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Introduction: We previously reported sex differences in the distribution of glycated haemoglobin (HbA1c) for men/women aged < 50 years vs older individuals, with implications for delayed diabetes diagnosis. Here, we explored whether this pattern was also seen in matched fasting plasma glucose (FPG) levels. Methods: We extracted data on same-day, paired HbA1c and FPG levels from clinical biochemistry laboratory databases from Mersey and West Lancashire Teaching Hospitals NHS Trust (n = 10,153) and Cambridge University Hospitals NHS Foundation Trust (n = 10,022) between Jan 2019 and Dec 2023. Only cases with a single, general-practice HbA1c test were utilised to minimise the risk of including non-diagnostic tests and tests from specialist care (e.g. endocrinology, antenatal services; final dataset: n = 17,271). We examined the links of HbA1c and FPG levels to age and sex. Results: Median HbA1c levels were 1 mmol/mol lower in women aged < 45 years compared to men aged < 45 years but not in those aged ≥ 45 years. This pattern was not seen with FPG, where median levels in women were 0.1–0.2 mmol/L lower across all ages. The HbA1c:FPG ratio was significantly higher in women than men in the 45–54 and ≥ 55 years age groups (p = 0.004, Z-score = 2.9 and p = < 0.001, Z-score = 8.9, respectively) but not in the < 45 years age group (p = 0.649, Z-score = 0.5). We confirmed our previous finding that median HbA1c levels in women aged ≥ 55 years and 45–55 years were the same as those in men (39 and 37 mmol/mol, respectively) and that for women aged < 45 years, the median HbA1c (34 mmol/mol) was 1 mol/mol lower than for men (35 mmol/mol). This is reflected in the Z-scores, which showed the largest deviation from zero in the < 45 years age group (− 9.1) and the smallest in the older age group (− 2.9). Conclusion: We showed differences in HbA1c and FPG patterns with age between men and women, with implications for the diabetes diagnostic threshold for HbA1c in pre-menopausal women, the underdiagnosis of type 2 diabetes in younger women, and missed opportunities for intervention. We propose that a suggested change to HbA1c reference ranges in this group warrants serious consideration and detailed evaluation. [ABSTRACT FROM AUTHOR]

Duchenne muscular dystrophy (DMD) is a severe neuromuscular disease due to loss of dystrophin, leading to progressive muscle wasting and physical inactivity. In this pilot study, we studied the effect of daily supplementation of the anabolic substrate beta-hydroxy-beta-methylbutyrate (HMB) on whole body protein and amino acid kinetics using novel isotope methods and daily activity in a canine model of DMD. Six DMD dogs were administered 3 g daily of HMB or placebo for 28 days according to a randomized, placebo-controlled, double-blinded crossover design. We measured pre- and post-intervention daily activity, biochemistry markers, and whole-body amino acid kinetics. We tracked daily activity with an activity monitoring device and measured plasma creatine kinase and standard clinical biochemistry panels to monitor muscle and organ function. To calculate whole body and intracellular amino acid production, we administered in the postabsorptive state an IV stable isotope solution containing 20 amino acid tracers. We collected blood before and six times after until two hours post tracer pulse administration and measured amino acid enrichments and concentrations by LC–MS/MS, subsequently followed by (non) compartmental modeling of the decay enrichment curves. Results were expressed as mean with 95% CI. Whole body production, plasma concentrations, and intra-/extracellular compartmental analyses of various amino acids were attenuated in HMB-dosed DMD dogs. Specifically, the plasma concentration of hydroxyproline (marker of collagen breakdown) was significantly higher in the placebo group compared to the HMB group. The intra- and extracellular pool sizes and flux between the two compartments of hydroxyproline was reduced in HMB treated dogs. DMD dogs treated with HMB as compared to placebo had a respective 40% increase in exertional (play) (951 [827, 1075] versus 569 [491, 647]; p < 0.0001) and 10.5% increase in non-exertional (active) activity (15,366 [14742, 15990] versus 13,806 [13148,14466]; p = 0.0016). In addition, a 6% reduction was found in rest time after HMB supplementation compared to placebo (23,857 [23,130, 24,584], versus 25,363 [24500, 26225]; p = 0.0122). Creatine kinase was not statistically different between groups. We did not observe any adverse clinical or biochemical-related effects of HMB dosing. Daily HMB supplementation in DMD dogs can safely and positively influence protein and amino acid metabolism and improve overall daily activity. [ABSTRACT FROM AUTHOR]

Background: Sepsis and shock are common complications of necrotising soft tissue infections (NSTI). Sepsis encompasses different endotypes that are associated with specific immune responses. Hyperbaric oxygen (HBO2) treatment activates the cells oxygen sensing mechanisms that are interlinked with inflammatory pathways. We aimed to identify gene expression patterns associated with effects of HBO2 treatment in patients with sepsis caused by NSTI, and to explore sepsis-NSTI profiles that are more receptive to HBO2 treatment. Methods: An observational cohort study examining 83 NSTI patients treated with HBO2 in the acute phase of NSTI, fourteen of whom had received two sessions of HBO2 (HBOx2 group), and another ten patients (non-HBO group) who had not been exposed to HBO2. Whole blood RNA sequencing and clinical data were collected at baseline and after the intervention, and at equivalent time points in the non-HBO group. Gene expression profiles were analysed using machine learning techniques to identify sepsis endotypes, treatment response endotypes and clinically relevant transcriptomic signatures of response to treatment. Results: We identified differences in gene expression profiles at follow-up between HBO2-treated patients and patients not treated with HBO2. Moreover, we identified two patient endotypes before and after treatment that represented an immuno-suppressive and an immune-adaptive endotype respectively, and we characterized the genetic profile of the patients that transition from the immuno-suppressive to the immune-adaptive endotype after treatment. We discovered one gene MTCO2P12 that distinguished individuals who altered their endotype in response to treatment from non-responders. Conclusion: The global gene expression pattern in blood changed in response to HBO2 treatment in a direction associated with clinical biochemistry improvement, and the study provides potential novel biomarkers and pathways for monitoring HBO2 treatment effects and predicting an HBO2 responsive NSTI-sepsis profile. Trial registration: Biological material was collected during the INFECT study, registered at ClinicalTrials.gov (NCT01790698) 04/02/2013. [ABSTRACT FROM AUTHOR]

The first part of this Inter-Society Document describes the mechanisms involved in the development of cardiovascular diseases, particularly arterial hypertension, in adults and the elderly. It will also examine how consistent physical exercise during adolescence and adulthood can help maintain blood pressure levels and prevent progression to symptomatic heart failure. The discussion will include experimental and clinical evidence on the use of specific exercise programs for preventing and controlling cardiovascular diseases in adults and the elderly. In the second part, the clinical relevance of cardiac-specific biomarkers in assessing cardiovascular risk in the general adult population will be examined, with a focus on individuals engaged in sports activities. This section will review recent studies that suggest a significant role of biomarkers in assessing cardiovascular risk, particularly the presence of cardiac damage, in athletes who participate in high-intensity sports. Finally, the document will discuss the potential of using cardiac-specific biomarkers to monitor the effectiveness of personalized physical activity programs (Adapted Physical Activity, APA). These programs are prescribed for specific situations, such as chronic diseases or physical disabilities, including cardiovascular diseases. The purposes of this Inter-Society Document are the following: 1) to discuss the close pathophysiological relationship between physical activity levels (ranging from sedentary behavior to competitive sports), age categories (from adolescence to elderly age), and the development of cardiovascular diseases; 2) to review in detail the experimental and clinical evidences supporting the role of cardiac biomarkers in identifying athletes and individuals of general population at higher cardiovascular risk; 3) to stimulate scientific societies and organizations to develop specific multicenter studies that may take into account the role of cardiac biomarkers in subjects who follow specific exercise programs in order to monitor their cardiovascular risk. [ABSTRACT FROM AUTHOR]

