A nationwide multicentre study in Turkey for establishing reference intervals of haematological parameters with novel use of a panel of whole blood.

INTRODUCTION: A nationwide multicentre study was conducted to establish well-defined reference intervals (RIs) of haematological parameters for the Turkish population in consideration of sources of variation in reference values (RVs). MATERIALS AND METHODS: K2-EDTA whole blood samples (total of 3363) were collected from 12 laboratories. Sera were also collected for measurements of iron, UIBC, TIBC, and ferritin for use in the latent abnormal values exclusion (LAVE) method. The blood samples were analysed within 2 hours in each laboratory using Cell Dyn and Ruby (Abbott), LH780 (Beckman Coulter), or XT-2000i (Sysmex). A panel of freshly prepared blood from 40 healthy volunteers was measured in common to assess any analyser-dependent bias in the measurements. The SD ratio (SDR) based on ANOVA was used to judge the need for partitioning RVs. RIs were computed by the parametric method with/without applying the LAVE method. RESULTS: Analyser-dependent bias was found for basophils (Bas), MCHC, RDW and MPV from the panel test results and thus those RIs were derived for each manufacturer. RIs were determined from all volunteers' results for WBC, neutrophils, lymphocytes, monocytes, eosinophils, MCV, MCH and platelets. Gender-specific RIs were required for RBC, haemoglobin, haematocrit, iron, UIBC and ferritin. Region-specific RIs were required for RBC, haemoglobin, haematocrit, UIBC, and TIBC. CONCLUSIONS: With the novel use of a freshly prepared blood panel, manufacturer-specific RIs' were derived for Bas, Bas%, MCHC, RDW and MPV. Regional differences in RIs were observed among the 7 regions of Turkey, which may be attributed to nutritional or environmental factors, including altitude.

Changes in platelet parameters in leukocytosis.

INTRODUCTION: In recent years, platelets are known to have a large variety of functions in many pathophysiological processes and their interaction with endothelial cells and leukocytes is known to play an important role in the pathophysiology of vascular inflammation. The aim of this study was to investigate the relationship between white blood cell count in conditions resulting in leukocytosis and platelet count and platelet parameters including mean platelet volume, platelet distribution width, and plateletcrit. METHODS: White blood cell counts count and all platelet parameters were evaluated in 341 results of normal complete blood count (of which the white blood cell counts were within reference range, group 1) and 327 results of elevated white blood cell counts count (group 2). RESULTS: There was a significant difference between these two groups in PLT counts and PCT values, being higher in Group 2. However, there was no statistically significant difference between two groups in MPV and PDW values. On the other hand, there were statistically significant, but weak, correlations between the WBC and platelet counts in both groups (p<0.01, r=0.235 for group 1, p<0.05, r=0.116 for group 2). CONCLUSION: As a conclusion PLT count and PCT values increase in infectious conditions. This study and previous studies show that PLTs are employed in infectious conditions but the exact mechanism and the exact clinical importance of this response remains to be cleared by further studies.

Comparison of Cobas 6500 and Iris IQ200 fully-automated urine analyzers to manual urine microscopy.

INTRODUCTION: Urine screening is achieved by either automated or manual microscopic analysis. The aim of the study was to compare Cobas 6500 and Iris IQ200 urine analyzers, and manual urine microscopic analysis. MATERIALS AND METHODS: A total of 540 urine samples sent to the laboratory for chemical and sediment analysis were analyzed on Cobas 6500 and Iris IQ200 within 1 hour from sampling. One hundred and fifty three samples were found to have pathological sediment results and were subjected to manual microscopic analysis performed by laboratory staff blinded to the study. Spearman's and Gamma statistics were used for correlation analyses, and the McNemar test for the comparison of the two automated analyzers. RESULTS: The comparison of Cobas u701 to the manual method yielded the following regression equations: y = - 0.12 (95% CI: - 1.09 to 0.67) + 0.78 (95% CI: 0.65 to 0.95) x for WBC and y = 0.06 (95% CI: - 0.09 to 0.25) + 0.66 (95% CI: 0.57 to 0.73) x for RBC. The comparison of IQ200 Elite to manual method the following equations: y = 0.03 (95% CI: - 1.00 to 1.00) + 0.88 (95% CI: 0.66 to 1.00) x for WBC and y = - 0.22 (95% CI: - 0.80 to 0.20) + 0.40 (95% CI: 0.32 to 0.50) x for RBC. IQ200 Elite compared to Cobas u701 yielded the following equations: y = - 0.95 (95% CI: - 2.13 to 0.11) + 1.25 (95% CI: 1.08 to 1.44) x for WBC and y = - 1.20 (95% CI: - 1.80 to -0.30) + 0. 80 (95% CI: 0.55 to 1.00) x for RBC. CONCLUSIONS: The two analyzers showed similar performances and good compatibility to manual microscopy. However, they are still inadequate in the determination of WBC, RBC, and EC in highly-pathological samples. Thus, confirmation by manual microscopic analysis may be useful.

