فصلنامه آزمایشگاه و تشخیص
پیاپی 65 (پاییز 1403)

Idiopathic inflammatory myopathies (IIM) are a group of autoimmune diseases with shared proximal muscle weakness and inflammation. Muscle involvement is typically symmetric, proximal and can be present very mild to very sever. IIMs are categorized to dermatomyositis (DM), polymyositis (PM), inclusion body myopathy and immune- mediated necrotizing myopathy (IMNM). Electromyography, MRI and muscle biopsy are valuable methods to differentiate myopathies. Muscle biopsy is critical for the diagnosis of the different forms of IIM. In this regard, the presence of perifascicular atrophy is strongly suggestive of DM, whereas the finding of rimmed vacuoles in the appropriate context suggests IBM. Besides these, the presence of autoantibodies and elevated muscle enzymes is helpful in the diagnosis of myositis. The known autoantibodies are of most important in the context of myositis include anti-Jo-1, anti- SRP (signal recognition particle), anti- HMGCR (3- hydroxyl-3-methyl-glutaryl coenzyme A r

Hemoglobin A1c is the percentage of total hemoglobin that is bound to the NH3+ amino acid valine of the initial beta-globin chain during erythropoiesis and the 120-day lifespan of RBCs, and by removing the positive charge, it induces a negative charge and, as a result, its rapid movement in hemoglobin electrophoresis. The normal value of Hb-A1c is about 6%, and its increase is an indicator of diabetes, treatment monitoring, and the approximate blood sugar level of the patient over the past 3 months. Since in hemoglobinopathies, one or both beta chains may mutate to another globin, as a result, the amount of hemoglobin A decreases and is added to the variant hemoglobin, and thus the amount of Hb-A1c also decreases. In homozygous cases such as S/S, the amount of hemoglobin A and consequently Hb-A1c reaches zero and Hb-S1c is formed instead, which must be corrected when using HPLC and capillary electrophoresis. In this article, methods for correcting Hb-A1c with the above two methods, interfering factors, and alternative methods will be discussed.

Futurism is the Science and of investigation planning, encouraging and architecture of the future composed of two stages: forsighting and forcasting. The application of futurism in clinical laboratory system is forcasting of the future through different scenarios and creation of forcasting of the forward-looking approach the 2030 for attaining of clinical laboratory services providing. Therefore this research was aimed to analyze the trend of related indicators and their description of possible, probable and desired futures to 2030 for clinical laboratory system in Iran.

This was a realistic review study conducted using different data bases and google scholar search engine, and Persian and English keywords from 1990 to 2023. The references selected based on inclusion and exclusion criteria’s by futurism and clinical laboratory scientists. Generally, 1025 references extracted from data bases and finally 121 references selected for this research.

In this research, In the framework structural blocks including leadership and governance, sustainable financing, supplying human research, laboratory technology and instrument, laboratory information systems, providing of laboratory services, and internal and external factors, effective propulsions and solutions for attainment of the providing of laboratory services were determined and introduced. Also four futurism scenarios including optimistic, pessimistic, probable and desired for providing of Iranian clinical laboratory system were suggested.

we need strong political commitment of governments for overcoming challenges and creating a consensus between key stakeholders for attaining an optimal scenario to attain the clinical laboratory care and services in Iran. In this way. The developed process of futurism create a special potential for values and investment to deliver laboratory services if the environment will be controlled better.

Artificial intelligence has revolutionized the diagnosis, identification, and management of infectious diseases in clinical laboratory diagnostics. Techniques based on artificial intelligence enable faster, more accurate, and more comprehensive analysis of diverse data sources related to the diagnosis of infectious diseases. Machine learning models can be trained on structured data such as patient symptoms, laboratory test results, and demographic information to aid in disease diagnosis and risk prediction. Deep learning algorithms can analyze unstructured data such as digital microscope images, mass spectra, and genomic sequences to automatically identify pathogens. This article reviews and analyzes the applications of artificial intelligence in laboratory diagnostics, exploring how AI can increase the accuracy and efficiency of laboratory diagnoses and ultimately lead to improved patient outcomes.

Hemoglobin A1c is routinely used to diagnose diabetes and monitor treatment. Therefore, it is important to identify factors that interfere with the accuracy of HbA1c measurement. Hemoglobin (Hb) Wayne is a frameshift alpha chain variant that produces two isoforms termed Hb Wayne I and II. Although clinically silent, this variant can interfere with HbA1c measurement with high performance liquid chromatography methods. Hb Wayne isoforms co-elute with HbF and HbA1c peaks, leading to a falsely elevated HbA1c. A few cases have been reported in the literature that inaccurate HbA1c measurement due to presence of Hb Wayne resulted in diabetes misdiagnosis (ie., HbA1c results > 6.5%) and treatment.
To describe the effect of hemoglobin Wayne variant on hemoglobin A1c (A1c) accuracy and to stress the importance of patient-physician communication and trust.  We present the clinical history and laboratory findings of 5 patients, with a review of related literature.
Most heterogenous hemoglobinopathies are benign and clinically silent, and if not suspected as the cause of spuriously elevated A1c, can be easily missed, which may lead to misdiagnosis of DM. Some studies have suggested that the presence of hemoglobin variants should be considered as a differential when there are discrepancies in the A1c and blood glucose levels.  The central lesson from these cases goes beyond the science of hemoglobin testing. In every cases, we were presented with a patient who insisted that they were following their diabetic treatment plan appropriately and yet experienced hypoglycemic episodes.
These cases not only present this rare and interesting hemoglobin variant but also remind providers that A1c testing is susceptible to misinterpretation due to multiple interfering factors. Use of additional laboratory tests, such as fasting glucose, in combination with A1c could help avoid diagnostic errors. With the proper awareness and improved patient-physician communication, providers may avoid the mismanagement of diabetic as well as nondiabetic patients and avoid the risk of hypoglycemia through unnecessary antihyperglycemic medications.

 Since January 2020, the 2019 coronavirus pandemic (COVID-19) has put the majority of global health economic systems under strain. Acute respiratory syndrome coronavirus (SARS-CoV-2) is the cause of COVID-19, which affects several bodily systems and may produce severe acute respiratory and cardiac symptoms that can lead to patient death. The study's findings indicate that vitamin D3 is a potentially useful chemical for preventing, protecting against, and reducing covid-19 disease.

 Given the massive damage produced by COVID-19 to the immune system, there is a lot of interest in vitamin D's ability to alleviate or avoid detrimental immunological responses. Data sources and study selection PubMed, Embase, Clements, Bmj, and other databases were searched from March 26, 2011 to June 9, 2023, with eligibility criteria used to select studies using the search terms (cholecalciferol or ergocalciferol or vitamin D2 or vitamin D3 or vitamin D or 25OHD) and (SARS-CoV-2 or coronavirus or COVID or respiratory infection).
As a result, the goal of this review is to combine the information around vitamin D in connection to COVID-19 in order to evaluate the current consensus on vitamin D supplementation as a strategy to treat and/or prevent the start or progression of COVID-19.
In this article, we provide an overview of the state of knowledge in this topic, including major papers and systematic reviews published until now.

Findings of epidemiological studies: 

The findings of this research revealed that persons with vitamin D3 insufficiency had worse health outcomes and died from COVID-19. Higher vitamin D3 dosages may increase health and survival in the elderly and persons suffering from underlying disorders.

The biological impacts of vitamin D3 can protect and repair many body systems of people influenced by SARS-CoV-2. Vitamin D3 supplementation can potentially support the reduction of acute and long-term covid-19 disease.