Background: The aim of this study was to determine the reference intervals of 14 clinical biochemistry tests in healthy individuals aged 18 - 65 years. The reference intervals determined by using direct and indirect methods were compared with each other and the manufacturer's RI in terms of gender. Methods: Blood was collected from 302 reference subjects selected on the basis of admission and exclusion criteria based on the procedures set out in document C28-A3, and 14 clinical chemistry tests were performed using the analytical systems available in our laboratory. The analyses were conducted using the MedCalc and SPSS20 programs in the direct method and the Bellview (1.2.6 Version) program in the indirect method, according to the Bhattacharya procedure. Results: Nine biochemical tests showed statistically significant differences according to gender (p < 0.05). These tests include alkaline phosphatase, lactate dehydrogenase, high-density cholesterol, low-density cholesterol, urea, uric acid, triglycerides, total cholesterol, and inorganic phosphate. Conclusions: The direct method was the first method used to obtain the reference intervals. The indirect method can be used as an alternative to the direct method for AMLY and UA tests for the general population. According to the manufacturer's RI, lower and upper limits of HDL, LDL, Ca, and Mg were compatible with indirect RI in two genders. Lower and upper limits of ALP, LDH, and ALB were compatible with manufacturer's RI in female. [ABSTRACT FROM AUTHOR]

This study aims to evaluate the knowledge, attitudes, and behaviors of medical biochemistry professionals in Türkiye regarding green and sustainable medical laboratory (GSML) practices. It also seeks to identify the most common and challenging barriers to adopting GSML practices.A cross-sectional survey was conducted among 130 medical biochemistry professionals, including academicians, specialists, and residents, across various hospital types in Türkiye. The survey, distributed via Google Forms, consisted of 29 questions divided into five sections covering participant characteristics, knowledge about GSML, individual attitudes, laboratory practices, and awareness of EFLM guidelines. Data were analyzed using Excel and SPSS.The survey revealed that only 10.8 % of participants received education on sustainability during their specialty training. Despite this, 76.2 % had heard of the concept of sustainability, although 74.6 % were unaware of green chemistry principles. Individual environmental practices were generally positive, with 96 % of participants turning off lights and equipment when not in use. However, significant gaps were found in laboratory GSML practices, particularly in energy (only 44 % of laboratories regularly defrost refrigerators and freezers) and water management (only 40.8 % perform regular maintenance). The most common barriers to GSML implementation were identified as education and awareness (46.2 %), sustainability (24.6 %), cost (15.4 %), motivation (8.5 %), and communication (2.3 %).There is a critical need for enhanced education and awareness of GSML practices. While individual environmental behaviors are positive, systemic changes in laboratory practices are necessary. Addressing the identified barriers, particularly through targeted educational initiatives, is essential for promoting sustainable practices in medical laboratories. [ABSTRACT FROM AUTHOR]

Introduction: Pre-analytical phase of laboratory testing is the most susceptible phase, as errors in this phase leads to more than 50% of erroneous results and often breaches the trust of the stakeholders on the quality of the laboratory results. Many pre-analytical errors occur during the pre-analytical phase, encompassing sample collection, labelling and transportation-factors often beyond the laboratory's direct control. Aim: To determine the type and frequency of pre-analytical errors leading to sample rejection in clinical biochemistry laboratory. Materials and Methods: Being a retrospective descriptive study, convenient sampling was used to analyse sample rejection due to pre-analytical errors in clinical biochemistry laboratory of a tertiary care teaching hospital- PSG Institute of Medical Sciences and Research, Coimbatore, Tamil Nadu, India for a period of six months from May 2023 to October 2023. All the cases/blood samples from Outpatient Department (OPD) and Inpatient Department (IPD), received and rejected during this period were included under study. The data collection and analysis was done over a period of five months using the sample rejection and resample description from Laboratory Information System (LIS). Using Statistical Package for the Social Sciences (SPSS) version 28.0, data were summarised using descriptive statistics such as numbers and percentages. Results: During the six months period out of the total of 667454 samples, 1505 (0.23%) samples were rejected due to pre-analytical errors. The majority of the samples which were rejected were from IPD than OPD. Among the pre-analytical errors, haemolysis accounted for 806 (53.6%), clotted samples 256 (17%), delta check 217 (14.4%), insufficient sample 129 (8.6%), contamination 74 (4.9%), identification error 14 (0.9%), sample without request form 3 (0.2%) while missing samples, billing error, inappropriate tube, delay in transport and wrong test selection accounted for <3 (0.1%). Conclusion: Haemolysis and clotted samples were the most common pre-analytical causes for sample rejection in the laboratory. The samples from IPD were rejected more often than OPD due to incorrect phlebotomy techniques. This accentuates the need for proper hands-on phlebotomy training sessions for novice nurses following their recruitment, as their competency will be instrumental in bringing down the errors in pre-analytical phase. [ABSTRACT FROM AUTHOR]

OBJECTIVE: To measure and model concentrations of the analgesic L-carvone, a natural component of spearmint, over time when administered IM to sheep and to characterize L-carvone's effects on CBCs and clinical biochemistry panels. METHODS: L-carvone formulated as a 50% solution (v/v) in ethanol and propylene glycol was administered at 71.6 mg/kg IM, split between each semitendinosus muscle in 6 sheep. Venous blood was sampled over 24 hours, and plasma was separated by centrifugation. Additional blood was collected for CBC and serum biochemical analysis, and tissues were sampled after euthanasia. L-carvone concentrations in plasma and tissue homogenates were measured using HPLC-MS-MS. Plasma pharmacokinetic data were described using a nonlinear mixed effects model. Complete blood count and biochemistry data were compared to baseline values using repeated-measures ANOVA and Holm-Šidák tests (P < .05). RESULTS: Maximum plasma concentrations ranged from 0.28 to 1.93 µg/mL and occurred within 9 to 15 minutes after injection. Pharmacokinetics were best described using 2 compartments. Elimination half-life was 33.7 minutes and 390.2 minutes in the central and peripheral compartments, respectively. Mild increases in neutrophil count and significant increases in creatinine kinase and aspartate aminotransferase were associated with injection site myonecrosis. No physical examination, behavioral, or other clinically significant laboratory changes were noted. CONCLUSIONS: Intramuscular L-carvone exhibits rapid time to peak concentration, relatively slow plasma elimination, and low tissue concentrations after 24 hours. CLINICAL RELEVANCE: L-carvone exhibits a favorable pharmacokinetic profile for an analgesic drug. A new L-carvone formulation or administration route is needed to reduce inflammation and necrosis at the injection site. [ABSTRACT FROM AUTHOR]

A catalogue of toxicity endpoints was developed for a consistent collection of toxicological information. The toxicity endpoints of relevance for cumulative risk assessment were organised in a table for each target organ/tissue/system (cumulative assessment group (CAG) at level 1) including information on specific toxicological effect(s) (CAG at level 2), indicators that reflect the relevance for the CAG at level 2, and descriptions/interpretations that allow an understanding of the CAG at level 2. A data model for the collection of toxicity endpoints was developed to ensure the possibility of integration of the collected data to the EFSA OpenFoodTox database, in order to extend it to non‐critical endpoints. The collection of toxicity endpoints and grouping of active substances were performed for a total of 328 active substances and 165 of their metabolites. The data model was filled in for all the OpenFoodTox columns as far as possible and essential information which could not be entered in the OpenFoodTox columns were noted in the 'Remark column'. In total, 29 CAGs at level 1 have been evaluated for inclusion of specific toxicological effects (CAGs at level 2), whereas four CAG1 targets (gastrointestinal tract, immune system, lungs and skin) were not evaluated as the effects observed in these CAG1 targets were not considered relevant for CAGs at level 2. A number of toxicological effects considered adverse and of relevance for human risk assessment, but generally not relevant for CAGs at level 2, include mortality, clinical signs of toxicity, changes in bodyweight and body weight gain, changes in food consumption and water consumption, changes in clinical biochemistry and urinalysis parameters and changes in organ weights without histopathological changes. © National Food Institute, Technical University of Denmark, 2024 [ABSTRACT FROM AUTHOR]

