Clinical Pathology Laboratory Research Articles

Myelomatous Ascitis, a Rare Presenting Symptom of Multiple Myeloma

Abstract Introduction/Objective In 2022, plasma cell neoplasms accounted for approximately 1.8% of all new cancers in the United States with an estimated 34,470 new cases of multiple myeloma. Diagnosis is often straight forward in ~80% of cases by performing serum protein electrophoresis (SPEP), serum immunofixation (SIFE), and/or urine immunofixation (UIFE) with M-spike quantification. The diagnostic challange is in the remainder of asymptomatic myeloma cases (~20%) which are found incidentally. Specialized laboratory technicians are often the first step in identifying plasma cells in body fluids and/or peripheral blood smears. These incidental findings on routine labs, paired with the keen eye of a specialist, are one of the first steps in early detection of multiple myeloma. Methods/Case Report A 62 year-old male, originally from Cambodia, presented to an outside hospital emergency department with abdominal distention and pain. His past medical history was significant for dialysis-dependent end- stage renal disease and insulin-dependent diabetes mellitus type 2. Abdominal CT showed ascites with no other diagnostic findings. Cardiac, renal and hepatic etiologies of ascites were ruled out. Body fluid analysis of the ascites in the Clinical Pathology laboratory revealed numerous plasma cells. Cytologic examination, after consultation with Clinical Pathology, also revealed numerous plasma cells. Subsequent SPEP and SIFE disclosed an IgA lambda monoclonal protein. A diagnosis of multiple myeloma was confirmed by bone marrow biopsy with FISH studies. Results showed several high-risk abnormalities including translocations of 4::14, 14::16, and 14::20, denoting a “triple hit” multiple myeloma. Results (if a Case Study enter NA) NA Conclusion Plasmacytosis in ascites is an extremely rare initial presentation for multiple myeloma. With only a few cases reported in the literature, many technicians and pathologists might easily overlook plasma cells on routine cytology, especially with normal imaging and no previous diagnosis of myeloma. In this case, flagged peritoneal fluid by a skilled medical laboratory technician was key to making a diagnosis. Without any signs of a plasmacytoma or lytic bone lesions on imaging, a normal CBC with non-specific labs, and an unsuspecting surgical pathology report, multiple myeloma was not on the differential. Fast interdepartmental consultation, communication, and teamwork between surgical pathology and clinical pathology, lead to a rapid diagnosis and prompt treatment of this patient.

Clot-Based Assay for Factor XI (FXI) Activity Is Highly Sensitive to Lupus Anticoagulant (LA) and Heparin with Potential Misdiagnosis of FXI Deficiency: The Importance of Recognizing Non-Parallelism

Introduction: Clot-based assays are employed to estimate coagulation factor activity in clinical pathology laboratories. These assays are PT- or aPTT-based and utilize dilutions of the patient's plasma in factor-deficient plasma. The curves of activity for each dilution follow a parallelism or non-parallelism pattern and the latter is typically seen in the presence of Lupus Anticoagulant (LA). Identification of this pattern is critical to avoid misdiagnosis of factor deficiency in patients who actually have an inhibitor. Materials and Methods: We observed low Factor XI (FXI) levels in patients with LA, while other factors were not affected. In order to determine the reason(s) why FXI levels are sensitive to LA, we collected 34 plasma samples from patients with dRVVT confirm ratio > 1.2, and estimated FVIII and FXI levels. FXI activity was also estimated with Dade ® Actin ® FS, a reagent that is not sensitive to the LA. The coefficient of variance (CV) for both FXI and FVIII levels were compared. To estimate the effects of heparin, plasma was spiked (0.1-1.0 IU/ML) and tested in the PTT, FXI, and FVIII assays. We tested with Dade ® Actin ® FS 4 known normal patients, 3 known FXI deficient patients, 20 known plasma positive for LA, and 10 with heparin. All assays were performed on a Siemens CS-5100 analyzer. Results: The results show that FXI is highly sensitive to LA, with non-parallelism and high CV, not observed with FVIII activity. As expected, FXI levels were not affected when LA-insensitive Dade ® Actin ® FS was used. Heparin (0.3-0.7 IU/ML) also showed non-parallelism in FXI activity, but not for FVIII. Only the highest dose of heparin (1.0 IU/ML) affected FVIII levels. Notably, the sensitivity of FXI activity to LA and heparin was explained by a few dilutions of the patient's plasma (5X) in the FXI assay, compared to other coagulation factors (20X). Of note, less diluted plasma is required for FXI activity because relatively higher levels of FXI is required to sustain and produce clot in the FXI-deficient plasma. Conclusion: This simple, yet not recognized explanation based on a literature search, is helpful to increase awareness of this analytical variable. It is also important to avoid misdiagnosis of FXI deficiency in patients with LA.

