Electronic Journal of the International Federation of Clinical Chemistry and Laboratory Medicine最新文献

{"title":"Association of Circulating and Urinary Calprotectin (S100A8/A9, MRP8/14) Levels with Type 2 Diabetes Mellitus and its Complications: A Systematic Review and Meta-analysis.","authors":"Roshan Kumar Mahat, Mritunjay Kumar Mishra, Nand Kishor Prasad Sah, Sushil Yadav","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>Calprotectin is a myeloid-derived damage-associated molecular pattern implicated in metabolic inflammation and vascular injury. Evidence regarding circulating and urinary calprotectin in type 2 diabetes mellitus (T2DM) and its complications remains inconsistent.</p><p><strong>Methods: </strong>PubMed, Scopus, and Web of Science were searched up to 25th October 2025. Human observational studies reporting quantitative calprotectin levels were included. Standardized mean differences (SMDs) with 95% confidence intervals (CIs) were calculated using a random-effects model. Heterogeneity was assessed using I² and Cochran's Q. Sensitivity analyses, prediction intervals, and publication bias evaluation using the Doi plot and LFK index were performed.</p><p><strong>Results: </strong>Seventeen studies were included in the metaanalysis. Circulating calprotectin levels were significantly higher in patients with T2DM compared with healthy controls (SMD = 1.08, 95% CI: 0.77-1.39; p < 0.0001; P = 78.2%). Sensitivity analyses confirmed the robustness of this association, although small-study effects were suggested. Higher circulating calprotectin levels were observed in T2DM patients with peripheral neuropathy (SMD = 1.02; 95% CI: 0.06-1.98) and macrovascular complications (SMD = 0.43; 95% CI: 0.08-0.77) compared with those without complications, but these associations showed considerable heterogeneity and limited stability. No significant difference in circulating calprotectin levels was observed between T2DM patients with microalbuminuria and normoalbuminuria. Urinary calprotectin levels did not differ significantly between T2DM patients and controls.</p><p><strong>Conclusions: </strong>Circulating calprotectin is elevated in T2DM, supporting its role as a biomarker of metabolic inflammation. Associations with neuropathy and macrovascular disease are suggestive but heterogeneous, while evidence for urinary calprotectin remains inconclusive.</p>","PeriodicalId":37192,"journal":{"name":"Electronic Journal of the International Federation of Clinical Chemistry and Laboratory Medicine","volume":"37 4","pages":"710-726"},"PeriodicalIF":0.0,"publicationDate":"2026-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13563546/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148956882","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Analytical Performance of an Alternative Wavelength in the O-CPC Calcium Assay.","authors":"Serdar Hira, Ömer Özcan, Osman Metin İpcioğlu, Mustafa Gültepe","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Objective: </strong>The o-cresolphthalein complexone (O-CPC) method is widely used for serum calcium measurement but may exhibit analytical limitations related to background absorbance and bias, particularly at low calcium concentrations. This study evaluated the analytical performance of an alternative wavelength (524 nm) compared with the conventional 572 nm measurement.</p><p><strong>Methods: </strong>Spectral analysis of the calcium-O-CPC complex identified a secondary absorbance feature near 536 nm. Because this wavelength was not available in routine analysers, 524 nm was selected as the nearest operational alternative for analytical evaluation. Performance was assessed using multipoint calibration models, control sera, precision analysis, and comparison with an automated analyzer in 40 samples, including prepared mixtures to extend the analytical range. Agreement between methods was evaluated using regression and Bland-Altman analyses.</p><p><strong>Results: </strong>Reagent blank absorbance was lower at 524 nm compared with 572 nm (0.048 vs 0.122). Linearity was high at both wavelengths (R²≈0.998). Precision analysis demonstrated comparable CV% values between wavelengths. Regression analysis showed a slope closer to unity and a smaller intercept at 524 nm relative to 572 nm. Bland-Altman analysis demonstrated comparable overall agreement between methods at both wavelengths. In the low concentration subgroup (<9 mg/dL), mean negative bias was reduced from -0.55 mg/dL at 572 nm to -0.30 mg/dL at 524 nm.