AmpathChat #74 - A QUICK GUIDE TO COVID-19 TESTS

The repertoire of laboratory tests related to COVID-19 has expanded since the first appearance of SARS-CoV-2 in December 2019. This guide provides an update on the latest Ampath COVID-19 tests (as of March 2021), including the appropriate indications for use.

AmpathChat #73 Familial hypercholesterolaemia detection using NGS

Familial hypercholesterolaemia (FH) is the most common autosomal-dominant inherited disorder of lipid metabolism.

AmpathChat #72 - Non-invasive prenatal testing: Introducing VERACITY

Non-invasive prenatal testing (NIPT) is a prenatal screening test that calculates the risk of a fetus being affected with a chromosome abnormality. The test utilises cell-free DNA released from the placenta into the maternal bloodstream during pregnancy. NIPT is the most sensitive and specific screening test for the common fetal aneuploidies and reduces the need for invasive prenatal testing, with its associated risks.

AmpathChat #71 SAFE AT WORK Minimizing risk of new COVID-19 infection in the workplace

Implement the most current version of regulations on health and safety measures to reduce and eliminate the escalation of COVID-19 infections in the workplace, as determined by the Department of Employment and Labour.

AmpathChat #70 Cutaneous Manifestations of Covid-19

SARS-CoV2, the cause of COVID-19, was identified in Wuhan, Hubei, China, in December 2019. Its unrepentant worldwide spread led to the World Health Organisation (WHO) declaring a worldwide pandemic in early March 2020

AmpathChat #69 - Primary Hyperparathyroidism

Primary hyperparathyroidism (PHPT) is a disorder of mineral metabolism characterised by incompletely (PTH) regulated, excessive secretion of parathyroid hormone (PTH) from one or more of the four parathyroid glands. It is usually first suspected on the basis of an elevated serum calcium concentration (corrected for the albumin level), or symptoms thereof – the so called “bones, stones, moans and groans syndrome” (Table 1).

AmpathChat #68 - COVID-19 Antibody Test

Ampath would like to inform you of the availability of a new SARS-CoV-2 antibody test. This test may be used to determine whether a patient has previously been exposed to SARS-CoV-2, the virus causing COVID-19.

AmpathChat #67 - Update on Paternity Testing

The term paternity testing, parental testing and human identity testing are interchangeable. Paternity testing refers to the use of genetic fingerprinting to determine a biological parent-child relationship.

AmpathChat #66 - The aetiology, diagnosis and management of the vaginal discharge syndrome

The vaginal discharge syndrome may be secondary to vulvovaginitis or cervicitis. Both of these conditions have infectious and non-infectious aetiologies.

AmpathChat #65 - Molecular Pathology of Lung Cancer

Worldwide, primary lung cancer remains the most common malignancy after non-melanocytic skin cancer. The World Health Organization (WHO) estimates lung cancer to be responsible for 1.59 million deaths globally per year, with smoking playing a major contributory role in 70% of cases.

AmpathChat #64 - The Diagnosis of Vitamin B12 Deficiency Revisited

Vitamin B12 deficiency can lead to devastating disabilities, morbidity and even death if not diagnosed timeously. Prompt diagnosis and treatment of Vitamin B12 deficiency can easily reverse the wide range of debilitating neurological and hematological symptoms associated with Vitamin B12 deficiency.

AmpathChat #63 - Pharmacogenomics

It is well established that unique patient characteristics exist to guide therapeutic drug decision making. These assist in optimising drug response and minimising adverse drug reactions (ADRs), and include age, weight, diet, co-morbidities, liver and renal function, as well as drug-drug interactions.

AmpathChat #62 - Pneumococcal Serotype-Specific Antibody Testing

Patients suffering from recurrent infections, autoimmunity or lymphoproliferative disease may have an underlying humoral immunodeficiency.

AmpathChat #61 SA Dyslipidaemia Guidelines

In 2016 the European Society of Cardiology (ESC) and the European Atherosclerosis Society (EAS) revised guidelines for the management of Dyslipidaemia.

AmpathChat #60 Stem Cell Transplantation

Haematopoietic stem cell transplantation (HSCT) is any procedure where haematopoietic stem cells of any donor and any source are given to a recipient with the intention of repopulating the haematopoietic system in total or in part.

AmpathChat #59 Diagnosing Pulmonary TB

According to the World Health Organisation (WHO) Global Tuberculosis Report of 2018, an estimated 10 million new cases of tuberculosis (TB) were reported in 2017.

AmpathChat #58 Influenza

Influenza is an infectious respiratory disease caused by the influenza virus. It can range from a mild infection to a severe life-threatening disease.

