ISSN  2587-2362  |  E-ISSN  2618-642X
International Journal of Medical Biochemistry - Int J Med Biochem : 2 (2)
Volume: 2  Issue: 2 - 2019
1.New generation oral anticoagulants may cause unreliable results in routine coagulation testing
Asuman Gedikbaşı, Yüksel Gülen Çiçek, Sebnem Tekin Neijmann, Soner Erdin, Nilgun Isiksacan, Zeynep Levent Çıraklı, Alev Kural
doi: 10.14744/ijmb.2019.33043  Pages 35 - 40
INTRODUCTION: The aim of this study was to raise awareness among laboratory staff and physicians that prothrombin timeinternational normalized ratio (PT-INR) tests are not reliable in patients receiving direct oral anticoagulant treatment and, in particular, dabigatran.
METHODS: PT-INR tests were performed on 151 plasma specimens using 3 coagulation analyzers with different methodologies: (i) the Thrombolyzer XRM (Behnk Elektronik GmbH & Co. KG, Norderstedt, Germany), which uses the optomechanical method; (ii) the Diagon CoagXL (Diagon Ltd., Budapest, Hungary), which uses the optical method; and (iii) the reference method for the study, the Stago STA Compact (Diagnostica Stago SAS., Asnières sur Seine Cedex, France), which uses the mechanical method. All of the results were analyzed using the intraclass correlation coefficient (ICC), Passing-Bablok regression analysis, and Bland-Altman analysis to examine the consistency of measurement techniques. Unacceptable results were observed for accuracy and precision when the analysis included 23 patients who were using the new generation oral anticoagulant dabigatran.
RESULTS: The Stago STA Compact-Thrombolyzer PT-INR ICC was higher than that of Stago STA Compact-Diagon CoagXL, with a narrow 95% confidence interval. Passing-Bablok regression analysis of all of the results revealed a significant deviation from linearity (p<0.01), but there was no significant deviation from linearity when the results of the patients using dabigatran were excluded. Once the patients using dabigatran were excluded, the results of the comparison studies reached more acceptable limits.

DISCUSSION AND CONCLUSION: It was determined that the use of a new generation oral anticoagulant (dabigatran) was a source of preanalytical error. It will be of great benefit for clinicians to communicate with laboratory specialists in the follow-up of patients who are other than traditional anticoagulation cases.

2.Angiostatin levels in systolic heart failure patients with chronic kidney disease
İsmail Erturk, Erdim Sertoglu, Taner Ozgurtas, Fatih Yesildal, Ramazan Acar, Birol Yildiz, Fevzi Nuri Aydin, Galip Büyükturan, Kenan Sağlam
doi: 10.14744/ijmb.2019.24633  Pages 41 - 45
INTRODUCTION: Heart failure (HF) with reduced ejection fraction (HFrEF) is defined as an ejection fraction (EF) of less than 40%. An EF of 40% to 50% is known as HF with mid-range EF, which is considered a subgroup of HF with preserved ejection fraction, rather than HFrEF. Angiostatin inhibits angiogenesis and the proliferation of mesenchymal stem cells. Though many studies in the literature have focused on the effect of angiostatin on endothelial cell apoptosis, studies about angiostatin levels in HF patients are limited. The aim of this study was to evaluate the angiostatin level in systolic HF patients with chronic kidney disease (CKD).
METHODS: A group of 69 individuals, consisting of patients with a diagnosis of systolic HF with CKD (n=29) and healthy (n=40) subjects, was included in the current study. Serum angiostatin, plasma N-terminal pro-brain type natriuretic peptide, and creatinine levels were assessed, and transthoracic echocardiography was performed.
RESULTS: The angiostatin level of the patient group was significantly higher than that of the control group (median: 163 ng/mL [25th–75th interquartile range: 48-336 ng/mL] and median: 58.14 ng/mL [25th–75th interquartile range: 18.1- 167 ng/mL], respectively; p=0.02). The angiostatin level of HF patients receiving beta blocker therapy was significantly higher than that of the HF patients who were not taking a beta blocker (105.3 ng/mL [50.7-220.7 ng/mL] and 70.4 ng/ mL [35-224 ng/mL], respectively; p=0.02).
DISCUSSION AND CONCLUSION: To the best of our knowledge, this study is the first to examine this subject. Angiostatin may be an important marker in systolic HF patients with CKD. The use of a beta blocker may inhibit angiogenesis and induce apoptosis in HF patients with CKD. Further studies are required.

