Your browser doesn't support javascript.
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 26
Filtrar
Mais filtros










Intervalo de ano de publicação
1.
Rev. lab. clín ; 12(3): e9-e24, jul.-sept. 2019. ilus, tab, graf
Artigo em Espanhol | IBECS-Express | ID: ibc-ET1-4168

RESUMO

La preeclampsia (PE) constituye una de las principales causas de mortalidad materna y perinatal en el mundo. En los países desarrollados, los estudios apuntan a un importante aumento de la incidencia de PE en la última década, en parte, por el aumento de la prevalencia, en la población general, de enfermedades que afectan a la función vascular, como la diabetes, la hipertensión crónica o la enfermedad renal. En el presente documento se lleva cabo una revisión actualizada de la PE. Se describen los criterios diagnósticos y la fisiopatología de la enfermedad. El objetivo principal del documento es revisar los nuevos marcadores bioquímicos que pueden ser de utilidad en la práctica clínica para la predicción y el diagnóstico de la PE, así como los distintos métodos mediante los cuales se puede llevar a cabo su determinación


Pre-eclampsia (PE) is one of the leading causes of maternal and perinatal mortality in the world. In developed countries, studies point to a significant increase in the incidence of PE in the last decade, partly due to the increase in the prevalence in the general population of diseases that affect vascular function, such as diabetes. chronic hypertension, or kidney disease. An updated review of PE is presented in this article. The diagnostic criteria and the pathophysiology of the disease are described. The main objective of the document is to review the new biochemical markers that may be useful in clinical practice for the prediction and diagnosis of PE, as well as the different methods by which yey can be determined

2.
Clin Chem Lab Med ; 57(10): 1474-1487, 2019 Sep 25.
Artigo em Inglês | MEDLINE | ID: mdl-31120856

RESUMO

Background Prostate-specific antigen (PSA) remains as the most used biomarker in the detection of early prostate cancer (PCa). Clinical practice guidelines (CPGs) are produced to facilitate incorporation of evidence into clinical practice. This is particularly useful when PCa screening remains controversial and guidelines diverge among different medical institutions, although opportunistic screening is not recommended. Methods We performed a systematic review of guidelines about PCa screening using PSA. Guidelines published since 2008 were included in this study. The most updated version of these CPGs was used for the evaluation. Results Twenty-two guidelines were selected for review. In 59% of these guidelines, recommendations were graded according to level of evidence (n = 13), but only 18% of the guidelines provided clear algorithms (n = 4). Each CPG was assessed using a checklist of laboratory issues, including pre-analytical, analytical, and post-analytical factors. We found that laboratory medicine specialists participate in 9% of the guidelines reviewed (n = 2) and laboratory issues were frequently omitted. We remarked that information concerning the consequences of World Health Organization (WHO) standard in PSA testing was considered by only two of 22 CPGs evaluated in this study. Conclusions We concluded that the quality of PCa early detection guidelines could be improved properly considering the laboratory issues in their development.

3.
Clin Biochem ; 68: 24-29, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30928393

RESUMO

BACKGROUND: Acute coronary syndrome (ACS) is a major cause of death and closely related with obstructive sleep apnea (OSA). Our hypothesis is that several cardiovascular-related biomarkers could have a differential prognostic value for ACS severity in patients with OSA, and could also help (individually or combined) in the detection of OSA in patients after a coronary event. METHODS: Up to 361 consecutive individuals admitted due to ACS were included in the study. All of them were evaluated for ACS severity (Killip score, number of diseased vessels, ejection fraction) and further classified as OSA or non-OSA. Medical records were registered and eleven blood biomarkers were measured, including heart-type fatty acid-binding globulin, N-terminal pro-brain natriuretic peptide, matrix metalloproteinase-9 (MMP9), placental growth factor (PlGF) and high-sensitivity C-reactive protein. Odds ratios of every biomarker for ACS severity-related parameters were calculated and adjusted for age, gender, body-mass index (BMI), hypertension, diabetes, smoking and drinking. The use of clinical measures and biomarkers for the diagnosis of OSA in ACS patients was evaluated both alone and combined using ROC curves. RESULTS: Several biomarkers showed a significant association with ACS severity, which remained after adjusting for OSA and other potentially confounding variables. The mathematical combination of age, BMI, PlGF and MMP9 showed an area under the ROC curve (AUC) for OSA identification of 0.741, which was greater than any individual parameter or combination assessed: AUC(BMI):0.687, AUC(age):0.576, AUC(PlGF):0.584, AUC(MMP9):0.555. CONCLUSIONS: The usefulness of biomarkers in the assessment of ACS severity was independent of OSA and the other variables evaluated. In patients admitted after a coronary event, the combination of clinical measures and biomarkers showed a significant discriminating power for the detection of OSA. CLINICAL TRIAL REGISTRATION: NCT01335087 (clinicaltrials.gov).


