Interpretation Of Laboratory Tests Research Articles

Introduction and content analysis of "Nurse's voice" WhatsApp group during COVID-19 pandemic: a qualitative study

BackgroundAt the beginning of the COVID-19 pandemic in Iran, the School of Nursing and Midwifery of Tehran University of Medical Sciences created several joint virtual groups to connect with people and answer their questions. One of these groups was called "Nurse's Voice,” in which nursing professors answered people's questions. The purpose of the current study was to analyze the content of questions in this WhatsApp group during the COVID-19 pandemic.MethodThis retrospective media content analysis qualitatively analyzed the text of questions and answers extracted from the above-named WhatsApp group.ResultsOut of 629 questions asked, 364 questions (58.0%) were related to COVID-19 and 265 questions (42.0%) were not. Those related to COVID-19 concerned COVID-19 symptoms and diagnosis, prevention and care, fear and worry, and interpretation of laboratory tests. The questions related to prevention and care fell into four subcategories: basic health principles, prevention of COVID-19 infection, care during COVID-19 infection, and care during COVID-19 recovery.ConclusionsNursing and midwifery schools can take advantage of the scientific capacity of professors and students for virtual communication and social accountability by integrating telehealth into their curricula. Cyberspace provides an opportunity for people to ask questions anonymously. With the results of the current study, the educational needs of the people during possible future epidemics can be predicted and answered faster. Furthermore, the large number of questions unrelated to COVID-19 indicates the need for counseling and training of the general public by nurses in all situations.

PREVALENCE AND MANAGEMENT OF IRON DEFICIENCY ANEMIA IN CHILDREN: A SYSTEMATIC REVIEW

Background: Even in affluent nations, IDA is still a significant public health issue, particularly for young children and women who are ready to have children. Aims: This systematic review is to review the treatment and prevalence of iron deficiency anemia in children. Methods: This study demonstrated compliance with all requirements by means of a comparison with the standards established by the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) 2020. Thus, the specialists were able to guarantee that the research was as current as feasible. Publications released between 2014 and 2024 were considered for this search strategy. This was accomplished by utilizing a number of distinct online reference sites, including Pubmed, ScienceDirect, and SagePub. It was determined that reviews, previously published works, and partially completed works would not be included. Result: In the PubMed database, the results of our search brought up 353 articles, whereas the results of our search on SCIENCE DIRECT brought up 8.865 articles, our search on SAGEPUB brought up 3.269 articles. The results of the search conducted for the last year of 2014 yielded a total 184 articles for PubMed, 4.071 articles for SCIENCE DIRECT and 1.144 articles for SAGEPUB. In the end, we compiled a total of 5 papers, 3 of which came from PubMed, 1 of which came from SCIENCE DIRECT and 1 of which came from SAGEPUB. We included five research that met the criteria. Conclusion: In summary, with its haematological repercussions of anemia, IDA is a prevalent and significant children health concern. To assess the effects of IDA on immunity and neurocognition, additional research is necessary. The key to successfully treating children with IDA is early identification and diagnosis of the condition together with competent interpretation of laboratory tests.

Interpretation of coagulation laboratory tests for patients on ECMO.

Extracorporeal membrane oxygenation (ECMO) is a type of circulatory life support for patients with severe lung failure. The use of ECMO has increased worldwide since the pandemic of H1N1 in 2009 and more recently SARS-CoV-2 in 2020 both of which caused severe respiratory failure. ECMO patients experience both increased risk of bleeding and thrombosis. This is due to the pathological insult that damages the lungs, the ECMO circuit, coagulopathy, inflammation and anticoagulation. ECMO presents unique demands on the coagulation laboratory both in tests required to manage the patients and result interpretation. This is a personal opinion of 20 years ECMO experience as a clinical scientist and a short current review of the literature. It will focus on the laboratory coagulation tests used to manage ECMO patients, including different anticoagulants used, testing frequency and interpretation of the results.

