Hospital Laboratory Research Articles

Serum Iron and Ferritin Levels in Beta Thalassemia Carriers in Duhok Governorate, Iraq.

Background Thalassemia and iron deficiency anemia (IDA) account for most cases of microcytic hypochromic anemia. It is a common misconception that iron deficiency does not occur in thalassemia. However, studies have found that iron deficiency can coexist in carriers of beta thalassemia. Objective The aim of this study was to determine the prevalence of iron deficiency and iron overload in carriers of beta thalassemia in Duhok, Iraq. Patients and methods This prospective cross-sectional study included 250 patients with beta thalassemia carriers attending Kurdistan Private Hospital Laboratory Department from July 2021 to June 2023. Patients with microcytic hypochromic blood picture were tested for HbA2 levels, and those with a level >3.7% were included in the study and were tested for serum iron and serum ferritin levels. Results The age range was 15-80 years, with a mean of 25 years, and the male-to-female ratio was 1.5:1. The prevalence of iron deficiency in beta thalassemia carriers was 16% (N = 40). The prevalence of iron overload was 8.4% (N = 21). There was a significant statistical difference among those with iron deficiency, normal iron status, and iron overload in terms of hemoglobin level (P=0.001), RBC count (P=0.012), HbA2 (P=0.015), and serum ferritin (P < 0.0001). Conclusion Iron deficiency is more prevalent in beta thalassemia carriers than iron overload, necessitating proper assessment of iron status in patients with beta thalassemia carriers. Those with abnormal iron status need effective treatment to optimize the overall outcomes in patients with beta thalassemia carriers.

Frequency of Hypoglycemia in Cirrhotic Patients Undergoing Endoscopy.

Liver cirrhosis isthe replacement of normal liver parenchyma by fibrous tissue and nodularity. Cirrhosis liver has a negative effect on the body's ability to regulate blood glucose levels because the liver cannot release the amount of glucose it wouldultimately cirrhotic patients are atrisk of hypoglycemia. To determine the frequency of hypoglycemia in cirrhotic patients just before endoscopy after being nil per mouth (NPO) for 6 hours. This cross-sectional study was done at the Department of Gastroenterology Lady Reading Hospital, Peshawar from 1st April 2023 to 30th September 2023.Patients aged > 20 years of both genders, having Child-Pugh class C cirrhosis, and undergoing upper gastrointestinal (GI) endoscopy were enrolled in the study while patients with a history of diabetes using oral or parenteral hypoglycemic medications, patients taking steroids, patients with hepatocellular carcinoma and patients with hepatic encephalopathy were excluded. Diagnosis of liver cirrhosis was based on clinical examination, serum albumin level, and prothrombin time followed by characteristic findings on ultrasound. Serum glucose level was determined in the blood sample of the patient from the hospital laboratory. Results:One hundred and ninety-six patients were enrolled including 130 (67.4%) males and 66 (32.6%) females. Age of the patients ranged from 20 to 60 years. The mean age of the participants was 46.68±10.239 years. Hypoglycemia was found in 48% of patients with liver cirrhosis. A significant association of hypoglycemia was found with disease duration and Child-Pugh class. Hypoglycemia is a frequent finding in patients with liver cirrhosis and needs urgent management to prevent complications. Prolonged illness and patients with Child-Pugh class C cirrhosis are more likely to have hypoglycemia.

Phenotypic and Genotypic Antibiotic Resistance Patterns of Clinical Shigella Isolates from Tehran, Iran

