Annales de biologie clinique最新文献

Screening for hepatitis C virus (HCV) infection relies on detecting total anti-HCV antibodies through an enzyme-linked immunosorbent assay (ELISA) performed on a single serum sample. However, in population with low seroprevalence, this one-step approach may lack specificity, leading to false-positive results. A low ELISA ratio combined with negative viremia can raise concerns about either a resolved infection or a non-specific result. The aim of our study was to assess the added value of HCV immunoblot testing in clarifying the serological status of patients without known risk factors for infection when a low ELISA ratio and no detectable viremia is retrieved. We retrospectively reviewed the risk factors of 176 non-viremic individuals with low-positive HCV screening results. An immunoblot was performed on samples from 50 individuals with no documented risk factors for HCV infection. The majority of immunoblot tests (36/50) were negative, while a smaller proportion were indeterminate (8/50) or positive (6/50), including cases with very low ratios close to 1. When used selectively, the HCV immunoblot can resolve ambiguities sometimes generated by the enzyme immunoassay.

The reliability of HbA1c test results is essential for the screening, diagnosis, and monitoring of diabetes. The objective of our study was to evaluate the analytical performance of HbA1c testing on the HLC®-723 G11 Tosoh analyzer, as well as the impact of the absence of a sample homogenization system prior to analysis on the stability of results. The analytical performance verification protocol was developed with reference to the recommendations of the Clinical and Laboratory Standards Institute and the SH 04 guide of the French Accreditation Committee. Repeated measurements were performed on samples at the following times: initial (T0), 30 minutes, 1 h, 2 h, 3 h, 4 h, 5 h, and 6 h, without prior homogenization. Biases were calculated and compared to the acceptability limits defined by Fraser. The coefficients of variation (CV) for repeatability and intermediate precision, as well as inaccuracy, were below the limits set by the French Society of Clinical Biology and the European Federation of Clinical Chemistry and Laboratory Medicine. The contamination rate was 0.05%. An excellent correlation between HLC®-723 G11 and Capillarys Octa3® was observed, both with and without a hemoglobin variant, with R² = 0.99 and R² = 0.97, respectively. HbA1c results were stable for up to 6 hours in the absence of a stirring system. The analytical performance of the HLC®-723 G11 analyzer was verified, allowing its routine use for HbA1c testing.

To evaluate the usefulness of C3 and C4 fractions, CH50, sC5b-9, and anti-dsDNA and anti-C1q antibodies in the immunological monitoring of systemic lupus erythematosus (SLE), with or without renal involvement. This cross-sectional study included 74 SLE patients, 32 with renal involvement and 42 without. Immunological parameters were correlated with overall disease activity and with lupus nephritis (LN) activity. Significant differences were observed between the two groups. Renal involvement was strongly associated with anti-dsDNA (P = 0.001), anti-C1q (P = 0.001), low C3 levels (P < 0.0001), and elevated plasma levels of sC5b-9 (P = 0.002). In non-renal SLE, no correlation was found between disease activity and C3, C4, CH50, sC5b-9, anti-C1q, only anti-dsDNA correlated with disease activity (P = 0.02). In contrast, in renal SLE, LN activity correlated positively with anti-dsDNA (P = 0.012) and anti-C1q (P < 0.0001), and negatively with C3 (P = 0.008) and CH50 (P = 0.003). Elevated sC5b-9 levels were also significantly associated with active LN (P = 0.018). Receiver operating characteristic (ROC) curve analysis identified anti-C1q as the best marker of renal involvement, with an area under the curve of 0.929 and a negative predictive value (NPV) of 92% for and active LN. Immunological monitoring of SLE should be tailored to the clinical phenotype. Complement exploration is of limited value in SLE without renal involvement due to moderate activation during active disease. In renal SLE, complement markers prove particularly useful, with anti-C1q emerging as the best marker of lupus nephritis activity.

