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Singhi A.K.,Madras Medical Mission | Vinoth B.,Madras Medical Mission | Kuruvilla S.,Clinical Laboratory Services | Sivakumar K.,Madras Medical Mission
Annals of Pediatric Cardiology | Year: 2015

Plastic bronchitis, a rare but serious clinical condition, commonly seen after Fontan surgeries in children, may be a manifestation of suboptimal adaptation to the cavopulmonary circulation with unfavorable hemodynamics. They are ominous with poor prognosis. Sometimes, infection or airway reactivity may provoke cast bronchitis as a two-step insult on a vulnerable vascular bed. In such instances, aggressive management leads to longer survival. This report of cast bronchitis discusses its current understanding.

Lupoli G.A.,University of Naples Federico II | Okosieme O.E.,University of Cardiff | Evans C.,University of Wales | Clark P.M.,Clinical Laboratory Services | And 4 more authors.
Journal of Clinical Endocrinology and Metabolism | Year: 2015

Context: Thyroglobulin antibodies (TgAbs) are surrogate markers of disease recurrence or persistence in differentiated thyroid cancer (DTC). However, the prognostic significance of TgAb heterogeneity in DTC has not been investigated. Objective: To evaluate the relationship between TgAb epitope specificities and clinical outcomes in DTC patients. Design:Westudied 61 TgAb-positive patients with DTC, post-thyroidectomy and remnant ablation (7 males, 54 females; age-range 16-80 years, median follow-up duration 8.9 years). TgAb epitope reactivities weremappedusing a panel of 10 thyroglobulin (Tg) monoclonal antibodies delineating six antigenic Tg clusters in competitive ELISA studies. Sera from 45 patients with Hashimoto's thyroiditis (HT) and 22 TgAb-positive healthy subjects served as autoimmune and healthy controls. Tg was measured by immunoradiometric assay (IRMA), electrochemiluminescence immunoassay (ECLIA), and RIA, while TgAbs was measured by ELISA and ECLIA methods. Results: Samples from 26 DTC patients showed TgAb epitope restriction similar to HT patients, while 35 patients exhibited nonspecific reactivity comparable to healthy controls. DTC patients with epitope restriction had higher rates of recurrent/persistent disease (81% vs 17%, P <.001), higher median TgAb concentration (887.0 vs 82.0 kIU/L; P <.001), and a higher prevalence of thyroid lymphocytic infiltration (71.4% vs 26.8%; P <.001) compared to patients with nonspecific reactivity. Samples with epitope restriction also had a lower median Tg-IRMA/RIA ratio (3.0% vs 36.0%; P <.001) denoting greater degrees of Tg assay interference. Conclusions: TgAb epitope restriction is associated with a less favorable prognosis than nonspecific reactivity in DTC patients. TgAb epitope specificities may have prognostic value in DTC. © 2015 by the Endocrine Society.

Giovanella L.,Oncology Institute of Southern Switzerland | Feldt-Rasmussen U.,Copenhagen University | Verburg F.A.,RWTH Aachen | Grebe S.K.,Mayo Medical School | And 2 more authors.
Clinical Chemistry and Laboratory Medicine | Year: 2015

Differentiated thyroid cancer (DTC) is the most common endocrine cancer and its incidence has increased in recent decades. The initial treatment consists of total thyroidectomy followed by ablation of thyroid remnants by radioiodine in most cases. As thyroid cells are the only source of thyroglobulin (Tg), circulating Tg serves as a biochemical marker of persistent or recurrent disease in the follow-up of DTC. Due to the suboptimal clinical detection rate of older Tg assays endogenous or exogenous thyrotropin (TSH) stimulations are recommended for unmasking occult disease. However, the development of new Tg assays with improved analytical sensitivity and precision at low concentrations now allows detection of very low Tg concentrations, reflecting minimal amounts of thyroid tissue, even without the need for TSH stimulation. Even if the use of these assays still has not found its way in current clinical guidelines, such assays are now increasingly used in clinical practice. As serum Tg measurement is a technically challenging assay and criteria to define a 'highly sensitive' assay may be different, a good knowledge of the technical difficulties and interpretation criteria is of paramount importance for both clinical thyroidologists, laboratory physicians and scientists involved in the care of DTC patients. © 2015 by De Gruyter.

Stotler B.A.,Columbia University | Stotler B.A.,Clinical Laboratory Services | Kratz A.,Columbia University | Kratz A.,Clinical Laboratory Services
American Journal of Clinical Pathology | Year: 2013

Objectives: To describe validation and performance of epoc, a blood gas analysis point-of-care system, in a live clinical setting. Methods: Data were collected for 156 epoc systems over 12 months. Preimplementation precision and correlation studies and postimplementation quality assurance data were collected, including test card, reader, and personal data assistant (PDA) failure rates. Results: The coefficient of variation was clinically acceptable for all analytes. Correlation studies yielded an R2 from 0.901 (for sodium) to 0.994 (for potassium) with the Nova analyzer and from 0.961 (sodium) to 0.991 (glucose) with the i-STAT. Average test card failure rate was 13%. Of the PDA/reader units, 55% needed repair within 1 year. Conclusions: The analytical performance showed high precision and good correlation with the Nova and i-STAT platforms. Test card and instrument failure rates were higher than that of the i-STAT system. © American Society for Clinical Pathology.

Oral B.,Information Services | Cullen R.M.,Information Services | Diaz D.L.,Information Services | Hod E.A.,Columbia University | And 3 more authors.
American Journal of Clinical Pathology | Year: 2015

Objectives: Downtimes of the laboratory information system (LIS) or its interface to the electronic medical record (EMR) disrupt the reporting of laboratory results. Traditionally, laboratories have relied on paper-based or phone-based reporting methods during these events. Methods: We developed a novel downtime procedure that combines advance placement of orders by clinicians for planned downtimes, the printing of laboratory results from instruments, and scanning of the instrument printouts into our EMR. Results: The new procedure allows the analysis of samples from planned phlebotomies with no delays, even during LIS downtimes. It also enables the electronic reporting of all clinically urgent results during downtimes, including intensive care and emergency department samples, thereby largely avoiding paper- and phone-based communication of laboratory results. Conclusions: With the capabilities of EMRs and LISs rapidly evolving, information technology (IT) teams, laboratories, and clinicians need to collaborate closely, review their systems' capabilities, and design innovative ways to apply all available IT functions to optimize patient care during downtimes. © 2015 American Society for Clinical Pathology.

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