Patterns of germs before, during and after the COVID-19 pandemic in Intensive Care Unit (ICU) patients at Dr. Wahidin Sudirohusodo, Makassar, Indonesia

Background: The intensive care unit (ICU) is a unit that cares for patients with a high risk of infection, while viral infections are one of the predisposing factors for someone being easily infected with bacteria. This research aims to see a picture of germ patterns before, during and after the COVID-19 pandemic. Methods: This research is descriptive with a retrospective approach. The research sample used secondary data from microbial culture results of clinical specimens (blood, sputum, pus, urine, etc.) from ICU patients for the period 2019-2022 at the Clinical Pathology Laboratory of Dr. Wahidin Sudirohusodo Hospital, Makassar. Data is grouped into Gram-positive and Gram-negative bacteria, based on the highest order, and presented as tables and graphs. Results: There were 440 isolates, 80 Gram-positive isolates (18%) and 360 Gram-negative isolates (82%). The five most common types of isolates were dominated by the Gram-negative group in the last 4 years, respectively: Burkholderia cepacia 92 (21%), Acinetobacter baumannii 89 (20%), Klebsiella pneumoniae ss. pneumoniae 58 (13%), Pseudomonas aeruginosa 37 (8%), Escherichia coli 37 (8%), and Staphylococcus aureus ss. aureus was the 6th most common, with 20 (5%) isolates. The majority of isolates identified were obtained from blood, as many as 192 (44%), sputum 136 (31%), pus 52 (12%) and urine 8 (2%). Bacteremia was the largest cause of infection by Burkholderia cepacia, 91 (47%), while sputum was dominated by Acinetobacter baumannii 49 (26%). Conclusion: The germ pattern in the ICU before, during, and after Gram-negative bacteria dominated the COVID-19 pandemic. Bacteremia is the largest proportion of causes of infection.

ASSESSMENT OF ALL TYPES OF LABORATORY ERRORS IN THE TERTIARY CARE CARDIAC FACILITY LABORATORY

A prospective examination of laboratory errors was performed during three months from July to September 2019 at the Rawalpindi Institute of Cardiology (RIC), a 272-bed tertiary care hospital serving the Punjab region and parts of Azad Jammu and Kashmir (AJK) and Khyber Pakhtunkhwa (KPK). The study aimed to thoroughly evaluate error incidence rates across the complete testing cycle, considering the pre-analytical, analytical, and post-analytical phases. During this time, nurses, physicians, and medical assistants from various hospital wards submitted samples and request forms to the clinical pathology laboratory at RIC. For a total of 17,917 patients, 73,540 tests were carried out. The overall observed laboratory error rate for the entire testing procedure (TTP) was 1.43%. Notably, pre-analytical mistakes made up the most significant percentage (0.82%), followed by post-analytical errors (0.51%) and analytical errors (0.10%). The data were carefully examined, and the results were presented using figures, charts, and tables to show the prevalence and magnitude of various mistake types. According to the distribution pattern, overall error rates had significantly decreased over the previous ten years. Despite this development, the largest error prevalence was still seen in the pre- and post-analytical processes. Interestingly, errors were frequently found during the pre- and post-analytical procedures outside the lab. To reduce the likelihood of mistakes, RIC undertook several initiatives, and the study highlighted these efforts, highlighting the significance of the laboratory testing procedure for mistake prevention throughout all testing phases.In addition to offering insightful information about the frequency of errors at RIC, this three-month descriptive analysis highlighted ongoing efforts to improve patient safety and lower laboratory errors. The observed gains over the past ten years are evidence of the success of adopted tactics. The results show how important it is to maintain constant watchfulness and employ methodical procedures to guarantee the accuracy and dependability of laboratory testing procedures, improving patient care and safety.

Correlation between Serum Levels of Vaspin, BMI, and Waist Circumference on Obese and Non-Obese Subjects

Obesity is the accumulation of excessive fat resulting from an imbalance in energy intake compared to energy used for a long period. Vaspin is secreted in adipose tissue and may exhibit compensatory responses related to obesity, insulin resistance, and type 2 diabetes mellitus. This study aimed to determine vaspin levels in obese and non-obese subjects. An observational research design with a cross-sectional approach was used in this study. A total of 80 research subjects were included in this study. The research was conducted at the Clinical Pathology Laboratory at the Department of Clinical Pathology, Hasanuddin University Hospital in January 2022. Kolmogorov-Smirnov test was used to determine the normality of the data. Chi-Square, unpaired T-test, Mann-Whitney test, and Spearman test were used as statistical tests. This study showed a significant difference in anthropometric parameters between the obese and non-obese groups (p < 0.001). There was a significant difference in the mean levels of vaspin between the obese and non-obese groups (707.68±774.47 ng/mL vs. 510.60±460.08 ng/mL, p=0.004). There was a positive correlation between vaspin levels and waist circumference (r = 0.245, p=0.004) and between vaspin levels and BMI (r = 0.322, p=0.028). The serum levels of vaspin tended to be higher in obese subjects compared to non-obese subjects. The positive correlation between vaspin levels and BMI and waist circumference indicated that a higher BMI and/or waist circumference led to a higher vaspin level.

