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[PMID]:28463870
[Au] Autor:Pines JM; Zocchi MS; Buchanan ME; Shah MN; Travers D
[Ad] Endereço:Center for Healthcare Innovation and Policy Research (Dr Pines and Mr Zocchi), Department of Emergency Medicine (Dr Pines), and School of Medicine and Health Sciences (Ms Buchanan), The George Washington University, Washington, District of Columbia; Department of Emergency Medicine, The University of Wisconsin-Madison (Dr Shah); and School of Nursing (Dr Travers) and Department of Emergency Medicine (Dr Travers), The University of North Carolina at Chapel Hill.
[Ti] Título:The Utility of Point-of-Care Testing at Emergency Department Triage by Nurses in Simulated Scenarios.
[So] Source:Adv Emerg Nurs J;39(2):152-158, 2017 Apr/Jun.
[Is] ISSN:1931-4493
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:We developed and tested simulated patient scenarios to assess how normal or abnormal point-of-care (POC) test results at triage change prioritization decisions. This was a cross-sectional study where our team developed simulated scenarios and presented them to triage nurses from 3 academic medical centers. Twenty-four scenarios were constructed on the basis of 12 clinical indications from a protocol previously developed by our team. In each scenario, nurses were presented with 2 patients with the same Emergency Severity Index Version 4 (ESI v.4; Agency for Healthcare Research and Quality, Rockville, MD) triage level (Level 2 or Level 3). One of the patients met the inclusion criteria for POC testing under the protocol (cases), whereas the other patient did not (controls). Nurses were asked which of the 2 patients to prioritize first in 3 separate rounds: first without any POC test results, once with abnormal POC test results for case patients, and once with normal POC test results for case patients. Prioritization decisions that changed on the basis of abnormal POC results were defined as "up-triage" and prioritization decisions that changed on the basis of normal results were defined as "down-triage." A total of 39 nurses completed 468 scenarios. In scenarios without any POC test results, 42.3% of case patients were prioritized first. When POC test results were abnormal, 71.6% of cases were prioritized first. When POC test results were normal, 32.7% of case patients were prioritized first. An abnormal POC test resulted in up-triage in 32.5% of the scenarios. When POC test results were normal, there was down-triage in 18.6% of the scenarios. Up- and down-triage rates varied considerably by scenario and clinical indication. Point-of-care testing at emergency department triage results in reasonably high rates of up- and down-triage in simulated scenarios; however, POC tests for specific indications appear to be more useful than others.
[Mh] Termos MeSH primário: Serviço Hospitalar de Emergência/organização & administração
Recursos Humanos de Enfermagem no Hospital
Testes Imediatos
Triagem
[Mh] Termos MeSH secundário: Feminino
Seres Humanos
Masculino
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1803
[Cu] Atualização por classe:180309
[Lr] Data última revisão:
180309
[Sb] Subgrupo de revista:IM; N
[Da] Data de entrada para processamento:170503
[St] Status:MEDLINE
[do] DOI:10.1097/TME.0000000000000140


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[PMID]:28451755
[Au] Autor:Bosi M; De Vito A; Bellini C; D'Agostino G; Firinu E; Gobbi R; Pacella A; Filograna Pignatelli G; Zeccardo E; Poletti V; Vicini C
[Ad] Endereço:Department of Diseases of the Thorax, GB Morgagni-Pierantoni Hospital, AUSL of Romagna, Forlì, Italy.
[Ti] Título:The interpretation of compact polysomnography/polygraphy in sleep breathing disorders patients: a validation's study.
[So] Source:Eur Arch Otorhinolaryngol;274(8):3251-3257, 2017 Aug.
