Medical Laboratory Journal

Diagnostic value of polarized optical microscopy in pseudogout: A review of calcium pyrophosphate deposition disease in the clinical laboratory

Mohammadreza Sheikh Sajjadieh

Background: Pseudogout, also known as calcium pyrophosphate deposition (CPPD) disease, is a common but often underdiagnosed crystal-induced arthropathy. It occurs when CPPD crystals deposit in articular cartilage and synovial fluid. Because its clinical manifestations often mimic gout or septic arthritis, accurate differentiation is essential for appropriate patient management. Recognition of the unique pathophysiology and crystal morphology of pseudogout is therefore critical for laboratory diagnosis.
Methods: This narrative review summarizes and integrates findings from selected, well-established sources to provide clinical and laboratory perspectives, highlight best practices, and identify areas requiring standardization. The existing evidence regarding the diagnostic application of polarized optical microscopy (POM) in pseudogout was evaluated. Key themes include the principles of POM, optimal specimen collection and handling, techniques for accurate crystal identification, and recommended laboratory workflow practices. Additionally, the review discusses factors that influence diagnostic accuracy, such as technician proficiency and the use of standardized microscopic evaluation protocols.
Results: The findings indicate that polarized light microscopy remains the gold standard for identifying CPPD crystals. Rhomboid-shaped crystals exhibiting weakly positive birefringence are characteristic of pseudogout and allow reliable differentiation from monosodium urate crystals observed in gout. Proper specimen preparation - particularly timely examination of fresh synovial fluid - and adherence to standardized microscopy practices significantly enhance diagnostic yield. In addition, targeted technician training in crystal recognition improves interobserver consistency and reduces misclassification.
Conclusion: Polarized light microscopy is an indispensable tool for the accurate laboratory diagnosis of pseudogout. Increasing awareness of crystal morphology, improving specimen-handling practices, and investing in consistent technician training can substantially enhance diagnostic accuracy. Standardizing the use of POM across clinical laboratories will support earlier detection and improved clinical management of pseudogout.

Identification of Candida species isolated from clinical samples by matrix-assisted laser desorption ionization time-of-flight mass spectrometry (MALDI-TOF MS) analysis

Beena Antony

Background: Candida species are responsible for substantial morbidity and mortality among susceptible populations. Contemporary epidemiological data indicate a noticeable shift in infection trends away from Candida albicans (C. albicans) toward non-albicans Candida (NAC) species. The primary objectives of this research were therefore to identify the prevalent Candida species and to assess the efficacy of matrix-assisted laser desorption ionization time-of-flight mass spectrometry (MALDI-TOF MS) for the identification of these species.
Methods: The standard protocol was employed for processing all routine clinical samples submitted to the bacteriology and mycology departments. Identification of Candida species isolated from diverse clinical specimens was performed using MALDI-TOF MS between September 2022 and November 2023. Subsequently, these findings were recorded in tables and subjected to statistical analysis.
Results: During the study period, a total of 342 Candida species were isolated. Patients diagnosed with candidiasis had a median age of 46.5 years and exhibited a male predominance. NAC species were the most frequently isolated group, with Candida tropicalis (C. tropicalis) (30.40%) as the most common species, followed by Candida parapsilosis (C. parapsilosis) (14.32%). Furthermore, 40 strains of Candida auris (C. auris) were identified over the 15-month duration of the study (11.69%).
Conclusion: The significance of Candida species, encompassing both NAC and novel, emerging drug-resistant strains, necessitates a cautious approach. Compared to conventional and automated systems that rely on biochemical reactions for the speciation of Candida isolates, MALDI-TOF MS offers a potentially advantageous alternative due to its rapid and accurate results.

