Nimalie Perera - Academia.edu (original) (raw)

Papers by Nimalie Perera

Research paper thumbnail of Measurement of Lipoprotein(a) in the Clinical Laboratory

Measurement of Lipoprotein(a) in the Clinical Laboratory

Contemporary cardiology, 2023

Research paper thumbnail of A Randomized Controlled Trial Investigating the Effects of a Low–Glycemic Index Diet on Pregnancy Outcomes in Gestational

OBJECTIVEdThe prevalence of gestational diabetes mellitus (GDM) is rising. There is little eviden... more OBJECTIVEdThe prevalence of gestational diabetes mellitus (GDM) is rising. There is little evidence to demonstrate the effectiveness of one dietary therapy over another. We aimed to investigate the effect of a low–glycemic index (LGI) versus a conventional high-fiber diet on pregnancy outcomes, neonatal anthropometry, and maternal metabolic profile in GDM. RESEARCHDESIGNANDMETHODSdNinety-nine women (age 26–42 years; mean6 SD prepregnancy BMI 24 6 5 kg/m2) diagnosed with GDM at 20–32 weeks ’ gestation were randomized to follow either an LGI (n = 50; target glycemic index [GI] ~50) or a high-fiber moderate-GI diet (HF) (n = 49; target GI ~60). Dietary intake was assessed by 3-day food records. Pregnancy outcomes were collected from medical records. RESULTSdThe LGI group achieved a modestly lower GI than the HF group (mean 6 SEM 476 1 vs. 536 1; P, 0.001). At birth, there was no significant difference in birth weight (LGI 3.36 0.1 kg vs. HF 3.36 0.1 kg; P = 0.619), birth weight centile...

Research paper thumbnail of Poster Sessions Monday/Tuesday

Poster Sessions Monday/Tuesday

Journal of Neurochemistry, 2015

This free journal suppl. entitled: Special Issue: 25th Biennial Meeting of the International Soci... more This free journal suppl. entitled: Special Issue: 25th Biennial Meeting of the International Society for Neurochemistry jointly with the 13th Meeting of the Asian-Pacific Society for Neurochemistry in conjunction with the 35th Meeting of the Australasian Neuroscience Society 23–27 August 2015, Cairns, Australia

Research paper thumbnail of The Adverse Health Consequences of the Use of Multiple Performance-Enhancing Substances—A Deadly Cocktail

The Journal of Clinical Endocrinology & Metabolism, 2013

Context: The harmful consequences of abuse of performance-enhancing substances (PESs), stimulants... more Context: The harmful consequences of abuse of performance-enhancing substances (PESs), stimulants, and masking agents among athletes, recreational weight lifters, and physical trainers are common. However, the adverse health outcomes with severe unexpected and dramatic consequences are unrecognized or under-reported at the expense of short-term glory or body-image effects, especially in elite sports. Objective: We report the case of a recreational weight lifter/physical trainer to help summarize the adverse health consequences and outcomes of polypharmacy among athletes and growing subsets in our population engaged in physical/fitness training. We show that in addition to the risk inherent to “stacking” of PESs, the users are predisposed to harmful consequences, including risk of exposure to toxic contaminants. Design and Setting: A previously healthy man with chronic use of multiple PESs, stimulants, and masking agents presented to a tertiary-care hospital with jaundice and mild he...

Research paper thumbnail of Misleading parathyroid sestamibi scan in lithium users

Misleading parathyroid sestamibi scan in lithium users

Internal Medicine Journal, 2009

Research paper thumbnail of Overview of endocrinopathies associated with β-thalassaemia major

Overview of endocrinopathies associated with β-thalassaemia major

Internal Medicine Journal, 2010

Thalassaemia major is a common and serious medical problem worldwide that is associated with a ... more Thalassaemia major is a common and serious medical problem worldwide that is associated with a range of complications, including effects on multiple endocrine pathways. Minimizing or preventing comorbidities is important for these individuals who need life-long multidisciplinary care and treatment. However, there are limited overviews of the endocrine complications associated with this illness, nor any consensus regarding management guidelines. A retrospective cohort analysis of β-thalassaemia patients attending an ambulatory transfusion clinic at Royal Prince Alfred Hospital was conducted from June 2008. All of our subjects (n=29) had at least one endocrinopathy present with 16 patients (55%) having three or more (≥3) endocrinopathies. Hypogonadism was the most prevalent followed by osteoporosis and growth failure (less than 3rd centile) with a frequency of 16/29 (55%), 14/29 (48%) and 10/29 (35%) patients respectively. Those with more endocrinopathies (≥3) had a longer duration of transfusion therapy when compared with those with fewer endocrinopathies. A summary of our clinical guidelines, which have been used to monitor and manage these complications, is presented along with a discussion on the results and pathophysiology of the associated endocrinopathies.