Background: The emergence of multidrug-resistant (MDR) Shigella is a health concern in both developed and developing countries. The indiscriminate use of antibiotics without considering resistance patterns has led to the emergence of resistant strains. Objectives: This study aimed to investigate the phenotypic and genotypic patterns of antibiotic resistance and virulence gene distribution in Shigella isolates from patients in Tehran, Iran. Methods: In this cross-sectional study, 60 Shigella isolates were collected from patients referred to Milad Hospital and Pasargad Laboratory in Tehran. The isolates were gathered over four months, from February 2023 to June 2023. After biochemical and genetic confirmation of the isolates, the disk diffusion method was employed to determine antibiotic resistance patterns. The distribution of beta-lactamase genes (blaCTX-M1, blaCTX-M2, blaCTX-M8, blaSHV, blaTEM, and blaOXA) and virulence genes (ial, virF, invE, sigA, and pic) was investigated in Shigella isolates using the multiplex PCR method. SPSS statistical software version 22 was used for data analysis. Results: Thirty-six percent of isolates were found to be MDR. The highest rate of resistance was against tetracycline (90%) and ampicillin (80%). The lowest resistance rate was against azithromycin (1.9%) and amikacin (7.1%). The blaCTX-M1 and blaCTX-M8 genes were more prevalent, detected in 38.3% and 50% of the isolates, respectively. However, the blaSHV and blaCTX-M2 genes were not detected in any of the isolates. Additionally, 32% of the MDR isolates harbored both the blaCTX-M1 and blaCTX-M8 genes simultaneously. The distribution of virulence genes ial, virF, invE, sigA, and pic in the studied isolates was 28.3%, 85%, 68.3%, 81.7%, and 15%, respectively. Conclusions: The present study emphasizes the increasing trend of MDR Shigella isolates. Therefore, serious measures are needed to prevent the spread of resistant genes. Furthermore, the detection of virulence factors could help in controlling shigellosis, which is a significant global health issue.

#431 Ionized and total magnesium levels in patients with chronic kidney disease: associated factors and outcomes

Abstract Background and Aims Association between hypo- and/or hypermagnesaemia and cardiovascular (CV) outcomes or mortality showed conflicting results in chronic kidney disease (CKD) and was mostly conducted on total magnesium (tMg) levels and not ionized magnesium (iMg). Thus, the objectives of the present study were to (i) describe the serum iMg concentration in patients at various CKD stages, (ii) measure the correlation between iMg and tMg concentrations, (iii) identify their associated factors and (iv) determine whether serum tMg and/or iMg concentrations are associated with adverse outcomes, such as major adverse cardiovascular events (MACE) and death before kidney replacement therapy (KRT, defined as the initiation of chronic dialysis or kidney transplantation) in CKD patients, after adjustment for confounding factors. Method CKD-REIN is a French prospective cohort of patients with stage 3 to 5 CKD (estimated glomerular filtration rate (eGFR) &amp;lt;60 mL/min/1.73 m²) recruited from 40 nephrology facilities, neither on maintenance dialysis nor transplanted, and followed up for 5 years. Baseline iMg and tMg serum concentrations were centrally measured. Patients were compared by subgroups according to serum tMg tertiles (Tertile 1 (T1): ≤0.73 mmol/L, T2: 0.74-0.81 mmol/L, T3: &amp;gt;0.81 mmol/L). Multivariate linear regressions were used to identify factors associated with iMg and tMg serum concentrations. Adjusted cause-specific Cox proportional hazard models were used to test the association between the risk of first MACE, all-cause mortality, and CV mortality with serum iMg and tMg concentrations at baseline. Results Of the 2, 419 included patients, 66% were men, median age was 68, and the mean eGFR was 34.8 mL/min/1.73 m². Mean serum iMg and tMg concentrations were respectively 0.48 mmol/L and 0.77 mmol/L. They were strongly correlated (r = 0.89, P &amp;lt; .001) and were independently associated with eGFR. Overall, iMg and tMg concentrations were associated with the same factors. The adjusted HR [95% CI] for MACE associated with the baseline serum tMg level was 1.27 [0.95; 1.69] for patients in T1, and 1.56 [1.18; 2.06] for patients in T3, relative to patients in T2. The adjusted HR [95% CI] for MACE associated with baseline serum iMg was 0.93 [0.71; 1.23] for patients in T1, and 1.14 [0.88; 1.48] for patients in T3, relative to patients in T2. The risks of all-cause death (HR [95% CI] = 1.48 [1.11; 1.97]) and CV mortality (HR [95% CI] = 1.98 [1.27; 3.10]) were also increased in T3 of tMg compared with T2. The adjusted risks for mortality (all-cause or CV) associated with the baseline serum iMg level were not significantly different from one tertile to another. Conclusion Our analysis of a large cohort of patients with moderate-to-advanced CKD demonstrated that individuals with higher serum tMg concentrations, although still within the normal range, had a greater likelihood of MACE and mortality. Total magnesium is routinely assayed in hospital laboratories and might be a useful variable to monitor in CKD patients. We failed to demonstrate the added value of iMg when studying its association with CV outcomes and mortality.

