RESUMEN
Toxicological screening is a specific approach to analytical toxicology that uses analytical tools such as GC-MS, LC-UV (diode array) or LC-MS. Toxicological screening allows the detection and simultaneous identification of a large number of compounds. The results may be based on the use of one or more techniques. As part of the accreditation process for medical biology examinations according to standard NF EN ISO 15189, the group from SFTA and SFBC recommends an approach to accredit toxicological screening. Indeed, the complexity of the accreditation of this analysis comes in particular from the high number of compounds that can be detected. Validation parameters are discussed in the specific context of toxicological screening by considering two distinct approaches: the simple identification of compounds, or the identification and estimation of a range of concentration related to clinical outcomes.
Asunto(s)
Acreditación , Química Clínica/normas , Pruebas Diagnósticas de Rutina/normas , Toxicología/normas , Química Clínica/métodos , Química Clínica/organización & administración , Cromatografía Liquida , Pruebas Diagnósticas de Rutina/métodos , Contaminación de Equipos , Cromatografía de Gases y Espectrometría de Masas , Ensayos Analíticos de Alto Rendimiento/métodos , Ensayos Analíticos de Alto Rendimiento/normas , Humanos , Tamizaje Masivo/métodos , Tamizaje Masivo/normas , Control de Calidad , Sociedades Médicas/organización & administración , Sociedades Médicas/normas , Espectrometría de Masas en Tándem , Toxicología/métodos , Toxicología/organización & administración , Estudios de Validación como AsuntoRESUMEN
BACKGROUND: We aimed to determine the association of clinical and routine cerebrospinal fluid biochemical markers (total protein, IgG index and oligoclonal bands) with disability in multiple sclerosis and whether these biomarkers assessed at diagnosis add prognostic value. METHODS: We followed a cohort of patients included in the Multiple Sclerosis Lorraine Register (eastern France) who had a diagnosis of multiple sclerosis for at least 5 years, as well as biological markers values and MRI findings (Barkhof's criteria). In a Cox regression model, endpoint was time to score of 4 on the Expanded Disability Status Scale (EDSS) (i.e., limited time walking without aid or rest for more than 500 m). RESULTS: For 407 patients included, the median time from multiple sclerosis onset to EDSS score 4 was 4.5 years [2.2-7.2]. Cerebrospinal fluid total protein factor < 500 mg/L was associated with EDSS score 4 on bivariate analysis (hazard ratio 0.66, 95% confidence interval 0.46-0.95, p = 0.02). On multivariate analysis, older age at disease onset (≥50 years) and initial primary progressive course of MS but not biological markers predicted worse prognosis. CONCLUSION: Routine cerebrospinal fluid biological markers at diagnosis were not prognostic factors of multiple sclerosis progression.
Asunto(s)
Biomarcadores/líquido cefalorraquídeo , Progresión de la Enfermedad , Esclerosis Múltiple/diagnóstico , Valor Predictivo de las Pruebas , Sistema de Registros , Adulto , Femenino , Estudios de Seguimiento , Francia , Humanos , Masculino , Persona de Mediana Edad , Esclerosis Múltiple/líquido cefalorraquídeo , Pronóstico , Índice de Severidad de la Enfermedad , Adulto JovenRESUMEN
Used in the treatment of spasticity at low doses, baclofen is also prescribed off-label at high doses for the treatment of alcohol dependence. Several cases of baclofen intoxication have been reported, but only 1 case deals with the treatment of alcohol dependence. Thus, we report the first death in the context of baclofen off-label use of an alcohol-dependent patient with a high blood baclofen concentration after intentional drug intoxication. The safety profile of baclofen in the treatment of alcohol dependence is reviewed and discussed, underlining the obligatory caution that may support any prescription of high doses of baclofen in this off-label indication and especially in patients with concomitant psychiatric disorders.
