Medical Laboratory Journal

The effect of COVID-19 infection on the hematological parameters in pregnant women

Eliz Thomas

Background: This study aimed to analyze the hematological parameters in pregnant women who were COVID-positive in a tertiary care hospital and to observe whether there was an association between the findings and disease severity.
Methods: This retrospective study included 64 COVID-positive pregnant patients who were admitted to our hospital, under the obstetrics department, during the period from June 2020 to December 2020. The hematological parameters, such as hemoglobin, MCV, RDW, etc., of these women during the third trimester were assessed, and the outcome of the pregnancy was recorded.
Results: Among 64 COVID-positive pregnant women, 14 complained of the usual symptoms like fever, cough, or headache. One complained of increased breathlessness. After hematological work-up, 46 (72%) patients were recorded to have anemia, and 38 (59%) showed leukocytosis. Neutrophilia was seen in 34 patients. The platelet count was within normal limits for all. Forty-nine of them underwent caesarean section for various reasons, the most common being previous caesarean section. Sixty-two deliveries were done at term. Only one of the babies delivered had anemia at birth. The 1- and 5-minute APGAR scores recorded for all the babies were 7 to 9. Fifteen babies delivered underwent RT-PCR testing and were found to be negative.
Conclusion: The laboratory parameters most commonly seen among the COVID-19 pregnant women were anemia, leukocytosis, and neutrophilia, which are comparable to the physiological changes in pregnancy. There was no adverse outcome observed in any of the pregnancies, and all the fetuses were normal. There was no incidence of vertical transmission of the virus among the tested neonates.

Clinico-epidemiology and resistance patterns of community-acquired and hospital-acquired staphylococcus aureus sepsis in children

Umar Amin Qureshi

Background: Staphylococcus aureus (S. aureus) is a virulent bacterium responsible for a spectrum of infections, from superficial dermatological issues to severe, life-threatening sepsis. The emergence of methicillin-resistant S. aureus (MRSA) strains, encompassing both hospital-acquired (HA) and community-acquired (CA) variants, presents significant challenges to effective treatment, especially in pediatric sepsis cases. This research endeavored to characterize S. aureus sepsis in pediatric patients, differentiate between cases caused by CA S. aureus (CA-SA) and HA S. aureus (HA-SA), and evaluate patterns of antibiotic resistance.
Methods: This study, conducted between January 2021 and December 2022 at the Postgraduate Department of Pediatrics, Children’s Hospital, Srinagar, Kashmir, J&K, investigated patients aged 1 month to 18 years with suspected S. aureus sepsis or disseminated disease. Standard methods (BacT Alert and Vitek II Compact) were employed for culturing various samples. Continuous data are presented as mean ± standard deviation (SD), while categorical variables are expressed as proportions.
Results: Out of 56 patients, CA-SA was observed in 66.1% of cases, while HA-SA accounted for the remaining 33.9%. The cohort primarily consisted of males (62.5%) and individuals residing in rural areas (71.43%). Localized musculoskeletal symptoms were a prominent feature, present in 91.9% of patients (P ≤ 0.05). Pleuropulmonary disease showed an association with HA-SA, whereas necrotizing soft tissue infections were linked to CA-SA. Common clinical manifestations included pneumonia and abscesses. Complications (such as septic shock, respiratory failure, and multi-organ dysfunction) were more frequently encountered in patients with HA-SA. Among 50 culture-confirmed cases, 96% were identified as methicillin-resistant S. aureus (MRSA). Survival rates differed between the two groups, with 94.6% for CA-SA patients and 89.5% for HA-SA patients.
Conclusion: The current study reveals a high prevalence of MRSA in pediatric sepsis, emphasizing the critical need for urgent antimicrobial stewardship. The observed distinct clinical profiles of CA-SA and HA-SA further underscore the necessity for tailored management strategies, particularly in resource-limited environments.

