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Background: Plasma cell dyscrasias encompass a diverse set of disorders, where early and precise diagnosis is essential for optimizing patient outcomes. Despite advancements, current diagnostic methodologies remain underutilized in applying artificial intelligence (AI) to routine laboratory data. This study seeks to construct an AI-driven model leveraging standard laboratory parameters to enhance diagnostic accuracy and classification efficiency in plasma cell dyscrasias. Methods: Data from 1,188 participants (609 with plasma cell dyscrasias and 579 controls) collected between 2018 and 2023 were analyzed. Initial variable selection employed Kruskal-Wallis and Wilcoxon tests, followed by dimensionality reduction and variable prioritization using the Shapley Additive Explanations (SHAP) approach. Nine pivotal variables were identified, including hemoglobin (HGB), serum creatinine, and β2-microglobulin. Utilizing these, four machine learning models (gradient boosting decision tree (GBDT), support vector machine (SVM), deep neural network (DNN), and decision tree (DT) were developed and evaluated, with performance metrics such as accuracy, recall, and area under the curve (AUC) assessed through 5-fold cross-validation. A subtype classification model was also developed, analyzing data from 380 cases to classify disorders such as multiple myeloma (MM) and monoclonal gammopathy of undetermined significance (MGUS). Results: 1. Variable selection: The SHAP method pinpointed nine critical variables, including hemoglobin (HGB), serum creatinine, erythrocyte sedimentation rate (ESR), and β2-microglobulin. 2. Diagnostic model performance: The GBDT model exhibited superior diagnostic performance for plasma cell dyscrasias, achieving 93.5% accuracy, 98.1% recall, and an AUC of 0.987. External validation reinforced its robustness, with 100% accuracy and an F1 score of 98.5%. 3. Subtype Classification: The DNN model excelled in classifying multiple myeloma, MGUS, and light-chain myeloma, demonstrating sensitivity and specificity above 90% across all subtypes. Conclusions: AI models based on routine laboratory results significantly enhance the precision of diagnosing and classifying plasma cell dyscrasias, presenting a promising avenue for early detection and individualized treatment strategies. [ABSTRACT FROM AUTHOR]

Background Plasma cell dyscrasias encompass a diverse set of disorders, where early and precise diagnosis is essential for optimizing patient outcomes. Despite advancements, current diagnostic methodologies remain underutilized in applying artificial intelligence (AI) to routine laboratory data. This study seeks to construct an AI-driven model leveraging standard laboratory parameters to enhance diagnostic accuracy and classification efficiency in plasma cell dyscrasias. Methods Data from 1,188 participants (609 with plasma cell dyscrasias and 579 controls) collected between 2018 and 2023 were analyzed. Initial variable selection employed Kruskal-Wallis and Wilcoxon tests, followed by dimensionality reduction and variable prioritization using the Shapley Additive Explanations (SHAP) approach. Nine pivotal variables were identified, including hemoglobin (HGB), serum creatinine, and β2-microglobulin. Utilizing these, four machine learning models (gradient boosting decision tree (GBDT), support vector machine (SVM), deep neural network (DNN), and decision tree (DT) were developed and evaluated, with performance metrics such as accuracy, recall, and area under the curve (AUC) assessed through 5-fold cross-validation. A subtype classification model was also developed, analyzing data from 380 cases to classify disorders such as multiple myeloma (MM) and monoclonal gammopathy of undetermined significance (MGUS). Results 1. Variable selection: The SHAP method pinpointed nine critical variables, including hemoglobin (HGB), serum creatinine, erythrocyte sedimentation rate (ESR), and β2-microglobulin. 2. Diagnostic model performance: The GBDT model exhibited superior diagnostic performance for plasma cell dyscrasias, achieving 93.5% accuracy, 98.1% recall, and an AUC of 0.987. External validation reinforced its robustness, with 100% accuracy and an F1 score of 98.5%. 3. Subtype Classification: The DNN model excelled in classifying multiple myeloma, MGUS, and light-chain myeloma, demonstrating sensitivity and specificity above 90% across all subtypes. Conclusions AI models based on routine laboratory results significantly enhance the precision of diagnosing and classifying plasma cell dyscrasias, presenting a promising avenue for early detection and individualized treatment strategies.

Backgrounds: COVID-19, a new health challenge, can be diagnosed by many laboratory biomarkers. Biomarkers became valuable for prognosis; identifying the severity and mortality of the disease in COVID-19 patients. This study aims to determine the association of clinical, demographics, and laboratory biomarkers (CRP, D-dimer, lymphocyte, and platelet) with the severity and mortality of COVID-19. Methods: Between June 1st and November 1st, 2020, 34 healthy controls and 104 COVID-19 cases were enrolled in this study. SARS-CoV-2 infection was confirmed using the real-time RT-PCR technique. All cases were analyzed for clinical, epidemiological, and laboratory biomarkers. COVID-19 cases were regrouped into mild (n=40), moderate (n=32), and severe (n=32) groups depending on the severity of the disease; it was also re-categorized into survivor (n=85) and non-survivor (n=19) groups depending on mortality. After collecting blood from participants, hematological parameters (lymphocyte and platelet) and other biomarkers (CRP and D-dimer) were measured by colter and Cobas c111, respectively. Results: For age categories and comorbidities, Statistical significance was found among COVID-19 groups. Regarding ABO, Rh, and gender, a non-significant difference was found among groups of COVID-19 patients. Cough and headache i the most common symptom in our population. SpO2 depressed more significantly in severe and moderate groups than in mild groups. Severe and moderate groups exhibit higher CRP, Ddimer, and lymphocyte percentages than control while there was a non-significant change for platelets and absolute lymphocyte counts among studies groups. All studied laboratory biomarkers were higher in non-survivors than in survivor COVID-19 groups. A significant correlation was found between D-dimer and other laboratory biomarkers. Conclusion: Gender, ABO, and Rh were not associated but age and comorbidities were associated with the severity of COVID-19. All studied laboratory biomarkers were associated with mortality.

