Berrin Bercik Inal

Background/Objectives: This study aimed to develop and evaluate machine learning models for predicting ionized calcium levels in patients with hypoalbuminemia, compare their performance with classical correction formulas and unadjusted total calcium levels, and assess their transportability through external validation. Methods: In a retrospective development cohort of 14,745 adults with hypoalbuminemia, XGBoost and ordinary least squares (OLS) models used total calcium, albumin, total protein, and eGFR and were evaluated with nested cross-validation. Frozen models were then applied without recalibration to an independent external cohort of 2751 patients using the same analyzer platforms. Results: Development XGBoost performance was R² = 0.500 and AUC-ROC = 0.798 (95% CI 0.788–0.807), with 98.5% sensitivity and 26.0% specificity. External R² was 0.397 for XGBoost and 0.363 for OLS. External AUC-ROC was 0.818 (95% CI 0.791–0.845) for XGBoost, 0.823 (0.797–0.850) for OLS, and 0.819 (0.791–0.845) for total calcium. Threshold-matched and exploratory decision-curve analyses showed no clear incremental XGBoost advantage over total calcium. Conclusions: Machine learning models provided useful continuous ionized-calcium estimates and high sensitivity for hypocalcemia detection, although specificity was low. In independent external validation, hypocalcemia discrimination was comparable to unadjusted total calcium. The models should be considered complementary rather than substitutes for measured ionized calcium, and further multicenter and prospective evaluation is warranted.

Background: Interpretation of laboratory data is a comparative process that requires reliable reference intervals (RIs) to support clinical decision‐making. Although population‐based reference intervals (popRIs) are commonly used for this purpose, more accurate interpretation can be achieved using RIs derived from an individual's own data—that is, personalized reference intervals (prRIs). In this study, we estimated prRIs for common hematology parameters and compared them with popRIs indirectly derived from laboratory data. Method: popRIs were estimated for a total of 17 complete blood count (CBC) subparameters using patient laboratory data. prRIs for the same parameters were calculated using longitudinal data from 200 healthy individuals, based on a prediction interval model. Additionally, the reference interval index (RII) was calculated as the ratio of the range of prRIs to the range of popRIs for each measurand. Results: prRIs calculated for CBC parameter differed from the corresponding popRIs. The median of RII varied from 0.41 for eosinophils to 2.97 for platelet distribution width (PDW). Conclusion: We concluded that the prRIs of the CBC parameters differ from their corresponding popRIs, and that prRIs should be used for a more accurate interpretation of patients' CBC results.

Objectives: The ‘Rational Laboratory Use Project’ (RLUP) was launched in 2018 by the Department of Examination and Diagnosis Services under the General Directorate of Health Services of the Republic of Turkey’s Ministry of Health. In this study, we aimed to determine the rate of implementation of RLUP in medical biochemistry laboratories, and to contribute to new regulations by collecting the information and opinions of the laboratory experts participating the survey. Methods: Thirty questions were uploaded to an online survey tool (SurveyMonkey ^® , San Mateo, ABD). The first five were descriptive for laboratories. Among the remaining 25 questions, one is open-ended and addresses the various topics encompassed by the project’s scope. Results: The questionnaire was completed by 202 medical biochemistry specialists, of whom 82.12 % reported that they did not implement autoverification. 55.65 % defined consultations in Hospital Management Information System (HIMS), but; 70.49 % were not using it actively. 57.69 % of the participants answered, “I agree” to the statement “I think RLUP is feasible”. It was observed that the specialists tried to implement rational laboratory practices partially depending on their laboratory capacity, hospital administration and Laboratory Information Management System (LIMS). Conclusions: Increasing clinicians’ awareness could increase the success of this project, which might provide more effective diagnosis and treatment for the patient. In our view, actively involving stakeholders of the information management system, which is not under the direct control of laboratory professionals, in the RLUP will accelerate the development of the project.

Ischemia/reperfusion,interleukin 6 blocker,lung,rat,tocilizumab

BACKGROUND YouTube is used to investigate medical conditions, diseases, drug abuse, etc., and may contain inaccurate material. OBJECTIVE Our study aims to investigate the effectiveness of YouTube videos in interpreting laboratory results. METHODS Two independent biochemists looked for and rated videos through the Global Quality Scale (GQS) and modified DISCERN methodology. The characteristics of the low-, intermediate-, and high-quality groups were compared using the Kruskal- Wallis test. The kappa coefficient measured the researchers' agreement. RESULTS Of thirty-five videos, thirteen (46%) were in the high-quality group, eleven (32%) were intermediate-quality, and eleven (32%) were low-quality, as determined by the GQS ratings. The quality groups had similar daily views, likes, dislikes, and comments (p>0.05). However, group DISCERN scores varied greatly (p<0.001). CONCLUSIONS Due to YouTube's lack of restrictions, content creators are not required to have a specific area of expertise, which may result in posting potentially confusing videos by persons devoid of knowledge or experience.

