RESUMEN
BACKGROUND: Usually serum albumin is measured with dye-binding assay as bromocresol green (BCG) and bromocresol purple (BCP) methods. The aim of this paper was to examine the differences in albumin measurements between the Advia2400 BCG method (AlbBCG), Dimension RxL BCP (AlbBCP) and capillary zone electrophoresis (CZE). METHODS: Albumin concentrations from 165 serum samples were analysed using AlbBCG, AlbBCP and CZE. CZE was employed to estimate different serum protein fractions. Influence of globulins on albumin concentration discrepancies between methods was estimated as well as the impact of the albumin method on aCa concentrations. Medcalc was employed for statistical analysis, setting a value of P < 0.05 as significant. RESULTS: Correlation of AlbBCG and AlbBCP was r = 0.948 (p < 0.0001), but mean difference was large. Bland-Altman plots showed greater bias at lower albumin concentrations. AlbBCG were positively biased versus CZE (3.54 g/L). There was good agreement between CZE and ALbBCP (< 1 g/L). The AlbBCG assay bias shows a good correlation with alpha-1-globulin concentrations (r = 0.758); moderate and weak correlations were observed with CRP (r = 0.729) and alpha-2-globulin (r = 0.585); we found no correlation with beta-globulin (r = 0.120) or gamma-globulin (r = -0.303). Mean aCa based on AlbBCG and AlbBCP methods were 2.34 ± 0.15 mmol/L and 2.46 ± 0.16 mmol/L (p < 0.01), with a mean BCG-BCP difference of -0.12. CONCLUSION: Albumin results from the BCP and BCG methods may result in unacceptable differences and clinical confusion, especially at lower albumin concentrations. Serum acute phase proteins contribute to overestimating the albumin concentration using AlbBCG.
Asunto(s)
Proteínas de Fase Aguda/química , Análisis Químico de la Sangre/métodos , Análisis Químico de la Sangre/normas , Verde de Bromocresol/química , Púrpura de Bromocresol/química , Globulinas/química , Albúmina Sérica/análisis , Humanos , Reproducibilidad de los ResultadosRESUMEN
We examined 785 placentas, including 51 from documented cases of congenital toxoplasmosis. Toxoplasma was detected in 16 placentas,including 1 in which congenital toxoplasmosis was ruled out. Placental screening had poor sensitivity (25%) but good specificity (99%), positive predictive value (93%), and negative predictive value (95%).
Asunto(s)
Bacteriemia/epidemiología , Fiebre de Origen Desconocido/complicaciones , Neutropenia/complicaciones , Medición de Riesgo , Antibacterianos/uso terapéutico , Sangre/microbiología , Niño , Preescolar , Femenino , Humanos , Lactante , Recuento de Leucocitos , Masculino , Pronóstico , Resultado del TratamientoRESUMEN
Introducción y objetivos. Las determinaciones de cistatina C se han propuesto como nuevo marcador de la función renal y predictor del riesgo cardiovascular en ancianos. Nuestro objetivo fue conocer la prevalencia de individuos con cistatina C elevada en población general y su asociación con factores de riesgo y enfermedad cardiovascular. Métodos. Estudio epidemiológico descriptivo transversal por muestreo aleatorio simple en población general mayor de 49 años, obtenido de la base de tarjeta sanitaria individual. Fueron seleccionados 415 pacientes de los que se realizó la determinación de cistatina C a 359 de ellos utilizando un método inmunonefelométrico. Como punto de corte se aceptó el recomendado para el método en adultos. Resultados. Se estudió a 359 pacientes (media de edad ± desviación estándar, 64 ± 10 años; el 63,5%, mujeres); presentó cistatina C elevada el 17,3% (intervalo de confianza del 95%, 13,4%-21,2%), con concentraciones medias de 0,81 ± 0,21 mg/l, que aumentaban con la edad. Las elevaciones de cistatina C se asociaron con: mayor edad (p < 0,0001), presión arterial sistólica (p < 0,0001), hemoglobina A1c (p = 0,031), triglicéridos (p = 0,019), homocisteína (p < 0,0001), proteína C reactiva (p = 0,015), fibrinógeno (p = 0,006), microalbuminuria (p = 0,001) y menor cifra de colesterol de las lipoproteínas de alta densidad (p = 0,021) y filtrado glomerular estimado (p < 0,0001). Las enfermedades cardiovasculares concomitantes fueron la cardiopatía isquémica (p = 0,013) y la insuficiencia cardiaca (p = 0,038). Los principales factores asociados de manera independiente con elevaciones de cistatina C fueron la diabetes (odds ratio [OR] = 5,37), el sexo masculino (OR = 4,91) y el filtrado glomerular descendido (OR = 0,83). Conclusiones. Encontramos una alta prevalencia de individuos con cistatina C elevada en la población general, lo que conlleva factores de riesgo cardiovascular clásicos, como diabetes, hipertensión arterial y enfermedad renal crónica, junto con concentraciones más elevadas de proteína C reactiva, homocisteína y fibrinógeno (AU)