Assuntos
Biomarcadores/sangue , Síndromes da Apneia do Sono/sangue , Apneia Obstrutiva do Sono/sangue , Síndrome Coronariana Aguda/sangue , Síndrome Coronariana Aguda/patologia , Algoritmos , Área Sob a Curva , Índice de Massa Corporal , Proteína C-Reativa/metabolismo , Feminino , Humanos , Masculino , Prognóstico , Síndromes da Apneia do Sono/patologia , Apneia Obstrutiva do Sono/patologia
4.
EJIFCC ; 30(1): 25-34, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30881272

RESUMO

Background: Despite many studies assessing hemolysis interference in almost every clinically relevant magnitude, sodium has poorly been assessed. Our aim was to evaluate hemolysis interference on plasma sodium, using different strategies of hemolysis preparation, at different baseline sodium ion concentrations and bias specifications. Methods: Two different strategies were used for the preparation of hemolysis from lithium heparin blood samples. Repeatibility was calculated at two levels for each strategy and interferograms were outlined for both approaches at sodium concentrations between 130-145 mmol/L. Results were interpreted according to different specifications: reference change value, RiLiBAK, Westgard's database, RCPA-QAP and CLIA. Results: The coefficients of variation of the hemolyzed samples using the first strategy were lower than for the second strategy (0.23-0.78% vs 0.57-48.6%, for 0.2 g/dL free Hb and 0.28-0.44% vs 0.40-135.1%, for 0.9 g/dL free Hb). Statistically significant differences were seen when comparing the slopes of the pairs of interferograms at each sodium concentration obtained by both strategies (p<0.001 for 130 mmol/L; p=0.068 for 135 mmol/L; p=0.002 for 140 mmol/L and p=0.001 for 145 mmol/L). Hemolysis cut-off values were generally independent of the sodium concentration. Conclusions: Reproducibility of hemolysate preparation is procedure-dependent. A greater standardization is needed for the preparation of a true hemolysate to better quantify the degree of interference of clinically relevant analytes, especially those with higher complexity such as sodium. We found a concentration-independent cut-off value for the hemolysis index that allows the establishment of a single and robust value in every laboratory, according to their quality specifications.

5.
Sleep Med ; 53: 101-105, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30504083

RESUMO

OBJECTIVE: Increased blood coagulation might be one important mechanism linking obstructive sleep apnea (OSA) with cardiovascular diseases. We tested the association between several hemostatic parameters and sleep breathing-related variables in a representative pediatric population with a clinical suspicion of OSA. METHODS: Polysomnography was performed in 152 snoring children to diagnose OSA. Anthropometric and clinical data were registered and venous blood samples were collected for the measurement of platelet count, plateletcrit, platelet distribution width (PDW), mean platelet volume (MPV), prothrombin time (PT), activated partial thromboplastin time (aPTT), fibrinogen and C-reactive protein. RESULTS: Children with OSA had significantly higher platelet count, plateletcrit and PDW compared with those without OSA. After controlling for the anthropometric characteristics (age, gender, body mass index (BMI) z-score), platelet count negatively correlated with minimum SaO2 while the plateletcrit correlated with time with SaO2 <90% and MPV correlated with apnea-hypopnea index. PT and PT international normalized ratio correlated with mean SaO2 and aPTT correlated with the oxygen desaturation index. CONCLUSION: Our findings suggest that different OSA-related effects may be factors contributing to an enhanced coagulability in pediatric OSA. Measures reflecting apnea severity and disrupted sleep were associated with clotting factor changes independent of covariates affecting hemostatic function.

