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Article: Audit of amylase and lipase requests in suspected acute pancreatitis and cost implications, South Africa.

Cook, Annie E / Jalavu, Thumeka P / Zemlin, Annalise E

2022 Volume 11, Issue 1, Page(s) 1834

Abstract: Background: The internationally accepted criteria for the diagnosis of acute pancreatitis (AP) requires two of the three following features to be present: characteristic abdominal pain, elevated serum amylase and/or lipase enzymes, or consistent imaging ...

Abstract	Background: The internationally accepted criteria for the diagnosis of acute pancreatitis (AP) requires two of the three following features to be present: characteristic abdominal pain, elevated serum amylase and/or lipase enzymes, or consistent imaging results. However, sensitivity and specificity can vary depending on the population and cut-off values used. Objective: This study evaluated the suitability of amylase and lipase as first-line diagnostic biomarkers of suspected AP for the local population served by Tygerberg Hospital, South Africa. Methods: This retrospective analysis was conducted in June 2019 using all amylase and/or lipase request data from December 2018. Patient clinical data were included in sensitivity and specificity analyses of amylase, lipase or dual requests for diagnosis of AP. Cost per test data were obtained from the National Health Laboratory Service and used to calculate the total cost of the tests and potential savings. Results: Sensitivity for lipase was 90.0% compared to 50.0% for amylase. Specificity was similar for singular measurements of lipase and amylase. Dual measurement of amylase and lipase showed no improvement in sensitivity (83.3%) and only a minor increase in specificity (97.4%) compared with measurement of lipase alone. The estimated savings was R2522.85 ($174.98 USD), with a potential annual cost saving of R84 423.74 ($5855.69 USD). Conclusion: Lipase was shown to be a more sensitive biomarker compared to amylase for the screening of AP, providing evidence for laboratories to educate local staff and promote improved requesting practices by clinicians. Additionally, preventing unnecessary dual requests may reduce costs.
Language	English
Publishing date	2022-09-26
Publishing country	South Africa
Document type	Journal Article
ZDB-ID	2708535-1
ISSN	2225-2010 ; 2225-2002
ISSN (online)	2225-2010
ISSN	2225-2002
DOI	10.4102/ajlm.v11i1.1834
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article: Serum-free light chain test utilisation at a South African academic laboratory and comparison with serum protein electrophoresis results.

Banderker, Razia B / Fazel, Fatima B / Zemlin, Annalise E / Khine, Aye-Aye / Jalavu, Thumeka P

African journal of laboratory medicine

2023 Volume 12, Issue 1, Page(s) 2201

Abstract: Background: Serum protein electrophoresis (SPE), urine protein electrophoresis and immunofixation electrophoresis were traditionally utilised for the diagnosis of monoclonal gammopathies. The quantitative serum-free light chain (SFLC) assay is ... ...

Abstract	Background: Serum protein electrophoresis (SPE), urine protein electrophoresis and immunofixation electrophoresis were traditionally utilised for the diagnosis of monoclonal gammopathies. The quantitative serum-free light chain (SFLC) assay is reportedly more sensitive and has been introduced to recent clinical guidelines. Objective: This study aimed to investigate SFLC test utilisation and describe SPE findings in patients with abnormal SFLC ratios. Methods: A retrospective audit of SFLC analyses was conducted in Cape Town, South Africa, from May 2018 to April 2020. Agreement between abnormal SFLC ratios and SPE results was determined in a sub-group of patients screened for monoclonal gammopathies. Serum-free light chains were analysed using Freelite Results: Of the 1425 patients included in the audit, 741 (52%) had abnormal SFLC ratios; 636 (45%) had increased and 105 (7%) had decreased SFLC ratios. In a sub-group analysis of 117 new patients with an abnormal SFLC ratio, 57 had a monoclonal protein (M-protein) on SPE (49%), and 60 (51%) did not. Four out of 60 patients without M-protein had a plasma cell dyscrasia, while renal impairment or inflammatory response accounted for the rest. Of the 57 patients with a M-protein and abnormal SFLC ratio, 41 (72%) had a plasma cell dyscrasia, seven (12%) had lymphomas and nine patients (16%) were unclassifiable. Conclusion: Serum-free light chains should be requested when there is a high index of clinical suspicion. Neither SFLC nor SPE should be performed in isolation when screening patients for monoclonal gammopathy, to ensure that no patient is missed. What this study adds: The study adds to the evidence on SFLC test utilisation. Serum protein electrophoresis alone may miss cases of light chain myeloma, while SFLC performed in isolation may produce false positive results in the setting of inflammatory disorders or renal impairment, leading to unnecessary further investigation.
Language	English
Publishing date	2023-11-24
Publishing country	South Africa
Document type	Journal Article
ZDB-ID	2708535-1
ISSN	2225-2010 ; 2225-2002
ISSN (online)	2225-2010
ISSN	2225-2002
DOI	10.4102/ajlm.v12i1.2201
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Article: Clinical staff knowledge and awareness of point-of-care-testing best practices at Tygerberg Hospital, South Africa.

