Annales de biologie clinique最新文献

Early diagnosis of liver fibrosis remains a challenge. The aim of this study was to compare the performance of the GPR, APRI and FIB-4 scores in the diagnosis of significant fibrosis in chronic hepatitis B. This was a 6-month cross-sectional study. Patients were aged 18 and over, had a FibroScan® and had venous blood samples taken. 133 patients were included. The mean FibroScan® value was 5.33 ± 0.47 kPa, with 26.32% showing significant fibrosis (>7.2 kPa). The GPR score had a sensitivity of 80% compared with 48.57% and 51.42% respectively for the APRI and FIB-4 scores. However, its specificity was lower (51.02%) compared with the APRI (77.55%) and FIB-4 (81.63%) scores. The area the ROC curve of the GPR score (0.760) was higher than that of the APRI (0.712) and FIB-4 (0.724) scores in predicting significant fibrosis (p < 0.05). The GPR score is more accurate for assessing liver fibrosis in chronic hepatitis B in sub-Saharan Africa.

Clinical biology plays a crucial role in healthcare. However, this specialty is facing a loss in attractiveness in medical studies. What is driving this decline in interest? Based on insights from the "Livre Blanc de la Formation en Biologie Médicale", written and validated by two unions representing laboratory medicine residents in France, and the insight of young clinical biologists, this article delves into young biologists' perspectives on their profession, through the eyes of the "New Generation in Clinical Biology" task force of the French Clinical Biology Society (SFBC). We explore key challenges our field will have to overcome for the new generation. At the same time, we shed light on their aspirations: modernizing missions, promoting research, and expanding career opportunities. Finally, we propose concrete solutions to revitalize the field and ensure a stronger integration of young professionals into the healthcare system.

An 86-year-old woman is monitored for IgA λ-associated multiple myeloma, treated in second intention with dexamethasone, revlimid and daratumumab after a relapse. A control serum protein electrophoresis detects the presence of a new monoclonal spike, later confirmed by immunofixation as an IgG κ. Suspecting an interference due to the immunotherapy, a daratumumab specific immunofixation reflex assay (DIRA) is performed, with the addition of anti-daratumumab antibodies, confirming the interference. A second multiple myeloma case is presented, describing interference with daratumumab co-migrating with the original monoclonal immunoglobulin. Based on these cases, we propose an algorithm of action to confirm the interference and provide an accurate biological result consistent with the therapeutic and clinical context.

Coronary artery disease (CAD) is a worldwide leading cause of death. Considering that 20%-40% of patients with CAD have a long asymptomatic period of atherosclerosis, it has become urgent to explore the feasibility of diagnosing CAD at an early stage. This is an observational, case-control study, a total of 489 consecutive CAD patients and 75 non-CAD controls were recruited. The levels of low-density lipoprotein subfractions (LDLC1-7) in serum were measured by the Quantimetrix Lipoprint LDL system. The levels of 18 trace elements (vanadium, chromium, manganese, cobalt, nickel, copper, zinc, gallium, arsenic, selenium, strontium, cadmium, tin, antimony, barium, mercury, thallium, and lead) were tested using inductively coupled plasma mass spectrometry. Six machine learning algorithms (Logistic Regression, K Neighbors, GaussianNB, Random Forest, Decision Tree and XGBoost) were used to construct CAD diagnostic models. The levels of LDLC-3, LDLC-4, LDLC-5, and lead were significantly higher in CAD patients, while the levels of LDLC-1, chromium, manganese, cobalt, and strontium were lower (p < 0.05 for all). Univariate logistic regression analysis indicates that LDLC-3, LDLC-4, and lead were the risk factors for CAD development (odds ratio >1 and p < 0.05 for all), while LDLC-1, chromium, manganese, cobalt, and strontium were the protective factors for CAD (odds ratio < 1 and p < 0.05 for all). XGBoost had the best overall diagnostic performance among the six algorithms. There are significant differences in the levels of several LDL subfractions and trace elements between non-CAD controls and CAD patients. These biomarkers may help the diagnostic of CAD while applying machine learning algorithms.

Medical biology is a medical specialty shared by medical doctor (MD) and pharmacists (PharmD), and Hemostasis is one of its disciplines. Since 2007, physicians have lost interest in medical biology. In haemostasis, the regulatory heterogeneity of status between medical biologists/MDs and medical biologists/PharmDs in a strained health system raises two major issues: (i) with demographic change, optimal patient care may no longer be guaranteed, (ii) medical biologists/PharmDs are sometimes forced to go beyond the scope of their regulatory field of practice. We conducted a survey in 2022 to examine hemostasis advice and consultation practices: 152 professionals responded, including 99 pharmacist-biologists (65.1%), 42 physician-biologists (27.6%) and 11 clinicians (7.2%). Of the practitioners questioned, 91.9% gave diagnostic advice and 75.0% therapeutic advice. 41% of respondents carried out haemostasis consultations, including 24.2% of pharmacists. Our survey reveals a little-known role for medical biologists specialized in haemostasis, particularly pharmacists, and calls for a global reflection on a possible regulated and supervised evolution of their field of practice, to enable them to pursue their mission in complete safety.

A 41-year-old woman presented to the emergency room for long-term dysphagia, with a loss of eight kilos in two months. Myositis or inflammatory myopathies were suspected. A marked increase in troponin T concentration was observed.

Nosocomial infections (NI) are a major concern of healthcare professionals. To propose targeted awareness-raising campaigns, we put in place NI monitoring of laboratory data. The positive bacteriological results after 48 hours hospitalisation are subject of a report via the Infection Control Team, to the physician corresponding in the department, for the clinical validation of diagnostic of NI. At hospital level and specialty activity, we measured NI incidence rates for 1 000 hospital days and for 100 admissions every month since October 1, 2016. Results were then declined by specialties and by infected anatomical site and investigation allowed to describe the microbial flora responsible for these infections. The request began in october 2016. Average results were stable over the year despite monthly fluctuations. For 2023, incidence rates are IAS 2,8 for 1 000 JH and IAS 1,2 for 100 admissions. The detail of the results is transmitted to the physicians and is the subject of internal communications. They will be allowed to follow up more closely with the NI epidemiology and propose targeted corrective measures as appropriate.