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4.
Am J Clin Nutr ; 110(6): 1344-1352, 2019 12 01.
Artigo em Inglês | MEDLINE | ID: mdl-31562496

RESUMO

BACKGROUND: Epidemiological studies in humans show increased concentrations of copeptin, a surrogate marker of arginine vasopressin (AVP), to be associated with increased risk for type 2 diabetes. OBJECTIVES: To examine the acute and independent effect of osmotically stimulated AVP, measured via the surrogate marker copeptin, on glucose regulation in healthy adults. METHODS: Sixty subjects (30 females) participated in this crossover design study. On 2 trial days, separated by ≥7 d (males) or 1 menstrual cycle (females), subjects were infused for 120 min with either 0.9% NaCl [isotonic (ISO)] or 3.0% NaCl [hypertonic (HYPER)]. Postinfusion, a 240-min oral-glucose-tolerance test (OGTT; 75 g) was administered. RESULTS: During HYPER, plasma osmolality and copeptin increased (P < 0.05) and remained elevated during the entire 6-h protocol, whereas renin-angiotensin-aldosterone system hormones were within the lower normal physiological range at the beginning of the protocol and declined following infusion. Fasting plasma glucose did not differ between trials (P > 0.05) at baseline and during the 120 min of infusion. During the OGTT the incremental AUC for glucose from postinfusion baseline (positive integer) was greater during HYPER (401.5 ± 190.5 mmol/L·min) compared with the ISO trial (354.0 ± 205.8 mmol/L·min; P < 0.05). The positive integer of the AUC for insulin during OGTT did not differ between trials (HYPER 55,850 ± 36,488 pmol/L·min compared with ISO 57,205 ± 31,119 pmol/L·min). Baseline values of serum glucagon were not different between the 2 trials; however, the AUC of glucagon during the OGTT was also significantly greater in HYPER (19,303 ± 3939 ng/L·min) compared with the ISO trial (18,600 ± 3755 ng/L·min; P < 0.05). CONCLUSIONS: The present data indicate that acute osmotic stimulation of copeptin induced greater hyperglycemic responses during the oral glucose challenge, possibly due to greater glucagon concentrations.This study was registered at clinicaltrials.gov as NCT02761434.


Assuntos
Glicemia/metabolismo , Cloreto de Sódio/administração & dosagem , Vasopressinas/metabolismo , Adulto , Estudos Cross-Over , Feminino , Glucagon/sangue , Teste de Tolerância a Glucose , Glicopeptídeos/sangue , Humanos , Insulina/sangue , Masculino , Pessoa de Meia-Idade , Concentração Osmolar , Osmose , Plasma/química , Cloreto de Sódio/análise
5.
Eur J Nutr ; 2019 Aug 19.
Artigo em Inglês | MEDLINE | ID: mdl-31428854

RESUMO

PURPOSE: This investigation had three purposes: (a) to evaluate changes in hydration biomarkers in response to a graded rehydration intervention (GRHI) following 3 days of water restriction (WR), (b) assess within-day variation in urine concentrations, and (c) quantify the volume of fluid needed to return to euhydration as demonstrated by change in Ucol. METHODS: 115 adult males and females were observed during 1 week of habitual fluid intake, 3 days of fluid restriction (1000 mL day-1), and a fourth day in which the sample was randomized into five different GRHI groups: no additional water, CON; additional 500 mL, G+0.50; additional 1000 mL, G+1.00; additional 1500 mL, G+1.50; additional 2250 mL, G+2.25. All urine was collected on 1 day of the baseline week, during the final 2 days of the WR, and during the day of GRHI, and evaluated for urine osmolality, color, and specific gravity. RESULTS: Following the GRHI, only G+1.50 and G+2.25 resulted in all urinary values being significantly different from CON. The mean volume of water increase was significantly greater for those whose Ucol changed from > 4 to < 4 (+ 1435 ± 812 mL) than those whose Ucol remained ≥ 4 (+ 667 ± 722 mL, p < 0.001). CONCLUSIONS: An additional 500 mL of water is not sufficient, while approximately 1500 mL of additional water (for a total intake between 2990 and 3515 mL day-1) is required to return to a urine color associated with adequate water intake, following 3 days of WR.

