Can mean platelet volume be a prognosis predictor in viral infections: An example of Covid-19.

Purpose: This study revealed the utility of mean platelet volume (MPV) as a mortality marker in SARS-CoV-2 infection, as well as its connection with other inflammatory indicators such as procalcitonin (PCT) and neutrophil-lymphocyte ratio (NLR). Methods: A total of 1528 patients (853 males and 653 females; mean age: 64.33 ± 16.36 years; range, 18-100 years) were hospitalized with COVID-19 between March 2020 and December 2022. The patients' demographic and clinical information, including ward and critical care data, were gathered from their medical records. On the first and last days, the PCT, NLR, and MPV values of the patients, who were divided into groups based on their hospitalization and outcomes, were analyzed. Results: When the relevant laboratory data from the first and last days were compared, each group was statistically significant (p < 0.05). There was a moderate association between the final MPV values and the PCT and NLR values of the patients admitted to the ward (r = 0.448 and r = 0.397, respectively, where p < 0.01). There was also a substantial and moderate correlation between the final MPV levels and the PCT and NLR values of patients admitted to the intensive care unit (r = 0.613 and r = 0.361, respectively, p < 0.01). When compared to the patients' outcomes, the MPV had greater specificity and AUC values than the PCT and NLR (94.4 %, 0.968, 80.6 %, 0.923, 81 %, 0.845, respectively). Conclusion: In patients hospitalized with COVID-19, the specificity of MPV values at the point of sickness severity and outcome was shown to be greater than PCT and NLR values, and MPV values may be a more accurate predictor of mortality than PCR and NLR.

Comparative analysis of epidemiological and clinical characteristics of appendicitis among children and adults.

BACKGROUND: This study aimed to investigate whether there are some differences between pediatric and adult patients with appendicitis. METHODS: We retrospectively reviewed the records of 279 pediatric and 275 adult patients with respect to demographics, past medical history, duration of symptoms, laboratory and radiological findings, operation notes, pathological reports, length of hospital stay and post-operative outcomes. RESULTS: No significant differences were found with respect to gender, rates of perforation and negative appendectomy, laboratory findings, and overall outcomes between children and adults. However, our study suggests that the diagnosis is more difficult in children, the most preferred radiologic diagnostic methods are abdominal ultrasound and plain X-ray in children vs. computed tomography in adults, air-fluid levels and right-sided scoliosis are more commonly detected on X-ray in children, appendiceal perforation is more common at both extreme of ages, the appendix is perforated earlier and length of hospital stay is longer in children, and misdiagnosis at first admission in children and advanced age in adults were the risk factors associated with the complications. CONCLUSION: The present study found some important differences between childhood and adulthood appendicitis. If these differences are considered when evaluating the patients, more desired outcomes can be achieved for both clinicians and patients.

Can NLR, PLR and LMR be used as prognostic indicators in patients with pulmonary embolism? A commentary.

We read with great interest the article "Prognostic role of NLR, PLR, and LMR in patients with pulmonary embolism" by Köse et al.[1]. They found that the neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR), and lymphocyte-monocyte ratio (LMR) were related to the prognosis and clinical severity of patients with pulmonary embolism (PE). First of all, we congratulate the authors for their invaluable contribution to literature. However, we think that some points should be discussed regarding the use of these laboratory parameters. White blood cell subtypes NLR, PLR, and LMR, have been associated with many inflammatory diseases, including PE [2,3]. These parameters, which can be easily determined by simple and easy measurement of systemic inflammation, maintain their importance today. However, these parameters are affected by many factors such as trauma, local or systemic infection, acute coronary syndromes, and malignancy [3-5]. For these reasons, it would be better for the authors to mention these factors and exclude them from the tables that included malignancy and trauma patients in the study. It is known that drugs, including steroids, can increase neutrophils and decrease lymphocytes and therefore affect NLR, PLR, and LMR values [6]. Consequently, it will be more valuable to exclude patients who use drugs that may affect laboratory parameters. Besides, plasma inflammatory biomarkers are time-dependent variables. The time of sample collection and the time from the onset of the symptom to the sampling may impact the parameters [3-6]. Therefore, it is essential to identify the time from the first symptom to sample collection and the factors that may affect it. In conclusion, because NLR, PLR, and LMR can be affected by many factors, prospective studies with large populations are needed to show the accuracy of use in critically ill patients.

Glutathione depletion induces oxidative injury and apoptosis via TRPM2 channel activation in renal collecting duct cells.