Aims: The aim of this study was to develop and validate a prognostic model based on clinical laboratory biomarkers for the early identification of high-risk patients who require intensive care unit (ICU) admission among those hospitalized with the Omicron variant of severe acute respiratory syndrome coronavirus 2 (SARSCoV-2) and complicated with myocardial injury (MI). Methods: This single-center study enrolled 263 hospitalized patients with confirmed Omicron variant infection and concurrent MI. The patients were randomly divided into training and validation cohorts. Relevant variables were collected upon admission, and the least absolute shrinkage and selection operator (LASSO) was used to select candidate variables for constructing a Cox regression prognostic model. The model's performance was evaluated in both training and validating cohorts based on discrimination, calibration, and net benefit. Results: Of the 263 eligible patients, 210 were non-ICU patients and 53 were ICU patients. The prognostic model was built using four selected predictors: white blood cell (WBC) count, procalcitonin (PCT) level, C-reactive protein (CRP) level, and blood urea nitrogen (BUN) level. The model showed good discriminative ability in both the training cohort (concordance index: 0.802, 95% CI: 0.716-0.888) and the validation cohort (concordance index: 0.799, 95% CI: 0.681-0.917). For calibration, the predicted probabilities and observed proportions were highly consistent, indicating the model's reliability in predicting outcomes. In the 21-day decision curve analysis, the model had a positive net benefit for threshold probability ranges of 0.2 to 0.8 in the training cohort and nearly 0.2 to 1 in the validation cohort. Conclusion: In this study, we developed a clinically practical model with high discrimination, calibration, and net benefit. It may help to early identify severe and critical cases among Omicron variant-infected hospitalized patients with MI. [ABSTRACT FROM AUTHOR]

The development and further optimization of the diagnostic criteria for multiple sclerosis (MS) emphasize the establishment of an early and accurate diagnosis. So far, numerous studies have revealed the significance of early treatment administration for MS and its association with slower disease progression and better late outcomes of the disease with regards to disability accumulation. However, according to current research results, both neuroinflammatory and neurodegenerative processes may exist prior to symptom initiation. Despite the fact that a significant proportion of individuals with radiologically isolated syndrome (RIS) progress to MS, currently, there is no available treatment approved for RIS. Therefore, our idea of "early treatment administration" might be already late in some cases. In order to detect the individuals who will progress to MS, we need accurate biomarkers. In this review, we present notable research results regarding the underlying pathology of MS, as well as several potentially useful laboratory and neuroimaging biomarkers for the identification of high-risk individuals with RIS for developing MS. This review aims to raise clinicians' awareness regarding "subclinical" MS, enrich their understanding of MS pathology, and familiarize them with several potential biomarkers that are currently under investigation and might be used in clinical practice in the future for the identification of individuals with RIS at high risk for conversion to definite MS. [ABSTRACT FROM AUTHOR]

Background: It has been reported that mid-regional proadrenomedullin (MR-proADM) could be considered a useful tool to stratify the mortality risk in COVID-19 patients upon admission to the emergency department (ED). During the COVID-19 outbreak, computed tomography (CT) scans were widely used for their excellent sensitivity in diagnosing pneumonia associated with SARS-CoV-2 infection. However, the possible role of CT score in the risk stratification of COVID-19 patients upon admission to the ED is still unclear. Aim: The main objective of this study was to assess if the association of the CT findings alone or together with MR-proADM results could ameliorate the prediction of in-hospital mortality of COVID-19 patients at the triage. Moreover, the hypothesis that CT score and MR-proADM levels together could play a key role in predicting the correct clinical setting for these patients was also evaluated. Methods: Epidemiological, demographic, clinical, laboratory, and outcome data were assessed and analyzed from 265 consecutive patients admitted to the triage of the ED with a SARS-CoV-2 infection. Results and conclusions: The accuracy results by AUROC analysis and statistical analysis demonstrated that CT score is particularly effective, when utilized together with the MR-proADM level, in the risk stratification of COVID-19 patients admitted to the ED, thus helping the decision-making process of emergency physicians and optimizing the hospital resources. [ABSTRACT FROM AUTHOR]

The COVID-19 pandemic caused by SARS-CoV-2 has emerged as a major global public health concern. In November 2022, Guangzhou experienced a significant outbreak of Omicron. This study presents detailed epidemiological and laboratory data on Omicron infection in a general hospital in Guangzhou between December 1, 2022, and January 31, 2023. Out of the 55,296 individuals tested, 12,346 were found to be positive for Omicron. The highest prevalence of positive cases was observed in the 20 to 39 age group (24.6%), while the lowest was in children aged 0 to 9 years (1.42%). Females had a higher incidence of infection than males, accounting for 56.6% of cases. The peak time of Omicron infection varied across different populations. The viral load was higher in older adults and children infected with Omicron, indicating age-related differences. Spearman’s rank correlation analysis revealed positive correlations between Ct values and laboratory parameters in hospitalized patients with Omicron infection. These parameters included CRP (rs = 0.059, p = 0.009), PT (rs = 0.057, p = 0.009), INR (rs = 0.055, p = 0.013), AST (rs = 0.067, p = 0.002), LDH (rs = 0.078, p = 0.001), and BNP (rs = 0.063, p = 0.014). However, EO (Eosinophil, rs = −0.118, p

