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Reduction in the cobalt binding capacity of human albumin with myocardial ischemia
RESEARCH FORUM ABSTRACTS
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Reduction in the Cobalt Binding Capacity of Human Albumin With Myocardial Ischemia
Bar-Or D, Lau E, Rao N, BamposN, Winkler JV, Curtis CG/SwedishMedical Center, Englewood, CO; Diagnostic Markers, Inc, BieDynamics,Cardiff, UK; University of Cambridge,Cambridge,UK Study objective: We observed, in serum samples of patients with myocardial ischemia, reduced in vitro binding of Co(lI) to albumin. This decrease in cobalt binding to albumin focused our attention on the locus of the binding sites(s) and how this region might be affected during ischemia. Previous studies have shown that for the transition metals copper, nickel, and cobalt, the amino terminus of albumin is a strong binding site. In addition to being a major binding site for metal ions, the N-terminns of human albumin is also particularly susceptible to degradation compared with albumin from other species. Consequently, significant changes to or loss of the N-terminal region of human albumin during ischemia would be expected to reduce the binding of cobalt. The objective of this study was to provide evidence for a rapid colorimetric assay measuring cobalt binding to human albumin as a test for cardiac ischemia. Methods: A simple colorimetric assay was developed to screen human plasma/serum samples for decreased cobalt binding to albumin. A measured amount of cobalt chloride was added to plasma and the binding to albumin measured indirectly by assay of the free (unbound) cobalt after the addition of dithiothreitol at 470 nm. Results: Using this assay, we screened serum samples for cobalt binding in 99 patients with chest pain suggestive of ischemia and 40 healthy volunteers. Of the patients clinically diagnosed with myocardial ischemia, 95 (96%) of 99 had reduced cobalt binding, whereas 37 (92.5%) of 40 normal volunteers without any evidence of ischemia had higher cobalt binding capacity than the ischemic patients. Conclusion: These results suggest that measuring the cobalt binding capacity of human albumin could be used for the early diagnosis of myocardial ischemia. The underlying mechanism for the cobalt binding capacity assay we describe here is dependent on rapid modification of circulating albumin that detects ischemia within minutes and long before blood markers of myocardial cell membrane disruption.
15
Use,Understanding,and BeliefsAboutAIternateMedicines
Weiss SJ, Ernst AA, TakakuwaK/Universityof California-Davis Medical Center, Sacramento, CA Study objective: To describe the extent of alternate medicine (AM) use among emergency department patients, evaluate patients' understanding of AMs, and determine gender differences in beliefs about AMs. Methods: This study was a convenience sampling of patients seen in an urban ED. Patient demographics were recorded. A questionnaire was administered that assessed patients' knowledge and use of AMs. Patients were also asked about their beliefs on safety, medication interactions, and conveying information about these substances to their physicians. Results: A total of 100 ED patients were included in the study; 69% had heard of at least one of the AMs. There was no difference between genders, but there was a significant difference among races (89% of white, 53% of black, and 25% of Hispanic patients had heard of AMs; P<.01). The most commonly known AMs were ginseng (60%), gingko biloba (39%), eucalyptus (38%), St John's wort (38%), echinacea (30%), and melatonin (28%). Forty-eight percent of respondees had used AMs at some time and 22% were presently using AMs. The most commonly used AMs were ginseng (33%), St John's wort and gingko biloba (20% each), and echinacea and eucalyptus (19% each). Six respondees (6%) were seeing a provider of alternative medicines. All AMs were considered to be safe by 14%, 30% would not tell their doctor, 15% believed that AMs do not interact with other medications, and 18% trusted AMs to be more effective than medicine. Females were more likely than males to believe that AMs do not interact with other medications (19% versus 2%, 95% confidence interval 4% to 29%). Conclusion: Two thirds of ED patients have heard of AMs, half have used them at some time, one fifth are presently using them, and 6% see AM providers. Thirty percent of patients state they would not tell their physician about AMs despite the fact that some are very toxic. Understanding race and gender differences can help in addressing AM use. Questions about AM use should be routinely included in ED examinations.
216 Serious U Adolescents lnjury S andeDeath Associated i n With Alcoholand Drug Nyquist SN, Mader TJ, Letourneau P/BaystateMedical Center,Tufts University School of Medicine, Springfield, MA Study objective: The purpose of this study was to review the incidence of alcohol and l~onprescription drug use m adolescent trauma patients and examine its influence on outcome.