[Is] ISSN:1434-4726
[Cp] País de publicação:Germany
[La] Idioma:eng
[Ab] Resumo:The Otorhinolaryngologist (ENT) frequently has to deal with OSA or suspicious OSA patients and undergone polysomnography (PSG) or portable monitoring (PM) and should be confident about the quality and consistency of the polysomnographic diagnosis. The main polysomnographic traces compressed in a unique epoch, defined as compact PSG/PM (CP), could represent an efficient tool to confirm the quality of PSG/PM Sleep Breathing Disorders diagnosis. This is a validation's study of a CP interpretation's method, analyzing the learning curve, the level of diagnostic accuracy, and the inter-operator agreement in interpreting the CP pattern between a group of ENT specialists not skilled in PSG/PM scoring, but managing SBD patients during daily practice. Seven ENT specialists have been enrolled in the study. 50 CP traces (ranging from normal to all main SBD patterns) have been showed to each participant for the interpretation and scoring process, before and after a 2-h theoretical-practical interactive lesson, focusing on the recognition of the four main oximetric patterns on CP traces (normal, phasic, prolonged, and overlap patterns). RESULTS: before and after the theoretical-practical interactive lesson, the whole diagnostic accuracy in interpreting the 50 CP has been reported improved from 0.12 to 0.80 (median 0.52) to 0.82-0.96 (median 0.92) (p = 0.006) and the inter-scorers' agreement showed a kappa value increased from of 0.18 to 0.75 (p < 0.0001). A complete clinical diagnostic evaluation is essential in OSA patients and the ENT specialist should be concerned to verify if the patient, suitable for surgical therapy, is affected really by an isolated form of OSA. The CP interpretation allows a checking of the proper nosographic SBD framework and could be significantly important for all ENT specialists not skilled in PSG/PM scoring, but managing SBD patients during daily practice. The data reported in our validation's study showed that the CP interpretation's method is easy to apply, with a rapid learning curve. The level of diagnostic accuracy is high with a high inter-scorer agreement in interpreting the CP patterns.
[Mh] Termos MeSH primário: Otolaringologia/educação
Testes Imediatos/normas
Polissonografia
Síndromes da Apneia do Sono/diagnóstico
[Mh] Termos MeSH secundário: Precisão da Medição Dimensional
Feminino
Seres Humanos
Itália
Curva de Aprendizado
Masculino
Meia-Idade
Oximetria/métodos
Administração dos Cuidados ao Paciente/métodos
Administração dos Cuidados ao Paciente/normas
Polissonografia/métodos
Polissonografia/normas
Desenvolvimento de Pessoal/métodos
[Pt] Tipo de publicação:JOURNAL ARTICLE; VALIDATION STUDIES
[Em] Mês de entrada:1803
[Cu] Atualização por classe:180307
[Lr] Data última revisão:
180307
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170429
[St] Status:MEDLINE
[do] DOI:10.1007/s00405-017-4578-8


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[PMID]:29304090
[Au] Autor:Mpoza E; Mukaremera L; Kundura DA; Akampurira A; Luggya T; Tadeo KK; Pastick KA; Bridge SC; Tugume L; Kiggundu R; Musubire AK; Williams DA; Muzoora C; Nalintya E; Rajasingham R; Rhein J; Boulware DR; Meya DB; Abassi M
[Ad] Endereço:Infectious Diseases Institute, Kampala, Uganda.
[Ti] Título:Evaluation of a point-of-care immunoassay test kit 'StrongStep' for cryptococcal antigen detection.
[So] Source:PLoS One;13(1):e0190652, 2018.
[Is] ISSN:1932-6203
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: HIV-associated cryptococcal meningitis is the leading cause of adult meningitis in Sub-Saharan Africa, accounting for 15%-20% of AIDS-attributable mortality. The development of point-of-care assays has greatly improved the screening and diagnosis of cryptococcal disease. We evaluated a point-of-care immunoassay, StrongStep (Liming Bio, Nanjing, Jiangsu, China) lateral flow assay (LFA), for cryptococcal antigen (CrAg) detection in cerebrospinal fluid (CSF) and plasma. METHODS: We retrospectively tested 143 CSF and 77 plasma samples collected from HIV-seropositive individuals with suspected meningitis from 2012-2016 in Uganda. We prospectively tested 90 plasma samples collected from HIV-seropositive individuals with CD4 cell count <100 cells/µL from 2016-2017 as part of a cryptococcal antigenemia screening program. The StrongStep CrAg was tested against a composite reference standard of positive Immy CrAg LFA (Immy, Norman, OK, USA) or CSF culture with statistical comparison by McNemar's test. RESULTS: StrongStep CrAg had a 98% (54/55) sensitivity and 90% (101/112) specificity in plasma (P = 0.009, versus reference standard). In CSF, the StrongStep CrAg had 100% (101/101) sensitivity and 98% (41/42) specificity (P = 0.99). Adjusting for the cryptococcal antigenemia prevalence of 9% in Uganda and average cryptococcal meningitis prevalence of 37% in Sub-Saharan Africa, the positive predictive value of the StrongStep CrAg was 50% in plasma and 96% in CSF. CONCLUSIONS: We found the StrongStep CrAg LFA to be a sensitive assay, which unfortunately lacked specificity in plasma. In lower prevalence settings, a majority of positive results from blood would be expected to be false positives.
