Grandes esforços são necessários para reduzir a ingestão de sal e proteger vidas

Relatório inédito da Organização Mundial da Saúde (OMS) sobre o consumo de sal (Relatório global sobre redução do consumo de sódio) mostra que estamos longe de atingir a meta global de reduzir o consumo de sódio em 30% até 2025.

Effect of hyponatremia normalization on osteoblast function in patients with SIAD.

OBJECTIVE: Hyponatremia is associated with an increased risk of bone fragility and fractures. Many studies suggest that hyponatremia stimulates osteoclast activation, whereas other studies rather reveal a possible role of acute hyponatremia in impairing osteoblast function. We aimed to assess whether and how correction of hyponatremia in hospitalized patients with the syndrome of inappropriate antidiuresis (SIAD) has an impact on bone metabolism. DESIGN AND METHODS: This was a predefined secondary analysis of 88 hospitalized patients with SIAD undergoing a randomized treatment with SGLT-2 inhibitors or placebo for 4 days. Biochemical markers of bone resorption (CTX) and bone formation (PINP) were collected in serum at baseline and after the intervention (day 5). Bone formation index (defined as PINP/CTX) and its difference between day 5 and baseline were calculated. Patients with steroid therapy (n = 6), fractures (n = 10), or whose data were missing (n = 4) were excluded from the analysis. RESULTS: Out of 68 patients, 27 (39.7%) were normonatremic at day 5. These patients showed an increase in serum PINP (P = 0.04), whereas persistent hyponatremic patients did not (P = 0.38), with a relevant difference between these two subgroups (P = 0.005). Serum CTX increased similarly in the two groups (P = 0.43). This produced a 47.9 points higher PINP/CTX difference between discharge and admission in normonatremic patients (95% CI: 17.0-78.7, P = 0.003) compared to patients with persistent hyponatremia, independent of age, sex, BMI, smoking habits, randomization arm, and baseline cortisol levels. CONCLUSIONS: Our predefined post hoc analysis shows that correction of hyponatremia in hospitalized patients with SIAD might have a positive impact on osteoblast function.

Evaluation of serum electrolytes measurement through the 6-year trueness verification program in China.

Objectives: The National Center for Clinical Laboratories (NCCL) in China initiated a serum electrolyte trueness verification (ETV) program in 2014 for measurement standardization. Methods: Every year, two levels of fresh frozen commutable serum samples determined by inductively coupled plasma mass spectrometry (ICP-MS) reference methods were transported to participating clinical laboratories for the measurement of sodium, potassium, calcium and magnesium. Both samples were measured 15 times in 3 days, and the mean values and coefficient variations (CVs) were calculated from the results. The tolerance limits of trueness (bias), precision (CV) and accuracy (TE) based on the biological variation database were used as the evaluation criteria. The overall trend of the ETV program over 6 years was surveyed by calculating the pass rates of the participating laboratories. The mean bias, inter-laboratory CV, and TE of all laboratory results were analysed. Furthermore, homogeneous and heterogeneous systems were compared, and the bias and CV results of mainstream analysis systems were analysed. Results: Pass rates of the three quality specifications increased, and the overall mean bias and inter-laboratory CVs decreased. The homogeneous system was superior to the heterogeneous system for calcium and magnesium measurements. For sodium, potassium, calcium and magnesium, the minimum bias corresponded to Hitachi, Siemens, Beckman AU and Roche, respectively. For inter-laboratory robust CVs, no obvious differences were observed between each peer group. Conclusions: The commutable ETV materials assigned via reference methods can evaluate the accuracy and reproducibility of an individual laboratory and the calibration traceability and uniformity between laboratories for measurements.

Commutability of external quality assessment materials for serum sodium and potassium measurements.

