25 (OH) Vitamin D Levels of Patients with COVID-19 are not Associated with the Length of Hospital Stay.

BACKGROUND: Vitamin D is known to suppress the release of proinflammatory cytokines, increase the release of anti-inflammatory cytokines, and present an immunomodulatory effect. In light of the foregoing, it is suggested that vitamin D may play an important role in the course of COVID-19 infection. This study, therefore, aimed to examine the relationship between vitamin D levels and length of hospital stay of COVID-19 patients. METHODS: This retrospective study was conducted between March 15th and October 15th, 2020, among 768 patients who were hospitalized due to the diagnosis of COVID-19 infection confirmed with PCR tests taken at the Health Sciences University, Antalya Training and Research Hospital. The study included 39 patients aged 18 - 65 years, whose 25 (OH) vitamin D levels were examined within 3 months prior to the diagnosis with PCR, and whose results were found ≥ 30 ng/mL, and those patients whose 25 (OH) vitamin D levels were examined within 3 months after the diagnosis with PCR, and whose results were found < 30 ng/mL. The patients were grouped according to 25 (OH) vitamin D levels and evaluated in terms of length of hospital stay. RESULTS: Of all the 39 patients in this study, 61.5% were female, 38.5% were male, with a mean age of 48.64 ± 11.79 years. The average of 25 (OH) vitamin D levels of the patients was 21.44 ± 11.17 ng/mL, the average length of hospital stay was 9.41 ± 8.90 days. The length of stay was found to increase significantly in participants who were 45 years and older, who were male, those with chronic diseases, and those with lung involvement detected on thoracic CT imaging at the time of admission. No statistically significant difference appeared with respect to the length of hospital stay when the patients were evaluated according to their 25 (OH) vitamin D levels. CONCLUSIONS: No statistically significant relationship was found between the patients' length of hospital stay due to the COVID-19 infection and their 25 (OH) vitamin D levels in patients aged 18 - 65 years. Further prospective clinical studies still need to be conducted with large numbers of patients excluding independent risk factors such as the presence of a chronic disease.

Effects of iron and vitamin B12 deficiencies on peripheral blood colony-forming unit capacity.

Iron and vitamin B12 deficiencies are two of the most common diseases in the childhood group. Deficiencies of iron and vitamin B12 affect many systems in the body. In this study, to discover the effects of iron and vitamin B12 deficiencies on the hematopoietic stem cells, we studied CFU assay from peripheral blood. One hundred and two children were included in our study and were evaluated in five categories: iron deficiency, iron deficiency anemia, vitamin B12 deficiency, iron and vitamin B12 deficiency, and controls. As a result of statistical analysis, no significant difference was detected between five groups in terms of CFU assays. The results of our study suggest that, in emergent situations, stem cell samples can be collected before treatment with B12 or iron which are common deficiencies in donors of hematopoietic stem cell transplantation. We conclude that we could reach more accurate results by designing a study which contains more patients and includes in vivo results.

Two versus three day upfront use of granulocyte-colony stimulating factor in healthy bone marrow donors for pediatric bone marrow transplantation.

In order to decrease donors' exposure to granulocyte-colony stimulating factor (G-CSF), we compared the effect of two versus three days of G-CSF priming on CD34+ yield in bone marrow (BM) harvest. Although the number of BM-CD34+ cells was higher in 3day G-CSF priming, we achieved the same number of CD34+ cells per recipient's weight in 2day G-CSF priming group, too. In addition, the number of total nucleated cells (TNC) harvested from BM were similar with two or three day regimen. But mononuclear cells (MNC) of the BM graft was higher in the 3day G-CSF priming group. Similar to CD34+ cell numbers, BM harvest yielded similar TNC, and MNC numbers per kilogram of the recipient. We also found that, young donors (≤10year) had more peripheral blood MNC, bone marrow MNC and CD34+ cell numbers. Another interesting finding of this study was obtaining adequate number of peripheral blood stem cells for leukapheresis with three day G-CSF administration. Since engrafment times were also similar in two groups, we concluded that 2-days G-CSF priming was resulted in sufficient mobilization of BM stem cells.

The Effect of Granulocyte Colony-Stimulating Factor on Immune-Modulatory Cytokines in the Bone Marrow Microenvironment and Mesenchymal Stem Cells of Healthy Donors.

Granulocyte colony stimulating factor (G-CSF) is sometimes administered to donors before bone marrow (BM) harvest. G-CSF-primed (G-BM) and unprimed BM (U-BM)-derived mesenchymal stem cells (MSC) were obtained from 16 healthy donors and were expanded in vitro. Their proliferative characteristics, morphology, and differentiation capacity were examined. Supernatants of the second passage of MSCs were evaluated for transforming growth factor ß1, hepatocyte growth factor, and prostaglandin E2 (PGE2) levels and compared with controls. The analyses of cytokines in the G-BM- and U-BM-derived MSCs supernatants revealed that PGE2 levels were significantly lower in the G-CSF-primed samples. These cytokines were also measured in BM plasma. The level of hepatocyte growth factor in G-BM plasma was significantly increased. The current study is the first to show the effects of G-CSF on the BM microenvironment of healthy human donors. The preliminary data suggest that G-BM- and U-BM-derived MSCs have similar morphologic/phenotypic properties and differentiation capacity but differ in their secretory capacity. Significant changes in cytokine levels of BM plasma in G-CSF-primed donors were also demonstrated. These findings suggest that BM MSCs and changes in the BM microenvironment may contribute to the effects of G-CSF on inflammation and immunomodulation.

Do two different stem cell grafts: G-CSF stimulated and unstimulated bone marrow differ according to hematopoietic colony forming capacity?

