scholarly journals The challenges of sodium measurements: indirect versus direct ion-selective method

2019 ◽  
Vol 181 (2) ◽  
pp. 193-199
Author(s):  
Julie Refardt ◽  
Clara Odilia Sailer ◽  
Irina Chifu ◽  
Bettina Winzeler ◽  
Ingeborg Schnyder ◽  
...  
Keyword(s):  
Healthy Volunteers ◽  
Primary Outcome ◽  
Acute Illness ◽  
Selective Electrode ◽  
Selective Method ◽  
Interclass Correlation Coefficient ◽  
Interclass Correlation ◽  
Osmotic Stimulation ◽  
The Difference ◽  
Hypertonic Saline Infusion

Background Diagnosis and treatment of dysnatremia is challenging and further complicated by the pitfalls of different sodium measurement methods. Routinely used sodium measurements are the indirect (plasma/serum) and direct (whole blood) ion-selective electrode (ISE) method, showing discrepant results especially in the setting of acute illness. Few clinicians are aware of the differences between the methods in clinically stable patients or healthy volunteers. Methods Data of 140 patients and 91 healthy volunteers undergoing osmotic stimulation with hypertonic saline infusion were analyzed. Sodium levels were measured simultaneously by indirect and direct ISE method before and at different time points during osmotic stimulation up to a sodium threshold of ≥150 mmol/L. The primary outcome was the difference in sodium levels between the indirect and direct ISE method. Results 878 sodium measurements were analyzed. Mean (s.d.) sodium levels ranged from 141 mmol/L (2.9) to 151 mmol/L (2.1) by the indirect ISE compared to 140 mmol/L (3) to 149 mmol/L (2.8) by the direct ISE method. The interclass correlation coefficient between the two methods was 0.844 (95% CI: 0.823–0.863). On average, measurements by the indirect ISE were 1.9 mmol/L (95% CI limits: −3.2 to 6.9) higher than those by the direct ISE method (P < 0.001). The tendency of the indirect ISE method resulting in higher levels increased with increasing sodium levels. Conclusion Intra-individual sodium levels differ significantly between the indirect and direct ISE method also in the absence of acute illness. It is therefore crucial to adhere to the same method in critical situations to avoid false decisions due to measurement differences.

scholarly journals Validity of different copeptin assays in the differential diagnosis of the polyuria-polydipsia syndrome

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Clara Odilia Sailer ◽  
Julie Refardt ◽  
Claudine Angela Blum ◽  
Ingeborg Schnyder ◽  
Jose Alberto Molina-Tijeras ◽  
...  
Keyword(s):  
Differential Diagnosis ◽  
Diagnostic Accuracy ◽  
Healthy Volunteers ◽  
Primary Outcome ◽  
The Other ◽  
Poor Correlation ◽  
Elisa Assay ◽  
Moderate Correlation ◽  
High Diagnostic Accuracy ◽  
Osmotic Stimulation

AbstractThe aim of this study was to correlate three commercially available copeptin assays and their diagnostic accuracy in the differential diagnosis of the polyuria-polydipsia syndrome. Analyzed data include repeated copeptin measures of 8 healthy volunteers and 40 patients with polyuria-polydipsia syndrome undergoing osmotic stimulation and of 40 patients hospitalized with pneumonia. Copeptin was measured using the automated Brahms KRYPTOR, the manual Brahms LIA and the manual Cloud Clone ELISA assay. Primary outcome was the interrater correlation coefficient (ICC) and diagnostic accuracy in the polyuria-polydipsia syndrome of the three assays. In healthy volunteers, there was a moderate correlation for the KRYPTOR and LIA (ICC 0.74; 95% CI 0.07 to 0.91), and a poor correlation for the KRYPTOR and ELISA (ICC 0.07; 95% CI − 0.06 to 0.29), as for the LIA and ELISA (ICC 0.04; 95% CI − 0.04 to 0.17). The KRYPTOR had the highest diagnostic accuracy (98% (95% CI 83 to100)), comparable to the LIA (88% (95% CI 74 to 100)), while the ELISA had a poor diagnostic accuracy (55% (95% CI 34 to 68)) in the differential diagnosis of the polyuria-polydipsia syndrome. The KRYPTOR and LIA yield comparable copeptin concentrations and high diagnostic accuracy, while the ELISA correlates poorly with the other two assays and shows a poor diagnostic accuracy for polyuria-polydipsia patients. The current copeptin cut-off is valid for the KRYPTOR and LIA assay. Our results indicate that interpretation with other assays should be performed with caution and separate validation studies are required before their use in differentiating patients with polyuria-polydipsia syndrome.Trial registration: NCT02647736 January 6, 2016/NCT01940614 September 12, 2013/NCT00973154 September 9, 2009.

