Clinical Chemistry

2019 ◽  
Author(s):  
Dan Furmedge
Keyword(s):  
Fluid Balance ◽  
Clinical Chemistry ◽  
Clinical Status ◽  
Serum Biochemistry ◽  
Left Ventricular ◽  
Intravenous Fluids ◽  
Blood Tests ◽  
Large Numbers ◽  
Per Se ◽  
Level 2

With so many tests available and increasingly fast laboratory processors, there is a growing temptation to request large numbers of blood tests on each and every patient. What we should remember is that they should be used as an adjunct to the history and clinical examination. Test results should reinforce the likely diagnosis and rule out our differentials, rather than be used to try and make the diagnosis per se. What makes things easier is to know how serum biochemistry and homeostasis are regulated and then to consider a number of questions: ● Which hormones are involved in the control of this electrolyte? ● What happens when these are increased or decreased? ● Does the patient have any renal or hepatic impairment? ● Are they taking any drugs that might be affecting serum electrolyte levels? ● Have they taken an overdose? ● Is the patient dehydrated/ hypovolaemic/ hypoxic? It can seem daunting at first when results come back unexpectedly out of range. They must be considered in combination with the patient’s clinical status; if the numbers just do not fit, then repeat the test— they may not be right. However, there are a few ‘unmissable’ electrolyte derangements that need to be dealt with immediately. Once detected, they should trigger the thoughts shown in Table 12.1. Interpreting serum values is important, but to prevent iatrogenic derangement, careful use and prescription of intravenous fluids are also needed. Does a patient who looks hypovolaemic, has a low blood pres­sure, and is tachycardic need crystalloids or blood? Colloids, such as ‘Gelofusine®’ or ‘Volplex®’, are now largely out of date, with evidence not supporting their use. Are they frail or do they have cardiac failure and therefore require cautious replacement? Do they have liver failure? Is their fluid balance so critical that close fluid monitoring in a level 2 crit­ical care setting required? Gone are the days when central venous lines are used on the wards for fluid balance. This chapter will help consider­ation of the whole picture before putting pen to paper and (potentially) wrongly prescribing 4 L of fluids a day for a frail older man with left ventricular failure.

Abstract 361: Utility of Transthoracic Echocardiogram to Assess Volume Status in the Intensive Care Unit

2015 ◽  
Vol 8 (suppl_2) ◽  
Author(s):  
Yasotha Rajeswaran ◽  
Brooke Hill ◽  
Anthony Gemignani ◽  
Scott Friedman ◽  
Robert Palac ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Clinical Management ◽  
Left Ventricular ◽  
Volume Status ◽  
Intravenous Fluids ◽  
Transthoracic Echocardiogram ◽  
Echocardiographic Parameters

Background: There is increasing concern regarding the value and cost of using transthoracic echocardiograms (TTEs) to assess volume status in critically ill patients. Using clinical and echocardiographic parameters, we assessed whether TTE changed clinical management of patients in the intensive care unit (ICU). Methods: Using the Dartmouth-Hitchcock echocardiography database, we identified 218 ICU patients whose TTE was performed to assess volume status from 4/1/11 to 3/31/14. The following TTE parameters were assessed: left ventricular ejection fraction (LVEF), diastolic function parameters, left atrial size, significant valvular disease, pericardial effusion, inferior vena cava (IVC) size and collapsibility, right ventricular (RV) function and pulmonary artery systolic pressure. In addition, clinical data were collected from review of the medical record including: age, vitals, intubation status, labs, and management change after TTE results became available. Results: Of the 218 patients, cardiac tamponade was present in 6 patients and right heart strain suggestive of pulmonary embolus was present in 2 patients. Of the remaining 210 patients, TTE did not affect clinical management in 186 (88.6%), led to administration of diuretics in 8 (3.8%), and intravenous fluids in 16 (7.6%). Of the 218 total patients, 123 (56.4%) were intubated. Compared to non-intubated patients, intubated patients were more likely to have elevated right atrial pressure, RV dysfunction, IVC size and collapsibility index (p<0.05). There was no difference in the severity of pulmonary hypertension, LVEF, or indices of elevated left ventricular filling pressure (p=NS). Although the echo parameters were different, the decision by physicians to administer intravenous fluids or diuretics was similar for both groups (p=NS). Conclusions: Transthoracic echocardiogram is commonly ordered to assess volume status in the ICU. The use of echocardiographic parameters to assess volume status did not change clinical management in majority of patients and should be used with caution in this cohort. Continued investigation to identify the best modality to assess volume status in critically ill patients is warranted.

