CYFRA 21-1 in patients with suspected cancer: evaluation of an optimal cutoff to assess the diagnostic efficacy and prognostic value.

Objectives: Chosen cutoff for cytokeratin 19 fragment antigen (CYFRA 21-1) as a tumor biomarker considerably influences its diagnostic and prognostic usefulness. The aim of the present study is to determine an optimal cutoff value for diagnostic validity of CYFRA 21-1 by Lumipulse ® technology in patients with suspected cancer and also to determine if CYFRA 21-1 levels provide prognostic value. Methods: A consecutive 284 patients suggestive of malignant disease from six hospitals of Madrid were enrolled in a retrospective design. Optimal CYFRA 21-1 cutoff value was obtained by receiver operating characteristic curve and Youden test. The diagnostic validity was evaluated according to sensitivity, specificity, predictive values and likelihood ratios. The prognostic value of CYFRA 21-1 was checked using multiple logistic regression. Thirty-two diagnostic cancers were confirmed. Results: The most optimal cutoff was 3.15 ng/mL. This cutoff showed a better specificity 93.63% (95% confidence interval [CI], 89.66-96.16), positive predictive value 60.98% (95% CI, 44.54-75.38) and positive likelihood ratio 12.65 (95% CI, 7.64-20.95) than the cutoff recommended by Fujirebio® (1.8 ng/mL) (specificity: 73.71% [95% CI, 67.72-78.95], positive predictive value: 29.79% [95% CI, 21.02-40.23] and positive likelihood ratio 3.43 [95% CI, 2.71-4.35]), improving the current diagnostic accuracy. In multivariate analysis, elevated levels of CYFRA 21-1 (>3.15 ng/mL) was confirmed as an unfavorable prognostic factor. Conclusions: The best cutoff for CYFRA 21-1 obtained was 3.15 ng/mL in patients with suspected cancer. This new cutoff decreases the false positive rate and improves the diagnostic efficacy of CYFRA 21-1 as a tumor marker as well as its association with death events.

Interferencia por ácido 2, 4 diamino-N10-metilpteroico en la determinación de metotrexato tras la administración de glucarpidasa / Interference due to 2, 4 diamino-N10-methylpteroic acid in the determination of methotrexate after the administration of glucarpidase

El tratamiento con metotrexato (MTX) a dosis elevadas implica una monitorización estrecha de los niveles del fármaco para confirmar su correcta eliminación. Uno de los posibles efectos secundarios es el fracaso renal, lo que ocasiona una acumulación de fármaco y un mayor efecto tóxico. La glucarpidasa (carboxipeptidasa-G2 o CPDG2) es una enzima recombinante que se utiliza para disminuir los niveles de MTX en pacientes que desarrollan fallo renal durante el tratamiento con altas dosis de MTX. La enzima reduce la concentración de MTX en un 95-99% de 15 a 30min después de la dosis. La glucarpidasa escinde el MTX en glutamato y ácido 2,4-diamino-N10-metilpteroico un metabolito menor e inactivo. Es conocida la reactividad cruzada del ácido 2,4-diamino-N10-metilpteroico en la medición de MTX mediante ensayos inmunológicos, que da lugar a una enorme sobreestimación de MTX. Sin embargo, los ensayos inmunológicos son la técnica mayoritariamente empleada en los laboratorios clínicos para la medición de MTX. Se presenta un caso de interferencia explicando la detección de MTX en las muestras de suero mediante cromatografía líquida acoplada a espectrometría de masas (LC-UHR-QTOF)

High-dose methotrexate (MTX) treatment involves close monitoring of drug level in order to confirm its proper elimination. One of the possible side effects of this therapy is renal failure, causing accumulation of the drug, and therefore is a mayor toxic effect. Glucarpidase (carboxypeptidase-G2 or CPDG2) is a recombinant enzyme used to reduce MTX serum levels in patients who develop acute renal failure during high-dose MTX treatment. The enzyme reduces MTX concentration by 95-99% within 15-30minutes after the dose. Glucarpidase cleaves MTX into glutamate and 2,4-diamino-N10-methylpteroic acid, a minor and non-active metabolite. Cross-reactivity of 2,4-diamino-N10-methylpteroic acid in immunological assays of MTX has been previously reported, and is said to cause an enormous overestimation in serum MTX analysis. However immunoassay is a widely used technique for MTX analysis, being the main method for its determination in most clinical laboratories. An interference case report is presented and MTX analysis in serum samples by liquid chromatography coupled with Ultra-High Resolution Q-Time of Flight Mass Spectrometry (LC-UHR-QTOF) is described