Objectives: In clinical laboratories, it is common to obtain serum and plasma by using a barrier tube due to its various advantages. In this study, we aimed to compare 18 biochemistry analytes in outpatient clinic and outpatient oncology patients by measuring in a Barricor tube and a serum separator tube (SST). Methods: Venous blood was drawn into the Barricor tube and SST from volunteers consisting of outpatients and outpatient oncology patients. The biochemical parameters were measured using the AU2700 autoanalyser (Beckman Coulter Inc., CA, USA) and Beckman Coulter Access immunoanalyser (Beckman Coulter Inc., CA, USA). The biochemical analytes evaluated in the two participant groups were compared between the Barricor tube and SST. Results: In the study, when the results in both the outpatient group and the outpatient oncology patient group, bias (%), allowable bias (%), CV (%), allowable CV (%), total error (%), total allowable error (TEa) (%) were evaluated; potassium (K) total error (%) between Barricor tube and SST exceeded TEa, however, all other parameters were within TEa. Conclusions: Considering its various advantages and compared biochemical analytes, we think that can be switched to the Barricor tube in clinical laboratories and the reference range change can be made for K.

Centrifugation separates particles within the specimen according to their shape, dimensions, and density and basically can be defined as a separation method. The centrifuge is an essential device in medical laboratories to prepare the serum, plasma, and urine samples for analysis. It is basically an electric device composed of the stationary (motor) and the motile (rotor) part. The centrifugation depends on two main variables: relative centrifugal force (RCF) and centrifugation time. The physical impact separating the specimen into its components in the centrifuge known as RCF is expressed as the multiples of gravitational acceleration (×g). RPM, defined as the number of rotations of the centrifuge per minute, shows the speed of the centrifuge. RCF value can be calculated by using RPM, and the centrifuge radius. Because models and sizes of centrifuges vary considerably, the use of gravity (g) forces instead of RPM is suggested. The centrifuges can be classified according to their usage, speed, technical specifications, and rotor type. An accurate and precise centrifugation process is essential to prevent errors in the preanalytical phase. The purpose of this document is to ensure the standardization of a good, precise protocol for the centrifugation process among the medical laboratories.

Objectives: Preanalytical phase quality, which begins with a request for testing and continues with patient preparation, sample collection, transport, processing and storage, is essential for coagulation tests. The Turkish Biochemical Society Preanalytical Phase Working Group created a survey to evaluate the preanalytical phase practices for coagulation laboratories in our country. Methods: The survey consisted of a total of 26 questions and included almost all steps of the preanalytical phase. Results: Fifty-four laboratory specialists have participated in the study. The survey results showed that participants have different practices for most stages of the preanalytical phase for coagulation tests. Conclusion: According to the survey results, a national guideline may help standardisation of the preanalytical phase for coagulation tests in our country and increasing training in this respect would contribute to achieving accurate test results.

Background: Unsuitable samples are common problem for laboratories. The blood collection tubes need to be validated or verified prior to their being used in the routine laboratory for reducing this situation. Objective: We aim to compare the technical qualifications of routinely used BD Vacutainer ^® Serum Separator Tubes™ II Advance Plus with BD Vacutainer ^® Barricor™ LH Plasma Tubes for local technical validation. Materials and methods: Apparently healthy 150 voluntary subjects were enrolled in the study. Samples were collected in two separated tubes by a single phlebotomist. Twelve quality indicators were used to compare these two different types of tubes for local technical validation. Differences (%) between them were calculated with the formula proposed by EFLM. In case of any difference of less than 1% for each indicator, the evaluated tube was considered as non-inferior. Results: Indicators, such as tubes with physical defects, that fail to create vacuum, not properly fitting into the blood collection device, under filling (10%), cracked tubes, tubes exterior surface contaminated with blood, hemolysed specimens, including fibrin strand/mass in the sample, red blood cell adhesion, poor/incomplete barrier formation were found non-inferior in Barricor™ tubes. White particulate matter (WPM) was observed in 24.6% of Barricor™. Therefore, the last indicator (tubes including gel/foreign material/WPM in sample after centrifugation) was found inferior for Barricor™. Conclusion: Technical local validation studies should be encouraged in terms of quality management. It was thought that WPM would not cause any interference in a properly filled tube. In addition to, Barricor™ was also found to be technically acceptable when evaluated through using all other indicators.