Showing papers in "Annals of Clinical Biochemistry in 2005"
TL;DR: Evidence supports the use of the 4-v MDRD formula as an improved estimate of GFR in people with moderate/advanced CKD and there remain significant problems with this approach and areas where further research is required.
Abstract: With increasing emphasis on the earlier detection and management of chronic kidney disease (CKD), estimation of the glomerular filtration rate (GFR) has assumed greater importance. It is accepted that use of serum creatinine concentration alone as a marker of kidney function is inadequate; in particular, it has a poor sensitivity for detecting CKD. International recommendations favour the reporting of creatinine-based estimates of GFR using formulae which also take into account age, gender and other variables that affect the relationship between serum creatinine and GFR: in particular, the four-variable formula derived from the Modification of Diet in Renal Disease study (4-v MDRD) is increasingly being used. We have reviewed the literature supporting the use of this formula compared with the well-established Cockcroft and Gault formula. Overall, evidence supports the use of the 4-v MDRD formula as an improved estimate of GFR in people with moderate/advanced CKD. Neither formula performs well in people with normal and mildly reduced kidney function. However, there remain significant problems with this approach and areas where further research is required. In particular, the widespread adoption of estimated GFR reporting has refocused attention on the limitations of creatinine measurement and highlighted clinical situations in which the formulae are inadequate.
242 citations
TL;DR: Serum copper, zinc and selenium concentrations are influenced by physiological conditions such as age, diet and gender, and their serum concentrations are also associated with coronary risk factors, including body mass index, levels of physical activity, serum HDL-C and CRP.
Abstract: Background: We have investigated the association between serum copper, zinc and selenium concentrations, dietary intake, and demographic characteristics, including individual coronary risk factors,...
182 citations
TL;DR: An assessment of the contribution that caspase and calpain make to human physiology and pathology is provided, with a description of how these proteases can be detected and quantified.
Abstract: Calpain and caspase are families of cysteine proteases that have important roles in the initiation, regulation and execution of cell death. The function of both groups of proteases in the progression of apoptotic and necrotic pathways is presented here in the context of a concise overview of regulated cell death. Many of the morphological differences between apoptotic and necrotic processes are thought to be as a consequence of the action of cysteine proteases. Recent studies suggest that caspase and calpain cascades are tightly interrelated and an appreciation of how these proteases cross-talk should enable a greater understanding of how the boundaries between apoptotic and necrotic cell death have become blurred. Furthermore, an assessment of the contribution that caspase and calpain make to human physiology and pathology is provided, with a description of how these proteases can be detected and quantified. Lastly, an evaluation is made of how caspase and calpain activation might be exploited diagnostically.
159 citations
TL;DR: It is essential that laboratories introduce screening programmes to examine samples with elevated total immunoreactive PRL for the presence of macroprolactin and determine the monomeric PRL component which is known to be bioactive in vivo.
Abstract: Two high molecular mass forms of prolactin (PRL) in serum have been identified by gel filtration chromatography (GFC): macroprolactin (big-big PRL, > 100 kDa) and big PRL (40-60 kDa). Macroprolactin has a variable composition and structure, but is most frequently a complex of PRL and IgG, with a molecular mass of 150-170 kDa. It is formed in the circulation following pituitary secretion of monomeric PRL but has a longer half-life, and the PRL in the complex remains reactive to a variable extent in immunoassays. In the majority of subjects little or no macroprolactin can be detected in serum, but in some individuals it may be the predominant immunoreactive component of circulating PRL and the cause of apparent hyperprolactinaemia. Owing to its high molecular mass, macroprolactin appears to be confined to the intravascular compartment and much evidence indicates that it has minimal bioactivity in vivo and is not of pathological significance. Nevertheless, hyperprolactinaemia due to macroprolactin can lead to diagnostic confusion and unnecessary further investigation and treatment if it is not recognized as such. Macroprolactin is a common cause of apparent hyperprolactinaemia with some assays and it is essential that laboratories introduce screening programmes to examine samples with elevated total immunoreactive PRL for the presence of macroprolactin and determine the monomeric PRL component which is known to be bioactive in vivo. A number of screening tests have been described; that based on the precipitation of macroprolactin with polyethylene glycol has been the most widely validated and applied. The reference technique of GFC should be available for confirmation and further investigation of samples, giving equivocal results in screening tests. In comparison with macroprolactin, little is known about big PRL. It is a more consistent component of total serum PRL but rarely, if ever, the cause of hyperprolactinaemia. Further research is required into the nature of macroprolactin and big PRL, the relationships between high molecular mass forms of PRL, and their clinical significance.
