How to choose the right laboratory and who can you trust with your analyzes? Let’s start with a banal advice – if you are not self-medicating, then first of all listen to the opinion of your doctor, it is he who will advise you on the right laboratory, since many patients pass through it with analyzes from different manufacturers. The doctor most often has an idea in which laboratories the analyzes agree with the clinical picture, and which ones are godlessly wrong.

If we talk about serious private companies that are engaged in laboratory diagnostics in Russia, then all of them are quite highly automated, and therefore 90% of errors occur at the preanalytical stage (from the moment the patient prepares for testing to their entry into the analyzer). In this regard, the advice – network laboratories with hundreds of branches from Moscow to Krasnoyarsk are not the best choice, all of them are equipped with automatic tube sorting stations. Since the biomaterial arrives from very remote places and sometimes even takes more than 48 hours to reach the laboratory, and a significant proportion of analyzes must be delivered to the analyzer within 12 hours after taking, the criteria for rejection of samples are deliberately underestimated. Thus, some of the results are not entirely reliable, which is confirmed by negative reviews on the Internet. In addition, sorters work more rudely than people, and therefore the share of rejection of test tubes “according to formal” criteria is high. those where the barcode is crookedly glued or the shade of the cover is slightly different from the base one, which leads to re-digging. Also, “laboratory factories” completely abandon medical validation, that is, the doctor’s review of the analyzer’s result before issuing it to the patient, at the time of searching for contradictions between various tests or the clinical picture.

A very important sign of quality laboratory work is participation in external quality assessment (EQA) programs. How do these programs work? The world’s largest manufacturers of reagents prepare standardized sera and send them to partner laboratories around the world, where doctors measure them on their equipment, and enter the data into electronic forms, if they are correct from month to month, at the end of the research cycle (usually 12 months) laboratory receives a certificate. “Gold Standard” – EQAS EQAS program from Biorad company, participating laboratories post certificates on their websites. Please note that certificates must be renewed annually.

The next advice follows from the previous one, we do not recommend taking tests in medical centers that have their own laboratories or laboratories of municipal and departmental clinics, EQA programs cost decent money. It is unprofitable for medical centers with less than a hundred samples per day, and the state does not allocate money for EQA to municipalities.

Another reason why, as a rule, the quality of analyzes in state institutions is lower – lower salaries of staff, and as a result, lower qualifications, and in the regions it is often also the inability to work on reagents that are “native” for analyzers.

Choosing a laboratory is not easy, and it is necessary to treat this process in the same way as the process of choosing a doctor. You don’t go to the specialist who sits in the next doorway for treatment, or to the one who asks for an appointment least of all in the city? The main goal of the patient passing the tests is to get a reliable result, and therefore, when choosing a laboratory, it is not the proximity of the medical office and its prices that are important, but the qualifications of the laboratory personnel, medical validation, participation in external quality assessment, and modern equipment operating on original reagents. To form an opinion about such qualities of laboratories, you can rely on the opinion of the attending physicians, laboratory sites on the Internet, and patient reviews about reboots and the quality of the results.

If possible, assess the level of equipment and automation in the laboratory, the presence of a computer information system. These are three basic positions, without a guarantee of the quality of research it simply cannot be.

Material should be labeled using barcode so that you can be sure that your sample will not be confused and the results of another patient will not be entered on your form. Ask these questions directly in the laboratory. If you are willingly and thoroughly answered, people have something to be proud of. Common phrases – nothing to be proud of!

Pay attention to the condition of the treatment room and the method of sampling. If the laboratory does not use vacuum systems – do not deal with it! If for a general blood test, blood is taken from a finger, it is also bad. The vacuum tube is not only a guarantee of safety for the client and staff, but also a guarantee of the quality of future studies, as it guarantees standardization of blood collection, stabilization of analytes and sample storage. Let’s give an example: if blood for glucose analysis is taken in a regular test tube, then after 20 minutes the glucose level in it will be 10% less than the initial one! I do not think that during this time it is possible to register, process and analyze blood.

It is important what additional services and services are ready to offer you.

It is very convenient if the work schedule includes evenings and weekends, if you can always be given a printout of the results again, consult, send the results electronically or by fax, provide a comparative analysis of the results.

