Interference of ketone bodies on laboratory creatinine measurement in children with DKA: a call for change in testing practices.

BACKGROUND: The presence of ketone bodies (KBs) can interfere with creatinine (Cr) measurement in both enzymatic and Jaffe methods. Since a high proportion of children hospitalized for diabetic ketoacidosis (DKA) develop acute kidney injury (AKI), here we investigate whether KB interferences affect the accuracy of pediatric Cr measurement. METHODS: Residual patient plasma samples were pooled to make three Cr levels (~ 50, 100, and 250 µM). KBs (acetone, acetoacetate, and ß-hydroxybutyrate) were used to spike the pooled samples. All samples were measured for Cr by two enzymatic methods (E1 and E2), two Jaffe methods (J1 and J2), and LC-MS/MS. LC-MS/MS was considered the gold standard, and the % difference in Cr concentration was calculated for each method. RESULTS: E1 and E2 were unaffected by the presence of all three KBs. J1 and J2 were unaffected by the presence of ß-hydroxybutyrate. The presence of acetone resulted in dose-dependent positive interference in both Jaffe methods, whereas the presence of acetoacetate resulted in dose-dependent positive and negative interference in J1 and J2, respectively. CONCLUSIONS: Compared to the enzymatic methods, the Jaffe methods were much more susceptible to interference by acetone and acetoacetate, especially at lower Cr values which are commonly seen in pediatrics. Interpretation of changes in Cr concentration between different hospitals when transferring patients can become ambiguous and true kidney function unclear if different methods are used without awareness of method-specific biases. To improve DKA patient care, we recommend standardizing all of the Cr methods to an enzymatic method. A higher resolution version of the Graphical abstract is available as Supplementary information.

Magnocaine: Physical Compatibility and Chemical Stability of Magnesium Sulphate and Lidocaine Hydrochloride in Prefilled Syringes.

OBJECTIVE: To evaluate the physical compatibility and chemical stability of mixtures of magnesium sulphate and lidocaine in order to determine the feasibility of manufacturing a prefilled syringe combining these two drugs for use as an intramuscular (IM) loading dose for eclampsia prevention and/or treatment. This ready-to-use mixture will provide a more tolerable and accessible route of administration appropriate for widespread use. METHODS: Physical compatibility (pH, colour, and formation of precipitate) and chemical stability (maintaining > 90% of initial concentrations) of mixtures of MgSO4, using both commercially available MgSO4 (50%) and MgSO4 reconstituted from salt (61%), with lidocaine hydrochloride (2%) were evaluated every 14 days over six months. The concentration of lidocaine was determined by a stability indicating high performance liquid chromatographic method, while the concentration of magnesium was determined by an automated chemistry analyzer. RESULTS: No changes in pH, color or precipitates were observed for up to 6 months. The 95% confidence interval of the slope of the curve relating concentration to time, determined by linear regression, indicated that only the admixtures of commercially-available magnesium sulfate and lidocaine as well as the 61% magnesium sulfate solution (reconstituted from salt) maintained at least 90% of the initial concentration of both drugs at 25°C and 40°C at 6 months. CONCLUSIONS: Commercially available MgSO4 and lidocaine hydrochloride, when combined, are stable in a pre-filled syringe for at least six months in high heat and humidity conditions. This finding represents the first step in improving the administration of magnesium sulphate in the treatment and prevention of eclampsia in under-resourced settings.

Simulating Hamiltonian dynamics with a truncated Taylor series.

We describe a simple, efficient method for simulating Hamiltonian dynamics on a quantum computer by approximating the truncated Taylor series of the evolution operator. Our method can simulate the time evolution of a wide variety of physical systems. As in another recent algorithm, the cost of our method depends only logarithmically on the inverse of the desired precision, which is optimal. However, we simplify the algorithm and its analysis by using a method for implementing linear combinations of unitary operations together with a robust form of oblivious amplitude amplification.

Classical simulation of entanglement swapping with bounded communication.

Entanglement appears under two different forms in quantum theory, namely, as a property of states of joint systems and as a property of measurement eigenstates in joint measurements. By combining these two aspects of entanglement, it is possible to generate nonlocality between particles that never interacted, using the protocol of entanglement swapping. We show that even in the more constraining bilocal scenario where distant sources of particles are assumed to be independent, i.e., to share no prior randomness, entanglement swapping can be simulated classically with bounded communication, using only 9 bits in total. Our result thus provides an upper bound on the nonlocality of the entanglement swapping process.

Utility of urine myoglobin for the prediction of acute renal failure in patients with suspected rhabdomyolysis: a systematic review.

BACKGROUND: Urine myoglobin continues to be used as a marker of rhabdomyolysis, particularly to assess risk of developing acute renal failure and evaluate treatment success. We sought to determine the predictive validity of urine myoglobin (uMb) for acute renal failure (ARF) in patients with suspected rhabdomyolysis. METHODS: We performed a broad systemic review of the literature from January 1980 to December 2006 using the search terms myoglobin$ AND (renal OR ARF OR kidney). Only primary studies published in English where uMb measurement was related to ARF were included. RESULTS: Of 1602 studies screened, 52 met all selection criteria. The studies covered a wide spectrum of etiologies for rhabdomyolysis, dissimilar diagnostic criteria for ARF and rhabdomyolysis, and various methods of uMb measurement and were mostly case series (n = 32). There was poor reporting on the uMb method, and 17 studies failed to provide any information about the method. The reporting of clinical criteria for ARF with respect to timing, description, performance, and interpretation also lacked adequate detail for replication. Eight studies (total 295 patients) had data for 2-by-2 tables. Sensitivity of the uMb test was 100% in 5 of the 8 studies, specificity varied widely (15% to 88%), and CIs around these measures were high. Pooling of data was not possible because of study heterogeneity. CONCLUSIONS: There is inadequate evidence evaluating the use of uMb as a predictor of ARF in patients with suspected rhabdomyolysis.

Intra-individual variability in troponin T concentration in dialysis patients.

PURPOSE: Haemodialysis patients often have increased TnT concentrations in the absence of symptoms suggestive of acute coronary syndrome. To evaluate the potential usefulness of establishing patient specific baselines, we investigated intra-individual variability of TnT concentration in stable haemodialysis patients. METHODS: We measured pre-dialysis troponin T concentrations weekly for 15 weeks in 61 stable haemodialysis patients. RESULTS: Thirty two of 61 patients had at least one result greater than the diagnostic cut-off for significant myocardial damage of 0.04 microg/L. The intra-individual variability was small; 99% of all the variance from each patient's median was < or = 0.063 microg/L. CONCLUSIONS: Intra-individual variability in TnT concentration is small enough to merit establishment a of baseline concentration for each haemodialysis patient. This baseline is stable over at least 15 weeks; samples need be collected no more frequently than this. A change in concentration of more than 0.06 microg/L from the individual's baseline is significant.