RESUMO
BACKGROUND: There have been numerous studies to define the diurnal variation of urinary excretions of substances. It is known that this variation is influenced by many factors. This diurnal variation also affects results of quantitative analysis of random urine. The purpose of this study is to evaluate the maximum excretion time of day for representative urinary analytes and to elucidate the most appropriate time for spot urine quantitative analysis. METHODS: The concentrations of following urinary analytes were measured on healthy male and female volunteers at 06, 08, 12, 16 and 24 hours in August 1995, March 1996 and January 1997: protein, amylase, urea nitrogen, creatinine, uric acid, sodium, potassium, chloride, magnesium, calcium and inorganic phosphorus were measured by Hitachi Model 747 automatic analyzer and microalbumin by Beckman Array 360. The statistical analyses of results were performed by one-way ANOVA and multiple comparison for the significance of difference. RESULTS: The excretion of protein, amylase, urea nitrogen, creatinine, sodium, potassium, chloride, magnesium and inorganic phosphorus showed the diurnal variations. The peak excretion time of protein, amylase, urea nitrogen and creatinine was at early morning. However, that of sodium, pota-ssium, chloride, magnesium and inorganic phosphorus was at afternoon. The excretion of urea nitrogen, sodium, chloride and magnesium revealed the seasonal variations. The excretion of urea nitrogen, sodium and chloride was increased during winter. CONCLUSIONS: The morning urine specimen is considered to be the most appropriate for analysing protein and nitrogenous substances and the afternoon specimen is appropriate for electrolytes.
Assuntos
Feminino , Humanos , Masculino , Amilases , Cálcio , Creatinina , Eletrólitos , Magnésio , Cloreto de Magnésio , Nitrogênio , Fósforo , Potássio , Estações do Ano , Sódio , Ureia , Ácido Úrico , VoluntáriosRESUMO
BACKGROUND: This study was conducted to evaluate accuracy of newly developed HCV Ab test kits by Korea Green Cross Co.(Yongin, Kyunggi), namely GenediaTM HCV ELISA 3.0 (ELISA) for routine test, GenediaTM HCV Rapid (RAPID) for quick screening. and GenediaTM HCV Confirm 4.0 (CONFIRM) for confirmation. METHODS: Performance of ELISA was compared with that of Ortho HCV 3.0 ELISA (Neckargemund, Germany; ORTHO ELISA) using 990 patients' sera. Accuracy of RAPID was evaluated by testing on 114 HCV Ab negative and 86 positive specimens by ELISA. Discrepant results obtained by RAPID were confirmed by Chiron RIBA HCV 3.0 Strip Immunoblot Assay (Ca, USA; RIBA) and HCV Blot 3.0 (Genelabs Diagnostics, Singapore; BLOT). Accuracy of CONFIRM test was compared between RIBA and BLOT using 78 ELISA positive sera. To elucidate prevalence of viremia, RT-PCR was performed on 165 serum samples and results were compared with that of ELISA and RAPID. RESULTS: Agreement of test results between ELISA and ORTHO ELISA was 99.6% (986/990). On HCV Ab negative specimens 99.1% (113/114) agreed among RAPID, ELISA and ORTHO ELISA. However, on seropositive specimens 91.7% (79/86) agreed between RAPID and ELISA. Agreement between CONFIRM and RIBA was 83.3% (65/78). Core antigen showed the highest reactivity and NS5 antigen showed the lowest reactivity with CONFIRM. HCV RNA was detected in 58.3% (28/48) of ELISA positive specimens, however, it was not detected in ELISA negative specimens. There was no correlation between prevalence of HCV RNA and 5 antigens used in ELISA test. CONCLUSIONS: Newly developed Korea Green Cross GenediaTM HCV ELISA 3.0, Rapid and HCV Confirm were considered to be clinically accurate routine, quick screening and confirmatory test for detecting HCV Ab in serum samples.