Introduction and objectives. Cystatin C has been proposed as a novel marker of renal function and as a predictor of cardiovascular risk in the elderly. The aim of this study was to determine the prevalence of an elevated cystatin C level in the general population and its relationship with cardiovascular risk factors and disease. Methods. This descriptive epidemiologic cross-sectional study involved a simple randomized sample of individuals aged >49 years from the general population, and was based on personal health records. From the final selection of 415 individuals, 359 underwent cystatin C measurement using a immunonephelometric assay. The cut-point used was that recommended for the method in adults. Results. Of the 359 individuals (mean±standard deviation age, 64±10 years, 63.5% female) studied, 17.3% (95% confidence interval [CI] 13.4%-21.2%) had an elevated cystatin C level. The mean level was 0.81±0.21 mg/L, and increased with age. Elevation of the cystatin C level was associated with: older age (P < .0001); high measures of systolic blood pressure (P < .0001), hemoglobin A1c (P=.031), triglycerides (P=.019), homocysteine (P < .0001), C-reactive protein (P=.015), fibrinogen (P=.006) and microalbuminuria (P=.001); and a low high-density lipoprotein cholesterol level (P=.021) and estimated glomerular filtration rate (P < .0001). Associated cardiovascular diseases included coronary heart disease (P=.013) and heart failure (P=.038). The main factors independently associated with an elevated cystatin C level were diabetes (odds ratio [OR]=5.37), male sex (OR=4.91) and decreased glomerular filtration (OR=0.83). Conclusions. The prevalence of an elevated cystatin C level in the general population was found to be high and was associated with the presence of classical cardiovascular risk factors such as diabetes, hypertension and chronic renal disease, along with higher levels of C-reactive protein, homocysteine and fibrinogen (AU)
Asunto(s)
Humanos , Cistatinas , Insuficiencia Renal Crónica/epidemiología , Enfermedades Cardiovasculares/epidemiología , Factores de Riesgo , Tasa de Filtración Glomerular , Proteína C-Reactiva , Fibrinógeno , Homocisteína , Hipertensión/epidemiologíaRESUMEN
INTRODUCTION AND OBJECTIVES: Cystatin C has been proposed as a novel marker of renal function and as a predictor of cardiovascular risk in the elderly. The aim of this study was to determine the prevalence of an elevated cystatin C level in the general population and its relationship with cardiovascular risk factors and disease. METHODS: This descriptive epidemiologic cross-sectional study involved a simple randomized sample of individuals aged >49 years from the general population, and was based on personal health records. From the final selection of 415 individuals, 359 underwent cystatin C measurement using a immunonephelometric assay. The cut-point used was that recommended for the method in adults. RESULTS: Of the 359 individuals (mean+/-standard deviation age, 64+/-10 years, 63.5% female) studied, 17.3% (95% confidence interval [CI] 13.4%-21.2%) had an elevated cystatin C level. The mean level was 0.81+/-0.21 mg/L, and increased with age. Elevation of the cystatin C level was associated with: older age (P< .0001); high measures of systolic blood pressure (P< .0001), hemoglobin A1c (P=.031), triglycerides (P=.019), homocysteine (P< .0001), C-reactive protein (P=.015), fibrinogen (P=.006) and microalbuminuria (P=.001); and a low high-density lipoprotein cholesterol level (P=.021) and estimated glomerular filtration rate (P< .0001). Associated cardiovascular diseases included coronary heart disease (P=.013) and heart failure (P=.038). The main factors independently associated with an elevated cystatin C level were diabetes (odds ratio [OR]=5.37), male sex (OR=4.91) and decreased glomerular filtration (OR=0.83). CONCLUSIONS: The prevalence of an elevated cystatin C level in the general population was found to be high and was associated with the presence of classical cardiovascular risk factors such as diabetes, hypertension and chronic renal disease, along with higher levels of C-reactive protein, homocysteine and fibrinogen.