Polymorphonuclear-Mononuclear Ratio in Peripheral Blood as Hematologic Malignancy Predictor in Pancytopenia

Pancytopenia is a laboratory finding of decreased hematological cells characterized by hemoglobin of <13.5 g/dL for males or <11.5 g/dL for females, leukocytes of <4x109/L and platelets of <150x109/L. The data from Dr. Moewardi Hospital reported 56 cases of pancytopenia in 2020. Follow-up tests such as reticulocyte test, Bone Marrow Puncture (BMP), or bone marrow biopsy are needed to determine the cause of pancytopenia. This study aimed to assess the performance of the Pm/M ratio of peripheral blood as a screening instrument to predict the cause of pancytopenia. A cross-sectional study was carried out on pancytopenia patients undergoing laboratory tests at the Clinical Pathology Laboratories of Dr. Moewardi Hospital from January 2020 to June 2021. The cut-off point of the Pm/M ratio was determined by ROC and AUC curves. The results were presented in a 2x2 table. The Pm/M ratio <0.91 as a predictor of hematological malignancy had a sensitivity of 82.9%, specificity of 82.9%, PPV 82.9, NPV 82.9%, LR positive 4.833 and LR negative 0.207. The Pm/M ratio can be used as a screening biomarker to predict the cause of pancytopenia before performing BMP and to distinguish between hematological malignancy and non-hematological malignancy.

Prospective Molecular Characterization of Multiple Myeloma Patient Samples Identifies High-Risk Patients and Informs Treatment Sequences through Resistance Mechanisms to Immunotherapies

Introduction. Multiple myeloma (MM) genetic diagnostics has traditionally been performed using fluorescence in situ hybridization (FISH), giving prognostic information based on immunoglobulin (Ig) translocations and key copy number abnormalities such as 1p, 1q, and 17p. However, in recent years it has become clear that more mutations, biallelic events, and focal deletions are also prognostically important and can be captured better through molecular techniques such as DNA sequencing. In addition, as targeted and immunotherapies become standard, monitoring the molecular targets will be important in determining the optimal sequence of therapies. Methods. Bone marrow aspirates from patients with MGUS/amyloid (n=3), smoldering MM (n=3), newly diagnosed MM (n=15), or progression/relapse MM (n=33) were collected. All patients were enrolled in the Indiana Myeloma Registry and consented for use of data for research purposes. CD138+ MACS cell separation was performed in a clinical pathology laboratory and DNA was extracted from CD138+ cells and patient-matched buccal swabs. 100 ng DNA from both the tumor and control sample were processed using the HyperPlus kit (KAPA Biosystems) and hybridized to the Myeloma Genome Project (MGP) sequencing panel in a CLIA-certified laboratory. The panel consisted of 228 genes for mutation and copy number analysis, as well as the immunoglobulin and MYC loci for translocation analysis. Samples were sequenced using paired-end reads to a median depth of 1063x. Data were analyzed using a clinical workflow and genomic abnormalities reported by a pathologist. Results. Of the 54 patients, Ig translocations were detected in 30 and included the known t(4;14), t(6;14), t(11;14), t(14;16) and t(12;14) as well as rare Ig translocations to partners such as GADD45B, LYN, PPCDC, and RCBTB2, of which over-expression of GADD45B and LYN are potentially targetable. A complex t(1;8;11;14) was also detected involving CCND1, MYC and the IGH loci which would not have been detectable by FISH. High-risk markers, such as gain/amp1q (22.2%) and deletion/mutation TP53 (16.6%) were detected including biallelic TP53 alterations in 5 patients (9.3%), which were mostly deletion plus mutation (4/5) and would not have been detected by traditional techniques. Of the MM patients who had been previously treated (n=33), 27 had received an IMiD and 30 had received a proteasome inhibitor. One patient showed mutation of CRBN (p.N236D) in conjunction with del3p and another patient with mutation of CUL4B (p.E277Ter) with delX indicating complete inactivation of the genes as a resistance mechanism to IMiDs. In addition, 17 patients had received an immunotherapeutic regimen including anti-CD38 or anti-BCMA. Of those that had received an anti-CD38 treatment (n=17), three had deletion of 4p (the location of CD38) including one patient, who had received three previous anti-CD38 regimens, with focal deletion of CD38. Six patients had also received anti-BCMA therapy, of which one had a mutation in the gene encoding BCMA, TNFRSF17, resulting in premature termination within the extracellular domain (p.S48Ter) in 42% of cells. This sample came from a patient who relapsed after an initial response to a BCMA CAR-T, followed by a progression occurring quickly while on a BCMA bispecific antibody Teclistamab, suggesting the loss of BCMA expression as a mechanism of resistance in both treatments. Interestingly, two patients harbored somatic mutations in the transmembrane domains of either CD38 (p.S29I) or TNFRSF17 (p.L60S) prior to the start of the respective treatments indicating that not all mutations seen in these genes are a result of treatment resistance. Conclusions. DNA sequencing approaches are cost-effective alternatives to FISH, the current standard diagnostic technology, to detect genomic abnormalities in multiple myeloma and they can identify clinically meaningful markers related to prognosis and treatment, particularly in the emerging era of immunotherapeutics where antigen evasion is a key mechanism of molecular resistance.