</p><p><strong>Conclusions: </strong>Measurement at 524 nm demonstrated comparable overall analytical performance to the conventional 572 nm wavelength and was associated with reduced negative bias in the low concentration range. These findings suggest that alternative wavelength selection may represent a practical approach for optimizing analytical performance in routine O-CPC calcium assays.</p>","PeriodicalId":37192,"journal":{"name":"Electronic Journal of the International Federation of Clinical Chemistry and Laboratory Medicine","volume":"37 4","pages":"659-666"},"PeriodicalIF":0.0,"publicationDate":"2026-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13563543/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148956699","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Hypoxia Trap: Worsening Sickle Cell Disease in the Setting of Tetralogy of Fallot.","authors":"Mohnish Darshan, Sonal Rajmane, Jignesh Sharma, Amber Kumar, Girish Chandra Bhatt, Shikha Malik","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>Tetralogy of Fallot (TOF) is the most common cyanotic congenital heart disease and predisposes affected children to thrombotic complications due to chronic hypoxia and polycythemia. Sickle cell disease (SCD) further increases the risk of vaso-occlusion through erythrocyte sickling and endothelial dysfunction. The coexistence of TOF and SCD is rare and creates complex diagnostic and therapeutic challenges with significant risk of catastrophic neurological events.</p><p><strong>Case presentation: </strong>We report a 14-month-old female with known TOF who presented with acute left-sided hemiparesis, fever, and seizures. Brain computed tomography with angiography revealed extensive bilateral ischemic infarctions with complete thrombosis of both middle cerebral arteries and occlusion of the right internal carotid artery. Haematological evaluation confirmed previously un-diagnosed SCD with an HbS fraction of 60.2%. Despite intensive therapy including oxygen, intravenous hydration, hydroxyurea, antiepileptic drugs, and exchange transfusion that reduced HbS to 28.9%, the child developed progressive encephalopathy and died. Chronic hypoxia from TOF combined with SCD-related sickling likely precipitated catastrophic cerebrovascular thrombosis.</p><p><strong>Conclusion: </strong>This case highlights the synergistic thrombotic risks of TOF and SCD, emphasising the critical need for routine hemoglobinopathy screening in children with cyanotic heart disease, especially in high-prevalence regions. Early diagnosis, proactive use of vasopressors to optimise oxygenation, and multidisciplinary management are essential to improve outcomes. Aggressive preventive interventions are essential to reduce morbidity and mortality in patients presenting with these rare coexisting pathologies. Enhanced screening awareness, stroke-preventing strategies and timely surgical intervention for TOF could improve prognosis in this rare, high-risk dual pathology.</p>","PeriodicalId":37192,"journal":{"name":"Electronic Journal of the International Federation of Clinical Chemistry and Laboratory Medicine","volume":"37 3","pages":"566-571"},"PeriodicalIF":0.0,"publicationDate":"2026-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13543445/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148897880","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Big Data and Diabetes: Seven-Year Data from Pakistan's Nation-Wide Laboratory Network.","authors":"Lena Jafri, Yousra Sarfaraz, Sibtain Ahmed, Zaib Un Nisa, Bilal Hashmi, Saad Bin Zafar Mahmood, Ayesha Sadiqa, Aysha Habib Khan, Imran Siddiqui, Hafsa Majid","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Introduction: </strong>Diabetes has become a prominent worldwide public health issue, with its prevalence notably higher in lower middle-income countries. Pakistan ranks third globally in terms of number of individuals diagnosed with Type 2 Diabetes Mellitus and have highest prevalence of diabetes throughout the world. The objective of current study was to assess the frequency of diabetes in relation to demographics utilizing laboratory data of individuals residing in Pakistan.</p><p><strong>Methods: </strong>Biochemical data of HbA1c, fasting and random plasma glucose, and oral glucose tolerance test were retrieved from Laboratory Information System analyzed in Pathology and Laboratory Medicine department from Jan 2016 to Dec 2022. Specimens were received from Aga Khan University laboratories' network, which is spread over the country. For interpretation of biochemical tests' values American Diabetes Association (ADA) criteria was applied.