Handling of lipemic samples in the clinical laboratory

Interferences in the clinical laboratory may lead physicians misinterpret results for some biological analytes. The most common analytical interferences in the clinical laboratory include hemolysis, icterus and lipemia. Lipemia is defined as turbidity in a sample caused by the accumulation of lipoproteins, mainly very-low density lipoproteins (VLDL) and chylomicrons. Several methods are available for the detection of lipemic samples, including the lipemic index, or triglyceride quantification in serum or plasma samples, or mean corpuscular hemoglobin (MCHC) concentration in blood samples. According to the European Directive 98/79/CE, it is the responsibility of clinical laboratories to monitor the presence of interfering substances that may affect the measurement of an analyte. There is an urgent need to standardize interference studies and the way interferences are reported by manufacturers. Several methods are currently available to remove interference from lipemia and enable accurate measurement of biological quantities. The clinical laboratory should establish a protocol for the handling of lipemic samples according to the biological quantity to be tested

First insights into the binding mechanism and colour effect of the interaction of grape seed 11S globulin with malvidin 3-O-glucoside by fluorescence spectroscopy, differential colorimetry and molecular modelling

Recently, the search for alternative proteins endogenous to grapes to be used as wine colour protecting agents became an important research trend. In this study, the molecular interaction between the grape seed 11S globulin from winemaking by-product and malvidin-3-O-glucoside was investigated by fluorescence, differential colorimetry and molecular modelling. Fluorescence studies revealed the formation of grape seed protein- pigment complex whose KS was 8.5 × 104 M−1 and binding sites, n = 1.3. Malvidin-3-O-glucoside showed darker and more vivid bluish colour of in the presence of 11S globulin, suggesting the flavylium cation protection in a hydrophobic region of the protein. Docking analysis and molecular dynamics simulation indicated that malvidin-3-O-glucoside interacts mainly with the acidic subunit (40 kDa) of the 11S globulin monomer (60 kDa). An average of two hydrogen bonds and Van der Wall forces were the main interaction forces found for the protein-pigment complex, whose stability was confirmed by root-means-square deviation. © 2023 Elsevier LtdMinisterio de Economía y Competitividad (MINECO). España PID2021-127126OB-C2Junta de Castilla-León SA0093P20European Commission (EC). Fondo Europeo de Desarrollo Regional (FEDER) SA0093P2

Manejo de muestras lipémicas en el Laboratorio Clínico

Las interferencias analíticas en el laboratorio clínico pueden causar errores en la interpretación de los resultados de diversas magnitudes biológicas por parte del médico peticionario. Las interferencias analíticas más frecuentemente observadas en el laboratorio clínico son la hemólisis, ictericia y lipemia. La lipemia se define como la turbidez de la muestra causada por la acumulación de lipoproteínas, principalmente lipoproteínas de muy baja densidad (VLDL) y quilomicrones. Existen diversos métodos de detección de muestras lipémicas, como por ejemplo, el índice lipémico o la determinación de triglicéridos en muestras de suero o plasma o la Concentración de Hemoglobina Corpuscular Media (CHCM) en muestras de sangre. Las empresas de diagnóstico in vitro son las responsables, según la Directiva Europea 98/79/CE, de realizar el estudio de las sustancias interferentes que pueden afectar a la medición de una magnitud. Existe una necesidad urgente de estandarizar la forma

Utilidad diagnóstica de los marcadores de estrés oxidativo en artritis reumatoide precoz en pacientes no fumadores y anti-CCP negativos