6.
Clin Chim Acta ; 496: 7-12, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31194966

RESUMO

Sepsis is a life-threatening organ dysfunction caused by a dysregulated response of the host to infection. It represents one of the major health care problems worldwide. Unfortunately, the diagnosis of sepsis is challenging for many reasons, including a lack of a sufficiently sensitive and specific diagnostic test. When procalcitonin (PCT) was discovered, it was thought that it could become the best test for identifying patients with sepsis. From the evidence sources in the available literature, it is now clear that the power of PCT in differentiating infectious from non-infectious forms of systemic inflammatory response syndrome in adults, and in stratifying morbidity and mortality risk, is limited. Nevertheless, PCT determination can be a useful tool for diagnosing late-onset neonatal sepsis, bacterial meningitis and other forms of organ-related bacterial infections and, above all, it can be used for guiding antibiotic stewardship in critical patients. The real impact of this application of PCT testing, however, still needs to be clearly defined. Laboratories should offer unrestricted PCT testing only to intensive care units (as an aid in decision for continuing or stopping antibiotics) and pediatric wards. For all other clinical wards, the laboratory should guide PCT requests and give them support towards the most appropriate approach to testing.


Assuntos
Medicina Baseada em Evidências , Pró-Calcitonina/metabolismo , Antibacterianos/farmacologia , Antibacterianos/uso terapêutico , Infecções Bacterianas/diagnóstico , Infecções Bacterianas/tratamento farmacológico , Infecções Bacterianas/metabolismo , Custos e Análise de Custo , Humanos , Sepse/diagnóstico , Sepse/tratamento farmacológico , Sepse/metabolismo
7.
Infez Med ; 27(2): 128-133, 2019 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-31205034

RESUMO

The use of procalcitonin (PCT) as a tool to assist clinicians in using antibiotics in intensive care patients has been postulated. Here we evaluate the efficacy of procalcitonin determination in helping clinicians in the decision to start or discontinue an antibiotic treatment in patients admitted to infectious disease wards. A retrospective observational single centre study was conducted in two infectious disease wards. Descriptive and inferential statistical analysis was carried out and receiver operating characteristic curves and area under the curve (AUC) were used to assess the accuracy of PCT and C-reactive protein (CRP) in separating patients undergoing antibiotic treatment or otherwise. In all, 164 patients were analysed of whom 99 (60.4%) were not on antibiotic treatment at the time of PCT determination, whereas 65 (39.6%) took antibiotics. Regarding the accuracy of PCT and CRP in determining a subsequent antibiotic prescription in patients without an ongoing antibiotic treatment, no statistically significant difference between the two markers was detected [AUC, 0.75; confidence interval (CI) 95%: 0.66-0.84; vs 0.69; CI 95%: 0.59-0.79 for PCT and CRP, respectively; p=0.32]. Conversely, in patients with an ongoing antibiotic treatment a statistically significant difference between PCT and CRP AUC in their ability to determine an antibiotic interruption was observed [0.77 (CI 95%: 0.65-0.89) vs 0.59 (CI 95%: 0.45-0.73) (p=0.03)]. PCT determination appeared to be more helpful than CRP in determining discontinuation of an antibiotic treatment in non-intensive care patients. However, PCT should supplement and not supplant a careful clinical evaluation.