</p><p><strong>Results: </strong>After removal of duplicates and missing data, the final sample included 4,260,171 unique individuals. Diabetes was present in 35.9% of the overall population, with the highest incidence (55.6%) recorded in males aged 35 to 59 years. Diabetes was significantly associated with advancing age and gender (p<0.001). Individuals who had the fasting blood glucose ≥ 126 mg/dl were (n=372,050), HbA1c exceeding 6.5% were (n=762,940) the random blood glucose ≥ 200 mg/dl were (n=128,820), OGTT level ≥ 200 mg/dl were (n=487) and diabetes confirmed with more than one diagnostic test were (n=505,609).</p><p><strong>Conclusion: </strong>The study, based on dataset of around 4.2 million individuals, revealed an overall diabetes frequency of 35.9%, with highest prevalence in middle-aged group (55.6%), and significant associations with both advancing age and gender.</p>","PeriodicalId":37192,"journal":{"name":"Electronic Journal of the International Federation of Clinical Chemistry and Laboratory Medicine","volume":"37 3","pages":"417-424"},"PeriodicalIF":0.0,"publicationDate":"2026-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13543477/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148897910","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Assessing Testosterone Epidemiology Using Distributional Approaches: Evidence From Large-Scale Longitudinal Laboratory Dataset in Pakistan.","authors":"Sibtain Ahmed, Minal Imran, Imran Siddiqui","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>Testosterone is the main circulating androgen in adult males and serves a crucial role in reproductive function, skeletal health, metabolic regulation, and overall physiological stability. In recent decades, concern has emerged regarding possible secular changes in serum testosterone concentrations, independent of aging. However, findings across populations remain inconsistent, and most evidence originates from high-income settings.</p><p><strong>Objective: </strong>This study aimed to evaluate long-term temporal patterns in serum testosterone levels among adult men, with particular emphasis on distributional shifts and population-wide hormonal instability, rather than solely on a mean decline.</p><p><strong>Methods: </strong>A retrospective observational analysis was conducted using anonymized laboratory-based serum testosterone measurements from adult males aged ≥18 years between 2008 and 2025. Only the earliest measurement per individual was included to reduce repeat testing bias. Annual descriptive statistics were calculated, and temporal trends were assessed using linear regression. Age-stratified analysis, percentile drift evaluation, and reference interval shifts were used to explore changes across the testosterone distribution over time.</p><p><strong>Results: </strong>A total of 104,559 testosterone measurements were analysed over 17 years. Linear regression demonstrated a statistically significant but clinically minimal association between calendar year and testosterone concentration (β = +1.97 ng/dL/year, p < 0.001; R2 = 0.002). Substantial overlap in testosterone distribution was observedacross age groups, with notable inter year variability. Percentile drift analyses indicated parallel movement across the distribution, suggesting population-wide hormonal fluctuation rather than a uniform secular decline.</p><p><strong>Conclusion: </strong>Mean testosterone levels did not demonstrate a consistent age-independent decline. Instead, findings support a temporal instability and persistent low exposure subgroups, emphasising the importance of distributional approaches in understanding contemporary hormonal epidemiology.</p>","PeriodicalId":37192,"journal":{"name":"Electronic Journal of the International Federation of Clinical Chemistry and Laboratory Medicine","volume":"37 3","pages":"450-458"},"PeriodicalIF":0.0,"publicationDate":"2026-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13543412/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148897674","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Drug-Induced Liver Injury During First-Line Anti-Tubercular Therapy (Isoniazid, Rifampicin, Pyrazinamide, and Ethambutol): A Case Report with De-challenge and Rechallenge.","authors":"Sridevi Chokkakula, Ashwitha Balasani, Sathwika Reddy Ammana","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>The primary treatment for tuberculosis, which includes isoniazid, rifampicin, pyrazinamide, and ethambutol, is vital for managing the disease but often leads to drug-induced liver injury (DILI), especially in older adults. It is important to accurately identify and manage hepatotoxicity caused by this treatment to safely continue therapy.