Is minimising waste volume for drawing blood samples in critically ill patients feasible?

INTRODUCTION: Drawing blood samples through a central venous catheter (CVC) is a customary practice in Intensive Care Units (ICUs). It is indicated to discard a volume of waste blood to avoid interference in the results. AIM: To determine whether a lower discard volume for obtaining blood samples from temporary CVCs placed into the internal jugular, femoral or subclavian vein offers valid results. METHOD: A quasi-experimental prospective cross-sectional study for which sixty-five patients of over 18 years of age in ICUs, who had been fitted with a triple lumen central venous catheter, were recruited over a period of eight months. Two consecutive blood samples were extracted with tubes for biochemistry, coagulation and hemogram from each patient from the distal lumen. The first sample was obtained with a discarded waste of 1.5 ml from a total extracted volume of 10.2 ml, similar to the usual waste in our ambit (10 ml). Subsequently the second sample was obtained. The paired t-test was used to analyse the data. The Bland-Altman plot and intraclass correlation coefficient (ICC) were used to measure the agreement between methods. The reference change value (RCV) was established as the admissible limit of variation between the pairs of samples. RESULTS: A total of 65 sample pairs were drawn (intervention-control). The paired t-test found statistically significant differences with a significance level of α = .05 for chlorine (-.536; .012); prothrombin time (-.092; .019) and prothrombin activity (.284; 1.375).The ICC was greater than .9 in all the variables and the limit determined for the RCV was not surpassed by any value. CONCLUSIONS: The results show the reliability of the blood samples drawn with a discard volume of 1.5 ml.

Minimizar el volumen de descarte para la extracción de muestras sanguíneas en los pacientes críticos: ¿es factible? / Is minimising waste volume for drawing blood samples in critically ill patients feasible?

Introducción: La extracción de muestras sanguíneas a través de un catéter venoso central es una práctica habitual en las unidades de cuidados intensivos. Está indicado desechar un volumen de sangre, denominado volumen de descarte, con la finalidad de evitar que los resultados puedan verse alterados. Objetivo: Determinar si un menor volumen de descarte para la obtención de analíticas procedentes de catéter venoso central temporales alojados en la vena yugular interna, femoral o subclavia ofrece resultados válidos. Método: Estudio cuasiexperimental, prospectivo, transversal donde se seleccionaron 65 pacientes críticos mayores de 18 años portadores de catéter venoso central temporal de 3 luces durante un período de 8 meses. Para cada paciente se extrajeron 2 analíticas consecutivas de la luz distal con los valores de hemograma, bioquímica y coagulación comúnmente analizados en el paciente crítico. Se obtuvieron 2 muestras consecutivas: la primera, con un descarte de 1,5ml y un volumen extraído total de 10,2ml, similar al desecho habitual en nuestro medio (10 ml). Seguidamente se obtuvo la segunda muestra. Para el análisis de datos se utilizó la prueba t pareada; para medir la concordancia entre métodos, la representación de Bland-Altman y el coeficiente de correlación intraclase. Se estableció el valor de referencia del cambio como límite admisible de variación entre los pares de muestras. Resultados: Se extrajeron un total de 65 pares de muestras (intervención-control). El contraste de medias encontró diferencias estadísticamente significativas con α=0,05 para cloro (−0,536; 0,012), tiempo de protrombina (−0,092; 0,019) y actividad de protrombina (0,284; 1,375). El coeficiente de correlación intraclase resultó mayor de 0,9 en todas las variables y el valor de referencia del cambio no fue superado por ningún valor. Conclusiones: Los resultados muestran la validez de los análisis de las muestras de sangre extraídas con un volumen de descarte de 1,5ml.(AU)

Introduction: Drawing blood samples through a central venous catheter is a customary practice in intensive care units. It is indicated to discard a volume of waste blood to avoid interference in the results. Aim: To determine whether a lower discard volume for obtaining blood samples from temporary central venous catheters placed into the internal jugular, femoral or subclavian vein offers valid results. Method: A quasi-experimental prospective cross-sectional study for which 65 patients of over 18 years of age in intensive care units, who had been fitted with a triple lumen central venous catheter, were recruited over a period of 8 months. Two consecutive blood samples were extracted with tubes for biochemistry, coagulation and haemogram from each patient from the distal lumen. The first sample was obtained with a discarded waste of 1.5ml from a total extracted volume of 10.2ml, similar to the usual waste in our ambit (10ml). Subsequently the second sample was obtained. The paired t-test was used to analyse the data. The Bland-Altman plot and intraclass correlation coefficient were used to measure the agreement between methods. The reference change value was established as the admissible limit of variation between the pairs of samples. Results: A total of 65 sample pairs were drawn (intervention-control). The paired t-test found statistically significant differences with a significance level of α=0.05 for chlorine (−0.536; 0.012); prothrombin time (−0.092; 0.019) and prothrombin activity (0.284; 1.375). The intraclass correlation coefficient was greater than 0.9 in all the variables and the limit determined for the reference change value was not surpassed by any value. Conclusions: The results show the reliability of the blood samples drawn with a discard volume of 1.5ml.(AU)

Prevalence of peripheral artery disease (PAD) and factors associated: An epidemiological analysis from the population-based Screening PRE-diabetes and type 2 DIAbetes (SPREDIA-2) study.

