Gestión de calidad en equipos de gases en sangre POCT. Expandiendo las fronteras del laboratorio / Quality management in POCT blood gas equipment. Expanding the frontiers of the laboratory

La realización de pruebas de laboratorio en el lugar de atención del paciente (POCT) de equipos de gases en sangre representa un desafío continuo tanto para los usuarios como para el laboratorio. La vulnerabilidad al error y la amenaza del riesgo que rodea esta forma de trabajo obliga a establecer un sistema de trabajo robusto para la obtención de un "resultado confiable" cerca del paciente crítico. La formación de un grupo interdisciplinario, la capacitación de usuarios externos al laboratorio, el aseguramiento de la calidad analítica y la conectividad, son los cuatro pilares sobre los cuales se sostiene el éxito de esta nueva era de laboratorio clínico. Además es necesaria la reinvención de la imagen bioquímica, asumiendo un rol de líder, comunicador, asesor e integrado al sistema de salud (AU)

Point of care laboratory testing (POCT) with blood gas equipment is an ongoing challenge for both the users and the laboratory. The vulnerability to error and the threat of risk that surrounds this way of working necessitates the establishment of a robust working system to obtain "reliable results" for the critically ill patient. The creation of an interdisciplinary group, the training of external users, analytical quality assurance, and connectivity are the four pillars on which the success of this new era of clinical laboratories is based. It is also necessary to reinvent the biochemical image, assuming the role of leader, communicator, and advisor integrated into the health system (AU)

Associations of chronotype and social jetlag with eating jetlag and their changes among German students during the first COVID-19 lockdown. The Chronotype and Nutrition study.

Due to their biologically later chronotype, young students are vulnerable to a discrepant sleeping pattern between work- and free days, coined social jetlag (SJL). This study examined whether a later chronotype and/or a larger SJL are related to an analogous discrepancy in meal timing defined as eating jetlag (EJL) and whether chronotype and/or changes in SJL during the first COVID-19 related lockdown in Germany associated with changes in EJL. Baseline data were collected from September 2019-January 2020 among 317 students (58% females) aged 18-25 years of which a total of 156 students (67% females) completed an online follow-up survey in June-July 2020 (1st lockdown). Data were collected on daily routines, timing of meals/snacks, and physical activity. Chronotype was determined using the Munich ChronoType Questionnaire; SJL and EJL correspond to the difference in the daily midpoint of sleep/eating duration between work- and free days. Multivariable linear regression revealed that students with a later chronotype or a larger SJL experienced a larger EJL (padjusted = 0.0124 and padjusted<0.0001). A later chronotype at baseline and reductions in SJL during lockdown associated with concurrent reductions in EJL (padjusted = 0.027 and padjusted<0.0001). In conclusion, students with a later chronotype exhibit a more erratic meal pattern, which associates with SJL. During lockdown, flexible daily schedules allowed students to align the meal timing with their inner clock.

Association between habitual coffee consumption and metabolic syndrome in type 1 diabetes.

BACKGROUND AND AIMS: In the general population, habitual coffee consumption is inversely associated with the metabolic syndrome, a syndrome that is rather common also in patients with type 1 diabetes. However, whether coffee intake is beneficially related to the metabolic syndrome also in type 1 diabetes, is not known. We, therefore, studied the potential association between coffee consumption and the metabolic syndrome in a large population of individuals with type 1 diabetes. Furthermore, we investigated whether coffee consumption is associated with insulin resistance (estimated glucose disposal rate, eGDR), kidney function (estimated glomerular filtration rate, eGFR), and low-grade chronic inflammation (high-sensitivity C-reactive protein, hsCRP). METHODS AND RESULTS: Data from 1040 participants in the Finnish Diabetic Nephropathy Study were included in these cross-sectional analyses. Metabolic syndrome was assumed if at least 3 of the following cardiovascular risk factors were present: central obesity, high blood pressure, low HDL-cholesterol concentration, high triglyceride concentration, and hyperglycaemia. Subjects were categorized based on self-reported daily coffee intake: non-consumers (<1 cup/d), low (≥1 cups/d < 3), moderate (≥3 cups/d < 5), and high coffee consumption (≥5 cups/d). In multivariable logistic regression analysis, moderate and high coffee consumption was associated with increased odds of the metabolic syndrome. Moreover, any level of coffee consumption was associated with increased risk of the blood pressure-component. An increasing trend was observed in the eGFR with increasing coffee consumption. CONCLUSIONS: In type 1 diabetes, high coffee intake is associated with the metabolic syndrome, and especially its blood pressure-component.