Background: Cystatin C has been associated with Coronary Artery Disease (CAD) even within normal ranges of Estimated glomerular filtration rate (eGFR) suggesting existence of GFR independent cystatin C mediated cardiovascular disease (CVD) risk. This study aimed to assess the relation between the biomarker and CV diseases. Methods: This is Case Control study which was conducted on 88 cases at departments of Medical Biochemistry and cardiac cath lab, Faculty of Medicine, Zagazig. Subjects enrolled in the study were divides into 2 groups: Group (I) included patients with CAD while Group (II) included healthy people with normal coronary artery. Every patient had a complete medical history taken, a routine clinical examination, laboratory testing, electrocardiography, coronary angiography and cystatin C assessment. Results: Compared to the control group, the cases group's serum cystatin C median levels increased in a statistically significant way. A statistically significant positive connection was seen between the Gensini score and the levels of TC, LDL, serum Cys-C and a positive significant correlation between serum Cys-C levels and both LDL and fasting blood glucose. ROC curve analysis was done during our study to show the values of cystatin C as a possible biomarker in CHD at (cut off =0.769), which had a sensitivity of 81.8% and a specificity of 69.1%, predictive values for positive (PVP) and negative (PVN) are 72%, 79%, and 75%, respectively, of accuracy. Conclusion: We concluded that high level of cystatin C is considered as an additional risk factor of coronary artery disease. [ABSTRACT FROM AUTHOR]

One of the most used chemotherapy agents in clinical practice is 5-Fluorouracil (5-FU), a fluorinated pyrimidine in the category of antimetabolite agents. 5-FU is used to treat a variety of cancers, including colon, breast, pancreatic, and stomach cancers, and its efficacy lies in its direct impact on the patient's DNA and RNA. Specifically, its mechanism blocks the enzymes thymidylate synthetase and uracil phosphatase, inhibiting the synthesis of uracil, which cannot be incorporated into nuclear and cytoplasmic RNA. Despite being one of the most used drugs in oncology, it is associated with several significant side effects, including inflammation of the mouth, loss of appetite, and reduction in blood cells. In our study, we examined the reduction of side effects in a 5-FU regimen administered at doses of 15 mg/kg and 6 mg/kg for 14 days in 6-week-old male Sprague-Dawley rats. On the 14th day, the rats were treated orally for 2 weeks with 100 mg/kg of Ulva pertusa, a well-known seaweed from the Ulvaceae family, which has demonstrated powerful biological properties. The administration of this green alga alleviated the side effects of 5-FU, improving several parameters including body weight, food intake, and diarrhea index. It also helped reduce side effects in the blood, kidneys, and liver. Histological and molecular analyses were conducted on serum and colon tissues from the rats, examining changes in colon structure and the release of oxidative stress markers such as iNOS, COX-2, and nitrotyrosine. Several biochemical indicators, including SOD, CAT, GSH, MDA, and ascorbic acid, were also evaluated. Overall, our data indicated Ulva pertusa to be a promising therapeutic against 5-FU's adverse effects, therefore, it could be worthwhile to investigate the possibility of using this alga in safer cancer treatment formulations. Certainly, future preclinical and clinical studies could assess the alga's efficacy in diverse cancer treatment regimens, exploring its role as an adjuvant therapy that may reduce chemotherapy-related toxicity without compromising therapeutic outcomes. [ABSTRACT FROM AUTHOR]

Objective: Design, synthesis, characterization, and in silico studies of novel nitrobenzene thiazolyl hydrazones (VIa–VIh) and inhibitory action against the EGFR. Methods: All synthesized compounds were evaluated for their anticancer activity against selected cancer cell lines in vitro utilizing 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide MTT assay and EGFR enzymatic assay. Target molecule features were investigated through a computational study that included drug-likeness, ADMET profiling, and molecular docking. Results and Discussion: The compounds (IVb), (IVe), and (IVh) showed prominent anticancer activity with an IC50 value of 15.45, 18.23, 10.69 μM, and 12.75, 16.05, 11.95 μM against chosen cancer cell lines A549, and MCF-7 respectively. Additionally, in vitro EGFR enzymatic activity provided insight into the process of anticancer action of the majority of the active molecules. According to a molecular docking study, every molecule binds to EGFR (PDB ID: 5D41) with high affinities. Conclusions: Among all, derivatives (IVb), (IVe), and (IVh) showed moderate inhibition compared to different tested derivatives. Thus, the present study of all novel nitrobenzene thiazolyl hydrazones could be further optimized to develop new EGFR inhibitors. [ABSTRACT FROM AUTHOR]

Purpose: The traditional method of oral examination, though a good tool for assessing the depth and breadth of student's knowledge, has its shortcomings. A variable number of questions with variable difficulty levels by different examiners with different expectations can introduce bias in scores. The process aspect of oral examinations of first-year undergraduate medical students was improved by structuring them and by creating uniformity in the number, time, and difficulty level of questions for assessment, and feedback was taken regarding its acceptance as an improved tool of assessment. Methods: After finalizing the topics, questions from a viva viewpoint were structured and categorized into three difficulty levels covering all aspects of chosen topics validated by subject experts. The number of questions asked per difficulty level, time, and marks given to each question was pre-decided. After briefing the students, the structured viva was conducted, and feedback was taken from students and examiners. Results: The majority (87%) of first-year undergraduate students undertook the structured viva and filled in the feedback form. Nearly all students felt that the structured oral examination was a fair and unbiased assessment tool with less subjectivity compared to traditional viva. Most students (83.9%) felt that the topics were comprehensively covered, and 96.4% of students felt less stressed. Among examiners, there was 100% agreement on the uniformity of questions asked, topics covered, less subjectivity, and no carryover effect. Conclusion: The examiners have accepted it as one of the formative assessment tools for future batches of students and are ready to explore its utility as a summative assessment tool. [ABSTRACT FROM AUTHOR]

Miranda’s donkey is an autochthonous asinine breed from northern Portugal classified as endangered by the Food and Agriculture Organization. Research on Miranda’s donkey in several scientific areas is important to standardize the breed and to assist the breed’s preservation. Reference values in clinical pathology are used to determine the health status of individuals and herds, and to control the evolution of diseases and their response to therapy. This review summarized the studies performed on Miranda’s donkey and evaluated the state of the art concerning studies performed in the clinical pathology field. Thirty-seven publications on Miranda’s donkey published between 2000-2023 in various scientific areas were found. In conclusion, research on Miranda’s donkey is scarce, and further studies are needed, especially in hematology and clinical biochemistry areas with respect to physiological and pathological changes that affect the breed, thus helping its conservation. [ABSTRACT FROM AUTHOR]

Background: Sigma methodology is a statistical calculation and quality management tool that provides information about process performance. If clinical laboratories start using sigma metrics to monitor their performance, they can more easily identify gaps in their performance, thereby improve their performance and patient safety. This study aimed to calculate sigma metrics and quality target index values by using internal quality control data from coagulation tests, thus evaluating the analytical performance. Methods: Sigma levels were calculated using the formula: [total allowable error (TEa) - bias]/coefficient of variation (CV). Sigma values ≥ 6, between 3 and 6, and < 3 were classified as "world-class", "good" or "unacceptable", respectively. A biological variation database (BVD) was used for TEa. The quality goal index (QGI) is the reason behind a low sigma value, that is, lower precision, lower accuracy, or both due to the combination. QGI was calculated using the formula QGI = bias/1.5 x % CV. With a QGI value of < 0.8, the measurement indicates that the accuracy of the procedure needs to be improved; QGI values > 1.2 indicate accuracy needs to be improved and values 0.8 ≤ QGI ≤ 1.2 indicate both precision and accuracy need to be improved. Results: Sigma and QGI of three-monthly two-level internal quality control values were calculated by using the laboratory automation system. In the prothrombin time (PT) and activated partial thromboplastin time (APTT) tests of the coagulation parameters studied, sigma values were found to be < 3 in both levels. When the QGI value was calculated, it was PT 0.45 and APTT 0.90 for level 1 and PT 0.16 and APTT 0.6 for level 2, respectively. Conclusions: It was decided that sigma values of coagulation parameters at "low quality" levels and improvement studies should be carried out for coagulation parameters in our laboratory. By evaluating sigma levels, it is possible to identify tests with a high probability of failure, and these tests should undergo strict quality control inspections. In clinical biochemistry laboratories, appropriate quality control planning should be performed for each test by using the Six Sigma methodology and by calculating the quality target index. [ABSTRACT FROM AUTHOR]