Effectiveness of a standardized scenario in teaching the management of pediatric diabetic ketoacidosis (DKA) to residents: a simulation cross-sectional study

BackgroundDiabetic ketoacidosis (DKA) is a frequent manifestation at the onset of type 1 diabetes mellitus in children, possibly associated with a wide range of complications, often as a consequence of wrong or delayed treatment. Due to its complex and risky management, direct exposure to real situations alone is not sufficient to achieve adequate skills in pediatric DKA for residents. Simulation could be a valuable aid, allowing to practice a standardized scenario of a complex real-world situation. We aimed to test the effectiveness of a standardized scenario of pediatric DKA in teaching its recognition and treatment.MethodsWe develop a standardized scenario able to guide step-by-step the learners through the flowchart of DKA management and considering alternative evolutions in the case of possible deviations from guidelines. It was a real-life simulation with the use of a high-fidelity pediatric simulator. It was played by 78 pediatrics 20 and emergency medicine residents. At the end of the simulation, a validated questionnaire was administered to collect feedback from participants regarding the impact of the simulation on learning. All materials to reproduce the DKA scenario are provided.ResultsOverall, the scenario was rated as realistic (mean score 4.37 ± 0.68, from 1 to 5) and relevant to professional training (4.72 ± 0.47), useful in increasing confidence in interpreting laboratory tests (3.97 ± 0.65), group organization and communication strategies (3.49 ± 0.94), and managing the treatment of DKA (3.46 ± 0.92).ConclusionsThe use of a standardized scenario of pediatric DKA may be a valid tool to reinforce theoretical knowledge in residents, both in pediatrics and in emergency medicine, and to directly and safely practice pediatric DKA management.

INDICATORS OF THE QUALITATIVE AND QUANTITATIVE COMPOSITION OF THE GUT COMMENSAL MICROBIOTA AS BIOMARKERS OF HOMEOSTASIS (Part 1)

In recent years, practical medicine has faced a surge of information highlighting the emergence of new microbes in the human body's microbiota, leading to challenges in interpreting laboratory test results. This study aims to equip medical professionals, including doctors of various specialties, medical students, and interns, with a comprehensive understanding of the current knowledge on the human gastrointestinal microbial profile. Our analysis included 53 articles from international literature sources indexed in PubMed, Scopus, and Google Scholar databases. These articles were identified through an electronic search. The composition of the human microbiome is shaped by alterations in environmental conditions, living environments, diet, climate, genetics, and various other factors. Following birth, the pivotal role in microbiome formation involves the vertical, horizontal, and mixed transfer of microorganisms. Navigating the diversity of resident microbiota can be challenging, leading scientists to suggest biomarkers such as diversity indices, enterotypes, and established ratios at typical taxonomic levels (genus, species) for convenience. In clinical practice, these indicators serve as indirect markers of microflora properties that model health or disease. To understand the distribution of species within types, ecologists introduced concepts like α-, β-, and γ-diversity, grounded in different mathematical models. These indicators are also employed to assess the human body microbiota. The division into enterotypes was proposed by scientists on the basis that the phylogenetic (species) composition of each category determines its own functional feature, which is likely to be related to long-term eating habits. Conclusion. Scientists endeavor to assess the intricate microbiome system and its substantial impact on the human body, as well as the adverse effects of dysbiosis, employing mathematical models applied in microbiology.

The European biological variation study (EuBIVAS): Biological variation data for testosterone, follicle stimulating hormone, prolactin, luteinizing hormone and dehydroepiandrosterone sulfate in men

BackgroundKnowledge of biological variation (BV) of hormones is essential for interpretation of laboratory tests and for diagnostics of endocrinological and reproductive diseases. There is a lack of robust BV data for many hormones in men. MethodsWe used serum samples collected weekly over 10 weeks from the European Biological Variation Study (EuBIVAS) to determine BV of testosterone, follicle-stimulating hormone (FSH), prolactin, luteinizing hormone (LH) and dehydroepiandrosterone sulfate (DHEA-S) in 38 men. We derived within-subject (CVI) and between-subject (CVG) BV estimates by CV-ANOVA after trend, outlier, and homogeneity analysis and calculated reference change values, index of individuality (II), and analytical performance specifications. ResultsThe CVI estimates were 10 % for testosterone, 8 % for FSH, 13 % for prolactin, 22 % for LH, and 9 % for DHEA-S, respectively. The IIs ranged between 0.14 for FSH to 0.66 for LH, indicating high individuality. ConclusionsIn this study, we have used samples from the highly powered EuBIVAS study to derive BV estimates for testosterone, FSH, prolactin, LH and DHEA-S in men. Our data confirm previously published BV estimates of testosterone, FSH and LH. For prolactin and DHEA-S BV data for men are reported for the first time.