The pathophysiological spectrum of maternal complications of pregnancy-induced hypertension: Review Article

Adedeji Okikiade

Background: Pregnancy-induced hypertension (PIH) is a multi-system disorder affecting 6-8% of pregnancies in the U.S. and contributing significantly to maternal mortality, accounting for 16% in developed countries. It progresses from preeclampsia to eclampsia, leading to multi-organ damage through mechanisms such as oxidative stress, placental ischemia, and endothelial dysfunction. While the exact pathogenesis remains unclear, genetic, immunologic, and environmental factors are implicated. The American College of Obstetricians and Gynecology (ACOG) recommends initiating treatment when diastolic blood pressure exceeds 105-110 mmHg.
Methods: This narrative review examines existing literature on PIH, including epidemiological data, pathophysiological mechanisms, clinical management guidelines, and associated complications such as abnormal placentation, oxidative stress, and endothelial dysfunction.
Results: This study demonstrates that hypertensive disorders of pregnancy (HDP) significantly impact maternal and fetal health, particularly in developing countries with limited healthcare access. Early detection and continuous monitoring play a key role in reducing complications. Additionally, HDP is associated with increased long-term cardiovascular and metabolic risks, highlighting the importance of postpartum follow-up.
Conclusion: HDP poses a serious threat to maternal and fetal health, with potential long-term consequences. Effective management requires early diagnosis, close monitoring, and postpartum follow-up. Global implementation of risk assessment and targeted care strategies can help reduce the burden of this condition. Strengthening healthcare systems and increasing awareness among healthcare providers and patients are essential steps toward improving outcomes.

Evaluation of Neutrophil cluster of differentiation 64 in adult sepsis as a novel diagnostic biomarker

Anjali Sharma

Background: Sepsis stands as a leading cause of mortality among critically ill patients in intensive care units (ICUs). Bacterial infections, including sepsis, upregulate Neutrophilic cluster of differentiation 64 (nCD64) expression on activated polymorphonuclear leukocytes (PMNs). Prompt diagnosis of sepsis is crucial for initiating timely and targeted treatment. Consequently, a rapid laboratory test with high specificity for sepsis in adults would significantly aid therapeutic decision-making and help reduce the overuse of antibiotics.
Methods: This study enrolled 40 sepsis patients diagnosed according to the Sepsis-3 definition. For biomarker evaluation, 2 mL blood samples were collected from each patient in both ethylenediaminetetraacetic acid (EDTA) and plain vials. In addition, nCD64 was analyzed using flow cytometry, high-sensitivity C-reactive protein (hs-CRP) via nephelometry, and procalcitonin (PCT) using chemiluminescence.
Results: For sepsis prediction, nCD64 demonstrated a positive predictive value (PPV) of 92.68% and a negative predictive value (NPV) of 94.87%. A receiver operating characteristic (ROC) curve was generated to assess the diagnostic accuracy of nCD64 (≥ 1.8), hS-CRP (≥ 3 mg/L), and PCT (≥ 0.4 ng/mL). The area under the curve (AUC) for nCD64 was highest at 0.938 (95% confidence interval [CI] = 0.876-0.999), followed by hS-CRP at 0.888 (95% CI = 0.807-0.968) and PCT at 0.850 (95% CI = 0.759-0.941).
Conclusion: These findings strongly suggest that nCD64 determination is a valuable diagnostic tool for identifying infections in patients with septic syndrome. Its performance appears to be superior to that of hs-CRP and PCT.

Cell population data analysis for early diagnosis and prognosis of COVID-19: A Case-Control Study

Priyadarshini Kumaraswamy Rajeswaran

Background: Several hematological indicators have been linked to the intensity and course of Coronavirus Disease of 2019 (COVID-19), including platelets, total white blood cell (WBC) count, lymphocytes, neutrophils (as well as the neutrophil-lymphocyte and platelet-lymphocyte ratios), and hemoglobin. The purpose of this study was to assess the utility of cell population data (CPD) of lymphocyte and monocyte parameters in the early diagnosis of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) infection.
Methods: The baseline complete blood count examination was performed for 222 patients with positive results for COVID-19 (case group) and 161 patients with negative results for COVID-19 (control group). Lymphocyte and monocyte CPD were calculated in both groups. The independent t-test was used to compare the mean values between the two groups. Receiver operating characteristic (ROC) curve analysis was performed to evaluate the discriminating capacity of the individual parameters.
Results: The analysis revealed that Standard Deviations of Monocyte Volume (SDMV) and Standard Deviations of Lymphocyte Conductivity (SDLC) showed the highest significance in predicting SARS-CoV-2 infection. Moreover, SDMV had a sensitivity of 93.7% and SDLC had a sensitivity of 80.6% at cut-off values of 22.25 and 10.9, respectively. In the case group, 49 of the 222 patients treated in the intensive care units (ICUs) showed a higher SDMV compared with the remaining 173 patients who were asymptomatic, or mildly symptomatic (P-value <0.03).
Conclusion: Our study demonstrates that SDMV and SDLC can serve as reliable and cost-effective markers for early prediction of SARS-CoV-2 infection. Furthermore, SDMV shows potential as a prognostic biomarker. These findings highlight the potential utility of CPD parameters in COVID-19 diagnosis and prognosis.

