Chemistry Tests Research Articles

A-122 Fluid Type (STILL) Matters: An Analysis of Quality Control Material Suitability for Measuring Eleven Body Fluid Analytes in the Clinical Laboratory

Abstract Background Measuring the concentration of albumin, amylase, bilirubin, cholesterol, creatinine, glucose, lactate dehydrogenase (LDH), lipase, total protein(TP), triglycerides, and urea nitrogen(UN) in body fluids(BFs) provides important information to aid in clinical decision-making. The range of expected values of these analytes in BFs may not match serum, and the distribution by fluid type is not well described. Quality control (QC) materials are designed to reflect clinically relevant concentrations in blood. Hence, the measuring ranges for assays modified for BF testing vary in suitability. Laboratorians and manufacturers would benefit from understanding the overlap in BF and serum analyte concentrations. The aim of this study was to characterize the range of BF analyte concentrations compared to serum and assess the suitability of QC materials used on these assays. Methods A retrospective analysis was performed for the following analytes in BFs with reportable ranges(including maximum dilution factor): albumin = 0.2–12.0 g/dL(×2), amylase = 3–14 000 U/L(×100), bilirubin = 0.1–72.2 mg/dL(×2), cholesterol = 4–8000 mg/dL(×10), creatinine = 0.1–92.0 mg/dL(×4), glucose = 2–3375 mg/dL(×5), LDH = 10–9000 U/L(×10), lipase = 3–300 000 U/L(×1000), TP = 0.2–36.0 g/dL(×3), triglycerides = 4–8850 mg/dL(×10), and UN = 2–300 mg/dL(×3). Chemistry tests were run on a cobas® 6000 c501 (Roche Diagnostics,Indiana). Patient analyte concentration and fluid type results reported between 9/16/2019 and 1/27/2022 at all Mayo Clinic locations were extracted from an institutional database of electronic medical record data. Serum results were included for comparison. Descriptive statistical analyses (median and range) were performed with R (version 4.2.2)/R Studio(version 2022.12.0). QC materials for BF testing were purchased from Bio-Rad (Multilevel Qual, Levels 1 and 3; Hercules, CA, USA). Target concentrations are reported. Results Conclusion BF median (range) concentrations are similar or higher for bilirubin, creatinine, glucose, lipase, and UN. Serum QC material is likely appropriate for these assays in BFs. BF median(range) concentrations are lower for albumin, cholesterol, TP, and triglycerides suggesting that serum QC material may not be well suited for BFs. The need for extended dilutions may impact BF amylase and lipase.

A-189 Volume Matters: Continuous Improvement to Reduce Blood Collection Volumes and Collection Tube Utilization

Abstract Background Clinical laboratories are constantly changing with automated analyzers and total lab automation (TLA) implemented and replaced over time. Some benefits of newer technologies include decreased specimen volume requirements, less need for repeat testing, and greater throughput. Recent implementation of new analyzers and replacement of TLA in the Central Clinical Laboratory (CCL) at Mayo Clinic, Rochester, MN, prompted the laboratory to reassess blood collection volumes for commonly ordered tests. Objectives The aim of this study was to evaluate whether updating the blood collection volumes for clinical chemistry and immunoassay tests performed in the CCL could reduce the volume of blood collected from patients and the number of blood collection tubes utilized. Methods Nearly 100 different serum assays from the CCL test menu were reviewed including the basic and comprehensive metabolic, hepatic function, renal function, electrolyte, and lipid panels as well as thyroid function tests, enzymes, hormones, electrolytes, and iron status tests. Cortisol, ferritin, folate, and Vitamin B12 testing were performed on the Beckman DxI800; all other testing was on Roche Diagnostics Cobas 8000 chemistry (ISE, c701, c502) and immunoassay (e801) analyzers. Updated blood volumes for each assay were calculated utilizing manufacturer’s analytical volumes and “dead volume” requirements. Baseline data retrieved from the laboratory information system (LIS) included blood collection volumes and number of tubes collected for 128 patients with physician-orders for laboratory testing on 5/2/21. The collection logic was then updated in the test LIS environment using the new blood volumes requirements and applied to the same 128 orders. Blood volumes and number of tubes collected per order were compared before and after the volume updates. Results Baseline data from 128 unique orders showed that 414 total tubes were collected with a median(range) of 3 (2–6) tubes per order and 5 (1–18) tests per tube. The total volume of blood requested at baseline was 2065 mL. Post-intervention, 197 tubes were needed with a median(range) of 2 (1–3) tubes per order and 13 (1–30) tests per tube. The total volume of blood requested after updating volumes was 851 mL. Conclusions The practice of reviewing and updating specimen volume requirements when replacing or implementing new analyzers or TLA can greatly reduce the volume of blood collected from patients and the number of blood collection tubes per order. In this study of 128 physician orders for common laboratory tests, updating blood collection information in the LIS reduced the requested blood collection volumes by 59% and decreased the number of blood collection tubes required by 52%. This not only benefits patients because less blood is collected but also conserves blood collection tubes and reduces supply chain demands. Additionally, fewer tubes on the TLA system has the potential to improve throughput and test turnaround time.