Impact of diagnostic management team on patient time to diagnosis and percent of accurate and clinically actionable diagnoses.

Diagnostic management teams (DMT) are groups of experts with specialized knowledge to guide test selection and interpretation of results. They have been active in institutions over the past 20 years. To date, there are limited data on whether the presence of experts to advise healthcare providers on appropriate laboratory test selection and interpretation of complex test results positively impacts patient care. A retrospective study at a regional healthcare system with 257,000 patient encounters between 2011 and 2022 reviewing test interpretations provided by clinical laboratory experts on a diagnostic management team. Cases reviewed by the coagulation DMT were 6 times more likely to have an established, scientifically based diagnosis compared to those without a DMT. Patients who have a coagulation DMT review were twice as likely to receive a diagnosis vs. having no diagnosis. This study demonstrates that for several objective clinical outcomes, specifically diagnostic conclusions and length of stay, a DMT of coagulation experts assessing patients' test results has had a major impact on outcomes and delivery of care.

Quality of Answers of Generative Large Language Models Versus Peer Users for Interpreting Laboratory Test Results for Lay Patients: Evaluation Study.

Although patients have easy access to their electronic health records and laboratory test result data through patient portals, laboratory test results are often confusing and hard to understand. Many patients turn to web-based forums or question-and-answer (Q&A) sites to seek advice from their peers. The quality of answers from social Q&A sites on health-related questions varies significantly, and not all responses are accurate or reliable. Large language models (LLMs) such as ChatGPT have opened a promising avenue for patients to have their questions answered. We aimed to assess the feasibility of using LLMs to generate relevant, accurate, helpful, and unharmful responses to laboratory test-related questions asked by patients and identify potential issues that can be mitigated using augmentation approaches. We collected laboratory test result-related Q&A data from Yahoo! Answers and selected 53 Q&A pairs for this study. Using the LangChain framework and ChatGPT web portal, we generated responses to the 53 questions from 5 LLMs: GPT-4, GPT-3.5, LLaMA 2, MedAlpaca, and ORCA_mini. We assessed the similarity of their answers using standard Q&A similarity-based evaluation metrics, including Recall-Oriented Understudy for Gisting Evaluation, Bilingual Evaluation Understudy, Metric for Evaluation of Translation With Explicit Ordering, and Bidirectional Encoder Representations from Transformers Score. We used an LLM-based evaluator to judge whether a target model had higher quality in terms of relevance, correctness, helpfulness, and safety than the baseline model. We performed a manual evaluation with medical experts for all the responses to 7 selected questions on the same 4 aspects. Regarding the similarity of the responses from 4 LLMs; the GPT-4 output was used as the reference answer, the responses from GPT-3.5 were the most similar, followed by those from LLaMA 2, ORCA_mini, and MedAlpaca. Human answers from Yahoo data were scored the lowest and, thus, as the least similar to GPT-4-generated answers. The results of the win rate and medical expert evaluation both showed that GPT-4's responses achieved better scores than all the other LLM responses and human responses on all 4 aspects (relevance, correctness, helpfulness, and safety). LLM responses occasionally also suffered from lack of interpretation in one's medical context, incorrect statements, and lack of references. By evaluating LLMs in generating responses to patients' laboratory test result-related questions, we found that, compared to other 4 LLMs and human answers from a Q&A website, GPT-4's responses were more accurate, helpful, relevant, and safer. There were cases in which GPT-4 responses were inaccurate and not individualized. We identified a number of ways to improve the quality of LLM responses, including prompt engineering, prompt augmentation, retrieval-augmented generation, and response evaluation.