Caffeine potentiates the release of GABA mediated by NMDA receptor activation: Involvement of A1 adenosine receptors.

Caffeine, a methylated derivative of xanthine and widely consumed psychoactive substance, acts in several targets in the nervous system. We investigated its role in retinal explants of chick embryo analyzing the role of purinergic receptors in [(3)H]-GABA release induced by d-aspartate (d-asp). d-Asp increases GABA-release 4.5-fold when compared to basal levels from 13-day-old chick embryo retinal explants. Caffeine 500µM elevated d-asp-induced GABA release in 60%. The release was inhibited in the presence of NNC-711, a GABA transporter-1 (GAT-1) blocker or by MK-801, an N-methyl-d-aspartate receptor (NMDAR) antagonist. Caffeine did not modify [(3)H]-GABA uptake carried out for 5, 10, 30 and 60min and did not increase the release of d-asp or glutamate at basal or stimulated conditions. The caffeine effect was mimicked by the adenosine A1 receptor antagonist DPCPX and by the adenylyl cyclase (AC) activator forskolin. It was also blocked by the protein kinase A (PKA) inhibitor H-89, tyrosine kinase inhibitor genistein or by the src family kinase (SFK) inhibitor PP1. Forskolin-stimulated cyclic adenosine monophosphate (cAMP) levels were reduced in the presence of the A1 receptor agonist CHA. Western blot analysis revealed that 500µM caffeine increased phosphoGluN2B expression levels in approximately 60% when compared to total GluN2B levels in embryonic E13 retina. The GluN2B subunit-containing NMDAR antagonist ifenprodil inhibited the caffeine effect. Our results suggest that caffeine potentiates d-asp-induced GABA release, which is mediated by GAT-1, via inhibition of adenosine A1 receptor and activation of the PKA pathway. Regulation of NMDAR by phosphorylation of GluN2B subunit by a SFK may also be involved in the effect promoted by caffeine.

The effects of footshock and immobilization stress on tyrosine hydroxylase phosphorylation in the rat locus coeruleus and adrenal gland.

Tyrosine hydroxylase (TH), the rate-limiting enzyme in catecholamine biosynthesis, is regulated acutely by protein phosphorylation. No studies have systematically investigated the time course of TH phosphorylation in vivo in response to different stressors. We therefore determined the extent of TH phosphorylation at Ser19, Ser31, and Ser40 over a 40-min period in response to footshock or immobilization stress in the rat locus coeruleus and adrenal medulla. There were significant changes in TH phosphorylation in both tissues and the responses to the two stressors differed markedly. With each of the phosphorylation sites immobilization stress caused a much smaller, or less sustained, response than footshock stress. With immobilization stress there was a transient increase in Ser31 phosphorylation in the locus coeruleus and in the adrenal medulla, but there were no effects on Ser19 or Ser40 phosphorylation. With footshock stress there was a substantial decrease in Ser19 phosphorylation over time, a substantial increase in Ser31 phosphorylation over time, but there were no effects on Ser40 phosphorylation. Measuring TH phosphorylation at Ser19, Ser31, and Ser40 over time can therefore be used as a sensitive index to differentiate the effects of different stressors on catecholaminergic cells.

Excellent agreement between genetic and hydrogen breath tests for lactase deficiency and the role of extended symptom assessment.