Research paper thumbnail of Icosapent ethyl reduces ischemic events in patients with hypertriglyceridemia

Pharmacy Today, 2019

The authors further commented that the benefits observed in this trial might be attributable to use of a highly puri- fied and stable EPA ethyl ester or to the higher daily dose of icosapent ethyl given.

Research paper thumbnail of Prevalence, causes and associated mortality of hypercalcaemia in modern hospital care

Prevalence, causes and associated mortality of hypercalcaemia in modern hospital care

Internal Medicine Journal, 2021

BACKGROUND Studies examining hypercalcaemia in inpatients were largely published over 20 years ag... more BACKGROUND Studies examining hypercalcaemia in inpatients were largely published over 20 years ago, and it is likely the epidemiology of hypercalcaemia has changed related to increased lifespan and changes in prevalence of the underlying causes such as malignancy. AIM To explore the epidemiology of hypercalcaemia in a modern tertiary hospital setting in Australia, and evaluate the risk of mortality associated with hypercalcaemia. METHOD A retrospective study was performed in all inpatients with elevated blood calcium levels admitted from July 2013 to June 2018. ICD coding data identified primary diagnoses and mortality. Electronic medical records were reviewed in n=292 patients admitted across 12 months from January to December 2017, to determine the causes of hypercalcaemia. RESULTS Hypercalcaemia occurred in 1819 admissions (0.93% of all hospital admissions), during the 5 year period. The admission primary diagnoses were: malignancy (20% of cases), cardiovascular disease (17%), and gastrointestinal disease (11%). The top causes of hypercalcaemia among the 292 cases where electronic records were reviewed were malignancy (26%), primary hyperparathyroidism (25%) and hyperparathyroidism in the setting of chronic kidney disease (12%). Mortality occurred in 17% of these admissions. Non-survivors had significantly higher calcium levels, phosphate and white cell count, and had lower haemoglobin and albumin levels. CONCLUSION Hypercalcaemia occurred in ~1% of admissions with main causes being malignancy and primary hyperparathyroidism, similar to historical studies. Hypercalcaemia in hospitalised patients is associated with high mortality and higher levels may be a marker for more severe underlying disease. This article is protected by copyright. All rights reserved.

Research paper thumbnail of Adjustment to a diagnosis of Homozygous Familial Hypercholesterolaemia and decision making regarding therapy in two unrelated families

Heart, Lung and Circulation, 2014

Research paper thumbnail of Refsum's Disease-Use of the Intestinal Lipase Inhibitor, Orlistat, as a Novel Therapeutic Approach to a Complex Disorder

Journal of obesity, 2011

Refsum's Disease is an inherited metabolic disorder in which a metabolite of branched chain f... more Refsum's Disease is an inherited metabolic disorder in which a metabolite of branched chain fatty acids accumulates due to lack of appropriate oxidative enzymes. Patients have elevated plasma phytanic acid levels and high concentrations of phytanic acid in a variety of tissues leading to progressive tissue damage. Besides retinal degeneration or retinal dystrophy associated with adult onset retinitis pigmentosa, additional symptoms include chronic polyneuropathy, cerebellar ataxia, sensorineural hearing loss, anosmia, ichthyosis, as well as skeletal, cardiac, hepatic, and renal abnormalities. Current management includes avoidance of dietary sources of branched chain fatty acids and regular plasmapheresis to prevent accumulation of these compounds to ameliorate progressive neurological deficits. Two brothers with Refsum's disease who experienced progressive symptoms despite optimal diet and plasmapheresis were commenced on a novel therapy. We report the effect of the intestin...

