ISSN  2587-2362  |  E-ISSN  2618-642X
International Journal of Medical Biochemistry - Int J Med Biochem : 2 (3)
Volume: 2  Issue: 3 - 2019
1.Assessment of diagnostic accuracy and optimal cut points of blood lead levels on serum proteins among workers exposed to Pb at a lead battery plant
Ravibabu Kalahasthi, Tapu Barman, Ravi Prakash Jamalpur, Vinayakumar Adepu
doi: 10.14744/ijmb.2019.41736  Pages 81 - 87
INTRODUCTION: This study assessed the diagnostic accuracy and the optimal cut point of blood lead (Pb) level (BLL) in serum proteins (total protein, albumin, globulin, and albumin/globulin ratio) among workers with exposure to Pb at a Pb battery plant.
METHODS: An examination of the diagnostic accuracy and optimal cut point value of BLL in serum proteins among workers exposed to Pb was performed using analysis of the area under the curve (AUC) and coordinates of receiving operating characteristic (ROC) curve. The study group consisted of 176 males who worked in a Pb battery plant. A control group consisted of 80 male office workers with no unusual occupational Pb exposure. The BLL of the patients was assessed using an atomic absorption spectrophotometer. The serum protein levels (total protein and albumin) were determined using diagnostic kits. The serum globulin was calculated from the total protein and albumin measures. The albumin: globulin ratio (A/G ratio) was calculated from the albumin and globulin levels.
RESULTS: The serum total protein and globulin concentration values were lower and the A/G ratio was significantly higher in the study group compared with the control group. A negative and significant association was found between the BLL and serum total protein and serum globulin values. A positive and significant association was found between the BLL and the serum albumin level and the A/G ratio. The AUC value was 0.626 (95% confidence interval [CI]: 0.540–0.712; p=0.005) for serum total protein with a cutoff value of ≤6.9 g/dL. For serum albumin, the AUC value was 0.466 (95% CI: 0.344–0.587; p=0.574) with a cutoff value of ≤4.0 g/dL. The AUC value of serum globulin was 0.625 (95% CI: a0.541–0.708, p=0.005) with a cutoff value of ≤2.4g/dL. The A/G ratio had an AUC value of 0.606 (95% CI: 0.521–0.692; p=0.012) with a cutoff value >1.5g/dL. An optimal BLL cut point value of 25.5µg/dL was noted for serum total protein, with 56% sensitivity and 51% specificity. The BLL value of 24.5 µg/dL was determined to be the optimal cut point for serum albumin, with 44% sensitivity and 44% specificity. The use of 27.5 µg/dL as an optimal BLL cut point value for serum globulin and the A/G ratio demonstrated 55% sensitivity and 55% specificity.
DISCUSSION AND CONCLUSION: The AUC values of serum total protein, globulin, and the A/G ratio were found to be significant when compared with the serum albumin. BLL optimal cut point values for serum proteins in Pb exposure ranged from 24.5 µg/dL to 27.5 µg/dL. The change in serum total protein, globulin, and A/G ratio suggested reduced liver function due to Pb-binding interactions.