N-acetylcysteine (NAC) is used as a sports supplement for its ability to modulate exercise-induced oxidative damage through its antioxidant actions and maintenance of glutathione homeostasis, positioning NAC as a strategy to improve physical performance. We aimed to evaluate the current evidence on the benefits of NAC supplementation on physical performance and laboratory biomarkers in adult men. Using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, we systematically reviewed studies indexed in the Web of Science, Scopus, and PubMed to assess the effects of NAC on physical performance, laboratory biomarkers, and adverse effects in adult men. Original articles published up to 30 April 2023 with a controlled trial design comparing NAC supplementation with a control group were included. The modified McMaster Critical Review Form for Quantitative Studies was used as an assessment tool and the Cochrane Risk of Bias was applied. Of the 777 records identified in the search, 16 studies met the inclusion and exclusion criteria. Overall, most of the trials reported beneficial effects of NAC supplementation and no serious adverse events were reported. Participants supplemented with NAC showed significant improvements in exercise performance, antioxidant capacity, and glutathione homeostasis. However, there was no clear evidence of beneficial effects of NAC supplementation on haematological markers, inflammatory response, and muscle behaviour. NAC supplementation appears to be safe and may regulate glutathione homeostasis, have antioxidant effects, and improve exercise performance. However, further studies are needed to clarify the relevance of its use. [ABSTRACT FROM AUTHOR]

Abstract Background There is a knowledge gap of specific characteristics linked to disease severity of the different COVID-19 waves, especially in underserved populations. We compared the demographic and clinical factors associated with SARS-CoV-2-infected patients admitted to the intensive care unit (ICU) during the Omicron and Alpha waves. Methods An observational study comparing two COVID-19 waves was conducted in Brooklyn, NY. Twenty-seven ICU admitted patients with a positive COVID-19 test result during the period of November 1, 2021, to January 31, 2022, (“Omicron wave”) were compared to 271 COVID-19 patients who received ICU consults during the Alpha wave, the period from March 28, 2020, to April 30, 2020. Results The Omicron wave had a 55.6% mortality rate compared to a 67.2% mortality rate in the Alpha wave. For the non-survivors, there were more females (66.7%) in the Omicron wave, while the trend was reversed in the Alpha wave (38.5%). Most of the patients seen were Black (> 85%) in both waves. A bivariate comparison of the two waves found that patients in the Omicron wave had overall significantly lower ALT levels (p = 0.03) and higher monocyte % (p = 0.005) compared to the patients in the Alpha wave. In the multivariate analysis, adjusting for age and sex, increasing levels of HCO3- were significantly associated with reduced mortality in the Omicron wave (OR: 0.698; 95% CI: 0.516 – 0.945; p = 0.02). Also, multivariable analyses using both waves combined found that neutrophil % was significantly associated with increased mortality (OR: 1.05; 95% CI: 1.02 – 1.09; p = 0.006) while lymphocyte % was significantly associated with reduced mortality (OR: 0.946; 95% CI: 0.904 – 0.990; p = 0.018). Conclusions The COVID-19-positive ICU patients in the Omicron wave experienced less severe outcomes than those of the Alpha wave. In contrast to the Alpha variant, the Omicron variant exhibited enhanced infectivity and disease severity in females.

Most studies that explore the long-term effects of COVID-19 are based on subjectively reported symptoms, while laboratory-measured biomarkers are mainly examined in studies of relatively small cohorts. This study investigates the long-term effects of SARS-CoV-2 infection on common laboratory biomarkers. We utilized a retrospective cohort of SARS-CoV-2 infected individuals and rigorously matched controls based on demographic and clinical characteristics, examining 63 common laboratory biomarkers. Additional lab-specific cohorts were matched with an additional criterion of baseline biomarker values. Differences in biomarkers over a 12-month follow-up were analyzed using standardized mean difference-in-differences. The general cohort included 361,061 matched pairs, with 26M laboratory results. The effects on most biomarkers lasted 1–4 months and were consistent with anticipated changes after acute viral infections. Some biomarkers presented prolonged effects, consistent across the general and lab-specific cohorts. One group of such findings included a 7–8 month decrease in WBC counts, mainly driven by decreased counts of neutrophils, monocytes, and basophils. Potassium levels were decreased for 3–5 months. Vaccinated individuals' data suggested potentially smaller effects on WBCs, but cohort sizes limited this analysis. This study explores SARS-CoV-2 infection effects on common laboratory biomarkers, characterizing the direction and duration of these effects on the largest infected cohort to date. The effects of most biomarkers resolve in the first months following infection. The most notable longer-lasting effects involved the immune system. Further research is required to characterize the magnitude of these effects among specific individuals. • Largest infected cohort for SARS-CoV-2's long-term biomarker effects study. • Unveils prolonged immune changes and potassium decrease post SARS-CoV-2 infection. • Objective evidence for the quick resolution of most laboratory abnormalities following SARS-CoV-2 infection. • Identifies population-level biomarkers associated with SARS-CoV-2 infection tendency. [ABSTRACT FROM AUTHOR]

COVID-19 has rapidly evolved since it was first discovered in December 2019. We aimed to retrospectively review our experience with COVID-19 infection across 2020–2022, focusing on differences in laboratory markers at presentation. Consecutive adult patients admitted to hospital with confirmed COVID-19 infection were retrospectively reviewed across three periods (29/3/2020–29/9/2020, 16/8/2021–13/10/2021 and 1/1/2022–31/1/2022), correlating with the lineages B.1.338, Delta (B.1.617.2) and Omicron (B.1.1.159), respectively. Laboratory findings of the first requested blood test within 24 h of presentation were recorded and correlated with patient outcome. The primary outcome was requirement for oxygen therapy at any point. Inflammatory markers, namely serum ferritin, lactate dehydrogenase (LDH), C-reactive protein (CRP) were significantly lower on presentation during 2022 compared to 2021, corresponding to a milder disease course. More than 80% of 2022 patients had received 2 or more vaccine doses and fully vaccinated patients displayed significantly lower inflammatory markers at presentation. Using 2022 data, a multivariate prediction model was constructed to predict for oxygen requirement, with c-statistic 0.86. Patients in 2022, corresponding with the Omicron variant, displayed a milder disease course, even in hospitalised patients, with the majority not requiring oxygen and lower inflammatory markers. We constructed a simple-to-use risk prediction model with c-statistic 0.86 which may identify individuals who can be safely managed as outpatients in the era of highly transmissible variants. [ABSTRACT FROM AUTHOR]

