Esin Eren, Furkan Yıldırım, Ozlem Giray and Necat Yilmaz
Hyperbaric oxygen (HBO) treatment is generally a relatively safe therapy for various conditions. However, there are some adverse side effects. For example HBO tratment has been reported to increase the production of free oxygen radicals(FRs). Furthermore, to our knowledge, no previous clinical research has been carried out to study the involvement of platelet-activating factor(PAF)as the lipid oxidative stressor in patients undergoing HBO treatment. A total of 45 patients included in this study were first given clinical assessment and laboratory measurements before starting HBO treatment and were named group baseline. After the HBO treatment, the same clinical and laboratory measurements from the same patients were repeated and this was named group sesion >20.As expected, long-term HBO treatment had no effect on oxLDL (oxidized low-density lipoprotein), a lipid oxidative stress(OS) marker. However, the mean PAF values in the second group showed a statistically significant increase compared to their pretreatment values, (P <0. 002).As this is a preliminary study, there is a need for more detailed investigations that demonstrate the association of HBO treatment with the lipid inflammatory response. Therefore, there is need for further clinical study for OS markers such as oxLDL in HBO treatment. Clinical prospective studies are required to confirm our laboratory findings.
Ozgur Aydin, Hamit Yasar Ellidag, Esin Eren and Necat Yilmaz
Background:Automated urine sediment analyzers have proven their feasibility in medical laboratories. However, editing manual microscopic review of some specimens severely limits the usefulness of such systems. This study aims to give feedback on the practical experience on »Yeast«, which is one of the parameters that compel frequent manual reviews.
Methods: 5448 freshly collected urine specimens submitted from various departments of our hospital for diagnostic urinalysis were studied by the UriSed® (77 Elektronika, Hungary). A specialist medical doctor inspected every image onboard, and reviewed the ones with a »Yeast« alarm by traditional manual microscopy.
Results: UriSed alarmed in 491 samples (9%) for yeast. In 59 samples (1%) the number of particles exceeded the cut-off and a »positive for yeast« was set. A false positive report of yeast +1 to 3+/HPF was found in 51 samples (0.9%). There were 8 cases with positive for yeast from both microscopic methods. Thirty-three »negative for yeast« samples were corrected as positive after the manual microscopic review.
Conclusion: We report a high percentage of false positives and negatives in the yeast parameter, in line with other studies on UriSed as well as on other instruments in the market. As an important feedback, our observations showed that the major concern in false results was »the focusing problem«. We believe in the necessity of a focus check and comparison of alarms between images on board
Ayşegül Uğur Kurtoğlu, Esin Eren, Vedat Aslan, Özgür Erkal, Erdal Kurtoğlu and Necat Yilmaz
Glycated hemoglobin (HbA1c) is used for the assessment of glycemic control in patients with diabetes. The presence of genetic variants of hemoglobin can profoundly affect the accuracy of HbA1c measurement. Here, we report two cases of Hemoglobin G-Coushatta (HBB:c.68A>C) variant that interferes in the measurement of HbA1c by a cation-exchange HPLC (CE-HPLC) method. HbA1c was measured by a CE-HPLC method in a Tosoh HLC-723 G7 instrument. The HbA1c levels were 2.9% and 4%. These results alerted us to a possible presence of hemoglobinopathy. In the hemoglobin variant analysis, HbA2 levels were detected as 78.3% and 40.7% by HPLC using the short program for the Biorad Variant II. HbA1c levels were measured by an immunoturbidimetric assay in a Siemens Dimension instrument. HbA1c levels were reported as 5.5% and 5.3%. DNA mutation analysis was performed to detect the abnormal hemoglobin variant. Presence of Hemoglobin G-Coushatta variant was detected in the patients. The Hb G-Coushatta variants have an impact on the determination of glycated hemoglobin levels using CEHPLC resulting in a false low value. Therefore, it is necessary to use another measurement method.
Background: Human serum paraoxonase-1 (PON1) shows wide variation among different ethnic groups around the world. The aim of the present study was to determine the phenotype distribution and enzymatic activity of PON1 and ARE (arylesterase) in colorectal cancer (CRC), bladder cancer (BC) and multiple myeloma (MM) patients compared to healthy subjects.
Methods: A total of 160 subjects (40 CRC patients, 40 BC patients, 40 MM patients and 40 healthy controls) were admitted to the study. The phenotype distribution of PON1 was determined by using the dual substrate (paraoxon and phenylacetate) method.
