Drug related deaths increase dramatically in Scotland

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Drug related deaths increase dramatically in Scotland

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20 September 2019

 

Drug related deaths increase dramatically in Scotland

In the past year, Scotland’s drug related deaths have increased dramatically by 27%.

This almost levels the fatality rate per capita with the US. The latest figures showed the majority of fatalities was from the over 35 age group, known as the “Trainspotting generation.”

Westminster currently hold the power on the Misuse of Drugs Act, which Scotland believes should be relaxed as a method of controlling the issue in the country. One of Scotland’s most senior police officers has described the Misuse of Drugs Act as a relic that was “ripe for reform.”

The chair of the Scottish government’s task force on drug deaths, Catriona Matheson believes that treatment challenges should be investigated alongside decriminalisation;

“I understand why decriminalisation grabs most attention, but legislation, criminal justice, healthcare and public attitudes are intertwined”.

There is also a significant increase in the number of fatalities amongst the under 35 age group. These deaths are heavily linked to poly-drug use, including the relatively newly available drug named “street benzodiazepines.”

The lead pharmacist for addiction services at the city’s health and social care partnership, Dr Carole Hunter, said;

“The major problem for Glasgow is heroin and illicit benzos like etizolam or street Valium, which have never been cheaper or more available.”

International trials have shown that medicinal heroin can be an effective treatment for a number of opioid users who do not respond to regular methods of treatment. Hunter proposes opening an enhanced drug treatment centre in Glasgow for this medicinal heroin to be administered under supervision.

Dave Liddell, chief executive of Scottish Drugs Forum stated;

“Neither decriminalisation nor one drug consumption room in Glasgow is going to impact substantially on the death rate. The key focus needs to be on improving our drug treatment and care services. We need to look at access to opioid replacement therapy. Only 40% of people with a drug problem in Scotland are currently in treatment, compared with far higher numbers in England and many countries in England.”

For further information please email info@randoxtoxicology.com or visit www.randoxtoxicology.com

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Metabolic Syndrome Arrays from Randox Biosciences

News       About Us        Randox Biosciences

17 September 2019

 

Metabolic Syndrome Arrays from Randox Biosciences

 

Metabolic syndrome is described as a combination of diabetes, high blood pressure and obesity. As result of three health conditions going on, it puts the individual at greater risk of developing coronary heart disease, stroke and many other risks. 1 As well as developing additional health conditions it can cause damage to the blood vessels, the blood pressure damages the blood vessels, the obesity causes a lot of strain on the blood vessels and the heart.2 Therefore, can result in serious long-term risks.

This serious health condition is very common, and studies state that it affects about 23% of adults. 3One in four adults in the UK are currently living with metabolic syndrome and often becomes more common with age2.

Usually it affects those who are overweight or considered obese, have an unbalanced diet containing high levels of sugar and fat and have high cholesterol and extremely high blood pressure2 therefore, the condition can be prevented by reducing the risks.

1 According to the NHS, metabolic syndrome occurs when a person has three or more of the following measurements:

-Abdominal obesity (Waist circumference of greater than 40 inches in men, and greater than 35 inches in women)

-Triglyceride level of 150 milligrams per deciliter of blood (mg/dL) or greater

– HDL cholesterol of less than 40 mg/dL in men or less than 50 mg/dL in women

– Systolic blood pressure (top number) of 130 millimeters of mercury (mm Hg) or greater, or diastolic blood pressure (bottom number) of 85 mm Hg or greater

There are many ways to prevent metabolic syndrome from developing, making lifestyle changes for example, ensuring their weight is healthy by increasing physical exercise, eating a well-balanced healthy diet containing whole grains, fruit, vegetables and fish and finally, visiting the GP to monitor and manage blood glucose, blood cholesterol and blood pressure, quit smoking and managing your stress.

Randox offers the Evidence Evolution including two Metabolic Syndrome Arrays which allows multiplex testing from a single sample allowing rapid turnaround time and are suitable for both serum and plasma samples.