3.Metabolic health status and cardiovascular risk of different ABO blood group phenotypes
Innocent Chidi Anioke, Charles Arinze Okafor, Innocent N Okonkwo, Peculiar Ngozi Kalu, Blessing Chidimma Okpagu, Faith Akpah
doi: 10.14744/ijmb.2019.54154  Pages 46 - 53
INTRODUCTION: ABO blood group antigens could play a role in the pathogenesis of cardiovascular disease (CVD). This study examined the metabolic health status (MHS) and CVD risk of apparently healthy individuals from across the ABO blood group system.
METHODS: Demographic details as well as anthropometric and biochemical data were collected in a cross-sectional survey from 120 participants of different ABO groups (range: 18-70 years). Height, weight, and waist circumference were measured using standard procedures. Body mass index was calculated as weight divided by height squared (kg/ m2). A blood sample of approximately 5 mL was collected after an overnight fast. Fasting blood glucose was estimated using a glucometer. The blood group was determined using a monoclonal ABO blood grouping reagent. Direct enzymatic methods and a commercial kit were used to measure the level of total cholesterol (TC), triglycerides, and highdensity lipoprotein. Low-density lipoprotein (LDL) and very low-density lipoproteins were estimated using the Friedewald equation. Metabolically healthy (MH) and metabolically unhealthy (MUH) individuals were identified based on the presence of metabolic syndrome using the Joint Interim Statement criteria. CVD risk was determined using the Systematic Coronary Risk Evaluation chart.
RESULTS: Females showed significant differences in TC across the ABO system: The O group (mean±SD: 4.85±0.77 mmol/L) demonstrated a significantly higher TC level compared with the A group (mean±SD: 4.22±0.72 mmol/L; p=0.015). The LDL in females was also significantly higher in the O group samples (mean±SD: 3.06±0.75 mmol/L) compared with the A samples (mean±SD: 2.53±0.62 mmol/L; p=0.042). There was no significant difference between the MUH and MH groups based on ABO blood phenotype (p>0.05). The CVD risk among those with the O phenotype (51.7%) was significantly higher than in the non-O blood groups among male subjects (χ2=6.213; p=0.045).
DISCUSSION AND CONCLUSION: MHS was not associated with the ABO system, but there is a possibility that male members of blood group O are more susceptible to CVD than men with non-O phenotypes.

4.The relationship between plasma viscosity and endotel markers in patients with ascending aortic aneurysms: A pilot study
Bahar Öztürk Kurt, Cengiz Köksal, Sinan Gocer, Alev Meltem Ercan
doi: 10.14744/ijmb.2019.88598  Pages 54 - 59
INTRODUCTION: An ascending aortic aneurysm (AsAA) is fundamentally defined as the "ballooning" of the aorta at its exit site from the heart. The role of plasma viscosity (PV) and endothelial markers in AsAA is unknown. This study was designed to investigate AsAA in association with PV and the endothelial markers of fibrinogen, nitric oxide (NOx), and asymmetric dimethylarginine (ADMA).
METHODS: This study group consisted of 23 patients who underwent surgical repair for AsAA and 30 controls without diabetes, hypo- or hyperlipidemia, or heart disease. Several parameters, including plasma viscosity (PV), fibrinogen, NOx, and ADMA were assayed in both groups.
RESULTS: The preoperative PV in the patient group was significantly higher than that measured on postoperative day 7 and that of the control group (p<0.05). Fibrinogen and ADMA values were significantly higher in the control group than the preoperative values (p<0.001). Postoperative NOx results were lower than preoperative NOx (p<0.05).
DISCUSSION AND CONCLUSION: An increase in PV may cause an increase in permeability and glomerular capillary pressure. The fibrinogen level may have been lower in the preoperative AsAA group as a result of impaired production or increased consumption due to intravascular coagulation. The decrease in ADMA is associated with increased NOx, which is a potent inhibitor of platelet aggregation and adhesion to the vessel wall. A high preoperative level of NOx can be accounted for by impaired blood flow. Our results suggest that PV and oxidative stress parameters may play a crucial role in the diagnosis, treatment, and follow-up of patients with AsAA.

