Nevin Manimala

Clin Lab. 2022 Jul 1;68(7). doi: 10.7754/Clin.Lab.2021.211110.

ABSTRACT

BACKGROUND: Excessive inflammatory immune response during SARS-CoV-2 infection contributes to severe disease in COVID-19 patients. Recently, some researchers hypothesized that dysregulation of the bradykinin (BK) system may also play a role in the pathogenesis of severe disease. Des-Arg(9)-bradykinin (DABK), an active metabolite of BK, is responsible for vasodilatation and increased permeability in the lungs and regulated by angiotensin converting enzyme 2 (ACE-2). Viral inhibition of ACE-2 by SARS-CoV-2 increases DABK levels. Serum levels of this metabolite may be linked to disease severity in COVID-19 patients. In this study, it is aimed to investigate the prognostic value of serial measurement of serum DABK levels in severe COVID-19 patients.

METHODS: This prospective cohort study was conducted in hospitalized severe COVID-19 patients. Serum DABK levels of patients were serially measured on day 0, day 3 and day 5. Patients were categorized as cases with poor or good prognosis and critical or non-critical cases. Serum DABK levels of these patient groups were compared with paired sample t-test. Serum DABK levels on different days in the same patients were compared with repeated measures ANOVA tests.

RESULTS: There was no statistically significant difference in serum DABK levels measured at day 0, day 3, and day 5 between good and poor prognosis groups. DABK levels in critical and non-critical COVID-19 patients also did not show any significant difference.

CONCLUSIONS: According to our results serially measured serum DABK levels did not correlate with outcome of severe COVID-19 and do not have prognostic value in severe COVID-19 patients.

PMID:35975542 | DOI:10.7754/Clin.Lab.2021.211110

Clin Lab. 2022 Jul 1;68(7). doi: 10.7754/Clin.Lab.2021.210910.

ABSTRACT

BACKGROUND: Candida auris is an opportunistic pathogen with multiple drug resistance. Therefore, researchers conducted a meta-analysis to review PCR’s ability to diagnose Candida auris to promote the development of accurate Candida auris diagnosis.

METHODS: Researchers systematically retrieved relevant articles from PubMed, Cochrane Library, Embase, and Web of Science. Then, researchers extracted the key data required for the study from the selected articles. Meta-DiSc 1.4 was used for the statistical analysis. RevMan 5.3 was employed to assess the quality of the included literature. A funnel plot can appraise whether the included articles have publication bias.

RESULTS: Five articles were included in the study. The results suggest that the pooled sensitivity and pooled specificity were 0.94 (95% CI: 0.92 – 0.95) and 0.99 (95% CI: 0.99 – 0.99), respectively. The positive and negative likelyhood ratios were 100.94 (95% CI: 47.51 – 214.47) and 0.07 (95% CI: 0.05 – 0.10), respectively. The diagnostic odds ratio was 1,814.70 (95% CI: 717.30 – 4,591.04), and the area under the SROC curve was 0.9935. Deek’s funnel plot indicated that there was no publication bias.

CONCLUSIONS: The results of the analysis indicate that PCR can become a valuable technique for the clinical diagnosis of Candida auris due to its excellent performance.

PMID:35975540 | DOI:10.7754/Clin.Lab.2021.210910

Clin Lab. 2022 Jul 1;68(7). doi: 10.7754/Clin.Lab.2021.210833.

ABSTRACT

BACKGROUND: Serum TSH reference intervals (RIs) are methodology, population, and age specific. However, the ethical and practical challenges restrict the establishment of pediatric RIs using conventional approaches and advocates the use of indirect data mining-based algorithms. This study was carried out to estimate the reference interval of neonatal serum TSH in Pakistani population using an indirect approach.

METHODS: A data mining of serum TSH results of neonates (≤ 1 month of age) from 2013 – 2018 was done. Two subgroups on the basis of age from birth to 5 days and 6 – 30 days were assessed. The German study group’s pre-validated indirect algorithm ‘KOSMIC’ was utilized for the statistical analysis.

RESULTS: A total of non-duplicate 82,299 neonatal serum TSH tests were retrieved over a period of 6 years, including 88% (n = 70,788) aged 0 – 5 days and 12% (n = 11,511) ranging from 6 days to 1 month. The estimated RIs for the first age partition was 0.7 (90% CI 0.6 – 0.8) to 15.5 (90% CI 12.9 – 16.2) and for the second group 0.7 (90% CI 0.5 – 0.9) to 7.8 (90% CI 6.1 – 9.9) µIU/mL.

