Assessment of the Clinical Utility of the FilmArrayTM Gastrointestinal Panel for Detecting Gastrointestinal Pathogens.

BACKGROUND: Gastrointestinal infections present a significant public health concern as they lead to diverse clinical presentations and healthcare challenges. The rapid and accurate identification of causative pathogens is imperative for effective patient management. This study aimed to assess the clinical utility of the FilmArrayTM Gastrointestinal (GI) Panel for detecting gastrointestinal pathogens. METHODS: Between November 1, 2022, and December 31, 2023, we analysed gastrointestinal specimens collected from a cohort of patients aged 21 to 91 at Asia University Hospital. These specimens were analyzed using the FilmArrayTM GI Panel. RESULTS: The study included 76 patients for whom the FilmArrayTM GI assay was conducted, with 40 (52.6%) showing positive results. Among the positive specimens, 23 (57.5%) had a single pathogen, while the remaining 17 (42.5%) had multiple pathogens. The remaining 36 (47.4%) specimens showed no pathogens. The overall positivity rate of the specimens was 52.6%. The most frequently detected pathogens included Salmonella, Clostridium difficile (toxin A/B), and Enteropathogenic Escherichia coli (EPEC). CONCLUSIONS: This study underscores the clinical value of the FilmArrayTM GI assay as a rapid and reliable tool for diagnosing gastrointestinal infections. Its capacity to detect multiple pathogens simultaneously enhances diagnostic accuracy and gives information to use in clinical decision-making. We strongly recommend its integration into clinical practice to expedite the diagnosis and management of gastrointestinal infections, ultimately leading to improved patient care and healthcare efficiency.

Correlations of sST2 and Gal-3 with Cardiothoracic Ratio in Patients with Chronic Kidney Disease.

Chronic kidney disease (CKD) frequently correlates with cardiovascular complications. Soluble suppression of tumorigenicity 2 (sST2) and Galectin-3 (Gal-3) are emerging as cardiac markers with potential relevance in cardiovascular risk prediction. The cardiothoracic ratio (CTR), a metric easily obtainable from chest radiographs, has traditionally been used to assess cardiac size and the potential for cardiomegaly. Understanding the correlation between these cardiac markers and the cardiothoracic ratio (CTR) could provide valuable insights into the cardiovascular prognosis of CKD patients. This study aimed to explore the relationship between sST2, Gal-3, and the CTR in individuals with CKD. Plasma concentrations of sST2 and Gal-3 were assessed in a cohort of 123 CKD patients by enzyme-linked immunosorbent assay (ELISA). On a posterior-to-anterior chest X-ray view, the CTR was determined by comparing the widths of the heart to that of the thorax. The mean concentration of sST2 in the study participants ranged from 775.4 to 4475.6 pg/mL, and the mean concentration of Gal-3 ranged from 4.7 to 9796.0 ng/mL. Significant positive correlations were observed between sST2 and the CTR (r = 0.291, p < 0.001) and between Gal-3 and the CTR (r = 0.230, p < 0.01). Our findings indicate that elevated levels of sST2 and Gal-3 are associated with an increased CTR in CKD patients. This relationship may enable better cardiovascular risk evaluation for CKD patients. Further studies are warranted to explore the clinical implications of these associations.

Assessment of antibiotic resistance patterns in Central Taiwan during the COVID-19 pandemic: A retrospective study.

BACKGROUND: Antimicrobial resistance (AMR) is a growing worldwide public health issue due to the overuse and inappropriate use of antibiotics. AMR has been more prevalent during the coronavirus pandemic of 2019 (COVID-19) compared to previous periods. Therefore, this study was conducted to evaluate the AMR profile of common bacteria that were isolated for routine analysis during the pandemic of COVID-19 in Central Taiwan. The main goal of this study was to examine and analyze the AMR patterns both before and after the start of the COVID-19 pandemic. METHODS: We conducted a retrospective analysis of clinical samples collected from two different time periods: the 1-year period before the onset of the COVID-19 pandemic (January 2019 to December 2019) and the 2-year period following the start of the pandemic (September 2020 to September 2022). The data for this study were obtained from clinical records, and both bacterial identification and antibiotic susceptibility testing were performed using the Phoenix identification system. RESULTS: Among the 8152 bacterial isolates obtained during the study period from September 2020 to September 2022, 4022 (49.3%) were Escherichia coli, 1346 (16.5%) were Klebsiella pneumoniae, 1156 (14.2%) were Staphylococcus aureus, 887 (10.9%) were Pseudomonas aeruginosa, 376 (4.6%) were Enterococcus faecium, and 365 (4.5%) were Acinetobacter baumannii. The overall prevalence of resistant bacteria during the COVID-19 pandemic was as follows: vancomycin-resistant Enterococcus, 69%; carbapenem-resistant A. baumannii, 65%; methicillin-resistant S. aureus, 49%; carbapenem-resistant K. pneumoniae, 29%; carbapenem-resistant P. aeruginosa, 17%; and carbapenem-resistant E. coli, 2%. Carbapenem-resistant A. baumannii, vancomycin-resistant Enterococcus, carbapenem-resistant K. pneumoniae, and carbapenem-resistant E. coli increased by 19%, 10%, 2%, and 1%, respectively. On the other hand, carbapenem-resistant P. aeruginosa and methicillin-resistant S. aureus decreased by 6%, respectively. CONCLUSION: This study provides a comprehensive assessment of AMR during the COVID-19 pandemic in Central Taiwan. Understanding the prevalence of AMR is crucial for preventing infection and formulating disease prevention policies. Further research is warranted to elucidate the correlation between AMR and the severity of infection in COVID-19 patients.

