Medical Laboratory Journal

Correlation of Diagnostic Yield with Laboratory Parameters and Histopathological Examination in Clinically Suspected Cases of Mucormycosis in Post-COVID-19 Patients: A Single-Center Study in Ahmedabad, India

Usha Patel

Background: Mucormycosis is a complication in post-coronavirus disease 2019 (COVID-19) patients in India. This study was done to evaluate the prognostic value of clinical, histopathologic findings, microbiological features, and biochemical parameters such as D-dimer, lactate dehydrogenase, and serum ferritin in post- COVID-19-patients with rhino-orbital mucormycosis.
Methods: This retrospective observational study was carried out on biopsies taken from 50 post-COVID-19 patients suspected of mucormycosis. The biopsy specimens were processed and stained with hematoxylin and eosin, periodic acid–schiff, and Wright-Giemsa. In addition, 10–20% potassium hydroxide wet mount and culture on sabouraud dextrose agar were performed to detect Mucor. The biochemical parameters were measured using ARCHITECT ci8200 chemistry analyzer.
Results: Overall, 30 cases (60%) were positive for fungal elements, and growth of Mucor spp. was found in 28 cases (56%). In histopathology, 70% of cases (n=35) showed broad, aseptate, ribbon-like hyphae with wide-angled branching diagnostic of mucormycosis. There seemed to be a site-wise overlap between the nasal/maxillary sinus and rhino-orbital/rhino-cerebral variety. There was no difference between the patients in terms of gender. The most common risk factor was diabetes mellitus (observed in 80% of cases). In patients with invasive mucormycosis, inflammatory biomarkers such as serum ferritin, serum lactate dehydrogenase, C-reactive protein, and D-dimer were greater than the normal range, whereas procalcitonin was within the reference range.
Conclusion: It can be concluded that raised metabolic markers, direct 10% KOH examination and histological features including angioinvasion as well as rhino-orbital and cerebral extension might assist doctors in diagnosis, progression, and survival rate.

Early Detection of Antibiotic Resistance in Positive Blood Cultures: A Study from a Tertiary Care Center in India

Abiroo Jan

Background: Conventional culture and sensitivity methods take around 48 hours to generate antibiotic sensitivity results after a blood culture is flagged as positive by automated systems. However, it is imperative to initiate early targeted antibiotic therapy for effective management of sepsis and to reduce morbidity, mortality, and cost of treatment. This study aimed to evaluate the direct sensitivity test (DST) as a potential tool to obtain quicker antibiotic susceptibility results from positive BacT/ALERT blood culture vials and the VITEK-2 system (the reference method).
Methods: Blood culture bottles flagged as positive by BacT/ALERT were Gram-stained. Cultures with polymicrobial growth were excluded from the study. The isolates were then simultaneously cultured and processed for the DST using the disk diffusion method. Agreements or errors were interpreted according to the Clinical and Laboratory Standards Institute’s guidelines.
Results: Among 76 Gram-positive isolates, we observed 99.2% essential agreement between the DST and AST. The rate of minor and major errors was 4.04% and 1.18%, respectively. Among 75 Gram-negative isolates, we observed 98.99% essential agreement between the DST and AST. The rate of minor and major errors was 4% and 2%, respectively. No very major error was seen in either Gram-negative or -positive isolates.
Conclusions: The DST results are available earlier than the AST results, which can ultimately help in the early initiation of targeted antibiotic therapy.

Effects of High-Intensity Interval Training on Transcription Factor 7-Like 2 / Glucagon-Like Peptide-1 Axis in Pancreatic Tissue of Obese Diabetic Ratsobese diabetic rats

