Medical Laboratory Journal

Is selenium intake important in cancer risk?

Hamidreza Joshaghani

Editorial

Predicting the severity of sickle cell disease using hematological, biochemical, and cellular parameters

Viren Laljbhai Vaghasiya

Background: Sickle cell disease is a hemoglobinopathy caused by a point mutation and has a heterogeneous clinical course. The level of Hb F within erythrocytes is believed to be the most important parameter determining disease severity. The aim of this study was to investigate whether Hb F level, F-cell count, and sickle cell percentage after in vitro induction of sickling can predict the severity of the disease.
Methods: All necessary data were collected from clinical history, biochemistry, and pathology laboratory tests. This was a cross-sectional study with 31 participants. Statistical analyses were performed using the correlation coefficient and chi-square test to identify significant differences between variables. Statistical analysis was performed using MedCalc software.
Results: The majority of patients fell into the mild severity score category, with a lack of severe disease phenotypes. The number of painful episodes, hospitalizations, and cumulative disease severity scores were associated with high levels of LDH and indirect bilirubin. However, none of the clinical disease severity parameters or the overall cumulative disease severity score was associated with Hb F level, F-cell count, or the percentage of sickled cells after in vitro induction of sickling. A high percentage of F-cells was associated with high MCV, MCH, and MCHC and low RDW, LDH, and indirect bilirubin levels.
Conclusion: Sickle cell disease severity is related to the susceptibility of RBCs to hemolysis, as indicated by serum LDH and indirect bilirubin levels. However, the extent of hemolysis may depend on multiple factors rather than F-cell count or Hb F level alone.

Comparison of antityphoidal efficacy of Moringa oleifera seed oil to antibiotics against Salmonella typhi

Sikiru Kayode Abdulahi

Background: Typhoid fever, a severe febrile illness prevalent in tropical regions, remains a significant cause of mortality. Drug-resistant pathogens have spurred research into medicinal plants as alternative treatments. While previous studies have focused on the inhibitory effects of Moringa oleifera leaf extract, limited attention has been given to M. oleifera seed oil and its effects on Gram-negative bacteria. This study aimed to evaluate the anti-typhoidal activity of M. oleifera seed oil against both typed and clinical Salmonella typhi isolates.
Methods: The anti-typhoidal activity of M. oleifera seed oil was assessed using agar diffusion and disk diffusion methods. Phytochemical screening of the seed oil was also conducted to identify its constituents.
Results: M. oleifera seed oil exhibited negligible or weak inhibitory effects on clinical and typed S. typhi strains (p>0.05), in contrast to the substantial inhibition observed with commercial antibiotics. Ciprofloxacin demonstrated the highest zones of inhibition (≥30 mm) against S. typhi, while tetracycline showed the least pronounced inhibition (≤16 mm). Phytochemical screening of M. oleifera seed oil identified terpenoids, cardiac glycosides, saponins, tannins, and flavonoids, with terpenoids being the most abundant and flavonoids the least abundant.
Conclusion: M. oleifera seed oil lacks significant therapeutic potential for the treatment of typhoid fever. Its antibacterial constituents are minimal or absent, resulting in insignificant inhibition against S. typhi.

Diagnostic and clinical characteristics of liver autoantibodies by immunoblot in a medical laboratory