Clinical manifestations of lactase (LCT) deficiency include intestinal and extra-intestinal symptoms. Lactose hydrogen breath test (H2-BT) is considered the gold standard to evaluate LCT deficiency (LD). Recently, the single-nucleotide polymorphism C/T(-13910) has been associated with LD. The objectives of the present study were to evaluate the agreement between genetic testing of LCT C/T(-13910) and lactose H2-BT, and the diagnostic value of extended symptom assessment. Of the 201 patients included in the study, 194 (139 females; mean age 38, range 17-79 years, and 55 males, mean age 38, range 18-68 years) patients with clinical suspicion of LD underwent a 3-4 h H2-BT and genetic testing for LCT C/T(-13910). Patients rated five intestinal and four extra-intestinal symptoms during the H2-BT and then at home for the following 48 h. Declaring H2-BT as the gold standard, the CC(-13910) genotype had a sensitivity of 97% and a specificity of 95% with a κ of 0.9 in diagnosing LCT deficiency. Patients with LD had more intense intestinal symptoms 4 h following the lactose challenge included in the H2-BT. We found no difference in the intensity of extra-intestinal symptoms between patients with and without LD. Symptom assessment yielded differences for intestinal symptoms abdominal pain, bloating, borborygmi and diarrhoea between 120 min and 4 h after oral lactose challenge. Extra-intestinal symptoms (dizziness, headache and myalgia) and extension of symptom assessment up to 48 h did not consistently show different results. In conclusion, genetic testing has an excellent agreement with the standard lactose H2-BT, and it may replace breath testing for the diagnosis of LD. Extended symptom scores and assessment of extra-intestinal symptoms have limited diagnostic value in the evaluation of LD.

Correlation between symptoms developed after the oral ingestion of 50 g lactose and results of hydrogen breath testing for lactose intolerance.

BACKGROUND: Lactase deficiency is a common condition responsible for various abdominal symptoms. Lactose hydrogen breath test is currently the gold standard in diagnosing lactose intolerance. AIM: To assess sensitivity and specificity of symptoms developed after oral lactose challenge. METHODS: Intensity of nausea, abdominal pain, borborygmi, bloating and diarrhoea was recorded every 15 min up to 3 h after ingestion of 50 g lactose in patients with positive (i.e. breath H2-concentration > or =20 p.p.m. above baseline) and negative lactose hydrogen breath test. RESULTS: Between July 1999 and December 2005, 1127 patients (72% females) underwent lactose hydrogen breath test. A positive result was found in 376 (33%). Sensitivity of individual symptoms ranged from 39% (diarrhoea) to 70% (bloating) while specificity ranged from 69% (bloating) to 90% (diarrhoea). A positive lactose hydrogen breath test was found in 21% of patients with one symptom, 40% of patients with two symptoms, 44% of patients with three symptoms, 67% of patients with four symptoms and 82% of patients with five symptoms. Symptom intensity was significantly higher for each symptom in the positive group. CONCLUSION: Evaluating symptoms developed after ingestion of 50 g lactose can be used as a simple screening test to select patients who need to be referred for lactose intolerance testing.

Clinical trial: effects of tegaserod on gastric motor and sensory function in patients with functional dyspepsia.

BACKGROUND Tegaserod, a serotonin receptor type-4 partial agonist, stimulates gastrointestinal motility and has been shown to increase gastric volumes before and after a meal in healthy volunteers. Its effect on gastric motor and sensory function in patients with functional dyspepsia is unclear. AIM To evaluate the effects of tegaserod on gastric compliance, accommodation and gastric sensory function in patients with functional dyspepsia and healthy volunteers. METHODS Sixteen patients with functional dyspepsia and 12 healthy volunteers were studied on two occasions, each after a 7-day treatment with either placebo or tegaserod 6 mg b.d. using a double-blind, randomized, crossover design. After each treatment period a gastric barostat study was performed fasting and during intraduodenal lipid infusion. RESULTS Tegaserod increased postprandial gastric compliance in functional dyspepsia patients (P = 0.04). Healthy volunteers showed enhanced postprandial gastric compliance after placebo (P = 0.03). Between-treatment analysis of gastric accommodation revealed a significant increase in intrabag volumes after tegaserod in healthy volunteer (P = 0.04); no difference could be seen in functional dyspepsia patients. Tegaserod had no effect on gastric sensation. CONCLUSIONS Tegaserod enhances postprandial gastric compliance in functional dyspepsia patients and gastric accommodation in healthy volunteers. The improvement of proximal gastric motor function suggests a beneficial role of tegaserod in patients with functional dyspepsia.

