Medical Laboratory Journal

Evaluation of blood glucose-lowering activity of aqueous extract of bark of Ficus lacor Buch Ham in alloxan-induced diabetes in New Zealand white rabbits

Piyushkumar Mansinh Pargi

Background: Although the anti-diabetic effects of various Ficus species have been investigated in animal models, research on the blood glucose-lowering potentials of Ficus lacor Buch Ham bark remains sparse. This study evaluated the blood glucose-lowering potentials of an aqueous extract derived from Ficus labor bark in a diabetic rabbit model.
Methods: Diabetes was induced in rabbits through intravenous administration of alloxan monohydrate (120 mg/kg). 36 rabbits were divided into six groups, each consisting of six animals. Control groups included a non-diabetic control (Distilled water) and a diabetic control (Distilled water). Two experimental groups received Ficus lacor extract at doses of 100 mg/kg (Low-dose) and 200 mg/kg (High-dose) orally for six weeks. Metformin was used as an active control. A non-diabetic group (Extract control) was also administered Ficus lacor extract at 200 mg/kg. Fasting blood sugar (FBS) and post-prandial blood sugar (PP2BS) levels were measured weekly over the 6 weeks. The percentage reduction in blood glucose levels was calculated and compared for each group.
Results: The administration of both low-dose and high-dose Ficus lacor extracts resulted in significant reductions in FBS and PP2BS levels in diabetic rabbits. After six weeks, the low-dose extract group exhibited an average reduction of 38.3% in FBS and 40.5% in PP2BS, whereas the high-dose extract group showed average reductions of 35.3% in FBS and 36.3% in PP2BS.
Conclusion: The aqueous extract of Ficus lacor bark demonstrates substantial glucose-lowering activity, indicating its potential utility as a therapeutic agent in diabetes management.

Platelet-to-lymphocyte ratio: A useful predictor of glycemic control in patients with diabetes mellitus

Swathy Shanker

Background: Diabetes Mellitus (DM) is a metabolic disorder whose pathophysiology has been linked to various genetic and environmental factors. The main mechanism of the development of complications has been implicated as inflammation-mediated. Various blood cell parameters are being used as early indicators of inflammation-mediated endothelial dysfunction; thereby predicting the severity or prognosis of DM. In this study, we aimed to evaluate the role of platelet-to-lymphocyte ratio (PLR) in predicting glycemic control in patients with DM.
Methods: This is a retrospective, hospital-based study conducted from August 2023 to December 2023. A total of 134 patients were included in the study. The hematological and biochemical reports of the study population were retrieved, and the data obtained was analyzed using SPSS software version 16.0.
Results: In this study, it has been found that PLR is significantly increased in patients suffering from DM with poor glycemic control compared to those patients with good glycemic control (P<0.001). In concordance with other studies, a positive association was observed between PLR and disease severity.
Conclusion: Based on the findings of the study, PLR may be used as a predictive marker in assessing the severity and prognosis of DM; however, the exact cut-off value is yet to be determined.

Antibiotic resistance profile of Acinetobacter baumannii isolates identified from blood cultures

Umut Safiye Şay Coşkun

Background: Acinetobacter baumannii (A. baumannii) has emerged as the predominant etiological agent responsible for bloodstream infections among hospitalized patients. The objective of this study was to evaluate antibiotic resistance in A. baumannii isolates identified from blood cultures.
Methods: A retrospective cohort evaluation was conducted on 117 A. baumannii isolates obtained from blood cultures collected between 2018 and 2019 at the Microbiology Laboratory of Tokat Gaziosmanpaşa University Hospital (Türkiye). The blood culture samples were incubated using the BACT-ALERT 3D system (bioMérieux, Durham, NC, USA). Microorganism identification and antibiotic susceptibility testing were performed using the VITEK 2 (bioMérieux, France) automated system.
Results: Of the 117 samples, 59.8% were obtained from males and 40.2% from females. A total of 90.6% of blood culture samples were collected from the intensive care unit, and 88.9% of isolates were identified as multidrug-resistant (MDR). The highest resistance was observed against meropenem (99.1%), while the lowest resistance was noted for colistin (17.1%) and tigecycline (27.3%). Resistance to amikacin was 74.4%, while resistance levels to gentamicin, tobramycin, cefoxitin, and cefotaxime were within the range of 80–90%. Resistance to imipenem, amoxicillin/clavulanic acid, ampicillin/sulbactam, ceftazidime, cefepime, ciprofloxacin, levofloxacin, meropenem, and ertapenem exceeded 90%.
Conclusion: The increasing number of MDR A. baumannii isolates poses a significant threat to all hospitalized patients. However, colistin and tigecycline remain preferable options for the treatment of MDR A. baumannii infections. Considering the increasing prevalence of MDR A. baumannii isolates, periodic analysis of epidemiological data in healthcare centers is important for managing resistance to colistin and tigecycline.

