ISSN  2587-2362  |  E-ISSN  2618-642X
International Journal of Medical Biochemistry - Int J Med Biochem : 4 (2)
Volume: 4  Issue: 2 - 2021
1.Full Issue

Page I

2.Laboratory employees’ perception of occupational risk factors
Hafize Boyacı, Gönen İlkar Dündar, Ilhan Kerem Senel
doi: 10.14744/ijmb.2021.02886  Pages 61 - 66
INTRODUCTION: The purpose of this study was to assess the understanding and views of hospital laboratory workers related to risk factors in their work environment.
METHODS: This quantitative analysis included 234 laboratory employees in a university hospital. The data were obtained using a survey consisting of 19 questions: 8 items solicited demographic characteristics of the respondents, 3 questions determined their observations about the work environment, and 8 questions asked about occupational risk perception. Risk perception was evaluated using a scale designed specifically for laboratory employees. Frequency, percentages, and averages were used to present descriptive data. A t-test and analysis of variance were used to analyze occupational risk perception according to participant characteristics and responses.
RESULTS: A total of 162 women and 72 men (mean age: 40-49 years) participated in the study. The most common health problem observed was lower extremity pain. The occupational risk perception level was found to be above average (3.13±0.68). There was a statistically significant difference between the occupational risk perception score and the length of employment in the unit (p<0.05); however, no statistical significance was found between occupational risk perception and other variables (gender, age, field of work, education, or length of overall professional experience).
DISCUSSION AND CONCLUSION: The occupational risk perception score of laboratory workers with 11-16 years of experience was higher than that of more recent employees. Training is known to be effective and would appear to be a valuable investment in the development of risk perception among laboratory employees to ensure a safe and effective environment.

3.An exploratory study of some pediatric liver function parameters in a segment of North Indian children
Abhaya Indrayan, Mohini Bhargava, Shubham Shukla
doi: 10.14744/ijmb.2021.41713  Pages 67 - 76
INTRODUCTION: Western clinical reference levels may not be valid for children in India because of differences in genetic profile, physique, dietary intake, lifestyle, and environmental factors; however, appropriate values for most biochemical parameters for children in India remain unknown. This study is an analysis of the total protein, albumin, globulin, albumin-globulin ratio, alanine aminotransferase, aspartate aminotransferase, gamma-glutamyl transferase, and alkaline phosphatase (ALP) levels in the serum of a segment of apparently healthy Indian children of aged 0-14 years.
METHODS: Liver function data from tests conducted between January and June of 2019 for 371 children were extracted from the laboratory records of a tertiary care hospital and double-filtered to obtain uncontaminated values. The data were statistically tested for significance by age group and sex. Reference ranges of 2.5th and 97.5th percentiles were determined for age groups of 1-4, 5-9, and 10-14 years. Due to the limitation of the sample size, we did not provide a reference range for children aged less than 1 year.
RESULTS: A significant sex difference (p<0.001) was observed only for the ALP level. Age group differences were not significant (all p>0.05); however, reference ranges were provided for age groups within 1-14 years to provide specificity and assist with comparisons. The liver function values in the study group of Indian children differed from what have been reported for Western children.
DISCUSSION AND CONCLUSION: The findings are suggestive and not confirmatory, as our sample was insufficient for a determination of definitive values. Nonetheless, the results provide valuable information and indicate a need to carry out more studies to delineate liver function parameters in Indian children since the values may differ from those of other populations.

4.Laboratory findings in predicting intensive care need and death of COVID-19 patients
Merve Sena Odabaşı, Güven Ozkaya, Erdinç Serin, Anıl Akkuş, Pınar Yılmaz, İsmet Sayan
doi: 10.14744/ijmb.2021.53315  Pages 77 - 84
INTRODUCTION: The ability to predict the course of COVID-19 is very valuable in terms of the optimal use of health resources. The aim of this study was to examine the value of biochemical and hematological parameters in the estimation of hospital stay, disease severity, and likelihood of death.
METHODS: Routine blood analysis data of confirmed COVID-19 cases (n=222) were collected and analyzed. The patients were divided into 3 groups: outpatient, inpatient, and patients requiring intensive care.
RESULTS: There were significant differences between the 3 groups in terms of age, lymphocyte, neutrophil, hemoglobin, hematocrit, mean corpuscular volume (MCV), red blood cell distribution width (RDW), neutrophil-to-lymphocyte ratio (NLR), neutrophil-to-monocyte ratio (NMR), platelet-to-lymphocyte ratio (PLR), procalcitonin, C-reactive protein (CRP), and D-dimer values. Univariate analysis for mortality revealed significant differences in neutrophil, NLR, PLR, NMR, procalcitonin, and CRP values. Multivariable logistic regression yielded significant differences in only NMR and procalcitonin values. A positive correlation was determined between the length of hospital stay and age, MPV, procalcitonin, and D-dimer values.
DISCUSSION AND CONCLUSION: The neutrophil count was the most appropriate parameter to predict the need for intensive care (area under the curve: 0.782, sensitivity: 73%, specificity: 75%, with a cutoff of 4.43). The NMR and procalcitonin values were significant to predict death in multivariate analysis. Age, CRP, and D-dimer values were the parameters most associated with the duration of hospitalization.