Research paper thumbnail of Evaluation of the impact of icodextrin metabolite interference on the accuracy of hospital based glucose meters

Research paper thumbnail of Evaluation of Acetaminophen Recovery in Human Serum

Pathology, 2009

uncommon, especially in high stage disease. Metastatic disease is present in 25% of cases at pres... more uncommon, especially in high stage disease. Metastatic disease is present in 25% of cases at presentation. Metastasis is generally via the haematogenous route with the most common sites for metastases being the lung. Other sites include pleura, other bones including skull, marrow, CNS and lymph nodes. To the best of our knowledge, there has been only one previous report of renal metastasis of Ewing's sarcoma. That case was not substantiated by CD99 immunohistochemistry, molecular or cytogenetic evidence. Late metastases are unusual with most recurrences occurring in the first 2 years. We present a rare case of Ewing's sarcoma which recurred after at least 9 years as metastatic disease in the kidney. The characteristic t(11;22) translocation was demonstrated and a positive immunohistochemical reaction with CD99 was observed.

Research paper thumbnail of Adjustment of direct high-density lipoprotein cholesterol measurements according to intercurrent triglyceride corrects for interference by triglyceride-rich lipoproteins

Adjustment of direct high-density lipoprotein cholesterol measurements according to intercurrent triglyceride corrects for interference by triglyceride-rich lipoproteins

Journal of Clinical Lipidology, 2010

Low plasma levels of high-density-lipoprotein cholesterol (HDL-C) and high triglyceride (TG) are ... more Low plasma levels of high-density-lipoprotein cholesterol (HDL-C) and high triglyceride (TG) are strongly associated with cardiovascular disease (CVD). Clinical recognition of this high-risk population demands accurate measurement of HDL-C, whereas cost and clinical demand dictate that optimal HDL-C measurement requires fully automated methods that avoid manual precipitation. Commercial techniques use specific reagents to selectively expose and "directly" measure cholesterol in HDL. However, these "direct" methods may experience interference from the cholesterol content of triglyceride-rich-lipoproteins (TRL), leading to analytical overestimation of HDL-C, with subsequent underestimation of low-density-lipoprotein cholesterol (LDL-C) and of CVD risk. The aim of this study was…

Research paper thumbnail of The danger of using inappropriate point-of-care glucose meters in patients on icodextrin dialysis

Diabetic Medicine, 2011

Aims Icodextrin is a glucose polymer used to maintain an osmotic gradient in peritoneal dialysis.... more Aims Icodextrin is a glucose polymer used to maintain an osmotic gradient in peritoneal dialysis. Metabolites of icodextrin are known to cause overestimation of blood glucose in glucose meters using glucose dehydrogenase ⁄ pyrroloquinolinequinone systems. The aim of this study is to determine the extent of icodextrin interference in glucose meters using the newer glucose dehydrogenase ⁄ NAD or glucose oxidase systems. This has not been established previously. Methods Fasting blood samples (n = 4) were spiked with either one icodextrin metabolite (maltose, maltotriose or maltotetraose) or a combination, at various blood concentrations expected during dialysis. Samples were tested in triplicate on: five glucose-meters, a RadiometerÒ (glucose oxidase ⁄ hydrogen peroxide) and laboratory (hexokinase) analysers. Each meter was also tested on blood from six patients undergoing dialysis. Accuracy was evaluated as % Bias = [(meter glucoselaboratory glucose) ⁄ laboratory glucose] • 100. Results A single icodextrin metabolite affected glucose measurements and, in combination, the interferences were additive in the two Accu-ChekÒ and OptiumÒ Xceed meters by > 10%. Amongst these meters, the Optium Xceed 5-s machine was less affected. Meters using glucose oxidase were least affected by interference. A similar trend in interference was observed in vivo. Conclusion While meters using glucose dehydrogenase ⁄ NAD are less affected by icodextrin metabolites, interference can still be demonstrated. The degree of interference can vary in different glucose meters using this enzyme ⁄ cofactor system, as seen in the Optium Xceed machines. Icodextrin is an important source of interference that sometimes even experienced professionals are unaware of and which leads to clinically significant errors in insulin dose adjustment. Awareness of this interference and selection of the most appropriate glucose meters are crucial to minimize this hazard.