Hidden risks: Fresh vegetable contamination with parasitic helminths

Arshad Mohammad Abdullah

Background: Vegetables and fruits are an important part of human nutrition and are consumed daily. Consumption of contaminated vegetables and fruits can sometimes cause health problems and facilitate the transmission of many intestinal parasites. This study aimed to determine the presence and percentage of helminths in commonly consumed vegetables in Duhok city, Iraq.
Methods: Sample collection for this study was conducted from June 2021 to August 2021 in different parts of the city. A total of one hundred twenty-six samples of lettuce, coriander, pepper, dill, radish, and parsley were collected, and all samples were examined microscopically for the detection of parasites.
Results: In this study, 15.9% of vegetables were found to be contaminated with parasitic helminths, with no significant difference between contaminated and non-contaminated samples (P-value: 0.628). Three species of helminths were identified in the collected samples at different percentages, including 7.9% Ascaris lumbricoides, 6.3% Enterobius vermicularis, and 2.4% Hymenolepis nana. Parsley was recorded as the most contaminated vegetable (23.8%), followed by lettuce (20%), while pepper showed the lowest contamination rate (4.8%).
Conclusion: This study demonstrated that vegetables were contaminated with helminths at moderate levels, which may play an important role in human infection through the consumption of contaminated vegetables.

Prevalence of cytogenetic and electrophoretic abnormalities in patients suspected of multiple myeloma

Jaya Kumari S

Background: Multiple myeloma (MM) is a blood cancer characterized by the uncontrolled growth of plasma cells in the bone marrow. It typically develops from monoclonal gammopathy of undetermined significance (MGUS), which can progress to smoldering myeloma and eventually to symptomatic disease. Diagnosis is primarily established using serum protein electrophoresis (SPEP), immunofixation electrophoresis (IFE), and free light chain (FLC) testing. Additionally, fluorescence in situ hybridization (FISH) plays a crucial role in identifying genetic abnormalities that influence disease course and prognosis. This study aims to evaluate the prevalence of electrophoretic and genetic abnormalities among patients referred for serum protein electrophoresis, with a focus on cytogenetic abnormalities detected by FISH in confirmed MM cases.
Methods: Samples received for SPEP from 2017 to 2023 were analysed. Patients with abnormalities on electrophoresis (Such as distortions or M-spikes) underwent further evaluation, including immunofixation, free light chain assays, bone marrow examination, and other hematologic investigations. Confirmed MM cases were referred for FISH analysis to identify common cytogenetic abnormalities.
Results: Out of 800 patients with electrophoretic abnormalities, 100 were confirmed to have multiple myeloma. FISH analysis was available for 68 of these cases, and cytogenetic abnormalities were detected in 67.6% of patients. The most common abnormalities were IGH break-apart (54.5%), followed by p53 deletion (23.5%), t (4; 14) (14.7%), t (14cvzaQ; 20) (7.4%), monosomy 13 (5.9%), and monosomy 14 (4.4%).
Conclusion: A majority of MM patients showed abnormalities on FISH, with IGH break-apart being the most frequently detected. These cytogenetic abnormalities provide valuable prognostic information and can help guide treatment decisions. This study emphasizes the importance of routine cytogenetic profiling in MM to optimize therapeutic outcomes. Molecular cytogenetic techniques, especially FISH, are essential tools in the evaluation of suspected multiple myeloma. They play a pivotal role in detecting genetic abnormalities, guiding treatment strategies, and ultimately improving patient outcomes.

Pacemaker pocket infection due to Mycobacterium abscessus subspecies abscessus: A Case Report and Literature Review

Sujatha Sistla

Background: Mycobacterium abscessus is a rapidly growing non-tuberculous mycobacterium that can cause various infections in humans. The identification of nontuberculous mycobacteria remains a challenge to date due to the availability of limited resources. There have been reports of device-related infections caused by these bacteria. Improper care of cardiac implants can give rise to infections that need to be identified promptly. This report emphasizes the need for early and prompt diagnosis of non-tuberculous mycobacterial infections.
Case Report: Here, we present a case of a 69-year-old man who presented with an atrioventricular block and therefore underwent pacemaker implantation. The implant became infected with Mycobacterium abscessus, which resolved after appropriate treatment and pacemaker removal.
Conclusion: Non-tuberculous mycobacteria must be promptly identified and treated for the appropriate duration to prevent complications associated with them.