AIM: To describe the prevalence of Peripheral Artery Disease (PAD) in a random population sample and to evaluate its relationship with Mediterranean diet and with other potential cardiovascular risk factors such as serum uric acid and pulse pressure in individuals ranged 45 to 74 years. METHODS: Cross-sectional analysis of 1568 subjects (mean age 6.5 years, 43% males), randomly selected from the population. A fasting blood sample was obtained to determine glucose, lipids, and HbA1C levels. An oral glucose tolerance test was performed in non-diabetic subjects. PAD was evaluated by ankle-brachial index and/or having a prior diagnosis. RESULTS: PAD prevalence was 3.81% (95% CI, 2.97-4.87) for all participants. In men, PAD prevalence was significantly higher than in women [5.17% (95% CI, 3.74-7.11) vs. 2.78% (95% CI, 1.89-4.07); p = 0.014]. Serum uric acid in the upper quartile was associated with the highest odds ratio (OR) of PAD (for uric acid > 6.1 mg/dl, OR = 4.31; 95% CI, 1.49-12.44). The remaining variables more strongly associated with PAD were: Heart rate >90 bpm (OR = 4.16; 95%CI, 1.62-10.65), pulse pressure in the upper quartile (≥ 54 mmHg) (OR = 3.82; 95%CI, 1.50-9.71), adherence to Mediterranean diet (OR = 2.73; 95% CI, 1.48-5.04), and former smoker status (OR = 2.04; 95%CI, 1.00-4.16). CONCLUSIONS: Our results show the existence of a low prevalence of peripheral artery disease in a population aged 45-74 years. Serum uric acid, pulse pressure and heart rate >90 bpm were strongly associated with peripheral artery disease. The direct association between Mediterranean diet and peripheral artery disease that we have found should be evaluated through a follow-up study under clinical practice conditions.

Performance of the Finnish Diabetes Risk Score and a Simplified Finnish Diabetes Risk Score in a Community-Based, Cross-Sectional Programme for Screening of Undiagnosed Type 2 Diabetes Mellitus and Dysglycaemia in Madrid, Spain: The SPREDIA-2 Study.

AIM: To evaluate the performance of the Finnish Diabetes Risk Score (FINDRISC) and a simplified FINDRISC score (MADRISC) in screening for undiagnosed type 2 diabetes mellitus (UT2DM) and dysglycaemia. METHODS: A population-based, cross-sectional, descriptive study was carried out with participants with UT2DM, ranged between 45-74 years and lived in two districts in the north of metropolitan Madrid (Spain). The FINDRISC and MADRISC scores were evaluated using the area under the receiver operating characteristic curve method (ROC-AUC). Four different gold standards were used for UT2DM and any dysglycaemia, as follows: fasting plasma glucose (FPG), oral glucose tolerance test (OGTT), HbA1c, and OGTT or HbA1c. Dysglycaemia and UT2DM were defined according to American Diabetes Association criteria. RESULTS: The study population comprised 1,426 participants (832 females and 594 males) with a mean age of 62 years (SD = 6.1). When HbA1c or OGTT criteria were used, the prevalence of UT2DM was 7.4% (10.4% in men and 5.2% in women; p<0.01) and the FINDRISC ROC-AUC for UT2DM was 0.72 (95% CI, 0.69-0.74). The optimal cut-off point was ≥13 (sensitivity = 63.8%, specificity = 65.1%). The ROC-AUC of MADRISC was 0.76 (95% CI, 0.72-0.81) with ≥13 as the optimal cut-off point (sensitivity = 84.8%, specificity = 54.6%). FINDRISC score ≥12 for detecting any dysglycaemia offered the best cut-off point when HbA1c alone or OGTT and HbA1c were the criteria used. CONCLUSIONS: FINDRISC proved to be a useful instrument in screening for dysglycaemia and UT2DM. In the screening of UT2DM, the simplified MADRISC performed as well as FINDRISC.

Antioxidant activity of Fraxetin: in vivo and ex vivo parameters in normal situation versus induced stress.

The aim of this paper was to study the influence of Fraxetin (7,8-dihydroxy-6-methoxv coumarin) treatment in a Drosophila melanogaster experimental model, analyzing several parameters in normal situations and instances of induced oxidative stress. Fraxetin treatment was introduced at different ages. Antigravity capacity and survival parameters were evaluated as in vivo assays, and levels of oxidative status, glutathione and lipid peroxidation, as ex vivo assays. The stress situation was induced by negative geotaxis, so physical exercise enhanced its basal metabolism, generating free radicals, which are probably implicated in the molecular damage related to the aging process. In our study, all treatment groups demonstrated a beneficial effect on the evaluated parameters. So, in vivo Fraxetin protects fruit flies against oxidative stress and improves the survival parameters. Moreover, Fraxetin prevents oxidative stress by an important increase in antioxidant reserves of GSH, and peroxidative damage is preserved by Fraxetin treatments.

Trisomía parcial 1q por translocación materna / Partial trisomy 1q due to maternal translocation

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Anti-inflammatory and antiulcer activity of Teucrium buxifolium.

Teucrium buxifolium Spanish endemic, have traditionally been used for the treatment of rheumatic and other inflammatory affections. In this work, phytochemical screening was carried out to ascertain the qualitative composition of this species and we have studied the anti-inflammatory and antiulcer activity of Teucrium buxifolium. This species has exhibited potent anti-inflammatory properties against experimentally-induced arthritis and carrageenin paw edema. Additionally, Teucrium buxifolium species have displayed significant antiulcer and cytoprotective activity.