El rol del laboratorio en los hallazgos de intoxicación y exposición a monóxido de carbono / The role of the laboratory in findings of carbon monoxide poisoning and exposure

El monóxido de carbono es un gas altamente tóxico que se origina principalmente por la combustión incompleta de combustibles fósiles. La intoxicación presenta síntomas inespecíficos que solapan otras patologías y por lo tanto es indispensable la confirmación mediante la medición de la carboxihemoglobina en sangre. El laboratorio incorporó la determinación en el informe del estado ácido base a partir de octubre del 2018, debido a que previamente el médico debía solicitarla frente a la sospecha de una intoxicación. El objetivo del trabajo fue evaluar si esta medida implementada por el laboratorio contribuyó a mejorar el diagnóstico de intoxicación por CO, analizar las características de los pacientes con COHb mayor o igual a 5% y definir un valor de reporte inmediato para la COHb. El 46% de los casos con COHb mayor o igual a 5% no se relacionaban con una intoxicación y/o exposición a CO. De los casos de intoxicación se encontró que el 77% fueron diagnosticados a partir de la sospecha médica y un 23% por hallazgo del laboratorio. Se concluyó que es de mucha utilidad el rol del laboratorio en detectar aquellos casos que no fueron evidentes clínicamente. Existen ciertas patologías como las oncológicas o la enfermedad de Wilson donde se vieron valores elevados de COHb sin presentar intoxicación y se definió finalmente, como valor de reporte inmediato 7% para la COHb. (AU)

Carbon monoxide is a highly toxic gas that originates mainly from incomplete combustion of fossil fuels. Intoxication causes nonspecific symptoms that overlap with other conditions and, therefore, confirmation by measuring blood carboxyhemoglobin is essential. The laboratory incorporated the measurement in the acid-base status report as of October 2018, as it was previously required to be requested by the physician in case of suspected intoxication. The aim of this study was to evaluate whether this measure implemented by the laboratory contributed to the improvement of the diagnosis of CO intoxication, to analyze the characteristics of patients with COHb greater than or equal to 5% and to define an immediate reporting value for COHb. Overall, 46% of the cases with COHb greater than or equal to 5% were not related to CO poisoning and/or exposure. Of the cases of intoxication, 77% were diagnosed based on medical suspicion and 23% on laboratory findings. It was concluded that the laboratory has a useful role in detecting cases that were not clinically evident. There are certain diseases including different types of cancer or Wilson's disease where elevated COHb values were seen without intoxication and finally, 7% for COHb was defined as the immediate reporting value (AU)

Is anogenital distance associated with semen quality in male partners of subfertile couples?

Experimental studies have shown that anogenital distance (AGD) at birth reflects androgen concentrations during prenatal development and predicts adult AGD. In male rodents, shortened AGD is associated with compromised reproductive function. The aim of this study was to examine associations between AGD measures and semen quality in male partners of subfertile couples. All men were attending an infertility service and provided a semen sample and completed epidemiological questionnaires on lifestyle and general health. Two variants of AGD [from the anus to the posterior base of the scrotum (AGDAS) and to the cephalad insertion of the penis (AGDAP)] were assessed in 91 men. Semen parameters (semen volume, sperm concentration, total sperm counts, motility, and morphology) were determined following WHO guidelines. Associations between AGD measures and semen quality were tested using multiple regression analyses controlling for appropriate covariates. Significant positive associations between AGDAS measures and sperm concentration, total sperm count, and total sperm motile count were detected (p-values < 0.05). This study represents the first analysis of AGD in potential infertile European men showing an association between perineal length and semen parameters. However, it is still uncertain the utility to clinical practice, therefore further studies are warranted to confirm and extent these findings.

Longer anogenital distance is associated with higher testosterone levels in women: a cross-sectional study.