Clinico-mycological profile of diagnosed cases of dermatophytosis in a tertiary care hospital, Pune: A Cross-Sectional Study

Bharati Avinash Dalal

Background: Dermatophytes are keratinophilic fungi that cause superficial infections of the skin, hair, and nails. The prevalence of dermatophytosis is influenced by factors, such as climate, age, gender, lifestyle, and socioeconomic status. In tropical and subtropical regions, like India, hot and humid conditions contribute to its high incidence. This study aimed to isolate and identify dermatophytes from clinically diagnosed cases of dermatophytosis.
Methods: A total of 100 clinically diagnosed cases were examined by direct microscopy (KOH mount) and fungal culture on Sabouraud dextrose agar (SDA) and Dermatophyte Test Medium (DTM).
Results: The most common clinical presentation was Tinea corporis (42%), followed by Tinea cruris (25%) and Tinea unguium (21%). Out of 100 samples, 53 were culture-positive. The predominant isolates were Trichophyton rubrum (30%), Trichophyton mentagrophytes (20%), and Trichophyton violaceum (13.3%). Among culture media, SDA yielded 92.45% isolates, while DTM showed higher sensitivity (96.22%).
Conclusion: Isolation and identification of dermatophytes are crucial for accurate diagnosis, effective treatment, and epidemiological surveillance. Understanding the local prevalence and etiological agents aids in managing therapeutic challenges and preventing transmission.

Characterization and antifungal susceptibility patterns of candida species isolated from a tertiary hospital in Benin city, Nigeria

Olalekan John Okesanya

Background: Candida species are known to be the most frequently encountered fungal pathogens in humans. There has been a noticeable rise in the occurrence of human infections caused by Candida over the past few decades. This cross-sectional study aimed to identify different species of Candida and determine the antifungal susceptibility patterns of Candida species isolated from clinical specimens in a tertiary hospital in Benin, Edo State, Nigeria.
Methods: A total of 104 Candida isolates were obtained from various clinical specimens using a simple random sampling technique. The isolates were cultured on Sabouraud dextrose agar and were later sub-cultured on CHROMagar Candida after morphological characteristics observation and identification of Candida species were confirmed based on characteristic color production on CHROMagar. Antifungal susceptibility testing for Candida isolates was conducted following the Clinical and Laboratory Standards Institute M44-A recommendations for Amphotericin B, Ketoconazole, Fluconazole, and Nystatin. Statistical analysis was conducted using SPSS version 20.0.
Results: Candida albicans was the most prevalent species, accounting for 72.1% of isolates, followed by Candida krusei (17.3%), Candida tropicalis (7.7%), and Candida glabrata (2.9%). High vaginal swabs showed the highest frequency of Candida isolates (46.2%). Females exhibited a higher preponderance of candidiasis (81.3%) compared to males. With p-values of 0.007* and 0.028*, respectively, Candida albicans and Candida glabrata exhibited significant differences in susceptibility to Amphotericin B and Fluconazole antifungal drugs. The antifungal susceptibility testing indicated variations in resistance patterns among different Candida species.
Conclusion: The study revealed a predominance of Candida albicans in clinical specimens, with emerging cases of non-albicans species. Antifungal resistance to clinically available agents raised concerns, necessitating continuous surveillance and monitoring of susceptibility patterns. The results underscore the importance of developing targeted strategies to combat the challenges posed by antifungal resistance.

