checks for detecting all contaminants (p-values <0.05). The multivariate Gaussian model did not surpass limit checks for detecting EDTA contamination but was superior for detecting the other additives. All models surpassed limit checks for identifying single-analyte errors, with the KNN distance model demonstrating the highest overall sensitivity. Multivariate anomaly detection models, particularly the KNN distance model, were superior to the conventional approach for detecting serum contamination and single-analyte errors. Developing multivariate approaches to autoverification is warranted to optimise error detection and improve patient safety.

Performance Evaluation of Semi-quantitative Urine Albumin Creatinine Ratio Using Meditape UC-11A Strip Test

The Urine Albumin/Creatinine Ratio (uACR) is one of the earliest markers of glomerular disorders. A comparative study of semi-quantitative urine uACR and quantitative uACR tests was carried out using Meditape UC-11A test strips on the Sysmex UC-3500 (automated urinalysis instrument) and Roche Cobas 501, respectively. A total of 213 retrospective data of urine chemistry tests were collected. Semi-quantitative urine albumin, creatinine, and uACR data were obtained using Meditape UC-11A strips on Sysmex UC-3500, whereas quantitative data were obtained using Roche Cobas c501. A weighted Cohen's Kappa agreement, sensitivity, specificity, PPV, NPV, and accuracy were analyzed using data from both instruments. The Kappa values for urine albumin, creatinine, and uACR between the semi-quantitative and quantitative methods were 0.83 (CI 0.771– 0.880), 0.535 (CI 0.417–0.652), and 0.691 (CI 0.606–0.775), respectively. The sensitivity, specificity, PPV, NPV, and accuracy of semi-quantitative methods were 90%, 73.3%, 75%, 89.2%, and 81.2%, respectively. The semi-quantitative uACR test on the UC-3500 showed excellent performance and could be used as a screening test for early detection of impaired kidney function.

Smoking induced salivary microbiome dysbiosis and is correlated with lipid biomarkers

BackgroundThe oral microbiome plays an essential role in maintaining oral homeostasis and health; smoking significantly affects it, leading to microbial dysbiosis. The study aims to investigate changes in the oral microbiome composition of smokers in the Qatari population and establish a correlation with lipid biomarkers.MethodsThe oral microbiota was profiled from saliva samples of 200 smokers and 100 non-smokers in the Qatari population, and 16s rRNA V3-V4 region were sequenced using the Illumina MiSeq platform. The operational taxonomic units (OTUs) were clustered using QIIME and the statistical analysis was performed by R.ResultsNon-smokers exhibited a more diverse microbiome, with significant alpha and beta diversity differences between the non-smoker and smoker groups. Smokers had a higher abundance of Firmicutes, Bacteroidota, Actinobacteriota, Patescibacteria, and Proteobacteria at the phylum level and of Streptococcus, Prevotella, Veillonella, TM7x, and Porphyromonas at the genus level. In contrast, non-smokers had more Bacteroidota, Firmicutes, Proteobacteria, Fusobacteriota, and Patescibacteria at the phylum level, and Prevotella, Streptococcus, Veillonella, Porphromonas, and Neisseria at the genus level. Notably, Streptococcus was significantly positively correlated with LDL and negatively correlated with HDL. Additionally, Streptococcus salivarius, within the genus Streptococcus, was substantially more abundant in smokers.ConclusionThis study highlights the significant influence of smoking on the composition of the oral microbiome by enriching anaerobic microbes and depleting aerobic microbes. Moreover, the observed correlation between Streptococcus abundance and the lipid biomarkers suggests a potential link between smokers-induced salivary microbiome dysbiosis and lipid metabolism. Understanding the impact of smoking on altering the oral microbiome composition and its correlation with chemistry tests is essential for developing targeted interventions and strategies to improve oral health and reduce the risk of diseases.

