Métodos para la determinación del estado del magnesio en humanos / Methods of assessment of magnesium status in humans / Métodos para a determinação do estado do magnésio em humanos

En la actualidad, datos epidemiológicos sugieren que, en países occidentales, la ingesta de magnesio no satisface la ingesta recomendada, lo que apoya un riesgo de deficiencia de magnesio latente en estas poblaciones. La evaluación del estado de magnesio sigue siendo un desafío para el laboratorio clínico ya que el magnesio se encuentra distribuido mayoritariamente en el hueso y tejidos blandos. Existe la necesidad de conciliación entre una prueba de fácil acceso, rápida, sensible y representativa del magnesio intracelular. La utilidad de diferentes biomarcadores en sujetos sanos ha sido evaluada; se ha reportado que el magnesio en plasma, eritrocitos y orina parecen ser biomarcadores sensibles a la ingesta dietética y útiles como biomarcadores en la población general. Sin embargo, esto no es concluyente, ya que se resalta que aún se requieren estudios mejor diseñados, que impliquen factores como mayor población empleada, dosis y tiempo de suplementación. El progreso en la genética y la genómica abren perspectivas interesantes en la búsqueda de estos biomarcadores que permitan cuantificar los niveles de magnesio celular así como también las reservas de todo el cuerpo, para poder así establecer recomendaciones dietéticas mejor ajustadas a la población.

Epidemiological studies suggest that dietary magnesium in the Western countries does not meet the recommended intake, supporting a risk of latent magnesium deficiency with Western diet behavior. Assessment of magnesium status remains a major challenge for the clinical laboratory, since, magnesium storage is mostly found in bone and soft tissues. The conciliation between an easy obtained sample, rapid and robust laboratory test, and the parameter representative for intracellular magnesium is extremely difficult to reach. In a current systematic review study, the usefulness of magnesium status biomarkers in healthy subjects has been evaluated. It is proposed that plasma and erythrocyte magnesium, and urinary magnesium excretion which respond to dietary manipulation appear to be useful biomarkers in the general population. However, it is emphasized that well-designed studies of sufficient size with varying doses and duration of magnesium supplementation are still required. The development of specific and sensible biomarkers, making it possible to obtain cell magnesium levels as well as body magnesium pool evaluation, relevant to study individuals, small and large populations, remains a major challenge for the assessment of magnesium status. A progress in genetics and genomics opens new interesting perspectives in the search of these biomarkers.

Na atualidade, dados epidemiológicos sugerem que, nos países ocidentais, a ingestão de magnésio não supre a ingestão recomendada, o que apoia um risco de deficiência de magnésio latente nestas populações. A avaliação do estado do magnésio continua sendo um desafio para o laboratório clínico, visto que o magnésio se encontra distribuído principalmente no osso e nos tecidos moles. Há a necessidade de conciliar evidência facilmente acessível, rápida, sensível e representativa do magnésio intracelular. A utilidade de vários biomarcadores em indivíduos saudáveis foi avaliada, e foi relatado que o magnésio em plasma, eritrócitos e urina parecem ser biomarcadores sensíveis à ingestão dietética e úteis como biomarcadores na população geral. No entanto, esta não é conclusiva, uma vez que se destaca que são requeridos ainda estudos melhor desenhados, envolvendo fatores como utilização de maior população, dosagem e tempo de suplementação. Um avanço na genética e na genômica abre perspectivas interessantes na busca desses biomarcadores para poder quantificar os níveis de magnésio celular bem como as reservas do corpo inteiro, e assim poder estabelecer melhores recomendações na dieta adaptadas à população.

"What took you so long?" The impact of PEPFAR on the expansion of HIV testing and counseling services in Africa.