Fundamento. A pesar del desarrollo de nuevos marcadores y cri- terios diagnósticos para la artritis reumatoide (AR), todavía mu- chos pacientes son diagnosticados tras varios años de síntomas. Los marcadores de estrés oxidativo se incrementan ya en una fase temprana de la enfermedad. El objetivo del presente estudio fue evaluar el valor diagnóstico adicional de estos marcadores. Método. Se realizó un estudio de casos y controles. Los pacien- tes reclutados para el estudio cumplían los criterios para AR de la ACR 1987, todos ellos tenían menos de 2 años de síntomas y sin tratamiento previo con fármacos modificadores de la enfer- medad antirreumática (DMARD), esteroides o vitamina E. Los controles fueron seleccionados de los familiares del paciente y pareados (1:1) por sexo, edad, hábito tabáquico actual. Los marcadores de daño oxidativo que se midieron fueron malo- nildialdehído (MDA), hidroperóxidos lipídicos (LOOH) y pro- teínas carboniladas (CP). El Análisis estadístico se realizó de acuerdo con la STARD. resultados. Se incluyeron sesenta y cinco pacientes con AR sin tratamiento y 65 controles sanos. LOOH, CP, los anticuerpos con péctidos citrulinados (anti-CCP) y el factor reumatoide (FR) fueron significativamente mayores en los pacientes, y MDA fue mayor en los controles. Los mismos resultados se obtuvieron en los subgrupos de pacientes que fuman o no, y en anti-CCP positivos o negativos. El valor diagnóstico de los marcadores tradicionales mostró una buena especificidad pero una baja sensibilidad. La construcción de los modelos logísti- cos con la adicción de LOOH y CP aumenta la sensibilidad y el área bajo la curva ROC, especialmente en los no fumadores (66%) y los pacientes negativos ante-CCP (51%). conclusiones. Al incorporar LOOH o CP a los marcadores de la enfermedad tradicionales en AR, bien por separado o ambos conjuntamente, mejoró el diagnóstico de AR, especialmente en los pacientes no fumadores o aquellos con anticuerpos anti- CCP negativos.background. Besides the development of new markers and di- agnostic criteria for rheumatoid arthritis (RA), many patients are still diagnosed after several years of symptoms. Oxidative stress markers are already increased at an early stage of RA. Our aim was to evaluate the additional diagnostic value of these markers. Methods. A case-control study was performed. Patients met the 1987 RA ACR criteria, less than 2 years of symptoms and no previous treatment with disease-modifying anti-rheumatic drugs (DMARD), steroids or vitamin E. Controls were select- ed from patient’s relatives and matched (1:1) by gender, age, and current smoking habit. Oxidative damage markers were malonyldialdehyde (MDA), Lipid hydroperoxides (LOOH) and Carbonyl proteins (CP). Statistical analysis was performed in agreement with the STARD initiative. results. Sixty-five RA patients without treatment and 65 healthy controls were included. LOOH, CP, antibodies against citrullinated peptides (anti-CCP) and rheumatoid factor (RF) were significantly higher in patients, and MDA higher in con- trols. The same results were obtained in the subgroups of pa- tients who smoke or not, and in anti-CCP positive or negative. The diagnosis performance of traditional markers showed good specificity but low sensitivity. The addition of LOOH and CP increased the sensitivity and the area under the receiving operating characteristic (ROC) curve especially in non-smok- ing (66%) and negative anti-CCP (51%) patients. conclusions. The separate or combined addition of LOOH or CP to the traditional disease markers improved the diag- nosis of RA, especially in non-smoking or negative anti-CCP patients

Teaching tools to improve academic performance.