OBJECTIVE: Animal models have suggested that anogenital distance (AGD) at birth reflects androgen levels during in utero development and predicts adult AGD. A recent study showed an association between perineal length and androgen levels in men, suggesting that serum testosterone levels in adulthood will depend on factors involved during the fetal period. The aim of this study is to assess the relationship between AGD measures and reproductive hormone levels in women. DESIGN: Cross-sectional study conducted between February and November 2011. SETTING: University-affiliated fertility clinics. POPULATION: 100 young college students. METHODS: Physical and gynaecological examinations were conducted on university students. All participants provided a blood sample for determination of reproductive hormones and completed an epidemiological questionnaire on lifestyles and gynaecological history. We used multiple linear regression analysis to examine the associations between perineal length measurements [anus-fourchette (AGDAF ) and anus-clitoris (AGDAC )] and reproductive hormone levels. MAIN OUTCOME MEASURES: Anogenital distance measurements and reproductive hormone levels. RESULTS: In the multiple linear regression analyses, AGDAF was positively associated with serum testosterone levels. Serum testosterone increased 0.06 ng/ml (95%CI 0.01, 0.10; P = 0.02) for each 1-cm increase in AGDAF . None of the measurements was associated with other reproductive hormones. CONCLUSIONS: Anogenital distance may predict normal reproductive development in women, and may be a new tool of potential clinical interest to evaluate ovarian function. Our results suggest that serum testosterone levels in adulthood may depend on factors operating in the prenatal period.

Relación entre las nuevas tecnologías y la preferencia en la comunicación en estudiantes de segundo año de la educación media / Relationship between new technologies and communication preference in students of second year of secondary education

Se llevó a cabo un análisis correlacional entre el conocimiento y uso de las nuevas tecnologías y la preferencia en la comunicación de estudiantes de segundo año de la Educación Media del Colegio Público seleccionado. La muestra fue intencional y autoseleccionada, conformada por 277 estudiantes de segundo año de la Educación Media. Se aplicó un diseño descriptivo, exploratorio y correlacional. Los instrumentos utilizados fueron los siguientes cuestionarios: "Conocimiento y Uso de las Nuevas Tecnologías de la Información y la Comunicación (NTIC's)" y "Preferencias de los jóvenes en su Comunicación Cotidiana". Los resultados reportan que existe correlación entre el conocimiento y uso y la preferencia de comunicación en los estudiantes de segundo año de la Educación Media.

It has been made a correlational analysis between knowledge and usage of new technologies and preference in communication of second year of Secondary Education (11th grade) students from a selected public school. The sample was intentional, self-selected and composed of 277 students. A descriptive, exploratory and correlational design was applied. The used instruments were the following questionnaires: "Knowledge and Usage of New Technologies of Information and Communication (NITC's)" and "Young people's Preference in Daily Communication". The results indicated that there is a correlation between knowledge and usage, and the preference of communication in students attending second year of Secondary.

Estabilidad de la 99mTc-tetrofosmina en función de envase, tiempo y temperatura de incubación / The infl uence of storage vessel, incubation time and temperature on the stability of 99mTc-tetrofosmin

Observar si el almacenamiento de la 99mTc-tetrofosmina durante el tiempo indicado por el fabricante de estabilidad del radiofármaco, 12 horas, a diferentes temperaturas (18-25º C o Tª ambiente, 32º C y 4-8º C), podría infl uir en la PRQ del radiofármaco y en su estabilidad, ya sea en los mismos viales del equipo reactivo como en jeringas. Del mismo modo, estudiar si la incubación requerida para la preparación del radiofármaco (20 min) va a afectar a la PRQ de la dosis si ésta ha sido cargada antes o después de ese tiempo. Material y Métodos: Los 40 viales de la fosfi na se marcaron siguiendo las indicaciones del fabricante. Se estudiaron 3 condiciones de almacenamiento en función de la temperatura en la que mantuviéramos el radiofármaco, para estudiar las condiciones ambientales extremas en las que se puede encontrar una dosis del fármaco. Resultados: Los valores medios de la PRQ (%) cuando el radiofármaco se incubaba en vial o en jeringa fueron de 95,79±2,32 y 96,16±2,32 respectivamente, no observándose diferencias en los valores. La estabilidad del radiofármaco a distintas temperaturas, y a diferentes tiempos fueron superiores al 90% en todos los casos. Conclusiones: El complejo 99mTc-tetrofosmina es estable durante 12 horas tanto si la incubación se realiza en el vial original del equipo reactivo como si se realiza en jeringa de insulina con aguja. El radiofármaco es estable durante 12 horas a diferentes temperaturas de almacenamiento

