Pre-analytical quality in clinical chemistry testing is as important as analytical and post-analytical quality. The most prevalent pre-analytical interference and a major source of error producing unreliable laboratory test results is hemolysis of blood samples. In vitro hemolysis may be due to the blood withdrawal technique or sample handling whereas in vivo hemolysis can originate from acquired, hereditary, or iatrogenic conditions and is not technique dependent. Interpreting in vivo or in vitro hemolysis requires clinicians to supply reliable clinical history and findings. Even then, to reject or release the result with interpretation is still under debate. Thus, hemolyzed specimens are a serious pre-analytical problem calling for well-designed and strictly implemented laboratory guidelines. The aim of this non-systematic review (addressed to healthcare professionals) was to highlight the challenges in identifying and rejecting hemolysis specimens.

Objectives: There is a tendency to use noninvasive ventilation (NIV) as a substitute for mechanical ventilation in preterm infants who need respiratory support. Two important modes of NIV include nasal continuous positive airway pressure (NCPAP) and nasal intermittent positive pressure ventilation (NIPPV). We sought to compare the efficacy of NCPAP and NIPPV as early respiratory support in preterm infants with respiratory distress syndrome in reducing the need for intubation, surfactant administration, and mechanical ventilation. Methods: We conducted a randomized clinical trial. Sixty-one preterm infants with a gestational age of 28–32 weeks and a birth weight < 1500 g were randomly allocated to early NCPAP (n = 31) or NIPPV (n = 30) groups. The primary outcome was the need for intubation and mechanical ventilation in first 72 hours of life and the secondary outcome was oxygen dependency beyond day 28 post-birth. Results: Surfactant replacement therapy was done in 15 neonates (50.0%) in the NIPPV group and 19 neonates (61.3%) in the NCPAP group, odds ratio (OR) = 1.58 (95% confidence interval (CI): 0.57–4.37; p = 0.370). Intubation and mechanical ventilation in the first 72 hours of life were needed in five cases (16.7%) in the NIPPV group and two cases (6.5%) in the NCPAP group, OR = 2.90 (95% CI: 0.51–16.27; p = 0.250). The mean duration of hospitalization was 26.2±17.4 days in the NIPPV group and 38.4±19.2 days in the NCPAP group, p = 0.009. Bronchopulmonary dysplasia (BPD) occurred in two (6.7%) neonates in the NIPPV group and eight (25.8%) neonates in the NCPAP group, p = 0.080. Conclusions: NIPPV and NCPAP are similarly effective as initial respiratory support in preterm infants in reducing the need for mechanical ventilation and occurrence of BPD. The duration of hospitalization was significantly reduced using NIPPV in our study.

Objectives: To determine the benefits of wet cupping on pain and health-related quality of life (HRQOL) in adult patients with migraine headaches. Methods: We conducted a prospective observational study of wet cupping in 128 patients referred to the cupping clinic at King Abdulaziz University Hospital, Jeddah, Saudi Arabia between January 2013 and December 2015. Bloodletting was performed at the base of the head and between the shoulders monthly four times. We assessed migraine headache pain using the visual analog scale (VAS) and the quality of life of patients before and after each cupping session using the World Health Organization Quality of Life assessment instrument. Results: The mean age of the patients was 40.5±11.3 years with a preponderance of females (n = 114, 89.1%). VAS was averaged at 7 before the procedure and reduced to 3 after wet cupping, both during rest and activity (p ≤ 0.005). Ninety-five patients agreed to complete the quality of life questionnaire. There was a significant improvement in the quality of life after wet cupping treatment in most of the displayed items (p < 0.050). None of the patients reported post-procedure complications. Conclusions: Wet cupping might be considered a complementary treatment for migraine headache pain relief and improvement to a patient’s quality of life.

Objectives: We sought to determine the total proportion of pediatric tuberculosis cases, characterize tuberculosis by its anatomical location and pretreatment sputum smear status, and to determine the association of the sociodemographic and clinical factors with tuberculosis disease among pediatric patients in Kelantan from 2012 until 2015. Methods: We conducted a comparative cross-sectional study between tuberculosis cases and tuberculosis contacts among pediatric patients using the Tuberculosis Information System as a source population. All notified cases that fulfilled the inclusion and exclusion criteria were included in the study. Descriptive statistics, simple and multiple logistic regressions were used for data analysis. Results: Of 5412 tuberculosis cases, 456 (8.4%) were pediatric patients with a mean age of 15.9 years. The majority had the pulmonary form of tuberculosis (78.1%) followed by the extrapulmonary (14.9%) and pulmonary form with concomitant extrapulmonary (7.0%) forms. Of all pulmonary tuberculosis cases, 64.9% were sputum smear-positive, and 35.1% were sputum smear-negative. Among 322 pediatric patients with tuberculosis, the majority were Malay (90.7%), 8.4% were illiterate, and 79.5% resided in non-urban areas. Of all cases, 2.8% were HIV-positive, and 14.6% were cigarette smokers. Older age, Malay ethnicity, female gender, non-urban residence, good education level, and cigarette smoking were the significant associated factors for tuberculosis disease among pediatric patients with an adjusted odds ratio (aOR) of 1.41 (95% confidence interval (CI): 1.29–1.54; p < 0.001), 0.17 (95% CI: 0.07–0.44; p < 0.001), 1.88 (95% CI: 1.33–2.65; p < 0.001), 1.92 (95% CI: 1.33–2.79; p = 0.001), 0.20 (95% CI: 0.12–0.33; p < 0.001), and 3.35 (95% CI: 1.86–6.01; p < 0.001), respectively. Conclusions: The study will assist practices of tuberculosis detection and control management in the local setting and may help other national tuberculosis programs to review their detection criteria with similar statistics.