[EN] The “flipped classroom” is a new teaching methodology model that seeks to reverse the way learning contents are delivered to students in order to promote the subject understanding by working at home. The aim of the study is to analyze whether the implementation with “flipped classroom” is useful as a teaching tool to improve academic performance and if it is dependent on the sex of participants. We have a sample of 75 kinesiology students (55% male and 46% female) and 98 of obstetrics (94% women and 4% men), between 20-24 years. They performed three tests in the academic semester: 1st test, control group N = 164; 2nd test, introduction from class to class on paper; 3 test, introduction of web platform. The average score of the first test was 3.86 ± 0.78 and confidence interval (3.74-3.99), second test average score was 4.12 ± 0.87 and confidence interval (3.99-4.26) and third test average score was 4.92 ± 0.94 and interval confidence (4.77- 5.05). An analysis of variance was done obtai[ES] El flipped classroom es un nuevo modelo metodológico docente que trata de invertir la forma en que los contenidos de aprendizaje se entregan a los alumnos para favorecer el entendimiento de la materia mediante un trabajo en casa .El objetivo del estudio es analizar si la implantación del ”flippedd classroom” es útil como herramienta docente para mejorar el rendimiento académico y si este es dependiente del sexo. Contamos con una cohorte de 75 alumnos de kinesiología (55% hombres y 46% mujeres) y 98 de obstetricia (94%mujeres y 4% hombres) de ambos sexos entre los 20-24 años. Se les realizo tres pruebas en el semestre académico, 1ºprueba, grupo control N=164, 2 prueba, introducción de clase a clase en papel, 3 pruebas, introducción de plataforma web. La nota media de la primera prueba fue 3,86± 0.78 e intervalo de confianza (3.74-3.99) la de la segunda prueba fue 4.12± 0.87 intervalo de confianza (3.99-4.26) y de la tercera prueba 4.92±0.94 e intervalo de confianza (4.77- 5.05.) Se realArrobas Velilla, T.; Cazenave Sánchez, JI.; Cañizares Díaz, JI.; Fernández Serrat, ML. (2014). Herramientas didácticas para mejorar el rendimiento académico. REDU. Revista de Docencia Universitaria. 12(4):397-413. https://doi.org/10.4995/redu.2014.5633OJS397413124Bergmann, J. (2012). Flip Your Classroom: Talk To Every Student In Every Class Every Day Author: Jonathan Bergmann, Aaron Sams, Publisher: Inte.Bligh, D. A. (1972). What's the Use of Lectures? (pp. 21-43). Harmondsworth: Penguin.Bloom, B. S., Engelhart, M. D., Furst, E. J., Hill, W. H., & Krathwohl, D. R. (1956). Taxonomy of educational objectives: Handbook I: Cognitive domain. New York: David McKay, 19, 56.Bonwell, C. C., & Sutherland, T. E. (1996). The active learning continuum: Choosing activities to engage students in the classroom. New Directions for Teaching and Learning, 1996(67), 3-16.Bunce, D., Flens, E., Neiles, K. (2011).How long can students pay attention in class? A study of student attention decline using clickers. J Chem Educ 87:1438-1443.Carbone, E. (1998). Teaching large classes: Tools and strategies (Vol. 19). Sage.Chesapeake, VA: AACE. Retrieved from http://www.editlib.org/p/39738Michele Houston, Lin Lin, University of North Texas, United StatesChickering, A., and Zelda FG(1987). Seven principles for good practice. American Association for Higher Education Bull 39 (7): 3±7.Demetry, C. Work in progress - An innovation merging -classroom flip‖ and teambased learning Published in: Frontiers in Education Conference (FIE), 2010 IEEE .Date of Conference: 27-30 Oct. 2010 .Page(s):T1E-1 - T1E-2 ISSN :0190-5848Houston, M.,Lin, L. (2012). Humanizing the Classroom by Flipping the Homework versus Lecture Equation. En P. Resta (Ed.), Proceedings of Society for Information Technology & Teacher Education International Conference 2012 (pp. 1177-1182).Herreid, C. F. (2002) Using Case Studies in Science-And Still Covering Content. In Team Based Learning: A Transformative Use of Small Groups (Ed. L. Michaelson, A. Knight & L. Fink) Praeger, Westport, Conn., pp.109-118.Koman K. Newton, 1998. Última fecha de acceso. 14.08.2013. Available: http:// www. columbia.edu/cu/gsapp/BT/RESEARCH/mazur.html.Lage, M. J., Platt, G. J., & Treglia, M. (2000). Inverting the classroom: A gateway to creating an inclusive learning environment. The Journal of Economic Education, 31(1), 30- 43.Lindquist, S. I., & McLean, J. P. (2011). Daydreaming and its correlates in an educational environment. Learning and Individual Differences, 21(2), 158-167.Novak, G. M., Patterson, E. T., Gavrin, A., & Enger, R. C. (1998, May). Just-in-Time Teaching: Active learner pedagogy with WWW. In IASTED International Conference on Computers and Advanced Technology in Education (pp. 27-30).Pastötter, B., Schicker, S., Niedernhuber, J., & Bäuml, K. H. T. (2011). Retrieval during learning facilitates subsequent memory encoding. Journal of Experimental Psychology: Learning, Memory, and Cognition, 37(2), 287.Rao, S. P., & DiCarlo, S. E. (2000). Peer instruction improves performance on quizzes. Advances in Physiology Education, 24(1), 51-55.Redish, F ., Rigden, J.( 1997). Getting students to think in class‖. En E.Mazur, Peer instruction ( pp. 981-988) .New York: Ed. EdwardRisko, E. F., Anderson, N., Sarwal, A., Engelhardt, M., & Kingstone, A. (2012). Everyday attention: variation in mind wandering and memory in a lecture. Applied Cognitive Psychology, 26(2), 234-242.Ruddick, K. W. (2012). Improving chemical education from high school to college using a more hands-on approach.Smallwood, J., McSpadden, M., & Schooler, J. W. (2008). When attention matters: The curious incident of the wandering mind. Memory & Cognition, 36(6), 1144-1150.Smallwood, J., Schooler, J. (2006) .The restless mind. Psychol Bull 132(6):946-958Smallwood, J., Baracaia, SF., Lowe, M., Obonsawin, M. (2003) Task unrelated thought whilst encoding information. Conscious Cogn 12(3):452-484.Szpunar, K. K., Khan, N. Y., & Schacter, D. L. (2013). Interpolated memory tests reduce mind wandering and improve learning of online lectures. Proceedings of the National Academy of Sciences, 110(16), 6313-6317.Wilson, K., & Korn, J. H. (2007). Attention during lectures: Beyond ten minutes. Teaching of Psychology, 34(2), 85-89.Zappe, S., Leicht, R., Messner, J., Litzinger, T., & Lee, H. W. (2009). Flipping" the classroom to explore active learning in a large undergraduate course. In American Society for Engineering Education. American Society for Engineering Education

Consensus document for lipid profile testing and reporting in Spanish clinical laboratories: What parameters should a basic lipid profile include?