 

 

metabolic syndrome

Metabolic Syndrome Array I

  • Ferritin
  • Interleukin-6 (IL-6)
  • Insulin
  • Leptin
  • Plasminogen Activator Inhibitor-1 (PAI-1)
  • Resistin

Metabolic Syndrome Array II

  • Adiponectin
  • C-reactive Protein (CRP)
  • Cystatin C

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Addressing Drugs and Alcohol in the Workplace

05 September 2019

Workplace Drug and Alcohol Testing

Addressing Drugs and Alcohol in the Workplace

Within any business, companies seek to outline clear methods in which employees should act and behave whilst carrying out their roles. These rules are outlined in company workplace policies. Every business – no matter which industry it operates in – should have well-documented and comprehensive workplace policies and procedures in place.

According to the Employment Law Handbook, a workplace policy is a set of rules and principles that aims to provide guidance to managers and workers in how to behave in the workplace. They can be in place for numerous different issues – bullying, harassment, internet use, health and safety are just a few that can be implemented.

Health and Safety

As mentioned above, health and safety is an important aspect of any workplace policy. The health and well-being of the working community is of utmost importance for sustainable development. Specifically, a drug and alcohol policy is a key part of the overall health and safety policy within a company. Alcohol and drugs through their effects on health, safety, work performance and absenteeism can jeopardise productivity, deny businesses the leading edge and curtail competitiveness. Effectively implemented drug and alcohol policies will help employers in the legal duty to protect the health, safety and welfare of employees.

The need for a Drug and Alcohol Policy

Drugs and alcohol misuse can have dangerous consequences within the workplace. All organisations can benefit from an agreed policy that applies to all staff. There are wide range of statistics available to highlight the worrying impact that drugs and alcohol can have on individuals. In 2016, it was estimated that £7 billion was lost in productivity through unemployment and sickness. Furthermore, 10.8 million adults in England are drinking at levels that pose some risk to their health. A survey carried out by UK based Health and Safety Consultants Protecting.co.uk showed that; from 2,600 workers in office, factory, retail and the public sector, 85% admit to being drunk at work in the last year; not including the Christmas party. 28% of those surveyed admitted using drugs at work, including NPS (formerly legal highs) cannabis and other illegal substances.

From a legal point of view, employers have a duty of care under the Health and Safety at Work Act 1974 to ensure, as far as is reasonably practicable, the health, safety and welfare at work of employees. Also, under the Management of Health and Safety at Work Regulations 1999, to assess the risks to the health and safety of employees. If an employer knowingly allows an employee under the influence of drug misuse to continue working and his/her behaviour places the employee or others at risk, they may face prosecution.

Advantages of having policies in place

Having well-developed policies and procedures can provide a range of benefits to an organisation. An effectively implemented drug and alcohol policy will ensure a clear understanding within the workplace of the rules relating to drugs and alcohol. It will also provide a greater awareness in workplaces of the effects of drugs and alcohol an consequently early recognition. Furthermore, it ensures that the necessary structures and procedures are in place should a problem arise. An up to date policy will also provide assurance that key staff have been trained to understand the issues involved and have the necessary skills to deal with any problems should they arise.

How can Randox Testing Services help?

At Randox Testing Services we offer a comprehensive consultancy service to help employers create an effective substance misuse policy. By providing this service we offer practical advice, guidance and support in composing a substance misuse policy.

Our confidential policy review service provides assistance to employers with an existing substance misuse policy. With this service, we help to modify existing documents to ensure it is legally viable and can withstand challenge in court.

For more information on our comprehensive consultancy service, visit our website: www.randoxtestingservices.com or contact us by emailing testingservices@randox.com.

To read more about workplace polices and their importance within an organisation, click here.

 

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Randox Health takes life-extending diagnostic service on the road

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03 September 2019

Randox Health Mobile Clinic

Do you know about our Mobile Health Service?