Asunto(s)
Enfermedades Cardiovasculares/sangre , Enfermedades Cardiovasculares/epidemiología , Cistatina C/sangre , Biomarcadores/sangre , Estudios Transversales , Femenino , Humanos , Masculino , Persona de Mediana Edad , Factores de RiesgoRESUMEN
OBJECTIVES: The diagnosis of prostate cancer has changed significantly with the introduction of PSA in the clinical practice. Despite screening is under controversy the use of PSA has become widespread. The objective of this paper is to know the use of PSA in our health-care area and to analyze perceived risks and benefits. METHODS: From the informatic archives we analyze PSA determinations performed in our health-care area (290.956 citizens) over 2000 and 2001. We also analyzed prostate biopsies generated and number of cancers detected. RESULTS: 25.519 PSA determinations were performed. 59% came from general practitioners (GP), 34% from urologists and 7% from the rest of specialists. 39% are performed to men older than 70 years. PSA was normal in 78.7% of the patients and higher than 4 ng/ml in 21.2%. 488 prostatic biopsies were performed diagnosing 178 cancers (diagnostic yield 36.5%). Depending on the first PSA, diagnosis was started by a GP in 44% of the cases, a urologist in 46%, and the remaining 10% by other specialists. Mean time from first PSA to diagnosis was 5 months, without significant differences between GPs and specialities . The use of PSA by GPs is variable (between 8.1 and 45.8 determinations per 100 men over 50 years), without significant differences in prostate cancer detection by number of PSAs or differences in age. In comparison with the period 1982-1993 the incidence of prostate cancer goes from 30.76 to 52.8 new cases/100.000 inhabitants/year. There is a greater incidence and increase of cancer in the rural area (from 33.52 to 221.1 new cases/ 100.000 inhabitants/year). CONCLUSIONS: We confirm the general use of this test and the trend to screening in the primary health-care level, which participates in an important manner in the diagnosis. PSA brings forward the diagnosis of prostate cancer 5 years in our area, and shoots its incidence rates. The high use of such marker in our population of advanced age may be considered inadequate.