Las enfermedades cardiovasculares (ECV) siguen siendo la principal causa de muerte en nuestro país. El control adecuado de las alteraciones del metabolismo lipídico es un reto clave en prevención cardiovascular que está lejos de alcanzarse en la práctica clínica real. Existe una gran heterogeneidad en los informes del metabolismo lipídico de los laboratorios clínicos españoles, lo que puede contribuir al mal control del mismo. Por ello, un grupo de trabajo de las principales sociedades científicas implicadas en la atención de los pacientes de riesgo vascular hemos elaborado este documento con una propuesta básica de consenso sobre la determinación del perfil lipídico básico en prevención cardiovascular, recomendaciones para su realización y unificación de criterios para incorporar los objetivos de control lipídico adecuados al riesgo vascular de los pacientes en los informes de laboratorio.Cardiovascular diseases (CVD) continue to be the main cause of death in our country. Adequate control of lipid metabolism disorders is a key challenge in cardiovascular prevention that is far from being achieved in real clinical practice. There is a great heterogeneity in the reports of lipid metabolism from Spanish clinical laboratories, which may contribute to its poor control. For this reason, a working group of the main scientific societies involved in the care of patients at vascular risk, has prepared this document with a consensus proposal on the determination of the basic lipid profile in cardiovascular prevention, recommendations for its realization and unification of criteria to incorporate the lipid control goals appropriate to the vascular risk of the patients in the laboratory reports10 página

Consensus document for lipid profile determination and reporting in Spanish clinical laboratories

Las enfermedades cardiovasculares (ECV) siguen siendo la principal causa de muerte en nuestro país. El control adecuado de las alteraciones del metabolismo lipídico es un reto clave en prevención cardiovascular que está lejos de alcanzarse en la práctica clínica real. Existe una gran heterogeneidad en los informes del metabolismo lipídico de los laboratorios clínicos españoles, lo que puede contribuir al mal control del mismo. Por ello, un grupo de trabajo de las principales sociedades científicas implicadas en la atención de los pacientes de riesgo vascular hemos elaborado este documento con una propuesta básica de consenso sobre la determinación del perfil lipídico básico en prevención cardiovascular, recomendaciones para su realización y unificación de criterios para incorporar los objetivos de control lipídico adecuados al riesgo vascular de los pacientes en los informes de laboratorio.Cardiovascular diseases (CVD) continue to be the main cause of death in our country. Adequate control of lipid metabolism disorders is a key challenge in cardiovascular prevention that is far from being achieved in real clinical practice. There is a great heterogeneity in the reports of lipid metabolism from Spanish clinical laboratories, which may contribute to its poor control. For this reason, a working group of the main scientific societies involved in the care of patients at vascular risk, has prepared this document with a consensus proposal on the determination of the basic lipid profile in cardiovascular prevention, recommendations for its realization and unification of criteria to incorporate the lipid control goals appropriate to the vascular risk of the patients in the laboratory reports

Identification of clusters of asthma control: A preliminary analysis of the inspirers studies

