ABSTRACT
Risk factors associated with severity and mortality attributable to COVID-19 have been reported in different cohorts, highlighting the occurrence of acute kidney injury (AKI) in 25% of them. Among other, SARS-CoV-2 targets renal tubular cells and can cause acute renal damage. The aim of the present study was to evaluate the usefulness of urinary parameters in predicting intensive care unit (ICU) admission, mortality and development of AKI in hospitalized patients with COVID-19. Retrospective observational study, in a tertiary care hospital, between March 1st and April 19th, 2020. We recruited adult patients admitted consecutively and positive for SARS-CoV-2. Urinary and serum biomarkers were correlated with clinical outcomes (AKI, ICU admission, hospital discharge and in-hospital mortality) and evaluated using a logistic regression model and ROC curves. A total of 199 COVID-19 hospitalized patients were included. In AKI, the logistic regression model with a highest area under the curve (AUC) was reached by the combination of urine blood and previous chronic kidney disease, with an AUC of 0.676 (95%CI 0.512-0.840; p = 0.023); urine specific weight, sodium and albumin in serum, with an AUC of 0.837 (95% CI 0.766-0.909; p < 0.001) for ICU admission; and age, urine blood and lactate dehydrogenase levels in serum, with an AUC of 0.923 (95%CI 0.866-0.979; p < 0.001) for mortality prediction. For hospitalized patients with COVID-19, renal involvement and early alterations of urinary and serum parameters are useful as prognostic factors of AKI, the need for ICU admission and death.
Subject(s)
Acute Kidney Injury/mortality , Acute Kidney Injury/urine , COVID-19/mortality , COVID-19/urine , Acute Kidney Injury/complications , Acute Kidney Injury/physiopathology , Adult , Aged , Area Under Curve , Biomarkers/urine , COVID-19/complications , COVID-19/physiopathology , Critical Care , Female , Hospitalization , Humans , Logistic Models , Male , Middle Aged , Observational Studies as Topic , Prognosis , ROC Curve , Retrospective Studies , Risk Factors , Severity of Illness Index , Urine/chemistryABSTRACT
This report describes a patient who developed a spheroidal calculus with a central part composed of potassium urate, surrounded by a continuous layer of calcium oxalate monohydrate with crystals of calcium oxalate dihydrate on the surface. The mechanism of calculus development is also suggested.
ABSTRACT
El avance tecnológico en el campo del diagnóstico clínico ha generado una diversidad de pruebas de laboratorio aplicables en el lugar de asistencia al paciente (POCT), y ha permitido contar con una mayor calidad analítica de los procedimientos implementados. La elaboración de un cuadro de mando integral es una herramienta útil para el éxito en la gestión de un proceso trasversal, complejo e interdisciplinario, como es el de obtener resultados analíticos fiables, transferibles de forma inmediata mediante sistemas POCT. Para la elaboración de un cuadro de mando integral se deben considerar cuatro perspectivas: la de los clientes (pacientes, médicos, grupos de interés), la financiera (inversores privados o públicos), la de los procesos operativos internos (sistemas, procesos) y la de los profesionales (cultura organizativa). El objeto de este documento es establecer recomendaciones para la elaboración de un cuadro de mando integral para gestionar los sistemas POCT disponibles en una institución
Technological development of in vitro diagnostics has led to a diversity of new tests for point-of-care testing (POCT) and at the same time provides quality in the process. Construction of a balanced scorecard is a useful tool for the success in the management of a cross-sectional, complex and interdisciplinary process, as well as to obtain reliable analytical results for immediately use with POCT systems. In constructing a balanced scorecard, four perspectives should be considered: Customer (patients, doctors), Financial (private or public investors), Operating procedures (systems, processes), and Professionals (organisational culture). The aim of this document is to establish the recommendations for the development of an adequate balanced scorecard to manage a point-of-care network in a healthcare system