CONCLUSIONS: This study revealed age related trends in serum TSH. The study advocates the need for population specific RIs owing to the significant variations noted on comparison with previously published literature. Precise RIs become vital particularly when serum TSH is undertaken as a confirmatory test for presumptive positive results on newborn screening for congenital hypothyroidism.

PMID:35975518 | DOI:10.7754/Clin.Lab.2021.210833

Clin Lab. 2022 Aug 1;68(8). doi: 10.7754/Clin.Lab.2022.220362.

ABSTRACT

BACKGROUND: Identifying the distribution and pattern of specific aeroallergens in Sichuan, China, after the corona-virus disease (COVID-19) epidemic and to provide a basis for future prevention and clinical treatment.

METHODS: Serological tests for 10 types of aeroallergens were performed on 10,036 participants attending the West China Second University Hospital from January 2020 to January 2021. SPSS23.0 was used to statistically analyze their specific immunoglobulin E (sIgE) grades in different genders, various age groups, and different diseases.

RESULTS: Of the 10,036 participants, 4,578 (45.62%) were allergic to at least one allergen. House dust had the highest sensitization rate (2,974, 29.63%), followed by Dermatophagoides farina (2,717, 27.07%) and Dermatophagoides pteronyssinus (2,611, 26.02%). Male and female participants had no significant difference in overall sensitization distributions. The prevalence differences between 0 – 3, 4 – 6, 7 – 9, 10 – 12, 13 – 15, and over 16-year-old age groups were statistically significant (p < 0.05), and the highest incidence age for children to be sensitive to aeroallergens was 4 – 6 years, respectively. Sensitization to D. pteronyssinus, D. farina, house dust, dog epithelium, and Alternaria alternata was more common in patients with rhinitis and asthma compared with bronchitis.

CONCLUSIONS: Aeroallergens are important causes of respiratory-related allergic diseases, and the characteristics of allergen sensitization discovered in this study could help with inhalant allergy disease prevention, diagnosis, and management in the post-epidemic era.

PMID:35975513 | DOI:10.7754/Clin.Lab.2022.220362

Clin Lab. 2022 Aug 1;68(8). doi: 10.7754/Clin.Lab.2021.211042.

ABSTRACT

BACKGROUND: The aim was to investigate the early diagnostic value of serum glial fibrillary acidic protein (GFAP) and ubiquitin C-terminal hydrolase (UCH-L1) levels in adults with minor head trauma (MHT) and whether it could be an alternative diagnostic method to computed tomography (CT). This is the first study with the combination of GFAP and UCH-L1 in the first 3 hours of MHT.

METHODS: The study comprised 88 patients, 60 patients and 28 controls, who were evaluated as having MHT, were admitted to the emergency department of our hospital within the first 3 hours of the trauma and met the inclusion criteria. CT was performed on all patients. Serum GFAP and UCH-L1 levels were measured within the first 3 hours of the trauma.

RESULTS: The median serum GFAP level was 1.07 ng/mL in the group with pathology on CT and 0.42 ng/mL in the group with no pathology on CT. The median serum UCH-L1 level was 0.40 ng/mL in the group with pathology on CT and 0.39 ng/mL in the group with no pathology on CT. A statistically significant difference was found between the serum GFAP levels of the CT (+) group and the CT (-) group (p = 0.021). GFAP levels were compared according to the CT (+) and CT (-) groups with a cutoff value of ≥ 1.56 ng/mL for GFAP, which had 50% sensitivity and 97.5% specificity. This was statistically significant (p = 0.008). It was found that the UCH-L1 level of the control group was lower than the UCH-L1 levels of the CT (+) and CT (-) groups, and this difference was found to be statistically significant (p = 0.003 and p = 0.018, respectively).

CONCLUSIONS: GFAP was found to be more specific than UCH-L1 in demonstrating the presence of intracranial pathology in patients with head trauma who were admitted to the emergency department in the first 3 hours after trauma.

PMID:35975499 | DOI:10.7754/Clin.Lab.2021.211042

Clin Lab. 2022 Aug 1;68(8). doi: 10.7754/Clin.Lab.2021.211030.

ABSTRACT

BACKGROUND: The aim was to explore the correlations of leukotriene B4 (LTB4) and 25-hydroxyvitamin D3 [25(OH)D3] levels with disease severity in children with Henoch-Schonlein purpura (HSP).