HIV testing and counseling services in Africa began in the early 1990s, with limited availability and coverage. Fears of stigma and discrimination, complex laboratory systems, and lack of available care and treatment services hampered expansion. Use of rapid point-of-care tests, introduction of services to prevent mother-to-child transmission, and increasing provision of antiretroviral drugs were key events in the late 1990s and early 2000s that facilitated the expansion of HIV testing and counseling services. Innovations in service delivery included providing HIV testing in both clinical and community sites, including mobile and home testing. Promotional campaigns were conducted in many countries, and evolutions in policies and guidance facilitated expansion and uptake. Support from President's Emergency Plan for AIDS Relief and national governments, other donors, and the Global Fund for AIDS, Tuberculosis, and Malaria contributed to significant increases in the numbers of persons tested in many countries. Quality of both testing and counseling, limited number of health care workers, uptake by couples, and effectiveness of linkages and referral systems remain challenges. Expansion of antiretroviral treatment, especially in light of the evidence that treatment contributes to prevention of transmission, will require greater yet strategic coverage of testing services, especially in clinical settings and in combination with other high-impact HIV prevention strategies. Continued support from President's Emergency Plan for AIDS Relief, governments, and other donors is required for the expansion of testing needed to achieve international targets for the scale-up of treatment and universal access to knowledge of HIV status.

Potential for new technologies in clinical practice.

PURPOSE OF REVIEW: Cost-effective neurorehabilitation is essential owing to financial constraints on healthcare resources. Technologies have the potential to contribute but without strong clinical evidence are unlikely to be widely reimbursed. This review presents evidence of new technologies since 2008 and identifies barriers to translation of technologies into clinical practice. RECENT FINDINGS: Technology has not been shown to be superior to intensively matched existing therapies. Research has been undertaken into the development and preliminary clinical testing of novel technologies including robotics, electrical stimulation, constraint-induced movement therapy, assistive orthoses, noninvasive brain stimulation, virtual reality and gaming devices. Translation of the research into clinical practice has been impeded by a lack of robust evidence of clinical effectiveness and usability. Underlying mechanisms associated with recovery are beginning to be explored, which may lead to more targeted interventions. Improvements in function have been demonstrated beyond the normal recovery period, but few trials demonstrate lasting effects. SUMMARY: Technologies, alone or combined, may offer a cost-effective way to deliver intensive neurorehabilitation therapy in clinical and community environments, and have the potential to empower patients to take more responsibility for their rehabilitation and continue with long-term exercise.

Clinical and laboratory trends in fetal lung maturity testing.

BACKGROUND: The surfactant/albumin ratio is a popular fetal lung maturity (FLM) test that will be unavailable in the near future. We conducted surveys of obstetricians and clinical laboratorians to assess FLM testing trends from the perspectives of both disciplines and to identify how both communities might adapt to the loss of the surfactant/albumin ratio. METHODS: 2067 physicians were surveyed about their familiarity with and clinical utility of various FLM tests. 6137 laboratorians were surveyed about their FLM test menu and volumes. RESULTS: Twenty-five percent of physicians indicated a decrease in FLM test ordering and the frequency of FLM testing has decreased significantly (p=0.011) since 1998. The surfactant/albumin ratio is the most frequently offered FLM test and was the test of choice for 62% of physicians. Without the surfactant/albumin ratio, 68% of physicians would order the lecithin/sphingomyelin ratio and 44% would order the lamellar body count (LBC) which were offered by 18 and 13% of laboratories, respectively. 16% of laboratories were planning to offer the LBC within 24 months. CONCLUSIONS: FLM testing is decreasing. The loss of the surfactant/albumin ratio will increase the demand for the lecithin/sphingomyelin ratio and the LBC, yet few laboratories offer either test and most are not planning to offer the LBC.

