Clinical laboratory最新文献

Background: This study aimed to assess the effect of vitamin D insufficiency or deficiency in early pregnancy on the Homeostasis Model Assessment of Insulin Resistance (HOMA-IR) in women with gestational diabetes mellitus (GDM) and to determine the correlation between HOMA-IR and pregnancy outcomes.

Methods: General clinical data, HOMA-IR, β-Cell function index (HOMA-β), and pregnancy outcomes were retrospectively analyzed in 248 GDM patients with vitamin D insufficiency and 81 GDM patients with vitamin D deficiency from September 2019 through April 20, 2023. The correlation between vitamin D and HOMA-IR was analyzed using multiple linear regression.

Results: Vitamin D-deficient GDM patients had reduced insulin sensitivity (i.e. increased HOMA-IR). Using a median HOMA-IR of 2.78 as the threshold, the incidence of preterm birth events in the cohort above the threshold was 11.90% (20/168), which was statistically different from that of the cohort below the threshold (p = 0.013). Women with GDM who had a vitamin D deficiency and had a HOMA-IR greater than 2.78 had higher rates of preterm labor (23.40%, 11/47) and transport to the neonatal intensive care unit (NICU) (21.74%, 10/46) than patients with vitamin D insufficiency (both p < 0.05). Multiple linear regression analysis showed a negative correlation between 25(OH)D and HOMA-IR (β, 95% CI: -0.14 (-0.18 - -0.10), p < 0.001), and the adjusted model was significant (β, 95% CI: 3.82 (1.61 - 6.04), p < 0.001).

Conclusions: Vitamin D deficiency is associated with reduced insulin sensitivity in women with GDM. GDM women with higher HOMA-IR and vitamin D deficiency are at an increased risk of adverse pregnancy outcomes.

Background: Although several chimeric antigen receptor T cells (CAR T) targeting CD19 are curative for patients with relapsed/refractory(R/R) B-cell lymphoma, but the clinical safety and efficacy of this CAR T therapy remain unclear. The risk of secondary malignancies, especially myeloid neoplasms, is of particular concern in the CAR T therapy.

Methods: A patient with R/R follicular lymphoma was diagnosed with secondary myelodysplastic syndrome (s-MDS) after CD19 CAR T therapy. We also provided a review of recently published literature concerning the risk of secondary myeloid neoplasms (SMN) following CAR T therapy.

Results: The patient had secondary MDS after CD19 CAR T therapy. She received active treatment for nearly one year and then she died.

Conclusions: The case illustrated the onset and progression of SMN after CD19 CAR T therapy in patients with R/R B-cell lymphoma and provides useful information of this uncommon later event.

Background: Neonatal pneumonia is a common and serious infectious disease in the neonatal period, particularly affecting preterm, low birth weight, and immunodeficient neonates, and poses a significant threat to their life and health. Finding convenient, reliable, and minimally invasive biomarkers is a key focus of clinical research. This study investigated the clinical value of the neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and systemic inflammatory index (SII) in the early diagnosis of neonatal pneumonia.

Methods: In this study, we retrospectively analyzed the clinical data of 322 patients with neonatal pneumonia diagnosed at our hospital from January through December 2023 and selected 80 healthy neonates from the same period as a control group. The severity of pneumonia was assessed using the Downes score, and general data and laboratory findings of the patients were collected and compared. Spearman's correlation analysis was used to explore the relationship between disease severity and each index, while multifactorial logistic regression analysis was employed to investigate the influencing factors. The value of NLR, PLR, and SII in the early diagnosis of neonatal pneumonia was evaluated using the receiver operating characteristic curve.

Results: Neutrophil count (NEU), platelet count (PLT), C-reactive protein (CRP), interleukin-6 (IL-6), NLR, PLR, and SII were significantly higher in the pneumonia group compared to the control group (p < 0.05). Correlation analysis showed that the Downes score positively correlated with NEU, PLT, NLR, PLR, SII, CRP, and IL-6 (p < 0.05). Multivariable logistic regression analysis indicated that PLR, CRP, and IL-6 were independent risk factors for the development of neonatal pneumonia (p < 0.05). The area under the curve (AUC) for diagnosing neonatal pneumonia was 0.770 for NLR, 0.805 for PLR, and 0.807 for SII.

Conclusions: PLR and SII have high diagnostic efficacy in the early diagnosis of neonatal pneumonia, while PLR, CRP, and IL-6 may be independent risk factors for neonatal pneumonia.

Background: Although they are declining, diarrheal diseases remain a significant cause of mortality. Rotavirus is reported to be the most important cause of severe diarrhea in children under the age of five in the prerotavirus vaccine era. This study aimed to determine the rotavirus positivity in diarrheal children in our region and examine the age distribution and seasonality of rotavirus to contribute to epidemiological studies.