Correlation between platelet counts, MPV, PDW, PCT and age in acute ischemic stroke patients

Babker Ahmed Mohamed

Background: Acute ischemic stroke occurs when blood clots obstruct blood vessels within the brain. Platelets (Plts) are integral to the pathophysiology of stroke. This research aimed to explore the relationship between Plt quality and Plt indices in the context of acute ischemic stroke.
Methods: This cross-sectional investigation involved 100 patients diagnosed with acute ischemic stroke at Kosti Teaching Hospital and Alyammama Hospitals. The diagnosis was confirmed using brain CT imaging and electrocardiography (ECG). Blood samples were collected in EDTA-containing tubes within 24 hours following the commencement of treatment and were subsequently analyzed for Plt count, mean Plt volume (MPV), Plt distribution width (PDW), and plateletcrit (PCT) utilizing a hematological analyzer. Data were analyzed using GraphPad Prism software.
Results: Platelet counts negatively correlated with PDW [r=-0.074, P=0.459; R=-0.023, P=0.815], MPV [r=-0.130, P=0.194; R=-0.081, P=0.417], and diastolic blood pressure [r= -0.023, P=0.818; R= -0.024, P=0.805]; and positively correlated with PCT [r= 0.103, P=0.308; R=0.143, P=0.155] and diastolic blood pressure [r=0.022, P=0.823; R= 0.008, P=0.932]. Moreover, PDW positively correlated with systolic blood pressure [r=0.105, P=0.298; R= 0.147, P=0.148] and diastolic blood pressure [r=0.146, P=0.145; R=0.173, P=0.084]. Based on Spearman but not Pearson correlation, PDW showed a negative correlation with PCT [r=-0.005, P=0.959; R=0.010, P=0.929].
Conclusion: The study shows a correlation between Plt count and indices in ischemic stroke patients. The research also presented evidence concerning the relationship between diastolic and systolic blood pressure and Plt counts and indices.

A study of prognostic significance of serum magnesium and serum potassium levels in acute stroke

Kavya Varshney

Background: Stroke is one of the major causes of morbidity and mortality worldwide. Various studies have examined the neuroprotective effects of magnesium and potassium ions through their effects on the glutamate receptor and the endothelium, achieved by lowering blood pressure and through their anti-inflammatory and anti-apoptotic properties. The objective of our study was to determine the prognostic significance of serum magnesium and serum potassium levels in acute stroke.
Methods: An observational study was conducted at Rajendra Institute of Medical Sciences, Ranchi, for 18 months on 150 adults in patients with acute stroke, enrolled within 72 hours after applying appropriate inclusion and exclusion criteria. Correlations between the Modified Rankin Scale (mRS) score at discharge and the Glasgow Coma Scale (GCS) score at admission with serum levels of magnesium and potassium were calculated. Statistical analysis was performed using SPSS software version 27.0.
Results: Two groups were formed based on serum magnesium levels: <1.5 mg/dL and >1.5 mg/dL. Similarly, two groups were created based on serum potassium levels: <3.5 mEq/L and >3.5 mEq/L. A significant correlation was found, using Spearman’s coefficient test, between serum potassium and magnesium levels and the GCS score at admission, as well as the mRS score at discharge (p < 0.05).
Conclusion: Lower concentrations of magnesium and potassium are associated with increased cerebral arterial contraction and greater neurological damage.

