A Novel and Simple Method for a Differentiation of Alcohol Types.

BACKGROUND: Alcohol poisoning is a significant global problem that has become an epidemic. The determination of the alcohol type is hereby essential as it may affect the course of the treatment; however, there is no routine laboratory diagnostic method for alcohol types other than for ethanol. In this study, we aimed to define a simple method for alcohol type differentiation by utilizing a combination of breathalyzer and spectrophotometrically measured serum ethanol results. METHODS: A breathalyzer and spectrophotometry were used to measure four different types of alcohol: ethanol, isopropanol, methanol, and ethylene glycol. To conduct serum alcohol analysis, four serum pools were created, each containing a different type of alcohol. The pools were analyzed using the spectrophotometric method with an enzymatic ethanol test kit. An experiment was conducted to measure the different types of alcohol using impreg-nated cotton and a balloon, simulating a breathalyzer test. An algorithm was created based on the measurements. RESULTS: Based on the results, the substance consumed could be methanol or isopropanol if the breathalyzer test indicates a positive reading and if the blood ethanol measurement is negative. If both the breathalyzer and the blood measurements are negative, the substance in question may be ethylene glycol. CONCLUSIONS: This simple method may determine methanol or isopropanol intake. This straightforward and innovative approach could assist healthcare professionals in different fields with diagnosing alcohol intoxication and, more precisely, help reducing related morbidity and mortality.

Hemolysis detection for ethanol measurement in whole blood samples before centrifugation: HemCheck device evaluation.

Background: As previously reported, the measurement of ethanol can also be affected by interference from hemolysis. This is a matter of concern since ethanol is widely regarded as the most commonly abused substance globally. When sample re-collection is ordered to eliminate hemolysis effects for ethanol testing, this can have unfavourable consequences for these patients. Rapid detection of hemolysed specimens would alleviate some issues associated with forensic samples. This study aimed to assess the qualitative analytical performance of a novel point-of-care testing device per the guidelines specified in CLSI-EP-12A document. HemCheck™ is a novel POCT device that qualitatively detects free-hemoglobin levels on the specimen shortly after drawing the sample. Methods: The system consists of two components. One is a cartridge with a needle that is used to transfer a small volume of whole blood from a vacuum tube to vertical and lateral flow filtration. The second component is the reader. The consumable cartridges are designed to be inserted into the reader without requiring the syringe or blood collection tube removal. A red indicator led illuminates, indicating that the sample has been hemolysed. To assess the imprecision of the method, we determined the C5-C95 interval and C50, using the Roche Cobas clinical chemistry analyser as the comparator. For this study, we utilised residual samples.

Comparison of Two Clinical Chemistry Analyzers by Total Analytical Error and Measurement Uncertainty.

BACKGROUND: Although analytical errors contain a small portion of laboratory errors, they are important in terms of intervention ability and practicality of follow-up by laboratory professionals. Also, from this point of view, the test results' quality, reliability, and accuracy are crucial to laboratories. Therefore, to determine analytical performance parameters for quality management in the analytical phase, clinical laboratories utilize total analytical error (TAE), bias, coefficient of variation (CV), and uncertainty of measurement (MU). METHODS: Fifteen biochemistry parameters were compared with Beckman Coulter AU 5800 for 2017 - 2018 and Roche Cobas 8000 for 2019 - 2020 in terms of TAE and MU. The results were evaluated between devices and compared with the EuBIVAS, CLIA, RCPA, PRDEQA%, pUQEAS%, pU%, and TEa-TR datasets. RESULTS: There were no significant differences between the devices for the mentioned periods. Device performances resulted in similar outcomes. During our four-year study, nearly all of our tests failed for EuBIVAS, RCPA, and pU%. On the contrary, almost all of our parameters gave valid results according to the CLIA, PRDEQA%, pUQEAS%, and TEa-TR ranges. CONCLUSIONS: It is crucial to distinguish between "mistake" and "uncertainty." The discrepancy between the measured value and the 'actual value' is called error. Uncertainty is a measure of how confident you are in the measurement outcome. We endeavor to remedy any known inaccuracies wherever feasible by applying adjustments from calibration certifications. On the other hand, any inaccuracy whose value is unknown is a cause of doubt.