Adrian Yong Sing Lee

Background: Autoimmune liver diseases (ALD) are a heterogeneous group of disorders affecting the hepatobiliary system and are characterized by specific autoantibodies. These are routinely measured in diagnostic laboratories using commercial line immunoblot (LIB) assays. However, the ordering characteristics and diagnostic performance of this test have not been extensively evaluated. This study aims to examine the performance of the ALD LIB in a single diagnostic laboratory.
Methods: A retrospective, cross-sectional audit of 12 months of data was performed at the Institute of Clinical Pathology and Medical Research diagnostic laboratory (Westmead Hospital, Australia). Patients referred for an ALD-LIB were included. Medical notes were reviewed to ascertain the clinical diagnoses of patients. Patients who had at least one positive ALD autoantibody on LIB were defined as “blot-positive” and compared with “blot-negative” patients. The performance of the ALD-LIB was assessed through the calculation of diagnostic sensitivities and specificities.
Results: There were 611 patients included over the 12-month period. Sixty-four of these patients (10%) were blot-positive. These patients were more likely to be female, to have other ALD-associated autoantibodies, and to have lower alkaline phosphatase (ALP) levels compared with blot-negative patients. An ALD diagnosis or systemic autoimmune disease was more likely to be identified in blot-positive patients. Finally, the LIB demonstrated a high negative predictive value for an ALD diagnosis in this patient cohort.
Conclusion: This real-world analysis of the laboratory’s ALD-LIB provided insights into the ordering characteristics and performance of this assay in patients referred for testing. When combined with other ALD investigations, the ALD-LIB is a useful adjunct in the evaluation of patients with suspected ALD.

Giant pigmented basal cell carcinoma in the inguinal region: A diagnostic challenge at an uncommon site

Nikhil Pudhu Veetil

Background: Basal cell carcinoma is the most common skin cancer. It accounts for 80% of all non-melanoma skin cancers. It most commonly occurs in sun-exposed areas. 0.094% of the cases occur in the inguinal region.
Case presentation: A 70-year-old male presented with swelling in the left inguinal region for 6 months, diagnosed as malignant melanoma based on clinical and cytological features and finally as pigmented basal cell carcinoma by histopathology and immunohistochemistry.
Conclusion: All pigmented lesions are not melanoma. Pigmented basal cell carcinoma is an important differential diagnosis for malignant melanoma irrespective of the site, size, and clinical picture. We take this opportunity to reiterate the chances and reasons for the misdiagnosis of basal cell carcinoma in cytology smears.

Papillary thyroid carcinoma in cervical lymph node found in a patient of primary tongue squamous cell carcinoma: Ectopic thyroid versus metastatic deposits; A diagnostic dilemma

Paridhi .

Background: The incidental discovery of papillary thyroid carcinoma (PTC) in cervical lymph nodes during neck dissection for tongue squamous cell carcinoma (SCC) is an exceedingly rare finding, reported in approximately 0.3 - 1.6% of head and neck squamous cell carcinoma (HNSCC) cases. Differentiating between metastatic PTC and papillary carcinoma arising in aberrant thyroid tissue poses a diagnostic challenge, especially in the absence of a detectable thyroid mass.
Case Presentation: A 35-year-old male presented with a rapidly growing ulcero-proliferative lesion on the lateral border of the tongue for four months. Biopsy revealed moderately differentiated SCC. The patient underwent hemiglossectomy with supraomohyoid neck dissection. Histopathology confirmed SCC with clear margins and no nodal metastasis; however, one cervical lymph node revealed thyroid follicles with cells showing optically clear nuclei. Immunohistochemistry was positive for TTF1 and HBME-1, confirming metastatic PTC. No palpable thyroid nodule was identified, and computed tomography demonstrated only hypodense colloid nodules. Thyroid function tests were normal, and the patient remains disease-free on follow-up without thyroid surgery.
Conclusion: The coexistence of tongue SCC and metastatic PTC in cervical lymph nodes is exceptionally uncommon. The absence of a primary thyroid lesion raises questions regarding the origin - occult metastasis versus transformation in aberrant thyroid tissue. The literature supports conservative management with vigilant follow-up when thyroid imaging shows no evidence of malignancy. Meticulous histopathological examination of neck dissection specimens in HNSCC is vital. Management should be individualized, balancing surgical intervention and surveillance based on clinic radiologic findings.

