Henry 39;s Clinical Diagnosis And Management By Laboratory Methods E-book

[Damaris]

Theprerequisites to follow the course are a working knowledge of the material of the courses "Biochemistry I and II" of the 1st year of the degree. Furthermore, although not official, it is advisable to have passed the course "Animal Physiology".

Clinical Biochemistry is a mandatory course of the 3rd year of the degree.

Clinical Biochemistry aims to initiate the student in understanding the in vitro study of the biological properties that contribute to the prevention, diagnosis, prognosis and monitoring of diseases and disease states in humans.

The general objectives of the course are:

1) Familiarize students with the specific characteristics of a laboratory of clinical biochemistry.

2) Understanding the pathophysiology and molecular basis of the most prevalent diseases.

3) Know the analytical methods commonly used in the clinical laboratory.

4) Know how can contribute the clinical laboratory to assess the health status of individuals.

At the end of the course the student will know: the pathophysiological bases of the most relevant and prevalent diseases in our population; the main biological properties that are altered in these diseases and are examined in a clinical biochemistry laboratory; the procedures for the biological properties measurement and test; and their semiologic characteristics. It will also be familiar with the use of tools for the operation in a clinical biochemistry laboratory: instructions or work protocols, implementation of internal control quality program, participation in an external quality evaluation programs and use of automated measurement systems.

Theme I. Metrological and semiological aspects of clinical laboratory

INTRODUCTION. Concepts. Pre-analytical, analytical and post-analytical phases of the clinical laboratory. Collection, preparation and preservation of specimens. Pre-analytical variability.

METROLOGY. Values and quantities, observations and measurements. Measures and errors. Random error: precision. Systematic error: trueness. The true value. Calibration and traceability. Specificity. Error of measurement: accuracy and uncertainty. Measuring analytical range. Analytical sensitivity. Detectability.

QUALITOLOGY. Control materials. Basis of internal control: control rules and charts. Algorithms. External quality assessment programs.

BIOLOGICAL VARIABILITY AND REFERENCE VALUES. Intra- and inter-individual biological variability. Theory of reference values. Transversal and longitudinal comparisons. Production of reference values.

SEMIOLOGY. Discriminant capacity. Cut-off value. Diagnostic sensitivity and specificity. Prevalence and predictive value. Likelihood ratio. Receiver operating curves (ROC).

Theme II. Biochemical assessment of metabolic pathways

PROTEINS. Classification of plasma proteins. Methods of identification, detection and quantification. Identification of electrophoretic profiles. Hyperproteinemia and hypoproteinemia. Polyclonal and monoclonal hyperimmunoglobulinemia. Paraprotein.

ENZYMES. Diagnostic usefulness of measuring plasma enzymes. Measuring the catalytic concentration and the mass concentration. Transformation and factors that affect it. Calibration. Standardization measures. Major diagnostic enzymes of interest.

CARBOHYDRATES. Hormonal control of glucose homeostasis. Hyperglycemia and diabetes mellitus and alterations in glucose tolerance. Procedures for measuring glucose, hemoglobin A1c and albumin in urine.

LIPOPROTEINS. Structure and classification of plasma lipoproteins. Procedures for the study of dyslipidemia: total cholesterol and triglyceride. Separation of lipoproteins, VLDL cholesterol, HDL and LDL. Apolipoproteins. Classification of dyslipidemia. Genetic basis. Atherothrombosis: coronary heart disease and risk factors.

CALCIUM. Hormonal regulation of calcium homeostasis. Hypercalcemia and hypocalcemia. Bone metabolism. Biochemical markers of bone formation and resorption. Metabolic bone. Procedures for measuring biochemical markers of mineral metabolism.

ACID-BASE BALANCE. Homeostasis acid-base: blood pH buffers. Origin of pH variations. Compensatory mechanisms. Determination of pH, pCO2 and pO2. Alterations of the acid-base balance. Respiratory and metabolic acidosis and alkalosis.

Theme III. Biochemical assessment of the function of organs and systems

LIVER FUNCTION. Hepatobiliary system. Liver functions. Catabolism of hemoglobin. Hepatobiliary disease. Laboratory tests for evaluation. Investigation of jaundice: bilirubin determination.

CARDIAC AND MUSCULAR FUNCTIONS. Myocardial infarction and angina. Mechanisms. Meaning diagnostic procedures and measuring creatine kinase and its isoenzymes, myoglobin and troponin. Natriuretic peptides in the diagnosis of heart failure. Myopathies: progressive muscular dystrophy, rhabdomyolysis and polymyositis.

RENAL FUNCTION. Formation of urine and renal functions. Kidney disease: glomerulonephritis, tubular diseases, kidney failure, diabetic nephropathy, renouretral lithiasis. Laboratory tests for evaluation: urea, creatinine, urate, clearance testing, protein and kidney stones.

THYROID FUNCTION. Thyroid. Synthesis, transport, metabolism and regulation of thyroid hormones. Hypothyroidism and hyperthyroidism.

GONADAL AND GESTATIONAL FUNCTIONS. Ovarian function. Hormonal studies: prolactin, estradiol, progesterone, androgen and gonadotropins. Evaluation of infertility. Testicular function. Alterations: hypogonadism, infertility, disorders of puberty. Diagnosis and monitoring of pregnancy. Evaluation of fetus-placental unit.

BIOCHEMISTRY OF CANCER AND TUMOR MARKERS. Concept and classification. Clinical utility. Dynamic interpretation of the results. Main markers: CEA, AFP, b-hCG, PSA, CA19.9, CA125 and CA15.3. Application in different types of tumors. Concept of hereditary cancer. Oncogenes and tumor suppressor genes.

Annotation: Within the schedule set by the centre or degree programme, 15 minutes of one class will be reserved for students to evaluate their lecturers and their courses or modules through questionnaires.

The assessment of the course is continuous and will be evaluated both individually and in group activities. All assessment activities are obligatory. None of the assessment activities represent more than 50% of the final grade.

(4) Clinical case (20 % of the final grade), consists of two parts: presentation of the case (15 %) in group of two students or individually, content and oral presentation and writing is evaluated; the clinical case presented must be submitted through the Virtual Campus in the deadline. The cases presented but not submitted are not evaluated. To get the remaining 5 % the student must participate by asking questions about the cases presented in class and at the request of the teacher. There is no possibility of re-assessment.

Students taking the single assessment must present the clinical case in person on the assigned day (attendance on the other seminar days is not mandatory). The assessment and the weight on the final grade will be the same as those of the continuous assessment (20 %).

The single assessment consists of a single summative test (with multiple-choice questions, short questions and problems) on the content of the entire theory program and the program of problem-based seminars.

The single assessment exam will coincide with the same date fixed in the calendar for the last continuous assessment exam (2nd midterm) and the same recovery system will be applied as for the continuous assessment.

Repeating students keep marks of the test problems and clinical case activities evaluated for the next academic course. If students do not pass the course in this period, they must return all seminars activities.

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