Subject(s)
Humans , Point-of-Care Systems/organization & administration , Point-of-Care Testing/organization & administration , Specimen Handling/methods , Analytic Sample Preparation Methods/methods , Clinical Laboratory Techniques/methods , Patient Care Management/methods , 34002 , Decision Support Techniques , Patient SafetyABSTRACT
INTRODUCTION: There is increasing awareness of the importance of transforming organisational culture in order to raise safety standards. This paper describes the results obtained from an evaluation of patient safety culture in a sample of clinical laboratories in public hospitals in the Spanish National Health System. MATERIAL AND METHODS: A descriptive cross-sectional study was conducted among health workers employed in the clinical laboratories of 27 public hospitals in 2012. The participants were recruited by the heads of service at each of the participating centers. Stratified analyses were performed to assess the mean score, standardized to a base of 100, of the six survey factors, together with the overall patient safety score. RESULTS: 740 completed questionnaires were received (88% of the 840 issued). The highest standardized scores were obtained in Area 1 (individual, social and cultural) with a mean value of 77 (95%CI: 76-78), and the lowest ones, in Area 3 (equipment and resources), with a mean value of 58 (95%CI: 57-59). In all areas, a greater perception of patient safety was reported by the heads of service than by other staff. CONCLUSIONS: We present the first multicentre study to evaluate the culture of clinical safety in public hospital laboratories in Spain. The results obtained evidence a culture in which high regard is paid to safety, probably due to the pattern of continuous quality improvement. Nevertheless, much remains to be done, as reflected by the weaknesses detected, which identify areas and strategies for improvement.
Subject(s)
Hospitals, Public/standards , Laboratories, Hospital/standards , National Health Programs , Organizational Culture , Patient Safety/standards , Total Quality Management , Adult , Attitude of Health Personnel , Cross-Sectional Studies , Female , Health Care Surveys , Humans , Laboratory Personnel , Male , Middle Aged , Patient Safety/legislation & jurisprudence , Personnel, Hospital/education , Quality Improvement , Quality Indicators, Health Care , Spain , Surveys and QuestionnairesABSTRACT
Pathological calcification generally consists of the formation of solid deposits of hydroxyapatite (calcium phosphate) in soft tissues. Supersaturation is the thermodynamic driving force for crystallization, so it is believed that higher blood levels of calcium and phosphate increase the risk of cardiovascular calcification. However several factors can promote or inhibit the natural process of pathological calcification. This cross-sectional study evaluated the relationship between physiological levels of urinary phytate and heart valve calcification in a population of elderly out subjects. A population of 188 elderly subjects (mean age: 68 years) was studied. Valve calcification was measured by echocardiography. Phytate determination was performed from a urine sample and data on blood chemistry, end-systolic volume, concomitant diseases, cardiovascular risk factors, medication usage and food were obtained. The study population was classified in three tertiles according to level of urinary phytate: low (<0.610 µM), intermediate (0.61-1.21 µM), and high (>1.21 µM). Subjects with higher levels of urinary phytate had less mitral annulus calcification and were less likely to have diabetes and hypercholesterolemia. In the multivariate analysis, age, serum phosphorous, leukocytes total count and urinary phytate excretion appeared as independent factors predictive of presence of mitral annulus calcification. There was an inverse correlation between urinary phytate content and mitral annulus calcification in our population of elderly out subjects. These results suggest that consumption of phytate-rich foods may help to prevent cardiovascular calcification evolution.
