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Authors followed the article "Estimated glomerular filtration rate in diabetic patients" published by Šálek, T. and Ponížil, P. We expanded original data set (N=565) with additional 950 examinations and compared equations for glomerular filtration rate estimation (eGFR) from KDIGO 2012 Guidelines (equation CKD-EPI, version 2009 for creatinine only, version 2012 for cystatin C only and version 2012 for the combination of creatinine + cystatin C). Authors concluded, that CKD-EPI equations offer different results in different intervals of glomerular filtration. Cystatin C based equation (CKD-EPI 2012, cystatin C) offers higher values of eGFR in the interval above 1.5 ml/s per 1.73 m2 in comparison to the equation CKD-EPI 2009 (creatinine) and vice versa in the interval below 1.5 ml/s per 1.73 m2. Combined equation CKD-EPI 2012 (creatinine + cystatin C) is more related to the concentration of cystatin C than to the concentration of creatinine. These results may have impact on the interpretation and strategy of GFR estimation in clinical practice.

Spatenkova V.,Krajska Nemocnice Liberec A.s. | Skrabalek P.,Oddeleni Klinicke Biochemie
Ceska a Slovenska Neurologie a Neurochirurgie | Year: 2014

Polyuria is often seen in neurocritical care patients and can cause severe water and sodium imbalance. There are two major mechanisms causing the loss of water via the kidneys. The loss may be either due to osmotic or water diuresis. Central diabetes insipidus is a typical water diuresis, with free water losses causing hypernatremia in acute brain disease. Sodium diuresis occurs in cerebral salt wasting syndrome and causes hypoosmolal hyponatremia. One of the aims of neurocritical care is to prevent iatrogenic dysnatremias by careful management of polyuria. This requires correct diagnosis of the type of diuresis and differentiation of the possible cause - whether this is the organism's compensatory response to higher fluid or osmotic agent intake or acute brain damage. We present a case of a 34-year-old female patient with subarachnoid hemorrhage and iatrogenic hypoosmolal hyponatremia, iatrogenic drug-associated SIADH (syndrome of inappropriate secretion of antidiuretic hormone) caused by erroneous administration of desmopressine acetate in polyuria with free water diuresis.

Hnikova O.,Klinika Deti A Dorostu | Vinohradska H.,Oddeleni Klinicke Biochemie | Dejmek P.,Klinika Deti A Dorostu | Al Taji E.,Klinika Deti A Dorostu
Cesko-Slovenska Pediatrie | Year: 2014

Neonatal population is in significantly higher risk of iodine deficiency (ID). Iodine saturation in newborns has been followed in the Czech Republic (CR) since 1991. In a pilot study in Prague 10 which included 50 neonates and their mothers, the median urinary iodine concentration observed on the 5th day after birth, revealed mild ID, according the WHO, UNICEF and the International Council for Control of Iodine Deficiency Disorders (ICCIDD). Grant supported study followed in 3 regions of CR (1993-95), ie. in Prague, Pribram and Ustí n. L. In each region ioduria, thyroid stimulating hormone (TSH), thyroxine (T4) measurements and thyroid ultrasound were performed in 50 neonates and their mothers. Median ioduria results were not consistent in three regions, varying from mild to middle ID. After extension of preventive measures, including recommendation of 100 μg of iodine/day in pregnant mothers, median ioduria values were close to normal in a study from 1997. Iodine saturation monitoring of neonatal population in CR has been initiated in 1996, using neoTSH method from neonatal screening for congenital hypothyroidism (SCH), according to WHO, ICCIDD and UNICEF. The adequate iodine saturation was evident if in less then 3% of newborns neoTSH was elevated in range 5,0-20,0 mIU/L. Blood samples were taken at 72-96 hours post partum (pp.). Since the year 2006 normal iodine intake, less than 3% of elevated neoTSH, was observed in newborns of CR until the end of September in 2009. Since October 1st 2009, new measures were introduced in neonatal screening in CR. Blood samples are taken earlier, ie. 48-72 hours pp. The percentage of newborns with neoTSH 5,0-20,0 mIU/L has doubled with earlier blood sampling and remained stable within this range during next years 2010-2013. The likely reason of this postpartum increase in neoTSH is associated with earlier sampling and intervention with after birth TSH elevation. In conclusion: neoTSH method for monitoring of iodine saturation in newborn population, using neoTSH 5,0-20,0 mIU/L from SCH, has been proven as an ideal method, reliable, cheap with easy organization in a long-term follow up. Earlier blood sampling (48-72 hours pp.) increased the upper range of normal iodine intake to 6% instead to 3% neoTSH (5,0-20,0 mIU/L) in newborn population of CR. Ongoing education, emphasizing iodine importance and its correct supply is crutial for pregnant and lactating mothers.