Retrospective Analysis of Allergen Distribution Dynamics in Central Taiwan.

Introduction: Allergy is a type Ⅰ hypersensitivity reaction to certain substances (allergens) such as environmental factors, food and drugs. Allergies are a significant public health issue, and therefore, understanding the distribution patterns of allergens in specific regions is important. This study aimed to retrospectively analyse allergen distribution patterns in Central Taiwan over a 5 years period (2018-2022). Methods: Data of patients who had allergen sensitization testing using the OPTIGEN® Allergen-Specific IgE Assay from the 1st of January 2018 to the 31st of December 2022 were reviewed retrospectively. Statistical analyses were performed to determine the prevalence and distribution of allergens in our study population. Results: A total of 8,444 patients (3,784 males and 4,660 females) who attended the Asia University Hospital for allergen detection were enrolled in this study. Dermatophagoides farina (41.8%), Dermatophagoides pteronyssinus (37.9%), house dust (24.6%), cockroach mix (17.7%), crab (12.6%), clam (9.8%), shrimp (9.1%), cat dander (8.1%), pig weed (8%) and peanut (7.8%) were identified as the ten allergens that most commonly induced sensitization in our study population. Additionally, crab, clam, shrimp, peanut and beef were the five most common food allergens. Conclusion: In summary, our findings contribute significantly to the knowledge on allergen distribution in Central Taiwan. Our identification of prevalent allergens may contribute to an improved understanding of the epidemiology of allergies in this region.

Cardiac markers and cardiovascular disease in chronic kidney disease.

Cardiovascular disease (CVD) is prevalent in patients with chronic kidney disease (CKD) and it is responsible for approximately half of all CKD-related deaths. CVDs are the primary cause of death in hemodialysis patients due to major adverse cardiovascular events. Therefore, better approaches for differentiating chronic hemodialysis patients at higher cardiovascular risk will help physicians improve clinical outcomes. Hence, there is an urgent need to discover feasible and reliable cardiac biomarkers to improve diagnostic accuracy, reflect myocardial injury, and identify high-risk patients. Numerous biomarkers that have significant prognostic value with respect to adverse CVD outcomes in the setting of mild to severe CKD have been identified. Therefore, a better understanding of the positive clinical impact of cardiac biomarkers on CVD patient outcomes is an important step toward prevention and improving treatment in the future. In this review, we address the relationship between cardiovascular biomarkers and CKD treatment strategies to elucidate the underlying importance of these biomarkers to patient outcomes.

Performance Evaluation of the VIDAS® D-Dimer Exclusion™ II Assay and the Beckman Coulter D-Dimer Assay.

BACKGROUND: The breakdown of fibrinogen and fibrin during the process of fibrinolysis creates D-dimer. A D-dimer analysis is crucial for the diagnosis of pulmonary embolism, deep vein thrombosis, and disseminated intravascular coagulation. The aim of this study is to evaluate the validity of two different D-dimer assays. METHODS: To analyze the D-dimer, venous blood taken in a vacuette containing 3.2% sodium citrate was used. Peripheral whole blood specimens were collected from 89 subjects, and plasma was separated from these specimens. VIDAS® D-dimer Exclusion™ II and the Beckman Coulter D-dimer assays were used for the quantitative detection of D-dimer levels. The analytical performance of the two different D-dimer assays was compared. RESULTS: The plasma values of D-dimer ranged from 89.2 to 7,452.9 ng/mL (FEU) when tested on the VIDAS® platform and from 20 to 7,770 ng/mL (FEU) when tested on the Beckman Coulter platform. Our results showed that the agreement between the two methods was acceptable and Pearson's correlation coefficient (r) was 0.93 (p < 0.001). CONCLUSIONS: A high correlation exists between quantitative D-dimer measurements conducted with the VIDAS® D-dimer Exclusion™ II and the Beckman Coulter D-dimer assays.

