Comparing the predictive values of procalcitonin/albumin ratio and other inflammatory markers in determining COVID-19 severity.

Objective: To examine the relationship between COVID-19 severity and procalcitonin/albumin ratio (PAR) and compare the PAR with oft-reported inflammatory markers, including procalcitonin, white blood cell (WBC), neutrophil/lymphocyte ratio (NLR) and C-reactive protein (CRP). Methods: In this retrospective research study conducted at Sanliurfa Training and Research Hospital during May to September 2020; total, 577 adult subjects diagnosed with COVID-19 were included and categorized into two groups based on place of hospitalization: the intensive care unit (ICU) group (n=151) and the general ward (GW) group (n=426). Laboratory test results and demographic characteristics of the subjects were recorded. Results: PAR, NLR, CRP, WBC, neutrophil and procalcitonin values were markedly higher in the ICU group than in the GW group. On the contrary, lymphocyte count and albumin level were markedly lower. PAR showed positive correlations with WBC, NLR, and CRP. Multivariate analysis showed that advanced age, presence of hypertension, elevated PAR, WBC, NLR, urea and lactate dehydrogenase levels were independent risk factors associated with the need for intensive care in COVID-19 subjects. Among them, the PAR showed the highest odds ratio (5.564) for ICU admission. Additionally, the area under the ROC curve of the PAR (0.888) was markedly greater than that of WBC (0.777), NLR (0.822), CRP (0.842) and procalcitonin (0.870). Conclusions: This study revealed that PAR was superior to procalcitonin, WBC, NLR and CRP in determining COVID-19 severity. PAR was an important predictor of ICU requirement in COVID-19 cases.

Role of NLR, PLR, ELR and CLR in differentiating COVID-19 patients with and without pneumonia.

OBJECTIVES: Neutrophil/lymphocyte ratio (NLR), platelet/lymphocyte ratio (PLR), monocyte/lymphocyte ratio (MLR), eosinophil/lymphocyte ratio (ELR), and C-reactive protein (CRP)/lymphocyte ratio (CLR) are well-established inflammatory indices. This study aimed to examine whether NLR, PLR, MLR, ELR and CLR could differentiate coronavirus disease 2019 (COVID-19) patients with pneumonia from those of without. METHODS: We retrospectively examined the laboratory parameters including CRP, D-dimer, procalcitonin and complete blood count of 306 COVID-19 patients (pneumonic = 152 and non-pneumonic = 154). NLR, PLR, MLR, ELR and CLR values of each patient were calculated. The ability of these indices to distinguish COVID-19 patients with and without pneumonia was determined by receiver operating characteristic (ROC) analysis. RESULTS: NLR, PLR and CLR values were higher while ELR value was lower in pneumonic COVID-19 patients compared with patients with non-pneumonic COVID-19 infection. MLR value was similar in the two groups. NLR, PLR and CLR were positively correlated with CRP and procalcitonin. ELR was negatively correlated with CRP. The ROC analysis revealed that the optimal cut-off value of CLR for discriminating COVID-19 patients with pneumonia from those without pneumonia was 1.14 and the area under curve (AUC) for CLR was 0.731 (sensitivity = 81.5% and specificity = 55.6%), which was markedly higher than the AUCs of NLR (0.622), PLR (0.585) and ELR (0.613). However, no statistical differences were observed between AUC values of NLR, PLR and ELR (P > .05). CONCLUSION: Our findings showed that NLR, PLR, ELR and CLR indices can be used in differentiating COVID-19 patients with or without pneumonia. Among them, the CLR index was the best predictor of pneumonia in COVID-19 patients.

Influenza vaccination rates, knowledge, attitudes and behaviours of healthcare workers in Turkey: A multicentre study.

AIM: Influenza vaccination is the most effective method in prevention of influenza disease and its complications. Our study aimed to investigate the rates of vaccination and the behaviours and attitudes against the vaccine in healthcare workers in Turkey. METHODS: This multicentre national survey is a descriptive study in which 12 475 healthcare workers. Healthcare workers were asked to answer the questionnaire consisting of 12 questions via the survey. RESULTS: It was found that 6.7% of the healthcare workers regularly got vaccinated each year and that 55% had never had the influenza vaccine before. The biggest obstacle against getting vaccinated was determined as not believing in the necessity of the vaccine (53.1%). CONCLUSION: The rates of influenza vaccination in healthcare workers in Turkey are quite low. False knowledge and attitudes on the vaccine and disease are seen as the most important reasons to decline vaccination. It is important to detect reasons for anti-vaccination and set a course in order to increase the rates of vaccination.

