Eosinophilia in the absence of allergies, asthma, drug reactions, parasitic infections and connective tissue diseases can be eosinophilic clonal disorders, lymphoma or myeloproliferative disorders.
Hypereosinophilia with the persistence of eosinophils ≥1500 /mm³ in blood or more than 20% of eosinophils in the bone marrow may be observed in many reactive or clonal disorders, the result of which is invasion of organs and the secretion of granules and multi-organ failure. For a patient with hypereosinophilia, reactive causes such as allergies, asthma, medications, infections, autoimmune disorders, or solid tissue tumors should be investigated. If reactive causes are not found, primary eosinophilia should be considered.
According to the WHO revision 2016, FISH or RT-PCR for FIPIL1-PDGFRA fusion and cytogenetic and FISH for gene rearrangements on chromosomes 4q12 (PDGFRA), 5q31-33 (PDGFRB), 8p11-12 (FGFR1) and 9P24 (Jak2) are essential.
Chronic eosinophilic leukemia is considered in the presence of ≥1.5 × 109/L absolute eosinophil count. These patients should lack myeloproliferative family genetic markers (such as t (9;22) and Jak2, CARL and CMPL mutations) and also lack myeloid/lymphoid genetic rearrangements associated with eosinophilia (including PDGFRA, PDGFRB and FGFR1).

While fungal infections of the CNS are relatively rare, they have become more common with the increasing number of individuals who are immunocompromised due to HIV/AIDS, immunosuppressive therapies, invasive diagnosis and treatment methods, and organ transplants. CNS fungal infections present many diagnostic and therapeutic challenges and are associated with a high mortality rate. Cryptococcal meningoencephalitis is the most common of these infections and usually affects patients with uncontrolled HIV infection.
While immunocompromised patients are the most susceptible to CNS fungal infections, they can also occur in immunocompetent patients undergoing invasive procedures such as neurosurgery and in patients exposed to contaminated devices or drugs. In addition, heavy exposure to fungi in endemic regions can lead to infection in immunocompetent individuals.
CNS infection due to Cryptococcus species is most often caused by Cryptococcus neoformans, with C gattii as a less common cause, and often arises from a primary lung infection. Meningoencephalitis is a typical feature of Cryptococcus infection of the CNS. Common signs and symptoms include headache, nausea, vomiting, altered mental status, impaired vision, and 6th nerve palsy. In patients with uncontrolled HIV infection, symptoms might be absent or subtle before initiation of antiretroviral therapy.
Candida-related CNS infections are usually caused by Candida albicans, arise from hematogenous spread, and present with overt meningitis. These cases may involve chronic meningitis, brain abscesses, vasculitis with cerebral infarctions, spinal infections, ventriculitis, and mycotic aneurysms.
Candida meningitis and meningoencephalitis are uncommon. Infection can be secondary to hematogenous dissemination or direct inoculation. Neurosurgery, recent antibiotics, and corticosteroids are predisposing factors. Fever, meningismus, elevated CSF pressures, and localizing neurologic signs are commonly noted. Delays in diagnosis, hypoglycorrhachia, intracranial hypertension, and focal neurological deficits are associated with a poor prognosis. Clinical manifestations of ventriculoperitoneal shunt-associated candidiasis include hydrocephalus, fever, meningoencephalitis, and abdominal symptoms. The cerebrospinal fluid may show a neutrophilic pleocytosis that is indistinguishable from bacterial meningitis or a predominance of lymphocytes. Ideally the diagnosis of infection is established by repeated cultures from both the indwelling device and lumbar puncture. Candida meningitis may be subacute, presenting with fever and headache of several weeks’ duration and lymphocytic pleocytosis. Neurological manifestations can range from normal examination to signs of brain infarcts or hydrocephalus. Infection may also present as intense granulomatous and necrotizing basal meningitis with cranial neuropathies or basilar artery thrombosis and resultant brainstem and temporo-occipital infarction.
Hematogenous Candida meningoencephalitis is frequently associated with systemic candidiasis in very low birth weight neonates. The initial clinical features are indistinguishable from those of other systemic infections in neonates.
In CNS, Candida invades small blood vessels, causing thrombosis and infarction. Disseminated granulomatous lesions may be scattered throughout the meninges and brain, causing meningitis or focal encephalitis. Candida meningitis can occur spontaneously, as a complication of disseminated candidiasis, or as a complication of an infected wound or ventriculostomies via direct inoculation of the organism into the CNS. At autopsy, gross lesions may not be apparent. Microscopically, multiple microabscesses, small macroabscesses, and microgranulomas in the distribution of anterior and middle cerebral vessels are found. The abscesses are composed of neutrophils, lymphocytes, and macrophages that evolve to a granuloma after a week. On histology, they are faintly basophilic when stained with H&E but are intensely stained with PAS and methenamine silver reaction.