#2134 Very low protein integrated diet (sVLPD), without keto analogues, in patients with advanced chronic renal failure: clinical and economic benefits

Abstract Background and Aims The integrated very low protein diet (sVLPD) has proven effective in slowing the progression of stage 5 chronic renal failure and in postponing the start of dialysis treatment (1)SVLPD with keto analogues is difficult to implement due to the high number of tablets to be taken (2), therefore, to increase compliance we decided to prescribe, in compliance with the guidelines of normal clinical practice, SVLPD (0.3 g/prot/day) integrated with only essential amino acid drugs without the use of keto analogues, in stage 5 patients and we have verified its effectiveness, safety and clinical and economic effects(3). Method 129 patients were started on dietary therapy (middle age 75.2 ± 13.7, 60.5%male, all with hypertension, 40.3% with diabetes and 24.8% with heart disease) who were tested at the beginning of the observation, every 3 months and for 24 months, characterizing blood chemistry tests and body composition (with impedance analysis). Results During the 24-month observation period 91 patients (70.5%) were compliant with dietary therapy. Chronic kidney disease progression is slowed with average eGFR 11.6 ± 3.3 (compliant) vs. 9.3 ± 2.7 (no compliant) mL/min/1.73 m2, p &amp;lt; 0.001) Urea (mg/dL) 116.1 ± 31.7 (compliant) 174.2 ± 42.2 (no compliant) p &amp;lt; 0.002; and initiation of dialysis treatment (adjusted HR = 0.361, CI 0.200–0.650, p = 0.001) was delayed without evidence of malnutrition, in compliant versus noncompliant patients. Metabolic acidosis was well compensated in both groups with an improving trend in bicarbonate levels in compliant patients. Hemoglobin, uricemia, serum albumin, glycemia (downward trend NS), potassium, sodium, chlorium, calcium, magnesium, pH, lipids remained within normal values. Better blood pressure control was observed in compliant patients compared to non-compliant patients (SBP (mmHg) 136.9 ± 11.8 vs 150.1 ± 7 &amp;lt;0.01), DBP (mmHg) 75 ± 3.1 vs 79.4 ± 1 &amp;lt;0.001) During the observation, there were 24 deaths (13 patients older than 85 years), 20 peritoneal dialysis hospitalizations, 36 hemodialysis hospitalizations, 4 preventive living transplants and 15 renal functional recoveries with eGFR consistently &amp;gt;15 mL/min/ 1.73 m2. The months of dialysis avoided generated gross savings in terms of healthcare expenditure equal to EUR 3,076,470; the expenditure sustained by the Marche region for protein-free products (EUR 90 per patient per month) was EUR 158,358. As a result, the total net savings were EUR 2,918,112. Conclusion This non-interventional longitudinal observational study is part of standard clinical practice and suggests that VLPD supplemented with only essential amino acids is safe and effective and could be widely used to reduce the incidence of dialysis treatments, with a favorable economic impact on the National Health Service.

#2094 Very low protein integrated diet (sVLPD), without keto analogues, in patients with advanced chronic renal failure: clinical and economic benefits

Abstract Background and Aims The integrated very low protein diet (sVLPD) has proven effective in slowing the progression of stage 5 chronic renal failure and in postponing the start of dialysis treatment (1)SVLPD with keto analogues is difficult to implement due to the high number of tablets to be taken(2), therefore, to increase compliance we decided to prescribe, in compliance with the guidelines of normal clinical practice, SVLPD (0.3 g/prot/day) integrated with only essential amino acid drugs without the use of keto analogues, in stage 5 patients and we have verified its effectiveness, safety and clinical and economic effects(3). Method 129 patients were started on dietary therapy (middle age 75.2 ± 13.7, 60.5%male, all with hypertension, 40.3% with diabetes and 24.8% with heart disease) who were tested at the beginning of the observation, every 3 months and for 24 months, characterizing blood chemistry tests and body composition (with impedance analysis). Results During the 24-month observation period 91 patients (70.5%) were compliant with dietary therapy. Chronic kidney disease progression is slowed with average eGFR 11.6 ± 3.3 (compliant) vs. 9.3 ± 2.7 (no compliant) mL/min/1.73 m2, p &amp;lt; 0.001) Urea (mg/dL) 116.1 ± 31.7 (compliant) 174.2 ± 42.2 (no compliant) p &amp;lt; 0.002; and initiation of dialysis treatment (adjusted HR = 0.361, CI 0.200–0.650, p = 0.001) was delayed without evidence of malnutrition, in compliant versus noncompliant patients. Metabolic acidosis was well compensated in both groups with an improving trend in bicarbonate levels in compliant patients. Hemoglobin, uricemia, serum albumin, glycemia (downward trend NS), potassium, sodium, chlorium, calcium, magnesium, pH, lipids remained within normal values. Better blood pressure control was observed in compliant patients compared to non-compliant patients (SBP (mmHg) 136.9 ± 11.8 vs 150.1 ± 7 &amp;lt;0.01), DBP (mmHg) 75 ± 3.1 vs 79.4 ± 1 &amp;lt;0.001) During the observation, there were 24 deaths (13 patients older than 85 years), 20 peritoneal dialysis hospitalizations, 36 hemodialysis hospitalizations, 4 preventive living transplants and 15 renal functional recoveries with eGFR consistently &amp;gt;15 mL/min/ 1.73 m2. The months of dialysis avoided generated gross savings in terms of healthcare expenditure equal to EUR 3,076,470; the expenditure sustained by the Marche region for protein-free products (EUR 90 per patient per month) was EUR 158,358. As a result, the total net savings were EUR 2,918,112. Conclusion This non-interventional longitudinal observational study is part of standard clinical practice and suggests that VLPD supplemented with only essential amino acids is safe and effective and could be widely used to reduce the incidence of dialysis treatments, with a favorable economic impact on the National Health Service.