A-069 Atellica® Ci 1900 Sample Carryover Performance Evaluation

Abstract Background The Atellica® CI 1900 Analyzer uses independent integration and random-access sampling to process chemistry (CH) and immunoassay (IM) tests. A single-use, disposable sample tip is used for IM assays, whereas a reusable dilution probe is used for CH assays. When a sample tube is first accessed by the CH dilution probe to process CH assays, then accessed by the IM disposable tip to process IM assays, there is the potential for sample carryover that could affect IM assay results. The purpose of this investigation was to evaluate sample-to-sample carryover performance on the Atellica® CI 1900 Analyzer. Methods Hepatitis B surface antigen (HBsAg) was selected as the test analyte, given the extreme HBsAg concentrations that can exist in clinical samples. High HBsAg pools ranging from 25 to 55 million Index values were prepared by spiking purified HBsAg into serum. Eleven low (L) samples containing 600 µL of HBsAg-negative control QC and 10 high (H) samples containing 300 µL of the high HBsAg serum pool were created. The samples were first processed with one replicate per sample with the Atellica® CH ALT assay on the Atellica® CI 1900 Analyzer so that the CH dilution probe would aspirate 50 µL of sample. Sample-to-sample carryover testing was performed in a defined high (H)- and low (L)-sample consecutive sequence: L1, L2, L3, H1, H2, L4, H3, H4, L5, L6, L7, L8, H5, H6, L9, H7, H8, L10, H9, H10, L11. All low (L) samples were next assayed for HBsAg using the Atellica® CI 1900 Analyzer. The sample carryover study was conducted on three Atellica® CI 1900 Analyzers. Carryover in parts per million (ppm) was determined by multiplying the difference of the “high-low” mean (L4, L5, L9, L10, L11) and “low-low” mean (L2, L3, L6, L7, L8) by 1 000 000 and dividing by the high HBsAg sample concentration. Results The measured sample carryover results were 0.00, 0.00, and 0.00 ppm. All three Atellica® CI 1900 Analyzers produced sample-to-sample carryover of <0.1 ppm using HBsAg as the analyte. Conclusions The Atellica® CI 1900 Analyzer* demonstrated the capability to ensure sample-to-sample carryover of <0.1 ppm into primary sample containers with a minimum of 600 µL sample volume. *Not available for sale in the US. Product availability varies by country.

The standardized extract of Centella asiatica L. Urb attenuates the convulsant effect induced by lithium/pilocarpine without affecting biochemical and haematological parameters in rats

BackgroundStatus epilepticus (SE) is a type of epileptic activity characterized by a failure of the inhibitory mechanisms that limit seizures, which are mainly regulated by the GABAergic system. This imbalance increases glutamatergic neurotransmission and consequently produces epileptic activity. It is also associated with oxidative stress due to an imbalance between reactive oxygen species (ROS) and antioxidant defences. Unfortunately, long-term treatment with anti-epileptic drugs (AEDs) may produce hepatotoxicity, nephrotoxicity, and haematological alterations. In this way, some secondary metabolites of plants have been used to ameliorate the deterioration of nervous system disorders through their antioxidant properties, in addition to their anticonvulsant effects. An example is Centella asiatica, a plant noted to have a reputed neuroprotective effect related to its antioxidant activity. However, similar to conventional drugs, natural molecules may produce side effects when consumed in high doses, which could occur with Centella asiatica. Therefore, we aimed to evaluate the effect of a standardized extract of Centella asiatica L. Urb with tested anticonvulsant activity on biochemical and haematological parameters in rats subjected to lithium/pilocarpine-induced seizures.MethodsTwenty-eight adult male Wistar rats were randomly divided into four groups (n = 7 each): vehicle (purified water), Centella asiatica (200 and 400 mg/kg), and carbamazepine (CBZ) (300 mg/kg) as a pharmacological control of anticonvulsant activity. Treatments were administered orally every 24 h for 35 consecutive days. On Day 36, SE was induced using the lithium/pilocarpine model (3 mEq/kg, i.p. and 30 mg/kg s.c., respectively), and the behavioural and biochemical effects were evaluated.ResultsCentella asiatica 400 mg/kg increased the latency to the first generalized seizure and SE onset and significantly reduced the time to the first generalized seizure compared to values in the vehicle group. Biochemical parameters, i.e., haematic cytometry, blood chemistry, and liver function tests, showed no significant differences among the different treatments.ConclusionThe dose of Centella asiatica that produces anticonvulsant activity in the lithium/pilocarpine model devoid of hepatotoxicity, nephrotoxicity, and alterations in haematological parameters suggests that the standardized extract of this plant could be of utility in the development of new safe therapies for the treatment of convulsions associated with epilepsy.

