Enzyme-linked Fluorescent Assay Research Articles

Immunization Against Hepatitis A in Migrant Children: Three Vaccination Strategies, A Retrospective Study.

Hepatitis A is endemic in many countries. Swiss guidelines recommend vaccinating patients native from endemic areas. In Geneva's Children's hospital, migrant children are screened and vaccinated if seronegative. Because hepatitis A's prevalence is decreasing worldwide, more children are seronegative at arrival, highlighting the need for immunization in medical centers and refugee camps and questioning the benefits of systematic serology. Other Swiss hospitals vaccinate regardless of serostatus. This study's aim is to assess migrant children's immunity according to origin and age, and the cost-effectiveness of different immunization strategies. We retrospectively analyzed 329 children's serostatus (1-16 years of age) between 2012 and 2015, using enzyme-linked fluorescent assay method. Serology and vaccine costs were based on local prices. Groups were compared with χ test and the age-seropositivity relationship was studied with linear regression. The predominant regions were the Eastern Mediterranean and European Regions with mostly negative serologies (71% and 83%) and the African Region with mostly positive serologies (79%). Immunity varied depending on birth country. Regardless of region, seropositivity increased with age (P < 0.001). The most cost-effective vaccination strategy was an individualized approach based on age and origin, reducing costs by 2% compared with serology-guided immunization and by 17% compared with systematic vaccination. Many migrant children >5 years old are seronegative and at risk of clinical infection. They need to be immunized. New guidelines according to age and origin should be defined to reduce immunization costs. We recommend systematic vaccination for patients <5 years old or native from low endemicity areas (≤25.7% of seropositivity). For the others, we propose serology-based vaccination.

Investigation of Hepatitis E Seroprevalence in HIV Positive Patients by a Novel Enzyme Linked Fluorescent Assay Test.

Hepatitis E virus (HEV) infection is usually an acute self-limiting disease, which causes rapidly progressive cirrhosis and chronic infection in patients with hematological malignancies, patients requiring chemotherapy, and HIV-infected patients. The aim of this study was to investigate the positivity of hepatitis E IgM and IgG in HIV positive patients with the recently introduced Enzyme Linked Fluorescent Assay (ELFA) commercial kits. The study included 126 patients who were followed up by the Infectious Diseases and Clinical Microbiology Clinic of Sakarya University Training and Research Hospital between October 2017 and December 2018 for HIV positivity. Serum samples of the patients were evaluated for anti-HEV IgG and IgM positivity with a novel commercially available kit using the ELFA method (bioMerieux, France). The study group consisted of 126 patients with HIV infection. Anti-HEV IgG antibodies were studied primarily from plasma samples. Anti-HEV IgM positivity was also investigated in patients with anti-HEV IgG positivity. The study group consisted of 114 (90.5%) males and 12 (9.5%) females with a mean age of 38.11 ± 13.32 (min: 18, max: 80) years. Anti-HEV IgG was positive in 5 (4.0%) HIV-positive patients. One of the anti-HEV IgG positive patients was newly diagnosed with HIV and the other four patients were being followed up for HIV positivity. Anti-HEV IgM was negative in all patients. None of the patients with anti-HEV IgG positivity had anti-HCV and HBsAg positivity. In the study, anti-HEV IgG positivity was found to be 4% in HIV-positive individuals, and no HCV and HBV co-infection was detected in any patients with HIV and HEV coexistence. HEV infections do not emerge as a priority among HIV-infected people, but HEV should also be investigated in HIV-infected individuals with liver abnormalities of uncertain etiology.

Vitamin D status of overweight and obese Bangladeshi adults.

Background:Both obesity and vitamin D deficiency are pandemics and both have influences on cardiovascular parameters. The reported prevalence of vitamin D deficiency in obesity is high. Data relating to vitamin D status in obese is currently lacking in Bangladesh.Objective:To discover the vitamin D status in Bangladeshi overweight and obese adults.Subjects and Methods:This cross-sectional study, conducted in a specialized endocrine center of Bangladesh, evaluated 500 consecutive overweight or obese subjects, diagnosed according to body mass index (BMI) categories applicable to the south Asian population. Serum 25(OH)D was measured by using the enzyme-linked fluorescent assay (ELFA) method, and the cutoffs described by the Endocrine Society were used to define vitamin D status.Results:The mean age of the study subjects was 45.85 (±11.41) years; most (59.6%) of them were in the age group 40–59 years; almost three-fourth (72.4%) were females; an almost equal number of them came from urban (33.8%), semi-urban (29.6%), and rural (36.6%) areas; three-fourth (74.2%) were homemaker. Their mean BMI was 29.54 (±3.11) kg/m2; the frequencies of overweight, class I obesity, class II obesity, and class III obesity were 27.6%, 57.4%, 12.2%, and 2.8%, respectively. The mean serum 25(OH)D level was 25.25 (±11.97) ng/mL. 27.4% were sufficient, and 33.4% were insufficient for vitamin D, whereas 39.2% had vitamin D deficiency. The 25(OH)D level did not differ across different age groups, gender, residence, education status, occupation, and income status. The 25(OH)D levels were also indifferent in overweight, obese class I, obese class II, and obese class III subjects. None of the demographic, anthropometric, and biochemical variables (except low-density lipoprotein cholesterol) correlated with 25(OH)D levels.Conclusions:The prevalence of vitamin D deficiency in overweight and obese Bangladeshi adults is very high.