Background: Remedial teaching is a tailored educational approach dedicated to enhancing the academic performance of students facing challenges within the curriculum. By identifying and addressing specific learning difficulties, it provides essential support and guidance to bring students closer to expected standards while preventing future setbacks. We hypothesize that underperforming medical students who receive daily, tailored remediation will demonstrate significant improvement in their formative and summative assessment scores in biochemistry. Methods: A cross-sectional mixed-method study was conducted on 56 underperforming first-year medical undergraduates to assess the effect of targeted remediation on formative and summative assessments in Biochemistry. Training sessions included various remediation techniques over six months. Post-remediation feedback was collected to gather insights into students' attitudes, perceptions, and the effectiveness of the methods in improving their understanding of the subject. Logistic regression analysis was employed to determine the most effective remediation for student performance. Benefits and weaknesses of remedial training approaches for future application as perceived by the students were derived through deductive thematic analysis of their feedback. Results: The mean marks, evaluated out of a maximum of 100, showed improvement from 29.86 ± 7.71 to 71.48 ± 10.19, with statistical significance (p < 0.001). From the students' perspective, the most effective remediation method was grade incentives in formative assessments (odds ratio 6.19). Five major themes were identified: perceived barriers prior to remediation, positive outcomes and behavioral changes observed after remediation, and strengths and areas for improvement in remediation. Conclusions: The study concludes that identifying underperformers in the early stages of the medical curriculum and providing them with tailored remediation can enhance their performance in exams. Grade incentives in formative assessments, mind maps, quizzes, quick revisions, and assignments were beneficial remedial tools. Targeted remediation proved advantageous for students in improving their academic skills, exam preparation, time management, and attitudes towards the subject. [ABSTRACT FROM AUTHOR]

Monoclonal gammopathy has been reported to interfere with several laboratory measurement results. We investigated potential interference in monoclonal gammopathy on immunoglobulin A (IgA), immunoglobulin G (IgG), and immunoglobulin M (IgM) concentrations using three different routine chemistry instruments: Alinity (Abbott Laboratories), Cobas 8000 (Roche Diagnostics) and Optilite (Binding Site) at the Department of Clinical Biochemistry, Aalborg University Hospital, Denmark. Blood samples collected from 216 patients with known monoclonal gammopathy were analyzed on Alinity, Cobas and Optilite. Diagnoses were ascertained from clinical records. Scatter plots with Passing-Bablok regression were used to investigate associations between concentrations of IgA, IgG and IgM measured with each of the different instruments. Furthermore, comparison of IgG analyses on Alinity, Optilite and Cobas according to monoclonal IgM concentration was explored with Bland-Altman plots. A total of 81 patients were identified with IgM type monoclonal gammopathy and 8 of these patients (10%) had analytical interference as reflected by more than 25% decrease in the level of IgG measured on Alinity as compared to Optilite and Cobas. All blood samples with interference on IgG measurement using Alinity were from patients with lymphoplasmacytic lymphoma/Waldenströms macroglobulinemia and all of them had monoclonal IgM concentrations above 10 g/L. This study identified a source of interference from IgM monoclonal gammopathy on IgG measurement performed using Alinity. The interferences caused falsely low results of IgG which is important to recognize to ensure proper patient management. [ABSTRACT FROM AUTHOR]

Background: Predicting mortality in emergency departments (EDs) using machine learning models presents challenges, particularly in balancing simplicity with performance. This study aims to develop models that are both simple and effective for predicting short- and long-term mortality in ED patients. Our approach uses a minimal set of variables derived from one single blood sample obtained at admission. Methods: Data from three cohorts at two large Danish university hospitals were analyzed, including one retrospective and two prospective cohorts where prognostic models were applied to predict individual mortality risk, spanning the years 2013–2022. Routine biochemistry analyzed in blood samples collected at admission was the primary data source for the prediction models. The outcomes were mortality at 10, 30, 90, and 365 days after admission to the ED. The models were developed using Light Gradient Boosting Machines. The evaluation of mortality predictions involved metrics such as Area Under the Receiver Operating Characteristic Curve (AUC), sensitivity, specificity, negative predictive values, positive predictive values, and Matthews correlation coefficient (MCC). Results: A total of 43,648 unique patients with 65,484 admissions were analyzed. The models showed high accuracy, with very good to excellent AUC values between 0.87 and 0.93 across different time intervals. Conclusions: This study demonstrates that a single assessment of routine clinical biochemistry upon admission can serve as a powerful predictor for both short-term and long-term mortality in ED admissions. [ABSTRACT FROM AUTHOR]

Background: Inter‐assay variation between different immunoassays and different mass spectrometry methods hampers the biochemical confirmation of male hypogonadism. Furthermore, some laboratories utilise assay manufacturer reference ranges that do not necessarily mirror assay performance characteristics, with the lower limit of normality ranging from 4.9 nmol/L to 11 nmol/L. The quality of the normative data underlying commercial immunoassay reference ranges is uncertain. Design: A working group reviewed published evidence and agreed upon standardised reporting guidance to augment total testosterone reports. Results: Evidence‐based guidance on appropriate blood sampling, clinical action limits, and other major factors likely to affect the interpretation of results are provided. Conclusions: This article aims to improve the quality of the interpretation of testosterone results by non‐specialist clinicians. It also discusses approaches for assay harmonisation which have been successful in some but not all healthcare systems. [ABSTRACT FROM AUTHOR]

Objective: Acute or chronic exposure to excess iodine has detrimental effects on thyroid physiology; therefore, this study aimed to determine the prevalence of overt hypothyroidism (OH) and subclinical hypothyroidism (SCH) in an elderly population residing in geographical areas with chronic exposure to excess iodine intake and to analyse contributing risk factors. Design: This cross‐sectional study was conducted from 2016 to 2017 in areas of Jiangsu Province that have documented chronic exposure to high iodine intake. Patients: We enroled 2559 adult participants using a multistage, stratified sampling method. Measurements: Urinary iodine concentration (UIC), serum thyroid‐stimulating hormone (TSH) level and other relevant parameters were measured. Demographic information was recorded using a standardized questionnaire. The age‐specific TSH references were determined by the National Academy of Clinical Biochemistry guidelines. Univariate and multivariate logistic regression analyses were performed to identify risk factors for hypothyroidism in the study population. Results: The median UIC of participants was 307.3 µg/L (interquartile range: 200.7, 469.8 μg/L). The prevalence of OH in subjects ≥70 years using laboratory reference ranges was 2.37%; however, it decreased to 1.78% with the use of an age‐specific reference range. Similarly, the prevalence of SCH also declined drastically from 29.59% to 2.96% with the application of an age‐specific reference range. In both univariate and multivariate models, advanced age, female gender and high UIC were identified as risk factors for hypothyroidism. Conclusions: Usage of age‐specific TSH reference ranges led to a significantly lower prevalence of OH and SCH in the study population, thus preventing unnecessary over‐diagnosis and over‐treatment. [ABSTRACT FROM AUTHOR]