Retrospective Study of Lower Respiratory Tract Infections in the Intensive Care Unit Detected by the FilmArray Pneumonia Panel.

BACKGROUND: Lower respiratory tract infections (LRIs) are an important public health concern and a leading cause of death from infection worldwide. The current study aims to evaluate the distribution of viral and bacterial pathogens in lower respiratory tract specimens. METHODS: Between April 2022 and December 2022, specimens from lower respiratory tract from patients aged between 37 and 85 years in an intensive care unit (ICU) of Asia University Hospital were analysed by the FilmArrayTM pneumonia panel (PP) assay. RESULTS: There were 54 patients for whom the FilmArrayTM PP assay was analysed, and 25 (46.3%) of them showed positive results. Among the 54 specimens, 12 (22.2%, 12/54) had a single pathogen, 13 (24.1%, 13/54) had multiple pathogens, and 29 (53.7%, 29/54) had no pathogens. The overall positive rate of the specimens was 46.3% (25/54). CONCLUSIONS: The FilmArrayTM PP assay may act as a feasible diagnostic tool for LRIs in ICUs.

Optimizing Blood Culture Volumes by Implementing PDCA Cycle Management.

BACKGROUND: The aim of this study was to optimize the mean volume of blood drawn by nurses to a level that is recommended by our hospital through the implementation of PDCA cycle management. The purpose of the current study was to match the mean volumes of blood drawn with the volume recommended by the manufacturer. METHODS: The adequacy of blood volume in a bottle of aerobic blood culture per venipuncture was evaluated for every month from January 2021 to March 2022 by using the Becton Dickinson BD blood volume monitoring system. Furthermore, the study compared changes in the mean blood volumes before and after the PDCA cycle management was implemented. RESULTS: The mean blood volumes calculated for Q1 2021 (January 2021 to March 2021) before the PDCA cycle management was 6.3 mL per culture bottle. After PDCA cycle management was implemented, the mean blood volumes for Q1 2022 (January 2022 to March 2022) were calculated as 8.6 mL (p < 0.01). In addition, the positive culture rate increased from 13% to 15%. CONCLUSIONS: Implementing the PDCA cycle management can improve the mean blood culture volumes effectively and match the volume recommended by the manufacturer. Additionally, our study indicated that a higher blood volume yielded a culture rate that was significantly positive.

Evaluation of Friedewald's Formula for Plasma LDL-Cholesterol Estimation.

BACKGROUND: Low-density lipoprotein cholesterol (LDL-C) can contribute to atherosclerosis if it is oxidized within the walls of arteries. Therefore, LDL-C plays an important role in cardiovascular disease risk assessment and prevention. The current study aims to evaluate the validity of Friedewald's formula in the Taiwanese population. METHODS: In this analytical cross-sectional study, a data set containing 31,729 results was used and lipid profiles of all samples were measured using the Beckman Coulter AU680 clinical chemistry analyzer. This study was conducted from September 2016 to August 2019. RESULTS: The agreement between the direct and calculated LDL-C was significant with Pearson's correlation coefficient (r) of 0.904 (p < 0.001). Mean LDL-C levels were 99.3 ± 32.8 mg/dL and 95.3 ± 37.6 mg/dL for direct and calculated LDC-C, respectively. CONCLUSIONS: Good agreement was observed between direct and calculated LDC-C. Therefore, it can be concluded that Friedewald's formula is applicable in LDL-C estimation when the direct method is not affordable.

High-Throughput and Automated Detection of HLA-B*27 Using the LabTurboTM AIO System.

The adoption of an automated system can decrease the hands-on time requirements in a clinical laboratory setting. For the detection of HLA-B*27, implementing a high-throughput and fully automated system has several advantages over using manual methods. Therefore, this study aimed to evaluate automation efficiency for the detection of HLA-B*27. Peripheral blood samples were obtained from 50 participants, and DNA was isolated from these samples. A Pharmigene PG27 detection kit was used for the qualitative detection of HLA-B*27. The performances of the semi-automated and fully automated LabTurboTM AIO systems in the detection of HLA-B*27 were compared. The mean absorbance (optical density) values for the MaelstromTM 8 and LabTurboTM AIO systems were found to be 1.88 and 1.9, respectively. The housekeeping gene was amplified and quantified using a real-time PCR assay across all DNA extracts to check the quality of the extracted human DNA. The results were expressed as the cycle threshold (Ct) values for all DNA extracts from both platforms. The mean Ct values for the Roche Cobas z480 and LabTurboTM AIO systems were found to be 22.7 and 20.4, respectively. This study demonstrated that the semi-automated method and the LabTurboTM AIO system yield consistent results for the detection of HLA-B*27. However, compared to the semi-automated method, the LabTurboTM AIO system provides standardized procedures, avoids manual handling, and improves turnaround time.