6.
Pediatr Pulmonol ; 52(8): 1085-1091, 2017 08.
Artigo em Inglês | MEDLINE | ID: mdl-28672086

RESUMO

INTRODUCTION: The effects of obstructive sleep apnea (OSA) on the metabolic system are not well understood, especially in children. Recent studies have provided evidence of the modulation of insulin action by branched-chain amino acids (BCAAs) and suggested novel mechanistic relationships between glucose and amino acid metabolic pathways. We hypothesized that plasma BCAA levels may serve as biomarkers of insulin resistance and metabolic dysfunction in children with OSA. METHODS: A polysomnography was conducted for the diagnosis of OSA in 90 snoring children, in a tertiary hospital. Anthropometric and clinical data were measured and venous blood samples were collected for the measurement of plasma glucose, insulin, HbA1c, and amino acids. RESULTS: Children with OSA had significantly higher levels of BCAAs (leucine, isoleucine, and total BCAAs) compared with those without OSA (P = 0.024). A positive significant correlation was observed between insulin levels and both leucine and isoleucine (r = 0.232; P < 0.05). On multivariate regression analyses, the presence of OSA was significantly associated with leucine, isoleucine, and total BCAA concentrations (P = 0.028), whereas the arousal index was associated with leucine, valine, and total BCAA levels (P = 0.037). CONCLUSIONS: The presence of OSA and sleep fragmentation may induce changes in branched-chain amino acid metabolism in snoring children, independently of obesity. These data may suggest a new mechanism linking OSA and glucose homeostasis.


Assuntos
Aminoácidos de Cadeia Ramificada/sangue , Apneia Obstrutiva do Sono/sangue , Antropometria , Biomarcadores/sangue , Glicemia/análise , Criança , Pré-Escolar , Feminino , Hemoglobina A Glicada/análise , Homeostase , Humanos , Insulina/sangue , Resistência à Insulina , Masculino , Polissonografia , Apneia Obstrutiva do Sono/diagnóstico , Ronco/sangue , Ronco/diagnóstico
7.
J Sleep Res ; 26(6): 773-781, 2017 12.
Artigo em Inglês | MEDLINE | ID: mdl-28513068

RESUMO

There is evidence that changes in branched-chain amino acid (BCAA) levels may correlate with the efficacy of therapeutic interventions for affecting improvement in metabolic control. The objective of this study was to evaluate whether serum concentrations of BCAAs (leucine, isoleucine, valine) could mediate in insulin sensitivity and glucose tolerance after continuous positive airway pressure (CPAP) treatment in patients with obstructive sleep apnea (OSA). A prospective randomized controlled trial of OSA patients with morbid obesity was conducted. Eighty patients were randomized into two groups: 38 received conservative treatment and 42 received CPAP treatment for 12 weeks. Plasma levels of BCAA, glucose tolerance and insulin resistance were evaluated at baseline and after treatment. After treatment, significant decreases of leucine levels were observed in both groups when compared with baseline levels (P < 0.005). With respect to patients with normal glucose tolerance (NGT), patients with impaired glucose tolerance (IGT) had higher baseline levels of isoleucine (78 ± 16 versus 70 ± 13 µmol L-1 , P = 0.014) and valine (286 ± 36 versus 268 ± 41 µmol L-1 , P = 0.049), respectively. Changes in levels of leucine and isoleucine after treatment were related negatively to changes in fasting plasma glucose and glycosylated haemoglobin values only in the conservative group (P < 0.05). In summary, we found that the treatment with CPAP for 12 weeks caused similar changes in circulating BCAAs concentrations to conservative treatment and a differential metabolic response of CPAP and conservative treatment was observed between the relationship of BCAAs and glucose homeostasis. Additional studies are needed to determine the interplay between branched-chain amino acids and glucose metabolism in patients with sleep apnea.