5.Apolipoprotein E and adiponectin levels in coronary artery disease patients with low-density lipoprotein cholesterol and non-high-density lipoprotein cholesterol discordance
Özge Kurmuş, Aycan Fahri Erkan, Neslihan Çoban, Ayşem Kaya, Evin Ademoğlu
doi: 10.14744/ijmb.2021.91886  Pages 85 - 90
INTRODUCTION: The aim of this study was to investigate whether serum apolipoprotein E (ApoE) and adiponectin were associated with discordance of low-density lipoprotein cholesterol (LDL-C) and non-high-density lipoprotein cholesterol (non-HDL-C) levels in coronary artery disease (CAD) patients.
METHODS: A total of 243 patients with significant CAD were studied. The fasting levels of serum lipids, plasma ApoE, and adiponectin were measured. The median LDL-C and non-HDL-C values were determined to assess and analyze discordance. Discordance was defined as an LDL-C≥ the median and non-HDL-C< the median, or an LDL-C< the median and a non-HDL-C≥ the median. ApoE and adiponectin were compared between discordant and concordant groups.
RESULTS: Discordance between the LDL-C and the non-HDL-C was observed in 14% of the patients. Although the median adiponectin was lowest in the group with an LDL-C< median and a non-HDL-C≥ the median, and the median ApoE was lowest in the group with an LDL-C≥ median and a non-HDL-C< the median, no statistically significant differences in the ApoE and adiponectin were recorded between the groups (p=0.186 and p=0.161, respectively). Adiponectin was negatively correlated with triglyceride and remnant cholesterol (p<0.001 and p<0.001, respectively).
DISCUSSION AND CONCLUSION: While discordance between the LDL-C and the non-HDL-C in CAD patients (14%) was observed, the plasma ApoE and adiponectin levels were not significantly different between the discordant and concordant groups.

6.Association between HBA locus copy number gains and pathogenic HBB gene variants
Güven Toksoy, Nergis Akay, Agharza Aghayev, Volkan Karaman, Şahin Avcı, Tugba Kalayci, Umut Altunoğlu, Zeynep Karakaş, Zehra Oya Uyguner
doi: 10.14744/ijmb.2021.65477  Pages 91 - 96
INTRODUCTION: Alpha (α) and beta (β) thalassemia are the most prevalent genetic hematological disorders. The co-occurrence of silent β-thalassemia with excess α-globin gene copies is associated with the thalassemia intermedia phenotype. This study was an investigation of the α globulin gene dosage and sequence variations in thalassemia patients.
METHODS: Multiplex ligation-dependent probe amplification and Sanger sequencing were used to identify the hemoglobin subunit alpha 1 (HBA1) and HBA2 gene alterations in 32 patients. Deletion, duplication, and other findings were analyzed in the index cases and family members.
RESULTS: Four of the 32 cases (12.5%) were found to have gross duplications. Two cases demonstrated α-globin triplication, and 2 had a quadruplicated HBA1/2 genes. Affected family members revealed genotype-phenotype correlation. In 1 patient, it was observed that quadruplicated HBA genes co-occurrence with hemoglobin subunit beta (HBB) mutation was inherited from his mother. Notably, the mother did not demonstrate any thalassemia phenotype. Further investigation showed that the mother was carrying a single copy HBA gene deletion in the trans allele that explained her clinical condition.
DISCUSSION AND CONCLUSION: This study examined the effect of increased copies of the HBA gene in HBB gene pathogenic variant carriers. The results indicated that β-thalassemia mutations with a co-occurrence of increased α-globin gene dosage is not very rare condition. Patients with clinical findings incompatible with their HBB genotypes should be investigated for small and gross α-globin gene variants in order to provide genetic counseling and prenatal diagnosis follow-up, as appropriate.

