Events on 28 September 2023
CONGRESS 2023 - Fetal Alcohol Spectrum Disorder- Clinical Chemistry to Clinical Practice
28/09/2023
The UK has the 4th highest prevalence rate of alcohol consumption in pregnancy in the world. Fetal Alcohol Spectrum Disorder (FASD) is the most common non-genetic learning disability in the UK with a prevalence rate of at least 5%, more than autism and ADHD combined. A high-profile public health campaign combined with effective antenatal and pre-conception care is urgently required.
Accurate and early identification of women at risk from alcohol consumption during pregnancy allows education and support to be targeted at those most in need. Self-report has limited sensitivity but is commonplace due to its acceptability and affordability. Biomarkers have the potential to provide an objective and reliable antenatal alcohol screening solution.
To explore the utility of blood biomarkers, we conducted a systematic review comparing the diagnostic accuracy of blood analysis and maternal self-report in detecting at antenatal alcohol exposure. We discovered that none of the biomarkers identified had both high sensitivity and specificity when compared to self-report. There was some evidence that a combination of biomarkers, or combining biomarkers with self-report, increases accuracy. Blood biomarkers examined were of limited use in screening for low and moderate alcohol consumption in pregnancy when compared to self-report. However, certain biomarkers, such as carbohydrate deficient transferrin (CDT) and phosphatidylethanol (PEth) may complement self-report and help improve the accuracy of diagnosis.
We applied these findings to practice with two studies comparing the prevalence of alcohol consumption in the first trimester of pregnancy using self-report and blood biomarker analysis. The booking bloods were from women under the care of Northumbria Healthcare NHS Foundation Trust (NHCT) and North Tees and Hartlepool NHS Foundation Trust (NTHFT).
Six-hundred routine blood samples were anonymously analysed from each location for the presence of Carbohydrate Deficient Transferrin (CDT), a validated marker of chronic alcohol exposure (normalising 2–3 weeks from abstinence) and Gamma-glutamyltransferase (GGT), a liver enzyme elevated for up to 8 weeks after alcohol exposure. At NHCT, CDT analysis revealed a prevalence rate of 1.4% and GGT a prevalence rate of 3.5% in the first trimester of pregnancy. Although those with elevated CDT generally had high levels of GGT, only one person was positive for CDT and GGT. The NTHFT data revealed a CDT prevalence rate of 1.7% (95% CI: 0.7–2.9) and GGT prevalence rate of 4.2% (95% CI: 2.6–5.9). No overlapping cases were identified, or a significant correlation was demonstrated between CDT or GGT. Although CDT and GGT analysis are not sensitive to low levels of alcohol, prevalence rates were similar in both areas, suggesting similar patterns of sustained alcohol use in pregnancy across the region.
We also took a full year's sample of data from the antenatal visits of women at NHCT, which documented the women's self-reported alcohol consumption. The percentage of women who reported alcohol intake in the first trimester was 0.8%, approximately half the rate of those identified by CDT. This compared to 74.1% of women who reported consuming alcohol before pregnancy, indicating the limited value of self-report in clinical practice.
Accurate and early identification of women at risk from alcohol consumption during pregnancy allows education and support to be targeted at those most in need. Self-report has limited sensitivity but is commonplace due to its acceptability and affordability. Biomarkers have the potential to provide an objective and reliable antenatal alcohol screening solution.
To explore the utility of blood biomarkers, we conducted a systematic review comparing the diagnostic accuracy of blood analysis and maternal self-report in detecting at antenatal alcohol exposure. We discovered that none of the biomarkers identified had both high sensitivity and specificity when compared to self-report. There was some evidence that a combination of biomarkers, or combining biomarkers with self-report, increases accuracy. Blood biomarkers examined were of limited use in screening for low and moderate alcohol consumption in pregnancy when compared to self-report. However, certain biomarkers, such as carbohydrate deficient transferrin (CDT) and phosphatidylethanol (PEth) may complement self-report and help improve the accuracy of diagnosis.
We applied these findings to practice with two studies comparing the prevalence of alcohol consumption in the first trimester of pregnancy using self-report and blood biomarker analysis. The booking bloods were from women under the care of Northumbria Healthcare NHS Foundation Trust (NHCT) and North Tees and Hartlepool NHS Foundation Trust (NTHFT).