The effects of tegaserod on oesophageal function and bolus transport in healthy volunteers: studies using concurrent high-resolution manometry and videofluoroscopy.

BACKGROUND: Tegaserod is a partial 5-hydroxytryptamine 4 receptor agonist with prokinetic effects on the gastrointestinal tract, its effects on oesophageal function are unknown. AIM: A randomized, placebo controlled, double-blind trial assessed the effect of tegaserod on the oesophagus in healthy, asymptomatic subjects. METHOD: A 7-day course of tegaserod 6 mg b.d. vs. placebo was prescribed (n = 17/21 completed both phases of study). High-resolution manometry and pH measurements were performed before and after a test meal. Bolus transport of liquids and solids was studied by high-resolution manometry and videofluoroscopy. RESULTS: Tegaserod had no effect on lower oesophageal sphincter pressure compared with placebo, peristaltic velocity increased (P < 0.001) and distal contractile pressure decreased slightly (P < 0.05). Transient lower oesophageal sphincter relaxations and reflux were infrequent regardless of treatment. During the studies of bolus transport, high-resolution manometry revealed that tegaserod promoted mid-oesophageal contractility (P < 0.02) and shortened the 'proximal transition zone' (P < 0.05), the level where bolus escape occurred most frequently. These effects had no effect on liquid bolus transport; however a non-significant trend to improved solid bolus transport was observed (66% vs. 31%;P = 0.07). CONCLUSION: Tegaserod did not alter lower oesophageal sphincter pressure, but had significant effects on peristaltic function. High-resolution manometry promoted mid-oesophageal contractility during bolus transport. This effect was associated with a non-significant trend to improved solid bolus transit.

The pathophysiology of faecal spotting in obese subjects during treatment with orlistat.

BACKGROUND: The intermittent loss of oil or liquid faeces ('spotting') is an adverse effect that occurs in obese patients during treatment with the lipase inhibitor orlistat; the pathophysiology is unknown. AIM: To investigate the effects of orlistat on anorectal sensorimotor function and continence. METHODS: Obese subjects susceptible to spotting were identified by an unblind trial of orlistat. Obese spotters (n = 15) and non-spotters (n = 16) completed a randomized, double-blind, cross-over trial of orlistat and placebo. Anorectal function was assessed by rectal barostat and anal manometry, together with a novel stool substitute retention test, a quantitative measurement of faecal continence. RESULTS: Orlistat increased stool volume and raised faecal fat and water. Treatment had no effect on anorectal motor function, but rectal sensation was reduced; on retention testing, the volume retained was increased. Subjects susceptible to spotting had lower rectal compliance, heightened rectal sensitivity and weaker resting sphincter pressure than non-spotters. On retention testing, gross continence was maintained; however, spotters lost small volumes of rectal contents during rectal filling. CONCLUSION: Treatment with orlistat has no direct adverse effects on anorectal function or continence. Spotting occurs during treatment with orlistat when patients with sub-clinical anorectal dysfunction are exposed to increased stool volume and altered stool composition.

[The nursing technician: profile developed by professionals of the area]. / Técnico de enfermagem: o perfil traçado por profissionais da área.