scholarly journals Vacutainer serum separator sebagai alternatif tabung penampung darah pada pemeriksaan kadar ureum

2021 ◽  
Vol 4 (1) ◽  
pp. 81
Author(s):  
Budi Setiawan ◽  
Ulfah Restu Nugraheni ◽  
Muji Rahayu
Keyword(s):  
Correlation Coefficient ◽  
Descriptive Analysis ◽  
Statistical Test ◽  
Cross Sectional ◽  
Urea Level ◽  
Interclass Correlation Coefficient ◽  
Interclass Correlation ◽  
Significant Difference ◽  
The Difference ◽  
Cross Sectional Design

ABSTRACT Serum using is preferred for urea level because it does not use anticoagulants which can interfere with activity and  reaction to the results. The tubes that are widely used to collect blood into serum are  vacutainer serum separator and  vacutainer plain.This researche aims to determine the degree of agreement s between vacutainer serum separator and vacutainer plain usage on serum urea level result.This research was cross sectional design and hold on October 2020 with subject were taken from  thirty blood samples of health analyst students which taken randomly and had no history of disease or kidney function disorder. Each student was taken 6 ml of blood drawn using a venoject with each vacutainer containing 3 ml, so we had 60 data. The data were analyzed by descriptively and inferentially using the Interclass Correlation Coefficient (ICC) statistical test. From the descriptive analysis, the difference in mean levels was 0.35 mg/dL and the ICC statistical test resulted in a degree of agreement 0.745. The data were analyzed by descriptively and inferentially using the Interclass Correlation Coefficient (ICC) statistical test. From the descriptive analysis, the difference in mean levels was 0.35 mg/dL and the ICC statistical test resulted in a degree of agreement was 0.745. The calculation of the average working time between the vacutainer serum separator and the vacutainer plain was 4 minutes 38 seconds and 35 minutes 58 seconds. The analysis concluded that the vacutainer serum separator and the vacutainer plain could be used as an alternative of blood collecting tubes for urea level testing which proved to be no significant difference in the results from this research. Keywords : Urea level,  Vacutainer Serum Separator,  Vacutainer Plain

scholarly journals Validity of Different Copeptin Assays in the Differential Diagnosis of the Polyuria-Polydipsia Syndrome

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. A637-A637
Author(s):  
Clara Odilia Sailer ◽  
Julie Refardt ◽  
Claudine Angela Blum ◽  
Ingeborg Schnyder ◽  
Jose Alberto Molina-Tijeras ◽  
...  
Keyword(s):  
Differential Diagnosis ◽  
Diagnostic Accuracy ◽  
Diabetes Insipidus ◽  
Healthy Volunteers ◽  
Primary Outcome ◽  
Poor Correlation ◽  
Elisa Assay ◽  
Moderate Correlation ◽  
High Diagnostic Accuracy ◽  
Osmotic Stimulation

Abstract Background: Copeptin is used in the differential diagnosis of diabetes insipidus. Different copeptin immunoassays exist but inter-assay comparability is unclear. The aim of this study was to correlate three commercially available copeptin assays and their diagnostic accuracy in the differential diagnosis of the polyuria-polydipsia-syndrome. Methods: Analyzed data include three different studies: repeated copeptin measures of 8 healthy volunteers undergoing osmotic stimulation; copeptin measures of 40 patients hospitalized with pneumonia; osmotically stimulated copeptin measures of 40 patients with polyuria-polydipsia-syndrome. Copeptin was measured using the automated B.R.A.H.M.S. KRYPTOR, the manual B.R.A.H.M.S. LIA and the manual Cloud Clone ELISA assay. Primary outcome was the diagnostic accuracy in the polyuria-polydipsia-syndrome. Results: In total, 150 copeptin measurements were analyzed. In healthy volunteers, there was a moderate correlation for the KRYPTOR and LIA (interrater correlation coefficient (ICC) 0.74; 95%-CI 0.07-0.91), and a poor correlation for the KRYPTOR and ELISA (ICC 0.07; 95%-CI -0.06-0.29), as for the LIA and ELISA (ICC 0.04; 95%-CI -0.04-0.17). The KRYPTOR had the highest diagnostic accuracy (98% (95%-CI: 83-100)), comparable to the LIA (88% (95%-CI: 74-100)), while the ELISA had a poor diagnostic accuracy (55% (95%-CI: 34-68)) in the differential diagnosis of the polyuria-polydipsia-syndrome. Conclusion: The KRYPTOR and LIA yield comparable copeptin levels and a high diagnostic accuracy, while the ELISA correlates poorly with the other two assays and shows a poor diagnostic accuracy between polyuria-polydipsia patients. Redefining cut-off levels for copeptin assays other than KRYPTOR and LIA must take place before their use in the differential diagnosis of diabetes insipidus.

