ISSN  2587-2362  |  E-ISSN  2618-642X
International Journal of Medical Biochemistry - Int J Med Biochem : 3 (2)
Volume: 3  Issue: 2 - 2020
1.COVID-19: Clinical and pathophysiological features and laboratory diagnosis
Dildar Konukoglu
doi: 10.14744/ijmb.2020.98852  Pages 47 - 51
A new coronavirus was detected in a series of mortal pneumonia cases in Wuhan, China, Disease is associated with acute respiratory distress syndrome and respiratory failure. The leading cause of death in patients with COVID-19 is respiratory failure. Older age and the presence of underlying health conditions or smoking are very important and are related to the severity of the disease. In this article, general information about the disease and laboratory tests are summarized.

2.Intravenous cannula can increase serum creatine kinase MB activity
Muammer Yucel
doi: 10.14744/ijmb.2020.07379  Pages 52 - 55
INTRODUCTION: Different blood sampling methods may result in differing creatine kinase MB (CK-MB) results. The aim of this study was to assess the effect of 2 phlebotomy methods on the CK-MB level in serum samples of healthy adults.
METHODS: The study used 50 volunteers (20 females, 30 males) who were employees at Baskent University Hospital in Ankara, Turkey. The subjects were randomly assigned to the study group. Blood samples were collected with the most widely used equipment for each method being tested (20G intravenous [IV] cannula and 20G needle unit) to compare the effects of different methods of blood sampling. The mean values of CK-MB and creatine kinase (CK) activity were compared using a paired samples t-test.
RESULTS: The mean CK-MB activity was 14.4±4.1 U/L and the mean CK activity was 127.3±17.1 U/L in samples that were drawn with a 20G needle unit, while in samples drawn with a 20G IV cannula, the corresponding results were 19.3±3.8 U/L and 132.5±16.1 U/L (p<0.001 for both).
DISCUSSION AND CONCLUSION: The study results indicated that blood sampling using an IV cannula caused more mechanical injury to vessel endothelium than sampling with a needle unit. This translates to greater interference with CK-MB and CK activity when the cannula method is used. Blood sampling with a cannula led to elevated CK-MB activity.

3.Evaluation of analytical performance of two iPTH immunoassay methods in hemodialysis patients
Ozgur Mehmet Yis, Guler Bugdayci, Mine Busra Pehlivan, Neslihan Yuce, Rabia Nur Yildiz, Merve Basol Goksuluk
doi: 10.14744/ijmb.2020.08370  Pages 56 - 61
INTRODUCTION: Renal excretion of parathormone (PTH) C-terminal fragments can cause an accumulation of the C-terminal form in the blood in chronic kidney disease patients. Thus, the measurement of the active form of PTH has become important. This study was designed to compare the Architect iPTH test measured using the Architect i2000SR System (Abbott Laboratories, Lake Bluff, IL, USA) and the Beckman iPTH test measured using the Beckman Coulter Dxi 800 (Beckman Coulter, Brea, CA, USA), which are 2 immunoassay systems commonly used in routine laboratory analyses, and to evaluate the analytical performance in hemodialysis patients.
METHODS: The immunoassays were assessed for accuracy, precision, limit of blank (LoB), limit of detection (LoD), and limit of quantification (LoQ).
RESULTS: A total of 86 samples were run on both systems and the correlation between the methods was evaluated. The i2000SR and Dxi 800 assays demonstrated good performance in terms of precision, accuracy, LoB, LoD, and LoQ. Intraclass correlation coefficient analysis revealed a difference of 0.912 (0.489-0.968) with a y=2.58+1.53x equation.
DISCUSSION AND CONCLUSION: It was confirmed that these analyzers widely used for iPTH measurement operate at an acceptable level of analytical performance. It was observed that the measurements obtained from both analyzers were consistent, but the Abbott Architect i2000SR provided higher results than the Beckman Coulter Dxi800. For consistency, is suggested that patient follow-up should be performed using the same kits, the same analysis system, and in the same laboratory.