Assuntos
Ensaio de Imunoadsorção Enzimática , Alemanha , Anticorpos Anti-Hepatite C , Coreia (Geográfico) , Programas de Rastreamento , Prevalência , RNA , Singapura , ViremiaRESUMO
BACKGROUND: Apart from devaluing the basic skills of history taking and clinical examinations, the indiscriminate use of STAT tests is increasing in hospital practice. The purpose of this study is to evaluate the appropriateness of the STAT test requests in a tertiary care teaching university hospital. METHODS: We assessed the reasons for the STAT test requests on 644 patients (inpatients 338, emergency room patients 215, and outpatients 91), totaling 1,681 requests, during a 2 week period (between August 8 to 22, 1996) by discussing with the clinicians and nurses and/or reviewing the patient's records. RESULTS: Of 1,681 requests, 779 (46.3%) were considered inappropriate according to the criteria used to define categories. Inappropriate requests were detected in 45.1% (265/588) in wards, 49.0% (446/910) in the emergency room, and 37.2% (68/183) in the out patient department. The frequency of requests during the day showed two peaks: the first between 10 and 11 a.m., and the second between 3 and 4 p.m., which appears to indicate that the STAT tests are often requested for the convenience of the physician rather than true need of the patients. CONCLUSIONS: Many STAT tests are requested for reasons other than true emergencies. Inconsiderate, wasteful, and disruptive STAT test requests imposed an extra burden on the laboratory and resulted in a delay of reports on other true STAT or routine tests. Strategies to reduce the number of inappropriate STAT tests should be established in order to reserve the emergency service for situations of true need.
Assuntos
Humanos , Emergências , Serviço Hospitalar de Emergência , Pacientes Ambulatoriais , Atenção Terciária à SaúdeRESUMO
BACKGROUND: Tuberculosis continues to be a major threat to health throughout the world, with an estimated 8 to 10 million new cases and 3 million deaths annually. And control of the disease is further threatened by the emergence of drug resistance. Recent major advances have been made in unravelling the molecular basis of M. tuberculosis resistance to isoniazid, streptomycin, quinolones and rifampin. And rifampin resistance is the useful indicator for the occurance of the multi-drug resistance. Hence, the rapid detection of rifampin resistant strain of M. tuberculosis is the key to have successful anti-tuberculosis therapy. Here we present our experience using PCR and line probe assay (INNO-LiPA) for easy and rapid detection of rifampin resistance of M. tuberculosis. METHODS: Thirty rifampin resistant and twenty susceptible strains of M. tuberculosis were collected from the routine culture and analyzed with INNO-LiPA. And results were compared with conventional antibiotic susceptibility testing. After amplification of the region of the RNA polymerase(rpoB), the amplified product is hybridized with a set of 10 oligonucleotides immobilized onto a membrane strip. From the pattern obtained the presence or not of rifampin resistance M. tuberculosis can be assessed. RESULTS: Ninety three percent of patients who had rifampin resistant strain revealed the multidrug resistance while only two showed resistance to rifampin only. The INNO-LiPA test results were generally agreeable with that of the conventional susceptibility testing(90%). The mutations in codon 531 (absence of 55 probe) were most commonly observed. In 55.2% of the 31 rifampin resistance M. tuberculosis confirmed on mutation by R-probes on the INNO-LiPA strips. CONCLUSIONS: The line probe assay after polymerase chain reaction is a fast and convenient method to detect both presence of M. tuberculosis complex strains and its resistance to rifampin in clinical specimens. We have suggested that detection of rifampin resistance may play a key role in monitoring multi-drug resistance. Consequently, the INNO-LiPA test may constitute an important tool for the control of tuberculosis.
Assuntos
Humanos , Códon , Resistência a Medicamentos , Resistência a Múltiplos Medicamentos , Isoniazida , Membranas , Mycobacterium tuberculosis , Mycobacterium , Oligonucleotídeos , Reação em Cadeia da Polimerase , Quinolonas , Rifampina , RNA , Estreptomicina , TuberculoseRESUMO
A 31-year-old woman admitted because of fever, chilling and sore throat for 4 days. The symptom was developed after receiving methimazole 20mg per day and carteolol 10mg per day due to Graves disease during last 4 weeks. Physical examination revealed hyperemic enlarged tonsils with whitish plaque. The peripheral blood total neutrophil count was 1,400/mm3 (absolute neutrophil count, ANC 36) and a peripheral blood smear revealed rare neutrophil with lymphocytosis. On the first day of hospitalization, the patient was severely ill with ANC 0, it was decided to administer G-CSF 2ug/kg daily. On the fifth day of hospitalization, ANC in peripheral blood count was persistently zero and bone marrow aspiration and biopsy were performed, which revealed hypocellularity and myeloid hypoplasia. G-CSF given daily for 7days, it was discontinued when the ANC reached 1,539/mm3. The availability of G-CSF may help to shorten the course of agranulocytosis and to reduce its mortality rate.
