Clinical biochemistry
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Clinical biochemistry · Feb 2009
ReviewCardiac point of care testing: a focused review of current National Academy of Clinical Biochemistry guidelines and measurement platforms.
Cardiac markers are a cornerstone for assessment of suspected acute coronary syndrome (ACS) patients. The National Academy for Clinical Biochemistry has recently developed practice guidelines for clinical, analytical and point-of-care (POC) testing in the context of ACS. Several technologies have become available for POC applications. ⋯ Cardiac troponin measurements at POC are a viable alternative when testing needs cannot be met by the central laboratory. Laboratory medicine must be involved in implementation and ongoing service. Quality of testing must not be compromised by performance at POC.
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Clinical biochemistry · Jul 2008
ReviewBiological and methodological features of the measurement of S100B, a putative marker of brain injury.
The S100B astroglial protein is widely used as a parameter of glial activation and/or death in several conditions of brain injury. Cerebrospinal fluid and serum S100B variations have been proposed to evaluate clinical outcomes in these situations. Here, we briefly broach some aspects, commonly not sufficiently valorized, concerning the biology and measurements of this protein. ⋯ We discuss the extracellular origin of this protein in brain tissue, as well as extracerebral sources of this protein in serum, comparing it with other available protein markers of brain damage. The superestimation of the heterodimer S100A1-B in the current clinical literature is also analyzed. We affirm that poor dualistic views that consider S100B elevation as "bad" or "good" simplify clinical practice and delay our comprehension of the role of this protein, both in physiological conditions and in brain disorders.
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Clinical biochemistry · Mar 2008
ReviewDiagnostic accuracy of BNP and NT-proBNP in patients presenting to acute care settings with dyspnea: a systematic review.
We sought to compare the diagnostic performance of B-type natriuretic peptide (BNP) and N-terminal proBNP measurements in patients presenting to acute care settings with dyspnea, a common presenting symptom of heart failure. ⋯ BNP and NT-proBNP have very similar diagnostic performance characteristics and can be used to rule out heart failure as a cause of dyspnea in the acute clinical setting. However, there is no easily identifiable optimum cut point value for each peptide.
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Clinical biochemistry · Apr 2005
ReviewMulti-analyte procedures for screening for and quantification of drugs in blood, plasma, or serum by liquid chromatography-single stage or tandem mass spectrometry (LC-MS or LC-MS/MS) relevant to clinical and forensic toxicology.
This paper reviews multi-analyte procedures for screening and quantification of drugs in blood, plasma, or serum using liquid chromatography coupled with a single stage or tandem mass spectrometer (LC-MS, LC-MS/MS). These procedures are relevant tools in clinical and forensic toxicology, and cover analysis of amphetamines, cocaine, hallucinogens, opioids, anesthetics, hypnotics, benzodiazepines, antidepressants, neuroleptics, antihistamines, sulfonylurea-type antidiabetics, beta-blockers, and other cardiac drugs. Basic information on the procedures is given in two tables and multi-analyte screening, identification, and quantification are illustrated in three figures. A critical discussion on the pros and cons of such LC-MS procedures is also included.
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Clinical biochemistry · Oct 2002
ReviewDrug and chemical metabolites in clinical toxicology investigations: the importance of ethylene glycol, methanol and cannabinoid metabolite analyses.
Metabolic pathways in humans have been elucidated for most therapeutic drugs, drugs of abuse, and various chemical/solvents. In most drug overdose cases and chemical exposures, laboratory analysis is directed toward identification and quantitation of the unchanged drug or chemical in a biologic fluid such as serum or whole blood. Specifically, most clinical laboratories routinely screen and quantitate unchanged methanol and/or ethylene glycol in suspected poisonings without toxic metabolite analysis. ⋯ Serial monitoring of the major urinary cannabinoid metabolite (delta(9)-THC-COOH) to creatinine ratios in paired urine specimens (collected at least 24 h apart) could differentiate new marijuana or hashish use from residual cannabinoid metabolite excretion in urine after drug use according to Huestis. The second objective is to demonstrate that creatinine corrected urine specimens positive for cannabinoids may help differentiate new marijuana use from the excretion of residual delta(9) -THC-COOH in chronic users of marijuana or hashish. Analysis of toxic chemical metabolites are helpful in the assessment and treatment of chemical poisoning whereas serial monitoring of urinary cannabinoid metabolites are predictive of illicit drug use in the substance abusing population.