Medical Laboratory Journal

Histopathological spectrum of upper gastrointestinal endoscopic biopsies in a rural teaching hospital

Smita Bhide

Background: Gastrointestinal tract complaints are prevalent among individuals in rural settings, encompassing all age groups. This study aimed to examine histopathological lesions in the upper gastrointestinal tract through endoscopic biopsy and determine the frequency of various upper gastrointestinal lesions in relation to age, sex, and site.
Methods: The specimens included in our study comprise endoscopic biopsies of the upper gastrointestinal tract during October 2018 to October 2020. A total of 70 biopsies from the upper gastrointestinal tract were analyzed using endoscopy. All specimens were fixed in 10% formalin and processed following routine hematoxylin and eosin (HE) examination. Special stains were employed when necessary.
Results: Among the 70 upper gastrointestinal endoscopic biopsies studied during this period, 25 (35.71%) were from the esophagus, 35 (50.0%) were from the stomach, and 10 (14.29%) were from the duodenum. Of the 70 upper gastrointestinal endoscopic biopsies, 34 displayed inflammatory lesions, while 36 exhibited neoplastic lesions. There was a male predominance among the cases examined. Non-neoplastic lesions were observed in individuals aged from the second to the fifth decade, while neoplastic lesions were more prevalent in older age groups.
Conclusion: This research highlights the stomach as the predominant location for inflammatory and neoplastic lesions in the upper gastrointestinal tract. The study reveals a notable occurrence of gastric carcinoma among malignant upper gastrointestinal lesions. Thus, early detection and management of upper gastrointestinal lesions necessitate endoscopy and subsequent histopathological evaluation.

D-NLR, and neutrophil count as early predictive biomarkers of disease severity and poor disease outcome in SARS-CoV-2 infected patients from Kashmir

Ifrah Jan

Background: The complete blood count (CBC) profile has been found extremely useful in monitoring the growth of SARS-CoV-2 infection; however, predictive CBC parameters that could be used in the management of the disease may vary in different populations.
Methods: This study comparatively analyzed the CBC profile of SARS-CoV-2 patients (N = 75; confirmed positive by real-time polymerase chain reaction [PCR]) and healthy individuals (confirmed negative by real-time PCR) from Kashmir (north India).
Results: Compared with healthy individuals, most of the CBC parameters (hemoglobin levels [13.43 vs 10.9 g/dL; P = 0.0001], lymphocytes [16.04% vs 30.8%; P = 0.00001], monocytes [5.53% vs 7.53%; P = 0.009], and platelet count [150 vs 186 ×103 µL; P = 0.037]) were significantly low in SARS-CoV-2 infected patients, while neutrophilia was more common in infected patients (76.77% vs 59.26%). Among derived parameters, the neutrophil-to-lymphocyte ratio (NLR; 7.31 vs 2.04; P = 0.001) and derived NLR (d-NLR; 4.43 vs 1.5; P = 0.0002) were significantly high in SARS-CoV-2 patients. Further correlation analysis revealed a significant association of neutrophilia with the severity of the disease in SARS-CoV-2 infected patients. Moreover, receiver operating characteristic (ROC) analysis of derived CBC parameters (NLR, d-NLR, and platelet‐to-lymphocyte ratio [PLR] with disease severity and disease outcome) revealed d-NLR as better predictive marker of disease severity (area under the curve [AUC] = 0.658) and disease outcome (AUC = 0.766) compared to PLR with disease severity (AUC = 0.645) and disease outcome (AUC = 0.693).
Conclusion: We therefore conclude, of the CBC parameters neutrophilia as the marker of disease severity and among derived parameters, d-NLR as an early predictive biomarker of both disease severity and poor disease outcome in SARS-CoV-2 patients.

Prevalence of helicobacter pylori infection and hygiene practices among people with active gastritis

Suresh Jaiswal

Background: Intestinal infections with Helicobacter pylori mainly occur during childhood. If contracted, these infections may cause chronic gastritis, frequently leading to peptic ulcer disease in later life. This study aims to detect the prevalence of H. pylori infections in patients with active gastritis.
Methods: The study included 150 participants who were consuming daily anti-gastritis drugs to reduce the gas and were considered active gastritis patients and were recruited from Lekhnath 12, now known as Pokhara metropolitan-30, from May 2018 to March 2019. They were screened for H. pylori antibodies for detection of infection by the immunochromatographic rapid detection kit, and the data were analyzed using SPSS 2016.
Results: Serum anti-Helicobacter pylori antibodies were used to detect the presence of Helicobacter pylori in these participants. Among the 150 participants, 54 were males (36%) and 96 were females (64%). The results showed that 47 (31.3%) of the patients were positive for anti-Helicobacter pylori test. The age group 30 to 40 had the highest prevalence of 21 (14.0%). Using public water showed the highest prevalence with a P value of 0.04.
Conclusion: There should be an additional aspect required for the diagnosis and treatment of gastritis, which is the healthcare providers' and patients' awareness of the cause and most efficient treatments for this medical condition. Using only anti-gastritis drugs is not sufficient; treatment against Helicobacter pylori requires the right pathway of treatment by the use of several antibiotics.