scholarly journals Reduced gastric injury with a novel, liquid lipid-aspirin formulation: results from a pooled, patient level analysis of two randomized endoscopy studies In healthy volunteers

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
D.L Bhatt ◽  
J Scheiman ◽  
D.J Angiolillo ◽  
P.G Steg ◽  
G.D Dangas ◽  
...  
Keyword(s):  
Healthy Volunteers ◽  
Primary Outcome ◽  
Immediate Release ◽  
Platelet Inhibition ◽  
Gastric Injury ◽  
Funding Source ◽  
Private Company ◽  
Patient Level ◽  
Repeat Endoscopy ◽  
Initiation Of Therapy

Abstract Background Gastrointestinal (GI) toxicity from aspirin is high at the time of initiation of therapy. Objective The current analysis aimed to determine rates of endoscopically detected gastroduodenal erosions and ulcers after 7 days of either immediate release aspirin (IR-ASA) or a novel, pharmaceutical lipid-aspirin complex (PL-ASA) liquid formulation that has an antiplatelet effect similar to IR-ASA. Methods Two randomized, single blind, multicenter active control studies comparing upper GI damage after 7 days of 325 mg PL-ASA or IR-ASA in healthy volunteers not taking a gastroprotectant and who had a negative baseline endoscopy were pooled at the patient level. The primary outcome was the composite of &gt;5 erosions and/or ≥1 ulcer (≥3 mm deep) assessed by a treatment-blinded reviewer at repeat endoscopy on day 7. Results Out of 451 randomized subjects (mean age 57 years, 47% males), 441 completed the 7-day endoscopy and represent the full analysis set. PL-ASA significantly reduced the primary outcome by 34% compared with IR-ASA (25.7% vs. 39%, p=0.0032) (figure). Notably, for ulcers there was a 61% reduction with PL-ASA (6.0% vs. 14.8%, p=0.0018) (Figure 1). The mean number of gastric erosions per patient was also reduced with PL-ASA (2.8±7.3 vs. 4.2±7.5, p&lt;0.0001), while erosions in the duodenum were not different (1.4±7.1 vs. 0.9±2.3, p=0.45). Conclusion The novel PL-ASA liquid capsules reduced rates of GI injury compared with IR-ASA tablets. The combination of reliable platelet inhibition with less GI injury makes PL-ASA an attractive new aspirin therapy option. Figure 1 Funding Acknowledgement Type of funding source: Private company. Main funding source(s): PLx Pharma

scholarly journals 881. Efficacy of Antibiotic Prophylaxis with Vancomycin in Cardiothoracic Surgery

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S477-S477
Author(s):  
Margaret Cooper ◽  
Jing Zhao
Keyword(s):  
Primary Outcome ◽  
Methicillin Resistant Staphylococcus Aureus ◽  
Medical Center ◽  
Surgical Site Infections ◽  
National Healthcare ◽  
National Healthcare Safety Network ◽  
High Incidence ◽  
The Difference ◽  
Gram Negative Organisms ◽  
Discernible Difference

Abstract Background Due to the high incidence of methicillin-resistant Staphylococcus aureus (MRSA) at the Detroit Medical Center, vancomycin is now routinely part of the prophylaxis regimen for cardiothoracic (CT) surgery. The study aims to compare the rate and types of surgical site infections (SSIs) when vancomycin is added to cefazolin for CT surgery compared to cefazolin alone. Methods This was a retrospective cohort study conducted at two university-affiliated hospitals. Patients who underwent CT surgery between January 2008 and August 2017 and had a readmission for SSI within 90 days of procedure were included. Patients who received cefazolin were compared to patients who received both cefazolin and vancomycin for CT surgery prophylaxis. The primary outcome was incidence of SSIs within 90 days of surgery as defined by the Centers for Disease Control and National Healthcare Safety Network. Results Out of 828 patients who underwent CT surgeries, there were 32 patients readmitted within 90 days for SSI. SSI occurred in 4.7% of patients who received cefazolin monotherapy, and 2.4% of patients who received both cefazolin and vancomycin (p=0.095). There was no discernible difference in types of SSI between groups. Pathogens were isolated in 78% of SSIs, with 75% Gram-positive and 19% Gram-negative organisms. SSIs resulted in an average 9.8 days in the hospital and 28.9 days of antibiotic therapy, and led to a total of 15 additional procedures. Conclusion Vancomycin added to cefazolin for prophylaxis in CT surgery resulted in lower incidence of SSI, however the difference was not statistically significant. Disclosures All Authors: No reported disclosures

