Basic Laboratory Tests Research Articles

Formulation and implementation of nonlinear elasticity in advanced constitutive models in geomechanics

Several formulations of a nonlinear elastic behavior within the yield surface of the selected advanced constitutive models are described and compared. Since concentrating on geotechnical applications the accompanied numerical simulations are limited to basic laboratory tests such as isotropic compression, oedometer, and drained triaxial compression. The results show a significant influence of the size of the initial load step on final predictions particularly when starting from a very low initial stiffness associated with the assumed zero initial stress. Differences in the predicted response arising from different formulations are also discussed. These might be quite significant and the design engineer should be aware of that when choosing a particular computational software.

MÉTODOS DE DIAGNÓSTICOS DE HIPERADRENOCORTICISMO EM CÃES UMA REVISÃO NARRATIVA

The objective of this research was to investigate and evaluate the diagnostic methods used for hyperadrenocorticism in dogs by analyzing the available literature from the past 20 years. The methodology employed was a qualitative and exploratory literature review, conducted through databases such as PUBMED, MEDLINE, BVS, SCOPUS, PERIÓDICOS, BIBLIOTECA ABERTA USP, and SCIELO. Keywords such as "dogs," "canine," "hyperadrenocorticism," "endocrine," "endocrinopathy," and "Cushing" were used to identify relevant studies. The content analysis of the selected articles revealed that diagnostic methods vary according to the clinical suspicion and include detailed anamnesis, thorough clinical examination, and basic and imaging laboratory tests. The choice between suppression and stimulation hormone tests depends on the suspected origin of the condition, with the low-dose dexamethasone suppression test being highly sensitive for detecting hyperadrenocorticism, while the ACTH stimulation test is crucial for differentiating between origins. Diagnostic confirmation also involves abdominal ultrasonography to visualize the adrenal glands and identify possible masses, which is essential for guiding appropriate treatment and determining the patient’s prognosis.

Pulmonary hypertension in patients on chronic hemodialysis

Abstract Introduction Pulmonary hypertension (PH) is a common condition in patients with advanced chronic kidney disease and is associated with higher morbidity and mortality. High arteriovenous fistula (AVF) flow is one of known etiological factors, but the association of AVF flow within the acceptable range and PH has not been tested. Moreover, the prevalence of PH differed among various studies. Purpose The aims of this study were: 1. to describe the prevalence of PH in the Czech hemodialysis population; 2. to analyze the relation between dialysis fistula flow and PH; 3. to reveal other etiology of PH in a cross-sectional non-invasive trial. Methods We analyzed index visits of the cohort CZecking HF-CKD study (ISRCTN 18275480). Thus, this is a cross-sectional analysis based on detailed echocardiography with cardiac output (CO) calculation, evaluation of the central venous pressure (CVP) and AVF flow, bio-impedance and basic laboratory tests. All these measurements were done within an hour. The presence of PH was based on the peak systolic pulmonary arterial pressure (PASP) estimation above 35 mmHg. Results We analyzed data of 162 patients. They were 73,2 ± 12,6 years old, dialysis vintage 30 ± 69 months. Pulmonary hypertension was present in 35 % of analyzed patients. Among these patients, mild PH was present in 35 %, moderate in 53 % and severe in 12 %. There was no significant impact of AVF/AVG flow on the presence of PH or PASP value (Table 1.). However patients with PH had higher prevalence of heart failure (HF), which was present in 86 % of patients with PH and only in 46 % without PH (p<0.00001), see Figure 1. This and other differences presented in Table 1. document significant contribution of postcapillary PH. Patients with PH were also more overhydrated when considered by CVP, by overhydration measurement using bioelectrical impedance analysis and had higher N-terminal pro brain natriuretic peptide (NTproBNP) (Table 1.). There was a positive correlation between systemic vascular resistance (SVR) and PASP (R=0,333, p= .001). Conclusions PH is present in approximately one third of the dialysis patients. The presence of heart failure and changes of left heart chambers show for the postcapillary etiology of PH. Neither the prevalence nor the severity of PH were significantly related to arteriovenous access flow.