4.The most common preanalytic problem of sweat testing: Insufficient sweat volume
Aysegul Ozgenc, Nesibe Esra Yasar, Mine Kucur, Ibrahim Murat Bolayirli, Dildar Konukoglu
doi: 10.14744/ijmb.2020.16870  Pages 62 - 66
INTRODUCTION: A sweat test is the gold standard method for the diagnosis of cystic fibrosis (CF). The most important preanalytical error for sweat testing is insufficient sweat volume. The aim of this study was to determine rates of insufficient sweat volume and evaluate the relationship of sweat volume with demographic characteristics of patients, as well as the implementation of corrective preventive actions.
METHODS: This study was performed retrospectively in the sweat test laboratory of the Cerrahpasa Faculty of Medicine of Istanbul University-Cerrahpasa. A total of 545 specimens that were referred to the laboratory between May and December 2016 were evaluated. Sweating was stimulated with pilocarpine iontophoresis, and the Macroduct Coil System (Wescor, Inc., Logan, UT, USA) was used as the sweat collection system. Sweat volume <15 μL was evaluated as quantity not sufficient (QNS). A chi-square test was used for statistical analysis; p<0.05 was considered significant.
RESULTS: The QNS rate in the study laboratory was 13.8% for infants ≤3 months of age and 6% for patients aged >3 months (p=0.019). There was no significant difference in the QNS ratios according to gender (p=1.000) or the season when the test was applied (p=0.181).
DISCUSSION AND CONCLUSION: The determination of QNS rates is a crucial step in the standardization of the preanalytical conditions of a sweat test. In this study, the QNS rate was above that recommended by the Cystic Fibrosis Foundation (<10% for infants ≤3 months of age, <5% for patients >3 months). High QNS ratios may be due to the inadequacy of optimization of pre-test preparation. Laboratory staff and parents should be well informed about preanalytical factors before a sweat analysis is performed in order to reduce the QNS rate.

5.Evaluation of serum levels of irisin and nesfatin-1 in patients with migraine without aura
Turan Akdag, Faruk Omer Odabas
doi: 10.14744/ijmb.2020.30301  Pages 67 - 72
INTRODUCTION: Migraine is a chronic neurological disorder. A number of cytokines have been linked to the pathogenesis of migraine. This is a preliminary assessment to determine and analyze the serum levels of irisin and nesfatin-1 in patients with migraine without aura.

METHODS: A total of 80 participants, 40 patients who had been diagnosed with migraine without aura (10 men, 30 women) and 40 healthy controls (10 men, 30 women), were included in the study. The serum irisin and nesfatin-1 parameters were investigated using blood samples drawn from the patient and control groups.
RESULTS: The mean serum irisin level was 16.87±14.66 ng/mL in the migraine group and 17.33±17.18 ng/mL in the healthy controls. No significant p value was determined (p=0.470), but the level was slightly lower in the migraine group. The mean nesfatin-1 level was 4.71±5.96 mmol/L in the migraine group and 4.13±5.41 mmol/L in the healthy controls (p=0.19), again revealing a small but statistically insignificant difference. In addition, there was no statistically significant difference according to age group, visual analog scale score for pain, body mass index, or length of disease duration.
DISCUSSION AND CONCLUSION: Although no statistically significant differences were observed, the present study is believed to be the first to provide insight on the serum levels of irisin and nesfatin-1 in migraine without aura patients.