129 citations
TL;DR: Estimates of GFR depend critically upon the accuracy and precision of the creatinine measurement used in their calculation, and the Cockroft and Gault formula tended to underestimate GFR and the MDRD formula to overestimate GFR.
Abstract: Background: It is recommended that measurement of serum creatinine should be supplemented with a creatinine-based estimation of glomerular filtration rate (GFR). The influence of creatinine methodo...
85 citations
TL;DR: Low homocysteine levels, decreased antioxidant levels, increased lipid peroxidation and increased tHcy levels were observed in patients with microalbuminuria, which may contribute to vascular disease in type 2 diabetes mellitus patients.
Abstract: Background: High levels of homocysteine and oxidative stress are known to be associated with premature vascular disease in type 2 diabetes mellitus (DM). The aim of this study was to estimate homocysteine levels and oxidant-antioxidant status and to determine the relationship between them in type 2 diabetic patients with and without microalbuminuria.Methods: Fasting blood samples were obtained from 48 diabetic patients (17 with and 31 without microalbuminuria) and 20 healthy subjects. Serum total homocysteine (tHcy), plasma malondialdehyde (MDA) erythrocyte glutathione (GSH) and glutathione peroxidase (GPx) activity were measured in these patients and the results were compared with those of controls who were chosen among healthy subjects.Results: MDA levels were found to be significantly lower and GSH levels and GPx activities were found to be significantly higher in control subjects when compared with patients with and without microalbuminuria (MDA: P<0.0001, P<0.0001; GSH: P<0.0001, P<0.0001; GPx: P<0.0...
80 citations
TL;DR: Increased oxidative stress is associated with poor outcome in critically ill patients, and may be a prognostic indicator in predicting outcome, according to clinical scores and outcome.
Abstract: BACKGROUND Oxidative stress is a consequence of critical illness, and may have an impact on survival. We studied markers of oxidative damage and antioxidant (AO) protection and compared them with clinical scores and outcome. METHODS Blood sampling and clinical scoring was carried out on 60 consecutively admitted intensive therapy unit (ITU) patients within 24 h of admission and then every three days of ITU stay. The patients included 30 surgical and 30 medical patients, of whom 46 survived their stay in ITU. Clinical scoring was by Acute Physiology and Chronic Health Evaluation (APACHE) II score, multiple organ dysfunction (MOD) score and sepsis rating. Oxidative damage was assessed by measurement of plasma malondialdehyde (MDA) and F2 isoprostanes (F2 IsoPs). AO protection was assessed by measurement of plasma total AO status, AO gap, ascorbic acid and the enzymes glutathione peroxidase and superoxide dismutase. RESULTS Both clinical markers, APACHE II and MOD, and oxidative damage markers MDA and F2 IsoPs were significantly higher in non-survivors (NS) than in survivors (S) at the time of admission. Median (interquartile ranges) were (APACHE II), 14[12--17] (S), 20.5[16.7--22.2] (NS),P<0.0001; (MOD), 3.0[2.0--5.0] (S), 8.0[4.7--9.2] (NS), P<0.0005; (MDA, mumol/L), 0.22[0.19--0.27] (S), 0.25[0.20--0.34] (NS), P=0.04 and (F2 IsoPs, pg/mL), 9.7[6.0--9.9] (S), 11.0[9.0--12.0] (NS), P=0.01. Oxidative damage markers reduced (improved) in the survivors but increased in the non-survivors. There was little difference between the groups in AO protection markers. There was a significant positive correlation between MOD and markers of oxidative damage at the time of admission (r=0.40, P=0.003, F2 IsoPs; r=0.28, P=0.035, MDA) and between the oxidative damage markers themselves (r=0.32, P=0.017). CONCLUSION Increased oxidative stress is associated with poor outcome in critically ill patients, and may be a prognostic indicator. Oxidative damage markers are more useful than AO protection markers in predicting outcome.
68 citations
TL;DR: LC/MS/MS compared favourably with ELISA for detection of specific drugs or their metabolites in the case of morphine, methadone and the cocaine metabolite benzoylecgonine.
Abstract: Background: There is increasing interest in the use of oral fluid as the matrix for the detection of drugs of abuse which requires the use of sensitive immunoassays to achieve the low detection lim...
