Glycosylated hemoglobin measurement has been shown to be a potentially useful tool for both a variety of research applications and for the management of patients with diabetes mellitus. None of the methods available to quantitate glycosylated hemoglobins is ideal. We have reviewed a number of critical methodologie considerations for Chromatographie procedures including the effects of sample storage under various conditions, and the importance of removing labile components prior to analyses. We have developed a method for the colorimetrie determination of glycosylated hemoglobins that is more rapid than methods reported previously, that correlates well with results using high-performance liquid chromatogra-phy, and that can he standardized between laboratories. We have reviewed our experience using glycosylated hemoglobin in a large population of diabetic youths. We have presented a method for developing realistic goals for glucose control using glycosylated hemoglobin and for using glycosylated hemoglobin as a patient education and care reinforcement tool.
This colorimetric assay for glycosylated hemoglobin can be performed in 120 min with equipment available in most clinical laboratories. The glucose moiety of glycosylated hemoglobin is converted to 5-hydroxymethylfurfural by heating with oxalic acid for 60 min is an autoclave at 124 degrees C and 124 kPa (18 lb/in.2). The adduct formed by reacting 2-thiobarbituric acid with hydroxymethylfurfural is measured photometrically and results are expressed either as nanomoles of hydroxymethylfurfural or as fructose equivalents. Within-assay and between-assay coefficients of variation were less than 2% and less than 3%, respectively. Comparison of results for 50 patients' specimens as measured by the present assay and as analyzed for hemoglobin A1c by liquid chromatography showed excellent correlation (r = 0.98).
Background: Parents often report that young children have "smelly urine" or a particular urinary odour. There is little evidence that these observations are relevant to the diagnosis of urinary tract infection (UTI). Aims: To determine whether parental reporting of smelly urine is of any relevance to the diagnosis of UTI in children less than 6 years of age. Methods: Parents whose children were having urine collected as part of their admission to a large district hospital were given a simple questionnaire to complete regarding the current smell of their child's urine. Parents were asked whether their child's urine smelled different from usual or had a particular smell. Microscopy and culture results of the child's urine were compared to their parent's questionnaire answers to see if there was a association between parental reporting of a different or particular urine smell and a diagnosis of UTI. Results: One hundred and ten questionnaires and urine samples were obtained. Fifty two per cent of parents thought that their child's urine smelled different from usual or had a particular smell. Only 6.4% of children were diagnosed as having a UTI. There was no statistically significant association between parental reporting of abnormal urine smell and diagnosis of UTI. Conclusion: In determining whether a young child has a UTI, asking parents about urine smell is unlikely to be of benefit.
Glycosylated hemoglobins have gained wide acceptance as an accurate index of long-term blood glucose control in diabetes mellitus. A variety of glycosylated hemoglobin assays is available. There is a high degree of correlation between results determined by these assays. The ideal laboratory method for measuring glycosylated hemoglobin in the diabetic should be accurate, precise, easily standardized, inexpensive, and rapidly performed. Unfortunately, none of the currently used methods meet all of the criteria necessary to be considered the ideal laboratory method. The most widely used methods for quantitating glycosylated hemoglobins--including ion exchange chromatography, electrophoresis, isoelectric focusing, thiobarbituric acid colorimetry, and affinity chromatography--are reviewed with respect to the important advantages and disadvantages of each method for the clinical laboratory. Techniques for quantitating glycosylated proteins other than hemoglobins, such as albumin, are also discussed.
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