Reference Intervals of Haematological Parameters for Apparently Healthy Adults in Northeast Ethiopia.

Clinical laboratory reference intervals play a vital role in evaluating overall well-being, tracking the progression of diseases, and detecting potential harmful effects and complications. Despite evidence revealing disparities, many African nations currently rely on reference intervals for blood analysis obtained mainly from Western populations. This practice increases the risk of misidentifying and misdiagnosing healthy individuals. The aim of this study was to establish common hematological parameters reference intervals for healthy adults in Northeast Ethiopia. This community-based cross-sectional study consisted of 328 individuals who were presumed to be in good health. To assess their blood-related characteristics, blood samples were collected and analyzed using the advanced Dirui BF-6500 analyzer, along with serological testing. In accordance with guidelines provided by the Clinical and Laboratory Standards Institute, the study employed a non-parametric approach to calculate the medians and 95% confidence intervals. To explore potential variations between males and females, a statistical test known as the Mann-Whitney U-test was used to compare the reference intervals. The established reference intervals were: white blood cells 3.5-11.3×109/L; red blood cells 4.0-6.1×1012/L; hemoglobin 11.2-17.5g/dL; hematocrit 35.4-52.0%; MCV 77.9-93.8fl; MCH 24.7-32.0pg; MCHC 306-349g/L; RDW-CV 12.1-13.8% and platelet 131-391×109/L. The reference values of monocytes, eosinophils, red blood cells, hemoglobin, hematocrit and RDW-CV in males were higher than females, while females had significantly higher platelet counts compared to males. The reference intervals discovered differed from the reference intervals now in use, those mentioned in earlier research in Ethiopia or other African nations, as well as those conducted on Western populations. In the adult demographic of Northeast Ethiopia, specific reference intervals for commonly observed hematological parameters were established, tailored to the local community. Consequently, these reference intervals hold the potential to enhance informed decision-making within this population, by providing valuable guidance when interpreting laboratory test outcomes.

Complement.

The role of complement in human autoimmune, inflammatory, and infectious diseases is reviewed, focusing on clinical applicability. A typical case is presented in which serum testing for C3 and C4 is performed to help assess a syndrome with a broad differential diagnosis. The review includes a discussion of complement deficiency states, consumption of complement by diseases characterized by immune-complex formation and deposition, usefulness and interpretation of laboratory tests for complement, and development of drugs targeting specific components of the complement pathway for a growing number of indications.

A pipeline for the fully automated estimation of continuous reference intervals using real-world data

Reference intervals are essential for interpreting laboratory test results. Continuous reference intervals precisely capture physiological age-specific dynamics that occur throughout life, and thus have the potential to improve clinical decision-making. However, established approaches for estimating continuous reference intervals require samples from healthy individuals, and are therefore substantially restricted. Indirect methods operating on routine measurements enable the estimation of one-dimensional reference intervals, however, no automated approach exists that integrates the dependency on a continuous covariate like age. We propose an integrated pipeline for the fully automated estimation of continuous reference intervals expressed as a generalized additive model for location, scale and shape based on discrete model estimates using an indirect method (refineR). The results are free of subjective user-input, enable conversion of test results into z-scores and can be integrated into laboratory information systems. Comparison of our results to established and validated reference intervals from the CALIPER and PEDREF studies and manufacturers’ package inserts shows good agreement of reference limits, indicating that the proposed pipeline generates high-quality results. In conclusion, the developed pipeline enables the generation of high-precision percentile charts and continuous reference intervals. It represents the first parameter-less and fully automated solution for the indirect estimation of continuous reference intervals.

Pharmacist-Led Management of HIV PrEP Within the Veterans Health Administration.

