Routine Laboratory Research Articles

A Pilot Study to Evaluate an International Normalized Ratio-Derived Formula in Combination with Heparin-Calibrated Anti-Xa Activity in Calculating a Plasma Edoxaban Level

Introduction: A drug-specific chromogenic assay is not immediately available, so it hampers the treatment of patients who present in a clinical emergency. In this pilot study, we aimed to create a formula to predict a plasma edoxaban level based on the international normalized ratio (INR) and heparin-calibrated anti-Xa activity and derive a novel workflow for routine laboratory diagnosis. Method: Forty-two patients prescribed edoxaban were recruited and randomized to a testing or validation cohort. Plasma levels from the testing cohort were used to create a prediction formula that was then validated in a validation cohort and real-world clinical requests. Results: The INR-derived formula had high sensitivity (95.8–100%) to predict the plasma edoxaban level > 50 ng/mL and >100 ng/mL but with low specificity. However, the specificity of predicting the plasma edoxaban level of ≥100 ng/mL was 100% by using an INR ≥ 1.5 as cut-off. Heparin-calibrated anti-Xa-derived formula had a high sensitivity (90.9–100%) and specificity (93.8–100%) in real clinical situations. A two-tier approach of combining INR-derived and heparin-calibrated anti-Xa-derived formulae can overcome the low specificity and utilize the advantages of wide availability and a short turnaround time of the INR-derived formula. Conclusions: Both INR-derived and heparin-calibrated anti-Xa-derived formulae can be applied to calculate the plasma edoxaban level. A two-tier workflow of combining these two formulae greatly helps streamline the treatment of patients prescribed edoxaban who present in a clinical emergency. Adoption of this framework is feasible for routine diagnostic laboratories.

Cardiac Biomarkers Predict Major Adverse Cardiac Events (MACE) in Incident Haemodialysis Patients: Results from a Global Federated Database

Background: Despite its many advantages, haemodialysis (HD) has been shown to be associated with significant cardiovascular events, especially in patients commencing HD. Currently, there is no specific method to risk-stratify incident HD patients. Blood-based biomarkers provide insight into myocardial injury and stress. We aimed to evaluate the association of increased circulating biomarker concentration in incident HD with incident major adverse cardiac events (MACE). Methods: This was a retrospective cohort study of incident haemodialysis cases within 3 months of treatment initiation (≥18 years) from the TriNetX database. Cohorts were grouped by biomarker thresholds: Troponin I: ≥50 ng/L, BNP ≥ 100 pg/mL and 1:1 propensity-score matched for demographic characteristics, baseline cardiovascular risk, laboratory values, and cardiovascular medication. Primary outcome: Incidence of major adverse cardiac events (MACE) censored prior to index event of HD. Secondary outcome: Risk of each individual component of the composite outcome. Cox regression reported hazard ratios (95% CI) for the outcomes. Results: In total, 62,206 and 10,476 patients were included in the troponin I and BNP cohorts, respectively. In the troponin I cohort, 5878 developed MACE (HR 1.33 (95% CI 1.26–1.41, p < 0.0001)). In the BNP cohort, 1050 developed MACE (HR 1.28 (95% CI 1.13–1.44, p < 0.0001)). Conclusions: In incident HD, routine clinical laboratory biomarkers can predict incident MACE. The results suggest the clinical need for CV mortality and morbidity risk profiling in incident HD using a combination of clinical and laboratory variables.