A reference interval study for common biochemical analytes in Eastern Turkey: a comparison of a reference population with laboratory data mining.

INTRODUCTION: The aim of this study was to define the reference intervals (RIs) in a Turkish population living in Northeast Turkey (Erzurum) for 34 analytes using direct and indirect methods. In the present study, the regional RIs obtained were compared with other RI studies, primarily the nationwide study performed in Turkey. MATERIALS AND METHODS: For the direct method, 435 blood samples were collected from a healthy group of females (N = 218) and males (N = 217) aged between 18 and 65 years. The sera were analysed in Ataturk University hospital laboratory using Roche reagents and analysers for 34 analytes. The data from 1,366,948 records were used to calculate the indirect RIs using a modified Bhattacharya method. RESULTS: Significant gender-related differences were observed for 17 analytes. There were also some apparent differences between RIs derived from indirect and direct methods particularly in some analytes (e.g. gamma-glutamyltransferase, creatine kinase, LDL-cholesterol and iron). The RIs derived with the direct method for some, but not all, of the analytes were generally comparable with the RIs reported in the nationwide study and other previous studies in Turkey.There were large differences between RIs derived by the direct method and the expected values shown in the kit insert (e.g. aspartate aminotransferase, total-cholesterol, HDL-cholesterol, and vitamin B12). CONCLUSIONS: These data provide region-specific RIs for 34 analytes determined by the direct and indirect methods. The observed differences in RIs between previous studies could be related to nutritional status and environmental factors.

The Evaluation of Serum Copeptin Levels and Some Commonly Seen Thrombophilic Mutation Prevalence in Acute Pulmonary Embolism.

Acute pulmonary embolism (PE) is a common, emergent condition and may affect a large number of patients. Copeptin has been indicated to be a sensitive biomarker of arginine vasopressin release, and has diagnostic and prognostic value in various clinical conditions. Genetic mutations are considerable components of thrombophilic diseases, and factor II gene G20210A, (FII20210A), factor V Leiden (FVL, G1691A) and methylenetetrahydrofolate reductase gene C677T (MTHFR677T) single nucleotide polymorphisms are the most common mutations of thrombophilic diseases. In this study, serum copeptin levels were determined in patients with PE and healthy controls, and the results were discussed. The prevalence of some commonly seen thrombophilic mutations was also evaluated in patients with PE. The study included 32 patients (18 male, 14 female) with PE and 24 (13 male, 11 female) age- and gender-matched healthy controls. A significant difference in serum copeptin levels was determined between the patient and control groups (8.58 ± 4.42 and 4.07 ± 1.02 pmol/L, respectively). Heterozygous mutant genotype for FII20210A and heterozygous mutant genotype for FVL were observed in 3.1 and 9.4% of patients, respectively. Mutant genotype of 49% was determined for MTHFR677T mutations. It was concluded that copeptin may have diagnostic value for PE.

Leptin and neuropeptide Y levels in newborns.