Polymerase chain reaction for Clostridioides difficile infection detection: Necessity or redundancy? – A pilot study in a tertiary health-care centre in Central Kerala

INTRODUCTION: Clostridioides difficile infection (CDI) is one of the hospital-acquired infections and the most common cause for antibiotic-associated diarrhoea. Documentation of CDI is difficult, and interpretation of diagnostic results often requires consultation with clinical microbiologists. The purpose of this study was to compare the results of the combination of glutamate dehydrogenase enzyme (GDH) and toxin assay with the polymerase chain reaction (PCR) results, in order to find if the combination could substitute for the expensive molecular tests. MATERIALS AND METHODS: The sample size was statistically calculated to be 30, using an SPSS software. Both GDH and toxin assay were simultaneously tested in all the randomly selected stool samples, by simple random sampling, and irrespective of the results, they were also tested for tcdB gene by PCR in the present study. All the samples were also plated onto Brazier's C. difficile agar and incubated anaerobically. RESULTS: The sensitivity and specificity of GDH (using PCR as gold standard) were found to be 100% and 76.47%, respectively, and the sensitivity and specificity of toxin enzyme immunoassay (EIA) assay (using PCR as gold standard) were found to be 66.67% and 92.86%, respectively. However, when the toxin-equivocal results were also considered as positive, the sensitivity of toxin EIA was found to be 100%. The overall agreeability, using Cohen's Kappa statistic between GDH and toxin detection by enzyme-linked fluorescence assay, showed that they had moderate and substantial agreement, respectively, when compared to PCR. CONCLUSIONS: In this study, each of the toxin negatives and positives was also PCR negative and positive, respectively. All the toxin-equivocal samples tested positive on PCR, so it is our conclusion that in the settings where they cannot be taken for further molecular testing, those samples be considered as harbouring toxigenic C. difficile.

Study of vitamin D status in male patients with hypogonadism

Background Male hypogonadism is a clinical and biochemical syndrome that results from failure to produce adequate testosterone levels, normal sperm count, or both. Male hypogonadism may adversely affect multiple organ functions and quality of life. Vitamin D is a steroid hormone; the major action of vitamin D is linked to maintaining musculoskeletal health. However, several epidemiological studies have suggested extraskeletal benefits of vitamin D. There is an accumulating body of evidence which suggests that vitamin D is involved in reproductive and gonadal functions. Although some studies have demonstrated that vitamin D levels are positively associated with androgen levels and that vitamin D supplementation may increase testosterone levels, other studies have observed a U-shaped association of vitamin D and hypogonadism in middle-aged men, in contrast, other studies fail to find an association between vitamin D and testosterone especially in young healthy men after exclusion of other confounding factors. Thus, the aim of our study was to study the possible association of vitamin D status with male hypogonadism among different age groups. Patients and methods The study included 80 men. Group I included 40 male patients aged 20 to less than 45 years who were further subdivided into two subgroups: group Ia included 20 male patients diagnosed with hypogonadism and group Ib included 20 eugonadal men serving as a control. Group II: included 40 male patients aged 45–70 years subdivided into two subgroups: group IIa included 20 male patients diagnosed with hypogonadism and group IIb included eugonadal men serving as a control. Using enzyme-linked fluorescent assay technique, serum total testosterone (TT), 25-hydroxyvitamin D3 [25(OH)D3], luteinizing hormone, follicle stimulating hormone, estradiol, and prolactin were assessed for all enrolled individuals. Sex-hormone-binding globulin (SHBG) was assessed using the electrochemiluminescence immunoassay technique. Free androgen index (FAI) was calculated using the equation [100×TT (nmol/l)/SHBG (nmol/l)]. Results It was found that TT, FAI, and SHBG were lower in hypogonadal men versus eugonadal men in both groups, there was no significant statistical difference between hypogonadal men in groups I and II as regards TT and SHBG (P=0.708, 0.124, respectively), whereas FAI was found to be significantly statistically lower in hypogonadal men aged 45–70 years as compared with hypogonadal men aged 20 to less than 45 years (P=0.021). There was a high prevalence of vitamin D deficiency and insufficiency in both hypogonadal and eugonadal men in the four studied subgroups. 25(OH)D3 was not statistically different between subgroups in both groups (P=0.681, 0.823, respectively), whereas 25(OH)D3 was significantly higher in hypogonadal men in group II versus hypogonadal men in group I (P=0.037). 25(OH)D3 was found to be positively correlated with TT, FAI, and SHBG, but not to serum estradiol, prolactin. Correlation of 25(OH)D3 was stronger in hypogonadal men aged 45–70 years (P=0.001) as compared with hypogonadal men aged from 20 to less than 45 years (P=0.023). Conclusion Low vitamin D is associated with male hypogonadism across all age groups. This association is more pronounced in elderly hypogonadal men with vitamin D deficiency.

