Vertical cutoff methods in serum protein electrophoresis for the measurement of monoclonal protein concentrations: Which is best?

BACKGROUND: Monoclonal protein (M-protein) concentrations are measured by serum protein electrophoresis (SPE). Two methods are used for demarcating the M-protein area in the electropherogram: perpendicular drop (PD) and tangent skimming (TS). The aim of this study was tocompare both methods and to establish which is the most accurate and precise. METHODS: We studied 24 sera containing M-protein (5-44 g/L). The systematic error (SE) was evaluated in a dilution series of 12 sera. Within-day, between-day, and interobserver variability were assessed. SPE was performed by capillary and agarose gel electrophoresis. M-protein concentrations were measured using both cutoff methods. RESULTS: The PD method shows a constant SE ranged 1.00-2.27 g/L, while constant SE for TS is ranged -0.30--0.57 g/L. None of the cutoff methods or electrophoretic methods showed a proportional SE, with the exception of the TS method in capillary electrophoresis for ß-migrating M-protein. The PD method was more precise than the TS method in all three estimates of imprecision. An increased CV for concentrations < 10 g/L in between-day imprecision was observed with the TS method. Interobserver imprecision was greater for M-protein concentrations < 17 g/L for both cutoff methods (14.85%, 26.42% respectively). CONCLUSIONS: Despite being less precise, the TS method provides a more accurate measurement of M-protein concentration.

Synthesis, Characterization, Uses and Applications of Porous Clays Heterostructures: A Review.

Porous clay heterostructures (PCH) are obtained by the insertion of an organic bulky cation in the interlayer spacing of a smectite, causing a swelling of the clay mineral. Right after, oxides species, mainly silicon oxide, are incorporated as pillars galleries between adjacent layers to form a porous structure after the removal of the template. The ordering of the clay mineral as well the organic cation incorporated in the synthetic step favors the modulation of the textural properties of the PCH. In addition, the incorporation of heteroatoms in the pillars galleries can also modulate the acidity of the PCH. The modulation of the pore size and the acid properties provides to these materials a wide range of applications in the fields of adsorption and catalysis. This paper carries out a detailed review of the synthesis of PCH, characterization as well as uses and application reported in the literature.

Enhanced electrochemical response of carbon quantum dot modified electrodes.

A glassy carbon electrode (GCE) was surface-modified with carbon quantum dots (CQDs) and applied for the effective enhancement of the electrochemical signal for dopamine and uric acid determination. CQDs were prepared from graphite by a green modification of the Hummers method. They were characterized by FTIR-ATR, XPS, solid-state NMR, fluorescence and Raman spectroscopies. TPD-MS analysis was applied to characterize the functionalization of the surface. The CQDs were assembled on the glassy carbon electrode by adsorption because of the large number of carboxy groups on their surface warrants effective adsorption. The modified GCE exhibits a sensitivity that is almost 10 times better than of the bare GCE. The lower limits of detection are 1.3µM for uric acid and 2.7µM for dopamine.

Crioglobulinas: características y metodología de estudio. Recomendación (2014) / Cryoglobulins: features and methodology of study. Recommendation (2014)

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Fluorescent sensor for Cr(VI) based in functionalized silicon quantum dots with dendrimers.

Highly luminescent nanoparticles based in Silicon quantum dots, coated by hydroxyl PAMAM dendrimer (PAMAM-OH) of 5th generation, were obtained by one step process by hydrothermal treatment of 3-Aminopropyl)triethoxysilane (APTES) in aqueous solution. Previous to the optimization of the synthesis procedure, different dendritic molecules of 5th generation were tested to obtain the most intense fluorescence signal. The influence of different parameters such ratio APTES/PAMAM-OH, pH and ionic strength on the fluorescence intensity was studied. The fluorescence spectra showed maximum excitation and emission wavelengths at 370 and 446 nm, respectively. The obtained silicon nanoparticles (SiQDs@PAMAM-OH) were characterized by TEM, DLS and XPS, and were found to detect selectively Cr(VI) in aqueous solutions at 2.7 µM level of detection, sensitivity of 0.2 µM with a RSD of 0.16% (n=10). To study the feasibility of the proposed system for Cr(VI) detection, it was tested in real electrochemical solution bath and a tanning effluent obtained from electrochemical industry and with two certified waters, demonstrating promising outcomes as nano-sensor.