Clinical laboratories as a one of the health care organizations are facing permanently different crises, events, and pandemics. These factors can bring their working conditions with many stressors and shocks. Clinical laboratories should be prepared to confront and accountable to crises, by implementing resilience system. Therefore, this research was aimed to explain the resilience system in clinical laboratories.

Conceptual literature review was conducted to explain and identify the resilience components in this research. Using the keywords such as resilience, health care organizations and clinical laboratories, and utilization of Persian and English data bases in a period of 2000 to 2022, 110 research and literature references selected and used in this study.

The resilience is the combination of flexibility, agility and compatibility with environmental conditions which categorized into individual, social, organizational, and ecological types at the time of occurrence of crises, disasters, and pandemics. As yet, a few researches conducted about how to establish resilience system in clinical laboratories. The results of these researches presented components of resilience system in clinical laboratories including prevention of infrastructures, planning, efficient management and leadership, available resources, application of requirements and guidelines, redesign of buildings, cultivation, self-confidence, staff training, equipment supply chain management, accountability, and social responsibilities.

Implementation and development of common strategic approach in health care system about organizational resilience, and explanation and introduction of related criterias and indices, along with exact and appropriate planning, effective resilience system in clinical laboratories may be designed and implemented, so that cascading effects of defects and challenges in other health care sections that impressed directly and indirectly clinical laboratories practices could be controlled effectively.

Microbiota is a collection of microorganisms that live in the oral cavity, respiratory tract and intestine of multicellular organisms. Microbiota exerts numerous physiological and pathological effects on the organism in which it resides. Increasing attention has been directed to the host-microbiota interaction, which is highly relevant to the development of carcinogenesis. Changes in the composition of the microbiota along with dysbiosis have provided an unbalanced digestive habitat for the microbiota, which causes the production of abnormal metabolites. Adenomatous polyps are a common symptom of colorectal cancer, the second leading cause of cancer-related deaths worldwide. Understanding the relationship between gut microbiota composition and colon adenomatous polyps may be a non-invasive tool for effective diagnosis as well as reducing health care costs. In this review article, we try to briefly examine the relationship between intestinal microbiota and adenomatous polyps.

Bladder cancer is among the ten most common cancers and the ten main causes of cancer-related deaths in the world. Currently, bladder tumors are diagnosed and followed up using a combination of cystoscopy and cytology. In addition, bladder cancer often recurs and can progress if not closely monitored after initial treatment. Constant monitoring of the patient with cystoscopy, which is an invasive procedure, has made bladder cancer a costly disease. While cancer biomarkers provide an opportunity for earlier and more accurate diagnosis of tumors. The present study aims to investigate measurable biomarkers in bladder cancer patients, which help in the timely diagnosis of the disease with high sensitivity and specificity. Based on available studies, among the diagnostic biomarkers of bladder cancer, BTA, ImmunoCyt, NMP22, and Urovision have been approved by the FDA and can be used for early diagnosis, screening, and monitoring of bladder cancer patients. Some of these biomarkers are also measured in Iran.

Alzheimer's disease is a progressive neurological disorder that causes the brain to shrink (atrophy) and brain cells die.
Alzheimer's disease is the most common cause of dementia and causes a decrease in thinking skills and social behaviors. Alzheimer's disease is more common in people over 65 years old. The risk of developing Alzheimer's disease and other types of dementia increases with age, and it is estimated that 1 in 14 people over the age of 65 and 1 in 6 people over the age of 80 will develop it. But about 1 in 20 people with Alzheimer's are under 65 years old. This is called early-onset or young-onset Alzheimer's disease. Approximately 5.8 million people in the United States age 65 and older are living with Alzheimer's disease. Of these, 80 percent are 75 years old and older. Of the approximately 50 million people with dementia worldwide, between 60 and 70 percent have Alzheimer's disease.
Alzheimer's disease is a progressive and neurodegenerative disease. The two main forms of this disease are early-onset (familial) and late-onset (disseminated) disease. Which is very rare and accounts for less than 5% of patients and is inherited in a Mendelian dominant manner and is caused by mutations in three APP, PSEN1 and PSEN2 genes. A late-onset disease that is common among people over 65 years of age. The heritability of this form of the disease is high (79%), and is caused by a combination of genetic and environmental factors. A large number of genes are involved in the development of late-onset Alzheimer's disease. Examples that have been confirmed by multiple studies include ABCA7, APOE, BIN1, CD2AP, CD33, CLU, CR1, EPHA1, MS4A4A/MS4A4E/MS4A6E, PICALM, and SORL1. Finding the remaining genetic factors involved in the development of late-onset Alzheimer's disease has the potential to provide new targets for treatment and prevention, leading to the development of effective strategies to combat this devastating disease.