Medical Laboratory Journal

Liver synthetic ability and hematological profile changes by Telfairia occidentalis in carbon-tetrachloride-induced toxicity in rats

Usunobun Usunomena

Background: Telfairia occidentalis is among the most popular vegetable crops propagated in the West African rainforest zone for its green leafy vegetable and ellipsoidal fruit, which are highly nutritious. This study investigated the liver's synthetic ability and hematological profile potential of T. occidentalis against carbon tetrachloride-induced toxicity in Wistar rats.
Methods: Five experimental groups of rats were used in this study. One group received distilled water and served as the normal control. The second group received carbon tetrachloride (CCl₄) alone for four days. The third and fourth groups received CCl₄ for four days prior to treatment with 200 mg/kg and 400 mg/kg T. occidentalis aqueous extract for six days, respectively. The last group received CCl₄ for four days prior to treatment with silymarin (100 mg/kg) for six days. With the exception of normal control rats, all rats received a mixture of freshly prepared CCl₄ in olive oil (1 ml/kg, 1:1 intraperitoneally) for four days. The activities of liver synthetic molecules, such as total protein, albumin, and total bilirubin, as well as hematological parameters, were measured in the blood.
Results: CCl₄exposure and toxicity caused a significant (P < 0.05) increase in total bilirubin and white blood cells and a significant decrease in total protein, albumin, hemoglobin, hematocrit, red blood cells, and platelets. However, treatment with T. occidentalis aqueous extract significantly (P < 0.05) ameliorated the levels of these markers toward normal values.
Conclusion: T. occidentalis aqueous extract exhibited enhancement of liver synthetic ability and hematological profile in CCl₄-induced toxicity.

Comparison of Vitek 2C antifungal susceptibility testing with broth microdilution testing for Candida species

Sukanya Sudhaharan

Background: The reference method for antifungal susceptibility testing is broth microdilution according to Clinical and Laboratory Standard Institute (CLSI) guidelines. However, the fully automated system, Vitek 2C system may reduce the workload and observer bias associated with manual broth microdilution. This study aimed to compare the results of YS08 card with the results of the broth microdilution (BMD) method.
Methods: A total of 50 clinical Candida isolates were included in the study. The susceptibility testing was done by Vitek 2C using the YS08 card. Broth microdilution was done according to CLSI guidelines M27M44S-Ed3.
Results: For C. albicans, the categorical agreement was 85.8%, 71.5%, 85.8%, and 100% for fluconazole, voriconazole, caspofungin, and micafungin, respectively. The minor errors (MiE) of 14.2% for fluconazole and caspofungin, 28.5% for voriconazole, were detected in C. albicans. In C. glabrata, the categorical agreement (CA) was 100% for micafungin, voriconazole, but 63.7% for caspofungin. An MiE of 36.3% was detected for caspofungin. C. parapsilosis showed a 100% CA for fluconazole, caspofungin, and micafungin, and 85.8% for voriconazole. There were 14.2% of MiEs for voriconazole. In C. tropicalis, 100 % CA was observed for fluconazole, micafungin, and caspofungin, and 88.9% for voriconazole. Moreover, 11.1% (1/9) of MiEs was observed for voriconazole. In C. auris, there was a 100% CA for caspofungin and micafungin, 77.8% for fluconazole, and 66.7% for amphotericin B. There was a major error of 22.2% for fluconazole and 33.3% for amphotericin B.
Conclusion: The majority of Vitek 2C showed comparable results with the broth microdilution (BMD) method. Only minor errors (MiEs) were observed in the tested Candida species.

