Predictors of subclinical atherosclerosis in HIV.

BACKGROUND: Cardiovascular disease is a major cause of morbidity and mortality in people with HIV. The detection of subclinical atherosclerosis through vascular ultrasound allows us to identify patients at an increased risk of cardiovascular disease as a primary prevention strategy; this test is not routine. Our objective is to identify predictors of subclinical atherosclerosis in a population with HIV. METHODS: People with HIV infection were selected for primary prevention and underwent carotid and femoral ultrasound to detect atheromatous plaques. Logistic regression analysis including vascular risk factors was performed to predict the presence of atherosclerosis. RESULTS: One hundred eighty-three patients were included, 54% of whom were smokers; the mean duration of HIV infection was 9.52 years, and all patients were undergoing antiretroviral treatment. Subclinical atherosclerosis was present in 62.29% of the patients; 83.32% had plaque in the carotid territory, 57.93% in the femoral territory and 25.6% in both vascular territories. Compared to those without atherosclerosis, patients with atherosclerosis were on average 5.35 years older (53.86 vs. 48.51, p < 0.001) and had a higher prevalence of smoking (63.23% vs. 39.12%, p = 0.020) and a CD4/CD8 ratio below 0.7 (44.23% vs. 29.02%, p = 0.043). A CD4/CD8 ratio lower than 0.3 was always associated with subclinical atherosclerosis (95% confidence interval (CI): 83.9-100%). The inclusion of smoking, the CD4/CD8 ratio and age in the logistic regression analysis led to a diagnostic yield of 72% measured by the area under the receiving operator characteristic (ROC) curve (95% CI: 64-80%). CONCLUSIONS: Tobacco use, age and a CD4/CD8 ratio below 0.7 allow prediction of the presence of subclinical atherosclerosis in primary prevention. A CD4/CD8 ratio below 0.3 was a diagnostic indicator of atherosclerosis in HIV patients undergoing primary prevention in our sample.

Analysis of blood markers for early colorectal cancer diagnosis.

Background: Colorectal cancer (CRC) is a very common tumor worldwide. Its mortality can be limited by early diagnosis through screening programs. These programs are based on fecal occult blood testing and colonoscopy. Our objective was to find a model based on the determination of blood biomarkers that was efficacious enough to become part of the early diagnosis of CRC. Methods: In a total of 221 patients who underwent a colonoscopy, two types of markers were identified (I) classic: carcinoembryonic antigen (CEA), CA19.9, α-fetoprotein, CA125, CA72.4, and ferritin; and (II) experimental: neutrophil gelatinase-associated lipocalin (NGAL), estimated glomerular filtration rate (EGFR), 8-hydroxydeoxyguanosine (8OHdG), calprotectin, and cysteine-rich 61 (Cyr61). We divided the patients into four groups according to colonoscopy results: a control group (n=83) with normal colonoscopy, a polyp group (n=56), a CRC group (n=45), and an inflammatory disease group (n=37). We built an algorithm based on multivariate logistic regression analysis. Results: A total of 51.6% were males, and the median age was 63 years. We designed an algorithm based on the combination of several markers that discriminated CRC patients from the rest of the patients with a performance of 94%, a sensitivity of 95.6%, and a specificity of 80.6%. Discriminating by sex also resulted in two powerful algorithms, although it performed better in males (97% vs. 91%). Conclusions: Our study has devised a predictive model with high efficacy based on the determination of several biomarkers. We think that it could be incorporated into the set of methods used in CRC screening.

An opportunity to emphasize the relevance of laboratory medicine.

Objectives: Clinical practice guidelines (CPGs) are recommendations based on a systematic review of scientific evidence that are intended to help healthcare professionals and patients make the best clinical decisions. CPGs must be evidence-based and are designed by multidisciplinary teams. The purpose of this study is to assess the topics related to the clinical laboratory addressed in CPGs and evaluate the involvement of laboratory professionals in the CPG development process. Methods: A total of 16 CPGs recommended by the Spanish Society of Laboratory Medicine and/or retrieved from PubMed-Medline were included. A review of the information provided in CPGs about 80 topics related to the clinical laboratory was performed. The authorship of laboratory professionals was assessed. Results: On average, the 16 CPGs addressed 49% (standard deviation [SD]: 11%) of the topics evaluated in relation to the clinical laboratory. By order of frequency, CPGs contained information about 69% of postanalytical variables (SD: 20%); 52% of preanalytical variables (SD: 11%); and 43% of the analytical variables studied (SD: 18%). Finally, half the CPGs included a laboratory professional among its authors. Conclusions: CPGs frequently failed to provide relevant laboratory-related information. Laboratory professionals were co-authors in only half the CPGs. There is scope for improvement, and laboratory professionals should be included in multidisciplinary teams involved in the development of CPGs.

Assessment of a change of protocol of prenatal screening by inclusion of non-invasive prenatal diagnosis.