Pharmacological Modulation of Cutaneous Reactivity to Histamine: A Double-Blind Acute Comparative Study between Cetirizine, Terfenadine and Astemizole

1989 ◽  
Vol 17 (1) ◽  
pp. 24-27 ◽  
Author(s):  
L. Ghys ◽  
J.-P. Rihoux
Keyword(s):  
Comparative Study ◽  
Healthy Volunteers ◽  
Inhibitory Effect ◽  
Blind Study ◽  
Double Blind Study ◽  
Single Administration ◽  
Double Blind ◽  
Pharmacological Modulation ◽  
The Difference ◽  
Cutaneous Reactivity

In a double-blind study performed in 81 healthy volunteers, 10 mg cetirizine and 60 mg terfenadine given orally in a single administration significantly inhibited skin reactivity to histamine. Astemizole (10 mg) was completely ineffective. The inhibitory effect of cetirizine was potent and regular whereas 6/28 (21%) volunteers did not respond to terfenadine. The difference observed beween cetirizine and terfenadine might be due to differences in the metabolism of the two drugs after administration: terfenadine is rapidly and extensively metabolized whereas cetirizine is directly active without the need for biotransformation and, indeed is poorly metabolized.

scholarly journals Quanto funziona il cortisone per os nel broncospasmo acuto in età prescolare? Risultati non confortanti di un RCT

2021 ◽  
Vol 28 (5) ◽  
pp. 2
Author(s):  
Gruppo di lettura di Milano
Keyword(s):  
Primary Outcome ◽  
Oral Prednisolone ◽  
Preschool Age ◽  
Severe Exacerbation ◽  
Intravenous Drug Use ◽  
Emergency Rooms ◽  
Oral Steroids ◽  
The Difference ◽  
Respiratory Outcomes ◽  
To Receive

How does oral cortisone work in acute bronchospasm in preschool age? ARCT with not reassuring results. The 2021 guide of the Global Initiatve for Asthma (GINA) states that the use of oral steroids in preschool children with acute bronchospasm is only recommended in cases of severe exacerbation, however the literature continues to present conflicting results. The Wheeze and Steroids in Preschoolers (WASP) Study, conducted in 3 New Zealand emergency rooms, randomized 477 children aged 24–59 months with acute bronchospasm to receive oral prednisolone for 3 days versus placebo. The respiratory outcomes measured were conflicting: the change in severity score (PRAM) at 24 hours was not different between the 2 groups, while the absolute value of the score at both 4 and 24 hours (secondary outcomes) was significantly lower in the prednisolone group. Hospitalization rate, need for further oral prednisolone treatment, and intravenous drug use were also lower in the prednisolone group. It is debated whether the equivalence design of the study and the margins chosen by the authors for the primary outcome have attenuated the difference between the treatments.

scholarly journals Employing multiple synchronous outcome samples per subject to improve study efficiency

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Roger P. A’Hern
Keyword(s):  
Primary Outcome ◽  
Sampling Error ◽  
Optimum Number ◽  
Intra Class Correlation ◽  
Additional Information ◽  
True Value ◽  
The Difference ◽  
Highly Correlated ◽  
The Cost ◽  
Multiple Samples

Abstract Background Accuracy can be improved by taking multiple synchronous samples from each subject in a study to estimate the endpoint of interest if sample values are not highly correlated. If feasible, it is useful to assess the value of this cluster approach when planning studies. Multiple assessments may be the only method to increase power to an acceptable level if the number of subjects is limited. Methods The main aim is to estimate the difference in outcome between groups of subjects by taking one or more synchronous primary outcome samples or measurements. A summary statistic from multiple samples per subject will typically have a lower sampling error. The number of subjects can be balanced against the number of synchronous samples to minimize the sampling error, subject to design constraints. This approach can include estimating the optimum number of samples given the cost per subject and the cost per sample. Results The accuracy improvement achieved by taking multiple samples depends on the intra-class correlation (ICC). The lower the ICC, the greater the benefit that can accrue. If the ICC is high, then a second sample will provide little additional information about the subject’s true value. If the ICC is very low, adding a sample can be equivalent to adding an extra subject. Benefits of multiple samples include the ability to reduce the number of subjects in a study and increase both the power and the available alpha. If, for example, the ICC is 35%, adding a second measurement can be equivalent to adding 48% more subjects to a single measurement study. Conclusion A study’s design can sometimes be improved by taking multiple synchronous samples. It is useful to evaluate this strategy as an extension of a single sample design. An Excel workbook is provided to allow researchers to explore the most appropriate number of samples to take in a given setting.

