The Importance of hematological parameters in the prognosis of patients with severe COVID-19, A single-center retrospective study.

Background: Inflammation biomarkers known as acute phase reactants (APRs) show significant variations in serum concentrations during inflammation brought on by both viral and noninfectious diseases. The erythrocyte sedimentation rate (ESR), the C-reactive protein (CRP), the lactate dehydrogenase (LDH), the ferritin, the fibrinogen, the procalcitonin, the D-dimer, and the troponin I are all significant APRs. During inflammation, the serum levels of each of these positive APRs rise. The sensitivity and specificity of hematologic parameters and indices are as high as the inflammatory biomarkers mentioned above for monitoring disease severity and treatment response. Aim: We aimed to evaluate the differences in hematological parameters and indices, and to reveal their treatment and prognostic values, especially in deceased patients with COVID-19. Materials and Methods: The hemogram parameters of 169 critical patients with COVID-19 (125 males and 44 females) who received inpatient treatment at ….between 1 March 2020 and 31 December 2021 were analyzed retrospectively. The patients were divided into two groups-deceased (77) and surviving (92)-noting demographic data such as age and gender. All analyses were performed using SPSS 25.0. Results: Analyses of the hematological parameters used during the treatment processes revealed statistically significant differences between the two patient groups. White blood cell (WBC), neutrophil, and neutrophil-to-lymphocyte ratio (NLR) values were significantly higher (P = 0.019, P = 0.000 and P = 0.000, respectively) for deceased subjects, while lymphocyte, platelet and plateletcrit (PCT) values were significantly lower (for all values, P = 0.000). Platelet volume (MPV) and platelet distribution width (PDW), as well as MPV/PLT, PDW/PLT, MPV/PCT, and PDW/PCT, levels were significantly higher in deceased subjects (P = 0.000). Particularly in our deceased cases, receiver operating characteristic analyses were performed to reveal the importance of such analyses in prognostic status evaluation in COVID-19 since the hematological parameters are quite different. Cut-off values were determined for each parameter, and sensitivity and specificity ratios were calculated. While the sensitivities of MPV/PLT, PDW/PLT, MPV/PCT, and PDW/PCT indices are over 80%, neutrophil and white blood cell sensitivities were found to be lower (74%, 68.8%, respectively). Conclusion: In addition to NLR, which is an important biomarker, the hematological indices MPV/PLT, PDW/PLT, MPV/PCT, and PDW/PCT can be used to determine the risk of death in patients with severe COVID-19.

ADRENAL METASTASIS OF BILATERAL RENAL CELL CARCINOMA: A CASE PRESENTATION 12 YEARS AFTER DIAGNOSIS.

This case presentation describes the scenario of a patient diagnosed with renal cell carcinoma (RCC) who remained asymptomatic for an extended follow-up period, only to develop adrenal metastasis. Despite a 12-year surveillance period without any evidence of recurrence or metastasis, subsequent investigations revealed the presence of rectosigmoid colon cancer and adrenal metastasis. This case highlights the insidious and aggressive nature of RCC, emphasizing the significance of early detection and regular monitoring for metastatic disease.

Primary epiploic appendagitis: evaluation of computed tomography findings in the differential diagnosis of patients that presented with acute abdominal pain.

OBJECTIVE: Primary epiploic appendagitis (PEA) is a rare cause of abdominal pain revealed by torsion of colonic structures called epiploic appendices. In this paper, we present our clinical data and experience regarding this rare condition that may be confused with many diseases, such as acute appendicitis, diverticulitis, salphingitis, renal colic that may require emergency surgery. MATERIALS AND METHODS: A total of 39 consecutive patients diagnosed as PEA confirmed by abdominal computed tomography with a clinical course. Basic demographic data, abdominal pain characteristics, physical examination findings, laboratory results, treatment methods, and clinical course of the patients were retrospectively evaluated. Statistical analysis was performed using SPSS (18.0; Chicago, IL, USA), using the χ2-test and Fisher's exact test. RESULTS: Of the 39 patients diagnosed with PEA, 35 were male and 4 were female; the mean age of the patients was 36.0 ± 10.3. The main complaints were 69.2% abdominal pain, 12.8% groin pain, 5.1% flank pain with nausea and vomiting (2.6%), and abdominal swelling and dysuria. The average time of symptom was 5.3 days (1-15 days). In the computed tomography scan images, PEA was located in the sigmoid colon (21, 53.8%), descending colon (10, 25.6%), ascending colon (5, 12.8%), cecum (2, 5.1%), and hepatic flexure (1, 2.6%). No patient underwent surgical treatment. However, 9 of 39 patients were hospitalized for medical treatments, such as antibiotics and analgesic drugs intravenously. All patients were followed-up for a period of 1-year and there were no recurrence symptoms. CONCLUSIONS: When patients with localized lower abdominal pain and tenderness do not have associated symptoms or laboratory abnormalities, a high index of suspicion for PEA and early radiologic examinations are required.