[Mh] Termos MeSH primário: Antígenos de Fungos/sangue
Antígenos de Fungos/líquido cefalorraquidiano
Cryptococcus/imunologia
Imunoensaio/métodos
Testes Imediatos
[Mh] Termos MeSH secundário: Adulto
Idoso
Contagem de Linfócito CD4
Feminino
Seres Humanos
Imunoensaio/normas
Masculino
Meia-Idade
Estudos Retrospectivos
[Pt] Tipo de publicação:JOURNAL ARTICLE; RESEARCH SUPPORT, N.I.H., EXTRAMURAL; RESEARCH SUPPORT, NON-U.S. GOV'T; VALIDATION STUDIES
[Nm] Nome de substância:
0 (Antigens, Fungal)
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180215
[Lr] Data última revisão:
180215
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:180106
[St] Status:MEDLINE
[do] DOI:10.1371/journal.pone.0190652


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[PMID]:29382017
[Au] Autor:Piskin Ö; Öz II
[Ad] Endereço:Department of Anesthesiology and Reanimation.
[Ti] Título:Accuracy of pleth variability index compared with inferior vena cava diameter to predict fluid responsiveness in mechanically ventilated patients.
[So] Source:Medicine (Baltimore);96(47):e8889, 2017 Nov.
[Is] ISSN:1536-5964
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:In the intensive care unit (ICU), stable hemodynamics are very important. Hemodynamic intervention is often effective against multiple organ failure, such as in tissue hypoxia and shock. The administration of intravenous fluids is the first step in regulating tissue perfusion.The main objective of this study is to compare the performance between 2 methods namely pleth variability index (PVI) and IVC distensibily index (dIVC).In this study, the hemodynamic measurements were performed before and after passive leg raising (PLR). Measurements were obtained, including, PVI, dIVC, and cardiac index (CI). Both CI and dIVC measurements were evaluated by transesophageal probe and convex probe respectively. The dIVC measurements were taken using M-mode, 2 cm from junction between the right atrium and the inferior vena cava. The PVI was measured by Masimo Radical-7 monitor, Masimo.A total of 72 patients were included. The dIVC at a threshold value of >23.8% provided 80% sensitivity and 87.5% specificity to predict fluid responsiveness and was statistically significant (P < .001), with an AUC 0.928 (0.842-0.975). The PVI at a threshold value of >14% provided 95% sensitivity and 81.2% specificity to predict fluid responsiveness and was statistically significant (P < .001), with an AUC 0.939 (0.857-0.982).Both PVI and dIVC can be used as a noninvasive method that can be easily applied at the bedside in determining fluid responsiveness in all patients with mechanical ventilation in intensive care.
[Mh] Termos MeSH primário: Hidratação/métodos
Monitorização Fisiológica/métodos
Testes Imediatos
Respiração Artificial/métodos
Veia Cava Inferior/patologia
[Mh] Termos MeSH secundário: Idoso
Idoso de 80 Anos ou mais
Feminino
Hemodinâmica
Seres Humanos
Unidades de Terapia Intensiva
Masculino
Meia-Idade
Pletismografia/métodos
Estudos Prospectivos
Sensibilidade e Especificidade
[Pt] Tipo de publicação:COMPARATIVE STUDY; EVALUATION STUDIES; JOURNAL ARTICLE
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180207
[Lr] Data última revisão:
180207
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:180201
[St] Status:MEDLINE
[do] DOI:10.1097/MD.0000000000008889


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[PMID]:29320558
[Au] Autor:Dolscheid-Pommerich RC; Dolscheid S; Eichhorn L; Stoffel-Wagner B; Graeff I
[Ad] Endereço:Department of Clinical Chemistry and Clinical Pharmacology, University Hospital Bonn, Bonn, Germany.
[Ti] Título:Thrombolysis in stroke patients: Comparability of point-of-care versus central laboratory international normalized ratio.
[So] Source:PLoS One;13(1):e0190867, 2018.
