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  1. Article: Complete laboratory diagnosis of Insulin Autoimmune Syndrome.

    Galván, Raquel / Fernández-Riejos, Patricia / Sánchez Martínez, Pilar María / Rodríguez-Chacón, Carmen / Sánchez Mora, Catalina / León-Justel, Antonio

    Practical laboratory medicine

    2023  Volume 36, Page(s) e00320

    Abstract: The definition of Insulin autoimmune syndrome includes the presence of high levels of blood insulin and insulin autoantibodies. We encountered a 45-years-old white man with a high insulin serum value that do not fit with the C-peptide result. To discard ... ...

    Abstract The definition of Insulin autoimmune syndrome includes the presence of high levels of blood insulin and insulin autoantibodies. We encountered a 45-years-old white man with a high insulin serum value that do not fit with the C-peptide result. To discard or to confirm an analytical interference and diagnose a possible Insulin Autoimmune Syndrome we performed the following investigations: dilution linearity test, heterophilic antibody blocking, polyethylene glycol precipitation, measurements with alternative assays, and gel filtration chromatography by size exclusion. The latter technique confirmed that most of the insulin was complexed with a 150-kDa protein, corresponding to immunoglobulin G, identified as insulin autoantibodies. These antibodies were responsible for hypoglycemia attacks in the patient, who had a previous autoimmune disease. This case highlights the importance of carefully analyzing the results and ruling out possible interferences, as well as considering all kinds of pathologies, even if they are infrequent.
    Language English
    Publishing date 2023-06-19
    Publishing country Netherlands
    Document type Case Reports
    ZDB-ID 2834973-8
    ISSN 2352-5517
    ISSN 2352-5517
    DOI 10.1016/j.plabm.2023.e00320
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  2. Article: Maternally Inherited Diabetes and Deafness in 4 Family Members with DNA Mutation and at Least 4 Generations with Suggestive Disease Phenotype.

    Gragera-Martínez, Álvaro / Fernández-González, Gema / León-Justel, Antonio

    The journal of applied laboratory medicine

    2020  Volume 2, Issue 2, Page(s) 278–283

    Language English
    Publishing date 2020-07-02
    Publishing country England
    Document type Journal Article
    ISSN 2576-9456
    ISSN 2576-9456
    DOI 10.1373/jalm.2017.023242
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  3. Article ; Online: SmartLab 2.0 in cardiovascular prevention of atherogenic dyslipidemia.

    Galván Toribio, Raquel / Arrobas Velilla, Teresa / Morales Porillo, Cristóbal / Rico, Miguel Ángel / Martínez Quesada, Mar / León Justel, Antonio

    Clinica e investigacion en arteriosclerosis : publicacion oficial de la Sociedad Espanola de Arteriosclerosis

    2022  Volume 35, Issue 3, Page(s) 123–128

    Abstract: Introduction: SmartLab 2.0 is an innovative concept of multidisciplinary collaboration between the clinical laboratory and the diabetes day unit that was born with the aim of identifying patients at high cardiovascular risk who require priority ... ...

    Title translation SmartLab 2.0 en prevención cardiovascular de dislipemia aterogénica.
    Abstract Introduction: SmartLab 2.0 is an innovative concept of multidisciplinary collaboration between the clinical laboratory and the diabetes day unit that was born with the aim of identifying patients at high cardiovascular risk who require priority attention, such as patients with atherogenic dyslipidemia, in order to create a cardiovascular prevention strategy.
    Objective: Implementation in the Laboratory Information System (LIS) of an automated biochemical algorithm for the identification of patients with atherogenic dyslipidemia in routine analyses and priority referral to the diabetes day unit.
    Material and methods: The algorithm designed in the SIL was: HBA1c>9.3 +TG>150mg/dl +HDLc<40mg/dl +LDL/ApoB<1.3. A comment was inserted alerting the requesting physician of the diagnosis of atherogenic dyslipidemia and priority referral was made from the laboratory to the diabetes day unit in the necessary cases.
    Results: In the 1-year period, a total of 899 patients with HBA1c>7 and atherogenic dyslipidemia criteria were identified. Of these, 203 patients from primary care with HbA1c>9.3 were referred to the diabetes day hospital.
    Conclusions: Reinforcement of cardiovascular prevention is necessary at all levels. The clinical laboratory should play a fundamental role in the diagnosis of dyslipidemias. Early detection of patients at high cardiovascular risk is essential and collaboration between the different clinical units is fundamental to guarantee patient safety.
    MeSH term(s) Humans ; Risk Factors ; Glycated Hemoglobin ; Atherosclerosis/diagnosis ; Diabetes Mellitus ; Dyslipidemias/drug therapy ; Cardiovascular Diseases/prevention & control
    Chemical Substances Glycated Hemoglobin
    Language Spanish
    Publishing date 2022-11-03
    Publishing country Spain
    Document type Journal Article
    ISSN 1578-1879
    ISSN (online) 1578-1879
    DOI 10.1016/j.arteri.2022.09.004
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  4. Article ; Online: Geostatistical analysis from the clinical laboratory in cardiovascular prevention for primary care.