Assuntos
Aminoácidos de Cadeia Ramificada/sangue , Glicemia/metabolismo , Pressão Positiva Contínua nas Vias Aéreas , Intolerância à Glucose , Resistência à Insulina , Obesidade Mórbida/complicações , Obesidade Mórbida/metabolismo , Apneia Obstrutiva do Sono/metabolismo , Apneia Obstrutiva do Sono/terapia , Adulto , Aminoácidos de Cadeia Ramificada/metabolismo , Jejum/sangue , Feminino , Hemoglobina A Glicada/análise , Humanos , Isoleucina/sangue , Leucina/sangue , Masculino , Pessoa de Meia-Idade , Obesidade Mórbida/sangue , Estudos Prospectivos , Apneia Obstrutiva do Sono/sangue , Apneia Obstrutiva do Sono/complicações
8.
Clin Biochem ; 50(13-14): 772-776, 2017 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-28372954

RESUMO

BACKGROUND: Osmolality reflects the concentration of all dissolved particles in a body fluid, and its measurement is routinely performed in clinical laboratories for the differential diagnosis of disorders related with the hydrolytic balance regulation, the renal function and in small-molecule poisonings. The aim of the study was to assess the stability of serum, plasma and urine osmolality through time and under different common storage conditions, including delayed centrifugation. METHODS: Blood and urine samples were collected, and classified into different groups according to several preanalytical variables: serum or plasma lithium-heparin tubes; spun or unspun; stored at room temperature (RT), at 4°C or frozen at -21°C. Aliquots from each group were assayed over time, for up to 14days. Statistical differences were based on three different international performance criteria. RESULTS: Whole blood stability was higher in the presence of anticoagulant. Serum osmolality was stable for 2days at RT and 8days at 4°C, while plasma was less stable when refrigerated. Urine stability was 5days at RT, 4days at 4°C and >14days when frozen. DISCUSSION: Osmolality may be of great interest for the management of several conditions, such as in case of a delay in the clinical suspicion, or in case of problems in sample collection or processing. The ability to obtain reliable results for samples kept up to 14days also offers the possibility to retrospectively assess baseline values for patients which may require it.


Assuntos
Métodos Analíticos de Preparação de Amostras , Análise Química do Sangue , Plasma/química , Soro/química , Urina/química , Adulto , Métodos Analíticos de Preparação de Amostras/normas , Análise Química do Sangue/normas , Centrifugação , Criopreservação , Guias como Assunto , Humanos , Ilhas do Mediterrâneo , Concentração Osmolar , Estudos Prospectivos , Refrigeração , Reprodutibilidade dos Testes , Espanha , Centros de Atenção Terciária , Fatores de Tempo
9.
Clin Biochem ; 50(1-2): 27-31, 2017 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-27614217

RESUMO

BACKGROUND: Prostaglandin D2 synthase, commonly known as ß-trace protein (ßTP), is an excellent biomarker for the assessment of cerebrospinal fluid (CSF) leaks. Despite being widely used, the limits for the diagnostic values of ßTP are not well established to date, and currently suggested cut-off values in literature range from 0.25 to 6.0mg/L. Sample-specific and more accurate thresholds are a current need. METHODS: A retrospective observational study, performed in a tertiary-care hospital, between January 2006 and January 2014. A total of 74 patients were included, with a definitive diagnosis after initial leak suspicion and at least one determination of ßTP using a nephelometry-based assay. A total of 46 CSF samples were included in the control group. Samples were obtained from nasal secretions, ear secretions or spinal surgical injury, directly using sterile Eppendorf tubes. The analysis of 3 different cut-off values was performed and the receiver operating curve (ROC) analyses were calculated. RESULTS: Initial diagnostic suspicion was confirmed in 51% of cases, most of which were of postoperative origin (51%) and traumatic (26%). The ßTP median concentration in different samples was significantly higher in the presence of cerebrospinal fluid fistula, regardless of sample type (22.0mg/L vs. 0.24mg/L, 95% confidence interval: 19.0-30.8 vs. 0.08-0.40; p<0.001). Data from contingency tables show 100% sensitivity and specificity, depending on sample type and the cut-off value used: for rhinorrhea and otorrhea samples, the most appropriate it was 0.7mg/L, while values >2.0mg/L could be used for spine postoperative fluid leakage samples. CONCLUSIONS: The cut off value for ßTP in the diagnosis and follow-up of cerebrospinal fluid leaks should be modified depending on the type of secretion (sample type), for a better diagnostic accuracy.