Interference of Blood Glucose Testing by an Increase in Serum IgM Levels.

BACKGROUND: An absurd result of plasma glucose test caused by increased serum IgM levels. METHODS: Serum immunoglobulin levels are determined by using an immunoturbidimetric assay. Additionally, serial dilutions were performed to assess the absurd results. RESULTS: Our results showed that an increase in serum IgM levels induces errors in the measurement of the plasma glucose level. CONCLUSIONS: This study simply presents a message that both medical technologists and physicians need to be aware of this because improper results of blood glucose levels may result in aggressive and invasive patient management. Additionally, physicians may be led to wrong interpretation due to false levels of glucose. In fact, we do not know how often this situation accidentally occurs in the laboratory. Therefore, all medical technologists must stay alert to absurd and unusual test results and reconfirm the reason for an absurd result.

Distribution of Viral Respiratory Infections during the COVID-19 Pandemic Using the FilmArray Respiratory Panel.

This study was conducted to evaluate the distribution of respiratory viral pathogens in the emergency department during the coronavirus disease 2019 (COVID-19) pandemic. Between May 2020 and September 2022, patients aged between 0.1 and 98 years arrived at the emergency department of Asia University Hospital, and samples from nasopharyngeal swabs were tested by the FilmArrayTM Respiratory Panel (RP). SARS-CoV-2 positivity was subsequently retested by the cobas Liat system. There were 804 patients for whom the FilmArrayTM RP was tested, and 225 (27.9%) of them had positive results for respiratory viruses. Rhinovirus/enterovirus was the most commonly detected pathogen, with 170 (61.8%) cases, followed by adenovirus with 38 (13.8%), SARS-CoV-2 with 16 (5.8%) cases, and coronavirus 229E, with 16 (5.8%) cases. SARS-CoV-2 PCR results were positive in 16 (5.8%) cases, and there were two coinfections of SARS-CoV-2 with adenovirus and rhinovirus/enterovirus. A total of 43 (5.3%) patients were coinfected; the most coinfection was adenovirus plus rhinovirus/enterovirus, which was detectable in 18 (41.9%) cases. No atypical pathogens were found in this study. Intriguingly, our results showed that there was prefect agreement between the detection of SARS-CoV-2 conducted with the cobas Liat SARS-CoV-2 and influenza A/B nucleic acid test and the FilmArrayTM RP. Therefore, the FilmArrayTM RP assay is a reliable and feasible method for the detection of SARS-CoV-2. In summary, FilmArrayTM RP significantly broadens our capability to detect multiple respiratory infections due to viruses and atypical bacteria. It provides a prompt evaluation of pathogens to enhance patient care and clinical selection strategies in emergency departments during the COVID-19 pandemic.

Transcriptome Profiling of Eutopic and Ectopic Endometrial Stromal Cells in Women with Endometriosis Based on High-Throughput Sequencing.

Endometriosis is a common gynecological disease that affects approximately 5-10% of reproductive-aged women. However, the etiology and pathophysiology of endometriosis are currently unclear. The objective of this study was to identify a potential pathogenic gene of endometriosis using RNA sequencing (RNA-seq) analysis. Human endometrial stromal cells were isolated from four patients receiving surgical treatment for endometriosis during laparoscopic surgery, and RNA-seq was used to examine differentially expressed genes (DEGs) in eutopic and ectopic endometrial stromal cells. The functional significance of the differentially expressed genes was analyzed using Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway enrichment analyses. A total of 1309 upregulated and 663 downregulated genes were identified through the analysis of the transcriptomes of eutopic and ectopic endometrial stromal cells. Furthermore, KEGG analysis indicated that these DEGs were mainly enriched in the PI3K-Akt signaling pathway, cytokine-cytokine receptor interaction, and MAPK signaling pathway. Our study identified differential gene expression in eutopic as compared to ectopic endometrial tissue stromal cells. We strongly believe that our findings can bring new insights into the underlying mechanisms of endometriosis. However, future research is necessary to clarify the roles of the identified genes.

Detection of the SARS-CoV-2 D614G Mutation Using VirSNiP SARS-CoV-2 Spike D614G Assay.