7.Assessment of analytical process performance using the Six Sigma method: A comparison of two biochemistry analyzers
Saniye Başak Oktay, Sema Nur Ayyildiz
doi: 10.14744/ijmb.2021.14633  Pages 97 - 103
INTRODUCTION: Six Sigma is a method of quality management analysis that integrates accuracy and precision of measurement, error identification, and process improvement. The aim of this study was to evaluate the analytical process performance of routine biochemical tests performed with 2 biochemistry analyzers in our laboratory according to Six Sigma methodology and compare the findings.
METHODS: Internal quality control (IQC) data of routine biochemical analytes used for 3 months in 2 Abbott Architect c16000 analyzers (Abbott Diagnostics Inc., Lake Forest, IL, USA) were extracted and the mean, SD, coefficient of variation %, bias % and sigma values were calculated. The performance of the analytes was classified according to the sigma level: <3 demonstrated poor performance, 3-6 was graded as acceptable, and >6 indicated good performance.
RESULTS: For both analyzers, 2 levels IQC sigma values of chloride and sodium were <3, while the levels of alkaline phosphatase, aspartate aminotransferase, amylase, creatine kinase, iron, gamma-glutamyl transferase, and magnesium were >6; and the sigma values of total bilirubin, phosphorus, glucose, high-density lipoprotein-cholesterol, total cholesterol, calcium, creatinine, and total protein were determined to be within the acceptable range of 3-6. Amylase and creatine kinase were the best performers on both analyzers, while sodium had the lowest sigma values.
DISCUSSION AND CONCLUSION: Six Sigma is a good method to evaluate the analytical process performance of a clinical laboratory. Quality control measures should be implemented for parameters with low sigma values.

8.Biosafety risk assessment of a clinical biochemistry laboratory for SARS-CoV2 infection
Nergiz Zorbozan, Orçun Zorbozan
doi: 10.14744/ijmb.2021.28290  Pages 104 - 120
INTRODUCTION: Clinical laboratories are a transfer point for infected patient samples. According to the World Health Organization (WHO) Laboratory Biosafety Guideline, a risk assessment approach is the backbone of laboratory biosafety. In laboratories, risk assessment is recommended at predetermined periods and in the event of new circumstances. On February 12, 2020, the WHO published an interim guidance document, "Laboratory biosafety guidance related to the novel coronavirus (2019-nCoV)" and it was highly recommended that all coronavirus 2019 (COVID-19) testing procedures be performed based on a local risk assessment. This study was designed to evaluate the biosafety risk in a biochemistry laboratory where routine testing of patients diagnosed with COVID-19 is performed.
METHODS: Risk assessment for tests performed on analyzers and a complete urinalysis was performed using the risk assessment template included in the subsequent WHO interim guidance document, “Laboratory biosafety guidance related to coronavirus disease (COVID-19).”
RESULTS: The overall initial risk for tests performed on analyzers and a complete urinalysis test was determined to be very high. Processes such as pipetting a sample and checking a sample tube by scanning the barcode during tests performed on analyzers were suspended until additional risk control measures could be implemented. The manual microscopic urinalysis process was also discontinued. To reduce the risk, surgical masks, surgical caps, eye protection, and disposable laboratory coats were added to the previously mandated personal protective equipment. After implementing additional risk control measures, the total residual risk of both processes was graded medium.
DISCUSSION AND CONCLUSION: Since there is as yet no effective treatment for COVID-19, exposure risk is considered severe. Therefore, the probability of exposure is important in determining the level of risk. Measures put in place reduced the total residual risk.

9.The effects of preconditioning with IFN-γ, IL-4, and IL-10 on costimulatory ligand expressions of mesenchymal stem cells
Alper Tunga Özdemir, Mustafa Öztatlici, Rabia Bilge Özgül Özdemir, Büşra Çakır, Kemal Özbilgin, Ertan Darıverenli, Cengiz Kirmaz
doi: 10.14744/ijmb.2021.77487  Pages 121 - 130
INTRODUCTION: Mesenchymal stem cells (MSCs) are strong immunomodulatory cells, and co-stimulation may play an important role in increasing the effects of MSCs on adaptive immune cells. Preconditioning may add to the effectiveness of MSCs. The aim of this study was to investigate alterations in the costimulatory ligand expressions of MSCs preconditioned with inflammatory cytokines.
METHODS: MSCs were preconditioned with interferon gamma (IFN-γ), interleukin (IL) 4 (IL-4), and IL-10, and changes in CD80, CD86, CD137L, CD252, CD274, CD275, and human leukocyte antigen (HLA) class I and II expressions were analyzed using flow cytometry and quantitative polymerase chain reaction methods. Human acute monocytic leukemia cell line (THP-1) macrophages preconditioned under the same conditions served as a control for comparison.
RESULTS: The frequencies of CD80 (p=0.0003), CD86 (p<0.0001), CD137L (p<0.0001), CD252 (p=0.0003), CD274 (p=0.0077), CD275 (p<0.0001), and HLA-II (p<0.0001) -positive MSCs was significantly lower than that of the THP-1 macrophages with either method, but there was no significant difference in the HLA-I (p=0.1506) cells. Comparison of the expression of the costimulatory ligands revealed that the expression of MSCs was significantly lower than that of THP-1 cells, and was not affected by cytokine stimuli.
DISCUSSION AND CONCLUSION: The study data indicated that although MSCs are strong immunomodulatory cells, the costimulatory ligand expression required for an effective antigen presentation was extremely low compared with that of professional antigen presenting cells. In addition, preconditioning with IFN-γ, IL-4, and IL-10 failed to increase the expression of important costimulatory ligands, such as CD80 and CD86, in MSCs. The stability of costimulatory ligand expression suggests that MSCs may be an effective source for HLA-I-mediated peripheral tolerance.