Assuntos
Vazamento de Líquido Cefalorraquidiano , Oxirredutases Intramoleculares/líquido cefalorraquidiano , Lipocalinas/líquido cefalorraquidiano , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Sensibilidade e Especificidade , Adulto Jovem
10.
Sleep Med ; 26: 12-15, 2016 10.
Artigo em Inglês | MEDLINE | ID: mdl-28007354

RESUMO

BACKGROUND: Obstructive sleep apnea (OSA) is now being recognized as an additional contributing factor to the pathogenesis of obesity-related comorbidities. At the same time, there is now increasing evidence to suggest that intestinal wall permeability plays a role in the development of metabolic syndrome. In the present study, circulating zonulin and fatty acid binding protein (I-FABP) were measured in association with metabolic, hepatic, and inflammatory parameters. RESULTS: Compared with controls, plasma I-FABP levels were significantly higher in patients with OSA (571 pg/mL [IQR 290-950] vs 396 pg/mL [IQR 234-559], p = 0.04). Zonulin levels were similar between groups. Significant relationships were observed between zonulin levels and waist circumference (p < 0.05), glucose (p < 0.05), and insulin (p < 0.05). In addition, in the OSA group, zonulin levels correlated negatively with the mean nocturnal oxygenation saturation (p < 0.05) and positively with total cholesterol (p < 0.05), alanine aminotransferase (ALT) (p < 0.005), aminotransferase (AST) (p < 0.01), gamma glutamyltransferase (GGT) (p < 0.005), and high-sensitivity C-reactive protein (hs-CRP) (p < 0.05). Multivariate analysis showed that associations between zonulin and ALT, AST, and hs-CRP were attenuated, but not eliminated, after adjustment for other variables. CONCLUSIONS: The results of this study suggest that OSA is a risk factor for intestinal damage, regardless of metabolic profile, and that intestinal permeability might be a possible contributor to nonalcoholic fatty liver disease in patients with OSA.


Assuntos
Toxina da Cólera/sangue , Proteínas de Ligação a Ácido Graxo/sangue , Absorção Intestinal/fisiologia , Síndrome Metabólica/complicações , Obesidade/complicações , Apneia Obstrutiva do Sono/complicações , Adulto , Alanina Transaminase/sangue , Biomarcadores/sangue , Estudos de Casos e Controles , Feminino , Humanos , Mucosa Intestinal/fisiopatologia , Masculino , Síndrome Metabólica/sangue , Pessoa de Meia-Idade , Hepatopatia Gordurosa não Alcoólica/sangue , Hepatopatia Gordurosa não Alcoólica/complicações , Obesidade/sangue , Estudos Retrospectivos , Apneia Obstrutiva do Sono/sangue , Apneia Obstrutiva do Sono/fisiopatologia , Circunferência da Cintura
11.
J Clin Anesth ; 33: 306-8, 2016 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-27555182

RESUMO

UNLABELLED: The green color in urine may suggest the presence of a severe pathology needing treatment. Many different potential causes of green urine have previously been reported. In our case, after ruling out other potential causes of green urine, it was suggested that the surgical manipulation of the paralytic ileum might have induced the reabsorption of the methylene blue which had been retained in the bowel (bezoar effect), even 96 hours after the nasogastric administration. CONCLUSIONS: The staff should keep in mind this possible effect due to methylene blue to recognize early and avoid unnecessary laboratory tests. AUTHORS SUMMARY: This case report illustrates the significance of urine discoloration, sometimes indicate the presence of a systemic disorder and some rare cases, this phenomenon has no pathologic effects. To our knowledge, this is the first case report of a green urine by drug bezoar due methylene blue in children.


Assuntos
Bezoares/urina , Criança , Cor , Corantes , Humanos , Íleo/cirurgia , Masculino , Azul de Metileno
13.
Clin Biochem ; 49(12): 925-8, 2016 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-27208556