Oxidative stress (OS)-induced glutathione (GSH) depletion plays an essential role in several kidney diseases such as chronic kidney disease and nephrotoxicity. The OS-dependent activation of TRPM2 cation channel in several neurons and cells were modulated by the concentration of intracellular GSH. However, the effects of GSH alteration on TRPM2 activation, OS, and apoptosis in the cortical collecting duct (mpkCCDc14) cells still remain elusive. We investigated the effects of GSH supplementation on OS-induced TRPM2 activation, mitochondrial oxidative stress, and apoptosis in the human embryonic kidney 293 (HEK293) and mpkCCDc14 cells treated with buthionine-sulfoximine (BSO), a GSH synthase inhibitor. The HEK293 and mpkCCDc14 cells were divided into five groups as control, GSH (10 mM for 2 h), BSO (0.5 mM for 6 h), BSO + GSH, and BSO + TRPM2 channel blockers. Apoptosis, cell death, mitochondrial OS, caspase -3, caspase -9, cytosolic free Zn2+, and Ca2+ concentrations were increased in the BSO group of the TRPM2 expressing mpkCCDc14 cells, although they were diminished by the treatments of GSH, PARP-1 inhibitors (PJ34 and DPQ), and TRPM2 blockers (ACA and 2-APB). The BSO-induced decreases in the levels of cell viability and cytosolic GSH were increased by the treatments of GSH, ACA, and 2-APB. However, the effects of BSO and GSH were not observed in the non-TRPM2 expressing HEK293 cells. Current results show that maintaining GSH homeostasis is not only important for quenching OS in the cortical collecting duct cells but equally critical to modulate TRPM2 activation. Thus, suppressing apoptosis and mitochondrial OS responses elicited by oxidant action of GSH depletion.

Curcumin Attenuates Hypoxia-Induced Oxidative Neurotoxicity, Apoptosis, Calcium, and Zinc Ion Influxes in a Neuronal Cell Line: Involvement of TRPM2 Channel.

Apoptosis/cell death and reactive oxygen species (ROS) via overload free Ca2+ and Zn2+ uptake into mitochondria are emerging as crucial events in the etiology of hypoxia (HPX)-induced neurodegenerative diseases. The neuroprotective actions of curcumin (CURC) via modulation of oxidative stress and the PARP1-dependent activated TRPM2 cation channel on the ROS generation and cell death in several neurons have been recognized. However, the molecular mechanisms underlying CURC's neuroprotection remain elusive. We investigated the role of CURC via modulation of TRPM2 on cell death and oxidative cytotoxicity in SH-SY5Y neuronal cells. The SH-SY5Y cells were divided into five groups as follows: CURC (10 µM for 24 h), HPX (200 µM CoCl2 for 24 h), CURC + HPX, and HPX + TRPM2 blockers (2-APB-100 µM or ACA-25 µM for 30 min). In some experiments, the cells in the HPX groups were additionally incubated with PARP1 (PJ34) and Zn2+ (TPEN) inhibitors. The exposure of CoCl2 induced increases of TRPM2 current density and Ca2+ fluorescence intensity with an increase of mitochondrial membrane depolarization and ROS generation. When HPX-induced TRPM2 activity was blocked by 2-APB and ACA, or the cells were treated with CURC, the increase of ROS generation, the expression levels of TRPM2 and PARP1 were restored. The levels of apoptosis and cell death in the cells were enriched with increases of caspase-3 and -9 activations, although they were decreased by CURC treatment. HPX-induced increase of cytosolic Zn2+ was attenuated by the TPEN and CURC treatments. In conclusion, CURC attenuates HPX-induced mitochondrial ROS generation, apoptosis, cell death, and TRPM2-mediated Ca2+ signaling and may provide an avenue for treating HPX-induced neurological diseases associated with the ROS, Ca2+, and Zn2+.

NLR, d-NLR and PLR can be affected by many factors.

We have read the article by Yang et al, entitled "The diagnostic and predictive role of NLR, d-NLR and PLR in COVID-19 patients" with great interest. The authors emphasized that the NLR (Neutrophil to lymphocyte ratio) is an independent prognostic biomarker for COVID-19 patients. First of all, we congratulate the authors for their valuable contribution to the literature in these difficult conditions. However, we would like to add on a few cases that need more attention.

Clinical use of copeptin in migraine patients admitted to the emergency department.

PURPOSE: The purpose of this study was to investigate the clinical use of copeptin to evaluate migraine attacks in the Emergency Department. An additional aim was to detect changes in serum copeptin levels in migraine patients during attack and attack-free periods. METHODS: This prospective case-control study included 52 migraine patients and 51 healthy individuals with similar demographic characteristics. Blood samples were collected from migraine patients both in attack and attack-free periods. RESULTS: The mean copeptin levels in the patients group in the attack and attack-free periods were 689.28 and 576.68 pg/ml, respectively, whereas they were 608.68 pg/ml in the control group. There was a significant difference in the mean copeptin level in the attack period and attack-free periods (p = 0.026). The sensitivity and specificity of copeptin in detecting headache episodes in migraine patients were 58.8% and 60.7%, respectively, at a cut-off value of 388.67 pg/ml. CONCLUSION: This is the first study to investigate the diagnostic efficacy of serum copeptin levels in migraine patients. Although the diagnostic efficacy of serum copeptin levels for migraines was unsatisfactory, it could be helpful at management of migraine patients in ED.