B-022 Technical Evaluation of Urine Chemistry Testing on the Beckman DxC700AU Chemistry Analyzer

Abstract Background The Singapore General Hospitals’ clinical biochemistry laboratory constantly reviews and optimizes its automated chemistry testing through workflow enhancements and advancement of technology. The laboratory had evaluated 11 urine chemistry analytes on a standalone Beckman Coulter DxC700AU in view of upgrading its existing Beckman Coulter AU680. Methods The laboratory evaluated the following urine chemistry analytes: urea, sodium, potassium, chloride, creatinine, total protein, calcium, inorganic phosphate, magnesium, amylase and uric acid. The parameters evaluated were: linearity, limit of detection (LOD), carryover, imprecision and patient comparison against the AU680. Linearity was verified by analyzing Validate-It linearity materials in triplicate, and assessed by generating linearity statistics using Analyze-It v2.03. LOD was verified by analyzing 20 replicates of a blank matrix (saline) and 20 replicates of a patient specimen with concentrations near the LOD. Carryover was verified by sequentially analyzing a low concentration sample in triplicates followed by a high concentration sample in duplicates and lastly the same low concentration sample in duplicates. Imprecision was performed in triplicates across 5 days using quality control material from Bio-Rad, and assessed against the vendor’s imprecision claims. Patient comparison was performed using 60 to 80 samples for each analyte between the DxC700AU and the AU680. Passing Bablok Regression, Spearman Correlation and Altman-Bland Bias Plots was generated using the Analyze-It program. Results All analytes were verified to be linear within their respective AMRs; all linearity material recovered within ±10% of its expected target value. LOD was assessed to be satisfactory and below the lower limit of measurement. No significant carryover was observed for any analyte. Total imprecision for all the analytes were generally <4.8%. Passing Bablok Regressions, where X is the AU680 and Y is the DxC700AU, generated slopes ranging between 0.98X and 1.04X with constants ranging between -1.13 and 31.18. The large constants were partly due to analytes with large AMR (e.g. creatinine and uric acid urine). Altman-Bland Bias Plots presented bias ranging between −3.6% to 1.7% for different analytes. All analytes had excellent correlation between the 2 analyzers with R values of 1.0. Conclusion The performance characteristics of the DxC700AU in analyzing urine chemistries was found to be acceptable and highly comparable to the AU680. The upgrade of the AU680 to DxC700AU was seamless in view of excellent comparability in assay performances. Although the DxC700AU was expected to be the technological successor to the AU680, the quality-of-life improvements of the analyzer were the highlights of the DxC700AU. Improvements included a large clear LED indicator that highlights the status of the instrument and on-the-fly loading of reagent kits. Future improvements that the laboratory is looking forward to is the removal of the need to manually load specimens onto the instrument by connecting the standalone equipment onto its total laboratory automation track.

Hematology and Blood Chemistry Reference Intervals for Antillean Manatees (Trichechus manatus manatus) in Colombia

Hematology and blood chemistry tests constitute an easy-to-apply veterinary tool that evaluates an organism’s systemic functioning and disease process by comparing the level of specific analytes against species norms. Such analyses help monitor marine mammals’ health and nutritional status. Although reference values have been published for a few manatee populations, there are none for Antillean manatees (Trichechus manatus manatus) in Colombia. We aim to establish the reference values for hematology and serum chemistries for these manatees and determine if there are variations between individuals of different age groups and sex. Thus, we obtained whole blood and serum samples from 45 rehabilitated manatees from Colombia between 1992 and 2021. Complete Blood Count and Comprehensive Metabolic Panel values were calculated, and differences between age groups and sex were determined. Results were compared with published reference intervals of other Antillean manatee populations, Florida manatees (Trichechus manatus latirostris), and Amazonian manatees (Trichechus inunguis) from Brazil. We determined the reference intervals of hematology and serum chemistry for manatees in Colombia for different age and sex categories. No relevant clinical variations were found in hematological parameters due to sex. Marked differences were found between age groups, mainly among young animals with an expected faster metabolism. There were significant variations between hematological and blood chemistry values when the Colombian manatees were compared to manatees from Puerto Rico and Amazonian manatees from Brazil. Such variations are likely influenced by evolutionary history and environmental factors associated with differences in habitat salinity and diet. We recommend that future studies correlate these blood tests with specific panels. We further recommend conducting wild manatee health assessments as this information will yield essential data for species management schemes needed due to the multiple anthropogenic and environmental threats that manatees face today which put the Colombian manatee’s health and ultimate survival at risk.