Assuntos
Antibacterianos/uso terapêutico , Proteína C-Reativa/análise , Tomada de Decisão Clínica , Pró-Calcitonina/sangue , Procedimentos Desnecessários , Adulto , Idoso , Antibacterianos/administração & dosagem , Biomarcadores/sangue , Intervalos de Confiança , Confiabilidade dos Dados , Feminino , Febre/tratamento farmacológico , Humanos , Infectologia , Masculino , Pessoa de Meia-Idade , Curva ROC , Estudos Retrospectivos , Suspensão de Tratamento
8.
Clin Chem Lab Med ; 57(11): 1721-1729, 2019 Oct 25.
Artigo em Inglês | MEDLINE | ID: mdl-31145686

RESUMO

Background Blood loss for laboratory testing may contribute to hospital-acquired anemia. When implementing the core laboratory (core-lab) section, we consolidated first-line tests decreasing the number of tubes previously dispatched to different sites. Here, hypothesized benefits of the amount of blood volume drawn were explored. Methods We retrieved, using a laboratory information system (LIS), the number of tubes received by laboratories interested in the change from all clinical wards in a year-based period, i.e. 2013 for pre-core-lab and 2015 for core-lab system, respectively. Data were expressed as the overall number of tubes sent to laboratories, the corresponding blood volume, and the number of laboratory tests performed, normalized for the number of inpatients. Results After consolidation, the average number of blood tubes per inpatient significantly decreased (12.6 vs. 10.7, p < 0.001). However, intensive care units (ICUs) did not reduce the number of tubes per patient, according to the needs of daily monitoring of their clinical status. The average blood volume sent to laboratories did not vary significantly because serum tubes for core-lab required higher volumes for testing up to 55 analytes in the same transaction. Finally, the number of requested tests per patient during the new osystem slightly decreased (-2.6%). Conclusions Total laboratory automation does not automatically mean reducing iatrogenic blood loss. The new system affected the procedure of blood drawing in clinical wards by significantly reducing the number of handled tubes, producing a benefit in terms of costs, labor and time consumption. Except in ICUs, this also slightly promoted some blood saving. ICUs which engage in phlebotomizing patients daily, did not take advantage from the test consolidation.

10.
J Clin Endocrinol Metab ; 104(6): 1917-1925, 2019 06 01.
Artigo em Inglês | MEDLINE | ID: mdl-30566641

RESUMO

OBJECTIVE: Because elevated copeptin, a marker of vasopressin, is linked to low water intake and high diabetes risk, we tested the effect of water supplementation on copeptin and fasting glucose. DESIGN, SETTING, AND PARTICIPANTS: Thirty-one healthy adults with high copeptin (>10.7 pmol · L-1 in men and >6.1 pmol·L-1 in women) identified in a population-based survey from 2013 to 2015 and with a current 24-hour urine osmolality of >600 mOsm · kg-1 were included. INTERVENTION: Addition of 1.5 L water daily on top of habitual fluid intake for 6 weeks. MAIN OUTCOME MEASURE: Pre- and postintervention fasting plasma copeptin concentrations. RESULTS: Reported mean water intake increased from 0.43 to 1.35 L · d-1 (P < 0.001), with no other observed changes in diet. Median (interquartile range) urine osmolality was reduced from 879 (705, 996) to 384 (319, 502) mOsm · kg-1 (P < 0.001); urine volume increased from 1.06 (0.90, 1.20) to 2.27 (1.52, 2.67) L · d-1 (P < 0.001); and baseline copeptin decreased from 12.9 (7.4, 21.9) pmol · L-1 to 7.8 (4.6;11.3) pmol · L-1 (P < 0.001). Water supplementation reduced fasting plasma glucose from a mean (SD) of 5.94 (0.44) to 5.74 (0.51) (P = 0.04). The water-associated reduction of both fasting copeptin and glucose concentration in plasma was most pronounced in participants in the top tertile of baseline copeptin. CONCLUSIONS: Water supplementation in persons with habitually low water consumption and high copeptin levels is effective in lowering copeptin. It appears a safe and promising intervention with the potential of lowering fasting plasma glucose and thus reducing diabetes risk. Further investigations are warranted to support these findings.


