POINT OF CARE TESTING (POCT) DURING CARDIAC SURGERY OPERATIONS

Otvaranjem kardiokirurškog odjela u KBC-u Rijeka jasno je definirana potreba brzog dobivanja osnovnih laboratorijskih nalaza za uspješnost liječenja. Ovaj cilj ostvarili smo uvoðenjem organizacijskih promjena u laboratorijskoj službi i postavljanjem brzog mjernog ureðaja u operacijsku dvoranu, koji u vremenu od nekoliko minuta može izdati laboratorijske nalaze za osnovne hematološke i biokemijske parametre. U ovom radu prikazali smo kvalitetu ovakvog laboratorijskog rada, usporeðujuæi nalaze dobivene na aparatu u dvorani sa usporedno izvr¹enim nalazima u centralnome medicinsko- biokemijskom laboratoriju, dobivenim primjenom drugih aparata i drugih laboratorijskih metoda. Nalaz visoke korelacije izmeðu ovih mjerenja za razlièite analitièke parametare (Na, K, pH, pO2, pCO2, hemoglobin, hematokrit), naglasio je pouzdanost brze analize krvi na aparatu u dvorani i njezinu korisnost u odreðenim urgentnim stanjima.Faster laboratory data during cardiac surgery operations are necessary for more rapid treatment of the patient and fewer clinical complications. We implemented clinical chemistry analyzer in operation room in order to perform urgent laboratory tests (potassium, sodium, pH, pO2, pCO2, hemoglobin, hematocrit) during cardiac surgery operations. Successful implementation required a new organization of laboratory work and new set of skills and jobs for laboratory. Internal quality control, accuracy of results and compatibility with central laboratory results are checked daily and some off these results are reported in this work showing a high coefficient of correlation and accuracy of results, as well as accessibility and speed. Point-of care testing (POCT) or Ònearpatient Ó testing allows for diagnostic assays to be performed at the site of patient care delivery so that laboratory data are more readily available to clinicians. Cost-benefit analysis are still to be evaluated, but faster turnaround times can only lead to more rapid treatment of the patient. Point-of-care testing (POCT) has the potencial to expand further by increasing the accessibility, speed and accuracy of results