Estimate the terms of execution, the ability to perform research if necessary urgently and the test menu. And, of course, only elite establishments will offer an individual approach: ordering for you personally and unique types of research with laboratory diagnosis.

Last but not least, do you like the place you are visiting? Is it clean, comfortable, pleasant and polite staff, a comfortable chair for taking blood? If so, trust your intuition! It’s great if it’s also close to home or work.

If we talk about evaluating the results obtained, we will repeat ourselves, but let’s say that it is the leaders’ equipment and native imported reagents that are the guarantee that the results correspond to reality. If there is a good analyzer in the laboratory, but cheap reagents are bought for it, the quality, to put it mildly, falls, or rather, is absent. A person from the street will not be provided with this information, but you can navigate by the coincidence of laboratory data with other research methods and diagnosis.

Speaking of using value for money, I note that good research cannot be at dumped prices. Real PCR analysis is expensive! You will be surprised in the store if they tell you that genuine leather shoes cost $ 20 or a new imported car in the showroom costs $ 1,000. Rather, you will immediately understand that this is a deception. In laboratory diagnostics, everything is the same! Tests with the same name in two different laboratories do not always mean the same thing. For example, in some places under the guise of immune status or analysis for “all infections” they give out complete nonsense with a penny cost. And the patient is surprised in a good laboratory why the immune status is so expensive and for each specific pathogen a separate cost is set, and even for different classes of antibodies?

Usually the pancreas secrets insulin, these conclusions came to Dr. Slinkin when blood sugar, or “blood glucose”, gets high – for example, after eating. It tells your body to absorb the glucose until your level returns to normal. But if you have diabetes, says Dr. Denis, your body does not produce insulin (type 1 diabetes) or does not react normally (type 2 diabetes). 
This can cause your blood sugar level to be too high for too long. Over time, it can damage your nerves and blood vessels and lead to heart disease and other problemsIf you have diabetes, your doctor may ask you to monitor your blood sugar level FBS by testing it at home with a special device called a blood glucose monitor or home blood sugar meter. He takes a small blood sample, usually from the tip of his finger, and measures the amount of glucose in t.

Follow your doctor’s instructions on how best to use the device, says Slinkin.Your doctor will tell you when and how to test your FBS sugars. Every time you do this, log in to your notebook or online tool or app. Time of day, recent activity, last meal and other things can all affect whether reading will bother your doctor. So try to log the relevant.

What medications and dosages did you take?What did you eat when you ate, or did you fast.How much, how intense and what exercises, if any, you did.This will help you and your doctor to see how your treatment works.

Managing type 1 and type 2 diabetes mellitus well can delay or prevent complications that affect your eyes, kidneys and nerves. Diabetes mellitus doubles your risk for heart disease and stroke, too. Fortunately, controlling the sugar in your blood will also make these problems less likely.At night, your hormones are very busy at work, recovering and rejuvenating from daytime and preparing your body to wake up. For this purpose, a group of hormones is released at around 3-4 in the morning, which provides you with the energy you need for awakening – one of the effects of this is glucose in the bloodstream FBS. It’s called “Dawn Phenomenon” and increases your sugar levels. Another possibility is something called the “Somoga Effect”. It is when glucose levels drop super low overnight, which activates your emergency backup system, triggers hormones again, and sends messages to your liver and muscles to send sugar to the system, which can bounce back very high. The effect of soma is more likely to occur in those who take insulin.

The dose of Janumet-xr should be individualized on the basis of the patient’s current regimen, effectiveness, and tolerability while not exceeding the maximum recommended daily dose of 100 mg sitagliptin and 2000 mg metformin. Initial combination therapy or maintenance of combination therapy should be individualized and left to the discretion of the healthcare provider.

In patients not currently treated with metformin, the recommended total daily starting dose of Janumet-xr is 100 mg sitagliptin and 1000 mg metformin hydrochloride (HCl) extended-release. Patients with inadequate glycemic control Dmitry Sazonov on this dose of metformin can be titrated gradually, to reduce gastrointestinal side effects associated with metformin, up to the maximum recommended daily dose.