The evaluation of the effect of periodic resistance training along with vitamin D3 consumption and mesenchymal stem cell transplantation on cortical TNF-β levels in streptozotocin-induced diabetic rats

Seyed Abdollah Hashemvarzi

Background: Inflammation plays a major role in the development and progression of diabetes. Vitamin D deficiency and physical inactivity can also increase the risk of developing type 2 diabetes. Combined therapeutic strategies are promising approaches for the treatment and prevention of diabetes. This study aimed to investigate the effects of resistance training, vitamin D3 supplementation, and adipose-derived mesenchymal stem cell (MSC) transplantation on tumor necrosis factor-beta levels in the cerebral cortex of diabetic rats.
Methods: Eighty male Wistar rats (Weighing 290±19 g) were randomly divided into 10 groups: healthy control, sham, diabetes, training, vitamin D, MSC, training+vitamin D, MSC+training, MSC+vitamin D, and training+MSC+vitamin D. Training groups were subjected to a resistance training program on a ladder. MSC groups received 1.5 × 106 MSCs, and vitamin D supplementation groups received 1 microgram/kilogram of vitamin D3 eight times. Cortical TNF-β levels and fasting serum glucose levels were measured.
Results: After six weeks, the combination of resistance training with vitamin D3 supplementation and MSC transplantation (P=0.018), as well as the combination of resistance training with MSCs (P=0.024), significantly reduced the diabetes-induced elevation of TNF-β levels.
Conclusion: Resistance training with appropriate intensity, duration, and recovery between exercise sessions, combined with MSC transplantation and vitamin D3 supplementation, has profound anti-inflammatory effects on the cerebral cortex tissue of diabetic rats. This type of intervention, especially the transplantation of MSCs, may be a promising protective strategy against some complications of diabetes.

Expression changes in the fibulin family in gastric cancer: A Systematic Review

Seyyed Mehdi jafari

Background: Gastric cancer (GC) is one of the most widespread gastrointestinal tumors worldwide, with mortality rates among the highest. Globally, we face more than one million newly diagnosed stomach cancer patients every year. Various factors are closely associated with the formation of GC. One of these factors is the change in the level of components of the extracellular matrix in the microenvironment of the stomach tumor. Fibulins are one of the secreted glycoproteins of the extracellular matrix, known as matrix organizers. The purpose of this study was to investigate the changes in fibulins in gastric tumor tissue compared to control samples.
Methods: In this systematic review, a search was conducted on June 21, 2024, in alignment with the guidelines set forth by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. Scopus, PubMed, and Web of Science databases were searched for articles that examined FBLN gene family and protein expression in patients with GC and GC cell lines.
Results: A total of 853 GC tumor samples, ranging from 8 to 197 per study, were analyzed across eight studies published between 2008 and 2023, all conducted in China. Several GC cell lines were also included, such as AGS, Kato III, MKN28, MKN45, SNU1, SNU16, NCI-N87, MGC-803, BGC-823, SGC-7901, and HGC27. Tumor size was reported in four studies, while histopathological grade and lymph node metastasis were each evaluated in four studies.
Conclusion: The downregulation of Fibulin-1 and Fibulin-2 supports their potential tumor-suppressive roles in GC, while the upregulation of Fibulin-5 is associated with tumor progression and worse prognosis, making it a candidate biomarker for aggressive disease.

Investigation of the simultaneous effect of resistance training and atorvastatin in improving nonalcoholic fatty liver disease in Wistar rats fed high high-fat/fructose diet

Amir Haji Ghasem

Background: Non-alcoholic fatty liver disease (NAFLD), a highly prevalent and chronic liver disease, is characterized by a diverse range of conditions that span across a broad spectrum. Engaging in consistent physical activity has proven to be a successful method in effectively managing NAFLD, as it has demonstrated the ability to enhance crucial elements implicated in the development of the condition.
Methods: Twenty-one male Wistar rats were divided into three groups: 1. NAFLD, 2. NAFLD + resistance training (RT), and 3. NAFLD + RT + atorvastatin (ATO). The groups received high-fat/fructose diet (HFFD) to induce NAFLD and it was confirmed through evaluation of histopathological analysis (H&E staining) and measurement of aminotransferase enzymes. ATO was administrated at a dose of 2 mg/kg/day. The interventions were carried out over eight weeks.
Results: Triglyceride (TG), Alanine transaminase (ALT), and aspartate transaminase (AST) were significantly reduced in the NAFLD + RT + ATO group. Additionally, low-density lipoprotein (LDL) levels were lower in NAFLD + RT group than NAFLD + RT + ATO group. Alkaline phosphatase (ALP) was reduced in both NAFLD + RT and NAFLD + RT + ATO groups compared to NAFLD. There was no significant difference in weight between the groups except the first, second, and fourth weeks.
Conclusion: Resistance training in combination with the administration of ATO can be deemed as an efficacious and supplementary strategy to effectively control and address NAFLD.