Laboratory diagnosis of liver disease

Laboratorijska dijagnostika jetrenih bolesti može se s obzirom na pretrage podijeliti u tri skupine. To su laboratorijske pretrage koje ukazuju na oštećenje jetrenih stanica i funkciju jetre, laboratorijske pretrage kojima se može utvrditi uzrok bolesti, te funkcijski dinamički testovi kojima se procjenjuje sposobnost jetre da oslobodi organizam od štetnih tvari. U laboratorijskoj dijagnostici bolesti jetre, različite preporuke obično uključuju sljedeće početne testove probira: određivanje katalitičke aktivnosti enzima alanin aminotransferaze (ALT), aspartat aminotransferaze (AST) i alkalne fosfataze (ALP) u serumu, određivanje koncentracije bilirubina, te eventualno određivanje koncentracije ukupnih proteina i albumina u serumu. Ovisno o dobivenim rezultatima, spektar pretraga proširuje se kako bi se postavila dijagnoza. Osim za postavljanje dijagnoze, laboratorijske pretrage koriste se za prognozu i praćenje kliničkog stanja kod bolesnika s bolešću jetre�������������������������������������������������������������������������������������������. Oštećenje jetrenih stanica najčešće se dokazuje određivanjem aktivnosti AST i ALT u serumu, dok aktivnosti ALP i gama glutamil transferaze (GGT) ukazuju na poremećaj u kolestazi. S obzirom na to da je jetra glavno mjesto sinteze i uklanjanja čimbenika koagulacije i fibrinolize te njihovih inhibitora, oštećenje jetre uglavnom rezultira složenim poremećajima hemostaze. Koagulacijski poremećaji ovise o stupnju oštećenja jetrenog parenhima. U akutnom hepatitisu obično je prisutno umjereno sniženje F VII i vitamin K ovisnih faktora, što rezultira blagim produženjem protrombinskog vremena, a fibrinogen i F VIII mogu biti blago povišeni. U cirozi jetre stupanj hemostatskih poremećaja ovisan je o oštećenju jetrenih stanica i dobar je pokazatelj funkcije jetre. Laboratorijske pretrage kojima se može utvrditi uzrok bolesti su virusni biljezi, tumorski biljezi, autoantitijela, specifični proteini i mikroelementi.There are three groups of tests for laboratory diagnostic of liver disease. The first group comprises laboratory tests which indicate damage of liver cells and liver function. The second group consists of tests which can determine the cause of liver disease, and the third group comprises functional dynamic tests which show the ability of liver to release harmful metabolic products from the body. Typical recommendations for laboratory diagnostics of liver disease include initial screening tests (enzyme activity of alanine aminotransferase (ALT), aspartat aminotransferase (AST) and alkaline phosphatase (ALP) in serum, concentration of bilirubin and eventually total protein and albumine concentrations), after which depending on obtained results, the physician can expand the diagnostics and perform other laboratory tests. Laboratory tests can help not only in establishing a diagnosis, but also in clinical prognoses and monitoring the course of liver disease. Activities of ALT and AST in serum indicate the damage of liver cells, while activities of ALP and gama-glutamyl transferase (GGT) indicate disorders in cholestasis. Liver is the main organ where coagulation and fibrinolysis factors and their inhibitors are synthesized, this liver damage will affect haemostasis. Coagulation disorders depend on the degree of the damage of liver parenchyma. In acute hepatitis there is usually moderate decrease of F VII and vitamin K dependent factors, resulting in a slight prolongation of prothrombin time, while fibrinogen and factor VIII can be elevated. In liver cirrhosis the degree of haemostatic disorders depends on the damage of liver cells and is a good indicator of liver function. Laboratory tests which can determine the cause of liver disease are: viral markers, tumor markers, auto antibodies, specific proteins and micronutrients

POINT OF CARE TESTING (POCT) DURING CARDIAC SURGERY OPERATIONS

Otvaranjem kardiokirurškog odjela u KBC-u Rijeka jasno je definirana potreba brzog dobivanja osnovnih laboratorijskih nalaza za uspješnost liječenja. Ovaj cilj ostvarili smo uvoðenjem organizacijskih promjena u laboratorijskoj službi i postavljanjem brzog mjernog ureðaja u operacijsku dvoranu, koji u vremenu od nekoliko minuta može izdati laboratorijske nalaze za osnovne hematološke i biokemijske parametre. U ovom radu prikazali smo kvalitetu ovakvog laboratorijskog rada, usporeðujuæi nalaze dobivene na aparatu u dvorani sa usporedno izvr¹enim nalazima u centralnome medicinsko- biokemijskom laboratoriju, dobivenim primjenom drugih aparata i drugih laboratorijskih metoda. Nalaz visoke korelacije izmeðu ovih mjerenja za razlièite analitièke parametare (Na, K, pH, pO2, pCO2, hemoglobin, hematokrit), naglasio je pouzdanost brze analize krvi na aparatu u dvorani i njezinu korisnost u odreðenim urgentnim stanjima.Faster laboratory data during cardiac surgery operations are necessary for more rapid treatment of the patient and fewer clinical complications. We implemented clinical chemistry analyzer in operation room in order to perform urgent laboratory tests (potassium, sodium, pH, pO2, pCO2, hemoglobin, hematocrit) during cardiac surgery operations. Successful implementation required a new organization of laboratory work and new set of skills and jobs for laboratory. Internal quality control, accuracy of results and compatibility with central laboratory results are checked daily and some off these results are reported in this work showing a high coefficient of correlation and accuracy of results, as well as accessibility and speed. Point-of care testing (POCT) or Ònearpatient Ó testing allows for diagnostic assays to be performed at the site of patient care delivery so that laboratory data are more readily available to clinicians. Cost-benefit analysis are still to be evaluated, but faster turnaround times can only lead to more rapid treatment of the patient. Point-of-care testing (POCT) has the potencial to expand further by increasing the accessibility, speed and accuracy of results