Pengaruh Latihan High Intensity Interval Training (HIIT) Terhadap Kadar Triglierida Pada Atlet Lari Jarak Jauh Pasi Kota Malang

Triglycerides are fats carried by the lipoprotein system located in the blood, are the main cause of arterial diseases and are usually compared with cholesterol using lipoprotein electrophoresis. Triglycerides consist of glycerol linked to fatty acid groups. The High Intensity Interval Training method is a sport designed to increase metabolism and burn body fat so as to balance triglyceride levels in the body. This exercise is often included in training programs for long-distance runners. This study aims to obtain information about the effect of the High Intensity Interval Training (HIIT) exercise on the interval running model on triglyceride levels in PASI Athletes in Malang City. The research method and design used was an experiment in the form of the one group pretest-posttest design, namely recording the results of triglyceride levels before HIIT training and after HIIT training. This study involved 8 long-distance runners whose blood was taken from the cubital vein before the HIIT treatment. The design of this study was initiated by screening all research subjects according to predetermined inclusion criteria. And all subjects were instructed to fill out a willingness form (informed consent) then proceed with taking a blood sample before the HIIT exercise treatment of ± 10 µL. After taking blood, the HIIT training program is continued with an interval running model, namely by running fast for 2 minutes, then walking for 2 minutes, doing 10 repetitions. After completing the HIIT training treatment, all subjects took blood again as much as ± 10 µL. When all subjects' blood samples have been taken, it is followed by laboratory tests in the clinical pathology laboratory, Faculty of Medicine, Brawijaya University. The results of the study by conducting a paired sample T-test were used to analyze the data obtained with a significant (2-tailed) value of 0.938 greater than the p value of 0.05 (0.938> 0.05) indicating H0 was accepted and Ha was rejected which means that HIIT training has no significant effect on the leukocyte levels of PASI Athletes in Malang City. So it can be concluded that HIIT training has no effect on increasing leukocyte levels in PASI Athletes running long distances in Malang City. The conclusion in this study was that the HIIT training provided had no significant effect on the amount of triglycerides after and after exercise. Triglyceride levels in long-distance runners are at normal levels. This is because there has been regular practice given by the coach as preparation for the match.

Nutritional status, anemia status and application of the Mentzer index on complete blood examination results of students

Thalassemia is a disease that attacks the hemoglobin gene, causing disturbances in erythropoiesis. Anemia is a condition in which the hemoglobin (Hb) concentration and the number of erythrocytes are below normal limits. The high number of anemia and thalassemia causes the need for early detection in order to prevent adverse effects in the future. Research objectives: to determine nutritional status, anemia status, and application of the Mentzer Index for SMK Muhammadiyah II Moyudan students. Methods: This study is a descriptive study with a cross-sectional design. The research subjects were first graders at SMK Muhammadiyah 2 Moyudan. Venous blood samples were examined at the Clinical Pathology Laboratory of FK-KMK UGM using the Sysmex XN-1000 tool on November 25, 2021. Data analysis used IBM SPSS Version 26 and Microsoft Office 365. Results: A total of 53 subjects participated in this study. A total of 47 (89%) respondents had normal hemoglobin values, and 6 (11%) respondents suffered from anemia. 31 (58.5%) respondents have normal nutrition, 15 (28%) respondents have less nutrition, 7 (13%) have excess nutrition, and 29 (54.7%) respondents have normal status. A total of 2 (3.8%) respondents showed Thalassemia. Conclusion: There are two students of SMK Muhammadiyah 2 Moyudan diagnosed with thalassemia and five students diagnosed with anemia. No statistically significant difference exists between Anemia Status in Adolescents at SMK Muhammadiyah 2 Moyudan and Nutritional Status. Further study is needed in wider and more diverse populations to analyze the influence of nutritional conditions on anemia in adolescents.