CGH Array and Karyotype as Complementary Tools in Prenatal Diagnosis: Prenatal Diagnosis of a 4q Derivative Chromosome from Maternal 4q;11q Translocation.

BACKGROUND: There is controversy whether chromosomal microarray (CMA) can replace karyotyping in prenatal diagnosis. Chromosomal microarray may detect more clinically significant chromosomal imbalances than karyotyping in a shorter time but does not detect inversions, triploidies or low mosaicisms. CASE REPORT: Amniocentesis was performed in the late second trimester based on ultrasound abnormalities. A CMA, obtained at 10 days, demonstrated a terminal deletion in 4q34.3-q35.2 and a duplication in 11q21-q25. The karyotype results, obtained 1 week later, showed a derivative chromosome 4 inherited from a maternal balanced 4;11 translocation. CONCLUSION: CMA and karyotype were complementary in this case, together permitting a more accurate diagnosis and genetic counseling than if only one method was used.

First plasma glucose value after urgent admission and in-hospital mortality in acutely decompensated heart failure.

BACKGROUND: We used data from three <250-bed hospitals to test how plasma glucose (PG) values influenced in-hospital mortality (IHM) in acute heart failure in people without diabetes. METHODS AND RESULTS: We identified 788 HF admissions (62% female; median age 83.3 years). 20.9% had chronic kidney disease, 7.7% cancer history, 24.7% acute renal failure and 29.7% concomitant infection. Mean first PG was 124.3 ± 32.4 mg/dl; 22.7% had stress hyperglycemia. Fifty-six people died (IHM = 7.1%). Women, older patients and people with infections showed higher PG values. People who died had higher PG values (136.3 ± 43.9 vs. 123.4 ± 31.2 mg/dl; p = 0.029). In a multivariate regression model with IHM as main outcome, the first PG (per mg/dl, odds ratio (OR): 1.01 [1.00-1.02]; p = 0.045), age (per year, OR: 1.06 [1.02-1.10]; p = 0.003) and acute renal failure (OR: 0.42 [0.24-0.74]; p = 0.003) remained significantly associated with IHM. CONCLUSIONS: The first PG value predicted IHM in participants without diabetes after admission for heart failure.

Brote de hepatitis C en una unidad de oncología / Hepatitis C outbreak in an oncology ward

Introducción Estudio de un brote de hepatitis C.Métodos Estudio de casos y controles. Se estudiaron pacientes con hepatitis C aguda y controles adecuados. Se estudió la odds ratio (OR) para varios factores de riesgo. Resultados Se estudiaron 7 casos y 46 controles. Se identificó como factor de riesgo el tener implantado un catéter central (OR=35; intervalo de confianza del 95%: 16,0 a 62,0).Conclusión La inadecuada manipulación del catéter con suero salino heparinizado, probablemente contaminado con virus de la hepatitis C, fue la causa del brote (AU)

Introduction Study of an outbreak of hepatitis C virus (HCV) infection. Methods Case-control study. Odds ratios for various risk factors were studied in patients with acute hepatitis C and an appropriate control group. Results Seven cases and 46 controls were included. Implantation of a central catheter was found to be an independent risk factor for hepatitis C (OR=35; 95% CI: 16.0–62.0).Conclusion Inadequate manipulation of central catheters with heparinized saline solution, which was likely to be HCV-contaminated, caused the outbreak (AU)

[Hepatitis C outbreak in an oncology ward]. / Brote de hepatitis C en una unidad de oncología.

