CLINICAL PATHOLOGY I
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- Versione italiana
- Academic year
- 2022/2023
- Teacher
- ELENA ADINOLFI
- Credits
- 6
- Didactic period
- Primo Semestre
- SSD
- MED/05
Training objectives
- The course is aimed at understanding the mechanisms underlying the development of diseases, principles of laboratory measurements and parameters associated with them in order to obtain information for the diagnosis and the degree of severity of the medical conditions encountered, and to allow monitoring. Given the large number of existing diseases, the course focuses more on those found in the population of our country and the Western world, to wich we belong. In reference to the analytical techniques the course aims to make clear to student the scientific principle on which the specific interaction between the analyte and the measurement method is based, highlighting potential limits and possible sources of errors through operational tools aimed to identify and reduce them. Particular attention is paid to associate theory with practice, referring mainly to the existing guidelines that combine clinical effectiveness and cost containment. An important goal provide skills to deal with future laboratory activity, operating the good laboratory practice with the necessary awareness and care, thus getting job satisfaction.
Prerequisites
- Basic knowledge of human anatomy
Course programme
- CLINICAL PATHOLOGY – FIRST PART
•Ischemic heart disease
Atheromatous plaque. Myocardial infarction (MI). Ischemia, necrosis and scarring of the lesion. Differential markers of necrosis, ischemic, and non-ischemic and from other clinical causes. Cardiac troponins: decision-making level, required accuracy, reporting, timing of the measures. Classification of MI (acute, reinfarction and recurrent). Heart failure.
•Cardiovascular Risk
Epidemiology and risk factors. Metabolic syndrome: diagnostic criteria. Areas of cardiovascular disease, an equivalent risk and prevalence in the population. Lipoprotein and markers of inflammation. Lipid profile: recommendations and directions for measurements. Apolipoproteins and Lp (a). Importance of cholesterol remnant and post prandial triglycerides. Multivariate models of cardiovascular risk.
•Diabetes mellitus
Insulin and blood glucose. Diabetes Mellitus (DM) type 1A, Type 1B and latent autoimmune diabetes in adults (LADA), DM type 2. Distinctive features of DM type 1 and 2. Pathogenesis of type 2 DM, the role of adipose tissue, defects in insulin processing. Clinical presentation and diagnosis of DM in adults. Diagnosis of DM and risk identification. Clinical significance of the measurement of blood glucose, glycosylated hemoglobin and glucose tolerance test. Glycemic control in DM and micro- and macrovascular complications. Diabetic nephropathy. Estimation of the average blood glucose.
•Chronic kidney disease
Renal function, the glomerular filtration rate (GFR), the equations for GFR calculation, their performance and guidance on using. Identification of renal damage, albuminuria importance, chronicity of damage and reduced renal function. Pathogenesis of uremia, the degree of renal dysfunction, progression and identification of the causes, treatment guidelines.
•Hyponatremia
Regulation of body water and hyponatremia. Mechanism of action and physiological role of ADH, water sensors and volume status. Classification of causes of hyponatremia according to the levels of ADH and osmolarity. Hyponatremia in: heart failure, liver cirrhosis, use of thiazide diuretics, SIADH, adrenal insufficiency, and hypothyroidism.
•Thyroid’s pathology
Physiology of thyroid hormone. Thyroid disease and laboratory evaluation of the function, with TSH measurement, FT4 and FT3. The dysthyroidism: identification and risk of associated abnormalities. Antithyroid antibodies. Monitoring therapy with levothyroxine and treatment of hyperthyroidism.
•Hyperparathyroidism
Parathyroid hormone (PTH) and its receptors. circulating PTH forms. Interrelationships between PTH and calcium, calcitriol and hyperphosphatemia. Action of PTH on bone and kidney. Primary hyperparathyroidism and differential diagnosis with other causes of hypercalcemia. secondary hyperparathyroidism. Pathogenesis in chronic kidney disease and impact on bone and mineral metabolism.
CLINICAL PATHOLOGY – SECOND PART
•Principles and techniques of clinical biochemistry: general principles, instrumental architecture, and diagnostic applications
•Variability, error and quality control of analytical data
•Chromatographic techniques (in particular HPLC)
•Electrophoresis techniques (protein electrophoresis on agarose gel and capillary electrophoresis of serum proteins)
•Photometric techniques: absorbance photometry, turbidimetry, nephelometry, fluorescence, luminescence
•Immunometric Techniques: RIA, IRMA, ELISA, ACMIA (Affinity Column Mediated Immunoassay), PETINIA (Particle Enhanced Turbidimetric Inhibition Immunoassay), CEDIA (Cloned Enzyme Donor Immunoassay), ECLIA (Elettrochemiluminescent immuno assay), SLFIA (Substrate Labeled Fluorescent Immunoassay)
•Electrochemical Techniques (in particular potentiometry and voltammetry)
• Osmometry
• Mass Spectrometry (in particular MALDI-TOF) Didactic methods
- lectures
Learning assessment procedures
- Aim of the exam test is to verify at which level the learning objectives previously described have been acquired. The examination is divided into two parts (A and B), which take place on the same day.
Test A normally involves three questions divided as follows:
•The first question concerns a topic chosen by the student aimed to assess his expositive ability (about 15 minutes)
•The second question concerns a topic chosen by the teacher in order to assess the completeness of learning (15 minutes)
•The third question is a short and detailed question on a specific topic chosen by the teacher to assess the level of understanding of the fundamental concepts (about 5 minutes).
Test B normally involves at least 3 questions divided as follows:
•a very detailed question on the variability and error of the analytical data
•exposure of an analytical technique chosen by the student
-a question about an analytical technique chosen by the teacher
For each question students have the necessary time to articulate and complete their answer. This time period usually consists of about 10 minutes.
If the answer is inadequate or grossly wrong, and further explanation is not encountered, the time to answer can be reduced by switching to the next question.
The value of the answer to question 1 amounts to 50% of the full test evaluation.
The evaluation criteria are the following:
•knowledge of the contents
•understanding of concepts / mechanisms
•clinical diagnostic contextualization
•organization and display logical and rigorous response
•language skills
•stimulation of critical thinking
The final mark is derived from the weighted average of the single marks obtained by both tests. In the specific case, the weighted average is the sum of both marks, corrected for the weight of the
two teachings (4/6 to the test A and 2/6 to test B), namely: (A mark x 0.66) + ( B mark x 0.33 ) The result is approximated to the higher decimal. To pass the exam it is necessary to get 18 points out of 30. If either test is insufficient, this will have to be repeated. Reference texts
- Teachers’ notes
Specific topics can be further developed in the following texts:
FIRST PART
M. Laposata, Laboratory Medicine The diagnosis of disease in the Clinical Laboratory, Mc Grow Hill, 2nd Edition, 2015
SECOND PART
Luigi Spandrio, Principi e tecniche di chimica clinica, editore Piccin, ed. 2000
Wilson Keith, Walker John, Biochimica e biologia molecolare, Raffaello Cortina Editore, ed. 2006
Valerio Anna, Tecniche di biochimica clinica, editore Cleup, ed. 2008
Paola Turini, Valeria Giarnieri, Pietro Tarola, Biochimica applicata alla diagnostica di laboratorio; Principi e metodologie, editore Seu, ed. IV 3/2012