RESUMO

BACKGROUND: Thyroid function biochemical tests are known for their usefulness in prognosis of long-term critical patients, although current data are controversial regarding the clinical benefit of both free triiodothyronine and thyroxine as prognostic thyroid markers during the first 48h after Intensive Care Unit (ICU) admission. METHODS: The aim of this study was to evaluate the usefulness of two strategies for thyroid function assessment in the first 48h after admission at the ICU. The usefulness of a two-step biochemical thyroid strategy (initial isolated TSH determination, followed by subsequent fT4 and fT3) was compared with a complete one-step biochemical profile (TSH+fT4+fT3). RESULTS: No significant differences were found between the rates of thyroid dysfunction detection when using both strategies (2.8% vs. 2.4%; p=0.71). Using the two-step strategy and a 2.5µUI/mL cut-off value for TSH, sensitivity and negative predictive value were 100%. Among patients with an altered fT3 only, mortality was 14% if TSH≤2.5µUI/mL, whereas it was 7% if TSH>2.5µUI/mL (p=0.008). CONCLUSIONS: For patients with critical illness, the early two-step thyroid screening strategy (starting with an isolated TSH determination between 24 and 48h after admission) led to a saving of 50% in fT4 and fT3 tests, with a false-negative rate of 1.3%. This represents an improved diagnostic approach, hence avoiding the performance of unnecessary complementary biochemical measurements.


Assuntos
Biomarcadores/sangue , Programas de Rastreamento/métodos , Doenças da Glândula Tireoide/diagnóstico , Doenças da Glândula Tireoide/mortalidade , Tireotropina/sangue , Tiroxina/sangue , Tri-Iodotironina/sangue , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Estado Terminal , Feminino , Seguimentos , Hospitalização , Humanos , Unidades de Terapia Intensiva , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Retrospectivos , Taxa de Sobrevida , Doenças da Glândula Tireoide/sangue , Testes de Função Tireóidea , Glândula Tireoide/metabolismo , Glândula Tireoide/patologia , Adulto Jovem
14.
Emergencias (St. Vicenç dels Horts) ; 28(1): 38-40, feb. 2016. tab
Artigo em Espanhol | IBECS | ID: ibc-148465

RESUMO

El objetivo de este estudio es la detección de parámetros analíticos asociados a la mortalidad en los pacientes con diabetes mellitus tipo 2 (DM2) con tratamiento crónico con metformina que acuden a urgencias por un cuadro clínico agudo con presencia de acidosis láctica. Se trata de un estudio observacional-analítico retrospectivo realizado en un hospital de tercer nivel. Se recogieron datos clínicos y analíticos en una serie de pacientes con acidosis láctica, estratificada por gravedad, y tratamiento con metformina para DM2. Se compararon los resultados en función de la mortalidad o supervivencia del episodio. De 16 pacientes estudiados, con una edad media de 70 años (rango de 60 a 77), el 75% presentó sintomatología gastrointestinal los 5 días previos a su ingreso. La mortalidad total observada fue del 19%, que se asoció a la presencia de sepsis al ingreso, leucocitosis con neutrofilia, plaquetopenia, elevación de proteína C reactiva (PCR), valores altos de procalcitonina y la comorbilidad con una o más patologías crónicas. Las cifras sé- ricas de metformina no se correlacionaron significativamente con la mortalidad. Se concluye que en pacientes con acidosis láctica y tratamiento con metformina pueden ser factores asociados a la mortalidad la presencia de criterios de sepsis, neutrofilia con plaquetopenia, elevación de PCR y de procalcitonina y la existencia de una o más patologías comórbidas (AU)


To identify analytical factors associated with mortality in patients with type-2 diabetes under long-term treatment with metformin who come to the emergency department with acute symptoms of lactic acidosis. Retrospective observational analysis of patient records in a referral hospital. We collected clinical data and laboratory results for a series of metformin-treated patients with type-2 diabetes who developed lactic acidosis, stratified by severity. Factors related to the episode were analyzed for associations with mortality or survival. Of 16 patients studied (mean age 70 years; range, 60-77 years), 75% had gastrointestinal symptoms in the 5 days before they came to the emergency department. Mortality (19%) was associated with sepsis on arrival; elevated white blood cell counts, particularly neutrophil counts; low platelet counts; high C-reactive protein (CRP) and procalcitonin levels; and 1 or more chronic concomitant diseases. Metformin concentration was not significantly associated with mortality. Signs of sepsis, high neutrophil counts with low platelet counts, elevated CRP and procalcitonin levels, and the presence of 1 or more concomitant diseases may be risk factors for death in metformin-treated patients with lactic acidosis (AU)