Clients of Randox Health are benefiting from “full-body MoTs” by providing blood samples in state-of-the-art Mobile Service clinics based on Mercedes-Benz Sprinters. The company’s phlebotomists use their strikingly styled vehicles to visit workplaces, gyms, private homes, and other locations, and provide an ultra-convenient service which can extend lives.

Randox Health is committed to identifying and preventing illness by detecting small changes in blood. Its patented diagnostic testing technology is capable of identifying up to 350 individual ‘biomarkers’ in a single sample. Randox Health operates clinics in Belfast, Liverpool and London, and introduced its first mobile unit in 2017. Such has been the demand from health-conscious clients throughout Ireland, that it has now added a second.

Based in Liverpool, the newer vehicle is from the latest-generation Sprinter range launched last year, which combines unprecedented levels of cab quality and comfort, with 4G wi-fi connectivity, and an industry-leading armoury of active and passive safety features. Like its predecessor, the 3.5-tonne 314 CDI L2 chassis cab was supplied by Intercounty Truck & Van, one of two members of the Mercedes-Benz Vans retail network whose parent company is Ballyvesey Holdings, of Newtownabbey, Northern Ireland.

Both vehicles’ purpose-designed bodies are the work of specialist coachbuilder Annard, of Loughall, County Armagh. Features include ‘pop out’ sections that address Randox Health’s requirement for additional floor space. With their aerodynamic enhancements, colour-coded door mirrors and bumpers, and alloy wheels, the Sprinters are real head-turners, and have attracted enthusiastic feedback from clients.

Explaining the rationale behind Randox Health’s decision to launch its mobile clinic service, Operations Manager Lauren Donaghy said: 

“Increasing demand from corporate clients and private individuals for our pioneering health checks meant we needed to come up with a solution which ensured they were accessible to all.

“Our mobile service was the answer, and by providing men and women, young and old, with what effectively amount to full-body MoTs, we’re now transforming the delivery of healthcare in the UK and Ireland.”

Lauren continued: “We provide a world-leading service, so naturally we were keen to partner with a world-leading automotive brand able to provide vehicles that offer the highest standards of reliability, comfort and safety.

“The name Mercedes-Benz is synonymous with quality, ingenuity and performance, so we knew it would be the perfect fit for our equally innovative and ambitious company. Ballyvesey Holdings, meanwhile, has worked with Mercedes-Benz for years, and came highly recommended. “With their bespoke design, the vehicles provide a perfect combination of phlebotomy functionality and patient comfort, while maintaining the look and feel of a high-end clinic room,” added Lauren Donaghy.

“People are able to book an appointment at a place of their choosing, and being able to undergo their health check in a luxurious Mercedes-Benz means the experience is first-class from start to finish.”

A world-leading health service

Mercedes-Benz Vans UK has been doing its bit to highlight issues of health and wellbeing affecting the UK’s community of van drivers, operators and owners, through its Business Barometer programme. In its latest bulletin, the manufacturer focused on poor quality diets and the apparent reluctance of many to visit a doctor, while previous instalments have covered everything from hydration in hot weather, to the affects of air pollution, and the high stress levels induced by a shortage of parking provision.

The Sprinter 314 CDI is powered by a fuel-efficient 2.1-litre common rail turbodiesel engine – although this model is now also available with front-wheel drive, as with its stablemate Randox Health’s new van transmits its 143 hp output via the rear wheels. Like all Mercedes-Benz vans, Randox Health’s Mobile Service vehicles are backed by three-year, unlimited mileage warranties and came with free MobiloVan cover, which includes round-the-clock emergency roadside assistance.

Randox Health: What We Do

Randox Health packages go beyond a health check. We have the world’s most comprehensive full-body health programmes available on the market today, thanks to Randox Biochips which enable hundreds of individual tests to be carried out from one sample and giving you truly unrivalled knowledge about your health and wellbeing both now and in the future. Our goal is to help you extend your life. Your health matters to us and, above all, we are committed to improving healthcare worldwide by identifying and preventing illness at the earliest possible stage.

