Hemolyzed Specimens: Major Challenge for Identifying and Rejecting Specimens in Clinical Laboratories

Pre-analytical quality in clinical chemistry testing is as important as analytical and post-analytical quality. The most prevalent pre-analytical interference and a major source of error producing unreliable laboratory test results is hemolysis of blood samples. In vitro hemolysis may be due to the blood withdrawal technique or sample handling whereas in vivo hemolysis can originate from acquired, hereditary, or iatrogenic conditions and is not technique dependent. Interpreting in vivo or in vitro hemolysis requires clinicians to supply reliable clinical history and findings. Even then, to reject or release the result with interpretation is still under debate. Thus, hemolyzed specimens are a serious pre-analytical problem calling for well-designed and strictly implemented laboratory guidelines. The aim of this non-systematic review (addressed to healthcare professionals) was to highlight the challenges in identifying and rejecting hemolysis specimens

Evaluation of HbA1c using high performance liquid chromatography and capillary electrophoresis in Type 2 Diabetes Mellitus patients suspected to have haemoglobin variant

BACKGROUND: High-Performance Liquid Chromatography (HPLC) is widely used for HbA1c measurement. However, it is prone to haemoglobin (Hb) variant interference. Capillary electrophoresis (CE) is believed to have better performance in patients with Hb variant. This study aimed to compare HbA1c level between HPLC and CE among Type 2 Diabetes Mellitus (T2DM) patients suspected to have Hb variant, determine the type of Hb variant among those patients, and evaluate the agreement between both methods.METHODS: A cross-sectional study conducted at Endocrine Laboratory, Hospital Universiti Sains Malaysia, from June till December 2020. HbA1c results of adults T2DM from HPLC with suspected Hb variant were re-analysed using CE. The comparisons of HbA1c were made using paired t-test and Wilcoxon Signed Rank Test. The correlation and method comparison were made using Pearson correlation, Bland Altman (BA) and Passing-Bablok (PB), whereas the agreement using Intraclass Coefficients Correlation (ICC).RESULTS: 250 patients were included with a median (IQR) age of 52.19 (11.11) years. For reportable results (?3.8% to ?18.5%), both methods showed no difference (p=0.382) whereas the results were difference for HbA1c >18.5% (p=0.048). 26 patients had Hb analysis with majority having Hb E trait 14 (5.6%). HPLC overestimated HbA1c in patients with Hb J and alpha Hb variant while CE able to report. Pearson correlation and PB regression analysis showed good correlation (r=0.987, p<0.001) and good agreement [slope of 1.0 (95% CI: 1.00 to 1.03); intercept of -0.3 (95% CI: ?0.61 to 0.30)]. BA plot revealed a mean difference of 0.30% (95% CI:0.00 to 0.50) with limits of agreement from ?0.54 to +1.14. ICC showed excellent reliability (0.983 (p<0.001).CONCLUSION: HPLC and CE can be used interchangeably for HbA1c analysis across the measurement range. CE is the preferred in T2DM with certain Hb variant.peer-reviewe

Association of serum vitamin D level and vitamin D receptor expression among newly diagnosed breast cancer

There is a mushrooming interest in the anti-carcinogenic property of vitamin D. However, many researches reported a conflicting result in the association of vitamin D levels to certain types of cancer. This study was designed to assess the association between vitamin D and vitamin D receptor (VDR) expression with breast cancer. This case-control study, carried out at Hospital Universiti Sains Malaysia, Kelantan, involved 69 newly diagnosed breast cancer patients and 73 healthy volunteers. Serum 25(OH)D was taken and compared between 2 groups. VDR expression in patients’ breast tissue samples was determined by immunohistochemical staining method using anti-VDR antibody. 85.5% of breast cancer patients and 97.3% of healthy control were vitamin D insufficient with a mean (SD) of 13.36 (6.96) ng/mL and 13.05 (3.71) ng/mL, respectively, and the difference was not statistically significant. VDR expression showed cytoplasmic positivity in 75.4% of breast cancer tissue, followed by both cytoplasmic and nuclear positivity in 21.5% and complete absence in 3%. There was no significant association between VDR expression and hormone receptor status. In conclusion, there was a high prevalence of vitamin D deficiency among breast cancer and healthy volunteers in our study. There was no significant association between breast cancer and vitamin D. The VDR expression in breast cancer cells showed high cytoplasmic localization