Six-hundred routine blood samples were anonymously analysed from each location for the presence of Carbohydrate Deficient Transferrin (CDT), a validated marker of chronic alcohol exposure (normalising 2–3 weeks from abstinence) and Gamma-glutamyltransferase (GGT), a liver enzyme elevated for up to 8 weeks after alcohol exposure. At NHCT, CDT analysis revealed a prevalence rate of 1.4% and GGT a prevalence rate of 3.5% in the first trimester of pregnancy. Although those with elevated CDT generally had high levels of GGT, only one person was positive for CDT and GGT. The NTHFT data revealed a CDT prevalence rate of 1.7% (95% CI: 0.7–2.9) and GGT prevalence rate of 4.2% (95% CI: 2.6–5.9). No overlapping cases were identified, or a significant correlation was demonstrated between CDT or GGT. Although CDT and GGT analysis are not sensitive to low levels of alcohol, prevalence rates were similar in both areas, suggesting similar patterns of sustained alcohol use in pregnancy across the region.
We also took a full year's sample of data from the antenatal visits of women at NHCT, which documented the women's self-reported alcohol consumption. The percentage of women who reported alcohol intake in the first trimester was 0.8%, approximately half the rate of those identified by CDT. This compared to 74.1% of women who reported consuming alcohol before pregnancy, indicating the limited value of self-report in clinical practice.
CONGRESS 2023 - Androgens and Sports: Conventional urine and modern dried blood sample testing methodologies
28/09/2023
Androgens are the naturally occurring or synthetic hormones which can increase lean body mass and decrease fat mass and are the most effective and widely abused ergogenic drugs in sport. The detection methodologies for the exogenous steroids is mostly based on the gas/liquid chromatography and mass spectrometry, while detection of the exogenous administration of endogenous steroids requires more complex methodologies including the longitudinal monitoring of individual urinary steroid concentrations/ratios and isotope ratio mass spectrometry. Although, urine has always been the first choice of sample matrix to detect androgens in sports. However, blood matrix is also now paving its way towards a complementary matrix for detection of androgens in sports. Dried blood spots (DBS) analysis is the latest tool in sports drug testing. DBS testing has advantages in the collection, shipment, and storage compared to traditional urine and blood-based procedures.
The World Anti-Doping Agency (WADA) has recently introduced DBS testing as an implementation for routine doping analysis during the recent Olympic and Paralympic Games in Tokyo and Beijing. DBS samples can be obtained with relatively little training and require minimal invasion at the collection site. A variety of devices based on micro-lancet and micro-needle approaches have been applied in the DBS collection.
Most androgens in DBS are stable at room temperature, so there are no specific requirements during transport. Also, considering the small size and weight of DBS, the DBS-based technique is more cost-effective compared to urine or blood samples. However, as a microscale sample, DBS require more sensitive and accurate analytical methods. The Drug Control Centre, King’s College London (a WADA accredited lab), we are currently investigating the use of DBS testing in our systematic regular analysis as a new methodology.
This presentation will discuss the current situation, perspectives, and challenges of implementing DBS testing for detecting androgens in sports.
The World Anti-Doping Agency (WADA) has recently introduced DBS testing as an implementation for routine doping analysis during the recent Olympic and Paralympic Games in Tokyo and Beijing. DBS samples can be obtained with relatively little training and require minimal invasion at the collection site. A variety of devices based on micro-lancet and micro-needle approaches have been applied in the DBS collection.
Most androgens in DBS are stable at room temperature, so there are no specific requirements during transport. Also, considering the small size and weight of DBS, the DBS-based technique is more cost-effective compared to urine or blood samples. However, as a microscale sample, DBS require more sensitive and accurate analytical methods. The Drug Control Centre, King’s College London (a WADA accredited lab), we are currently investigating the use of DBS testing in our systematic regular analysis as a new methodology.
This presentation will discuss the current situation, perspectives, and challenges of implementing DBS testing for detecting androgens in sports.
CONGRESS 2023 - Delegates attending this presentation will learn: Which androgens are tested for in sport The problems with current sample collection techniques Comparison of conventional urine with dried blood spots.
