Elevated zinc concentrations in a 5 months old infant: A case report

Pre-analytical errors account for the majority of laboratory-associated errors. In a 5 months old infant hospitalised with lung dysfunction due to prematurity, a routine measurement of zinc revealed an unexpected elevated concentration of 20.2 μmol/L (reference interval 10.0 - 19.0 μmol/L) compared to 11.6 μmol/L five days earlier. Zinc measurement was repeated two days later and had further increased to 42.4 μmol/L. Of note, there were no clinical signs of the increased zinc concentrations. Performance data for the zinc analysis (performed by inductively coupled plasma mass spectrometry) was found satisfactory. A thorough review of the patient´s medication and nutrition supplements revealed no relevant zinc content. The blood was obtained through capillary blood sampling, and anything at the skin puncture site containing zinc could therefore potentially contribute to the elevated zinc results. It was investigated if any ointment containing zinc had been applied at the puncture site, which revealed that the mother had applied vitamin E ointment containing zinc-oxide at the infant’s heel. A capillary sample obtained from the opposite heel, where no vitamin E ointment had been applied, revealed a zinc concentration of 14.3 μmol/L. In conclusion, pre-analytical contamination with ointments must be considered in case of unexpected measurements from capillary blood

Adipose Tissue-Derived Stem Cell Yield Depends on Isolation Protocol and Cell Counting Method

In plastic surgery, lipofilling is a frequent procedure. Unsatisfactory vascularization and impaired cell vitality can lead to unpredictable take rates in the fat graft. The proliferation and neovascularization inducing properties of adipose tissue-derived stem cells may contribute to solve this problem. Therefore, the enrichment of fat grafts with stem cells is studied intensively. However, it is difficult to compare these studies because many factors—often not precisely described—are influencing the results. Our study summarizes some factors which influence the cell yield like harvesting, isolation procedure and quantification. Stem cells were isolated after liposuction. Quantification was done using a cell chamber, colony counting, or flow cytometry with changes to one parameter, only, for each comparison. Quantification of cells isolated after liposuction at the same harvesting site from the same patient can vary greatly depending on the details of the isolation protocol and the method of quantification. Cell yield can be influenced strongly by many factors. Therefore, a comparison of different studies should be handled with care

Recommendations for the Use of Antibiotics in Primary and Secondary Esthetic Breast Surgery

The use of systemic prophylactic antibiotics to reduce surgical-site infection in esthetic breast surgery remains controversial, although the majority of surgeons prefer to utilize antibiotics to prevent infection. Nonetheless, postoperative acute and subclinical infection and capsular fibrosis are among the most common complications following implant-based breast reconstruction. After esthetic breast augmentation, up to 2.9% of women develop infection, with an incidence rate of 1.7% for acute infections and 0.8% for late infections. After postmastectomy reconstruction (secondary reconstruction), the rates are even higher. The microorganisms seen in acute infections are Gram-positive, whereas subclinical late infections involving microorganisms are typically Gram-negative and from normal skin flora with low virulence. In primary implantation, a weight-based dosing of cefazolin is adequate, an extra duration of antibiotic cover does not provide further reduction in superficial or periprosthetic infections. Clindamycin and vancomycin are recommended alternative for patients with β-lactam allergies. The spectrum of microorganism found in late infections varies (Gram-positive and Gram-negative), and the antibiotic prophylaxis (fluoroquinolones) should be extended by vancomycin and according to the antibiogram when replacing implants and in secondary breast reconstruction, to target microorganisms associated with capsular contracture. All preoperative antibiotics should be administered <60 minutes before incision to guarantee high serum levels during surgical procedure

Efficacy of Patient Education and Duloxetine, Alone and in Combination, for Patients With Multisystem Functional Somatic Disorder: Study Protocol for the EDULOX Trial

Background Multisystem functional somatic disorder is characterized by specific patterns of persistent physical symptoms with a complex biopsychosocial etiology. The disorder can lead to disability and personal suffering. Current treatment options require specialized settings, therefore patients often wait a long time to receive specific treatment. Patient education is considered important in most treatment programs, but has only been investigated sparsely as a stand-alone treatment. Pharmacological treatment is limited to tricyclic antidepressants in low doses with not antidepressant properties. Duloxetine has been found effective in single organ functional disorders. As a treatment for multisystem functional somatic disorder, duloxetine could reduce symptoms and treat comorbid anxiety and depression. It may furthermore enhance the effect of patient education through a hypothesized effect on cognitive functioning. The purpose of the EDULOX trial is to study psycho-EDUcation and duLOXetine alone and in combination. Methods This is a nested study design. The parent trial EDULOX1 (n = 424) will compare a patient education program with enhanced usual care in an open-labelled, randomized controlled trial. In addition to this, eligible participants will furthermore receive either duloxetine or active placebo in the nested, double-blinded randomized controlled trial, EDULOX2 (n = 212). Patient and clinician reported outcomes will be collected through questionnaires. Conclusion The EDULOX trial may establish evidence for treatments applicable for the majority of patients with multisystem functional somatic disorder. If effective, duloxetine would be a more tolerable pharmacological treatment option that can target comorbid depression and anxiety, and potentially boost the effect of patient education

Identification of Novel Genetic Loci Associated with Thyroid Peroxidase Antibodies and Clinical Thyroid Disease

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