Medical Laboratory Journal

Histopathological spectrum of upper-gastrointestinal lesions on endoscopic biopsies

Anupama Ishwar Dayal

Background: Upper gastrointestinal (GI) lesions are significant contributors to morbidity, with endoscopy serving as a crucial minimally invasive tool for their visualization and biopsy. This study explores the demographic patterns of upper GI lesions by age, sex, and biopsy site, comparing the prevalence of neoplastic and non-neoplastic lesions across the esophagus, stomach, and duodenum, while underscoring the importance of early detection and management.
Methods: This cross-sectional retrospective study was conducted at a tertiary care center in Gujarat, India, from July 2019 to October 2021. A total of 104 upper GIT biopsies were included and categorized based on age, sex, site, endoscopic findings, and histomorphology. Histopathological analysis involved routine processing, staining, and microscopic examination by a histopathologist.
Results: Out of the 104 endoscopic biopsies, the majority were from the 46-55 age group, followed by the 66-75 age group, with a male-to-female ratio of 1.7:1. Esophageal biopsies were the most common (48%). Non-neoplastic lesions (52.8%) were predominant, with duodenitis (48%) and celiac disease (33.3%) being the most frequent. Neoplastic lesions (47.1%) were prevalent in the esophagus (36.5%), primarily squamous cell carcinoma. Gastric biopsies showed more benign lesions, such as gastritis, than malignant ones, with adenocarcinoma being the most common. Endoscopic findings included thickening, scalloping, nodularity, polyps, and fragile growths, emphasizing the diversity of upper GIT lesions and the need for early detection and treatment.
Conclusion: The study emphasizes the crucial role of biopsies in promptly diagnosing esophageal malignancies and identifying premalignant conditions like Barrett's esophagus for timely intervention. It reaffirms the pivotal role of endoscopic biopsy in clinical management, stressing the necessity of a multidisciplinary approach.

The effect of methotrexate on blood, liver, and renal parameters in patients with rheumatoid arthritis

Bizav Rasheed

Background: Rheumatoid arthritis (RA) is a long-term autoimmune disorder that primarily affects joints. The disease may also affect other parts of the body, including the skin, eyes, lungs, heart, nerves, and blood. This study aimed to evaluate the effect of methotrexate on blood, liver, and renal parameters in patients with RA.
Methods: A six-month cross-sectional study was carried out on 60 consecutive patients aged 19-70 years diagnosed with RA on methotrexate treatment (10 mg) orally per week. A questionnaire was taken from participants, and laboratory tests were done on renal and liver function and complete blood count (CBC), erythrocyte sedimentation rate (ESR), glutamic oxaloacetic transaminase (SGOT or AST), glutamate pyruvate transaminase (SGPT or ALT), Creatinine, C-reactive protein (CRP), and rheumatoid factor (RF) as a follow-up to drug intake.
Results: At the end of sample collection, participants ranged in age from 19 to 70 years, with a female-to-male ratio of 1.5:1. Significant differences in platelet (PLT) levels were observed only between days 1 and 14 of the treatment (p <0.05). Similarly, SGPT levels showed significant variation between days 1 and 30 of the treatment (p <0.05). Additionally, RF levels exhibited significant differences between days 1 and 14 (p <0.01) and between days 1 and 30 of the treatment (p <0.04).
Conclusion: The recommended medication for all kinds of patients with RA is methotrexate, which has had a notable impact on blood, liver, and kidney parameters. These characteristics can serve as indicators for monitoring the medication’s effectiveness, safety, and patient follow-up.