How we can help you

Identifying the very first signs and risks of disease can help prevent health problems that may be on the horizon. Randox Health aim to do this before the appearance of unpleasant symptoms or illness. Prevention is always better than cure. Long-term mild dehydration may have caused damage to your health and our packages tests for up to 350 different biomarkers. Read about our packages here, or contact a member of our team for more information!

 

 

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Randox Food Diagnostics are attending AOAC Denver 2019

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30 August 2019

Randox Food Diagnostics are attending AOAC Denver 2019

Randox Food Diagnostics are exhibiting at AOAC in Denver. Various contaminants are administered to animals during the farming process to treat infection and maintain herd health. Regulations are often adhered to, as quality control procedures are put in place to ensure the safe supply of agricultural produce and this is where Biochip technology can streamline the quality control process. By offering a system that can analyse up to 48 sample simultaneously, our technology delivers higher throughput which in turn saves time and money on laboratory costs and labour.

Randox Food and Biochip Array Technology

Biochip Array technology (BAT) is designed with the aim of revolutionising the screening practices of your laboratory. Designed to work across a wide variety of matrices, BAT uses a micro-spotting technique to create an assay that can detect and provide quantitative results for up to 44 residues from a single sample.

The market leading 9mm x 9mm ceramic chip brings the capacity to detect the range of antibiotics, anti-parasitic, anti-inflammatory, growth promoting and mycotoxin residues simultaneously in a range of food and feed samples.

AOAC’s annual meeting is taking place this September in Denver. The meeting organises scientific sessions, roundtable discussions, workshops and poster presentations discussing a variety of analytical methods and requirements. Attended by scientists from across the world the conference discusses science at a different level.

At AOAC Denver you will get the opportunity to speak to our experts on the Biochip Array Technology. By visiting booth #416 you will get an introduction to BAT and find out how the technology can perfectly fit any of your screening needs.

To learn more about Biochip Array Technology contact info@randoxfooddiagnostics.com or stop by Booth #416 at AOAC Denver 2019 and chat the Randox Food team!

Find out more about AOAC.

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Flexible Drug and Alcohol Testing Methods

06 August 2019

Flexible Drug and Alcohol Testing Methods

At Randox Testing Services our complete testing solutions include flexible drug and alcohol testing methods that can be tailored to meet our customer needs. In all aspects of testing we ensure the accuracy and reliability of results and utilise strict chain of custody procedures across all our testing methods.

To guarantee the most effective form of testing our dedicated Account Managers make informed recommendations to our customers on what type of testing best suits their business needs. The different methods are outlined below along with the sample types that can be tested:

Drug and Alcohol Testing Methods

  • Abstinence Monitoring

Conducted as a follow up on a confirmed positive drug or alcohol test. If an employer provides support to an employee who has had a confirmed positive drug or alcohol test, this type of testing may be used to help with rehabilitation.

  • Post-Incident

Used to determine if drugs or alcohol may have contributed to an accident/incident in the workplace. This type of testing can be an effective tool in accident investigations and it is our recommendation that should an incident occur, all employees involved should be tested.

  • Pre-Employment

This is the most popular type of workplace testing especially in industries which have safety critical roles. This type of testing is an essential part of a company’s recruitment process and clearly states the company’s position on drug and alcohol misuse for any potential employee.

  • Random

A popular type of testing within workplaces as it acts as a deterrent to drug and alcohol abuse. A company’s drug and alcohol testing policy should clearly outline that they carry out random workplace testing ensuring employees do not know when the event is planned.

  • With-Cause

Performed when a company is suspicious that an employee may be currently under the influence of alcohol or misusing drugs. This suspicion is normally raised if an employee is acting out of character and there has been observed different behaviours.

Sample Types

  • Urine (Alcohol and Drugs)

The most common sample type for drug testing and offers a longer detection window than oral fluid for drugs.