Assuntos
Humanos , Diabetes Mellitus Tipo 2/complicações , Acidose Láctica/mortalidade , Diabetes Mellitus Tipo 2/tratamento farmacológico , Metformina/uso terapêutico , Serviço Hospitalar de Emergência/estatística & dados numéricos , Tratamento de Emergência/métodos , Estudos Retrospectivos
15.
Emergencias ; 28(1): 38-40, 2016 02.
Artigo em Espanhol | MEDLINE | ID: mdl-29094825

RESUMO

EN: To identify analytical factors associated with mortality in patients with type-2 diabetes under long-term treatment with metformin who come to the emergency department with acute symptoms of lactic acidosis. Retrospective observational analysis of patient records in a referral hospital. We collected clinical data and laboratory results for a series of metformin-treated patients with type-2 diabetes who developed lactic acidosis, stratified by severity. Factors related to the episode were analyzed for associations with mortality or survival. Of 16 patients studied (mean age 70 years; range, 60-77 years), 75% had gastrointestinal symptoms in the 5 days before they came to the emergency department. Mortality (19%) was associated with sepsis on arrival; elevated white blood cell counts, particularly neutrophil counts; low platelet counts; high C-reactive protein (CRP) and procalcitonin levels; and 1 or more chronic concomitant diseases. Metformin concentration was not significantly associated with mortality. Signs of sepsis, high neutrophil counts with low platelet counts, elevated CRP and procalcitonin levels, and the presence of 1 or more concomitant diseases may be risk factors for death in metformin-treated patients with lactic acidosis.

17.
J Anal Toxicol ; 39(9): 734-40, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-26203185

RESUMO

We present a false-positive result of ecstasy (3,4-methylenedioxy-NN-methylamphetamine) screening due to the therapeutic use of fenofibrate, an antihyperlipidemic drug. Our hypothesis was that the main metabolite of fenofibrate, fenofibric acid, was responsible for this cross-reactivity on a DRI(®) Ecstasy Assay, using a cut-off of 500 ng/mL. We estimated that the addition of 225 µg/mL pure fenofibric acid to blank urine would be sufficient to result in a positive DRI(®) Ecstasy Assay. The results obtained on the urine samples analyses of the patient show that the DRI(®) Ecstasy Assay resulted negative 2 days after discontinuing fenofibrate treatment, when the urine fenofibric acid concentration corrected by creatinine and determinated by gas chromatography-mass spectrometry was 20.3 µg/mg creatinine. The cross-reactivity data for fenofibric acid would seem to indicate that there was insufficient concentration of measured compound to account for the positive immunochemical results for ecstasy. This apparent discrepancy can be explained in several ways, one of them is that the ß-glucuronidase-resistent fenofibric acid isomers are responsible. This process could explain the low recovery of free fenofibric acid when we use the developed method for its quantification in urine samples. Positive results on immunoassay screening must be considered presumptive until confirmation with another method based on a different principle, preferably gas chromatography-mass spectrometry or liquid chromatography-mass spectrometry.


Assuntos
Fenofibrato/análogos & derivados , Imunoensaio , N-Metil-3,4-Metilenodioxianfetamina/urina , Reações Falso-Positivas , Feminino , Fenofibrato/urina , Cromatografia Gasosa-Espectrometria de Massas , Glucuronidase/metabolismo , Humanos , Detecção do Abuso de Substâncias , Adulto Jovem
18.
Emergencias (St. Vicenç dels Horts) ; 27(3): 169-173, jun. 2015. tab, ilus
Artigo em Espanhol | IBECS | ID: ibc-139123