Landmarks in wayfinding: a review of the existing literature.

Landmarks are accepted as one of the vital elements in both virtual and real environments during wayfinding tasks. This paper provides an overview of the existing literature on the selection of landmarks in wayfinding mostly in large-scale urban environments and outdoors by discussing two main aspects of landmarks: visibility and salience. Environments and layouts used in previous studies, different tasks given to people and the main findings are explained and compared. Summary tables are created from these findings. The review concludes that there is mostly a consensus on the selection of landmarks, when considering their location. Accordingly, landmarks on route and also at decision points (with a turn) are more effective during wayfinding tasks. However, visibility of landmarks as well as visual and cognitive saliency need to be further investigated using different environments, tasks or different levels of familiarity with environments.

Stenotic double-orifice mitral valve after surgical repaired partial atrioventricular septal defect.

Double-orifice mitral valve (DOMV) is an uncommon congenital anomaly account for 1% of congenital heart disease. However, accurate diagnosis and evaluation of valve stenosis or regurgitation and other concomitant congenital anomalies due to DOMV are required to obtain suitable treatment. Two- and three-dimensional echocardiography can contribute valuable functional and anatomic information that can support to reach this goal. Here, we present a case of complete bridge-type DOMV that causes mitral stenosis after surgical repair of the partial atrioventricular septal defect in childhood.

The Value of Serum Prolidase Activity in Progression of Microalbuminuria in Patients With Type 2 Diabetes Mellitus.

BACKGROUND: Prolidase is a cytosolic exopeptidase that plays a pivotal role in collagen turnover. Diabetic nephropathy (DN) is associated with structural changes in glomerular basement membrane accompanied with increased amounts of collagen. Prolidase is known to be abundant in kidney and collagen accumulation is increased in DN, so we aimed to determine the value of serum prolidase activity (SPA) in predicting the progression of nephropathy in type 2 diabetes mellitus (DM). METHODS: Thirty type 2 DM patients having microalbuminuria (microalbuminuric group), 30 type 2 DM patients without albuminuria (normoalbuminuric group), and 28 healthy controls (control group) were enrolled. Study groups had similar age, sex distribution, and body mass index (BMI). RESULTS: Metabolic parameters, SPA and urinary microalbumin were determined. SPA was significantly higher in microalbuminuric group when compared with normoalbuminuric and control groups (P = 0.05 and P < 0.001, respectively). Triglyceride levels were significantly higher and high density lipoprotein cholesterol (HDL-C) levels were significantly lower in microalbuminuric group compared to control group (Both P < 0.05). SPA showed a negative correlation with HDL-C level and a positive correlation with urinary albumin excretion (r = -0.219, P < 0.05 and r = 0.39, P < 0.001 respectively). In regression analysis, albumin excretion was the sole parameter influencing SPA. CONCLUSION: SPA appears to be higher in type 2 DM patients having microalbuminuria compared to patients without microalbuminuria and healthy controls. The pathophysiological role and the significance of SPA in predicting DN need to be further evaluated.

Can first-trimester screening program detect women at high risk for gestational diabetes mellitus?

This study was designed to compare first-trimester maternal serum biochemical markers of aneuploidy and fetal nuchal translucency in pregnancies complicated by gestational diabetes mellitus and those of a control group. The study included 60 gestational diabetic and 60 control women who attended the first-trimester combined screening program for Down syndrome between 11 and 14 gestational weeks with complete follow-up data and delivered in our institution. Maternal serum free ß-human chorionic gonadotropin, pregnancy-associated plasma protein-A and fetal nuchal translucency were investigated. The combined risks, double test risks and age risks were calculated by PRISCA software version 4.0. Comparison of the results between the two groups yielded no significant differences in serum levels of free ß-human chorionic gonadotropin and fetal nuchal translucency. However, women who developed gestational diabetes mellitus had significantly lower pregnancy-associated plasma protein-A. And also, the combined risks and double test risks calculated by PRISCA software were statistically higher in gestational diabetic women than normal pregnant women. These results suggest that differences can be seen between diabetic and healthy pregnant women in first-trimester maternal serum biochemical markers of aneuploidy.