The study was designed to compare colony forming capacity of granulocyte-colony stimulating factor (G-CSF) stimulated bone marrow (G-BM) with standard unstimulated bone marrow (U-BM) of healthy donors of pediatric patients. CFU-Assay results of 26 healthy donors of pediatric patients undergoing allogeneic hematopoietic stem cell transplantation (HSCT) were analyzed retrospectively. 13 of donors received 10 µg/kg per day of G-CSF as a single injection for 3 consecutive days and other 13 of donors had unstimulated BM. Colony forming capacity of hematopoietic stem cells evaluated with Colony Forming Unit-Assay (CFU-Assay) with in semi-solid agar culture medium after 14-18 days of culture period. CFU-Assay results of G-BM and U-BM (expressed as means) were; Burst Forming Unit-Erythroid (BFU-E): 15.20 × 10(4)/kg and 8.38 × 10(4)/kg, Colony Forming Unit-Granulocyte Macrophage (CFU-GM): 10.35 × 10(4)/kg and 5.67 × 10(4)/kg, Colony Forming Unit-Erythroid (CFU-E): 0.59 × 10(4)/kg and 0.33 × 10(4)/kg, CFU-Granulocyte Erythroid Macrophage Megakaryocyte (CFU-GEMM): 0.52 × 10(4)/kg and 0.53 × 10(4)/kg respectively. BFU-E and CFU-GM capacity of G-BM was increased and statistically significantly different than standard U-BM (p ⩽ 0.01). In conclusion, increased colony forming capacity of hematopoietic stem cells of G-BM when compared with standard unstimulated BM could be a major advantage for transplantation.

Pathological Internet Use, Aggression, and Cyberbullying in Children and Adolescents With Attention Deficit Hyperactivity Disorder.

Objective: The aim of this study was to evaluate the relationship between pathological internet use, aggression, and cyberbullying/victimization in children with attention deficit hyperactivity disorder. Methods: Male children (10-18 years old) with attention deficit hyperactivity disorder (n = 30) and without any diagnosis (n = 30) were evaluated using Questionnaire of Computer/Internet Use of Children and Adolescents (Children-Adolescent Form and Parent Form), Children's Aggression Scale-Parent Version, Young Internet Addiction Scale, and Cyber Bullying and Online Aggression Survey Instrument. Results: Weekly internet/computer using time, Young Internet Addiction Scale scores, Children's Aggression Scale-Parent Version scores were higher in the attention deficit hyperactivity disorder group. When all participants included in the study were compared for the availability of rules related to the PC/internet use at their homes, it was determined that there were rules by 53.3%, and the rate of setting rules was higher in the control group than attention deficit hyperactivity disorder group. There is a high level of positive correlation between Internet Addiction Scale score and duration in internet use in the attention deficit hyperactivity disorder group. Those who experienced cyberbullying throughout their lives were at a higher rate in the attention deficit hyperactivity disorder group compared to the control group. "Physical aggression without provoking" subgroup of Children's Aggression Scale-Parent Version is correlated with cyberbullying in the attention deficit hyperactivity disorder group and cyber victimization in the control group. Conclusion: Children with attention deficit hyperactivity disorder have higher levels of aggression and pathological internet use than healthy controls, but there is no difference between cyberbullying and victimization. Cyberbullying/victimization is independent of diagnosis. For this reason, it is necessary to create awareness and preventive measures of cyberbullying.

Kounis Syndrome Induced by Oral Intake of Diclofenac Potassium.

An acute coronary syndrome (ACS) occurring during the course of an allergic reaction is called Kounis syndrome (KS). The second case of KS induced by diclofenac potassium (DP) is presented in this report. A 67-year-old man was brought to our emergency department with the possible diagnosis of anaphylactic shock by the ambulance staff. It emerged that widespread erythema and pruritus developed after taking DP. Then, he lost consciousness. Diffuse urticarial lesions were detected on physical examination at the emergency department. He complained of chest pain during his observation, and progressive ST segment elevation was seen in the inferior leads on serial electrocardiograms. His coronary angiography showed 100% occlusion of the right coronary artery.  Then, KS was diagnosed. The patient was discharged on the second day, and he was doing well on the control visit 2 weeks later. All allergic reactions may trigger an ACS so physicians should be aware of KS and always keep that unique clinical entity in mind to recognize it promptly and direct the therapy at suppressing the allergic reaction and improving the coronary circulation simultaneously when encountering a patient with symptoms suggesting an allergic reaction and a concomitant ACS.

Angiopoietins in the bone marrow microenvironment of acute lymphoblastic leukemia.

OBJECTIVE: Angiogenesis have implications in leukemia biology. Angiopoietin 1 (Ang 1) is an angiogenic cytokine which is essential in survival and proliferation of endothelial cells. Angiopoietin 2 (Ang 2) promotes dissociation of pericytes and increases vascular permeability and stromal derived factor 1 alpha (SDF 1α) which is a key player in stem cell traffic in the bone marrow (BM), has stimulating effects on angiogenesis as well. Here, we investigated the role of the leukemic BM microenvironment and specifically, the role of SDF 1α-CXCR4 and Ang 1/Ang 2-Tie 2 axes. METHODS: Here, Ang 1, Ang 2, and SDF 1α levels were measured in the BM plasma and in supernatants of mesenchymal stem/stromal cells (MSCs) of patients with ALL and compared with those of healthy controls. RESULTS: The results showed that at diagnosis, BM plasma levels of Ang 1 and SDF 1α were significantly low and Ang 2 was high when compared to control values. Remission induction was associated with an increase in Ang 1/Ang 2 ratio and SDF levels in BM plasma. DISCUSSION: The results suggest that BM microenvironment and leukemic cell-stroma interaction influences the secretion of Ang 1, 2 and SDF 1α, thus, may affect both angiogenesis, homing and mobilization of leukemic blasts.