Assuntos
Adulto , Feminino , Humanos , Agranulocitose , Biópsia , Medula Óssea , Carteolol , Fatores Estimuladores de Colônias , Febre , Fator Estimulador de Colônias de Granulócitos , Granulócitos , Doença de Graves , Hospitalização , Linfocitose , Metimazol , Mortalidade , Neutrófilos , Tonsila Palatina , Faringite , Exame FísicoRESUMO
In order to elucidate employees satisfaction levels in using graphic user interface(GUI) in a laboratory information system(LIS), users attitudes toward GUI versus CUI(Character User Interface) in a similar LIS were surveyed one month after implementing upgrade version of LIS in a tertiary care university hospital laboratory. The outcome of the study showed that approximately two third of users preferred to have GUI in LIS. There was no difference in preference of GUI or not. However the female and older employees tend to shy away from GUI. The employee productivity was improved with GUI although it takes slightly longer program loading time than that of CUI. In conclusion, the laboratory employee satisfaction was higher with GUI than CUI and their productivity was improved with GUI.
Assuntos
Feminino , Humanos , Sistemas de Informação em Laboratório Clínico , Eficiência , Laboratórios Hospitalares , Atenção Terciária à SaúdeRESUMO
BACKGROUND: We have experienced sporadic cases of nosocomial bacteremia/sepsis due to contaminated rubber caps of intravenous (IV) fluid bottles from May through August in 1996. We investigated the possible sources of the infections, and developed the measures to control this type of nosocomial infections. METHODS: During initial investigation of an outbreak of sporadic nosocomial bacteremia we could not found possible sources of infections from medical care providers. However, some rubber caps of IV fluid bottles showed water drops on top of them, and were suspected as possible sources of the infection. A total of 95 caps including 50 wet caps and 45 dry caps, were randomly selected from nursing stations and pharmacy receiving area for culture. We also investigated if routine disinfection methods were effective to sterilize the contaminated caps as follows; twenty of 50 wet caps were randomly selected and were divided into 2 groups. Caps of one group were disinfected with 70% isopropanol alcohol wipes and the other with 70% isopropanol alcohol wipes plus Betadine. All caps were subjected to culture before and after disinfections. Cultures were performed on blood agar plate after inoculating by using swab. RESULTS: The result of culture showed that 128 of 50(56%) wet caps were contaminated by Burkholderia picketti, Pseudomonas species, glucose-nonfermenting bacilli, Acinetobacter lowffii and Alkaligenes species. One of 45 (2.2%) dry caps grew Burkholderia picketti and Pseudomonas species. Both 70% isopropanol alcohol and 70% isopropanol alcohol plus povidone-iodine (Betadine) wipes terilized contaminated caps effectively when they were used for disinfecting caps. CONCLUSION: It is concluded that wet caps of IV fluid bottles are indicative of possible contamination by microorganisms. And use of alcohol wipe and/or Betadine to disinfect ontaminated caps at time preparing for infusion of IV fluids can be one of effective sterilization methods.
Assuntos
2-Propanol , Acinetobacter , Ágar , Bacteriemia , Burkholderia , Infecção Hospitalar , Desinfecção , Postos de Enfermagem , Farmácia , Povidona-Iodo , Pseudomonas , Borracha , Esterilização , ÁguaRESUMO
Blood utilization review has recently been used to minimize inappropriate transfusion, reduce post transfusion infections and improve the quality of transfusion practices. Ajou University Hospital is a 906 bed tertiary care teaching institution. Since March, 1995, the concurrent review of blood transfusion requests using institutional blood transfusion criteria has been initiated. To evaluate the effectiveness of the transfusion review, the units of blood components transfused per patient(total number of units of blood components transfused/total number of patients discharged) and inappropriate transfusion ratio of blood components(total number of units of blood components inappropriately transfused/total number of units of blood components transfused) were compared during the concurrent review for 9 months and pre-concurrent review for 9 months, respectively. The possible savings of blood components realized by the review were also extrapolated. The results were as follows : 1. The unit transfused per patient for pre-review and during review were 0.675 (9,080/ 13,422) and 0.654(12,123/18,546) for packed RBC(PRBC); 0.417 (5,602/ 13,422) and 0.296 (5,444/18,546) for fresh frozen plasma(FFP); 0.372(5,007/13,422) and 0.424(7,868/18,546) for platelet con-centrates(PC), respectively. 2. The inappropriate transfusion ratio of blood components for pre-review and during review were 0.039 and 0.009 for PRBC; 0.321 and 0.064 for FFP; 0.143 and 0.008 for PC, respectively. These differences were statistically significant(p=0.000). 3. The PRBC and FFP anticipated to have been saved by this review was 519 units and 2,992 units annually, respectively. 4. However, 2,621 units of PC were used additionaly during this review due to increased number of oncology patients and better hemostatic therapy practiced during the same period. In conclusion, the concurrent review of transfusion requests was very effective tool to educate residents in clinical departments the transfusion medicine and improve utilization of blood and its components.