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Resumen El avance tecnologico en el campo del diagnostico clinico ha generado una diversidad de pruebas de laboratorio aplicables en el lugar de asistencia al paciente (POCT), y ha permitido contar con una mayor calidad analitica de los procedimientos implementados. La elaboracion de un cuadro de mando integral es una herramienta util para el exito en la gestion de un proceso trasversal, complejo e interdisciplinario, como es el de obtener resultados analiticos fiables, transferibles de forma inmediata mediante sistemas POCT. Para la elaboracion de un cuadro de mando integral se deben considerar cuatro perspectivas: la de los clientes (pacientes, medicos, grupos de interes), la financiera (inversores privados o publicos), la de los procesos operativos internos (sistemas, procesos) y la de los profesionales (cultura organizativa). El objeto de este documento es establecer recomendaciones para la elaboracion de un cuadro de mando integral para gestionar los sistemas POCT disponibles en una institucion.

Risk factors associated with severity and mortality attributable to COVID-19 have been reported in different cohorts, highlighting the occurrence of acute kidney injury (AKI) in 25% of them. Among other, SARS-CoV-2 targets renal tubular cells and can cause acute renal damage. The aim of the present study was to evaluate the usefulness of urinary parameters in predicting intensive care unit (ICU) admission, mortality and development of AKI in hospitalized patients with COVID-19. Retrospective observational study, in a tertiary care hospital, between March 1st and April 19th, 2020. We recruited adult patients admitted consecutively and positive for SARS-CoV-2. Urinary and serum biomarkers were correlated with clinical outcomes (AKI, ICU admission, hospital discharge and in-hospital mortality) and evaluated using a logistic regression model and ROC curves. A total of 199 COVID-19 hospitalized patients were included. In AKI, the logistic regression model with a highest area under the curve (AUC) was reached by the combination of urine blood and previous chronic kidney disease, with an AUC of 0.676 (95%CI 0.512–0.840; p = 0.023); urine specific weight, sodium and albumin in serum, with an AUC of 0.837 (95% CI 0.766–0.909; p p

This report describes a patient who developed a spheroidal calculus with a central part composed of potassium urate, surrounded by a continuous layer of calcium oxalate monohydrate with crystals of calcium oxalate dihydrate on the surface. The mechanism of calculus development is also suggested.

Improving knowledge about normal urine composition in children is important for early prevention of lithiasis. We describe urinary excretion values of calcium (Ca), magnesium (Mg), phosphate (P), citrate (Cit), uric acid (Ur), and oxalate (Ox) in healthy children with and without a family history of lithiasis, using a 12-h urine collection protocol.Urine samples were obtained from 184 children (5-12 years): a spot sample collected in the afternoon, and a 12-h overnight sample. Solute/creatinine (Cr) and 12-h solute excretion was calculated.Urinary excretion values of the studied solutes are presented as percentile values, separately for each type of sample. Due to age-related differences in the solute/creatinine ratios, except for Ca and Cit, results are described according to the child's age. The presence of excretion values related to an increased risk of lithiasis was more common in children with a family history.We report data from urine samples collected by using a simplified collection protocol. The observed differences between children with and without a family history of lithiasis could justify that in population studies aimed at setting reference values, the former are excluded.

The prevalence of lithiasis is increasing at all ages. This study aimed to assess the crystallization risk in urine from healthy school children and to determine urinary parameters that are most associated with it. Urine samples were obtained from 184 children aged 5–12 years: a spot sample collected in the afternoon, and a 12-h overnight sample. Information was obtained regarding family histories of lithiasis. Urine volume, pH, and biochemical parameters of stone risk were measured. Crystallization risk was defined by the presence of specific urine conditions that had previously been associated with stone formation in vitro. Crystallization risk was observed in 15 % of spot urine samples and 54 % of 12-h samples. Metabolic abnormalities and a low urinary volume were more frequently detected in children with crystallization risk. Calcium excretion and calcium/citrate ratio were higher in children with a family history of lithiasis. We observed a high prevalence of crystallization risk in urine, especially in children with a family history of the disease. Low urinary volume was the factor most associated with increased risk. Adequate fluid intake at an early age may be a simple and effective measure to reduce the incidence of nephrolithiasis.