Vodicka M.,Lekarna | Salek T.,Oddeleni Klinicke Biochemie | Roderova E.,Interni Klinika IPVZ | Cerny D.,Oddeleni Klinicke Farmacie
Klinicka Onkologie | Year: 2013

Background: Cyproterone acetate is associated with hepatotoxicity during prostate cancer treatment. The information about its toxic mechanism and risk factors is limited, based on pharmacovigilance reports and published case reports only. Case: We describe a case of a patient treated with cyproterone acetate (200 mg/day for 9 months) for adenocarcinoma of the prostate. The 75-year-old patient was admitted for the development of jaundice and loss of appetite to the T. Bata Regional Hospital in Zlin, Czech Republic. Laboratory values ALT 994 U/l, AST 1,046 U/l, ALP 193 U/l, GGT 1,128 U/l, bilirubin 177 μmol/l, conjugated bilirubin 138 μmol/l, albumin 26 g/l. Quick time INR 1.23. The concomitant medication included atorvastatin 10 mg daily. Clinical and laboratory outcomes showed acute fulminant liver failure caused predominantly by hepatocellular damage. Hepatotoxicity induced by cyproteron acetate was diagnosed after exclusion of other causes, with a gradual improvement after discontinuation of the respective drug treatment Conclusion: All patients treated with cyproteron acetate for prostate cancer are in risk for the development of liver failure and therefore should be monitored and well educated. More information is needed to sufficiently identify risk factors and explain mechanism of damage.

Sychra P.,II. Interni Klinika Gatroenterologicka A Hepatologicka LFUP A FN Olomouc | Prochazka V.,II. Interni Klinika Gatroenterologicka A Hepatologicka LFUP A FN Olomouc | Roubalova L.,Oddeleni Klinicke Biochemie | Zapletalova J.,Ustav Lekarske Biofyziky | Konecny M.,II. Interni Klinika Gatroenterologicka A Hepatologicka LFUP A FN Olomouc
Gastroenterologie a Hepatologie | Year: 2016

Colorectal cancer still persists despite advances in diagnosis and therapy. The unfulfilled expectations of screening programs has led to the development of new tests based on molecular biology for early diagnosis. Reports over the past 15 years concerning the possibility of using epigenetic markers of colon cancer for colon cancer diagnosis led us to study the feasibility of using the Septin 9 test comprised in the Epi proColon Plasma Quick Kit on a group of 108 patients undergoing colonoscopy, the reference method. We were interested in the sensitivity and specificity of the test under our clinical conditions. Among the 108 patients, colonoscopy detected adenomas in 41, carcinomas in 21, and no findings in 46 persons. In the patients with negative colonoscopic findings, the Septin 9 test was negative for 34 and positive for two, with 10 people were classified as "not detected" (ND) because the DNA concentration in the isobath was below the required level. In patients with a confirmed adenoma, the Septin 9 test was negative in 26 and positive in one, and 14 people were classified as ND. In patients with cancer, the Septin 9 test was negative in seven and positive in seven, and seven were classified as ND. The sensitivity of the Septin 9 assay was 19.5% and the specificity was 94.4%. Septin 9 test positivity was found significantly more often in people with cancer than in those with an adenoma or with negative findings on colonoscopy (p = 0.003). The Septin 9 test showed a high degree of specificity (94.4%). It was disappointing that the test showed very low sensitivity in patients with adenoma (only 3.7%). The overall results of the study were affected by the high proportion of tests in which the concentration of DNA in the isolate was insufficient, necessitating that these patients be classified as ND.