28/09/2023
Androgens are the naturally occurring or synthetic hormones which can increase lean body mass and decrease fat mass and are the most effective and widely abused ergogenic drugs in sport. The detection methodologies for the exogenous steroids is mostly based on the gas/liquid chromatography and mass spectrometry, while detection of the exogenous administration of endogenous steroids requires more complex methodologies including the longitudinal monitoring of individual urinary steroid concentrations/ratios and isotope ratio mass spectrometry. Although, urine has always been the first choice of sample matrix to detect androgens in sports. However, blood matrix is also now paving its way towards a complementary matrix for detection of androgens in sports. Dried blood spots (DBS) analysis is the latest tool in sports drug testing. DBS testing has advantages in the collection, shipment, and storage compared to traditional urine and blood-based procedures.
The World Anti-Doping Agency (WADA) has recently introduced DBS testing as an implementation for routine doping analysis during the recent Olympic and Paralympic Games in Tokyo and Beijing. DBS samples can be obtained with relatively little training and require minimal invasion at the collection site. A variety of devices based on micro-lancet and micro-needle approaches have been applied in the DBS collection.
Most androgens in DBS are stable at room temperature, so there are no specific requirements during transport. Also, considering the small size and weight of DBS, the DBS-based technique is more cost-effective compared to urine or blood samples. However, as a microscale sample, DBS require more sensitive and accurate analytical methods. The Drug Control Centre, King’s College London (a WADA accredited lab), we are currently investigating the use of DBS testing in our systematic regular analysis as a new methodology.
This presentation will discuss the current situation, perspectives, and challenges of implementing DBS testing for detecting androgens in sports.
The World Anti-Doping Agency (WADA) has recently introduced DBS testing as an implementation for routine doping analysis during the recent Olympic and Paralympic Games in Tokyo and Beijing. DBS samples can be obtained with relatively little training and require minimal invasion at the collection site. A variety of devices based on micro-lancet and micro-needle approaches have been applied in the DBS collection.
Most androgens in DBS are stable at room temperature, so there are no specific requirements during transport. Also, considering the small size and weight of DBS, the DBS-based technique is more cost-effective compared to urine or blood samples. However, as a microscale sample, DBS require more sensitive and accurate analytical methods. The Drug Control Centre, King’s College London (a WADA accredited lab), we are currently investigating the use of DBS testing in our systematic regular analysis as a new methodology.
This presentation will discuss the current situation, perspectives, and challenges of implementing DBS testing for detecting androgens in sports.
CONGRESS 2023 - Dimorphine-assisted treatment programme
28/09/2023
Dimorphine-assisted treatment programme
CONGRESS 2023 - The public health side of drug misuse
28/09/2023
The public health side of drug misuse
CONGRESS 2023 - From the laboratory to headlines. How to validate laboratory methods to screen and measure novel drugs
28/09/2023
In the US, the death rate from drug overdoses more than tripled between 1999 and 2017, this was driven by increase use of opioids. This opioid epidemic had three phases: the first was dominated by prescription opioids such as oxycodone, the second by heroin, and the third by cheaper but more potent synthetic opioids such as fentanyl.
Despite a few outbreaks of synthetic opioids (such as fentanyl analogues) causing death is particular geographic areas, the UK has not faced the same epidemic as the US. However, over the past 2-3 years the UK has seen an increase in the detection of 2-benzyl benzimidazole (‘nitazene’) type opioids. These are found mixed with heroin or purchased online, typically sold as oxycodone. This talk will give a brief overview of novel opioids, discuss the potential for harm and highlight the analytical strategies to develop validated assays to detect and measure both novel opioids and other novel psychoactive substances.
Despite a few outbreaks of synthetic opioids (such as fentanyl analogues) causing death is particular geographic areas, the UK has not faced the same epidemic as the US. However, over the past 2-3 years the UK has seen an increase in the detection of 2-benzyl benzimidazole (‘nitazene’) type opioids. These are found mixed with heroin or purchased online, typically sold as oxycodone. This talk will give a brief overview of novel opioids, discuss the potential for harm and highlight the analytical strategies to develop validated assays to detect and measure both novel opioids and other novel psychoactive substances.
CONGRESS 2023 - New Advanced Specialist Diploma in Histopathology Reporting Qualifications (Thursday)
28/09/2023
The session will provide an overview of the Histopathology Reporting qualifications outlining the success so far and then will focus on the two new limited scope Reporting qualifications. It will provide guidance on the eligibility criteria for these qualifications, the portfolio requirements and the support needed by candidates from colleagues in order to undertake the qualification.
CONGRESS 2023 - Digital cervical cytology: The Monklands experience
28/09/2023
Digital cervical cytology: The Monklands experience