Purpose
Beta lactams are standard empirical therapy for febrile neutropenia (FN). The aim of this study was to evaluate the efficacy and safety of cefepime monotherapy compared with ...cefoperazone/sulbactam plus amikacin (CS + A) for empirical treatment of high risk FN.
Methods
One hundred seventy-five patients with 336 FN episodes were randomized to receive either cefepime (2 g q8h for adults and 50 mg/kg q8h for children) or CS (2 g q8h for adults and 50 mg/kg q8h for children) plus amikacin (15 mg/kg once a day). Positive response was defined as afebrile within 72 h of starting antibiotics, persistent afebrile status more than 48 h and no requirement of second-line antibiotics and antifungal agents.
Results
Three hundred thirty-six episodes were assessable for efficacy (168 cefepime, 168 CS + A). The positive response to antibiotics was identical for cefepime (53%) and CS + A (53%). Positive response was similar in MDI (microbiologically documented infection), 50 vs. 35% (
p
= 0.248), CDI (clinically documented infection), 50 vs. 35% (
p
= 0.259), combination CDI + MDI, 25 vs. 15% (
p
= 0.400), FUO (fever of unknown origin), 68 vs. 72% (
p
= 0.577) respectively in the two groups. The successful discontinuation of antibiotics at 72 h in FUO was similar in both groups (60 vs. 59%,
p
= 0.544). Total drug-related adverse events were similar in both groups (8 vs. 6%) except renal dysfunction was high in CS + A (1 vs. 7 events). Mortality was the same between two groups (8 vs 7%).
Conclusions
Cefepime monotherapy and CS + A had similar efficacy as first-line therapy for FN. Discontinuation of empirical antibiotics is safe and feasible approach in selected group of FUO patients.
Methotrexate, abbreviated as MTX, is a anti-metabolite and anti-folate drug. Methotrexate test is used for the measurement of methotrexate in human samples, typically serum or plasma. The ...measurements thus obtained are used in monitoring levels of methotrexate to ensure appropriate drug therapy. The degree of methotrexate cytotoxicity is related to the drug's concentration and to the duration of exposure. The use of lecovorin "rescue" permits relatively safe administration of very high doses of methotrexate to achieve maximum antineoplastic activity. Monitoring methotrexate concentrations & rate of decline in serum during high-dose therapy is essential when designing adequate leucovorin rescue dosages. Syva Emit Methotrexate Assay is a homogenous enzyme immunoassay intended for use in the quantitative analysis of methotrexate in human serum or plasma. The goal of this study was to establish the Syva Emit Methotrexate Assay on Siemens Dimension RXL analyser and to verify the related parameters. We established Syva Emit Methotrexate Assay on the Siemens rimension RxL analyser for Methotrexate evaluation. All the quality parameters like CV%, Precision, Linearity, Limit of detection, limit of blank, inter-lab comparison were assessed for the assay. CV% of 6.4, Linearity of 0.17-1.98 microMol/L, Limit of detection 0.17 microMol/L and Limit of blank 0 microMol/L were observed. Syva Emit Methotrexate Assay can be successfully established on Siemens Dimension RXL analyser and used in the evaluation of methotrexate levels
Medical laboratories are the key partners in patient safety. Laboratory results influence 70% of medical diagnoses. Quality of laboratory service is the major factor which directly affects the ...quality of health care. So to enhance credibility and competency of our testing services we chose the path of laboratory Accreditation, that is a voluntary process by which a third party gives formal recognition on the competency of laboratory to carry out specific tasks. Process of accreditation was started in 2007 and its effective in our lab till date with continued compliance. Our laboratory has referred ISO 15189 along with NABL 112. ISO 15189 consist of management requirements and technical requirements. On this basis, 23 deficiencies were cited in the first year which was also our first assessment in 2008, followed by improvements in coming years. In 2011 only 7 NCs, followed by 7NCs again in 2012, and 4NCs in 2013 with further improvement in 2015 and 2017 only 1 deficiency cited. The study concludes that participation in accreditation programs that certify quality can improve operational efficiency and customer service with reduction in of laboratory errors. Deficiencies cited have lead to improvement in other areas of the laboratory. Owing to accreditation, the staff awareness on quality in laboratory testing at various levels has increased. Not only is there improvement in quality but also laboratory safety in laboratory area has been improved.
In a medical laboratory post-testing, non-separated human serum samples are stored at ambient temperature (22-24degreesC) for 24 hours so that it may be used for re-testing, additional testing or as ...quality control (QC) sample for precision check. It will be interesting to see if any biochemical variation takes place in such serum stored in above conditions. Study aims to find the effect of storage on various biochemical parameters in stored samples. Five samples were centrifuged at 4000 rpm for 10 minutes. The non-separated centrifuged serum was tested at intervals of 2,4,6,8 and 24 hours for various biochemical parameters viz. urea, uric acid, creatinine, protein, albumin, alkaline phosphatase, total bilirubin, AST, ALT, sodium, potassium, chloride, calcium, magnesium, phosphorus, LDH on fully-automated Siemens biochemistry analyzer "Dimension RXL-Max". During the whole procedure the samples were kept at ambient room temperature (22-24degreesC). Percent coefficient of variation (%CV) for all parameters were calculated and compared with the target CV of the laboratory. The results showed percent CV obtained for various parameters were as follows: urea (3.6), uric acid(2.3), creatinine (6.7), protein(0.7), albumin(2.4), alkaline phosphatase(1.7), total bilirubin (9.0), AST(5.0), ALT(2.2), sodium(1.0), potassium(1.4), chloride(0.8), calcium(1.6), magnesium (1.8), phosphorous (2.8), LDH (1.6). No obvious trend was observed in the values obtained. The study showed that low %CV is a reflection of a good laboratory practice and better internal quality control measures. However low %CV and no trend in the graphical study suggest that centrifuged non-separated human serum sample remains stable for biochemistry parameters at ambient temperature for 24 hours. A further study with more number of samples is recommended.