[Is] ISSN:1932-6203
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: In acute stroke patients, thrombolysis is one gold standard therapy option within the first four hours after the ischemic event. A contraindication for thrombolysis is an International Normalized Ratio (INR) value >1.7. Since time is brain, rapid and reliable INR results are fundamental. Aim was to compare INR values determined by central laboratory (CL) analyzer and Point-of-Care Testing(POCT)-device and to evaluate the quality of POCT performance in cases of potential therapeutic thrombolysis at a certified stroke unit. METHODS: In 153 patients INR measurements using POCT-devices (HEMOCHRON Signature Elite®) were compared to INR measurements (BCS®XP) performed at the central laboratory. Outlier evaluation was performed regarding the critical thrombolysis cut-off. RESULTS: Overall, we demonstrated a significant correlation (r = 0.809, p<0.0001) between both measurement methods. Mean value of the absolute difference between CL-INR and POCT-INR measurements was 0.23. In 95.4% of these cases, no differences regarding the critical cut-off (INR 1.7) were observed. POCT-INR values tended to be higher than the CL-INR values (p = 0.01). In 4.6% cases, a different value regarding thrombolysis cut-off was found. All patients were >75 years. CONCLUSIONS: POCT-INR measurements based on our POCT concept are suitable to determine INR values in critical stroke patients. Nevertheless, outlier evaluation is mandatory.
[Mh] Termos MeSH primário: Serviços de Laboratório Clínico
Coeficiente Internacional Normatizado/métodos
Testes Imediatos
Acidente Vascular Cerebral/sangue
Acidente Vascular Cerebral/tratamento farmacológico
Terapia Trombolítica
[Mh] Termos MeSH secundário: Adolescente
Adulto
Idoso
Idoso de 80 Anos ou mais
Anticoagulantes/uso terapêutico
Serviços Médicos de Emergência
Feminino
Fibrinolíticos/uso terapêutico
Seres Humanos
Coeficiente Internacional Normatizado/instrumentação
Masculino
Meia-Idade
Estudos Retrospectivos
Terapia Trombolítica/métodos
Adulto Jovem
[Pt] Tipo de publicação:COMPARATIVE STUDY; JOURNAL ARTICLE; OBSERVATIONAL STUDY
[Nm] Nome de substância:
0 (Anticoagulants); 0 (Fibrinolytic Agents)
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180205
[Lr] Data última revisão:
180205
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:180111
[St] Status:MEDLINE
[do] DOI:10.1371/journal.pone.0190867


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[PMID]:28463879
[Au] Autor:Long LC; Maskew M; Brennan AT; Mongwenyana C; Nyoni C; Malete G; Sanne I; Fox MP; Rosen S
[Ad] Endereço:aDepartment of Internal Medicine, School of Clinical Medicine, Faculty of Health Sciences, University of Witwatersrand bHealth Economics and Epidemiology Research Office, Wits Health Consortium, Johannesburg, South Africa cDepartment of Global Health dDepartment of Epidemiology, School of Public Health, Boston University, Boston, Massachusetts, USA.
[Ti] Título:Initiating antiretroviral therapy for HIV at a patient's first clinic visit: a cost-effectiveness analysis of the rapid initiation of treatment randomized controlled trial.
[So] Source:AIDS;31(11):1611-1619, 2017 Jul 17.
[Is] ISSN:1473-5571
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:OBJECTIVE: Determine the cost and cost-effectiveness of single-visit (same-day) antiretroviral treatment (ART) initiation compared to standard of care initiation. DESIGN: Cost-effectiveness analysis of individually randomized (1 : 1) pragmatic trial of single-visit initiation, which increased viral suppression at 10 months by 26% [relative risk (95% confidence interval) 1.26 (1.05-1.50)]. SETTING: Primary health clinic in Johannesburg, South Africa. STUDY PARTICIPANTS: HIV positive, adult, nonpregnant patients not yet on ART or known to be eligible who presented at the clinic 8 May 2013 to 29 August 2014. INTERVENTION: Same-day ART initiation using point-of-care laboratory instruments and accelerated clinic procedures to allow treatment-eligible patients to receive antiretroviral medications at the same visit as testing HIV positive or having an eligible CD4 cell count. Comparison was to standard of care ART initiation, which typically required three to five additional clinic visits. MAIN OUTCOME MEASURE(S): Average cost per patient enrolled and per patient achieving the primary outcome of initiated 90 days or less and suppressed 10 months or less, and production cost per patient achieving primary outcome (all costs per primary outcome patients). RESULTS: The average cost per patient enrolled, per patient achieving the primary outcome, and production cost were $319, $487, and $738 in the standard arm and $451, $505, and $707 in the rapid arm. CONCLUSION: Same-day treatment initiation was more effective than standard initiation, more expensive per patient enrolled, and less expensive to produce a patient achieving the primary outcome. Omitting point-of-care laboratory tests at initiation and focusing on high-volume clinics have the potential to reduce costs substantially and should be evaluated in routine settings.
