RESUMEN
BACKGROUND: To compare the inter-practice and inter-regional variability in laboratory test requests by general practitioners in Spain, through the measure of appropriateness indicators. METHODS: A call for data was posted on the Redconlab website. We obtained production statistics for 2010 from laboratories in 37 different hospitals from diverse Spanish regions. The following appropriateness indicators were calculated: test requests per 1000 inhabitants, ratios of related tests requests and index of variability. The results obtained in the laboratories in the region of authors were compared to the rest of the participating laboratories in order to establish whether there were regional differences in the test requesting patterns. RESULTS: The rate of request of the tests ranged from 31.5 per 1000 inhabitants for vitamin B12 to 372.6 per 1000 inhabitants for glucose. The index of variability ranged from 1.53 for glucose and triglycerides to 7.4 for alkaline phosphatase. Regarding the ratios of related test requests, the variability index ranged from 1.24 for folic acid/vitamin B12 to 26.38 for lactate dehydrogenase/alanine transaminase. The most frequently ordered tests were the ones with less variability, except for uric acid and urinalysis. No significant differences were identified between the results of the laboratories in the region of authors and the rest, except for urinalysis (p < 0.001), folic acid/vitamin B12 (p = 0.030), and transferrin/ferritin (p = 0.018). CONCLUSIONS: A considerable variability exists in laboratory test ordering patterns by general practitioners across Spanish regions. Local habits must have been decisive as shown by the regional differences in the results of indicators of some tests. The study results bring out the need to accomplish interventions to improve appropriate use of laboratory tests.
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Pruebas de Química Clínica/estadística & datos numéricos , Pruebas Hematológicas/estadística & datos numéricos , Atención Primaria de Salud/organización & administración , Humanos , EspañaRESUMEN
Some studies have determined that oxidative stress is a decisive factor in Alzheimer's disease (AD) and even suggested that it is present in the initial phase of mild cognitive impairment (MCI). The aim of our study was to investigate the process of oxidative stress by measuring the level of malondialdehyde (MDA), the specific activity of two peripheral antioxidant defenses (superoxide dismutase (SOD) and ceruloplasmin), and the level of copper in AD and MCI patients and compare those results with healthy subjects. The sample group consisted of 36 patients with AD, 18 patients with MCI, and 33 healthy aged subjects. Blood samples were obtained from each subject. A significantly higher copper level was found in patients with AD and MCI compared to the control group. The levels of MDA showed a similar trend and were higher in patients from the AD and MCI groups than in the control group. It was found that both studied parameters had positive correlation in the whole studied population (r = 0.340; p = 0.001). A stepwise logistic regression analysis was used to identify an optimal combination of these biomarkers. The optimal biomarker combinations were MDA and SOD with area under the curve of 0.803 (0.691-0.915, CI 95%, p < 0.001) for the diagnosis of AD. The optimal cutpoint yielded 88.0% Sensitivity and 70.0% Specificity. The biomarker combinations predicted AD and were markedly superior to individual biomarkers. Our findings support the hypothesis that oxidative stress might represent a sign of AD pathology and could be an early event in the progression of MCI to AD.
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Enfermedad de Alzheimer/fisiopatología , Disfunción Cognitiva/fisiopatología , Estrés Oxidativo/fisiología , Anciano , Anciano de 80 o más Años , Análisis de Varianza , Ceruloplasmina/metabolismo , Cobre/metabolismo , Femenino , Humanos , Modelos Logísticos , Masculino , Malondialdehído/metabolismo , Escala del Estado Mental , Curva ROC , Sensibilidad y Especificidad , Superóxido DismutasaRESUMEN
No disponible
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Humanos , Femenino , Adulto , Anemia de Células Falciformes/diagnóstico , Complicaciones Hematológicas del Embarazo , Hemorragia Posparto/etiologíaRESUMEN
BACKGROUND: Abacavir has been associated with an increased risk of acute myocardial infarction, but the pathogenic mechanisms remain unknown. We evaluated longitudinal changes in pro-atherosclerotic biomarkers in patients initiating abacavir or tenofovir. METHODS: Consecutive patients initiating antiretroviral therapy (ART) with abacavir/lamivudine or tenofovir/emtricitabine were included. Plasma levels of high sensitivity C reactive protein (hsCRP), interleukin-6 (IL-6), intercellular adhesion molecule-1, vascular cell adhesion molecule-1 (sVCAM-1) and plasminogen activator inhibitor-1 (PAI-1) were measured at baseline and at different time points throughout 48 weeks. Comparisons were adjusted for age, sex, ART status at inclusion, viral load, lipodystrophy, Framingham score and hepatitis C virus co-infection status. RESULTS: 50 patients were analyzed, 28 initiating abacavir and 22 tenofovir. The endothelial biomarker sVCAM-1 declined significantly in both treatment groups. hsCRP tended to increase soon after starting therapy with abacavir, a trend that was not seen in those initiating tenofovir. IL-6 significantly increased only at week 24 from baseline in patients on abacavir (+225%, p < 0.01) although the differences were not significant between groups. The procoagulant biomarker PAI-1 plasma levels increased from baseline at week 12 (+57%; p = 0.017), week 24 (+72%; p = 0.008), and week 48 (+149%; p < 0.001) in patients on tenofovir, but differences between groups were not statistically significant. CONCLUSION: Changes in biomarkers of inflammation, coagulation, and endothelial function are not different in viremic patients starting ART with abacavir/lamivudine or tenofovir/emtricitabine. These changes occur in the early phases of treatment and include anti- and pro-atherosclerotic effects with both drugs.