AmpathChat #57 Hypercalcaemia a Diagnostic Approach

Hypercalcaemia is a relatively common clinical problem. Primary hyperparathyroidism and malignancy are the most common causes of hypercalcaemia

AmpathChat #56 Cystic Fibrosis

Cystic fibrosis (CF) is one of the most common life-limiting autosomal recessive conditions in South Africa. CF is increasingly being recognised in all of South Africa.

AmpathChat #55 - Tissue typing: HLA typing and screening

Ampath Immunology is proud to announce the introduction of HLA tissue typing and antibody screening using Luminex PCR-based multiplex technology.

AmpathChat #54 - Helicobacter pylori: an update

Helicobacter pylori is a highly prevalent curved gram-negative bacterium. Seropositivity rates in South-Africa range between 60% and 100%. It causes more than 90% of duodenal ulcers and up to 80% of gastric ulcers. Atrophic gastritis due to H. pylori can lead to gastric cancer.

AmpathChat #53 - Molecular testing in colorectal carcinoma

Colorectal carcinomas arise from colorectal epithelium, which has undergone a series of molecular changes, referred to as the adenoma-carcinoma progression sequence.4 With increasing genetic mutations, progression from normal epithelium to adenomas with dysplasia occurs. Eventually, adenomas that show high-grade dysplasia give rise to invasive colorectal carcinomas.

AmpathChat #52 - Breast Cancer

All individuals with a positive family history of breast or ovarian cancer are not equally at risk. The likelihood that BRCA testing will be informative should be assessed prior to testing.

AmpathChat #51 - Penicillin Allergy

Penicillin allergy is the most commonly reported antibiotic allergy. However, very few patients ever have their penicillin allergy confirmed. Furthermore, less than 20% of patients who report a positive history of a prior reaction to penicillin are found to be allergic to penicillin upon skin prick testing. Avoidance of penicillin based on self-reported allergic history alone often leads to the use of an alternate antibiotic with greater cost or side effect profile.

AmpathChat #50 - Bordetella pertussis

Pertussis, also known as whooping cough, is a highly infectious disease of the respiratory tract. Bordetella pertussis is classically regarded as the sole agent of pertussis. However, infection with other Bordetella species, such as B. parapertussis and B. holmesii, can cause a similar, though typically milder, clinical picture.

AmpathChat #49 - Cystatin C

The prevalence of chronic kidney disease (CKD) and end- stage renal disease is increasing worldwide. Initial diagnosis relies on estimation of the glomerular filtration rate (GFR), and examination of urinary sediment and protein-excretion to establish the presence of kidney damage.

AmpathChat #48 - Expanded chromosome screening of products of conception (POCs)

Ampath Genetics is excited to announce the introduction of products of conception (POCs) testing using next generation sequencing (NGS) technology. NGS allows analysis of all chromosomes (1-22, X and Y), resulting in significantly increased pick-up rates of chromosomal abnormalities when compared to conventional testing approaches.

AmpathChat #47 - CRP vs PCT

Clinicians are faced with a growing population of immuno- compromised patients who are at risk of systemic infections. The diagnosis of bacterial septicaemia is unfortunately not straightforward. Positive blood cultures remain the gold standard.

AmpathChat #46 - Screening and Diagnosis of Diabetes

Fasting glucose levels are affected by the duration of fasting and the effect of circadian rythmicity, the latter being the predominant factor. Both glucose and insulin levels are highest in the early morning,

AmpathChat #45 - Non-invasive prenatal testing (NIPT)

NIPT is a safe and accurate prenatal screen to calculate the risk that a foetus has of being affected with a chromosomal condition, for example, Down Syndrome. NIPT makes use of cell-free DNA released from the placenta into the maternal bloodstream (Figure 1)

AmpathChat #44 - Vitamin D Overview

After much consideration about the most appropriate cutoffs to define adequate vitamin D status, Ampath has decided to lower the currently reported cutoffs to those proposed by the Institute of Medicine, and recently endorsed by the National Osteoporosis Foundation of South Africa. According to these guidelines, a 25-hydroxyvitamin D level < 12 ng/ml is regarded as vitamin D deficient, with levels between 12 and 19 regarded as insufficient and levels of 20 ng/ml or above as sufficient.

AmpathChat #43 - Approach to the Neutropaenic Patient

The extent of evaluation and the nature of intervention depends on duration, severity and clinical findings. The normal absolute neutrophil count (ANC) in adults is 1.5 to 7 x 10/9 per l. The following grading evolved from clinical experience with patients on cancer chemotherapy

AmpathChat #42 - Frozen Section - An Invaluable Tool for Intra-operative Surgical Consultation

The frozen section technique has evolved and has improved immensely from 1818, when Dutch anatomist Pieter de Reimer utilised cold brine (salt water) to harden tissues, until 1895, when Thomas Cullen, MD, published the first written frozen section technique from Johns Hopkins [1].