[Mh] Termos MeSH primário: Fármacos Anti-HIV/administração & dosagem
Fármacos Anti-HIV/economia
Infecções por HIV/tratamento farmacológico
Infecções por HIV/economia
Visita a Consultório Médico/economia
Testes Imediatos
Atenção Primária à Saúde
[Mh] Termos MeSH secundário: Assistência Ambulatorial/economia
Assistência Ambulatorial/métodos
Contagem de Linfócito CD4
Análise Custo-Benefício
Infecções por HIV/imunologia
Seres Humanos
Testes Imediatos/economia
Atenção Primária à Saúde/economia
África do Sul
Fatores de Tempo
Resultado do Tratamento
[Pt] Tipo de publicação:JOURNAL ARTICLE; PRAGMATIC CLINICAL TRIAL; RANDOMIZED CONTROLLED TRIAL
[Nm] Nome de substância:
0 (Anti-HIV Agents)
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180202
[Lr] Data última revisão:
180202
[Sb] Subgrupo de revista:IM; X
[Da] Data de entrada para processamento:170503
[St] Status:MEDLINE
[do] DOI:10.1097/QAD.0000000000001528


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[PMID]:28747205
[Au] Autor:Fingerhuth SM; Low N; Bonhoeffer S; Althaus CL
[Ad] Endereço:Institute of Integrative Biology, ETH Zurich, Zurich, 8092, Switzerland. stephanie.fingerhuth@env.ethz.ch.
[Ti] Título:Detection of antibiotic resistance is essential for gonorrhoea point-of-care testing: a mathematical modelling study.
[So] Source:BMC Med;15(1):142, 2017 07 26.
[Is] ISSN:1741-7015
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Antibiotic resistance is threatening to make gonorrhoea untreatable. Point-of-care (POC) tests that detect resistance promise individually tailored treatment, but might lead to more treatment and higher levels of resistance. We investigate the impact of POC tests on antibiotic-resistant gonorrhoea. METHODS: We used data about the prevalence and incidence of gonorrhoea in men who have sex with men (MSM) and heterosexual men and women (HMW) to calibrate a mathematical gonorrhoea transmission model. With this model, we simulated four clinical pathways for the diagnosis and treatment of gonorrhoea: POC test with (POC+R) and without (POC-R) resistance detection, culture and nucleic acid amplification tests (NAATs). We calculated the proportion of resistant infections and cases averted after 5 years, and compared how fast resistant infections spread in the populations. RESULTS: The proportion of resistant infections after 30 years is lowest for POC+R (median MSM: 0.18%, HMW: 0.12%), and increases for culture (MSM: 1.19%, HMW: 0.13%), NAAT (MSM: 100%, HMW: 99.27%), and POC-R (MSM: 100%, HMW: 99.73%). Per 100 000 persons, NAAT leads to 36 366 (median MSM) and 1228 (median HMW) observed cases after 5 years. Compared with NAAT, POC+R averts more cases after 5 years (median MSM: 3353, HMW: 118). POC tests that detect resistance with intermediate sensitivity slow down resistance spread more than NAAT. POC tests with very high sensitivity for the detection of resistance are needed to slow down resistance spread more than by using culture. CONCLUSIONS: POC with high sensitivity to detect antibiotic resistance can keep gonorrhoea treatable longer than culture or NAAT. POC tests without reliable resistance detection should not be introduced because they can accelerate the spread of antibiotic-resistant gonorrhoea.