Computational Challenges and Experimental Validation of the Flexural Behaviour of RC Beams Using the Nonlinear 3D Finite Element Analysis by the Damage Plasticity Model in Abaqus: a Guidance Study

Statement of the problem. Due to the remarkable development of the reinforced concrete (RC), there is a growing need to rely on the finite element analysis (FEA) and numerical analysis, specifically with complicated phenomena (as nonlinearity and failure) that are hard to clarify experimentally. Results. This study tackles both the finite element analysis and the numerical one to extend a valuable supplement to the behavioral laboratory study besides approving the theoretical calculations. Thus, the 3D finite element simulation was conducted with the suitable modeling elements types, size, and the corresponding constitutive model using the well-known structural analysis package ABAQUS. The material parameters of the concrete damage plasticity (CDP) model in ABAQUS were validated based on the test results of simply supported two beams tested under four-point loading taken from the open literature and the numerical results were compared with the experimental values. In terms of a load-deflection response, the results of both the experimental and the numerical studies show good agreement. In terms of crack patterns, a good agreement between the two models was also observed. The concrete damaged plasticity model is capable of predicting the ultimate load capacity and the formation of the concrete cracks in RC beams against any kind of loads. Conclusions. Therefore, the CDP model is a versatile tool for modeling RC structures and meticulous choice of solution procedures in order to obtain an accurate modeling using a few routine laboratory test results of the materials. While analyzing the beams structurally, it was proved that the suggested model exhibited an excellent approximation to the projects of reinforced concrete beams.

3D visualization of human colon tissue using a modified CUBIC-based tissue-clearing technique

Background: Colorectal cancer represents one of the most common neoplastic diseases worldwide, making it a frequent focus in routine pathological analyses. Visualizing complex three-dimensional (3D) structures, such as nerves within tumors, requires thick tissue sections, which necessitates the use of optical tissue-clearing methods to achieve transparency. However, following tissue clearing, samples typically require advanced imaging techniques such as light-sheet and two-photon confocal microscopy, which are usually unavailable in standard histological laboratories. Objective: We aimed to demonstrate how a well-established tissue-clearing approach can be adapted for use in a routine histological laboratory, enabling a robust 3D visualization of nerve fibers in samples of both normal human colon and colon cancer tissues. Methods: We modified the “clear unobstructed brain/body imaging cocktails” method, originally developed for whole-brain imaging in mice, and applied it to human colon tissue samples measuring approximately 10 mm3, a standard size typically processed in pathological laboratories. Results: Our protocol, which integrates a tissue-clearing technique, enabled reliable immunofluorescent visualization of colonic nerve fibers labeled with anti-β3-tubulin antibodies. The labeled nerve fibers could be observed using a standard epifluorescence microscope, and high-quality 3D reconstructions were generated through a simple image analysis approach using the open-source software ilastik, which eliminates the need for confocal microscopy. Conclusion: The proposed steps provide a valuable method for researchers to visualize complex 3D structures, such as neural cells and processes, in both normal and tumor-transformed tissue settings.

Effect of endoscopic sinus surgery on eustachian tube function in adult patients with chronic rhinosinusitis

BackgroundChronic rhinosinusitis (CRS) is a frequent chronic heterogeneous inflammatory disease of the upper airways and paranasal sinuses persistent for ≥ 12 weeks causing considerable healthcare expenses and reduction of patients’ quality of life due to severe tiredness and disappointment as well as diminished cognitive function. CRS is commonly associated with eustachian tube (ET) dysfunction.Aim of the studyTo evaluate the effect of endoscopic sinus surgery on ET function in the form of (tympanogram, Valsalva maneuver, and total ET dysfunction questionnaire score), in adult patients with CRS.MethodThis non-randomized clinical trial study was conducted at the Otorhinolaryngology department, the Faculty of Medicine, Cairo University, on 40 patients > 18 years old, suffering from CRS with or without sinonasal polyposis who are indicated for endoscopic sinus surgery (ESS) and were recruited from Otorhinolaryngology department’s outpatient clinic in the period from November 2022 to June 2023. All selected patients were subjected to a full history taken, a full general examination, and a local otorhinolaryngology examination. Routine preoperative laboratory investigation including complete blood count (CBC), liver and kidney function tests, and coagulation profile. An electrocardiogram (ECG) examination was done routinely for all patients above 40 years old. Radiological examination included the following: preoperative CT nose and paranasal sinus, axial and coronal soft tissue cuts, and bone windows. Assessment of ET function was done using the ET dysfunction questionnaire (ETDQ-7), Valsalva maneuver, and tympanogram. ET function was reevaluated 6 weeks post-operative in the form of an ETDQ-7, Valsalva maneuver, and tympanogram.ResultsThe ages of selected patients ranged from 21 to 45 years old with mean ± SD = 30.98 ± 10.24 years old. 52.5% of patients were males. Our results showed a statistically significant postoperative improvement in the Valsalva maneuver and the tympanogram type of both ears compared to preoperative with a p-value < 0.001. Similar results were found regarding the assessment of ET function using ETDQ-7 items and the total score (15.35 ± 4.92 vs 26.12 ± 7.79 respectively) with p-value < 0.001.ConclusionA significant improvement in ET function in the form of tympanogram, Valsalva maneuver, and total ET dysfunction questionnaire score, following endoscopic sinus surgery in adult patients with CRS with or without sinonasal polyposis.