Objectives/Background: Since the outbreak of COVID-19, healthcare professionals suggested a wide range of recommendations in the fields of diagnosis, treatment, and prevention. Laboratory biomarkers are considered one of the crucial diagnostic tools for COVID-19, assessing its severity and progress predictor. Owing to the lack of consensus regarding changes in biomarkers and their correlations, researchers are encouraged to detect more interesting findings. A few studies were conducted in Iraq considering this aspect. This study aimed to investigate certain biomarkers in patients with severe COVID-19 and their relations to mortality outcomes. Also, this study aimed to identify the correlation between these markers in severe disease. Patients and Methods: A cross-sectional study was conducted at the Fallujah Teaching Hospital, west of Iraq, which included all admittance with severe COVID-19 between September 20, 2021, and February 30, 2022. A questionnaire was designed to collect socio-clinical characteristics and in-hospital outcomes (recovery/death). Procalcitonin (PCT) and certain biomarkers were analyzed, based on that outcome, and correlations between these markers were assessed. Results: For 75 patients who were enrolled in this study, the mean age was 62.3 ± 14.3 years, of which females constituted 62%. The most preponderance age was ≥60 years with a statistically significant higher rate of death (37.3%) when compared to other ages (P = 0.007), while other socio-clinical characteristics revealed nonsignificant differences. High PCT levels were found in 34.7% of the enrolled patients, while neutrophilia, lymphopenia, and elevated levels of troponin, ferritin, and C-reactive protein (CRP) were the prominent abnormal biomarker findings. However, only ferritin and troponin mean levels revealed significant differences in relation to the outcomes (P = 0.019 and 0.010, respectively). A moderate positive correlation was found between PCT and interleukin-6 (IL-6) (r = 0.586, P = 0.005), and also PCT correlates positively with CRP (r = 0.49, P = 0.005) and troponin (r = 0.41, P = 0.001). Additionally, there were significant positive correlations of troponin with IL-6 (r = 0.41, P = 0.005) and PCT (r = 0.37, P = 0.001). Also, IL-6 correlates positively with troponin (r = 0.62, P = 0.005). Conclusions: We found an elevated level of PCT in almost three-quarters of patients with severe COVID-19, with a non-significant difference with the specific recovery/death outcomes. In addition, high troponin levels, neutrophilia, and lymphopenia regardless of the outcome were found. Also, there were valuable correlations between certain biomarkers in patients with COVID-19. [ABSTRACT FROM AUTHOR]

Background: There is a knowledge gap of specific characteristics linked to disease severity of the different COVID-19 waves, especially in underserved populations. We compared the demographic and clinical factors associated with SARS-CoV-2-infected patients admitted to the intensive care unit (ICU) during the Omicron and Alpha waves. Methods: An observational study comparing two COVID-19 waves was conducted in Brooklyn, NY. Twenty-seven ICU admitted patients with a positive COVID-19 test result during the period of November 1, 2021, to January 31, 2022, ("Omicron wave") were compared to 271 COVID-19 patients who received ICU consults during the Alpha wave, the period from March 28, 2020, to April 30, 2020. Results: The Omicron wave had a 55.6% mortality rate compared to a 67.2% mortality rate in the Alpha wave. For the non-survivors, there were more females (66.7%) in the Omicron wave, while the trend was reversed in the Alpha wave (38.5%). Most of the patients seen were Black (> 85%) in both waves. A bivariate comparison of the two waves found that patients in the Omicron wave had overall significantly lower ALT levels (p = 0.03) and higher monocyte % (p = 0.005) compared to the patients in the Alpha wave. In the multivariate analysis, adjusting for age and sex, increasing levels of HCO3- were significantly associated with reduced mortality in the Omicron wave (OR: 0.698; 95% CI: 0.516 – 0.945; p = 0.02). Also, multivariable analyses using both waves combined found that neutrophil % was significantly associated with increased mortality (OR: 1.05; 95% CI: 1.02 – 1.09; p = 0.006) while lymphocyte % was significantly associated with reduced mortality (OR: 0.946; 95% CI: 0.904 – 0.990; p = 0.018). Conclusions: The COVID-19-positive ICU patients in the Omicron wave experienced less severe outcomes than those of the Alpha wave. In contrast to the Alpha variant, the Omicron variant exhibited enhanced infectivity and disease severity in females. [ABSTRACT FROM AUTHOR]

Background: Inflammatory processes activated by rapid viral replication of SARS-CoV-2 can play a key role in the pathogenesis of multiple organ damage and be responsible for the COVID-19 patients' dramatic outcomes and common abnormal laboratory findings. The aim of this study was to assess the correlation between various laboratory biomarkers, ferritin/transferrin ratio (FTR) and receiver operating characteristic (ROC) analysis in monitoring COVID-19 patients. Methods: This observational study was conducted in three groups: healthy participants, non COVID-19 patients with COVID-19-like clinical signs, and COVID-19 patients (severe and non-severe). Biochemical (CRP, ferritin, transferrin and albumin) and hematological (WBC, lymphocytes) parameters were assessed by automated methods. Moreover, FTR and NLR markers were calculated in the three groups mentioned. Statistical analyses were done using R (version 4.1.0). ROC curve was used to validate the predictive value of parameters. Results: The COVID-19 positive group had significantly higher NEU, CRP, ferritin, FTR values, while it's WBC, absolute counts of lymphocytes and albumin were significantly lower compared to the non-COVID-19 patients (p < 0.001). Serum ferritin and FTR level of the severe group was significantly higher than that of the non-severe group (p = 0.006 and (p = 0.011, respectively). The strongest correlation in all subjects showed between lymphocytopenia and increased NEU (r = -0.99, p < 0.001). The AUC values of WBC (0.95), lymphocytes (0.89), NEU (0.88), and NLR (0.88) were higher than CRP (0.64) or Ferritin (0.81). Conclusions: We recommend using FTR, WBC, and NLR changes as simple, useful, and inexpensive indicators in early detection of COVID-19 patients. [ABSTRACT FROM AUTHOR]