    Martín Pérez, Salomón / Arrobas Velilla, Teresa / Fabiani de la Iglesia, Juan / Vázquez Rico, Ignacio / Varo Sánchez, Gema / León-Justel, Antonio

    Clinica e investigacion en arteriosclerosis : publicacion oficial de la Sociedad Espanola de Arteriosclerosis

    2022  Volume 35, Issue 2, Page(s) 75–84

    Abstract: Introduction and objectives: Cardiovascular diseases continue to lead the ranking of mortality in Spain. The implementation of geostatistical analysis techniques in the clinical laboratory are innovative tools that allow the design of new strategies in ... ...

    Title translation Análisis geoestadístico desde el laboratorio clínico en prevención cardiovascular para atención primaria.
    Abstract Introduction and objectives: Cardiovascular diseases continue to lead the ranking of mortality in Spain. The implementation of geostatistical analysis techniques in the clinical laboratory are innovative tools that allow the design of new strategies in primary prevention of cardiovascular disease. The aim of this study was to study the prevalence and geolocation of severe dyslipidemia in the health areas under study in order to implement prevention strategies in primary care. A retrospective cohort study of low-density protein-bound cholesterol, triglyceride and lipoprotein (a) levels in the years 2019 and 2020 were carried out. In addition, a geostatistical analysis was performed including representation in choropleth maps and the detection of clustering clusters, using geographic information in zip code format included in the demographic data of each analytic.
    Results: The analytical data included in the study were triglycerides (n=365,384), low density protein-bound cholesterol (n=289,594) and lipoprotein to lipoprotein (a) (n=502). Areas with the highest and lowest percentage of cases were identified for the established cut-off points of LDL-C>190mg/dL and TG>150mg/dL. Two clustering clusters with statistical significance were detected for cLDL>190mg/dL and a total of 6 clusters for TG values>150mg/dL.
    Conclusions: The detection of clusters, as well as the representation of choropleth maps, can be of great help in detecting geographic areas that require greater attention to intervene and improve cardiovascular risk.
    MeSH term(s) Humans ; Cholesterol, LDL ; Cholesterol, HDL ; Laboratories, Clinical ; Retrospective Studies ; Triglycerides ; Cardiovascular Diseases/epidemiology ; Cardiovascular Diseases/prevention & control ; Primary Health Care
    Chemical Substances Cholesterol, LDL ; Cholesterol, HDL ; Triglycerides
    Language Spanish
    Publishing date 2022-09-29
    Publishing country Spain
    Document type Journal Article
    ISSN 1578-1879
    ISSN (online) 1578-1879
    DOI 10.1016/j.arteri.2022.08.003
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  5. Article ; Online: Study of the diagnostic efficiency of anti-ZnT8 autoantibodies for type 1 diabetes in pediatric patients.

    Fuentes-Cantero, Sandra / González-Rodríguez, Concepción / Rodríguez-Chacón, Carmen / Galvan-Toribio, Raquel / Hermosín-Escudero, Joaquín / Pérez-Pérez, Antonio / León-Justel, Antonio

    Laboratory medicine

    2023  

    Abstract: Objective: Zinc transporter 8 autoantibodies (ZNt8A) are 1 of the 4 main autoantibodies used for the diagnosis of type 1 diabetes (T1D), with glutamic acid decarboxylase autoantibodies (GADA), islet antigen-2 autoantibodies (IA-2A), and insulin ... ...

