Biochemia medica最新文献

This case report describes a patient with uric acid kidney stones. Alkalization therapy using mainly potassium citrate is the first-choice treatment. When hyperuricosuria > 4 mmol/24 hours is present, xanthine oxidase inhibitors are added. It implies that accurate urine uric acid measurement is of high importance. Uric acid was measured in a 24-hour collection and a second-morning sample. Urine uric acid was measured after sample alkalization to pH > 6.5 and heating to 56 °C for 10 minutes, and for educational reasons without sample treatment. The uric acid excretion in the sample without alkalization in the 24-hour collection was 2.436 mmol, after alkalization, the excretion was 4.650 mmol/24 hours. Sample alkalization led to a prescription for xanthine oxidase inhibitor medication that is indicated as the second-line therapy when hyperuricosuria > 4 mmol/24 hours is present. This case study shows how the correct preanalytical phase is essential for medical decision-making.

Acute abdominal pain accounts for 7-10% of all emergency department visits. Appendicitis, being one of the leading causes of acute abdominal surgery, poses significant diagnostic challenges. Negative appendectomy rates can be as high as 40%, while complications occur in more than 90% if the diagnosis is missed during the initial examination. Therefore, more effective preoperative screening is required for patients with suspected appendicitis. Recent studies suggest that novel biomarkers, particularly leucine-rich alpha 2-glycoprotein and calprotectin, may improve the early and accurate diagnosis of acute appendicitis by demonstrating high specificity and sensitivity, respectively. Unlike C-reactive protein, the production of leucine-rich alpha 2-glycoprotein 1 and calprotectin takes place at the site of inflammation. As a result, their raised concentrations might be evident early in a disease, possibly before other common markers of inflammation start to rise. This literature review aims to assess the potential role of leucine-rich alpha 2-glycoprotein 1 and calprotectin as diagnostic biomarkers in patients with suspected acute appendicitis, acknowledging the need for additional data to fully assess their diagnostic accuracy.

TriNetX, a rapidly growing global network of anonymized patient data, enables clinical researchers to perform large-scale retrospective cohort studies. However, its functionality for querying laboratory data outcomes is significantly constrained, as it only provides the results of the most recent test within a specified observation period. Consequently, the platform is not optimized for analyzing laboratory data collected at multiple time points during an observation period. This paper introduces innovative, data-informed solutions to address these limitations, offering practical guidance for researchers aiming to leverage TriNetX for examining clinical laboratory data.

Introduction: Primary Sjögren's syndrome (pSS) is a chronic autoimmune disease affecting exocrine glands and is frequently accompanied by depression and anxiety. Proinflammatory cytokines, particularly interleukin 6 (IL-6), have been implicated in the pathogenesis of both pSS and mood disorders. This study aimed to assess the association between inflammatory markers, disease activity, and psychological symptoms in patients with pSS.

Materials and methods: A cross-sectional study was conducted on 60 female patients diagnosed with pSS at Sestre milosrdnice University Hospital Center between 2019 and 2021. Depression and anxiety were evaluated using the Hospital Anxiety and Depression Scale. Inflammatory biomarkers (erythrocyte sedimentation rate, rheumatoid factor, ferritin, fibrinogen, CRP, C3, C4, IL-6) and disease activity indices (ESSDAI, ESSPRI) were analyzed. Statistical analyses, including logistic regression, were applied to determine independent predictors of depression and anxiety.

Results: Depression was detected in 39/60 of patients, while 34/60 exhibited anxiety symptoms. Patients with either depression or anxiety had significantly higher IL-6 concentration (P < 0.001 and P = 0.002, respectively). Logistic regression identified IL-6 as an independent predictor of depression (OR = 3.23, 95%CI: 1.07 - 9.80, P = 0.038), while ESSPRI fatigue was a significant predictor of anxiety (OR = 2.01, 95%CI: 1.13 - 3.58, P = 0.018).