Association between Albuminuria and Serum Phosphate Levels in Non-Dialysis Stage 3-5 Chronic Kidney Disease Patients

Introduction: Chronic kidney disease (CKD) remains a global burden and catastrophic disease as about 697.5 million people suffering from it in 2017. About 42% of CKD mortality in Indonesia is related to cardiovascular complications. Hyperphosphatemia, a manifestation of chronic kidney disease-mineral bone disorder, could increase the risk of cardiovascular mortality. Albuminuria has been proven to inhibit the compensatory mechanisms for hyperphosphatemia, thereby aggravating this condition. This study was conducted to analyze the association between albuminuria and serum phosphate levels among CKD patients in Dr. Soetomo General Academic Hospital, Surabaya, Indonesia.Methods: This cross-sectional study used medical records of 129 non-dialysis stage 3-5 CKD patients at the outpatient clinic of Dr. Soetomo General Academic Hospital from March-November 2021. Descriptive analysis was performed on albuminuria, serum phosphate, age, sex, body mass index, comorbid, blood chemistry tests, and CKD stages data. Correlational analysis was conducted using the Spearman Rank test on albuminuria and serum phosphate levels.Results: The majority of the subjects in this study were male (55.81%); mean age was 55.21±11.99 years; mean BMI was 22.39±2.27 kg/m2; hypertension was found in 65.89% of the patients; mean eGFR was 25.01±16.1 ml/min/1.73 m2 and dominated by CKD stage 3-5. The distribution of albuminuria grade was dominated by heavy albuminuria (>300 mg/g) and the mean serum phosphate level was 4.81±1.9 mg/dl. Spearman Rank analysis found a significant positive correlation with weak association strength (p<0.001; rs=0.277) between albuminuria and serum phosphate levels.Conclusion: There was a significant positive correlation with weak association strength between albuminuria and serum phosphate levels.

Comparison of quality results between semi-autoanalyzer and autoanalyzer: A retrospective study conducted in a tertiary care center (Rural India)

Introduction and Aim: In India, the primary health centres, urban health centres and privatized small-scale laboratories use basic laboratory services like point of care testing (POCT) and quantitative results obtained from semi-auto analysers for diagnosis and treatment. Our objectives were to analyse biochemical parameters in the autoanalyzer and the semi-autoanalyzer and to compare the test performance of analysed biochemical parameters in the semi-autoanalyzer and autoanalyzer. Materials and Methods: One hundred samples (10 patient samples and 90 internal quality control values), tested for 15 biochemical parameters were retrospectively studied. They were processed with the same reagent, methodology and environmental conditions in autoanalyzer Mindray BS 390 and semi-autoanalyzer KLS BA 200. Statistical analysis was carried out using independent student t test, Pearson correlation, Bias percent and Bland-Altman plot analysis Results: Our study showed strong positive correlation for the 15 biochemical parameters between semi-autoanalyzer and autoanalyzer except for calcium, which showed moderate positive correlation (r=0.879). Bias % were all in acceptable limits except for SGOT and Albumin. Bland Altman analysis for ALP and Triglycerides also showed high variability between the two measurements with a mean difference of -6.23 and 4.48 respectively. Conclusion: The test performance of biochemical parameters measured in the semi-auto analyser and fully automatic analyser were highly related and comparable, with a significant positive correlation. Semi-auto analysers could be an efficient alternative in peripheral setups to provide quality laboratory services. During the breakdown of any autoanalyzer, the semi-autoanalyzer acts as backup for analysing routine chemistry tests in some laboratories.

A bicentric cohort study comparing umbilical cord and neonatal blood samples for chemistry tests at birth.

