Capillary Blood Levels Research Articles

Capillary Blood Levels of Hydroxychloroquine and Methotrexate Are Stable for up to 5 Years When Collected on Volumetric Absorptive Microsamplers.

Hydroxychloroquine (HCQ) and methotrexate (MTX) are common antirheumatic drugs used chronically by patients with systemic lupus erythematosus (SLE) and rheumatoid arthritis (RA) (1, 2). Therapeutic drug monitoring (TDM) of HCQ and MTX provides critical compliance information, but typically requires venipuncture and shipment of refrigerated blood samples to the clinical laboratory. Capillary blood collection by finger prick offers a convenient alternative to venipuncture. The long-term stability of capillary blood HCQ and MTX collected using volumetric absorptive microsamplers (VAMS) has not previously been evaluated. In this study, we evaluated the stability of capillary MTX and HCQ levels when stored on VAMS for up to 5 years. Samples of patients with RA and SLE were collected for HCQ or MTX monitoring as part of 2 clinical studies in 2015 (HCQ: n = 24 | MTX: n = 61) and 2017 (HCQ: n = 126). Venous and capillary blood samples were shipped to Exagen Inc.'s clinical laboratory. HCQ and MTXPG3 were measured using separate LC-MS/MS methodologies. Baseline venous blood levels of HCQ and MTXPG3 were determined within 1 week of draw and compared to capillary blood levels determined following 3 or 5 years of storage. Venous blood HCQ and capillary blood MTXPG3 determinations made at baseline were significantly different from capillary blood determinations performed following 5 years of storage at -80 °C. However, these differences were within the specified limits of agreement [HCQ: Avg % change after storage (CI 95%) = -7.1% (-12.6, -1.6%), pt-test = 0.0205, interclass correlation coefficient (ICC) = 0.96 | MTXPG3: Avg % change after storage (CI 95%) = 13.3% (7.1, 19.4%), pt-test = 0.0001, ICC = 0.90]. Dried capillary blood HCQ and MTXPG3 levels collected on VAMS are stable for up to 5 years.

Insulin DEgludec in hospitalized patients with type 2 diabetes (IDEOS Study): what effects on glycemic control, glycemic variability and hypoglycemia

Modern guidelines suggest the control of hyperglycemia in hospitalized patients through insulin therapy and the achievement of individualized glycemic targets, avoiding hypoglycemia, associated with a worsening of outcomes and a mortality increase. There is little evidence in literature on the use of new basal insulins in a hospital setting. OBJECTIVE OF THE STUDY Document, in real life context, the use of insulin degludec and the results in terms of glycemic control, variability and hypoglycemia in hospitalized patients with type 2 diabetes, com pared to a population treated with traditional basal insulins. DESIGN AND METHODS Prospective observational study on patients hospitalized in internist area. Personal and clinical data, in particular capillary blood levels on 4 daily points and hypoglycemia were collect ed. In a group of patients on traditional basal insulin therapy not at tar get, a switch to insulin degludec was performed. RESULTS 65 patients (58.5% male) were enrolled: age 70.8±10.7 years, BMI 27.7 ± 4.4, HbA1c 8.4 ± 1.3% (average+/SD). 76.4% of patients had 3 or more comorbidities. 69.2% of patients were treated with basalbolus, 7.7% with basalplus, 16.9% with basal insulin alone. In the group treated with degludec (35 patients), a significant reduction in mean capillary glycaemia was obtained between the first day of hospitaliza tion or initiation of therapy and discharge in each time slot: 36.6 mg /dl fasting (p <0.0001), 30 mg/dl before lunch (p <0.005), 38.9 mg/dl before dinner (p <0.001) and 37.3 mg/dl bedtime (p <0.001) and also fewer hypoglycemia (20% had at least one daytime hypoglycemia, no subjects had nocturnal hypoglycaemia). In the group receiving insulin glargine for the entire period (30 patients), a significant reduction in capillary blood sugar levels is present only in the pre lunch range (43.8 mg / dl, p <0.001) and 26% of subjects had at least one daytime hypoglycemia and 2% nocturnal hypoglycemia. In the group switched to degludec, the mean capillary fasting blood glucose decreased from 176.6 ± 27.9 to 130.4 ± 36.6 mg/dl, that of predinner from 217.9 ± 36.7 to 170.9 ± 49.1 mg/dl, patients at target upon awakening increased from 10% to 65%, glycemic variability expressed as the mean of morning standard deviations fell from 45.2 to 25.6 and hypoglycemia decreased (% of patients with at least one daytime hypoglycemia from 25% to 15%, with nocturnal hypoglycemia from 5% to 0%). Conclusions The use of insulin degludec in hospitalized patients in medical area was effective and safe, with better glycemic control in every time slot, fewer hypoglycemia and reduced glycemic variability. KEY WORDS basal insulins; hospitalized patients; hypoglycemia; glycemic variability.