Jalavu, Thumeka P / Rensburg, Megan / Erasmus, Rajiv

African journal of laboratory medicine

2020 Volume 9, Issue 1, Page(s) 853

Abstract: Background: Point-of-care testing (POCT) is defined as testing done near or at the site of patient care with the goal of providing rapid information and improving patient outcomes. Point-of-care testing has many advantages and some limitations which ... ...

Abstract	Background: Point-of-care testing (POCT) is defined as testing done near or at the site of patient care with the goal of providing rapid information and improving patient outcomes. Point-of-care testing has many advantages and some limitations which affect its use and implementation. Objective: The aim of the audit was to determine the current practices, staff attitudes and training provided to hospital clinical staff. Methods: The audit was conducted with the use of a questionnaire containing 30 questions. One hundred and sixty questionnaires were delivered to 55 sites at Tygerberg Academic Hospital in Cape Town, South Africa, from 21 June 2016 to 15 July 2016. A total of 68 questionnaires were completed and returned (42.5% response rate). Results: Most participants were nursing staff (62/68, 91%), and the rest were medical doctors (6/68, 9%). Most participants (66/68, 97%) performed glucose testing, 16/68 (24%) performed blood gas testing and 17/68 (25%) performed urine dipstick testing. Many participants (35/68, 51%) reported having had some formal training in one or more of the tests and 25/68 (37%) reported having never had any formal training in the respective tests. Many participants (46/68, 68%) reported that they never had formal assessment of competency in performing the respective tests. Conclusion: Participants indicated a lack of adequate training in POCT and, thus, limited knowledge of quality control measures. This audit gives an indication of the current state of the POCT programme at a tertiary hospital and highlights areas where intervention is needed to improve patient care and management.
Language	English
Publishing date	2020-07-16
Publishing country	South Africa
Document type	Journal Article
ZDB-ID	2708535-1
ISSN	2225-2010 ; 2225-2002
ISSN (online)	2225-2010
ISSN	2225-2002
DOI	10.4102/ajlm.v9i1.853
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Article ; Online: An investigation of the correlation of vitamin D status and management outcomes in patients with severe COVID-19 at a South African tertiary hospital.

Jalavu, Thumeka P / Sigwadhi, Lovemore N / Kotze, Maritha J / Yalew, Anteneh / Ngah, Vera / Tamuzi, Jacques L / Chapanduka, Zivanai C / Allwood, Brian W / Koegelenberg, Coenraad F / Irusen, Elvis M / Lalla, Usha / Matsha, Tandi E / Erasmus, Rajiv T / Zumla, Ali / Zemlin, Annalise E / Nyasulu, Peter S

IJID regions

2023

Abstract: Background: Severe COVID-19 has a poor prognosis, and biomarkers may predict disease severity. This study aimed to assess the effect of baseline Vitamin D (VitD) inadequacy on outcome of patients with severe COVID-19 admitted to intensive care unit (ICU) ...

Abstract	Background: Severe COVID-19 has a poor prognosis, and biomarkers may predict disease severity. This study aimed to assess the effect of baseline Vitamin D (VitD) inadequacy on outcome of patients with severe COVID-19 admitted to intensive care unit (ICU) in a tertiary hospital in South Africa. Methods: Patients with confirmed SARS-CoV-2 were recruited during wave II of the pandemic in Cape Town. Eighty-six patients were included in the study. They were categorized into three groups "VitD deficient, VitD insufficient and VitD sufficient". We combined the VitD deficient with insufficient group to form "VitD inadequate'' group. Cox regression analysis was done to assess the association between VitD status and mortality. Factors with p< 0.05 in adjusted multivariable cox regression were considered statistically significant. Results: The proportion of VitD inadequacy was 64% (55/86), with significantly higher proportion of hypertension (66%; p 0.012). Kaplan Meir curve showed no significant difference in the probability of survival among the COVID-19 patients admitted in the ICU with or without VitD inadequacy. However, patients with elevated serum creatinine were significantly more at risk of dying (Adjusted Hazard Ratio 1.008 (1.002 - 1.030, p<0.017). Conclusion: Our study found a high prevalence of VitD inadequacy (combined deficiency and insufficiency) in COVID-19 patients admitted to the ICU. This may indicate a possible risk of severe disease. Whilst there was no statistically significant relationship between VitD status and mortality in this cohort, baseline VitD may be an important prognostic biomarker in COVID-19 patients admitted to the ICU, particularly in those with comorbidities that predispose to VitD deficiency.
Language	English
Publishing date	2023-06-01
Publishing country	England
Document type	Journal Article
ISSN	2772-7076
ISSN (online)	2772-7076
DOI	10.1016/j.ijregi.2023.05.007
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Article ; Online: Predicting COVID-19 outcomes from clinical and laboratory parameters in an intensive care facility during the second wave of the pandemic in South Africa.