Toxoplasmosis: A Timeless Challenge for Pregnancy.

This study aimed to evaluate the prevalence of toxoplasmosis in pregnant women, as well as the general characteristics, clinical and laboratory findings, and pregnancy and fetal outcomes of pregnant women diagnosed with acute toxoplasma infection (ATI). The toxoplasma IgM, IgG, and IgG avidity test results of pregnant women who applied to our referral hospital between January 2016 and June 2022, and among them, those diagnosed with ATI, were analyzed. The 119 patients diagnosed with ATI during this time period were included for further analysis. The prevalence of toxoplasmosis in pregnant women was found to be 46.2%, and the rate of ATI was 4%. The total mother-to-child transmission rate was 5% (5/101). Congenital toxoplasmosis (CT) was observed in 1 (1.1%) child of the 87 pregnant women who received spiramycin prophylaxis, though it was found in 4 (30.8%) of the children of the 13 untreated mothers. With respect to prenatal treatment, CT rates were significantly higher in the children born to untreated mothers (p = 0.001). In conclusion, although toxoplasma seroprevalence was found to be high in our region, there was a paucity in diagnosis, follow-up, and treatment. Our findings support that prenatal spiramycin prophylaxis is effective in preventing the transmission of parasites from mother to child.

Thiol level and total oxidant/antioxidant status in patients with COVID-19 infection.

BACKGROUND: Accumulating evidence suggests that oxidative stress is closely related to the pathogenesis and severity of COVID-19 infection. Here, we attempted to compare thiol, total oxidant status (TOS), total antioxidant status (TAS), and oxidative stress index (OSI) levels between COVID-19 patients who need and do not need intensive care unit (ICU) support, and determine whether these markers could be used as predictors of ICU admission. METHODS: We recruited 86 patients with COVID-19 infection and classified them into two groups according to the level of care: ICU group (n = 40) and non-ICU group (n = 46). Thiol, TAS, TOS, and OSI levels were determined and compared between the two groups. RESULTS: The levels of thiol and TAS in serum were markedly lower in ICU patients than in the non-ICU patients. On the contrary, TOS and OSI levels were markedly higher. Inflammatory markers, including white blood cell, neutrophil, C-reactive protein, procalcitonin, and ferritin, were negatively correlated with the thiol and TAS, and positively correlated with the TOS and OSI. We determined that areas under the ROC curve for thiol, TAS, TOS, and OSI were 0.799, 0.778, 0.713, and 0.780, respectively. CONCLUSIONS: Our results revealed that the increase in oxidative stress and decrease in antioxidant levels in COVID-19-infected patients were associated with worsening of disease. Thiol, TAS, TOS, and OSI parameters can be used to distinguish between ICU patients and those who do not, among which thiol was the best predictor of ICU requirement.

COVID-19 infection in pregnancy: a single center experience with 75 cases.

OBJECTIVES: This study aimed to summarize the clinical features, maternal, fetal, and perinatal outcomes of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) proven infections of pregnancies. MATERIAL AND METHODS: This retrospective single center study was conducted on 75 pregnant patients diagnosed of coronavirus disease 2019 (COVID-19). Demographic characteristics, clinical courses, laboratory and radiological findings, and maternal and perinatal outcomes were analyzed using medical records. RESULTS: Of the 75 pregnant women infected with COVID-19, 49 had mild infections. The most common initial symptoms were myalgia (61.4%), cough (57.9%), headache (50.9%), and dyspnea (49.1%). More than half of the patients (57.3%) on admission were in their third trimester. Three patients had pre-existing chronic illnesses (hypothyroidism, asthma and rheumatoid arthritis) and three patients had gestational diabetes. There were two cases admitted to intensive care unit, one of whom was due to COVID-19 infection. No maternal mortality was recorded. The mode of delivery was a cesarean section in 20 cases among the 35 labors. Six gestations ended in a miscarriage and 11 women gave birth prematurely. One stillbirth occurred at the 38th week of gestation. Among 37 neonates, 14 necessitated admission to neonatal intensive care unit. Neonatal mortality, congenital malformation, and mother to child transmission were not seen in the newborns. CONCLUSIONS: The results of our study suggest that the clinical course of COVID-19 infection in pregnant women was mostly asymptomatic/mild. There was also no evidence of vertical transmission of COVID-19 infection.