Assuntos
Glicemia/análise , Diabetes Mellitus Tipo 2/prevenção & controle , Ingestão de Líquidos/fisiologia , Glicopeptídeos/sangue , Água/administração & dosagem , Administração Oral , Adulto , Idoso , Glicemia/fisiologia , Diabetes Mellitus Tipo 2/sangue , Diabetes Mellitus Tipo 2/metabolismo , Jejum/sangue , Jejum/fisiologia , Feminino , Glicopeptídeos/metabolismo , Voluntários Saudáveis , Humanos , Masculino , Pessoa de Meia-Idade , Concentração Osmolar , Projetos Piloto , Resultado do Tratamento , Urina/química , Urina/fisiologia , Vasopressinas/sangue , Vasopressinas/metabolismo , Adulto Jovem
12.
G Ital Nefrol ; 35(5)2018 Sep.
Artigo em Italiano | MEDLINE | ID: mdl-30234239

RESUMO

BACKGROUND: The morphological examination of urinary sediment (MEUS) is traditionally associated with urinalysis (UA), with workload implications and the need for automation of its execution. METHODS: Considering MEUS as a test requiring specialized knowhow and skill for its execution, since 2005 in our laboratory it is performed for inpatients only upon specific request. Eleven years after, we have analyzed the long-term impact of this approach on the provided service. We evaluated results in the 2009-2016 period, in which our hospital did not undergo any change both in the number of beds and in the clinical case-mix. RESULTS: From 2009 to 2013 an average of 2264 MEUS and 10,204 UA per year were ordered, respectively, with an average ratio of 22.2%. Since 2014, a change on computerized order entry involving MEUS caused a further decrease of its requests (in average, 923 per year), which was not associated to a decrease in UA (in average, 9810 per year) (in average, MEUS/UA 9.4%). MEUS requests came mainly from Paediatrics (47.8%), Nephrology (20.9%) and Rheumatology (18.3%) wards. By filling a satisfaction survey, clinical wards evaluated the provided service as satisfactory, while highlighting some critical issues, mainly referred to preanalytical phase. CONCLUSIONS: The alternative proposal for managing MEUS presented in this paper markedly reduces the number of requests and increases their appropriateness. This is achieved without any negative impact on patient care.


Assuntos
Urinálise/métodos , Automação , Precipitação Química , Governança Clínica , Grupos Diagnósticos Relacionados , Número de Leitos em Hospital , Departamentos Hospitalares , Humanos , Laboratórios Hospitalares/estatística & dados numéricos , Utilização de Procedimentos e Técnicas , Estudos Retrospectivos , Urinálise/estatística & dados numéricos , Carga de Trabalho
13.
Int J Sport Nutr Exerc Metab ; : 1-10, 2018 Oct 15.
Artigo em Inglês | MEDLINE | ID: mdl-29893590

RESUMO

This study systematically examined the influence of carbohydrate (sucrose), sodium, and caffeine on the fluid retention potential of beverages under euhydrated conditions, using the beverage hydration index method. Three cohorts, each of 12 young, healthy, active men, ingested 1 L of beverages containing four different concentrations of a single component (sucrose, sodium, or caffeine) in a double-blind, crossover manner. Urine output was collected for the subsequent 4 hr. Cumulative urine output was lower and net fluid balance was higher after 10 and 20% sucrose beverages than 0 and 5% sucrose beverages (p < .05), and after 27 and 52 mmol/L sodium beverages than 7 and 15 mmol/L sodium beverages (p < .05). No difference in urine output or net fluid balance was apparent following ingestion of caffeine at concentrations of 0-400 mg/L (p = .83). Consequently, the calculated beverage hydration index was greater in beverages with higher sucrose or sodium content, but caffeine had no effect. No difference was observed in arginine vasopressin or aldosterone between any trials. These data highlight that the key drivers promoting differences in the fluid retention potential of beverages when euhydrated are energy density, likely through slowed fluid delivery to the circulation (carbohydrate content effect), or electrolyte content through improved fluid retention (sodium content effect). These data demonstrate that beverage carbohydrate and sodium content influence fluid delivery and retention in the 4 hr after ingestion, but caffeine up to 400 mg/L does not. Athletes and others can use this information to guide their daily hydration practices.