To compare umbilical cord and neonatal blood for chemistry tests upon admission to the neonatal intensive care unit (NICU). We designed a prospective, bicentric cohort study enrolling newborns (n = 71) with a planned admission to the NICU. Paired samples of umbilical cord and infant's blood were collected, analyzed, and compared. An intraclass correlation coefficient (ICC) was calculated for a repeatability analysis, and a Bland-Altman analysis was performed to assess the agreement between the 2 methods of sampling. The multivariable coefficient of determination (R2) was reported to quantify the degree of correlation between the methods of measurement. The degree of agreement between the 2 sampling methods for chemistry tests was fair to good for high-sensitivity C-reactive protein (ICC = 0.79 [95% CI, 0.67-0.87]), phosphorus (ICC = 0.83 [95% CI, 0.73-0.90]), and albumin (ICC = 0.76 [95% CI, 0.60-0.86]), while it was good to excellent for γ-glutamyl transpeptidase (ICC = 0.95 [95% CI, 0.88-0.98]) and procalcitonin (ICC = 0.90 [95% CI, 0.76-0.96]). Umbilical cord blood is a reliable replacement source for multiple chemistry tests at birth. This sampling method has the potential to minimize the risk of transfusion-requiring anemia in newborns and its associated complications. Further studies are warranted to assess the efficacy of this strategy in improving neonatal outcomes.

Tips and Recommendations for Creating Tests in Chemistry

This article presents tips and recommendations for test creation (not only in chemistry). First, a general characteristics of tests, the individual items and distractors are defined. Subsequently, 7 tips and recommendations are given, shown on 12 test items. For each test item, the success rate, sensitivity and distractor attractivity are calculated. Finally, the impact of a low correlation coefficient between real and expected item difficulty is discussed.

The effect of hormonal contraceptive therapy on clinical laboratory parameters: a literature review.

Hormonal contraceptives (HC) are widely used among women in reproductive ages. In this review, the effects of HCs on 91 routine chemistry tests, metabolic tests, and tests for liver function, hemostatic system, renal function, hormones, vitamins and minerals were evaluated. Test parameters were differently affected by the dosage, duration, composition of HCs and route of administration. Most studies concerned the effects of combined oral contraceptives (COC) on the metabolic, hemostatic and (sex) steroids test results. Although the majority of the effects were minor, a major increase was seen in angiotensinogen levels (90-375 %) and the concentrations of the binding proteins (SHBG [∼200 %], CBG [∼100 %], TBG [∼90 %], VDBP [∼30 %], and IGFBPs [∼40 %]). Also, there were significant changes in levels of their bound molecules (testosterone, T3, T4, cortisol, vitamin D, IGF1 and GH). Data about the effects of all kinds of HCs on all test results are limited and sometimes inconclusive due to the large variety in HC, administration routes and dosages. Still, it can be concluded that HC use in women mainly stimulates the liver production of binding proteins. All biochemical test results of women using HC should be assessed carefully and unexpected test results should be further evaluated for both methodological and pre-analytical reasons. As HCs change over time, future studies are needed to learn more about the effects of other types, routes and combinations of HCs on clinical chemistry tests.

Kinetic coefficients of cell growth and removal of organic substances for modeling Anaerobic-anoxic-aerobic method.

Anaerobic-anoxic-aerobic process is one of the biological removal processes of nutrients in wastewater treatment. Phosphorus removal by biological method is a new and developed technique that is done by changing the design of suspended growth systems. This is a cross-sectional descriptive study, which is a pilot workshop based in the first module, and chemistry, physics and microbiological tests were carried out at the wastewater treatment plant laboratory in one of the cities (Pardis) of Tehran province in 2020-2021 during a period of 12months. Was completed. In this research, a total of 500 samples were taken from raw wastewater, aeration pond, effluent, secondary sedimentation and return activated sludge. In this research, the internal decay coefficient and the growth efficiency coefficient are equal to d-1 0.1264 and 0.6579 gVSS/gCOD, respectively. And the maximum specific rate of consumption of food substance and the semi-saturation constant of food substance respectively were gCOD/gVSS.d 3.3467 gCOD/m 25.305. If the specific rate of consumption of food substance or efficiency factor in our research is 0.27 gCOD/gVSS.d and the semi-constant Ks saturation equal to 27.9 gCOD/m has been obtained, this actually shows that the organic matter (COD) in the waste water of Pardis city had a higher degradability (sbCOD). According to the obtained results, the synthetic coefficients in the Lineweaver-Burk and Hanes models are suitable, but in the Hofstee model, the amount of K and Kd is less than the optimal amount for the proper exploitation of the pilot.