Introduction: We aimed to define specific reference intervals (RIs) for 11 biomarkers including inflammatory and oxidative stress biomarkers, liver, and renal function tests in a healthy Iranian adult population for the first time. Methods: CLSI Ep28‐A3 guidelines were then used to calculate accurate age‐ and sex‐ as well as body mass index (BMI)‐specific RIs. Results: RIs for studied biomarkers showed no significant age and sex‐specific differences, except for uric acid, which had higher concentrations in men when compared to women. Additionally, after partitioning the participants based on the BMI with a cutoff point of 25 kg/m2, only the levels of hs‐CRP were positively associated with higher BMI (RI for BMI>25: 0.51–7.85 mg/L and for BMI<25: 0.40–4.46 mg/L). RI for PAB and anti‐hsp‐27 were reported 4.69–155.36 HK and 0.01–0.70 OD in men and women aged 35–65 years old. Conclusion: Partitioning by sex and BMI was only required for uric acid and hs‐CRP, respectively, while other biomarkers required no partitioning. These results can be expected to valuably contribute to improve laboratory test result interpretation in adults for improved monitoring of various diseases in the Iranian population. [ABSTRACT FROM AUTHOR]

Cardiogenic shock is a state of reduced cardiac output leading to hypotension, pulmonary congestion, and hypoperfusion of tissues and vital organs. Despite the advances in intensive care over the last years, the morbidity and mortality of patients remain high. The available studies of patients with cardiogenic shock suggest a connection between clinical variables, the level of biomarkers, the results of imaging investigations, strategies of management and the outcome of this group of patients. The management of patients with cardiogenic shock initially complicating acute myocardial infarction is challenging, and the number of studies in this area is growing fast. The purpose of this review is to summarize the currently available evidence on cardiogenic shock initially complicating acute myocardial infarction with particular attention to predictors of prognosis, focusing on laboratory variables (established and new), and to discuss the practical implementation. Currently available scoring systems developed during the past few decades predict the clinical outcome of this group of patients using some of the established biomarkers among other variables. With the new laboratory biomarkers that have shown their predictive value in cardiogenic shock outcomes, a new design of scoring systems would be of interest. Identifying high-risk patients offers the opportunity for early decision-making. [ABSTRACT FROM AUTHOR]

The development of clinical laboratory diagnostics is in line with the evidence-based medicine, which requires that clinical decisions have to be based on diagnostic methods with proven informativity. This creates a request for the scientific validity of the use of laboratory researches and application of probabilistic interpretation tools corresponding to the tasks. The concept of indefiniteness (analytical, biological and clinical) is at the heart of interpretation of laboratory results. The inclusion of laboratory research in clinical guidelines, the choice and appointment of this research to the patient should not be made from the position of ideas about increasing or decreasing the laboratory index in the disease, but on the basis of its scientifically proven characteristics as a laboratory biomarker sensitivity, specificity, predictive value, as well as the relationship with certain clinical events, outcomes, risks. These characteristics are probabilistic and can be defined.

In recent years, the number of cases with severe Plasmodium vivax malaria has shown an increasing trend. It is, therefore, important to identify routine laboratory markers that best characterize the acute disease phase and can serve as a tool for clinical follow-up of patients. In a cohort study, we followed 87 patients with acute P. vivax monoinfection acquired in an endemic region of the Brazilian Amazon. Forty-two different biochemical and hematological parameters frequently tested in clinical routine were evaluated at the acute phase and the convalescent phase. A total of 42 laboratory tests were performed: biochemical parameters measured were serum lipids levels, aminotransferases, bilirubin, amylase, glucose, urea, creatinine, albumin, globulin, uric acid, C-reactive protein, and alpha-1-acid glycoprotein. Hematological parameters included total and differential white blood cell and platelet counts, hemoglobin concentration, mean platelet volume, platelet width distribution, and plateletcrit. Our results show that several biochemical and hematological parameters were associated with acute phase P. vivax malaria and these parameters reverted to normal values in the convalescent phase. The use of these parameters during diagnosis and follow-up of the infection is a useful clinical tool to evaluate the clinical course and therapeutic response of patients with uncomplicated vivax malaria.

The article reviews the literature data on the problem of connective tissue dysplasia and attempts to clarify it's role in the mechanisms of herniogenesis in the anterior abdominal wall. Hernia carriers are presented as patients with systemic pathology of the connective tissue, which made it possible to reinterpret the high frequency of occurrence among them comorbid hernial defects of chronic multiorgan and polysystem disorders and present a range of possible complications during the early and late postoperative period. The questions about the need for a more accurate diagnosis of external and visceral signs of connective tissue dysplasia in hernias according to accepted diagnostic schemes are considered. The possibilities and results of histological and laboratory methods of verifying the level of severity of undifferentiated connective tissue pathology were studied. Generalized experience of methods of surgical treatment of external abdominal hernia, considering the presence of connective tissue among dysplasia patients.