Cluster headache (CH) is a severe and disabling headache disorder generally considered as the greatest level of physical pain a person can experience. Despite the significant range of -therapeutic and pharmacological options available, the intense pain the patient endures is poorly controlled. In this way, drugs misuse and illicit substances use, notably amphetamines is widely reported in patient with cluster headache. We herein describe a case of addiction to cocaine and other drugs in a patient with cluster headache following intranasal treatment with Bonain anesthetic mixture, a compounded preparation including cocaine and still used in some european countries. Cocaine misuse was confirmed by the clinical observations and the use of toxicological screening using liquid chromatography on urines. This last one highlights the presence of cocaine and its metabolites (benzoylecgonine, anhydroecgonine, ecgonine, ecgonine methylester, norbenzoylecgonine) and some other drugs the patient used to misuse (cyamemazine, codeine). In blood, the concentrations of cocaine, benzoylecgonine and ecgonine methylester were 2.5 ng/mL, 149.3 ng/mL and 6.5 ng/mL respectively. These results are consistent with a misuse of cocaine due to the benzoylecgonine high concentration and the absence of phenol and menthol, the other compounds of the Bonain anesthesic mixture. This case highlights the importance of performing toxicological monitoring in CH patients, particularly among those who have an increased risk of addictological behavior.

This study aimed to assess the rate at which general practitioners (GPs) sought advice from biologists after selective reporting of antibiotic susceptibility testing (AST) was introduced for enterobacterial urinary tract infections in adult women. This study also aimed to describe the characteristics and reasons for these requests, as well as the acceptability of selective reporting of AST. A prospective descriptive study was conducted as part of the ABC-MG trial in 2023-24. We collected data on the number of selective reporting of AST, requests for advices, and the reasons for these requests. A telephone questionnaire was administered to GPs who had requested advices. A total of 4,144 selective reporting of AST were performed for 537 GPs. The rate of requests for advice related to selective reporting of AST was 1.0%. Half of GPs were satisfied with the use of selective reporting of AST and praised its added-value in combating antibiotic resistance and limiting the prescription of broad-spectrum antibiotics. The main constraints were the need to contact a biologist for a full reporting of AST, delays in introducing antibiotic therapy, lack of clarity in selective reporting of AST, and unsuitable results in cases of suspected simple acute kidney infection. The implementation and use of selective reporting of AST are well accepted by GPs and result in a low rate of requests to biologists. These are promising tools for use in antibiotic management programs.

We report a case of pseudohyperphosphatemia in a patient with multiple myeloma that progressed to plasma cell leukaemia. This pseudohyperphosphatemia was caused by an analytical interference between monoclonal immunoglobulin and ammonium molybdate, a reagent used for measuring inorganic phosphate. Accurate measurement of blood inorganic phosphate levels requires prior protein precipitation to eliminate assay interference. Extrarenal purification treatments helped reduce the monoclonal immunoglobulin concentration and eliminated the interference during phosphate measurement. Pseudohyperphosphatemia is a rare event that can lead to inappropriate and harmful medical management for affected patients; thus, prompt recognition by clinical biologists is crucial to avoid misdiagnosis and inappropriate interventions. This case report also provides an opportunity to do a brief review of the literature and to remind some recommendations and actions to take into consideration in the presence of discrepancies between the clinic and the biology.

In a context where public procurement of biomedical equipment increasingly includes environmental criteria, this article presents a 2025 overview of sustainable development commitments among major suppliers of in vitro diagnostic (IVD) medical devices, specifically in biochemistry, hematology, and hemostasis. Through interviews and document analysis, the study evaluates suppliers' initiatives based on ISO 14001 (environmental management), ISO 50001 (energy performance), and carbon footprint assessments. Many companies report ISO certifications and concrete actions: carbon footprint reduction, energy optimization (renewables, Light-Emitting Diode (LED), solar panels), water stewardship, and waste recycling. The analysis reveals that sustainability criteria are often underweighted in tenders compared to financial ones. The article offers recommendations to strengthen environmental requirements in hospital purchasing, such as requiring tangible proof of certifications and measurable outcomes. Emphasis is also placed on incorporating scopes 1, 2, and 3 in carbon footprint reports, aligning with recent French legislation. This integration is presented as a key driver for the ecological transition in healthcare. The article advocates for better-structured CSR strategies across the IVD sector, encouraging companies to align with the United Nations Sustainable Development Goals (SDGs) and adopt a more holistic and measurable approach to environmental responsibility.

Pheochromocytoma with ectopic ACTH secretion is very unusual. The diagnosis is difficult. This case report illustrates the necessity of a thorough endocrinological investigation. In this case, normalization of biological result just after tumorectomy has confirmed the diagnosis. In addition, diagnosis needs also medical imaging and eventually immunostaining on resected tumor. Clinical symptoms and biological results presentation are more serious than pheochromocytoma without ACTH secretion or than Cushing disease. In this kind of situation, the removal of tumor remains the main treatment and a symptomatic treatment has to be initiated before surgery.