    Abstract Objective: Zinc transporter 8 autoantibodies (ZNt8A) are 1 of the 4 main autoantibodies used for the diagnosis of type 1 diabetes (T1D), with glutamic acid decarboxylase autoantibodies (GADA), islet antigen-2 autoantibodies (IA-2A), and insulin autoantibodies (IAA). The objective of this study is to evaluate the diagnostic efficiency of these autoantibodies for the diagnosis of T1D in pediatric patients.
    Methods: A retrospective analysis of patients under 16 years of age with suspected T1D was made between June 2020 and January 2021. A total of 80 patients were included in the study, with 1 sample per patient. Subjects were classified according to diagnosis.
    Results: Of the subjects included in the study, 50 developed T1D. The diagnostic efficacy was IA-2A (cutoff ≥ 28 U/L) sensitivity 0.26 (95% CI: 0.14-0.38) and specificity 0.97 (95% CI: 0.79-1.0); GADA (cutoff ≥ 17 U/mL) sensitivity 0.40 (95% CI: 0.26-0.54) and specificity 0.87 (95% CI: 0.75-0.99); ZnT8A (cut off ≥ 15 U/L) sensitivity 0.62 (95% CI: 0.49-0.75) and specificity 0.97 (95% CI: 0.90-1.0). ZnT8A obtained the most significantly global diagnostic accuracy (0.75), and GADA with ZnT8A showed the highest correlation.
    Conclusion: The results obtained indicate a higher efficiency of anti-ZnT8 autoantibodies for the diagnosis of T1D in pediatric patients. Clinical efficiency of diabetic autoantibodies is method and assay dependent and influences combined diagnostic strategies.
    Language English
    Publishing date 2023-09-02
    Publishing country England
    Document type Journal Article
    ZDB-ID 391758-7
    ISSN 1943-7730 ; 0007-5027
    ISSN (online) 1943-7730
    ISSN 0007-5027
    DOI 10.1093/labmed/lmad079
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  6. Article ; Online: Prevalence of severe hypercholesterolemia observed in different hospitals in Andalusia and Ceuta.

    Arrobas Velilla, Teresa / Varo Sánchez, Gema / Romero García, Irene / Melguizo Madrid, Enrique / Rodríguez Sánchez, Firma Isabel / León Justel, Antonio

    Clinica e investigacion en arteriosclerosis : publicacion oficial de la Sociedad Espanola de Arteriosclerosis

    2021  Volume 33, Issue 5, Page(s) 217–223

    Abstract: Severe hypercholesterolaemia is a major cardiovascular risk factor. Early detection and treatment can reduce the incidence of cardiovascular disease. Given the high prevalence of hypercholesterolaemia in Andalusia, the development of a screening strategy ...

    Title translation Prevalencia de hipercolesterolemias severas observadas en los distintos hospitales de Andalucía y Ceuta.
    Abstract Severe hypercholesterolaemia is a major cardiovascular risk factor. Early detection and treatment can reduce the incidence of cardiovascular disease. Given the high prevalence of hypercholesterolaemia in Andalusia, the development of a screening strategy for its detection in Primary Care may be an efficient measure.
    Objective: To identify patients in Primary Care with severe hypercholesterolaemia that may increase their cardiovascular risk by reviewing LDL-cholesterol results in computerised laboratory systems.
    Material and methods: Observational, retrospective, multi-centre study in 16 hospitals in Andalusia and Ceuta. Anonymous analytical data were acquired from the different laboratory computer systems for the year 2018, and exclusively from Macarena Hospital for the year 2019.
    Results: From a total of 1,969,035 determinations on≥18 years old, 2,791 patients (0.14%) were detected with LDL-cholesterol>250mg/dl and from a total of 2.327.211 determinations studied in children under 18 years old, 3,804 patients (0.16%) were detected with LDL-cholesterol>135mg/dL. The highest incidence of possible genetic hypercholesterolaemia in adults corresponded to the province of Seville with 23.6 cases/1,000 determinations, while in minors, the highest incidence corresponded to the province of Cadiz with 75 possible cases/1,000 determinations. A geographical triangle of greater prevalence is observed between the provinces of Seville, Huelva and Cadiz.
    Conclusions: The development of a screening strategy using a computerised review of LDL-cholesterol in Primary Care detects a large number of subjects with severe hypercholesterolaemia that could benefit from an early intervention.
    MeSH term(s) Adolescent ; Adult ; Child ; Cholesterol, LDL ; Hospitals ; Humans ; Hypercholesterolemia/epidemiology ; Prevalence ; Retrospective Studies ; Risk Factors
    Chemical Substances Cholesterol, LDL
    Language Spanish
    Publishing date 2021-04-02
    Publishing country Spain
    Document type Journal Article ; Multicenter Study ; Observational Study
    ISSN 1578-1879
    ISSN (online) 1578-1879
    DOI 10.1016/j.arteri.2020.12.009
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  7. Article ; Online: Comparison of the analytical and clinical performances of two different routine testing protocols for antinuclear antibody screening.