Background The commutability of electrolyte trueness verification materials (ETVs) and commercial general chemistry materials (GCs) was evaluated to investigate their suitability for use in an external quality assessment (EQA) program for serum sodium and potassium measurements. Methods Eighty fresh individual human samples (40 for sodium measurements and 40 for potassium measurements), six ETVs and three GCs were analyzed by five routine methods (validated methods) and by inductively coupled plasma mass spectrometry reference methods (comparative methods) for the determination of sodium and potassium. The commutability was analyzed according to Clinical and Laboratory Standards Institute (CLSI) EP14-A3 protocol and difference in bias approach, respectively. The linearity, bias and imprecision of the routine methods were also assessed according to CLSI guidelines. Results According to EP14-A3 protocol, ETVs were commutable for all assays, and GCs were commutable for 3/5 assays for sodium. ETVs were commutable in most assays except Cobas C501, while GCs showed no commutability except in case of AU5821 for potassium. According to a difference in bias approach, the commutability of ETVs was inconclusive for most routine assays for both sodium and potassium, and GCs were inconclusive for sodium and non-commutable for potassium in most routine assays. The routine methods exhibited excellent linearities and precisions. The majority and minority of relative biases between the routine and reference methods were beyond the bias limits for sodium and potassium, respectively. Conclusions Superiority in the commutability of ETVs over GCs was observed among the sodium and potassium assays whichever evaluation approach was applied.

Moving average quality control: principles, practical application and future perspectives.

Moving average quality control (MA QC) was described decades ago as an analytical quality control instrument. Although a potentially valuable tool, it is struggling to meet expectations due to its complexity and need for evidence-based guidance. For this review, relevant literature and the world wide web were examined in order to (i) explain the basic concepts and current understanding of MA QC, (ii) discuss moving average (MA) optimization methods, (iii) gain insight into practical aspects related to applying MA in daily practice and (iv) describe future prospects to enable more widespread acceptance and application of MA QC. Each of the MA QC optimization methods currently available has their own advantages and disadvantages. Recently developed simulation methods provide realistic error detecting properties for MA QC and are available for laboratories. Operational MA management issues have been identified that allow developers of MA software to upgrade their packages to support optimal MA QC application and guide laboratories on MA management issues, such as MA alarm workup. The new insights into MA QC characteristics and operational issues, together with supporting online tools, may promote more widespread acceptance and application of MA QC.

Effects of dialysate to serum sodium (Na+) alignment in chronic hemodialysis (HD) patients: retrospective cohort study from a quality improvement project.

BACKGROUND: Evidence indicates favorable effects of dialysate (DNa+) to serum sodium concentration (SNa+) alignment, however, results from larger sample populations are needed. For this reason, we conducted a retrospective propensity score-matched cohort study from a quality improvement project to investigate the effects of alignment on population of maintenance hemodialysis patients. METHODS: At 4 participating hemodialysis (HD) clinics, patients with SNa+ lower than the standard DNa+ of 137 mEq/L who received HD with DNa+ aligned to the average of the last 4 SNa+ measurements were evaluated (clinicaltrials.gov # NCT01825590 ). In this retrospective data analysis, an intention-to-treat (primary) and an as-treated "intervention" (secondary) cohort were created. "Aligned" patients from both cohorts (N = 163 for the primary and N = 137 for the secondary) were then propensity-score matched in a 1:1 fashion to "unaligned" patients from the Renal Research Institute database. The propensity score was generated based on age, gender, white race, Hispanic ethnicity, absence or presence of diabetes, hemodialysis vintage, interdialytic weight gain (IDWG; as a percentage of postdialysis body weight), catheter as primary dialysis access, predialysis systolic blood pressure, serum sodium concentration, hospitalization count during baseline. T-Test was employed for group comparisons of changes to the primary (volume-related and hemodynamic parameters) and tertiary outcomes. All-cause and fluid overload-related hospitalization admission rates were compared using Wilcoxon Rank Sum test and Cox regression analysis for repeated events. RESULTS: In the primary analysis, aligned and unaligned subjects showed comparable demographics at baseline. Treatment effects were significant for IDWG [-0.12 (95% CI -0.24 to 0) L] and showed decreasing non-significant trends for pre-dialysis hemodynamic parameters. Count comparison and Cox regression analysis showed no clear advantage of alignment in terms of all-cause and fluid overload-related hospitalization. CONCLUSIONS: Results from the largest sodium alignment program to date suggest positive treatment effects on volume-related and hemodynamic parameters, but no clear effect on risk of hospitalization. Well-matched control patients minimized confounding effects. Small effects and lack of significant differences may be explained by a low baseline DNa+ limiting the interventional change.