Metabolic Disorders in Delirious Syndrome in Patients with Acute Poisoning with Gamma-Hydroxybutyric Acid and its Precursor

Abstract In 21 male patients aged 20 to 40 years, metabolic disorders in post-toxic delirious syndrome caused by gamma-hydroxybutyric acid poisoning and its precursors were studied. In the examined group of patients, hyperammonemia was detected in 71.4% of cases, metabolic lactic acidosis was revealed in 76.2%. The direct correlation between the severity of metabolic disorders and delirious syndrome according to DRS-R-98 scale was established. The statistically significant increase in capillary blood levels of lactate on day 3 of psychotic period was 4.9 mlmol/L and ammonia on day 5 was 187.0 mmol/L. The greatest severity of metabolic disorders was found in patients over the age of 27 years who systematically use the studied substances with narcotic effects for 7 months or more and combine their intake with other psychoactive substances.

Occurrence and duration of various operational definitions of sedentary bouts and cross-sectional associations with cardiometabolic health indicators: The ENERGY-project

ObjectiveThis study examined the occurrence and duration of sedentary bouts and explored the cross-sectional association with health indicators in children applying various operational definitions of sedentary bouts. MethodsAccelerometer data of 647 children (10–13 years old) were collected in five European countries. We analyzed sedentary time (<100cpm) accumulated in bouts of at least 5, 10, 20 or 30min based on four operational definitions, allowing 0, 30 or 60s ≥100cpm within bouts. Health indicators included anthropometrics (i.e. waist circumference and body mass index (BMI)) and in a subsample from two European countries (n=112) fasting capillary blood levels of glucose, C-peptide, high-density- and low-density cholesterol, and triglycerides. Data collection took place from March to July 2010. Associations were adjusted for age, gender, moderate-to-vigorous physical activity, total wear time and country. ResultsOccurrence of sedentary bouts varied largely between the various definitions. Children spent most of their sedentary time in bouts of ≥5min while bouts of ≥20min were rare. Linear regression analysis revealed few significant associations of sedentary time accumulated in bouts of ≥5–30min with health indicators. Moreover, we found that more associations became significant when allowing no tolerance time within sedentary bouts. ConclusionDespite a few significant associations, we found no convincing evidence for an association between sedentary time accumulated in bouts and health indicators in 10–13 year old children.

Percutaneous progesterone delivery via cream or gel application in postmenopausal women

This study aims to investigate the distribution of progesterone in venous whole blood, venous serum, fingertip capillary blood, and saliva after its topical application in both cream and gel formulations. Ten postmenopausal women were randomized to receive 80 mg of progesterone cream or gel applied daily for 14 days, crossing over after a 14-day washout. On the last day of each treatment period, venous blood, fingertip capillary blood, and saliva were sampled frequently for 24 hours after the final application. After progesterone cream or gel application, serum progesterone levels rose gradually, reaching a peak at 9 and 8 hours, respectively; AUC(0-24) h was significantly higher with cream (12.39 vs 8.32 ng h mL(-1), P = 0.0391). Whole venous blood levels followed a pattern similar to that of serum but were considerably lower. Saliva progesterone showed a peak at 1 and 6 hours after cream and gel application, respectively, and C(max) was comparable with cream and gel. Saliva AUC(0-24) h was substantially higher than the corresponding area under the curve for serum or whole blood but did not differ significantly by delivery method (39.02 and 58.37 ng h mL(-1), P = 0.69). In capillary blood, C(max) was reached at the same time (8 h) and was similar with both formulations; AUC(0-24) h was also similar with both formulations (1,056 ng h mL(-1) for cream and 999 ng h mL(-1) for gel) but was dramatically higher than the corresponding areas under the curve for venous serum and whole blood. After application of topical progesterone, saliva and capillary blood levels are approximately 10-fold and 100-fold greater, respectively, than those seen in serum or whole blood. High capillary blood and saliva levels indicate high absorption and transport of progesterone to tissues. Reliance on serum levels of progesterone for monitoring topical dose could lead to underestimation of tissue levels and consequent overdose.