Fluorescent chemosensor for pyridine based on N-doped carbon dots.

Fluorescent carbon dots (CDs) and its nitrogen doped (N-CDs) nanoparticles have been synthesized from lactose as precursor using a bottom-up hydrothermal methodology. The synthesized nanoparticles have been characterized by elemental analysis, FTIR, Raman, TEM, DLS, XPS, and steady-state and life-time fluorescence. The synthesized carbon nanoparticles, CDs and N-CDs, have a size at about 7.7±2.4 and 50±15nm, respectively, and quantum yields of 8% (CDs) and 11% (N-CDs). These techniques demonstrated the effectiveness of the synthesis procedure and the functionalization of the CDs surface with amine and amide groups in the presence of NH3 in aqueous media. The effect of excitation wavelength and pH on the luminescent properties was studied. Under the optimal conditions, the nitrogen doped nanoparticles can be used as pyridine sensor in aqueous media because they show an enhancement of its fluorescence with a good linear relationship. The analytical method is simple, reproducible and very sensitive for pyridine determination.

Miocarditis fulminante asociada a influenza A / Fulminant myocarditis associated to influenza A

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Microwave-assisted synthesis of carbon dots and its potential as analysis of four heterocyclic aromatic amines.

Fluorescent water soluble carbon nanoparticles, in short carbon dots (CDs), was synthesized from lactose by microwave assisted hydrochloric acid method. Characterized by TEM and DLS to obtain the morphology shape (average 10nm in size), with a higher negative surface charge supported by the composition was obtained by XPS spectroscopy. The maximum of the emission was centered at 450 nm with a lifetime of 2.1 ns. Without further functionalization of the CDs a nanosensor was obtained that responded exponentially to HAAs in the 0.35-0.45 mg L(-1) concentration range by fluorescence static quenching, demonstrated by the lifetime analysis of the CDs in presence of HAAs. Some amino compounds were selected as model for interferences to evaluate the selectivity of this method, showing a notorious added value, with recoveries around 98%. The accuracy of the method was in terms of RSD about 2.5%. The results suggest their promising applications in chemical sensing.

Carbon dots obtained using hydrothermal treatment of formaldehyde. Cell imaging in vitro.

Highly photoluminescent carbon dots have been prepared in a one step procedure by hydrothermal treatment of formaldehyde at 180 °C. They show green fluorescence under UV light exposure and emission spectra are centered at 440 nm. Fluorescence lifetimes comprise between 0.7 and 2.70 ns, when the synthesis process lasted for 1-7 days. TEM images of nanoparticles showed a homogeneous size/shape distribution. When the thermal treatment process was carried out for a long time (30 days) formation of aggregates occurred. Carbon dots were further analyzed using (1)H and (13)C-NMR, Raman and FTIR spectroscopy techniques and XPS. Cell imaging of nanoparticles was carried out by using mouse MC3T3-E1 pre-osteoblasts as a model. The nanoparticles were selectively localized in the cytoplasm without further functionalization and could be realized by cellular phagocytosis, so that the fluorescence of these can be used for live cell imaging in vitro.