Association of Vitamin D with oxidative stress in patients with Type 2 diabetes mellitus

Mahendran Kanumuru

Background: Type 2 diabetes mellitus (T2DM) is a non-communicable disease, manifesting hyperinsulinemia, insulin resistance, hyperglycemia, and low-grade chronic inflammation associated with various micro and macrovascular complications. The present study aimed to estimate vitamin D (Vit D) levels, total antioxidant capacity, and malondialdehyde (MDA) levels in T2DM patients compared with healthy individuals. In addition, we assessed Vit D, total antioxidant capacity, and MDA levels in patients with T2DM and their association with HbA1c, insulin resistance and lipid profile parameters.
Methods: Seventy patients with T2DM aged 35 to 50 years were selected and 70 healthy age-matched subjects were selected as controls. Serum Vit D and insulin were estimated by the enzyme-linked immunosorbent assay (ELISA). Glycosylated hemoglobin (HbA1C) was assessed by high-performance liquid chromatography (HPLC) method and other routine lipid profile investigations were carried out using a Beckman Coulter fully automated analyzer.
Results: Vitamin D levels significantly decreased in T2DM patients. HbA1C and insulin resistance values are significantly increased in type 2 diabetic patients. Vitamin D levels negatively correlated with MDA, insulin resistance, and HbA1c, while positively correlated with total antioxidant capacity. Nevertheless, there is no significant correlation between lipid profile parameters.
Conclusion: Vitamin D deficiency may be one of the vital risk factors responsible for increased oxidative stress in patients with T2DM. Regular monitoring and supplementation of Vit D are beneficial for the reduction of oxidative stress and vascular complications in these patients.

Overdiagnosis of epithelial abnormalities in atrophic cervical pap smears unmasking overdiagnosis in atrophic pap smears

Fasahath Jahan Uzma

Background: Cervical cancer has seen a significant decline in death rates due to early diagnosis and treatment. The Pap test remains valuable but exhibits limitations, such as false positives and false negatives, with the former associated with atrophy-related changes. This article aims to bring attention to cervical carcinoma screening, focusing on the interpretation of atrophy-related changes in Pap smears and minimizing intervention.
Methods: This retrospective study, conducted at a tertiary care center, evaluated cases with intra-epithelial abnormalities or malignancies in Pap smears.
Results: A total of 11,680 cervical cytology smears received in the Department of Pathology, Vydehi Institute of Medical Sciences and Research Centre, Bengaluru, over 7.5 years (From January 1, 2016, to June 30, 2023), were reviewed. Of these, 56 cases exhibited epithelial abnormalities and were categorized as follows: 1. Atypical squamous cells of undetermined significance, 2. Low-grade squamous intraepithelial lesion, 3. High-grade squamous intraepithelial lesion, and 4. Malignancy. Among the 56 smears, 40 (71%) showed co-existent atrophy. Biopsies were available for 22 smears, and atrophy with epithelial abnormalities co-existed in 16 (28%) of these cases. Of these 16 cases, only eight (50%) were found to have abnormalities greater than Cervical Intraepithelial Neoplasia II dysplasia. This results in the positive predictive value of cervical cytology smears detecting epithelial abnormalities in cases with co-existing atrophy-related changes being only 50%.
Conclusion: The article emphasizes the importance of cautious interpretation of Pap smears in the presence of atrophy.

Variability of blood parameters across ABO and Rh blood groups: Insights from a master health check-up data of adult population

Periasamy Aparnavi

Background: The ABO and Rh blood group systems have been associated with variations in disease susceptibility. This study aimed to assess the variability in blood parameters, including red cell parameters and metabolic parameters (Renal function, hepatic function, blood glucose, lipid profile, and thyroid function), by ABO and Rh blood grouping systems.
Methods: A secondary data analysis was conducted among patients who underwent a preventive health check-up at a private tertiary care hospital in Coimbatore, India. The laboratory database contained records of 62,808 adult participants who reported for master health check-ups between January 2017 and February 2024. Among these patients, those who reported for the first time were included.
Results: Blood grouping and typing data were available for 50,368 and 56,155 participants, respectively, with a mean age range of 52.6 to 53.0 years across all blood groups. The most prevalent blood group was O, followed by B, A, and AB, with a similar distribution across genders. The mean hemoglobin level was highest in the B group (13.7 ± 13.9 g/dl). MCH and MCV values were elevated in the A and O groups, while MCHC and ESR were higher in the B and AB groups. Renal and liver parameters mostly did not vary by blood group or Rh type, except for elevated urea levels in the A group and higher ALP levels in the O and Rh-positive groups. LDL and total cholesterol were highest in the A group, while HDL was highest in the AB group.
Conclusion: The results underscore the importance of considering blood group variations when interpreting blood parameters in clinical practice.