Serum Zinc Concentrations in the Maintenance Hemodialysis Patients

Zinc is necessary for growth and cells’ division. Its deficiency may seriously affect antioxidant defense system and is usually related to renal failure, gastrointestinal diseases and alcoholism. It is very important to know zinc status in dialyzed patients and to prevent hypo- or hyperzincemia. Serum samples from 89 patients with chronic terminal renal failure on regular hemodialysis were withdrawn for the estimation of zinc concentrations immediately before and after dialysis. Serum zinc concentrations showed to be highly dependent on hemodialysis. In 57 (64%) patients, serum zinc concentrations decreased, sometimes from very high to normal values. In remaining 32 (36%) patients serum zinc concentrations tended to increase, but remained within normal range. Zinc supplementation may be recommended only in the patients with proven zinc deficiency, but for all chronic renal failure patients it is questionable

Effect of duration of diabetes mellitus type 1 in children and adolescents on urinary N-acetyl-β-D-glucosaminidase excretion

Cilj: Cilj je bio ispitati ovisi li izlučivanje NAG u mokraći djece i adolescenata s šećernom bolesti tipa 1 o trajanju bolesti. Metode: Katalitičke koncentracije N-acetil-β-D-glukozaminadaze određivale su se spektrofotometrijski u slučajnim uzorcima mokraće 66 djece i adolescenata s šećernom bolesti tipa 1 68 ispitanika iz kontrolne skupine. Bolesnici iz skupine dijabetičara bili su podijeljeni s obzirom na trajanje bolesti: skupina I manje od tri godine (N=17); skupina II tri do pet godina (N=19); skupina III pet do deset godina (N=19); skupina IV više od deset godina (N=11). Vrijednosti NAG izražene su u odnosu na koncentraciju kreatinina u mokraći radi isključivanja razlika u koncentraciji mokraće. Rezultati: Izlučivanje NAG mokraćom kod dijabetičara bilo je statistički značajno povišeno u odnosu na kontrolnu skupinu. (p0,10; skupina II vs. III, p=0,549; skupina II vs. IV, p>0,10; skupina III vs. IV, p>0,10). Nije nađena korelacija između vrijednosti NAG u mokraći dijabetičara i trajanja bolesti (r=—0,017, p=0,892) Zaključak: Izlučivanje NAG mokraćom povećano je kod djece i adolescenata s šećernom bolesti tipa 1, ali ne ovisi o trajanju bolesti.Objective: The aim of this study was to examine whether there are differences between urinary NAG activity between children and adolescents with diabetes mellitus type 1 and healthy subjects and examine whether urinary NAG activity changes in relation to duration of the disease. Methods: N-acetyl-β-D-glucosaminidase (NAG) activities were determined spectrophotometrically in random urine samples children and adolescents (N=66) with type 1 diabetes mellitus and control subjects (N=68). Patients in the diabetic group were divided according to the duration of diabetes in four groups: group I, less than three years (N=17); group II, three to five years (N=19); group III, five to ten years (N=19) and group IV, more than ten years (N=11). To exclude interference due to urine concentration differences, urinary NAG activities were referred to the level of urinary creatinine. Results: Urinary NAG excretion in diabetic patients was significantly increased compared to the controls (P0.10; group II vs. III, P=0.549; group II vs. IV, P>0.10 and group III vs. IV, P>0.10). There was no correlation between urinary NAG activities in diabetic patients and duration of diabetes (r= - 0.017, P=0.892). Conclusion: Urinary NAG excretion was elevated in children and adolescents with diabetes mellitus type I but it did not depend on duration of the disease

Serum Zinc Concentrations in the Maintenance Hemodialysis Patients

Zinc is necessary for growth and cells’ division. Its deficiency may seriously affect antioxidant defense system and is usually related to renal failure, gastrointestinal diseases and alcoholism. It is very important to know zinc status in dialyzed patients and to prevent hypo- or hyperzincemia. Serum samples from 89 patients with chronic terminal renal failure on regular hemodialysis were withdrawn for the estimation of zinc concentrations immediately before and after dialysis. Serum zinc concentrations showed to be highly dependent on hemodialysis. In 57 (64%) patients, serum zinc concentrations decreased, sometimes from very high to normal values. In remaining 32 (36%) patients serum zinc concentrations tended to increase, but remained within normal range. Zinc supplementation may be recommended only in the patients with proven zinc deficiency, but for all chronic renal failure patients it is questionable