Effect of Physical Training on the Levels of Sex Hormones and the Expression of Their Receptors in Rats With Induced Mammary Cancer in Secondary Prevention Model - Preliminary Study.

Breast cancer is the most common malignant tumor among women worldwide. In previous work, we presented results of physical activity in primary prevention in a model of induced mammary gland cancer. In the present study, we assessed the influence of physical activity on sex hormone levels (estradiol and progesterone) and the expression of their receptors (ER, PR), as well as the level of apoptosis of tumor cells in secondary prevention. Fifty 1-month-old female Sprague-Dawley rats received intraperitoneal injection of 180 mg/kg body weight of N-methyl-N-nitrosourea (MNU) for tumor induction. Three months after the administration of MNU, rats were divided into four groups: low-intensity, moderate-intensity, and high-intensity physical training groups (combined as PT) and a sedentary control (SC) group. Physical training was conducted 5 days per week with a three-position treadmill according to a precisely described protocol. The entire training was completed by 32 rats from which tissue and blood were collected for further analysis. Immunohistochemistry for ER and PR expression, terminal deoxynucleotidyl transferase dUTP nick-end labeling method for detection of apoptosis, and enzyme-linked fluorescent assay for detection of plasma hormone levels (estradiol and progesterone) were performed. Statistical analysis used p<0.05 as the significance level. Significantly stronger expression of ER and PR was found in the SC in comparison to the PT group (p=0.035 and p=0.036, respectively). No statistically significant differences were found in estradiol or progesterone concentrations between SC and PT groups. Apoptosis was non-significantly increased in the PT group in comparison with the SC group. Stronger apoptosis in the PT group correlated positively with the level of training intensity (r=0.35, p=0.05). Physical training may reduce ER and PR expression in breast cancer cells, and reduce cell sensitivity to pro-proliferative and anti-apoptotic effects of estrogens, ultimately leading to apoptosis.

Serum vitamin D level, measured by two methods, in a sample of normal subjects in Basrah

Background: Low vitamin D levels had been reported to be common in normal subjects worldwide. Studies in the Middle East had reported extremely low levels of serum vitamin D, despite high exposure to sunlight. Aim: To estimate vitamin D serum concentration in a sample of apparently healthy subjects from Basrah, by 2 methods (chemiluminescent and fluorescent assays). Methods: The study was carried out on apparently healthy subjects during the period from September 2018 to February 2019. Quantitative determination of the total 25-hydroxy vitamin D in serum was made using chemiluminescent microparticle immunoassay and enzyme-linked fluorescent assay. Other parameters (calcium, phosphorus, alkaline phosphatase, parathyroid hormone, hemoglobin, and erythrocyte sedimentation rate and body mass index) were also measured. Results: The mean level of vitamin D measured by the two methods, was 11.57±6.63 ng/ml and 13.31±6.52 ng/ml by chemiluminescent and fluorescent assays respectively. The prevalence of vitamin D deficiency was high, where more than 80% of the 57 subjects had vitamin D level below 20 ng/ml. If the cut-off point of vitamin D deficiency was taken as 10 ng/ml, around 46% of the subjects were found deficient in both methods. Although the two methods of vitamin D assay were well correlated with each other, fluorescent assay gave, on average, a significantly higher levels compared with the chemiluminescent method. Serum parathyroid hormone, showed a negative correlation with vitamin D serum levels. After excluding children and females, no significant difference was found between adult smokers and non-smokers when vitamin D was measured by both methods.Conclusion: Vitamin D deficiency is common (> 80%) among normal subjects. The enzyme-linked fluorescent assay resulted in higher mean level than chemiluminescent assay. The use of a deficiency cut-off point of 10 ng/ml may be more appropriate.