Methods: This study was a retrospective analysis of data collected (1994-1998) by the National Pediatric Trauma Registry (NPTR). Patients with positive toxicology screen (TS) were descriptively compared with those who were negative. Results: Of the 22,059 patients in the NPTR, 5,761 were age 12 to 17 years. Sixteen percent (928) had blood alcohol level (BAL) or urine toxicology screen (UTS) done on admission. Twenty-nine percent (95% confidence interval 26% to 32%) of the TS obtained were positive. Both groups were predominately male and had similar mean Glasgow Coma Scale (GCS) scores. The TS-positive children were older and more likely to have penetrating injuries. A positive TS was associated with more severe injury, as determined by the pediatric trauma score (PTS) (P<.05). No statistically significant difference was found in measured outcomes as outlined in the Table including morbidity and mortality. There was a slight decrease in the duration of ICU care for the TS-positive group (P<.05). This study is limited by not having quantitative measures of BAL and no detail on what nonprescription drugs were included on the UTS. Conclusion: A significant number of adolescent trauma patients have positive toxicology screens. A positive toxicology screen is associated with penetrating trauma but does not appear to adversely affect outcome.
Table, abstract 216. Negative (n=661)
Factor Male Age(y) Bluntinjury(%) GCS PTS Intubations(%) Admissionto operating room(%) Admissionto ICU (%) ICU stay(d) Complicationrate (%) Delayeddiagnosis(%) Mortality rate (%)
66 (62-69) 15.0 (14.8-15.1) 88 85-90 14.5 (14.5-14.6) 8.5 (8.4-8.6) 20 (17-23) 33 (29-36) 46 (42-50) 4.2 (4.0-4.3) 32 (28-35) 0.6 (0~2) 3.8 (2-6).
TS (n=267)
Positive BAL 0nly (n=82)
67 (61-73) 15.6 (15.4-15.7) 80 (75-85) 14.6(14.6-14.7) 7.9 (7.6-8.3) 25 (20-30) 41 (35-47)
52 (51-73) 15.8 (15.6-16.0) 92 (83-96) 14.4 (14.3-14.5) 8.2 (7.6-8.8) 21 (13-31) 40 (30-52)
46 (42-54) 3.8 (3.7-3.9) 30 (24-35) 0.8 (0-3) 3.8 (2-7)
46 (35-58) 4.5 (4.0-5.0) 29 (20-40) 1.2 (0-7) 5.0 (1-12)
Values represent means or proportions. 95% Confidence intervals shown in parentheses.
217
Epidemic US 0plate Mortality Rates: 1979-1996
Martin TG/Universityof Washington, Seattle, WA Poisoning is the third leading cause of injury mortality and opiates are the leading cause of poisoning mortality in the United States. Study objectives: To describe unintentional 0piate-related mortality (UOM) in the United States overall and within subgroups9 Methods: The US National Center for Health Statistics' (NCHS) compressed mortality data were analyzed by the Centers for Disease Control and Prevention (CDC) Wonder computer program. UOM was identified from the underlying cause of death (UCOD) field containing either an International Classification of Diseases-ninth revision N or E code. Rates, changes in rates and proportions in sex, race, and age groups in 52 states and 4 national regions were determined. All rates are per 100,000 population. Results: From 1979 to 1996, 20,666 cases of UOM had the following UCOD distribution: 85.4% E850.0 (Accidental poisoning, Heroin), 5.5% E850.1 (Accidental Poisoning, Methadone), 4.6% E850.2 (Accidental Poisoning, Other Opiates), 2.8% N305.5 (Nondependent Abuse of Opioids), 1.6% N304.0 (Opioid Dependence), 0.2% E935.0 (Adverse Effects of Heroin), and 0.1% E304.7 (Dependence on Opioid Combinations). Opiates Were responsible for 9.5% of all unintentional deaths in the United States in 1979 compared with 23% in 1996. During this period, the UOM rate in males was 4 times greater than females and accounted for 80% of all UOM. UOM in blacks accounted for only 18% of all UOM, but blacks had a higher rate (0.69) than whites (0.45) or the "Other" (0.19) racial group. Of male groups, blacks had the highest UOM rate (1.66), then whites (1.51), then others (0.53)9 The 25- to 34-year-old and 35- to 44-year-old age groups had the highest overall UOM rates (0.93 and 1.24)
z S 56
ANNALS OE EMERGENCY MEDICINE
34:4 OCTOBER 1999, PART 2
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Reduction in the Cobalt Binding Capacity of Human Albumin With Myocardial Ischemia