URINARY TRACT INFECTION (UTI) IN POSTMENOPAUSAL WOMEN WITH TYPE 2 DIABETES MELLITUS USING SODIUM GLUCOSE CO TRANSPORTER 2 INHIBITORS (SGLT-2 I)

OBJECTIVE. To determine the frequency of urinary tract infection in postmenopausal women with type 2 diabetes mellitus using sodium-glucose co-transporter 2 inhibitors. MATERIAL AND METHODS. This descriptive cross-sectional study was performed on 101 postmenopausal patients with type 2 diabetes mellitus using sodium-glucose co-transporter 2 inhibitors. Samples of blood and urine were sent to the hospital laboratory for analysis. Data was analyzed using SPSS version 20. The Chi-square test was performed after stratification. RESULTS. The mean and standard deviation for age was 60.9±4.4. 24.8% of post-menopausal women with type 2 diabetes mellitus using sodium-glucose co-transporter 2 inhibitors were having urinary tract infections. The majority of these patients were illiterate or had primary education and the duration of diabetes was more than 10 years. CONCLUSION. Urinary tract infection is a common problem in postmenopausal women with type 2 diabetes mellitus using sodium-glucose co-transporter 2 inhibitors. Patients with poorly controlled diabetes and increased duration of menopause have an increased risk of urinary tract infection. KEYWORDS. Urinary tract infection (UTI), Post-menopausal, type 2 diabetes mellitus (DM), sodium-glucose co-transporter 2 inhibitors (SGLT2Is).

The association between probable post-COVID-19 condition and sleep-related parameters: a longitudinal study of non-hospitalised patients.

The long-term effects of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection on sleep remain poorly known. We evaluated the association between probable post-COVID-19 condition and changes in sleep quality and quantity before and after SARS-CoV-2 infection in a consecutive sample of non-hospitalized adults. Individuals were identified with SARS-CoV-2 infection in 2020 at the central laboratory of a tertiary hospital in Porto and followed as outpatients. We included patients diagnosed with SARS-CoV-2 infection ≥3 months before this evaluation, with no missing data on key variables (n = 2445). Participants completed a questionnaire that included sociodemographic, clinical, and infection-related questions. We computed changes in sleep-related parameters referred to 1 month before diagnosis and 1 week before the questionnaire. Multinomial logistic regression models were fitted to compute crude and adjusted odds ratios and 95% confidence intervals (95% CIs). Compared to the pre-infection period, those with probable post-COVID-19 condition reported a greater decrease in hours of sleep, had a 2.60 (95% CI 2.02-3.34) higher adjusted odds of perceiving their sleep quality as worsened and experienced a significant increase in number of days with sleeping disturbances as defined according to multiple items. The association between post-COVID-19 condition and indicators of poor sleep health requires special attention from healthcare professionals and services. It is essential that appropriate multidisciplinary care is provided to mitigate the physical, psychological, social, and professional impact of sleeping problems in these already burdened patients.

Implementation of the EUCAST rapid antimicrobial susceptibility test (RAST) for carbapenemase/ESBL-producing Escherichia coli and Klebsiella pneumoniae isolates, and its effect on mortality.