Serum Vitamin D, Zinc Levels and the Relationship between them in Children and Adolescents.

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.

Interferograms plotted with reference change value (RCV) may facilitate the management of hemolyzed samples.

Background: The European Federation of Clinical Chemistry and Laboratory Medicine (EFLM) Working Group for Preanalytical Phase (WG-PRE) have recommended an algorithm based on the reference change value (RCV) to evaluate hemolysis. We utilized this algorithm to analyze hemolysis-sensitive parameters. Methods: Two tubes of blood were collected from each of the 10 participants, one of which was subjected to mechanical trauma while the other was centrifuged directly. Subsequently, the samples were diluted with the participant's hemolyzed sample to obtain the desired hemoglobin concentrations (0, 1, 2, 4, 6, 8, and 10 g/L). ALT, AST, K, LDH, T. Bil tests were performed using Beckman Coulter AU680 analyzer. The analytical and clinical cut-offs were based on the biological variation for the allowable imprecision and RCV. The algorithms could report the values directly below the analytical cut-off or those between the analytical and clinical cut-offs with comments. If the change was above the clinical cut-off, the test was rejected. The linear regression was used for interferograms, and the hemoglobin concentrations corresponding to cut-offs were calculated via the interferograms. Results: The RCV was calculated as 29.6% for ALT. Therefore, ALT should be rejected in samples containing >5.9 g/L hemoglobin. The RCVs for AST, K, LDH, and T. Bil were calculated as 27.9%, 12.1%, 19.2%, and 61.2%, while the samples' hemoglobin concentrations for test rejection were 0.8, 1.6, 0.5, and 2.2 g/L, respectively. Conclusions: Algorithms prepared with RCV could provide evidence-based results and objectively manage hemolyzed samples.

Could Some Laboratory Parameters Predict Mortality in COVID-19?

BACKGROUND: The number of confirmed cases of COVID-19 continues to increase worldwide and threatens public health. Our aim in this study is to examine the relationship between some laboratory parameters and hematological ratios with the severity of the disease and hospital mortality. METHODS: This study was designed as a retrospective cohort. The clinical data of 743 COVID-19 diagnosed patients who were eligible for hospitalization between March 16, and May 15, 2020 analyzed, retrospectively. The patients were separated into two groups as discharged from hospital (n = 681) and dead in hospital (n = 62). ROC curves and cutoff values of NLR (Neutrophil/Lymphocyte Ratio), PLR (Platelet/Lymphocyte Ratio), MLR (Monocyte/ Lymphocyte Ratio), CRP, and ferritin upon admission to hospital were calculated for the two groups. Binary Logistic Regression used to determine independent risk factors for mortality. RESULTS: The difference between both groups for age, duration in hospital, WBC, neutrophil, lymphocyte, NLR, PLR, MLR, CRP, and ferritin values were statistically significant. NLR had the highest area under the curve with a cutoff of 5.5 in the ROC curve [(AUC: 0.892, 95% CI: 0.844 - 0.939); Sensitivity = 85%, Specificity = 84%]. NLR, MLR, PLR, CRP and Ferritin groups have significant effects on the survival times of the Covid-19 patients. According to logistic regression analysis, increments of NLR (OR = 18.1, 95% CI: 6.4 - 51.4), CRP (OR = 5.5, 95% CI: 2.5 - 12.2), and age (OR = 2.7 95% CI: 1.3 - 5.5) values proportionally increase the death probability. CONCLUSIONS: NLR, CRP, and age are independent risk factors for mortality from COVID-19. We believe that evaluating these parameters together during diagnosis will be important in predicting the prognosis of the disease and in treatment approaches.

Effect of haemolysis on an enzymatic measurement of ethanol.

INTRODUCTION: We investigated the interference of haemolysis on ethanol testing carried out with the Synchron assay kit using an AU680 autoanalyser (Beckman Coulter, Brea, USA). MATERIALS AND METHODS: Two tubes of plasma samples were collected from 20 volunteers. Mechanical haemolysis was performed in one tube, and no other intervention was performed in the other tube. After centrifugation, haemolysed and non-haemolysed samples were diluted to obtain samples with the desired free haemoglobin (Hb) values (0, 1, 2, 5, 10 g/L). A portion of these samples was then separated, and ethanol was added to the separated sample to obtain a concentration of 86.8 mmol/L ethanol. After that, these samples were diluted with ethanol-free samples with the same Hb concentration to obtain samples containing 43.4, 21.7, and 10.9 mmol/L. Each group was divided into 20 equal parts, and an ethanol test was carried out. The coefficient of variation (CV), bias, and total error (TE) values were calculated. RESULTS: The TE values of haemolysis-free samples were approximately 2-5%, and the TE values of haemolysed samples were approximately 10-18%. The bias values of haemolysed samples ranged from nearly - 6.2 to - 15.7%. CONCLUSIONS: Haemolysis led to negative interference in all samples. However, based on the 25% allowable total error value specified for ethanol in the Clinical Laboratory Improvement Amendments (CLIA 88) criteria, the TE values did not exceed 25%. Consequently, ethanol concentration can be measured in samples containing free Hb up to 10 g/L.

The use of preanalytical quality indicators: a Turkish preliminary survey study.

OBJECTIVES: The utilization of reliable quality indicators (QIs) proven to be suitable for monitoring and improvement tools is one of the best choices to minimize of the risk of errors in all laboratory processes called as total testing process (TTP). In 2008, a Working Group "Laboratory Errors and Patient Safety" (WG-LEPS) established by International Federation of Clinical Chemistry and Laboratory Medicine (IFCC) developed the Model of Quality Indicators (MQI) complying with requirements of the ISO 15189:2012 standard for laboratory accreditation. They have also been dealing with harmonizing the QIs in most laboratories worldwide since then. The present study was set out to investigate the frequency of using IFCC WG-LEPS' pre-QIs by Turkish laboratories and to assess the conformity of them, by taking into account Turkey's conditions. METHODS: A survey consisting nine questions was applied in 81 laboratories using SurveyMonkey. RESULTS: According to the survey results, most of the laboratories reported they have used pre-QIs in the quality standards of health prepared by Turkish Ministry of Health (MOH). A part of IFCC WG-LEPS' pre-QIs were being utilized by more than 80% of the laboratories, the rest of which only used by 10% of laboratories. CONCLUSIONS: The majority of the medical laboratories have been using the pre-QIs included in the guidelines of Quality Standards prepared by the MOH. The pre-QIs are partially compatible with IFCC WG-LEPS' pre-QIs. The definitions of IFCC WG-LEPS' pre-QIs may also be revised to make them more clear and understandable by IFCC WG-LEPS. The insufficiency of Health Information Management Systems (HIMS) limits the use of pre-QIs proposed by IFCC WG-LEPS. Finally, the education of relevant personnel about the use of HIMS and pre-QIs is very crucial to harmonize and to extend the use of IFCC WG-LEPS' pre-QIs in Turkish medical biochemistry laboratories.

Evaluation of the relationship between Behcet's disease and cardiovascular disorders through metabolic function and copeptin.

INTRODUCTION: Behcet's disease (BD) is a chronic inflammatory and multisystem vasculitis. Cardiac involvement is one of the major complications of BD. Cardiac involvement is sporadic in terms of its specific relationship to mortality. How to identify and follow up on cardiac-related complications in BD patients has yet to be determined. AIM: The aim of our study is to assess cardiovascular diseases in BD patients by measuring metabolic function and copeptin levels and comparing these to a healthy control group. Knowing the specific metabolic functions that are negatively affected by BD will help doctors determine which functions need to be more closely monitored in BD patients. Our study is the first study in the available literature that evaluates copeptin in BD patients. MATERIAL AND METHODS: A control group of 58 healthy volunteers, including 32 females and 26 males (average age: 39.8 ±10.3 years, range: 18-50 years), was formed to compare with 84 BD patients (average age: 40.5 ±11 years, range: 21-63 years), including 39 females and 45 males. Diastolic and systolic blood pressure, height, weight, body mass index (BMI), and waistline were measured for both groups. All study patients were also given hemograms, and fasting blood sugar (FBS), uric acid, lipid profile, insulin, C-reactive protein (CRP), and copeptin levels were measured. An ELISA Kit was used to measure copeptin. RESULTS: FBS, CRP, and insulin levels were significantly higher in the patient group (p < 0.001, p = 0.004, and p = 0.038, respectively). Patients who had had the disease for more than 10 years had higher BMIs, total cholesterol, low-density lipoprotein (LDL) cholesterol, and triglyceride (TG) levels (p = 0.034, p = 0.004, p = 0.016, and p = 0.045, respectively). Additionally, CRP levels were found to be higher in long-term patients and patients with active lesions. Diastolic blood pressure and waist circumference were also higher in the BD group. Patients who had active lesions had significantly higher diastolic blood pressure (p = 0.047). There were no statistically significant differences in copeptin levels between BD and control groups. CONCLUSIONS: Cardiovascular involvement rarely contributes to the high mortality rate of BD patients. There were meaningful elevations in metabolic markers identified when BD and cardiovascular disease risk was assessed with metabolic parameters. The cardiac disease risk should be closely followed using metabolic functions, particularly in long-term BD patients with vascular involvement.

The diagnostic value of irisin in patients with acute abdominal pain: A preliminary study.

BACKGROUND: The aim of this study was to investigate the prognostic value of irisin by examining the serum level of this smooth muscle protein in patients presenting at the emergency department (ED) with acute abdominal pain. METHODS: This research was performed as a single-center, prospective, cross-sectional study. In all, 213 adult patients presenting at the ED with acute abdominal pain and 140 healthy controls were enrolled. The serum irisin level was correlated with the leukocyte, C-reactive protein, amylase, and creatine kinase values. The irisin level was compared between groups of those who were admitted or discharged, and those who received surgical or medical treatment. RESULTS: The mean irisin level of the 213 patients and the 140 controls was 6.81±3.17 mcg/mL vs. 5.69±2.08 mcg/mL. The mean irisin value of the hospitalized patients (7.98±3.11 mcg/mL) was significantly higher than that of the discharged patient group (6.38±3.09 mcg/mL) and the controls (control vs. discharged: p=0.202; control vs. hospitalized: p<0.001; discharged vs. hospitalized: p=0.001). When compared with that of the control group, the irisin level was significantly higher in patients with gall bladder diseases, urolithiasis, and acute appendicitis (p=0.001, p=0.007, p=0.007). CONCLUSION: The serum irisin level in patients with abdominal pain may serve as a guide in diagnostic decision-making and determining the prognosis for cases of acute abdominal pain involving luminal obstruction in tubular intra abdominal organs.

Evaluation of Ethanol Interference on Routine Biochemical Tests.

OBJECTIVES: Ethanol is a widely consumed drug in almost every society. In this study, the potential interfering effect of ethanol on routine biochemical tests was evaluated. METHODS: Serum pools were prepared from blood samples collected from patients seeking treatment at the emergency department. Five separate groups were formed by adding ethanol to the samples, so the final concentrations were negative: 50 mg/dL, 100 mg/dL, 200 mg/dL, and 400 mg/dL. Each group was divided into 20 portions, and routine biochemical tests were measured from each portion. The coefficient of variation (CV), bias, and total error values were calculated for the measured parameters. RESULTS: Alanine aminotransferase (ALT; EC 2.6.1.2) and lactate dehydrogenase (LDH; EC 1.1.1.27) activities decreased in proportion to the ethanol level. High negative biases were observed, suggesting a dose-dependent negative interference. The total error values calculated for direct bilirubin and urea were higher than the allowable total error reported in the Clinical Laboratory Improvement Amendments of 1988. For direct bilirubin, it was observed that the cause of this shift was due to the increase in CV values. CONCLUSIONS: We conclude that ethanol may cause interference in the measurement of some biochemical tests, whereas the most prominent effect was observed for LDH and ALT.

Tissue Expressions of Soluble Human Epoxide Hydrolase-2 Enzyme in Patients with Temporal Lobe Epilepsy.

OBJECTIVE: We sought to simply demonstrate how levels of soluble human epoxide hydrolase-2 show changes in both temporal the cortex and hippocampal complex in patients with temporal lobe epilepsy. METHODS: A total of 20 patients underwent anterior temporal lobe resection due to temporal lobe epilepsy. The control group comprised 15 people who died in traffic accidents or by falling from a height, and their autopsy findings were included. Adequately sized temporal cortex and hippocampal samples were removed from each patient during surgery, and the same anatomic structures were removed from the control subjects during the autopsy procedures. Each sample was stored at -80°C as rapidly as possible until the enzyme assay. RESULTS: The temporal cortex in the epilepsy patients had a significantly higher enzyme level than did the temporal cortex of the control group (P = 0.03). Correlation analysis showed that as the enzyme level increases in the temporal cortex, it also increases in the hippocampal complex (r2 = 0.06, P = 0.00001). More important, enzyme tissue levels showed positive correlations with seizure frequency in both the temporal cortex and hippocampal complex in patients (r2 = 0.7, P = 0.00001 and r2 = 0.4, P = 0.003, respectively). The duration of epilepsy was also positively correlated with the hippocampal enzyme level (r2 = 0.06, P = 0.00001). CONCLUSIONS: Soluble human epoxy hydrolase enzyme-2 is increased in both lateral and medial temporal tissues in temporal lobe epilepsy. Further studies should be conducted as inhibition of this enzyme has resulted in a significant decrease in or stopping of seizures and attenuated neuroinflammation in experimental epilepsy models in the current literature.

Evaluation of the Postmortem Glucose and Glycogen Levels in Hepatic, Renal, Muscle, and Brain Tissues: Is It Possible to Estimate Postmortem Interval Using These Parameters?

The aim of our study was to investigate the postmortem levels of glucose and glycogen in hepatic, renal, muscle, and brain tissues and then examine the changes in those levels that could be useful for estimating postmortem interval. We established an animal model. Seventy female BALB/c albino mice were used in this study. After being sacrificed, the mice were randomly divided into six groups according to time elapsed since death (Group 1: 0 h; Group 2: 12 h; Group 3: 24 h; Group 4: 36 h; Group 5: 48 h; and Group 6: 60 h). Glucose levels were significantly different between groups for all tissues studied. Slope of the change per unit time was higher for the hepatic glucose levels. Based on these results, it is possible to estimate postmortem interval using postmortem glucose levels in hepatic tissue. Tissue-specific assessment may contribute valuable information to postmortem interval studies.

Evaluation of the Post-Mortem Superoxide Dismutase, Glutathione Peroxidase Activities and Malondialdehyde Level in Renal and Brain Tissues: Is it Possible to Estimate Post-Mortem Interval Using these Parameters?