10.Data to assist in the determination of biochemistry test ranges to assess hemodialysis efficacy in patients with chronic renal failure
Claudio Ilardo, Yoann Ehrhard, Olivier Calas, Joel Barthes
doi: 10.14744/ijmb.2021.86548  Pages 131 - 135
INTRODUCTION: Reference intervals are usually defined based on blood samples from healthy subjects and specific reference ranges for patients on hemodialysis (HD) are not currently available. The aim of the study was to establish expected ranges of biochemical analytes before and after HD for patients with chronic renal failure (CRF).
METHODS: The findings of the 4 most recent quarterly check-ups of 684 patients (233 women and 451 men; age 18-95 years) treated with HD in several dialysis units attached to a single laboratory were studied. Biochemical analytes were measured using fully automated Roche Cobas C 501 or C 701 analyzers (Roche Diagnostics, Basel, Switzerland). Expected ranges were set according to International Federation of Clinical Chemistry and Clinical and Laboratory Standards Institute guidelines using the nonparametric method.
RESULTS: Compared with pre-HD values, beta-2 microglobulin (β2m), chloride, creatinine, phosphate, potassium, and urea concentrations were lower post-HD (p<0.001), while bicarbonate, calcium, protein, and sodium concentrations were higher (p<0.001). Comparison with healthy subjects revealed that the levels of β2m, creatinine, and urea were higher before and after HD. Other analyte ranges were either lower, higher, or equivalent to healthy subjects in pre- and post-dialysis measurements. Differences between sexes were not significant, with the exception of creatinine, as well as a significant difference (>10%) in the creatinine level between individuals under and over 60 years of age (p<0.0001).
DISCUSSION AND CONCLUSION: The establishment of specific ranges for dialysis patients could contribute to finding specific thresholds to monitor the effectiveness of HD.

11.The significance of teaching human biochemistry to dental students
Haseeb Ahsan
doi: 10.14744/ijmb.2021.61687  Pages 136 - 142
Biochemistry instructions in dental studies should highlight the fact that the basic biochemical processes occurring in the oral cavity are the same as those that take place in other tissues and organs of the body. Saliva is a complex fluid that plays an essential role in the maintenance of oral health and contains a wide range of proteins, enzymes (lysozyme, lactoferrin, peroxidases) and secretory immunoglobulins. Salivary cationic peptides and defense proteins, such as lysozyme, salivary amylase, cystatins, mucins, peroxidases, and statherin, are primarily responsible for innate immunity. The role of collagen, which forms a large part of the organic material of dentin, should be given prominence in the study of proteins. The study of carbohydrates and lipids is also an important topic, since the digestion of starch and lipids begins in the oral cavity due to the presence of various enzymes, e.g., amylase and lipase. The biochemistry syllabus for dental sciences should also include the role of weak acids and bases and buffers to help students understand the buffering capacity of saliva and its implications for oral health. Patients with poor glycemic control are more prone to oral manifestations of diabetes, including periodontal disease, salivary gland dysfunction, halitosis, burning mouth sensation, delayed wound healing, and increased susceptibility to infection. Diabetic patients are also at greater risk of an intraoperative diabetic emergency in the dental clinic. Therefore, dentists must appreciate and implement important dental management considerations when providing care to diabetic patients. Strategies to investigate bleeding disorders can help guide stepwise, rational testing for inherited and acquired causes of bleeding. It is clear that biochemistry is becoming increasingly important in the field of dentistry, and this should be reflected in both teaching and research.

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