Allwood, Brian W / Koegelenberg, Coenraad F / Ngah, Veranyuy D / Sigwadhi, Lovemore N / Irusen, Elvis M / Lalla, Usha / Yalew, Anteneh / Tamuzi, Jacques L / McAllister, Marli / Zemlin, Annalise E / Jalavu, Thumeka P / Erasmus, Rajiv / Chapanduka, Zivanai C / Matsha, Tandi E / Fwemba, Isaac / Zumla, Alimuddin / Nyasulu, Peter S

IJID regions

2022 Volume 3, Page(s) 242–247

Abstract: Background: The second wave of coronavirus disease 2019 (COVID-19) in South Africa was caused by the Beta variant of severe acute respiratory syndrome coronavirurus-2. This study aimed to explore clinical and biochemical parameters that could predict ... ...

Abstract	Background: The second wave of coronavirus disease 2019 (COVID-19) in South Africa was caused by the Beta variant of severe acute respiratory syndrome coronavirurus-2. This study aimed to explore clinical and biochemical parameters that could predict outcome in patients with COVID-19. Methods: A prospective study was conducted between 5 November 2020 and 30 April 2021 among patients with confirmed COVID-19 admitted to the intensive care unit (ICU) of a tertiary hospital. The Cox proportional hazards model in Stata 16 was used to assess risk factors associated with survival or death. Factors with Results: Patients who died were found to have significantly lower median pH ( Conclusions: The mortality of patients with COVID-19 admitted to the ICU was associated with elevated D-dimer and a low HCO3std level. Large studies are warranted to increase the identification of patients at risk of poor prognosis, and to improve the clinical approach.
Language	English
Publishing date	2022-04-01
Publishing country	England
Document type	Journal Article
ISSN	2772-7076
ISSN (online)	2772-7076
DOI	10.1016/j.ijregi.2022.03.024
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Article ; Online: Latent class analysis: an innovative approach for identification of clinical and laboratory markers of disease severity among COVID-19 patients admitted to the intensive care unit.

Sigwadhi, Lovemore N / Tamuzi, Jacques L / Zemlin, Annalise E / Chapanduka, Zivanai C / Allwood, Brian W / Koegelenberg, Coenraad F / Irusen, Elvis M / Lalla, Usha / Ngah, Veranyuy D / Yalew, Anteneh / Savieri, Perseverence / Fwemba, Isaac / Jalavu, Thumeka P / Erasmus, Rajiv T / Matsha, Tandi E / Zumla, Alimuddin / Nyasulu, Peter S

IJID Regions (Online)

2022 Volume 5, Page(s) 154–162

Abstract: Objective: The aim of this study was to identify clinical and laboratory phenotype distribution patterns and their usefulness as prognostic markers in COVID-19 patients admitted to the intensive care unit (ICU) at Tygerberg Hospital, Cape Town.: ... ...

Abstract	Objective: The aim of this study was to identify clinical and laboratory phenotype distribution patterns and their usefulness as prognostic markers in COVID-19 patients admitted to the intensive care unit (ICU) at Tygerberg Hospital, Cape Town. Methods and results: A latent class analysis (LCA) model was applied in a prospective, observational cohort study. Data from 343 COVID-19 patients were analysed. Two distinct phenotypes (1 and 2) were identified, comprising 68.46% and 31.54% of patients, respectively. The phenotype 2 patients were characterized by increased coagulopathy markers (D-dimer, median value 1.73 ng/L vs 0.94 ng/L; Conclusion: The identification of COVID-19 phenotypes and sub-phenotypes in ICU patients could help as a prognostic marker in the day-to-day management of COVID-19 patients admitted to the ICU.
Language	English
Publishing date	2022-11-01
Publishing country	England
Document type	Journal Article
ISSN	2772-7076
ISSN (online)	2772-7076
DOI	10.1016/j.ijregi.2022.10.004
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Article ; Online: The association between acid-base status and clinical outcome in critically ill COVID-19 patients admitted to intensive care unit with an emphasis on high anion gap metabolic acidosis.