    González Rodríguez, Concepción / Fuentes Cantero, Sandra / Pérez Pérez, Antonio / Vázquez Barbero, Francisco Javier / León Justel, Antonio

    Journal of clinical laboratory analysis

    2021  Volume 35, Issue 9, Page(s) e23914

    Abstract: Background: The diagnosis of systemic autoimmune rheumatic diseases (SARD) is based on the detection of serum antinuclear antibodies (ANA) for which indirect immunofluorescence (IIF) is the golden standard. New solid-phase immunoassays have been ... ...

    Abstract Background: The diagnosis of systemic autoimmune rheumatic diseases (SARD) is based on the detection of serum antinuclear antibodies (ANA) for which indirect immunofluorescence (IIF) is the golden standard. New solid-phase immunoassays have been developed to be used alone or in combination with the detection of extractable antinuclear antibodies (ENA) to improve SARD diagnosis. The purpose of this study was to compare the clinical performances of different ANA screening methods alone or in combination with ENA screening methods for SARD diagnosis.
    Methods: A total of 323 patients were screened for ANA by IIF, EliA™ CTD Screen, and ELISA methods. Agreements were calculated between the methods. Then, EliA™ CTD Screen positive samples were screened for ENA by line immunoassay (LIA) and fluorescence enzyme immunoassay (FEIA).
    Results: The diagnostic accuracy of EliA™ CTD Screen (79% sensitivity and 91% specificity) was better than that of ELISA or IIF. The combination of EliA™ CTD plus IIF had the highest sensitivity (93%). ENA determination revealed that Ro52 and Ro60 were the most prevalent specificities. The use of IIF alone was not able of detecting up to 36% of samples positive for Ro52, and 41% for Ro60.
    Conclusions: EliA™ CTD Screen has a better diagnostic performance when compared to IIF and ELISA. The combined use of EliA™ CTD Screen and IIF clearly improves the rate and accuracy of SARD diagnosis. The use of EliA™ CTD Screen as first-line screening technique allows the detection of antibodies, which could not be detected by IIF alone.
    MeSH term(s) Antibodies, Antinuclear/blood ; Antibodies, Antinuclear/immunology ; Autoimmune Diseases/blood ; Autoimmune Diseases/diagnosis ; Autoimmune Diseases/immunology ; Blood Coagulation Tests/methods ; Enzyme-Linked Immunosorbent Assay/methods ; Female ; Fluorescent Antibody Technique, Indirect/methods ; Humans ; Immunoassay/methods ; Immunoenzyme Techniques/methods ; Male ; Mass Screening/methods ; Middle Aged ; Rheumatic Diseases/blood ; Rheumatic Diseases/diagnosis ; Rheumatic Diseases/immunology
    Chemical Substances Antibodies, Antinuclear
    Language English
    Publishing date 2021-08-04
    Publishing country United States
    Document type Comparative Study ; Journal Article
    ZDB-ID 645095-7
    ISSN 1098-2825 ; 0887-8013
    ISSN (online) 1098-2825
    ISSN 0887-8013
    DOI 10.1002/jcla.23914
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  8. Article ; Online: Temporal trends in hospitalizations due to diabetes complications during COVID-19 pandemic in Andalusia, Spain.