15-year evaluation of changes in the HBsAg positivity rate in pregnant women in Turkey: the prominent effect of national vaccination.

Background: The detection of hepatitis B surface antigen positivity in pregnant women before delivery is crucial to preventing mother-to-child transmission of hepatitis B virus. Aims: This study aimed to evaluate the status and rate of testing for hepatitis B surface antigen, rate of hepatitis B surface antigen positivity, hepatitis B surface antigen positivity distribution rate by age, and changes in hepatitis B surface antigen positivity rate in pregnant women over the study period. Methods: We conducted a multicentre, cross-sectional, descriptive study covering the period January 2005 to June 2019 for 2 145 668 pregnant women from 27 provinces in all 7 regions of Turkey, collected using Microsoft Excel before statistical analysis. Results: We found that 1 012 593 (47.1%) pregnant women were tested for hepatitis B surface antigen over the 15-year period, out of which 11 471 (1.1%) were hepatitis B surface antigen-positive. Overall, 97% of the hepatitis B surface antigen positive women were born before 1998, the year that national HBV vaccination was launched in Turkey. The rate of hepatitis B surface antigen positivity in that group was 1.1%, compared with 0.3% among women born after 1998. Conclusion: There was a downward trend in the hepatitis B surface antigen positivity rate among pregnant women in the younger age groups, especially among those born after universal hepatitis B vaccination was inaugurated, and low rate of HBsAg testing during pregnancy.

DE-PASS Best Evidence Statement (BESt): modifiable determinants of physical activity and sedentary behaviour in children and adolescents aged 5-19 years-a protocol for systematic review and meta-analysis.

INTRODUCTION: Physical activity among children and adolescents remains insufficient, despite the substantial efforts made by researchers and policymakers. Identifying and furthering our understanding of potential modifiable determinants of physical activity behaviour (PAB) and sedentary behaviour (SB) is crucial for the development of interventions that promote a shift from SB to PAB. The current protocol details the process through which a series of systematic literature reviews and meta-analyses (MAs) will be conducted to produce a best-evidence statement (BESt) and inform policymakers. The overall aim is to identify modifiable determinants that are associated with changes in PAB and SB in children and adolescents (aged 5-19 years) and to quantify their effect on, or association with, PAB/SB. METHODS AND ANALYSIS: A search will be performed in MEDLINE, SportDiscus, Web of Science, PsychINFO and Cochrane Central Register of Controlled Trials. Randomised controlled trials (RCTs) and controlled trials (CTs) that investigate the effect of interventions on PAB/SB and longitudinal studies that investigate the associations between modifiable determinants and PAB/SB at multiple time points will be sought. Risk of bias assessments will be performed using adapted versions of Cochrane's RoB V.2.0 and ROBINS-I tools for RCTs and CTs, respectively, and an adapted version of the National Institute of Health's tool for longitudinal studies. Data will be synthesised narratively and, where possible, MAs will be performed using frequentist and Bayesian statistics. Modifiable determinants will be discussed considering the settings in which they were investigated and the PAB/SB measurement methods used. ETHICS AND DISSEMINATION: No ethical approval is needed as no primary data will be collected. The findings will be disseminated in peer-reviewed publications and academic conferences where possible. The BESt will also be shared with policy makers within the DE-PASS consortium in the first instance. SYSTEMATIC REVIEW REGISTRATION: CRD42021282874.

Paraoxonase-1 is not affected in polycystic ovary syndrome without metabolic syndrome and insulin resistance, but oxidative stress is altered.