Prognostic prediction of cardiovascular adverse events in patients after percutaneous coronary intervention using machine learning

Abstract Introduction While prevention of major cardiovascular adverse events (MACE) is important in the management of patients after percutaneous coronary intervention (PCI), risk stratification of MACE remains a significant challenge with increasingly diverse and complex patient backgrounds. In response to that, this retrospective observational study aimed to explore whether machine learning (ML) methods can predict future MACE after PCI using a variety of features extracted from electronic medical records (EMRs). Methods In 3,016 patients with coronary artery disease who performed PCI, 3 machine learning (ML) algorithms (gentle boost, random forest, and neural network) and statistical model were retrospectively applied to predict the occurrence of MACE within two years after PCI (564 patients, 18.7%). MACE was defined as composite endpoint of cardiac death, myocardial infarction (MI), any revascularization, and congestive heart failure (CHF). Basic patient information (e.g., age, sex, coronary risk factors) and laboratory test results were used for the analysis. Feature importance was calculated to identify key factors for MACE. Hold-out method with an 8:2 split between training and test was used to calculate sensitivity, specificity, positive predictive value, negative predictive value, and F-value for each model. Results As shown in Figure 1, ML models showed excellent diagnostic accuracies in the prediction of MACE after PCI, demonstrating higher F-values compared with statistical model (logistic regression analysis). Similar results were seen in the subgroup analyses for estimating cardiac death, MI, revascularization, or CHF. Although the weighting of feature importance for MACE recurrence varied among ML models, infarct size (peak CK levels), increased inflammatory status, and traditional coronary risk factors were identified as important features for predicting MACE within two years after PCI (Figure 2). Conclusions It is suggested that ML using EMRs is promising for inferring future MACE within two years after PCI. Further studies are warranted to address whether ML-based risk stratification could lead to improved clinical decision-making after PCI.

The relationship between the Barthel Index and stroke-associated pneumonia in elderly patients and factors of SAP

BackgroundStroke-associated pneumonia (SAP) is a common complication in stroke patients, and the Barthel Index (BI) is a well-established metric for assessing activities of daily living (ADL). However, the association between BI and SAP in acute ischemic stroke (AIS) patients remains unclear. This study aims to investigate the relationship between BI at admission and SAP, and explore the factors in AIS elderly patients.MethodRetrospective data were collected from ischemic stroke patients hospitalized at the Second Affiliated Hospital of Nanchang University between January 2018 and July 2021, including their basic demographic and laboratory test results. Restricted cubic spline regression, multivariate logistic regression analysis, and receiver operating characteristic (ROC) curve analysis were employed to investigate the relationship between BI and SAP. Additionally, the Shapley Additive exPlanations (SHAP) method was used to identify the factors influencing SAP.ResultsThe study included 7,548 eligible stroke patients with a mean age of 75.1 ± 7.6 years, among which 41.14% were female. The SAP group demonstrated significantly lower BI compared to the non-SAP group (50.86 ± 35.60 vs. 75.27 ± 26.33, P < 0.001). Additionally, a conspicuous trend of decreasing SAP risk across the Q1-4 groups was observed (P < 0.001). The RCS analysis further confirmed a gradual reduction in SAP risk with increasing BI. Based on the clinical model, both the BI (NRI = 0.014, P = 0.005; IDI = 0.04, P < 0.001) and the NIHSS score (NRI = 0.09, P = 0.03; IDI = 0.025, P < 0.001) demonstrated additional predictive value for SAP. Multivariate logistic regression and SHAP analysis identified WBC, CONUT, TG, UA, and RBC levels, as well as the type of health insurance (urban employee basic medical insurance), as important independent predictors of SAP.ConclusionBI at admission constitutes a risk factor for the onset of SAP in elderly patients with AIS, Compared to the NIHSS and mRS score, BI may be a more reliable and practical predictor of SAP.

Endoplasmic reticulum stress and expression of nitric oxide synthases in heart failure with preserved and with reduced ejection fraction - pilot study.