Clinical And Molecular Investigation in Feline Infectious Peritonitis Cat Treated with Gs-441524 Contained Drug

An immune-mediated disease caused by a highly virulent Feline coronavirus (FCoV), Feline infectious peritonitis, is one of the most challenging diseases in cats due to its difficulty in either diagnosis or treatment. However, the recent investigation has offered some hope with the discovery of adenosine nucleoside analog GS-441524, which has shown promising results in terms of survival rates and clinical recoveries. This study demonstrated the effectiveness of GS-441524 for FIP treatment. A-two-year-old male mix breed was admitted to Satwakita Animal Clinic, Yogyakarta and examined by responsible veterinarian. Abdominal effusion was aseptically collected for further examination in Veterinary Medicine Clinical Pathology Laboratory, Universitas Gadjah Mada. The analysis utilized RT-qPCR targeting 5’UTR confirmed FCoV infection in the cat. The cat was treated by daily administration of the nucleoside analog GS-441524 by subcutaneously injection route for 40 days. The result of this treatment proves that GS-441524 effectively cured FIP and eliminated FCoV infection in the cat. In this case report, we showed that GS-441524 was effective in this cat. Both clinical signs and FCoV RNA were significantly reduced. The results highlight the promising potential of GS-441524 for treating FIP that naturally occurs in cats

Analisa Kadar HbA1c Darah Vena dengan Antikoagulan EDTA dan Heparin Menggunakan Metode Imunofluoresens

An unhealthy lifestyle can lead to chronic diseases, one of which is diabetes such as smoking habits, excessive alcohol consumption and careless eating habits. Diabetes is a non-communicable disease caused by the pancreas not functioning properly to produce insulin normally. HbA1c is a glycated hemoglobin and a subfraction resulting from the binding of a different glucose molecule to the HbA molecule (hemoglobin in adults), which increases with the average blood sugar concentration. This study aims to look at the differences in HbA1c levels in venous blood with the EDTA and Heparin immunofluency methods. The type of research used is pure experiment. This research was conducted in the Clinical Pathology Laboratory (PK) IKesT Muhammadiyah Palembang with a total of 29 samples. The results of research that has been done on Examination of HbA1c Levels Using Venous Blood with EDTA Anticoagulant and Heparin Immunofluency Method can be concluded that the average HbA1C value in the EDTA Anticoagulant sample is 7.9%, while the average HbA1C value in the Heparin Anticoagulant sample is 7. 8%. The Wilcoxon test obtained a p value ≤0.050 with a value of 0.021. The conclusion of this study was that there were differences in HbA1C levels in the EDTA and Heparin anticoagulant samples. Examination of HbA1c levels should use EDTA and Heparin anticoagulants because there are no anticoagulant particles that can affect the results of the examination and can provide accurate results because getting the average value of HbA1c levels is not too far away

Diagnostic Performance of Precore Protein 22 Kilodalton Levels of HBV DNA in Chronic Hepatitis B Patients

Hepatitis B Virus (HBV) infection causes inflammation of the liver, which has a high prevalence in both Indonesia and the world. Serum HBV deoxyribonucleic acid (DNA) is important in determining the initiation therapy for Chronic Hepatitis B (CHB) patients. However, it has several limitations. Precore protein 22 kilodalton (p22cr) is synthesized from the HBV gene in hepatocytes, representing covalently closed circle (ccc) DNA. This study aimed to analyze the diagnostic performance of p22cr levels on HBV DNA in CHB patients. An observational analytic study with a cross-sectional approach was conducted on 83 CHB patients who were examined at the Clinical Pathology Laboratory of Dr. Moewardi General Academic Hospital in December 2020. Blood plasma samples were taken for HBV DNA and p22cr examination by using Polymerase Chain Reaction (PCR) and Enzyme-Linked Immunosorbent Assay (ELISA), respectively. The cut-off level of p22cr was determined by the Receiver Operating Curve (ROC) with the widest area Under the Curve (AUC). Sensitivity, specificity, Positive Predictive Value (PPV), Negative Predictive Value (NPV), Positive Likelihood Ratio (PLR), Negative Likelihood Ratio (NLR), and accuracy were calculated for the diagnostic performance of p22cr. The cut-off point of p22cr on HBV DNA > 20,000 IU/mL was 7.440 ng/mL with AUC 0.693 (p=0.003). The diagnostic performance of p22cr levels on HBV DNA obtained 44.44% sensitivity, 82.98% specificity, 66.67% PPV, 66.10% NPV, 2.61 PLR, 0.67 NLR, and 66.27% accuracy. P22cr level has a good specificity so it can be an alternative examination of HBV DNA in making decisions on therapy in patients with chronic hepatitis B. Further research needs to be done using HBcrAg and excluding elderly patients.