Objectives: Non-invasive prenatal screening (NIPS) is a test for the detection of major fetal chromosomal abnormalities in maternal blood during pregnancy. The purpose of this study was to assess the performance of NIPS implemented within the framework of the Screening Program for Congenital Abnormalities of the Andalusian Health System. Methods: A retrospective observational study was undertaken to determine the number of NIPS tests performed since its introduction. The number of invasive diagnostic tests done after the implementation of NIPS in the patients included in the program between March 2016 and August 2017 was also quantified. Results: A total of 6,258 combined first- and second trimester screening tests were performed, covering 95% of the population. In total, 250 subjects were identified as high risk, of whom 200 underwent NIPS after loss to follow-up. NIPS showed a sensitivity of 100% (95% CI: 76.84-100%) and a specificity of 99.46% (95% CI: 97.04-99.99%). Conclusions: This test has proven to have a very high sensitivity and specificity. The results obtained demonstrate that the incorporation of NIPS in clinical practice minimizes the rate of miscarriages and reduces the frequency of invasive procedures by 70%.

Validación de un glucómetro en una unidad de cuidados intensivos / Validation of a glucose meter at an intensive care unit

Introducción Los pacientes ingresados en las unidades de cuidados intensivos (UCI) con hiperglucemia presentan mayor morbi-mortalidad que los pacientes normoglucémicos. Habitualmente, la monitorización de la glucemia de los pacientes en las unidades de cuidados intensivos es realizado por medio de glucómetros. El objetivo del estudio fue evaluar un glucómetro (StatStrip, Nova Biomedical) para determinar su grado de acuerdo con el método habitual de determinación de la glucemia en el laboratorio. Material y métodos Se recogieron 89 muestras de diferentes pacientes (76,4% hombres y 23,6% mujeres) ingresados en una UCI durante los meses de septiembre a diciembre del 2010. En cada extracción, se recogió un tubo de heparina litio y otro tubo de EDTA. La alícuota de sangre total era utilizada para la determinación de glucemia mediante el glucómetro. El tubo de heparina litio era procesado a la misma vez para la determinación de la glucemia plasmática (Analizador Cobas 6000, Roche Diagnostic, SA). Para evaluar el grado de acuerdo entre los dos métodos, seguimos el procedimiento indicado en la guía EP-9-A2 del Clinical and Laboratory Standards Institute (CLSI).Resultado La glucemia en sangre total medida por el glucómetro presentaba un valor medio de 126,53±49,28mg/dL con un rango de 33,5 a 431mg/dL y la glucemia plasmática del método de laboratorio reflejaba un valor medio de 138,13±78,6mg/dL con un rango de 43-451mg/dL. El coeficiente de correlación entre ambos métodos fue de 0,99 con un intervalo de confianza al 95% (IC) de 0,98 a 0,99; el coeficiente de determinación (R2) fue de 0,97 y el coeficiente de correlación intraclase fue 0,99 con un IC de 0,98 a 0,99.Conclusiones El glucosímetro evaluado (StatStrip) presenta una buena asociación lineal, precisión y exactitud, cuando es comparado con el método de referencia del laboratorio clínico. Es un dispositivo adecuado para la monitorización de la glucosa(AU)

Introduction Hyperglycemic patients admitted to Intensive care units (ICUs) have higher morbidity and mortality than normoglycemic patients. Blood glucose levels of ICU patients are usually measured with a glucose meter. The aim of this study was to evaluate a glucose meter (StatStrip, Nova Biomedical) to assess its agreement with the standard laboratory method for testing glucose.Material and methods Eighty-nine different samples were collected from patients (76.4% men and 23.6% women) admitted to an ICU from September to December 2010. Each blood sample was collected into two tubes, a lithium heparin tube and an EDTA tube. The total blood aliquot was used to measure glycemia using the glucose meter. The lithium heparin tube was processed at the same time for measuring plasma glucose (Cobas 6000 Analyzer, Roche Diagnostics, SA). Agreement between the two methods was assessed according to the EP-9-A2 Clinical Laboratory Standards Institute guideline.Results Mean whole blood glucose level measured by the glucose meter was 126.53+49.28mg/dL (range, 33.5-431mg/dL), while mean plasma glucose value measured by the laboratory reference method was 138.13+78.6mg/dL (range, 43-451mg/dL). Correlation coefficient was 0.99, with a 95% confidence interval of 0.98 to 0.99. Coefficient of determination (R2) was 0.97, and intraclass correlation coefficient was 0.99 with a 95% CI of 0.98 to 0.99.ConclusionsThe tested glucose meter (StatStrip) shows a good linear association, precision, and accuracy when compared to the laboratory reference method. This device is adequate for glucose monitoring(AU)

[Validation of a glucose meter at an intensive care unit]. / Validación de un glucómetro en una unidad de cuidados intensivos.