Fallacies and Pitfalls of Dialysis Sodium Prescription and Control.

Dialysate conductivity is routinely used as a surrogate for dialysate sodium concentration. However, dialysis machine manufacturers apply different conductivity temperature correction coefficients. With the same conductivity in dialysis machines manufactured by different manufacturers, dialysate sodium may significantly differ. Also, electrolyte prescriptions are individualized (K, Ca, HCO3) and this is associated with another variation in dialysate sodium in the order of 1-5 mmol/L and both deviations are cumulative and chronic for each patient. Equivalence of the prescribed dialysate sodium and the concentration measured in it is not granted. Both variables differ and it is machine dependent! This paper analyses those variations from a technical point of view and suggests how to detect them and how to deal with or avoid them in clinical practice.

Stakeholder discussion to reduce population-wide sodium intake and decrease sodium in the food supply: a conference report from the American Heart Association Sodium Conference 2013 Planning Group.

BACKGROUND: A 2-day interactive forum was convened to discuss the current status and future implications of reducing sodium in the food supply and to identify opportunities for stakeholder collaboration. METHODS AND RESULTS: Participants included 128 stakeholders engaged in food research and development, food manufacturing and retail, restaurant and food service operations, regulatory and legislative activities, public health initiatives, healthcare, academia and scientific research, and data monitoring and surveillance. Presentation topics included scientific evidence for sodium reduction and public health policy recommendations; consumer sodium intakes, attitudes, and behaviors; food technologies and solutions for sodium reduction and sensory implications; experiences of the food and dining industries; and translation and implementation of sodium intake recommendations. Facilitated breakout sessions were conducted to allow for sharing of current practices, insights, and expertise. CONCLUSIONS: A well-established body of scientific research shows that there is a strong relationship between excess sodium intake and high blood pressure and other adverse health outcomes. With Americans getting >75% of their sodium from processed and restaurant food, this evidence creates mounting pressure for less sodium in the food supply. The reduction of sodium in the food supply is a complex issue that involves multiple stakeholders. The success of new technological approaches for reducing sodium will depend on product availability, health effects (both intended and unintended), research and development investments, quality and taste of reformulated foods, supply chain management, operational modifications, consumer acceptance, and cost. The conference facilitated an exchange of ideas and set the stage for potential collaboration opportunities among stakeholders with mutual interest in reducing sodium in the food supply and in Americans' diets. Population-wide sodium reduction remains a critically important component of public health efforts to promote cardiovascular health and prevent cardiovascular disease and will remain a priority for the American Heart Association.

From menu to mouth: opportunities for sodium reduction in restaurants.

Restaurant foods can be a substantial source of sodium in the American diet. According to the Institute of Medicine, the significant contribution made by restaurants and food service menu items to Americans' sodium intake warrants targeted attention. Public health practitioners are uniquely poised to support sodium-reduction efforts in restaurants and help drive demand for lower-sodium products through communication and collaboration with restaurant and food service professionals and through incentives for restaurants. This article discusses the role of the public health practitioner in restaurant sodium reduction and highlights select strategies that have been taken by state and local jurisdictions to support this effort.

Candidate reference measurement procedures for chloride, potassium, sodium, calcium, magnesium, and lithium by inductively coupled plasma (isotope dilution) sector field mass spectrometry (ICP-(ID) SFMS) in serum.