Correlation of sTfR, Hemoglobin, Serum Iron, and eGFR in Pre-dialysis CKD Patients at Sanglah Hospital

Patients with CKD usually have chronic inflammation and impaired antioxidant systems, which worsen with the degree of renal impairment. Anemia is one of the major complications in pre-dialysis CKD patients Examination of iron status that is commonly done today such as serum iron parameters, ferritin, and transferrin saturation is still influenced by the inflammatory process. As an alternative to assessing iron status, the soluble transferrin receptor (sTfR) is not affected by chronic disease or inflammation. The purpose of this study was to determine the correlation of sTfR, hemoglobin, serum iron, and estimation of glomerular filtration rate (eGFR) in pre-dialysis CKD patients. This research was conducted from February to June 2022 at the Nephrology Outpatient Clinic and Clinical Pathology Laboratory of Sanglah Hospital, Denpasar. This research is an observational analytic study with a cross-sectional study design. The research subjects involved were 61 pre-dialysis CKD patients who met the inclusion and exclusion criteria. The results showed that the research subjects consisted of 54.1% male and 45.9% female. The results of the Spearman correlation test showed a weak significant negative correlation between sTfR levels and serum iron in pre-dialysis CKD patients (r = -0.264; p=0.040), but no significant correlation with hemoglobin (r = -0.116; p=0.372) and eGFR ((r = 0.134; p=0.302). This study showed a significant correlation indicating that an increase in serum sTfR levels would affect a decrease in serum iron, so it could be considered as a marker for the management of iron deficiency anemia in CKD.

Hubungan Status Vitamin D dengan Risiko Jatuh pada Pasien Lansia dengan Penyakit Ginjal Kronik yang Menjalani Hemodialisis Reguler

Introduction. Fall is one of the main causes of hospitalization in the elderly, which is caused by several factors including gait disturbances, balance disorders, visual disturbances, chronic kidney disease (CKD), vitamin D deficiency, and so on. Chronic kidney disease can cause disruption of vitamin D metabolism, especially in the elderly population. This study aimed to assess the relationship between vitamin D status and the risk of falling in elderly patients with CKD who receive regular hemodialysis programs. Methods. We conducted a cross-sectional study by assessing the relationship between vitamin D status and the risk of fall in elderly patients undergoing regular hemodialysis at H. Adam Malik General Hospital and Rasyida Kidney Special Hospital Medan. Fall risk assessment was carried out using the Morse fall scale (MFS) and vitamin D status was examined in the Clinical Pathology Laboratory of H. Adam Malik General Hospital, Medan. The data was analyzed statistically with the chi square test. Results. This study involved 92 subjects with a median vitamin D level of 20.15 (3.9-52.1) mg/dL and a median MFS value of 65 (25-95). As many as 87% of subjects had insufficient vitamin D levels, 11% of subjects had inadequate levels, and 1% of subjects had adequate levels of vitamin D. High fall risk was found in 56% of subjects, 43% had moderate fall risk, and 1% had low fall risk. The chi square test found a significant relationship between vitamin D status and risk of falling with p value = 0.001 and an odds ratio 0.056 (95%CI 0.007-0.454). Conclusion. Reduction of vitamin D level has a significant relationship with the risk of falling in elderly patients with CKD undergoing regular hemodialysis.

Neuronal autoantibodies in a sample of Egyptian patients with drug-resistant epilepsy

BackgroundEpilepsy is one of the most common and chronic neurological diseases. About one-third of epilepsy patients do not achieve seizure freedom despite adequate therapy with antiseizure medications (ASMs) and develop drug-resistant epilepsy (DRE). Autoimmunity is increasingly being recognized as a cause of epilepsy in those patients. Some cases are associated with antibodies against several target antigens, including neuronal extracellular proteins as well as intracellular structures. In such patients, immunotherapy may be highly effective. This study aimed to investigate the presence of NMDA-R, AMPA1-R, AMPA2-R, CASPR2, LGI1, GABAB-R, and GAD65 autoantibodies in a sample of Egyptian patients with new-onset DRE; also, to assess the clinical, cerebrospinal fluid (CSF), electroencephalogram (EEG), and radiological characteristics of those patients. Twenty-five patients with recent onset DRE were recruited from the department of Neurology at Ain Shams University (ASU) hospitals. All patients underwent serum and CSF antibody testing using cell-based assay (CBA) at the Immunology unit of the Clinical pathology laboratory at ASU hospitals. This is beside routine CSF analysis, EEG and MRI brain with contrast.ResultsOut of 25 patients with recent onset DRE, one (4%) patient tested positive to anti-NMDA-R antibodies and another one (4%) tested positive to anti-GAD 65 in both serum and CSF. Although the remaining 23 patients tested negative for the 7 autoantibodies, yet 92% of them achieved either seizure freedom or more than 50% reduction in the frequency of seizure and 84% had marked improvement in seizure-associated symptoms after receiving immunotherapy trial. Also, evidence of neuroinflammation was detected in the CSF and MRI brain of the majority of those patients.ConclusionsAutoimmunity should be considered as a possible etiology of new-onset DRE. It is essential to provide insight into the clinical phenotypes and other associated features of those patients, as there are probably numerous patients who are not positive for one of the available antibodies via clinical laboratory testing. In addition to early diagnosis, early treatment and empirical immunotherapy trial based on the clinical judgment is crucial and is likely to improve outcomes with near-complete seizure freedom.