New insights on conservation of marble artworks from computational chemistry

Architectural elements made of marble are subject to deterioration when exposed outdoors. A promising route to prevent deterioration is treating marble with an aqueous solution of diammonium hydrogen phosphate (DAP) to form hydroxyapatite (HAP). In this way, dissolution of marble can be prevented (as the solubility of HAP is orders of magnitude lower than calcite’s solubility) and cracks can be sealed (as HAP creates new bridges between calcite grains). To improve the treatment performance, the addition of alcohol to the DAP solution has recently been investigated with encouraging results. Here, we combined computational chemistry and experimental tests to identify alternative organic solvents that can further increase the treatment efficacy. First, we used density functional theory and molecular dynamics to screen alternative solvents (water, ethanol, isopropanol, and acetone), comparing their binding affinity and competitive adsorption behaviour onto calcite. Then, we treated marble specimens with DAP solutions with the additives and characterized the resulting performance. The results of the study indicate that acetone binds to calcite less strongly than the other solvents and does not completely displace water from the surface, which is expected to be beneficial. Nonetheless, the coating formed using acetone showed similar composition, thickness, and protective ability as the coatings formed with the other solvents. In terms of consolidation, all solvents were effective in improving surface and bulk mechanical properties. Overall, the extent of interaction with the calcite surface does not seem to be a critical factor. This can be explained by considering that, in addition to the different binding affinity to the calcite surface, the solvents may weaken the hydration shell of the phosphate ions in the DAP solution, thus facilitating the formation of HAP. Based on our results, this latter aspect seems to be predominant. Additional computational studies are in progress to elucidate this aspect.

Evaluation of tumour marker utilisation and impact of electronic gatekeeping in the province of KwaZulu-Natal, South Africa.

Inappropriate testing remains a high healthcare cost driver. Tumour marker tests are more expensive than routine chemistry testing. Implementing test demand management systems like electronic gatekeeping (EGK) has reportedly decreased test requests. This study aimed to describe the appropriateness of tumour marker tests, carcinoembryonic antigen, alpha foetal protein, prostate-specific antigen, carbohydrate antigen 19-9, cancer antigen 15-3, cancer antigen 125, and human chorionic gonadotropin, and determine the effectiveness of the EGK used in the public health sector in KwaZulu-Natal, South Africa. Tumour marker test data for the KwaZulu-Natal province were extracted from the National Health Laboratory Service Central Data Warehouse for 01 January 2017 - 30 June 2017 (pre-EGK) and 01 January 2018 - 30 June 2018 (post-EGK implementation). Questionnaires were sent to the clinicians in the regional hospitals ordering the most tumour marker tests to assess ordering practices. In addition, we assessed monthly rejection reports to determine the effect of the EGK. The EGK minimally reduced tumour marker requests or associated costs (1.4% average EGK rejection rate). An overall 18% increase in the tumour marker tests occurred in 2018. The data suggest inappropriate tumour marker test utilisation, particularly for screening. The introduction of EGK as a test demand management had little impact on tumour marker test requests and costs. Continuous education and reiteration of indications for tumour marker test use are required. This study demonstrates the ineffectiveness of EGK in tumour marker orders, and provides some insight as to why these markers are being ordered, which is important in trying to decrease inappropriate ordering of these tests.

Risk Factors Increased Levels of Serum Glutamate Oxcaloacetate Transferase (SGOT) and Serum Glutamate Pyruvate Transferase (Sgpt) in The Community in The District North Konawe

Background: Based on data on the number of blood chemistry tests at the North Konawe Regency Regional General Hospital in 2019 amounted to 1,519 cases, an increase in 2020, namely 1,659 cases and an increase in 2020 to 2,264 cases. The purpose of the study was to analyze the risk factors for increasing SGOT and SGPT levels in the People of North Konawe Regency.
 Methods: This study used the Case Control Studyapproach. The population numbered 48 people. The Study Sample totaled 23 SGOT and SGPT improvement samples and 23 control samples. The sample technique in this study is Simple Random Sampling. The data was processed using the Data Normality Test (Kolmogrov Smirnov Test) Odds Ratio Test and logistic regression
 Result: The results showed that smoking or 2,769, alcohol consumption OR 6.476 and consumption of or drugs OR 5.312 against the increase in serum glutamate pyruvate transferase levels (SGPT) in The Community of North Konawe District. Regression tests showed that alcohol consumption was the most at-risk factor for increased levels of serum glutamate oxaloacetictransferase (SGOT) and serum glutamate pyruvate transferase (SGPT) in the People of North Konawe Regency.
 Conclusion: Research shows that occupation, smoking habits, alcohol consumption and drug consumption are risk factors for increased levels of serum glutamate oxaloacetictransferase (SGOT) and serum glutamate pyruvate transferase (SGPT) in the people of North Konawe Regency.