AmpathChat #41 - Drugs of Abuse Screening

Drugs of abuse screening (DOAS) is well established in the workplace and in professional sports. It is increasingly being used in casualties and/or emergency departments for the medical management of patients with an altered mental state and in trauma patients.

AmpathChat #40 - The Utility of Urinary Lipoarabinomannan Antigen - LAM- in HIV Infected Patients with Suspected TB

The urine lipoarabinomannan test (U-lam) has been marketed as an adjunct diagnostic modality in HIV-infected patients with severe immunosuppression. The test detects a cell wall component of the Mycobacterium tuberculosis bacterium that is excreted in urine. The lateral flow test format of the test (DetermineTM TB-LAM Ag test) is rapid and can be performed directly on urine.

AmpathChat #39 - Anaemia of Chronic Disease Inflammation

Anaemia of chronic disease (ACD)/inflammation is the leading cause of anaemia in hospitalised patients and the second-most common cause of anaemia after iron deficiency. The main aetiologies are infection, autoimmune disorders and malignancies.

AmpathChat #38 - Diagnosing Primary immunodeficiencies (PID) - The Genetic Revolution

Primary immunodeficiencies (PID) are a diverse group of inborn errors in immunity. PID can present at any age, with the more severe forms presenting in infancy. Due to the heterogeneity of presentation and age of onset, the diagnosis of PID is often delayed or missed. There are at least 300 known genetic defects resulting in PID.

AmpathChat #36 - Zika Virus Declared A Public Health Emergency of International Concern

The Zika virus belongs to the family of viruses, Flaviviridae. The term “flavi”, translated from Latin, means “yellow”, as the disease most commonly associated with this group of viruses is yellow fever, which can cause jaundice in infected individuals. Flaviviridae mostly circulate among ticks and mosquitoes, which can then transmit the viruses to humans.

AmpathChat #35 - Update on the Management of Carbapenemase Producing Enterobacteriaceae(CPE)

Dr Tom Frieden, Director of the US Centres for Disease Control and Prevention, has called carbapenem-resistant Enterobacteriaceae (CRE) “nightmare bacteria”. CRE emerged in South Africa in 2011 when the first cases of Klebsiella pneumoniae carbapenemase (KPC) and New Delhi metallo-β-lactamase (NDM) were described.

AmpathChat #34 - Hypogonadism in the Elderly Male

Testosterone is the principal male sex hormone, and is secreted primarily by the Leydig cells of the testicles in the presence of luteinizing hormone (LH). Small amounts are also secreted by the adrenal glands. Testosterone plays a key role in the development of male reproductive tissues (testis and prostate),

AmpathChat #33 - Triple Negative Breast Cancer

Breast cancer is the most common cancer among women worldwide, with approximately 1.7 million cases diagnosed annually. In South Africa, the incidence is 40 new cases per 100 000 persons per year. The incidence of breast cancer varies across the world between races and regions.

AmpathChat #32 - Diagnosing Acute Bacterial Meningitis - The Value of Multiplex PCR

Acute meningitis is generally defined as having compatible symptoms for less than seven days’ duration and can be caused by a variety of bacterial, viral and fungal pathogens. Acute bacterial meningitis is a medical emergency that requires early administration of antibiotics and hospital referral for investigation and further therapy. The most common bacterial causes of acute meningitis, according to the patient’s age

AmpathChat #31 - Screening for Inhalant Allergy In South Africa

Allergic rhinitis and inhalant allergy are common problems in primary care. Their diagnosis and subsequent management are often suboptimal. This may impact on a patient’s quality of life, asthma control and exacerbations

AmpathChat #30 - Post Exposure Prophylaxis After Occupational Exposure to HIV HBV and HCV

It is important that healthcare workers (HCWs) know the steps to follow when an accidental exposure to infectious bodily fluids occurs. Viruses that can be transmitted after occupational exposure to potentially infectious bodily fluids include HIV.

AmpathChat #28 - Anti-Mullerian Hormone (AMH) Physiology and Clinical Utility

Anti-Müllerian hormone (AMH), previously termed Müllerian- inhibiting substance, is a 140 kDa dimeric glycoprotein belonging to the TGF-β (transforming growth factor beta) superfamily.