Cord blood utilization as a blood conservation measure in the neonatal intensive care unit

Cord blood utilization as a blood conservation measure in the neonatal intensive care unit

Simultaneous radionuclide determination using PSresin: 2in2 and 2in1 tandem configuration.

Analyzing mixtures of radionuclides is a complex task. Two situations are the mixtures of 89Sr with 90Sr and 90Sr with plutonium isotopes. The challenge arises in emergency scenarios resulting from accidents where the activity of 89Sr is over 20 times higher than that of 90Sr, complicating its quantification and requiring delayed measurements. In scenarios involving accidents, both 90Sr and plutonium isotopes, may be present within various matrices. Given their distinct elemental properties, separation is typically achieved using different methods, followed by a measurement post-elution through alpha spectrometry and scintillation techniques. Therefore, methods which allow the fast and reliable determination of those mixtures are still required in routine laboratories. A novel method for the simultaneous determination of radionuclide mixtures using PSresin is introduced. This innovative approach utilizes PSresins in tandem and has been applied to the analysis of 89Sr and 90Sr, as well as mixtures of 90Sr and plutonium isotopes. Two strategies were investigated: using two PSresin in two cartridges and two measurements (2in2); and using two PSresin in a single cartridge and one measurement employing α/β discrimination (2in1). The methods were validated with standard solutions and applied to river water samples, achieving quantification errors below 10% for both strategies within 5 and 8h, respectively, from sample reception. This represents a great improvement for 89Sr and 90Sr quantification which is achieved in less than 5h since sample reception reducing the 30 days required by conventional methods. Additionally, the simultaneous measurement of 90Sr and plutonium isotopes reduce the number of required analysis to half, reducing the overall time and cost of the analysis.

Diagnosis of myelodysplastic syndromes: the classic and the novel.

The myelodysplastic syndromes (MDS) are a heterogenous group of clonal bone marrow (BM) stem cell myeloid neoplasms, characterized by BM dysplasia, macrocytic anemia or cytopenia with a tendency for leukemic transformation. The suspicion of MDS is raised by a typical but not specific clinical picture and routine laboratory findings, but the gold standard for the diagnosis of MDS is still BM examination with the presence of uni-or multi-lineage dysplasia and blast percentage, together with exclusion of other reasons. Cytogenetics is also a part of the diagnostic process. Flow cytometry and genetics are helpful but are not always mandatory for the diagnosis of MDS. This review summarizes the current steps in the diagnostic approach for a patient suspected of having MDS. We also describe new concepts that use non-invasive diagnostic technologies, especially digital methods as well as peripheral blood genetics. The hope is that one day these will mature, be introduced into clinical practice, and perhaps in many cases even replace the invasive BM biopsy.