Conclusions: The findings suggest that IL-6 could be a predictor of pSS-related depression, potentially serving as a biomarker for this extraglandular manifestation and ESSPRI fatigue as a predictor for anxiety.

This study aimed to investigate potential benefit of personalized reference intervals (prRIs) by conducting a four-month observation of a woman with SARS-CoV-2 reinfection. Two types of prRIs were calculated: one derived from the population biological variation (BV) data provided by the European Federation of Clinical Chemistry and Laboratory Medicine (EFLM) biological variation database (prRIs__pop.), and the other derived from individual variation data (prRIs__ind.). These were subsequently compared. A total of 110 test results encompassing complete blood count (CBC) and leukocyte differential counts from the case were assessed according to the limits of prRIs__pop., reference change values (RCVs__pop.) and the population-based reference intervals (popRIs). In instances where limited historical health data are available (N ≤ 3), the application of prRIs__pop. was recommended over prRIs__ind. The prRIs__pop. and RCVs__pop. identified a greater number of potential clinical pathological change compared to popRIs (the ratio of potential abnormal values to total test values: prRIs__pop. 22/110, RCVs__pop. 25/110, popRIs 2/110, respectively). The findings suggest that the use of prRIs can be advantageous in clinical settings and is worthy of broader adoption. However, it is essential to choose an appropriate calculation method tailored to the specific clinical context.

Thyroid function tests (TFTs) - thyroid stimulating hormone (TSH), total triiodothyronine (T3), total thyroxine (T4), free triiodothyronine (FT3), free thyroxine (FT4), thyroid peroxidase antibodies (anti-TPO), thyroglobulin antibodies (anti-Tg), TSH receptors antibodies (anti-TSHR), and thyroglobulin (Tg) - are used to diagnose thyroid disorders and are crucial biomarkers for monitoring and managing thyroid cancer. The 2022 national survey results revealed that thyroid function testing is not standardized among Croatian medical-biochemistry laboratories. Laboratories follow individual protocols at each testing stage, from patient preparation to result reporting. To address this, the Working group for laboratory endocrinology of the Croatian society of medical biochemistry and laboratory medicine has developed recommendations based on the latest national and international guidelines, research and the authors' expert opinion. The document aims to standardize all phases of thyroid function testing, with 7 preanalytical, 12 analytical, and 8 postanalytical recommendations, each supported by expert explanations. While primarily directed at Croatian laboratory professionals, this document is also relevant to other healthcare professionals managing thyroid-related health issues.

Introduction: Hepcidin (Hep), a key regulatory hormone of iron (Fe) homeostasis, governs its absorption and storage, and is influenced by inflammation and Fe status. This study investigated serum Hep concentrations and their associations with Fe markers and inflammation in patients with sporadic colorectal cancer (CRC).

Materials and methods: We compared serum concentrations of Hep, Fe, unsaturated and total iron binding capacity, transferrin, transferrin saturation, ferritin, C-reactive protein (CRP), interleukin-6 (IL-6) and tumor markers in 82 CRC patients and 58 controls. Statistically significant differences were tested using the Mann-Whitney U test and Student's t test. Additionally, Hep were analyzed according to tumor stage. Colorectal cancer was confirmed histopathologically after colonoscopy with biopsy (TNM staging).

Results: Colorectal cancer patients exhibited significantly lower Hep concentrations than controls (8.1 vs. 19.7 ng/mL, P = 0.020). Ferritin was also lower in CRC (109 vs. 250 µg/L, P = 0.002). Hepcidin showed the strongest positive correlation with ferritin in CRC. Inflammatory markers (CRP and IL-6) correlated moderately to weakly with hepcidin in both groups (controls: rho = 0.52 (P < 0.001); CRC: rho = 0.26 (P = 0.022) for CRP and CRC: rho = 0.30 (P = 0.033) for IL-6). Notably, Hep concentrations were lower in patients with advanced tumor stage (T0 vs. T3, P = 0.043).

