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Resumen

Objetivos

El SARS-CoV-2 es un nuevo coronavirus, responsable de la enfermedad COVID-19. Entre las alteraciones de los parámetros de laboratorio se han descrito leucocitosis con linfopenia, neutrofilia y aumento de dímero D, proteína C reactiva, ferritina, procalcitonina y lactato deshidrogenasa. El objetivo de este estudio ha sido describir las características clínicas y los parámetros de laboratorio de pacientes ingresados con infección por SARS-CoV-2 e identificar factores pronósticos de progresión de la enfermedad.

Materiales

Los pacientes incluidos en el estudio fueron clasificados en dos grupos en función de la gravedad de la infección. Los variables estudiadas fueron los datos demográficos, antecedentes personales, días de ingreso hospitalario, evolución del cuadro neumónico, tratamiento farmacológico y parámetros analíticos. Se realizó un análisis descriptivo de los datos recogidos, así como un análisis multivariante para identificar factores pronósticos de gravedad de la infección.

Resultados

La población de este estudio incluyó a 197 pacientes, considerándose 127 leves y 70 graves. Se encontraron diferencias estadísticamente significativas entre los dos grupos en la mayoría de los parámetros de laboratorio. El análisis multivariante incluyó como factores pronósticos de gravedad la edad avanzada, niveles elevados de leucocitos y concentraciones aumentadas de proteína C reactiva (PCR), γ-glutamiltransferasa (GGT) y procalcitonina (PCT) en el momento del ingreso hospitalario.

Conclusiones

Los factores pronósticos de gravedad de la infección por SARS-CoV-2 identificados en este estudio (edad, leucocitos, PCR, GGT y PCT) permiten predecir el curso de la enfermedad en las etapas iniciales.

Resumen

Objetivos

La intoxicación por paracetamol es una de las causas no infecciosas asociada al incremento de la concentración de procalcitonina. Presentamos dos casos de pacientes ingresados por intoxicación por paracetamol en el que los datos analíticos revelaron un aumento significativo de procalcitonina sin datos clínicos, radiológicos y/o microbiológicos de infección. El mecanismo que explicaría este incremento no ha sido aclarado.

Caso clínico

Se presentan dos casos correspondientes a dos pacientes atendidos en el Servicio de Urgencias por intoxicación por paracetamol requiriendo ambos el ingreso en la Unidad de Cuidados Intensivos (UCI). Ambos mostraron un incremento de procalcitonina en las primeras horas de ingreso, sin evidencia clínica y/o microbiológica de infección que justificase dicho incremento. De forma llamativa, sólo el paciente 1 presentó disfunción hepática, con alteración de las concentraciones de alanino aminotransferasa (ALT), aspartato aminotransferasa (AST), bilirrubina y bilirrubina esterificada, hallazgos no observados en la paciente 2.

Conclusiones

los pacientes presentados en este caso clínico mostraron un aumento de procalcitonina asociado a la intoxicación por paracetamol, pero sólo uno de ellos mostró signos de disfunción hepática. Ello sugiere que en la intoxicación por este fármaco la secreción del biomarcador no estaría solamente ligado al daño sobre el hepatocito, sino que otros mecanismos en los que estarían implicados otros órganos y tejidos contribuirían al aumento de procalcitonina. En cualquier caso, y aunque el mecanismo no ha sido perfectamente aclarado, es importante conocer esta limitación para el uso de procalcitonina como marcador de infección en pacientes intoxicados por paracetamol.

Abstract

Objectives

Lactose malabsorption is generally assessed by hydrogen breath testing (HBT). However, this test is not recommended in patients with high baseline hydrogen concentrations (H2B). In addition, breath testing is not recommended in the current situation created by the COVID-19 pandemic, due to the potential infectiveness of the samples. The objective is to assess concordance between HBT and lactose tolerance test (LTT) depending on H2B concentrations.

Methods

A total of 430 patients (40 years, Q1–Q3 = 28–54 years; 66.7% women) suspected of lactose malabsorption were included in the study. Breath and heparinized blood samples were collected at baseline and sequentially after the intake of 50 g of lactose, to measure hydrogen in breath and glycemia in blood, respectively.

Results

H2B was <10 ppm in 69.5% of subjects; 10–20 ppm in 14.7%; and >20 ppm in 15.8% of subjects. In patients with H2B <20 ppm, concordance between HBT and LTT was moderate and consistently improved when the cut-off in LTT was set at 15 mg/dL. The increase in hydrogen and glucose correlated negatively (r=−0.389; p<0.05). The increase in glycemia during LTT was not influenced by H2B levels obtained in HBT.

Conclusions

LTT emerges as an alternative to HBT to assess lactose malabsorption in the presence of high H2B levels or when breath testing is not recommended by the circumstances. The best concordance was obtained when the cut-off for LTT was set at 15 mg/dL.

Abstract

Objectives

Immunoassays used to assess thyroid function are vulnerable to different types of interference that may affect clinical decision-making.

Case presentation

We report the case of a 37-year-old woman who developed iatrogenic hypothyroidism after having received radioiode therapy who visited our hospital for her annual checkup. The patient was asymptomatic, without signs suggestive of thyroid disease. However, laboratory analysis proved otherwise: thyrotropin (TSH) 7.75 mU/L, thyroxine (FT4) >7.7 ng/dL.

Conclusions

The inconsistency between her clinical symptoms and the biochemistry data raised the possibility of a methodological interference. A thorough evaluation of the main causes of interference was conducted in the laboratory to exclude the presence of interference in TSH and FT4. Finally, different interfering agents were identified, which affected free thyroid hormone and TSH determination.

Abstract

Objectives

The objective of this study was to highlight the role of the clinical laboratory and the relevance of reporting the case immediately to the unit of hematology for the diagnosis and early administration of treatment in the presence of such an urgent hematologic disease as thrombotic thrombocytopenic purpura (TTP).

Case presentation

An elderly patient was referred to the emergency department of our hospital by his general practitioner for speech difficulty, facial asymmetry and weakness in the upper limb. Stroke code was activated. However, laboratory findings (anemia, thrombocytopenia, elevated creatinine, total bilirubin and LDH, negative direct Coombs test) and presence of schistocytes in the peripheral blood smear test were consistent with a completely different diagnosis: TTP thrombotic microangiopathy.

Conclusions

The first diagnostic approach of left hemispheric stroke was not confirmed in the laboratory, with findings of nonautoimmune hemolytic anemia, thrombocytopenia without apparent cause and presence of schistocytes. We should not forget that the clinical manifestations of this condition are widely variable and may include multiorganic dysfunction. Although confirmation of diagnosis is based on ADAMTS-13, its associated high mortalitiy requires immediate treatment on mere suspicion.

Abstract

Background

The pandemic caused by the emergence of the new SARS-CoV-2 virus worldwide has had a major impact at all levels and has forced in-depth research into its behavior, pathogenicity and treatment.

Content

This review provides an overview of various aspects of the virus and the immune response it triggers, as well as a description of the different diagnostic and therapeutic approaches adopted.

Summary

SARS-COV-2 is a RNA virus with some peculiarities that make it different from its predecessors SARS-CoV and MERS. Given its structural characteristics and pathogenesis, it can cause different clinical manifestations as the disease progresses. The immune system has been proven to play a major role in the response to this virus and, therefore, the study of antibodies and lymphocyte populations during the different stages of the disease is crucial.

Outlook

The knowledge of the effect of the virus and the immune response is crucial for the development of good quality vaccines, therapies and diagnostic techniques, which are essential for the control and eradication of the disease.