A convenient and effective synthesis of imidazo[1,2-a]pyrimidine derivatives has been developed under microwave irradiations using Al2O3 as a catalyst in solvent-free conditions. The functionalized imidazo[1,2-a]pyrimidine derivatives are useful in biochemistry and medical science. In our investigation, the antimicrobial activity of the synthesized compounds was evaluated against 13 microorganisms, including 6 Gram-positive bacteria, 4 Gram-negative bacteria, and 3 pathogenic fungi. Bioactivity tests revealed that the majority of the compounds exhibited good antimicrobial activity. Finally, molecular docking simulations and ADME-T predictions were performed, showing that the most active compounds have good binding modes with microbial targets and promising pharmacokinetic safety profiles. [ABSTRACT FROM AUTHOR]

Gamification is emerging as an active learning innovation in medical education to enhance student engagement and promote life‐long learning in a unique and collaborative environment. Clinical enzymology in biochemistry is one of the core topics in the medical curriculum. However, students face challenges in comprehension and retention of information. Hence, CARd & Board GAmes in Medical Education (CARBGAME) was introduced and evaluated for its effectiveness in enhancing learning, application, and retention of knowledge in clinical enzymology via gamification context. This mixed‐method study involved 150 first‐year undergraduate medical students. Before the game, students completed a pre‐test in clinical enzymology. Later they were divided into 25 small groups to compete in the board game designed for enzymology in biochemistry. The students took turns throwing the dice and answering the questions on the game board to continue moving forward. The first team to reach 100 and solve the case‐based question was deemed the winner. Following the board game, the students took up the post‐test to compare the educational impact of the innovation. Also, the subsequent internal assessment scores were compared with previous batch who were not implemented with this intervention. Then students evaluated the effectiveness of CARBGAME—Clinical Enzymology using a 32‐item questionnaire on 5‐point Likert scale. The feedback obtained on a 10‐point rating scale and for qualitative analysis, students' and faculty perceptions were recorded in small groups. CARBGAME received overwhelmingly positive feedback from both students and faculty. It was perceived well by students for being fun, relevant, consistent, motivating, collaborative, and promoting experiential learning. The game's low‐stakes approach, effective feedback, and sense of accomplishment were highly appreciated, making it a valuable tool for education. A significant improvement in knowledge was recorded, from a mean score of 8.37 ± 1.126 on a 20‐point scoring scale before the game to 16.53 ± 1.219 after with a p‐value of 0.0001. The comparison of the internal assessment scores between the intervention and non‐intervention group of students also showed a significant improvement among those implemented with CARBGAME (p < 0.0001). The CARBGAME innovation has achieved the intended outcome of promoting active learning and enhanced performance in clinical enzymology. Highly positive responses from faculty and students also indicate the exigent need to introduce innovative components like games into curricula to achieve student engagement and promote a meaningful learning experience. [ABSTRACT FROM AUTHOR]

Objective: This scoping review protocol describes the strategy for a scoping review that aims to provide a comprehensive overview of published guidelines for the prescription of standard laboratory tests performed in intensive care unit (ICU) patients. Background: The use of clinical laboratories is constantly increasing. However, there is evidence of inappropriate use. Inappropriate laboratory testing has the potential to harm patients, increase costs, burden staff, and has an environmental impact. Effective management can be achieved through demand managing strategies, such as providing guidelines on performing the appropriate test, for the right patient, at the right time. Although national and international guidelines exist for individual tests, a comprehensive summary of available recommendations for laboratory testing in the ICU is currently unavailable. Inclusion criteria: This scoping review will incorporate documents that provide explicit advice on which test to perform in ICU patients. We selected 34 tests routinely ordered in the ICU. This review will consider any document type that matches our concept and context. We will consider gray literature with appropriate adherence to guidelines methodology. We will not limit the review by geographical location, but will only include articles published in English. Search strategy: Our scoping review will follow the Joanna Brigg Institute (JBI) methodology. We will search Medline (PubMed), Embase, Scopus, Google Scholar, and Google. Our search strategy adheres to the JBI 3-step construction approach for systematic reviews. We will search for keywords related to guidelines, laboratory testing, and the 34 selected tests. We will report our study using the S1 Checklist. Review registration number: osf.io/yfs9z. [ABSTRACT FROM AUTHOR]

Summary To evaluate the relationship between serum gamma‐glutamyl transferase (GGT) levels and fatty pancreas in subjects with concurrent obesity, insulin resistance and metabolic dysfunction‐associated steatotic liver disease (MASLD) without a history of pancreatitis. From March 2019 to September 2021, 31 adult subjects with concurrent obesity and MASLD were recruited as part of the study investigating the biological impact of bariatric surgery and lifestyle modification on obesity. Chemical shift encoded MRI of the abdomen, LiverMultiScan, anthropometric, clinical and blood biochemistry analyses were performed prior to any intervention at baseline. GGT (p <.001) was significantly different between those ‘with fatty pancreas’ and ‘without fatty pancreas’ groups. GGT (p <.001) was significantly different between those ‘with both metabolic syndrome and fatty pancreas’ and those ‘with metabolic syndrome but without fatty pancreas.’ GGT (p <.001) was also significantly different between those ‘with both diabetes and fatty pancreas’ and those ‘with diabetes but without fatty pancreas’. Logistic regression analysis showed that abnormal GGT levels (p = .010) and Hypertension (p = .045) were significant independent predictors of fatty pancreas. GGT was associated with fatty pancreas by an odds ratio 7.333 (95% [CI]: 1.467–36.664), while the AUROC of GGT in determining fatty pancreas was 0.849. Elevation in serum GGT might be a potential marker to identify fatty pancreas. [ABSTRACT FROM AUTHOR]

Background: Delivering feedback to students who have just joined a new course is relevant for it may help them to understand their subject better and hence enhance their performance. Aim: The present study aimed to provide feedback to students using two different techniques: the sandwich method and the Ask-Tell-Ask method. It also evaluated students' perceptions of the feedback and assessed the quality of the feedback provided. Materials and Methods: The present study was a prospective randomized study conducted in the department of biochemistry with 1st-year MBBS students from August 2022 to November 2022. Students were divided into two groups based on their midterm marks: 58 students who scored more than 50% received collective feedback, while 41 students who scored <50% received feedback individually. Results: The difference in midterm marks obtained by students of the group which was provided feedback individually compared to the other group which received collective feedback was statistically significant (P ˂ 0.000). After applying the intervention, the mean marks obtained by the group who received the individual feedback increased by 12.35 ± 17.57. This lead to a decreased difference in the mean marks between both the groups although it still remained statistically significant (P = 0.0004). However, no statistical difference has been observed in the mean increment of marks based on which faculty provided the feedback as determined by the one-way analysis of variance (P = 0.8). The perceptions of students regarding the provided feedback and the quality of the feedback taken with the help of two different questionnaires revealed that 75.5% of students felt that the feedback provided was relevant and related to the topic. The feedback was provided within 2 weeks (75.3%) of conducting the test. About 75.6% of students felt that they got motivated for working hard. About 65.9% of students feel that providing feedback should be made a norm in the institute. Conclusions: The study found that providing individual feedback increased the mean marks of students with no statistical difference in the mean increment of marks based on which faculty member provided the feedback. The students perceived the feedback as relevant, timely (provided within 2 weeks of the test), and related to their performance. They felt that the culture of delivering feedback should be made an institutional norm. [ABSTRACT FROM AUTHOR]

