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1.
Rev. lab. clín ; 12(3): e57-e66, jul.-sept. 2019. tab, graf
Article in Spanish | IBECS | ID: ibc-187165

ABSTRACT

Este documento describe recomendaciones para la estandarización de la medida de las magnitudes lipídicas, puesto que resultan críticas para la toma de decisiones clínicas. Deben emplearse métodos recomendados validados frente a un método de referencia o definitivo, y materiales de control que cumplan con la Directiva Europea sobre Diagnóstico in vitro; deben cumplir también los objetivos recomendados por el National Cholesterol Education Program (NCEP) y la Sociedad Española de Medicina del Laboratorio (SEQCML). La determinación de colesterol de HDL por métodos homogéneos en equipos automatizados se considera aceptable para la práctica rutinaria, y la fórmula de Friedewald utilizable para estimar la concentración de colesterol de LDL siempre que las concentraciones de triglicéridos sean iguales o inferiores a 200mg/dL (2,3mmol/L); en otro caso, se recomienda utilizar la concentración de colesterol-no-HDL. La cuantificación rutinaria de apolipoproteínas A1 y B, y lipoproteína (a), puede efectuarse por métodos de inmunonefelometría e inmunoturbidimetría, con calibradores trazables a materiales de referencia


Some recommendations are presented for standardising the measurement of lipids and lipoproteins, as they are critical for clinical decisions making. Recommended methods validated against a reference or definitive method should be employed, as well as the use of control materials that comply with European Directives on in vitro diagnostics. Additionally, the chosen methods must comply with the objectives set forth by the National Cholesterol Education Program (NCEP) and by the Spanish Society of Laboratory Medicine (SEQCML). Determination of HDL cholesterol using automatic homogenous methods is considered acceptable for normal clinical practice, and the Friedewald Formula is considered to be usable to estimate LDL cholesterol concentration when triglyceride concentrations are below 200mg/dL (2.3mmol/L). If this should not be the case, the use of non-HDL cholesterol is recommended. Routine quantification of apolipoproteins A1 and B, and lipoprotein (a) can be measured using immunonephelometric or immunoturbidimetric methods, with calibrators that are traceable to reference materials


Subject(s)
Humans , Lipids/analysis , Lipoproteins/analysis , Apolipoproteins/analysis , Cholesterol/analysis , Triglycerides/analysis , Reference Values , Clinical Laboratory Techniques/standards , Cardiovascular Diseases/diagnosis , Immunoturbidimetry/methods , Risk Factors , Atherosclerosis/diagnosis , Sensitivity and Specificity
2.
Rev Chil Pediatr ; 88(4): 487-494, 2017.
Article in Spanish | MEDLINE | ID: mdl-28898316

ABSTRACT

BACKGROUND: Metabolic bone disease (MBD) of prematurity is a complication of multifactorial aetiology, which has been increasing, due to progressive decrease in mortality of preterm newborns. The aim of the study was to analyze risk factors of severe MBD and its analytical markers. PATIENTS AND METHOD: Retrospective study involving preterm infants less than 32 weeks gestational age and/or weight less tan 1,500 g born between january 2012 and december 2014. Comparison was made according to the presence of severe MBD. RESULTS: 139 patients were recruited. Mean value of 25(OH)D3 was 70.68 ± 25.20 nmol/L, being higher in patients born in spring-summer than in autumn-winter (80.94 ± 25.33 vs 61.13 ± 21.07; p = 0.000). Levels of 25(OH)D3 were similar in patients with severe MBD compared with the rest of patients (65.61 ± 26.49 vs 72.07 ± 24.89, P = 0.283). Higher levels of alkaline phosphatase (AP, IU/L ) (1314.19 ± 506.67 vs 476.56 ± 188.85; p = 0.000) were found in these patients. Cutoff point of AP 796.5 IU/L (S 95.2%, specificity 92.4%) was calculated by ROC curve. The risk factors most associated to severe EMO were restricted fetal growth, birth weight, duration of ventilation therapy and parenteral nutrition. CONCLUSIONS: AP levels were the best marker of severe MBD development. EMO risk increases with the number of risk factors and lower levels of 25(OH)D3. Levels of 25(OH)D3 higher than 70nmol/L appear to protect from the development of severe MBD, even in patients with multiple risk factors.