Subject(s)
Calcinosis/urine , Cardiomyopathies/urine , Heart Valve Diseases/urine , Heart Valves/pathology , Phytic Acid/urine , Aged , Aging , Calcification, Physiologic , Calcinosis/blood , Cardiomyopathies/blood , Cardiomyopathies/epidemiology , Cross-Sectional Studies , Diabetes Mellitus/epidemiology , Durapatite/metabolism , Echocardiography , Female , Heart Valve Diseases/blood , Heart Valve Diseases/epidemiology , Humans , Hypercholesterolemia/epidemiology , Leukocyte Count , Male , Mitral Valve/pathology , Phosphates/blood , Risk FactorsABSTRACT
BACKGROUND: Improving knowledge about normal urine composition in children is important for early prevention of lithiasis. We describe urinary excretion values of calcium (Ca), magnesium (Mg), phosphate (P), citrate (Cit), uric acid (Ur), and oxalate (Ox) in healthy children with and without a family history of lithiasis, using a 12-h urine collection protocol. METHODS: Urine samples were obtained from 184 children (5-12 years): a spot sample collected in the afternoon, and a 12-h overnight sample. Solute/creatinine (Cr) and 12-h solute excretion was calculated. RESULTS: Urinary excretion values of the studied solutes are presented as percentile values, separately for each type of sample. Due to age-related differences in the solute/creatinine ratios, except for Ca and Cit, results are described according to the child's age. The presence of excretion values related to an increased risk of lithiasis was more common in children with a family history. CONCLUSIONS: We report data from urine samples collected by using a simplified collection protocol. The observed differences between children with and without a family history of lithiasis could justify that in population studies aimed at setting reference values, the former are excluded.
Subject(s)
Lithiasis/urine , Calcium/urine , Child , Child, Preschool , Citric Acid/urine , Creatinine/urine , Female , Humans , Lithiasis/genetics , Magnesium/urine , Male , Oxalates/urine , Phosphates/urine , Reference Values , Uric Acid/urineABSTRACT
BACKGROUND: The prevalence of lithiasis is increasing at all ages. This study aimed to assess the crystallization risk in urine from healthy school children and to determine urinary parameters that are most associated with it. METHODS: Urine samples were obtained from 184 children aged 5-12 years: a spot sample collected in the afternoon, and a 12-h overnight sample. Information was obtained regarding family histories of lithiasis. Urine volume, pH, and biochemical parameters of stone risk were measured. Crystallization risk was defined by the presence of specific urine conditions that had previously been associated with stone formation in vitro. RESULTS: Crystallization risk was observed in 15 % of spot urine samples and 54 % of 12-h samples. Metabolic abnormalities and a low urinary volume were more frequently detected in children with crystallization risk. Calcium excretion and calcium/citrate ratio were higher in children with a family history of lithiasis. CONCLUSIONS: We observed a high prevalence of crystallization risk in urine, especially in children with a family history of the disease. Low urinary volume was the factor most associated with increased risk. Adequate fluid intake at an early age may be a simple and effective measure to reduce the incidence of nephrolithiasis.
Subject(s)
Nephrolithiasis/genetics , Urinary Calculi/etiology , Biomarkers/urine , Calcium/urine , Chi-Square Distribution , Child , Child, Preschool , Citric Acid/urine , Female , Genetic Predisposition to Disease , Humans , Male , Pedigree , Risk Assessment , Risk Factors , Urinalysis , Urinary Calculi/diagnosis , Urinary Calculi/genetics , Urinary Calculi/physiopathology , Urinary Calculi/urine , UrinationABSTRACT
Introducción. El uso del laboratorio es inadecuado (excesivo o innecesario) y es preciso controlarlo. Material y métodos. Elaborar una estrategia para gestionar, según criterios de medicina basada en la evidencia, la derivación de pruebas subcontratadas y comparar los resultados entre dos años consecutivos. Resultados. La demanda se ha reducido un 6,56% y los costes un 26,9%. Es de destacar que solo el 1,9 % de los peticionarios a los que se les ha denegado alguna prueba contacta con el laboratorio para reclamar o mostrar su disconformidad. Conclusiones. El profesional del laboratorio clínico debe implicarse como consultor clínico para mejorar la eficiencia de las pruebas de laboratorio (AU)
