The validity of the Medisafe self-monitoring blood glucose system

Self-monitoring blood glucose (SMBG) meters are widely used in the management of diabetes. The new SMBG meter Medisafe, which is based on the optoelectric colorimetry method, has been introduced. The objective of this study was to validate the Medisafe SMBG meters in comparison with the reference autoanalyzer (Hitachi 717) and to assess the repeatability of the instrument as well as variations of tip replacement. Samples of capillary and venous blood from 299 patients were tested. The correlation coefficients between the Medisafe-measured capillary and venous blood glucose levels and the reference autoanalyzer venous plasma glucose levels were 0.976 and 0.975, respectively. The range of differences from the reference value was examined; only 4% was in excess of +/- 20% of the reference laboratory value, and more than 40% of the values were within 5% of the reference laboratory value. Moreover, repeatability of the Medisafe capillary blood samples measured in three patients with three different blood glucose levels was determined. The coefficients of variation of blood glucose values are within 5%. In addition, the results of mean and SEM from each replication in three patients and glucose measurement from different lots of tips showed no significant difference (p > 0.05). It is concluded that the Medisafe SMBG meter has shown good results in terms of validity and repeatability. Furthermore, it provides safety from blood contamination, which is recommended in countries with a high prevalence of human immunodeficiency virus.     

Surgery in severe factor XIII deficiency: report of a case of epilepsy neurosurgery and review

Factor XIII (FXIII) deficiency is a rare autosomal recessive congenital disorder of haemostasis, associated with a high risk of intracranial haemorrhage. Intracranial haemorrhage can result in neurological sequelae including seizure disorders. In some cases, medically intractable epilepsy led to epilepsy surgery. Little has been reported on the management of FXIII deficiency during surgery, and there is only a few data on the management, safety and efficacy of epilepsy surgery in the patients with haemostatic disorder. We report here an epilepsy neurosurgery in a case of severe FXIII deficiency.     

Mutations at the activated protein C cleavage sites Arg336 and Arg562 of factor VIII in Thai patients with venous thrombosis

Venous thrombosis is a multicausal disease, more than one genetic risk factor may cooperate to effect thrombotic risk. Factor V Leiden is found to be an important hereditary risk factor for venous thromboembolism. Analogous to factor V Leiden, a point mutation at amino acid positions Arg336 and Arg562 in factor VIII may predispose patients to thrombosis. Eighty-one Thai patients with venous thrombosis and 100 Thai healthy volunteers have been studied. Neither heterozygous nor homozygous mutations were detected both thrombosis patients or normal volunteers. However, further studies with larger samples of venous thrombosis patients are recommended.     

HLA-B27 testing in Thai patients using the PCR-SSP technique

We develop the HLA-B27 test kit using the PCR-SSP technique. Five hundred forty blood samples were tested for HLA-B27 by microlymphocytotoxicity test (LCT) and PCR-SSP. It was found that 127 (23.5%) and 134 (24.8%) of these samples were positive for HLA-B27 by LCT and PCR-SSP, respectively. The sensitivity and specificity of the PCR-SSP were 94.8 and 100%, respectively, when using LCT as the standard method. The PCR-SSP positive predictive value was 100%, negative predictive value was 98.3%, and a concordance rate of 98.7%. This study shows that the PCR-SSP is simple, convenient, and a more cost-effective in-house test kit.     

Factor V Leiden and prothrombin G20210A mutations in Thai patients awaiting kidney transplant

Renal transplantation provides the best long-term treatment for chronic renal failure, but thrombosis of the transplanted renal artery or renal vein is one of the causes of kidney failure in the early postoperative period. Factor V Leiden (FVL) and prothrombin G20210A mutation are the most frequent genetic abnormalities associated with venous thrombosis. We investigated the prevalence of FVL and prothrombin G20210A by polymerase chain reaction with restriction fragment length polymorphism in 75 Thai patients awaiting renal transplant, and a control group of 106 healthy blood donors. Of those awaiting renal transplant, none was found to carry FVL or prothrombin G20210A mutations. Neither the heterozygous nor the homozygous FVL mutation nor the prothrombin G20210A mutation was detected in the 106 healthy volunteers. Although we failed to detect FVL and prothrombin G20210A mutation among those waiting for a kidney transplant, the population size was small. Further studies need to be performed in order to ascertain if these coagulation mutations are of relevance in predicting patients at risk of early transplant failure.     

