Oddeleni klinicke biochemie

Czech Republic

Oddeleni klinicke biochemie

Czech Republic
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Soska V.,Oddeleni klinicke biochemie | Soska V.,Katedra Laboratornich Metod Lf Mil Brno O Ii Internf Klinika Lf Mil A Fn U Sv Anny
Vnitrni Lekarstvi | Year: 2016

The study HOPE-3 aimed to determine whether treatment with statin and with antihypertensive drugs (candesar-Tan and hydrochlorothiazide) in routine clinical practice in people without cardiovascular diseases (men aged over 55, women over 65 years) will reduce cardiovascular events. Another objective was to answer whether the effect of the above-mentioned treatment will be the same in different ethnic (anthropometric) populations. All drugs were administered as an "polypills". The study demonstrated that use of antihypertensive medication in this population does not reduce the incidence of cardiovascular events. In contrast, statin treatment reduced cardiovascular events statistically highly significant (p = 0.002). The effect of treatment was the same for all ethnic groups included to the study (total of 6 continents).

Objective: The aim of the study was to compare the results of ALP catalytic concentration in serum and plasma determined by the routine ALP method (Roche Diagnostics), with the results of those determined by the alkaline phosphatase approach (BLW Diagnostics), after the IFCC reference method 2011. Assessment was made of the influence of standardization for ALP determination on results in patient samples. Setting: Department of Clinical Biochemistry, St. Anne's University Hospital (FNUSA), Brno. Material and Methods: Single samples were taken from a set of 135 patients examined in FNUSA. The ALP catalytic concentration was determined by the routine ALP method (Roche Diagnostics) on a Modular P analyzer and by the Alkaline phosphatase method (BLW Diagnostics) on a Cobas c311 analyzer. The null hypothesis was that the mean difference between the ALP results compared would not be significantly different from zero in statistical terms. The ALP results were evaluated by paired samples t-test, by Wilcoxon test and by variance ratio test (F-test). Results: In a group of 135 men and women the mean difference between ALP values determined was statistically significantly different between the results of Roche and BLW methods. The mean difference between ALP-BLW and ALP-Roche was 0.58 μkat/l. The mean value of ALP-Roche was 3.036 μkat/l, 95%CI (2.165 - 3.906 μkat/l). The mean value of ALP-BLW was 3.615 μkat/l, 95%CI (2.563 - 4.666 μkat/l). Results that were significantly different in terms of exceeding the upper reference limits in ALP-Roche and ALP-BLW appeared in 12% of the female part of the group and 17% in the male part. Conclusion: ALP results determined by the Roche and BLW methods may be different, judged in terms of exceeding upper reference limits for ALP.

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.

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.

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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