Aerobic bacterial profile and antibiotic susceptibility patterns of post-operative wound infections in a tertiary care hospital

Arshi Syed

Background: Post-operative wound infection has been a problem since surgery was started as a treatment modality and is the third most common cause of nosocomial infections with a reported incidence rate of 14-16%. This study aimed to investigate the prevalence, isolate and identify aerobic pathogenic bacteria from surgical site infections (SSI) and to determine the antibiotic susceptibility testing (AST) pattern of pathogenic bacteria.
Methods: This study was conducted at the Department of Microbiology SKIMS-Medical College, Bemina Srinagar, over a period of six months from November 2021 to April 2022. In the study, 210 samples from patients with SSI were included. Isolation, identification, and AST of the isolates were performed by standard microbiological techniques.
Results: Out of 210 SSI samples, 163 bacterial isolates were recovered and infection rate was more in 21-30 years age group (24.2%). Gram-negative bacteria were isolated in 50.4% (82/163) cases and E. coli was the most common organism (59.75%, 49/82). Gram-negative bacteria were sensitive to imipenem and none were resistant to polymyxin-B and colistin. E. coli was mostly resistant to cefoperazone, Acinetobacter and Klebsiella species were resistant to ceftazidime, Pseudomonas and Citrobacter were resistant to ceftriaxone. Gram-positive bacteria constituted 49.6% (81/163) and Methicillin-resistant Staphylococcus aureus (MRSA) was a frequently isolated species (66.6%, 54/81). MRSA- and methicillin-sensitive Staphylococcus aureus (MSSA) were mostly sensitive to amikacin, gentamycin, and tetracycline. Moreover, none of the Gram-positive isolates were resistant to linezolid, vancomycin, and teicoplanin. Enterococcus spp was mostly resistant to gentamycin.
Conclusion: This study developed an insight into post-operative wound infections and their incidence, organisms’ prevalence, and their antibiogram. Culture positivity in suspected cases of SSI was high (77.6%). MRSA and E. coli were frequently isolated from Gram-positive and Gram-negative bacteria.

Infantile presentation of osteoporosis-pseudoglioma syndrome: A Case Report

Qudsiya Ansari

Osteoporosis-pseudoglioma syndrome (OPPG) is a rare disorder characterized by severe osteoporosis and vision impairment, due to mutations in the low-density lipoprotein receptor-related protein 5 (LRP5) gene. This autosomal recessive disorder is characterized by fractures, bone fragility, and pseudoglioma with blindness in infancy. Herein, we present a rare case of OPPG syndrome in an infant who, at 80 days of life (DOL), exhibited multiple fractures without any ophthalmic findings at the time of presentation. This is relatively earlier presentation of the symptoms as fractures are more commonly seen after two years of life.

Comparison of glycated albumin and glycated Hemoglobin in type 2 diabetic patients with end-stage of renal disease

AbdElkarim A. Abdrabo

Background: Various analytes are used to assess glycemic control in laboratory medicine. Glucose measurements show current glucose levels, but sample stability can be influenced by diet and stress. Hemoglobin A1c (HbA1c) is the best marker for long-term control but can be affected by elevated urea levels. This study compared glycated albumin (GA) and HbA1c in diabetic patients undergoing hemodialysis.
Methods: A comparative cross-sectional study was conducted with a sample size of 280 volunteers. Among these, there were 115 diabetic patients with end-stage renal disease (ESRD), 95 diabetic patients without ESRD, and 75 non-diabetic patients with ESRD. Laboratory measurements included HbA1c, GA, urea, and creatinine, assessed using standard laboratory techniques. Data analysis was carried out using SPSS statistical software.
Results: Levels of HbA1c were lower in diabetic patients with ESRD compared to diabetic patients without ESRD. In contrast, GA levels were higher in diabetics with ESRD. A significant negative association was observed between HbA1c levels and urea levels. However, creatinine levels were not associated with either HbA1c or GA.
Conclusion: The estimation of glycated hemoglobin levels can be affected by high blood urea. Therefore, GA may be a better glycemic indicator for diabetic patients with ESRD.