P53 immunohistochemistry staining is a rapid screening method for TP53 mutation in myeloid malignancies suitable for integration into routine diagnostic laboratory practice

p53 immunohistochemistry staining is a rapid screening method for TP53 mutation in myeloid malignancies suitable for integration into routine diagnostic laboratory practice

Development and Validation of a Novel Model to Discriminate Idiosyncratic Drug-Induced Liver Injury and Autoimmune Hepatitis.

Discriminating between idiosyncratic drug-induced liver injury (DILI) and autoimmune hepatitis (AIH) is critical yet challenging. We aim to develop and validate a machine learning (ML)-based model to aid in this differentiation. This multicenter cohort study utilised a development set from Beijing Friendship Hospital, with retrospective and prospective validation sets from 10 tertiary hospitals across various regions of China spanning January 2009 to May 2023. Different ML algorithms were tested using 24 routine laboratory parameters. The Shapley Additive exPlanations (SHAP) analysis was used to evaluate the contribution of each parameter in the ML model. A total of 2554 patients (1750 for DILI and 804 for AIH) were included. Using Gradient Boost Decision Tree algorithm, five key parameters-aspartate transaminase, globulin, prealbumin, creatinine and platelet count-were selected to construct the ML model. Consequently, a web-based tool named Beijing-AID (BJ-AID) was developed (http://43.143.153.225:5000/). The BJ-AID model demonstrated excellent discrimination performance, with an area under the receiver operating characteristic curve (AUROC) of 0.94 (95% CI, 0.902-0.975) in the development set, 0.91 (95% CI, 0.900-0.928) in all external validation sets and 0.93 (95% CI, 0.889-0.974) in a prospective validation set. Notably, the BJ-AID model also effectively discriminated atypical cases, including drug-induced autoimmune-like hepatitis and AIH with the history of drug consumption, achieving an AUROC = 0.85 (95% CI, 0.742-0.949). We successfully developed and validated a machine learning-based model, BJ-AID, which exhibits a strong discrimination performance. BJ-AID can assist practitioners and hepatologists in diagnosing both typical and atypical cases of DILI and AIH. ClinicalTrials.gov identifier: NCT05532345.

Bone Densitometry Parameters in Females with Ehlers–Danlos Syndrome—Does the Hypermobile Subtype Increase the Risk of Low Bone Mass in Patients with Ehlers–Danlos Syndrome?

Background: The purpose of this study was to assess bone densitometry parameters in patients with classical and hypermobile Ehlers–Danlos syndrome (EDS) and to determine whether the hypermobile subtype increases the risk of low bone mass, which is particularly important in this patient group, since the genetic mutation responsible for this subtype is still unknown. Material and Methods: In order to conduct this study, we collaborated with the EDS society in Poland. A total of 30 females of reproductive age who were included in the study were divided into two groups: Group 1—those with classical EDS (n = 9) and Group 2—those with hypermobile EDS (n = 21). Routine laboratory test results, bone turnover markers, and densitometry parameters were evaluated and compared. Results: The study groups showed no differences in terms of densitometry parameters or markers of calcium–phosphate metabolism. A multivariate logistic analysis demonstrated no increase in the risk of low bone mass (defined as a Z-score lower than -2) in patients with hypermobile EDS (OR 0.067 [95% Cl 0.0–20.927]; p = 0.356). Conclusions: The hypermobile subtype of EDS does not increase the risk of low bone mass; there were no significant differences between patients with hypermobile EDS and those with classical EDS in terms of either densitometry parameters or markers of calcium–phosphate metabolism. Although patients with hypermobile EDS are not at a higher risk of developing low bone mineral density, they should be regularly monitored for any calcium and phosphate metabolism abnormalities.

Unveiling mycobacterial infections in Brazilian swine: Insights from epidemiological and diagnostic studies.