AST, ALT, Bilirubin and AST/ALT Ratio role; Covid- 19 Patients

Background Impaired liver function upon admission has been linked to the severity of COVID-19 infection, yet the data is debated [1]. Therefore, this retrospective study aimed to evaluate the liver function among COVID-19 patients during hospitalization and its association with the disease severity. Methodology The patient aged 18 to 80 with positive COVID-19 at Hospital Raja Perempuan Zainab II (HRPZ II), Kota Bharu, Kelantan, with available AST, ALT, Bilirubin, and AST/ALT ratio data on admission, were retrospectively evaluated from March 2021 to March 2022. Disease severity was categorized based on Annex 2e guidelines by Malaysia's Ministry of Health, which further classified them into mild to moderate disease (Stage 1-3) and severe to critical illness (Stage 4-5). The AST, ALT, Bilirubin, and AST/ALT ratio levels on Day 1 admission were archived from the electronic medical record system and compared between the two groups. The statistical analysis was using SPSS version 27. This study was approved by (JEPeM-USM) protocol code USM/JEPeM/21100691 and Ministry of Health Malaysia NMRR-21-762-58458 (IIR). Results and Discussion The study included a total of 168 COVID-19 patients with a mean (SD) age of 46.67(16.10) for mild to moderate and 56.66(12.41) for severe to critical. There is a significant age group for both groups (p-value=0.002). During hospitalization, 16(14.41%) patients progressed to death from severe to critically ill patients. Upon admission, the median (IQR) of AST and ALT were significantly higher in the severe to critical group compared to in the mild to moderate group, [AST; 39.0(49.0) and 24.0(14.0), ALT 38.0(43.0) and 21.0(18.0)], p<0.05. However, no significant difference between both groups for bilirubin level and AST/ALT ratio. Non-survivors had a higher AST and ALT level compared to survivors, with a median (IQR) of [AST 98.0(88.0) and 32.0 (26.0), ALT of 67.5(90.0) and 28.0(31.0), (p<0.05). Similarly, no significant difference between non-survivors and survivors for bilirubin and AST/ALT ratio. Our study support that, abnormal liver function at admission has been shown to be associated with the disease severity and mortality of COVID-19 infection. However, there is also a need to observe the COVID-19 survivors' hepatobiliary sequelae and dynamic liver function changes following hospital discharge. Conclusion Abnormal AST and ALT level at admission has been shown to be associated with the disease severity and mortality of COVID-19 infection. Further study needed to evaluate liver damage in COVID-19 post-discharge

Determination of leg injury criteria subjected to frontal impacts

The leg injury criteria subjected to frontal impact is presented and discussed. The aim is to analyze the effect of steel material of bumper shell on pedestrian leg injury criteria of front bumper system. The front bumper beam is made of mild steel and characterized by impact modeling using LS-DYNA V971, according to United States New Car Assessment Program (US-NCAP) frontal impact velocity and based on European Enhanced Vehicle-safety Committee. The most important variable of this structure are mass, material, internal energy, and Leg Injury Criterion (LIC). In order to evaluate the protective performance of the baseline hood, the Finite Element Models (FEM) of legform of an adult pedestrian is used. The result shows that the acceleration of 91.5 g, shear displacement of 4.2 mm and bending angle of 12.0˚ graphs are performing below the danger limit. The reason found to be there were no contact between the front bumper beam and the legform, so that the injury is less. This is shows that the clearance between the bumper shell and front bumper beam are sufficient

Vitamin D levels and steroid usage are not associated with disease activity in systemic lupus erythematosus patients

Introduction: Suboptimal vitamin D levels are commonly presented by systemic lupus erythemathosus (SLE) patients. This is likely due to protection measures from sunshine exposure adopted by SLE patients to reduce the likelihood of SLE flares onset. In this study, we investigated the vitamin D level among SLE patients and its association with SLE Disease Activity (SLEDAI) scores and among groups of steroid and non-steroid usage. Methods: We recruited 84 SLE patients who attended the Rheumatology Clinic of Hospital Universiti Sains Malaysia from June 2018 until October 2018. Their clinico-demographic data were retrieved and serum vitamin D immunoassay was conducted to measure the vitamin D levels of each patient Vitamin D levels were categorized as normal (≥75nmol/L), insufficient (50-74 nmol/L) or deficient (<50 nmol/L). Comparison between the clinico-demographic parameters with vitamin D levels were conducted using the Fisher’s exact test (for categorical variables) and unpaired t-test (for continuous variables). Results: The mean vitamin D level among the subjects was 40.79 ± 20.2 nmol/L. Fifty-eight (69%) patients were vitamin D deficient, while 20 (23.8%) patients were vitamin D insufficient, and only 6 (7.1%) patients had sufficient level of vitamin D. Vitamin D status was not significantly associated with SLEDAI score (p=0.185) as well as between steroids and non-steroids groups (p=0.255). Conclusion: Vitamin D deficiency occurred in majority of our SLE patients. SLE disease activities were not associated with the status of vitamin D or steroid usage

Association between vitamin D receptor polymorphisms (BsmI and FokI) and glycemic control among aatients with type 2 diabetes