With the rise in antimicrobial resistance, there is a growing demand for rapid antimicrobial susceptibility testing (RAST). In this study, we applied the EUCAST RAST method to ESBL/carbapenemase-producing Escherichia coli and Klebsiella pneumoniae isolates without using advanced identification systems and analysed the effect of this method on mortality rates Also the clinical impact of this method on patients infected with these bacteria and its effect on mortality rates were investigated. RAST was used for clinical blood cultures containing carbapenemase/ESBL-producing E. coli and K. pneumoniae without advanced identification systems (e.g. MALDI TOF), with preliminary identification by simple diagnostic tests (predicted RAST, or p-RAST), and its categorical agreement was investigated. The impact of the method on mortality was analysed by comparing the clinical data of patients whose blood cultures were subject to p-RAST (p-RAST group, n = 49) and those who were not subject to p-RAST (non-RAST group, n = 145). p-RAST results were analysed based on 539 antibiotic-bacteria combinations. Total error rates at 4, 6 and 8 h of incubation were 2.9%, 3.9% and 3.8%, respectively. In the p-RAST group, patients who did not receive appropriate antibiotics (29/45, 59.1%) were switched to appropriate treatment within 8 h at the latest. In contrast, in the non-RAST group, treatment of patients who received inappropriate antibiotics (79/145, 54.5%) could be changed after at least 24 h. Mortality rates were lower in the p-RAST group than in the non-RAST group (28.6% versus 51.7%, P = 0.005). p-RAST can be used safely in hospital laboratories with high rates of antimicrobial resistance and can reduce mortality rates by shortening the transition time to appropriate treatment.

Analysing the Stability of Various Biochemical Analytes in Samples Stored at Different Predefined Storage Conditions at a Tertiary Care Hospital Laboratory

1) To estimate stability of biochemical analytes in a samples stored at different predefined storage conditions. 2) To evaluate the stability of biochemical analytes in serum when stored for different time duration.

Evaluating proficiency testing implementation and identifying challenges that government comprehensive specialized hospital laboratories in northwest Ethiopia faced as they participated in the external quality assessment scheme: A document-based, interview-driven evaluation.

To assess the implementation of proficiency testing in the northwest Ethiopian government comprehensive specialized hospital laboratories, with a focus on identifying and understanding the challenges encountered during their participation in the external quality assessment scheme. A cross-sectional study was conducted among 3 comprehensive specialized hospitals in northwest Ethiopia, analyzing 41 documented laboratory test parameters from 2020 to 2022. In addition, face-to-face, in-depth interviews were carried out to identify the major challenges the participating institutions faced. The study covered a total of 41 tests across 9 cycles. Overall, proper implementation of proficiency testing was observed in 59.3% of the tests, with 61.8% maintaining consistent implementation status over 3 consecutive years. In addition, the overall performance of the laboratory was 54.3%, with a 68.7% participation rate. The predominantly identified challenges included the lack of participation, insufficient reagents and supplies, inadequacy of suitable proficiency testing materials, equipment malfunction and downtime, lack of management support, insufficient budget, and inadequate training and awareness. The results of this study highlight the ineffective implementation of proficiency testing. Contributing factors include personnel issues, equipment and supplies challenges, managerial shortcomings, difficulties with proficiency testing providers, budgetary constraints, and a lack of training and motivation.

An evaluation of the internal quality control performance of the general biochemistry analytes in a laboratory of a tertiary care hospital of Sri Lanka

An evaluation of the internal quality control performance of the general biochemistry analytes in a laboratory of a tertiary care hospital of Sri Lanka

Implementation of a genetic teleconsultation in the laboratory of a district hospital

Implementation of a genetic teleconsultation in the laboratory of a district hospital

Evaluation of toxoplasma IgG avidity results and their correlation with toxoplasma Gondii IgM and IgG, in pregnant women during the first trimester at American Hospital, International Hospital and Cambridge Clinical Laboratories, Albania

Evaluation of toxoplasma IgG avidity results and their correlation with toxoplasma Gondii IgM and IgG, in pregnant women during the first trimester at American Hospital, International Hospital and Cambridge Clinical Laboratories, Albania