2.The mechanism of apoptosis in human acute promyelocytic leukemia cells treated with sorafenib and lithium chloride
Aysun Ekinci, Safiye Kaya
doi: 10.14744/ijmb.2019.19484  Pages 88 - 96
INTRODUCTION: This study was an investigation of the mechanisms of sorafenib (SOR) and lithium chloride (LiCl), which cause apoptosis, in the acute promyelocytic leukemia (APL) HL-60 cell line.
METHODS: HL-60 cells were treated with 100 µM of SOR, LiCl, and a combination of the 2 drugs, and a control group was not treated. Cells were collected after a period of 24, 48, and 72 hours, and cell proliferation and the apoptotic index were assessed with a hemocytometer and flow cytometry analysis. The level of caspase-3, phospho-glycogen synthase kinase-3 beta (p-GSK-3β), phospho-protein kinase B (p-AKT), phospho-extracellular-signal-regulated kinase (p-ERK), p38, phospho-c-Jun (p-c-Jun), and phospho-inhibitor kappa B (p-IκBα) were analyzed using the enzyme-linked immunosorbent assay method. The effects of the drugs on cell ultrastructure were evaluated with a transmission electron microscope (TEM).
RESULTS: Single and combination drug administration decreased cell proliferation and increased the apoptosis rate (p<0.01 for both). The increase in apoptosis in the SOR+LiCl group was greater than that of the SOR group (p<0.01); however, there was no significant increase compared with the LiCl group. While both drugs increased the caspase-3 level (p<0.01 for both), LiCl increased caspase-3 activity more than SOR. Although p-GSK-3β levels decreased in the SOR group (p<0.01), levels increased in the LiCl group (p>0.05). Combined drug administration decreased the level of p-AKT and p38 (p<0.01 for both); however, it did not significantly affect the level of p-ERK, p-IκBα, or p-c-Jun (p>0.05). TEM examination revealed severe lytic cytoplasmic damage and apoptotic morphology, an indication of apoptosis.
DISCUSSION AND CONCLUSION: The results of this study demonstrated that in human APL cells treated with SOR and LiCl, increased apoptosis led to a decrease in tumor cells. This combination may become a preferred drug alternative for patients with APL and a mood disorder.

3.High-sensitivity troponin T predicts perioperative adverse events in patients undergoing neurosurgical procedures
Arsal Acarbaş
doi: 10.14744/ijmb.2019.02411  Pages 97 - 101
INTRODUCTION: Previous studies have shown that troponin is a valuable predictor of perioperative complications after non-cardiac surgery. However, the relationship of the preoperative troponin level with perioperative adverse events has not been well described in patients undergoing neurosurgical procedures. The aim of this study was to evaluate the impact of the preoperative high-sensitivity cardiac troponin T (hs-cTnT) level on the outcome of patients who underwent neurosurgery.
METHODS: The records of 2519 patients who were over 18 years of age and underwent elective neurosurgery between December 2014 and December 2018 were retrospectively evaluated. Patient medical and demographic data and the results of routine preoperative laboratory tests, including the hs-cTnT level, were collected to assess a potential association between these factors and perioperative adverse events.
RESULTS: Perioperative adverse events occurred in 251 (10.0%) patients. Older patients and those with more comorbid conditions tended to have a higher rate of perioperative adverse events. The preoperative hs-cTnT level was significantly higher in the individuals who experienced a complicated in-hospital course than in those who did not (21.6±8.2 ng/L vs 6.3±3.1 ng/L; p<0.001). Multivariate analysis indicated that age (odds ratio [OR]: 2.33, 95% confidence interval [CI]: 1.16-4.35; p<0.01), the presence of diabetes (OR: 3.13; 95% CI: 1.15-6.32; p=0.004), and a preoperative hs-cTnT level of >18.3 ng/L (OR: 4.51, 95% CI: 2.34–7.82; p<0.001) were significant and independent predictors of perioperative adverse events.
DISCUSSION AND CONCLUSION: The results of this study indicated that a higher preoperative hs-cTnT level was associated with perioperative adverse events in adult patients undergoing elective neurosurgery.