Results: PON 1 and ARE activities were significantly lower in the cancer patients compared to the control group. The following phenotype distributions were assessed in the cancer and control groups: MM: 52.5% (QQ), 40% (QR), 7.5% (RR); CRC: 52.5% (QQ), 40% (QR), 7.5% (RR); BC: 55% (QQ), 35% (QR), 10% (RR); and controls: 40% (QQ), 57.5% (QR), 2.5% (RR).
Conclusions: We found that MM, CRC and BC patients were associated with lower PON1, ARE and stPON1 enzyme activities compared to the healthy subjects. However, PON1 phenotypes were similar between the cancer groups and control group.
Background: Oxidative stress may be involved in the pathogenesis of every human disease. To understand its possible role in benign prostatic hyperplasia (BPH), we measured the overall oxidative status of patients with BPH and the serum activity of the high density lipoprotein (HDL)-related antioxidant enzymes paraoxonase 1 (PON1) and arylesterase (ARE).
Methods: Fifty-six urology outpatient clinic patients with BPH (mean age 64±8.6 years) were prospectively included in the study. Forty volunteer healthy controls from the laboratory staff (mean age 62±10 years) were enrolled for comparison. Serum total antioxidant status (TAS), total oxidant status (TOS), PON1, ARE, and HDL levels were measured by commercially available, ready-to-use kits.
Results: Serum TAS and HDL levels were significantly lower in the BPH group than in the control group (P=0.004 and P=0.02, respectively). No significant between-group differences were observed for TOS levels or PON1 and ARE enzyme activities (P=0.30, P=0.89, and P=0.74, respectively). In the BPH group, the calculated parameters PON1/HDL and ARE/HDL were significantly higher (P=0.02 and P=0.04, respectively).
Conclusions: Our findings agree with the previous reports of impaired oxidant/antioxidant balance in BPH patients. The activities of HDL-related enzymes between groups with significantly different HDL levels may be deceptive; adjusted values may help to reach more accurate conclusions.
Hamit Yasar Ellidag, Esin Eren, Necat Yilmaz and Asli Bayindir
Background: Impaired oxidative/antioxidative balance plays an important role in the pathogenesis of many diseases, including cancer. The aim of this study was to evaluate the levels of the novel marker ischemia modified albumin (IMA) and albumin adjusted-IMA (Adj-IMA) in patients with multi- ple myeloma (MM) as well as its association with total antiox- idant status (TAS), total oxidant status (TOS) and oxidative stress index (OSI).
Methods: Forty patients with MM (18 females, 22 males; mean age 67.55±8.39 years) and forty age/sex-matched healthy persons (19 females, 21 males; mean age 66.37 ± 6.76 years) were included in this study. Serum levels of IMA, TAS, TOS were analyzed and Adj-IMA and OSI was calcu- lated. Results:
Serum IMA, TOS and OSI levels were significantly higher in patients with MM compared to controls (p<0.001 all parameters). There was no significant difference for serum albumin-adjusted IMA and TAS levels between groups (p=0.83 and p=0.17 respectively).
Conclusions: In this study, an impaired oxidative/antioxidant status in favor of oxidative stress was found in MM patients. This observation was not confirmed by Adj-IMA calculation. Further studies are needed to establish the relationship of IMA and oxidative stress parameters in multiple myeloma and their relationship to MM and other cancers.
Güzin Aykal, Mustafa Keşapli, Özgür Aydin, Hatice Esen, Ayşenur Yeğin, Faruk Güngör and Necat Yilmaz
Background: After the introduction of modern laboratory instruments and information systems, preanalytic phase is the new field of battle. Errors in preanalytical phase account for approximately half of total errors in clinical laboratory. The objective of this study was to share an experience of an education program that was believed to be successful in decreasing the number of rejected samples received from the Emergency Department (ED).
Methods: An education program about laboratory procedures, quality requirements in the laboratory, patient and health-care worker safety was planned by the quality team to be performed on 36 people who were responsible for sample collection in the ED. A questionary which included 11 questions about the preanalytic phase was applied to all the attendees before and after training. The number of rejected samples per million was discovered with right proportion account over the number of accepted and rejected samples to laboratory after and before the training period.
Results: Most of the attendees were nurses (n: 22/55%), with over 12 years of experience in general and 2-4 years experience in the ED. Knowledge level of the attendees was calculated before training as 58.9% and after training as 91.8%. While the total rate of sample rejection before training was 2.35% (sigma value 3.37-3.50), the rate after training was 1.56% (sigma value 3.62-3.75).
Conclusions: Increasing the knowledge of staff has a direct positive impact on the preanalytic phase. The application of a pre-test was observed to be a feasible tool to shape group specific education programs.