BACKGROUND: Estimation of the postmortem interval (PMI) is one major area of interest in forensic medicine. We investigated changes of superoxide dismutase (SOD) and glutathione peroxidase (GSH-Px) activities and malondialdehyde (MDA) levels in rat brain and renal tissues in the PMI and examined the potential changes which may be useful for an estimation of time of death. METHODS: Forty albino female rats were used in this study. The rats were sacrificed and divided into five groups: Group 1: 0 hour, Group 2: 6 hours, Group 3: 12 hours, Group 4: 24 hours, and Group 5: 48 hours. The rats were housed at room temperature (22 degrees C ± 2 degrees C) for the defined period for each group, and their brains and kidneys were excised. RESULTS: The postmortem MDA levels were significantly different between groups for both renal and brain tissues (p = 0.003; p = 0.007). The diagnostic adequacy of MDA was calculated. Regarding SOD and GSH-Px, we were not able to obtain any date that would be useful for the prediction of PMI. CONCLUSIONS: According to this study, it is possible that an estimation of the PMI can be made using postmortem MDA levels. Regarding SOD and GSH-Px, we were not able to obtain any data that would be useful for the prediction of PMI.

Thrombin-activatable fibrinolysis inhibitor levels in patients with non-small-cell lung cancer.

BACKGROUND: An increased incidence of thromboembolic events has been described in patients with cancer. Cancer cells are attributed with producing procoagulant substances such as cysteine protease and tissue factor to activate factor X and factor VII, respectively. However, there are limited data on the pathogenesis behind this hypercoagulability state, and the thrombin generation, fibrinolytic system, and coagulation inhibition system during cancer are largely obscure. In this study, we investigated the changes of different steps of coagulation pathway in patients with non-small-cell lung cancer (NSCLC) and compared the data with those of healthy controls. PATIENTS AND METHODS: Forty-four patients with NSCLC and 36 age-matched controls were recruited for this study. Prothrombin fragment 1 + 2 (F 1 + 2) were used as a marker of thrombin generation; thrombin-activatable fibrinolysis inhibitor (TAFI) immunologic activity level was measured for inhibition of the fibrinolytic system, and tissue factor pathway inhibitor (TFPI) activity was assessed for the coagulation inhibition system. In the patient group, the relationships between TAFI activity levels and patient parameters (age, sex, body mass index [BMI], histopathology, and stage) were evaluated. RESULTS: The TAFI activity, F 1 + 2 levels, and TFPI activity were significantly higher in patients with lung cancer than in subjects in the control group (P < .05; P < .0001; and P < .0001; respectively). However, there were no statistically significant associations between TAFI activity levels and patient age, sex, BMI, histopathology, or stage of disease (P > .05). CONCLUSION: In this study, it was clearly shown that patients with lung cancer have hypercoagulable states and that the pathogenesis of thrombotic events in these patients is multifactorial. Increased TFPI is a reflection of thrombin activity in this patient group. Confirmatory studies with larger patient groups should be performed in this population.

Hemodialysis and protein oxidation products.

The presence of a chronic inflammatory state has also been widely documented in end-stage renal disease patients receiving maintenance hemodialysis (HD). It is commonly attributed to the constantly renewed activation of circulating neutrophils and monocytes following blood passage through dialysis circuits and subsequent generation of activated complement components due to contact of plasma with bioincompatible membranes and/or transfer of endotoxins from the dialyzate to the blood compartment. This conjunction leads to a massive generation of reactive oxygen species (ROS), for example, superoxide anion, hydrogen peroxide, hydroxyl radical, and chlorinated oxidants, such as hypochlorous acid by activated neutrophils. The exquisite vulnerability of proteins to ROS is now well documented. Oxidation of amino acid residues, such as tyrosine, leads to the formation of dityrosine, protein aggregation, cross-linking, and fragmentation. Dityrosine-containing protein cross-linking products in the plasma of dialysis patients are named as advanced oxidation protein products (AOPP). In addition, advanced glycation end-products (AGE) is a protein carbonyl compound and produced by protein-ROS interaction. We investigated both the effect of the renewed activation of the immune cells, due to blood-dialyzer interaction over protein oxidation products like AOPP and AGE, among chronic renal failure (CRF) patients receiving maintenance HD, and choice of dialyzers like high flux or the other group on protein oxidation product levels.