4.The role of serum acute phase reactant levels in the prediction of impacted ureteral stone
İsmet Aydın Hazar, Tuncay Tas, Cem Tuğrul Gezmiş, Ersan Arda, Nusret Can Çilesiz, Basri Cakiroglu
doi: 10.14744/ijmb.2019.20592  Pages 102 - 106
INTRODUCTION: The aim of this study was to investigate the determination of ureteral stone impaction using acute phase reactants.
METHODS: A total of 110 patients who had a single ureteral stone treated during a single month using medical expulsive therapy of tamsulosin 0.4 mg/day, diclofenac 75 mg upon analgesic requirement, and at least 3 liters fluid per day were evaluated prospectively. The patients underwent ureteroscopy and were divided into 2 groups according to the presence or absence of impaction. The preoperative white blood cell (WBC) count, red blood cell distribution width (RDW), C-reactive protein (CRP) level, erythrocyte sedimentation rate (ESR), mean platelet volume (MPV), and neutrophil-to-lymphocyte ratio (NLR) in the non-impacted stone group (Group 1; n=59) and the impacted group (Group 2; n=51) were statistically compared.
RESULTS: There was no statistically significant difference in terms of age, stone diameter, body mass index, grade of hydronephrosis, or stone localization between the 2 groups. The WBC, RDW, and MPV value differences were statistically significant between the groups (p=0.035, p=0.035, and p=0.005, respectively). An MPV cut-off value of 9.55 fL was defined in Group 2 with 66% sensitivity and 62% specificity for impaction. There was no statistically significant difference between the groups in CRP, ESR, or NLR values (p=0.44, p=0.76, p=0.54, respectively).
DISCUSSION AND CONCLUSION: Evaluation of serum MPV with a cut-off value of 9.55 fL may predict ureteral stone impaction.

5.Evaluation of the analytical performance of two vitamin D immunoassay methods
Özgür Mehmet Yis, Guler Bugdayci, Rabia Nur Yıldız, Hamdi Oğuzman
doi: 10.14744/ijmb.2019.29491  Pages 107 - 112
INTRODUCTION: The increasing clinical significance of 25-hydroxyvitamin D [25(OH)D] has made it an indispensable test in the laboratory. The aim of this study was to investigate the analytical performance of 2 widely used immunoassay methods, the new Abbott Architect 5P02 25-OH Vitamin D assay (Abbott Laboratories, Lake Bluff, IL, USA) and the Beckman Coulter product, the Access 25 (OH) Vitamin D Total assay (Beckman Coulter, Inc., Brea, CA, USA).
METHODS: A total of 96 serum samples were used to compare the accuracy, linearity, limit of blank, limit of detection, limit of quantification, and precision of the 2 tests using the Architect i2000SR System (Abbott Laboratories, Lake Bluff, IL, USA) and the Access2 (Beckman Coulter, Brea, CA, USA) immunoassay platform. Deming regression analysis and Bland Altman graphs were used to compare the 2 methods.
RESULTS: The within-run coefficient of variation (CV%) of the Architect and the Access systems was <3.1% and <6.72%, respectively. There was good linearity of the 25(OH)D measurement at 98.9-114% for the Architect assay and 94.1-103.5% for the Access assay at concentrations of 5-160 ng/mL and 6.2-210.4 ng/mL, respectively. The correlation coefficient was 0.921 (y=-2.1+0.97x).
DISCUSSION AND CONCLUSION: Thorough testing indicated that the new 5P02 Abbott Architect 25(OH)D and the Beckman Coulter Access2 25(OH)D Total test demonstrated appropriate analytical performance.

6.S100B and latent toxoplasmosis in Alzheimer’s disease
Hakan Ayyildiz, Mehmet Kalayci, Nuran Karabulut, Fatih Karaboga
doi: 10.14744/ijmb.2019.47965  Pages 113 - 117
INTRODUCTION: Alzheimer’s disease (AD) is a fatal, multifactorial neurodegenerative disorder characterized by progressive neuronal loss and the loss of cognitive function. The etiology has not yet been fully elucidated. It has been suggested in some studies that central nervous system infections may play a role in the development of Alzheimer’s disease. The aim of the present study was to investigate a possible relationship with a latent Toxoplasma gondii (T. gondii) infection in astrocytes and S100 proteins released as a result of astrocyte damage.
METHODS: A total of 33 patients with AD and 32 healthy individuals were included in this study. There were 16 Toxoplasma-negative and 17 Toxoplasma-positive patients in the AD group, and 15 Toxoplasma-negative and 17 Toxoplasma-positive individuals in the control group.
RESULTS: There were no statistically significant differences between the groups in terms of mean age or gender. An inter-group comparison of the subjects revealed that the S100B level was higher in patients with AD than in the control group (p<0.05). There was no statistically significant difference between the groups in terms of the T. gondii immunoglobulin G test (p>0.05).
DISCUSSION AND CONCLUSION: In our study, although there was no relationship between T. gondii infection and AD, significantly higher levels of S100B in patients with AD suggest that this protein may be important both in diagnosis and in possible treatment processes. The authors suggest that reproduction of the current study using different genotypes of T. gondii would further contribute to knowledge of the etiology of AD.