Stringent sanitary standards are imperative for swine production, ensuring high biosecurity and safe meat. However, granulomatous lesions, often detected as "lymphadenitis" in slaughterhouses, lack routine laboratory examination, potentially overlooking tuberculosis among other etiologies. This study aimed to: (i) explore epidemiological variables linked to swine carcasses condemned due to "tuberculosis" or "lymphadenitis" in Rio Grande do Sul, southern Brazil in a retrospective survey; and (ii) evaluate the frequency of Mycobacterium tuberculosis in granulomatous lymphadenitis lesions. Epidemiological data from the public surveillance system including farm origin, slaughter location, season, producer type and the inspection scope, were evaluated by their association with the occurrence of animal transport guides (ATG) with at least one animal condemned due to lymphadenitis or tuberculosis. For the prospective study, tissue samples from 118 animals with granulomatous lymphadenitis lesions were examined through histopathology and bacterial isolation. The frequency of ATG with at least one carcass condemned due to lymphadenitis or tuberculosis was 2.27 % and 0.027 % respectively. The factors associated with lymphadenitis were slaughter location, origin, producer type, and inspection scope (state or municipal). However, no significant risk factors emerged for tuberculosis in multivariable analysis. Histopathology confirmed granulomatous lymphadenitis in 44.92 % of lymph nodes, and M. tuberculosis var. bovis was isolated in 2.54 % of cases. Although the tuberculosis frequency (0.002 %) was low, it surpassed federal inspection data (<0.001 %), evidencing that laboratory diagnosis should be considered in such lesions. This study underscores the need for improved diagnostic routine in slaughterhouses to enhance biosecurity and public health protection in the swine industry.

Coagulation Profile of Convalescent Plasma Donors and Recipients.

Convalescent plasma (CP) therapy for COVID-19 infection may have favorable safety but varying efficacy, with concerns about its procoagulant impact. We investigated whether administration of CP to hospitalized patients affects their coagulation profile. Fifty-four patients randomized in a double-blinded fashion received either placebo, low-titer CP (LCP) or high-titer CP (HCP). Donor blood samples were obtained at the time of the plasmapheresis, while recipient blood samples were collected before infusion, one day post-infusion and between two and six days after infusion. Routine laboratory follow-up, coagulation biomarkers, antiphospholipid antibodies, and thrombin generation (TG) were assessed. CP donors had normal blood cell counts and coagulation profiles, without differences between LCP and HCP donors at the baseline. All CP recipients were on low-molecular-weight heparin thromboprophylaxis at the time of the infusion. Despite randomization, the HCP group had lower baseline (p = 0.004) and Day 1 platelet counts (p = 0.019) than the LCP group. Von Willebrand antigen (VWF:Ag) levels clearly exceeded normal without differences at baseline. At Day 1, LCP recipients had higher VWF:Ag (mean ± SD 224 ± 15%) than HCP recipients (210 ± 8%) (p = 0.012). In all groups, overall 80% lupus anticoagulant was positive. Baseline TG variables were comparable, but again LCP recipients exhibited higher endogenous thrombin potential (ETP) (1313 ± 535 nM.min) (p = 0.038) and peak TG (184 ± 106 nM) (p = 0.037) than the HCP group (870 ± 425 nM.min and 86 ± 54 nM). Our findings show that LCP increases VWF:Ag levels and enhances TG despite the thromboprophylaxis. These results suggest that HCP induces less hypercoagulability than LCP, which may contribute to the variability in CP efficacy.

FIB-4 Index Can Predict Mortality in Hospitalized Patients with COVID-19 Infection, Independent of CT Severity Score