Bar-Or D, Lau E, Rao N, BamposN, Winkler JV, Curtis CG/SwedishMedical Center, Englewood, CO; Diagnostic Markers, Inc, BieDynamics,Cardiff, UK; University of Cambridge,Cambridge,UK Study objective: We observed, in serum samples of patients with myocardial ischemia, reduced in vitro binding of Co(lI) to albumin. This decrease in cobalt binding to albumin focused our attention on the locus of the binding sites(s) and how this region might be affected during ischemia. Previous studies have shown that for the transition metals copper, nickel, and cobalt, the amino terminus of albumin is a strong binding site. In addition to being a major binding site for metal ions, the N-terminns of human albumin is also particularly susceptible to degradation compared with albumin from other species. Consequently, significant changes to or loss of the N-terminal region of human albumin during ischemia would be expected to reduce the binding of cobalt. The objective of this study was to provide evidence for a rapid colorimetric assay measuring cobalt binding to human albumin as a test for cardiac ischemia. Methods: A simple colorimetric assay was developed to screen human plasma/serum samples for decreased cobalt binding to albumin. A measured amount of cobalt chloride was added to plasma and the binding to albumin measured indirectly by assay of the free (unbound) cobalt after the addition of dithiothreitol at 470 nm. Results: Using this assay, we screened serum samples for cobalt binding in 99 patients with chest pain suggestive of ischemia and 40 healthy volunteers. Of the patients clinically diagnosed with myocardial ischemia, 95 (96%) of 99 had reduced cobalt binding, whereas 37 (92.5%) of 40 normal volunteers without any evidence of ischemia had higher cobalt binding capacity than the ischemic patients. Conclusion: These results suggest that measuring the cobalt binding capacity of human albumin could be used for the early diagnosis of myocardial ischemia. The underlying mechanism for the cobalt binding capacity assay we describe here is dependent on rapid modification of circulating albumin that detects ischemia within minutes and long before blood markers of myocardial cell membrane disruption.
15
Use,Understanding,and BeliefsAboutAIternateMedicines
Weiss SJ, Ernst AA, TakakuwaK/Universityof California-Davis Medical Center, Sacramento, CA Study objective: To describe the extent of alternate medicine (AM) use among emergency department patients, evaluate patients' understanding of AMs, and determine gender differences in beliefs about AMs. Methods: This study was a convenience sampling of patients seen in an urban ED. Patient demographics were recorded. A questionnaire was administered that assessed patients' knowledge and use of AMs. Patients were also asked about their beliefs on safety, medication interactions, and conveying information about these substances to their physicians. Results: A total of 100 ED patients were included in the study; 69% had heard of at least one of the AMs. There was no difference between genders, but there was a significant difference among races (89% of white, 53% of black, and 25% of Hispanic patients had heard of AMs; P<.01). The most commonly known AMs were ginseng (60%), gingko biloba (39%), eucalyptus (38%), St John's wort (38%), echinacea (30%), and melatonin (28%). Forty-eight percent of respondees had used AMs at some time and 22% were presently using AMs. The most commonly used AMs were ginseng (33%), St John's wort and gingko biloba (20% each), and echinacea and eucalyptus (19% each). Six respondees (6%) were seeing a provider of alternative medicines. All AMs were considered to be safe by 14%, 30% would not tell their doctor, 15% believed that AMs do not interact with other medications, and 18% trusted AMs to be more effective than medicine. Females were more likely than males to believe that AMs do not interact with other medications (19% versus 2%, 95% confidence interval 4% to 29%). Conclusion: Two thirds of ED patients have heard of AMs, half have used them at some time, one fifth are presently using them, and 6% see AM providers. Thirty percent of patients state they would not tell their physician about AMs despite the fact that some are very toxic. Understanding race and gender differences can help in addressing AM use. Questions about AM use should be routinely included in ED examinations.
216 Serious U Adolescents lnjury S andeDeath Associated i n With Alcoholand Drug Nyquist SN, Mader TJ, Letourneau P/BaystateMedical Center,Tufts University School of Medicine, Springfield, MA Study objective: The purpose of this study was to review the incidence of alcohol and l~onprescription drug use m adolescent trauma patients and examine its influence on outcome.