Unfolded Protein Response (UPR), endoplasmic reticulum (ER) stress, and inducible nitric oxide synthase (iNOS) overexpression have been found to influence heart failure with preserved ejection fraction (HFpEF) pathogenesis. Their importance in heart failure with reduced ejection fraction (HFrEF) is not entirely established; there is little data involving a detailed comparison between HFpEF and HFrEF from this perspective. This pilot study aimed to compare circulating levels of Glucose-regulated protein 78kDa (GRP78) (ER - stress marker) and all NOS isoforms between both HFpEF and HFrEF and to analyze the correlation between these markers and the clinical characteristics of the patients. Forty-two patients with HFpEF and thirty-eight with HFrEF were involved in this study. Clinical characteristics and echocardiographic data were obtained. Basic laboratory tests were performed and ELISA tests for iNOS, endothelial NOS (eNOS), neuronal NOS (nNOS), and GRP78. Patients with HFpEF had lower circulating levels of GRP78 and higher iNOS concentrations when compared to HFrEF patients (P = 0.023, P < 0.0001, accordingly). The subgroup of the HFpEF population with eGFR < 60 mL/min/1.73m2 had higher nNOS and eNOS levels than HFpEF patients with normal GFR (P = 0.049, P = 0.035, respectively). In the HFrEF subgroup, patients with coexistent diabetes mellitus had elevated concentrations of nNOS compared to the subpopulation without diabetes mellitus (P = 0.041). There was a positive correlation between eNOS and nNOS concentrations (ρ = 0.86, P < 0.0001). In HFpEF, there is a more intensified iNOS overexpression, while in HFrEF, ER stress is more prominent.

Somatostatin in Treatment of Acute Recurrent Pancreatitis and Role of Endoscopic Ultrasonography in The Diagnostic Workup

The pancreas is an elongated, soft, flat, lobulated, and yellowish gland located on the posterior abdominal wall in a transverse orientation. The structure is located in the retroperitoneum and has a thin capsule. An abrupt response to pancreatic injury is known as acute pancreatitis (AP). Chronic pancreatitis can lead to enduring harm to the composition and the pancreas' endocrine and exocrine functions. The term idiopathic RAP (IRAP) is employed when the reason cannot be readily identified by the assessment of physical examination, medical history, basic laboratory tests (calcium and serum triglyceride levels, for example), and diagnostic imaging studies (e.g., CT scans and transabdominal ultrasounds). With endoscopic ultrasonography (EUS), you may see the inside of your digestive tract and any surrounding tissues in high resolution and real time. When it comes to evaluating a wide variety of benign and malignant GI illnesses, this technique is both efficient and cost-effective. Somatostatin inhibits the release and manufacture of certain enzymes, which in turn decreases the pancreas' ability to absorb amino acids. The release of somatostatin from the pancreatic islets is stimulated by high glucose concentration.

Development and validation of a nomogram for predicting advanced liver fibrosis in patients with chronic hepatitis B.

The progression of chronic hepatitis B (CHB) to liver fibrosis and even cirrhosis is often unknown to patients, but noninvasive markers capable of effectively identifying advanced liver fibrosis remains absent. Based on the results of liver biopsy, we aimed to construct a new nomogram to validate the stage of liver fibrosis in CHB patients by the basic information of CHB patients and routine laboratory tests. Patients with CHB diagnosed for the first time in the First Affiliated Hospital of Anhui Medical University from 2010 to 2018 were selected, and their basic information, laboratory tests and liver biopsy information were collected. Eventually, 974 patients were enrolled in the study, while all patients were randomized into a training cohort (n = 732) and an internal validation cohort (n = 242) according to a 3:1 ratio. In the training cohort, least absolute shrinkage and selection operator (Lasso) regression were used for predictor variable screening, and binary logistic regression analysis was used to build the diagnostic model, which was ultimately presented as a nomogram. The predictive accuracy of the nomograms was analyzed by running operating characteristic curve (ROC) to calculate area under curve (AUC), and the calibration was evaluated. Decision curve analysis (DCA) was used to determine patient benefit. In addition, we validated the built models with internal as well as external cohort (n = 771), respectively. Ultimately, the training cohort, the internal validation cohort, and the external validation cohort contained sample sizes of 188, 53, and 149, respectively, for advanced liver fibrosis. Gender, albumin (Alb), globulin (Glb), platelets (PLT), alkaline phosphatase (AKP), glutamyl transpeptidase (GGT), and prothrombin time (PT) were screened as independent predictors. Compared with the aminotransferase-to-platelet ratio index (APRI), fibrosis-4 index (FIB-4), and King's score, the model in the training cohort (AUC = 0.834, 95% CI 0.800-0.868, p < 0.05) and internal validation cohort (AUC = 0.804, 95% CI 0.742-0.866, p < 0.05) showed the best discrimination and the best predictive performance. In addition, DCA showed that the clinical benefit of the nomogram was superior to the APRI, FIB-4 and King's scores in all cohorts. This study constructed a validated nomogram model with predictors screened from clinical variables which could be easily used for the diagnosis of advanced liver fibrosis in CHB patients.