  • Oral Fluid (Drugs only)

Oral fluid testing analyses a saliva sample for parent drugs and their metabolites, providing analysis of short-term drug abuse.

  • Hair (Alcohol and Drugs)

A hair drugs test offers a longer window of detection than alternative testing and can provide a detailed view or overall picture of drug use. Detection window is based on hair length with 1cm of head equating to approximately 1 month of detection.

  • Breath (Alcohol only)

Breath can be tested for alcohol using hand-held devices which provide immediate results. These devices can gauge blood alcohol content (BAC) by measuring deep lung air.

About Randox Testing Services

Randox Testing Services is a market leader in the drug and alcohol testing industry. Our expertise is relied upon by a range of leading safety-critical companies across the world.

We pride ourselves on helping our customers improve the health and safety of their working environment through helping them implement a comprehensive substance misuse policy. Our expertise within this industry allows us to craft customised packages to meet the testing needs of any workplace. Our drug and alcohol testing methods are flexible to adapt to any changes and our testing processes are accurate, to guarantee reliable results.

Contact us today be at testingservices@randox.com or call 028 9445 1011 to speak to one of our experts.

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Drugs of Abuse – A Global Pandemic

4th September 2019

Drugs of Abuse – A Global Pandemic

The prevalence of drug addiction and abuse across the globe has become a growing concern. It is currently estimated that 71 million people use drugs of abuse with around 166,000 direct deaths occurring from drug use in 2017.

The WHO (World Health Organisation) estimate that 11 million people inject drugs across the globe, of which 1.3 million are living with HIV, 5.5 million with hepatitis C, and 1 million with both HIV and hepatitis C. In addition to infectious disease, long term drug abuse increases the risk of several cancers, cardiovascular effects, respiratory effects, gastrointestinal effects, kidney & liver damage and mental health issues.

The abuse of drugs is one of the most pressing issues in the USA and other countries globally. Drug abuse not only affects the individual, but can also have far-reaching consequences that affect family, employment, personal health, health care systems, local communities, and society as a whole.

Global Drug Abuse – The buzz that keeps on going!

> Misuse of illicit drugs affects society through secondary costs incurred such as crime, reduced productivity at work, and health care expenses.

> Substance abuse costs the US health care system about $11 billion, with overall costs reaching $193 billion.

> Substance abuse and addiction also affects other areas of life leading to broken families, destroyed careers, death due to negligence or accident, domestic violence, physical abuse and child abuse.

> Drug abuse and addiction changes the chemistry of your brain. The longer an individual abuses drugs, the more damage is caused, making it more difficult to return to ‘normal’ during drug rehabilitation.

> Treating and tackling drug addiction is a challenge. As drug treatment and health services continue to fall short, there is an increased need to continuously adapt drug detection and analysis.

Randox laboratories are at the forefront, aiding the fight against drugs of abuse with a comprehensive range of 10 drugs of abuse assays including several stimulants, sedatives and opioids available to run on Randox’s very own clinical chemistry analysers, the RX series. To find out now how Randox is helping to tackle the ongoing prevalence of drugs of abuse click here or buy directly from the Randox Online Store.

About Randox Laboratories

    As a world leader in the in-vitro diagnostic industry with over 35 years’ experience, Randox is leading the charge in moving from a one-size-fits-all approach towards decisions, practices and products tailored to the needs of the individual.  This innovative approach to diagnostics has facilitated the development of revolutionary products designed specifically to enhance a patients’ quality of life.

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    Contact us or visit our Drugs of Abuse pages to learn more.

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    • References


    What Do You Know about Dehydration?

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    News       Getting Fit        Eating Healthy

    02 August 2019

    What do you know about Dehydration?

    Dehydration: Do you know the signs?

    Dry mouth with thick saliva, headaches, feeling sleepy or irritable, weakness, dizziness made worse when you are standing… sounds like a hangover, right? These are actually all symptoms of early to mild dehydration.