Methods: This study was a retrospective analysis of data collected (1994-1998) by the National Pediatric Trauma Registry (NPTR). Patients with positive toxicology screen (TS) were descriptively compared with those who were negative. Results: Of the 22,059 patients in the NPTR, 5,761 were age 12 to 17 years. Sixteen percent (928) had blood alcohol level (BAL) or urine toxicology screen (UTS) done on admission. Twenty-nine percent (95% confidence interval 26% to 32%) of the TS obtained were positive. Both groups were predominately male and had similar mean Glasgow Coma Scale (GCS) scores. The TS-positive children were older and more likely to have penetrating injuries. A positive TS was associated with more severe injury, as determined by the pediatric trauma score (PTS) (P<.05). No statistically significant difference was found in measured outcomes as outlined in the Table including morbidity and mortality. There was a slight decrease in the duration of ICU care for the TS-positive group (P<.05). This study is limited by not having quantitative measures of BAL and no detail on what nonprescription drugs were included on the UTS. Conclusion: A significant number of adolescent trauma patients have positive toxicology screens. A positive toxicology screen is associated with penetrating trauma but does not appear to adversely affect outcome.
Table, abstract 216. Negative (n=661)
Factor Male Age(y) Bluntinjury(%) GCS PTS Intubations(%) Admissionto operating room(%) Admissionto ICU (%) ICU stay(d) Complicationrate (%) Delayeddiagnosis(%) Mortality rate (%)
66 (62-69) 15.0 (14.8-15.1) 88 85-90 14.5 (14.5-14.6) 8.5 (8.4-8.6) 20 (17-23) 33 (29-36) 46 (42-50) 4.2 (4.0-4.3) 32 (28-35) 0.6 (0~2) 3.8 (2-6).
TS (n=267)
Positive BAL 0nly (n=82)
67 (61-73) 15.6 (15.4-15.7) 80 (75-85) 14.6(14.6-14.7) 7.9 (7.6-8.3) 25 (20-30) 41 (35-47)
52 (51-73) 15.8 (15.6-16.0) 92 (83-96) 14.4 (14.3-14.5) 8.2 (7.6-8.8) 21 (13-31) 40 (30-52)
46 (42-54) 3.8 (3.7-3.9) 30 (24-35) 0.8 (0-3) 3.8 (2-7)
46 (35-58) 4.5 (4.0-5.0) 29 (20-40) 1.2 (0-7) 5.0 (1-12)
Values represent means or proportions. 95% Confidence intervals shown in parentheses.
217
Epidemic US 0plate Mortality Rates: 1979-1996
Martin TG/Universityof Washington, Seattle, WA Poisoning is the third leading cause of injury mortality and opiates are the leading cause of poisoning mortality in the United States. Study objectives: To describe unintentional 0piate-related mortality (UOM) in the United States overall and within subgroups9 Methods: The US National Center for Health Statistics' (NCHS) compressed mortality data were analyzed by the Centers for Disease Control and Prevention (CDC) Wonder computer program. UOM was identified from the underlying cause of death (UCOD) field containing either an International Classification of Diseases-ninth revision N or E code. Rates, changes in rates and proportions in sex, race, and age groups in 52 states and 4 national regions were determined. All rates are per 100,000 population. Results: From 1979 to 1996, 20,666 cases of UOM had the following UCOD distribution: 85.4% E850.0 (Accidental poisoning, Heroin), 5.5% E850.1 (Accidental Poisoning, Methadone), 4.6% E850.2 (Accidental Poisoning, Other Opiates), 2.8% N305.5 (Nondependent Abuse of Opioids), 1.6% N304.0 (Opioid Dependence), 0.2% E935.0 (Adverse Effects of Heroin), and 0.1% E304.7 (Dependence on Opioid Combinations). Opiates Were responsible for 9.5% of all unintentional deaths in the United States in 1979 compared with 23% in 1996. During this period, the UOM rate in males was 4 times greater than females and accounted for 80% of all UOM. UOM in blacks accounted for only 18% of all UOM, but blacks had a higher rate (0.69) than whites (0.45) or the "Other" (0.19) racial group. Of male groups, blacks had the highest UOM rate (1.66), then whites (1.51), then others (0.53)9 The 25- to 34-year-old and 35- to 44-year-old age groups had the highest overall UOM rates (0.93 and 1.24)
z S 56
ANNALS OE EMERGENCY MEDICINE
34:4 OCTOBER 1999, PART 2