Enabling laboratory readiness and preparedness for the evaluation of suspected viral hemorrhagic fevers: development of a laboratory toolkit.

Viral hemorrhagic fevers (VHFs), such as Ebola virus disease, Marburg virus disease, and Lassa fever, are associated with significant morbidity and mortality and the potential for person-to-person transmission. While most individuals in whom VHF is suspected will ultimately be diagnosed with a non-VHF illness, such patients may present to any United States healthcare facility (HCF) for initial evaluation; therefore, all HCFs must be prepared to evaluate and initiate care for suspect VHF patients, especially if they are acutely ill. Included within this evaluation is the ability to perform basic routine laboratory testing before VHF-specific diagnostic test results are available, as well as rapid malaria testing to assess for a common, dangerous "VHF mimic." To improve laboratory preparedness and readiness in the initial care of suspect VHF patients who may present to acute care hospitals. Plan-Do-Study-Act quality improvement model. Frontline healthcare facilities and their clinical laboratories. We describe the development of a laboratory testing toolkit for a suspect VHF patient that can assist frontline HCFs in providing basic laboratory testing required for the care of these patients. The toolkit provides guidance on infection prevention and control, waste management, occupational health, laboratory test collection, processing, and resulting, in the context of suspect VHF patient evaluation. The toolkit is designed to be readily adapted by any frontline HCF in the US. With the guidance provided, facilities will be able to support safer initial evaluation of VHF suspects and ensure high-quality patient care.

Locating Insulation Defects in HV Substations Using HFCT Sensors and AI Diagnostic Tools.

In general, a high voltage (HV) substation can be made up of multiple insulation subsystems: an air insulation subsystem (AIS), gas insulation subsystem (GIS), liquid insulation subsystem (power transformers), and solid insulation subsystem (power cables), all of them with their grounding structures interconnected and linked to the substation earth. Partial discharge (PD) pulses, which are generated in a HV apparatus belonging to a subsystem, travel through the grounding structures of the others. PD analyzers using high-frequency current transformer (HFCT) sensors, which are installed at the connections between the grounding structures, are sensitive to these traveling pulses. In a substation made up of an AIS, several non-critical PD sources can be detected, such as possible corona, air surface, or floating discharges. To perform the correct diagnosis, non-critical PD sources must be separated from critical PD sources related to insulation defects, such as a cavity in a solid dielectric material, mobile particles in SF6, or surface discharges in oil. Powerful diagnostic tools using PD clustering and phase-resolved PD (PRPD) pattern recognition have been developed to check the insulation condition of HV substations. However, a common issue is how to determine the subsystem in which a critical PD source is located when there are several PD sources, and a critical one is near the boundary between two HV subsystems, e.g., a cavity defect located between a cable end and a GIS. The traveling direction of the detected PD is valuable information to determine the subsystem in which the insulation defect is located. However, incorrect diagnostics are usually due to the constraints of PD measuring systems and inadequate PD diagnostic procedures. This paper presents a diagnostic procedure using an appropriate PD analyzer with multiple HFCT sensors to carry out efficient insulation condition diagnoses. This PD procedure has been developed on the basis of laboratory tests, transient signal modeling, and validation tests. The validation tests were carried out in a special test bench developed for the characterization of PD analyzers. To demonstrate the effectiveness of the procedure, a real case is also presented, where satisfactory results are shown.