6.Multiplexed tandem mass spectrometry-based screening for five lysosomal storage disorders: A pilot study
Rita Christopher, Manjunath Supriya, Chandra Sadanandavalli Retnaswami
doi: 10.14744/ijmb.2020.36449  Pages 73 - 81
INTRODUCTION: The need for early detection of lysosomal storage diseases (LSDs) for which therapeutic options are available makes them attractive candidate disorders to perform high-throughput population screening. This is a pilot study designed to simultaneously screen for Krabbe, Niemann-Pick types A/B, Fabry, Gaucher and Pompe diseases in putatively normal Indian subjects, using dried blood spots and a liquid chromatography-tandem mass spectrometry method.
METHODS: Blood spots from 12,559 putatively normal subjects were used to measure 5 lysosomal enzymes: galactocerebrosidase, acid sphingomyelinase, α-galactosidase, β-glucocerebrosidase, and α-glucosidase. From each blood spot, 3.2-mm punches were extracted and incubated using specific substrates and internal standards. After several liquid- and solid-phase extraction steps, the resulting solution was reconstituted and injected into a triple quadrupole, liquid chromatography-tandem mass spectrometer after recombining the reaction products into a single 96-well plate.
Results: A standard calibration curve demonstrated good linearity for each enzyme. No positive case was detected among the 12,559 putatively normal subjects tested.
RESULTS: A standard calibration curve demonstrated good linearity for each enzyme. No positive case was detected among the 12,559 putatively normal subjects tested.
DISCUSSION AND CONCLUSION: Tandem mass spectrometry technology makes it possible to perform high-throughput screening to identify LSDs using blood spots. Further large-scale studies to determine the population prevalence and incidence of these disorders are warranted.

7.Reference interval with age-gender variation for 4 liver function parameters in an adult segment of the Indian population
Abhaya Indrayan, Mohini Bhargava, Shubham Shukla
doi: 10.14744/ijmb.2020.65265  Pages 82 - 90
INTRODUCTION: The proper interpretation of the laboratory values seen in individuals depends on the validity of the reference intervals. These intervals may differ from one population to another due to variation in factors such as genetic profile, physical characteristics, and dietary intake. Reference intervals for most parameters are not available for the Indian population. This study presents reference intervals for 4 liver function parameters: total protein, albumin, globulin, and the albumin-globulin ratio for a segment of the Indian population, as well as a study of age trend and gender differences.
METHODS: The results were based on a minimum of 12.264 values for each parameter from individuals aged 0 to 98 years. These values were extracted from a large database of the laboratory of a tertiary care hospital after careful filtration of the appropriate reference values. The age-gender variation in the mean and median was examined and the reference intervals were obtained as 2.5th to 97.5th percentile.
RESULTS: There was a sufficient number of values in the various age groups and by gender except for the group aged 0-14 years. Therefore, this age group was excluded. The age trend was studied for males and females separately, as gender differences were substantial and consistent across age groups. Total protein and albumin levels declined with age, but the decline in albumin level was more rapid. Specific age-gender reference intervals were obtained for adults.
DISCUSSION AND CONCLUSION: The effect of age and gender on all of the parameters examined was substantial. The obtained reference intervals are slightly different from those previously reported in the literature and currently used.

8.Serum irisin levels are correlated with insulin resistance in women with gestational diabetes mellitus
Nilufer Celik
Pages 91 - 95
INTRODUCTION: The aim of this study was to determine the serum irisin level in pregnant women with gestational diabetes mellitus (GDM) and those with a normal glucose tolerance test (NGT).
METHODS: Forty-three pregnant women who underwent a 50-g glucose challenge test (GCT) at 24-28 gestational weeks were included the study. If the serum glucose level result of the 50-g GCT was >140 mg/dL, a 100-g oral glucose tolerance test (OGTT) was applied. Diagnosis of GDM was confirmed if any 2 of the blood glucose test results were above the following levels: fasting serum glucose ≥92 mg/dL, 1-hour glycemia ≥180 mg/dL, or 2-hour glycemia ≥153 mg/dL. Patients with a result below this value were accepted as NGT. Nine pregnant patients with 50-g GCT results below 140 mg/dL and 5 pregnant women with a history of chronic hypertension were excluded. The remaining 29 pregnant women underwent a 100-g OGTT and were divided into 2 groups according to their results: 15 had GDM and 14 had a NGT. Maternal serum irisin was measured using an enzyme immunoassay method. The correlation between biochemical and demographic parameters and the serum irisin level in all participants were analyzed.
RESULTS: There were no significant difference between the GDM and NGT groups in terms of the maternal serum irisin level (8.71±1.34 µg/mL vs 8.17±1.01 µg/mL; p>0.32). The levels of fasting insulin, fasting glucose, and the 2-hour glucose level, as well as the homeostatic model assessment of insulin resistance (HOMA-IR) results of patients with GDM were higher than those of the NGT group. The maternal serum irisin level of the GDM subjects were positively and significantly correlated with the HOMA-IR value (r: 0.65; p<0.05), fasting insulin level (r: 0.44; p<0.05), and body mass index (BMI) (r: 0.81; p<0.05). A negative but significant correlation between the serum irisin level and diastolic blood pressure of the GDM subjects was also seen. Insignificant associations were found between the HOMA-IR score, fasting insulin level, BMI, and the serum irisin level of the NGT subjects.
DISCUSSION AND CONCLUSION: The maternal serum irisin level may regulate the HOMA-IR value, fasting insulin level, and diastolic blood pressure in women with GDM.