Comparison of clinical pathology examination scores and grade point averages of Royal Thai Army medical cadets

This retrospective study assesses the relationship between clinical pathology (CP) examination scores and grade point averages (GPAs) of Royal Thai Army (RTA) medical cadets. Altogether, 411 of the third-year RTA medical cadets studying CP at Phramongkutklao College of Medicine in 1995-2001 were included in this study. Correlations between CP examination scores, clinical year GPAs, and cumulative GPAs were analyzed by using Pearson's product-moment correlation coefficient. The CP scores showed positive correlations (p < 0.01) with GPAs in the clinical years (4th to 6th) of study (r = 0.616, r = 0.602, and r = 0.540) and cumulative GPAs (r = 0.698). These significant findings may be attributable to the integration of small group teaching and case study discussions, together with traditional lectures and laboratory practice, in the CP course. Our results indicate that CP examination scores can be used as a reliable predictor of success in the 6-year course of study for RTA medical cadets.     

Thalassemia screening among Royal Thai Army medical cadets

Thalassemia, common in Thailand, varies from mild to severe anemia, resulting in work inefficiency, particularly during exertion. Therefore, it is important for military cadets to be screened. The objective of this study was to screen for thalassemia and hemoglobinopathies among Royal Thai Army medical cadets. We tested 358 third-year Royal Thai Army medical cadets for complete blood count, red blood cell indices, hemoglobin (Hb) typing, inclusion bodies, and Hb A2, and Hb E. DNA analysis confirmed alpha-thalassemia, trait detection. The Hb E trait was the most frequent, respectively, in men and women, at 12.61% and 12%, followed by the a-thalassemia1 trait, at 3.3% and 4% and the beta-trait, at 1.5% and 0%. Two cases of homozygous Hb E were found only in men. Interestingly, a mild form of 1-thalassemia/Hb E was found in one male RTA medical cadet. These findings suggest that consistent thalassemia screening should be considered.     

Evaluation of point‐of‐care testing device for anemia detection: A cross‐sectional method comparison study from Thailand

BackgroundA comparison study is crucial before launching a new medical device; therefore, we compared the Mission Ultra Hb Testing System with the Sysmex XN‐3000 automated hematology analyzer in Thai adult males and non‐pregnant adult females.MethodsParallel studies were conducted using discarded venous K2‐ethylenediaminetetraacetic acid samples from participants requiring hematological investigations. According to the World Health Organization criteria, the participants were categorized as overall, anemia, and non‐anemia for analysis.ResultsThree hundred participants were included in this study. In all participants, near‐perfect correlation and agreement were observed between the two methods for Hb measurement (r = 0.963, p < 0.001) with an interclass correlation coefficient (ICC) of 0.981 (95% confidence interval [CI]: 0.976–0.985) and Hct measurement (r = 0.941, p < 0.001) with an ICC of 0.965 (95% CI: 0.956–0.972). The sensitivity and specificity of the device in detecting anemia were 86.2% (95% CI: 79.7–91.2) and 98.6% (95% CI: 95.2–99.8), respectively. The area under the curve was 0.976 (95% CI: 0.963–0.989). The device showed average biases of 0.76 g/dl (95% limits of agreement [LOA]: −1.03 to 2.54) for Hb measurement and −2.73% (95% LOA: −9.28 to 3.82) for Hct measurement in all participants.ConclusionAgreement between the Mission Ultra Hb Testing System and Sysmex XN‐3000 was observed. The device was excellent for detecting anemia. However, the essential evidence showing biases of the Hb and Hct measurements obtained from the device was revealed. Laboratory interpretation should be carefully performed, particularly at the near cut‐off values.