Aim: To determine the stability and radio chemical purity (RCP) of 99mTc-tetrofosmin kept for different time intervals of up to 12 hours, the maximum recommended by the manufacturers, at different temperatures (18-25º C or room temperature, 32ºC & 2-8ºC), in both reactive equipment vials or in syringes, and to determine whether shorter or longer incubation times, other than the recommended 20 minute period, could affect the RCP of doses of the radiopharmaceutical. Materials and Methods: 40 vials of phosphine were labelled in accordance with manufacturer’s recommendations. Three different storage temperature conditions were studied, in order to determine how possible extremes may affect dosages of the drug. Results: The average RCP percentages of the radiofarmaceutical incubated in vials and syringes were 95.79±2.32 & 96.16±2.32 respectively, with no signifi cant differences observed. Stability at different temperatures and different time intervals was over 90% in all cases. Conclusions: The 99mTc-tetrofosmin complex remains stable for 12 hours, whether it is incubated in the original reactive equipment or within insulin syringes with needle. Additionally, the radiopharmaceutical also remained stable at the different studied storage temperatures and at all time intervals for up to 12 hours

Comparación entre la determinación analítica del colesterol-LDL y su estimación por cálculo / Comparison between the analytical determination of LDL-cholesterol and its estimation by calculation

El colesterol­LDL (LDL.C) es uno de los principales marcadores de riesgo aterogénico y es utilizado para objetivos preventivos, su determinación por cálculo es frecuente en los laboratorios. Por lo tanto, el objetivo de este estudio fue comparar el método de Friedewal con un método analítico basado en la precipitación de las LDL con sulfato de polivinilo (PVS) descrito por Kerscher. El colesterol ligado a las mismas se determinó empleando el sistema enzimático con colorimetría de Trinder. Por diferencia entre el Colesterol total y el determinado en el sobrenadante, se obtuvo el colesterol unido a las LDL.(C.LDLa). Se comparó con el método por cálculo para la estimación de LDL.C (C.LDLc).Se eliminaron todos los valores de triglicéridos > o = a 400 mg/dl. En los pacientes normolipémicos el valor medio de C.LDLa fue 95 ±29 mg/dl y para C­LDL 99 ±26 mg/dl. El coeficiente de correlación fue r= 0.91 (p< 0.001). En pacientes hipercolesterolémicos, el valor medio de C­LDLa fue 170± 22 mg/dl y para C­LDLc 160 ± 21 mg/dl; el coeficiente de correlación fue r = 0.87 (p< 0.001). En los hipertrigliceridémicos, el valor medio de C­LDLa fue 122 ± 42 mg/dl y para C­LDLc 106 ± 41 mg/dl con coeficiente de correlación r = 0.92 (p< 0.001). En base a estos resultados podemos destacar que el método analítico es rápido, preciso y fácilmente utilizable en el laboratorio clínico y que ambos métodos son comparables entre sí hasta valores de triglicéridos menores a 400 mg/dl.

LDL­cholesterol(LDL­C) is one of the principal markers of atherogenic risk and is used for preventive aims. The determination of this marker by calculation is frequent in laboratories. Thus, the aim of this study was to compare Friedewald formula with an analytical method based on the precipitation of LDL with polyvinyl sulphate (PVS) described by Kerscher. The cholesterol linked to these proteins was determined using the enzymatic colorimetric system of Trinder. The cholesterol linked to LDL (LDL­Ca) was obtained by the difference between total cholesterol and the one determined in the supernatant. This result was compared with the method of calculation for LDL­C estimation. All values of triglycerids > or equal to 400 mg/dl were eliminated. In the normolipemic patients, the mean LDL­Cc was 95 ± 29 mg/dl and for LDL­Cc 99 ± 26 mg/dl. The correlation coefficient was r=0.91 (p <0.001). In hypercholesterolemic patients, mean LDL­Ca was 170 ± 22 mg/dl and for LDL­Cc 160 ± 21 mg/dl; the correlation coefficient was r=0.87 (p <0.001). In hypertriglyceridemic patients, mean LDL­Ca was 122 ± 42 mg/dl and LDL­Cc 106 ± 41 mg/dl with a correlation coefficient of r= 0.92 (p <0.001). Based in these results, we could emphasize that the analytical method is rapid, precise and easy to use in the clinical laboratory and that both methods are comparable for triglyceride values lower than 400 mg/dl.

