Rapid venous lactate: new parameter for diagnostic and prognostic utility in acute chest pain

This study included 75 patients, 10 of them were critically ill, with a lactate level of 12.4 +/- 2.5 mmol/dl, this could be a predictor of death or critical illness and for the need of ICU admission. Twenty-one cases of acute myocardial infarction had a lactate level of 3.4 +/- 1.1 mmol/dl. The overall sensitivity of a positive lactate finding for acute myocardial infarction [AMI] was 92%. The specificity was 50%. The mean lactate level for patients not requiring ICU admission was 1.4 +/- 0.7 mmol/dl. The study showed that hyperlactemia correlates with the critical illness and mortality in the Emergency Department [ED] patients presenting with chest pain. Patients who have a normal lactate, normal history and normal ECG should be considered at a low risk for AMI and should be referred for the appropriate test than admitting them for the 24-hour rule out procedure. The admission lactate levels are immediately available and highly sensitive markers of AMI in patients with chest pain. A false positive lactate finding is useful as a prognostication of other critical illness and the need for resuscitation and early admission. The rapid venous lactate diagnostic and prognostic value should be confirmed by incorporation into large multicenter trials

value of transfferrin receptors assay and erythrocyte zinc protoporphrin in diagnosis of iron deficiency in hemodialysis patients.

This study aimed to evaluate the clinical usefulness of serum transferrin receptor and erythrocytes zinc protoporphyrin as possible markers of iron deficiency anemia in dialysis patients. This cross sectional study included 50 patients undergoing regular hemodialysis treatment, three times weekly. None of these patients received intravenous iron therapy, blood transfusion or recombinant human erythropoietin [rHuEpo] within three months before the study. Patients who had factors affecting serum ferritin and transferrin receptor [TR] levels as well as other causes of iron deficiency anemia were excluded. All patients were subjected to complete blood count [including hemoglobin concentration, hematocrit and MCV] and routine biochemical profile including blood urea and serum creatinine, sodium, potassium, calcium, phosphorus and albumin. Iron studies included serum transferrin, serum iron, total iron binding capacity [TIBC], serum ferritin, transferrin saturation index, erythrocyte zinc protoporphyrin and serum transferrin receptors. Iron status was evaluated by bone marrow examination by a biopsy from the posterior iliac crest or sternal bone marrow aspiration. Sections were examined for iron with Prussian blue stain and graded according to scale described by Ho-Yen. The study concluded that TR is more sensitive than s. ferritin as an indicator of iron deficiency, while s. ferritin is more specific screening test for iron store deficiency. ZPP also gives low sensitivity and specificity as an indicator of iron store deficiency. It may be predicted that these measurements are likely to replace the conventional parameters. They would be especially used in the outpatient clinics, where bone marrow examination is either not available or regarded as an invasive mean