7.Vitamin D deficiency status in Turkey: A meta-analysis
Medine Alpdemir, Mehmet Fatih Alpdemir
doi: 10.14744/ijmb.2019.04127  Pages 118 - 131
Objectives: Vitamin D deficiency is a significant public health problem in both developed and developing countries, with a reported worldwide prevalence of 30% to 80% among children and adults. The purpose of this study was to examine vitamin D deficiency/insufficiency in Turkey based on a review of the existing research.
Methods: PubMed, DergiPark, The Scientific and Technological Research Council of Turkey (TUBITAK), Google Scholar, Google, and Scopus search engines were queried. The keywords of Turkey, vitamin D, serum 25-hydroxyvitamin D, 25(OH)D3, 25(OH) vitamin D, deficiency/insufficiency of vitamin D, and prevalence were used in the screening process. The review included prospective and retrospective research studies with healthy individuals of various communities. The Newcastle-Ottawa Quality Assessment Scale was used to assess the risk of bias of the included studies.
Results: A total of 40 studies with a sample size of 111.582 were included in the meta-analysis. The prevalence of vitamin D deficiency was estimated at 63% (95% confidence interval [CI]: 58.9-66.6) for the overall population. It was observed that vitamin D deficiency has been reported as 86.6% (95% CI: 70.2-94.6) for infants, 76% (95% CI: 65.2-84.3) for pregnant women, 39.8% (95% CI: 38-41.6) for children, and 63.5% (95% CI: 58.8-67.9) for adults. The prevalence of vitamin D deficiency among women and men was identified as 64.7% (95% CI: 57.5-71.2) and 39.5% (95% CI: 31.0-48.7), respectively.
Conclusion: The results obtained in this meta-analysis revealed a high rate of vitamin D deficiency in Turkey, which varies from 58.9% to 66.6% with 95% CI. In particular, neonates, pregnant women, and adult women have a higher risk of vitamin deficiency. The results of this meta-analysis demonstrate that the vitamin D level of the Turkish public should periodically be measured and supplemented as necessary.

8.Procalcitonin in the diagnosis of sepsis and correlations with upcoming novel diagnostic markers
Mustafa Erinç Sitar, Belkiz Ongen Ipek, Aslı Karadeniz
doi: 10.14744/ijmb.2019.30502  Pages 132 - 140
Sepsis is a complex and lethal condition. For successful treatment, clinicians need high quality testing to guide the approach to pathogen identification and treatment. Medical laboratories play a vital role in the detection of infectious agents, and must continually strive to discover new and reliable tests and to analyze the reliability of existing tests in different diseases and expand their usage as appropriate. Selecting the appropriate therapy, reducing the use of antibiotics and thereby reducing antibiotic resistance are also undeniable parts of this task. The most commonly used parameters to guide infection therapy are the white blood cell count, the erythrocyte sedimentation rate, the absolute count of neutrophils, the absolute number of lymphocytes, and the level of C-reactive protein, serum amyloid A protein, ceruloplasmin, haptoglobin, fibrinogen, and procalcitonin (ProCT). Although ProCT has been accepted as quite effective in differentiating serious bacterial infections, there are unresolved questions regarding effective usage during follow-up, as there are with other markers. ProCT and other promising biomarkers in a sepsis setting were the focus of this review, beginning with the first study to define ProCT in the literature, and examining some of the studies related to the importance of the ProCT-sepsis relationship, and detailed information on candidate markers.

9.Reviewer List 2019

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