فصلنامه آزمایشگاه و تشخیص
پیاپی 66 (زمستان 1403)

Thalassemia syndromes are one of well known hereditary hemolytic diseases and in terms of classification, it has been based on clinical and hematological indicators and abnormal biochemical findings, and in this regard, it creates confusing situations and requires a deep laboratory approach and analysis. And in terms of screening in high-prevalence communities, it requires precise and specific diagnostic algorithms that depend on factors such as race, consanguineous marriages, migrations, prevalence in malaria-prone areas, and the accuracy of laboratory techniques. Accurate interpretation of test results and definitive diagnosis of carriers and the borderline results due to technical diagnosis limitation and forbidden of termination of pregnancy due to legal and religious reason. marriage of carrier couples sometimes creates confusion for health center consultants and hematology specialists.
Many families are unable to meet the annual cost of about $ 3,200 for children with thalassemia. Therefore, this disease not only affects the family but also affects the health budget of high-prevalence countries. Therefore, preventing the birth of new cases is a priority in high-prevalence countries.
Genetic counseling, carrier screening, prenatal diagnosis, and termination of pregnancy of affected fetuses are included in these programs.
Accordingly, the National Committee for Prenatal Diagnosis of the Ministry of Health has issued guidelines for health center consultants to identify high-risk carrier couples and refer them to the relevant laboratories, and on the other hand, it evaluates the network laboratories by creating EQA programs.
In the following study, several challenging cases of suspected carrier couples are examined, with the hope that over time, as network laboratories encounter such challenging cases share and report these cases to the National Committee for Prenatal Diagnosis of the Ministry of Health, along with long-term follow-up of the children born to these families, the aforementioned committee's guidelines will be updated so that, in addition to observing professional ethics and legal considerations, the least financial and emotional pressure is placed on the family, society, consulting physicians, and laboratories providing these services.

Acute kidney injury (AKI) is a serious condition in critically ill newborns, marked by a sudden decline in kidney function. Traditionally, it is diagnosed using serum creatinine (Scr) levels, but Scr is not sensitive enough for early detection. This highlights the urgent need for more reliable biomarkers. This study explores kidney injury molecule-1 (KIM-1) as a potential early indicator of AKI in neonates receiving intensive care.

This systematic review and meta-analysis adhered to PRISMA and Cochrane guidelines. A systematic search was conducted in databases such as PubMed, Scopus, and Web of Science, along with Google Scholar, using keywords and MeSH terms related to “KIM-1,” “Neonates,” and “AKI.” Two independent investigators performed searches and data extraction, resolving conflicts with a third author. The inclusion criteria focused on observational studies evaluating KIM-1 for AKI diagnosis in critically ill neonates, while exclusions encompassed reviews, animal studies, conference papers, book chapters, letters, trials, studies lacking a control group, and adult studies. Study quality was appraised using the Newcastle-Ottawa Scale, and heterogeneity was determined via I² statistics. Findings were reported as weighted mean differences (WMDs) and pooled area under the curve (AUC) with 95% confidence intervals (CI). Statistical analyses were performed using Stata 14.2.

Out of 201 studies, 186 were excluded (114 duplicates, 72 irrelevant). In the end, 14 studies (10 case-control and 4 cohort studies) met the criteria for inclusion. The total sample consisted of 675 critically ill neonates, of whom 283 (42%) had AKI and 392 (58%) were in the control group. KIM-1 levels were significantly higher in neonates with AKI compared to those without (WMD = 0.91; 95% CI = 0.05-1.77; I² = 95.7%; Z = 2.07; P = 0.038). The pooled AUC was 0.72 (95% CI = 0.64-0.80; I² = 0%), indicating a moderate ability of KIM-1 to distinguish between AKI and non-AKI cases.

These findings suggest that KIM-1 could be a promising biomarker for the early detection of AKI in critically ill neonates, offering a potential improvement over traditional diagnostic methods.