Investigation of the frequency and antimicrobial susceptibility patterns of bacteria isolated from blood cultures in Khorramabad in 2018

Somayeh Delfani

Background: The widespread increase in the prevalence of antibiotic resistance in bacteria is considered one of the biggest problems in the global health and treatment system today. Therefore, this study was conducted to investigate the prevalence and antibiotic resistance pattern of bacteria isolated from blood cultures at Shahid Rahimi Hospital in Khorramabad in 2018.
Methods: This cross-sectional study investigated blood cultures of patients admitted to Shahid Rahimi Hospital from June to December 2018. The disc diffusion method was used according to CLSI instructions, and the data were analyzed using SPSS software.
Results: Out of a total of 2591 blood culture samples, 247 blood culture samples were positive. The highest frequency was related to the emergency department (62%) and ICU (23%), and the lowest frequency was related to the children's department (2.4%). Among the tested samples, 28% were Gram-negative bacilli and 72% were Gram-positive cocci. The most common Gram-negative and Gram-positive bacteria were Escherichia coli (38%) and Staphylococcus epidermidis (54.2%), respectively. Among Gram-negative bacteria, the highest level of resistance was seen in Acinetobacter baumannii strains, which showed resistance to all antibiotics. Among Gram-positive bacteria, the highest resistance of Streptococcus group D strains to the antibiotic erythromycin (92%) was reported.
Conclusion: The prevalence of antibiotic resistance in common microorganisms isolated from blood cultures in different departments is worrying, and choosing an effective drug to eliminate these bacteria by performing accurate laboratory tests is of particular importance.

Preliminary phytochemical screening and antitrichomonal activity of Ferula pseudalliacea

Mohammad Matini

Background: Trichomonas vaginalis (T. vaginalis) causes human trichomoniasis, a common type of protozoan vaginitis. Due to the increasing incidence of drug-resistant trichomoniasis, new pharmacological research is needed. The aim was to investigate the activity of Ferula pseudalliacea (F. pseudalliacea) against T. vaginalis and to perform a preliminary phytochemical analysis of its extracts.
Methods: Essential oil and various extracts of F. pseudalliacea roots, including n-hexane, ethyl acetate, and methanol, were obtained. Susceptibility testing of the plant products was performed on five T. vaginalis isolates using the microtiter plate method. Minimum lethal concentration (MLC) and growth inhibitory percent (GI%) of sub-MLC concentrations were reported after 24- and 48-hour exposures. Phytochemical screening of the extracts was carried out using a standard procedure.
Results: The antitrichomonal effect of the plant products depended on time and concentration, with the greatest effect observed after 48 hours of exposure. The essential oil and n-hexane extract of F. pseudalliacea demonstrated remarkable activity with MLC of 250 µg/ml, followed by the ethyl acetate (MLC=500 µg/ml) and methanol extract (MLC=1000 µg/ml), with GI% 92.8, 50.6, 85.2, and 42.8, respectively. The bioactive constituents of the extracts were coumarins, terpenoids, steroids, phenols, tannins, and glycosides.
Conclusion: The results of this study demonstrated in vitro antitrichomonal properties of F. pseudalliacea. Therefore, further studies are needed to investigate the potential antitrichomonal activity of its bioactive constituents.

