Clinics in laboratory medicine
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Sepsis, severe sepsis, and septic shock cause significant morbidity and mortality worldwide. Rapid diagnosis and therapeutic interventions are desirable to improve the overall mortality in patients with sepsis. ⋯ This article discusses the usefulness and potential of biomarkers and molecular test methods for a more rapid clinical and laboratory diagnosis of sepsis. Because new technologies are quickly emerging, physicians and laboratories must appreciate the key factors and characteristics that affect the clinical usefulness and diagnostic accuracy of these test methodologies.
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"Bath salts" has attracted young adults primarily due to its stimulatory and hallucinogenic effects akin to amphetamines and cocaine. Although other designer amines have been incorporated to newer generation "bath salts", synthetic cathinones remain to be their major component. This article discusses our current understanding of the chemistry and metabolism of synthetic cathinones. It also presents a comprehensive review of the most recent laboratory analyses done on this class of compounds in drug products and biological samples.
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An epidemic of prescription drug abuse in the United States has increased the burden on clinical toxicology testing laboratories. Urine drug testing provides objective evidence for compliance and aberrant drug behavior in patients on chronic (non-cancer) pain management. This article describes the testing menu, drug testing assays including tandem mass spectrometry and their limitations, interpretation of opiate results and clinical considerations.
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Inborn errors of metabolism (IEM) have a characteristic clinical presentation overlapping with infection and intoxication. Diagnostic modalities for IEM vary from biochemical to molecular methods including next-generation sequencing. ⋯ Prenatal diagnosis and newborn screening help to reduce the societal burden as well as the morbidity due to IEM. IEM occur in India, and the need of the time is to have large diagnostic and screening programs to dilute the gene pool.
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An evolving understanding of the consequences of allogeneic blood transfusion and escalating costs of providing allogeneic blood have resulted in an interest in blood management. Understanding the consequences of allogeneic transfusion includes a recognition of the immunosuppressive effects of allogeneic transfusion, a growing awareness of transfusion-related acute lung injury, and a rediscovery of transfusion-associated circulatory overload. More recently, interest has focused on the effect of stored blood on patient outcome. Although this discussion is not all-inclusive, it is intended to show that many techniques can be applied to decrease the exposure to allogeneic blood.