Journal of Clinical and Basic Research

Evaluation of Pre-Analytical Errors in Clinical Biochemistry Laboratory of a Tertiary Care Center in India

KAPILA GAIKWAD

Background and objectives: Laboratory medicine is equally challenged by economic and new technological pressures. Clinical laboratories have undergone major change due to advancement of technology, which has improved the decision making of clinicians but introduced the risk of errors. This study aimed to evaluate the errors that occurred in the pre-analytical phase of laboratory testing.
Methods: This was a prospective observational study that was done in the Clinical Biochemistry Laboratory of a tertiary care center from June 2016 to May 2017. The path of the sample was analyzed from sample collection to transport. Frequency of deficiencies in the request forms and different types of pre-analytical errors were recorded.
Results: During the study period, the frequency of pre-analytical errors was about 3.1%. Sample hemolysis was the predominant error in sample collected from both indoor and outdoor patients.
Conclusion: Proper management of pre-analytical errors requires continuous evaluation of source of errors, taking corrective measures, and significant interdepartmental cooperation.

An Overview of the Therapeutic Effects of Environmental Enrichment on Traumatic Brain Injury

Abayomi Oyeyemi Ajagbe͓

Traumatic brain injury (TBI) occurs due to primary or secondary brain damages that result in temporary or permanent neurological deficits. The sum combined rates for TBI-related emergency department visits, hospitalizations, and deaths have escalated in 2001-2010. Environmental enrichment (EE) is a non-invasive therapy used to enhance learning and memory function. Given its positive effects on neuronal plasticity, EE can be applied as therapy for medical conditions such as neurodegenerative disorders (Parkinson’s, Alzheimer disease) and TBI. This study reviewed the therapeutic effects of EE via music therapy and mastication for treatment of TBI. The introduction of EE in animal studies has been well established compared to human studies. This entails the use of various objects with different shapes, sizes, colors, textures, running wheels, ropes, plastic tunnels, balls, stairs, and shelters as part of this method that enhance physical activity compared with standard housing. Studies have shown that EE boosts cognitive function after TBI. It is also recommended to use wooden dowels as an EE tool in animal brain research.

Unilateral Pleural Effusion in a Pediatric Patient: A Case of T-Cell Acute Lymphoblastic Leukemia Complicated with COVID-19

lobat shahkar

Background: Exudative pleural effusion in children is mainly caused by bacterial infections. Here, we present a 2.5-years-old boy with acute fever, unilateral pleural effusion, and poor response to the insertion of chest tube.
Case description: The patient was admitted to the Taleghani Hospital of Gorgan (northeast of Iran) with complaint of fever starting from a week ago. The patient was treated with intravenous (IV) antibiotics and a chest tube was inserted. Considering the poor response to this treatment and leukocytosis, further assessments were made. Microbial examination of pleural fluid and SARS-CoV-2 test of nasopharyngeal swab were negative. Pleural biopsy and bone marrow aspiration analysis by flow cytometry revealed T-cell-acute lymphoid/lymphoblastic leukemia (ALL). The patient was referred to the oncology ward and chemotherapy was performed. After four weeks, he started to develop symptoms of respiratory distress, fever, and melena. The next SARS-CoV-2 test on throat swab was suspicious. Chest CT scan showed centrilobular ground glass opacity and peribronchial wall thickening in both lungs in favor of COVID-19. Treatment started with hydroxychloroquine, cotrimaxazole, meropenem, vancomycin, and pantoprazole. The patient was transferred to the PICU because of respiratory distress and decreased O₂ saturation. Four days later, repeated test on nasopharyngeal swab was positive for COVID-19. Unfortunately, the patient did not respond to treatment and passed away a few days later.
Conclusion: T-cell ALL is an aggressive type of leukemia with poor response to treatment, and plural effusion is a rare presentation of malignancy in children. Our patient's condition was unfortunately complicated with COVID-19 involvement and he passed away before we see the effect of treatment on ALL.

In Vitro Antibacterial Activity of Ethanolic Extract of Aloe Vera and Silver Nanoparticles on Standard Strains of Some Pathogenic Bacteria

Abolfazl jafari-Sales

Background and objectives: Today, with the increasing rate of antibiotic resistance, treatment of bacterial infections has become challenging. Therefore, it is essential to find suitable alternative antibacterial compounds. The aim of this study was to investigate in vitro effects of silver nanoparticles and ethanolic extract of Aloe vera alone and combined on standard strains of some pathogenic bacteria.
Methods: After collection and verification of A. vera plants, extraction was performed by the Soxhlet extractor method. Antibacterial effects of ethanolic extract of A. vera and silver nanoparticles on standard strains of Staphylococcus aureus, Bacillus cereus, Escherichia coli and Pseudomonas aeruginosa were investigated by agar well diffusion and tube dilution methods, respectively.
Results: The ethanolic extract of A. vera and silver nanoparticles had antibacterial effects on the tested bacteria in a dose-dependent manner. The ethanolic extract of A. vera was more effective against S. aureus and B. cereus compared to gram-negative bacteria. However, silver nanoparticles were more effective against gram-negative bacteria (P. aeruginosa and E. coli). The effect of combination of ethanolic extract of A. vera and silver nanoparticles was much greater than the effect of either alone. This combination showed the greatest and lowest effect on P. aeruginosa and S. aureus, respectively.
Conclusion: For the first time, this study showed that the combination of ethanolic extract of A. vera and silver nanoparticles is effective against potentially pathogenic bacteria. Given the high rate of antibiotic resistance and side effects of conventional antibiotics, it is recommended to identify active compounds of this plant and evaluate the antimicrobial effects of this combination of fungi and other pathogenic bacteria both in vitro and in vivo.

In Silico Identification of Housekeeping Genes by Expressed Sequence Tags and Assessment of Short Tandem Repeats in Their Promoters

Morteza Oladnabi

Background and objectives: In gene expression studies, to validate and obtain reliable results, normalization of qRT-PCR data by housekeeping genes (HKGs) is required. However, the expression level of these genes may vary in tissues or cells and may change under certain circumstances. Thus, selection of HKGs is critical for gene expression studies. For this purpose, we analyzed expression of protein-coding genes by expressed sequence tags (ESTs) and short tandem repeat (STR) to select suitable HKGs.
Methods: The EST profile of 17242 protein-coding genes was extracted from the UniGene database. Log2 (TPM + 2) scale was used to normalize EST counts across 16 normal and tumor tissues. Selection of HKGs was limited to genes expressed in developmental stages as well as in normal and tumor tissues. Then, the genes with no expression change between the normal and tumor tissues were selected. Finally, the STRs and the gene ontology analysis of candidate genes were performed.
Results: We found that 93 genes had no expression change between the normal and tumor tissues. The STRs analysis showed that GCGCGC repeats had the highest frequency in candidate gene promoters.
Conclusion: We introduced a new set of genes as potential HKGs, some of which can be used for a particular tissue. However, further investigations are required to confirm our findings.