Autorización de usos de medicamentos fuera de indicación en un hospital de tercer nivel / Off-label approval of drug use in a tertiary hospital

Fundamento y objetivo. Comisión de Farmacia y Terapéutica (CFT) evalúa peticiones de usos fuera de indicación con un modelo de informe abreviado. El objetivo fue realizar un análisis descriptivo de esta actividad y estudiar la tasa de autorizaciones. Material y métodos. Estudio descriptivo de los informes de la CFT del hospital entre septiembre de 2009 y abril de 2011. Se analizó tipo de fármaco por grupo terapéutico y por tipo de dispensación, indicación y servicio peticionario. Además, se estudió la decisión final adoptada como variable principal y porcentaje de solicitudes aprobadas según características del medicamento evaluado, indicación solicitada, alternativas usadas, evidencia y coste, como resultados secundarios. Resultados. De un total de 51 solicitudes analizadas, un 60,8% fueron medicamentos de uso hospitalario y un 54,9% citostáticos. Destacaron las indicaciones oncohematológicas (43,2%) y autoinmunes (35,3%). Los servicios con más peticiones fueron Hematología (11 peticiones aprobándose el 72,7%), Oncología y Pediatría (10 peticiones aprobándose el 50% para ambas). Se aprobaron el 60,8% de las peticiones. De las no autorizadas, 11 no agotaron las alternativas terapéuticas y 8 no presentaban evidencia suficiente para ser aceptadas. El 47,1% de los medicamentos solicitados tenían un coste/paciente entre 10.000-100.000 euros aprobándose el 58,3% (coste por tratamiento completo si tenía duración definida o coste por año en tratamientos crónicos). Conclusión. Hay una gran actividad de la CFT que crece con los años. La mayoría de las solicitudes son de fármacos de uso hospitalario, sobre todo de citostáticos por Oncohematología. Existe una alta tasa de autorización con una alta variabilidad según servicio y tipo de evidencia. La diferencia, entre aprobados y no aprobados respecto al coste sigue una lógica de coste-efectividad(AU)

Background and objective. The Pharmacy and Therapeutics Committee (PTC) evaluates the requests for off-label uses with an abbreviated report format. The aim of this study is to perform a descriptive analysis of this activity and to study the rate of approvals. Material and Methods. A descriptive study was performed on the PTC reports in a tertiary hospital between September 2009 and April 2011. The type of drug by treatment group and by type of dispensing, indication and requesting department was analysed. The final decision adopted was studied as the primary outcome, and the percentage of requests approved according to the characteristics of the drug evaluated, indication requested, alternatives used, evidence and cost, as secondary outcomes. Results. A total of 51 applications were analysed, of which 60.8% were drugs for hospital use and 54.9% cytostatic. The most requested indications were the onco-haematological (43.2%) and autoimmune (35.3%). Haematology was the department that made most requests (11 requests with 72.7% approved), Oncology and Paediatrics (both with 10 requests, with 50% approved). Almost two-thirds (60.8%) of the requests were approved. Of those that were not approved, 11 had not used up the therapeutic alternatives, and 8 had no evidence. Just under half (47.1%) of the drugs requested had a cost/patient between 10,000-100,000 euros,of which 58.3% were approved (cost per course of treatment if it had a defined period, or cost of treatment per year for chronic treatment). Conclusion. There is an increase in the activity of the PTC that is growing over the years. Most applications focus on drugs for hospital use and cytostatic drugs by Onco-haematology. There is a high rate of approval by the PTC, and high variability in the percentage of approval depending on the department and the evidence of use. The difference between approved and unapproved requests followed a logic of cost-effectiveness(AU)

[Off-label approval of drug use in a tertiary hospital]. / Autorización de usos de medicamentos fuera de indicación en un hospital de tercer nivel.