Comparative evaluation of in vitro activity of tigecycline using the disc diffusion method and the VITEK-2 COMPACT in clinical isolates at a tertiary care cancer center

Vivek Bhat

Background: Tigecycline susceptibility testing and reporting remain enigmatic due to the lack of established guidelines. Disc diffusion, as a method of performing susceptibility testing, is more widely accepted worldwide due to its ease of use. Limited published literature is available from India on the utility of this method, especially in a cancer care setting. Hence, this study was conducted to evaluate the performance characteristics of disc diffusion by comparing its results with those of the VITEK-2 COMPACT, considering the latter as the standard.
Methods: Disc diffusion was performed using Kirby-Bauer’s method on Mueller-Hinton agar with a HiMedia 15 mcg TGC disc, following FDA and EUCAST breakpoints. According to CLSI criteria, disc diffusion breakpoints can be considered acceptable when categorical agreement is ≥ 90%, the very major error is ≤ 1.5%, and the major error is ≤ 3%.
Results: Using Cohen’s kappa coefficient, the kappa value was 0.328, with a p-value of <0.05. The agreement percentage observed was 60.84%. Two strains reported as resistant by VITEK-2 COMPACT were misclassified as sensitive by disc diffusion, resulting in a very major error rate of 0.76%. A major error rate of 9.5% and a minor error rate of 27.7% were noted, as 25 strains reported as susceptible were identified as resistant.
Conclusion: Since poor agreement was observed, exceeding the acceptable performance rate, the disc diffusion method was unacceptable according to CLSI criteria. There is a gap in uniformity and a lack of streamlined, harmonized TST, which might become an alarming cause for concern.

Estimation of sensitivity and specificity of antinuclear antibody by automated indirect immunofluorescence and enzyme-linked immunoassay

Mohammadreza Sheikh Sajjadieh

Background: Immunofluorescence and serology analysis are the most common laboratory methods for diagnosing antinuclear antibodies in autoimmune diseases and are paramount for screening and therapeutic purposes. This study aims to estimate the sensitivity and specificity of antinuclear antibodies measured by automated indirect immunofluorescence and enzyme-linked immunoassay in patients at risk for autoimmune diseases.
Methods: Serum antinuclear antibodies in 3020 patients suspected of autoimmune diseases at Nobel Medical Laboratory, Esfahan, IRAN, were measured from 2017 until 2020 with automated indirect immunofluorescence and enzyme-linked immune assay methods. The sensitivity, specificity, prevalence, positive and negative predictive value, and likelihood ratio were calculated for each technique. In addition, the receiver operating characteristic curve (ROC) was analysed as a statistical method for assessing the diagnostic accuracy of these tests.
Results: The immunofluorescence method demonstrated low sensitivity and high specificity compared with the enzyme-linked immunoassay. For the automated indirect immunofluorescence method, sensitivity and specificity were 88% and 62%, respectively, whereas this number for the ELISA method was determined as 89.6% and 28.5 %, respectively.
Conclusion: It is crucial to choose a suitable method for detecting autoantibodies for diagnostic purposes. ANA analysis by a sensitive test, such as an enzyme-linked immunoassay, should be used for screening. In contrast, a highly specific test, such as an indirect immunofluorescence assay, should be used to confirm the result and monitor dynamic treatment.

Biofilm-forming ability and Agr-specific group of methicillin-resistant Staphylococcus aureus in Northern Iran