Analysis Of The Relationship Between HBA1C and Serum Galectin-3 Levels in Subjects With Type 2 Of Diabetes Mellitus

<div><table cellspacing="0" cellpadding="0" align="left"><tbody><tr><td align="left" valign="top"><p><em>Type 2 diabetes mellitus is a disease characterized by increased blood glucose levels known as hyperglycemia. This disease can be diagnosed by examining HbA1c (glycated hemoglobin). Hemoglobin A1c is a minor component of hemoglobin related to glucose. Meanwhile, galectin-3 is a protein encoded in humans by the LGALS3 gene. This study aimed to clarify the relationship between HbA1c and serum galectin-3 levels in patients with type 2 diabetes. This study was conducted using an observational analysis technique with a cross-sectional study design</em><em>. This research was conducted at the Clinical Pathology Laboratory, Hasanuddin University State University Hospital, and Laboratorium Universitas Hasanuddin Medical Research Center State College Hospital Universitas Hasanuddin Makassar</em><em>. This research was conducted from January to March 2023</em><em>. </em><em>The population in this study were all patients with type 2 DM who visited the Hasanuddin University Hospital (RSPTN-UH) for treatment a total of 112 patients</em><em>. Research sampling technique with non-probability purposive sampling. The sample of this study was 60 patients. Data analysis with the Independent T-test or Mann-Whitney test. The results of the study were that serum Galectin-3 levels in uncontrolled type 2 diabetes mellitus had a higher average value of 20.18 ± 6.15 ng/mL compared to controlled type 2 diabetes mellitus, namely 14.80 ± 6.41 ng/ mL although there was a statistically significant difference (p=0.012) but no significant correlation was found between HbA1c and serum Galectin-3 levels in type 2 diabetes mellitus subjects (r=0.176 p=0.179) with the distribution of data in the Scatterplot not forming a linear relationship pattern</em><em>. </em><em>It is recommended that type 2 Diabetes Mellitus patients carry out an HbA1c examination as an effective test to control glucose levels, reduce the risk of complications, and maintain a healthy lifestyle to avoid type 2 DM.</em></p><p><em><br /></em></p></td></tr></tbody></table></div><strong><em>Keyword: HbA1c, Serum Galectin-3, Type 2 Diabetes Mellitus</em></strong>

Comparing and Correcting Spectral Sensitivities between Multispectral Microscopes: A Prerequisite to Clinical Implementation.

Multispectral, multiplex immunofluorescence (mIF) microscopy has been used to great effect in research to identify cellular co-expression profiles and spatial relationships within tissue, providing a myriad of diagnostic advantages. As these technologies mature, it is essential that image data from mIF microscopes is reproducible and standardizable across devices. We sought to characterize and correct differences in illumination intensity and spectral sensitivity between three multispectral microscopes. We scanned eight melanoma tissue samples twice on each microscope and calculated their average tissue region flux intensities. We found a baseline average standard deviation of 29.9% across all microscopes, scans, and samples, which was reduced to 13.9% after applying sample-specific corrections accounting for differences in the tissue shown on each slide. We used a basic calibration model to correct sample- and microscope-specific effects on overall brightness and relative brightness as a function of the image layer. We tested the generalizability of the calibration procedure and found that applying corrections to independent validation subsets of the samples reduced the variation to 2.9 ± 0.03%. Variations in the unmixed marker expressions were reduced from 15.8% to 4.4% by correcting the raw images to a single reference microscope. Our findings show that mIF microscopes can be standardized for use in clinical pathology laboratories using a relatively simple correction model.