5.Investigation of the distribution of thyroid dysfunction in the geriatric patient population in Corum province
Mustafa Sahin, Alpaslan Karabulut, Huseyin Kayadibi
doi: 10.14744/ijmb.2019.54254  Pages 60 - 64
INTRODUCTION: The aim of this study was to identify and analyze the incidence of thyroid dysfunction in geriatric patients in Corum province, Turkey.
METHODS: The results of thyroid-stimulating hormone (TSH), free thyroxine (FT4), and free triiodothyronine (FT3) tests, as well as the demographic characteristics of 220 randomized patients were retrospectively investigated. Patients who had a total or partial thyroidectomy surgery and those receiving any medical thyroid treatment were not included in the study. The patients were divided into 5 groups: subclinical hypothyroidism, hypothyroidism, euthyroid, subclinical hyperthyroidism, and hyperthyroidism.
RESULTS: In the group, 114 were male and 106 were female. The mean age of the male and female patients was 74±7 years and 75±7 years, respectively. The entire study group had a median TSH of 0.94 μIU/mL (25th-75th percentile, interquartile range [IQR] 0.33-1.86 μIU/mL), a median FT4 of 1.14 ng/dL (IQR: 1.02-1.33 ng/dL), and a median FT3 of 2.73 pg/mL (IQR: 2.25-3.11 pg/mL). For male patients, the median TSH was 0.87 μIU/mL (IQR: 0.36-1.66 μIU/mL), the median FT4 was 1.14 ng/dL (IQR: 1.02-1.29 ng/dL), and the median FT3 was 2.74 pg/mL (IQR: 2.18-3.15 pg/mL), while for female patients the median TSH was 0.95 μIU/mL (IQR: 0.20-2.21 μIU/mL), the median FT4 was 1.17 ng/dL (IQR: 1.06-1.38 ng/ dL), and the median FT3 was 2.72 pg/mL (2.31-3.10 pg/mL). Of the males, 1.8% had subclinical hypothyroidism, another 1.8% had hypothyroidism, 72.8% were euthyroid, 19.3% had subclinical hyperthyroidism, and 4.4% had hyperthyroidism. Among the females, there were findings of 2.8% subclinical hypothyroidism, 1.9% hypothyroidism, 64.2% euthyroid, 26.4% subclinical hyperthyroidism, and 4.7% hyperthyroidism. No statistically significant difference was observed when the diagnosis incidence was compared according to gender (p=0.696).
DISCUSSION AND CONCLUSION: Independent of gender, the geriatric patient population had a high incidence of subclinical hyperthyroidism, which often has a delayed diagnosis. This can complicate the prompt diagnosis of other metabolic diseases. As thyroid function affects the metabolism of the entire body, thyroid hormone status should be investigated when considering other metabolic diseases in geriatric patients. Excluding thyroid disfunction could save time in making an accurate diagnosis and providing treatment. Furthermore, since thyroid diseases are influenced by environmental iodine, regional thyroid disease incidence studies should be performed.

6.Bone markers
Dildar Konukoğlu
doi: 10.14744/ijmb.2019.60362  Pages 65 - 78
Objectives: Bone has a dynamic metabolism that includes modeling and remodeling activities. There is continuous communication between 3 types of bone cells; osteoblasts, osteoclasts, and osteocytes. Local stress factors, cytokines, and hormones play an important role in these relationships. The most important structural component of bone is type 1 collagen. During the formation and degradation of collagen, some compounds are secreted into the bloodstream, and in cases of diseases involving the bone, the quantity of these compounds increases both in blood concentration and urinary excretion. Some bone markers are secreted into the circulation during bone formation, and some are released into the circulation through bone resolution. Bone markers reflect changes in bone metabolism due to primary or secondary causes, rather than a specific bone disease. Some factors affecting the results should be considered during the evaluation of changes. These factors include preanalytical effects, such as age, gender, diurnal rhythm, and analytical problems. This review is a summary of the current applications of bone turnover markers and the effects of preanalytical conditions.

7.Do ointments really cause glyceroluria?
Soner Erdin, Asuman Gedikbasi, Tufan Karaçam
doi: 10.14744/ijmb.2019.88597  Pages 79 - 80
Abstract | Full Text PDF

8.Association of Clinical Biochemistry Specialists Preanalytic Phase Symposium on Hematology Tests

Pages E81 - E98
Abstract | Full Text PDF

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