The cut-off values of discriminator indices for screening of beta-thalassemia trait

Aradhana Harrison

Background: β-thalassemia trait (BTT) can be screened by several discriminator indices (DIs) using complete blood counts (CBC). These DIs can help differentiate BTT from other causes of anaemia, thus reducing the financial burden of laboratory testing. At standard cut-off values, statistical analyses traditionally used to compare the diagnostic competence of these DIs give variable results. This study establishes new optimal cut-off values to improve the applicability of these DIs for BTT screening.
Methods: This was a retrospective study conducted on anaemic adults whose high-performance liquid chromatography (HPLC) and CBC results achieved over the past 6 months were reviewed. Based on HPLC reports, patients were categorised into BTT and non-BTT groups, with each group comprising 25 age- and sex-matched patients. Discriminator indices, including Mentzer’s Index (MI), Green and King Index (GKI), Sehgal Index (SI), Shine and Lal Index (SLI), Srivastava Index (SrI), and England and Fraser Index (EFI), were calculated for both groups. Statistical analysis was performed respective to standard cut-off values to establish new optimal cut-off values with the highest sensitivity and specificity.
Results: According to the results, SrI emerged as the best index, offering high sensitivity, specificity, Youden’s Index, accuracy, and odds ratio. On the other side, SLI and GKI were observed to be poor indices with low sensitivity and specificity. The new optimal cut-off values for the best performance of each DI for BTT screening were as follows: SrI ≤3.5, MI ≤11.4, GKI ≤59.7, SI ≤709.4, SLI ≤941.1, and EFI ≤1.91.
Conclusion: The performance of DIs at standard cut-off values was poor to screen BTT. New optimal cut-off values provided maximal sensitivity and specificity thereby enhancing their performance as screening parameters for BTT in regions with a high-prevalence of the condition. Further studies are warranted to substantiate the new cut-off values for BTT screening.

Evaluation of blood parameters in the management of patients with thyroid disease

Mahdieh Mehrpouri

Background: Thyroid hormones play a critical role in hematopoiesis, and thyroid disorders such as hypothyroidism and hyperthyroidism can affect blood parameters. Therefore, this study aimed to evaluate the effect of thyroid dysfunction on various blood parameters.
Methods: This case-control study included 194 subjects who were classified into three groups based on TSH levels: hypothyroid (n=70), hyperthyroid (n=56), and control (n=68). Conditions that affect blood parameters, including pregnancy, inherited or acquired red blood cell abnormalities, chronic inflammatory diseases, evidence of nutritional deficiencies, and underlying diseases such as cancer, as well as patients unwilling to participate in the study, were excluded. Hematological parameters were measured using a cell counter, and the results were analyzed using SPSS software.
Results: The results showed that 78% of the participants were female and 22% were male, aged 4 to 89 years. The analyses revealed that RBC, Hb, HCT, WBC count, and WBC differential count were significantly different between the three groups (P-value <0.05), but the differences were not significant for MCV, MCH, MCHC, RDW, PLT, and MPV (P-value >0.05). Correlation analysis indicated a significant correlation between TSH and Hb, HCT, WBC, PLT, neutrophils, lymphocytes, monocytes, and eosinophils (P<0.05).
Conclusion: Since thyroid hormones play a critical role in hematopoiesis, thyroid dysfunction can affect many hematological parameters. Therefore, the management of patients with thyroid disease should include the CBC test. In addition, patients with poor responses to anemia treatment may have an underlying thyroid disorder.

Relationships between serum lipid profile and HbA1c levels in patients with diabetes