Zemlin, Annalise E / Sigwadhi, Lovemore N / Wiese, Owen J / Jalavu, Thumeka P / Chapanduka, Zivanai C / Allwood, Brian W / Tamuzi, Jacques L / Koegelenberg, Coenraad F / Irusen, Elvis M / Lalla, Usha / Ngah, Veranyuy D / Yalew, Anteneh / Erasmus, Rajiv T / Matsha, Tandi E / Zumla, Alimuddin / Nyasulu, Peter S

Annals of clinical biochemistry

2022 Volume 60, Issue 2, Page(s) 86–91

Abstract: Objective: The aim of this study was to identify arterial blood gas (ABG) abnormalities, with a focus on a high anion gap (AG) metabolic acidosis and evaluate outcomes in coronavirus disease 2019 (COVID-19) patients admitted to the ICU.: Methods: A ... ...

Abstract	Objective: The aim of this study was to identify arterial blood gas (ABG) abnormalities, with a focus on a high anion gap (AG) metabolic acidosis and evaluate outcomes in coronavirus disease 2019 (COVID-19) patients admitted to the ICU. Methods: A retrospective, observational study was conducted in a tertiary hospital in Cape Town during the first and second COVID-19 waves. Age, gender, sodium (Na), potassium (K), chloride (Cl), bicarbonate (HCO Results: This study included 465 patients, 226 (48%) of whom were female. The sample population's median (IQR) age was 54.2 (46.1-61.3) years, and 63% of the patients died. ABG analyses found that 283 (61%) of the 465 patients had alkalosis (pH ≥ 7.45), 65 (14%) had acidosis (pH ≤ 7.35) and 117 (25%) had normal pH (7.35-7.45). In the group with alkalosis, 199 (70.3%) had a metabolic alkalosis and in the group with acidosis, 42 (64%) had a metabolic acidosis with an increased AG of more than 17. Non-survivors were older than survivors (56.4 years versus 50.3 years, Conclusion: Most of the COVID-19 patients admitted to the ICU had an alkalosis, and those with acidosis had a much worse prognosis. Higher AG metabolic acidosis was not associated with patients' characteristics.
MeSH term(s)	Humans ; Female ; Middle Aged ; Male ; Acid-Base Equilibrium ; Retrospective Studies ; Critical Illness ; COVID-19 ; South Africa ; Acidosis ; Alkalosis ; Intensive Care Units
Language	English
Publishing date	2022-11-07
Publishing country	England
Document type	Observational Study ; Journal Article
ZDB-ID	390309-6
ISSN	1758-1001 ; 0004-5632
ISSN (online)	1758-1001
ISSN	0004-5632
DOI	10.1177/00045632221134687
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Article ; Online: Prognostic value of biochemical parameters among severe COVID-19 patients admitted to an intensive care unit of a tertiary hospital in South Africa.

Zemlin, Annalise E / Allwood, Brian / Erasmus, Rajiv T / Matsha, Tandi E / Chapanduka, Zivanai C / Jalavu, Thumeka P / Ngah, Vera / Sigwadhi, Lovemore N / Koegelenberg, Coenraad F / Irusen, Elvis / Lalla, Usha / Yalew, Anteneh / Baines, Nicola / Tamuzi, Jacques L / Barasa, Anne K / Magutu, Valerie Kemunto / Njeru, Caroline / Amayo, Angela / Mureithi, Marianne Wanjiru /

Mungania, Mary / Sono-Setati, Musa / Zumla, Alimuddin / Nyasulu, Peter S

IJID Regions (Online)

2022 Volume 2, Page(s) 191–197

Abstract: Background: Data on biochemical markers and their association with mortality rates in patients with severe coronavirus disease 2019 (COVID-19) admitted to intensive care units (ICUs) in sub-Saharan Africa are scarce. An evaluation of baseline routine ... ...