Asunto(s)
Adenocarcinoma/sangre , Biomarcadores de Tumor/sangre , Tamizaje Masivo/estadística & datos numéricos , Proteínas de Neoplasias/sangre , Antígeno Prostático Específico/sangre , Neoplasias de la Próstata/sangre , Adenocarcinoma/diagnóstico , Adenocarcinoma/epidemiología , Adulto , Anciano , Anciano de 80 o más Años , Biopsia , Diagnóstico Precoz , Humanos , Incidencia , Masculino , Persona de Mediana Edad , Valor Predictivo de las Pruebas , Atención Primaria de Salud/estadística & datos numéricos , Próstata/patología , Neoplasias de la Próstata/diagnóstico , Neoplasias de la Próstata/epidemiología , Derivación y Consulta/estadística & datos numéricos , Estudios Retrospectivos , Riesgo , Sensibilidad y Especificidad , España/epidemiología , Urología/estadística & datos numéricosRESUMEN
OBJETIVO: Con la introducción del PSAen la práctica clínica diaria, el diagnóstico del cáncerde próstata ha sufrido importantes cambios. Aunque elscreening es controvertido, su uso parece que se hageneralizado. Conocer la utilización que se hace delPSA en nuestro área sanitaria y analizar los beneficiosy riesgos que se perciben.MÉTODO: A través del archivo informático, analizamoslas determinaciones realizadas durante los años2000 y 2001 en nuestro área (290.956 habitantes).Se analizaron también las biopsias de próstata generadasy los cánceres detectados.RESULTADOS: Se realizaron 25.590 determinacionesde PSA. Proceden de Atención Primaria 59%, Urología34% y resto de especializada 7%. El 39% se realizana hombres mayores de 70 años. El PSA fue normal enel 78,7%, y mayor de 4 ng/mL en 21,2%. Se realizaron488 biopsias prostáticas, detectándose 178 carcinomas(36,5% rendimiento diagnóstico). Según el primerPSA el diagnóstico parte de primaria en 44%,Urología en 46% y resto de especializada 10%. Eltiempo medio desde el primer PSA hasta el diagnósticofue de 5 meses, sin diferencias significativas entrePrimaria y Especializada. El uso del PSA por Primariaes variable (entre 8,1 y 45,8 determinaciones porcada 100 hombres mayores de 50 años), sin diferenciassignificativas de detección de cáncer prostáticosegún número de PSAs ni diferencias de edad. Frenteal periodo 1982-1993 la incidencia de cáncer prostáticopasa de 30,76 a 52,8 nuevos casos/ 100.000habitantes/ año. Existe mayor incidencia e incrementodel cáncer en la zona rural (de 33,52 a 221,1 nuevoscasos/ 100.000 habitantes/ años).CONCLUSIONES: Confirmamos la utilización generalizadade esta prueba y la tendencia al cribado en primaria,que participa de manera importante en el diagnóstico.El PSA adelanta el diagnóstico del cáncer depróstata en 5 años en nuestro área, y dispara las tasasde incidencia de este cáncer. La elevada utilización deeste marcador en población de edad avanzada sepuede considerar inadecuada
OBJECTIVES: The diagnosis of prostatecancer has changed significantly with the introductionof PSA in the clinical practice. Despite screening isunder controversy the use of PSA has become widespread.The objective of this paper is to know the use of PSA inour health-care area and to analyze perceived risks andbenefits.METHODS: From the informatic archives we analyzePSA determinations performed in our health-care area(290.956 citizens) over 2000 and 2001. We alsoanalyzed prostate biopsies generated and number ofcancers detected.RESULTS: 25.519 PSA determinations were performed.59% came from general practitioners (GP), 34% fromurologists and 7% from the rest of specialists. 39% areperformed to men older than 70 years. PSA was normalin 78.7% of the patients and higher than 4 ng/ml in21.2%. 488 prostatic biopsies were performeddiagnosing 178 cancers (diagnostic yield 36.5%).Depending on the first PSA, diagnosis was started by aGP in 44% of the cases, a urologist in 46%, and theremaining 10% by other specialists. Mean time fromfirst PSA to diagnosis was 5 months, without significantdifferences between GPs and specialities . The use ofPSA by GPs is variable (between 8 .1 and 45.8determinations per 100 men over 50 years), withoutsignificant differences in prostate cancer detection bynumber of PSAs or differences in age. In comparisonwith the period 1982-1993 the incidence of prostatecancer goes from 30.76 to 52.8 new cases/100.000inhabitants/year. There is a greater incidence andincrease of cancer in the rural area (from 33.52 to221.1 new cases/100.000 inhabitants/year).CONCLUSIONS: We confirm the general use of thistest and the trend to screening in the primary health-carelevel, which participates in an important manner in thediagnosis. PSA brings forward the diagnosis of prostatecancer 5 years in our area, and shoots its incidencerates. The high use of such marker in our population ofadvanced age may be considered inadequate