Aplicación de un método de mejora continua para la selección de los marcadores diagnóstico de pancreatitis aguda en un servicio de urgencias / Application of a continual improvement approach to selecting diagnostic markers for acute pancreatitis in an emergency department

Objetivo: Aplicar un ciclo de mejora continua (CMC) para la determinación de un algoritmo de solicitud de pruebas de laboratorio en el diagnóstico de la pancreatitis aguda (PA) en un servicio urgencias hospitalario (SUH). Método: Estudio cuasiexperimental que aplicó la metodología CMC en dos fase consecutivas en pacientes atendidos en un SUH: en la primera se usaron la amilasa y lipasa para el diagnóstico de PA, y en la segunda solo la lipasa y solo si esta estaba en un rango determinado, se añadía automáticamente la amilasa. Se recogieron datos demográficos, número y valores de amilasa y lipasa, el diagnóstico final, y se realizó una encuesta de satisfacción a los médicos de urgencias. Resultados: El primer ciclo incluyó 517 pacientes, 20 de ellos con PA. Las características de las pruebas diagnósticas fueron: amilasa [sensibilidad (Se): 0,70; especificidad (Es): 0,85; cociente de probabilidad positivo (CPP): 17 y cociente de probabilidad negativo (CPN): 0,31], lipasa (Se: 0,85; Es: 0,96; CPP: 21 y CPN: 0,16) y la determinación de ambas (Se: 0,85; Es: 0,99; CPP: 85 y CPN: 0,15). En el segundo ciclo se incluyeron 4.815 pacientes, de los cuales 118 sufrieron una PA. El nuevo algoritmo propuesto tuvo una Se: 0,92; Es: 0,98; CPP: 46 y CPN: 0,08. Conclusiones: La elaboración de un protocolo de solicitud de marcadores de laboratorio y la estrategia secuencial de solicitud de enzimas pancreáticas pueden ser efectivas para diagnosticar PA en un SUH (AU)

Objective: To apply a continual improvement model to develop an algorithm for ordering laboratory tests to diagnose acute pancreatitis in a hospital emergency department. Methods: Quasi-experimental study using the continual improvement model (plan, do, check, adjust cycles) in 2 consecutive phases in emergency patients: amylase and lipase results were used to diagnose acute pancreatitis in the first phase; in the second, only lipase level was first determined; amylase testing was then ordered only if the lipase level fell within a certain range. We collected demographic data, number amylase and lipase tests ordered and the findings, final diagnosis, and the results of a questionnaire to evaluate satisfaction with emergency care. Results: The first phase included 517 patients, of whom 20 had acute pancreatitis. For amylase testing sensitivity was 0.70; specificity, 0.85; positive predictive value (PPV), 17; and negative predictive value (NPV), 0.31. For lipase testing these values were sensitivity, 0.85; specificity, 0.96; PPV, 21, and NPV, 0.16. When both tests were done, sensitivity was 0.85; specificity 0.99; PPV, 85; and NPV, 0.15. The second phase included data for 4815 patients, 118 of whom had acute pancreatitis. The measures of diagnostic yield for the new algorithm were sensitivity, 0.92; specificity, 0.98; PPV, 46; and NPV, 0.08]. Conclusion: This study demonstrates a process for developing a protocol to guide laboratory testing in acute pancreatitis in the hospital emergency department. The proposed sequence of testing for pancreatic enzyme levels can be effective for diagnosing acute pancreatitis in patients with abdominal pain (AU)

Detection of host-specific immunogenic proteins in the saliva of patients with oral squamous cell carcinoma.

The main purpose of this article is to develop a new and reliable saliva-based clinical diagnostic method for the early detection of oral squamous cell carcinoma (OSCC). This study used an immunoproteomic approach which allowed the detection of immunogenic host proteins in patients' samples using pooled human antibodies. In an attempt to investigate potential biomarkers of OSCC, two-dimensional electrophoresis (2-DE) followed by immunoblotting of saliva from patients and controls were compared. The protein spots of interest were analyzed using 2-DE image analyzer and subsequently subjected to MALDI-TOF/TOF and then matched against NCBI database. The result showed that four protein clusters, namely Human Pancreatic Alpha-amylase (HPA), Human Salivary Amylase (sAA), keratin-10 (K-10), and Ga Module Complexed with Human Serum Albumin (GA-HSA), had exhibited immunoreactivity in western blot. The results are suggestive of the potential use of the differentially expressed saliva protein as tumor biomarkers for the detection of OSCC. However, further studies are recommended to validate this finding.

Age and gender specific pediatric reference intervals for aldolase, amylase, ceruloplasmin, creatine kinase, pancreatic amylase, prealbumin, and uric acid.

BACKGROUND: Reference intervals can vary based on age and gender. Proper partitioning is necessary to classify health status in different age groups. METHODS: Seven analytes; aldolase, amylase, ceruloplasmin, creatine kinase, pancreatic amylase, prealbumin and uric acid; were assayed on Roche Modular P analyzers using serum samples from 1765 children (867 females and 898 males; age range, 6 months to 17 y). Subjects 6 months up to 7 y were undergoing minor surgical procedures. Children 7 to 17 y were apparently healthy. Subjects with significant medical history or who were taking any medications were excluded. RESULTS: Separate reference intervals for boys and girls were required for 33% of the groups. Aldolase showed gender variation in the 6-8, 12-14, and 15-17 y. Amylase was the only analyte that showed no significant gender differences within any age group. Both ceruloplasmin and uric acid had significant differences between the 12-14 and 15-17 y groups. Creatine kinase exhibited statistically significant gender differences in all age groups with the exception of 6-8 y. CONCLUSION: We verified that when establishing pediatric reference intervals, partitioning by age and gender is frequently necessary.