BACKGROUND AND OBJECTIVE: The Pharmacy and Therapeutics Committee (PTC) evaluates the requests for off-label uses with an abbreviated report format. The aim of this study is to perform a descriptive analysis of this activity and to study the rate of approvals. MATERIAL AND METHODS: A descriptive study was performed on the PTC reports in a tertiary hospital between September 2009 and April 2011. The type of drug by treatment group and by type of dispensing, indication and requesting department was analysed. The final decision adopted was studied as the primary outcome, and the percentage of requests approved according to the characteristics of the drug evaluated, indication requested, alternatives used, evidence and cost, as secondary outcomes. RESULTS: A total of 51 applications were analysed, of which 60.8% were drugs for hospital use and 54.9% cytostatic. The most requested indications were the onco-haematological (43.2%) and autoimmune (35.3%). Haematology was the department that made most requests (11 requests with 72.7% approved), Oncology and Paediatrics (both with 10 requests, with 50% approved). Almost two-thirds (60.8%) of the requests were approved. Of those that were not approved, 11 had not used up the therapeutic alternatives, and 8 had no evidence. Just under half (47.1%) of the drugs requested had a cost/patient between 10,000-100,000 euros,of which 58.3% were approved (cost per course of treatment if it had a defined period, or cost of treatment per year for chronic treatment). CONCLUSION: There is an increase in the activity of the PTC that is growing over the years. Most applications focus on drugs for hospital use and cytostatic drugs by Onco-haematology. There is a high rate of approval by the PTC, and high variability in the percentage of approval depending on the department and the evidence of use. The difference between approved and unapproved requests followed a logic of cost-effectiveness.

Bilateral primary renal lymphoma: case report and bibliographic review.

OBJECTIVE: To review the presentation, diagnosis and treatment of primary renal lymphoma through a new case report. METHODS: We report the case of a 73-year-old man who presented at A&E with constitutional symptoms and weight loss of 9 kilograms over 3 months RESULTS: Laboratory analysis showed impaired renal function, anemia and hypercalcemia. Imaging tests showed a large solid mass in the right perirenal area with infiltration of the parenchyma and Gerota's fascia surrounding the hilum of the kidney, as well as a solid mass in the inferior pole of the left kidney. Pathology showed the presence of lymphoid-like monomorphic cells. After establishing the diagnosis of bilateral primary renal lymphoma it was decided to start treatment with CHOP-Rituximab-type combination chemotherapy. CONCLUSIONS: Primary renal lymphoma is a rare entity and the diagnostic technique of choice is CT. Definitive diagnosis is confirmed on histology. In view of its aggressive nature and poor prognosis, it is important to make an early diagnosis in order to start treatment promptly. The treatment of choice is systemic chemotherapy using a CHOP regimen.

Linfoma renal primario bilateral: aportación de un nuevo caso y revisión de la literatura / Bilateral primary renal lymphoma: case report and bibliographic review

OBJETIVO: Revisar la forma de presentación, diagnóstico y tratamiento del linfoma renal primario mediante la presentación de un nuevo caso.MÉTODOS: Presentamos el caso de un de 73 años que acudió a Urgencias por síndrome constitucional y pérdida de peso de 9 kilos de 3 meses de evolución.RESULTADOS: En la analítica sanguínea se evidencia deterioro de la función renal, anemia e hipercalcemia. Las pruebas de imagen realizadas evidencian una gran masa solida perirrenal derecha con infiltración del parénquima incluida en la fascia de Gerota que engloba el hilio renal, además de una masa solida en el polo inferior del riñon izquierdo. El estudio anatomopatologico revela la presencia de células monomorfas de naturaleza linfoide. Tras establecer el diagnostico de linfoma renal primario bilateral se decide iniciar tratamiento con poliquimioterapia tipo CHOP-Rituximab.CONCLUSIONES: El linfoma renal primario es una entidad poco frecuente cuya técnica diagnostica de elección es el TC. El diagnostico definitivo se establece mediante estudio histológico. Dado su carácter agresivo y su mal pronóstico es importante realizar un diagnostico temprano para iniciar de forma precoz el tratamiento. La terapia de elección es la quimioterapia sistémica basada en el régimen CHOP(AU)