Resumen Introduccion El uso del laboratorio es inadecuado (excesivo o innecesario) y es preciso controlarlo. Material y metodos Elaborar una estrategia para gestionar, segun criterios de medicina basada en la evidencia, la derivacion de pruebas subcontratadas y comparar los resultados entre dos anos consecutivos. Resultados La demanda se ha reducido un 6,56% y los costes un 26,9%. Es de destacar que solo el 1,9 % de los peticionarios a los que se les ha denegado alguna prueba contacta con el laboratorio para reclamar o mostrar su disconformidad. Conclusiones El profesional del laboratorio clinico debe implicarse como consultor clinico para mejorar la eficiencia de las pruebas de laboratorio.

El aumento de la utilizacion de los servicios de laboratorio, con una tasa de crecimiento anual del 6,15%, es motivo de preocupacion para los servicios de salud con un gasto sanitario cada vez mayor y unos recursos limitados Para algunos el aumento de costes requiere un mayor control y contencion, si bien esta perspectiva olvida el valor que aporta el laboratorio clinico. Sabemos que asimismo hay una demanda inadecuada que genera un uso excesivo del laboratorio, lo que iria precisamente en la direccion contraria a la creacion de valor. Las solicitudes de analisis innecesarios hacen que los costes aumenten sin que los resultados en salud mejoren, por ello las organizaciones sanitarias se plantean como objetivo el uso eficiente del laboratorio. Tambien se sabe que hay una gran variabilidad en la utilizacion del laboratorio entre paises, entre regiones de un mismo pais y entre los mismos clinicos. Estas variaciones reducen el coste-efectividad. Para adecuar la demanda a las necesidades clinicas y evitar el uso inapropiado, es imprescindible que los profesionales de la clinica y los laboratorios trabajen conjuntamente. En la actualidad se recomienda una mejora en la seleccion de magnitudes, que las solicitudes se realicen guiadas por algoritmos elaborados siguiendo los criterios de la medicina basada en la evidencia (MBE). Por otra parte, es imprescindible la evaluacion y valoracion rigurosas y criticas de las nuevas ofertas antes de que se incorporen a la cartera de servicios, la eliminacion de tecnicas obsoletas y de paneles fijados sin criterios clinicos y, en especial, evitar peticiones redundantes y repeticiones innecesarias.

This aim of this study is to monitor the activity carried out in the emergency laboratory of Son Dureta University Hospital during the years 2000–2004 and to discuss the variations. This work is based on the the graphical comparison between the trends of indicators of analytical demand (tests/requests), (URV/requests), and (URV/tests) that represent the productivity of laboratory and also other indicators that associate emergency activities of the hospital with the laboratory (laboratory requests/emergencies), (tests/emergencies), and (URV/emergencies). The results show an inverse relationship between the hospital emergencies and laboratory. The hospital emergencies have decreased as there is a new hospital in Palma, on the other hand, the activity of the urgent laboratory has increased. The reason is due to the increase inpatient activity in new hospital areas: heart surgery, a significant increase of critical care, psychiatry, toxicology, etc. A trend to complexity is observed, that is due to the increase in indices: URV/tests, tests/emergencies, and URV/emergencies; that have arisen from the new diagnostic criteria for myocardial infarction. This has caused a large increase tropinin assays, the use of CRP as a sepsis marker and drug abuse testing to confirm the suspicion of drug taking.

Introduction: There is increasing awareness of the importance of transforming organisational culture in order to raise safety standards. This paper describes the results obtained from an evaluation of patient safety culture in a sample of clinical laboratories in public hospitals in the Spanish National Health System. Material and methods: A descriptive cross-sectional study was conducted among health workers employed in the clinical laboratories of 27 public hospitals in 2012. The participants were recruited by the heads of service at each of the participating centers. Stratified analyses were performed to assess the mean score, standardized to a base of 100, of the six survey factors, together with the overall patient safety score. Results: 740 completed questionnaires were received (88% of the 840 issued). The highest standardized scores were obtained in Area 1 (individual, social and cultural) with a mean value of 77 (95%CI: 76-78), and the lowest ones, in Area 3 (equipment and resources), with a mean value of 58 (95%CI: 57-59). In all areas, a greater perception of patient safety was reported by the heads of service than by other staff. Conclusions: We present the first multicentre study to evaluate the culture of clinical safety in public hospital laboratories in Spain. The results obtained evidence a culture in which high regard is paid to safety, probably due to the pattern of continuous quality improvement. Nevertheless, much remains to be done, as reflected by the weaknesses detected, which identify areas and strategies for improvement.