9.Change in vitamin B12 level in breast milk according to the week of delivery in Turkish women
Fatih Yesildal, Esin Koc, Hakan Ozturk, Taner Ozgurtas
doi: 10.14744/ijmb.2020.82905  Pages 96 - 100
INTRODUCTION: Vitamin B12 is one of the most important micronutrients in breast milk, as a deficiency can lead to growth and developmental retardation in infants. The aim of this study was to investigate differences in the level of vitamin B12 in breast milk in preterm, late preterm, and term groups according to the number of gestational weeks at delivery, and how vitamin B12 content in breast milk changed during the first 28 days of lactation.
METHODS: A total of 30 mothers (n=10 each for preterm, late preterm, and term delivery groups) were included in the study. Breast milk samples were collected from the participants on day 3, 7, and 28 after delivery. The level of vitamin B12 was analyzed in each sample using the Advia Centaur XP autoanalyzer (Siemens Healthineers GmbH, Erlangen, Germany). Analysis of variance (ANOVA) and post hoc Tukey tests were used for group comparisons.
RESULTS: There was a significant difference in the level of vitamin B12 between the 3 groups based on the week of delivery (ANOVA test, p=0.012). In addition, regardless of the number of days of lactation, a significant difference was found between the preterm (954.1±462.8 ng/L) and term (647±253.2 ng/L) groups in the post hoc Tukey pairwise comparison results (p=0.010). The vitamin B12 level in the 28th day breast milk samples was significantly different between the preterm group (1104.1±431.9 ng/L) and the term group (547.1±274.4 ng/L) (p=0.030).
DISCUSSION AND CONCLUSION: In the term delivery group, the highest level of vitamin B12 was seen in the colostrum, and was lower in transition milk and mature milk. In contrast, in the preterm delivery group, mature milk contained a higher level of vitamin B12 than the colostrum. The vitamin B12 level in breast milk in the preterm group was higher on the 28th day of lactation compared with the term group. This may be a compensation mechanism to prevent possible retardation of growth in the preterm group. According to these results, preterm delivery infants do not require additional vitamin B12 supplementation unless there is a pathology of the maternal or infant vitamin metabolism, or there is a problem performing breastfeeding.

