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

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

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

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

Implementation of a biochemical, clinical, and genetic screening programme for familial hypercholesterolemia in 26 centres in Spain: The ARIAN study.

Background: Familial hypercholesterolemia (FH) is clearly underdiagnosed and undertreated. The aim of this present study is to assess the benefits of FH screening through a joint national program implemented between clinical laboratories and lipid units. Methods: All clinical laboratory tests from 1 January 2017 to 31 December 2018 were reviewed, and those with LDL cholesterol (LDL-C) levels >250 mg/dl were identified in subjects >18 years of age of both sexes. Once secondary causes had been ruled out, the treating physician was contacted and advised to refer the patient to an LU to perform the Dutch Lipid Clinic Network score and to request genetic testing if the score was ≥6 points. Next Generation Sequencing was used to analyse the promoter and coding DNA sequences of four genes associated with FH (LDLR, APOB, PCSK9, APOE) and two genes that have a clinical overlap with FH characteristics (LDLRAP1 and LIPA). A polygenic risk score based on 12 variants was also obtained. Results: Of the 3,827,513 patients analyzed in 26 centers, 6,765 had LDL-C levels >250 mg/dl. Having ruled out secondary causes and known cases of FH, 3,015 subjects were included, although only 1,205 treating physicians could be contacted. 635 patients were referred to an LU and genetic testing was requested for 153 of them. This resulted in a finding of sixty-seven pathogenic variants for FH, 66 in the LDLR gene and one in APOB. The polygenic risk score was found higher in those who had no pathogenic variant compared to those with a pathogenic variant. Conclusion: Despite its limitations, systematic collaboration between clinical laboratories and lipid units allows for the identification of large numbers of patients with a phenotypic or genetic diagnosis of FH, which will reduce their vascular risk. This activity should be part of the clinical routine

Study of lymphocyte subpopulations and intrathecal secretion in patients with defnite multiple sclerosis

Multiple sclerosis is an infammatory demyelinating autoimmune disease that affects the brain and spinal cord. The aim of the study was to quantify lym-phocyte subpopulations in cerebrospinal fuid and blood of patients diagnosed with multiple sclerosis and in patients whit degenerative diseases not (control) in order to fnd some relationships between them that make it possible to differentiate the immune status of patients in each group. This work was jointly carried out with Hospital Universitario Virgen Macarena in Seville during 2008, 2009 and 2010. It is a descriptive, transversal and cohort study. The selected population is composed of 142 subjects who were subjected to lumbar puncture and a blood sample. Group 1 (n=70), control, Group 2 (n=53), patients with relapsing remitting multiple sclerosis, Group 3 (n=5), patients with primary type progressive multiple sclerosis, and Group 4 (n=14) patients with isolated neurological syndrome. The results show an increase in CSF B cells in MS patients suggesting an increase in focal infammatory activity in the CNS. Regarding NKCD8, reduced total levels of NK and NKCD8 regard-ing controls were observed, and it showed an increased IgG index value in patients with RRMS.YesLa esclerosis múltiple (EM) es una enfermedad inflamatoria desmielinizante y autoinmune del sistema nervioso central que afecta al cerebro y a la médula espinal. El objetivo del estudio fue la cuantificación de subpoblaciones linfocitarias en líquido cefalorraquídeo y sangre de pacientes diagnosticados de esclerosis múltiple y en pacientes con enfermedades no degenerativas (controles), para encontrar variables o relaciones entre las mismas que permitan diferenciar el estado inmunológico de los pacientes de cada grupo.Este trabajo se ha llevado a cabo conjuntamente con el Hospital Universitario Virgen Macarena de Sevilla entre los años 2008 y 2010. Es un estudio de tipo descriptivo, transversal y de cohortes. La población seleccionada (n=142) estuvo compuesta por sujetos a los que se les realizó una punción lumbar y una citometría de flujo, tanto de LCR como de sangre. El Grupo 1 (n=70) fue el grupo control, Grupo 2: (n=53): pacientes con esclerosis múltiple remitente recidivante (EMRR), Grupo 3: (n=5), pacientes con esclerosis múltiple de tipo primaria progresiva y Grupo 4 (n=14), pacientes que presentaban un síndrome neurológico aislado. Los resultados mostraron un aumento de células B en LCR en pacientes con EM que sugirieron un aumento de la actividad inflamatoria focal en el SNC. En cuanto a NKCD8- se observó una disminución de los niveles totales de NK, así como de los NKCD8 con respecto a los controles y un mayor valor del índice de IgG en los pacientes con EMR