Pathological calcification generally consists of the formation of solid deposits of hydroxyapatite (calcium phosphate) in soft tissues. Supersaturation is the thermodynamic driving force for crystallization, so it is believed that higher blood levels of calcium and phosphate increase the risk of cardiovascular calcification. However several factors can promote or inhibit the natural process of pathological calcification. This cross-sectional study evaluated the relationship between physiological levels of urinary phytate and heart valve calcification in a population of elderly out subjects. A population of 188 elderly subjects (mean age: 68 years) was studied. Valve calcification was measured by echocardiography. Phytate determination was performed from a urine sample and data on blood chemistry, end-systolic volume, concomitant diseases, cardiovascular risk factors, medication usage and food were obtained. The study population was classified in three tertiles according to level of urinary phytate: low (1.21 mu M). Subjects with higher levels of urinary phytate had less mitral annulus calcification and were less likely to have diabetes and hypercholesterolemia. In the multivariate analysis, age, serum phosphorous, leukocytes total count and urinary phytate excretion appeared as independent factors predictive of presence of mitral annulus calcification. There was an inverse correlation between urinary phytate content and mitral annulus calcification in our population of elderly out subjects. These results suggest that consumption of phytate-rich foods may help to prevent cardiovascular calcification evolution., This work was supported by grant PI14/00853 from the Ministerio de Economia y Competitividad (Gobierno de Espana), and by FEDER funds (European Union). JP expresses his appreciation to Ministerio de Educacion y Cultura (Gobierno de Espana) for the fellowship of the FPU program. BI expresses his appreciation to the Conselleria d'Innovacio i Energia del (Govern de les Illes Balears) for the doctoral fellowship. PS express her appreciation for the postdoctoral fellowship PD/009/2013 to the Conselleria de Educacio, Cultura i Universitats (Govern de les Illes Balears) and the European Social Fund through the ESF Operational Programme of the Balearic Islands 2013-2017.

Background: Phytate as sodium salt has been used at high doses to treat stone-former patients with idiopathic hypercalciuria. The experimental and clinical hypocalciuric effects of dietary fiber have also been assigned to the presence of phytate as calcium-magnesium salt (phytin). As a consequence of the additional interest in phytate due to its capacity as crystallization inhibitor, now a study of the effects of potassium phytate on urinary calcium excretion is presented and compared with the effects caused by other phytate salts. Methods: To study the effect of calcium-magnesium phytate, 36 Wistar rats (6 groups) were fed with a purified diet in which phytate was practically absent (4068.02 Reference Diet). Three groups were fed with increasing calcium amounts and with the same amount of phytin, each one corresponding to one control group. To study the effects of magnesium-potassium, sodium and potassium phytate salts, 48 Wistar rats (8 groups) were fed with UAR-A04 diet (a standard diet which contains 0.8% of phytin). Two control groups fed with low and high calcium amounts and 6 treated groups were formed. The effect of the dose of potassium phytate on urinary calcium was carried out using 2 additional groups of 6 Wistar rats each one fed with UAR-A04 diet and increasing amounts of potassium phytate. Results: No significant changes in urinary calcium were observed when phytin (calcium-magnesium phytate) was supplied. The urinary calcium was clearly reduced by the three phytate salts assayed (magnesium-potassium, sodium, potassium), but the most significant decrease was noticed when the potassium phytate salt was administered. Phytate administration, independently of the salt or dose used, did not significantly affect the urinary oxalate. Conclusion: It can be clearly deduced that the effects of phytate on the urinary parameters, mainly calcium, fundamentally depend on the type of salt used. Thus, the most remarkable effects on urinary calcium reduction were caused by the potassium salt. Obviously, these findings must be confirmed in human studies.

A simple test to evaluate the capacity of a urine to crystallize calcium salts is presented. The test is based on the fact that if a non-protected non-renewed surface remains in contact with a urine, sooner or later the contained supersaturated substances crystallize on it. Thus, by using an adequate surface, it is possible to derive a period within which a normal urine does not crystallize whereas a lithogenic urine induces the growth of calcium salts. The test was applied to urines of oxalocalcic stone-formers and healthy people and showed an excellent discrimination between clearly abnormal and healthy urines. Semiologic analysis of the data is also included.