AmpathChat #27 - Diagnosis and Investigation of Occupational Exposure to Metals - A General Review

Exposure to metals in the workplace presents serious and significant health risks. The hazards that metals present are a function of the toxic properties of metals and include the duration, dose and route of exposure, and health history of the individuals exposed to them. Controlling and preventing metal exposures often involves a multidisciplinary team, usually beginning with the primary healthcare provider.

AmpathChat #26 - Antimicrobial Stewardship (AMS) In the Outpatient Setting

The majority of antibiotic prescriptions for systemic use are prescribed in the outpatient setting,1 with acute respiratory tract infections (ARTIs) being the most common indication, followed by urinary tract infections (UTIs).2 In fact, general practitioners (GPs) prescribe approximately 80% of all antibiotics,

AmpathChat #24 - Laboratory Markers for Alcohol Use

Alcohol use disorders (AUD) were reclassified by the DSM-5i in 2013. The DSM-5 replaced the DSM-IV, which differentiated alcohol abuse (problem drinking without compulsive use) from alcohol dependence (compulsive drinking).

AmpathChat #23 - The Role of PF 200 in Evaluating Platelet Dysfunction

A standard incision is made on the volar surface of the forearm with the application of 40 mmHg pressure to the upper arm Time to cessation of bleeding is recorded

AmpathChat #22 - Heparin Induced Thrombocytopaenia-HIT Happens

Most patients who receive unfractionated heparin experience a small, quick drop in their platelet count. This is called Type 1 HIT and is clinically insignificant.

AmpathChat #21 - Clinical Use of the D-Dimer Assay

Upon presentation, all patients should be carefully evaluated for clinical pretest probability of VTE using a validated clinical prediction rule (CPR) and then stratified into clinical probability groups: low, intermediate and high. The Wells prediction rules for DVT and for pulmonary embolism have been validated and are frequently used to estimate the probability of VTE before performing more definitive testing on patients.

AmpathChat #20 Adult HIV Diagnosis

The standard approach to the laboratory diagnosis of HIV infection in children older than 18 months and adults is to test for HIV infection by serological means, whereby the presence of HIV-specific antibodies in a patient’s blood specimen is determined by a screening enzyme-linked immunosorbent assay (ELISA).

AmpathChat #20 - Diagnosing Bacterial and Viral Gastroenteritis - The Role of Molecular Testing

Infectious causes of gastroenteritis account for approximately 1.4 billion cases of diarrhoea globally and in excess of two million deaths every year. These infections can be caused by various bacteria, viruses and parasites.

AmpathChat #19 - Three Extra Helpful Parameters on the FBC

With the exception of pregnant women and neonates, the presence of immature granulocytes (IG) in the blood indicates a response to infection, inflammation or other stimuli of the bone marrow. Having a six-part differential count facilitates new diagnostic possibilities. The IG count includes stab cells, metamyelocytes and myelocytes, and requires a specific Sysmex analyser (XE-2100) for determination.

AmpathChat #18 - Chronic Kidney Disease - Updated Recommendations on Definition and Classification

Chronic kidney disease (CKD) is defined as abnormalities of kidney structure or function, present for longer than three months, with implications for health.

AmpathChat #17 - Haemostasis Problems - A Logical Approach

Haemostasis is the delicate balance between the naturally occurring procoagulant and anticoagulant mechanisms found in the body. Any shift in this balance or interference in the control mechanisms results in either a bleeding or a thrombotic tendency.

AmpathChat #16 - Cervical Cancer Screening - Role of HPV DNA Based Screening and Cytology

Genital infection with human papillomavirus (HPV) is the most common sexually transmitted infection today, and persistent infection with high-risk genotypes is the cause of cervical cancer. Over 40 HPV genotypes infect mucosal surfaces, including the anogenital epithelium (e.g. cervix, vagina, vulva, rectum, urethra, penis and anus).

AmpathChat #16 - Cervical Cancer Screening - Role of HPV DNA Based Screening and Cytology

Genital infection with human papillomavirus (HPV) is the most common sexually transmitted infection today, and persistent infection with high-risk genotypes is the cause of cervical cancer. Over 40 HPV genotypes infect mucosal surfaces, including the anogenital epithelium (e.g. cervix, vagina, vulva, rectum, urethra, penis and anus).

AmpathChat #15 - Screening and Diagnosing Diabetes Mellitus During Pregnancy (Revised Criteria)

Gestational diabetes mellitus (GDM) has traditionally been defined as any degree of hyperglycaemia in pregnancy, including overt diabetes mellitus (DM), impaired glucose tolerance and impaired fasting glycaemia (as defined in the criteria for non-pregnant adults). The GDM guidelines had mainly focused on the increased risk of future maternal DM.