The effect of running and starvation interventions on atherogenic index and Xbp1 gene expression in the endoplasmic reticulum of liver in non-alcoholic fatty liver rats

Habib Asgharpour

Background: Running and starvation can have a positive effect on the reticulophagy of the liver tissue. The purpose of this research was to investigate the effect of running and starvation interventions on the atherogenic index and Xbp1 gene change in the liver endoplasmic reticulum of non-alcoholic fatty liver rats (NAFLD).
Methods: Thirty obese male Wistar rats aged 18-20 weeks with an average body weight of 348 ± 25.53 grams, after one week of familiarization with the laboratory environment, were randomly divided into six groups (n=5 per group): 1) starvation, 2) three days of training, 3) five days of training, 4) three days of training plus starvation, 5) five days of training plus starvation, and 6) the control group. All fatty liver animal models had free access to water and standard food pellets (10 gr per 100 g of mouse body weight). The statistical test of one-way analysis of variance was used at a significance level of less than 0.05, and the LSD post-hoc test was used to compare research groups.
Results: According to the experimental results and statistical analyses (One-way analysis of variance), a significant decrease was noticed in the ratio of lipoproteins (VLDL/HDL and LDL/HDL) in all experimental groups compared to the control group. Also, a significant decrease was observed in the expression of XBP1 and CHOP genes in animals doing 3 and 5 days of exercise alone or along with starvation.
Conclusion: Regular exercise for 3 and 5 days per week with starvation can possibly reduce the activity of the genes involved in endoplasmic reticulum stress in NAFLD patients.

Molecular characterization of efflux pumps in beta-lactam resistant pseudomonas aeruginosa

Mozhgan Ghiasian

Background: Pseudomonas aeruginosa (P. aeruginosa) is a common causative agent of hospital-acquired infections and exhibits resistance to many antibiotics, including beta-lactams. One of the mechanisms of resistance to beta-lactams is the MexAB-OprM efflux pump. This study investigated the genetic pattern of resistant P. aeruginosa strains concerning the presence of the gene encoding the MexAB-OprM efflux pump
Methods: This descriptive-analytical study was conducted between 2022 and 2023 in Isfahan, and 110 strains of P. aeruginosa isolated from various clinical samples were identified. Antibiotic susceptibility testing of the isolates was conducted using the disk diffusion method, and strains producing extended-spectrum beta-lactamases (ESBLs) were identified using the double disk diffusion method. The gene encoding the MexAB-OprM efflux pump in these strains was investigated using polymerase chain reaction.
Results: A significant proportion of the 101 P. aeruginosa isolates originated from the emergency department and ICU-2, highlighting the clinical significance of this pathogen in these settings. Meropenem demonstrated a high resistance rate (74%), while gentamicin exhibited lower resistance (33.33%). Resistance rates to amikacin, levofloxacin, cefepime, ceftazidime, tazocin, ciprofloxacin, and ceftriaxone were 40.4%, 68%, 65.34%, 66.33%, 57.42%, 71.42%, and 50%, respectively. The prevalence of extended-spectrum beta-lactamases (ESBLs) was 29.7%, and the MexAB-OprM efflux pump gene was identified in 80% of ESBL-producing strains, suggesting a potential role in multidrug resistance.
Conclusion: Our findings reveal a strong association between the presence of the MexAB-OprM efflux pump and extended-spectrum beta-lactamase production in P. aeruginosa. This observation suggests that the MexAB-OprM efflux pump plays a pivotal role in the development of multidrug resistance in this pathogen. Future studies should focus on elucidating the molecular mechanisms underlying the regulation and function of this efflux system to inform the design of novel antimicrobial agents and combination therapies.