KADAR GLUKOSA PADA SERUM LIPEMIK DENGAN PENGGUNAAN POLYETHYLENE GLYCOL 6000 8% DAN HIGH SPEED SENTRIFUGASI

Bacground: Lipemic serum is a problem in many laboratories because it can cause the results of glucose levels in the serum to be falsely high. The examination uses a photometric method, which can cause interference with wave lengths and light scattering. As an alternative to high-speed centrifugation to remove lipemic serum, another method for handling lipemic serum is precipitation, which is carried out by processing polyethylene glycol 6000 8%.Aims: This research wants to know the differences in the handling of lipemic serum before and after being processed using polyethlyene glycol 6000 8% and high-speed centrifugation.Method: This type of research is an experiment with Static Group Comparison. Research conducted at the Clinical Pathology Laboratory Installation at the Gadjah Mada University Academic Hospital in November 2022. The sample of this study was lipemic serum with a total of twenty samples obtained from the rest of the examination in two Clinical Laboratory Installations Hospitals in Yogyakarta. Research data were analyzed using the Paired T-Test and Independent T-Test. Result: The statistical analysis (p = 0.000) 0.05 revealed that there is a difference in lipemic serum glucose levels before and after PEG 6000 8% processing and high-speed centrifugation. Before processing with polyethylene glycol 6000 8% and high-speed centrifugation, the average yield of glucose levels in lipemic serum was 116.3 mg/dl. The average glucose level before and after PEG 6000 8% processing was 108.65 mg/dl. Before and after high-speed centrifugation, the average glucose level was 114.1 mg/dl.Conclusion: Overall, both the PEG 6000 8% processing and the high-speed centrifugation resulted in a significant decrease in lipemic serum glucose levels. These methods appear to be effective in reducing the interference caused by lipemia and improving the accuracy of glucose measurements in the serum.

Evaluation of Pleural Effusion Type Determination Based on Light's and Heffner's Criteria

Pleural effusion is an abnormal accumulation of pleural fluid in the pleural cavity due to excessive transudation or exudation. Light's criteria is used as the standard method to distinguish between exudates and transudates. Some recent studies reported misclassifications which led to development of several alternative criteria, such as Heffner's criteria. The purpose of this study was to determine the sensitivity and specificity of Heffner's criteria to determine the type of pleural effusion. This research was an observational study with a cross-sectional method using a pleural effusion of patients at the Clinical Pathology Laboratory Installation at the Wahidin Sudirohusodo Hospital in July 2018. Total protein, LDH, and cholesterol levels were measured in all samples that met the inclusion and exclusion criteria. There were 45 pleural effusion samples that consisted of 30 transudate and 15 exudate samples. Based on clinical diagnosis, the Light's criteria showed 3 misclassifications and Heffner's criteria obtained showed 2 misclassifications. Based on the data above, the statistical data showed that Light's criteria had a sensitivity of 96.7% and specificity of 86.7%. Heffner's criteria had a sensitivity of 100% and specificity of 86.7%. Heffner's criteria can be used an alternative method to determine the type of pleural effusion because it showed a better sensitivity and specificity than Light's criteria.

Leptospirosis and characterization of Leptospira isolates from patients in Koprivnica-Križevci County, Croatia from 2000-2004.

Leptospirosis, caused by spirochetes of the genus Leptospira , is present in the Koprivnica-Križevci County area, Croatia. Clinical manifestation can range from asymptomatic, short-term mild, non-specific febrile disease, to severe forms with high mortality rates. The aim of the study was to valuate culture in front of microscopic agglutination test (MAT) for diagnosis of infection, and to evaluate clinical and laboratory features of the disease. Moreover, we want to characterize Leptospira strains involved in infection in Koprivnica-Križevci County, Croatia. We included 68 patients with clinical presentation consistent with leptospirosis collected in a 5-year period (2000-2004). Clinical samples (blood, urine and cerebrospinal fluid, CSF) were inoculated in Kolthoff's medium; species of isolated Leptospira strains was determined with Tm of real-time PCR, serogroup/serovar with MAT and NotI-RFLP analysis. Demonstration of specific antibodies in patients' sera was done using microscopic agglutination test. Leptospira was isolated from the blood of 14/51(27.5 %) patients and the most often identified serogroup/serovar was Icterohaemorrhagiae (8/10, 80%) followed by Grippotyphosa (10%). Regarding to species level, 8/10 isolated belonged to L. interrogans sensu stricto and one to L. kirschneri species. MAT was carried out on 51 patients with suspected leptospirosis, and was positive in 11/51(21.5 %) patients. Most of our patients presented with moderate severe symptoms, were hospitalized from August to October, and were infected mainly during the work or recreation in our county. The frequency of particular clinical features and pathological laboratory findings correlated with the severity of the clinical condition. Leptospirosis can be confirmed microbiologically, culture and MAT contributed almost equally to the diagnosis of infection. Serovar Icterohaemorrhagiae was found as the dominant one, and L. interrogans sensu stricto as dominant species in our county. Epidemiological data shown that leptospirosis occurs seasonally, affects the rural population, and most commonly is presented with moderate severe clinical course.