Introduction. The use of the laboratory is inadequate and it is necessary to control it. Materials and methods. To elaborate a strategy to manage, according to evidence-based medicine criteria, the origin of requested tests and to compare the results between two consecutive years. Results. The demand has reduced by 6.56% and the costs by 26.9%. It is worth emphasizing that only 1.9% of the requesters, for which some test has been refused, contacts the laboratory to show disapproval. Conclusions. The professionals of the clinical laboratory must be involved in their function as clinical consultant to improve the efficiency of laboratory tests (AU)
Subject(s)
Humans , Male , Female , Clinical Laboratory Techniques/instrumentation , Clinical Laboratory Techniques/standards , Clinical Laboratory Techniques , Clinical Laboratory Techniques/methods , Clinical Laboratory Techniques , Primary Health Care/ethics , Primary Health Care/methods , Referral and Consultation/ethics , Referral and Consultation/organization & administration , Clinical Laboratory Techniques/classification , Clinical Laboratory Techniques/economics , Clinical Laboratory Techniques/ethics , Clinical Laboratory Techniques/trendsSubject(s)
Humans , Male , Female , Clinical Laboratory Techniques/standards , Clinical Laboratory Techniques/trends , Clinical Laboratory Techniques/trends , Clinical Laboratory Techniques , Laboratory Test/classification , Clinical Laboratory Information Systems/classification , Clinical Laboratory Information Systems/ethics , Biomedical Technology/organization & administration , Biomedical Technology/standards , Clinical Laboratory Information Systems/organization & administrationABSTRACT
El objetivo de este trabajo es monitorizar la actividad realizada por el laboratorio de urgencias del Hospital Universitario Son Dureta durante el período 2000-2004 y tratar de justificar las variaciones. El estudio se basa en la comparación gráfica de la tendencia mostrada por los indicadores de demanda analítica (magnitudes/peticiones, unidades relativas de valor (URV)/peticiones y URV/magnitudes), que representan la productividad del laboratorio, y la de los indicadores que relacionan la actividad de urgencias del hospital y la del laboratorio (peticiones laboratorio/urgencias, magnitudes/urgencias, URV/urgencias). Los resultados demuestran una relación inversa entre las urgencias del hospital y las del laboratorio. Las urgencias hospitalarias han disminuido por la apertura de un segundo hospital en Palma; en cambio, la actividad del laboratorio de urgencias ha aumentado. El motivo es el incremento de las urgencias de hospitalización derivadas fundamentalmente de áreas relacionadas con nuevas acciones hospitalarias: cirugía cardíaca, unidad de reanimación, psiquiatría, desintoxicación, toxicología, hemodinámica intervencionista 24 h, etc. Se observa una tendencia hacia la complejidad por el incremento de los índices URV/magnitudes, magnitudes/urgencias y URV/urgencias; a ello han contribuido, sobre todo, los nuevos criterios diagnósticos del infarto de miocardio que conllevan realizar muchas más determinaciones de troponina, el uso de proteína C reactiva como marcador de sepsis y las determinaciones de drogas de abuso para confirmar la sospecha de ingestión en las urgencias hospitalarias(AU)
This aim of this study is to monitor the activity carried out in the emergency laboratory of Son Dureta University Hospital during the years 20002004 and to discuss the variations. This work is based on the the graphical comparison between the trends of indicators of analytical demand (tests/requests), (URV/requests), and (URV/tests) that represent the productivity of laboratory and also other indicators that associate emergency activities of the hospital with the laboratory (laboratory requests/emergencies), (tests/emergencies), and (URV/emergencies). The results show an inverse relationship between the hospital emergencies and laboratory. The hospital emergencies have decreased as there is a new hospital in Palma, on the other hand, the activity of the urgent laboratory has increased. The reason is due to the increase inpatient activity in new hospital areas: heart surgery, a significant increase of critical care, psychiatry, toxicology, etc. A trend to complexity is observed, that is due to the increase in indices: URV/tests, tests/emergencies, and URV/emergencies; that have arisen from the new diagnostic criteria for myocardial infarction. This has caused a large increase tropinin assays, the use of CRP as a sepsis marker and drug abuse testing to confirm the suspicion of drug taking(AU)
