RESUMEN
The purpose of this clinical report is to discuss several recent advances in assessing exocrine pancreatic insufficiency (EPI) and pancreatitis in children, to review the array of pancreatic function tests, to provide an update on the inherited causes of EPI, with special emphasis on newly available genetic testing, and to review newer methods for evaluating pancreatitis.
Asunto(s)
Insuficiencia Pancreática Exocrina/diagnóstico , Pruebas de Función Pancreática/métodos , Pancreatitis Crónica/diagnóstico , Niño , Femenino , Humanos , Masculino , Informe de Investigación , SociedadesRESUMEN
OxyContin, a controlled-release formulation of oxycodone, is increasingly abused. Monitoring patient compliance by urine drug testing may deter illegal diversion of OxyContin. Two urine immunoassays were evaluated with a 100 ng/mL cutoff for oxycodone. The Microgenics Corporation Oxycodone DRI on the Bayer ADVIA 1650 and a point-of-care (POC) immunoassay, Monitect Oxycodone POC from Branan Medical Corporation, were compared to gas chromatography-mass spectrometry (GC-MS) with a detection limit of 50 ng/mL free oxycodone. Between-day precision for DRI yielded coefficients of variation from 3.9% to 7.0% at 75 and 125 ng/mL. Fifty-two positive and 52 negative urines were tested. The DRI had a 100% agreement with GC-MS. Two positive specimens had free oxycodone < 50 ng/mL, but oxycodone metabolites, oxymorphone and oxycodone glucuronide > 100 ng/mL, were identified by GC-MS analysis. The POC assay had two false positives and 15 indeterminate (+/-) results. Codeine or hydrocodone was present in all but one of these samples. There was no interference with DRI from morphine, codeine, hydrocodone, hydromorphone, dihydrocodeine, or 6-monoacetyl morphine. Four-hundred and ninety urine samples were subsequently tested with DRI to estimate the oxycodone-positive rate at our hospital, and 47 (9.4%) were positive. The confirmation rate with GC-MS for free oxycodone, not including metabolites, was 93%. The Microgenics DRI offers good performance for oxycodone urine testing and is a better choice for the clinical laboratory than the POC assay. Confirmation of screened positive samples requires a method that can detect total oxycodone and oxymorphone.
Asunto(s)
Técnicas de Laboratorio Clínico , Cromatografía de Gases y Espectrometría de Masas , Inmunoensayo/métodos , Narcóticos/orina , Oxicodona/orina , Detección de Abuso de Sustancias/métodos , Calibración , Medicina Legal/métodos , Humanos , Narcóticos/inmunología , Oxicodona/inmunología , Sistemas de Atención de Punto , Reproducibilidad de los ResultadosRESUMEN
This study examined factors that predicted depressed mood at discharge and 3 months after discharge for 124 elders with chronic obstructive pulmonary disease (COPD). After the use of control for physiologic status (forced expiratory volume in 1 second percent predicted), the factors of anxiety, perceived health competence, daily functioning, and family emotional coping predicted depressed mood. Discharge referrals for home care services could be used to assess the 4 factors with the potential for the healthcare team to intervene. Interventions could include anxiety reduction through music or other therapies, education to enhance perceived health competence, oxygen use with activities to improve functioning, and integration of informal caregiving support from the community to increase family emotional support.