Uptake and access to HIV preexposure prophylaxis (PrEP) is key to reducing incident HIV infections. Pharmacists are one of the most accessible health care professionals in the United States and are well suited to address this need. We describe a model of care at the Veterans Affairs Greater Los Angeles Healthcare System in which clinical pharmacist practitioners developed and implemented a pharmacy-led PrEP clinic colocated within an infectious disease clinic. Veterans Health Administration clinical pharmacists provide direct patient care under a scope of practice that includes ordering and interpreting laboratory tests and providing PrEP prescriptions. To improve access and patient acceptability, we also used novel telemedicine modes of care to ensure flexible appointment scheduling. This model can be used by other federal and community-based health care organizations to implement interdisciplinary pharmacist-managed PrEP clinics and expand telehealth modalities to deliver outpatient services.

Determination of reference intervals of hemogram with advanced clinical parameters by indirect method on Sysmex XN-1000

Abstract Objectives The reference interval is the primary tool used to interpret laboratory test results. Each laboratory should determine reference intervals (RIs) that reflect their population. In this study, it was aimed to determine the RIs of hemogram routine and advanced clinical test parameters for our hospital and region by indirect method and to compare these calculated RIs with the limits recommended by the current manufacturer and the literature. Methods The hemogram results of patients aged 18–65 years who applied to Kastamonu Training and Research Hospital between July 2020 and June 2022, were included in the study. Hemogram analyzes were performed on Sysmex XN-1000 (Kobe, Japan) hematology auto analyzers. The RIs were determined by indirect method from the obtained data using the non-parametric percentage estimation method. Harris-Boyd method was used to decide on subgroup separation based on gender. Results All parameters had non-parametric distribution. RBC, HGB, HCT, MCH, MCHC, PLT, RDW-CV, RDW-SD, PCT, monocytes count, eosinophils count, monocytes % and macroR parameters which required gender-spesific RIs were determined separately for genders. Conclusions When the results are evaluated, it shows that the manufacturer’s recommendations together with the studies in the literature do not fully reflect the RIs of our population. Therefore, it is very important for each laboratory to determine its own RIs due to the differences in population, diet, technical equipment used and reference group. In addition, we think that our study will make a significant contribution to the literature, since there is insufficient data in the literature on RIs for advanced clinical parameters.

Dried blood spot reference intervals for 18 amino acids in a 1 to 6 years old pediatric cohort

ObjectivesReference intervals are indispensable for the accurate clinical interpretation of clinical laboratory tests. The reference intervals of amino acids in dried blood spots (DBS) from nonnewborn children are limited. In this study, we aim to establish the pediatric reference intervals for amino acids in DBS from healthy Chinese children aged from 1 to 6 years and to investigate the effect of sex and age. Design and MethodsIn 301 healthy subjects aged from 1 to 6 years old, eighteen DBS amino acids were determined using ultra-performance chromatography-tandem mass spectrometry method. Amino acid concentrations were examined in relation to sex and age. Reference intervals were established according to the CLSI C28-A3 guidelines. ResultsReference intervals of 18 amino acids bounded by the 2.5 and 97.5 percentiles were calculated in DBS specimen. No significant influence of age was observed for all the target amino acid concentrations in 1- to 6-year-olds. Sex differences were found in leucine and aspartic acid. ConclusionsThe RIs established in the present study added value for diagnosing and managing the amino acid-related diseases in the pediatric population.

An Improved Acid Fracturing Design through RoqSCAN Technology: A Case Study from Daniudi Gas Field in Ordos Basin, China

The concept of geological engineering-integrated fracturing is widely applied in the conventional and unconventional reservoirs, aiming to achieve efficient and economic development. There is no doubt that fine reservoir evaluation is the basis and core of geological engineering-integrated fracturing. Therefore, in this paper, we performed a series of investigations on the basis of formation fine evaluation by using RoqScan technology. Firstly, the physical parameters of the target well located in Daniudi Gas Field were evaluated by a laboratory test and logging interpretation. Next, the composition and function of the RoqSCAN tool were introduce in detail. Furthermore, the elements, minerals, and rock mechanical parameters of the target well were evaluated by the RoqSCAN tool. Finally, the fine reservoir model was established on the basis of fine formation evaluation. Moreover, we conducted a series of research on porosity and principal stress of the target formation to compare the difference between the fine model and the conventional model. Based on the fine reservoir model, the acid-fracturing design and numerical simulation were further investigated. The results of experiments and numerical simulation mainly achieved the following findings: 1. The porosity and permeability of the target formation indicated that it was a tight, low-permeability reservoir; 2. According to the comparison of the distribution for different parameters in the target well, the modeling with fine reservoir evaluation had higher accuracy than the traditional modeling; 3. Based on the fine evaluation results, acid fracturing is recommended as a stimulation method to enhance the productivity of the target formation. This study provides an essential method for the integrated fracturing design of geological engineering.