The analytical phase of sample processing contributes to total turnaround time (TAT) in a clinical biochemistry laboratory. Integrated systems combine photometry-based chemical assays with enhanced chemiluminescence-based immunoassays on one platform. This study aimed to decrease TAT by introducing samples separately (for photometry-based chemical tests and chemiluminescence-based immunoassays) in the analyzer. On 3 consecutive days, 40 samples each were run on the integrated biochemistry analyzer by taking (a) a single sample for all tests and processing using the automation track, (b) separate samples each for photometry-based chemical tests and chemiluminescence-based immunoassays using the track, and (c) separate samples for each run without the use of automation track. The time taken in the analytical phase was recorded for all. Data were presented as mean and standard deviation. For comparison, a one-way analysis of variance (ANOVA) followed by Tukey's Honest Significant Difference (HSD) post hoc test was used. P < 0.05 was considered significant. The average time in the analytical phase for photometry-based chemical tests was observed to be lesser than that of chemiluminescence-based immunoassays. A significant difference in the mean time in the analytical phase was observed when samples were processed separately for photometry-based chemical tests and chemiluminescence-based immunoassays with or without using track (one-way ANOVA, F = 3.07, P < 0.05, followed by Tukey's HSD post hoc test). There is a need to develop a laboratory information system that can segregate the reports of photometry-based chemical and chemiluminescence-based immunoassay tests even when performed from a single sample, and, till such a development occurs, separate samples for each should be introduced in such a system for patients admitted, particularly to intensive care units. [ABSTRACT FROM AUTHOR]

Objectives: The aim of the study is to measure the performance of pre-analytical phase of a clinical biochemistry laboratory using sigma metrics and the six sigma scale. Materials and Methods: The study included documented data of blood sample rejection from March 2023 to February 2024 and follow-up data from March 2024 to August 2024. International Federation of Clinical Chemistry and Laboratory Medicine developed Quality Indicators (QIs) used are QI-9 Wrong tubes; QI-10 Hemolyzed samples; QI-11 Clotted samples; QI-12 Insufficient samples; QI-14 Damaged samples in transport; and QI-15 Mislabeled samples. Based on "Six Sigma Quality Design and Control" established by Dr. Westgard, the sigma metric was calculated for the above-mentioned QIs. Statistical analysis: Obtained data were entered and analyzed using Microsoft Excel 2021. Results: Out of 162,380 received samples, 547 samples were rejected as not satisfied with the sample acceptance criteria. The most common pre-analytical error in the observed QIs is hemolyzed samples (458), followed by insufficient sample volume (55). The Sigma score of QI-10 was determined to be 4.81, whereas QI-9, QI-11, QI-12, and QI-15 were well maintained and graded excellent. Following training sessions, the follow-up month revealed a sigma score of 4.98 for QI-10. Conclusions: Six sigma metrics are a competent means to measure the performance of pre-analytical QIs in a clinical biochemistry laboratory. The observed QIs were effectively managed (>4 σ). [ABSTRACT FROM AUTHOR]

"True" cobras (genus Naja) are among the venomous snakes most frequently involved in snakebite accidents in Africa and Asia. The Cape cobra (Naja nivea) is one of the African cobras of highest medical importance, but much remains to be learned about its venom. Here, we used a shotgun proteomics approach to better understand the qualitative composition of N. nivea venom and tested its cytotoxicity and protease activity as well as its effect on intracellular Ca2+ release and NO synthesis. We identified 156 venom components representing 17 protein families, with the dominant ones being three-finger toxins, mostly of the short-chain type. Two-thirds of the three-finger toxin entries identified were assigned as cytotoxins, while the remainder were categorized as neurotoxins, including short-chain, long-chain, and ancestral three-finger toxins. We also identified snake venom metalloproteinases and members of CRISP, l-amino acid oxidase, and other families. Protease activity and its effect on intracellular Ca2+ release and NO synthesis were low. Phospholipase A2 activity was surprisingly high, despite this toxin family being marginally recovered in the analyzed venom. Cytotoxicity was relevant only at higher venom concentrations, with macrophage and neuroblastoma cell lines showing the lowest viability. These results are in line with the predominantly neurotoxic envenomation symptoms caused by Cape cobra bites. The present overview of the qualitatively complex and functionally intriguing venom of N. nivea may provide insights into the pathobiochemistry of this species' venom. [ABSTRACT FROM AUTHOR]

AbstractThe cultivation of tilapias, the third most farmed fish group globally, has been rapidly growing, especially in Southeast Asia. This surge in tilapia farming intensification has led to increased use of antibiotics to control bacterial diseases. This study investigated the safety implications of administering graded doses of enrofloxacin (ENF) at 0 (control), 10, 30, 50 and 100 mg/kg biomass/day orally to Oreochromis niloticus. The 43-day study comprised 7 days of pre-dosing, 15 days of ENF-dosing, and a 21-day recovery period with a periodical assessment of the biological responses of fish. The results revealed that the overdosed groups experienced up to 21% reduction in feed consumption, 11% mortalities, and adverse impacts on hematology, including a decrease in erythrocytes, and monocytes and an increase in leukocytes, thrombocytes, lymphocytes, and neutrophils. Haematological indices like mean corpuscular volume and mean corpuscular hemoglobin decreased, while mean corpuscular hemoglobin concentration increased. The plasma biochemical parameters including glucose and liver and kidney enzymes unveiled a significant dose- and time-dependent increase, while calcium and chloride levels decreased. Erythrocytes displayed several erythrocyte cellular and nuclear abnormalities. The frequency of micronucleus increased with dose and time, suggesting potential genotoxicity of ENF. Additionally, a dose-dependent increase in residues in the tissues with the highest accumulation in muscle was documented. Nevertheless, the recovery of the measured parameters upon dose termination indicated that the ENF-induced alterations are reversible. The study affirmed the safety of ENF at the recommended dose (10 mg) in O. niloticus and their adoptive responses to higher doses. [ABSTRACT FROM AUTHOR]

Background: Myxomatous mitral valve degeneration (MMVD) is a prevalent canine heart condition often accompanied by pulmonary hypertension (PH). Echocardiography is a valuable diagnostic tool for MMVD, but its accessibility is limited in small veterinary clinics. Aim: This study aimed to identify clinical parameters and biochemistry and cardiac biomarkers as prognostic indicators for cardiac mortality in MMVD dogs with and without PH. Animals: Ninety-nine MMVD dogs and nineteen normal dogs. Methods: In a five-year longitudinal study, data including clinical and laboratory measurements as well as echocardiographic parameters were collected every 6 months. Dogs were monitored until death or loss to follow-up, and the cause of death was determined when possible. Statistical analysis was performed to identify factors that predicted death. Results: Alterations in body condition score, total protein, fractional shortening percentage, and mean corpuscular volume were predictive of impending cardiac mortality. High blood urea nitrogen-to-creatinine ratio, heart rate, and low hemoglobin levels were associated with an increased risk of death. N-terminal pro-B-type natriuretic peptide was also a significant predictor of cardiac-related mortality, with higher levels indicating increased risk. Moreover, MMVD dogs with PH had a significantly lower survival rate than those with MMVD without PH. However, no significant difference in survival was observed between MMVD stage C and D with PH and MMVD stage C and D without PH groups. Conclusion: These findings provide valuable insights into the monitoring of MMVD progression in dogs using clinical parameters and biomarkers, especially when echocardiography cannot be performed. [ABSTRACT FROM AUTHOR]

The translation of discoveries on extracellular vesicle (EV) based cancer biomarkers to personalised precision oncology requires the development of robust, sensitive and specific assays that are amenable to adoption in the clinical laboratory. Whilst a variety of elegant approaches for EV liquid biopsy have been developed, most of them remain as research prototypes due to the requirement of a high level of microfabrication and/or sophisticated instruments. Hence, this study is set to develop a simple DNA aptamer‐enabled and fluorescence polarisation‐based homogenous assay that eliminates the need to separate unbound detection ligands from the bound species for EV detection. High specificity is achieved by immobilising EVs with one set of antibodies and subsequently detecting them with a DNA aptamer targeting a distinct EV biomarker. This two‐pronged strategy ensures the removal of most, if not all, non‐EV substances in the input biofluids, including soluble proteins, protein aggregates or non‐vesicular particles, prior to quantifying biomarker‐positive EVs. A limit of detection of 5.0 × 106 EVs/mL was achieved with a linear quantification range of 5.0 × 108 to 2.0 × 1010 EVs/mL. Facilitated by a multiple parametric analysis strategy, this aptamer‐guided fluorescence polarisation assay was capable of distinguishing EVs from three different types of solid cancer cells based on quantitative differences in the levels of the same sets of biomarkers on EVs. Given the simplicity of the method and its ease of implementation in automated clinical biochemistry analysers, this assay could be exploited for future EV‐based continuous and real‐time monitoring of the emergence of new macro‐ or micro‐metastasis, cancer progression as well as the response to treatment throughout different stages of cancer management in the clinic. [ABSTRACT FROM AUTHOR]

Pseudothrombocytopenia (PTCP) is defined by the occurence of spouriously low platelet count as a consequence of in vitro platelet aggregation. It is a rare and benign artifact, not associated with any specific disorder or therapy, that becomes clinically relevant when it is not timely and reliably recognized. Thus, it may result in inappropriate clinical decisions (i.e. unnecessary further testing, misdiagnoses and potential patients' mismanagement) unavoidably compromising patient safety. The most common form of PTCP is caused by ethylenediaminetetraacetic acid (EDTA). Several approaches for the management of samples with EDTA-induced PTCP have been described in the literature. However, expert recommendations are scarce. The scope of these recommendations is to assist in achieving national harmonisation in laboratory management (i.e. detecting and reporting platelet counts) of samples with EDTA-induced PTCP. These minimal recommendations were prepared by the members of the joint working group of the Croatian Chamber of Medical Biochemists and Working group for Laboratory Hematology of the Croatian Society of Medical Biochemistry and Laboratory Medicine, and might be customized according to specific conditions (i.e. personnel and equipment) of each individual laboratory. These recommendations are primarily intended to all laboratory professionals involved in the management of samples with EDTA-induced PTCP, but also to other healthcare professionals involved in collecting samples and interpreting complete blood count results. [ABSTRACT FROM AUTHOR]

Harmonization of the laboratory total testing process (TTP) is critical to improving patient outcome. In 2016, an EFLM survey on the harmonization of TTP underlined the serious shortcomings pertaining to the post-analytical phase. In 2023, the WG-H conducted a new survey aiming to update information in the 2016 harmonization report in order to ascertain whether countries that had declared they were keen to adopt SI units had continued with this program, the aim being to verify the state-of art in harmonization units in areas of laboratory medicine not included in the previous survey. Questionnaires were distributed to the Presidents and National Representatives of EFLM Full Member Societies and EFLM affiliate Members. The survey questions were grouped into three categories: measurement units, reference intervals, and nomenclature/terminology, and results were evaluated using Survey Monkey software and Excel. A total of 123 questionnaires from 31 countries were analyzed. A trend (+19.3 %) was observed toward a wider use of SI units for general clinical biochemistry parameters. The results for tests not included in the 2016 survey (i.e., endocrinology diagnostics and coagulation panels), demonstrated that for reports on hormones, responses were satisfactory, 70–90 % of the responders adopting the recommended units, whereas for coagulation test panels, a serious lack of harmonization was found, "seconds", which are inaccurate and not recommended, being widely used units (91 %). The findings made in the 2023 survey demonstrated a progressive, albeit slow, improvement in harmonization reports. However, further efforts at improvement are mandatory. [ABSTRACT FROM AUTHOR]

Background: In our study, we aimed to compare the Friedewald, Martin/Hopkins, and Sampson formulae with direct LDL-cholesterol (d-LDL-C) measurement. Methods: The study was a retrospective investigation by the Department of Medical Biochemistry of the Ankara Training and Research Hospital between January 1, 2021, and December 31, 2022. Our study evaluated the results of 6297 patients aged 18–95 years who underwent cholesterol panel TC, TG, HDL-C, and direct LDL-C in our laboratory. The estimated LDL-C was calculated according to Friedewald, Martin/Hopkins, and Sampson formulae. Results: All three formulae showed a stronger positive correlation with d-LDL-C (0.905, 0.897, and 0.886, respectively, for all data, p<0.001). In addition, when we compared the total median difference (1st–3rd quartile) of all formulae, it was -0.69 (-1.62 to 0.39) for Friedewald, 0.034 (-0.74 to 1.14) for Martin/Hopkins and -0.40 (-1.19 to 0.55) for Sampson. According to Passing Bablok regression analyses, the intercept was determined as -0.97 (95% CI=-1.01 to -0.93), 0.41 (95%=0.37 to 0.44) and -0.05 (-0.08 to -0. 03) and slopes were calculated as 1.083 (95% CI=1.07–1.09), 0.88 (0.88 to 0.89) and 0. 90 (95%=0.89 to 0.90) for Friedewald, Martin/Hopkins and Sampson, respectively. Conclusions: Our findings suggest that the Martin/Hopkins formula performed better than the Friedewald and Sampson formulas. We figured out utilizing the Martin/ Hopkins formula as a good alternative for estimated LDL-C in Turkish adults. [ABSTRACT FROM AUTHOR]

Systemic lupus erythematosus (SLE) is a common autoimmune disease marked by the formation of apoptotic debris and the presence of autoantibodies that target nuclear components. At this moment, the actual cause of SLE is uncertain. Genetic variables have been well proven to have a significant role in the propensity of SLE. This study aimed to investigate the effect of (ZNF76) rs (10947540) and (SCUBE) rs (1888822) gene polymorphism in patients with systemic lupus erythematosus. A case control study has been carried out at Medical Biochemistry & Molecular biology and Rheumatology unit of Internal Medicine Departments, Faculty of Medicine, Menoufia University, Egypt, for 1-year duration between 1 June 2022 and 1 June 2023. Sixty patients were females (75%) and twenty patients were males (25%). Their ages ranged from 19 to 53 years. Their disease durations ranged from 7 months to 20 years. The findings indicated that the TC genotype of the ZNF76 rs10947540 gene increases the risk of SLE by 2.274-fold, while the dominant TC + CC increases the risk by 2.472-fold, and the C allele increases the risk by 2.115-fold. Additionally, the results showed that the TT genotype of the SCUBE3 rs1888822 gene increases the risk of SLE by 3.702-fold, the dominant GT + TT increases the risk by 2.304-fold, and the T allele increases the risk by 2.089-fold, while the GT genotype increases the risk by 1.918-fold. The study revealed significant associations between the genotypes of these polymorphisms and certain clinical parameters in SLE patients. These findings highlight the potential genetic contributions to SLE susceptibility and its clinical manifestations, providing valuable insights for future research and potential personalized approaches to the management of this complex autoimmune disease. [ABSTRACT FROM AUTHOR]

Gastroesophageal reflux disease (GERD) represents one of the most prevalent foregut illnesses, affecting a large portion of individuals worldwide. Recent research has shown that inflammatory mediators such as cytokines, chemokines, and enzymes are crucial for causing esophageal mucosa alterations in GERD patients. It seems likely that the expression of various cytokines in the esophageal mucosa also induces oxidative stress by increasing the production of reactive oxygen species (ROS) and reactive nitrogen species (RNS). As humoral agents and peptidergic neurotransmitters that may support the enterogastric axis, bombesin and its related bombesin-like peptide, GRP (gastrin releasing peptide), have not been fully investigated. Therefore, considering all these assumptions, this study aimed to evaluate the influence of bombesin in reestablishing biochemical markers linked with inflammation and oxidative/nitrosative stress in GERD pathological settings. C57BL/6 mice were alternatively overfed and fasted for 56 days to induce GERD and then treated with bombesin (0.1, 0.5, and 1 mg/kg intraperitoneally) once daily for 7 days, and omeprazole was used as the positive control. After 7 days of treatment, gastric pain and inflammatory markers were evaluated. Abdominal pain was significantly reduced following bombesin administration, which was also successful in diminishing inflammatory and oxidative/nitrosative stress markers in a manner overlapping with omeprazole. Moreover, bombesin was also able to appreciably modulate gastric pH as a result of the restoration of gastric homeostasis. Overall, these observations indicated that the upregulation of bombesin and interconnected peptides is a promising alternative approach to treat GERD patients. [ABSTRACT FROM AUTHOR]

The letter discusses the relevance of sweat conductivity testing as a screening test for cystic fibrosis (CF) over the past decade. While sweat conductivity has been used as a simplified test to exclude CF in patients with clinical features of the disease, there has been a decline in participation in sweat conductivity analysis programs. The authors recommend that sweat chloride concentration should be the only analyte considered for sweat testing, leading to the removal of sweat conductivity assessment from the program in 2024. [Extracted from the article]

Coronavirus disease 2019 (COVID-19) exhibits variations in terms of patients’ clinical symptoms and levels of routinely employed biochemical markers. The aim of the current study was to determine the correlation between serum levels of the C-X-C chemokine ligand type 12 (CXCL12) and C-X-C chemokine receptor type 4 (CXCR4), one of its specific receptors, and disease severity in COVID-19 patients.