Background: Several studies have suggested that the vitamin D receptor (VDR) gene plays a role in type 2 diabetes mellitus (T2DM) susceptibility. Nonetheless, the association between T2DM and VDR polymorphisms remains inconclusive. We determined the genotype of VDR rs1544410 (BsmI) and rs2228570 (FokI) polymorphisms among Malaysian patients with T2DM and their association with glycemic control factors (vitamin D levels, calcium, magnesium, and phosphate). (2) Methods: A total of 189 participants comprising 126 patients with T2DM (63 with good glycemic control and 63 with poor glycemic control) and 63 healthy controls were enrolled in this case–control study. All biochemical assays were measured using spectrophotometric analysis. VDR gene FokI and BsmI polymorphisms were analyzed using polymerase chain reaction and endonuclease digestion. (3) Results: Our findings revealed no significant differences in VDR FokI and BsmI genotypes between participants with T2DM and healthy controls. Moreover, no significant association was observed between both single nucleotide polymorphisms and glycemic control factors. Participants with poor glycemic control had significantly lower serum magnesium levels and significantly higher HOMA-IR compared to the other groups. (4) Conclusions: The present study revealed that VDR gene BsmI and FokI polymorphisms were not significantly associated with T2DM

A preliminary study on the effects of stingless bee honey (SBH) on fasting blood glucose in streptozotocin (STZ)-induced diabetic rat models

Diabetes is a metabolic disorder characterized by hyperglycemia due to defects in insulin secretion, insulin action, or both. SBH has good antihyperglycemic potential and has traditionally been used as an alternative treatment for diabetes mellitus (DM). Since the role of SBH in glucose control is still unclear in animal and human studies, the present study was designed to evaluate the antihyperglycemic effects of SBH in streptozotocin-induced diabetic rat models. Fifteen Sprague-Dawley rats (200-250 g) were equally divided into five groups, the first group being a normal (non-diabetic) rat and the other four groups being diabetic. The normal and untreated diabetic groups received normal saline while the other diabetic groups were treated with SBH (2 g/kg body weight), metformin (MET /250 mg/kg body weight) and SBH + MET respectively. The treatment was given within 12 days. Fasting blood glucose (FBG) was measured at baseline and every two weeks thereafter. On days 7 and 12, SBH significantly lowered FBG, comparable to the normal group (p<0.05). In the group treated with MET and the combination of SBH-MET, FBG improved only on the 12th day of treatment (p<0.05). The results show that a single SBH treatment is effective in lowering blood glucose levels. Thus, SBH could be of great value in the treatment of diabetes in humans

Global Prevalence of Macroprolactinemia among Patients with Hyperprolactinemia: A Systematic Review and Meta-Analysis

Hyperprolactinemia (hPRL) often poses a diagnostic dilemma due to the presence of macroprolactin. Understanding the prevalence of macroprolactinemia (mPRL) has an important implication in managing patients with hPRL. The primary aim of this study was to determine the prevalence of mPRL globally and to explore selected factors influencing the prevalence estimate. Studies with original data related to the prevalence of mPRL among patients with hPRL from inception to March 2020 were identified, and a random effects meta-analysis was performed. Of the 3770 records identified, 67 eligible studies from 27 countries were included. The overall global prevalence estimate was 18.9% (95% CI: 15.8%, 22.1%) with a substantial statistical heterogeneity (I2 = 95.7%). The highest random effects pooled prevalence was observed in the African region (30.3%), followed by Region of the Americas (29.1%), European (17.5%), Eastern Mediterranean (13.9%), South-East Asian (12.7%), and Western Pacific Region (12.6%). Lower prevalence was observed in studies involving both sexes as compared to studies involving only female participants (17.1% vs. 25.4%) and in more recent studies (16.4%, 20.4%, and 26.5% in studies conducted after 2009, between 2000 and 2009, and before 2000, respectively). The prevalence estimate does not vary according to the age group of study participants, sample size, and types of polyethylene glycol (PEG) used for detection of macroprolactin (PEG 6000 or PEG 8000). With macroprolactin causing nearly one-fifth of hPRL cases, screening for mPRL should be made a routine before an investigation of other causes of hPRL

A preliminary study on the effects of Stingless Bee Honey (SBH) on fasting blood glucose in Streptozotocin (STZ)-Induced diabetic rat models

Diabetes is a metabolic disorder characterized by hyperglycemia due to defects in insulin secretion, insulin action, or both. SBH has good antihyperglycemic potential and has traditionally been used as an alternative treatment for diabetes mellitus (DM). Since the role of SBH in glucose control is still unclear in animal and human studies, the present study was designed to evaluate the antihyperglycemic effects of SBH in streptozotocin-induced diabetic rat models. Fifteen Sprague-Dawley rats (200-250 g) were equally divided into five groups, the first group being a normal (non-diabetic) rat and the other four groups being diabetic. The normal and untreated diabetic groups received normal saline while the other diabetic groups were treated with SBH (2 g/kg body weight), metformin (MET /250 mg/kg body weight) and SBH + MET respectively.The treatment was given within 12 days. Fasting blood glucose (FBG) was measured at baseline and every two weeks thereafter. On days 7 and 12, SBH significantly lowered FBG, comparable to the normal group (p<0.05). In the group treated with MET and the combination of SBH-MET, FBG improved only on the 12th day of treatment (p<0.05). The results show that a single SBH treatment is effective in lowering blood glucose levels. Thus, SBH could be of great value in the treatment of diabetes in human