Soska V.,Oddeleni klinicke biochemie | Soska V.,Katedra laboratornich metod
Interni Medicina pro Praxi | Year: 2015

Dyslipidemia is one of the main components of the metabolic syndrom. Is is characterized by elevated triglycerides, low HDL-cholesterol and elevated concentrations of small aterogenic LDL particles. The basic step in treatment should be always a lifestyle changes, especially changes in diet, weight optimization and ban of smoking. Pharmacotherapy DLP is indicated if a patient is in very high or high risk of fatal cardiovascular event during next 10 years and if (at the same time) is LDL-cholesterol higher than its target level. Pharmacotherapy is based on statins therapy, in case of their intolerance ezetimibe. If target level of LDL-cholesterol is achieved and persist elevated levels of triglycerides and/or decreased HDL-cholesterol, adding fenofibrate to a statin should be considered.

Drug hypersensitivity reactions are adverse effects of drugs that clinically resemble allergic reactions. They represent a significant health problem and a correct diagnosis is essential for its solution. This aim can be achieved by complete drug allergy work up only. A cornerstone of the diagnostic algorithm is a thorough and detailed clinical history followed by laboratory, skin and provocation tests. The article summarizes current diagnostic guidelines including its pitfalls and wider context of the issue and informs about the establishment of the Working group for drug allergy in the Czech Society of Allergology and Clinical Immunology.

Prochazka J.,Oddeleni Klinicke Biochemie | Borecka K.,Oddeleni Klinicke Biochemie | Lanska V.,Oddeleni Lekarske Statistiky
Klinicka Biochemie a Metabolismus | Year: 2013

Objective: We tested an effect of hemolysis (H index) on concentrations of total and direct bilirubin to determine the threshold level of hemolysis, until which quantitative results can be issued only with an additional comment. Materials and Methods: We added haemolysate to serum samples with low primary concentration of total or direct bilirubin and created different degrees of hemolysis. Then we established a deviation from original values of bilirubin concentration by repeated measurement and statistically processed (by the least squares method and by the contrast method in the analysis of variance). Results: We found negative bias in the case of both total and direct bilirubin. However a rise of primary bilirubin concentration was expressed in samples with high hemolysis, caused probably by increased absorbance of hemoglobin, then by direct photometric interference. The rise was significant mainly in samples with low original concentration of direct bilirubin. We deduced the threshold level of hemolysis for measurement of total (H index 95) and direct bilirubin (H index 53) by method used in our laboratory. Conclusion: We have verified the effect of hemolysis on concentrations of total and direct bilirubin by the experiment based on routine laboratory practice. We have determined the threshold level of hemolysis, until which quantitative results cannot be issued.

Most patients treated with statins die due to cardiovascular events. The risk of cardiovascular event during statin treatment is called residual risk. The source of residual risk are some risk factors including dyslipidemia, characterized by low HDL-cholesterol, elevated triglycerides and apolipoprotein B, small dense LDL and sometimes also high lipoprotein(a). High residual risk is common in patients with metabolic syndrom, type 2 diabetes mellitus, insulinoresistance and abdominal obesity. Residual risk can be decreased by combination therapy statins with fibrates or statins with niacin; niacin can affect almost all lipids and lipoproteins that participate in residual risk. There are evidences from clinical trials that combinations statin with fibrates or statin with niacin are safe.

Background: Pernicious anaemia is an autoimmune disease that causes acquired vitamin B12 deficiency. The diagnostic process includes the detection of typical changes in the blood count, low serum levels of vitamin B12, endoscopic and histological signs of gastritis and autoantibodies against the gastric parietal cells antigen H+/K+ ATPase and intrinsic factor. Objective: Our aims were to establish immunological tests for the detection of autoantibodies against intrinsic factor and target gastric parietal cell antigen H+/K+ ATPase and to evaluate their diagnostic benefits in patients with pernicious anaemia. Material and Methods: Sera from 95 patients were tested for autoantibodies against H+/K+ ATPase and intrinsic factor by multiplex Luminex assay. The results were compared with those of the immunofluorescence assay for the detection of autoantibodies against gastric parietal cells and with the diagnostic criteria. Results: The autoantibodies against gastric parietal cell H+/K+ ATPase had a sensitivity of 68.2% with a specificity of 91.7% for the diagnosis of pernicious anaemia. The respective rates for the autoantibodies against intrinsic factor were 40.9% and 98.6%. The combined sensitivity and specificity rates for both autoantibodies were 86.36% and 90.28%, respectively, the combined positive predictive value was 73.08% and the combined negative predictive value was 95.59%. Conclusion: The detection of both autoantibodies is helpful in diagnosing pernicious anaemia and the combination of the two assays increases diagnostic sensitivity.

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