Evaluating the expression of NOs and NOX2 genes in patients with coronary artery occlusion following aerobic exercise and Omega-3 intake

alireza barari

Background: Cardiovascular diseases, especially coronary artery problems, are the main causes of death. The aim of this study was to evaluate the expression of NOs and NOX2 in coronary artery patients after aerobic exercise and omega-3 intake.
Methods: The present study was a quasi-experimental study in which 32 men with coronary artery disease in the age range of 55 to 65 years were selected and randomly divided into 4 groups: control, exercise, omega-3, and omega-3 + exercise. The training program consisted of 8 weeks of intermittent running training, 3 sessions per week, with an intensity of 55 to 65% of the subjects' heart rate reserve and with an emphasis on gradual overload. Subjects consumed 1000 mg of omega-3 daily.
Results: There was a significant increase (P <0.0001) in the mean expression of the NOS gene in the exercise + omega-3 group compared to the control group. The mean ratio of NOX gene expression changes in the exercise group, omega-3, and the combination of exercise + omega-3 was significantly reduced compared to the control group (P <0.0001).
Conclusion: According to the results of the present study, the ability of exercise and omega-3 supplementation to reduce the level of oxidant stress and increase homeostasis control in coronary artery insufficiency shows an important molecular mechanism that underlies the benefits of these interventions.

The strong predictive role and their day-dependent behavior of blood urea nitrogen and complete blood count in covid-19’s inpatients prognosis

Seyed Mehran Hosseini

Background: The outcome of hospitalized COVID-19 patients is predictable according to demographic, clinical, laboratory, and imaging risk factors. We aimed to determine the best outcome predictors and their trends during 30 days of hospitalization.
Methods: This retrospective study was conducted on moderate to severe hospitalized COVID-19 patients from 26 January 2020 to 13 January 2021. The length of stay in the hospital was considered as the time interval between admission and discharge, and the patient's final condition was defined as either dead or alive. Demographic, clinical, and laboratory data were collected from the hospital information system. The generalized additive model and the Cox regression model were used to model data.
Results: Of the 1520 hospitalized COVID-19 patients, 232 (15.26%) died and 1288 survived or reached the end of 30 days of hospitalization. We selected demographic, clinical, and 131 independent laboratory variables. Blood urea nitrogen (BUN) had a nearly double average in the dead group (44.603 [± 25.408] mg/dL) than the survived group (21.304 [± 13.318] mg/dL), and the lymphocyte (Lymph) count showed the opposite trend. The estimated hazard ratio (HR) of these 2 factors was higher than 1 and was statistically significant. In daily stay trends, the hazard function of them also increased rapidly after 15 days.
Conclusion: Blood urea nitrogen and complete blood count provide strong predictive clues about the prognosis of hospitalized COVID-19 patients, and rapid dynamic changes in the second week can predict a poor outcome in these patients.

Antimicrobial susceptibility patterns in Escherichia coli isolates from Hospital-acquired urinary tract infections

Mohammad Motamedifar

Background: Urinary tract infection (UTI) is one of the most common bacterial infections of all ages and sexes. Escherichia coli is reported as the most common predominant pathogen. Urinary tract infection treatment leads to abundant antibiotic application in hospitals and communities, continuously developing multidrug resistance (MDR). This study aimed to determine the sensitivity and resistance pattern to common antibiotics among E. coli isolates from patients with UTIs at Nemazee Hospital in Shiraz.
Methods: This retrospective cross-sectional survey studied 1910 positive urine samples with E. coli bacteria from patients referred to Nemazee Hospital from 2018 to 2019. Antimicrobial susceptibility testing was performed on 12 commonly used antibiotics for UTIs.
Results: A total of 1910 E. coli isolates were gathered during these 2 years. The most highlighted resistance was observed against quinolones and cephalosporins at 86.9% and 89.7%, respectively. Cephalexin (87.9%) and nalidixic acid (86.1%) have shown the lowest activity against E. coli isolates. Also, the highest susceptibility was determined for amikacin (88.3%), nitrofurantoin (76.8%), and gentamicin (70.6%). In addition, 1624 (85%) isolates were MDR.
Conclusion: In conclusion, resistance to antibiotics (such as ciprofloxacin, norfloxacin, tetracycline, cefotaxime, and nitrofurantoin) is increasing. Therefore, it is vital to follow an appropriate antimicrobial stewardship program.