C-reactive Protein Is a Strong Predictor of Mortality in Hemodialysis Patients

Background. To establish the baseline cutoff value of C-reactive protein (CRP) that would predict increased overall and cardiovascular mortality in patients with end-stage renal disease (ESRD). Methods. A cohort of 270 prevalent hemodialysis patients treated at Rijeka University Hospital was eligible for the study. Monthly CRP measurements were performed for three consecutive months. Only the patients with CRP values varying 10.0 mg/L. The survival was evaluated by Kaplan-Meier curve. Results. During the two-year follow-up, 59 patients died. The major cause of death was cardiovascular disease (64%). Significantly higher overall and cardiovascular mortality was observed in group 3 when compared with groups 1 and 2 (χ2=11.97; P < 0.001) and in group 4 when compared with groups 1 and 2 (χ2=14.40; P<0.001). Compared with survivors, non-survivors had a higher median CRP value (19.0 [1.5–99.7] mg/L vs. 2.3 [0.1–49.1] mg/L, respectively; P<0.001). Conclusion. Serum concentration of CRP above 6.2 mg/L is a strong predictor of overall and cardiovascular mortality in patients with ESRD

Survival of Patients Treated with Online Hemodiafiltration Compared to Conventional Hemodialysis

Accumulating data from observational studies showed that online hemodiafiltration (OLHDF) might improve sur- vival in chronic hemodialysis (HD) patients. According to this data, the aim of our study was to investigate whether there was a difference in survival of patients treated with OLHDF compared to standard, conventional HD. We included 85 prevalent patients with end-stage renal disease (ESRD) treated with HD as a method of renal replacement therapy (RRT) for more than three months. Patients were previously treated with HD and divided into two groups: in 42 patients new treatment with OLHDF was introduced, and 43 patients were treated with HD. Both groups were followed over a period of 36 months. The study showed significantly better survival of patients treated with OLHDF, compared to the survival of patients treated with HD in the whole study population, as well as in the subgroups of diabetics, of patients who were on RRT with HD for more than five years and of the patients who were older than 65 years. In the nondiabetics, patients who were on RRT for less than five years and in the patients who were younger than 65 years, survival results in the OLHDF group were not significantly better compared to those in the HD group. As in our study, there are accumulating data from observational studies that HDF may improve survival in chronic HD patients, but new, prospective random- ized trials are needed to support evidence about this hypothesis

Psychological, Medical and Laboratory Predictors of Cardiac Anxiety in Patients with Heart Failure

Objective: The aim of the study was to identify predictors of heart-focused anxiety in patients with heart failure. A better understanding of such predictors may help in detecting the comorbidity underlying heart-focused anxiety and identifying patients who need psychological help. Methods: In order to account for multiple sources of heart-focused anxiety, we included psychological, lifestyle, and medical/laboratory predictors. The study involved 148 patients, of whom 74 had a leading diagnosis of worsening heart failure and were hospitalized during the COVID-19 epidemic. A second group of 74 patients suffering from cardiovascular diseases without a diagnosis of acute heart failure, were examined in various out-patient cardiology clinics. The sample consisted of 37.8% females and 62.2% males, with an average age of 63.35 years. The patients completed the Cardiac Anxiety Questionnaire, the Generalized Anxiety Disorder scale, the Patient Health Questionnaire, and the Intolerance of Uncertainty Scale. Results: Patients with heart failure with higher levels of depression and intolerance of uncertainty had higher overall levels of heart-focused anxiety, higher levels of fear about chest and heart sensations. Older patients with higher levels of depression had higher levels of activity avoidance, especially activities believed to elicit cardiac symptoms. Cardiac patients with higher level of anxiety and with anaemia as comorbidity had higher levels of heart-focused attention and monitoring of cardiac activity. Conclusion: In patients with heart failure, the presence of heart-focused anxiety significantly reduces the quality of life, leads to avoidant behaviours, and is associated with anxiety and depressive symptoms. These patients are more likely to seek medical help and specialist services, but the need for psychological help is very rarely recognized