BACKGROUND: Standardization of the measurement of electrolyte concentrations in serum is of considerable interest for quality assurance in patient care. To promote the ongoing process of standardization we developed candidate reference measurement procedures of highest metrological order for Cl, K, Na, Ca, Mg, and Li using ICP-(ID) SFMS. METHODS: Serum samples were diluted with 4 mmol/L nitric acid and were spiked with the internal standard for quantification, separately for each analyte. The samples were introduced in the ICP-SFMS device by continuous infusion using a peristaltic pump. The measurement results were compared with reference measurement procedure values obtained by atom absorption spectroscopy, flame emission spectroscopy, and coulometry. The measurement accuracy and precision was calculated by analyzing certified reference materials and EQAS samples. RESULTS: The mean coefficient of variation (CV) of the ICP-MS procedures for the serum samples was 0.65% for Cl, 0.46% for K, 0.51% for Na, 0.77% for Ca, 0.78% for Mg, and 0.58% for Li. The mean bias from target values of NIST certified reference materials was +0.85% for Cl, -0.46% for K, +0.68% for Na, -0.21% for Ca, +0.27% for Mg, and -0.39% for Li. CONCLUSIONS: Candidate reference measurement procedures for 6 electrolytes were developed by high performance magnetic sector field ICP-MS fulfilling the requirements of ISO 15193:2009 for reference measurement procedures with traceability to SI according to ISO 17511:2003 and can be used for setting target values in EQAS and for certification of reference materials.

Indirect determination of pediatric blood count reference intervals.

BACKGROUND: Determination of pediatric reference intervals (RIs) for laboratory quantities, including hematological quantities, is complex. The measured quantities vary by age, and obtaining samples from healthy children is difficult. Many widely used RIs are derived from small sample numbers and are split into arbitrary discrete age intervals. Use of intra-laboratory RIs specific to the examined population and analytical device used is not yet fully established. Indirect methods address these issues by deriving RIs from clinical laboratory databases which contain large datasets of both healthy and pathological samples. METHODS: A refined indirect approach was used to create continuous age-dependent RIs for blood count quantities and sodium from birth to adulthood. The dataset for each quantity consisted of 60,000 individual samples from our clinical laboratory. Patient samples were separated according to age, and a density function of the proportion of healthy samples was estimated for each age group. The resulting RIs were merged to obtain continuous RIs from birth to adulthood. RESULTS: The obtained RIs were compared to RIs generated by identical laboratory instruments, and to population-specific RIs created using conventional methods. This comparison showed a high concordance of reference limits and their age-dependent dynamics. CONCLUSIONS: The indirect approach reported here is well-suited to create continuous, intra-laboratory RIs from clinical laboratory databases and showed that the RIs generated are comparable to those created using established methods. The procedure can be transferred to other laboratory quantities and can be used as an alternative method for RI determination where conventional approaches are limited.

Risk assessment of physico-chemical contaminants in groundwater of Pettavaithalai area, Tiruchirappalli, Tamilnadu - India.

A study was carried out in Pettavaithalai area to evaluate the current status of physico-chemical contaminants and their sources in groundwater. Groundwater samples collected from pettavaithalai area in 15 different stations were analyzed every alternative months over a period of two years from August 2000 to June 2002. A sugar mill is situated at the heart of the study area. Three profiles (profile A, B and C) were selected based on the direction in which the sugar mill effluent flows. In each profile five samples were collected from five different station at a regular distance of about 1 Km. The physico-chemical parameters such as pH, EC TDS, TH, NO3, SO4, PO4, Na, K, Ca, Mg, DO, BOD and COD have been analyzed. The results showed that among the three profiles, many of the estimated physico-chemical parameters of profile C were very high when compared to profile B and A which indicates the poor quality of the groundwater around this area.

The effect of profiled hemodialysis on intradialytic hemodynamics when a proper sodium balance is applied.