16.
Clin Biochem ; 57: 62-64, 2018 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-29343410

RESUMO

BACKGROUND: Automatic photometric determination of the hemolysis index (HI) on serum and plasma samples is central to detect potential interferences of in vitro hemolysis on laboratory tests. When HI is above an established cut-off for interference, results may suffer from a significant bias and undermine clinical reliability of the test. Despite its undeniable importance for patient safety, the analytical performance of HI estimation is not usually checked in laboratories. Here we evaluated for the first time the random source of measurement uncertainty of HI determination on the two Abbott Architect c16000 platforms in use in our laboratory. METHODS: From January 2016 to September 2017, we collected data from daily photometric determination of HI on a fresh-frozen serum pool with a predetermined HI value of ~100 (corresponding to ~1g/L of free hemoglobin). Monthly and cumulative CVs were calculated. RESULTS: During 21months, 442 and 451 measurements were performed on the two platforms, respectively. Monthly CVs ranged from 0.7% to 2.7% on c16000-1 and from 0.8% to 2.5% on c16000-2, with a between-platform cumulative CV of 1.82% (corresponding to an expanded uncertainty of 3.64%). Mean HI values on the two platforms were just slightly biased (101.3 vs. 103.1, 1.76%), but, due to the high precision of measurements, this difference assumed statistical significance (p<0.0001). CONCLUSIONS: Even though no quality specifications are available to date, our study shows that the HI measurement on Architect c16000 platform has nice reproducibility that could be considered in establishing the state of the art of the measurement.


Assuntos
Testes Hematológicos/instrumentação , Hemólise , Fotometria/métodos , Incerteza , Testes Hematológicos/normas , Humanos , Fotometria/normas , Reprodutibilidade dos Testes
18.
High Alt Med Biol ; 18(3): 199-208, 2017 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-28418725

RESUMO

Sutherland, Angus, Joseph Freer, Laura Evans, Alberto Dolci, Matteo Crotti, and Jamie Hugo Macdonald. MEDEX 2015: Heart rate variability predicts development of acute mountain sickness. High Alt Med Biol. 18: 199-208, 2017. AIMS: Acute mountain sickness (AMS) develops when the body fails to acclimatize to atmospheric changes at altitude. Preascent prediction of susceptibility to AMS would be a useful tool to prevent subsequent harm. Changes to peripheral oxygen saturation (SpO2) on hypoxic exposure have previously been shown to be of poor predictive value. Heart rate variability (HRV) has shown promise in the early prediction of AMS, but its use pre-expedition has not previously been investigated. We aimed to determine whether pre- and intraexpedition HRV assessment could predict susceptibility to AMS at high altitude with better diagnostic accuracy than SpO2. METHODS: Forty-four healthy volunteers undertook an expedition in the Nepali Himalaya to >5000 m. SpO2 and HRV parameters were recorded at rest in normoxia and in a normobaric hypoxic chamber before the expedition. On the expedition HRV parameters and SpO2 were collected again at 3841 m. A daily Lake Louise Score was obtained to assess AMS symptomology. RESULTS: Low frequency/high frequency (LF/HF) ratio in normoxia (cutpoint ≤2.28 a.u.) and LF following 15 minutes of exposure to normobaric hypoxia had moderate (area under the curve ≥0.8) diagnostic accuracy. LF/HF ratio in normoxia had the highest sensitivity (85%) and specificity (88%) for predicting AMS on subsequent ascent to altitude. In contrast, pre-expedition SpO2 measurements had poor (area under the curve <0.7) diagnostic accuracy and inferior sensitivity and specificity. CONCLUSIONS: Pre-ascent measurement of HRV in normoxia was found to be of better diagnostic accuracy for AMS prediction than all measures of HRV in hypoxia, and better than peripheral oxygen saturation monitoring.