Paraoxonase-1 (PON1) activity is decreased in polycystic ovary syndrome (PCOS) having metabolic syndrome (MetS) or insulin resistance (IR). We aimed to assess PON1 activity and oxidative stress in PCOS without MetS or IR. Metabolic and hormonal parameters, high-sensitive C-reactive protein (hs-CRP), oxidative stress parameters (total antioxidant status (TAS), total oxidative stress (TOS), oxidative stress index (OSI), lipid hydroperoxide (LOOH), total free sulfhydryl (--SH) groups), PON and arylesterase were analyzed in 30 normal weighed patients with PCOS without MetS or IR and 20 normal controls. Hs-CRP, PON, arylesterase, and TAS levels of PCOS and control groups were similar. LOOH, TOS, and OSI of PCOS group were higher than in the controls (p < 0.05; p < 0.001, and p < 0.001, respectively). - SH group levels showed a positive correlation with free testosterone (fT). TOS positively correlated with free androgen index (FAI), body mass index (BMI), waist-to-hip ratio (WHR), LOOH, and OSI. This study showed that oxidative stress is increased in PCOS even in the absence of MetS or IR. PON1 activity appears not to be affected in PCOS without MetS and IR. Several metabolic and antropometric risk factors may aggravate this altered oxidative state in PCOS.

The value of C-reactive protein/albumin, fibrinogen/albumin, and neutrophil/lymphocyte ratios in predicting the severity of CoVID-19.

OBJECTIVE: This retrospective study aimed to determine the predictive values of the C-reactive protein (CRP)/albumin ratio (CAR), fibrinogen/albumin ratio (FAR), and neutrophil/lymphocyte ratio (NLR) parameters, which reflect the systemic inflammatory status, for the severity of COVID-19. METHODS: A total of 188 patients diagnosed with COVID-19 were enrolled in this study. Among them, 118 were in the severe group, and 70 were in the non-severe group. Levels of albumin, CRP, D-dimer, procalcitonin, fibrinogen, and hemoglobin; leukocyte, neutrophil, lymphocyte, and monocyte counts; and the FAR, CAR, and NLR were compared between the two groups. RESULTS: The CAR, FAR, and NLR values were significantly higher in the severe group compared to the non-severe group. CAR, FAR, and NLR were positively correlated with leukocyte and neutrophil counts and CRP, procalcitonin, and fibrinogen levels. On the other hand, they were inversely correlated with monocyte (except for NLR) and lymphocyte counts. Receiver operator characteristic analysis showed that the area under the curve (AUC) for CAR, FAR, and NLR was 0.841, 0.737, and 0.802, respectively. CONCLUSIONS: Our investigation revealed that the CAR, FAR, and NLR indices can be used to predict the severity of COVID-19, among which CAR was the best predictor of severe COVID-19.

Serum total antioxidant status and lipid peroxidation marker malondialdehyde levels in overt and subclinical hypothyroidism.

BACKGROUND: Mitochondria are the main production site of free oxygen radicals, which can cause organ dysfunction by oxidation of cellular macromolecules such as carbohydrates, lipids and proteins. Oxidative stress may result from either overproduction of these species or from failure of the antioxidant defence systems. Thyroid hormones have well-known effects on mitochondrial oxygen consumption, but data about how hypothyroidism affects oxidative stress are controversial, and little is known about oxidative stress in subclinical hypothyroidism. Total antioxidant status (TAS) gives information about all of the antioxidants in the organism, while malondialdehyde (MDA) is a lipid peroxidation marker used to assess lipid peroxidation due to increased oxidative stress. We aimed to determine how hypothyroidism and subclinical hypothyroidism affect serum MDA and TAS. SUBJECTS AND METHODS: Serum TAS, MDA, C-reactive protein levels and lipid compositions were studied in 20 hypothyroid, 40 subclinical hypothyroid and 40 healthy subjects. RESULTS: MDA was elevated in both hypothyroid and subclinical hypothyroid patients compared with controls, while TAS levels show no significant differences between groups. Low-density lipoprotein (LDL) cholesterol levels were significantly high in both hypothyroid and subclinical hypothyroid patients. Triglyceride levels were high only in hypothyroid patients when compared with the controls. MDA showed a correlation with LDL cholesterol, total cholesterol and triglyceride. CONCLUSIONS: These results suggest an increased oxidative stress in both hypothyroid and subclinical hypothyroidism states, which can be explained by both the insufficient increase in the antioxidant status and the altered lipid metabolism in these cases.