AmpathChat #14 - Acquired Haemophilia A - Are We Missing the Diagnosis

Acquired Haemophilia A is a rare bleeding disorder caused by an autoantibody to factor VIII. The condition is often mistaken for other acquired bleeding disorders, such as disseminated intravascular coagulation (DIC). This may lead to delayed or suboptimal treatment. There is a poor correlation between measurable factor VIII or strength of the inhibitor and severity of bleeding.

AmpathChat #13 - Current Update on the Ebola Virus Outbreak

Guinea is currently experiencing an outbreak of Ebola, which – as of 1 April – includes a suspected 127 cases to date, with 83 recorded deaths (case fatality rate of 65%). The areas of Guinea involved in the outbreak are Guékédou, Macenta, Kissidougou and Nzérékoré.

AmpathChat #12 - An Update on Autoimmune Limbic Encephalitis

Encephalitis (inflammation of the brain) is a pathological diagnosis, yet the diagnosis is made clinically. Diagnosis is made through the observation of neurologic dysfunction (e.g. depressed level of consciousness, seizures etc.) combined with corroborating findings of a cerebrospinal fluid (CSF) tap, EEG and neuroimaging studies.

AmpathChat #11 - Diagnosing Schistosomiasis an Update

Schistosomiasis, or bilharzia, is a common intravascular infection caused by the Schistosoma trematode worm. Bilharzia is endemic in sub-Saharan Africa where the majority of infections are caused by S. haematobium and S. mansoni. Important transmission sites in Africa are Lake Malawi and Lake Victoria and travellers are commonly infected when swimming there. In South Africa

AmpathChat #10 - BRCA Gene Testing - A General Overview

BRCA1 and BRCA2 gene testing is anything but straightforward. This article attempts to discuss the salient points to consider when faced with testing requests.

AmpathChat #09 - Basic Approach to Abnormal FBC (Part 2): Platelets and WBC

A pseudo (false) thrombocytopenia, due to either a difficult bleed or ethylenediamine- tetraacetic acid (EDTA)-related platelet clumping, should be excluded by examining a peripheral blood (PB) slide or repeating the platelet count using a sodium citrate tube.

AmpathChat #09 - Basic Approach to Abnormal FBC (Part 1): RBC indices

There are three main possibilities for a microcytic anaemia, namely iron deficiency, thalassaemia and anaemia of chronic disease (ACD). Since iron deficiency is the most common cause of a microcytic anaemia, a ferritin level is recommended as an initial investigation. A low ferritin level confirms iron deficiency. A normal or raised ferritin level suggests possible thalassaemia or ACD.

AmpathChat #08 - Myelodysplastic Syndromes

The myelodysplastic syndromes (MDS) are a group of clonal haematopoietic disorders characterised by progressive bone marrow failure due to ineffective haematopoiesis. There are progressive cytopenias involving one or more of the myeloid cell lines, with a variable increased risk of development of acute leukaemia.

AmpathChat #07 - Transfusion Medicine (Blood Safety) The Right Blood Product to the Right Patient at the Right Time

The decision to transfuse a blood product by the clinician requires an evaluation of the risk benefit ratio for the individual patient and documented informed consent.

AmpathChat #06 - The Case of Newborn Screening in South Africa - A Personal Perspective

Newborn screening (NBS) is a public health measure that is recognised worldwide. It is aimed at the early screening, diagnosis and management of selected, inherited diseases. Such diseases are selected based on the current ability to detect and treat them, and the demonstration of the positive economic impact of such interventions.

AmpathChat #05 - Newborn Screening of Primary Immundeficiencies - TRECS and KRECS

Screening for severe primary immunodefi- ciencies involving the cellular and humoral immune system allows early detection and treatment, potentially saving the lives of babies affected by the disease.

AmpathChat #04 - Primary Immunodeficiencies - A Diagnostic Approach

Primary immunodeficiencies are a group of heterogenous genetic disorders that cause an enhanced susceptibility to recurrent and severe infections.

AmpathChat #03 - The Diagnostic Approach to Coeliac Disease

Coeliac disease used to be a disease of infancy, with children presenting with life-threatening malabsorbtion. Currently and more commonly, the disease presents between the ages of 10 and 40 with milder manifestations.

AmpathChat #01 - A Practical Approach to the Biochemical Assessment of Osteoporosis

Recognising the risk of osteoporosis and starting preventative action timeously has become increasingly important. Annually, osteoporosis is responsible for around 9 million fractures worldwide. The lifetime risk of sustaining an osteoporotic fracture above the age of 50 years is up to 40% in women and 20% for men.

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