    While not a hangover, this can happen from drinking alcohol as it suppresses your production of a hormone called vasopressin. This hormone would normally tell your kidneys to reabsorb water rather than passing it along to your bladder – which explains the ten trips to the bathroom on a night out –  and also makes your hangover worse the next day. Below are a list of dehydration signs to look out for:

     

     

    Early or mild dehydration include:

    • Flushed face
    • Extreme thirst or unable to drink
    • Dry, warm skin
    • Can’t pass urine or reduced amounts, dark yellow colour
    • Dizziness, made worse when you are standing
    • Feeling Weak
    • Cramping in the arms and legs
    • Sleepy or irritable
    • Headaches
    • Dry mouth with thick saliva

    Moderate to severe dehydration include:

    • Heart failure
    • Low blood pressure
    • Fainting
    • Convulsions
    • Sunken dry eyes
    • Fast but weak pulse
    • Severe muscle contractions in the arms, legs or back
    • Bloated stomach
    • Skin loses its firmness and looks wrinkled
    • Rapid and deep breathing – faster than normal
    • Lack of elasticity of the skin

    Are you at risk?

    While anyone can become dehydrated, there are certain groups that are particularly at risk such as infants, older people, diabetics and athletes. But what can you do to prevent dehydration? Drink plenty of fluids. Water is the best fluid to drink when dehydrated but also having a non-fizzy, low sugar sports drink will help to replace electrolytes that have been lost. These are minerals the body needs such as chloride, calcium, magnesium, sodium and potassium. Long term dehydration can have serious effects on your health.

     

    Randox Health: What We Do

    Randox Health packages go beyond a health check. We have the world’s most comprehensive full-body health programmes available on the market today, thanks to Randox Biochips which enable hundreds of individual tests to be carried out from one sample and giving you truly unrivalled knowledge about your health and wellbeing both now and in the future. Our goal is to help you extend your life. Your health matters to us and, above all, we are committed to improving healthcare worldwide by identifying and preventing illness at the earliest possible stage.

     

    How we can help you? 

    Identifying the very first signs and risks of disease can help prevent health problems that may be on the horizon. Randox Health aim to do this before the appearance of unpleasant symptoms or illness. Prevention is always better than cure. Long-term mild dehydration may have caused damage to your health and our packages tests for up to 350 different biomarkers. Read about our packages here, or contact a member of our team for more information!

    Want to know more?

    Contact us or visit our Randox Health page to view more.

    Our Randox Health programmes

    Everyman

    Everywoman

    Signature

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    Randox Food Diagnostics to attend Apimondia 2019 in Montreal

    Randox Food Diagnostics will be attending Apimondia 2019 in Montreal, Canada from the 8th – 12th September.

    Apimondia is the International Federation of Beekeepers’ Association. Its major objective is to facilitate the exchange of information and discussions within the honey industry by organising seminars where beekeepers, scientists, honey-traders, agents for development, technicians and legislators meet to listen, discuss and learn from one another.

    In order to help the honey industry Randox Food Diagnostics have developed Biochip Array Technology. Biochip allows for the detection of multiple antibiotics / antimicrobials / pesticides from a single honey sample.

    Antibiotics such as oxytetracycline are essential for the control of bacterial diseases of agricultural plants. Most applications are by spray treatments in orchards therefore bees collecting nectar from treated plants causes antibiotic residues to transfer to the honey.

    It has previously been idenitified that antibiotic-resistant bacteria can be found in the guts of insects feeding on a variety of plants, which are not exposed to significant levels of antibiotics in other forms. K Ignasiak 2016 Insects are responsible for the pollination of most flowering plants. Importantly, insects have an economic role, as domesticated pollinators bees alone contribute between $1.6 and $5.7 billion to US agriculture alone. This exposure to antibiotic residues can cause adverse health effects in humans via honey consumption and in the long term create antibiotic resistance within the entire food chain.