Subject(s)
Bone Diseases, Metabolic/diagnosis , Bone Diseases, Metabolic/etiology , Infant, Premature, Diseases/diagnosis , Infant, Premature, Diseases/etiology , Biomarkers/metabolism , Bone Diseases, Metabolic/metabolism , Female , Humans , Infant, Newborn , Infant, Premature , Infant, Premature, Diseases/metabolism , Male , Retrospective Studies , Risk Factors
3.
Rev. chil. pediatr ; 88(4): 487-494, 2017. ilus, tab
Article in Spanish | LILACS | ID: biblio-900007

ABSTRACT

Introducción: La enfermedad metabólica ósea (EMO) del recién nacido prematuro (RNPT) es una complicación de origen multifactorial, que ha ido en aumento, consecuencia de la disminución progresiva de la mortalidad. El objetivo del estudio fue analizar los factores de riesgo (FR) pre y postnatales relacionados con la EMO severa y sus marcadores analíticos. Pacientes y Métodos: Estudio retrospectivo observacional, descriptivo y analítico, que incluyó RNPT nacidos con menos de 32 semanas y/o peso menor de 1.500 g entre enero de 2012 y diciembre de 2014. Se analizó la muestra en función del desarrollo de EMO severa. Resultados: 139 pacientes, con 25(OH)D3 media de 70,68 ± 25,20 nmol/l, mayor en los nacidos en primavera-verano que en otoño-invierno (80,94 ± 25,33 vs 61,13±21,07; p = 0,000). Los pacientes con EMO severa presentaron valores de 25(OH)D3 similares al resto de pacientes (65,61 ± 26,49 vs 72,07 ± 24,89; p = 0,283), y superiores de fosfatasa alcalina (FA) (1314,19 ± 506,67 vs 476,56 ± 188,85; p = 0,000). Mediante curva ROC se calculó un punto de corte de FA de 796,5 IU/l (S 95,2%, E 92,4%). Los FR más asociados al desarrollo de EMO severa fueron el crecimiento intrauterino restringido, el peso al nacimiento y la duración de ventiloterapia y nutrición parenteral. Conclusiones: Las cifras de FA son las que mejor se relacionan con el desarrollo de EMO severa. El riesgo de ésta aumenta a mayor número de factores de riesgo y menores cifras de vitamina D3. Niveles de 25(OH)D3 por encima de 70 nmol/l parecen proteger del desarrollo de EMO, incluso en pacientes con múltiples factores de riesgo.


Background: Metabolic bone disease (MBD) of prematurity is a complication of multifactorial aetiology, which has been increasing, due to progressive decrease in mortality of preterm newborns. The aim of the study was to analyze risk factors of severe MBD and its analytical markers. Patients and Method: Retrospective study involving preterm infants less than 32 weeks gestational age and/or weight less tan 1,500 g born between january 2012 and december 2014. Comparison was made according to the presence of severe MBD. Results: 139 patients were recruited. Mean value of 25(OH)D3 was 70.68 ± 25.20 nmol/L, being higher in patients born in spring-summer than in autumn-winter (80.94 ± 25.33 vs 61.13 ± 21.07; p = 0.000). Levels of 25(OH)D3 were similar in patients with severe MBD compared with the rest of patients (65.61 ± 26.49 vs 72.07 ± 24.89, P = 0.283). Higher levels of alkaline phosphatase (AP, IU/L ) (1314.19 ± 506.67 vs 476.56 ± 188.85; p = 0.000) were found in these patients. Cutoff point of AP 796.5 IU/L (S 95.2%, specificity 92.4%) was calculated by ROC curve. The risk factors most associated to severe EMO were restricted fetal growth, birth weight, duration of ventilation therapy and parenteral nutrition. Conclusions: AP levels were the best marker of severe MBD development. EMO risk increases with the number of risk factors and lower levels of 25(OH)D3. Levels of 25(OH)D3 higher than 70nmol/L appear to protect from the development of severe MBD, even in patients with multiple risk factors.