Investigating the role of miR-30c in modulating γ-secretase activity: Implications for Alzheimer’s disease

Rasoul Sharifi

Background: Alzheimer’s disease (AD), the most common form of dementia, affects millions of people worldwide. Clinical trials using anti-Aβ antibodies demonstrate that amyloid plaque removal in early-stage AD can slow disease progression. Along with β-secretase, γ-secretase plays a role in cleaving amyloid precursor protein (APP). The aim of this study was to use computational docking to identify molecules that can activate γ-secretase.
Methods: Initially, the targets of hsa-miR-30c-5p were assessed using the TargetScanHuman server. The structure of γ-secretase was prepared in Chimera by removing non-standard residues and water molecules. Adjacent amino acids to the cholesterol ligand were then identified using PyMOL. The 3D structure and SMILES notation for cholesterol were obtained from PubChem. Docking results in pdbqt format were analyzed using Discovery Studio, LigPlus+, and PDBsum, with LigPlus+ focusing on protein subunit interactions.
Results: The TargetScanHuman server indicated that γ-secretase is a target of hsa-miR-30c-5p. Drug-like properties (Solubility, tumorigenicity, LogP, toxicity) of compounds were predicted using tools such as SwissTargetPrediction, PASS-Way2Drug, and SwissADME, following Lipinski’s Rule of Five. Amino acids Trp227, Leu192, Arg186, Leu199, Leu203, Leu206, Tyr155, Leu215, Phe162, Ser223, and Ile230, located on the γ-secretase C subunit, were analyzed for interactions using LigPlot after AutoDock Vina docking and Chimera visualization.
Conclusion: These in silico findings suggest cholesterin acetate as a potential activator of γ-secretase; further experimental validation is warranted.

Effects of ethanolic extract of Artemisia Sieberi Besser on DNA glycation of glucose: Possible antidiabetic mechanism

Parisa Hasanein

Background: DNA glycation damages DNA by inducing strand breaks, mutations, and ultimately changes in gene expression, which is considered a main factor in the pathogenesis of diabetes and its complications. Therefore, antiglycation agents have become the focus of recent research for preventing and alleviating diabetes complications. According to the reported antidiabetic effects of Artemisia sieberi (A. sieberi) leaf extract, this study aimed to determine the effect of the ethanolic extract of A. sieberi on glucose-mediated DNA glycation for the first time.
Methods: DNA was incubated with glucose in the presence or absence of A. sieberi for 4 weeks. The inhibitory or facilitatory effects of A. sieberi on DNA structural changes were studied by various techniques. These techniques included UV–Vis, fluorescence spectroscopy, circular dichroism (CD), and agarose gel electrophoresis.
Results: The findings of UV–Vis and fluorescence spectroscopy showed that A. sieberi decreased DNA-AGE (Advanced glycation end products) formation. Based on the CD and agarose gel electrophoresis results, the structural changes of glycated DNA were decreased in the presence of A. sieberi.
Conclusion: Thus, A. sieberi has beneficial effects against DNA glycation and could be a promising agent for ameliorating the adverse effects of glycation in the presence of glucose and in conditions of raised blood glucose, such as diabetes, after confirmation in further studies.

Comparison of anthropometric indicators, heart rate, lactate and lactate dehydrogenase of champion wrestlers of the province in three different age groups

Mohammad Bagher Nikzad

Background: Since the physiological and physical factors of the body may change due to wrestling, in this study, the effect of strenuous exercise was investigated in different age groups of wrestlers.
Methods: This semi-experimental study was conducted on 21 wrestling champions of Golestan province in three age groups, including teenagers, young adults, and adults (7 people in each age group), using the availability sampling method. They performed strenuous exercise on a treadmill at a speed of 6 km per hour until exhaustion, and their biochemical and physical factors were measured before and after running.
Results: According to the results obtained from the research, although the heart rate of adult wrestlers was lower than that of teenagers and young adults before and after the activity and the concentration of LDH and La was higher, based on the findings, intra-group and inter-group changes in anthropometric variables and HR (Heart rate), La (Blood lactate) and LDH (Lactate dehydrogenase) were not statistically significant in all three groups (p≤0.05).
Conclusion: The heart rate decreased with the increase in the age group, which may be due to long-term training adaptation. Also, the LDH concentration increased with the age group of the wrestlers, which may be due to the high number of fast-twitch fibers and the muscularity of this age group, although there was no significant difference between the indicators of the present research among the three groups.