Leila Asadpour

Background: Staphylococcus aureus is one of the most common agents of nosocomial infection worldwide. Methicillin-resistant and biofilm-associated infections of this bacterium have become a clinical concern in patients. This research aimed to identify biofilm-forming ability and accessory gene regulator (Agr) - specific group of clinical isolates of methicillin-resistant S. aureus (MRSA) in Northern Iran.
Methods: In 2021, a total of 200 clinical isolates were identified as S. aureus by biochemical tests. The disk diffusion method was used to examine the antibiotic resistance of isolates and the microplate method was applied to investigate the biofilm production capability. In addition, the PCR method was used to determine the frequency of biofilm-associated genes and Agr typing of MRSA isolates. P £ 0.05 was considered significant.
Results: Overall, 62.5% of isolates were methicillin-resistant and 75% were multiple antibiotic-resistant. Biofilm-forming ability was detected in 99 (79.2%) methicillin-resistant isolates in which icaA and icaD were found in 85% and 78% of biofilm-producing isolates, respectively. Type 1 of the Agr gene was the most common type among methicillin-resistant isolates. The frequency of biofilm-associated genes showed a significant association with MDR phenotype and the presence of Agr locus (P £ 0.05).
Conclusion: The present findings indicate a high frequency of biofilm and antibacterial resistance in methicillin-resistant S. aureus isolates in Guilan Province. These findings suggest reliable and rapid identification of biofilm-forming MRSA strains to prevent the spread of these bacteria.

Isolation of Pasteurella multocida and pan-drug-resistant bacteria causing nosocomial infection in a patient with multiple sclerosis: A Case Report and Literature Review

Mohammad Ranaei

Pasteurella species are one of the most common pathogenic bacteria in domestic animals, and they are seen more in people with weak immune systems. This research aims to investigate a case of a patient with multiple sclerosis from whose sputum Pasteurella multocida (P. multocida) was isolated. The patient was a 28-year-old man with multiple sclerosis who had persistent coughs due to food being stuck in his throat. The patient was a 28-year-old man with multiple sclerosis who had persistent coughs due to food being stuck in his throat. The primary diagnosis was pneumonia hydropneumothorax and complete collapse of the left lung. The patient's sputum culture after the first visit to the hospital was positive for P. multocida, which was not found in a second culture. In the subsequent cultures of the patient, Acinetobacter, Klebsiella, Pseudomonas aeruginosa (P. aeruginosa), and Citrobacter were found, which had extensive drug resistance to all antibiotics. In the secondary computerized tomography (CT) scan, mild pleural effusion on the left side, pneumothorax, and complete collapse with bronchiectasis was seen. Despite the treatments, the patient finally died of cardiac arrest and bradycardia. Infection with P. multocida was found in a patient with multiple sclerosis. Also, hospital-acquired infections with drug resistance caused by the weakness of the patient's system appeared in the patient who was hospitalized in the intensive care unit (ICU), and finally, the patient died. According to antibiotic patterns, the best antibiotic to which the bacteria is sensitive can be considered the primary treatment to avoid irrational antibiotic prescriptions.

The effects of swimming, cell therapy, and laser therapy on the expression of dynamin-related protein 1, muscle-specific ring finger protein 1, and mitofusin 2 genes in the testes of azoospermic rats

Habib Asgharpour

Background: One of the causes of infertility is azoospermia. The present study aimed to investigate the effects of swimming exercise, cell therapy, and laser therapy on the expression of genes involved in mitochondrial dynamics in the testicular tissue of azoospermic rats.
Methods: In this experimental study, 40 rats (6-8-weeks old) were randomly assigned to 8 groups: 1) Healthy control, 2) patient, 3) sham, 4) laser, 5) exercise, 6) cell, 7) cell + laser, and 8) cell + exercise. The azoospermia model was induced using busulfan at a dose of 40 mg. Stem cells were transplanted once into the vas deferens at a concentration of 1000000 cells per rat. One week after cell transplantation, laser therapy was applied in three repetitions throughout the study period, with an interval of once a week, and after wound healing, the rats swam for 30 minutes a day, 5 days a week, for 8 weeks. To investigate the expression of the studied genes, tissue analysis was performed by the real-time polymerase chain reaction (RT-PCR) technique.
Results: Azoospermia significantly reduced the expression of mitofusin 2 (Mfn2) and significantly increased the expression of dynamin-related protein 1 (Drp1) and muscle-specific RING finger protein 1 (Murf1) in testicular tissue. The use of interventional methods increased the expression of Mfn2, and significantly reduced the expression of Murf1.
Conclusion: Based on the findings, the best changes were observed in the exercise + laser group. Therefore, it can be said that in rats using the azoospermia model, the simultaneous use of regular exercise interventions and laser therapy is the most effective.