RESUMO

Objetivo. Analizar el rendimiento de un punto de corte de 3 μg/mL en la determinación de paracetamol urinario (PCTo) como método de cribado para detectar paracetamol en posibles sobreingestas en población pediátrica. Método. Estudio de caso-control, observacional, analítico y prospectivo realizado en una unidad de cuidados intensivos pediátricos (UCIP). Se seleccionó una muestra compuesta por aquellos pacientes ingresados en UCIP, considerando el grupo de casos aquellos con administración pautada de una dosis terapéutica endovenosa de paracetamol y un grupo control sin administración del fármaco. Se recogió una muestra de orina dentro de la primera hora y una segunda muestra pasadas 4 horas de la dosis del fármaco. En todos se determinó PCTo cuantitativamente. Se comparó la proporción de pacientes con PCTo _ 3 μg/mL. Se calcularon sensibilidad, especificidad y valores predictivos. Resultados. Se incluyeron 40 niños de edades entre 1 mes y 19 años (20 en cada grupo). No se obtuvo ningún paciente de control con PCTo positiva. La sensibilidad de la prueba en la primera orina recogida fue del 95% (IC 95%: 85,5-100%) y su especificidad del 100%. El valor predictivo positivo fue 100%, y el negativo del 95,2% (IC 95%: 86,1-100%). En las segundas orinas recogidas todos los valores de rendimiento del test fueron del 100%. Conclusión. La detección de PCTo antes de las 4 horas es útil para descartar la ingesta de paracetamol en población pediátrica. Se requieren estudios que permitan validar el nuevo punto de corte de 3 μg/mL para su posible inclusión en el algoritmo de sospecha de intoxicación aguda (AU)


Objective. To analyze the diagnostic yield of a cut-point of 3 μg/mL for paracetamol in urine to screen for poisoning in children. Methods. Prospective case–control observational study in a pediatric intensive care unit (PICU). All enrolled patients had been admitted to the PICU. Cases were children receiving a therapeutic dose of intravenous paracetamol. Controls were not receiving paracetamol. Urine samples were collected early in the morning and 4 hours after a dose of paracetamol was received by case patients. Paracetamol concentration was measured in all samples. We compared the percentages of cases and controls who had a concentration of 3 μg/mL or more. The sensitivity, specificity, and predictive values of the cut-point were calculated. Results. Forty children aged between 1 month and 19 years (20 per matched group) were enrolled. Paracetamol was not detected in any of the control samples. The sensitivity of the test in early morning urine was 95% (95% CI, 85.5%–100%); specificity was 100%. The positive predictive value was 100%; the negative predictive value was 95.2% (95% CI, 86.1%–100%). Paracetamol was detected in all of the second samples collected from cases. Conclusions. Measuring the paracetamol concentration in urine within 4 hours of dosing is useful to rule out prior intake of paracetamol and overdosing in PICU patients. Studies to validate the new cut-point of 3 μg/mL for paracetamol in urine are required with a view to possibly including it in a diagnostic protocol for suspected acute poisoning (AU)


Assuntos
Criança , Feminino , Humanos , Masculino , Acetaminofen/uso terapêutico , Sensibilidade e Especificidade , Valor Preditivo dos Testes , Envenenamento/complicações , Amostras de Medicamentos , Acetaminofen/toxicidade , Programas de Rastreamento/métodos , Estudos de Casos e Controles , Estudos Prospectivos , Cuidados Críticos/métodos
19.
Clin Biochem ; 48(6): 419-24, 2015 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-25680858

RESUMO

OBJECTIVES: Newborn screening strategies for cystic fibrosis (CF) are run worldwide, and aim at the early detection of the disorder to significantly improve the quality of life. Elevated levels of immunoreactive trypsinogen (IRT) represent a high likelihood for the screened child to be affected with CF. However, the specificity of IRT is low. The objective of this study was to assess the screening program in the Balearic Islands during the past 14 years. DESIGN & METHODS: We evaluated all results of the screening program after 14 years, by considering all changes in the protocol and assessing the number of positive samples, the mutations detected, the number of sweat tests performed, the incidence of CF and the presence of false-negative cases. RESULTS: Despite a great variability among the different Balearic Islands, the global incidence of CF was 1:6059 for the 14 years assessed. The incidence in the smaller islands is about 5 times higher than in Majorca (1:2376 versus 1:10,613). After different changes in the protocol, an IRT cut-off value of 60 ng/mL was established. The two most common mutations are ΔF508 and G542X, in accordance with other geographical regions. CONCLUSIONS: The changes in the protocol helped reduce the number of sweat tests performed without any increase in the false-negative rate.


Assuntos
Fibrose Cística/diagnóstico , Triagem Neonatal/normas , Fibrose Cística/genética , Fibrose Cística/imunologia , Regulador de Condutância Transmembrana em Fibrose Cística/genética , Análise Mutacional de DNA , Humanos , Recém-Nascido , Técnicas de Diagnóstico Molecular , Mutação de Sentido Incorreto , Melhoria de Qualidade , Espanha , Tripsinogênio/imunologia
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA