Prognostic Implications of Elevated Cardiac Troponin T in Patients with Acute Ischemic Stroke

BACKGROUND: Elevated cardiac troponin T (cTnT) levels have been reported in patients with acute ischemic stroke, however, the prognostic relevance is not well established. We evaluated the association between cTnT elevation and prognosis in patients with acute ischemic stroke. METHODS: The 182 consecutive patients enrolled had new-onset acute ischemic stroke. Their clinical and laboratory findings were collected retrospectively. Stroke severity and prognosis were determined using the National Institutes of Health Stroke Scale (NIHSS) and the modified Rankin Scale (mRS) scores, as well as 30-day all-cause mortality. The patients were divided into two groups according to their cTnT levels: ≤14 and >14 ng/L. Cox proportional hazards regression analysis was performed to determine the associations between clinical or laboratory variables and 30-day all-cause mortality. The Kaplan-Meier method was used to compare the overall survival rate in patients with elevated and normal cTnT levels. RESULTS: The cTnT level was elevated in 14.8% of the patients. Age, NIHSS and mRS scores, creatinine kinase-MB, and 30-day all-cause mortality were significantly higher in patients with elevated cTnT levels than in those with normal cTnT levels. The hazard ratio of the elevated vs. normal cTnT group for 30-day all-cause mortality was 8.06 (95% confidence interval: 1.13-57.25, P=0.037). A Kaplan-Meier survival analysis revealed a significantly higher survival rate in patients with normal cTnT levels compared to those with elevated cTnT levels (P<0.0001). CONCLUSIONS: An elevated cTnT level is significantly associated with poor short-term outcomes in patients with acute ischemic stroke.

Overgrowth Syndrome with 9q22.3 Microdeletion Detected by Microarray Comparative Genomic Hybridization

Microdeletion of 9q22.3 is a rare chromosomal disorder characterized by body overgrowth, facial dysmorphic features and psychomotor delay. The presence of genomic microdeletion or microdu-plication can not be identified by the conventional chromosomal analysis. Microarray comparative genomic hybridization (CGH) is a newly developed molecular cytogenetic technique that enables the identification of minute copy number variation (CNV) in the human genome. Here, we report a case of microdeletion in the 9q22.31-q22.33 region, which included a patched homolog 1 (PTCH1) gene, as detected by CGH and confirmed by fluorescence in situ hybridization (FISH) analyses in a neonate with prenatal onset of macrosomia, dysmorphism, and muscle hypotonia. To the best of our knowledge, this is the first case report of 9q22.3 microdeletion detected by CGH in Korea.

A Case of IgM Deficiency with B Cell Deficiency Detected by ABO Discrepancy in a Patient with Acute Osteomyelitis

ABO discrepancy refers to an inconsistency between red cell and serum typings and has various causes, including hypogammaglobulinemia. IgM deficiency is a rare disorder that may accompany several conditions such as infection and autoimmune disorders. Here, we describe a case of IgM deficiency discovered during the evaluation of an ABO discrepancy in a 16-yr-old Korean boy. ABO blood grouping showed that while his cell type was O+, serum typing detected only anti-A (3+). Anti-B was not detectable at room temperature but was graded at 1+ at 4degrees C. ABO genotyping revealed an O/O genotype. His serum IgG, IgA, and IgM concentrations were 770 mg/dL (reference range: 800-1,700 mg/dL), 244 mg/dL (reference range: 100-490 mg/dL), and 13.5 mg/dL (reference range: 50-320 mg/dL), respectively. He was diagnosed with acute osteomyelitis on the basis of clinical presentation and imaging studies. The symptoms gradually improved within 3 weeks of treatment. However, the ABO discrepancy and IgM deficiency persisted even 6 months after recovery and lymphocyte subset analysis revealed CD19+ B cell deficiency. To the best of our knowledge, IgM deficiency detected by ABO discrepancy in a patient with acute osteomyelitis has not been reported before.

A Case of IgM Deficiency with B Cell Deficiency Detected by ABO Discrepancy in a Patient with Acute Osteomyelitis

ABO discrepancy refers to an inconsistency between red cell and serum typings and has various causes, including hypogammaglobulinemia. IgM deficiency is a rare disorder that may accompany several conditions such as infection and autoimmune disorders. Here, we describe a case of IgM deficiency discovered during the evaluation of an ABO discrepancy in a 16-yr-old Korean boy. ABO blood grouping showed that while his cell type was O+, serum typing detected only anti-A (3+). Anti-B was not detectable at room temperature but was graded at 1+ at 4degrees C. ABO genotyping revealed an O/O genotype. His serum IgG, IgA, and IgM concentrations were 770 mg/dL (reference range: 800-1,700 mg/dL), 244 mg/dL (reference range: 100-490 mg/dL), and 13.5 mg/dL (reference range: 50-320 mg/dL), respectively. He was diagnosed with acute osteomyelitis on the basis of clinical presentation and imaging studies. The symptoms gradually improved within 3 weeks of treatment. However, the ABO discrepancy and IgM deficiency persisted even 6 months after recovery and lymphocyte subset analysis revealed CD19+ B cell deficiency. To the best of our knowledge, IgM deficiency detected by ABO discrepancy in a patient with acute osteomyelitis has not been reported before.

Comparison of Two Automated Immunoassays for the Detection of Anti-Hepatitis A Virus Total Immunoglobulin and IgM / 임상검사와정도관리

BACKGROUND: The detection of total anti-hepatitis A virus (anti-HAV) immunoglobulin (Ig) and IgM is important for diagnosing acute hepatitis A. Our laboratory introduced new commercial automated chemiluminescence immunoassays (CLIAs) for use in addition to pre-existing automated CLIA. We evaluated the rate of agreement in the detection of total anti-HAV Ig and IgM in serum samples between two automated CLIAs. METHODS: We analyzed 181 samples those were submitted for testing at Kangbuk Samsung Medical Center. We analyzed the rate of agreement between the ADVIA Centaur XP (Siemens, Germany) and the MODULAR ANALYTICS E170 (Roche, Switzerland) analyzers. We performed reverse transcription (RT)-PCR when there was a discrepancy between the results from the two analyzers. RESULTS: The agreement rates between the ADVIA Centaur XP and the MODULAR ANALYTICS E170 for total anti-HAV Ig and IgM were 97.2% and 98.9%, respectively. Discrepant results were obtained in seven cases; all were found to be HAV-negative based on RT-PCR analysis. CONCLUSIONS: The total anti-HAV Ig and IgM results obtained using the two automated analyzers were comparable. However, in cases of equivocal results tested by the ADVIA Centaur XP for anti-HAV IgM, retesting and follow-up testing of samples are recommended.

Clinical Evaluation of the Multiplex PCR Assay for the Detection of Bacterial Pathogens in Respiratory Specimens from Patients with Pneumonia / 대한임상미생물학회지

BACKGROUND: Community-acquired pneumonia (CAP) is a major infectious disease with significant morbidity and mortality worldwide. Streptococcus pneumoniae, Haemophilus influenzae, Mycoplasma pneumoniae, Chlamydophila pneumoniae, Legionella pneumophila, and Bordetella pertussis are common pathogens of CAP; however, the conventional methods used to detect these agents, including culturing, lack sensitivity and are time-consuming. We evaluated a recently developed multiplex PCR assay which can test these agents simultaneously. METHODS: One hundred patients with pneumonia and 99 healthy adults were tested using the Seeplex Pneumobacter ACE Detection assay (Seegene, Inc., Seoul, Korea). Culture and urinary antigen tests were also performed. RESULTS: In patients with pneumonia, the positive detection rates of PCR for S. pneumoniae and H. influenzae were 52.0% (52/100) and 30.0% (30/100), respectively, those of M. pneumoniae and L. pneumophila were 2.0% (2/100) and 1.0% (1/100), respectively, and B. pertussis and C. pneumoniae were not detected. In healthy adults, the detection rates of S. pneumoniae and H. influenzae revealed similar results, 53.5% (53/101) and 40.4% (40/101), respectively, and the other four pathogens were not detected. The sensitivity and specificity of PCR for S. pneumoniae in pneumonia patients were 100% (95% confidence interval [CI], 87.9~100%) and 65.7% (95% CI, 55.2~76.5%), respectively, according to the urinary antigen test and cultures of the respiratory samples and blood. CONCLUSION: Differentiating S. pneumoniae and H. influenzae colonization from infection was difficult using the PCR assay. Therefore, the use of this assay is inappropriate for the diagnosis of pneumonia due to these agents, although multiplex PCR assay would be useful for the detection of M. pneumoniae and L. pneumophila.