scholarly journals Testicular Microlithiasis: Case Report and Literature Review

2017 ◽  
Vol 34 (3) ◽  
pp. 241-245
Author(s):  
Goran Savić ◽  
Vladimir Vasić ◽  
Milan Petrović ◽  
Jovan Petrović ◽  
Dragoslav Bašić ◽  
...  
Keyword(s):  
Literature Review ◽  
Retrospective Studies ◽  
Klinefelter Syndrome ◽  
Specific Antigen ◽  
Unknown Etiology ◽  
Standard Laboratory ◽  
Testicular Microlithiasis ◽  
Normal Prostate ◽  
Blood Tests ◽  
Large Numbers

Summary Testicular microlithiasis is a condition characterized by the ultrasonographic findings with multiple microliths, with the prevalence of 0.6% to 9%. This is a condition of unknown etiology; however, in many cases it may be associated with cryptorchidism, Klinefelter syndrome, Down syndrome, varicocele, testicular torsion and male pseudohermaphroditism. Many retrospective studies point to the association between testicular microlithiasis and testicular cancer. We report a case of a 50-year-old patient who presented to the urologist because of dysuric symptoms. Ultrasonographic examination of both testicles revealed microcalcifications in large numbers, i.e. “the phenomenon of the starry sky”. More than 20 microcalcifications were present on the cross section of both testicles. Standard laboratory blood tests were normal. Prostate-specific antigen was 1.22 ng/ml. If risk factors for developing cancer are present, some authors recommend a biopsy of the testicles. However, based on the literature review, currently, there is no a strictly defined protocol.

scholarly journals His-optimized cardiac resynchronization therapy in a patient with heart failure and right bundle branch block: a case report

2021 ◽  
Vol 5 (8) ◽  
Author(s):  
Dmytro Volkov ◽  
Dmytro Lopin ◽  
Stanislav Rybchynskyi ◽  
Dmytro Skoryi
Keyword(s):  
Heart Failure ◽  
Cardiac Resynchronization Therapy ◽  
Right Bundle Branch Block ◽  
Clinical Status ◽  
Left Ventricular ◽  
Cardiac Resynchronization ◽  
Left Ventricular Ejection ◽  
Resynchronization Therapy ◽  
Bundle Branch Block ◽  
Ventricular Ejection Fraction

Abstract Background  Cardiac resynchronization therapy (CRT) is an option for treatment for chronic heart failure (HF) associated with left bundle branch block (LBBB). Patients with HF and right bundle branch block (RBBB) have potentially worse outcomes in comparison to LBBB. Traditional CRT in RBBB can increase mortality and HF deterioration rates over native disease progression. His bundle pacing may improve the results of CRT in those patients. Furthermore, atrioventricular node ablation (AVNA) for rate control in atrial fibrillation (AF) can be challenging in patients with previously implanted leads in His region. Case summary  We report the case of 74-year-old gentleman with a 5-year history of HF, permanent AF with a rapid ventricular response, and RBBB. He was admitted to the hospital with complaints of severe weakness and shortness of breath. Left ventricular ejection fraction (LVEF) was decreased (41%), right ventricle (RV) was dilated (41 mm), and QRS was prolonged (200 ms) with RBBB morphology. The patient underwent His-optimized CRT with further left-sided AVNA. As a result, LVEF increased to 51%, RV dimensions decreased to 35 mm with an improvement of the clinical status during a 6-month follow-up. Discussion  Patients with AF, RBBB, and HF represent the least evaluated clinical subgroup of individuals with less beneficial clinical outcomes according to CRT studies. Achieving the most effective resynchronization could require pacing fusion from sites beyond traditional with the intention to recruit intrinsic conduction pathways. This approach can be favourable for reducing RV dilatation, improving LVEF, and maximizing electrical resynchronization.

P4545ACUTE HF score: a new multi-parametric score for the prognostication of acute heart failure

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
G E Mandoli ◽  
G De Carli ◽  
M C Pastore ◽  
L Rizzo ◽  
C Nannelli ◽  
...  
Keyword(s):  
Heart Failure ◽  
Multivariate Analysis ◽  
Acute Heart Failure ◽  
Prognostic Score ◽  
Univariate Analysis ◽  
Left Ventricular ◽  
Non Invasive ◽  
Blood Tests ◽  
Icu Stay ◽  
Previous Stroke

Abstract Background Prognosis of patients with acute heart failure (AHF) and different etiologies remains a challenging issue for the Cardiologist. Purpose We aimed to evaluate clinical and echocardiographic indexes and blood tests values of patients admitted to Intensive Care Unit (ICU) for AHF to test their capability to predict events at short-, medium- and long-term follow-up. Methods We retrospectively enrolled 830 patients who entered the ICU of our third-level hospital between 2010 and 2013 for AHF. Exclusion criteria included: active malignances, heart transplantation, patients with left ventricular assist device. We evaluated in each subject: cause of admission, medical history, chest congestion severity at admission, blood tests, echocardiographic parameters and administered drugs during in-hospital stay. Primary endpoints included: mortality rate at 30 days, 6 months and 5 years after dismission, days of ICU stay and cardiology ward stay. Indexes with statistical significance at univariate analysis, were then tested by multivariate analysis. Results The study population (average age 72.2±13 y) had an ejection fraction (EF) 36±12% at ICU admission. Best predictors of prognosis in the populations, after multivariate analysis, resulted to be: renal failure, EF, age, mitral regurgitation (MR) more than mild, use of non-invasive ventilation support during ICU stay, previous stroke or transient ischemic attack (TIA). With these indexes, we created a multi-parametric prognostic score composed by: 0.7*[age >76 years] + 1.4*[plasmatic creatinine >2mg/dl] + 0.8*[non-invasive mechanical ventilation] + 0.9*[previous stroke/TIA] + 0.8*[EF <30%] + + 0.7*[previous hospitalization for AHF] + 0.5*[moderate/severe MR]. According to the score, we stratified the population in 3 tertiles with increasing mortality risk: low if <1.5, medium if 1.5–3, high risk if >3 (Figure 1). At ROC curve analysis, the score showed a greater prognostic accuracy than each parameter (30 days AUC 0.75, 6 months AUC 0.78, 5 years AUC 0.79). Figure 1 Conclusions A combined clinical, humoral and echocardiographic score could represent a new tool in the prognostication of patients with AHF since the admission in ICU.

scholarly journals The effect of the absence of rumen ciliate protozoa on growing lambs fed on a roughage–concentrate diet

1971 ◽  
Vol 26 (2) ◽  
pp. 155-167 ◽  
Author(s):  
J. Margaret Eadie ◽  
J. C. Gill
Keyword(s):  
Fatty Acids ◽  
Weight Gain ◽  
Volatile Fatty Acids ◽  
Soluble Sugar ◽  
Group Differences ◽  
Rumen Bacteria ◽  
Body Measurements ◽  
Large Numbers ◽  
Per Se ◽  
Ciliate Protozoa