49,XXXXY syndrome with autoimmune diabetes and ocular manifestations.

OBJECTIVE: We report a rare case of 49,XXXXY syndrome with autoimmune diabetes (requiring insulin therapy), bilateral cataracts and unilateral glaucoma. CLINICAL PRESENTATION AND INTERVENTION: A 25-year-old man with mental retardation presented with multiple skeletal abnormalities, polyuria and polydipsia. He had high glucose concentrations, without ketonuria, and hypergonadotropic hypogonadism. Ophthalmic examination revealed a polar cataract in both eyes and increased intraocular pressure in the left eye. The anti-islet cell antibody test was positive, and anti-glutamic acid decarboxylase autoantibody levels were elevated. Karyotype analysis revealed 49,XXXXY. Intensive insulin therapy and testosterone replacements were started. CONCLUSION: The autoimmune nature of diabetes that we observed in our patient seems to be predisposed by hypogonadism. Cataract and glaucoma in this case seem to be the result of diabetes, and an association of these ocular manifestations with the syndrome 49,XXXXY seems unlikely.

The Clinical Value of Diffusion-Weighted Magnetic Resonance Imaging in Diabetic Foot Infection.

BACKGROUND: Osteomyelitis is a common complication in the diabetic foot that can conclude with amputation. The purpose of this study was to evaluate the role of diffusion-weighted magnetic resonance imaging (DWI) in the diagnosis of osteomyelitis in diabetic foot ulcer (DFU). METHODS: Thirty patients with type 2 diabetes mellitus and a DFU were enrolled. Both DWIs and conventional MRIs were obtained. Apparent diffusion coefficient (ADC) measurements were made by transferring the images to a workstation. The measurements were made both from bone with osteomyelitis, or nearest to the injured area if osteomyelitis is not available, and from the adjacent soft tissue. RESULTS: The patients comprised nine women (30%) and 21 men (70%) with a mean age of 58.7 years (range, 41-78 years). The levels of ADC were significantly low (P = .022) and the erythrocyte sedimentation rates were significantly high (P = .014) in patients with osteomyelitis (n = 9) compared with patients without osteomyelitis (n = 21). The mean ± SD bone ADC value (0.75 ± 0.16 × 10-3 mm2/sec) was significantly lower than the adjacent soft-tissue ADC value (0.90 ± 0.15 × 10-3 mm2/sec) in patients with osteomyelitis (P = .04). CONCLUSIONS: It is suggested that DWI contributes to conventional MRI with short imaging time and no requirement for contrast agent. Therefore, DWI may be an alternative diagnostic method for the evaluation of DFU and the detection of osteomyelitis.

Frequency, risk factors, and responsible pathogenic microorganisms of asymptomatic bacteriuria in patients with type 2 diabetes mellitus.

Urinary tract infection is a serious problem in diabetic patients, and asymptomatic bacteriuria (ASB) in these patients is a risk factor for pyelonephritis and renal dysfunction. In the present study, we investigated the relationships between age, body mass index, duration of diabetes, HbA1c level, glucosuria, glomerular filtration rate and microalbuminuria in type 2 diabetic patients with ASB. One hundred and twenty-three patients with type 2 diabetes mellitus were included in the study. The patients were divided into two groups according to ASB; Group I consisted of 22 patients with ASB, and Group II of 101 patients without ASB. There were no significant differences between the groups in regard to age, body mass index, creatinine clearance or microalbuminuria, while there were significant differences in HbA1c, duration of diabetes mellitus, glucosuria and pyuria (P < 0.05). The most commonly isolated microorganism was Escherichia coli. The present study identified the duration of diabetes, high HbA1c, glucosuria and pyuria as risk factors for ASB in type 2 diabetic patients.

Intrasellar epidermoid cyst presenting as pituitary apoplexy.

We herein present a patient with intrasellar epidermoid cyst presenting as pituitary apoplexy, who was operated upon with a trans-sphenoidal approach. The clinical presentation, radiological and histological differential diagnosis and type of surgical intervention for intrasellar epidermoid cysts are discussed.