The Analysis and Research of the Integrated, 30 A MOSFET Gate Driver Dedicated to High-Frequency Applications

This paper presents basic properties and laboratory tests of a commercial integrated high-frequency MOSFET gate driver IXRFD631 operating in the frequency range up to 30 MHz. The MOSFET driver has been tested for two operating states: in the idle state (no load) and at the gate load of a DE275-501N16A series MOSFET transistors. The obtained laboratory results were compared with three other commercial integrated drivers: DEIC420, DEIC515 and IXRFD630 (which are the base structures), and two previous solutions from the author (4xUCC27516 and 8xUCC27526). Additionally, this paper presents the characteristics of power losses and efficiency, measurements of switching and propagation times of the tested gate drivers. Also, this paper presents the output voltage waveforms of the integrated driver IXRFD631 for two operating states. The integrated circuit IXRFD631 of the gate driver is characterized by an efficiency of up to 70% for the tested frequency range, the power losses for two operating states (at idle state—15 W, at gate MOSFET load—43 W) and switching times of 2 ns for an operating frequency of 30 MHz.

In vitro and in vivo characterization of citral and limonene combinations against Vibrio campbellii in brine shrimp

The use of essential oils (EOs) has recently gained popularity due to their antimicrobial properties. However, current research primarily focuses on basic laboratory tests to identify active compounds or screen different plant sources. EOs comprise numerous constituents that interact intricately, complicating the understanding of their effective mechanisms. To address this issue, the study aimed to investigate the antibacterial activity and biological function of two major components (citral and limonene) extracted from the EO of Litsea citrata. Six assays were performed to investigate the antibacterial activity of citral and limonene, including a checkerboard assay, an inhibitory growth assay, a vapor-phase-mediated assay, a regrowth assay, a release of cellular contents assay, and an in vivo bioluminescence assay. Additionally, a challenge test and quantitative PCR of immune gene expression were conducted to assess the biological function of citral and limonene. The results showed that a citral/limonene mixture in a 1:8 ratio exhibited a synergistic effect against V. campbellii. While the antibacterial activity of the EOC mixture of citral/limonene (1:8) at the concentration of 0.0005% was relatively weak, it significantly increased the survival of Artemia when challenged with V. campbellii in vivo. These results suggest that the citral/limonene mixture in a 1:8 ratio at 0.0005% probably protects brine shrimp by immunomodulation at the host level and by reducing the colonization and/or virulence of the pathogen V. campbellii. Our results indicate the potential of this novel EOC combination to combat vibriosis in aquaculture.

X-ray Repair Cross Complementing 1 (XRCC1) Gene Polymorphism in Hepatocellular Carcinoma (HCC)

Abstract Background Several risk factors for hepatocellular carcinoma (HCC) have been identified, including chronic infection of hepatitis B virus (HBV) and hepatitis C virus (HCV). Nevertheless, only a fraction of infected patients develops HCC during their lifetime suggesting that genetic factors might modulate HCC development. The human X-ray repair cross- complementing protein 1 (XRCC1) gene encodes for one of the major repair factors involved in base excision repair (BER), which is reported to be associated with the risk of several cancers. A few studies have explored the association between risk of hepatocellular carcinoma (HCC) and single-nucleotide polymorphisms (SNPs) in different DNA repair genes. Aim of the Work to investigate the possible association between XRCC1-G28152A (rs25487) single nucleotide polymorphism (SNP) and hepatocellular carcinoma (HCC) in chronic hepatitis C patients. Patients and Methods The study included 35 patients who had HCC and 15 patients who had liver cirrhosis. XRCC1 gene polymorphism was done to all participants by RT-PCR After collection of relevant clinical data and basic laboratory tests. Results A statistically higher frequency of XRCC1 (GG, GA) genotypes and increased (G) allele frequency in patients with HCC was found in comparison to cirrhotic HCV patients as well as control group but Our results revealed that the genotypic and allelic frequencies of XRCC1 gene polymorphism rs25487 didn’t show statistically significant difference between HCC patients group and liver cirrhosis control group. Conclusion The present study had demonstrated that there was no significant association between XRCC1 gene polymorphism (rs25487) and HCC in the sample of Egyptian population included in our study. Also, non-significant differences among the XRCC1 genotypes and alleles were found regarding age, sex, BMI and laboratory data including CBC, AFP, coagulation profile (PT, INR), liver function test ( total protein, albumin, AST, total bilirubin and direct bilirubin), BCLC and Milan criteria. While a statistically significant difference was observed as regards PTT and ALT between genotypes.