OBJECTIVE: To review the presentation, diagnosis and treatment of primary renal lymphoma through a new case report.METHODS: We report the case of a 73-year-old man who presented at A&E with constitutional symptoms and weight loss of 9 kilograms over 3 months.RESULTS: Laboratory analysis showed impaired renal function, anemia and hypercalcemia. Imaging tests showed a large solid mass in the right perirenal area with infiltration of the parenchyma and Gerota`s fascia surrounding the hilum of the kidney, as well as a solid mass in the inferior pole of the left kidney. Pathology showed the presence of lymphoid-like monomorphic cells. After establishing the diagnosis of bilateral primary renal lymphoma it was decided to start treatment with CHOP-Rituximab-type combination chemotherapy. CONCLUSIONS: Primary renal lymphoma is a rare entity and the diagnostic technique of choice is CT. Definitive diagnosis is confirmed on histology. In view of its aggressive nature and poor prognosis, it is important to make an early diagnosis in order to start treatment promptly. The treatment of choice is systemic chemotherapy using a CHOP regimen(AU)

Hybrid porous phosphate heterostructures as adsorbents of Hg(II) and Ni(II) from industrial sewage.

Porous phosphate heterostructures (PPH), functionalized with different ratios of aminopropyl and mercaptopropyl groups, labelled as N(x=5,25,50)-PPH and S(x=5,25,50)-PPH, respectively, were tested as adsorbents for Ni(II) and Hg(II) found in industrial sewage from electroplating processes and button battery recycling. X-ray diffraction was used to study the structures. The specific surface area of the pristine material (PPH) was 620 m(2)g(-1), whereas the specific surface areas of the modified mercaptopropyl (S(5)-PPH) and aminopropyl (N(5)-PPH) were 472 and 223 m(2)g(-1), respectively. The adsorption data were fitted to a Langmuir isotherm model. The S(5)-PPH material was saturated by 120 mmol Hg(II) per 100g of material, whereas for Ni(II) adsorption, N(25)-PPH material displayed the highest adsorption with a saturation value of 43.5 mmol per 100g. These results suggest that functionalized PPH materials may be promising toxic metal scavengers and that they may provide an alternative environmental technology.

Reacción adversa grave a diclofenaco / Serious adverse reaction to diclofenac

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Uso de internet en pacientes que acuden a consulta hospitalaria de urología / Internet use in patients attending a hospital urology clinic

Hipótesis: El aumento en los conocimientos de informática de la población general y la difusión de Internet como herramienta de comunicación y conocimiento, permite a los pacientes tener un mayor entendimiento de sus patologías. Objetivo: Evaluar el uso de Internet por parte de la población de un área sanitaria y el conocimiento extraído sobre sus patologías de carácter urológico. Material y Métodos: En este estudio prospectivo se incluyeron todos los paciente mayores de edad que acudieron a consulta hospitalaria de urología entre el 1 de Septiembre y el 31 de Diciembre de 2006, en un área sanitaria de 200,000 habitantes. A todos los pacientes se les entregó un cuestionario autoadministrado para su cumplimentación, no interviniendo el facultativo en su desarrollo en ningún caso. Las variables a estudio fueron la edad (menores de 30 años, entre 30 y 60 años y mayores de 60 años), el sexo, patología del paciente (únicamente se valorarán aquellas con al menos 5 casos), el nivel educativo (ninguno, graduado escolar, estudios medios y estudios universitarios), presencia de ordenador en su casa (si/no), conocimiento de la existencia de internet (si/no), búsquedas realizadas sobre patologías urológicas e influencia de dichas consultas en su relación con el médico. Se evaluará la relación entre el uso de internet y las distintas variables mediante el test de Kruskall-Wallis. Se considerará significativa una verosimilitud de la hipótesis nula inferior a 0,05. Resultados: En total se recibieron 1.111 cuestionarios de los cuales fueron útiles para su procesamiento 1062. La edad media fue de 60,98, con un error estándar de 15,08. El 18,4 % fueron mujeres. La distribución poblacional por nivel de estudios fue: 22,2 % sin estudios, 43,5 % con graduado escolar, 27,5 con un nivel educativo medio y un 6,8 % de universitarios. El 58,4 % de los pacientes niega tener ordenador en casa, el 37,7 % desconoce lo que es internet, el 76,7 % carece de dirección de correo electrónico y únicamente el 6,7 % visitan páginas médicas pero sólo el 1,5 % reconocen haber preguntado a su médico sobre la información recibida en internet. Según la categorización por edades, los pacientes con edades inferiores a 30 años tienen significativamente unos mayores conocimientos en informática e internet (p<0,001). No obstante no se han evidenciado diferencias estadísticamente significativas entre la edad y el hecho de preguntar sobre la información recibida a través de internet (p=0,1). Las páginas web más visitadas fueron por orden de más a menos visitadas: tuotromedico.com, varicocele.com, aecc.es, wikipedia.com, prostatitis.org, ondasalud.com y mapfrecajasalud.com. Las patologías más buscadas fueron: prostatitis crónica (25 % de los pacientes afectos), cáncer de testículo (20 % de los pacientes), varicocele (18,7 %), enfermedad de Peyronie o incurvación congénita peneana (18,1 %) y estenosis de la unión pielo-uretereral (16,6 %). Conclusiones: - La explotación de internet como herramienta de información por parte de los pacientes es muy baja, debido a las características inherentes de la población, como son el bajo nivel de estudios. - Las páginas web urológicas deberían dedicar una parte amplia para la patología más frecuente en los grupos de población más jóvenes, como el varicocele o la prostatitis. No obstante, es lógico esperar que estos patrones epidemiológios se modifiquen con el paso del tiempo. - Se debería fomentar el uso de internet y de la informática en general entre los distintos grupos poblacionales en el área sanitaria a estudio