Background: The fibrosis 4 (FIB-4) index is typically used in assessing liver fibrosis, and has shown potential in predicting the outcome in various diseases. This study aims to evaluate the predictive power of the FIB-4 index for mortality in COVID-19 patients admitted to a reference hospital in Tehran, Iran. Methods: In this prospective cohort study, 387 patients with COVID-19 without diabetes, were categorized into deceased and surviving groups. We compared anthropometric and demographic data, liver function tests, CT scores, and FIB-4 indices between the groups. Multivariate logistic regression assessed the independent association of FIB-4 with mortality. Results: Among the 387 patients, (all non-diabetics), 58 (15%) died, with a higher mortality rate observed in patients with a FIB-4 index≥2.6 (63.4%) compared to those with FIB-4&lt;2.6 (29.7%). Deceased patients were considerably older and more likely to be hypertensive (P values&lt;0.001). After adjustment of confounding factors, a FIB-4 index≥2.6 was found to be independently associated with increased mortality (OR: 13.511, 95% CI: 1.356-134.580, P=0.026). Conclusion: The FIB-4 index, calculable by routine laboratory tests, may be a valuable prognostic factor for COVID-19 mortality. This easily obtainable marker could help identify high-risk patients early, potentially allowing for more rapid intervention and treatment prioritization.

Peripheral Inflammatory and Metabolic Markers as Potential Biomarkers in Treatment-Resistant Schizophrenia: Insights from a Qatari Cohort.

Schizophrenia presents significant diagnostic and treatment challenges, particularly in distinguishing between treatment-resistant (TRS) and non-treatment-resistant schizophrenia (NTRS). This cross-sectional study analyzed routine laboratory parameters as potential biomarkers to differentiate TRS, NTRS, and healthy individuals within a Qatari cohort. The study included 31 TRS and 38 NTRS patients diagnosed with schizophrenia, alongside 30 control subjects from the Qatar Biobank. Key measurements included complete blood count, lipid panel, HbA1c, and ferritin levels. Our findings indicated elevated body mass index (BMI) and triglyceride (TG) levels in both patient groups compared to controls. The NTRS group also showed higher HbA1c levels. Variations in inflammatory markers were noted, with the NTRS group exhibiting a higher platelet/lymphocyte ratio (PLR). Multivariate analysis highlighted significant differences in platelet count, mean platelet volume (MPV), TG, HbA1c, BMI, neutrophil/lymphocyte ratio (NLR), monocyte/lymphocyte ratio (MLR), and ferritin among the groups. Linear regression analysis revealed that MLR and clozapine treatment were significantly correlated with the severity of schizophrenia symptoms. The Random Forest model, a supervised machine learning algorithm, efficiently differentiated between cases and controls and between TRS and NTRS, with accuracies of 86.87 % and 88.41 %, respectively. However, removing PANSS scores notably decreased the model's diagnostic effectiveness. These results suggest that accessible peripheral laboratory parameters can serve as useful biomarkers for schizophrenia, potentially aiding in the early identification of TRS, enhancing personalized treatment strategies, and contributing to precision psychiatry. Future longitudinal studies are necessary to confirm these findings and further explore the role of inflammation in schizophrenia pathophysiology and treatment response.

The potential role of N-acetylcysteine as an adjuvant therapy in acute aluminum phosphide poisoning: a randomized clinical trial.

Aluminum phosphide (AP) intoxication is a life-threatening emergency with no available effective antidote. This study evaluated the efficacy and safety of N-acetylcysteine (NAC) infusion in cases of acute AP poisoning. This randomized, single-blinded, parallel-group, controlled, clinical trial enrolled 96 patients with acute AP poisoning. The patients were allocated to two groups and received either conventional treatment (control group) or conventional treatment plus NAC infusion (NAC group). The patients were subjected to full clinical evaluation, routine laboratory investigations, silver nitrate test, and evaluation of the oxidative markers, malondialdehyde (MDA) and total antioxidant capacity (TAC), at admission and after 24h treatment. The primary outcome was mortality, and the secondary outcomes were the arterial blood pressure, the length of hospital stay, and the need for intubation or mechanical ventilation. Compared to the control group, the NAC group showed significantly lower MDA (median [interquartile range (IQR)]: 4.6 [1.9-10.6] vs. 6.8 [3.5-17.4] nmol/mL, P=0.014) and higher TAC levels (median [IQR]: 0.7 [0.6-0.7] vs. 0.6 [0.6-06] mM/L, P<0.001). The mortality rate and the need for mechanical ventilation were comparable in both groups (P=0.601 and 0.505, respectively). However, the NAC group showed significant improvements of both systolic and diastolic blood pressure values (both P=0.030). The duration of hospitalization was significantly shorter in the NAC group (P=0.017). No adverse events were reported in patients who received NAC infusion. In patients with acute AP poisoning, the use of NAC mitigates oxidative stress and partially enhances clinical manifestations without inducing noticeable adverse effects.

