Is automated kinetic measurement superior to end-point for advanced oxidation protein product?

BACKGROUND: Advanced oxidation protein product (AOPP) was first described as an oxidative protein marker in chronic uremic patients and measured with a semi-automatic end-point method. Subsequently, the kinetic method was introduced for AOPP assay. We aimed to compare these two methods by adapting them to a chemistry analyzer and to investigate the correlation between AOPP and fibrinogen, the key molecule responsible for human plasma AOPP reactivity, microalbumin, and HbA1c in patients with type II diabetes mellitus (DM II). The effects of EDTA and citrate-anticogulated tubes on these two methods were incorporated into the study. METHODS: This study included 93 DM II patients (36 women, 57 men) with HbA1c levels > or = 7%, who were admitted to the diabetes and nephrology clinics. The samples were collected in EDTA and in citrate-anticoagulated tubes. Both methods were adapted to a chemistry analyzer and the samples were studied in parallel. RESULTS: In both types of samples, we found a moderate correlation between the kinetic and the endpoint methods (r = 0.611 for citrate-anticoagulated, r = 0.636 for EDTA-anticoagulated, p = 0.0001 for both). We found a moderate correlation between fibrinogen-AOPP and microalbumin-AOPP levels only in the kinetic method (r = 0.644 and 0.520 for citrate-anticoagulated; r = 0.581 and 0.490 for EDTA-anticoagulated, p = 0.0001). CONCLUSIONS: We conclude that adaptation of the end-point method to automation is more difficult and it has higher between-run CV% while application of the kinetic method is easier and it may be used in oxidative stress studies.

Evaluation of MDRD, Cockcroft-Gault, and CKD-EPI formulas in the estimated glomerular filtration rate.

BACKGROUND: The aim of this study was to compare the use of the ideal weight with the use of the patient's actual weight in the C-G (Cockcroft-Gault) formula for the measurement of the GFR (Glomerular Filtration Rate). We also aimed to compare the results of the calculations explained above with the results of the MDRD (Modification of Diet in Renal Disease) formula and CKD-EPI (Chronic Kidney Disease Epidemiology Collaboration) results of the classical 24-hour creatinine clearance method. METHODS: Creatinine clearance values, which were obtained from 24-hour urine collection, were compared with the values from the C-G formula in which each patient's ideal weight was used, with the values from the C-G for- mula in which each patient's actual body weight was used, and with the MDRD Formula and CKD-EPI. RESULTS: The correlation analysis between 24-hour creatinine clearance and the GFR obtained from the C-G formula with adjusted ideal weight in the Control group, Group I (patients with diabetes mellitus) and Group II resulted in values of r = 0.526, 0.576, and 0.850 (p < 0.0001), respectively. The correlation analysis between 24-hour creatinine clearance and the MDRD formula among the same groups resulted in r = 0.814, 0.682, and 0.861 (p < 0.0001), respectively. The correlation analysis between creatinine clearance and the CKD-EPI formula among the same groups resulted in r = 0.821, 0.679, and 0.871 (p < 0.0001), respectively. CONCLUSIONS: The results of the CKD-EPI formula were the most compatible with the results of 24-hour urine cre- atinine clearance which is used in clinical practice, especially in the control and diabetic group.

The effects of carbohydrate-rich drink on perioperative discomfort, insulin response and arterial pressure in spinal aesthesia.

BACKGROUND: The aim of this study was to investigate the role of carbohydrate-rich drink (CHO) on perioperative discomfort, hemodynamic changes, and insulin response in patients undergoing surgery with spinal anesthesia. METHODS: Forty-four adult patients were assigned to one of the two groups of 22, namely preparation with CHO (CHO group) or fasting from midnight (control group). Ten different discomfort variables, blood glucose and insulin concentrations, and hemodynamic changes were recorded during the perioperative period. RESULTS: Preparation with CHO was effective in reducing hunger, thirst, malaise, unfitness, and, to some extent, anxiety (p < 0.05). Plasma glucose and insulin concentrations were increased in the CHO group (p < 0.05). Plasma glucose increased and insulin decreased in the control group (p < 0.05). In the control group, mean arterial pressure was lower compared to the CHO group (p < 0.05). CONCLUSIONS: Preparation with CHO before spinal anesthesia is advantageous due to reducing perioperative discomfort, improving insulin response and stabilizing mean arterial pressure.

Dexmedetomidine attenuates the hemodynamic and neuroendocrinal responses to skull-pin head-holder application during craniotomy.

We tested dexmedetomidine, an alpha2 agonist, for its ability to decrease heart rate, arterial blood pressure, and neuroendocrinal responses to skull-pin head-holder application during craniotomy. In a randomized, double-blinded, placebo-controlled study, 40 patients undergoing craniotomy with attachment of a pin head-holder were randomly assigned to one of 2 equal groups. The placebo group received saline, whereas the treatment group (DEX group) received a single bolus dose of dexmedetomidine (1 microg/kg) intravenously over 10 minutes before induction of anesthesia. Arterial blood pressure, heart rate, and sequential concentrations of circulating cortisol, prolactin, insulin, and blood glucose were measured. Relative to baseline and the other group, arterial blood pressure and heart rate decreased significantly after the administration of dexmedetomidine through skull pinning (P<0.05). In the placebo group, patients' heart rate and arterial blood pressure measures increased at 1 and 5 minutes after skull-pin insertion, compared with baseline and the DEX group (P<0.05). In both groups, plasma cortisol, prolactin, and blood glucose increased significantly relative to baseline after skull-pin insertion. However, the values were significantly higher in the placebo group compared with the DEX group (P<0.05). Although insulin levels were not significantly altered in the DEX group, the plasma concentrations of insulin decreased significantly after pin insertion in the placebo group. Our results suggested that, a single bolus dose of dexmedetomidine before induction of anesthesia attenuated the hemodynamic and neuroendocrinal responses to skull-pin insertion in patients undergoing craniotomy.