AIM: Several studies have investigated leptin and neuropeptide Y (NPY) levels in children, but the information for newborns in the literature is limited. The purpose of this study was to determine leptin and NPY levels in 14- to 28-day-old newborns. MATERIALS AND METHODS: This prospective study was performed in Atatürk University Medical Faculty Research Hospital Neonatal Clinic, Erzurum, Turkey between July and December, 2014. Sixty-two 14- to 28-day-old neonates, 26 female and 36 male, were included. Age, height, and body weight of the patients were recorded. Feeding status was also recorded. The newborns were divided into two groups--those receiving breastfeeding only and those receiving breastfeeding and formula. Plasma leptin levels were measured using enzyme amplified sensitivity immunoassay (EASIA). RESULTS: The mean leptin level in 14- to 28-day-old female neonates was 4.25 ± 3.08 ng/mL, and the mean NPY level was 24.79 ± 9.87 ng/mL. The mean leptin level in 14- to 28-day male neonates was 3.49 ± 2.52 ng/mL, and the mean NPY level was 25.80 ± 9.58 ng/mL. No significant difference was determined between leptin (p=0.228) or NPY (p=0.144) in terms of feeding status. No significant difference was also observed between the sex in terms of leptin or NPY levels (leptin p=0.775 and NPY p=0.687). CONCLUSION: There were no differences in terms of feeding status and sex in leptin and NPY levels in the neonatal period.

Plasma Kisspeptin Levels in Newborn Infants with Breast Enlargement.

OBJECTIVE: Kisspeptin levels have been reported in children with premature thelarche, precocious puberty and adolescent gynecomastia, but there are no reports on kisspeptin levels in the neonatal period. This study aimed to investigate plasma kisspeptin hormone levels in newborns with and without breast enlargement. METHODS: Plasma kisspeptin levels and other related biochemical variables were investigated in this prospective study conducted on 40 (20 girls and 20 boys) newborn infants with breast enlargement and on 40 healthy control infants (20 girls and 20 boys). Two-milliliter venous blood samples were taken in hemogram tubes with K2EDTA. Kisspeptin assays were performed using the enzyme-immunoassay method. RESULTS: Mean plasma kisspeptin levels were 0.6 ± 0.2 ng/mL in the study group and 0.5 ± 0.2 ng/mL in the control group. Plasma kisspeptin concentrations were significantly higher in the study group (p=0.039) and also showed a correlation with serum prolactin levels (p=0.006). Significant correlations were also determined between plasma kisspeptin and luteinizing hormone concentrations (p=0.05, r=0.312). CONCLUSION: The findings of this study suggest that plasma kisspeptin and serum prolactin levels may be involved in the physiopathology of breast enlargement in newborns.

A multicenter nationwide reference intervals study for common biochemical analytes in Turkey using Abbott analyzers.

BACKGROUND: A nationwide multicenter study was organized to establish reference intervals (RIs) in the Turkish population for 25 commonly tested biochemical analytes and to explore sources of variation in reference values, including regionality. METHODS: Blood samples were collected nationwide in 28 laboratories from the seven regions (≥400 samples/region, 3066 in all). The sera were collectively analyzed in Uludag University in Bursa using Abbott reagents and analyzer. Reference materials were used for standardization of test results. After secondary exclusion using the latent abnormal values exclusion method, RIs were derived by a parametric method employing the modified Box-Cox formula and compared with the RIs by the non-parametric method. Three-level nested ANOVA was used to evaluate variations among sexes, ages and regions. Associations between test results and age, body mass index (BMI) and region were determined by multiple regression analysis (MRA). RESULTS: By ANOVA, differences of reference values among seven regions were significant in none of the 25 analytes. Significant sex-related and age-related differences were observed for 10 and seven analytes, respectively. MRA revealed BMI-related changes in results for uric acid, glucose, triglycerides, high-density lipoprotein (HDL)-cholesterol, alanine aminotransferase, and γ-glutamyltransferase. Their RIs were thus derived by applying stricter criteria excluding individuals with BMI >28 kg/m2. Ranges of RIs by non-parametric method were wider than those by parametric method especially for those analytes affected by BMI. CONCLUSIONS: With the lack of regional differences and the well-standardized status of test results, the RIs derived from this nationwide study can be used for the entire Turkish population.

Biochemical and histologic study of lethal cisplatin nephrotoxicity prevention by mirtazapine.