1. Lambs were removed form their dams at 2 d of age, and at 5 weeks of age eitht of one group were incoulated with a mixed rumen ciliate and seven in a second group were maintained ciliate-free throughout the 61 weeks of the experiment. Performance of the groups was compared when given a 2:1 roughage:concentrate diet as a set ration and withad lib.roughage.2. Mixed ciliate populations developed in all faunated lambs and average-sized populations were maintained. Large numbers of flagellate protozoa developed in the ciliate-free animals after flagellates had been introduced into the building with the ciliate-free animals after flagellates had been introduced into the building with the ciliate inoculum.3. Higher numbers of rumen bacteria were found in the ciliate-free group.4. Only between the 14th and 21st weeks was there a significant different between groups in weight gain and this was infavour of the faunated group. The only significant different in body measurements was greater girth in the ciliate-free lambs.5. Only minor differences were found between the groups in calorimetric trials, digestibility and nitrogen balanes. There were no differences between groups in concentration of total protein N and soluble sugar in the rumen. The ammonis concentration was significantly higher in the faunated group.6. The concentrations of total rumen volatile fatty acids (VFA) were higher in the faunated group. Differences, between groups, in proportions of VFA were attributed to the activity of the rumen bacteria rather than the ciliatesper se.7. No differences between groups were found in the concentrations of blood sugar and haemoglobin.8. It was concluded that the changes due to the presence of rumen ciliates were not great enough to be reflected in animal performance under the conditions of this experiment.

scholarly journals Artificial light in baited pots substantially increases the catch of cod (Gadus morhua) by attracting active bait, krill (Thysanoessa inermis)

2018 ◽  
Vol 75 (6) ◽  
pp. 2257-2264 ◽  
Author(s):  
Odd-Børre Humborstad ◽  
Anne Christine Utne-Palm ◽  
Michael Breen ◽  
Svein Løkkeborg
Keyword(s):  
Light Source ◽  
North Atlantic ◽  
Coastal Waters ◽  
Gadus Morhua ◽  
Catch Rate ◽  
Light Sources ◽  
The North ◽  
Important Prey ◽  
Large Numbers ◽  
Per Se

Abstract The use of pots in the north Atlantic finfish fisheries is negligible because this fishing method typically has a low capture efficiency. Large numbers of individuals encounter baited pots, but the proportions of fish that enter the pot and become caught are low. Krill, which constitutes an important prey for cod (Gadus morhua), is attracted by light. The catching efficiency of baited cod pots with three light sources with different colours and intensities (white: 9744 mW m−2, white: 23 mW m−2, green: 8 mW m−2) were tested in coastal waters in northern Norway. Pots with the light source of highest intensity gave a 17 times higher catch rate of cod than that of control pots (with bait only). The light source of medium intensity gave about a five times higher catch rate, whereas the weakest light did not influence the catch. Cod caught in pots with light had more krill and arrowworms in their stomach and were observed feeding on these preys inside the pot. We concluded that light sources of increasing intensity attract more krill, and that cod were attracted into the pot by the dense swarms of prey and not the light per se.

Abstracts for the British Congenital Cardiac Association Annual Meeting: The Barbican, London, 24–25 November 2005: Winner of the Young Investigator's Prize: B-Type Natiuretic Peptide (BNP) as a marker of paediatric heart failure

2006 ◽  
Vol 16 (3) ◽  
pp. 316-317
Author(s):  
J. Mangat ◽  
C. Carter ◽  
Y. Foo ◽  
M. Burch
Keyword(s):  
Heart Failure ◽  
Ventricular Function ◽  
Correlation Coefficient ◽  
Clinical Status ◽  
Viral Myocarditis ◽  
Left Ventricular ◽  
Idiopathic Dilated Cardiomyopathy ◽  
Z Score ◽  
Anthracycline Cardiotoxicity ◽  
Parametric Data