Sandwich structures are gaining more importance in automobile industry due to its low weight, high flexural stiffness, and corrosion free properties. The composite structure with paper core ...sandwiched between two Polypropylene Glass-Filled (PP-GF) faces are being utilized for load floor of luggage compartments in passenger cars. To design, develop, and optimize the luggage floors, reliable Finite element (FE) methods are essential. This study deals with developing a finite-element method to predict the behavior of the luggage floor of a typical Sedan car during ball impact test and static stiffness test. FE simulations are performed using LS-Dyna explicit code. Honeycomb core is modelled using solid elements and Modified honeycomb material model in LS-Dyna is assigned to the honeycomb structure. The two faces, bottom and top, are modelled using shell elements and modified-piecewise linear plasticity material model is assigned to them, respectively. Experimental investigations are done for quasi-static four point bend test. FE simulations are performed for quasi-static four point bend test and validated with experimental results. Based on validated FE method, the ball impact test and static push test are simulated. Experiments are performed for the ball impact test and static push test. The results are compared and correlation between experiment and FE simulation is studied by comparing the deformation pattern, forces, and displacements. This developed FE method is for predicting the behavior of the luggage floor.
Vehicle side crash is a critical crash event where the vehicle is crashed by a movable car or vehicle may hit a tree or pole. Minimising the intrusion into the occupant space is important to protect ...the occupant. In side pole crash, vehicle rocker (sill) plays an important role in resisting the load due to the crash. The objective is to study the functional performance and potential mass reduction in the vehicle sill/rocker area by use of carbon fibre reinforced polymer (CFRP) tubes. The study is divided into three parts. First part investigates the behaviour of CFRP square section tubes in a three-point quasi-static bending in comparison to conventional steel structure using finite element method. By keeping the resistance force offered by a steel section as the baseline resistance value, different combination of CFRP tubes and metal holding brackets are evaluated and compared with the baseline. In the second part, CFRP tube is simulated in dynamic three-point bending test and compared with quasi-static simulations in order to check the influence of inertial effects on the CFRP tube behaviour. In the third part, the best performing design variants from the three-point quasi-static bending simulations are used in the sill or rocker of a vehicle and evaluated in full vehicle US NCAP pole impact load case. The full vehicle crash simulations for side pole impact is compared between the baseline with the steel reinforcement and design variants with the CFRP tube. Resistance force levels, intrusion and structural integrity are the key parameters on which this comparison is made. It is concluded that using CFRP tubes does not reduce the performance in terms of structural integrity and intrusion levels in typical side crash scenario like a US NCAP side pole impact. It can also be concluded that there is potential for mass reduction. Further investigation into the assembly feasibility is suggested as future work.
Bacterial infection is a frequent complication in cancer patients. C-reactive protein (CRP) is used mainly as a marker of inflammation and neutrophilia is an indicator of bacterial infection. In this ...retrospective study we have tried to determine the significance of these parameters in predicting bacterial sepsis in cancer patients. During a period of 6 months, 146 samples (Blood-PICC/peripheral blood/Hickman Catheter, stool, urine, sputum, fluids, and swab) were received for suspected infection from hemato-lymphoid and hematopoietic stem cell transplant (HSCT) units. Serum CRP and Neutrophil values of these samples were estimated as part of routine investigations as per institutional protocol. Statistical evaluation was carried out to assess significance of CRP and neutrophil count in patients with culture positive samples. Of 146 samples studied, 69 showed bacterial growth. Of these 67% (33/49) samples showed leucopenia, 33% (16/49) samples were non-leucopenic. Amongst the leucopenic samples, 79% (26/33) showed CRP values >5 mg/dl and 31% (5/16) samples from non-leucopenic cases had CRP value >5 mg/dl (p = 0.0019). In leucopenic cases neutrophilia was observed in 18% (6/33) cases, while 50% (8/16) of non-leucopenic cases showed neutrophilia (p = 0.0483). Although Serum CRP levels are a non-specific indicator of inflammation, a value of more than 5 mg/dl is a reliable indicator for suspected bacterial infection in leucopenic patients; however the relationship between the neutrophil counts and clinical sepsis was not clear in our group of patients.
Analysis of Blood Glycosylated Haemoglobin Gavhane, Umakant A; Poladia, P; Pillai, B ...
Indian journal of clinical biochemistry,
05/2022, Letnik:
33, Številka:
S1
Journal Article
Recenzirano
Various factors may affect the accuracy of haemoglobin (Hb) A1c measurements that are widely used to monitor glycaemic control in diabetic patients. Glycosylated haemoglobin levels were estimated on ...two different biochemistry analysers. The values obtained were compared statistically. This study aims at the possibility of using either analyser interchangeably. Measurements of HbA1c were carried out in blood samples from 67 patients using two different analysers SIEMENS DIMENSION EXL-LM and BECKMAN COULTER AU5800 based on the turbidometric inhibition immunoassay (TINIA). The data was statistically analysed using Linear regression, Passing Bablok Bland-Altman plot. Linear-regression analysis showed r2 as 0.9245, Passing Bablok Regression showed 95% confidence interval between 0.95 and 1.12. Bland-Altman showed bias of -0.11. There was good correlation between Blood Glycosylated Haemoglobin (HbA1C) levels obtained by two different analysers having same principle and methodology. This suggests that either of the analysers may be used for HbA1C analysis.
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