</p><p><strong>Objective: </strong>This report discusses a case of liver injury induced by first-line anti-tubercular drugs in an elderly patient, emphasiz-ing the importance of de-challenge, alternative non-hepatotoxic treatments, and a carefully monitored stepwise rechallenge.</p><p><strong>Methods: </strong>An 84-year-old woman with pulmonary tuberculosis and hypertension (treated with amlodipine) experienced abnormal liver function tests after starting first-line anti-tubercular therapy. A thorough clinical evaluation, laboratory tests, causality assessment, de-challenge, alternative treatment, and stepwise rechallenge were conducted with close biochemical monitoring.</p><p><strong>Results: </strong>Initial tests showed significant hyperbilirubinemia (total bilirubin 5.2 mg/dL), elevated aspartate aminotransferase (AST 176-247 U/L), slightly increased Alanine Aminotransferase (ALT 40-55 U/L), and an R-ratio of about 2.6, indicating a predominantly cholestatic pattern with mixed features of liver injury. After discontinuing the hepatotoxic treatment and starting alternative medications (Moxifloxacin, Streptomycin, and Ethambutol), liver function tests improved significantly within 3-5 days. Once liver parameters normalized, Rifampicin was gradually reintroduced, and liver function tests remained stable four days after rechallenge, with no return of hepatotoxicity.</p><p><strong>Conclusion: </strong>This case illustrates that early detection of liver injury from anti-tubercular therapy, prompt de-challenge, use of alternative non-hepatotoxic drugs, and a carefully monitored stepwise rechallenge can enable the safe continuation of tuberculosis treatment in elderly patients. Close biochemical monitoring, along with consideration of therapeutic drug monitoring, may further improve patient safety.</p>","PeriodicalId":37192,"journal":{"name":"Electronic Journal of the International Federation of Clinical Chemistry and Laboratory Medicine","volume":"37 3","pages":"558-565"},"PeriodicalIF":0.0,"publicationDate":"2026-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13543505/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148897850","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Autoantibody Profiles and Clinical Correlations in Systemic Sclerosis: A Cross-Sectional Study.","authors":"Debamita Datta, Sushil Kumar, Lekha Priyadharshini Kamarajan, Mala Mahto, Bandana Kumari, Ayan Banerjee, Swetalina Pradhan, Bijay Nanda Naik","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>Systemic sclerosis (SSc) is a rare autoimmune disease marked by immune dysregulation, vascular injury, and fibrosis. Antinuclear antibodies (ANA) are pivotal for diagnosis and prognosis, yet Indian data remain scarce. This study assessed ANA patterns and autoantibody profiles in SSc and their clinical relevance.</p><p><strong>Methods: </strong>A cross-sectional study was conducted in the Department of Dermatology, AIIMS Patna, from September 2022 to September 2023. Eighty-five patients fulfilling ACR/EULAR criteria for SSc were enrolled. Clinical features were documented using a structured proforma, and patients were classified into diffuse cutaneous (dcSSc) and limited cutaneous (lcSSc) subsets. ANA screening was performed by indirect immunofluorescence (IIF) on HEp2 cells, followed by autoantibody profiling with line immunoassay (LIA). Statistical analyses were performed using JAMOVI v2.3.28, with p<0.05 considered significant.</p><p><strong>Results: </strong>Of 85 patients, 70 (82.4%) were female (ratio of 5:1), with a mean age of 34.7 ± 10.7 years. dcSSc accounted for 55.3%. Common manifestations included arthralgia (69.4%), respiratory symptoms (68.2%), and interstitial lung disease (ILD) (64.1%). Homogeneous ANA was the predominant IIF pattern (41.2%), followed by centromere (10.6%) and speckled (8.2%). LIA revealed anti-Scl70 as the most frequent autoantibody (58.3%), significantly associated with ILD and Raynaud's phenomenon. Anti-U1 snRNP and anti-PMScl antibodies correlated with musculoskeletal involvement.</p><p><strong>Conclusion: </strong>SSc in this cohort showed female predominance with frequent arthralgia and respiratory symptoms. Anti-Scl-70 antibodies were most common, strongly linked to diffuse disease and ILD. ANA profiling provides disease characterization in Indian SSc.