Novas tecnologias na pesquisa de alergias

Deu no Medical News Today, uma nota a respeito do lançamento de dois produtos pela Phadia: Phadia ISAC e Phadia HR. ISAC é uma abordagem molecular, o que traz uma nova variável ao sistema todo. Vale a leitura:

Phadia Introduces New Food Allergy Diagnostic Tools To Meet The Needs Of Allergists: "Today at the 2009 Annual Meeting of the American College of Allergy, Asthma & Immunology, Phadia US introduced two new products designed specifically to meet the unique needs of the nation's 6,000 allergists. ImmunoCAP ISAC and ImmunoCAP HR are new offerings designed to augment traditional allergy testing methodologies and enable diagnosis of complex food allergies at the molecular level, available through itsN own PiRL testing facility."

Para Refletir: Mind the Gap: Difference between knowledge and action in the laboratory

Saiu no The Westgard Rules, Blog do site do James Westgard: http://james.westgard.com/

Trata-se de um texto para a gente refletir, a respeito do que sabemos, e não sabemos, de como encarar os dados provenientes de controle interno de qualidade (CQI), e de como as pessoas apresentam diferentes compreensões de problemas conforme são apresentados.

Boa Leitura:




Mind the Gap: Difference between knowledge and action in the laboratory: "

Posted by Sten Westgard, MS

In June of this year, Zoe Brooks presented an AACC-sponsored webinar with the title, Laboratory QC: Bridging the Gap Between Theory and Practice. During this webinar, Zoe presented a poll and more than 100 participants responded. The results are very interesting...

When asked to agree or disagree with this statement, "Method quality is OK if all the results on a QC chart are within +/- 2 SD of the Mean" only 67% of the respondents said No. (I suppose we should be encouraged with that result? More than a majority of laboratorians have learned the most basic lesson of QC.)

But then Zoe did a clever thing. She presented participants with this graph:

Again, she asked, is this method OK or not or is there not enough information? Now only 29% of the participants answered that there was not enough information to make a decision.

Here's the trick: The two questions are the same. The first is a verbal presentation, while the second is a graphic presentation, of the same situation.

Let's be clear. When presented with the theoretical statement, 67% of the participants recognized that using 2sd limits as accepability critieria was not a good idea. But when presented with an actual example in a graph illustrating that theory, about half of those people did use 2sd limits as acceptability criteria. Let's estimate that roughly a third of the participants knew the correct theory, but acted incorrectly in practice.

The moral: even among experienced laboratorians, there is a lot of room for improvement.

I suspect if the poll had asked what rules were actually being used in the participant laboratories, we would find an even larger number still use 2sd limits as acceptability criteria. Even when you know the theory, and can recognize the practice, the pressures of generating fast results often force the capitulation of principles to production.

Zoe's website is http:www.awesome-numbers.org

"

Biblioteca Digital SBPC

Feliz a iniciativa da SBPC em oferecer um srviço de biblioteca virtual para documentos de uso laboratorial.

Vale a visita à Biblioteca Digital da SBPC, dá para encontrar muita coisa interessante por lá.

Consolidação do uso de Cistatina C como marcador de função renal.

Saiu no Renal Fellow Network, o texto abaixo:


As we all know, there are significant limitations to the use of creatinine as an estimate of GFR. Creatinine is freely filtered at the glomerulus, but in addition is also secreted to some degree, meaning that creatinine clearance can overestimate GFR. Furthermore, since creatinine is produced by muscle, individuals with high muscle mass may have a calculated GFR which is low despite actually preserved renal function. Another failing of creatinine-based GFR calculations is highlighted by the ability of creatinine to predict all-cause mortality: although high creatinines are associated with a higher risk of mortality, individuals with extremely low creatinines, perhaps reflective of a poor nutritional status or low muscle mass--also show poor mortality outcomes.

In a recent article in JASN by Astor et al, the investigators provide evidence that cystatin C does a better job of predicting mortality than creatinine. Cystatin C is a cysteine protease inhibitor which is freely filtered at the glomerulus, but not secreted like creatinine is. Furthermore, cystatin C production is independent of muscle mass, making it less susceptible to the limitations of creatinine. One of the main strengths of the study is the it uses data from NHANES, which is generated from a large and ethnically diverse U.S. population with a long follow-up time; it also contains a large number of individuals with only mildly reduced GFRs in the CKD3 range. The apparent superiority of cystatin C to predict mortality and provide more accurate assessments of GFR compared to creatinine suggest it could eventually play a major role in routine lab assessment in many of our patients.

Specialty Labs

Mais um recurso interessante: o site do Specialty Labs. Lá tem o conteúdo típico de se encontrar em homepages de laboratórios, mas não deixe de visitar a parte dos livros. Não tem ali nada de espetacular, mas é mais uma boa fonte de informações.

Pathology Outlines

Mais um recurso útil na internet para quem trabalha em laboratório: Pathology Outlines, onde se pode encontrar um volume interessante de informação atualizada.

Visite a seção Clinical Pathology Chapters, e encontre uma série de dados (atualizados) sobre vários assuntos. Procure os diagramas e flowcharts.

Espero que seja de utilidade a todos.

Albumina/ Creatiina Urinária: Potencial Marcador

Aí está uma notícia interessante: a determinação da razão entre albumina e creatinina urinárias pode discriminar maior risco para insuficiência cardíaca. Saiu no Lancet, leia o resumo:

Albuminuria in chronic hearth failure: prevalence and prognostic importance

Colette E Jackson MB ChB a, Scott D Solomon MD b, Prof Hertzel C Gerstein MD c, Sofia Zetterstrand PhD d, Bertil Olofsson PhD d, Prof Eric L Michelson MD e, Prof Christopher B Granger MD f, Prof Karl Swedberg MD g, Prof Marc A Pfeffer MD b, Prof Salim Yusuf DPhil c, Prof John JV McMurray MD a , for the CHARM Investigators and Committees

Summary

Background

Increased excretion of albumin in urine might be a marker of the various pathophysiological changes that arise in patients with heart failure. Therefore our aim was to assess the prevalence and prognostic value of a spot urinary albumin to creatinine ratio (UACR) in patients with heart failure.

Methods

UACR was measured at baseline and during follow-up of 2310 patients in the Candesartan in Heart failure: Assessment of Reduction in Mortality and morbidity (CHARM) Programme. The prevalence of microalbuminuria and macroalbuminuria, and the predictive value of UACR for the primary composite outcome of each CHARM study—ie, death from cardiovascular causes or admission to hospital with worsening heart failure—and death from any cause were assessed.

Findings

1349 (58%) patients had a normal UACR, 704 (30%) had microalbuminuria, and 257 (11%) had macroalbuminuria. The prevalence of increased UACR was similar in patients with reduced and preserved left ventricular ejection fractions. Patients with an increased UACR were older, had more cardiovascular comorbidity, worse renal function, and a higher prevalence of diabetes mellitus than did those with normoalbuminuria. However, a high prevalence of increased UACR was still noted among patients without diabetes, hypertension, or renal dysfunction. Elevated UACR was associated with increased risk of the composite outcome and death even after adjustment for other prognostic variables including renal function, diabetes, and haemoglobin A1c. The adjusted hazard ratio (HR) for the composite outcome in patients with microalbuminuria versus normoalbuminuria was 1·43 (95% CI 1·21—1·69; p<0·0001) p="0·0001)">

Interpretation

Increased UACR is a powerful and independent predictor of prognosis in heart failure.

Funding

AstraZeneca.