    Mayoral, Eduardo / Ravé, Reyes / Rodriguez de Vera, Pablo / Rojo-Martinez, Gemma / Olveira, Gabriel / Aguilar-Diosdado, Manuel / León-Justel, Antonio / Martinez-Brocca, Maria Asuncion

    BMJ open diabetes research & care

    2022  Volume 10, Issue 2

    MeSH term(s) COVID-19/epidemiology ; Diabetes Complications/epidemiology ; Diabetes Mellitus/epidemiology ; Hospitalization ; Humans ; Pandemics ; Spain/epidemiology
    Language English
    Publishing date 2022-03-29
    Publishing country England
    Document type Letter
    ZDB-ID 2732918-5
    ISSN 2052-4897 ; 2052-4897
    ISSN (online) 2052-4897
    ISSN 2052-4897
    DOI 10.1136/bmjdrc-2021-002623
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  9. Article: Laboratory Value-Based Innovation in Heart Failure Improves Patient Health-Related Outcomes.

    Leon-Justel, Antonio / Garcia-Polavieja, Jose I Morgado / Alvarez-Rios, Ana Isabel / Vazquez-Rico, Ignacio / Rios, Alvaro Lopez-Masjuan / Albarran, Adrian Rodriguez / Rios, Elena Galvez / Fernandez, Jose F Diaz

    Clinical laboratory

    2022  Volume 68, Issue 2

    Abstract: Background: NT-proBNP is emerging as a novel tool for improving management of patients with heart failure (HF). The concept of health-related outcomes as the primary endpoint for therapeutic intervention in chronic disease, such as HF, should be the ... ...

    Abstract Background: NT-proBNP is emerging as a novel tool for improving management of patients with heart failure (HF). The concept of health-related outcomes as the primary endpoint for therapeutic intervention in chronic disease, such as HF, should be the focal point going forward.
    Methods: We conducted a prospective real-world study in heart failure with reduced ejection fraction (HFrEF) patients. The main target was to evaluate the impact on patient's health-related outcomes of a personalized medical follow-up procedure, based on a laboratory model of risk stratification supported by NT-proBNP. One hundred and five consecutive patients admitted to the Hospital Heart-Failure unit were stratified into three groups (low, medium, and high risk) and prospective follow-ups during the 12 months post discharge.
    Results: It was found that patients under this new approach experienced early and robust improvements in patient health-related outcomes with consistency in most domains which persisted beyond 12 months post follow-up. Improvements in health related quality of life score (HRQLS) was observed over the time of the study. After 6 months we found a significant improvement in HRQLS of 18.2% (from 76.5 ± 22.4 to 95.0 ± 15.7) and 14.4% (from 76.5 ± 22.4 to 96.3 ± 15.9) after 12 months of follow-up (p < 0.001). The highest improvements were found in the symptom severity domain where patients reported an improvement of 22.6% after 6 months and 18.9% after 12 months (p < 0.001). The lowest scores were reported in the physical domain with increase of 11.0% and 4.3% after 6 months and 12 months (p = 0.089). Psychosocial domain and the ability to carry out the activities of normal life showed improvement as well.
    Conclusions: Our strategy based on NT-proBNP optimizes HFrEF management and represents a major new approach for clinical laboratories to improve patient health-related outcomes in HFrEF.
    MeSH term(s) Aftercare ; Heart Failure/diagnosis ; Heart Failure/therapy ; Humans ; Laboratories ; Patient Discharge ; Prospective Studies ; Quality of Life ; Stroke Volume
    Language English
    Publishing date 2022-02-09
    Publishing country Germany
    Document type Journal Article
    ZDB-ID 1307629-2
    ISSN 1433-6510 ; 0941-2131
    ISSN 1433-6510 ; 0941-2131
    DOI 10.7754/Clin.Lab.2021.210503
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  10. Article ; Online: Lipoprotein(a) in a selection of hospitals in Andalusia and Extremadura. Underdiagnosed and underused?

    Arrobas Velilla, Teresa / Fabiani de la Iglesia, Juan / Martín Pérez, Salomon / Calbo Caballos, Luis / Gómez Barrado, Jose Javier / León Justel, Antonio

    Revista espanola de cardiologia (English ed.)

    2022  Volume 75, Issue 10, Page(s) 844–845

    MeSH term(s) Hospitals ; Humans ; Lipoprotein(a) ; Spain/epidemiology
    Chemical Substances Lipoprotein(a)
    Language Spanish
    Publishing date 2022-05-21
    Publishing country Spain
    Document type Case Reports
    ZDB-ID 2592481-3
    ISSN 1885-5857 ; 1885-5857
    ISSN (online) 1885-5857
    ISSN 1885-5857
    DOI 10.1016/j.rec.2022.05.001
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