BACKGROUND: Profiled hemodialysis (HD) has been claimed to ameliorate intradialytic complications such as hypotension. Frequently, these profiles are based on providing the patient with an accumulating sodium load. This increases the risk of interdialytic complications, such as hypertension and increased weight gain. The present study investigated the effect of profiled HD, without an accompanying sodium loading, on intradialytic hemodynamics in stable HD patients. METHODS: In eight stable HD patients a standard hemodialysis (S-HD) was compared to a decreasing Na(+)-profiled hemodialysis (Na-HD), and an ultrafiltration profiled hemodialysis (UF-HD). Care was taken to have the sodium balances similar during these sessions. The patients were monitored non-invasively during dialysis with respect to their cardiac performance by means of electrical impedance cardiography, their variation in blood volume by means of an on-line optical measurement, and their hydration state by means of body impedance analysis. RESULTS: Sodium balance and mean arterial sodium concentrations were similar in the three treatments. Intradialytic hemodynamics during UF-HD were similar to those of S-HD. However, Na-HD improved blood pressure preservation, remarkably without significant blood volume preservation, due to a better stroke volume preservation in the first hour of dialysis. CONCLUSION: Sodium-balanced, Na-profiled HD improves blood pressure preservation in stable HD patients without providing the patients with a sodium load. This effect is due to a better stroke volume preservation early in dialysis, without a significant reduction in blood volume decrease. UF-HD, as mono-therapy, has no beneficial effect on intradialytic hemodynamics in stable patients.

Transferability of results obtained for sodium, potassium and chloride ions with different analysers.

In this study we have assessed transferability in seven different analysers commonly used in clinical chemistry laboratories to measure sodium, potassium and chloride ions. The inaccuracy and linearity of the techniques were satisfactory in most cases, and therefore all the equipment may be used in both pathological and normal ranges of the electrolytes evaluated. In most cases it was possible to correct the inaccuracy. The equipment which gave the best performance when analysing the three ions assessed after considering the Process Capability Index (CPI) and Performance Index (PI) was Nova-5. According to Hyltoft-Petersen's criteria, the results obtained for the three ions with the different analysers cannot be used indiscriminately, apart from potassium. However, after comparison of the results obtained by indirect potentiometry with those obtained by other techniques, we can conclude that the transferability of results is possible in almost every case, as standard deviation from regression (Sy,x) was lower than the permissible analytical error.

Utilization of the skin attachment model to determine the antibacterial efficacy of potential carcass treatments.

Two experiments (EXP), utilizing the skin attachment model (SAM), were conducted to determine the bactericidal activity of six potential carcass disinfectants [EXP 1: 20, 400, and 800 ppm sodium hypochlorite; EXP 2: 5% acetic acid (AA), 8% trisodium phosphate (TSP), and 1% sodium metabisulfite (SS)] during simulated scalder (50 C for 2 min), chiller (0 C for 60 min), or post-process dip (23 C for 15 s) application. Efficacies of treatments were determined against populations of Salmonella typhimurium that were "loosely" or "firmly" attached to chicken breast skin (10 cm diameter). For comparison, activity of the six disinfectants was also determined against S. typhimurium in aqueous suspension. All disinfectants except SS reduced numbers of freely suspended S. typhimurium by > or = 4.5 log10 cfu/mL. The sodium metabisulfite did not reduce populations of salmonellae. In both EXP, there were disinfectant by application interactions (P < 0.05) on activity against loosely and firmly attached cells. Sodium hypochlorite at 20 ppm had little activity regardless of application, whereas higher levels were more effective (P < 0.001), particularly in the chiller application, in which loosely and firmly attached populations were reduced by 2.3 to 2.5 and 1.3 to 1.9 log10 cfu per skin, respectively. In EXP 2, SS showed no activity regardless of application. Trisodium phosphate was similarly effective (reduction by 1.2 to 1.8 log10 cfu per skin) in all applications (P > 0.05). In contrast, AA activity was affected by the application method (P < 0.05). Against loosely attached cells, AA was most effective in the chiller application (2.5 log10 reduction), whereas against firmly attached cells, AA was effective only in the scalder application (2.0 log10 reduction). Attachment of S. typhimurium to poultry skin apparently increased the ability of the bacteria to resist various disinfectants, and efficacy was influenced by extent of attachment of bacteria to skin and method of disinfectant application.