Hypothesis: The increase in the awareness of computers in the general population and the spread of Internet as a tool for communication and knowledge, allows patients to have greater understanding of their conditions. Objective: To evaluate the use of Internet by the population from a health area and the knowledge extracted about their urological conditions. Material and Methods: This prospective study included all patients of age who attended a hospital urology clinic between 1st September and 31st December 2006, in a health area of 200,000 inhabitants. All patients were given a self-administered questionnaire to complete; medical staff did not intervene in filling it out in any case. The study variables were age (under 30, between 30 and 60 and over 60), sex, patient’s pathology (only those with at least 5 cases were assessed), educational level (none, primary school qualification, intermediate studies and university studies), presence of a computer at home (yes/no), knowledge of the existence of internet (yes/no), searches performed on urological conditions and influence of these consultations in their relationship with their doctor. The relationship between the use of internet and the different variables was evaluated using the Kruskall-Wallis test. A probability of the null hypothesis less than 0.05 was considered significant. Results: A total of 1,111 questionnaires were received, of which 1,062 were useful for processing. The mean age was 60.98 with a standard error of 15.08. 18.4 % were women. The population distribution by level of studies was: 22.2 % uneducated, 43.5 % with primary education qualification, 27.5 % with intermediate educational level and 6.8 % university graduates. 58.4 % of patients denied having a computer at home, 37.7 % do not know what internet is, 76.7 % do not have an e-mail address and just 6.7 % visit medical pages, although only 1.5 % admit having asked their doctor about information received on internet. According to classification by age, patients under 30 have significantly greater knowledge of computers and internet (p<0.001). However, there were no significant differences shown between the age and the fact of asking about information received through internet (p=0.1). The most visited web pages were, in order of the most to least visited: tuotromedico.com, varicocele.com, aecc.es, wikipedia.com, prostatitis.org, ondasalud.com and mapfrecajasalud.com. The most searched for conditions were: chronic prostatitis (25 % of patients affected), testicular cancer (20 % of patients), varicocele (18.7 %), Peyronie’s disease or congenital penile curvature (18.1 %) and stenosis of the pyeloureteral junction (16.6 %). Conclusions: - The exploitation of the internet as an information tool on the part of patients is very low, due to the characteristics inherent to our population, such as the low level of studies. - Urological web pages should dedicate an extensive part to the most common conditions in the younger population groups, such as varicocele or prostatitis. However, it is logical to expect that these epidemiological patterns will modify with time. - The use of internet and computers in general should be promoted among the different population groups in the health area under study