Background : Errors in pre analytical phase have a profound effect on test results.This study was taken up to recognize various preanalytical errors in Clinical Biochemistry Lab of a tertiary hospital, Anantapur. Methods : This was a retrospective study conducted in Clinical Biochemistry Lab of Government General Hospital, Anantapur. Data from the sample rejection register & requisition forms sent by the clinicians was evaluated for a period of 6 months from January 2024 to June 2024. Various errors in pre analytical phase were noted & the percentage of occurrence of each error was calculated. Results : The data obtained showed the following errors as percentage of total pre analytical errors. Improper labeling of the samples : 69%, insufficient quantity of sample 22%, hemolysis : 3%, delayed transport : 2.5%,wrong container 0.7%, clotted sample 1.5%, lipemic sample : 0.7% Conclusion : The study revealed burden of preanalytical errors and the necessity to focus on reducing the same as they have significant impact on test reports. [ABSTRACT FROM AUTHOR]

The teaching objectives of traditional approaches in higher education emphasize mostly students' mastery of knowledge and have insufficient directionality to social needs. In this study, we developed a BOPPPS (Bridge-in, Objectives, Pre-assessment, Participatory Learning, Post-assessment and Summary) teaching model combined with the OBE (Outcome Based Education) concept to enhance the teaching outcomes. Firstly, based on the graduation requirements and professional training objectives of students, we divided the course objectives into three dimensions (knowledge, ability and quality), and further specified into index points. Then, the teaching content of each chapter was set to correspond with the index points. Finally, the BOPPPS teaching model was used to meet each requirement. Clinical biochemistry testing course was used as a model to assess the effects of the teaching reform. After the class, the teaching effect was analyzed based on the questionnaire surveys from the students and their scores of both the chapter and final examinations. The results showed that compared with the traditional approach, the BOPPPS teaching model combined with the OBE concept has demonstrated a notable enhancement in student engagement, and significant improvement of their mastery of knowledge, application skills, and problem-solving abilities. The examination scores of the BOPPPS group were markedly higher than those of the traditional group. Moreover, the difference between the two groups diverse assessment scores was much bigger than that between the two group examination scores. Our study indicates that the BOPPPS teaching model combined with the OBE concept is a highly effective teaching model for enhancing the learning effectiveness of students. [ABSTRACT FROM AUTHOR]

Background: One method used selectively in medical education institutions is the Flipped Classroom Model. According to this paradigm, students receive their first material education at home by completing tasks instead of the typical, boring teacher-centric lectures. (minimum 48-72 h before the session), and spend class time in interactive sessions and group activities. Aim and Objectives: The objectives of the study were to introduce Flip classroom teaching in the subject of biochemistry, compare teaching-learning with the flip classroom method and interactive lecturing in biochemistry for 1st-year MBBS students, and assess the acceptability and feasibility of this method among undergraduates and faculty members. Materials and Methods: A cross-sectional interventional study was carried out and department faculties were introduced to this method. One hundred students of 1st-year MBBS class were included in the study. There were two Groups, A and B, each with 50 students. For Topic I, Group A was taught by the flip classroom method and Group B was taught by the interactive Lecture method. For Topic II, Group A will be taught by the interactive Lecture method while Group B will be taught by the flip classroom method. Pre- and post-tests were conducted for both sessions. Feedback was taken as questionnaires from the students and faculties at the end of the sessions. Results: We found statistically significant differences among both methods from feedback received from the students. Feedback received from the faculties was very positive. The average Likert score was above four in almost all questionnaires. Conclusion: Our research indicates that interactive lectures are not as effective as the flipped classroom approach for teaching and learning. Due to providing material ahead of the lecture, students are more interactive in flipped classrooms and perform well in post-session examinations. [ABSTRACT FROM AUTHOR]

A recent proof-of-concept pilot clinical study has demonstrated that consumption of CL18100F4, a proprietary herbal blend of Withania somnifera root and Abelmoschus esculentus fruit extracts, significantly relieved the participants from functional constipation and improved their quality of life. The objective of the present randomized, double-blind, placebo-controlled study was to reevaluate the efficacy and tolerability of CL18100F4 in a larger number of subjects. Male and female subjects (n = 135; age: 25–60 years), selected through Rome-IV criteria for functional constipation, were randomized into placebo and 300 or 500 mg of CL18100F4 groups and supplemented daily over 60 consecutive days. The primary efficacy outcome measure was Patient Assessment of Constipation-Symptoms (PAC-SYM), evaluated at baseline and on days 7, 30, and 60 of supplementation. The secondary efficacy parameters included Patient Assessment of Constipation-Quality of Life (PAC-QOL), Gastrointestinal Symptom Rating Scale (GSRS) scores, Gastrointestinal Transit Time (GIT), and Complete Spontaneous Bowel Movement (CSBM). Serum levels of Interleukin (IL)-6, IL-10, cortisol, gastrin, serotonin, Diamine oxidase (DAO), and Zonulin were measured. CL18100F4 supplementation significantly (p < 0.001) reduced the PAC-SYM, PAC-QOL, GSRS scores, and GIT and improved CSBM scores. CL18100F4 significantly improved (p < 0.001) sleep quality and decreased depression and anxiety symptoms in the participants. Notably, relief in constipation symptoms and improved gastrointestinal (GI) function were reported starting from day 7. Furthermore, CL18100F4 supplementation significantly (p < 0.001) increased the serum levels of IL-10, DAO, serotonin, gastrin, reduced IL-6, cortisol, and Zonulin. No major adverse events were observed. Participants' vital signs, hematology, clinical biochemistry, and urinalysis parameters were within the normal ranges. The present investigation demonstrates that CL18100F4 is tolerable and efficacious in relieving functional constipation, alleviating GI dysfunction, and improving associated non-GI factors in male and female adults. [ABSTRACT FROM AUTHOR]

Background Methods Results Conclusions Routine clinical biochemistry tests are crucial for clinical diagnostics and play a key role in enhancing outpatient turnover efficiency and patient satisfaction. This study aimed to implement Lean Six Sigma in the biochemistry laboratory of a hospital in China to improve efficiency and quality by reducing turnaround time.The study was conducted from January to December 2023, using the DMAIC (Define, Measure, Analyze, Improve, Control) framework, and employed tools such as the voice of the customer, Value Stream Mapping, ‘5 whys’ technique, Nominal Group Technique, and Pareto chart.The turnaround time for outpatient routine clinical biochemistry tests was reduced from 139 min to 58 min (p < 0.05), effectively increasing both patient and physician satisfaction.Lean Six Sigma aimed to reduce the turnaround time for biochemical tests have significant advantages. This study confirms the effectiveness of Lean Six Sigma in a Chinese clinical laboratory setting and provides guidance for optimizing efficiency in global clinical laboratories with limited implementation experience, constrained technical and equipment resources, and high demand for medical diagnostics. [ABSTRACT FROM AUTHOR]