Hyponatremia and Bone Fractures: An Intriguing and Often Overlooked Association

Hyponatremia and Bone Fractures: An Intriguing and Often Overlooked Associatio

La liaison fructueuse: Laboratory and emergency medicine

La liaison fructueuse: Laboratory and emergency medicin

Is Google Trends a reliable tool for digital epidemiology? Insights from different clinical settings

Internet-derived information has been recently recognized as a valuable tool for epidemiological investigation. Google Trends, a Google Inc. portal, generates data on geographical and temporal patterns according to specified keywords. The aim of this study was to compare the reliability of Google Trends in different clinical settings, for both common diseases with lower media coverage, and for less common diseases attracting major media coverage. We carried out a search in Google Trends using the keywords "renal colic", "epistaxis", and "mushroom poisoning", selected on the basis of available and reliable epidemiological data. Besides this search, we carried out a second search for three clinical conditions (i.e., "meningitis", "Legionella Pneumophila pneumonia", and "Ebola fever"), which recently received major focus by the Italian media. In our analysis, no correlation was found between data captured from Google Trends and epidemiology of renal colics, epistaxis and mushroom poisoning. Only when searching for the term "mushroom" alone the Google Trends search generated a seasonal pattern which almost overlaps with the epidemiological profile, but this was probably mostly due to searches for harvesting and cooking rather than to for poisoning. The Google Trends data also failed to reflect the geographical and temporary patterns of disease for meningitis, Legionella Pneumophila pneumonia and Ebola fever. The results of our study confirm that Google Trends has modest reliability for defining the epidemiology of relatively common diseases with minor media coverage, or relatively rare diseases with higher audience. Overall, Google Trends seems to be more influenced by the media clamor than by true epidemiological burden

Is digital epidemiology the future of clinical epidemiology?

[no abstract available

Seasonal variation in the frequency of myocardial infarction diagnosed in a large emergency department of a European country with a temperate climate

Previous studies at different latitudes showed that acute myocardial infarction (AMI) exhibits a seasonal variation, with higher frequency in spring and winter. We conducted a retrospective analysis to verify whether the frequency of AMI cases diagnosed in the emergency department (ED) may follow a seasonal pattern in a European country with a temperate climate. A retrospective analysis was performed in the hospital database of the University Hospital of Parma (northwestern Italy), to retrieve the total number of AMI cases diagnosed in the ED during the entire year 2010. The search for AMI cases was conducted using both ICD-9 codes and related diagnostic terms. The seasonality was defined according to the typical equinoxes and solstices at the latitude of the study. A total of 83,919 patients visited the ED of the University Hospital of Parma during the year 2010, 502 (0.6%) of whom with a final diagnosis of AMI (mean age, 73±14 years; 188 women and 314 men). The largest frequency of AMIs was observed in autumn (n=148; 29%), followed by winter (n=136, 27%), whereas the lowest frequencies were recorded in spring (n=110; 22%) and summer (n=108; 22%). The difference in frequency distribution of AMI cases across the four seasons of the year was found to be statistically significant (P<0.001), and this trend was independent from sex and age. Compared to the summer period (i.e., the season with the lowest frequency of AMI cases), the relative risk (RR) for AMI was significantly higher in autumn (1.37; 95% CI, 1.15-1.63; P<0.001) and winter (1.26; 95% CI, 1.05-1.51; P=0.013), but not in spring (1.02; 95% CI, 0.83-1.24; P=0.857). Compared to the spring period, the RR for AMI was found also to be significantly higher in autumn (1.34; 95% CI, 1.13-1.60; P<0.001) and winter (1.24; 95% CI, 1.03-1.48; P=0.021)

Red blood cell distribution width: A marker of anisocytosis potentially associated with atrial fibrillation

The incorporation of biomarkers in the actually used risk scores seem to be helpful for early identifying atrial fibrillation (AF) patients at higher risk. The aim of this critical review of the scientific literature is to investigate the potential clinical significance of red blood cell distribution width (RDW) in AF. A systematic electronic search was carried out to identify all articles describing an epidemiological association between RDW and AF in adult human populations. Data abstraction was conducted on a final number of 35 articles (13 cross-sectional, 12 prospective and 10 retrospective studies). The results of these epidemiological investigations were all virtually concordant to emphasize that an enhanced RDW value is not only a predictive factor and a marker of AF but its measurement may also be helpful for predicting the risk of developing many adverse complications in patients with AF, such as recurrence and duration of AF, hospitalization for heart failure, bleeding, left atrial thrombosis and stasis, thromboembolic events and mortality. AF patients with RDW values exceeding the local reference range may be more aggressively investigated and managed, in order to identify and attenuate the impact of possible underlying disorders causing both anisocytosis and AF