Modeling of mechanical behavior of Agave sisalana fiber's yarn using the design of experiments method

The aim of this study is to propose a model for predicting the mechanical properties of natural sisal yarn based on mechanical strength of used fibers, unit twist of yarn and its density. To achieve this, a complete factorial design modelling method was used, based on a design of experiments approach, which is recommended today because of the ease it offers in taking into account the most complex phenomena. It was developed on the basis of laboratory tests. The model obtained predicts mechanical strength and elasticity modulus of sisal yarn, based on control parameters such as fiber strength, unit twist and yarn mass. This model is currently one of the most accurate tools for predicting and optimising the mechanical properties of sisal yarns. The iso-surface curves represented by this model, can be used to obtain the strength and elasticity modulus of sisal yarn during manufacture, by varying the optimum control parameters. This model is an original tool that can be recommended to the spinning and sisal fiber composite manufacturing industries and others, as it saves time and materials and ensures precision in the manufacture of yarns according to the field of application, thereby contributing to safety in use.

Basic performance, cavitation and runaway investigations of a high specific speed Francis turbine with emphasis on cavitation analysis: A case study

The paper presents comprehensive experimental research on a high specific speed model Francis turbine with a characteristic runner diameter of 250 mm under the head of 12 m. Essentially, the turbine was designed for use at heads between 10 and 50 m, which are typical for installations with low specific speed Kaplan turbines. The basic performance, cavitation and runaway characteristics of the machine, which were determined as a result of the work, are quite rarely available in the literature in the case of high specific speed Francis turbines. The turbine achieved the maximum efficiency of 91%, kinematic specific speed of 82, and relatively wide operation range, so that it can be attractive as an alternative to the low specific speed Kaplan, semi-Kaplan or propeller turbines.In result of the basic laboratory tests, the performance characteristics of the machine operation in a wide range of guide vane opening angles between 9° and 36° as well as the shell efficiency characteristics were determined. On the characteristics plotted vs. rotational speed, the saddle effect was identified for the guide vane opening angles with values greater than the optimal one (22°). During the operation of the machine in the area of saddles, the change in the flow rate took quite surprising patterns. The share of the turbine thrust torque in the total torque was also determined, the characteristics of which are also burdened with a similar saddle effect.In the case of cavitation tests, a multi-aspect approach to cavitation diagnostics was used to characterize the cavitation phenomenon from the viewpoint of various criteria. Following this approach, the signals of the draft tube wall acceleration, acoustic emission at the draft tube cone upper flange, and pressure fluctuations inside the draft tube were used. The determined cavitation characteristics indicate little cavitation susceptibility of the Francis turbine blade system, despite the presented turbine having been designed to operate at higher flow rates than the classic high head Francis turbines with long interblade channels. The cavitating flow in the draft tube, directly below the runner, was also visualized during the cavitation tests. The paper presents the results of visualization for all cavitation states at five selected settings of the guide vane opening angle (two states in Partial Load, two states in High Load area and one state in the Best Efficiency Point), thanks to which it was possible to track the development of vortices during pressure reduction in the flow system.The runaway coefficient was determined as a result of the runaway tests. The value of 1.497 was reached at the optimum guide vane opening angle.Additionally, the work also presents in detail the efficiency scale effects to be expected at prototype turbines, i.e. those intended for operation at a higher head and with larger runner diameters. The efficiency of the machine with a runner diameter of 1.5 m and working at a head of 50 m reaches ∼93%. The influence of water viscosity on the change in efficiency of the prototype turbine is also shown.The presented methodology can be used for the proper selection of turbines intended for hydropower plants and for the proper installation of the runner in respect to the tailwater level in order to avoid the phenomenon of cavitation erosion.