METHODS: A total of 260 HSP children admitted from January 2017 to December 2018 were selected, and 60 healthy children physically examined in the same period were enrolled as controls. The results of general laboratory tests and expression levels of leukotriene B4 (LTB4) and 25-hydroxyvitamin D3 [25(OH)D3] were compared. The correlations of LTB4 and 25(OH)D3 with immunoglobulin A (IgA) were statistically analyzed, and the expression levels of LTB4 and 25(OH)D3 were compared between Henoch-Schonlein purpura nephritis (HSPN) group and non-Henoch-Schonlein purpura nephritis (NHSPN) group. The optimal cutoff values of LTB4 and 25(OH)D3 to predict HSP were analyzed by receiver operating characteristic (ROC) curves, based on which they were divided into low-, intermediate-, and high-risk groups. The length of hospital stay and recurrence rate within 6 months were compared.

RESULTS: The levels of white blood cell count, platelets, C-reactive protein, IgA, IgM, IgE, complement C3, and LTB4 were significantly higher and 25(OH)D3 was lower in HSP group than those in control group (p < 0.05). IgA, LTB4, and 25(OH)D3 levels were independent risk factors for HSP (p < 0.05). LTB4 was positively correlated with IgA (p < 0.05), and 25(OH)D3 was negatively correlated with IgA (p < 0.05). LTB4 level was significantly higher and 25(OH)D3 level was lower in HSPN group than those in NHSPN group (p < 0.05). The optimal cutoff values of LTB4 and 25(OH)D3 were 27.82 pg/mL and 22.10 ng/mL, respectively, the length of hospital stay gradually increased in low-, intermediate-, and high-risk groups, and the recurrence rates within 6 months were 14.2%, 31.5%, and 39.6%, respectively (p < 0.05).

CONCLUSIONS: LTB4 level increases and 25(OH)D3 level decreases in children with HSP, and the expression levels are significantly correlated with disease severity, suggesting predictive values for prognosis.

PMID:35975496 | DOI:10.7754/Clin.Lab.2021.211030

Clin Lab. 2022 Aug 1;68(8). doi: 10.7754/Clin.Lab.2021.211026.

ABSTRACT

BACKGROUND: According to recent studies, thrombotic complications frequently occur in Coronavirus Disease-19 (COVID-19) and are associated with increasing disease severity and poor prognosis. However, conventional coagulation assays are unable to identify these patients’ hypercoagulable states, raising questions about the appropriate assessment tool. We aimed to evaluate coagulation abnormalities in patients with different severity of CO-VID-19 using viscoelastic tests.

METHODS: This was a single center retrospective observational study in a group of 50 adult patients with SARS-COV-2 infection and different severity of pneumonia (20 moderate, 30 severe). Coagulation status was evaluated using rotational thromboelastometry (ROTEM®) in conjunction with conventional coagulation assays (platelet count, PT, aPTT, fibrinogen, and D-dimer levels).

RESULTS: Shorter than normal EXTEM CFT, higher than normal A10 and MCF in INTEM, EXTEM, and FIBTEM and higher than normal α-angle were classified as markers of hypercoagulable state. Forty-four (88%) patients had at least two hypercoagulable ROTEM parameters. Seven patients developed thromboembolic complications. All were classified as having severe COVID-19 pneumonia. With increment increases in disease severity, we observed an increase in the number of patients with hypercoagulable parameters and higher INTEM, EXTEM, and FIBTEM MCF but without being statistically significant. On the other hand, we noted a significant decrement of PT (p = 0.039), higher fibrinogen (p = 0.001), higher D dimer (p < 0.001), and shorter CT EXTEM (p < 0.001).

CONCLUSIONS: Our findings support the presence of a hypercoagulable state in COVID-19 patients, especially in the severe forms. It also highlights the role of viscoelastic tests in assessing COVID-19 coagulopathy and, therefore, their potential use in thrombophrophylactic management.

PMID:35975495 | DOI:10.7754/Clin.Lab.2021.211026

Clin Lab. 2022 Aug 1;68(8). doi: 10.7754/Clin.Lab.2021.211003.

ABSTRACT

BACKGROUND: Along with vitamin D deficiency, a common global health problem in developed and developing countries, zinc deficiency also remains one of the most common micronutrient deficiencies-related public health problems in some parts of the world. Determination of vitamin D and Zn status is important for the growth, development, and health of school-age children, as well as their intellectual achievement and academic performance. In this study, we aimed to evaluate serum 25(OH)D and Zn levels and the relationship between them in a nationally representative sample of Turkish children and adolescents.

METHODS: A total of 541 children and adolescents aged 1 – 16 years were included in our study whose vitamin D and zinc test levels were measured and who applied to the Basaksehir Cam and Sakura City Hospital Pediatric Outpatient Clinic. Cases were examined by dividing them into subgroups according to their vitamin D levels (≤ 15 ng/mL deficiency; 15 – 20 ng/mL insufficiency; ≥ 20 ng/mL sufficiency) and age (< 5 years preschool; 5 – 10 years middle childhood; 11 – 16 years adolescence).