Formation of calcium oxalate crystals, either as monohydrate or dihydrate, is apparently unrelated to urinary pH because the solubilities of these salts are practically unaltered at physiologic urinary pH values. However, a urinary pH5.5 or6.0 may induce uric acid or calcium phosphate crystals formation, respectively, which under appropriate conditions may induce the development of the calcium oxalate calculi. We assessed the relationship between the urinary pH and the formation of different types of calculi. A retrospective study in 1,478 patients was done. We determined the composition, macrostructure, and microstructure of the calculi and the urinary pH, 50.9% of calcium oxalate monohydrate unattached calculi were present in patients with urinary pH5.5. We found that 34.1 and 41.5% of calcium oxalate dihydrate calculi were present in patients with urinary pH5.5 and6.0, respectively. Infectious calculi were found primarily in patients with urinary pH6.0 (50.7%). Only calcium oxalate monohydrate papillary calculi were associated with urinary pH between 5.5 and 6.0 (43.1%). Urine of pH5.5 shows an increased capacity to develop uric acid crystals, which can act as a heterogeneous nuclei of calcium oxalate crystals. In contrast, urine of pH6.0 has an increased capacity to develop calcium phosphate crystals, which can act as a heterogeneous nuclei of calcium oxalate crystals. Oxalate monohydrate papillary calculi were associated to pH between 5.5 and 6.0 because the injured papilla acts as a heterogeneous nucleant. Consequently, measurement of urinary pH may be used to evaluate the lithogen risk of given urine.

The phytate urinary levels in a group of active calcium oxalate stone formers were studied and compared with those found in healthy people. Urinary phytate was significantly lower for stone formers. If deficit of the capacity to inhibit crystallization of calcium salts is considered an important factor related to calcium stone formation, the excretion of low phytate amounts could be an important risk factor in the development of this type of renal calculi. The influence of dietary phytate on urinary excretion was also studied. Clearly maintenance of a phytate-free diet significantly decreased the urinary excretion of phytate (about 50% after 36 h). This demonstrated the importance of dietary phytate in maintaining adequate urinary levels to permit effective crystallization inhibition of calcium salts and consequently preventing renal stone development.

This paper presents the results of a test to globally determine the urinary risk factor of calcium stone formation in the evaluation of treatments using crystallization inhibitors, such as citrate and phytate.Three groups of active calcium oxalate stone-formers have been selected. The lithogen urinary risk was determined using a specially designed disposable test before any medical treatment. After evaluation group I did not receive any treatment, group II was treated with potassium citrate and group III with a phytate-rich dietary complement. When 15 days had elapsed, the test to evaluate the risk of urinary calcium stone formation was applied again to the three groups. The main lithogenic biochemical parameters of each tested urine were also determined before and after treatment.An important number of calcium oxalate stone-formers with high urinary risk factor (positive test) became negative after medical treatment (52% of the citrate-treated patients and 50% of the phytate-treated patients), but only 7% of the untreated patients (1 patient) showed a decrease in their urinary risk factor for calcium stones (negative test) after 15 days had elapsed. When the treatment was not effective, in an important number of cases, the urine contained high levels of calcium or showed pH values greater than 6.5.From the obtained results it can be concluded that the test is useful to evaluate the efficacy of a given renal lithiasis medical treatment, and also the efficacy of the treatment of calcium oxalate renal lithiasis using crystallization inhibitors, such as citrate and phytate, in an important number of cases.

We present a case of urinary silica (silicon dioxide) lithiasis in a patient without a background of medication use justifying the formation of this calculus. We review the literature on this type of lithiasis and comment on some aspects of the metabolism of silica connected with urolithiasis.

This paper presents the results of a test to globally determine the urinary risk factor of calcium stone formation in the evaluation of treatments using crystallization inhibitors, such as citrate and phytate.Three groups of active calcium oxalate stone-formers have been selected. The lithogen urinary risk was determined using a specially designed disposable test before any medical treatment. After evaluation group I did not receive any treatment, group II was treated with potassium citrate and group III with a phytate-rich dietary complement. When 15 days had elapsed, the test to evaluate the risk of urinary calcium stone formation was applied again to the three groups. The main lithogenic biochemical parameters of each tested urine were also determined before and after treatment.An important number of calcium oxalate stone-formers with high urinary risk factor (positive test) became negative after medical treatment (52% of the citrate-treated patients and 50% of the phytate-treated patients), but only 7% of the untreated patients (1 patient) showed a decrease in their urinary risk factor for calcium stones (negative test) after 15 days had elapsed. When the treatment was not effective, in an important number of cases, the urine contained high levels of calcium or showed pH values greater than 6.5.From the obtained results it can be concluded that the test is useful to evaluate the efficacy of a given renal lithiasis medical treatment, and also the efficacy of the treatment of calcium oxalate renal lithiasis using crystallization inhibitors, such as citrate and phytate, in an important number of cases.