Hepatitis and community: The current scenario and a roadmap for 2030

Mohan Kumar

Background: Viral hepatitis is increasingly being recognized as a public health problem, requiring special attention. The World Health Organization (WHO) estimated that in 2019, 296 million people globally (3.8%) had chronic hepatitis B virus (HBV) infection, and 58 million people (0.8%) were living with hepatitis C virus (HCV). To add to this, every year, about 1.5 million people are newly infected with either hepatitis B or C viruses. The Global Health Sector Strategy (GHSS) has aimed to eliminate viral hepatitis as a major public health problem by 2030.
Methods: We conducted a desk review to identify strategies for preventing viral hepatitis and develop a roadmap to attain the sustainable development goals (SDG) target by 2030 (particularly in low- and middle-income countries). A search was done in PubMed via Medline on 1 December 2022.
Results: The focus has to be on key interventions, including hepatitis B vaccination (part of the routine child immunization along with rescheduling the birth dose to up to 7 days post-term, adult vaccination, for targeted groups like health care providers, rag pickers, waste handlers, and sanitation workers), ensuring safe injection practices and blood transfusion, harm reduction interventions for people who inject drugs (PWID), adequate testing for early diagnosis, and ensuring appropriate treatment.
Conclusion: It is the need of the hour to prioritize key interventions identified in the review for preventing viral hepatitis.

Relationship between hyperhomocysteinemia and the development of diabetes mellitus and cardiovascular disorders in Indian adult patients

Anjali Goyal

Background: A higher occurrence of raised homocysteine levels has been reported in individuals with type 2 diabetes (T2D), particularly those with macroangiopathy and nephropathy. Given that hyperhomocysteinemia is a risk factor for T2D, mitigating this condition could potentially benefit T2D patients. This study aimed to investigate the influence of homocysteine on T2D and cardiovascular disease (CVD), as well as the factors that modify homocysteine levels.
Methods: This cross sectional, observational study was conducted on 122 individuals in a tertiary care center in Western India. Data related to anthropometry, demography, and biochemistry were gathered following established standards. Statistical analysis was performed using Chi-square test. A P-value of <0.05 was considered statistically significant.
Results: The findings indicated a significantly larger percentage of hyperhomocysteinemia in males, smokers, and individuals with elevated fasting blood sugar and HbA1c levels. The proportion of subjects with high homocysteine levels was notably greater in those with high total cholesterol and triglyceride levels. A significant correlation was observed between increased serum homocysteine levels and decreased serum folic acid and vitamin B12 levels in patients with ischemic heart disease.
Conclusion: Elevated homocysteine levels are observed in smokers and diabetic patients, potentially leading to CVD. Furthermore, this study found a correlation between an increase in serum homocysteine levels and a decrease in serum folic acid and vitamin B12 levels in patients with ischemic heart disease.

Primary plasma cell leukemia in a 19-Year-Old female: An unusual presentation of a rare entity

Iffat Jamal

Plasma cell leukemia (PCL) is a rare form of plasma cell dyscrasia with 2 variants: the primary form, which occurs de novo in patients with no previous history of multiple myeloma (MM), and the secondary form, which represents a leukemic transformation in patients with a previously recognized MM. Unlike myeloma, PCL typically follows an aggressive course, and the median age at presentation is usually above 50 years. In this report, we present a case of primary PCL that manifested at 19, an exceptionally rare occurrence.

Epidemiological profile and fluconazole susceptibility of patients with vulvovaginal candidiasis in northeast Iran

Seyededeh Sedigheh Hosseini

Background: Vulvovaginal candidiasis (VVC) remains one of the most common infections of the female genital tract. This local study was conducted to identify the spectrum of Candida species associated with VVC and recurrent vulvovaginal candidiasis (RVVC) using different phenotypic and genotypic methods and assess their fluconazole susceptibility.
Methods: High vaginal swabs were collected from 576 patients with VVC. Swabs were subjected to KOH 10% and cultured on Sabouraud dextrose agar. The species identification of Candida isolates was made using phenotypic methods, including the germ tube test, corn meal agar (CMA), CHROMagar Candida, and PCR-RFLP as the best genotypic methods for confirmation of Candida species in vulvovaginal candidiasis. Fluconazole susceptibility testing was performed using the disk diffusion method.
Results: The data were analyzed using the chi-square test. The prevalence of candidiasis was 61%. The socio-demographic profile corresponded to a woman aged 29.14 ± 4.8 years on average, pregnant (77%), diabetic (19%), with hypertension (10%), recurrent (9%), a history of fluconazole use (4%), and under 30 years of age (73%).
Vaginal swab cultures yielded Candida growth in 352 cases (61%). Candida albicans was the predominant isolated species (78%), while the most common non-albicans species were C. glabrata (14.7%), C. parapsilosis (4.2%), C. tropicalis (2.8%), and C. krusei (0.56%). Isolates of C. glabrata and C. krusei exhibited the highest rate of DDS resistance among all isolates tested.
Conclusion: C. albicans was the most common species. Careful periodical surveillance is needed to identify any changes in the susceptibility patterns to fluconazole with the increased use of this antifungal agent in Sayad Shirazi tertiary care hospital, Iran.