INTRODUCTION: Study of an outbreak of hepatitis C virus (HCV) infection. METHODS: Case-control study. Odds ratios for various risk factors were studied in patients with acute hepatitis C and an appropriate control group. RESULTS: Seven cases and 46 controls were included. Implantation of a central catheter was found to be an independent risk factor for hepatitis C (OR=35; 95% CI: 16.0-62.0). CONCLUSION: Inadequate manipulation of central catheters with heparinized saline solution, which was likely to be HCV-contaminated, caused the outbreak.

Déficit de yodo en una población de mujeres embarazadas pertenecientes a un área con leve deficiencia de yodo / Iodine deficiency in pregnant women from a mildly iodine-deficient area

Objetivo: Los estudios realizados en España proponen que la ingesta de yodo de las mujeres embarazadas está por debajo de los requerimientos nutricionales. Con este estudio se pretende conocer el estado nutricional de yodo en una población de mujeres embarazadas de Madrid. Pacientes y método: Estudio prospectivo de una cohorte de 112 mujeres gestantes con enfermedad endocrina entre enero y septiembre de 2004. Resultados: La yoduria fue 101,5 (60,25-176,75) µg/l. Sólo el 30,4% de las mujeres mostraban suficiencia de yodo (yoduria > 160 µg/l). La tirotropina fue 2,1 (1,12-2,95) µU/ml; la tiroxina libre, 0,87 (0,77-1) ng/dl; los anticuerpos antitiroglobulina y los anticuerpos antiperoxidasa, positivos en el 5,4 y el 19,6% respectivamente. En el análisis bivariable, el consumo de sal yodada se asoció con la suficiencia de yodo (odds ratio [OR] = 3,6; intervalo de confianza [IC] del 95%, 1,45-8,93). El 41,3% de las consumidoras de sal yodada presentaron yodurias > 160 µg/l, frente al 16,3% de las no consumidoras (p = 0,004). No hubo asociación entre suficiencia de yodo y antecedentes familiares de enfermedad tiroidea, bocio, tratamiento con levotiroxina, tirotropina, tiroxina libre, anticuerpos antitiroglobulina ni anticuerpos antiperoxidasa. En el análisis multivariable, la OR ajustada del consumo de sal yodada sobre la suficiencia nutricional de yodo fue 3,92 (1,46-10,53; p = 0,008). Conclusiones: En esta muestra, el 69,6% de las gestantes presentaron yodurias < 160 µg/l. El consumo de sal yodada se asoció a suficiencia de yodo. En esta cohorte no encontramos asociación de suficiencia de yodo con positividad de anticuerpos antitiroglobulina y anticuerpos antiperoxidasa ni con concentraciones de tirotropina y tiroxina libre

Objective: Studies performed in Spain suggest that iodine intake in pregnant women is below nutritional requirements. This study was designed to determine the degree of iodine nutrition during pregnancy in women from Madrid. Patients and method: A prospective study of 112 pregnant women with endocrinological disorders was performed between January 2004 and September 2004. Results: The urinary iodine level was 101.5 µg/l (60.25-176.75). Only 30.4% of the women showed adequate urinary iodine levels (higher than 160 µg/l). Serum thyroid-stimulating hormone (TSH) and free thyroxine (FT4) concentrations were 2.1 µU/ml (1.12-2.95) and 0.87 µg/dl (0.77-1), respectively. Antithyroglobulin (TgAb) and antiperoxidase (TPOAb) antibody values were positive in 5.4% and 19.6%, respectively. In the bivariate analysis, iodized salt intake was associated with iodine sufficiency (OR = 3.6; 95% CI, 1.45-8.93). A total of 41.3% of women with iodized salt intake had urinary iodine levels higher than 160 µg/l compared with 16.3% of those not consuming iodized salt (p = 0.004). No association was found between iodine sufficiency and a family history of thyroid disease, the presence of goiter, levothyroxine treatment, TSH, FT3, FT4, TPOAb or TgAb. In the multivariate analysis, the adjusted OR for the association between intake of iodized salt and iodine sufficiency was 3.92 (1.46-10.53; p = 0.008). Conclusions: In this sample, 69.6% of the pregnant women showed urinary iodine levels lower than 160 µg/l. Intake of iodized salt was associated with iodine sufficiency. We found no correlation between urinary iodine levels and TSH, FT4, FT3, or antibody positivity