RESULTS: The levels of 25(OH)D were lower than 20 ng/mL in 33% of the children. There was deficiency in 80 (15%) and insufficiency in 99 (18%) cases. A statistically significant difference was found in 25(OH)D and Zn levels in groups separated by 25(OH)D level and age (p < 0.001). A positive significant correlation was found between serum 25(OH)D and Zn levels (r = 0.468; p < 0.001). A negative correlation was found between 25(OH) D levels and age (r = -0.261; p < 0.001) and body mass index (BMI) (r = -0.308; p < 0.001).

CONCLUSIONS: In our study, we found high levels of vitamin D deficiency and insufficiency and a significant positive correlation between serum 25(OH)D and Zn levels in the pediatric population. Based on this possible contribution, we think that providing vitamin D support to children of all ages, including adolescents, and thus improving zinc levels may be beneficial in protecting from diseases that lead to morbidity and mortality as a result of reducing the rate of growth and development retardation, regulating of bone development, and contributing to the development of the immune system.

PMID:35975493 | DOI:10.7754/Clin.Lab.2021.211003

Clin Lab. 2022 Aug 1;68(8). doi: 10.7754/Clin.Lab.2022.220102.

ABSTRACT

BACKGROUND: Patients with peritoneal dialysis commonly have severe disorders of lipid metabolism, with particularly severe changes in serum lipoprotein(α) [Lp(α)]. Serum Lp(α) may play a role in the risk of mortality in peritoneal dialysis patients. The aim was to investigate the correlation between high serum Lp(α) levels and all-cause mortality and death from cardiovascular events and infection in peritoneal dialysis patients.

METHODS: Three hundred and ninety-two patients with end-stage kidney disease who started peritoneal dialysis treatment between March 1, 2007 and May 31, 2020, were selected. Clinical data of all enrolled patients after 3 months of peritoneal dialysis were collected. Based on the median value of serum Lp(α) level, all enrolled patients were divided equally into a high serum Lp(α) level group (> 275.95 mg/L, n = 196) and a low serum Lp(α) level group (< 275.95 mg/L, n = 196). SPSS25.0 statistical software was used to analyze the factors affecting serum Lp(α) levels and the correlation between high serum Lp(α) levels and all-cause mortality and death from cardiovascular events and infection in peritoneal dialysis patients.

RESULTS: Binary multivariate logistic regression analysis showed that higher low-density lipoprotein (LDL) levels (OR = 1.614, 95% CI: 1.261 – 2.068, p = 0.000) and high Body Mass Index (BMI) levels (OR = 1.063, 95% CI: 1.004 – 1.126, p = 0.036) were the risk factors for the high serum Lp(α) levels. High serum albumin levels (OR = 0.959, 95% CI: 0.927 – 0.991, p = 0.014) and high parathyroid hormone levels (OR = 0.999, 95% CI: 0.997 – 1.000, p = 0.010) were protective factors for the high serum Lp(α) levels. The cumulative survival of patients in the high serum Lp(α) level group was lower in death from cardiovascular events as shown by Kaplan-Meier survival analysis (Log-rank test χ2 = 4.348, p = 0.037). Multivariate Cox regression analysis showed that high serum Lp(α) levels were an independent risk factor for death from cardiovascular events in peritoneal dialysis patients (HR = 1.002, 95% CI: 1.001 – 1.003, p = 0.001).

CONCLUSIONS: The occurrence of high serum Lp(α) levels in peritoneal dialysis patients was positively associated with LDL and BMI, and negatively associated with serum albumin and parathyroid hormone levels. High serum Lp(α) levels were related to the risk of death from cardiovascular events in peritoneal dialysis patients.

PMID:35975486 | DOI:10.7754/Clin.Lab.2022.220102

Math Med Biol. 2022 Aug 16:dqac012. doi: 10.1093/imammb/dqac012. Online ahead of print.

ABSTRACT

As the SARS-CoV-2 virus spreads around the world new variants are appearing regularly. Although some countries have achieved very swift and successful vaccination campaigns, on a global scale the vast majority of the population is unvaccinated and new variants are proving more resistant to the current set of vaccines. We present a simple model of disease spread, which includes the evolution of new variants of a novel virus and varying vaccine effectiveness to these new strains. We show that rapid vaccine updates to target new strains are more effective than slow updates and containing spread through non-pharmaceutical interventions is vital while these vaccines are delivered. Finally, when measuring the key model inputs, e.g. the rate at which new mutations and variants of concern emerge, is difficult we show how an observable model output, the number of new variants that have been seen, is strongly correlated with the probability the virus is eliminated.

PMID:35975450 | DOI:10.1093/imammb/dqac012