Correlation between common mutations of MTHFR gene and missed abortion cases, during the first trimester of pregnancy, at American Hospital, International Hospital and Cambridge clinical laboratories in Albania

Correlation between common mutations of MTHFR gene and missed abortion cases, during the first trimester of pregnancy, at American Hospital, International Hospital and Cambridge clinical laboratories in Albania

How to compare point-of-care testing results with hospital laboratory results: Recommendations for primary healthcare laboratories

How to compare point-of-care testing results with hospital laboratory results: Recommendations for primary healthcare laboratories

Thyroid profile abnormalities among patients tested at the Nairobi Hospital Laboratory, Kenya

Thyroid profile abnormalities among patients tested at the Nairobi Hospital Laboratory, Kenya

Chlamydia trachomatis and Neisseria gonorrhoeae detection: Comparing the recommended detection methods and the ones used in a regional hospital laboratory

Chlamydia trachomatis and Neisseria gonorrhoeae detection: Comparing the recommended detection methods and the ones used in a regional hospital laboratory

Specific Immune Marker Associated With Coronavirus Disease 2019

Background: The infection that caused the pneumonia, the virus known as severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is the source of coronavirus disease 2019 (COVID-19) is the source of the global pandemic. The pneumonia cases began in Wuhan, China in December 2019 and had no apparent reason. Essential inflammatory mediators Chemokines are necessary for an immune response to eliminate pathogens. However, the fundamental cause of hyperinflammation is their excessive release. Chemokines may be directly responsible for the acute respiratory illness syndrome in the current COVID-19 outbreak. Objective: The current study aimed to estimate hematological changes with immunogenic markers CD177, GNLY, and CXCR4 gene expression in COVID-19 patients, and compare these parameters among patients and healthy individuals. Materials and Methods: The study was conducted at Al-Yarmouk Teaching Hospital and Medical Teaching Laboratories. Finally, to detect the immune markers level in samples of patients, by RT-PCR. Results: The results revealed the gene expression results in patients with COVID-19 means Ct difference of CD177 (24.70) fold more than (10.5) elevated when compared with the mean of Ct control healthy group is (28.21) fold of gene expression is 1.00 of CD177 when our study showed increased gene expression the mean of GNLY Ct receptor was reached to (28.70 ng/L) with fold more than 15.0 in COVID-19 patients, while mean Ct in healthy control was (32.61 ng/L) with fold 1.00, the current study found mean CT of CXCR4 gene expression ( 31.2) with fold (1.1) compared with healthy control CT(31.3) fold of gene expression was (1.0). Conclusion: It was concluded that COVID-19 caused significant changes in many immunological parameters and found the titer of immune markers was higher in infection compared with control.

Diagnostic Accuracy of Fetal Middle Cerebral Artery Peak Systolic Velocity in the Detection of Fetal Anaemia Keeping Neonatal Hae Moglobin Estimation at Birth as the Gold Standard

Objective: To assess whether monitoring the peak systolic velocity (PSV) in the middle cerebral artery (MCA) was a useful, non-invasive method for predicting anaemia in fetuses. Study Design: Cross-sectional study Place and Duration of Study: Armed Forces Institute of Radiology, Rawalpindi Pakistan, from Feb and Aug 2022. Methodology: Fifty pregnant women who did not have hydropic babies were included. The peak systolic velocity (PSV) was measured in the middle cerebral artery (MCA). A positive result was determined when the MCA-PSV value exceeded 1.5multiples of the median (MoM). The blood samples obtained from neonates were forwarded to the hospital laboratory to estimate haemoglobin levels shortly after birth. The outcome of the method (MoM) was observed and subsequently compared with neonatal haemoglobin levels. Results: 60% of neonates were anaemic according to middle MCA-PSV while the haematology laboratory reported 74% of neonates as anaemic according to cut-off haemoglobin of less than 13.5gm/dl. Sensitivity, specificity, positive predictive value(PPV), negative predictive value (NPV), and accuracy of the MCA-PSV in detecting the anaemia were 93.75%, 61.1%, 81.08%, 84.62%, and 82%, respectively. Conclusion: MCA-PSV Doppler is deemed valuable as a diagnostic technique for fetal anaemia, albeit secondary to the primary approach of neonatal haemoglobin estimation upon birth.