Conclusion: These findings suggest that CRC is associated with lower hepcidin and ferritin concentrations, potentially reflecting complex and cancer-specific dysregulation in Fe metabolism beyond inflammation alone.

Atherosclerosis is an active interaction between lipoproteins and inflammatory cells. Monocytes and macrophages are the most important immune cells involved in the process of atherosclerosis. They interact with atherogenic lipoproteins, in particular low density lipoprotein (LDL) cholesterol and lipoprotein(a) (Lp(a)). The increased concentration of the LDL cholesterol and Lp(a) accelerates the polarization of monocytes and macrophages toward proinflammatory phenotype and the formation of the foam cells. These cells then release large quantities of inflammatory cytokines that stimulate the oxidation of atherogenic lipoproteins that are even more atherogenic and contribute to the formation of foam cells and the secretion of the pro-inflammatory cytokines, thus creating a vicious circle. Surface marker C-C chemokine receptor type 2, expressed on monocytes/macrophages, enables their adhesion and migration into the subendothelial layer. The rupture of the atherosclerotic plaque on one hand, and the ability of the oxidized LDL cholesterol and Lp(a) to trigger arterial thrombosis by different mechanisms on the other hand, result in acute cardiovascular event. Here, we summarize the role of the monocytes and macrophages in atherosclerosis and explore the influence of LDL cholesterol and Lp(a) on monocytes and macrophages during the entire process of atherosclerosis, from its initiation to progression.

The study aims to present a case study of a patient with supratherapeutic serum gentamicin concentration. An 83-year-old male was admitted to the Department of Internal Medicine for persistent loss of appetite, decompensated heart failure, and pneumonia. He was treated with 240 mg gentamicin daily alongside ampicillin/sulbactam penicillin antibiotic. The trough gentamicin concentrations and estimated glomerular filtration rate from creatinine (eGFRcrea) and cystatin C (eGFRcys) were performed. The patient had the supratherapeutic trough gentamicin concentration of 2.5 mg/L. eGFRcrea was 62 mL/min/1.73m² and eGFRcys was 25 mL/min/1.73m². The difference between eGFRcrea and eGFRcys was 148%. Falsely high eGFRcrea in elderly patient led to the supratherapeutic gentamicin concentration even after the standard 240 mg gentamicin dose.

The alcohol dehydrogenase (ADH) method is commonly used to measure serum alcohol concentration (SAC) and plasma alcohol concentration (PAC) for the rapid detection of ethanol intoxication in emergency medical departments. Alcohol dehydrogenase methods are sometimes used in forensic laboratories as a preliminary screening test prior to confirmation by gas chromatographic (GC) methods. This review identifies critical factors affecting results of ADH methods of analysis including clinical reliability and forensic defensibility. Key considerations include intra-analytical factors (method chemistry, calibration, analytical performance, interferences, calibrator stability, and sample matrix effects) and post-analytical factors (measurement units, reference ranges, performance specifications, uncertainty budget, medical decision levels, legal intoxication thresholds, ADH-GC agreement, and SAC/PAC to blood alcohol concentration (BAC) conversion). The yeast ADH method demonstrates high selectivity for ethanol with no assay-specific bias, and measurement error and uncertainty meet regulatory standards. However, ADH methods are prone to interferences, particularly from lactate dehydrogenase/lactic acid (LD/LA), leading to potential false positive results. Free hemoglobin (hemolysis) is another problem with ADH methods introducing a negative bias. When results provided by hospital laboratories are interpreted in a legal context, care is needed because ethanol concentrations in plasma/serum are about 15% higher than in whole blood (range 10-20%). Although less important in clinical practice, these differences are important to consider in a forensic context. The ADH method is not inherently a forensic assay, but these limitations can be mitigated by refining laboratory procedures and standardizing the assay methodology and quality control, thus strengthening forensic reliability and boosting confidence in the analytical results.