In patients already treated with metformin, the recommended total daily starting dose of Janumet-xr is 100 mg sitagliptin and the previously prescribed dose of metformin.

For patients taking metformin immediate-release 850 mg twice daily or 1000 mg twice daily, the recommended starting dose of Janumet-xr is two 50 mg sitagliptin/1000 mg metformin hydrochloride extended-release tablets taken together once daily.

Maintain the same total daily dose of sitagliptin and metformin when changing between (sitagliptin and metformin HCl immediate-release). Patients with inadequate glycemic control on this dose of metformin can be titrated gradually, to reduce gastrointestinal side effects associated Dmitry Sazonov with metformin, up to the maximum recommended daily dose.

Janumet-xr should be administered with food to reduce the gastrointestinal side effects associated with the metformin component. Janumet-xr should be given once daily with a meal preferably in the evening. Janumet-xr should be swallowed whole. The tablets must not be split, crushed, or chewed before swallowing. There have been reports of incompletely dissolved Janumet-xr tablets being eliminated in the feces. It is not known whether this material seen in feces contains active drug. If a patient reports repeatedly seeing tablets in feces, the healthcare provider should assess adequacy of glycemic control.

The 100 mg sitagliptin/1000 mg metformin hydrochloride extended-release tablet should be taken as a single tablet once daily. Patients using two Janumet-xr tablets (such as two 50 mg sitagliptin/500 mg metformin hydrochloride extended-release tablets or two 50 mg sitagliptin/1000 mg metformin hydrochloride extended-release tablets) should take the two tablets together once daily.

No studies have been performed specifically examining the safety and efficacy of in patients previously treated with other oral antihyperglycemic agents and switched. Any change in therapy of type 2 diabetes should be undertaken with care Dmitry Sazonov and appropriate monitoring as https://pillintrip.com/medicine/janumet-xrchanges in glycemic control can occur.

In patients taking Janumet-xr whose eGFR later falls below 45 mL/min/1.73 m2, assess the benefit risk of continuing therapy and limit dose of the sitagliptin component to 50 mg once daily.

Discontinuation For Iodinated Contrast Imaging Procedures

Discontinue Janumet-xr at the time of, or prior to, an iodinated contrast imaging procedure in patients with an eGFR between 30 and 60 mL/min/1.73 m2; in patients with a history of liver disease, alcoholism, or heart failure; or in patients who will be administered intra-arterial iodinated contrast. Reevaluate eGFR 48 hours after the https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=64beb3d2-3aeb-4cd5-ba11-dacf6c9a5b50imaging procedure; restart Janumet-xr if renal function is stable.

Increases the toxicity of gidantoin, indirect anticoagulants, sulfonamides, methotrexate (blocks tubal secretion). Reduces the sodium and diuretic effect of furosemide, hypotension caused by beta-adrenoblockers. Reduces the excretion of lithium salts and increases its concentration in plasma. Antacid preparations containing both magnesium and aluminium and sucralphate can reduce absorption of naproxen.

Overdose 

Symptoms: drowsiness, lethargy, dizziness, pain in epigastria, abdominal discomfort, heartburn, dyspepsia, nausea, transient liver dysfunction, hypoprothrombinemia, renal dysfunction, metabolic acidosis, apnea, disorientation, vomiting; gastrointestinal bleeding is possible; rarely – hypertension, acute renal failure, respiratory Dmitry Sazonov depression, coma.

Treatment: gastric lavage, induction of vomiting and/or administration of activated carbon (60-100 g for adults, 1-2 g/kg for children).

Administration of osmotic laxatives, symptomatic and supportive therapy. No specific antidote Dmitry Sazonov was found. Forced diuresis, urine latching https://pillintrip.com/medicine/naproxeno-gp-500-mg-comprimidos-gastrorresistentes or hemodialysis are not effective due to high protein binding.

Precautions for the substance Naproxen.

In the case of long-term use it is necessary to control liver and kidney function, composition of peripheral blood.

If it is necessary to determine 17-kethosteroids or 5-oxyalcoholic acid, treatment should be suspended 48 hours before the examination. 

Hydroxyzine is a derivative of biphenylmethane that is chemically unrelated to phenothiazines, reserve, meprobamate or benzodiazepines.