Research paper thumbnail of Suboptimal Performance of Blood Glucose Meters in an Antenatal Diabetes Clinic

Diabetes Care, 2011

OBJECTIVE The objective of this study was to evaluate the performance of blood glucose meters in ... more OBJECTIVE The objective of this study was to evaluate the performance of blood glucose meters in diabetes associated with pregnancy (DP). RESEARCH DESIGN AND METHODS Finger-prick blood glucose levels measured using six different glucose meters on 102 patients with DP attending an antenatal clinic were compared with laboratory plasma glucose results. HbA1c and hematocrit were also measured. RESULTS The plasma glucose range was 2.2–9.4 mmol/L with hematocrit 33–37% and mean HbA1c 5.5% ± 0.56 (SD). All meters provided plasma equivalent results except one, which reported whole blood glucose that was adjusted to plasma equivalent values. The absolute glucose difference [meter − plasma glucose] was 0.232 ± 0.69 to 0.725 ± 0.62 mmol/L mean ± SD and bias ranged from 6.1 to 15.8%. Two meters were affected by hematocrit <36% (P < 0.05). CONCLUSIONS Blood glucose meters in current use are not optimally accurate when compared with plasma glucose measurement in DP. Recognition of this devi...

Research paper thumbnail of Sodium copeptin ratio differentiates patients with and without acute diabetes insipidus post neurosurgery

Sodium copeptin ratio differentiates patients with and without acute diabetes insipidus post neurosurgery

Endocrine Abstracts

Research paper thumbnail of Paediatric age related reference intervals for random urine biogenic amines using LCMS/MS

Paediatric age related reference intervals for random urine biogenic amines using LCMS/MS

Pathology

Research paper thumbnail of Random urine catecholamine testing for neural crest tumours in paediatrics using a LC-MSMS method with age specific reference intervals

Random urine catecholamine testing for neural crest tumours in paediatrics using a LC-MSMS method with age specific reference intervals

Pathology

Research paper thumbnail of Random urine testing for carcinoid tumours in paediatric subjects using a LC-MSMS method with age specific normalised reference intervals

Random urine testing for carcinoid tumours in paediatric subjects using a LC-MSMS method with age specific normalised reference intervals

Pathology

Research paper thumbnail of A randomized controlled trial investigating the effects of a low glycemic index diet on pregnancy outcomes in gestational diabetes mellitus

A randomized controlled trial investigating the effects of a low glycemic A randomized controlled... more A randomized controlled trial investigating the effects of a low glycemic A randomized controlled trial investigating the effects of a low glycemic index diet on pregnancy outcomes in gestational diabetes mellitus index diet on pregnancy outcomes in gestational diabetes mellitus

Research paper thumbnail of Measurement of Lipoprotein(a) in the Clinical Laboratory

Measurement of Lipoprotein(a) in the Clinical Laboratory

Contemporary cardiology, 2023

Research paper thumbnail of A Randomized Controlled Trial Investigating the Effects of a Low–Glycemic Index Diet on Pregnancy Outcomes in Gestational

OBJECTIVEdThe prevalence of gestational diabetes mellitus (GDM) is rising. There is little eviden... more OBJECTIVEdThe prevalence of gestational diabetes mellitus (GDM) is rising. There is little evidence to demonstrate the effectiveness of one dietary therapy over another. We aimed to investigate the effect of a low–glycemic index (LGI) versus a conventional high-fiber diet on pregnancy outcomes, neonatal anthropometry, and maternal metabolic profile in GDM. RESEARCHDESIGNANDMETHODSdNinety-nine women (age 26–42 years; mean6 SD prepregnancy BMI 24 6 5 kg/m2) diagnosed with GDM at 20–32 weeks ’ gestation were randomized to follow either an LGI (n = 50; target glycemic index [GI] ~50) or a high-fiber moderate-GI diet (HF) (n = 49; target GI ~60). Dietary intake was assessed by 3-day food records. Pregnancy outcomes were collected from medical records. RESULTSdThe LGI group achieved a modestly lower GI than the HF group (mean 6 SEM 476 1 vs. 536 1; P, 0.001). At birth, there was no significant difference in birth weight (LGI 3.36 0.1 kg vs. HF 3.36 0.1 kg; P = 0.619), birth weight centile...