scholarly journals Soft Coagulation Using Hemostatic Forceps for Prevention of Postendoscopic Papillectomy Hemorrhage

2018 ◽  
Vol 09 (03) ◽  
pp. 114-117
Author(s):  
Nobuhiko Fukuba ◽  
Hiroki Sonoyama ◽  
Ichiro Moriyama ◽  
Shunji Ishihara ◽  
Yoshikazu Kinoshita
Keyword(s):  
Adverse Events ◽  
Success Rate ◽  
Primary Outcome ◽  
Exact Test ◽  
Conventional Procedure ◽  
Soft Coagulation ◽  
Secondary Endpoints ◽  
Closed Position ◽  
The Difference ◽  
Prophylactic Use

Aim: Few reports of the prophylactic use of soft coagulation with hemostatic forceps for postendoscopic papillectomy hemorrhage (PEPH) have been presented. The aim of this study was to clarify the utility of that procedure for prophylaxis. Materials and Methods: From April 2009 to March 2012, PEPH was treated in four patients after the development of the condition with a conventional procedure at our institution. Thereafter, from April 2012 to March 2016, soft coagulation using hemostatic forceps was performed as prophylactic hemostasis following an EP in five patients. For the latter procedure, the hemostatic forceps device (FD411‑QR, Olympus, Tokyo, Japan) was used in a closed position, with the coagulation wave set at 60 W (VIO 300D; ERBE, Tubingen, Germany). The primary outcome was the onset of PEPH, which was defined as a decrease in hemoglobin ≥2 g/dL after EP. Secondary endpoints were the success rate and the incidence of adverse events of soft coagulation using hemostatic forceps for emergency bleeding cases after EP. Results: The incidence of PEPH was 20% (1 of 5 cases) in the prophylactic procedure group, which was lower than that in the conventional procedures group (75%, 3 of 4 cases), though the difference was not statistically significant (P = 0.206, Fisher’s exact test). All cases of PEPH were successfully treated by soft coagulation using hemostatic forceps. Conclusion: Soft coagulation with hemostatic forceps may be suitable for use as a routine technique following EP to prevent PEPH.

scholarly journals Indwelling urinary catheters, aortic valve treatment and delirium: a prospective cohort study

BMJ Open ◽  
2018 ◽  
Vol 8 (11) ◽  
pp. e021708 ◽  
Author(s):  
Leslie SP Eide ◽  
Anette H Ranhoff ◽  
Sandra Lauck ◽  
Bengt Fridlund ◽  
Rune Haaverstad ◽  
...  
Keyword(s):  
Cohort Study ◽  
Aortic Valve ◽  
Prospective Cohort Study ◽  
Prospective Cohort ◽  
Postoperative Delirium ◽  
Primary Outcome ◽  
University Hospital ◽  
Transcatheter Aortic Valve ◽  
The Difference ◽  
Valve Implantation

ObjectivesTo determine whether an association exists between delirium and length of time indwelling urine catheters (IUC) are used in octogenarian patients treated with surgical aortic valve treatment (SAVR) or transcatheter aortic valve implantation (TAVI).DesignProspective cohort study.SettingTertiary university hospital covering the western region of Norway.ParticipantsOctogenarian patients undergoing elective SAVR or TAVI and willing to participate in the study were eligible. Patients unable to speak Norwegian were excluded. Between 2011 and 2013, 143 consecutive patients were included, and data from 136 of them are presented.Primary outcomeDelirium.ResultsLogistic regression analysis shows that lower cognitive function was positively associated with delirium (OR 0.86, CI 0.74 to 0.99, p=0.047). Besides, the interaction term in the model shows that IUC use and delirium differed between SAVR and TAVI patients (p=0.04). The difference corresponded to a weaker association between hours of IUC use and delirium for SAVR (OR 1.01, CI: 0.99 to 1.03, p=0.54) compared with that for TAVI (OR 1.04, CI: 1.01 to 1.08, p=0.004).ConclusionsThe association between IUC use and delirium is stronger for octogenarian patients treated with TAVI than for patients who received SAVR. Our results revealed a previously unknown association between the number of hours an IUC is used and postoperative delirium in octogenarian patients treated with TAVI.

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