Objectives: Staphylococcus aureus has emerged as a major public health concern. It is a common pathogen in high-risk hospital intensive care units (ICUs). We analyzed the molecular characteristics on the SCCmec and spa genes of S. aureus isolates gathered from ICUs. The antibiotic resistance patterns and carriage of resistance and virulence determinants were also identified. Methods: In this cross-sectional study, 84 non-duplicated S. aureus strains isolated from ICU patients in were genotyped using SCCmec and spa typing. The Kirby-Bauer disk diffusion and micro-broth dilution methods were used to determine resistance patterns. Virulence and resistance gene profiling were also determined using the polymerase chain reaction technique. Results: All isolates were methicillin-resistant S. aureus and belonged to seven spa types: t388 (36.9%), t852 (14.3%), t924 (13.1%), t790 (11.9%), t064 (10.7%), t037 (9.5%), and t084 (3.6%). They differed in the carriage of resistance and toxin genes. The most common SCCmec type was III detected in 50 isolates (59.5%), followed by type IV in 34 isolates (40.5%). The pvl gene was detected in 14.3% (n = 12) of isolates, of which 66.7% (n = 8) belonged to t852 and 33.3% (n = 4) belonged to t790. Among the tested strains, 9.5% (n = 8) carried the mupA gene and belonged to the t064 spa type. Conclusions: The data revealed a high resistance rate to antibiotics, which could be a threat to ICU patients. It is necessary to detect antimicrobial resistance and resistance and toxin-encoding of gene profiles in different molecular types..

Objectives: We sought to evaluate the trends in age-standardized incidence rates of cancer by gender, age, and types in the Sivas province of Turkey from 2004 to 2014. Methods: Data were obtained from the Sivas Public Health Department Cancer Unit and the Cumhuriyet University Hospital Cancer Record Unit for the studied period. Data were presented as incidence rates by age, gender, and cancer site using world age-standardized incidence rate (ASR-W) per 105 populations. Results: Of the 13 377 registered new cases of cancer during the study period, 43.1% (5771) were female, and 56.9% (7606) were male. The ASR-W of all cancers was 205.2 per 105 in males and 168.0 per 105 in females. The ASR-W was increased for both genders over the 11-year period. The greatest incidence cancer type in males was prostate cancer (ASR-W = 35.8) followed by lung (ASR-W = 33.9), colorectal (ASR-W= 19.0), urinary (ASR-W = 18.4), and stomach (ASR-W = 17.3) cancer. Among females, thyroid (ASR-W= 37.5) was the cancer type with the greatest incidence followed by breast (ASR-W = 27.7), colorectal (ASR-W = 11.7), lymphoma (ASR-W = 10.4), and stomach (ASR-W = 10.0) cancer. Conclusions: The cancer incidence rate in males has remained higher than in females from 2004 to 2014, and an increased incidence of various cancers was observed in both genders. Raising public awareness about the risk factors for cancer and the development of appropriate and effective screening programs to provide more reliable data for cancer prevention and control programs in Sivas province is necessary.

Objectives: Blood counts are commonly performed tests in neonatal intensive care units with the results having various clinical ramifications. Interpreting blood counts as normal or abnormal requires reference ranges as per gestation. Studies on reference ranges for neonatal neutrophil counts are already scarce, and data is lacking in the Asian context. We sought to formulate gestation-wise reference ranges of neutrophil counts in an Indian setting. Methods: Healthy, newborn babies of either gender, aged between 30 to 41 weeks gestation were included in the study. Gestational age was corroborated through first trimester dating scan and postnatally by the New Ballard Score. Single venous blood samples were drawn on day three and day five for estimation of total leukocyte count, differential count (neutrophils, lymphocytes), and peripheral blood smear examination. Results: We evaluated the data of 420 newborns. The normative values were compiled week-wise for gestational ages of 30 to 41 weeks at birth. We observed a clustering of neutrophil count values below 8000 cells/μL on day three and below 5000 cells/μL on day five. No gender-based differences in counts were observed. We were able to generate reference range curves for neutrophil counts as per gestational age. Conclusions: The absolute neutrophil counts of term and preterm Indian newborns are higher than the values depicted in the standard reference chart used currently. This indicates that a different standard chart as per gestation should be used in Indo-Asian countries to differentiate ‘normal’ from ‘abnormal’.