Benzalkonium interference with test methods for potassium and sodium.

Six automated instruments that measure sodium and potassium were tested for interference from two compounds used in catheters. Tridodecylmethylammonium heparin did not interfere with any of the methods. However, benzalkonium heparin falsely increased sodium measurement with the Kodak Ektachem, and falsely increased potassium measurements with three instruments (Beckman Astra, Baxter Paramax, and the Instrumentation Laboratory Monarch) in which ion-selective electrodes measure potassium in diluted serum. Three instruments in which ion-selective electrodes measure serum directly--Du Pont Dimension, Abbott Spectrum, and Kodak Ektachem--experienced no interference with potassium measurements. Interference of benzalkonium with potassium measurements may result from its interaction with the electrode membranes, which is accentuated in diluted serum.

[Bacteriologic studies of bicarbonate dialysate and suitable initial solutions]. / Bakteriologische Untersuchungen von Bicarbonatdialysat und entsprechenden Ausgangslösungen.

Dialysates for the haemodialysis are produced unsterile and usually contain bacteria. Own investigations of bicarbonate dialysate and adequate initial solutions comprised sterility tests, determinations of the germ count and germ tolerance experiments. Only the "acid concentrate" was sterile. In the other solutions Corynebacteria, Acinetobacter and Pseudomonas bacteria dominated as typical water germs. In the fresh reverse osmosis water and the bicarbonate dialysate as well as in the recently produced 35-mmolar and 1-molar NaHCO3-solution the germ count was in each case about 10(5)/l and did not change itself essentially at room temperature within 6 hours. The "acid concentrate" and at a lower level also the 1-molar NaHCO3-concentrate have an antibacterial effect. The reverse osmosis water is the main contamination source for the bicarbonate dialysate, the application of which within 6 hours seems worth being used on account of the low germ count.

Basic statistics for quality control in the clinical laboratory.

A systematic approach toward selection and evaluation of laboratory methods should improve the quality of the analytical service. However, any testing approach only assesses whether the analytical method can achieve the desired level of performance under the test conditions. It does not assure that the performance is actually achieved under the conditions of each routine analytical run. The quality of the routine analysis must be monitored by suitable quality control procedures. Unfortunately, the present practice of quality control achieves an arbitrary and usually unknown level of quality. Achieving a known level of quality requires that one understand the performance characteristics of the quality control procedures themselves. Achieving a specified level of quality requires that one design the quality control system to achieve a stated error specification. This can be accomplished by careful choice of control procedures in order to have the desired capability for detecting analytical errors which would invalidate the medical usefulness of the test results. A high-caliber quality control system will be the result of a logical sequence of the objective evaluation and selection of an optimal analytical method followed by regular rigorous statistical monitoring of each analytical method.

Japanese minimum requirements for albumin preparations: recent amendments and current problems.

The following amendments have been introduced to the Minimum Requirements for Human Serum Albumin (HSA) and Plasma Protein Fraction (PPF): 1) The upper limit of sodium content was fixed at 3.7 mg/ml; 2) test for chloride content was introduced; 3) sodium and chloride contents were required to be stated on the label; 4) use of zone electrophoresis was introduced in addition to the free-boundary electrophoresis; and 5) albumin content in HSA was lowered from 97% to 96%. Moreover, current problems in quality control which may require further amendments were discussed, namely: 1) limulus amoebocyte lysate test to replace or supplement the pyrogen test in rabbits; 2) attempt of quantitative expression of visual turbidity; 3) establishment of reference A and B blood group substances; 4) gel permeation analysis and scanning at 370-800 nm; and 5) test for prekallikrein activator (PKA).