Research paper thumbnail of Poster Sessions Monday/Tuesday

Poster Sessions Monday/Tuesday

Journal of Neurochemistry, 2015

This free journal suppl. entitled: Special Issue: 25th Biennial Meeting of the International Soci... more This free journal suppl. entitled: Special Issue: 25th Biennial Meeting of the International Society for Neurochemistry jointly with the 13th Meeting of the Asian-Pacific Society for Neurochemistry in conjunction with the 35th Meeting of the Australasian Neuroscience Society 23–27 August 2015, Cairns, Australia

Research paper thumbnail of The Adverse Health Consequences of the Use of Multiple Performance-Enhancing Substances—A Deadly Cocktail

The Journal of Clinical Endocrinology & Metabolism, 2013

Context: The harmful consequences of abuse of performance-enhancing substances (PESs), stimulants... more Context: The harmful consequences of abuse of performance-enhancing substances (PESs), stimulants, and masking agents among athletes, recreational weight lifters, and physical trainers are common. However, the adverse health outcomes with severe unexpected and dramatic consequences are unrecognized or under-reported at the expense of short-term glory or body-image effects, especially in elite sports. Objective: We report the case of a recreational weight lifter/physical trainer to help summarize the adverse health consequences and outcomes of polypharmacy among athletes and growing subsets in our population engaged in physical/fitness training. We show that in addition to the risk inherent to “stacking” of PESs, the users are predisposed to harmful consequences, including risk of exposure to toxic contaminants. Design and Setting: A previously healthy man with chronic use of multiple PESs, stimulants, and masking agents presented to a tertiary-care hospital with jaundice and mild he...

Research paper thumbnail of Misleading parathyroid sestamibi scan in lithium users

Misleading parathyroid sestamibi scan in lithium users

Internal Medicine Journal, 2009

Research paper thumbnail of Overview of endocrinopathies associated with β-thalassaemia major

Overview of endocrinopathies associated with β-thalassaemia major

Internal Medicine Journal, 2010

Thalassaemia major is a common and serious medical problem worldwide that is associated with a ... more Thalassaemia major is a common and serious medical problem worldwide that is associated with a range of complications, including effects on multiple endocrine pathways. Minimizing or preventing comorbidities is important for these individuals who need life-long multidisciplinary care and treatment. However, there are limited overviews of the endocrine complications associated with this illness, nor any consensus regarding management guidelines. A retrospective cohort analysis of β-thalassaemia patients attending an ambulatory transfusion clinic at Royal Prince Alfred Hospital was conducted from June 2008. All of our subjects (n=29) had at least one endocrinopathy present with 16 patients (55%) having three or more (≥3) endocrinopathies. Hypogonadism was the most prevalent followed by osteoporosis and growth failure (less than 3rd centile) with a frequency of 16/29 (55%), 14/29 (48%) and 10/29 (35%) patients respectively. Those with more endocrinopathies (≥3) had a longer duration of transfusion therapy when compared with those with fewer endocrinopathies. A summary of our clinical guidelines, which have been used to monitor and manage these complications, is presented along with a discussion on the results and pathophysiology of the associated endocrinopathies.

Research paper thumbnail of Icosapent ethyl reduces ischemic events in patients with hypertriglyceridemia

Pharmacy Today, 2019

The authors further commented that the benefits observed in this trial might be attributable to use of a highly puri- fied and stable EPA ethyl ester or to the higher daily dose of icosapent ethyl given.

Research paper thumbnail of Prevalence, causes and associated mortality of hypercalcaemia in modern hospital care

Prevalence, causes and associated mortality of hypercalcaemia in modern hospital care

Internal Medicine Journal, 2021

BACKGROUND Studies examining hypercalcaemia in inpatients were largely published over 20 years ag... more BACKGROUND Studies examining hypercalcaemia in inpatients were largely published over 20 years ago, and it is likely the epidemiology of hypercalcaemia has changed related to increased lifespan and changes in prevalence of the underlying causes such as malignancy. AIM To explore the epidemiology of hypercalcaemia in a modern tertiary hospital setting in Australia, and evaluate the risk of mortality associated with hypercalcaemia. METHOD A retrospective study was performed in all inpatients with elevated blood calcium levels admitted from July 2013 to June 2018. ICD coding data identified primary diagnoses and mortality. Electronic medical records were reviewed in n=292 patients admitted across 12 months from January to December 2017, to determine the causes of hypercalcaemia. RESULTS Hypercalcaemia occurred in 1819 admissions (0.93% of all hospital admissions), during the 5 year period. The admission primary diagnoses were: malignancy (20% of cases), cardiovascular disease (17%), and gastrointestinal disease (11%). The top causes of hypercalcaemia among the 292 cases where electronic records were reviewed were malignancy (26%), primary hyperparathyroidism (25%) and hyperparathyroidism in the setting of chronic kidney disease (12%). Mortality occurred in 17% of these admissions. Non-survivors had significantly higher calcium levels, phosphate and white cell count, and had lower haemoglobin and albumin levels. CONCLUSION Hypercalcaemia occurred in ~1% of admissions with main causes being malignancy and primary hyperparathyroidism, similar to historical studies. Hypercalcaemia in hospitalised patients is associated with high mortality and higher levels may be a marker for more severe underlying disease. This article is protected by copyright. All rights reserved.

