Biomedical subjects

F Sedor

Publications and source records attributed to F Sedor.

7 recordsLinked to original sources

PubMed2001

Urinary interleukin-8 with asymptomatic bacteriuria in pregnancy.

OBJECTIVE: To evaluate urinary interleukin-8 (IL-8), an inflammatory cytokine, as a screening method for detecting asymptomatic bacteriuria in pregnancy. METHODS: Clean-catch urine samples from 200 pregnant women undergoing screening for asymptomatic bacteriuria were evaluated by urine culture, urine dipstick analysis, and measurement of IL-8. Interleukin-8 levels were measured by a chemiluminescent immunoassay (Immulite IL-8, Diagnostic Products Corp., Los Angeles, CA), and a receiver operating characteristic curve was used to determine the optimal cutoff point. Asymptomatic bacteriuria was defined as at least 100,000 colony-forming units of a single organism per mL. Dipstick testing included nitrite assessment as positive or negative and leukocyte esterase as negative, trace, 1+, 2+, or 3+. Dipstick testing was considered positive if nitrite was positive or leukocyte esterase was trace or greater. Sensitivities, specificities, positive and negative predictive values were determined for urinary leukocyte esterase and nitrite and compared with those of IL-8. chi(2) and Mann-Whitney U tests were used for statistical analyses. RESULTS: Twenty women were identified with asymptomatic bacteriuria by urine culture. The median urinary IL-8 levels for women with and without asymptomatic bacteriuria were 356 pg/mL and 125 pg/mL, respectively (P <.01, Mann-Whitney U test). Using an optimal cutoff point of 264 pg/mL, IL-8 had a sensitivity, specificity, positive and negative predictive value of 70%, 67%, 19%, and 95% for predicting asymptomatic bacteriuria. Urine dipstick analysis with either a positive leukocyte esterase or nitrite had a sensitivity, specificity, positive and negative predictive value of 45%, 62%, 12%, and 91%, respectively, for detecting asymptomatic bacteriuria. The differences between these testing methods were not statistically significant. CONCLUSION: Urinary interleukin-8 is not an acceptable screening method for asymptomatic bacteriuria in pregnancy because it fails to detect 30% of women with this condition.

Adult↗

PubMed2000

Comparison of cardiac troponin T versus creatine kinase-MB for risk stratification in a chest pain evaluation unit.

We evaluated cardiac troponin T (cTnT) and creatine kinase-MB (CK-MB) for risk stratification of chest pain unit (CPU) patients. We studied 383 consecutive patients with chest pain assigned to our CPU by emergency department physicians. At baseline all had normal or nondiagnostic electrocardiograms, no high-risk clinical features, and negative CK/CK-MB. CK-MB and electrocardiograms were taken at 0, 4, 8, and 12 hours and cTnT at 0, 4, and 8 hours. Eight patients (2.1%) were CK-MB positive and 39 (10.2%) were cTnT positive, including all but 1 CK-MB-positive patient. All marker-positive patients were detected by 8 hours. Seven cTnT-positive patients and 1 cTnT-negative patient had myocardial infarction (p <0.0001). cTnT-positive patients were older, less likely to be women or smokers, and more often had diabetes mellitus or known coronary disease (CAD). Seventy-one percent of patients underwent diagnostic testing. cTnT-positive patients more often underwent angiography (46% vs 20%) and underwent stress testing less often (28% vs 57%) than cTnT-negative patients. When performed, their stress tests were more often positive (46% vs 14%) and they more often had angiographically significant lesions (89% vs 49%) and multivessel disease (67% vs 29%). There were no short-term deaths. Long-term mortality was higher in cTnT-positive patients (27% vs 7%, p <0.0001). Thus, cTnT identified more CPU patients with myocardial necrosis and multivessel CAD than CK-MB and a population with high long-term mortality risk. Routine use of cTnT in CPUs could facilitate risk stratification and management.

Aged↗

PubMed1997

Laboratory tests in evaluation of acute febrile illness in pediatric emergency room patients.