HIV-Positive Nigerian Adults Harbor Significantly Higher Serum Lumefantrine Levels than HIV-Negative Individuals Seven Days after Treatment for Plasmodium falciparum Infection

Management of coinfection with malaria and HIV is a major challenge to public health in developing countries, and yet potential drug-drug interactions between antimalarial and antiviral regimens have not been adequately investigated in people with both infections. Each of the constituent components of artemether-lumefantrine, the first-line regimen for malaria treatment in Nigeria, and nevirapine, a major component of highly active antiretroviral therapy, are drugs metabolized by the cytochrome P450 3A4 isoenzyme system, which is also known to be induced by nevirapine. We examined potential interactions between lumefantrine and nevirapine in 68 HIV-positive adults, all of whom were diagnosed with asymptomatic Plasmodium falciparum infections by microscopy. Post hoc PCR analysis confirmed the presence of P. falciparum in only a minority of participants. Day 7 capillary blood levels of lumefantrine were significantly higher in HIV-positive participants than in 99 HIV-negative controls (P = 0.0011). Associations between day 7 levels of lumefantrine and risk of persistent parasitemia could not be evaluated due to inadequate power. Further investigations of the impact of nevirapine on in vivo malaria treatment outcomes in HIV-infected patients are thus needed.

Comparison of plasma, venous and capillary blood levels of piperaquine in patients with uncomplicated falciparum malaria

PurposeDihydroartemisinin-piperaquine (DP) is a fixed-dose artemisinin-based combination treatment. Field pharmacokinetic studies would be simplified and facilitated by being able to use small volume capillary assays rather than venous blood. The aim of this study was to describe the relationship between piperaquine concentrations measured in capillary blood, venous blood and venous plasma.MethodsSamples of plasma, whole blood obtained by venesection and capillary blood were taken simultaneously from patients with uncomplicated Plasmodium falciparum malaria treated with DP between 0 and 9 weeks after treatment. Piperaquine concentrations in venous and capillary samples were measured using solid phase extraction and analysis by liquid chromatography with ultraviolet detection.ResultsA total of 161 sets of the three measures were obtained from 54 patients. Piperaquine concentrations in the venous blood samples were approximately twofold higher and those in the capillary blood samples were threefold higher than the corresponding venous plasma concentrations. Capillary blood piperaquine concentrations were approximately 1.7-fold higher than venous blood concentrations, and this difference also increased with time.ConclusionDifferences in whole blood and plasma levels of piperaquine suggest compartmentalisation of the drug within blood cells, as also occurs with the structurally related quinoline chloroquine. The relationship between piperaquine concentrations in the venous plasma, venous blood and capillary blood is variable and unpredictable at low concentrations. However, within the range of concentrations usually present in patients between 3 and 21 days after treatment with currently recommended doses, the relationship between capillary and venous whole blood is predictable; consequently, capillary blood sampling can be used in field assessments.

Relapse of diabetic ketoacidosis secondary to insulin pump malfunction diagnosed by capillary blood 3-hydroxybutyrate: a case report

A 14 year old female with type 1 diabetes mellitus and a subcutaneous insulin pump was treated for diabetic ketoacidosis presumed secondary to dietary indiscretion, and then restarted her subcutaneous insulin pump after exchanging the tubing. An hour later, nursing review determined that she was using outdated insulin in the pump, and it was exchanged. However, 5 hours later relapse was suggested by a rise in capillary blood 3-hydroxybutyrate, in spite of a normal serum anion gap and a minimal increase in serum bicarbonate. Insulin pump failure was suspected, and the patient was treated for relapse of diabetic ketoacidosis. Following resolution, her insulin pump was replaced without further complications. Capillary blood levels of 3-hydroxybutyrate may be sensitive, early indicators of relapse of diabetic ketoacidosis, and are easily obtained.

Apolipoprotein screening in Australian children: feasibility and the effect of age, sex, and ethnicity.

(i) To evaluate the feasibility of detecting adverse lipid profiles in schoolchildren by measuring capillary dried blood spot apolipoprotein levels, and (ii) to assess the effect of age, sex and ethnicity on apolipoprotein levels. We measured capillary dried blood spot apolipoproteins B and A-I (apo B and apo A-I); assessed levels in relation to age, sex and ethnicity; and recalled children with elevated levels for a full lipid profile measurement. 6992 children (3501 boys and 3491 girls), aged 5-13 years, from schools in eastern Sydney, 1991-1995. Capillary blood levels of apolipoproteins B and A-I, and serum total cholesterol level. Of the 6951 children who provided an adequate fingerprick blood sample, we recalled 1465 children (21.1%) (640 boys [43.7%] and 825 girls [56.3%]) with elevated apo B levels and/or apo B:apo A-I ratios for further testing, either by us or by their family doctor (overall estimated compliance rate up to 70%). Among the 458 children who returned to us, there was a 90% positive predictive value for a total cholesterol level of over 4.5 mmol/L in those with both elevated apo B levels and high apo B:apo A-I ratios. Girls had higher apo B levels and apo B:apo A-I ratios than boys (P < 0.00001 for both), and in both sexes there was a trend downwards for apo B and upwards for apo B:apo A-I ratio over the age range tested, but levels were relatively stable between the ages of 6 and 10 years. Indian children (1.5% of the screened population) had the highest apo B levels, followed by white children (71.1%); Asian children (9.2%) had the lowest (P < 0.00001 compared with Indian and white children). The high positive predictive value of capillary blood apolipoprotein levels for an adverse lipid profile in children suggests that measuring apolipoprotein levels by this method is a useful initial approach to cardiovascular risk assessment.