Keywords: Infant, Newborn; Neutrophils.

Objectives: We sought to determine the effect of consultation and follow-up phone calls on biochemical indicators and intradialytic weight gain (IWG) in patients undergoing hemodialysis. Methods: We conducted a double-blind, randomized clinical trial of 86 patients undergoing hemodialysis in Iran. Patients were grouped through convenience sampling and randomly allocated into two groups. The experimental group had face-to-face consultations, and each patient was given a monthly diet. Next, over 12 weeks, we conducted 28 follow-up phone calls. In both groups, biochemical indicators and IWG were measured at baseline, and in the fourth, eighth, and twelfth weeks of the study. Results: The results showed that calcium and IWG indices in the fourth, eighth, and twelfth week, and phosphorus and potassium and IWG indices in the eighth and twelfth weeks had statistically significant differences between the experimental and control groups (p < 0.050). Conclusions: In our study, consultation and follow-up phone calls in hemodialysis patients result in improved biochemical indicators. Therefore, in patients undergoing hemodialysis, consultation and follow-up phone calls are recommended to improve patient’s biochemical indicators.

Intranasal lobular hemangioma of the inferior turbinate is a rare occurrence in children. A 12-year-old girl presented with a two-month history of multiple epistaxis episodes. Contrast-enhanced computed tomography showed a large nasal mass in the right nasal cavity. Endonasal endoscopic excision of the hemangioma with cauterization of the feeding vessel was performed to remove the lesion completely. There was no recurrence at 11 months follow-up.

Pilomatricoma is an uncommon benign skin tumor arising from the hair follicle. It usually occurs in the head and neck region and is typically found in the pediatric age group particularly girls. The tumor has inconsistent clinical features and may manifest as a small superficial lesion with benign features or a large and seemingly aggressive lesion with local invasion. Due to its variable clinical presentations, it can occasionally be misdiagnosed as a malignant tumor. We encountered a case of pilomatricoma in a 12-year-old girl with a left preauricular swelling for two years, which became progressively larger and more painful in the few weeks before presentation. Clinically, the swelling resembled a malignant parotid tumor. Multiple fine-needle aspirations were performed, but the cytology results were all inconclusive. Subsequent computed tomography scan revealed a well-defined calcified subcutaneous mass with suspicious parotid involvement. The case was posted for tumor excision and superficial parotidectomy. Intraoperatively, however, the mass could be easily separated from the parotid gland. Histopathological examination of the excised specimen showed characteristic ghost cells, basophilic cells, and ossifications typical of pilomatricoma. In conclusion, preauricular pilomatricoma may pose a diagnostic dilemma. A heightened knowledge of the disease is needed for early recognition of its clinical and imaging features to prevent aggressive therapy than is required.

Papillary cystadenocarcinomas (PCAs) are rare low-grade salivary gland tumors first introduced in the World Health Organization classification in 1991. While classically regarded as a low-grade malignancy, PCAs with more clinically and histologically high-grade features have been reported, reflecting the often-underrecognized morphological diversity of this entity. Although no universally advocated grading system exists, high-grade PCAs tend to demonstrate locally aggressive features, cytologic atypia, high mitotic rate, necrosis, and an absence of papillary features. We present a case of a 51-year-old male with slow-onset, progressive right facial fullness over four years. Contrast-enhanced computed tomography of the neck demonstrated a 3.3 cm peripherally enhancing cystic and solid mass in the right superficial lobe of the parotid gland. Following a superficial parotidectomy and a selective right neck dissection, histopathology demonstrated a large cyst with papillary projections lined with cuboidal cells of mild to moderate atypia and surrounding solid tumor nests. The tumor displayed stromal, lymphovascular, and subcutaneous fibroadipose tissue invasion. One of 12 lymph nodes was positive for metastatic carcinoma without extranodal extension. A diagnosis of intermediate-grade PCA was rendered. This case report summarizes the features typical of high-grade PCAs, the few reported cases of intermediate- and high-grade PCAs within the existing literature and provides a brief overview of the radiological and pathological differential diagnosis when considering a parotid gland PCA.

We present a case of a 35-year-old male patient who underwent live donor kidney transplantation at our unit in 2003. While working overseas, he had deterioration in his kidney function and was treated conservatively over three years duration including acquirement of a renal biopsy. Upon presentation to our unit in June 2015, an ultrasound and computed tomography angiogram demonstrated a huge aneurysm arising from his upper renal artery. His lower renal artery was patent and normal. The aneurysm was treated by endovascular means with preservation of the kidney and improvement in his kidney function over the following 12 months. When feasible, endovascular repair of transplanted renal artery aneurysms provides a safe and less invasive modality of treatment.