INFLUENCE OF DIETARY PATTERN AND METHYLENTETRAHYDROFOLATE REDUCTASE C677T POLYMORPHISM ON THE PLASMA HOMOCYSTEINE LEVEL AMONG HEALTHY VEGETARIANS AND OMNIVORES

Povišena razina homocisteina u plazmi (Hcy) povezana je s fiziološkim i prehrambenim čimbenicima, kao i genetskim defektom enzima koji su uključeni u metabolizam Hcy. Ciljevi ove studije bili su (1) utvrditi razlike između zdravih vegetarijanca i omnivora u odnosu na biokemijske parametare, prevalenciju MTHFR genotipa i razinu Hcy, i (2) utvrditi učinke polimorfizma metilentetrahidrofolat reduktaze (MTHFR) C677T i načina prehrane na razinu Hcy u plazmi. U 47 vegetarijanaca i 53 omnivora izmjerena je razina Hcy, folata, vitamina B12, glukoze, ukupnog kolesterola, triglicerida, HDL i LDL kolesterola i kreatinina u plazmi. Polimorfizam MTHFR C677T analiziran je pomoću PCR-RFLP metode. Dobiveni rezultati su pokazali da su vegetarijanci imali niži vitamin B12, ukupni kolesterol, LDL-kolesterol i status kreatinina. Razina Hcy u plazmi bila je veća kod vegetarijanaca u usporedbi s omnivorima (14,10 ± 6,69 vs 10,49 ± 2,41 μmol/L) i negativno je korelirala sa statusom vitamina B12 i folatom. Razina plazme Hcy nije bila različita u odnosu na genotipove MTHFR C677T, ni među vegetarijancima ni omnivorima. Za razliku od MTHFR C677T polimorfizma, potvrđen je utjecaj načina prehrane na razinu Hcy u plazmi. Može se zaključiti da vegetarijanci obično imaju niži status vitamina B12 i višu razinu Hcy u plazmi. Polimorfizam MTHFR C677T nema utjecaja na razinu Hcy plazme, za razliku od prehrambenog uzorka koji ukazuje na važnost adekvatnog vitamina B12 i statusa folata u zaobilaženju mutacije.Elevated total plasma homocysteine level (Hcy) is associated with physiological and dietary factors as well as the genetic defect of enzymes involved in Hcy metabolism. The objectives of the study were to examine (1) differences between healthy vegetarian and omnivorous subjects in relation to biochemical parameters, prevalence of the MTHFR (methylentetrahydrofolate reductase) T/T genotype, and the plasma Hcy level, and (2) the effects of the MTHFR C677T polymorphism and dietary pattern on the plasma Hcy level. In 47 vegetarian and 53 omnivorous subjects the plasma level of Hcy, folate, vitamin B12, glucose, total cholesterol, triglycerides, HDL and LDL-cholesterol and creatinine were measured. MTHFR C677T polymorphisms were analyzed using the PCR-RFLP method. Obtained results have shown that vegetarians had lower vitamin B12, total cholesterol, LDLcholesterol and creatinine status. The plasma Hcy level was higher among vegetarians compared with omnivore subjects (14.10±6.69 vs. 10.49±2.41 μmol/L) and negatively correlated with vitamin B12 status and folate. The plasma Hcy level did not differ between the given MTHFR C677T genotypes among either vegetarians or omnivores. Unlike the MTHFR C677T polymorphism, the effect of dietary pattern on plasma Hcy level was confirmed. It could be concluded that vegetarians tend to have lower vitamin B12 status and a higher plasma Hcy level. The MTHFR 677C/T polymorphism has no effect on plasma Hcy level, in contrast to dietary pattern which indicates the importance of adequate vitamin B12 and folate status in bypassing the mutation