The rising costs of health care and the movement for health care reform have focused attention on methods of cost containment. Of routine laboratory and radiologic procedures, complete blood cell count (CBC) and determination of serum electrolyte values rank as high as 2nd and 9th in overall cost. We retrospectively studied use of the clinical laboratory to aid diagnosis of an acute infectious event in a pediatric emergency department population. For 5 months, we reviewed medical records of pediatric patients younger than 15 years brought to the emergency department because of a febrile episode. Of 155 cases reviewed, electrolyte concentrations were determined in 108 patients and CBC in 155. In all patients, either culture or rapid test for streptococcal organisms was performed. In addition, 838 pediatric patients with similar symptoms but who did not undergo laboratory testing were monitored for 100 days. Measures of effectiveness including sensitivity, specificity, positive and negative predictive values, and likelihood ratio were used to correlate specific laboratory findings with antibiotic therapy, serious bacterial disease, and culture positivity. Electrolyte abnormalities were found largely to be dismissed clinically, with the major clinical response consisting of parental education about hydration. The CBC profile was evaluated, with white blood cell count (WBC) indicator limits of > 10,000, > 10,000 but < 15,000, and > 15,000/mm3, and differentiated into absolute neutrophil count, neutrophil percent, and band cell percent. Temperature was evaluated as an independent variable. Insofar as serious bacterial disease and culture positivity, sensitivity was uniformly low (70%), and specificity was only marginably acceptable for WBC > 15,000 (77%). Both positive predictive values and likelihood ratio were low with respect to predicting either serious bacterial disease or culture positivity, emphasizing the limited usefulness of these clinical laboratory measurements. The best hematologic predictors of serious bacterial disease or culture positivity were obtained with automated hematologic analyzers and exceeded manual differential measurement of neutrophil percent and band cell percent. In addition, we correlated the administration of antibiotics with the various hematologic parameters and discovered that WBC > 15,000, regardless of cause, almost uniformly resulted in treatment (positive predictive value, 93.5%; likelihood ratio, 5.60). These findings support the use of automated hematology analyzer-derived measurements and question the use of manual differential counts, unless specific issues are to be addressed. Furthermore, the findings seem to support more reliance on clinical impression and less on laboratory values.

Acute Disease↗

PubMed1994

Stability of plasma lactate in vitro in the presence of antiglycolytic agents.

The use of plasma lactate to assess metabolic or circulatory impairment requires definition of critical preanalytical and analytical parameters. Stability has been documented for only 15 min after acquisition when samples were collected with fluoride and transported on ice. We examined time elapsed before analysis, storage temperature, and the antiglycolytic agent used to define preanalytical conditions. Plasma lactate was measured with a Kodak Ektachem 700XR analyzer. In controlled studies on volunteers, storage on ice slowed but did not eliminate the production of lactate; for samples collected with sodium fluoride (F) and potassium oxalate (OX), lactate increased by 0.2 mmol/L after 1 h, then changed little regardless of the storage temperature. For patients' samples collected in F/OX, the mean increase was only 0.15 mmol/L after 24 h. Samples with leukocytosis (neutrophil counts 23 x 10(9)-52 x 10(9)/L) were also stable, with a mean increase of 0.3 mmol/L at 8 h. Use of the antiglycolytic agents F and OX (at 60 and 12 mmol/L, respectively) maintained apparently stable lactate concentrations at room temperature for up to 8 h without special handling.

Acidosis, Lactic↗

PubMed1984

Breast milk iodide: reassessment in the 1980s.

In addition to iodized salt, the American diet is inadvertently supplemented with iodine from other foods, such as bread and cow's milk. The iodine content of breast milk has not been assessed recently in this country. Sixty-one samples of breast milk from 37 women were analyzed for iodide content using an iodide-selective electrode method. Mean breast milk iodide level on initial samples for this population was 178 micrograms/L (range 29 to 490 micrograms/L), about four times the recommended daily allowance for infants. Iodide levels in breast milk did not correlate with the age of the infant (ie, stage of lactation). There was a significant correlation between the iodide level in the breast milk and dietary iodine as estimated by a food frequency questionnaire, and iodized salt intake was significantly related to the iodide content of the breast milk.

Adult↗

PubMed1981

Unpredictable fluctuations in serum acid phosphatase activity in prostatic cancer.

Repeated determinations of the elevated serum acid phosphatase activities in five patients with advanced prostatic cancer were found to be highly variable during 24 to 48 hours of observation. Samples collected every three hours had fluctuations of 44% to 97% around the 24- to 48-hour mean values. These fluctuations appeared to be random, had no apparent circadian rhythm, and were unrelated to concurrent medications or activity. These spontaneous variations indicate the need for caution when using serial serum acid phosphatase determinations as an indicator of the response of prostate cancer to therapy. Elevated serum alkaline phosphatase activities did not show these extreme fluctuations.

Acid Phosphatase↗

PubMedDate not supplied

Nomogram for estimating creatinine clearance.

Several methods have been published for estimating creatinine clearance from serum creatinine concentrations. Such estimates of creatinine clearance are widely used for dosage adjustments of drugs which are primarily eliminated through the kidneys in patients with reduced renal function. Most of these methods involve the use of equations, requiring a few steps of calculations. A simple and easy-to-use nomogram is presented for estimating creatinine clearance from serum creatinine concentration, plus the age, sex, and bodyweight of the individual patient. This nomogram is based on the linear relationship between creatinine clearance and the reciprocal value of the serum creatinine concentration, where the slope of this relationship is determined by the rate of creatinine production. The rate of creatinine production, however, is related to age, sex, and bodyweight. These physical characteristics are therefore used to scale the slopes of the relationships between creatinine clearance and serum creatinine concentration. The validity of the nomogram was tested in 50 consecutive hospitalised patients for which creatinine clearance was measured. There was an excellent correlation (r = 0.903) between predicted and observed creatinine clearance values.

Creatinine↗