Predicting in-hospital mortality in infective endocarditis: insights from complete blood count parameters and NT-proBNP

Abstract Funding Acknowledgements None. Introduction Infective endocarditis (IE) is a rare condition with an increasing incidence rate and complexity of cases over the last few years, accompanied by a high mortality rate ranging from 18% to 25%. Recent studies have shown the utility of new outcome predictors based on complete blood count (CBC), such as red blood cell distribution width (RDW) and neutrophils/lymphocytes ratio (NLR). Drawing retrospectively from an 8-year experience, we provide a perspective from a tertiary center on predictors of in-hospital mortality based on basic laboratory test results in patients with valve-related IE. Purpose The aim of the study was to assess the clinical accuracy of CBC-based parameters as in-hospital mortality predictors. Methods From a tertiary center database (serving a stable population of 2.5 million citizens), we selected all patients hospitalized due to valve-related infective endocarditis between 2015 and 2022. We analyzed clinical data (including sex, age, IE localization, and etiological factors, number of cases, management and mortality), laboratory test results at admission (including CBC parameters, C-reactive protein - CRP, procalcitonin - PCT, N-terminal prohormone of brain natriuretic peptide - NT-proBNP, estimated glomerular filtration rate - eGFR, Creatinine - Crea, urea - UR). For three NT-proBNP, NLR, and RDW we provided a further analysis to compare their clinical accuracy. Univariable logistic regression was used to assess the impact of specific factors on mortality. To determine the optimal cutoff values for predicting mortality, we analyzed the area under the curve (AUC) from receiver operating characteristic (ROC) curves and used Youden's index. P-values &amp;lt; 0.05 were considered statistically significant. Results A total of 194 consecutive patients with confirmed IE were included in the study, the majority of whom were men (75.3%) with an overall median age of 62 years. The overall mortality rate was 27.8%. The most common localization was left-sided IE (92.3%). In 39.7% of cases, the etiological factor was unidentified, while Staphylococcus spp. were the most common bacteria among the identified cases. We identified significant impacts on mortality in most of the analyzed laboratory tests (RDW, platelet count, hemoglobin, NLR, PCT, NT-proBNP, eGFR, Crea, UR). Results showed that for every 1000pg/ml of NT-proBNP the risk of in-hospital death increases by 6%. ROC analysis was performed for the three parameters (RDW, NLR, and NT-proBNP), and each parameter showed an acceptable area under the curve - AUC (RDW: 0.69; NLR: 0.62; NT-proBNP: 0.78). Although we found the highest AUC for NT-proBNP (p&amp;lt;0.001). Conclusions Although CBC parameters are easy to assess and useful in predicting in-hospital death in IE, the accuracy of NT-proBNP is higher. The management of IE cases requires a complex approach, and NT-proBNP, which also reflects the clinical state of patients, still remains a more useful tool.In-hospital deaths ROC analysis

Pleural effusion guidelines from ICS and NCCP Section 1: Basic principles, laboratory tests and pleural procedures.

Pleural effusion is a common problem in our country, and most of these patients need invasive tests as they can't be evaluated by blood tests alone. The simplest of them is diagnostic pleural aspiration, and diagnostic techniques such as medical thoracoscopy are being performed more frequently than ever before. However, most physicians in India treat pleural effusion empirically, leading to delays in diagnosis, misdiagnosis and complications from wrong treatments. This situation must change, and the adoption of evidence-based protocols is urgently needed. Furthermore, the spectrum of pleural disease in India is different from that in the West, and yet Western guidelines and algorithms are used by Indian physicians. Therefore, India-specific consensus guidelines are needed. To fulfil this need, the Indian Chest Society and the National College of Chest Physicians; the premier societies for pulmonary physicians came together to create this National guideline. This document aims to provide evidence based recommendations on basic principles, initial assessment, diagnostic modalities and management of pleural effusions.