17. Utility of Metabolic Imaging in Oral Squamous Cell Carcinoma (SCC) Staging. Experience in 30 Patients.

Purpose: SCC represents nearly 90% of all oral malignancies, with an increasing incidence. Accurate Tumour-Node-Metastasis staging (TNM) is mandatory for planning surgical options and chemotherapy-radiotherapy management. Positron Emission Tomography (PET) using 18F-Fluorodeoxyglucose (FDG) provides functional information about tumoral tissues that may improve preoperative staging obtained by conventional morphologic procedures (CT-MRI). The purpose of this study is to evaluate the accuracy of FDG-PET in oral SCC staging and to compare those data from conventional and PET studies according to the pathologic results obtained from surgical specimen.Methods: A prospective study of 30 patients was carried out, through a 26 months period. Inclusion criteria include positive biopsy for Oral SCC, no other malignancies during the past 5 year and surgery as preferred therapeutic option. All patients underwent CT, MRI, and FDG-PET studies consecutively. Results obtained from conventional and PET preoperative staging were compared with those from postoperative histopathological studiesResults: FDG-PET modified preoperative staging obtained by conventional morphologic studies in 21% cases, which was confirmed postoperatively by histological findings. Kappa test showed higher values for PET studies (0.89) than conventional studies (0.41), when compared with postoperative controlConclusion: FDG-PET may be helpful to improve the accuracy of conventional studies in oral SCC preoperative TNM staging, although no definitive conclusions can be withdrawn due to the limited size of the sample. Modifications of preoperative staging showed by PET are a matter of controversy and must be kept in mind for further studies.

[PET-FDG in thyroid cancer with high thyroglobulin levels and negative 131-I scan. A case report]. / La PET-FDG en el cáncer de tiroides ante niveles altos de tiroglobulina y rastro 131-I negativo. A Propósito de un caso.

The value of whole body PET-FDG in the evaluation of metastases has been demonstrated in a wide variety of tumors. In this report, we present the case of a patient with antecedent of papillary thyroid carcinoma, who was operated twelve years ago, and submitted to an ablative dose of residual thyroid tissue through 131I, being the levels of thyroglobulin normals. After twelve years of evolution, the patient refers bag pain and respiratory trouble, appearing in the CT image suspicious of metastases in right pulmonary base. The levels of thyroglobulin were shown increased, being the 131I scan negative. A whole body PET-FDG study was performed in order to exclude metastases of his malignant process, showed multiple high FDG uptake focus in brain, cerebellum, neck, chest, lymphatic nodes and bone, suggestive of dedifferentiated disease These findings were confirmed subsequently in the clinic evolution. Therefore, whole-body PET-FDG is a complementary diagnostic technique for study patients with CDT (Thyroid Differentiated Carcinoma) with 131I scan negative and rising thyroglobulin levels.

Prevalence of diabetes mellitus and associated cardiovascular risk factors in an adult urban population in Paraguay.

A cross-sectional study was conducted on a 20-74-year-old population in an urban white-Hispanic population in Paraguay to determine the prevalence of diabetes mellitus (DM), impaired glucose tolerance (IGT), and associated cardiovascular disease (CVD) risk factors. In total 1606 subjects completed the study (response rate 80.3%; 1094 women, 512 men). The overall prevalences were: DM 6.5%, IGT 11.3%, hypertension 17.1%, and obesity 31.6% with more obesity in women (35.7% vs 22.8%, p < 0.05). Age-standardized prevalences were: DM 6.5%, IGT 13.5% in females and DM 5.5%, IGT 7.2% in males. DM and IGT subjects had two or more CV risk factors significantly more often than the normal population. In conclusion, DM, IGT, hypertension, and obesity are common in this South American Hispanic urban population, particularly in women. Public health measures, such as lifestyle education, are required to decrease these noncommunicable diseases.