BACKGROUND: Cisplatin is a platinum derivative frequently used in the chemotherapy of different solid tumors. This biochemical and histologic study investigated a possible protective effect of mirtazapine with regard to cisplatin-induced nephrotoxicity in the rat. METHODS: The animals were divided into 4 groups: 15 mg/kg mirtazapine + 10 mg/kg cisplatin, 30 mg/kg mirtazapine + 10 mg/kg cisplatin, only 10 mg/kg cisplatin and negative control (healthy) group. During 14 days, the treatment and treated control group took drugs, while the healthy animals were given distilled water on the same schedule. All animals were sacrificed by high-dose anesthesia at the end of the 14 days of treatment; their kidneys were removed and subjected to histologic and biochemical study. RESULTS: In both of the doses we used, mirtazapine decreased the levels of malondialdehyde, creatinine, blood urea nitrogen and myeloperoxidase activity when compared to cisplatin group. On the other hand, it increased total glutathione level in all doses. Slight histopathological findings were determined in mirtazapine groups when compared to cisplatin control group. CONCLUSION: In the light of our results and literature knowledge, we can conclude that the protective effect of mirtazapine in cisplatin toxicity originates from its own antioxidant activity.

An intervention study for viral hepatitis. Peer-led health education among high school students.

OBJECTIVE: To check the effectiveness of peer-led education in improving the knowledge, attitudes, and behavior of high school students regarding viral hepatitis (VH). METHODS: This study was conducted at 29 high schools in Erzurum city center, Turkey between February and May 2007. The study design is a prospective before-and-after intervention trial. In this study, 2930 students from 29 different schools were included. A total of 559 volunteer students were trained as peer educators. These students applied a standard education to their peers. RESULTS: The total knowledge scores of peer educators before was 7.99 ± 2.73, and 13.91 ± 3.85 after peer-training (p=0.000). The total knowledge scores of other students increased from 7.27 ± 2.85 to 11.20 ± 4.21 (p=0.000). There was an increase in all correct answers to the knowledge questions after the intervention (p=0.000). Response to the questions exploring attitude of students towards people infected with hepatitis virus significantly changed after the training (p=0.002). There was also a significant positive change in the behaviors after the intervention (p=0.000). CONCLUSION: The significant increase in the knowledge of students trained by their peers proves this method is effective to be utilized in the prevention strategies regarding VH infections. Further studies with long term follow-up would be useful to demonstrate the long term value of peer education.

Serum lipid profile, oxidative status, and paraoxonase 1 activity in hyperemesis gravidarum.

The aim of this study was to investigate lipid profile, paraoxonase 1 (PON1) activity, and oxidative stress status in the serum of hyperemesis gravidarum (HG) patients. Thirty-six HG cases and 36 normal pregnants were included in the study. Serum total cholesterol (TC), triglyceride (TG), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), apoproteins A1 (apo A1) and B (apo B), malondialdehyde (MDA), and total antioxidant activity (TAO) values and PON1 and arylesterase activities were determined. Although serum TC, TG, LDL-C, and apo B levels were not different among; the groups (P>0.05), HDL-C (P=0.01) and apo A1 (P=0.007) levels were lower in HG patients than in normal pregnants. HG group had significantly lower serum PON1 (P=0.03) and arylesterase activities (P=0.03) compared with the control group. Additionally, mean TAO values were lower (P=0.01) and MDA levels were higher (P=0.02) in HG group than in the healthy pregnants. A significant negative correlation between PON1 and MDA was found in HG group (r=-0.33, P<0.05). The findings of this study have revealed that HG may be one of the conditions in which oxidant and antioxidant balance is impaired.

Relationship between serum levels of some acute-phase proteins and stage of disease and performance status in patients with lung cancer.

BACKGROUND: Lung cancer is the leading cause of cancer death in both developed and developing countries. The aim of the present study was to compare serum levels of alpha1-acid glycoprotein, ceruloplasmin, transferrin, ferritin, and albumin with tumor stage, distant metastasis, lymphadenopa thy, and patient performance status in patients with non-small-cell lung cancer and those with small-cell lung cancer. MATERIAL/METHODS: The study was carried out in 46 patients with primary lung cancer (39 men and 7 women) and 34 healthy subjects as the control group. RESULTS: Serum ceruloplasmin and ferritin levels were higher and transferrin and albumin levels were lower both in non-small-cell and small-cell lung cancer patients than in controls. The levels of alpha1-acid glycoprotein and ferritin associated with both performance status and lymph node metastasis. CONCLUSIONS: Measurement of alpha1-acid glycoprotein and ferritin levels could be a useful prognostic factor in addition to performance status in patient with primary lung cancer.