Vitamin D, Calcium and Phosphor in Patients with β-Thalassemia Major

There has been many reports that patients with β-thalassemia major have bone problems such as thinning of the bone, bone fragility and pathological fractures. For so many years it was believed that the bone problems is mainly caused by marrow expansion due to compenstation of the bone marrow to handle the chronic anaemia and hiypoxia in β-thalassemia major. Recently, there is evidence to suggest that in β-thalassemia major there is hypocalcemia and hypovitaminosis D. So, this study is to clarify if hypovitaminosis D is trully the cause of bone problem in thalassemia. Forty five subjects were recruited in this study, 35 were β-thalassemia major patients and 10 normal subjects as controls. Ten mL of venous blood were taken from median vein for investigations of total vitamin D [25(OH) vitamin D], total calcium and phosphor using the Enzyme-Linked Fluorescent Assay (ELFA), metallochromic dye (Arsenazo III) and chemical reaction of inorganic phosphate with amonium mollybdate respectily. Mean ± SD of vitamin D in β-thalassemia major is 21.28 ± 6.36 ng/ml and in control 34.85 ± 3.50 ng/ml (p&lt;0.05); total calcium in β-thalassemia major is 8.58 ± 0.68 mg/dl and in control 9.22 ± 0.35 mg/dl (p&lt;0.05); and phosphor in β-thalassemia major 3.98 ± 0.53 mg/dl and control 3.89 ± 0.49 mg/dl (p&gt;0.1). There was no significant correlation (r = 0.17, p&gt;0.05), when vitamin D was analysed against calcium for the correlation study,. This study demostrates that there was state of hypovitaminosis D and hypocalcemia in β-thalassemia major but hypovitaminosis D is not the only causative factor of the calcium levels. There should be another factor responsible for the calcium levels in β-thalassemia major and marrow expansion may remain the factors responsible for bone abnomarlities.

2654. Myocarditis in Dengue: A Prospective Observational Study

BackgroundCardiac involvement in dengue fever is underdiagnosed due to low index of suspicion and overlapping clinical manifestations of capillary leak associated with dengue. The frequency of subclinical dengue myocarditis and its relative contribution to the hemodynamic instability in severe dengue needs to be explored. We studied the prevalence of myocarditis and clinical outcomes among admitted patients with dengue.MethodsA prospective observational study was carried out in admitted patients with age between 18 and 65 years having confirmed dengue (NS1/IgM ELISA). Patients with electrolyte abnormalities or on medications affecting heat rhythm/ rate, pre-existing heart disease were excluded. The baseline demographic, clinical and laboratory parameters were collected. A baseline ECG was done and repeated every second day. Trop-I and NT-proBNP were done at baseline and repeated only if elevated at baseline or there were ECG changes. The cardiac enzymes were measured using enzyme-linked fluorescent assay (VIDAS, bioMérieux, France). Patients with elevated enzymes underwent 2-dimensional echocardiography. Diagnosis of myocarditis was as per ESC 2013 criteria. Fluid management was as per WHO guidelines (2009).ResultsA total of 183 patients were recruited with median age of 29 years (IQR 21, 37) and 31% were females. Dengue with warning signs was present in 80 (44%) and severe dengue in 45 (25%) patients. Cardiac enzymes were elevated in 27 (15%) patients (cTnI in 25, NT-proBNP in 22). Among these 27 patients, 11 [6% (2.6–9.4, 95% CI)] had echo evidence and diagnosed as having myocarditis according to ESC 2013 criteria (Figure 1). Clinical features of fluid overload were more common in myocarditis group [8 (73%) vs 4 (2%), P = Overall, 5 (2.7%) patients expired, all of them had myocarditis (5/11 = 45%). These patients had severe dengue, 2 patients developed hospital-acquired pneumonia and 1 had malaria co-infection. Among patients with raised enzymes and normal echo (n = 16), 3 patients developed clinical signs of fluid overload compared with only 1 out of 156 patients without raised enzymes (P < 0.01).ConclusionMyocarditis in admitted patients with dengue is not uncommon [6% (2.6–9.4, 95% CI)] and may lead to a complicated disease course. Disclosures All authors: No reported disclosures.