Subject(s)
Humans , Male , Female , Infant, Newborn , Bone Diseases, Metabolic/diagnosis , Bone Diseases, Metabolic/etiology , Infant, Premature, Diseases/diagnosis , Infant, Premature, Diseases/etiology , Bone Diseases, Metabolic/metabolism , Infant, Premature , Biomarkers/metabolism , Retrospective Studies , Risk Factors , Infant, Premature, Diseases/metabolism
4.
Nutr Hosp ; 32(5): 2331-7, 2015 Nov 01.
Article in English | MEDLINE | ID: mdl-26545695

ABSTRACT

BACKGROUND: subclinical hyperthyroidism (SHT) is associated with harmful effects on cardiovascular system, bone metabolism and progression to clinical hyperthyroidism. Loss of weight is a common fact in patients with clinical hyperthyroidism and of particular relevance in elderly patients. OBJECTIVE: to assess changes in body composition after radioiodine therapy for SHT due to toxic nodular goiter. SUBJECTS AND METHODS: prospective controlled cohort study. Patients with persistent SHT due to toxic nodular goiter were purposed to receive treatment with radioiodine (treatment group) or to delay treatment until the study was over (control group). All treated patients received 555 MBq of ¹³¹I. Body composition (lean mass, fat mass and bone mineral content) was determined by dual-energy X-ray absorptiometry (DEXA) at baseline and 12 months after. RESULTS: twenty-nine patients were studied (age 69.5 ± 11.5; 75.9% women; BMI 27.1 ± 5.7 kg/m²; serum thyrotropin (TSH) 0.20 ± 0.21 µUI/mL; serum free thyroxine (T4) 1.01 ± 0.19 ng/dL), 17 belonging to the treatment group and 12 to the control group. Study groups were comparable, although there was a trend for the treatment group to have more fat mass. No longitudinal changes in body composition were noted in either group, except for a trend to gain fat mass. However, when individuals with age > 65 years were selected, only patients who received radioiodine therapy showed a significant increase in body weight (from 64.1 ± 10.0 to 66.9 ± 9.2 kg), BMI (from 27.3 ± 4.8 to 28.7 ± 4.5 kg/m²), fat mass (from 26.1 ± 8.5 to 27.8 ± 7.9 kg), lean mass (from 36.3 ± 0.4 to 37.4 ± 0.4 kg) and skeletal muscle mass index (SMI) (from 6.0 ± 0.6 to 6.3 ± 0.6 kg/m²). CONCLUSIONS: treatment of SHT has impact on body composition in subjects older than 65 years. Weight gain reflects increases in fat and, more interestingly, in lean mass.


Introducción: el hipertiroidismo subclínico (HS) se asocia a efectos deletéreos sobre el sistema cardiovascular, el metabolismo óseo y puede progresar a hipertiroidismo clínico. La pérdida de peso es habitual en los pacientes con hipertiroidismo clínico y adquiere especial relevancia en los sujetos añosos. Objetivo: evaluar los cambios en la composición corporal después del tratamiento del HS por bocio nodular con radioyodo. Sujetos y métodos: estudio de cohortes prospectivo controlado. A los pacientes con HS persistente debido a bocio nodular tóxico se les ofreció la opción de recibir tratamiento con radioyodo (grupo tratamiento) o retrasar dicho tratamiento hasta que el estudio hubiera acabado (grupo control). Al final, todos los pacientes recibieron 555 MBq de 131I. La composición corporal (masa magra, masa grasa y contenido mineral óseo) se determinó por absorciometría con rayos X de doble energía (DEXA) al inicio y a los 12 meses. Resultados: se estudiaron 29 pacientes (edad 69,5 ± 11,5; 75,9% mujeres; BMI 27,1 ± 5,7 kg/m²; tirotropina sérica (TSH) 0,20 ± 0,21 µUI/mL; tiroxina libre sérica(T4) 1,01 ± 0,19 ng/dL), 17 pertenecientes al grupo tratamiento y 12 al grupo control. Los grupos de estudio fueron comparables, aunque existía una tendencia del grupo tratamiento a presentar más masa grasa. No se detectaron cambios en la composición corporal en ningún grupo, salvo una tendencia general a ganar masa grasa. Sin embargo, cuando se seleccionaron los individuos con edad > 65 años, sólo los pacientes que recibieron tratamiento con radioyodo mostraron un significativo incremento de peso (de 64,1 ± 10,0 a 66,9 ± 9,2 kg), IMC (de 27,3 ± 4,8 a 28,7 ± 4,5 kg/m²), masa grasa (de 26,1 ± 8,5 a 27,8 ± 7,9 kg), masa magra (de 36,3 ± 0,4 a 37,4 ± 0,4 kg) e índice de masa muscular esquelética (de 6,0 ± 0,6 a 6,3 ± 0,6 kg/m²). Conclusiones: el tratamiento del HS tiene impacto sobre la composición corporal en sujetos mayores de 65 años. La ganancia de peso refleja incrementos en la masa grasa y, lo que es más interesante, en la masa magra.