Cardiogenic shock is a state of reduced cardiac output leading to hypotension, pulmonary congestion, and hypoperfusion of tissues and vital organs. Despite the advances in intensive care over the last years, the morbidity and mortality of patients remain high. The available studies of patients with cardiogenic shock suggest a connection between clinical variables, the level of biomarkers, the results of imaging investigations, strategies of management and the outcome of this group of patients. The management of patients with cardiogenic shock initially complicating acute myocardial infarction is challenging, and the number of studies in this area is growing fast. The purpose of this review is to summarize the currently available evidence on cardiogenic shock initially complicating acute myocardial infarction with particular attention to predictors of prognosis, focusing on laboratory variables (established and new), and to discuss the practical implementation. Currently available scoring systems developed during the past few decades predict the clinical outcome of this group of patients using some of the established biomarkers among other variables. With the new laboratory biomarkers that have shown their predictive value in cardiogenic shock outcomes, a new design of scoring systems would be of interest. Identifying high-risk patients offers the opportunity for early decision-making.

Although congestion is considered to be the main reason for hospital admission in patients with acute heart failure, a simplistic view considering idro saline retention and total body volume accumulation did not provide convincing data. Clinical congestion occurrence is often the tip of the iceberg of several different mechanisms ranging from increased filling pressure to extravascular fluid accumulation and blood flow redistribution. Therefore, the clinical evaluation is often restricted to a simple physical examination including few and inaccurate signs and symptoms. This superficial approach has led to contradictory data and patients have not been evaluated according to a more realistic clinical scenario. The integration with new diagnostic ultrasonographic and laboratory tools would substantially improve these weaknesses. Indeed, congestion could be assessed by following the most recognized HF subtypes including primitive cardiac defect, presence of right ventricular dysfunction, and organ perfusion. Moreover, there is a tremendous gap regarding the interchangeable concept of fluid retention and redistribution used with a univocal meaning. Overall, congestion assessment should be revised, considering it as either central, peripheral, or both. In this review, we aim to provide different evidence regarding the concept of congestion starting from the most recognized pathophysiological mechanisms of AHF decompensation. We highlight the fact that a better knowledge of congestion is a challenge for future investigation and it could lead to significant advances in HF treatment. [ABSTRACT FROM AUTHOR]

Introduction. Acute leukemias treatment requires strong chemotherapy. Patients that develop bone marrow aplasia become immunocompromised, thus becoming liable to bacterial and fungal infections. Fungal infections caused by Candida are frequent. Hepatosplenic candidiasis (HSC) is a frequent consequence of invasive candidiasis which is clinically presented with prolonged febrility unresponsive to antibiotics. Case Outline. A 53-year-old patient with acute myeloid leukemia was submitted to standard chemotherapy “3+7” regimen (daunoblastine 80 mg i.v. on days 1 to 3, cytarabine 2Ч170 mg i.v. during 7 days) and achieved complete remission. However, during remission he developed febrility unresponsive to antibiotics. Computerised tomography (CT) of the abdomen showed multiple hypodense lesions within the liver and spleen. Haemocultures on fungi were negative. However, seroconversion of biomarkers for invasive fungal infection (IFI) (Candida and Aspergillus antigen/Ag and antibody/Ab) indicated possible HSC. Only high positivity of anti-Candida IgG antibodies, positivity of mannan and CT finding we regarded sufficient for the diagnosis and antimycotic therapy. Three months of treatment with different antimycotics were necessary for complete disappearance of both clinical symptoms and CT findings. Conclusion. In patients with prolonged febrile neutropenia IFI has to be strongly suspected. If imaging techniques show multiple hypodense lesions within liver and spleen, HSC has to be taken seriously into consideration. We believe that, along with CT finding, positive laboratory Candida biomarkers (mannan and IgG antibodies) should be considered sufficient for “probable HSC” and commencement of antifungal therapy, which must be long enough, i.e. until complete disappearance of clinical symptoms and CT findings are achieved. [Projekat Ministarstva nauke Republike Srbije, br. OI 175034]

Significant progress in treating immunoinflammatory rheumatic diseases (RD) is related to the design of a novel family of drugs, genetically engineered (GE) drugs. Molecular and cellular biomarkers (antibodies, indicators of acute inflammation, cytokines, chemokines, growth factors, endothelial activation markers, immunoglobulins, cryoglobulins, T- and B-cell subpopulations, products of bone and cartilage metabolism, genetic and metabolic markers) that allow one to conduct immunological monitoring and prediction of the effectiveness of RD therapy using tumor necrosis factor α inhibitors (infliximab, adalimumab, golimumab, etanercept), anti-B-cell drugs (rituximab, belimumab), interleukin-6 receptor antagonist (tocilizumab), and T-cell costimulation blocker (abatacept) have been detected in blood, synovial fluid, urine, and bioptates of the affected tissues. In addition to the conventional uniplex immunodiagnostics techniques, multiplex analysis of marker, which is based on genetic, transcriptomic and proteomic technologies using DNA and protein microarrays, polymerase chain reaction, and flow cytometry, is becoming increasingly widespread. The search for and validation of immunological predictors of the effective response to GE drug therapy make it possible to optimize and reduce the cost of therapy using these drugs in future.

Since the outbreak of the 2019 pandemic coronavirus disease (COVID-19), great attention has been given to identifying the main clinical features of the disease. Identification of laboratory parameters able to classify patients based on their risk is mandatory to improve their clinical management. We retrospectively evaluated twenty-six laboratory tests measured in COVID-19 positive patients admitted to the hospital in March and April 2020 to find any correlation between their changes and the risk of death. We divided them into surviving and non-surviving patients. A total of 1587 patients were recruited, 854 males with median age of 71 (IQR 56-81) and 733 females with median age of 77 (IQR 61-87). On admission, death was found to be positively correlated with age (p=0.001), but not with sex (p=0.640) or with hospitalization in days (p=0.827). Brain natriuretic peptide (BNP), creatinine, C-reactive protein (CRP), INR, leukocyte count, lymphocyte count, neutrophil count, and procalcitonin (PCT) demonstrated a statistically significant difference between the two groups (p<0.001), suggesting their role as markers of disease severity; only lymphocyte count resulted as an independent risk factor for death.