</p>","PeriodicalId":37192,"journal":{"name":"Electronic Journal of the International Federation of Clinical Chemistry and Laboratory Medicine","volume":"37 3","pages":"468-475"},"PeriodicalIF":0.0,"publicationDate":"2026-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13543460/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148897731","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Integration of Patient-Based Real-Time Quality Control with Conventional Internal Quality Control: Improved Error Detection and Cost-Benefit Analysis in a Clinical Laboratory.","authors":"Mudasir Bashir Dandroo, Devanatha Desikan V, Ramesh Ramasamy","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>Internal Quality control (IQC) is essential as it ensures analytical accuracy. However, IQC may have certain limitations, for example, it may miss intermittent or matrix-related errors. Patient-Based Real-Time Quality Control (PBRTQC) can overcome this limitation by continuously monitoring the patient data and also aids in early detection of shifts. Hence, integration of PBRTQC with IQC enhances the error detection and the cost efficiency in clinical laboratories.</p><p><strong>Aim: </strong>To study the effect of integrating Patient-Based Real-time Quality Control with Conventional Quality Control for improved detection of errors, cost benefit and risk-based cost benefits.</p><p><strong>Methods: </strong>Four parameters, creatinine, urea, Aspartate Transaminase (AST), and Thyroid Stimulating Hormone (TSH), were selected based on low sigma value and high monthly sample load. Historical patient data was collected from the laboratory information system. Data was divided into training and validation sets. Truncation limits were calculated using the interquartile range method. Simple Moving Average (SMA) was calculated for various block sizes. Control limits were set using the maximum/minimum of the moving average or percentiles. A bias simulation study was performed by introducing bias from -50% to +50% to plot bias detection curves and determine the optimum block size and ANPed. Optimized PBRTQC parameters were validated. The optimized algorithm was applied to daily patient data and integrated with IQC. Moving average alarm rate and percentage increase in error detection were calculated. Potential cost-benefit and risk-based benefits were determined.</p><p><strong>Results: </strong>optimum block size and (ANPed) at TEa was 50 for creatinine (161), 25 for urea (207), 50 for AST (22), and 25 for TSH (68). The MA alarm percentage remained below 1% for all analytes. Integration improved error detection by 28.57% for creatinine, 25% for urea, and 20% for TSH. Net cost benefit demonstrated total savings of 426.92 through QC reductions (264.56) and avoided reanalysis costs (162.36).</p><p><strong>Conclusion: </strong>PBRTQC integration with IQC significantly improves error detection for low sigma performance assays, is cost-effective and provides a strong risk-based cost-benefit advantage.</p>","PeriodicalId":37192,"journal":{"name":"Electronic Journal of the International Federation of Clinical Chemistry and Laboratory Medicine","volume":"37 3","pages":"493-505"},"PeriodicalIF":0.0,"publicationDate":"2026-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13543464/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148897934","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"National Survey on Delta Check Practices in Clinical Laboratories Across Pakistan.","authors":"Fatima Kanani, Saba Raza, Harim Fatima, Adnan Mustafa Zubairi","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>Delta check is a quality control tool in clinical laboratory that compares a patient's current test results with previous ones. It is often considered to be a useful tool to identify pre-analytical errors. Delta check procedures vary across labs. A survey was conducted to determine national delta check practices.</p><p><strong>Method: </strong>An online survey was sent to pathologists. Data was analyzed by Microsoft excel and figures were generated via R statistical software.</p><p><strong>Results: </strong>The survey was sent out to 84 participants. There were 30 (35.7%) final responses, after exclusion of duplicates and incomplete entries. Respondents varied in their designations from Professor 2(6.7%) to Assistant Professor 10(33.3%). Most respondents 25 (83.3%) were Fellows of College of Physicians and Surgeons, while there were 3(10%) PhDs. Work experience varied from less than 3 years, 5(16.7%) to more than 10 years, 17(56.7%). 