Teste de anticorpos antifosfolípídes e cistatina C em pacientes com esclerose múltipla

Cystatin C is considered the most important physiological inhibitor of endogenous cysteine proteases; the role of cystatin C is believed to be to modulate the activity of proteases secreted or released from damaged cells or in the process of necrosis, therefore cystatins being fundamental regulatory processes and a potential prevention of local proteolytic damage. Antiphospholipid antibodies are used to clarify the diagnosis of diseases like multiple sclerosis (MS) and other pathologies could present similar symptoms or paraclinical findings. The objective of the present work is to analyze the concentration of cystatin C and the presence or absence of antiphospholipid antibodies in patients diagnosed with relapsing remitting multiple sclerosis (RRMS) as markers of demyelization. This work was carried out jointly by the Vascular Risk Laboratory, the Laboratory of Autoimmunity and Multiple Sclerosis Unit, Hospital Universitario Virgen Macarena in Seville in one year. Two types of people were selected: Group 1 (n = 30) RRMS group and a control group, n = 30. Cystatin C and antiphospholipid antibodies IgG and IgM, IgG and IgM anticardiolipin, β2 glycoprotein IgG and IgM were determined. Patients showed negative titers of antiphospholipid antibodies IgG and IgM, IgG and IgM anticardiolipin, β2 glycoprotein IgG and IgM. Cystatin C concentration is lower in the group of patients diagnosed with MS, which could give rise to a decrease in the modulation of endogenous cysteine proteases. This would exacerbate the progress of demyelization in MS.YesLa cistatina C es considerada el inhibidor fisiológico más importante de las proteasas de cisteína endógenas. Se cree que el papel de la cistatina C es el de modular la actividad de las proteasas secretadas o liberadas de células dañadas o en proceso de necrosis, siendo por tanto las cistatinas fundamentales para los procesos de regulación y prevención del potencial daño proteolítico local. Los anticuerpos antifosfolípidos se usan para esclarecer el diagnóstico de esclerosis múltiple (EM) ya que existen patologías que pueden cursar con sintomatología o hallazgos paraclínicos semejantes. El objetivo de este trabajo fue analizar la concentración de cistatina C y la presencia o ausencia de anticuerpos antifosfolipídicos en pacientes diagnosticados de esclerosis múltiple remitente recurrente (EMRR) como marcadores de desmielinización. Este trabajo se llevó a cabo conjuntamente por el laboratorio de Riesgo Vascular, el laboratorio de Autoinmunidad y la Unidad de Esclerosis Múltiple del Hospital Universitario Virgen Macarena de Sevilla, España, con una duración de un año. Se seleccionaron dos tipos de poblaciones: grupo 1, n=30 pacientes con EMRR y un segundo grupo, denominado grupo control, n=30. Se determinó cistatina C y anticuerpos antifosfolípidos IgG e IgM, anticuerpos anticardiolipina IgG e IgM y anticuerpos β2 glicoproteína IgG e IgM. Los pacientes diagnosticados de EMRR presentan títulos negativos de anticuerpos antifosfolípidos IgG e IgM, anticardiolipina IgG e IgM y β2 glicoproteína IgG e IgM. La concentración de cistatina C es menor en el grupo de pacientes diagnosticados de EM, lo que podría producir un déficit en la modulación de las proteasas de cisteína endógenas. Dicha desmielinización agudizaría el progreso de la EM

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 en que se realizan y se reportan los estudios de interferencia por parte de los fabricantes. La interferencia por lipemia puede ser eliminada por diferentes métodos permitiendo la determinación de magnitudes biológicas de manera exacta. El laboratorio clínico debe decidir los protocolos de actuación ante muestras lipémicas dependiendo de la magnitud biológica que se quiere analizar

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