This work was funded by ERDF (European Regional Development Fund) through the operations: POCI- -01-0145-FEDER-029130 (“mINSPIRERS—mHealth to measure and improve adherence to medication in chronic obstructive respiratory diseases - generalisation and evaluation of gamification, peer support and advanced image processing technologies”) co-funded by the COMPETE2020 (Programa Operacional Competitividade e Internacionalização), Portugal 2020 and by Portuguese Funds through FCT (Fundação para a Ciência e a Tecnologia).© 2020, Sociedade Portuguesa de Alergologia e Imunologia Clinica. All rights reserved. Aims: To identify distinct asthma control clusters based on Control of Allergic Rhinitis and Asthma Test (CARAT) and to compare patients’ characteristics among these clusters. Methods: Adults and adolescents (≥13 years) with persistent asthma were recruited at 29 Portuguese hospital outpatient clinics, in the context of two observational studies of the INSPIRERS project. Demographic and clinical characteristics, adherence to inhaled medication, beliefs about inhaled medication, anxiety and depression, quality of life, and asthma control (CARAT, >24 good control) were collected. Hierarchical cluster analysis was performed using CARAT total score (CARAT-T). Results: 410 patients (68% adults), with a median (percentile 25–percentile 75) age of 28 (16-46) years, were analysed. Three clusters were identified [mean CARAT-T (min-max)]: cluster 1 [27(24-30)], cluster 2 [19(14-23)] and cluster 3 [10(2-13)]. Patients in cluster 1 (34%) were characterised by better asthma control, better quality of life, higher inhaler adherence and use of a single inhaler. Patients in clusters 2 (50%) and 3 (16%) had uncontrolled asthma, lower inhaler adherence, more symptoms of anxiety and depression and more than half had at least one exacerbation in the previous year. Further-more, patients in cluster 3 were predominantly female, had more unscheduled medical visits and more anxiety symp-toms, perceived a higher necessity of their prescribed inhalers but also higher levels of concern about taking these inhalers. There were no differences in age, body mass index, lung function, smoking status, hospital admissions or specialist physician follow-up time among the three clusters. Conclusion: An unsupervised method based on CARAT--T, identified 3 clusters of patients with distinct, clinically meaningful characteristics. The cluster with better asthma control had a cut-off similar to the established in the validation study of CARAT and an additional cut-off seems to distinguish more severe disease. Further research is necessary to validate the asthma control clusters identified.publishersversionpublishe

Alveolite alérgica extrínseca com expressão imunológica atípica Extrinsic allergic alveolitis with an atypical immune expression

A alveolite alérgica extrínseca e a sarcoidose são ambas doenças granulomatosas pulmonares que se caracterizam pela presença de granulomas não necrotizantes. Ambas apresentam alterações típicas no lavado broncoalveolar, com relações CD4/CD8 opostas. No entanto, a sarcoidose não apresenta hoje em dia factores etiológicos bem definidos, como a alveolite alérgica extrínseca. As autoras apresentam dois casos clínicos com curso clínico, imagiológico, funcional e imunológico semelhante, embora com confirmação histopatológica não concordante com as alterações do LBA e com a particularidade de pertencerem a dois elementos da mesma família, convivente, e de terem surgido com poucas semanas de intervalo.Extrinsic allergic alveolitis and sarcoidosis are two granulomatosis of the lung characterized by non-necrotizing granuloma. Both have typical bronchoalveolar lavage immunology, with opposite CD4/CD8 relation. However, sarcoidosis does not have such well defined etiology as extrinsic allergic alveolitis. The authors present two cases with similar clinical course, imagiology, lung function and immunology, although they both had an histology that was not concordant with the bronchoalveolar lavage, and with the peculiarity of being two elements of the same family, co -inhabitants and with a clinical presentation only a few weeks apart

Alveolite alérgica extrínseca com expressão imunológica atípica

Resumo: A alveolite alérgica extrínseca e a sarcoidose são ambas doenças granulomatosas pulmonares que se caracterizam pela presença de granulomas não necrotizantes. Ambas apresentam alterações típicas no lavado broncoalveolar, com relações CD4/CD8 opostas. No entanto, a sarcoidose não apresenta hoje em dia factores etiológicos bem definidos, como a alveolite alérgica extrínseca. As autoras apresentam dois casos clínicos com curso clínico, imagiológico, funcional e imunológico semelhante, embora com confirmação histopatológica não concordante com as alterações do LBA e com a particularidade de pertencerem a dois elementos da mesma família, convivente, e de terem surgido com poucas semanas de intervalo.Rev Port Pneumol 2009; XV (2): 313-318 Abstract: Extrinsic allergic alveolitis and sarcoidosis are two granulomatosis of the lung characterized by non-necrotizing granuloma. Both have typical bronchoalveolar lavage immunology, with opposite CD4/CD8 relation. However, sarcoidosis does not have such well defined etiology as extrinsic allergic alveolitis. The authors present two cases with similar clinical course, imagiology, lung function and immunology, although they both had an histology that was not concordant with the bronchoalveolar lavage, and with the peculiarity of being two elements of the same family, co-inhabitants and with a clinical presentation only a few weeks apart.Rev Port Pneumol 2009; XV (2): 313-318 Palavras-chave: Alveolite alérgica extrínseca, pneumonia de hipersensibilidade, sarcoidose, Key-words: Extrinsic allergic alveolitis, hypersensitivity pneumonitis, sarcoidosi