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Chemical Pathology

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Browsing Chemical Pathology by Author "Gounden, Verena."

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    A comparison of 24-hour urine versus random urine samples for determination and quantification of Bence Jones protein in a South African population.
    (2019) Reddy, Ashandree.; Gounden, Verena.
    Objectives: The International Myeloma Working Group (IMWG) and College of American Pathologists recommend a 24-hour collection for Bence Jones proteins(BJP). Although a 24-hour urine collection is a definitive means to determine BJP excretion, it has several issues related to sample collection and is prone to inaccuracy. Protein to creatinine ratios have demonstrated good correlation with 24-hour urine. The aim of this study was to compare measured 24-hour urine to random urine collections for the quantitation of BJP in a South African population. Method: Known patients with multiple myeloma(MM) collected 24-hour urine as part of their routine clinical assessment for BJP, random urine samples were submitted following completion of the 24-hour collection. The measured 24-hour urine BJP was then compared to 2 estimated 24-hour BJP excretions which were calculated as follows; Estimation 1 (E1): Estimated 24-hour BJP (mg/24hour) = Urine BJP/Creatinine ratio (mg/mmol) ´ 10, Estimation 2 (E2): Estimated 24- hour BJP (mg/24hour) = Urine BJP/Creatinine ratio (mg/mmol) ´ 15mg/kg for women or ´20mg/kg for men. All the 24-hour BJP results were classified according to IMWG treatment response criteria. Results: When using the Wilcoxon paired test analysis, the measured 24-hour urine BJP was significantly different to both the E1 (p=0.049) and E2 (p=0.049) equations. But analysis following categorization of each patient per IMWG BJP response criteria, indicated no significant difference in classification of treatment response using either the E1 or E2 estimation equations (P=0.69). Conclusion: 24-hour urine collections are cumbersome. Random urine BJP estimates are simple, rapid and inexpensive. This study demonstrates that both the estimates of 24-hour BJP can be used to monitor response in patients with MM. This can be added to the body of evidence that random samples can be used to monitor patients’ treatment response in MM.
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    Evaluation of the utilisation of semi-quantitative procalcitonin versus C-reactive protein for the diagnosis of infection in a Hospital paediatric population,with particular reference to utilisation in suspected bacterial meningitis.
    (2019) Ngxamngxa, Unathi.; Gounden, Verena.
    Background: The high mortality and morbidity due to bacterial infections such as meningitis, alongside the long turnaround times for gold standard microscopy and culture testing, warrants alternative laboratory tests such as C-reactive protein (CRP) and procalcitonin(PCT), which demonstrate adequate test sensitivity and specificity. In addition, there is a need for more studies a in Africa, which will show the diagnostic value of CRP and PCT in bacterial infections. The aims of this study were a) to describe the utilisation of semiquantitative serum PCT in aiding with the diagnosis of bacterial infections in a South African paediatric population and b) to compare the utility of PCT in a subset of patients with suspected bacterial meningitis. Methods A retrospective observational study with charts review was done. It included data for all paediatric patients admitted to the King Edward Hospital (Durban, South Africa) for which semi quantitative PCT testing was performed for the period April 2013- April 2016. Descriptive statistical methods were employed for the analysis of data. Results The semi-quantitative PCT results correlated well with the serum CRP levels and showed significant correlation with extent of rise in CRP. A statistically significant (p=0.035) difference of median CRP levels across different categories of PCT levels, with higher values associated with PCT categories associated with greater degrees of infection. Kappa statistic analysis performed to determine agreement between positive and negative culture results with positive and negative semi quantitative PCT results, showed poor observed agreement of 53.13% (acceptable >75%). Conclusions Findings of the current study do not demonstrate added benefit of use of semi-quantitative PCT over traditional CRP. Further studies will need to be done to examine utility of the semiquantitative PCT test for early diagnosis specific bacterial infections including meningitis and pneumonia in this specific population.