Upregulated A20 (TNFAIP3) expression during respiratory syncytial virus infection in mice

Alireza Tahamtan

Background: Severe lower respiratory tract infections in infants and young children are frequently caused by respiratory syncytial virus (RSV), with the degree of illness strongly associated with disproportionate inflammatory activity. The signaling protein A20 (TNFAIP3) functions to inhibit NF-κB pathway activation, suggesting a possible role in tempering RSV-triggered lung inflammation. In this study, we assessed how RSV infection alters A20 gene expression in the lungs using a mouse model system.
Methods: Of the twelve female BALB/c mice allocated for the study, half were administered RSV intranasally at a concentration of 3 × 106 plaque-forming units (PFU), while the remaining six served as uninfected controls. All animals were humanely euthanized five days post-infection. Upon collection, lung tissue samples were immediately processed. The relative expression levels of messenger RNA (mRNA) for the TNFAIP3 gene, which encodes the A20 protein, were subsequently quantified using real-time reverse transcription polymerase chain reaction (RT-PCR).
Results: Analysis by quantitative PCR revealed that A20 expression was significantly higher in the lungs of RSV-infected mice compared with uninfected controls at day 5 post-infection (P = 0.0048).
Conclusion: The upregulation of A20 in RSV-infected mice suggests its potential role in modulating post-viral pulmonary inflammation.

Sestrin2, NFATc1, and NRF2 in PBMCs of patients with ankylosing spondylitis treated with etanercept compared to the new case patients

Koushan Sineh Sepehr

Background: Ankylosing spondylitis (AS) is an inflammatory autoimmune disease characterized by progressive bone destruction and pathological new bone formation. Sestrin2 is activated in inflammatory and oxidative responses and protects cells from injury. Sestrin inhibits reactive oxygen species (ROS) by activating nuclear factor erythroid 2-related factor 2 (NRF2). Nuclear factor of activated T-cell cytoplasmic 1 (NFATc1), a key regulator of osteoclast differentiation, is induced following stimulation of the receptor activator of nuclear factor kappa-B ligand (RANKL) and promotes bone resorption. Emerging evidence suggests that impaired Sestrin2/NRF2 signaling may lead to increased oxidative stress, thereby enhancing NFATc1 activity and exacerbating bone destruction in AS. This study analyzed the expression of these genes in newly diagnosed AS patients and AS patients receiving etanercept, an anti-tumor necrosis factor (Anti-TNF) drug, compared with a control group.
Methods: The expression levels of Sestrin2, NRF2, and NFATc1 genes were analyzed by real-time PCR in 60 peripheral blood mononuclear cell (PBMC) samples, which were divided into three groups: newly diagnosed AS patients, AS patients receiving etanercept (Etanercept group), and healthy control individuals. Statistical analysis was performed using SPSS version 18 software. A P-value < 0.05 was considered statistically significant.
Results: NRF2 gene expression was increased in the newly diagnosed AS group compared with the control group (P < 0.001). It was also increased in the etanercept group compared with the control group (P < 0.01). The expression levels of the other two genes (SESN2 and NFATc1) in the etanercept group were higher than those in both the newly diagnosed and control groups; however, these differences were not statistically significant (P > 0.05).
Conclusion: The expression levels of genes involved in the regulation of inflammation increased following treatment with etanercept. These results suggest that, in addition to its inhibitory effects on the TNF-α pathway, etanercept may also influence the expression of genes involved in the control of inflammatory processes.

Comparison of three types of exercise methods on some factors of sarcopenia and inflammation in elderly women

Mahmoud Soltani

Background: Sarcopenia and systemic chronic inflammation are hallmark features of biological aging, contributing significantly to functional decline in geriatric populations. The present study aimed to evaluate and compare the efficacy of eight-week endurance, resistance, and concurrent (Combined) training protocols on key biomarkers of sarcopenia (C-terminal agrin fragment, CAF) and inflammatory profiles (Cortisol and interleukin-6, IL-6) in elderly women.
Methods: Forty-eight elderly female volunteers (Mean Age: 65.24 ± 3.14 years; Weight: 82.76 ± 5.89 kg; Height: 162.06 ± 4.40 cm; BMI: 31.45 ± 3.21 kg/m²) were recruited and randomly allocated into four homogeneous groups (n = 12 per group): Endurance Training, Resistance Training, Concurrent Training, and Control. The experimental groups participated in their respective exercise regimens for eight weeks (Three sessions per week). To measure serum variables (Cortisol, CAF, and IL-6), fasting blood samples were collected 48 hours before the intervention and 48 hours after the final training session. Data were analyzed using one-way ANOVA, ANCOVA, and Bonferroni post-hoc tests.
Results: Post-intervention analysis demonstrated significant reductions in serum cortisol (P = 0.001), CAF (P = 0.001), and IL-6 (P = 0.001) in all training groups compared to baseline. Significant differences were observed between the exercise groups and the control group, particularly for cortisol levels (P = 0.001); however, intergroup comparisons among the three exercise modalities showed no statistically significant differences (P > 0.05).
Conclusion: The findings suggest that, regardless of modality, an eight-week exercise intervention effectively reduces biomarkers associated with neuromuscular junction degradation and systemic inflammation in elderly women. Therefore, these training strategies may be recommended as viable non-pharmacological approaches to counteract sarcopenic progression and age-related metabolic dysfunction.