Research paper thumbnail of Adjustment to a diagnosis of Homozygous Familial Hypercholesterolaemia and decision making regarding therapy in two unrelated families

Heart, Lung and Circulation, 2014

Research paper thumbnail of Refsum's Disease-Use of the Intestinal Lipase Inhibitor, Orlistat, as a Novel Therapeutic Approach to a Complex Disorder

Journal of obesity, 2011

Refsum's Disease is an inherited metabolic disorder in which a metabolite of branched chain f... more Refsum's Disease is an inherited metabolic disorder in which a metabolite of branched chain fatty acids accumulates due to lack of appropriate oxidative enzymes. Patients have elevated plasma phytanic acid levels and high concentrations of phytanic acid in a variety of tissues leading to progressive tissue damage. Besides retinal degeneration or retinal dystrophy associated with adult onset retinitis pigmentosa, additional symptoms include chronic polyneuropathy, cerebellar ataxia, sensorineural hearing loss, anosmia, ichthyosis, as well as skeletal, cardiac, hepatic, and renal abnormalities. Current management includes avoidance of dietary sources of branched chain fatty acids and regular plasmapheresis to prevent accumulation of these compounds to ameliorate progressive neurological deficits. Two brothers with Refsum's disease who experienced progressive symptoms despite optimal diet and plasmapheresis were commenced on a novel therapy. We report the effect of the intestin...

Research paper thumbnail of Evaluation of the impact of icodextrin metabolite interference on the accuracy of hospital based glucose meters

Research paper thumbnail of Evaluation of Acetaminophen Recovery in Human Serum

Pathology, 2009

uncommon, especially in high stage disease. Metastatic disease is present in 25% of cases at pres... more uncommon, especially in high stage disease. Metastatic disease is present in 25% of cases at presentation. Metastasis is generally via the haematogenous route with the most common sites for metastases being the lung. Other sites include pleura, other bones including skull, marrow, CNS and lymph nodes. To the best of our knowledge, there has been only one previous report of renal metastasis of Ewing's sarcoma. That case was not substantiated by CD99 immunohistochemistry, molecular or cytogenetic evidence. Late metastases are unusual with most recurrences occurring in the first 2 years. We present a rare case of Ewing's sarcoma which recurred after at least 9 years as metastatic disease in the kidney. The characteristic t(11;22) translocation was demonstrated and a positive immunohistochemical reaction with CD99 was observed.

Research paper thumbnail of Adjustment of direct high-density lipoprotein cholesterol measurements according to intercurrent triglyceride corrects for interference by triglyceride-rich lipoproteins

Adjustment of direct high-density lipoprotein cholesterol measurements according to intercurrent triglyceride corrects for interference by triglyceride-rich lipoproteins

Journal of Clinical Lipidology, 2010

Low plasma levels of high-density-lipoprotein cholesterol (HDL-C) and high triglyceride (TG) are ... more Low plasma levels of high-density-lipoprotein cholesterol (HDL-C) and high triglyceride (TG) are strongly associated with cardiovascular disease (CVD). Clinical recognition of this high-risk population demands accurate measurement of HDL-C, whereas cost and clinical demand dictate that optimal HDL-C measurement requires fully automated methods that avoid manual precipitation. Commercial techniques use specific reagents to selectively expose and &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot;directly&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot; measure cholesterol in HDL. However, these &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot;direct&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot; methods may experience interference from the cholesterol content of triglyceride-rich-lipoproteins (TRL), leading to analytical overestimation of HDL-C, with subsequent underestimation of low-density-lipoprotein cholesterol (LDL-C) and of CVD risk. The aim of this study was…

Research paper thumbnail of The danger of using inappropriate point-of-care glucose meters in patients on icodextrin dialysis