Laboratory diagnostics for vasculitis beyond antineutrophil cytoplasmatic autoantibodies

The diagnosis of systemic vasculitis (SV) is amajor clinical challenge due to the very different forms of presentation and requires an interdisciplinary approach. Targeted laboratory diagnostics support making the diagnosis, differential diagnosis and classification and are also akey component in the detection of active organ manifestations and treatment complications. The basic laboratory tests include the erythrocyte sedimentation rate (ESR), C‑reactive protein (CRP), blood count, serum creatinine, urinalysis, specific autoantibodies, complement, immunoglobulins, cryoglobulins and hepatitisB and C serology. Antineutrophil cytoplasmic autoantibodies (ANCA), antiglomerular basement membrane antibodies (anti-GBM antibodies) and anti-C1q antibodies are valuable laboratory markers for the diagnosis of the various forms of small vessel vasculitis. There are no specific laboratory tests for the diagnosis of medium and large vessel vasculitis. Despite advances in our understanding of the pathogenesis of vasculitis, no biomarkers have yet been identified that can be reliably used to guide treatment or that are useful in distinguishing vasculitis from other inflammatory diseases such as infections or treatment complications.

Osteoarticular TB specimen yield rates. Large joint analysis at a single centre.

Tuberculosis (TB) remains endemic in South Africa. The spine, hip, and knee joints are common extra-pulmonary TB sites. Sound history taking, clinical examination, and basic laboratory and pathological tests remain key important steps in osteoarticular TB diagnosis. In our resources-stricken context cost is everything, if we can make a diagnosis cheaply that would go a long way. The diagnostic yield of standard laboratory tests compared to a real-time polymerase chain reaction (PCR) for osteoarticular TB diagnosis in a single orthopaedic unit has not been analysed. We conducted a retrospective record review of extra-spinal osteoarticular TB infection at our hospital from 01 June 2016 to 31 December 2021. Patient demographics, clinical history, and laboratory test results were analysed. A total of 34 cases were identified, with 32 of the cases being articular and two osseous involvement. The knee was the most common joint affected followed hip joint. Acid Fast Bacilli were detected in 32% of cases with microscopy, while TB culture was positive in 29% of samples. Histopathological examination and real-time PCR diagnosed TB in 66% and 63% of the cases, respectively. Our findings suggest that in the right context of a suggestive history and examination, histological analysis is as good as PCR for diagnosing osteoarticular TB.

Diagnosis and Treatment of Chronic Urticaria: The Importance of Autoimmune Aspects and Comorbidity

The study aimed to conduct a comprehensive systematic review of the literature on the autoimmune mechanisms associated with chronic spontaneous urticaria (CSU) in adults, explore the association between chronic urticaria (CU) and autoimmune disorders, analyze two case reports, and develop a diagnostic algorithm considering the autoimmune pathogenesis.&#x0D; Materials and Methods. The literature review was conducted to study the mechanisms underlying autoimmune CU. Two case reports were analyzed and a diagnostic algorithm for patients suspected of autoimmune urticaria was formulated.&#x0D; Results. CU significantly impairs patients’ quality of life, posing problems in daily activities and is often associated with concomitant autoimmune diseases. Though the pathogenesis of CSU remains incompletely understood, in recent years, there has been significant progress in understanding the pathophysiology of this condition, prompting researchers to explore new agents, especially biological ones, in cases with severe refractory urticaria. We have developed a diagnostic algorithm aimed at improving the management tactics for CSU and autoimmune pathology, that involves a thorough collection of complaints, medical history, performing a series of basic laboratory tests for specific markers of autoimmune disorders, and expanding their spectrum with detailed differential diagnostics.&#x0D; Conclusions. CU is an important medical and social issue that requires an interdisciplinary personalized approach to patients. The diagnosis of the condition involves a comprehensive approach, considering potential concomitant autoimmune disorders and detailed laboratory investigations, especially in cases refractory to standard second-generation antihistamine therapy. The treatment of CU, specifically the stepwise therapy protocol based on symptom severity and response to treatment and aimed at reducing symptoms, improving patients’ quality of life, and achieving CU remission, is outlined in various national and international guidelines, and is carried out gradually, involving three lines of therapy.