CLINICAL CASE OF A VERY YOUNG PATIENT AFFECTED BY CAD

Abstract Young patient of 24 years old, smoker, dyslipidemic and family history of coronary artery disease (CAD). He was admitted to emergency room for chest pain after moderate effort in December. EKG was normal, troponin was negative and echocardiography showed left ventricle with normal contractility. Blood chemistry test showed LDL 130 mg/dL, Triglycerides 200 mg/dL e Lipoprotein (a) 16 nmol/L. Elective cardiovascular exercise test resulted positive for signs and symptoms of cardiovascular ischemia (Figure 1). Coronary angio–TC showed 60% stenosis of proximal LAD and intramyocardial bridging of mid LAD. Subsequently elective coronary angiography confirmed the description of coronary angio–TC; contextually optical coherence tomography (OCT) was performed and showed fibrous cap rupture of proximal LAD (Figure 2 – 3). The patient was discharged with indication of medical therapy (Cardioaspirina 100 mg, Atorvastatina 40 mg, Bisoprololo 1,25 mg). CAD is a chronic condition usually occurring after the sixth decade of life. However, some populations experience this disease prematurely. In the last few decades, different studies have shown an increased incidence of CAD in very young people. The prevalence of CAD reported in very young people is 1–16%. Clinical and interventional management of CAD in very young people is still subject of discussion today. The literature showed how risk factors such us current smokers, dyslipidemia, and family history of CAD are significantly associated with the existence of severe CAD in patients of ≤40 years. The above risk factors are present in this patient, therefore we opted for correct them by medical therapy and follow–up by OCT at 6 months. The patient was stable and asyntomatic for chest pain at 1 month telephone follow–up.Figure 1.Figure 2.Figure 3.

Toxicological Impact of Brick Kiln Emissions on the Liver of Brick Kiln Workers and Residents

Pakistan is the third-largest brick-producing nation in South Asia, behind China and India. In Pakistan, there are over 20,000 brick kilns and 1.8 million brick kiln employees, 50% of them are in Punjab. Brick kilns in rural Punjabi communities like district Narowal still use antiquated methods and are subject to bad laws, which has a negative impact on people's health. A cross-sectional study was carried out in the Narowal district from January 2021 to January 2022 to examine the toxicological effects of brick kiln emissions on the liver. The participants were divided into three groups based on their demographic profiles in order to examine the relationship between appropriate liver function indices, such as ALT, AST, ALP, and bilirubin, and demographic factors like age, BMI, smoking index, and length of employment among exposed (residents and workers) and control groups. The outcome demonstrated that exposed workers and residents had mean ALT (p, 0.001), AST (p, 0.001), and ALP (p, 0.002) levels that were considerably higher than reference values. Bilirubin, a measure of the liver, remained negligible. Blood chemistry tests cannot establish the presence of liver disorders. Therefore, molecular-based follow-up investigations are required to assess the health concerns related to emissions from brick kilns.