Hemoglobin Yamagata: Hemoglobin Variant Detected by HbA1c Test / 대한진단검사의학회지

Hemoglobin (Hb) Yamagata is a rare Hb variant, which has been reported only twice-one case each in Japan and Korea. This variant arises from a Lys --> Asn substitution due to a mutation of AAA to AAC or AAT at codon 133 of the beta-globin gene. This study reports the third case of a patient detected with Hb Yamagata [HBB: c.399A>T; p.Lys133Asn] and discusses the effect of this variant on HbA1c measurement. This variant was detected in a 70-yr-old Korean man with diabetes mellitus during a routine follow-up. The HbA1c concentration determined using Variant ll Turbo (Bio-Rad, USA) was abnormally high at 47.9%. It was impossible to measure the HbA1c level accurately using Variant ll Thalassemia Mode (Bio-Rad, USA). However, the HbA1c levels analyzed by HLC-723 G7 (Tosoh, Japan), Cobas Integra (Roche, Switzerland) and NycoCard (Axis-Shield, Norway) were 5.0%, 8.0%, and 7.9%, respectively. This study shows that Hb Yamagata interferes with the accurate measurement of HbA1c levels in a diabetic patient. Taking these findings into consideration, we think that an immunoassay or affinity chromatography can be used as an alternate method for measuring the HbA1c level in a patient with this variant. In conclusion, a patient can be inferred to have an Hb variant if the HbA1c concentration is abnormally high or low or if there is a discrepancy between the results obtained using different methods, and if the clinical status of the patient suggests the presence of abnormal Hb. Subsequently, the HbA1c values can be determined by methods based on different principles.

Clinical Usefulness of Real-time PCR and Amplicor MTB PCR Assays for Diagnosis of Tuberculosis / 대한임상미생물학회지

BACKGROUND: PCR assay has provided a mean of more rapid and sensitive detection of Mycobacterium tuberculosis (MTB) complex than conventional acid- fast bacilli (AFB) smears and MTB cultures. Using the recently developed AdvanSure TB/NTM kit (LG Life Science Diagnostic Division, Korea), which could differentiate nontuberculous mycobacteria (NTM) from MTB, this study compared clinical usefulness of real-time PCR assay and Amplicor MTB PCR assay (Roche Molecular Systems, USA) for diagnosis of tuberculosis. METHODS: A total of 213 specimens (148 respiratory and 65 nonrespiratory specimens) were tested by using real-time PCR, Amplicor MTB PCR, AFB smear, and MTB culture. The sensitivity and specificity of four methods were evaluated according to clinical diagnosis. RESULTS: Of six NTM grown in culture, four (67%) were detected by real-time PCR. The overall agreement of real-time and Amplicor MTB PCR was 92% (191/207). The overall sensitivity and specificity were 91% and 87%, respectively, for real-time PCR, and 86% and 93% for Amplicor MTB PCR. In nonrespiratory specimens, the sensitivities of real-time PCR, Amplicor MTB PCR, AFB smear, and MTB culture were 67%, 60%, 13%, and 40%, respectively, and the specificity of the four methods were all 100%. CONCLUSION: For diagnosis of tuberculosis, the sensitivity and specificity of the real-time PCR assay using AdvanSure TB/NTM kit and Amplicor MTB PCR were similar, and the former could differentiate NTM from MTB. The PCR assay can be considered as a more sensitive technique for the detection of MTB than the conventional AFB smear and culture.

Clinical Significance of Minor Elevation of Cardiac Troponin I / 대한진단검사의학회지

BACKGROUND: Cardiac troponin I (cTnI) is known as a sensitive and specific marker for myocardial ischemia. The purposes of this study are to establish cut-off values of cTnI for acute myocardial infarction (AMI) and to analyze clinical significance of minor elevation of cTnI. METHODS: Two hundred and four patients from whom cTnI was measured at Ewha Womans University Dongdaemun hospital from January to March, 2006 were enrolled in the study. cTnI was measured using Dimension RxL (Dade Behring, USA). The lower limit of detection (LLD), 10% CV value, 99th percentile of healthy individuals, and cut-off value for AMI by ROC curve analysis were determined. RESULTS: LLD, 10% CV value, and 99th percentile of cTnI were 0.00 ng/mL, 0.10 ng/mL, and 0.07 ng/mL, respectively. The cut-off value of peak cTnI for AMI by ROC curve analysis was 0.13 ng/mL with the sensitivity, specificity, and AUC of 90.9%, 87.7%, and 0.921, respectively. The peak value of cTnI of patients with ischemic heart disease (IHD) was higher than that of the patients without IHD (P or =0.60 ng/mL (group 4), and compared frequencies of AMI, IHD, cardio vascular disease (CVD) and death after 1 month among groups. Frequencies of AMI, IHD, CVD, and death after 1 month were significantly increased as the cTnI concentrations were increased (P<0.05). CONCLUSIONS: Minor elevation of cTnI value, even in group 3 was significantly associated with high incidence of AMI, IHD, CVD, and death rate after 1 month.