Mohammad Taher Hojjati

Background: Diabetes mellitus (DM) is a metabolic disease characterized by hyperglycemia, disturbed lipid metabolism, and cardiovascular disease (CVD). Poor glycemic control results in lipid and lipoprotein abnormalities, suggesting that dyslipidemia is secondary to insulin resistance or factors closely related to insulin resistance. Glaciated hemoglobin (HbA1c) is a routinely used marker for long-term glycemic control. This form of hemoglobin is chemically processed through post-translational glycosylation that reflects the plasma glucose concentration during the last two to three months.
Methods: This cross-sectional study was conducted on blood samples from 592 cases referred to Dezyani Specialty Clinic, affiliated with the Golestan University of Medical Sciences. In patients with diabetes mellitus (DM) and non-diabetic individuals, hemoglobin A1c (HbA1c), total cholesterol (T-chol), triglycerides (TG), low-density lipoprotein cholesterol (LDL-C), and high-density lipoprotein cholesterol (HDL-C) were measured.
Results: In the study, there were 460 female participants (76.9%) and 132 male participants (23.1%). Among them, 403 (67.4%) were diabetic patients, and 193 (32.4%) were non-diabetic. HbA1c levels were significantly lower in younger individuals than in middle-aged participants (p=0.000). No significant difference was found between middle-aged and older individuals (p>0.121). LDL levels were significantly lower in the young group than in the middle-aged group (p<0.001). Total cholesterol (TC) was also significantly lower in the young group compared to middle-aged and older groups (p<0.001).
Conclusion: HbA1c can be a helpful lipid and glycemic control marker in diabetes.

Association among liver biochemical parameters, thyroid gland hormones, and TNF-Alpha in hypothyroid patients compared to euthyroid subjects

Safoura Khajeniazi

Background: Tumor necrosis factor alpha (TNFα) is a 17 kDa, an important soluble pro-inflammatory cytokine, which is involved in some tissue dysfunctions, including thyroid and liver tissue. In spite of its role in thyroid and tissue damage separately, the relationship between this factor and these two disorders has not been clarified. The aim of the present study was to evaluate liver biochemical parameters and TNFα in hypothyroid patients compared to euthyroid subjects.
Methods: To achieve this purpose, samples were transferred into tubes without anticoagulants and then centrifuged immediately to separate the serum. All markers in the serum were measured using commercial kits, including T3, T4, TSH, and TNFα, which were detected using the ELISA method. Liver function tests, including albumin, total bilirubin, and total protein were measured by spectroscopy and the colorimetric method, respectively. In addition, AST, ALT, ALP, and GGT were detected using enzymatic methods.
Results: Our results showed that the level of TNFα in hypothyroid patients was significantly higher than that in normal individuals (P = 0.009). TNFα had a significantly positive correlation with TSH and T3 but a negative correlation with T4. Furthermore, AST, ALT, and GGT had a positive correlation with TSH and a negative correlation with albumin, total protein, and total bilirubin. These correlations were insignificant (P < 0.05).
Conclusion: According to our data, the positive correlation of TSH with both TNFα and liver function tests may indicate a relationship between thyroid and liver function with each other.

Engineering a DYRK1B R102C mutation: insights into metabolic syndrome pathogenesis through lentiviral gene delivery

Mehdi Dianatpour

Background: A rare heterozygous DYRK1B mutation (R102C) recently linked to a familial form of metabolic syndrome prompted this study to introduce the R102C mutation into the mouse DYRK1B gene, utilizing recombinant lentiviruses for long-term gene expression.
Methods: In the present fundamental study, the DYRK1B R102C mutation was generated via Overlap Extension-PCR (OE-PCR) and inserted into the LeGO-iG2 transfer vector with a GFP marker. Recombinant lentiviruses were produced by co-transfection of the transfer vector carrying DYRK1B R102C, psPAX2 (Packaging vector), and pMD2 (Envelope vector) into HEK-293T cells.
Results: The accuracy of the intended mutation was confirmed through OE-PCR and sequencing. Expression of DYRK1B and successful gene transfer were visualized using a fluorescence microscope to detect the GFP marker. Lentiviral titer was quantified using flow cytometry, with an infection efficiency of 108 TU/ml in HEK-293T cells.
Conclusion: DYRK1B plays a crucial role in the pathogenesis of metabolic syndrome, central obesity, early-onset coronary artery disease, hypertension, type 2 diabetes, and adipogenesis, suggesting its potential as a target for therapeutic interventions. Lentiviruses carrying the DYRK1B R102C mutation offer significant advantages for both in vitro and in vivo research on metabolic syndrome. This study showcases the successful application of recombinant lentiviral vectors for gene transfer into eukaryotic cells.