Study of platelet parameters in the patients with acute myocardial infarction referred to Ali Shariati Hospital in 2018

Introdution: The rapid and accurate diagnosis of acute myocardial infarction is essential for effective treatment. Recently, troponin has been introduced as a biochemical marker for early diagnosis of acute myocardial infarction. Platelet parameters (P-LCR, MPV, PDW) play a key role in the pathophysiology of acute coronary syndrome. The aim of this study was to evaluate platelet indexes in the patients with acute myocardial infarction.&#x0D; Methods: In this cross- sectional descriptivestudy, 345 patients with acute myocardial infarction who referred to Shariati Hospital with chest pain were examined in 2018. Troponin was measured by Enzyme-Linked Fluorescence Assay. The platelet indexes of the patients were determined by Hydrodynamically focused detection method.&#x0D; Results: The results of Spearman correlation test between the three variables MPV, PLCR and PDW showed that there was a significant relationship between platelet parameters. Spearman correlation coefficient between two variables PLCR and troponin also showed a significant positive correlation.&#x0D; Following an increase in the proportion of large platelets, the serum levels of troponin were increased in the affected patients. Mean of the MPV, PLCR and PDW were obtained (10.37, 27.74, 12.15femtoliter), respectively.&#x0D; Conclusion:Platelet indexes of the MPV, PLCR and PDW can be considered as potent and non-dependent prognostic factors in the patients with acute myocardial infarction. In this study, P-LCR was more pronounced than other platelet indexes.

Safety and immune response of a live-attenuated herpes zoster vaccine in patients with systemic lupus erythematosus: a randomised placebo-controlled trial

ObjectivesTo study the safety and immunogenicity of a live-attenuated herpes zoster (HZ) vaccine in patients with systemic lupus erythematosus (SLE).MethodsAdult SLE patients having a SLEDAI <6 and stable immunosuppressive treatment...

Application of sequential serological testing strategy for detection of Hepatitis B surface antigen (HBsAg) for diagnosing HBV infection

The diagnostic accuracy of any serological test for detection of HBsAg is not 100%. We hypothesized that the sequential testing strategy proven for anti-HIV laboratory diagnosis should also apply to other infectious disease markers like HBsAg. Therefore, we evaluated the diagnostic accuracy of these strategies, I (single test), II (two tests in sequence), III (three tests in sequence) for diagnosis in patients and blood donors and compared it to the confirmatory test for HBsAg (Neutralization Test). Samples were initially tested for HBsAg by A1- Enhanced Chemiluminescent Immuno Assay (ECLIA). Initial reactive (aliquoted donor/patient) samples were reflexly tested by A2- Enzyme Linked Fluorescence Assay (ELFA) and A3- Immuno Chromatography Assay (ICA) assays. Confirmatory neutralization assay was performed on all initial reactive samples. Four strategies (I, II A, II B, and III) that were used in this analysis were; I = A1, IIA = A1 + A2, IIB = A1 + A3, and III = A1 + A2 + A3. The results of all four strategies were compared to Gold Standard (Neutralization Test). A total of, 112, 011 blood samples (75,111 patient samples and 36,900 whole blood donor samples) were initially tested for HBsAg by A-1 (CLIA). Amongst the tested samples, 1,296, 1,188, 1,078, 1,074 samples were found to be reactive by strategy I, IIA, IIB, III respectively. We observed that the PPV (Positive Predictive Value) of Strategy III > Strategy IIB > Strategy IIA > Strategy I. Sequential serological testing strategy comprising of initial sensitive test followed by more specific test increases the diagnostic accuracy of test report as compared to a single test.

Field Test and Validation of the Multiplier Measles, Mumps, Rubella, and Varicella-Zoster Multiplexed Assay System in the Democratic Republic of the Congo by Using Dried Blood Spots.