Case Study: Open Pyometra in a Pomeranian Dog at INI Veterinary Service Clinic

A five-year-old female Pomeranian dog presented with vomiting, restlessness, decreased appetite, and vaginal discharge. The physical examination revealed yellowish to brownish purulent vaginal discharge with an unpleasant smell. The X-ray image showed an enlarged uterus, while the hematology results revealed hypochromic normocytic anemia, neutrophilia, lymphopenia, and thrombocytopenia. The blood chemistry test results showed abnormalities, including elevated levels of alkaline phosphatase levels (ALP) and cholesterol as well as decreased amylase levels. Based on the anamnesis, clinical findings, physical examination, and supporting examinations, it was concluded that the dog was diagnosed with open cervix pyometra. The dog was treated with oxytocin hormone at a dose of 0.5 IU/kg BW, methylergometrine at a dose of 0.125 mg/dog, enrofloxacin at a dose of 5 mg/kg BW, carprofen at a dose of 2.5 mg/kg BW, cyproheptadine at a dose of 0.5 mg/kg BW, ranitidine at a dose of 3.5 mg/kg BW, ondansetron at a dose of 1 mg/kg BW, glyseryl guaiacolate at a dose of 20 mg/kg BW, ambroxol HCl at a dose of 2 mg/kg BW, Fufang® at adose of 1 ml, Sangobion® at a dose of 100 mg/dog, Maxbiotik® at a dose of 66 mg, and Transfer Factor Plus® at a dose of 20 mg. The treatment resulted in an improvement in the animal's condition as evidenced by the absence of nasal and vaginal discharges and vomiting, as well as a stool consistency of two out of five.

Outcomes of Brentuximab Vedotin with or without Bendamustine and Nivolumab in Relapsed or Refractory Hodgkin’s Lymphoma: An Early Experience from Patient Access Programme in India

Hodgkin's lymphoma (HL) accounts for 30 % of all lymphomas. The primary therapy regimens ABVD or BEACOPP are frequently used for Hodgkin's lymphoma. Up to 40% of patients with advanced Hodgkin's Lymphoma (HL) experience a relapse after receiving their first therapy, despite current treatment protocols. Autologous Stem Cell Transplantation (ASCT) can produce long-lasting responses following an initial relapse in roughly 50% of patients with chemo-sensitive relapse. Patients included were both pediatric and adult with pathologically confirmed HL who have relapsed, refractory, or progressive disease after at least one line of treatment. Demographic and clinical data was collected along with details of treatment and responses to the treatment was observed. Safety assessments included evaluation of adverse events, routine hematology and serum chemistry tests. Data was analyzed in IBM SPSS Statistics V22.0. Descriptive statistics were performed, and categorical variables were expressed as percentages and continuous variables were expressed as mean. this series of 12 patients supports the potential clinical benefit of brentuximab vedotin as a therapeutic option for patients suffering relapse of HL with primary treatment and SCT, with equal response of &lt;PR and &gt;PR in 50% patients and a PFS of 8 months.

Every Picture Tells A Story: Managing Exertional Heatstroke with Rotating Ice Water Towels.

A 23-year-old woman completing her first marathon collapsed near the finish line at 4 hours 6 min with a rectal temperature of 41.8°C. She was in good health before the race with no recent illness, had completed a full training program, and was taking no medications or supplements. On the initial exam, she was unconscious with a response to painful stimulus, spontaneous breathing, rapid pulse, eyes closed, fully dilated pupils, poor muscle tone, and pale skin that was warm to touch. The medical team initiated whole-body cooling using rapidly rotating ice water towels and ice packs placed in the neck, axilla, and groin. She developed echolalia during active cooling. About 20 minutes into the cooling procedure, she "woke up," was able to answer questions coherently, and her pupils were normal size and reactive. She was discharged home with instructions to follow-up in 2 d for evaluation and blood chemistry testing.