    Randox offer a vast number of arrays for the detection of antimicrobials in honey including: sulphonamides, trimethoprim, dapsone, Quinolones, streptomycin, tetracyclines, erythromycin, nitroimidazoles and many more. Our Biochip platform enables the user to run up to 54 honey samples on the Evidence Investigator analyser in under 2 hours 30 minutes, allowing the user to consolidate costs and time.

    See our full range of arrays for the detection of antibiotics on Biochip Array Technology:

    AM I Ultra

    AM II Plus

    AM III

    AM IV

    AM V

    AM Cap Only

    Stop by booth B1 at Apimondia to find out about the Randox Food Diagnostics range of products for the screening of antibiotics in honey.

    For further information please email info@randoxfooddiagnostics.com

     


    Total Bile Acids: The Value of Fifth Generation Tests

    22 July 2019

    Total Bile Acids: The Value of Fifth Generation Tests

    Bile acids are water-soluble, amphipathic end products of cholesterol metabolism and are involved in liver, biliary and intestinal diseases. They are formed in the liver and are absorbed in the small intestine before being excreted. The fundamental role of bile acids is to aid in the digestion and absorption of fats and fat-soluble vitamins in the small intestine.1

    Intrahepatic Cholestasis of Pregnancy

    Intrahepatic cholestasis of pregnancy (ICP) is a pregnancy-specific liver disorder. It can be indicated by pruritus, jaundice, elevated total bile acids and/or serum transaminases and usually affects women during the second and third trimester of pregnancy.2,3

    Intrahepatic Cholestasis of pregnancy or Obstetric Cholestasis is a condition that restricts the flow of bile through the gallbladder resulting in a build-up of bile acids in the liver.3 Due to the build-up, bile acids leak into the bloodstream where they are detected at concerning levels. It is an extremely serious complication of pregnancy that can lead to the increased risk of premature birth or even stillbirth, as such it is vital that women with the disease are monitored carefully.

    In healthy pregnancies, there is very little increase in total bile acid levels although a slight increase is likely to be seen in the third trimester. Measurement of total bile acids in serum is thought to be the most suitable method of diagnosing and monitoring ICP.6

    According to several reports total bile acid levels in ICP can reach as high as 100 times the upper limit of a normal pregnancy. It has been reported that a doubling in maternal serum bile acids, results in a 200% increased risk of stillbirth with total bile acids thought to trigger the onset of preterm labour. Additionally, bile acids can affect the foetal cardiovascular system as it has been found that there are often cardiac rhythm disturbances in the foetus due to the elevated bile acids in circulation.5

    Although it is a rare condition, with only 0.3-0.5% of women likely to develop ICP, it can have extreme risks and so it is important to properly diagnose and monitor the condition.6 ICP increases the risk of meconium staining of the amniotic fluid and is reported to be a sign of foetal distress. This complication is found in 16-58% of all ICP cases, worryingly 100% of cases have resulted in foetal death. The frequency of this condition is found to be greater in pregnancies with higher levels of serum total bile acids.

    Did you know?

    Liver disease is the only major cause of death still increasing every year with 2 million deaths per year being caused by it.4

    Risk factors

    There are several risk factors associated with ICP such as a family history of ICP, use of oral contraceptives, assisted reproduction techniques and multiple gestation. Genetic influence accounts for approximately 15% of ICP cases. Dietary selenium is a contributing environmental factor as serum selenium levels often decrease throughout pregnancy. Further to this, incidences of ICP rise in the winter months, most likely due to the fact selenium levels are naturally less during these months.7,8

    Total Bile Acids

    In addition to ICP, bile acid levels are also measured in the diagnosis of other liver disorders. The bile acids test in an extremely sensitive indicator of liver function, capable of detecting changes in hepatic function before clinical symptoms arise, thus providing valuable information that standard liver function tests cannot. As a result of its high sensitivity, bile acids can be used to assess liver function in transplant patients, allowing monitoring of the transplant success and of antirejection therapy. The bile acids test is most beneficial when used in conjunction with standard liver function tests such as ALT and AST which are markers of liver damage rather than liver function.