Rapid detection of carbapenemase production in Aeromonas using phenotypic tests based on colorimetric microtube assay.

Antibiotic resistance, particularly carbapenem resistance, poses a significant global health threat due to the limited availability of effective antibiotics. Carbapenem-resistant Aeromonas are increasingly recognized for their role in various infections, necessitating rapid and accurate detection methods. This study aimed to evaluate several phenotypic tests, including the Carba NP test (CNPt), Carba NP-direct test (CNPd), and Blue-Carba test (BCT), for their effectiveness in rapidly detecting carbapenemase production in Aeromonas. These tests target both the chromosomally encoded CphA metallo-β-lactamase (MBL) and acquired carbapenemases. Additionally, a modified phenotypic test called the Colony-Carba NP test (c-CNPt) was introduced to enhance sensitivity and specificity. A retrospective analysis was conducted on 131 clinically conserved Aeromonas strains harboring identified carbapenem resistance genes, using CNPt, CNPd, BCT, and the newly developed c-CNPt and EDTA-Colony-Carba NP test (ec-CNPt). The stability of c-CNPt reagents stored at -80°C was also assessed. Additionally, a prospective study conducted from July 2021 to November 2023 evaluated 152 Aeromonas isolates to determine the clinical applicability of these tests. Our results demonstrated that CNPd and BCT achieved 100% sensitivity and specificity, surpassing the traditional CNPt, which showed only 63.6% sensitivity for Aeromonas strains. The c-CNPt also showed 100% sensitivity and specificity, with the ec-CNPt effectively differentiating between MBL and serine carbapenemase types. Stability tests confirmed that c-CNPt reagents could be stored at -80℃ for up to 1 year without performance degradation. These findings highlight the practicality and reliability of these phenotypic tests for routine laboratory use, providing a rapid and cost-effective method for detecting carbapenemase production.The rapid detection of carbapenemase production in Aeromonas is of paramount importance due to the significant clinical and public health implications associated with antibiotic resistance. The development and validation of rapid phenotypic tests such as the Colony-Carba NP test (c-CNPt) and the EDTA-Colony-Carba NP test (ec-CNPt) are crucial advancements in the field. These tests offer a highly sensitive and specific method for detecting carbapenemase production in Aeromonas, including the differentiation between metallo-β-lactamase and serine carbapenemases. The c-CNPt and ec-CNPt are cost-effective, easy to perform, and provide rapid results, making them suitable for routine clinical use. Additionally, the stability of the reagents ensures their practicality for long-term application in various healthcare settings. Implementing these phenotypic tests in clinical laboratories can significantly enhance the early detection and appropriate treatment of carbapenem-resistant Aeromonas infections.

Repeated maxillary sinusitis following sinus floor augmentation in an HIV-infected patient: A case report and literature review

A patient who underwent sinus floor augmentation (SFA) for dental implants at a local clinic was referred to our dental hospital for the treatment of maxillary sinusitis and oroantral fistula. After successfully treating them, a second SFA was performed by an experienced surgeon without any intraoperative complications. However, during postoperative follow-up, the patient developed severe maxillary sinusitis again and was referred to the Department of Otolaryngology for endoscopic sinus surgery under general anesthesia. During the preoperative assessment, routine laboratory testing revealed that the patient was positive for human immunodeficiency virus (HIV), a fact previously unknown to the healthcare providers. This case report discusses the increased risk of postoperative infection in HIV-infected patients and underscores the necessity of comprehensive pre-treatment evaluations for underlying health conditions in outpatient-based dental clinics. Additionally, a review of relevant literature is included to support these findings.