The effect of smoking on neutrophil/lymphocyte and platelet/lymphocyte ratio and platelet indices: a retrospective study.

OBJECTIVE: Smoking commonly leads to death. Although the neutrophil/lymphocyte Ratio, platelet/lymphocyte ratio and platelet indices have been shown to be important for the diagnosis, prognosis and severity of some diseases, the smoking status of patients in these studies has not been well defined. In this study, we compared ratios derived from complete blood count and platelet indices to smoking status and length in smokers and non-smokers. PATIENTS AND METHODS: The data of healthy males and females aged between 18-60 years who presented to our institute for a routine check-up were collected, and subjects were divided in two groups - smokers and non-smokers. The presence of medical history or laboratory results which could affect inflammatory response, formed our exclusion criteria. All complete blood count results were noted and persons' smoking habits were calculated as pack/years. RESULTS: White blood cell, neutrophil, basophil and eosinophil counts; mean corpuscular volume, red cell distribution width and neutrophil/lymphocyte ratio were significantly higher in smokers when compared to non-smokers (p<0.05). When smokers were grouped according to smoking habits; positive linear correlations were detected between pack/year and Neutrophil/lymphocyte ratio and also pack/year and plateletcrit in smokers (p<0.05). CONCLUSIONS: Neutrophil/lymphocyte ratio increases in correlation with pack/year while platelet/lymphocyte ratio is not affected and platelet distribution width is increased in smokers. If smokers are not excluded from studies evaluating neutrophil/lymphocyte ratio and platelet distribution width, the relationship between smoking status as well as pack/year must be determined and reported.

How obesity affects the neutrophil/lymphocyte and platelet/lymphocyte ratio, systemic immune-inflammatory index and platelet indices: a retrospective study.

OBJECTIVE: Obesity is an important preventable cause of death and is a major risk factor for cardiovascular diseases as well as skeletal system diseases and malignancies. In many studies, complete blood count (CBC) and ratios derived from its results - such as the neutrophil/lymphocyte ratio, platelet/lymphocyte ratio and systemic immune inflammatory index have been associated with some diseases and their surveys. In these studies, the body mass index (BMI) and state of obesity of patients and the possible effects of these factors on CBC have not been defined. In this study, our aim was to evaluate the effect of BMI and smoking on CBC and ratios derived from CBC. PATIENTS AND METHODS: In this cross-sectional, retrospective study; the data of male and female patients aged between 18-65 years who presented for a routine check-up or obesity was collected and subjects were grouped as normal weight, overweight, obese and morbidly obese accordingly BMI. Persons' smoking habits were calculated as pack/years. All complete blood count results were noted. Smoking status and BMI groups were compared to CBC findings and ratios derived from these findings. RESULTS: After exclusion, 223 participants' data (104 female and 119 male) was included in the study. BMI was found to have a statistically significant positive linear correlation with lymphocyte number, PDW, SII and RDW (p < 0.05), and an extremely significant positive linear correlation (p < 0.01) was found between BMI and WBC, neutrophil count, PCT and platelet count. When BMI was not considered and 135 smokers were compared to 88 non-smokers, leukocytes and neutrophil counts were found to be higher in smokers (p < 0.05). CONCLUSIONS: Our study has found that WBC, neutrophil count, lymphocyte count, platelet count, PCT, PDW and SII are significantly affected by BMI status. Future studies that use these parameters and indices must take the participants' BMI and smoking status into account.

Renal papillary attenuation differences between primary and recurrent idiopathic calcium stone disease patients.

AIM: The aim of this paper was to investigate whether renal papillae of patients with nephrolithiasis are more radiodense than that of control patients and to evaluate the predictability of urolithiasis using papillary density differences between stone and non-stone formers. METHODS: Renal papillary Hounsfield Unit (HU) measurements were conducted at the level of upper pole, middle region and lower pole of both kidneys in a total of 126 primary (group 1), 133 recurrent (group 2) stone disease patients and 108 controls (group 3). RESULT: Mean patient age did not differ significantly between groups (P>0.05). Mean stone diameters (±SD) were 5.0±3.1 mm (3-9 mm) and 6.1±3.3 mm (3-15 mm) for primary and recurrent groups, respectively and group distributions and variances were similar (P>0.05). Mean papillary attenuation values (±SD) were 27.26±9.30 (4.00-56.00) in group 1, 30.42±9.88 (12.00-64.00) in group 2 and 25.83±2.72 (20.30-32.56) in the control group. The difference between the mean papillary attenuation value of the primary stone disease group and the control group was statistically insignificant (P=0.104). When the control group and the recurrent stone group was compared without variances, in terms of the mean renal papillary attenuation value, a statistical significance was achieved (P=0.000). CONCLUSION: With increasing renal papillary HU values, the risk of recurrent calcium stone disease is increased.