Pathomorphology of cutaneous mastocytosis

Introduction. Mastocytosis as a result of mast cell infiltration of the skin and other organs develops at any age. The relevance of this work is determined by the lack of systematic data on the pathomorphological features of the clinical forms and types of cutaneous mastocytosis, defined by the Consensus European-American Mastocytosis Group and the WHO classification in 2016. The variability of dermatological clinical manifestations in children and adults, the difficulties in interpreting laboratory tests create a problem for verifying the diagnosis and further treatment. The aim. To determine the main pathohistological features of clinical forms and types of cutaneous mastocytosis. Material and methods. The article includes data from patients who were treated and monitored at the Moscow Scientific and Practical Center of Dermatovenereology and Cosmetology in 2019–2022. Results. The literature and own data on the characteristic pathomorphological patterns that are important for the diagnosis of mastocytosis with skin lesions in children and adults are systematized. The pathological substrate of lesions in diffuse cutaneous mastocytosis and mastocytoma was a massive infiltrate of mast cells in the papillary and reticular layers of the dermis. The histological picture in the monomorphic type of maculopapular cutaneous mastocytosis (MPCM) in children was characterized by a relatively lower density of mast cell infiltration of the papillary dermis compared to other clinical forms of mastocytosis. Also, in children, the density of mast cells in the affected skin was significantly higher compared to adults. In addition, in adults with PPCM, the papillary dermis was less infiltrated with mast cells. This confirms the opinion that the monomorphic type of MPCM in children is phenotypically similar to MPCM in adults. Conclusions. Further prospective follow-up of patients may allow conclusions to be drawn about the prognostic value of pathological examination in mastocytosis in adults and children.

Potentials and pitfalls of ChatGPT and natural-language artificial intelligence models for the understanding of laboratory medicine test results. An assessment by the European Federation of Clinical Chemistry and Laboratory Medicine (EFLM) Working Group on Artificial Intelligence (WG-AI).

ChatGPT, a tool based on natural language processing (NLP), is on everyone's mind, and several potential applications in healthcare have been already proposed. However, since the ability of this tool to interpret laboratory test results has not yet been tested, the EFLM Working group on Artificial Intelligence (WG-AI) has set itself the task of closing this gap with a systematic approach. WG-AI members generated 10 simulated laboratory reports of common parameters, which were then passed to ChatGPT for interpretation, according to reference intervals (RI) and units, using an optimized prompt. The results were subsequently evaluated independently by all WG-AI members with respect to relevance, correctness, helpfulness and safety. ChatGPT recognized all laboratory tests, it could detect if they deviated from the RI and gave a test-by-test as well as an overall interpretation. The interpretations were rather superficial, not always correct, and, only in some cases, judged coherently. The magnitude of the deviation from the RI seldom plays a role in the interpretation of laboratory tests, and artificial intelligence (AI) did not make any meaningful suggestion regarding follow-up diagnostics or further procedures in general. ChatGPT in its current form, being not specifically trained on medical data or laboratory data in particular, may only be considered a tool capable of interpreting a laboratory report on a test-by-test basis at best, but not on the interpretation of an overall diagnostic picture. Future generations of similar AIs with medical ground truth training data might surely revolutionize current processes in healthcare, despite this implementation is not ready yet.