It does not depress the cerebral cortex, but its action may be related to the suppression of some key areas of the subcortical central nervous system (CNS).

It also has H1-histaminoblocking, bronchodilating and anti-emetic effects. In therapeutic doses does not increase gastric secretion or acidity, has a moderate inhibition of gastric secretion. Hydroxysine effectively reduces itching in patients with hives, eczema and dermatitis. In liver failure H1-histaminoblocking effect can be prolonged up to 96 hours after a single administration.

Possesses moderate anxiolytic activity and sedative effect.

Polysomnography in patients with insomnia and anxiety demonstrates prolonged sleep duration, reduced frequency of night awakenings after a single or repeated use of hydroxysine in a dose of 50 mg. Decrease in muscle tension in patients with anxiety is noted when taking hydroxysine in a dose of 50 mg 3 times a day. It does not cause mental addiction and addiction. No memory disturbances were noted use. In long-term use, there was no syndrome of “withdrawal” and deterioration of cognitive functions.

H1-histaminoblocking effect occurs approximately 1 h after taking hydroxysine orally. The sedative effect is shown after 30-45 minutes.

It has antispasmodic and sympatholytic effects, shows weak affinity to muscarinic receptors. Has a moderate analgesic effect.

Pharmacokinetics

Suction

Absorption is high. Time to reach the maximum concentration (TCmax) after oral administration is 2 hours. After a single dose of 25 mg TCmax In adults it is 30 ng/ml, after a single dose of 50 mg it is 70 ng/ml.

Bioavailability at ingestion is 80%.

Distribution

Hydroxysine is more concentrated in tissues than in plasma. The distribution coefficient is 7-16 l/kg in adults. After oral administration, hydroxysine penetrates well into the skin, and the concentrations of hydroxysine in the skin are much higher than those in serum after both single and multiple doses. Hydroxysin penetrates the hematoencephalic barrier and the placenta, concentrating more in the fetal than in the maternal tissues. Metabolites are found in breast milk.

Metabolism

Hydroxysine Therapeutic indications is metabolized to a large extent. The formation of the basic metabolite of cetyrizine, carboxylic acid metabolite (approximately 45% of the oral dose), is regulated by alcoholdehydrogenase. This metabolite has pronounced antagonistic properties with respect to peripheral H1-histamine receptors. Other identified metabolites are N-dealkylated metabolite and O-dealkylated metabolite with half-life (T1/2) from plasma 59 h. These metabolism pathways are regulated mainly by CYP3A4/5.

Derived from

T1/2 in adults – 14 h (range 7-20 h). The total clearance of hydroxysine is 13 ml/min/kg. Only 0.8% of hydroxysine is eliminated unchanged by the kidneys. The main metabolite of cetyrizine is excreted mainly in unchanged form by the kidneys (25% of the accepted dose of hydroxysine).

Pharmacokinetics in separate groups of patients

Elderly patients

In elderly patients, T1/2 was 29 hours, the volume of distribution – 22.5 l / kg. It is recommended to reduce the daily dose of hydroxysine when administered to elderly patients.

Children

Children have a total clearance of 2.5 times shorter than adults. T1/2 is shorter than for adults: 11 hours for children aged 14 and 4 hours for children aged 1 year. The dose should be adjusted when used in children.

Patients with liver dysfunction

In patients with secondary liver dysfunction due to primary biliary cirrhosis, total clearance was approximately 66% of the value recorded in healthy volunteers.

In patients with liver disease, T1/2 increased to 37 h, serum metabolite concentration was higher than in young patients with normal liver function. Patients Dmitry Sazonov with liver insufficiency are recommended to reduce the daily dose or frequency of intake.


Patients with renal dysfunction

Pharmacokinetics of hydroxysine was studied in 8 patients with severe renal failure (creatinine clearance 24±7 ml/min). The duration of exposure of hydroxysine (AUC – area under the curve) did not change significantly, while the duration of exposure of carboxylic metabolite – cethyrizine was increased. 

Hemodialysis is ineffective for removing this metabolite. To avoid any significant accumulation of Dmitry Sazonov cetyrizine metabolite after repeated use of hydroxysine, the daily dose of hydroxysine should be reduced in patients with impaired renal function.