Estudio del tiempo de procesamiento de un sistema preanalítico en un laboratorio de atención primaria / Study of the processing time of a preanalytical system in a primary care laboratory

Objetivo: adaptación del sistema preanalítico modular (MPA) conectado a un sistema modular analítico SWA (Roche Diagnostics) y estudio de la optimización del tiempo de procesamiento preanalítico basándose en cambios en el proceso de alicuotación. Material y métodos: descripción de la arquitectura y de la configuración funcional del sistema preanalítico. Estudio observacional basado en la carga de trabajo diaria, comparando los tiempos y las velocidades de procesamiento de las muestras tal y como está definido el sistema en la actualidad, con los que se obtendrían de 2 modelos teóricos basados en la agrupación de destinos correspondientes a los analizadores de inmunoquímica. Resultados: se comentan los cambios en el diseño inicial del sistema. El tiempo de procesamiento para una media de 1.364 especímenes/día es de 255,9 min. La velocidad de procesamiento resultante es de 319 especímenes/h para una media de 0,95 alícuotas/espécimen. El tiempo de procesamiento se reduce un 18,3% con la combinación más favorable de los modelos teóricos. Conclusiones: el diseño actual del sistema preanalítico se adecua a las características del laboratorio (volumen de muestras elevado y horario laboral limitado), aunque deben realizarse mejoras. Con el modelo teórico más favorable, no se disminuye suficientemente el tiempo de procesamiento como para permitir hacer una alícuota destinada al archivo de muestras. Se necesitan estudios suplementarios que incluyan el tiempo total de procesamiento de las muestras en los analizadores, para comprobar si una futura agrupación de analizadores de inmunoquímica y, en concreto, cuál de ellas aumentaría la eficiencia del proceso total(AU)

Objective: Adjustment of a Modular Preanalytics (MPA) and Modular Analytics System SWA (Roche Diagnostics) to our laboratory. A study was carried out in order to optimize the turnaround times of the process, changing the system configuration to reduce the number of aliquots. Material and methods: Description of the preanalytical system and its operational configuration. The study of turnaround times of the preanalytical process on the daily workload was compared with 2 theoretical models in which the serum destined for the immunoassay analyzers were grouped in 2 different ways. Results: There are comments about the changes in the initial design of the system. For an average workload of 1364 serum samples/day, the turnaround time of the current configuration was 255.9 min. The resulting rate was 319 samples/h with an average of 0.95 aliquots/sample. In the theoretical models, with the most favorable combination of aliquots, the reduction in turnaround time was 18.3%. Conclusions: The present design of the preanalytical system was adapted to the characteristics of our laboratory, with a large number of samples and with limited working hours, however, improvements should be made. Even the more favorable theoretical model does not allow us to make an aliquot for storage of serum in our work time. Additional studies are needed, including the total turnaround time of process in the immunoassay analyzers, to verify if a possible grouping of immunoassay analyzers and, in particular. which of them, will increase the efficiency of the overall analytical process(AU)

Investigación y cirugía / Research and surgery

A partir de la Segunda Guerra Mundial se ha producido un desarrollo sin precedentes en la ciencia y en la práctica médico-quirúrgicas: antibióticos, bancos de sangre, cirugía cardiaca, órganos artificiales, trasplante de órganos y de tejidos, reemplazamiento articular completo, alimentación parenteral total o cirugía mínimamente invasiva. Paradójicamente, durante las últimas dos décadas del siglo pasado, la apreciación pública de los médicos ha disminuido, a la vez que ha tenido lugar una serie de distorsiones: escalada de costes en la atención de la salud, cuestionamiento de los centros médicos académicos, pleitos por errores médicos o alza de las medicinas alternativas. La creciente complejidad de la investigación biomédica en la era continuamente cambiante de la biología molecular, ha promovido una actitud de escepticismo respecto a si los clínicos y en especial los cirujanos, pueden seguir contribuyendo a los avances médicos. El estudio de la historia de la medicina contemporánea pone de manifiesto que varios de los logros más significativos se deben a cirujanos. No cabe duda de que la ciencia y la clínica sabrán acomodarse a estos tiempos de cambio y continuarán generando importantes hallazgos. La práctica médico-quirúrgica de hoy está determinada por la investigación científica de ayer; mañana no será diferente