Evaluation of serum adiponectin and leptin levels in type 2 diabetic patients: The potential role in predicting metabolic syndrome

Zahra Hesari

Background: Leptin and adiponectin, two members of the adipokine family, play roles in increasing lipid metabolism and inhibiting lipogenesis. Reduced levels of these cytokines are associated with obesity and insulin resistance. This study aimed to determine the serum levels of leptin and adiponectin in type-2 diabetic patients with and without metabolic syndrome compared to a control group.
Methods: Three groups of individuals participated in this study: 47 type-2 diabetic patients with metabolic syndrome (DM+MetS), 25 type-2 diabetic patients without metabolic syndrome (DM-MetS), and 40 individuals with no history of diabetes or metabolic syndrome (Control group). Fasting blood samples were collected, and serum levels of fasting blood sugar, cholesterol, triglycerides, HDL-cholesterol, and LDL-cholesterol were measured using the enzymatic method. Blood pressure, height, and weight were recorded using stadiometers, while leptin and adiponectin levels were determined via enzyme-linked immunosorbent assay.
Results: A significant difference was observed between the DM+MetS group and the DM-MetS group in serum leptin (p = 0.004) and adiponectin (p < 0.001) levels. In patients with type-2 diabetes and metabolic syndrome, serum leptin (p = 0.530) and adiponectin (p < 0.001) levels were lower compared to the control group.
Conclusion: A decrease in the serum levels of key adipokines, such as leptin and adiponectin, in type-2 diabetic patients may serve as a predictor of metabolic syndrome.

Self-sampling for cervical cancer screening: preferences, acceptability, convenience and cost-effectiveness

Abdolvahab Moradi

Background: Human papillomaviruses (HPVs) are DNA viruses from the Papillomaviridae family. These viruses are linked to about 5% of human cancers, with a significant association with cervical cancer. Infection with this virus can be screened in women to prevent cervical cancer.
Methods: This review analyzes articles published over the last two decades regarding self-sampling, papillomavirus, and cervical cancer. The search for articles was conducted using various scientific databases, with selections based on their relevance to the topic and their contribution to understanding and comparing methods. Key results were examined, focusing on social aspects, economic savings, and participants' satisfaction with the self-sampling method.
Results: One of the most common and effective methods for HPV screening is sampling from the cervix using the Pap smear method and molecular techniques, widely used in various countries. Currently, HPV screening methods in different countries are primarily limited to clinical sampling, which cannot cover all urban and rural populations. The World Health Organization has recommended and supported self-sampling for HPV screening as a new strategy.
Conclusion: This mini-review discusses the self-sampling method for HPV screening, its advantages, and its application in different countries. As self-sampling can address the needs of both rural and urban areas, it is more economically viable and helps minimize cultural barriers and public opinion challenges compared to clinical sampling. The HPV self-sampling strategy offers an effective and efficient method for HPV screening, aiming to cervical cancer caused by the HPV virus in various countries.

The effect of aerobic exercise and psilocybin following methamphetamine induction on the gene expression of certain semaphorins in female Wistar rats

Asieh Abbassi Daloii

Background: The purpose of the present study was to investigate the effect of aerobic exercise and psilocybin after methamphetamine induction on the gene expression of certain cerebral cortex semaphorins in female Wistar rats.
Methods: In this experimental study, 40 female rats were placed into five groups: control (C), amphetamine (A), amphetamine-aerobic (AA), amphetamine-psilocybin (AP), and amphetamine-psilocybin-aerobic (AAP). Methamphetamine was injected at a dose of 15 mg/kg for 5 days in the morning. Psilocybin was administered at a dose of 1 mg/kg. The aerobic training program included running on a treadmill at 20–25 m/min, three days a week for eight weeks. After eight weeks, gene expression was measured using the Real-Time PCR method. The data were analyzed by one-way analysis of variance and Tukey's post hoc test at a significance level of P < 0.05.
Results: The results showed that the average gene expression of semaphorin 3A, semaphorin 4A, and semaphorin 7A in the cerebral cortex of the A group had a significant increase compared to the C group (P = 0.001). The AA, AP, and AAP groups showed a significant decrease in the average expression of semaphorin 3A and semaphorin 4A genes compared to the A group (P = 0.001). The AAP group had a significant decrease in the average expression of the semaphorin 3A gene compared to the AA and AP groups (P = 0.001). In addition, the AAP group showed a significant decrease in semaphorin 7A expression compared to the AP group (P = 0.007).
Conclusion: According to the results, aerobic training and psilocybin supplementation can help reduce semaphorin expression in the cerebral cortex of rats induced with methamphetamine.