Development of Computer Based Test (CBT) Website-based Chemistry National Exam for Students of Islamic High School (MA)

Computer Based Test (CBT) website-based chemistry national exam is an online-based chemistry exam system in terms of test prep and practice for a national exam, provided with item analysis. The results of the item analysis serve to determine the indicators of questions that are considered difficult by students so that the deepening of the materials is more accurate to the students’ needs. This research aims to develop a computer-based test (CBT) for students of Islamic High School (MA). The product is also categorized as Computer Based Test (CBT) because a computer is required to implement the exam. The development of CBT used the Borg and Gall model with five stages: (1) research and information collecting, (2) planning, (3) developing preliminary products (4) preliminary field testing, and (5) primary product revision. The instruments used were product validation sheets under the authority of media and IT experts, quality assessment sheets from reviewers (chemistry teacher of MA), and student response sheets. Based on the assessment of reviewers (chemistry teachers of MA), the developed product, website-based chemistry test obtained an ideal percentage of 91% with the very good category (VG), and student response was 92% with the very good category (VG). Therefore, it can be concluded that the website-based chemistry test is feasible for national exam practice.

Self-sampling of blood using a topper and pediatric tubes; a prospective feasibility study for PSA analysis using 120 prostate cancer patients.

Self-collection of blood for diagnostic purposes by blood collection assist devices (BCAD) has gained a lot ofmomentum. Nonetheless, there are a lack of studies demonstrating the feasibility and reliability of self-collecting capillary blood for routine (immuno)chemistry testing. In this study we describe the topper technology together with pediatric tubes to enable self-collection of blood and investigated its feasibility for PSA testing by prostate cancer patients. A total of 120 prostate cancer patients for which a routine follow-up PSA test was requested, were included in this study. Patients received instruction materials and the blood-collection device consisting of a topper, pediatric tube and base-part, and performed the blood collection procedure themselves. Afterwards a questionnaire was filled-in. Finally, PSA was measured on a Roche Cobas Pro. The overall self-sampling success rate was 86.7 %. Furthermore, when specified per age category, a 94.7 % success rate for patients under 70 years and a 25 % success rate for patients of 80 years and older was observed. Venous and self-collected PSA were highly comparable when analyzed by Passing-Bablok regression with a slope of 0.99 and intercept of 0.00011, Spearmans correlation coefficient (0.998) and average self-collected PSA recovery of 99.8 %. Evidence is presented that self-collected capillary blood by topper and pediatric tube from the finger is feasible, particularly for patients under 70 years. Furthermore, capillary blood self-sampling did not compromise any of the PSA test results. Future validation in a real-world setting, without supervision and including sample stability and logistics, is required.

#6086 NEUTRAL LIPID STORAGE DISEASE WITH RENAL INVOLVEMENT: A CASE REPORT

Abstract Background and Aims Neutral lipid storage diseases (NLSD) are rare conditions caused by an inborn error of neutral lipid metabolism that results in a deficit in the degradation of cytoplasmic triglycerides and a consequent abnormal storage of the neutral lipids. Their accumulation in cytoplasmic lipid droplets in most tissues of the body results in a very heterogeneous phenotype: myopathic syndrome, intellectual deficit, cataract, neuropathy, cardiomyopathy, hepatomegaly are the main clinical manifestations. Less frequent conditions are diabetes, chronic pancreatitis and renal involvement. Method A 27-year-old woman visited our hospital on November 2022 because of progressive onset of edema, dyspnea, nausea and loss of appetite. The medical history showed that 4 years before she was diagnosed with diabetes mellitus and she has been suffering from severe muscle weakness (she was helping herself with the wheelchair) for two years. In 2017 a proctological evaluation showed an anal hypotonia from likely neuropathy. Blood chemistry tests revealed a metabolic acidosis, a decreased renal function, anaemia and nephrotic range proteinuria at the urinalysis. A bilateral pleural effusion was described at the chest radiograph and a circumferential pericardial effusion at a first echocardiogram. The ultrasound of the abdomen described a small size of the right kidney (90 mm) and an angiomyolipoma on the left kidney. Neurological examination showed a mild intellectual disability, facies with dysmorphic appearance and hypotonia of proximal and distal muscular masses of the upper limbs. Lower limbs showed a more pronounced strength deficit on the left and a hypotonia to proximal muscle masses. Electromyography showed a condition of severe sensitivity polyneuropathy: signs of chronic denervation and morphological alterations of the motor unit especially in the proximal districts of the lower limbs. Ophthalmological examination showed an advanced cataract. Cardiological evaluation through heart echo scanshowed a dilated heart disease with ventricular function and dilation of the pulmonary artery. A quadriceps muscle biopsy finally revealed myogenic features consistent with neutral lipid storage disease. Fabry test came back negative. Despite several drug treatments, the patient continued to be asthenic, inappetent and the oxygen therapy could not be removed because frequent episodes of desaturation. The deterioration of the patient's clinical conditions required the onset of dialysis immediately. Unfortunately, despite adequate information on the risks of possible refusal, the patient denied consent for central venous catheter placement and hence the beginning of renal replacement therapy. Sadly, the patient was lost to follow up and it was not possible to carry out other diagnostic investigations. Results Our patient developed an end-stage renal disease in the framework of a neutral lipid storage disease. Since cytoplasmic lipid droplets are ubiquitous organelles, we can assume that in this case, kidney involvement is due to a pathogenetic mechanism similar to that of other storage diseases such as Fabry disease (Table 1). Conclusion Here we describe a 27-year-old NLSD female patient showing late onset myopathy and difficulties in mobilization in association with severe cardiac and ocular involvement, mild intellectual disability, diabetes mellitus type 2 and end stage renal disease. Our data expand the clinical manifestations of NLSD, providing further evidence for clinical NLSD heterogeneity and mainly, further evidence for storage diseases with renal involvement.