Stability evaluation of stored samples for routine chemistry tests

Stability evaluation of stored samples for routine chemistry tests

Impact of sex used for assignment of reference intervals in a population of patients taking gender-affirming hormones

BackgroundGender-affirming hormone therapy with either estradiol or testosterone for transgender persons can significantly impact chemistry and hematology laboratory tests. The sex used for assignment of reference intervals (RIs) in the electronic health record (EHR) will influence normal/abnormal flagging of test results. ObjectiveTo analyze common non-hormonal laboratory tests with sex-specific RIs ordered in patients with sexual orientation/gender identify (SOGI) field differences (one or more differences between legal sex, sex assigned at birth, and gender identity) in the EHR at an academic medical center in midwestern United States. MethodsWe utilized a previously characterized data set of patients at our institution that included chart review information on gender identity and gender-affirming therapy. We focused on the subset of these patients that had orders for 18 common laboratory tests in calendar year 2021. ResultsA total of 1336 patients with SOGI field differences (1218 or 91.2% identifying as gender-expansive; 892 or 66.8% receiving estradiol or testosterone as gender-affirming therapy) had a total of 9374 orders for 18 laboratory tests with sex-specific RIs. Hemoglobin, creatinine, alkaline phosphatase, alanine aminotransferase, aspartate aminotransferase, and high-density lipoprotein were the most frequently ordered tests. For patients taking estradiol, 128 of 970 (13.2%) creatinine and 39 of 193 (20.2%) hemoglobin measurements were within the RI for one sex but not the other. For those taking testosterone, 119 of 531 (22.4%) creatinine and 49 of 120 (40.8%) hemoglobin measurements were within the RI for one sex but not the other. Values above the cisgender female RI but within the cisgender male RI were common for hemoglobin, alkaline phosphatase, alanine aminotransferase, and aspartate aminotransferase in patients taking testosterone. ConclusionsClinicians should be aware of the potential impact of gender-affirming therapy on laboratory tests and what sex/gender is being used in the EHR to assign RIs.

DEVELOPMENT OF INITIAL ABILITY TEST INSTRUMENT BASED ON SCIENCE GENERIC SKILLS

This study aims to develop an initial ability test instrument based on science generic skills in the form of a scholastic test and develop a final chemistry evaluation test instrument in the topic of thermochemistry as well as find out the validity of the content and construction validity of the instrument. Research and development research, with a 4D development model consisting of 4 main stages, namely: Define, Design, Develop and Disseminate, due to time constraints this research was only up to develop. The results of the content validity test by experts obtained an average percentage of material aspects, namely 87.08%, construction aspects, namely 90.41%, language aspects, 92.5% and additional rules, 96.67%, so the question instrument is suitable for use. Based on the construction validation test data, it was found that of the 20 questions on the scholastic potential test tested, there were 19 questions that were valid and considered appropriate, while 1 other item was invalid, while of the 20 questions on the chemistry test tested, there were 17 questions that were valid and considered feasible, leaving 3 questions other invalid. For further research, it is hoped that this instrument can be implemented.

Web-accessible critical limits and critical values for urgent clinician notification.

To survey the World Wide Web for critical limits/critical values, assess changes in quantitative low/high thresholds since 1990-93, streamline urgent notification practices, and promote global accessibility. We identified Web-posted lists of critical limits/values at university hospitals. We compared 2023 to 1990-93 archived notification thresholds. We found critical notification lists for 26 university hospitals. Laboratory disciplines ranged widely (1-10). The median number of tests was 62 (range 21-116); several posted policies. The breadth of listings increased. Statistically significant differences in 2023 vs. 1990 critical limits were observed for blood gas (pO2, pCO2), chemistry (glucose, calcium, magnesium), and hematology (hemoglobin, platelets, PTT, WBC) tests, and for newborn glucose, potassium, pO2, and hematocrit. Twenty hospitals listed ionized calcium critical limits, which have not changed. Fourteen listed troponin (6), troponin I (3), hs-TnI (3), or troponin T (2). Qualitative critical values expanded across disciplines, encompassing anatomic/surgical pathology. Bioterrorism agents were listed frequently, as were contagious pathogens, although only three hospitals listed COVID-19. Only one notification list detailed point-of-care tests. Two children's hospital lists were Web-accessible. Urgent notifications should focus on life-threatening conditions. We recommend that hospital staff evaluate changes over the past three decades for clinical impact. Notification lists expanded, especially qualitative tests, suggesting that automation might improve efficiency. Sharing notification lists and policies on the Web will improve accessibility. If not dependent on the limited scope of secondary sources, artificial intelligence could enhance knowledge of urgent notification and critical care practices in the 21st Century.

Proficiency testing in analytical chemistry, microbiology and laboratory medicine: discussions on current practice and future directions

Proficiency testing in analytical chemistry, microbiology and laboratory medicine: discussions on current practice and future directions