The purpose of the present investigation is to recognize the basis of qualification and the nuances that permeate the performance of the nursing technicians, at the present time, in the district of Uberlândia. Qualitative research, having as reference the analysis of discourse, was the methodology chosen, and semi-structured interviews were used for data collection. The analysis was based on four categories: education-work, curriculum, professional identity and expectations. Starting from a detailed study of these categories, it was possible to evaluate education-work relationship in nursing technical courses, aspects related to the regulation and exercise of nursing work in Brazil, the importance of the curriculum in the organization of knowledge experiences; the meaning and influences of this work on the construction of professional identity. Finally, this research has also as its objective draw a profile of the nurse technician based on the analysis of their performance at work and the way this professional relates to his/her work.

[Magnesium therapy in preeclampsia and HELLP syndrome--studies of pathophysiology]. / Magnesiumtherapie bei Präeklampsie und beim HELLP-Syndrom--Untersuchungen zur Pathophysiologie.

Aggregation und Serotonin-release were investigated depending on plasma magnesium levels. High magnesium levels inhibit the platelet function, which is stimulated in preeclamptic patients. Magnesium-infusions therefore might be of therapeutical use in SIH-patients by reducing the platelet function.

[Successful treatment of anemia in hemolysis patients using recombinant human erythropoietin. Maintenance dosage and serum concentration]. / Erfolgreiche Behandlung der Anämie bei Hämodialyse-Patienten mit rekombiniertem humanem Erythropoietin. Erhaltungsdosis und Serumkonzentration.

Recombinant human erythropoietin (r-huEpo) was administered i.v. to eight anemic patients on hemodialysis in increasing doses 3 times a week. 7 out of 8 patients showed an increase in hemoglobin level by 2 g/dl over the baseline of 7.9 +/- 0.8 g/dl after a mean period of 8 +/- 2 weeks. During treatment a cumulative dose of 692 +/- 358 IU/kgBW erythropoietin was given. Before the rise in hemoglobin, reticulocytes increased from 1.6 +/- 0.7% initially to 5 +/- 1.6%. The serum ferritin concentration decreased from 426 (range 19-1223) to 250 (5-707) micrograms/l. No side effects were observed. Mean blood pressure before dialysis increased slightly from 125 mmHg to 137 mmHg systolic, and diastolic pressure from 75 to 80 mmHg. Maintenance doses to maintain hemoglobin values between 10 und 12 g/dl varied from 2 X 72 IU/kgBW to 3 X 168 IU/kgBW per week. Measurement of serum levels of erythropoietin by radioimmunoassay showed deficiency of the hormone in the patients with chronic renal failure: before treatment mean serum values were 4 +/- 6.4 mU/ml and during maintenance doses with r-huEpo 33.7 +/- 8.1 mU/ml, which is within normal ranges related to hematocrit. These data show erythropoietin to be effective in ameliorating anemia during hemodialysis treatment.

[Seldinger's technic of puncture of the internal jugular vein in a patient with a coagulation disorder. Report of a fatal complication]. / Punktion der Vena jugularis interna nach Seldinger bei einer Patientin mit Gerinnungsstörung. Bericht über eine tödliche Komplikation.

It is reported that the catheterization of the internal jugular vein in patients with severe coagulopathies had fatal consequences. The catheterization was done with a Sheldon-catheter for dialysis. The technique of Seldinger was performed, which has been described for morbid patients in most literatures.

[Feasibility of the in vitro evaluation of bioavailability. 3: Method of operation of a newly-developed absorption model and results obtained with it]. / Möglichkeiten zur in-vitro-Beurteilung der Bioverfügbarkeit. 3: Mitteilung: Funktionsweise eines neu konstruierten Resorptionsmodells und damit erhaltene Ergebnisse.

In connection with the function of a newly constructed absorption model the problem of interpretation of values obtained by models in regard of bioavailability is discussed. Wrong interpretations can be obtained if nonanalogous values are compared. An interpretation is proposed to calculate a value which is analogous to the relative bioavailability (calculated bioavailability). The efficiency of the absorption model and of the interpretation method is demonstrated by three examples of preparations of phenytoin, digoxin and chloramphenicol. We compared these results with the bioavailability of these preparations and we found a good correspondence.