[Mh] Termos MeSH primário: Antibacterianos/uso terapêutico
Resistência Microbiana a Medicamentos
Gonorreia/tratamento farmacológico
Gonorreia/transmissão
Modelos Teóricos
Neisseria gonorrhoeae/efeitos dos fármacos
Testes Imediatos
[Mh] Termos MeSH secundário: Adulto
Feminino
Gonorreia/microbiologia
Seres Humanos
Incidência
Masculino
Testes de Sensibilidade Microbiana/métodos
Testes de Sensibilidade Microbiana/estatística & dados numéricos
Técnicas de Amplificação de Ácido Nucleico/métodos
Técnicas de Amplificação de Ácido Nucleico/estatística & dados numéricos
Sistemas Automatizados de Assistência Junto ao Leito/normas
Sistemas Automatizados de Assistência Junto ao Leito/estatística & dados numéricos
Testes Imediatos/normas
Testes Imediatos/estatística & dados numéricos
Prevalência
Adulto Jovem
[Pt] Tipo de publicação:JOURNAL ARTICLE; RESEARCH SUPPORT, NON-U.S. GOV'T
[Nm] Nome de substância:
0 (Anti-Bacterial Agents)
[Em] Mês de entrada:1712
[Cu] Atualização por classe:180127
[Lr] Data última revisão:
180127
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170728
[St] Status:MEDLINE
[do] DOI:10.1186/s12916-017-0881-x


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[PMID]:29303719
[Au] Autor:Bury D; Martin-Hirsch PL; Martin FL; Dawson TP
[Ad] Endereço:School of Pharmacy and Biomedical Sciences, University of Central Lancashire, Lancashire, Preston, UK.
[Ti] Título:Are new technologies translatable to point-of-care testing?
[So] Source:Lancet;390(10114):2765-2766, 2018 12 23.
[Is] ISSN:1474-547X
[Cp] País de publicação:England
[La] Idioma:eng
[Mh] Termos MeSH primário: Neoplasias/diagnóstico
Testes Imediatos
[Mh] Termos MeSH secundário: Seres Humanos
Invenções
Espectroscopia de Ressonância Magnética
Análise Espectral
Pesquisa Médica Translacional
Vibração
[Pt] Tipo de publicação:LETTER
[Em] Mês de entrada:1801
[Cu] Atualização por classe:180117
[Lr] Data última revisão:
180117
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:180106
[St] Status:MEDLINE


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[PMID]:29180192
[Au] Autor:Zivkovic AR; Tourelle KM; Brenner T; Weigand MA; Hofer S; Schmidt K
[Ad] Endereço:Department of Anesthesiology, Heidelberg University Hospital, Heidelberg, Germany. Electronic address: aleksandar.zivkovic@med.uni-heidelberg.de.
[Ti] Título:Reduced serum cholinesterase activity indicates splenic modulation of the sterile inflammation.
[So] Source:J Surg Res;220:275-283, 2017 Dec.
[Is] ISSN:1095-8673
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Sterile inflammation is an immediate and well-coordinated immune response to surgical injury. The cholinergic system plays a pivotal role in the inflammatory response. Induced inflammation stimulates the vagus nerve, which in turn activates anti-inflammatory nonneuronal processes. Serum cholinesterase (butyrylcholinesterase [BChE]) is an enzyme that hydrolyzes acetylcholine. Measuring the activity of the BChE in blood might indicate the level of the nonneuronal cholinergic activity. The spleen is a major organ of the immune system playing an important role during inflammation. A functional connection of the neuroimmune reflex has thus far been described only in experimental settings. MATERIALS AND METHODS: In 48 patients receiving major pancreatic surgery, BChE activity was measured by applying point-of-care-testing, in addition to standard laboratory tests. RESULTS: The BChE activity decreased in patients receiving surgery. This reduction emerged much earlier than changes in C-reactive protein concentration, an inflammatory biomarker broadly used in the clinical environment. A milder reduction in the BChE activity was observed in patients subjected to surgery with splenectomy than in those with a preserved spleen. CONCLUSIONS: The use of the point-of-care-testing system for quick bedside diagnostics and the rapid effects of inflammation on BChE levels provide a method and a marker to facilitate the early detection of systemic inflammation. Furthermore, this study provides evidence that the experimentally documented neuroimmune interaction is part of the physiological response to surgery-induced sterile inflammation. Splenic function plays an essential role in modulating the cholinergic anti-inflammatory response.