Abstract	Background: Data on biochemical markers and their association with mortality rates in patients with severe coronavirus disease 2019 (COVID-19) admitted to intensive care units (ICUs) in sub-Saharan Africa are scarce. An evaluation of baseline routine biochemical parameters was performed in COVID-19 patients admitted to the ICU, in order to identify prognostic biomarkers. Methods: Demographic, clinical, and laboratory data were collected prospectively from patients with PCR-confirmed COVID-19 admitted to the adult ICU of a tertiary hospital in Cape Town, South Africa, between October 2020 and February 2021. Robust Poisson regression methods and the receiver operating characteristic (ROC) curve were used to explore the association of biochemical parameters with severity and mortality. Results: A total of 82 patients (median age 53.8 years, interquartile range 46.4-59.7 years) were enrolled, of whom 55 (67%) were female and 27 (33%) were male. The median duration of ICU stay was 10 days (interquartile range 5-14 days); 54/82 patients died (66% case fatality rate). Baseline lactate dehydrogenase (LDH) (adjusted relative risk 1.002, 95% confidence interval 1.0004-1.004; Conclusions: LDH and NT-proBNP appear to be promising predictors of a poor prognosis in COVID-19 patients in the ICU. Studies with a larger sample size are required to confirm the validity of this combination of biomarkers.
Language	English
Publishing date	2022-01-23
Publishing country	England
Document type	Journal Article
ISSN	2772-7076
ISSN (online)	2772-7076
DOI	10.1016/j.ijregi.2022.01.012
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Article ; Online: Haematological predictors of poor outcome among COVID-19 patients admitted to an intensive care unit of a tertiary hospital in South Africa.

Chapanduka, Zivanai C / Abdullah, Ibtisam / Allwood, Brian / Koegelenberg, Coenraad F / Irusen, Elvis / Lalla, Usha / Zemlin, Annalise E / Masha, Tandi E / Erasmus, Rajiv T / Jalavu, Thumeka P / Ngah, Veranyuy D / Yalew, Anteneh / Sigwadhi, Lovemore N / Baines, Nicola / Tamuzi, Jacques L / McAllister, Marli / Barasa, Anne K / Magutu, Valerie K / Njeru, Caroline /

Amayo, Angela / Wanjiru Mureithi, Marianne W / Mungania, Mary / Sono-Setati, Musa / Zumla, Alimuddin / Nyasulu, Peter S

PloS one

2022 Volume 17, Issue 11, Page(s) e0275832

Abstract: Background: Studies from Asia, Europe and the USA indicate that widely available haematological parameters could be used to determine the clinical severity of Coronavirus disease 2019 (COVID-19) and predict management outcome. There is limited data from ...

Abstract	Background: Studies from Asia, Europe and the USA indicate that widely available haematological parameters could be used to determine the clinical severity of Coronavirus disease 2019 (COVID-19) and predict management outcome. There is limited data from Africa on their usefulness in patients admitted to Intensive Care Units (ICUs). We performed an evaluation of baseline haematological parameters as prognostic biomarkers in ICU COVID-19 patients. Methods: Demographic, clinical and laboratory data were collected prospectively on patients with confirmed COVID-19, admitted to the adult ICU in a tertiary hospital in Cape Town, South Africa, between March 2020 and February 2021. Robust Poisson regression methods and receiver operating characteristic (ROC) curves were used to explore the association of haematological parameters with COVID-19 severity and mortality. Results: A total of 490 patients (median age 54.1 years) were included, of whom 237 (48%) were female. The median duration of ICU stay was 6 days and 309/490 (63%) patients died. Raised neutrophil count and neutrophil/lymphocyte ratio (NLR) were associated with worse outcome. Independent risk factors associated with mortality were age (ARR 1.01, 95%CI 1.0-1.02; p = 0.002); female sex (ARR 1.23, 95%CI 1.05-1.42; p = 0.008) and D-dimer levels (ARR 1.01, 95%CI 1.002-1.03; p = 0.016). Conclusions: Our study showed that raised neutrophil count, NLR and D-dimer at the time of ICU admission were associated with higher mortality. Contrary to what has previously been reported, our study revealed females admitted to the ICU had a higher risk of mortality.
MeSH term(s)	Adult ; Humans ; Female ; Middle Aged ; Male ; COVID-19/epidemiology ; Tertiary Care Centers ; South Africa/epidemiology ; Intensive Care Units ; Hospitalization ; Retrospective Studies
Language	English
Publishing date	2022-11-04
Publishing country	United States
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	2267670-3
ISSN	1932-6203 ; 1932-6203
ISSN (online)	1932-6203
ISSN	1932-6203
DOI	10.1371/journal.pone.0275832
Database	MEDical Literature Analysis and Retrieval System OnLINE

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