Methods: A total of 18,847 stool samples were collected from pediatric patients (0 - 18 years) who presented with diarrhea at the Department of Medical Microbiology, Istanbul University, Istanbul Faculty of Medicine, between March 2011 and December 2021. These samples were examined for rotavirus antigen positivity using a commercial immunochromatographic kit.

Results: Rotavirus antigen was detected in 2,353 (12.5%) of the samples. The positivity rates for 2011 - 2021 were 14.9%, 16.1%, 13%, 9.9%, 12.3%, 10.3%, 9.1%, 7.9%, 22.1%, 10.6%, and 12.6%, respectively. Rotavirus seasonality analysis revealed that the season starts in November and ends in May, with the highest rates in March (20.5%) and February (19.9%). The highest positivity rate (41.8%) was found in the 1 - 2 years age group.

Conclusions: Rotavirus remains a leading cause of gastroenteritis in children in Turkey. Monitoring rotavirus epidemiology is crucial, especially for countries without rotavirus vaccines in their national immunization programs.

Background: This study aimed to investigate the correlation between early thrombelastography (TEG) and serum Homer1 with hemorrhagic transformation (HT) after intravenous thrombolysis (IVH) in acute ischemic stroke (AIS).

Methods: This prospective cohort study was conducted from January 2021 to December 2023. TEG parameters and serum Homer1 levels were measured after IVH treatment. Baseline clinical factors were constructed using multifactor logistic regression analysis (Model 1). Subsequently, TEG parameters and serum Homer1 were incorporated into Model 1 to construct Models 2 and 3, respectively, for predicting HT after AIS. The predictive value of the three models was evaluated by using ROC curves.

Results: A total of 221 patients with AIS (40 cases with HT and 181 cases without HT) and 40 controls were included in this study. Reaction time of blood coagulation (R) was significantly higher in the HT group (6.65 vs. 5.50) than in the non-HT group (p < 0.001). Maximal amplitude (MA) was significantly lower in the HT group (61.28 vs. 64.94) than in the non-HT group (p < 0.001). Serum levels were significantly higher in AIS patients (20.73 vs. 38.43) than in controls (p < 0.001). Serum Homer1 levels were higher in patients in the HT group (54.35 vs. 37.43) than in non-HT patients (p < 0.001). Baseline NIHSS, prolonged coagulation reaction time R, and increased serum Homer1 levels were risk factors for post-thrombolytic HT in patients with AIS, whereas elevated Hgb was a protective factor. Both the construction of a model to predict the risk of post-thrombolytic HT in pa¬tients with AIS using clinical factors and the combination of clinical factors with TEG parameters (or serum Homer1) had similar predictive value (p < 0.05).

Conclusions: Measurement of TEG parameters and Homer1 levels in patients with AIS early after IVH may be a potentially useful, relatively rapid, and minimally invasive method for predicting the risk of HT in patients with AIS.

Background: Polycythemia vera (PV) and chronic lymphocytic leukemia (CLL) are distinct hematological malignancies. While their coexistence is rare, it poses unique diagnostic and therapeutic challenges.

Methods: A 50-year-old male patient presented with elevated hemoglobin levels and a marked lymphocytosis. Diagnostic investigations revealed the presence of both PV and CLL. The patient received treatment for PV followed by CLL.

Results: Initial treatment with hydroxyurea for PV led to progression of CLL. Subsequent treatment with rituximab and venetoclax effectively managed CLL, although the JAK2V617F mutation re-emerged.

Conclusions: This case highlights the potential for independent origins of myeloid and lymphoid neoplasms. Further research is needed to understand the interplay between these two malignancies and optimize their management.

Background: Effective blood transfusion services rely heavily on comprehending the distribution of blood antigens among populations. Saudi Arabia's unique genetic and evolutionary influences require thorough comprehension of these antigen frequencies as they are crucial for patient care. This systematic analysis aimed to explore the frequencies of Rh and Kell blood group antigens across various regions of Saudi Arabia.

Methods: An exhaustive literature search was conducted using PubMed, Embase, and the Cochrane Library, focusing on studies from 2019 through 2024 that report Rh and Kell blood antigen frequencies within the Saudi population.