Evaluation of the HealthID PSD microsampling device for the simultaneous determination of cholesterol, high-density lipoprotein, triglycerides, creatinine, and HbA1c in capillary blood

IntroductionThe use of dried capillary microsamples for clinical chemistry testing is an interesting alternative to conventional phlebotomy. Sampling devices capable to produce plasma from whole blood application are particularly useful. The aim of this study was to validate theHealthID PSDmicrosampling device for the determination of cholesterol (CHOL), high-density lipoprotein (HDL), triglycerides (TRIG), creatinine (CRE), and glycated hemoglobin (HbA1c) after collection of capillary blood. MethodsDried blood and plasma extracts were analyzed using modified methods in an open-channel biochemistry analyzer. The plasma volume in the extracts was corrected by the concentration of chloride (CL). Linearity, imprecision, bias, stability, and comparability to conventional samples were evaluated. ResultsDried plasma assays presented total error (TE) within acceptable limits. The analytes were stable for up to 14 days at 40 °C. Predicted serum concentrations of CHO, HDL, TRI, and CRE and predicted whole blood levels of HbA1c, using dried extracts measurements, did not presented systematic or proportional differences to serum and whole blood levels. ConclusionsDried sample extracts obtained with capillary blood applied to the HealthID PSD allowed the determination of CHO, HDL, TRI, CRE, and HbA1c, as well as the calculation of LDL level, using only 5 drops of blood. This sampling strategy can be useful for population screening programs, particularly in Developing Countries.

0076 Resilience to Acute Sleep Loss When Learning Organic Chemistry

Abstract Introduction Short sleep is often associated with worse academic outcomes, but it remains unknown whether this relationship is causal. In addition, many students perceive that cutting back on sleep is necessary for successful performance in rigorous and intimidating courses, such as organic chemistry. In the current work, we experimentally tested whether acute sleep restriction affected organic chemistry learning outcomes. Methods Participants were 60 undergraduate students who had not previously taken organic chemistry. They maintained a sleep diary for seven days and then completed an overnight session that included polysomnography (PSG) monitoring. Participants were randomly assigned to go to bed at either 10:30pm (normal sleep) or 1:30am (sleep restriction). The next morning, all participants were woken up at approximately 7am and completed a virtual lecture on organic chemistry. In one segment, the lecture was self-paced; in the other segment, the lecture was set to advance automatically at a speeded pace. Following the lecture, participants completed a 50-item test over the studied material. Results The conditions were similar in age, gender, race/ethnicity, chemistry intimidation, chronotype, prior sleep, and fluid intelligence (ps > .30). The bedtime manipulation successfully decreased total sleep time from 454.10 (47.90) minutes to 300.93 (37.23) minutes (p<.001), by decreasing time spent in REM and N2 (ps<.01; no changes to N1 or N3, ps>.05). Sleep restriction significantly altered stress levels during the test (p<.05), but not test performance (p>.10). Organic chemistry test performance was lower after a speeded lecture than a self-paced lecture, F(1, 57) = 15.649, p < .001, though this pattern did not interact with sleep condition (ps>.10). Students who were more intimidated by chemistry (at baseline) performed more poorly on the speeded section (r=-.36, p<.01), but just as well on the self-paced section (r=-.09, p=.51), and these patterns were not moderated by sleep duration. Conclusion Students who are intimidated by organic chemistry learning can overcome these barriers via self-paced learning, even when they have been acutely sleep restricted. Support (if any) This work was supported by the National Science Foundation (1943323 and 1920730).