From the Second World War onwards an amazing development in science and clinical & surgery practice has taken place: antibiotics, blood storage, cardiac surgery, organ and tissue transplant, complete joint replacement, total intravenous nutrition or minimally invasive surgery. Paradoxically, during the last two decades of the XXth century, social popularity of doctors has decreased at the same time of some important changes: increases in costs of medical attention, trials against medical mistakes, some doubts on the real role of Academic Public Hospitals and rising in the importance of alternative medicine. Increasing complexity of biomedical research in the continuous changing age of molecular biology has promoted an increasing scepticism regarding clinics and surgeons are able to keep on contributing to medical advances. The study of the contemporaneous History of Medicine demonstrates that some of the more significant achievements have been accomplished by surgeons. Undoubtedly Science and Clinics must get adapted to these times of change and persist in generating important findings. Current Clinical and surgical practice is completely determined by yesterdayscientific research; tomorrow won´t be different

Direct access testing: nuts and bolts of starting DAT in a hospital environment.

Direct Access Testing (DAT) is a consumer-driven phenomenon that is sweeping the country. It is a highly controversial subject, the implementation of which requires methodical planning and development to be successful. DAT's purpose is to allow the consumer to order a battery of laboratory tests previously available only with a physician's order. With proper planning, DAT can be beneficial to a medical facility in a number of ways. Whether introduced to a hospital or an integrated health system, physician buy-in is vital to the success of DAT. Physicians need to publicly champion the program, even if members of the laboratory are doing the behind-the-scenes work. DAT is growing rapidly, but everyone still wants the stamp of approval from their physician(s) when it comes to their health.

Valor de los parámetros clínicos en el diagnóstico de una infección amniótica en gestantes con amenaza de parto prematuro / Value of clinical signs in the diagnosis of amniotic infection in patients with preterm labor

Objetivo: Estudiar el valor de la leucocitosis, fiebre materna y la taquicardia fetal en el diagnóstico de una infección amniótica.Sujetos y métodos: Un total de 113 gestantes con amenaza de parto prematuro a las que se les practicaron una amniocentesis y un cultivo de líquido amniótico. Al ingreso se tomó la temperatura axilar, se realizó un hemograma y se realizó un registro cardiotocográfico. Se relacionó la presencia de un cultivo de líquido amniótico positivo con la fiebre ( 37,8 °C), la taquicardia fetal ( 160 lat/min) y la leucocitosis materna (> 15.000 leucocitos/ml).Resultados: Trece de las gestantes (11,5 por ciento) presentaron una infección amniótica; 26 mujeres (23 por ciento) tuvieron una leucocitosis, cinco de ellas tenían un cultivo de líquido amniótico positivo (p = 0,1); 5 gestantes tuvieron fiebre, dos de ellas con un cultivo de líquido amniótico positivo (p = 0,1); 26 gestantes presentaron una taquicardia fetal (23 por ciento), ocho de las cuales tuvieron un cultivo de líquido amniótico positivo (p = 0,001). La sensibilidad de la taquicardia fetal para detectar una infección amniótica fue del 61,5 por ciento y la especificidad del 82 por ciento.Conclusión: La taquicardia fetal fue el único parámetro clínico que se asoció significativamente a la infección amniótica, aunque su valor predictivo positivo fue bajo. (AU)

Laboratory diagnostics in light of massive changes in official health policies.

Virtually 100% of the German population has health insurance. Of this 100%, approximately 90% are members of the Statutory Health Insurance plan. This insurance plan assumes responsibility for practically all of the costs of treatment; self-participation by the patient in the costs is minimal. To counteract the financial deficits of the Statutory Health Insurance funds, the Health Care Reform Act was introduced in 1993, bringing with it massive economy measures for everyone involved in the health sector. For the practitioner sector, this new legislation provides for, among other things, revision of the structure and the reimbursement of laboratories. In this context, the originally agreed-upon introduction of lump-sum payments as reimbursement for laboratory tests was abandoned, in the face of vigorous resistance by the medical profession. Instead, the system of reimbursement for each individual test continues to apply. However, the number of tests is to be limited for each specific group of doctors. In addition, the laboratory fee in the practitioner sector is being reduced by 20%.