62 citations
TL;DR: Estimates of coronary heart disease reduction by 20-25% with plant sterols/stanols is based mainly on short-term studies, but long-term cholesterol lowering, needed for the prevention of coronaryHeart disease, may be successful with plant stanol esters, which lower serum cholesterol in both genders over at least a year.
Abstract: Phytosterols are plant sterols, mainly campesterol and sitosterol, and their respective stanols (5alpha-saturated derivatives), which chemically resemble cholesterol They are present in a normal diet and are absorbed proportionally to cholesterol, but to a much lesser extent, such that less than 01% of serum sterols are plant sterols Phytosterols inhibit intestinal cholesterol absorption, and fat-soluble plant stanol esters were introduced as a functional food for lowering serum cholesterol in the early 1990s; plant sterol esters entered the market at the end of the 1990s Inhibition of the intestinal absorption of cholesterol stimulates cholesterol synthesis, a factor which limits serum cholesterol lowering to about 10% with phytosterols Enrichment of the diet with plant stanol esters reduces absorption and serum concentrations of both cholesterol and plant sterols, whereas enrichment of the diet with plant sterol esters, especially in combination with statins, lowers serum cholesterol but increases serum plant sterol levels Recent studies have suggested that high-serum plant sterol levels may be associated with increased coincidence of coronary heart disease Estimates of coronary heart disease reduction by 20--25% with plant sterols/stanols is based mainly on short-term studies Long-term cholesterol lowering, needed for the prevention of coronary heart disease, may be successful with plant stanol esters, which lower serum cholesterol in both genders over at least a year
61 citations
TL;DR: Routine genotyping of CYP1A2 *1F, *1C or *1D polymorphisms for their effect on metabolic capacity is, at least in Caucasians, not yet indicated.
Abstract: Background: The atypical antipsychotic drug clozapine is metabolized by CYP1A2. The activity of CYP1A2 is highly variable and is among others dependent on smoking habits. Certain genotypes of CYP1A...
55 citations
TL;DR: Instead of reporting the post-haemolysis corrected potassium result a qualitative comment is given, indicating the likely range of the potassium concentration, if the potassium result is in a critically low or high range, it is communicated promptly to the requesting clinician.
Abstract: Background: Potassium is usually the most important analyte affected by in vitro haemolysis and the result obtained may falsely indicate or disguise a life-threatening abnormality and so give rise to inappropriate treatment. The purpose of the study was to provide a solution to the problem of reporting potassium on haemolysed samples, taking into account both clinical needs and analytical concerns (inter-individual and inter-sample variability).Methods: Using a new procedure that mimics the collection process in an actual clinical setting, haemolysed samples were prepared from 41 volunteers with a range of inter-individual factors - haemoglobin 80-173 g/L, red blood cells 2.42-6.77 x 1012/L, leucocytes 3.0-306 x 109 /L and platelets 31-710 x 109/L - in order to develop a more accurate correction equation using a haemolytic index (HI) corresponding to g Hb/L in plasma.Results: The mean (range) potassium increase was 0.0036 mmol/L (0.0029-0.0053 mmol/L) per unit HI. The following equation was developed to e...
TL;DR: Investigations reveal a probable drug-induced autoimmune hepatitis during cholesterol-lowering treatment with atorvastatin and ezetimibe, the first report of an autoimmune hepatitis associated with ezETimibe therapy.
Abstract: A case is presented of a patient who developed acute hepatitis during cholesterol-lowering treatment with atorvastatin and ezetimibe. Further investigations reveal a probable drug-induced autoimmune hepatitis, and ezetimibe is considered to be the most likely causal agent. This case is the first report of an autoimmune hepatitis associated with ezetimibe therapy.
TL;DR: Although the values obtained by the IFCC laboratories are significantly lower than the values assigned to Lot 2 by the JDS, the relationship is linear and standardization of HbA1c based on JDS Lot 2 is currently at a satisfactory level in Japan.
Abstract: Background: The Committee on Standardization of Laboratory Testing Related to Diabetes Mellitus of the Japan Diabetes Society (JDS) previously recommended use of the primary calibrator (JDS Lot 1) ...
TL;DR: The results of this study suggest an in vivo anti-oxidative effect for green tea and an influence of green tea on atherosclerotic biological markers that provides a potential mechanism for the cardiovascular benefits of regular ingestion of greenTea.