Serum levels of eosinophil cationic protein and eosinophil protein x in pollen atopic patients with stable asthma and its relation with bronchial hyperresponsiveness.

Eosinophils are important effector cells in allergic inflammation described in allergic rhinitis (AR) and allergic bronchial asthma (BA). During the pollen season serum levels of eosinophil cationic protein (ECP) and eosinophil X protein/eosinophil-derived neurotoxin (EPX/EDN) are increased in BA. The aim of the present study was to evaluate the serum levels of ECP and EPC in pollen atopic patients with AR and BA during the winter. 92 patients were studied. They were divided into three groups: I 29 patients with AR, II 51 patients with BA and III 12 healthy subjects. Allergic rhinitis and bronchial asthma were diagnosed by routine clinical tests: clinical history, skin tests, total IgE and specific IgE. In addition ECP and EPX were determined in serum. All patients were asymptomatic, stable and without medical treatment. Methacholine challenge test (MCT) was performed in all patients. MCT were positive in 4 patients of group I and 45 patients of group II. ECP levels (ug/l) were: 21 (I), 24 (II) and 7 (III). EPX levels (ug/l) were 35 (I), 45 (II) and 21 (III). Statistical differences (p < 0.01) were observed both in ECP and EPX levels in patients with MCT positive in relation to patients with MCT negative, and in allergic patients (I and II) in comparison with the healthy subjects (III) (p < 0.01). ECP and EPX serum levels are increased in patients with a positive MCT in the winter, out of the pollen season, when patients are asymptomatic, stable and without treatment. This fact suggests that eosinophils play an important role in the pathogenesis of bronchial asthma.

[PSA and PSAD study in patients with renal dysfunction]. / Estudio de PSA y PSAD en pacientes con disfunción renal.

This study analyzes the changes in serum and urinary PSA values in 28 subjects; 13 with creatinine clearance under 75 ml/mn and 15 with creatinine clearance over 75 ml/mn. Both groups were compared for prostate size, measured by transrectal ultrasound, prostate weight, serum PSA (SPSA), 24h urine PSA (PSAO), PSA clearance (PSACl), serum creatinine (SCr), creatinine clearance (CrCl), PSA density (PSAD), PSA/creatinine ratio (PSA/Cr) and PSACl/CrCl ratio. Mean values of SPSA and PSAO were 4.5 +/- 0.8 and 222 +/- 29.7 ng/ml respectively, values for SCr, CrCl and PSACl averaging 1.62 +/- 0.2 mgr/dl, 71.6 +/- 6.5 ml/mn and 150.5 +/) 32.9 ml/mn. Median prostate size was 32.6 +/- 3.9 cc, with weights of 40.3 +/- 4.9 g and mean PSA density (PSAD) 0.13 +/- 0.02. The results of the homogeneity study showed that there are no significant differences between both groups with regard to the variables considered in the study. SPSA values were higher in patients with CrCl < 75; 3.4 vs 5.7, but not significantly. There are no significant differences between PSAO and PSACl values for both groups, even though PSAO levels were higher in patients with CrCl < 75 ml/min (p = 0.1). PSAD values for patients with CrCl > 75 ml/mn were lower than those for patients with CrCl < 75 ml/mn; 0.09 vs 0.17 (p = 0.08). In the entire sample, PSAD levels showed correlation with SPSA and PSA/Cr values; R = 0.63 (P = 0.0003) and r = 0.5 (p = 0.009) respectively. Also, they were significantly but inversely correlated with PSACl levels; r = - 0.5 (p = 0.006) and PSACl/CrCl; r = - 0.048 (p = 0.01). No correlation was seen between PSAD values and the following parameters; PSAO (p = 0.7), SCr (p = 0.5) and CrCl (p = 0.27). When the group of patients with CrCl < 75 ml/mn is considered, PSAD values are correlated exclusively with PSACl values; r = - 0.69 (p = 0.008) and PSACl/CrCl; r = 0.68 (p = 0.009). Our data appear to indicate that there is a certain relationship between PSAD and the renal function although the physiopathological mechanism responsible for that is unknown. Nevertheless, considering the sample size, more comprehensive studies will be necessary to obtain more convincing results.