Here we describe baseline validation studies and field performance of a research-use-only chemiluminescent multiplex serology panel for measles, mumps, rubella, and varicella-zoster virus used with dried blood spots in support of the 2013-2014 Democratic Republic of the Congo Demographic and Health Survey. Characterization of the panel using U.S. FDA-cleared commercial kits shows good concordance for measles, mumps, rubella, and varicella-zoster with average sensitivity across assays of 94.9% and an average specificity of 91.4%. As expected, performance versus available standards validated for plaque-reduction assays does not provide a 1:1 correspondence with international units and yet demonstrates excellent linearity (average Hill's slope = 1.02) and ∼4 logs of dynamic range. In addition, for the four assays, the multiplexed format allowed for inclusion of three positive and two negative controls for each sample. A prototype Dynex Multiplier chemiluminescent automated immunoassay instrument with a charge-coupled device camera provided a rugged and robust processing and data acquisition platform. Performance of a multiplex instrument for serological testing in a substantially resource-limited environment shows excellent reproducibility, minimal cross-reactivity, and a clear discrimination between specific assays and should be considered a viable option for future serosurveys.IMPORTANCE The critical evaluation of immunization programs is key to identifying areas of suboptimal vaccination coverage, monitoring activities, and aiding development of public health policy. For evaluation of vaccine effectiveness, direct antibody binding assay methods, including enzyme immunoassay, enzyme-linked fluorescence assays, and indirect immunofluorescence assay, are most commonly used for detection of IgG antibodies. However, despite their well-demonstrated, reliable performance, they can be labor-intensive and time-consuming and require separate assays for each individual marker. This necessitates increased sample volumes, processing time, and personnel, which may limit assessment to a few key targets in resource-limited settings, that is, low- and middle-income locations where funding for public health or general infrastructure that directly impacts public health is restricted, limiting access to equipment, infrastructure, and trained personnel. One solution is a multiplexed immunoassay, which allows for the detection of multiple analytes in a single reaction for increased efficiency and rapid surveillance of infectious diseases in limited-resource settings. Thus, the scope of the project precluded a full validation, and here we present abbreviated validation studies demonstrating adequate sensitivity, specificity, and reproducibility.

Determination of the relationship between serum anti-Müllerian hormone level and superovulatory response in Simmental cows.

The most significant focal points of the embryo transfer technology are as follows: the selection of donors, the response of the selected donor to the superovulation protocol and the obtained number of the transferable embryos. For this purpose, it is suggested that donor selection can be done by anti-Müllerian hormone (AMH) levels, and embryo production is evaluated. AMH is secreted by the granulosa cells of primordial, pre-antral and antral follicles below 4mm in the ovary, independent of FSH. Therefore, the aim of this study was to investigate the relationship between serum AMH levels and the number of corpus luteum (CL), total embryos and transferable embryos that were shaped after a uniform superovulation protocol. For this reason, 48 Simmental cows, which were located at General Directory of Agricultural Enterprises (region, province, etc. instead of the general directorate), were used as donors for the embryo transfer. Blood samples were taken at random, regardless of the stage of animal's sexual cycle. AMH levels were measured by enzyme-linked fluorescent assay (ELFA) method of the miniVIDAS® (bioMérieux SA) using AMH Bovine Test Kit. According to the statistical analyses of the obtained data, AMH levels were positively correlated with CL and total embryos (p<.05). No significant correlations between AMH and transferable embryos were approved (p>.05). It was also determined that each 200pg/ml increase in serum AMH level resulted in one increase in CL number. Overall, considering the positive correlation between AMH level and the obtained number of CL and total embryos after a superovulation treatment, it was concluded that measuring blood AMH level prior to any further costly implementation may be an effective method in donor selection.

Levels of creatine kinase MB-mass in chronic kidney disease patients on maintenance hemodialysis without coronary complications

Introduction: A triad of clinical evaluation, electrocardiography and biomarkers of acute cardio necrosis are basis for diagnosing acute coronary syndrome (ACS). Evaluation of ACS by electrocardiography can be inconclusive in patients on maintenance hemodialysis; thereby making cardiac biomarkers better indicators. Hemodialysis is known to alter troponin I values with studies suggesting high false positives but not for the values of CKMB mass. Aim: The aim of the study was to estimate the levels of cardiac CKMB-mass in patients with stage IV/stage V renal failure on maintenance hemodialysis (MHD) with no evidence of cardiac disease, and to correlate these values with manufactures guidelines for healthy individuals (cut off of Materials and Methods: The study was conducted on 23 patients between age group 20 to 70 years, diagnosed with stage IV or V Chronic Kidney disease (CKD) (confirmed biochemically and ultrasonographically). These patients were undergoing regular biweekly regime of maintenance hemodialysis for more than 3 months at dialysis unit PESIMSR, Kuppam. CKMB mass levels were measured in these patients. Results and Conclusion: The kidney function tests and electrolyte values were deranged in patients with CKD, however as the patients were on calcium supplementation, mineral levels were within normal range. Liver function tests of these patients were found to be normal. The hemoglobin and RBC levels were lower due to CKD associated anemia. CKMB-mass levels of these patients were done in Biomerieux Vidas analyzer using Enzyme linked fluorescent assay (ELFA) method. The values were within manufacturer’s cutoff range of 5ng/ml with mean value of 3.0±1.69 ng/ml. The patients were followed up either until death or for 24 months for any cardiac related events and follow up rate was 99%. The overall survival rates of the patients were found to be 77% and none of the patients were found to have developed cardiac related events and specifically myocardia