Nutrition Bio-shield Superfood (NBS) is an organic and viable herbal supplement that could improve the function of the immune system. The present study aims to determine the effect of NBS on disease severity and laboratory biomarkers in patients with COVID-19. This current study was a randomized, comparative, parallel two-arm and single-blind clinical trial study performed in Tehran, Iran. In total, 70 patients with COVID-19 were included in the present study and assigned to two groups including 1) intervention group (n = 35) and 2) control group (n = 35). All patients included in the intervention group received 4.5 gr daily rate of NBS superfood, three times the daily rate of 1.5 gr for 14 days. In contrast, patients included in the control group received a placebo three times a day for 14 days. The measurement of laboratory parameters including CRP, ESR, D-Dimer, LDH, CPK, SGOT, SGPT, ALP, FBG, WBC count, PLT, and lymphocyte count was performed using standard kits and methods. Moreover, all serum samples were tested to determine the levels of IL-6 and TNF-ɑ using specific commercially available ELISA kits according to the instructions of the manufacturer. A significant decrease in the mean serum level of several variables including CRP (p < 0.001), ESR (p < 0.001), D- Dimer (p = 0.001), LDH (p < 0.001), SGOT (p = 0.002), SGPT (p = 0.019), ALP (p < 0.001), WBC count (p < 0.001), body temperature (p = 0.013), IL-6 (p < 0.001), and TNF-α (p < 0.001) was seen 14 days after intervention from baseline in the intervention group than control group. In contrast, in the intervention group, the significant increase from baseline of lymphocyte percentage (p < 0.001) and oxygen saturation (p < 0.001) was seen 14 days after receiving NBS superfood than the control group. Results showed that the use of NBS superfood had various beneficial effects on COVID-19 disease severity. These results suggest that NBS superfood can be used as an effective natural supplement in the treatment process of COVID-19 disease. • NBS is an organic, healthy and viable herbal supplement that was prepared from wheat. • NBS has various health benefits and may be used as a good therapeutic target in patients with COVID-19. • NBS reduced the serum level of CRP, ESR, D- Dimer, LDH, SGOT, SGPT, ALP, WBC count, IL-6, and TNF-α in COVID-19 patients. • NBS increased the lymphocyte percentage, lymphocyte count, and oxygen saturation in COVID-19 patients. • NBS superfood reduced the mortality rate and duration of hospitalization in COVID-19 patients. [ABSTRACT FROM AUTHOR]

Rheumatoid arthritis (RA) is a common autoimmune disease in which heterogeneous course and different pathogenic mechanisms are implicated in chronic inflammation and joint destruction. Despite diagnostic contribution of anti-citrullinated protein/peptide antibodies (ACPAs) and rheumatoid factors, about one-third of RA patients remain seronegative. ACPAs belong to a heterogeneous family of autoantibodies targeting citrullinated proteins including myelin-basic protein, several histone proteins, filaggrin and fibrin, fibrinogen or vimentin. In addition to ACPAs, antibodies directed against other posttranslationally modified - carbamylated proteins (anti-CarP) were detected in up to 30% of ACPA-negative patients. Using phage display technology, further autoantibodies were recently discovered as candidate biomarkers for seronegative RA patients. Furthermore, in clinical practice, ultrasound may reveal subclinical synovitis and radiographically undetected bone erosions. To improve diagnostic certainty in undifferentiated arthritis and seronegative patients, ultrasound imaging and several new biomarkers may help to identify at risk patients and those with early disease. In this commentary we summarize recent advances in joint ultrasound and future potential of serological biomarkers to improve diagnosis of RA. [ABSTRACT FROM AUTHOR]

Background: The metabolic syndrome (MS) is a clustering of cardiovascular risk. The high prevalence of metabolic syndrome among populations of lower socioeconomic status is a cause of concern and calls for an effective public health response. Objectives: The aim of this study was to determine the prevalence of metabolic syndrome in the Roma population compared with the non-Roma population in the eastern part of Slovakia and to determine the parameter which has the strongest association with metabolic syndrome. Results: 123 Roma and 79 non-Roma patients with metabolic syndrome were evaluated. In the subgroup of Roma men, we found that waist circumference conferred the highest chance of MS (more than 12-times), followed by triglycerides (TG) (3.670-times). In the subgroup of non-Roma men, we found that waist circumference conferred the highest chance of MS (more than 16-times), followed by high-density lipoprotein (HDL) (4.348-times increased risk per one unit decrease in HDL). In the subgroup of Roma women as well as non-Roma women, we found that serum TG conferred the highest chance of MS, followed by waist circumference for Roma women. Comparing non-classical risk factors for MS we found that only age (with OR 1.977) and high-sensitivity C-reactive protein (hsCRP) (OR 1.887) were significant and independent predictors of MS in Roma men. Among Roma women apolipoprotein B100 was also found to be an independent predictor of MS, besides age and hsCRP. Conclusion: Our study confirmed that the prevalence of metabolic syndrome is strongly associated with hypertriglyceridemic waist, besides other risk factors, a marker of the atherogenic metabolic triad among younger Roma population, which may be the reason for the increased cardiovascular (CV) morbidity and mortality in elderly Roma compared with non-Roma. In light of these results, better prevention of CV events for Roma minority settlements in Slovakia should be provided. [ABSTRACT FROM AUTHOR]