BACKGROUND: At the end of 2019, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) rapidly spread worldwide. Until recently, over 190 million cases and nearly four million deaths have been reported globally due to the virus. A point mutation in the SARS-CoV-2 spike protein, the D614G variant, was identified in late February 2020. Studies showed that the D614G mutation is related to higher infectivity. The current study was conducted to determine the validity of VirSNiP SARS-CoV-2 Spike D614G assay to detect the SARS-CoV-2 D614G mutation. METHODS: In this study, the detection of the SARS-CoV-2 D614G mutation was performed using VirSNiP SARS-CoV-2 Spike D614G assay (TIB Molbiol) and by Sanger sequencing. Two plasmids carrying A allele (wild-type) and G allele (mutant type) were designed using GenScript's OptimumGene gene design tool (GenScript Inc., Piscataway, NJ, USA). RESULTS: It was found that VirSNiP SARS-CoV-2 Spike D614G assay could detect the SARS-CoV-2 D614G mutation. The specific mutation is easily distinguishable in the melting peaks. All of the samples were confirmed using Sanger sequencing. CONCLUSIONS: In summary, it was shown that VirSNiP SARS-CoV-2 Spike D614G assay is a rapid, accurate, and reliable method for identifying the SARS-CoV-2 D614G mutation. In contrast, Sanger sequencing is time consuming and labor intensive. We strongly believe that VirSNiP SARS-CoV-2 Spike D614G assay will provide more information on the prevalence of the D614G mutation in Taiwanese populations.

Trends and Gender Differences in Mental Disorders in Hospitalized Patients in Thailand.

Previous studies have shown that gender differences play a substantial role in the influence of mental disorders. This study was designed to investigate gender differences in mental disorders by presenting odd ratio (OR) trends and cumulative effects over a period of 13 years in Thailand. This observational study used hospital data from the Ministry of Public Health on selected patients admitted to inpatient departments in public hospitals with mental disorders, according to ICD-10 cause groups from 2007 to 2019, counting from more than 1,90,000 cases in 2007 to more than 4,00,000 cases in 2019. Data were collected from the Thailand Ministry of Public Health website. The results indicate that compared to women, men were positively related to five mental disorders revealed by the OR and the ratio per 100,000 population (mean and SD): psychoactive alcohol use (OR = 7.31-9.07, 271.19 (59.26)), substance abuse (OR = 5.06-7.82, 59.25 (33.71)), schizophrenia (OR = 1.64-1.93, 108.32 (19.62)), mental retardation (OR = 1.15-1.58, 10.64 (1.88)), and other mental and behavioral disorders (OR = 1.10-1.55, 70.67 (22.75)). Three mental disorders in men were found to be negatively related: neurotic and related disorders (OR=.34-.46, 27.98 (3.26)), mood (affective) disorders (OR = .44-.56, 31.91 (9.59)), and dementia (OR = .78-10.82, 13.75 (2.73)). Gender can become a key biological element that contributes to the dissimilarity of mental illness. Preventive care for men and women should, therefore, be prioritized for health conditions separately. More specifically, screening and detection, and providing appropriate intervention.

Comparison of Manual and Automated Nucleic Acid Extraction Methods in Virus Transport Medium.

BACKGROUND: The implementation of an automated nucleic acid extraction system has many advantages over the manual methods. The purpose of this study was to evaluate the validity of two different methods for nucleic acid extraction in virus transport medium. METHODS: We collected 20 nasopharyngeal swabs in viral transport medium from the emergency department of the Asia University Hospital for the detection of SARS-CoV-2. The performance of the MaelstromTM 8 (Taiwan Advanced Nanotech) and the QIAamp Viral RNA Mini Kit (Qiagen) were compared for the extraction of nucleic acid from viral transport medium. The extracts were used for the validation of the RNA extraction procedures. The RNase P target was amplified in a one-step reverse transcription-quantitative PCR (RT-qPCR) reaction, as internal control for the extraction method. RESULTS: In this study, the agreement between the two methods was good and Pearson's correlation coefficient (r) was 0.919 (p < 0.001). The mean cycle threshold value of the two methods was 29.1. CONCLUSIONS: Overall, the performance values of the MaelstromTM 8 and the QIAamp Viral RNA Mini Kit were comparable to each other. In summary, the MaelstromTM 8 provides a standardized procedure, avoidance of sample-to-sample cross contaminations, is easy to use, improves turnaround time and requires less hands-on time as compared to the manual extraction method. The MaelstromTM 8 is more suitable for clinical laboratories that carry small or medium-sized samples for nucleic acid extraction.