A journal as a mirror of continued progress in internal medicine. A century of <i>Polish Archives of Internal Medicine</i>

Internal medicine emerged as a new medical specialty in the second half of the 19th century. It was based on a novel diagnostic and therapeutic paradigm, and included pathophysiologic interpretation of physical examination, laboratory tests, and imaging techniques, in contrast with previous descriptive approach to clinical problems. Professor Edward J. Sas-Korczyński in 1891 proposed to organize Polish meetings on internal medicine. The proposal was implemented only in 1906 by Antoni W. Gluziński, a famous Polish internist. Despite obstacles set by the partitioning powers, the Society of Internists of the Polish Lands was founded. The name of the association was changed to the Polish Society of Internal Medicine during the congress held in Vilna (now Vilnius) in 1923, the first one organized in the independent Poland. The journal of the Society, Polish Archives of Internal Medicine, was founded and Antoni W. Gluziński was its first editor-in-chief. Later, the journal was edited by Władysław Janowski, Witold E. Orłowski, Andrzej Biernacki, Tadeusz Orłowski, Artur Czyżyk, and Anetta Undas. Witold E. Orłowski was a father of modern Polish internal medicine, and contributed to the development of its subspecialties and their societies. Most of them had roots in the specialist sections of the Polish Society of Internal Medicine. The journal supported the newly founded societies by publication of issues focused on selected subspecialties. Despite the development of subspecialties, the role of internal medicine as a holistic discipline covering the diagnosis and therapy of many organs does not decrease.

Review on Diagnosis and Management of Cauda Equina

Disorders of the cauda equina are etiologically and physically connected to the neuromuscular system in the spinal cord. A thorough history and neurological examination are necessary for clinical recognition of a cauda equina-affecting condition, and to make a rapid diagnosis, the selection and interpretation of relevant neuroimaging investigations, neurophysiologic testing, and laboratory tests are necessary. The diagnosis and treatment of Cauda Equina Syndrome (CES) are difficult. It could app

S3276 A Rare Case of Non-Small Cell Lung Cancer Causing False Positive Hepatitis B Surface Antigen

Introduction: Hepatitis B surface antigen (HBsAg) is a protein on the surface of HBV which can be a distinctive serological marker of acute or chronic hepatitis B infection. We present a case of 74-year-old male with a false positive HBsAg test. Case Description/Methods: A 74-year-old African American male with medical comorbidities of stage IV non-small cell lung cancer (NSCLC) and HTN presented to the hospital for an acute kidney injury with proteinuria. Hepatitis B virus (HBV) panel was obtained and revealed positive HBsAg. HBsAg was previously negative two years prior. Patient had multiple risk factors for hepatitis B infection including prior use of IV cocaine and multiple sexual partners. The patient denied any recent vaccinations. Liver function tests were normal. Physical examination did not reveal chronic liver disease manifestations. HBs Antibody (HBsAb) was positive with a quantitative value of 0.53. Hepatitis B core immunoglobulin M (HBc IgM), HBcAb total, HBeAg, HBeAb were all negative with undetectable serum HBV DNA. The HBsAg was not confirmed as a true positive after repeat testing with an antibody neutralizing procedure involving a human antibody to HbsAg. Discussion: Accurate interpretation of laboratory tests is imperative in diagnosing hepatitis B. There was high suspicion that patient had false positive HBsAg. The patient’s serological profile did not fit acute or chronic hepatitis B. The patient had no evidence of acute hepatitis B with negative HBc IgM, HBV DNA and no evidence of chronic hepatitis B with HBcAb total being negative. Furthermore, a positive HBsAb is not seen in acute and chronic hepatitis B. Transient HBsAg has been seen in patients for up to 2 weeks after HBV vaccination, however, our patient had not been vaccinated recently. The most common cause is the presence of heterophile antibodies. These naturally occurring human antibodies can bind to a variety of chemical structures including animal antibodies seen in immunochemistry assays. They can be neutralized by specific inactivating binders. Other viral infections such as Epstein-Barr Virus (EBV), transfusions, or systemic disease can cause false positives. A likely suspect was the patient’s NSCLC causing a paraneoplastic syndrome which would be the first instance of such in the literature. There have been cases of parathyroid adenoma and basal cell carcinoma causing false positivity. Patients with false-positive HBsAg need further workup to prevent misdiagnosis and potentially harmful management.