RETINOL UMBILICAL VEIN TO UMBILICAL ARTERY CONCENTRATION GRADIENTS AT TERM DELIVERY - DECREMENT IN PLASMA LEVELS 11 TO 24 HOURS AFTER BIRTH.1859

To clarify postnatal needs for retinol, we have measured the retinol concentration in paired samples of umbilical and umbilical artery blood immediately after uncomplicated term delivery (n=8). In these 8 infants, umbilical vein concentration was always higher than umbilical artery. As shown in the figure, concentration gradients varied widely from baby to baby, but, for each cord pair, there was a significant correlation of gradient with concentration of retinol in the umbilical vein. Tissue uptake of retinol was estimated assuming a 100 ml/kg/minute umbilical blood flow, a HCT of 50% and non participation of RBC in tissue uptake. It varied from 0.58 to 8.42 mg/kg/day (mean of 3.36)*. This represents a higher supply of retinol than that provided by routine postnatal nutrition. In another group of 8 term infants cord retinol levels were compared to capillary blood levels at age 11 to 24 hours. A mean decrement of 28% in retinol concentration in paired samples was found (8.1μg/dl ± 6.7 SD, range 0 to 20). Conclusions: This preliminary data suggests that optimal retinal intake after birth for growing preterm and term infants has probably been underestimated.

Apolipoproteins A-I and B and the B/A-I Ratio in the First Year of Life

To investigate early detection of young families with inherited dyslipidemia, we assessed changes in circulating apolipoprotein (apo) B and A-I levels and the apo B/A-I ratio during the 1st year of life and their relations to parental values. After measuring initial dried blood spot capillary blood levels in 919 babies when aged 4.25 +/- 0.98 d (mean +/- SD), we recalled at a mean age of 8.5 +/- 2.3 mo those with levels in one or more of the following categories: the top 5% of apo B values (group 1), the top 5% of apo B/A-I ratios (group 2), the bottom 5% of apo A-I values (group 3), and a group of 18 infants (group 4) who were not in any of the above three categories. We thus obtained serum lipid measurements in 51 infants and their parents. Two of the 13 group 1 infants had persistent hyperapo B at 8.5 mo; there was an inverse relationship between apo B and apo A-I levels in this group (p less than 0.001). Two of 11 babies in group 2 had lipid profiles consistent with familial hypercholesterolemia. However, none of the infants in group 3 had evidence at 8.5 mo of abnormal apo A-I or HDL levels, nor did their parents. For groups 1, 2, and 3, there was at 8.5 mo a regression of apo B and A-I toward mean levels for the "normal" 18 babies of group 4. In contrast, the high apo B/A-I ratios in group 2 remained high (p less than 0.01) and showed evidence of tracking.(ABSTRACT TRUNCATED AT 250 WORDS)

A liquid chromatographic method for determination of theophylline in serum and capillary blood — a comparison

A simple, fast and reliable liquid chromatographic method for the determination of theophylline in serum and capillary blood after a solid phase extraction is described for therapeutic drug monitoring. The employment of capillary blood permits the determination of an individual drug profile and other pharmacokinetic studies in neonates and infants. There were no differences in venous- and capillary-blood levels but these values compared poorly with those in serum. An adjustment of the results by correction of the different volumes of serum and blood by haematocrit was unsuccessful. Differences in the binding of theophylline to erythrocytes could be an explanation for the differences in serum at blood levels of theophylline.

The Neonatal Neurobehavioral Effects of Bupivacaine, Mepivacaine, and 2-Chloroprocaine Used for Pudendal Block

MERKOW, ALAN J.; McGUINNESS, GAIL A.; ERENBERG, ALLEN; KENNEDY, ROLAND L. Author Information

Character of placentation in twins, as related to hemoglobin levels.

Capillary hemoglobin values estimated simultaneously in liveborn partners of 86 pairs of dichorionic twins during the first week of life were comparable in the two partners. In 20 pairs of liveborn twins with monochorionic placentas the values were different, with the second-born having the higher hemoglobin concentration. This difference, which was small in the first hours after delivery but became greater later (12 to 24 hours), indicates that shunting of blood occurs during delivery. Because of the abundant and easily recognizable anastomoses this placentofetal transfusion is greater in monochorionic twins. Ergometrine injection immediately after delivery of the second twin may enhance this process. Estimations of venous hemoglobin in 17 dichorionic twins showed slightly higher values in the second-born partners. The corresponding capillary blood levels were an average of 2.5 Gm./100 ml. higher than the venous values.