Mojtaba Eizadi

Background: Genetic studies have indicated the effective role of transcription factors in insulin synthesis and secretion, especially in the case of diabetes. This study aimed to assess the effects of high-intensity interval training on transcription factor 7-like 2/ glucagon-like peptide 1 (TCF7L2 / GLP-1) axis in pancreatic tissue of obese rats with type 2 diabetes mellitus (T2DM).
Methods: For this purpose, obesity was induced in 21 male Wistar rats (weighting 220±10 g) by exposure to a high-fat diet for six weeks. Then, the rats were randomly assigned to a non-diabetic, a control T2DM, and an exercise diabetic group. Next, T2DM was induced by intraperitoneal injection of streptozotocin (25 mg/kg). The rats in the exercise group participated in a HIIT program, five times a week, for six weeks. After the intervention, TCF7L2 and GLP1 expression in the pancreas tissue was determined by real-time PCR. Serum insulin, glucose, and beta cell function were compared between the study groups. Data were analyzed using one-way ANOVA and Tukey post hoc test at a significance level of 0.05.
Results: Induction of T2DM increased glucose level and TCF7L2 expression but decreased insulin, beta cell function, and GLP-1R expression. In addition, HIIT significantly decreased TCF7L2 expression as well as glucose level, serum insulin, and beta cell function; however, it did not significantly change GLP-1R expression compared with the control diabetes rats.
Conclusion: Based on the findings, the improvement of serum insulin and glucose level following HIIT may be attributed to the decrease in TCF7L2 gene expression in the pancreatic tissue of diabetic rats.

An Update on the Prevalence of Nontuberculous Mycobacteria in Clinical Samples in Iran during 2000-2022: A Systematic Review and Meta-Analysis

Arezoo Firoozeh

Background: Nontuberculous mycobacteria (NTM) are isolated from domestic and animal products as well as man-made systems such as medical devices, drinking water systems, water tanks, and shower streams. This study aimed to investigate the prevalence of NTM in clinical samples in Iran during 2000-2022.
Methods: Published studies addressing the prevalence of NTM in clinical samples in Iran were reviewed according to the Preferred Reporting Items for Meta-Analyses and Systematic Reviews protocol. Original articles in Persian and English published between January 2000 and 2022 in databases such as Scopus, PubMed, Web of Science, Google Scholar, and Iranian databases were included. The prevalence of NTM at 95% confidence interval (CI) was calculated by comprehensive meta-analysis.
Results: Overall, 26 studies were included in the review. The combined prevalence of NTM in positive mycobacterial cultures was 4.5% (95% Cl: 3.1-6.5). Mycobacterium simiae [35.8% (95% CI 16.4-44.4)], Mycobacterium intracellulare [19% (95% CI 8.7-28.3)], and Mycobacterium kansasii [13.4% (95% CI 7.3-24.3)] were the most common slowly growing species, while Mycobacterium fortuitum [24.6% (95% CI 12.9-46.7)], Mycobacterium terrae [18.5 % (95% CI 11.5-29.2)], and Mycobacterium gastri [15.9% (95% CI6.0-41.2)] were the most prevalent rapidly growing mycobacteria.
Conclusion: In summary, our findings indicate a relatively high combined prevalence of NTM in clinical samples in Iran. Some of these species such as M. simiae can have clinical and radiologic manifestations similar to those of TB and are resistant to anti-TB drugs. Therefore, standardizing the use of molecular methods for the detection of NTM seems necessary.

Frequency of Plasmid-Located Quinolone Resistance Genes in Clinical Isolates of Klebsiella pneumoniae in Northern Iran

Leila Asadpour

Background: Fluoroquinolones are a class of broad-spectrum antimicrobials typically used for the treatment of lower urinary tract infections. We aimed to determine the frequency of quinolone resistance genes in Klebsiella pneumoniae isolates from urinary tract infections in Guilan Province, Iran.
Methods: The resistance of 114 clinical isolates of K. pneumoniae to common fluoroquinolones and the minimum inhibitory concentration of ciprofloxacin were determined by disk diffusion and broth microdilution methods, respectively. Frequency of five plasmid-mediated quinolone resistance (PMQR) genes including qnrA, qnrB, qnrS, qepA, and aac (6')-Ib-cr was determined by PCR.
Results. According to phenotypic assays, 60 isolates (52.6%) were resistant to at least one quinolone compound, 42 isolates (36.8%) were resistant to all tested quinolones, and 28 isolates (24.6%) showed a high level of ciprofloxacin resistance. In addition, aac(6')-Ib-cr was the most common PMQR gene (𝑛 = 44), followed by qnrS (𝑛 = 32), and qnrB (𝑛 = 21).
Conclusion: The possible dissemination of PMQR genes poses a serious threat to the management of infections by resistant Klebsiella pneumoniae.