Abstract: Background: The objective of this study was to evaluate the effects of green tea ingestion over four weeks on atherosclerotic biological markers.Methods: After a one-week baseline period, 12 healthy male volunteers aged 28-42 years drank 600 mL of green tea dailyfor four weeks. Lipid profile, oxidized low-density lipoprotein (ox-LDL), total antioxidant capacity (TAC), C-reactive protein (CRP) and soluble cell adhesion molecules were measured at baseline and after two and four weeks ingestion of green tea.Results: There was no significantchange in the concentrations of lipid profile, TAC, CRP, soluble intercellular adhesion molecule-1 (sICAM-1), or soluble E-selectin after ingestion of green tea. The levels of ox-LDL and soluble vascular cell adhesion molecule-1 (sVCAM-1) were significantly decreased after four weeks of green tea ingestion (Wilcoxon signed rank test, P=0.006).Conclusions: The results of this study suggest an in vivo anti-oxidative effect for green tea and an influence of green tea on ather...
TL;DR: A UFC LC-MS/MS method with a solid-phase extraction clean-up step that shows adequate performance and no interference from the numerous drugs and steroids tested is developed and is suitable for routine laboratory use.
Abstract: Background: The measurement of urinary free cortisol (UFC) is commonly used in the investigation of possible Cushing's syndrome. With the recent availability of liquid chromatography-tandem mass sp...
TL;DR: Increased PCO and decreased P-SH concentrations in all patient groups in comparison to the control subjects indicate increased protein oxidation, and data in ESRD patients propose plasma protein carbonyl derivates and thiol concentrations as novel specific markers for oxidative protein damage.
Abstract: Oxidative stress has been defined as a loss of balance between free radical production and the antioxidant systems. There have been many reports of increased production of oxidants and decreased levels of antioxidants in chronic renal failure (CRF) patients. An increase in oxidative stress may contribute to the development of oxidative protein damage in CRF. Our aim was to reveal oxidative modifications of plasma proteins by measuring 2,4-dinitrophenylhydrazine reactive carbonyl derivates (PCO), protein thiol (P-SH) and reduced glutathione (GSH) in predialytic uraemic and haemodialysed (HD) patients before and after dialysis. We included 20 predialytic uraemic patients, 20 HD patients and 20 healthy volunteers in our study. PCO concentration in predialytic uraemic patients increased compared with the concentration of the control group and this increase was more profound in HD patients. P-SH concentrations were significantly decreased in haemodialytic patients compared with those of controls. GSH level was higher in HD patients (both before and after dialysis). Increased PCO and decreased P-SH concentrations in all patient groups in comparison to the control subjects indicate increased protein oxidation. Our data in ESRD patients propose plasma protein carbonyl derivates and thiol concentrations as novel specific markers for oxidative protein damage.
TL;DR: The menopause is associated with an increase in oxidative stress and a decrease of some antioxidants, such as ascorbic acid, α-tocopherol, total thiols and erythrocyte GSH, and this study can be regarded as a pilot.
Abstract: Background: Oxidative stress has been implicated in the pathogenesis of ageing and menopause, and can arise through the increased production of lipid peroxides and/or a deficiency of antioxidant de...
TL;DR: Neuroblastoma was the most common cause of elevated dopamine in children's specimens, although other associations are described, and some await explanation.
Abstract: Background: Information on the significance of an elevated urinary dopamine is limited and can lead to misinterpretation of the cause of such a finding. This laboratory-based study examines the ass...
TL;DR: Methods for the detection and monitoring of hepatic fibrosis, particularly in hepatitis C, alcoholic liver disease, non-alcoholic fatty liver disease and during methotrexate therapy are explored.
Abstract: Hepatic fibrosis is an important consequence of inflammatory disorders affecting the liver, and ultimately progresses to cirrhosis. Here we explore methods for the detection and monitoring of hepatic fibrosis, particularly in hepatitis C, alcoholic liver disease, non-alcoholic fatty liver disease and during methotrexate therapy, in all of which progressive fibrosis can develop over a number of years in a minority of patients. Liver biopsy currently remains the gold standard to assess fibrosis. However, it has several limitations, including manpower issues, cost, risk of patient injury, including mortality and morbidity, observer variability and sampling variation. Several non-invasive diagnostic tests for fibrosis and cirrhosis have therefore been evaluated. The usefulness of a laboratory test for screening for a pathological abnormality such as fibrosis is critically dependent on the prevalence of the pathology in the population under investigation. When the prevalence is expected to be low, screening tests should have a high negative predictive value so that large numbers of patients can be spared the next diagnostic step, namely liver biopsy. For the moment, clinical chemistry laboratories should offer the aspartate aminotransferase alanine aminotransferase ratio, AST/platelet ratio and the Rosenberg fibrosis index as part of their routine service for monitoring the development of hepatic fibrosis.