CORRELATION BETWEEN SERUM VITAMIN D LEVELS AND SEVERITY OF SCHIZOPHRENIA PATIENTS IN THE DR. SOETOMO HOSPITAL

Introduction. Vitamin D deficiency is a common health problem that occurs in various countries. Vitamin D deficiency is linked to various diseases such as kidney failure, liver damage, atherosclerosis, obesity and psychiatric disorders such as depression and schizophrenia. This study aimed to analyze the correlation between serum vitamin D levels and schizophrenia severity. Methods. Schizophrenia patients who visited the Inpatient and Outpatient Clinic Department of Psychiatry of the Dr. Soetomo Hospital Surabaya. This was a cross-sectional observational study, conducted in December 2017 - April 2018 . The subjects consisted of 53 schizophrenia patients, vitamin D levels &lt; 30 ng /mL (35 (66.04%); &gt; 30 ng/mL (18 (33.96%). Serum vitamin D levels test by enzyme linked fluorescent assay (ELFA) method using Vidas. The severity of schizophrenia was measured using a positive and negative syndrome scale (PANSS) score. Results. Mean serum vitamin D levels in schizophrenia were 23.45 ± 9.16 ng / mL, serum vitamin D levels in males were 24.36 ± 9.80 ng / ml and females 21.96 ± 7.98 ng / ml. The mean serum vitamin D level and PANSS scores of positive symptoms was 16.42 ± 8.50. The mean serum vitamin D level and PANSS scores of negative symptoms was 15.60 ± 6.12. The mean serum vitamin D level and PANSS scores of general psychopathology symptoms was 29.51 ± 10.29. The statistical results showed no association between vitamin D levels and PANSS scores. Conclusion. The results of this study indicated low serum vitamin D levels in schizophrenia. There was no association between serum vitamin D levels and the severity of schizophrenia using PANSS scores.

THE COMPATIBILITY OF NEUTROPHIL TO LYMPHOCYTE COUNT RATIO WITH SERUM PROCALCITONIN AS BACTERIAL INFECTION MARKERS IN SEPSIS PATIENTS

Bacterial infections and sepsis remain significant causes of morbidity and mortality in critical cases in Intensive Care Units (ICU) around the world. A quick and accurate diagnosis for sepsis is a challenge for clinicians and laboratory. The problem of an existing marker for sepsis with high sensitivity and specificity is still not satisfactory. Serum procalcitonin test is still widely used but cannot be supported by hospital laboratories especially in the regional public hospitals and needs more cost. Neutrophil-lymphocyte ratio is a potential index, easy, fast and cheap for bacteremia in patients with sepsis. This study aimed to determine the agreement of neutrophil-lymphocyte ratio with serum procalcitonin as a bacterial infection marker in sepsis patients. This study was an observational, analytical study with a cross-sectional design of 30 patients who had been diagnosed as sepsis by clinicians based on clinical signs of sepsis in the Intensive Care Unit of the Dr. M. Djamil Hospital Padang. The study was conducted from February to July 2016. Neutrophil and lymphocyte count was performed by flow cytometry method and procalcitonin test with Enzyme Linked Fluorescent Assay (ELFA). Results were analyzed by Kappa test with a statistical significance if p &lt; 0.05. There were 30 subjects, consisting of 15 females (50%) and 15 males (50%) with the age mean of 48 years. Based on the Kappa test, the value obtained was kappa=0.634 (p=0.001) for the ratio neutrophil lymphocyte with procalcitonin. There was a substantial agreement between ratio neutrophil lymphocyte with procalcitonin test.

Vitamin D status and its relationship with systemic lupus erythematosus as a determinant and outcome of disease activity.