Diabetic Medicine, 2011

Aims Icodextrin is a glucose polymer used to maintain an osmotic gradient in peritoneal dialysis.... more Aims Icodextrin is a glucose polymer used to maintain an osmotic gradient in peritoneal dialysis. Metabolites of icodextrin are known to cause overestimation of blood glucose in glucose meters using glucose dehydrogenase ⁄ pyrroloquinolinequinone systems. The aim of this study is to determine the extent of icodextrin interference in glucose meters using the newer glucose dehydrogenase ⁄ NAD or glucose oxidase systems. This has not been established previously. Methods Fasting blood samples (n = 4) were spiked with either one icodextrin metabolite (maltose, maltotriose or maltotetraose) or a combination, at various blood concentrations expected during dialysis. Samples were tested in triplicate on: five glucose-meters, a RadiometerÒ (glucose oxidase ⁄ hydrogen peroxide) and laboratory (hexokinase) analysers. Each meter was also tested on blood from six patients undergoing dialysis. Accuracy was evaluated as % Bias = [(meter glucoselaboratory glucose) ⁄ laboratory glucose] • 100. Results A single icodextrin metabolite affected glucose measurements and, in combination, the interferences were additive in the two Accu-ChekÒ and OptiumÒ Xceed meters by > 10%. Amongst these meters, the Optium Xceed 5-s machine was less affected. Meters using glucose oxidase were least affected by interference. A similar trend in interference was observed in vivo. Conclusion While meters using glucose dehydrogenase ⁄ NAD are less affected by icodextrin metabolites, interference can still be demonstrated. The degree of interference can vary in different glucose meters using this enzyme ⁄ cofactor system, as seen in the Optium Xceed machines. Icodextrin is an important source of interference that sometimes even experienced professionals are unaware of and which leads to clinically significant errors in insulin dose adjustment. Awareness of this interference and selection of the most appropriate glucose meters are crucial to minimize this hazard.

Research paper thumbnail of Suboptimal Performance of Blood Glucose Meters in an Antenatal Diabetes Clinic

Diabetes Care, 2011

OBJECTIVE The objective of this study was to evaluate the performance of blood glucose meters in ... more OBJECTIVE The objective of this study was to evaluate the performance of blood glucose meters in diabetes associated with pregnancy (DP). RESEARCH DESIGN AND METHODS Finger-prick blood glucose levels measured using six different glucose meters on 102 patients with DP attending an antenatal clinic were compared with laboratory plasma glucose results. HbA1c and hematocrit were also measured. RESULTS The plasma glucose range was 2.2–9.4 mmol/L with hematocrit 33–37% and mean HbA1c 5.5% ± 0.56 (SD). All meters provided plasma equivalent results except one, which reported whole blood glucose that was adjusted to plasma equivalent values. The absolute glucose difference [meter − plasma glucose] was 0.232 ± 0.69 to 0.725 ± 0.62 mmol/L mean ± SD and bias ranged from 6.1 to 15.8%. Two meters were affected by hematocrit <36% (P < 0.05). CONCLUSIONS Blood glucose meters in current use are not optimally accurate when compared with plasma glucose measurement in DP. Recognition of this devi...

Research paper thumbnail of Sodium copeptin ratio differentiates patients with and without acute diabetes insipidus post neurosurgery

Sodium copeptin ratio differentiates patients with and without acute diabetes insipidus post neurosurgery

Endocrine Abstracts

Research paper thumbnail of Paediatric age related reference intervals for random urine biogenic amines using LCMS/MS

Paediatric age related reference intervals for random urine biogenic amines using LCMS/MS

Pathology

Research paper thumbnail of Random urine catecholamine testing for neural crest tumours in paediatrics using a LC-MSMS method with age specific reference intervals

Random urine catecholamine testing for neural crest tumours in paediatrics using a LC-MSMS method with age specific reference intervals

Pathology

Research paper thumbnail of Random urine testing for carcinoid tumours in paediatric subjects using a LC-MSMS method with age specific normalised reference intervals

Random urine testing for carcinoid tumours in paediatric subjects using a LC-MSMS method with age specific normalised reference intervals

Pathology

Research paper thumbnail of A randomized controlled trial investigating the effects of a low glycemic index diet on pregnancy outcomes in gestational diabetes mellitus

A randomized controlled trial investigating the effects of a low glycemic A randomized controlled... more A randomized controlled trial investigating the effects of a low glycemic A randomized controlled trial investigating the effects of a low glycemic index diet on pregnancy outcomes in gestational diabetes mellitus index diet on pregnancy outcomes in gestational diabetes mellitus