Assuntos
Doença da Altitude/etiologia , Frequência Cardíaca/fisiologia , Montanhismo/fisiologia , Oximetria/estatística & dados numéricos , Aclimatação/fisiologia , Doença Aguda , Adulto , Altitude , Doença da Altitude/diagnóstico , Doença da Altitude/fisiopatologia , Expedições , Feminino , Voluntários Saudáveis , Humanos , Hipóxia/fisiopatologia , Masculino , Pessoa de Meia-Idade , Oximetria/métodos , Valor Preditivo dos Testes , Descanso/fisiologia , Sensibilidade e Especificidade , Adulto Jovem
19.
Clin Biochem ; 50(10-11): 605-611, 2017 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-28390779

RESUMO

During the past decades the healthcare systems have rapidly changed and today hospital care is primarily advocated for critical patients and acute treatments, for which laboratory test results are crucial and need to be always reported in predictably short turnaround time (TAT). Laboratories in the hospital setting can face this challenge by changing their organization from a compartmentalized laboratory department toward a decision making-based laboratory department. This requires the implementation of a core laboratory, that exploits total laboratory automation (TLA) using technological innovation in analytical platforms, track systems and information technology, including middleware, and a number of satellite specialized laboratory sections cooperating with care teams for specific medical conditions. In this laboratory department model, the short TAT for all first-line tests performed by TLA in the core laboratory represents the key paradigm, where no more stat testing is required because all samples are handled in real-time and (auto)validated results dispatched in a time that fulfills clinical needs. To optimally reach this goal, laboratories should be actively involved in managing all the steps covering the total examination process, speeding up also extra-laboratory phases, such sample delivery. Furthermore, to warrant effectiveness and not only efficiency, all the processes, e.g. specimen integrity check, should be managed by middleware through a predefined set of rules defined in light of the clinical governance.


Assuntos
Automação Laboratorial , Técnicas de Laboratório Clínico , Laboratórios Hospitalares , Automação Laboratorial/instrumentação , Automação Laboratorial/métodos , Automação Laboratorial/normas , Técnicas de Laboratório Clínico/instrumentação , Técnicas de Laboratório Clínico/métodos , Técnicas de Laboratório Clínico/normas , Técnicas de Laboratório Clínico/tendências , Humanos , Laboratórios Hospitalares/organização & administração , Laboratórios Hospitalares/normas , Laboratórios Hospitalares/tendências
20.
Clin Chem Lab Med ; 55(11): 1683-1689, 2017 Oct 26.
Artigo em Inglês | MEDLINE | ID: mdl-28343173

RESUMO

The introduction of "highly sensitive" cardiac troponin assays (hsTn) has reinforced the evidence that only serial testing incorporated in running algorithms allows a more accurate diagnosis of acute myocardial infarction. In this report, we consider the available evidence supporting the use of fast track protocols for ruling out and ruling in non-ST elevation myocardial infarction (NSTEMI) and compare it with the content of recently released guideline by the European Society of Cardiology, noting some uncomfortable aspects that need urgent clarification and/or revision. Firstly, the guideline drafters have to reconsider the available evidence that does not permit to assign the same class and level of evidence to the very well-validated 0-3 h algorithm and to the 0-1 h algorithm. In agreement with the validity of available data, the limitations of fast track protocols, in particular of the 0-1 h algorithm for NSTEMI rule-in, calls for caution. Secondly, as the current diagnostics guidance by the UK National Institute for Health and Care Excellence recommends, rapid diagnostic protocols should be performed only using well-validated hsTn; recommending the use of an assay before being commercially available is not fair and scientifically sound.


Assuntos
Infarto do Miocárdio sem Supradesnível do Segmento ST/diagnóstico , Troponina/análise , Algoritmos , Bioensaio , Intervalos de Confiança , Serviço Hospitalar de Emergência , Humanos , Limite de Detecção , Fatores de Tempo
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