Effects of Taurine Supplementation during Endurance Training on Antioxidant Activity in Males

mohammad fathi

Background: Endurance exercise causes fatigue due to mitochondrial dysfunction and oxidative stress. The present study was designed to investigate the effects of taurine supplementation on lipids peroxidation and antioxidant activity during endurance activities.
Methods: Twenty-four male volunteers aged 27 ± 1.8 years and weighting 74.9 ± 5.9 kg were randomly divided into three groups: taurine supplementation (n=8), placebo (n=8), and control (n=8). The subjects completed a 28-day endurance training protocol. Biochemical parameters such as superoxide dismutase (SOD), glutathione peroxidase (GPX) activities, as well as malondialdehyde (MDA) concentrations (8 hours before the first session and 8 hours after the last session) and maximum rate of oxygen consumption, were measured to evaluate the antioxidant, lipid peroxidation, and VO₂max status respectively. Finally, data were analyzed by SPSS software at a significance level of <0.05.
Results: Taurine supplementation significantly increased SOD (p=0.001) and GPX (p=0.001) but significantly decreased MDA (p=0.001). However, it had no significant effect on the VO₂max.
Conclusion: The results of the present study indicate that taurine has antioxidant effects against endurance exercise-induced oxidant stress and lipid peroxidation.

Perovskia abrotanoides Kar. as a Promising Source of Antimicrobial Compounds against Foodborne Pathogens

Poozesh Vahid

Background: Foodborne pathogens can significantly affect the public health and cause medical, social, and economic burden. Listeria monocytogenes, Salmonella enterica, and Yersinia enterocolitica are important foodborne pathogens that can cause various diseases. Plant-derived compounds are promising bioactive substances with inhibitory effects against bacteria. Perovskia abrotanoides Kar. is a medical plant with broad therapeutic activities. In the present study, we aimed to investigate the inhibitory effects of P. abrotanoides extracts against some foodborne pathogens.
Methods: Flowering branches of P. abrotanoides were collected in 2018 and 2019 from three different habitats in the eastern Alborz Mountains, Iran. The antimicrobial activity of the extracts was evaluated using the agar well diffusion test. The minimum inhibitory concentration (MIC) and minimum bactericidal concentration (MBC) of the extracts were determined against L. monocytogenes, S. enterica, and Y. enterocolitica. In addition, the antioxidant activity of the extracts was investigated by the DPPH test.
Results: The lowest MIC (200 µg/ml) and MBC (400 µg/ml) values against Y. enterocolitica were related to the ethyl acetate extract of plants collected from habitat 1 in 2019. The lowest MIC (50 µg/ml) and MBC (400 µg/ml) values against L. monocytogenes were related to the dichloromethane extract of plants collected from habitat 1 in 2019. All extracts showed antioxidant properties. Results of one-way ANOVA indicated that the DPPH scavenging activity of extracts from plants collected in 2019 was greater than that of those collected in 2018. In most cases, the methanol and ethyl acetate extracts showed more radical scavenging potential.
Conclusion: It seems that P. abrotanoides is a rich source of antimicrobial and antioxidant compounds with great potential for use in the pharmaceutical and food industries.

Decreased Serum Neurofilament Light Chain and Fatigue Severity in Patients with Multiple Sclerosis after Home-Based and Outdoor Pilates Training

faranak Balaghi Inaloo

Background: Studies have reported contradictory results regarding the relationship between serum neurofilament light chain (NFL) and fatigue severity. The aim of our study was to investigate serum NFL and fatigue severity in patients with multiple sclerosis (MS) after home-based and outdoor Pilates training.
Methods: The study population consisted of 44 women with MS (aged 25 to 40 years) with an expanded disability status scale score of 2-5. The patients were randomly divided into three groups: home-based training (HPT, n=15), outdoor training (OPT, n=15), and a control group (n=14). The training groups performed Pilates exercises for 8 weeks individually at home and under the sun. Blood samples and completed Fatigue Severity Scale forms were taken 48 hours before the first session and after the 8-week intervention.
Results: The results showed that OPT caused a more notable increase in serum vitamin D (32.76±5.13, p<0.001) and a decrease in NFL (15.98±2.26, p <0.001) and FSS score (2.51±0.35, p<0.001) compared with HPT. Also, HPT lowered NFL (18.01±2.28, p<0.001) and FSS score (3.84±0.98, p<0.001) compared with the control group.
Conclusion: Pilates training can reduce NFL levels and FSS scores in women with MS. In addition, OPT is more effective than HPT in reducing NFL and FSS and increasing vitamin D levels.