Background The importance of vitamin D (VD) in systemic lupus erythematosus (SLE) is being increasingly appreciated, with studies suggesting a relationship between VD deficiency and SLE onset/disease activity. We investigated VD status in SLE patients and its associations with disease activity in a geographical region of India receiving low solar ultraviolet-B (UV-B) index. Materials and methods We enrolled 109 SLE patients along with 109 healthy controls belonging to same ethnicity and localities. Demographic and clinico-laboratory information were recorded. VD status was assessed by estimating serum 25-hydroxyvitamin D (25-OH-D) concentrations (deficient: <20 ng/mL, insufficient: 21-29 ng/mL, and sufficient/normal: ≥30 ng/mL) using an enzyme-linked fluorescent assay (ELFA). The SLE Disease Activity Index (SLEDAI) scoring system was used to evaluate disease activity. The association between VD status and disease activity was assessed by univariate and multivariate approaches. Results Hypovitaminosis D was prevalent in 90.83% SLE patients [vs. 77.98% healthy controls; chi-squared (χ2) = 10.125, df = 2, p < 0.01]. SLEDAI scores and 25-OH-D values were inversely associated, which extended in a two-way manner as revealed by multiple logistic regression models. SLE patients with VD deficiency were more likely to have high/very high disease activity [adjusted odds ratio (OR) = 3.5, 95% confidence intervals (CI): 1.4-8.9]. Conversely, patients with high SLEDAI scores (>10) also had greater risks of being VD deficient (adjusted OR = 3.9, 95% CI: 1.5-10.8). Conclusion VD deficiency is widespread in SLE. The relationship appears to be bidirectional, with VD status associated both as determinant and outcome of disease activity in SLE.

Case control evaluation of serum vitamin D levels in psoriasis

Abstract Introduction: Psoriasis is a chronic non-infectious skin disorder which is mainly characterized by the hyperproliferation and disturbance in keratinocyte differentiation. Data shows that vitamin-D have role in regulation of keratinocyte proliferation, differentiation and apoptosis along with immunomodulatory actions. However, studies pertaining to the evaluation of vitamin-D serum level in psoriasis is relatively less. We studied the serum level of vitamin-D in psoriasis and compared with the controls at a tertiary care hospital. Materials and Methods: This is a case-control study carried on 50 psoriasis and 44 age and sex matched controls from the dermatology outpatient clinic. Age, sex, occupation, family history and body mass index were recorded. Severity of psoriatic skin lesions were assessed using Psoriasis Area Severity Index (PASI) scoring. Serum vitamin-D level was assessed by Enzyme Linked Fluorescent Assay (ELFA) technique. Less than 20ng/ml (50nmol/l) was considered as vitamin-D deficiency and the data were statistically analyzed. Results: The mean vitamin-D level of cases and controls was 15.6±7.7 and 19.8±10.2 respectively. Their difference was statistically significant (P Conclusions: Serum vitamin-D level was significantly lower in psoriasis cases than controls and was inversely proportional to PASI score. Vitamin D could play a role in the disease pathogenesis but the exact nature remains unclear. Keywords: Psoriasis, Keratinocyte, Vitamin D, Psoriasis area severity index, Enzyme linked fluorescent assay. Introduction Psoriasis is a chronic skin ailment characterized by inflammatory and hyperproliferative skin lesions with genetic, environmental and immune factors playing a major role in its etiopathogenesis.[1] Initially, the disease was considered to arise due to an increased proliferation and altered differentiation of keratinocyte with secondary cutaneous inflammatory infiltration.[2] Later, it became evident t

Investigation of syphilis coinfection and performance of the Architect Syphilis Tp ELISA screening test in HIV positive patients

Limited data on syphilis coinfection in human immunodeficiency virus (HIV) positive cases exist in Turkey. Our aim is to investigate syphilis coinfection and to evaluate the compatibility of the screening Architect Syphilis Tp ELISA with the fluorescent treponemal antibody absorption (FTA-abs) confirmation test in HIV positive cases. Totally 519 HIV positive patients were included in the study. Enzyme linked fluorescent assay (ELFA) was used as a screening test and positive samples were confirmed by line immunassay (LIA). In order to discriminate acute HIV infection and false ELISA positivity, HIV-1 RNA PCR was performed in ELFA positive and LIA negative samples. Architect Syphilis TP ELISA was used for the detection of total antibodies against Treponema pallidum in HIV positive patients. Positive results were confirmed by the FTA-abs test. Out of 519 HIV-1 positive patients, IgG and IgM positivity, and only IgG positivity was detected as 1.9% and 11.4% in all the samples, respectively. A total of 79 (15.2%) sera were positive with Architect Syphilis Tp ELISA test and 69 (13.3%) were positive with FTA-abs test. Statistically significant, almost perfect agreement was found between Architect Syphilis Tp ELISA and FTA-abs tests (kappa = 0.921 and P < 0.001). Implementation of syphilis and HIV screening tests together among risk groups is considered to be appropriate.