    Measurement of Total Bile Acids

    The enzyme cycling method, also known as the Fifth Generation Bile Acids test, is a method that allows for signal amplification through cycled regeneration reactions as can be seen in Figure 1. In the presence of Thio-NAD, the enzyme 3-α hydroxysteroid dehydrogenase (3-α  HSD) converts bile acids to 3-keto steroids and Thio-NADH.  The reaction is reversible and 3-α  HSD can convert 3-keto steroids and Thio-NADH to bile acids and Thio-NAD.  In the presence of excess NADH, the enzyme cycling occurs efficiently and the rate of formation of Thio-NADH is determined by measuring specific change of absorbance at 405 nm and is proportional to the amount of total bile acids in the sample. The analysing capability of the fifth generation total bile acids assay is far beyond the performance of conventional bile acid tests.10,11

    Figure 1: The assay principle

    Inadequacies of Traditional Bile Acids Assays

    Determining the cause and extent of liver damage is important in guiding treatment decisions and preventing disease progression. Standard liver function tests include; ALT, AST, ALP, GGT and Bilirubin. The measurement of TBA is most beneficial in conjunction with these standard liver tests and offers unrivalled sensitivity allowing identification of early stage liver dysfunction. There are several commercial methods available for the detection and measurement of TBA in serum. Traditional TBA tests based on the enzymatic method use nitrotetrazolium blue (NBT) to form a formazan dye. The reaction is measured at 546nm and the intensity of the colour is proportional to the concentration of bile acids.

    Newer methods such as the enzyme cycling method or fifth generation methods offer many advantages including greater sensitivity, liquid reagents, small sample volumes and reduced instrument contamination from formazan dye. Additionally, the fifth generation assay does not suffer from interference from lipaemic or haemolytic samples. Both lipemia and haemolysis are common in new-borns and pregnant women, so this further supports that the fifth generation test is more sensitive for these sample types.12

    Want to know more?

    Contact us or download our total bile acids whitepaper

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    • References

      [1] The continuing importance of bile acids in liver and intestinal disease. A.f., Hofmann. 1999, Arch Intern Med, pp. 2647-2658.

      [2] Diagnostic and Therapeutic Profiles of Serum Bile Acids in Women with Intrahepatic Cholestasis of Pregnancy – A Pseudo-Targeted Metabolomics Study. Cui, Yue. Xu, Biao. Zhang, Xiaoqing. He, Yifan. Shao, Yong. Ding, Min. s.l. : Clinica Chimica, 2018, Vol. 483.

      [3] Randox Laboratories. Bile Acids Test for Obstetric Cholestasis – A serious complication of pregnancy. 2012.

      [4] British Liver Trust (2019) Facts about Liver Disease, Available at: https://www.britishlivertrust.org.uk/about-us/media-centre/facts-about-liver-disease/ (Accessed: 18th June 2019).

      [5] .Geenes, Victoria. Williamson, Catherine. 17, s.l. : World J Gastroenterol, 2009, Vol. 15.

      [6] Howland, Genevieve. Cholestasis of Pregnancy: Why You Can’t Ditch the Itch. Mama Natural. [Online] December 22, 2018. [Cited: February 19, 2019.] https://www.mamanatural.com/cholestasis-of-pregnancy/.

      [7] Bile Acid Levels and Risk of Adverse Perinatal Outcomes in Intrahepatic Cholestasis of Pregnancy: A Meta-Analysis. Cui, Donghua, et al.

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      [11] Evaluation of a Colorimetric Enzymatic Procedure for Determining the Total Bile Acids in the Blood. Agape, V, et al. 3, s.l. : Minerva Gastroenterologica e Dietologica, 1989, Vol. 35.

      [12] Total Bile Acids Test & Clinical Diagnosis. Diazyme. 2019.


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