TL;DR: While laboratories may find some organizational benefit from running first trimester Down's syndrome screening on such routine high-throughput immunoassay analysers, better clinical performance is likely to be achieved with alternative platforms to the DPC Immulite 2000.
Abstract: Background: Recent NICE Guidelines have emphasized the need to have in place by 2007 the capability of offering screening to all women in the first trimester using a combination of maternal age with the ultrasound marker nuchal translucency thickness (NT) and the maternal serum biochemical markers free β-hCG and pregnancy-associated plasma protein-A (PAPP-A). Laboratories will therefore need to consider how to introduce the biochemical component of screening. With the recent launch of these assays on the DPC Immulite 2000 platform, it is appropriate and timely to investigate their clinical and analytical performance on a high throughput immunoassay analyser.Methods: Within-run and between-day precision was assessed in the normal way. Bias was assessed by comparing samples from normal pregnancies (n = 813) and pregnancies with Down's syndrome (n = 60) run on both the DPC system and our routine Kryptor system. Gestational day-specific medians for each marker were calculated from the unaffected population. M...
TL;DR: The measurement of DHEAS by liquid chromatography-tandem mass spectrometry is robust and has a simple sample preparation procedure with a rapid cycle time of only 4 min.
Abstract: Background: Dehydroepiandrosterone sulphate (DHEAS) is a steroid that is increasingly being recognized as a potential drug of abuse in many countries. This is due to its reputation as a hormone tha...
TL;DR: The accumulation of acylcarnitines during long-term haemodialysis suggests that removal by haemmodialysis is less efficient than removal from the body by the healthy kidney.
Abstract: Background: Patients with end-stage renal disease (ESRD) undergoing long-term haemodialysis exhibit low L-carnitine and elevated acylcarnitine concentrations. This study evaluated endogenous concentrations of an array of acylcarnitines (carbon chain length up to 18) in healthy individuals and ESRD patients receiving haemodialysis, and examined the impact of a single haemodialysis session on acylcarnitine concentrations.Methods: Blood samples were collected from 60 healthy subjects and 50 ESRD patients undergoing haemodialysis (pre- and post-dialysis samples). Plasma samples were analysed for individual acylcarnitine concentrations by electrospray MS/MS.Results: Of the 31 acylcarnitines, 29 were significantly (P<0.05) elevated in ESRD patients compared with healthy controls; in particular, C5 and C8:1 concentrations were substantially elevated. For acylcarnitines with a carbon chain length less than eight, plasma acylcarnitine concentrations decreased significantly over the course of a single dialysis sess...
TL;DR: This unique POC model for supporting diabetes management is the first of its type to be developed for indigenous communities and has considerable potential to be adopted worldwide.
Abstract: Background: Type 2 diabetes is the leading cause of end-stage renal failure in Australia's indigenous people. The measurement of urine albumin:creatinine ratio (ACR) as a marker for early renal disease is an important component of the management of indigenous patients with diabetes.Methods: An innovative national program (Quality Assurance for Aboriginal Medical Services [QAAMS]) for point-of-care (POC) urine ACR testing on the DCA 2000 analyser (Bayer Diagnostics) was established to monitor microalbuminuria in indigenous people with diabetes in 30 Aboriginal and Torres Strait Islander medical services across Australia. Aboriginal health workers perform the ACR test. The QAAMS model provides ongoing education and training, an annual workshop, monthly quality assurance testing and a telephone help hotline. Quality assurance testing is conducted using paired, linearly related samples with a wide range of ACR concentrations (1-25 mg/mmol).Results: The average participation rate across four six-monthly QAAMS ...
TL;DR: The role of aluminium monitoring in long-term renal dialysis patients needs re-evaluation and regular monitoring of plasma aluminium may not be required, but should be considered in any patient showing signs or symptoms of aluminium toxicity or exposed to a contaminated water supply.
Abstract: Background: Aluminium toxicity as a cause of dementia, osteodystrophy and anaemia in patients receiving renal dialysis was first described in the 1970s and led to the regular monitoring of aluminiu...