25 labs surveyed were from tertiary care hospitals. Most laboratories were in Sindh Province, 13 (43.3%). Delta check procedures were used by 19(63.3%) labs, of which 6(31.6%) used automated checks, 12(63.2%) had defined delta limits for different tests, 15(78.9%) had defined time limits to check delta results, 17(89.5%) had a checklist for its investigation and 10(52.6%) had a Laboratory Information System or middleware to block failed delta results. Most of the respondents considered the smallest available option as the ideal delta difference value for blocking results.</p><p><strong>Conclusion: </strong>Delta check procedures vary among surveyed labs and efforts are required for the formulation of national guidelines to synchronise and standardize delta check practices.</p>","PeriodicalId":37192,"journal":{"name":"Electronic Journal of the International Federation of Clinical Chemistry and Laboratory Medicine","volume":"37 3","pages":"409-416"},"PeriodicalIF":0.0,"publicationDate":"2026-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13543523/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148897843","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Acute Intermittent Porphyria with a Secondary Porphyria Cutanea Tarda-like Biochemical Pattern in a Patient with Co-Morbid Human Immunodeficiency Virus Infection.","authors":"Kagiso M Masemola, Kgaogelo R Masemola, Mogomotsi Dintshi, Taryn Pillay","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Introduction: </strong>Porphyrias are rare inherited disorders of heme synthesis caused by reduced activity of one of the eight enzymes in the pathway. When early precursors accumulate, acute hepatic porphyrias occur, which present as severe neurovisceral attacks. When later, light-sensitive porphyrins accumulate, they cause cutaneous forms with chronic photosensitivity, blistering and skin fragility. Although these patterns are usually distinct, acute, and cutaneous features may appear together. This may reflect two separate genetic defects, but more often occurs when oxidative stress, such as from iron overload, chronic infection, or drugs, secondarily inhibits the fifth enzyme, uroporphyrinogen decarboxylase. This creates a mixed porphyrin pattern in which the usual distinctions between acute and cutaneous porphyrias are blurred, making diagnosis challenging.</p><p><strong>Case presentation: </strong>A 22-year-old woman living with human immunodeficiency virus (HIV) infection presented with recurrent abdominal pain during the luteal phase of menstruation, autonomic instability, and limb weakness that improved following heme arginate therapy. Urine porphobilinogen was markedly elevated, and hydroxymethylbilane synthase <i>(HMBS)</i> gene sequencing confirmed acute intermittent porphyria (AIP). However, her porphyrin studies also demonstrated pronounced urinary uroporphyrin elevation together with faecal isocoproporphyrins, a pattern characteristic of porphyria cutanea tarda (PCT).</p><p><strong>Discussion: </strong>The findings are consistent with AIP complicated by secondary hepatic inhibition of uroporphyrinogen decarboxylase. In this patient, secondary uroporphyrinogen decarboxylase (UROD) inhibition was likely driven by persistent HIV viraemia, antiretroviral-associated hepatic oxidative stress, and chronic inflammatory activation which are well-recognised risk factors for acquired PCT-like biochemical patterns.</p><p><strong>Conclusion: </strong>This case demonstrates how co-morbidities can modify classical porphyria biochemical patterns and reinforces the need for integrated urine, plasma, and faecal interpretation, especially when biochemical profiles appear mixed. Clinically, patients living with HIV who have porphyria may benefit from closer monitoring for factors that increase liver stress, especially ongoing viraemia, hepatotoxic or porphyrinogenic drugs, alcohol use and iron overload. When virological control is poor, the risk of secondary UROD inhibition and mixed biochemical findings may increase. Regular review of HIV virological control, liver function, medication safety and porphyrin profiles may therefore help prevent recurrent attacks and reduce diagnostic confusion.</p>","PeriodicalId":37192,"journal":{"name":"Electronic Journal of the International Federation of Clinical Chemistry and Laboratory Medicine","volume":"37 3","pages":"539-544"},"PeriodicalIF":0.0,"publicationDate":"2026-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13543482/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148897482","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}