Results: Analysis of seven selected studies provided data from locales including Samtah, Jazan, Hail, Riyadh, the Eastern region, Taif City, and Najran. The DCcee (R1r) Rh phenotype was the most prevalent throughout these regions. However, the frequencies of individual Rh (D, C, E, c, e) and Kell (K) antigens demonstrated regional variability. Notably, the K antigen was found to be less common in Jazan compared to other regions. The observed variations in antigen frequencies suggest that factors beyond geography may influence the distribution of Rh and Kell blood groups. Comprehending these findings is critical for enhancing blood transfusion services, including refining donor recruitment strategies, managing blood inventory, and developing personalized transfusion protocols. Additionally, understanding similarities and variations is essential for managing pregnancies affected by Rh incompatibility and improving care for patients with conditions like sickle cell disease that require frequent transfusions. Further investigation is needed to explore the underlying causes of regional similarities or variations.

Conclusions: Further studies are necessary to investigate the genetic and environmental factors influencing the regional similarity and differences in blood group antigen frequencies. Expanding the scope of data collection throughout Saudi Arabia is also imperative to provide a comprehensive understanding that supports optimal transfusion practices and enhanced healthcare outcomes.

Background: Diabetes mellitus (DM) is a chronic metabolic disorder characterized by high blood glucose levels, leading to severe complications over time. Diabetic ketoacidosis (DKA) is a critical acute complication of DM marked by hyperglycemia and acidosis due to ketone body accumulation, often seen in younger patients. The pathophysiology involves insulin deficiency and the effects of counter-regulatory hormones, leading to increased gluconeogenesis and lipolysis. This study investigated the relationship between urine netrin-1 and β-hydroxybutyrate (β-OHB) levels in DKA patients.

Methods: The study included 40 patients diagnosed with DKA and 40 healthy controls. Urine samples were collected, centrifuged, and stored at -80℃. Netrin-1 and β-OHB levels were measured using BTlab quantitative ELISA kits. Data were analyzed using SPSS, with tests for normality and appropriate statistical comparisons conducted.

Results: No significant demographic differences were found between the patient and control groups. Urine ketone and glucose positivity were significantly higher in DKA patients. Blood glucose, urea, lactate, and metabolic acidosis markers were also elevated in DKA patients. No significant difference was found in urine β-OHB and netrin-1 concentrations between the groups. However, a moderate positive correlation between β-OHB and netrin-1 was observed, along with various significant correlations between these markers and other biochemical parameters.

Conclusions: This study highlights significant biochemical differences between DKA patients and healthy controls, emphasizing the importance of monitoring biochemical parameters for managing DKA. Although no significant differences in urine β-OHB and netrin-1 concentrations were found, their correlation suggests a potential role in DKA pathophysiology, warranting further research with larger sample sizes.

Background: Anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) is a group of autoimmune diseases including granulomatous polyvasculitis (GPA), microscopic polyvasculitis (MPA), and eosinophilic granulomatous polyvasculitis (EGPA). The main antigens ANCA targets are protease 3 (PR3) and myeloperoxidase (MPO). PR3-ANCA is mainly related to GPA, while MPO-ANCA is related to MPA. The presence of these antibodies is critical to the diagnosis of AAV.

Methods: A case of ANCA-associated vasculitis with PR3 and MPO antibody positive due to PTU was reported.

Results: After the patients stopped PTU, PR3 antibody gradually decreased to negative, MPO antibody was relatively stable, and the fluorescent karyotype was p-ANCA. The positive PR3 antibody in this patient was considered to be related to PTU.

Conclusion: ANCA, anti-PR3 antibody, and anti-MPO antibody are closely related to systemic vasculitis and are affected by many factors. Abnormal results in clinical work should be reviewed immediately and communicated with clinicians to avoid adverse consequences.

Background: We identified two cases of Omicron BA.5.2.1 that exhibited characteristics of open-reading frame 1a (ORF1a) gene target failure (OGTF) in RNA detection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The purpose of this study was to determine the cause of the OGTF in the two samples.

Method: Samples were specimens obtained from a 37-year-old male and a 43-year-old female who were suspected to have Coronavirus disease 2019. SARS-CoV-2 RNA detection using μTAS Wako g1 system (FUJIFILM Wako Pure Chemical, Osaka, Japan) was performed and it detected S gene but did not detect ORF1a gene.

Results: The results of whole genome sequencing of these samples showed that SARS-CoV-2 genome in these two samples matched to Omicron BA.5.2.1. SARS-CoV-2 genomes in the two samples had a deletion of 15 bases and a deletion of 9 bases, so that they overlapped with the 3'-terminal side of the primer binding region in ORF1a gene, and these deletions were considered to be the cause of OGTF.

Conclusions: Since such a gene target failure due to base deletion is not considered rare, it was considered desirable to implement a multi-target detection in SARS-CoV-2 RNA molecular diagnostic system to address the mutation or deletion of the viral gene.