TL;DR: The present state of standardization for the routine measurement of HbA1c in Japan, as indicated by the 2002 survey, is excellent and should aid in the eventual conversion of Lot 2 to IFCC-based values from the results of the 2002 national Hb a1c survey.
Abstract: Background: In 2001, the Committee on Standardization of Laboratory Testing Related to Diabetes Mellitus of the Japan Diabetes Society (JDS) prepared and certified a new reference material for haem...
TL;DR: It is recommended that where blood platelet count is above 500 x 109/L, potassium measurements should be repeated using lithium heparin plasma, and it is also recommended that when serum potassium results of >5.4 mmol/L are obtained, it is the authors' policy to check the Platelet count if a sample is available before reporting results.
Abstract: Background: Thrombocytosis is one of several pre-analytical factors which contribute to spuriously high serum potassium concentrations, yet there is little published data to guide analysts in the selection of a specific platelet count threshold above which serum potassium results become unreliable. We have studied the sensitivity and specificity of blood platelet count as a predictor of false elevations in potassium. Methods: Paired serum and plasma potassium measurements together with full blood count were performed for 300 patients. All samples were stored at room temperature and analysed within 4 h of collection. The difference between serum and plasma potassium was plotted against blood platelet count. Results: When the difference (serum-plasma) in potassium concentration was plotted against platelet count, there was a direct linear relationship. Blood platelet counts of >500 x 109/L will detect elevations in serum relative to plasma potassium of >0.5 mmol/L, with a sensitivity of 71% and a specificity of 89%. Conclusion: It is recommended that where blood platelet count is above 500 x 109/L, potassium measurements should be repeated using lithium heparin plasma. When serum potassium results of >5.4 mmol/L are obtained, it is our policy to check the platelet count if a sample is available before reporting results. If available and above 500 x 109/L, potassium results are withheld and plasma requested.
TL;DR: Ascorbic acid causes a false increase in sodium, potassium, calcium and creatinine results and a false decrease in chloride, total bilirubin, uric acid, total cholesterol, triglyceride, ammonia and lactate results.
Abstract: Background: Ascorbic acid can interfere with methodologies involving redox reactions, while comprehensive studies on main chemistry analysers have not been reported. We therefore attempted to deter...
TL;DR: The newer or recently modified assays such as the Beckman Coulter AccuTnI and Dade Behring assays are best able to identify very low concentrations of troponin.
Abstract: Background: Low troponin concentrations have been shown to be informative in the prognosis of acute coronary syndrome. We have investigated the analytical performance of four commonly used cardiac ...
TL;DR: A 19-year-old man who developed extensive oesophageal lye (Alkali) stricture and received long-term enteral nutrition with a jejunostomy tube developing macrocytic anaemia and leucopenia is suggested to have copper deficiency anaemia.
Abstract: A 19-year-old man who developed extensive oesophageal lye (Alkali) stricture and received long-term enteral nutrition (eight months) with a jejunostomy tube developed macrocytic anaemia (Hb: 41 g/L) with leucopenia (white blood cell [WBC]: 3.0 x 10(9)/L). The patient's serum vitamin B12, folate, iron and liver function tests were normal. Bone marrow examination revealed gross erythroid hyperplasia and cytoplasmic vacuolization of erythroid and myeloid elements. Further investigations revealed low serum copper (0.3 micromol/L) and ceruloplasmin concentrations (<30 mg/L) with marginally low normal serum concentration of red cell peroxidase (13 U/gHb), establishing the diagnosis of copper deficiency anaemia. The anaemia and leucopenia responded intermittently to intravenous copper therapy, but the serum copper concentration dropped when intravenous copper therapy was withdrawn. Enteral jejunostomy copper supplementation failed to maintain adequate serum copper concentrations. After stabilizing the general condition of the patient, a pharyngo-gastric anastamosis was performed and normal oral diet commenced, which restored normal serum copper concentration. This case report suggests that copper supplements in the form of copper sulphate are not adequately absorbed when administered through a jejunostomy tube.
TL;DR: The use of FPG concentration followed by selective measurement of HbA 1 c in patients who are at high risk of developing diabetes may represent a reasonable approach to identifying patients requiring an OGTT.
Abstract: Background: Although the oral glucose tolerance test (OGTT) is the 'gold standard' for diagnosing prediabetes/diabetes, it is inconvenient for the patient and time consuming. The only alternative s...