Subject(s)
Body Composition , Hyperthyroidism/metabolism , Hyperthyroidism/radiotherapy , Absorptiometry, Photon , Aged , Aged, 80 and over , Cohort Studies , Female , Goiter, Nodular/metabolism , Goiter, Nodular/radiotherapy , Humans , Iodine Radioisotopes/therapeutic use , Male , Middle Aged , Prospective Studies , Thyroid Hormones/blood , Weight Gain
5.
Nutr. hosp ; 32(5): 2331-2337, nov. 2015. tab, graf
Article in English | IBECS | ID: ibc-145566

ABSTRACT

Background: subclinical hyperthyroidism (SHT) is associated with harmful effects on cardiovascular system, bone metabolism and progression to clinical hyperthyroidism. Loss of weight is a common fact in patients with clinical hyperthyroidism and of particular relevance in elderly patients. Objective: to assess changes in body composition after radioiodine therapy for SHT due to toxic nodular goiter. Subjects and methods: prospective controlled cohort study. Patients with persistent SHT due to toxic nodular goiter were purposed to receive treatment with radioiodine (treatment group) or to delay treatment until the study was over (control group). All treated patients received 555 MBq of 131I. Body composition (lean mass, fat mass and bone mineral content) was determined by dual-energy X-ray absorptiometry (DEXA) at baseline and 12 months after. Results: twenty-nine patients were studied (age 69.5 ± 11.5; 75.9% women; BMI 27.1 ± 5.7 kg/m²; serum thyrotropin (TSH) 0.20 ± 0.21 µUI/mL; serum free thyroxine (T4) 1.01 ± 0.19 ng/dL), 17 belonging to the treatment group and 12 to the control group. Study groups were comparable, although there was a trend for the treatment group to have more fat mass. No longitudinal changes in body composition were noted in either group, except for a trend to gain fat mass. However, when individuals with age > 65 years were selected, only patients who received radioiodine therapy showed a significant increase in body weight (from 64.1 ± 10.0 to 66.9 ± 9.2 kg), BMI (from 27.3 ± 4.8 to 28.7 ± 4.5 kg/m²), fat mass (from 26.1 ± 8.5 to 27.8 ± 7.9 kg), lean mass (from 36.3 ± 0.4 to 37.4 ± 0.4 kg) and skeletal muscle mass index (SMI) (from 6.0 ± 0.6 to 6.3 ± 0.6 kg/m²). Conclusions: treatment of SHT has impact on body composition in subjects older than 65 years. Weight gain reflects increases in fat and, more interestingly, in lean mass (AU)


Introducción: el hipertiroidismo subclínico (HS) se asocia a efectos deletéreos sobre el sistema cardiovascular, el metabolismo óseo y puede progresar a hipertiroidismo clínico. La pérdida de peso es habitual en los pacientes con hipertiroidismo clínico y adquiere especial relevancia en los sujetos añosos. Objetivo: evaluar los cambios en la composición corporal después del tratamiento del HS por bocio nodular con radioyodo. Sujetos y métodos: estudio de cohortes prospectivo controlado. A los pacientes con HS persistente debido a bocio nodular tóxico se les ofreció la opción de recibir tratamiento con radioyodo (grupo tratamiento) o retrasar dicho tratamiento hasta que el estudio hubiera acabado (grupo control). Al final, todos los pacientes recibieron 555 MBq de 131I. La composición corporal (masa magra, masa grasa y contenido mineral óseo) se determinó por absorciometría con rayos X de doble energía (DEXA) al inicio y a los 12 meses. Resultados: se estudiaron 29 pacientes (edad 69,5 ± 11,5; 75,9% mujeres; BMI 27,1 ± 5,7 kg/m²; tirotropina sérica (TSH) 0,20 ± 0,21 µUI/mL; tiroxina libre sérica(T4) 1,01 ± 0,19 ng/dL), 17 pertenecientes al grupo tratamiento y 12 al grupo control. Los grupos de estudio fueron comparables, aunque existía una tendencia del grupo tratamiento a presentar más masa grasa. No se detectaron cambios en la composición corporal en ningún grupo, salvo una tendencia general a ganar masa grasa. Sin embargo, cuando se seleccionaron los individuos con edad > 65 años, sólo los pacientes que recibieron tratamiento con radioyodo mostraron un significativo incremento de peso (de 64,1 ± 10,0 a 66,9 ± 9,2 kg), IMC (de 27,3 ± 4,8 a 28,7 ± 4,5 kg/m²), masa grasa (de 26,1 ± 8,5 a 27,8 ± 7,9 kg), masa magra (de 36,3 ± 0,4 a 37,4 ± 0,4 kg) e índice de masa muscular esquelética (de 6,0 ± 0,6 a 6,3 ± 0,6 kg/m²). Conclusiones: el tratamiento del HS tiene impacto sobre la composición corporal en sujetos mayores de 65 años. La ganancia de peso refleja incrementos en la masa grasa y, lo que es más interesante, en la masa magra (AU)