Molecular identification of Leishmania in rodents and their hard ticks in Golestan province, Northern Iran

Farideh Tohidi

Background: Leishmaniasis is a zoonotic disease transmitted between humans and animals and is caused by the Leishmania parasite. This parasite is transmitted through the bite of the female sandfly. Rodents and canids serve as reservoir hosts, while humans act as incidental hosts for this parasitic disease. Given the crucial role of rodents as reservoirs for zoonotic cutaneous leishmaniasis in the endemic regions of Golestan province, we aimed to investigate the presence of Leishmania in rodents and their hard ticks in the Agh Qala and Inche Broun areas of Golestan province.
Methods: This study is a descriptive cross-sectional study. It involved the analysis of 28 liver and 28 skin samples from 28 rodents and their isolated hard ticks for the presence of Leishmania parasites using the ITS1-PCR method.
Results: In this study, 6 species were identified among the 28 rodents captured in the Agh Qala and Inche Broun areas of Golestan province, with the dominant species being Rhombomys opimus, accounting for 75% of the rodents. Through PCR analysis, 13 rodents (46.4%) and 15 hard ticks (10.7%) were positive for Leishmania major parasites. Interestingly, it was observed that 69% of the rodents infected with Leishmania parasites were female. Most rodents infected with Leishmania were found to inhabit the Inche Broun area. The majority of ticks belonged to the genera Rhipicephalus spp., Ornithonyssus bacoti, and Ixodes ricinus.
Conclusion: Given the positivity of Leishmania parasites in some ticks isolated from infected animals, it is important to consider the potential epidemiological role of hard ticks in the transmission of rodent leishmaniasis.

The effect of Sinopharm COVID-19 vaccine on fecal calprotectin levels and clinical symptoms in patients with ulcerative colitis

Kiana Shahzamani

Background: The ongoing COVID-19 pandemic has raised concerns regarding the safety and efficacy of vaccination in immunocompromised patients, including those with inflammatory bowel disease (IBD). In this study, we aimed to investigate the effect of the Sinopharm anti-COVID-19 vaccine on fecal calprotectin (fCP) levels and clinical symptoms in patients with ulcerative colitis (UC).
Methods: A total of 28 patients with UC (8 females and 20 males), with a mean age of 40.8 ± 9.7 years, were enrolled in the study. Most patients were receiving 5-aminosalicylic acid (5-ASA) agents. All patients received the Sinopharm anti-COVID-19 vaccine. Fecal calprotectin levels and clinical symptoms were assessed at baseline and at 2 and 12 weeks after vaccination. The Lichtiger score and Mayo score were used to evaluate clinical symptoms.
Results: No IBD-related adverse events were reported following vaccination. There was no significant difference in fCP levels between baseline and 2 weeks after vaccination. However, a significant decrease in fCP levels was observed at 12 weeks after vaccination compared to baseline and 2 weeks post-vaccination. Similarly, a significant improvement in clinical symptoms was noted at 2 and 12 weeks after vaccination compared to baseline, as evidenced by a reduction in the Lichtiger score. There was no association between vaccination and the clinical bleeding score (Mayo score). None of the other parameters, including location of injury, type of medication, or sex, were associated with fCP levels, Lichtiger score, or Mayo score.
Conclusion: The results of this study suggest that the Sinopharm anti-COVID-19 vaccine is safe for patients with IBD and does not lead to exacerbation of UC symptoms.