Genomic Variation in Dengue Virus Non-Structural Protein 1 (NS1)

To understand in an improved way how the dengue virus (DENV) spreads, presents, and becomes hazardous, researching its genetic makeup is necessary. The positive sense RNA of DENV encodes three structural proteins and seven non-structural proteins. One of the non-structural proteins that aids in the replication of viral RNA is the non-structural protein 1 (NS1). The objective was to identify the most frequently repeated mutations in the NS1 protein in DENV RNA isolated from dengue patients in the province Punjab, Pakistan. Selection of 120 DENV isolates was done from laboratories of tertiary care hospitals of Punjab for analysis of sequencing of the whole genome. Only 23 samples were sequenced after viral isolation, quantification and cDNA synthesis. A total of 133 different types of mutations were detected along the entire length of NS.1. The most common mutations with the highest frequency were, K324R and K347R (n=7), D278N (n=6), K174R, and F178S (n=4), found at c-terminal of NS.1 protein. Mutations K347R, K174R, and F178S are novel. Future DENV vaccination development research will be especially profited by the mutations found in the current study. During each DENV outbreak in different places, studying genomic variations is crucial for strengthening societal health and developing new policies for future outbreaks.

Effect of Ureaplasma/Mycoplasma genital tract infection on preterm labor.

Genitourinary tract infections in pregnant women are one of the causes of abnormal pregnancy development including miscarriages, premature labor or premature rupture of membranes (PPROM). Atypical bacteria responsible for reproductive tract infections include Mycoplasma genitalium, Mycoplasma hominis, Ureaplasma urealyticum and Ureaplasma parvum. Identification of pathogens and appropriately selected therapy can improve obstetric outcomes in patients with symptoms of threatened miscarriage or threatened preterm labor. The purpose of our study is to analyze the impact of reproductive tract infections with ureaplasma and mycoplasma bacteria during pregnancy. In the presented study, we retrospectively analyzed the cases of 201 pregnant patients hospitalized in the Obstetrics and Gynecology Department of Poznan Regional Hospital in 2019-2022, who had a swab taken from external os area of the cervix for atypical bacteria - Ureaplasma and Mycoplasma. Only patients with symptoms of threatened miscarriage or threatened preterm labor were included in the study group. Microbiological tests were performed in the hospital laboratory with the Mycoplasma IST 3 test from Biomerieux. We found a higher incidence of preterm labor in patients with symptoms of threatened preterm labor and a genital tract infection with Ureaplasma/Mycoplasma bacteria, compared to patients not infected with Mycoplasma/Ureaplasma - 31.1% vs 20% (p = 0.098). This observation in the case of Ureaplasma/Mycoplasma monoinfection group applied to 6 patients. - 75% of the group. Pregnant patients who had co-infection with other types of bacteria (48 patients in total) gave birth before 37 weeks of pregnancy in 27.1% of cases. We obtained a significant difference (p = 0.007) when comparing groups with positive and negative cultures for Ureaplasma/Mycoplasma by the presence of monoinfection/coinfection and the week of pregnancy in which delivery occurred. We also noted the effect of atypical bacterial infection for PPROM - this complication preceded preterm delivery in 40% of ureaplasma-positive patients, compared to 20% of PPROM without infection. We found a similar rate of preterm labor and pregnancy loss in Ureaplasma/Mycoplasma-positive patients who received antibiotic therapy (35.7%) compared to a group of pregnant women who did not receive treatment (31.6%). Infection of the genital tract with atypical bacteria Ureaplasma and Mycoplasma has a negative impact on the course of pregnancy. Identification of the type of microorganisms in cervical canal secretions of pregnant patients with symptoms of threatened miscarriage or preterm labor seems crucial. The impact of antibiotic therapy though, requires further analysis.