Subject(s)
Humans , Hyperthyroidism/drug therapy , Body Composition/physiology , Absorptiometry, Photon/methods , Asymptomatic Diseases , Prospective Studies , Case-Control Studies , Weight Gain
6.
Rev. lab. clín ; 5(1): 18-27, ene.-mar. 2012.
Article in Spanish | IBECS | ID: ibc-99799

ABSTRACT

Introducción. Los resultados de los programas de garantía de calidad indican que existen diferencias significativas entre los métodos homogéneos disponibles para la medición del colesterol HDL. Sin embargo, la posible influencia de efectos matriz en las muestras liofilizadas empleadas y la ausencia de un valor verdadero en estas muestras, hace difícil la valoración completa de estos métodos. En este estudio experimental multicéntrico hemos comparado los métodos homogéneos más utilizados en nuestro medio, con respecto al de precipitación de ácido fosfotúngstico-MgCl2. Material y métodos. Cada laboratorio procesó unas 100 muestras de suero de pacientes por uno o dos métodos homogéneos y envió alícuotas congeladas de las muestras analizadas al laboratorio central donde se procesaron por el método de precipitación. Resultados. Las imprecisiones de los métodos homogéneos fueron buenas e inferiores a las de precipitación, que cumplía las especificaciones de calidad para sesgo y error total (ET). Sin embargo, no todos los métodos homogéneos cumplían los objetivos de calidad mínimos, pues algunos procedimientos producían sesgos positivos muy altos (en relación al método de comparación) y uno un sesgo negativo muy bajo. El estudio de la concordancia, realizado estratificando a los pacientes según las concentraciones de colesterol HDL, mostró diferencias entre los métodos. Conclusiones. Estos resultados sugieren que existen discrepancias en la valoración de las magnitudes obtenidas con los métodos homogéneos, probablemente generada por una elevada inexactitud en algunos de ellos y que es conveniente que los laboratorios conozcan las caracteristicas de imprecisión y sesgo del metodo directo que utilizan con respecto al de referencia (AU)


Introduction. The results of quality assurance programs suggest that there are significant differences between the homogeneous methods available for the measurement of HDL cholesterol. However, the possible influence of matrix effects in the lyophilized samples used and the absence of a true value in these samples means that a full assessment of these methods cannot be made. In this multicentre pilot study we compared the most used homogeneous methods in our country with the phosphotungstic acid-MgCl2 method. Material and methods. Each laboratory processed about one hundred serum samples from patients with one or two homogeneous methods and sent frozen aliquots of the samples in special packaging with dry ice to the central laboratory where they were processed by the precipitation method. Results. The imprecision of homogeneous methods were good and lower than those of the precipitation method, and met the quality specifications for bias and total error (TE). However, not all homogeneous methods met the minimum quality objectives, as some procedures produced a very high positive bias (relative to the comparison method) and one, a low negative bias. In addition, the study of the agreement between methods, made by stratifying patients according to HDL cholesterol concentrations, showed differences. Conclusions. These results suggest that there are discrepancies in the assessment of the levels obtained with homogeneous methods, probably due to a high inaccuracy in some of them, and it is advised that the laboratories be aware of the characteristics of inaccuracy and bias of the direct method used compared to the reference method (AU)


Subject(s)
/organization & administration , /standards , Phosphotungstic Acid/chemical synthesis , Phosphotungstic Acid , Specimen Handling/instrumentation , Specimen Handling/methods , Cholesterol, HDL/analysis , Cholesterol, HDL/chemical synthesis , Cholesterol, HDL/metabolism , Specimen Handling/standards , Specimen Handling/trends , Specimen Handling , Selection Bias , Clinical Laboratory Information Systems/standards , Clinical Laboratory Information Systems , Medical Laboratory Science/methods
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