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Adenina/análogos & derivados , Fármacos Anti-VIH/uso terapéutico , Didesoxinucleósidos/uso terapéutico , Infecciones por VIH/complicaciones , Infecciones por VIH/tratamiento farmacológico , Mediadores de Inflamación/inmunología , Organofosfonatos/uso terapéutico , Trombosis/inmunología , Adenina/efectos adversos , Adenina/uso terapéutico , Adulto , Fármacos Anti-VIH/efectos adversos , Biomarcadores/sangre , Proteína C-Reactiva/inmunología , Coagulantes/sangre , Coagulantes/inmunología , Didesoxinucleósidos/efectos adversos , Femenino , Infecciones por VIH/inmunología , Humanos , Mediadores de Inflamación/sangre , Interleucina-6/sangre , Interleucina-6/inmunología , Estudios Longitudinales , Masculino , Persona de Mediana Edad , Organofosfonatos/efectos adversos , Inhibidor 1 de Activador Plasminogénico/sangre , Inhibidor 1 de Activador Plasminogénico/inmunología , Tenofovir , Trombosis/etiología , Molécula 1 de Adhesión Celular Vascular/sangre , Molécula 1 de Adhesión Celular Vascular/inmunologíaRESUMEN
CONTEXT: -The preanalytic phase of 24-hour urine collection, before clinical analysis, requires the active participation of patients and usually takes place outside the laboratory. OBJECTIVE: -We verify whether distribution of adequate information to health care personnel and patients will result in fewer preanalytic incidents. We also determine the intraindividual biologic variability associated with micturition and the corresponding reference change value (RCV). DESIGN: -The intervention provided training for 24-hour urine collection to the health care personnel of the 20th health district of the Valencian community in Spain. The preanalytic incidents related to 24-hour micturition were estimated before and after the intervention. An opinion survey on the problems involved in urine collection was also conducted among patients. The Harris formula was used to calculate the RCV. RESULTS: -Before the intervention, 130 preanalytic incidents were recorded (11.5%) and after the intervention, 76 (8.6%) (P = .04) were recorded. Of the 130 incidents recorded before the intervention, 63 (48.5%) involved omission to indicate the urine volume, and of the 76 incidents recorded after the intervention, only 1 (1.3%) (P < .001) involved this omission. Forty of 302 patients (13.2%) surveyed reported problems and more than half (175; 57.9%) had to collect various urine samples sequentially. The RCV determined was 54.5% for a percentage of variation in volume of 24-hour urine (PVVI) of 19.0 +/- 16.5%. Therefore, micturition associated with a PVVI >+/-54.5% suggests that 24-hour urine collection by the patient was incomplete. The results obtained when applying the RCV after the intervention showed that 6.3% of the 24-hour urine samples should be rejected. CONCLUSIONS: -The percentage of preanalytic incidents was reduced by providing health care personnel with information and training. The percentage of variation in volume of 24-hour urine can be used to evaluate the variation in patients' micturition. Reference change value was shown to be useful when determining whether 24-hour urine was properly collected.
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Técnicas de Laboratorio Clínico/normas , Personal de Salud/normas , Manejo de Especímenes/normas , Urinálisis/normas , Sistemas de Información en Laboratorio Clínico/normas , Recolección de Datos/estadística & datos numéricos , Personal de Salud/educación , Humanos , Valores de Referencia , España , Manejo de Especímenes/métodos , Urinálisis/métodos , MicciónRESUMEN
Ante la sospecha de una situación de infarto agudo de miocardio en pacientes que acuden al Servicio de Urgencias, se utilizan numerosas herramientas desde el laboratorio con el objeto de verificar dicha impresión clínica. Al margen de las determinaciones enzimáticas, se ha propuesto recientemente el aumento en la sensibilidad diagnóstica que supone la presencia de alteraciones en el contaje de linfocitos junto con la elevación de la CK-MB. Nuestro objetivo fue confirmar este hallazgo en nuestro medio de trabajo. Hemos encontrado diferencias estadísticamente significativas en el grupo de pacientes con alteraciones en las enzimas cardiacas, tanto en lo que respecta al recuento de leucocitos como de linfocitos, así como mejoría de la sensibilidad diagnóstica cuando se añade la presencia de una linfopenia en este mismo grupo de pacientes. Su aplicación en la práctica puede suponer una ampliación del potencial diagnóstico del laboratorio de Urgencias a un coste mínimo (AU)