Glycogen phosphorylase isoenzyme BB in the diagnosis of acute myocardial infarction: a meta-analysis

Background: Early diagnosis is crucial for management of patients with suspected acute myocardial infarction (AMI). Among innovative and promising biomarkers, the recent interest raised on glycogen phosphorylase isoenzyme BB (GPBB) has prompted us to perform a meta-analysis of published studies. Materials and methods: A systematic electronic search was carried out on PubMed, Web of Science and Google Scholar, with no date restriction, to retrieve all articles that have investigated the early diagnostic performance of GPBB in patients with suspected AMI, and directly reported or allowed calculation of sensitivity and specificity. A meta-analysis of the reported sensitivity and specificity of each study and pooled area under the curve (AUC) was then performed by random effect approach. Heterogeneity was assessed by I-square statistics. Results: Eight studies were finally selected for analysis (941 subjects; 506 cases and 435 controls), with a high heterogeneity (I-squared, 86.3%). The resulting pooled estimates and 95% confidence interval were 0.854 (0.801-0.891) for sensitivity, 0.767 (0.713-0.815) for specificity, 0.826 (0.774-0.870) for negative predictive value, 0.802 (0.754-0.844) for positive predictive value, and 0.754 (0.602-0.907) for AUC. In those studies that have simultaneously assessed GPBB and a troponin immunoassay, the combination of these biomarkers did not significantly improve the performance of troponin alone. Conclusion: GPBB does not meet the current requirements for an efficient diagnosis of AMI when used as a stand-alone test, whereas its combination with troponin merits further investigation in larger trials

Hospital admissions for alcohol-related problems in concomitance with weekends, New Year’s Eve and Christmas Eve: Myth or reality?

This retrospective observational study was carried out by searching the database of the laboratory information system for identifying all requests for alcohol testing placed from emergency departments and intensive care units of the University Hospital of Verona between June 29th, 2012 and December 31st, 2018. The study population consisted of 7488 patients. The number of alcohol tests was more than double in concomitance with New Year’s Eve than in the rest of the year (7.6±6.1 vs 3.1±2.8 requests/day; P<0.001), whereas blood alcohol concentration was similar (1.55 vs 1.12 g/L; P=0.308). The risk of measuring alcohol concentrations >0.1 g/L and >1.0 g/L was 1.9-fold and 1.6-fold higher in concomitance with New Year’s Eve. In multivariate analysis, younger age, female sex and alcohol testing during New Year’s Eve remained significant predictors of alcohol concentrations >0.1 g/L and >1.0 g/L. The requests for alcohol testing were similar in concomitance with Christmas Eve and in other periods of the year, whilst number of requests (4.0±3.2 vs 2.8±2.5 requests/day; P<0.001) and concentration (1.37 vs 0.77 g/L; P<0.001) were higher during weekends than in other weekdays

Cardiac troponins and physical exercise. It’s time to make a point

The timely diagnosis of acute coronary syndrome (ACS), in particular myocardial infarction (MI), is still one of the most challenging issues in medicine. The introduction into routine laboratory practice of assays for measuring the cardiospecific troponins has dramatically revolutionized the diagnostic ap-proach and the recent development of methods with improved analytical sensibility (i.e., highly sensitivity [HS] assays), has further contributed to improve the negative predictive value of troponin testing but, contextually, has substantially lowered the clinical specificity of these markers. In particu-lar, clinical studies have demonstrated the existence of an exercise-related increase of HS-troponins, with measurable values detectable in up to 94% of athletes undergoing endurance sports. This mea-surable amount of troponin in blood would mirror an increased membrane permeability and early tro-ponin release rather than reflecting a clinically threatening myocardial injury. As such, the measurable amount of cardiac troponins as assessed with the novel HS assays requires major clinical focus (i.e., serial measurement of cardiac biomarkers, detailed clinical history-taking, integration with ECG and imaging findings) to prevent misdiagnosis of ACS and/or MI in otherwise healthy persons