[Mh] Termos MeSH primário: Butirilcolinesterase/sangue
Testes Imediatos
Complicações Pós-Operatórias/diagnóstico
Baço/imunologia
Síndrome de Resposta Inflamatória Sistêmica/diagnóstico
[Mh] Termos MeSH secundário: Idoso
Procedimentos Cirúrgicos do Sistema Digestório/efeitos adversos
Feminino
Seres Humanos
Masculino
Meia-Idade
Pâncreas/cirurgia
Complicações Pós-Operatórias/enzimologia
Complicações Pós-Operatórias/imunologia
Síndrome de Resposta Inflamatória Sistêmica/enzimologia
Síndrome de Resposta Inflamatória Sistêmica/imunologia
[Pt] Tipo de publicação:CLINICAL TRIAL; JOURNAL ARTICLE
[Nm] Nome de substância:
EC 3.1.1.8 (Butyrylcholinesterase)
[Em] Mês de entrada:1712
[Cu] Atualização por classe:171211
[Lr] Data última revisão:
171211
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:171129
[St] Status:MEDLINE


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[PMID]:29173326
[Au] Autor:Futatani T; Shimao A; Ina S; Higashiyama H; Fujita S; Ueno K; Igarashi N; Hatasaki K
[Ad] Endereço:Department of Pediatrics, Toyama Prefectural Central Hospital, Toyama, Japan. Electronic address: futatani@tch.pref.toyama.jp.
[Ti] Título:Capillary Blood Ketone Levels as an Indicator of Inadequate Breast Milk Intake in the Early Neonatal Period.
[So] Source:J Pediatr;191:76-81, 2017 Dec.
[Is] ISSN:1097-6833
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:OBJECTIVE: To determine the utility of capillary blood ketone levels as an indicator of inadequate intake of breast milk in the early postnatal period. STUDY DESIGN: Levels of capillary blood beta-hydroxybutyrate (ßOHB), the main ketone body in the blood, were measured with a bedside ketone meter in 585 full-term neonates aged 48-95 hours who were breastfed exclusively. Relationships between weight-loss percentage, blood sodium, glucose, pH, partial pressure of carbon dioxide, base-deficit levels, and ßOHB levels were investigated. The diagnostic accuracy of ßOHB for predicting excessive weight loss (weight loss ≥10% of birth weight) and hypernatremic dehydration (blood sodium level ≥150 mEq/L) was determined. RESULTS: ßOHB levels were correlated positively with weight-loss percentage and blood sodium levels and were correlated negatively with blood glucose levels. The diagnostic accuracy of ßOHB was 0.846 (optimal cut off, 1.55 mmol/L; sensitivity, 80.9%, specificity, 74.0%) for predicting excessive weight loss and 0.868 (optimal cut off, 1.85 mmol/L; sensitivity, 94.3%; specificity, 69.9%) for predicting hypernatremic dehydration according to the area under the receiver operating characteristic curve. Multiple logistic analysis revealed that ßOHB and weight loss percentage were the only independent predictors of hypernatremic dehydration. Increases in ßOHB levels also were associated with worsening metabolic acidosis and hypocapnia. CONCLUSION: High ßOHB levels were associated with inadequate intake of breast milk in the early postnatal period. The use of bedside capillary blood ketone levels may be clinically useful as an indicator of dehydration, energy depletion, and acid-base imbalance in breastfeeding infants in the early postnatal period.
[Mh] Termos MeSH primário: Ácido 3-Hidroxibutírico/sangue
Desequilíbrio Ácido-Base/diagnóstico
Aleitamento Materno
Desidratação/diagnóstico
Desnutrição/diagnóstico
[Mh] Termos MeSH secundário: Desequilíbrio Ácido-Base/sangue
Desequilíbrio Ácido-Base/etiologia
Biomarcadores/sangue
Capilares
Desidratação/sangue
Desidratação/etiologia
Feminino
Seres Humanos
Cuidado do Lactente
Recém-Nascido
Modelos Logísticos
Masculino
Desnutrição/sangue
Desnutrição/etiologia
Testes Imediatos
Sensibilidade e Especificidade
Perda de Peso
[Pt] Tipo de publicação:CLINICAL TRIAL; JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Biomarkers); TZP1275679 (3-Hydroxybutyric Acid)
[Em] Mês de entrada:1712
[Cu] Atualização por classe:171211
[Lr] Data última revisão:
171211
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:171128
[St] Status:MEDLINE



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