1,721,473 research outputs found
Self-monitoring of blood glucose in diabetic patients.
No full textThe self-monitoring of blood glucose through the
use of instrumentation point of care testing is an essential component in the management of the diabetic patient, in order to achieve and maintain glycaemic control, prevent and identify hypoglycaemia, prevent severe hyperglycaemia, adjust lifestyle changes and establish the need to begin treatment with insulin in gestational diabetes mellitus. The factors that can affect the accuracy of the measurement of blood glucose meters and of all devices for decentralized analysis may occur essentially in all stages of the diagnostic process, from the pre-analytical to post-analytical phase. In
addition, self-monitoring of blood glucose may have a role in improving metabolic control if it is part of a wider educational strategy. Since the accuracy of the measures obtained by the meter depends on both the instrument and the user, it is recommended that patients receive initial education in the proper use of instrumentation and interpretation of data to
adjust therapy, skills that must then be revaluated in time
Troponin elevation reflects myocardial injury in carbon monoxide poisoning
No full textWe describe the case of a 48-year-old white man, who was admitted to the emergency department with neurologic deficits and high suspicion of carbon monoxide (CO) poisoning. Blood carboxyhemoglobin (COHb) level was foundsubstantially increased (i.e., 18%). Clinical symptoms of myocardial infarction were lacking and the medical history was negative for major risk factors of coronary heart disease. However, electrocardiogram and troponin value were both suggestive for an acute coronary syndrome (i.e., a highly-sensitive troponin T value of 0.12 μg/L), while the echocardiogram showed hypokinesia of left ventricular apical lateral wall. The coronary angiogram performed one week after admission did not reveal the presence of coronary obstructions. It is hence assumed that high levels of COHb in blood, such as after CO exposure, may trigger myocardial injury by severe generalized tissue hypoxia (i.e.,impaired oxygen delivery) and a direct toxic effect on myocardium. Contributing factors that also decrease myocardial oxygenation include inadequate myocardial perfusion and prothrombotic state. This case report suggests that increased troponin values, especially when measured with highly-sensitive immunoassays, may be observed in patients with CO poisoning, and mirror the presence of myocardial injury. Therefore, although the measurement of cardiac biomarkers may be advisable in the presence of CO toxicity to identify cardiac involvement, aution should be used when troubleshooting the underlying source of troponin elevations in order to preven t overdiagnosis or misdiagnosis of acute coronary syndrome
Troponin elevation reflects myocardial injury in carbon monoxide poisoning.
No full textWe describe the case of a 48-year-old white man, who was admitted to the emergency department with neurologic deficits and high suspicion of carbon monoxide (CO) poisoning. Blood carboxyhemoglobin (COHb) level was foundsubstantially increased (i.e., 18%). Clinical symptoms of myocardial infarction were lacking and the medical history was negative for major risk factors of coronary heart disease. However, electrocardiogram and troponin value were both suggestive for an acute coronary syndrome (i.e., a highly-sensitive troponin T value of 0.12 μg/L), while the echocardiogram showed hypokinesia of left ventricular apical lateral wall. The coronary angiogram performed one week after admission did not reveal the presence of coronary obstructions. It is hence assumed that high levels of COHb in blood, such as after CO exposure, may trigger myocardial injury by severe generalized tissue hypoxia (i.e.,impaired oxygen delivery) and a direct toxic effect on myocardium. Contributing factors that also decrease myocardial oxygenation include inadequate myocardial perfusion and prothrombotic state. This case report suggests that increased troponin values, especially when measured with highly-sensitive immunoassays, may be observed in patients with CO poisoning, and mirror the presence of myocardial injury. Therefore, although the measurement of cardiac biomarkers may be advisable in the presence of CO toxicity to identify cardiac involvement, aution should be used when troubleshooting the underlying source of troponin elevations in order to preven t overdiagnosis or misdiagnosis of acute coronary syndrome
An historical approach to the diagnostic biomarkers of acute coronary syndrome
No full textSuspected acute myocardial infarction (AMI) is one of the leading causes of admission to the emergency departments in Western countries but also an increasing cause in many other nations. The diagnosis of AMI involves the evaluation of clinical signs and symptoms, electrocardiographic assessment, and measurement of cardiac circulating biomarkers. In the last sixty years, the use of laboratory markers has changed considerably. Early biomarkers assessment has entailed testing for total enzyme activity of aspartate aminotransferase (AST), lactate dehydrogenase (LDH) and creatine kinase (CK). Advances in electrophoresis allowed the identification of more cardio-specific isoenzymes of both CK and LDH, thus leading to the introduction of the CK-MB and LDH-1 activity assays. Soon thereafter, the development of immunoassays, as well as technical advances in automation, allowed the measurements of the CK-MB in mass rather than in activity and myoglobin. Currently, cardiac troponins have the highest sensitivity and specificity for myocardial necrosis and represent the biochemical gold standard for diagnosing AMI. This review provides a chronology of the major events which marked the evolution of cardiac biomarkers testing and the development of the relative assays from the first introduction of AST in the 1950s to the last high sensitivity troponin immunoassays in the 2010s
Laboratory and precision medicine: the reasons for the birth of a new journal
No full textLaboratory and precision medicine: the reasons for the birth of a new journa
Il dosaggio ematico dei farmaci antidiabetici: importanza nelle sindromi ipoglicemiche.
No full textLa determinazione degli ipoglicemizzanti assume importanza nella diagnosi differenziale dell’ipoglicemia nel diabetico. La determinazione dell’insulina è complicata da problematiche relative a scarsa standardizzazione e armonizzazione tra i vari laboratori, che può complicare il confronto dei risultati. Il numero elevato di principi attivi, la variabile associazione e l’implicita complessità delle metodiche, complica la determinazione soprattutto in urgenza dei farmaci ipoglicemizzanti orali
Il dosaggio ematico dei farmaci antidiabetici: importanza nelle sindromi ipoglicemiche
No full textLa determinazione degli ipoglicemizzanti assume importanza nella diagnosi differenziale dell’ipoglicemia nel diabetico. La determinazione dell’insulina è complicata da problematiche relative a scarsa standardizzazione e armonizzazione tra i vari laboratori, che può complicare il confronto dei risultati. Il numero elevato di principi attivi, la variabile associazione e l’implicita complessità delle metodiche, complica la determinazione soprattutto in urgenza dei farmaci ipoglicemizzanti orali
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