Migraine and ergot use increase plasma pentraxin 3 levels: an Egyptian study

ABSTRACT Background Endothelial dysfunction and inflammation are linked to migraine, which may contribute to atherogenesis and increase the risk of ischemia. In migraineurs, preclinical vascular involvement manifested as compromised structural characteristics of vessel wall has not received enough attention or evaluation. Objectives To measure plasma pentraxin 3 as an indicator of endothelial dysfunction in migraine in comparison to controls and to examine its correlation with clinical characteristics, headache severity, and brain magnetic resonance imaging findings. Subjects and methods This study was conducted on 40 migraineurs and 40 healthy matched control subjects. The severity and intensity of headaches were quantified using the Headache Impact Test and the translated Arabic version of Migraine Disability assessment questionnaires. Both patients and controls underwent routine laboratory assessment, brain MR imaging, and measurement of plasma pentraxin 3 level. Results Patients with migraine had a significantly higher mean plasma pentraxin 3 when compared to controls. Patients with chronic migraine and those taking ergots also had significantly higher plasma pentraxin 3 levels. Additionally, there were statistically significant positive correlation between frequency of headaches and duration of the disease with plasma pentraxin 3 level. For diagnosing endothelial dysfunction in migraine patients, the sensitivity and specificity of pentraxin 3 levels were 85% and 95%, respectively, with cut-off value of 3.100 ng/ml. Conclusion Pentraxin 3 levels could be used as a chemical biomarker for endothelial dysfunction in migraines with high sensitivity and specificity. Higher plasma levels of pentraxin 3 in patients receiving ergots may influence the selection of treatment for migraine patients.

Identifying biomarkers and establishing their threshold values concordantly with LV remodeling for predicting long-term MACE following STEMI

Abstract Background Following STEMI, diastolic function is altered by myocardial necrosis and microvascular disfunction. Consistent with these changes, the cardiac troponins are degraded and the release of cardiac natriuretic hormones inhibit the pathophysiological mechanisms responsible for ventricular remodeling (adverse diastolic remodeling, worsening of diastolic function ≥ 1 grade or persisting of restrictive pattern), thus NT-proBNP in non-acute phase of STEMI (early phase of ventricular remodeling) is a strong predictor of heart failure and mortality. Methods Prospective study population consisted of 96 consecutive patients with STEMI of onset &amp;lt;12h who underwent primary percutaneous coronary intervention (pPCI). The levels of creatine kinase (CK), the MB fraction of creatine kinase (CK-MB), troponin I, NT-proBNP, CRP, and other routine laboratory parameters were measured. In particular, we evaluated the levels troponin I on the first and seventh days (enzyme-linked immunosorbent assay (ELISA) ) and NT-proBNP in seventh day ( electro-chemiluminiscence method) after reperfusion therapy in all patients. Results The follow-up period was 12 months. Baseline clinical characteristics of patients are presented in table 1. A receiver operating characteristics (ROC) curve plots the true positive rate against the false positive rate at different cut-off points for NT-proBNP AUC=0.69 (95% CI, 0.53-0.85), p=0.012 and other biomarkers (Figure 1 and Table 2). Kaplan-Meier curves were used to show the number of MACE and the proportion of patients that survived at each even time point based on the cut-off value of NT-proBNP on the seventh day (1131pg/mL). The log-rank test for the difference in survival resulted in a p value of 0.007 (Figure 2.) In total 17 (17.7%) patients suffered from heart failure, 5 (5.2%) among patients with NT-proBNP value ≤ 1131pg/mL and 12 (12.49%) with value &amp;gt; 1131pg/mL (p &amp;lt; 0.001). Conclusions Adverse diastolic remodeling in the non-acute phase of STEMI (early phase of ventricular remodeling) were associated with high rates of MACE after STEMI, with significant variability in the NT-proBNP values.