Fungal urinary tract infection usually means urinary tract infection caused by Candida species with special attention to Candida albicans as the major fungal infectious agent. Fungi are pathogenic agents that can also cause disseminated infections involving the kidneys. Besides Candida, other agents, such as Cryptococcus spp., can cause urinary tract infections. Non-yeast fungi, like some members of the Aspergillus, Mucorales, Blastomyces, and Histoplasma families, can also cause infections, especially among immunocompromised patients. The detection and identification of fungi in urine samples (by microscopy and culture) plays an essential role in the diagnosis of fungal UTI. Leukocyturia is a cardinal sign of urinary tract infections caused both by bacteria or fungi and also is a key sign of the immune response occurring in the urinary tract when the organism faces an UTI. This work explains the urinary findings and clinical picture of patients with fungal UTI caused by Candida spp. and some aspects related to the immune response in fungal UTI, in addition to urinalysis perspectives in this clinical condition. The finding of candiduria in a patient with or without symptoms should be neither dismissed nor hastily treated, but requires a careful evaluation, which should proceed in a logical fashion. Symptoms of Candida pyelonephritis, cystitis, prostatitis, or epididymo-orchitis are little different from those of the same infections produced by other pathogens. Candiduria occurring in critically ill patients should initially be regarded as a marker for the possibility of invasive candidiasis. The first step in evaluation is to verify funguria by repeating the urinalysis and urine culture. Pyuria is a nonspecific finding; the morphology of the offending yeast may allow separation of Candida glabrata from other species. Candida casts in the urine are indicative of renal candidiasis but are rarely seen. With respect to culture, colony counts have not proved to be diagnostically useful. In symptomatic or critically ill patients with candiduria, ultrasonography of the kidneys and collecting systems is the preferred initial study. However, computed tomography is better able to discern pyelonephritis or perinephric abscess. The role of magnetic resonance imaging and renal scintigraphy is ill defined, and prudent physicians should consult with colleagues in the departments of radiology and urology to determine the optimal studies in candiduric patients who require in-depth evaluation.

Cardiovascular diseases are the most important cause of death worldwide. Acute coronary syndrome (ACS) is the most common heart disease caused by atherosclerosis and plaque formation in the coronary arteries. ACS causes a wide range of disorders from unstable angina to myocardial infarction. The increasing prevalence of ACS has increased the need for effective diagnostic and prognostic tools to recognize these diseases. Today, biomarkers have become an important tool in ACS diagnosis, risk assessment, and prognosis. The most important of these markers are cardiac troponins I and T. The sensitive methods of measuring these two markers have caused great progress in diagnosing ACS. However, challenges related to standardization and interpretation of results still exist.  In addition to cardiac troponins, creatine kinase MB, hormonal markers, and inflammatory markers have also been considered. The advantages and disadvantages of these markers are discussed in this article.

Managers and leaders of clinical laboratories in Iran need vital ability and skills for effective communication. They should use effective communication process effectively. There are several important application for using effective communication, for examples establishment of team works, direction and support for laboratories’ staffs along with improvement of organizational culture and climate.

This was a scoping review conducted by 84 articles with added 16 papers totally 100 references. The papers selected using data bases including PubMed, Scopous, Science Direct, Emerald from 2001 to 2023 by Medical laboratory, Clinical laboratory, effective Communication, Information and Communication Technology as keywords, searched alone and in combination with Boolean operators AND and OR.

The findings presented in a especial scope including formal and non-formal communication, electronic messengers, and social media, using appropriate information and communication technology in clinical laboratory work media, the main challenges and concerns regarding privacy protection and organizational productivity in electronic communications system, the impact of information and communication technology on development and promotion of Iranian healthcare system especially clinical laboratories, training of a skill enhancement among clinical laboratories staffs, and finally promotion of infrastructures of ICT in medical laboratory system for development and facilitating of effective communication between, patients, physicians, clinical laboratories directors and scientists regarding their increase of proactive role in Iranian health care system.

Various factors play a role in developing effective communication in clinical laboratories. Managers and leaders of these organizations can significantly contribute by creating organizational transparency, institutionalizing ethical values, engaging and interacting with staff, taking responsibility, and developing appropriate communication programs, training communication skills, and ultimately strengthening the infrastructure to improve information and communication management in clinical laboratories. This, in turn, can facilitate effective communication between patients, doctors, and medical laboratory specialists and enhance their advocacy role in the health system.

The first step in genetic experiments is usually the extraction of high-quality DNA. In 1869, Friedrich Miescher discovered DNA during a study on cellular composition, isolating it from leukocytes and naming it "nuclein." In 1958, Meselson and Stahl introduced a standard DNA extraction method using density gradient centrifugation on E. coli samples. Subsequently, DNA extraction techniques were refined for various biological sources.

DNA extraction methods are classified into two main categories: physical and chemical. Physical methods involve sample grinding, while chemical methods rely on materials such as cultured cells, which can be lysed easily. Commercial kits have simplified the DNA extraction process from sources such as white blood cells, hair, bones, saliva, nails, skin, and other nucleated cells, increasing both speed and precision.

DNA analysis is crucial for determining demographic and genetic characteristics and identifying unidentified individuals. Recent advancements in DNA analysis have made this technology more accessible, enabling archaeologists, anthropologists, and forensic experts to extract reliable genetic data from ancient remains.

This paper aims to explore the application of laboratory DNA extraction methods in archaeology. Technological advancements and the use of commercial kits have facilitated DNA extraction from ancient remains, playing a significant role in archaeological research and related scientific fields.