A New Promising Treatment Strategy for Carbon Monoxide Poisoning: High Flow Nasal Cannula Oxygen Therapy.

BACKGROUND High-flow nasal cannula (HFNC) is an alternative to conventional normobaric oxygen therapy (NBO) for hypoxemic patients. Since nothing is known about its effect on carbon monoxide (CO) poisoning, we hypothesized that HFNC might be a useful device in the treatment of CO poisoning victims. MATERIAL AND METHODS We retrospectively reviewed the medical records of patients who were admitted consecutively to the emergency department with CO intoxication. Patients were divided into 2 groups: patients treated with HFNC and patients treated with conventional face mask (CFM). Demographic data, pretreatment, and control (after 1 hour) arterial blood gas analyses values of the patients were evaluated. RESULTS Sixty-eight patients (mean age 35.8±18.7 years) were included in this study. NBO was given via HFNC to 38 patients (55.9%), and via CFM to 30 patients (44.1%). The demographic characteristics and pretreatment values of carboxy-hemoglobin (COHb) were similar in the 2 groups. The mean COHb value of the HFNC group at the first hour was found significantly lower than the CFM group: 9.5±4.7 and 12.0±5.1, respectively (P=0.041). Improvement of COHb level was significantly higher in the HFNC group compared to the CFM group: 12.5±4.5 versus 6.7±3.7, respectively (P=0.001). CONCLUSIONS HFNC was superior than CFM in alleviating COHb levels in the victims of CO poisoning. We believe that using HFNC will increase patient comfort by shortening the duration of treatment in emergency department settings, especially in patients who have mild clinical findings of CO poisoning.

A novel approach for manual de-torsion of an atypical (outward) testicular torsion with bedside Doppler ultrasonography guidance.

A 17-year-old boy presented with right testicular torsion to the lateral side. Torsion was diagnosed by physical examination; the colour Doppler ultrasonography (CDU) confirmed right testicular torsion with minimal peripheral hydrocele. Transverse and longitudinal examination of the spermatic cord with ultrasound and CDU revealed a counter-clockwise testicular torsion. Manual de-torsion was performed in a clockwise direction (720o) and testicular blood flow and the neutral position of the spermatic cord were confirmed by CDU. We did not encounter a residual twist of the spermatic cord upon surgical exploration. In our experience, ultrasound and CDU may predict the direction of testicular torsion and may allow appropriate management of cases prior to surgery.

Effects of pentoxifylline and alpha lipoic acid on methotrexate-induced damage in liver and kidney of rats.

The aim of the current study was to investigate the probable protective effects of Pentoxifylline (PTX) and Alpha Lipoic Acid (ALA), which display anti-oxidative efficacy against hepatotoxicity and nephrotoxicity, those being the major side effects of Methotrexate (MTX). Rats were divided into four groups: a control group; MTX (20mg/kg/day) group; MTX+PTX (20mg/kg/day+50mg/kg/day) group; and an MTX+ALA (20mg/kg/day+100mg/kg/day) group. At the end of the experiment, biochemical, histochemical and immunohistochemical analyses were performed on liver and kidney tissues of rats. We determined Glutathione Peroxidase (GSH-Px), Superoxide Dismutase (SOD), Catalase (CAT), Malondialdehyde (MDA), Nitric Oxide (NO) and Xanthine Oxidase (XO) levels in the liver and kidney. Moreover, Gamma Glutamyl Transferase (GGT), Direct Bilirubin (DBil), Blood Urea Nitrogen (BUN), and urea levels were measured in the serum. The histochemical evaluation revealed a significant decrease in MTX caused damage in the PTX- and ALA-treated groups (especially in ALA group). On the other hand, the immune staining of iNOS and TNF-α were observed most densely in the MTX group, while the density decreased in the PTX- and ALA-administered groups. We determined increased GGT, BUN, urea and levels of CAT, MDA, NO, and XO values in both groups, while GSH-Px (an increase in liver tissue) and DBil levels were decreased in the group that received MTX. However, we determined decreased SOD levels in liver tissue. In the PTX and ALA groups, the levels of GGT, BUN and urea as well as the levels of CAT, MDA, NO and XO decreased (SOD increased in the liver tissue), and the levels of GSH-Px and DBil increased. In conclusion, it can be stated that, although ALA is more effective in preventing the toxic effects of MTX on the liver and kidney, PTX also has a preventive effect. As a result, we can readily suggest that ALA and PTX can have protective effects by decreasing MDA, NO, BUN and urea values as antioxidants against MTX-induced damage in liver and kidney of rats.