10.Evaluation of serum proinflammatory cytokines, oxidative stress, and other biochemical markers in chronic viral hepatitis B and C infections
Nihayet Bayraktar, Mehmet Bayraktar
doi: 10.14744/ijmb.2020.96268  Pages 101 - 105
INTRODUCTION: Infection with the hepatitis B virus (HBV) or the hepatitis C virus (HCV) results in inflammatory responses, which can subsequently lead to severe progressive hepatic disease. Oxidative stress resulting from changes in the activity of antioxidant enzymes and cytokines and causing an excessive accumulation of reactive oxygen species has been identified as a key factor in the pathogenesis and progression of chronic liver inflammation and disease. Minerals such as zinc (Zn) and copper (Cu), which are part of the biochemical structure of some antioxidant enzymes, also play a part in the complicated pathogenesis of HBV and HBC infections. The aim of this study was to investigate the effects of chronic viral HBV and HCV infection on the status of some serum cytokines, antioxidant enzymes, lipid peroxidation, and serum Zn and Cu levels, and to determine if there was any relationship between them.
METHODS: A total of 78 patients with positive clinical and serological markers of HBV or HCV infection were included: 40 chronic HBV-positive patients, 30 inactive HBV carriers, and 8 chronic HCV-positive patients. Thirty healthy subjects were also included in the study as a control group. The level of serum cytokines tumor necrosis factor-α (TNF-α), interleukin-1β, (IL-1 β), interleukin-2R (IL-2R), interleukin-6 (IL-6), and interleukin-8 (IL-8) was analyzed with a chemiluminescent enzyme immunometric test, the activity of antioxidant enzymes superoxide dismutase (SOD), phospholipid hydroperoxide glutathione peroxidase (GSH-Px), and catalase (CAT) was measured in erythrocytes, and the malondialdehyde (MDA) level was measured in plasma using a fluorescence spectrophotometric method. The serum Zn and Cu concentration was measured with a flame atomic absorption spectrophotometer.
RESULTS: Serum cytokine (TNF-α, IL-2R, IL-6, and IL-8) levels were significantly higher in both the HBV- and HCV-positive patient groups when compared with the control group (p<0.05). No statistically significant difference was found in IL-1β values between chronic HBV patients and inactive HBV carriers (p>0.05). Erythrocyte SOD, GSH-Px, and CAT activity, and the serum Zn level were low in both HBV and HCV patients (p<0.05), whereas the plasma MDA and serum Cu levels were found to be significantly elevated (p<0.05).
DISCUSSION AND CONCLUSION: An impaired oxidative stress reaction and increased proinflammatory cytokines were observed in patients infected with chronic HBV or HCV. Chronic viral hepatitis infection was also observed to affect the homeostasis of Zn and Cu, leading to an increase in the serum Cu level and a decrease in Zn as a result of metabolic interactions. The lipid peroxidation marker MDA may be a useful tool for observing and following up pathogenic mechanisms and the course of chronic HBV and HCV.

11.Digitalization and artificial intelligence in laboratory medicine
Ali Rýza Sisman, Banu Isbilen Basok
doi: 10.14744/ijmb.2020.81994  Pages 106 - 110
In parallel with the increasing number and variety of medical tests and the widespread use of electronic health records combined with the growing capabilities and capacity of computers have attention to “big data.” Processing and extracting meaningful interpretations from such vast and complex data require artificial intelligence (AI) that refers to complex software systems that enable computers to augment and even imitate human intelligence and decision-making. Machine learning (ML) is a subfield of AI that uses algorithms to parse and learn data and then apply this new learning to make predictions and informed recommendations.
In recent years, the effects that the digitalization of healthcare services will have on medicine, especially laboratory medicine as seen in the industry, the economy, and social life. The abundance of health data will lead to a shift from analytical competence in diagnostic tests to the ability to integrate data and simultaneously interpret them within the clinical context. Therefore, “computational laboratory medicine” units should be established and integrated into resident and undergraduate education curricula. Using the computational approach, the promise of improved medical interpretation will further increase the effectiveness of laboratory diagnostics in the process of intensive dialogue/consultation and clinical decision-making. Medical laboratories may play an active role in the future as a "nerve center of diagnostics" and joining the patient and physician to form a "Diagnostics 4.0" triangle.
As the big data continue to grow in healthcare, the need for implementing AI and ML techniques into laboratory medicine is inevitable. In this new AI-supported era, clinical laboratories will move towards a more specialized role in translational medicine, advanced technology, management of clinical information, and quality control of results generated outside the laboratory. The field of laboratory medicine should consider such a development sooner rather than later.

12.Working plan update for medical biochemistry laboratories during the COVID-19 pandemic
Mustafa Sahin
doi: 10.14744/ijmb.2020.06078  Pages 111 - 112
Abstract | Full Text PDF

13.Symposium on Laboratory Management and Control from Preanalytic to Postanalytic Phase

doi: 10.14744/ijmb.2020.05025  Pages 113 - 124
Abstract | Full Text PDF

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