The diagnostic approach to acute coronary syndromes (ACS) remains one of the most difficult and controversial challenges facing emergency physicians. In recent years, cardiac troponins have emerged as the biochemical "gold standard" for diagnosis of patients with acute chest pain, enhancing our ability to recognize ACS. Early diagnosis and treatment of myocardial ischemia improve patient outcomes, but conventional markers are often nondiagnostic at the time of arrival at the emergency department. Promising new biomarkers, which appear earlier after the onset of ischemia, are being studied and integrated into clinical practice. Some are markers of myocyte necrosis, but others, including ischemia-modified albumin and natriuretic peptides, detect myocardial ischemia and myocardial dysfunction. The aim of the present article is to review the diagnostic approach to ACS, focusing on recent literature describing novel biochemical markers. If ongoing and future studies confirm their role in probability-based models risk assessment, a new era in the diagnostic approach to ACS may be dawning. [ABSTRACT FROM AUTHOR]

Inborn errors of metabolism (IEM) are a diverse collection of abnormalities that cause a variety of morbidities and mortality in children and are classified as uncommon genetic diseases. Early and accurate detection of the condition can save a patient's life. By aiding families as they navigate the experience of having a child with an IEM, healthcare practitioners have the chance to reduce the burden of negative emotional consequences. New therapeutic techniques, such as enzyme replacement and small chemical therapies, organ transplantation, and cellular and gene-based therapies using whole-genome sequencing, have become available in addition to traditional medical intake and cofactor treatments. In the realm of metabolic medicine and metabolomics, the twentyfirst century is an exciting time to be alive. The availability of metabolomics and genomic analysis has led to the identification of a slew of novel diseases. Due to the rarity of individual illnesses, obtaining high-quality data for these treatments in clinical trials and real-world settings has proven difficult. Guidelines produced using standardized techniques have helped enhance treatment delivery and clinical outcomes over time. This article gives a comprehensive description of IEM and how to diagnose it in patients who have developed clinical signs early or late. The appropriate use of standard laboratory outcomes in the preliminary patient assessment is also emphasized that can aid in the ordering of specific laboratory tests to confirm a suspected diagnosis, in addition, to begin treatment as soon as possible in a resource limiting setting where genomic analysis or newborn screening facility is not available., (Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.net.)

Understanding mechanisms of inducible antigen-specific tolerance will improve immunotherapy and reveal the most relevant biomarkers for objectively measuring response to immunotherapy in clinical trials and routine practice. Various physiological and laboratory parameters are proposed as biomarkers of an immunological response to vaccines, although their surrogacy for clinical end points is unproven. Examples of physiological biomarkers include suppression of allergen-induced earlyand late-phase responses. Laboratory biomarkers include increases in bioactive allergen-specific IgG and IgA levels and T-cell interleukin (IL)-10 production. There is a continuing unmet need for biomarkers that will allow prediction of treatment efficacy and assist in monitoring the response after starting therapy or postwithdrawal. [ABSTRACT FROM AUTHOR]

Background: Circulating cell-free tumor DNA (cfDNA) is of crucial interest in oncology. cfDNA constitutes a potential prognostic and therapeutic marker for different solid tumors and can be used in the diagnostic and therapeutic management of cancer patients for which nowadays there are no valid laboratory markers. In the present study, the quality and quantity of the cfDNA were assessed by different quantification procedures, in order to identify the potential applications of these techniques in the preliminary cfDNA quantification., Methods: Qubit with single (ss) and double strand (ds) DNA assay kits, NanoDrop and quantitative Real Time PCR (qPCR), were adopted to assess the cfDNA in the blood samples of 18 melanoma patients, 67 prostate cancer patients and 15 healthy controls., Results: The quantification by NanoDrop (average value 8.48ng/μl, 95% confidence limit (CL)=7.23-9.73), Qubit ssDNA (average value 23.08ng/μl, CL=19.88-26.28), dsDNA (average value 4.32ng/μl, CL=3.52-5.12) assay kits and qPCR (average value 0.39ng/μl, CL=0.31-0.47) revealed differences among the four procedures. Qubit 2.0 ss-DNA kit gave higher cfDNA concentration values for all the samples analyzed. In detail, Qubit ssDNA assay revealed higher sensitivity in the quantification of small amounts of pure ss-DNA and ds-DNA, while NanoDrop allowed the assessment of the purity of cfDNA samples., Conclusions: The NanoDrop and Qubit 2.0 measurements were analyzed in order to define their correlation with qPCR cfDNA assessment, showing good correlation values with the qPCR that should be considered the "gold standard". In our proposal, the sequential combination of NanoDrop and Qubit ssDNA methods should be adopted for a cost-effective preliminary assessment of total circulating cfDNA in melanoma and prostate cancer patients, and only discordant values should undergo qPCR assessment., (Copyright © 2018 Elsevier B.V. All rights reserved.)

Autoantibodies can help clinicians to allow early detection of autoimmune diseases and their clinical manifestations, to determine effective monitoring of prognosis and the treatment response. From this point, they have a high impact in rheumatic disease management. When used carefully they allow rapid diagnosis and appropriate treatment. However, as they may be present in healthy population they may cause confusion for interpreting the situation. False positive test results may lead to wrong treatment and unnecessary anxiety for patients. Autoantibody positivity alone does not make a diagnosis. Similarly, the absence of autoantibodies alone does not exclude diagnosis. The success of the test is closely related to sensitivity, specificity and likelihood ratios. So, interpretation of these is very important for a proper laboratory evaluation. In conclusion, in spite of the remarkable advances in science and technology, a deeply investigated anamnesis and comprehensive physical examination still continue to be the best diagnostic method. The most correct approach is that clinicians apply laboratory tests to confirm or exclude preliminary diagnosis based on anamnesis and physical examination. This review will discuss these issues., Competing Interests: Conflict-of-interest statement: All authors declare no potential conflicts of interests for this paper and no financial support.