Background: Paediatric heart failure can be difficult to assess. Symptoms vary widely in children who have poor ventricular function on echocardiogram. In addition exercise testing is not possible in young children. BNP has been used in adult heart failure and more recently in paediatrics. We investigated BNP in the setting of a paediatric heart failure and transplantation service to assess its usefulness as a clinical marker of heart failure. Method: Clinical and echocardiographic data were correlated to 126 BNP samples. Patients were 3 weeks to 16 years of age. Left ventricular end-diastolic dimension (LVEDd) was related to normal values for body surface area (z-score). Clinical status was defined using Ross and NYHA scores. Thirty four samples were from patients with normal ventricular function. Of the remainder, most were from patients with idiopathic dilated cardiomyopathy (38), anthracycline cardiotoxicity (15), congenital heart disease (25), viral myocarditis (6) and restrictive cardiomyopathy (6). Analysis: BNP was correlated to parametric data (fractional shortening (FS%)) with pearsons correlation coefficient. For non-parametric data (z-score, NYHA and Ross score), spearmans correlation coefficient was used. Results: Rising BNP levels correlate to deteriorating clinical status with significance to the 0.01 level (Ross and NYHA), Figure 1. There was also correlation, significant to the 0.01 level to FS%, Figure 2. Increasing BNP levels correlated to the increasing LVEDd z-score significant to the 0.05 level. Mean BNP: in ventricular dysfunction 634 pg/ml (S.E.M. = 80), in normal function 11.9 pg/ml (S.E.M. = 1.6). Conclusions: This is the largest study of BNP in paediatric heart failure. The stronger correlation of BNP to NYHA and ROSS than to LVEDD and FS% suggests a useful role in assessment of children with heart failure. We believe it is useful in the outpatient setting particularly when care is shared with general paediatricians. It also appears to be a useful addition in the assessment of heart failure and perhaps timing of transplantation in a specialist centre.

scholarly journals Continuous Aspiration Thrombectomy in High- and Intermediate-High-Risk Pulmonary Embolism in Real-World Clinical Practice

2020 ◽  
Vol 2020 ◽  
pp. 1-9
Author(s):  
Aleksander Araszkiewicz ◽  
Sylwia Sławek-Szmyt ◽  
Stanisław Jankiewicz ◽  
Bartosz Żabicki ◽  
Marek Grygier ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
High Risk ◽  
Low Dose ◽  
Mechanical Thrombectomy ◽  
Arterial Oxygen Saturation ◽  
Clinical Status ◽  
Systolic Pressure ◽  
Left Ventricular ◽  
Arterial Oxygen ◽  
Pulmonary Artery Systolic Pressure

Objectives. We sought to assess the technical and clinical feasibility of continuous aspiration catheter-directed mechanical thrombectomy (CDT) in patients with high- or intermediate-high-risk pulmonary embolism (PE). Methods and Results. Fourteen patients (eight women and six men; age range: 29–71 years) with high- or intermediate-high-risk PE and contraindications to or ineffective systemic thrombolysis were prospectively enrolled between October 2018 and February 2020. The Indigo Mechanical Thrombectomy System (Penumbra, Inc., Alameda, California) was used as CDT device. Low-dose local thrombolysis (alteplase, 3–12 mg) was additionally applied in three patients. Technical and procedural success was achieved in 14 patients (100%). Complete or nearly complete clearance of pulmonary arteries was achieved in nine patients (64.3%), whereas partial clearance was achieved in five (35.7%). A significant improvement in the pre- and postprocedural patients’ clinical status was observed in the following fields (median; interquartile range): heart rate (110; 100–120/min vs. 85; 80–90/min; p < 0.0001 ), systolic blood pressure (106; 90–127 mmHg vs. 123; 110–133 mmHg; p = 0.049 ), arterial oxygen saturation (88.5; 84.2–93% vs. 95.0; 93.8–95%, p = 0.0051 ), pulmonary artery systolic pressure (55; 44–66 mmHg vs. 42; 34–53 mmHg; p = 0.0015 ), Miller index score (21.5; 20–23 vs. 9.5; 8–13; p < 0.0001 ) and right ventricular/left ventricular ratio (1.3; 1.3–1.5 vs. 1.0; 0.9–1.0; p < 0.0001 ). No major periprocedural bleeding was detected. Conclusions. CDT is a feasible and promising technique for management of high- or intermediate-high-risk PE to decrease thrombus burden, reduce right heart strain, and improve hemodynamic and clinical status. Some patients may benefit from simultaneous local low-dose thrombolytic therapy. Nevertheless, its criteria and role in CTD-managed patients require further elucidation.

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