INTRODUCTION: Hyperglycemic patients admitted to Intensive care units (ICUs) have higher morbidity and mortality than normoglycemic patients. Blood glucose levels of ICU patients are usually measured with a glucose meter. The aim of this study was to evaluate a glucose meter (StatStrip, Nova Biomedical) to assess its agreement with the standard laboratory method for testing glucose. MATERIAL AND METHODS: Eighty-nine different samples were collected from patients (76.4% men and 23.6% women) admitted to an ICU from September to December 2010. Each blood sample was collected into two tubes, a lithium heparin tube and an EDTA tube. The total blood aliquot was used to measure glycemia using the glucose meter. The lithium heparin tube was processed at the same time for measuring plasma glucose (Cobas 6000 Analyzer, Roche Diagnostics, SA). Agreement between the two methods was assessed according to the EP-9-A2 Clinical Laboratory Standards Institute guideline. RESULTS: Mean whole blood glucose level measured by the glucose meter was 126.53+49.28 mg/dL (range, 33.5-431 mg/dL), while mean plasma glucose value measured by the laboratory reference method was 138.13+78.6 mg/dL (range, 43-451 mg/dL). Correlation coefficient was 0.99, with a 95% confidence interval of 0.98 to 0.99. Coefficient of determination (R2) was 0.97, and intraclass correlation coefficient was 0.99 with a 95% CI of 0.98 to 0.99. CONCLUSIONS: The tested glucose meter (StatStrip) shows a good linear association, precision, and accuracy when compared to the laboratory reference method. This device is adequate for glucose monitoring.

Empleo de un nuevo protocolo de extracción y disminución de las falsas hiperprolactinemias / Use of a new protocol for prolactin extraction and reduction of false hyperprolactinemia

Introducción La medición de prolactina está influenciada por una serie de factores y ello ha sido descrito por numerosos autores, lo que puede falsear el valor obtenido no correspondiendo el mismo a la realidad fisiológica del individuo estudiado. Si no se adoptan una serie de medidas, sobre todo en la fase preanalítica, pueden aparecer resultados más altos. Como objeto pretendemos evaluar en qué medida la optimización o no de la extracción en sí, se traduce en resultados más altos y como el informe realizado en términos de prolactina monomérica (activa biológicamente) puede ser decisivo a la hora de adoptar un diagnóstico y actitud terapéutica. Material y métodos Para ello realizamos 2 extracciones a cada mujer (previa observación del protocolo que universalmente se contempla para este tipo de análisis) una por punción directa y otra a los 60min sin nueva punción (se canaliza la vena en la punción directa y se mantiene permeable por salinización) y con posterioridad estudiamos la fracción monomérica, en los casos requeridos. Resultados De los resultados obtenidos podemos deducir una diferencia significativa desde el punto de vista estadístico entre la punción directa y a los 60min y al observar la fracción monomérica se encuentra concentraciones hasta 3 veces menores que los obtenidos por punción directa. Discusión Los resultados de nuestro estudio justifican la sistematización del uso de técnicas de extracción que soslayen el estrés de la venopuntura y el informe de prolactina con actividad biológica (monomérica, «little») (AU)

Introduction Numerous authors have reported that prolactin measurement is influenced by several factors and consequently the values obtained may not faithfully reflect the physiological reality of the individual studied. Unless a series of measures is adopted, especially in the pre-analytic stage, values may be falsely elevated. The objective of the present study was to evaluate the extent to which optimization or non-optimization of the extraction procedure translates into higher results and how reports expressed in terms of monomeric (biologically active) prolactin could be crucial to adopt a diagnosis and therapeutic approach. Material and methods We performed two extractions in each woman (following the protocol universally used for this kind of analysis): one through direct puncture and another 60min later without a new puncture (a catheter was inserted in the site of the first puncture and kept permeable by salinization). The monomeric fraction was then studied, if required. Results A statistically significant difference was observed between the 2 extractions. The monomeric fraction was three times lower in the second extraction than in the first. Discussion The results of this study justify systematic use of extraction techniques that avoid the stress of venous puncture, as well as the use of the term biologically active prolactin [monomeric (little) prolactin fraction] in reports (AU)

[Use of a new protocol for prolactin extraction and reduction of false hyperprolactinemia]. / Empleo de un nuevo protocolo de extracción y disminución de las falsas hiperprolactinemias.

INTRODUCTION: Numerous authors have reported that prolactin measurement is influenced by several factors and consequently the values obtained may not faithfully reflect the physiological reality of the individual studied. Unless a series of measures is adopted, especially in the pre-analytic stage, values may be falsely elevated. The objective of the present study was to evaluate the extent to which optimization or non-optimization of the extraction procedure translates into higher results and how reports expressed in terms of monomeric (biologically active) prolactin could be crucial to adopt a diagnosis and therapeutic approach. MATERIAL AND METHODS: We performed two extractions in each woman (following the protocol universally used for this kind of analysis): one through direct puncture and another 60 min later without a new puncture (a catheter was inserted in the site of the first puncture and kept permeable by salinization). The monomeric fraction was then studied, if required. RESULTS: A statistically significant difference was observed between the 2 extractions. The monomeric fraction was three times lower in the second extraction than in the first. DISCUSSION: The results of this study justify systematic use of extraction techniques that avoid the stress of venous puncture, as well as the use of the term biologically active prolactin [monomeric (little) prolactin fraction] in reports.

Uso racional del medicamento y eficacia terapéutica / Adequate use of drugs and therapeutic efficacy

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