A new biomarker in severe pneumonia associated with coronavirus disease 2019: hypoalbuminemia. A prospective study

ABSTRACT BACKGROUND: Effective triage and early detection are very important for controlling and treating coronavirus disease 2019 (COVID-19). Thus, the relationships between hypoalbuminemia and other acute-phase reactants in such cases need to be evaluated. OBJECTIVES: To investigate the importance of albumin levels in cases of severe pneumonia due to COVID-19. DESIGN AND SETTING: Prospective study conducted in Ankara City Hospital (a stage 3 hospital), Turkey. METHODS: Data from 122 patients diagnosed with pneumonia due to COVID-19 who were admitted to this hospital were analyzed statistically in comparison with date from 60 healthy controls. Three groups were established: healthy controls, intubated patients and non-intubated patients. Lung tomography scans from the patients were examined one-by-one. Real-time polymerase chain reaction (RT-PCR) test results were recorded. RESULTS: Albumin levels were statistically significantly lower in the intubated and non-intubated groups than in the control group, in comparing the three groups (P < 0.01). The other acute-phase reactants, i.e. neutrophil-to-lymphocyte ratio and C-reactive protein levels, were significantly higher in the intubated and non-intubated groups than in the control group (P < 0.05). Albumin levels were also significantly lower in the intubated group than in the non-intubated group (P = 0.02). No differences were detected with regard to other parameters (P > 0.05). CONCLUSIONS: Hypoalbuminemia may constitute a biomarker indicating the severity of pneumonia due to COVID-19.

A new biomarker in severe pneumonia associated with coronavirus disease 2019: hypoalbuminemia. A prospective study.

BACKGROUND: Effective triage and early detection are very important for controlling and treating coronavirus disease 2019 (COVID-19). Thus, the relationships between hypoalbuminemia and other acute-phase reactants in such cases need to be evaluated. OBJECTIVES: To investigate the importance of albumin levels in cases of severe pneumonia due to COVID-19. DESIGN AND SETTING: Prospective study conducted in Ankara City Hospital (a stage 3 hospital), Turkey. METHODS: Data from 122 patients diagnosed with pneumonia due to COVID-19 who were admitted to this hospital were analyzed statistically in comparison with date from 60 healthy controls. Three groups were established: healthy controls, intubated patients and non-intubated patients. Lung tomography scans from the patients were examined one-by-one. Real-time polymerase chain reaction (RT-PCR) test results were recorded. RESULTS: Albumin levels were statistically significantly lower in the intubated and non-intubated groups than in the control group, in comparing the three groups (P < 0.01). The other acute-phase reactants, i.e. neutrophil-to-lymphocyte ratio and C-reactive protein levels, were significantly higher in the intubated and non-intubated groups than in the control group (P < 0.05). Albumin levels were also significantly lower in the intubated group than in the non-intubated group (P = 0.02). No differences were detected with regard to other parameters (P > 0.05). CONCLUSIONS: Hypoalbuminemia may constitute a biomarker indicating the severity of pneumonia due to COVID-19.

Evaluation of patients with acute pancreatitis associated with SARS-CoV-2 (COVID-19); The importance of lipase/lymphocyte ratio in predicting mortality.

BACKGROUND: SARS-CoV-2 is the cause of a pandemic with high mortality. In the present study, the effects of the lipase/lymphocyte ratio on mortality were investigated in cases diagnosed with Covid-19 and acute pancreatitis. METHODS: A total of 21 patients who were diagnosed with Covid-19 and acute pancreatitis, 34 patients who were not diagnosed with COVID-19 but diagnosed with acute pancreatitis, and 55 healthy control groups were divided into 3 groups and included in the study retrospectively. The patients who had positive RT-PCR (real­time polymerized chain reaction) test results were included in the study. Complete blood count and biochemical values ​​of the patients were compared with those of the control group. RESULTS: When the data of the cases diagnosed with COVID-19 and acute pancreatitis were examined retrospectively, the amylase, lipase, lipase/lymphocyte ratio, and D-dimer levels were found to be significantly higher than in the control group (p < 0.01). In the ROC analysis, the amylase, lipase, and lipase/lymphocyte ratio had a high AUC (area under the curve) value (0.993 / 0.949 / 0.978, respectively). CONCLUSION: The lipase/lymphocyte ratio can be used in cases diagnosed with Covid-19 and acute pancreatitis to predict mortality (Tab. 3, Fig. 3, Ref. 23).

Dynamic Thiol/Disulphide Homeostasis in Acute Urticaria.

BACKGROUND: Urticaria is an unknown, sudden, and itchy skin disease that is recognized with redness, swelling, and is sometimes seen with angioedema. It is classified as acute or chronic, depending on the duration of symptoms. Thiols in plasma are powerful antioxidants that physiologically eliminate free radicals. The mostly and rapidly affected proteins are thiols that contain the sulfhydryl group. In the present study, the thiol/disulfide homeostasis was investigated as a brand new indicator of oxidative stress in patients who had acute urticaria and presented to the emergency department. OBJECTIVE: In the present study, the thiol/disulfide homeostasis, ischemia-modified albumin (IMA), and and neutrophil lymphocyte ratio (N/L ratio) were investigated in the etiopathogenesis of acute urticaria. MATERIAL AND METHOD: A total of 37 patients and 40 healthy volunteers were included in the study. Thiol/disulfide homeostasis (TDH) [total thiol-native thiol/disulfide changes] was measured in both groups (patient group and control group) using a brand novel method developed by Erel and Neselioglu. Half of the difference between total thiol and native thiol concentrations gives the amount of disulfide bond. RESULTS: Total thiol and native thiol levels in blood were found to be low. The levels of total thiol (P = 0.218) and native thiol (P = 0,001) were significantly lower in patients with acute urticaria than in the control group. At the same time, the level of disulfide was significantly higher in the patient group than in the control group (P = <0.001). The level of IMA was higher in the patient group than in the control group (P < 0.001). CONCLUSION: While total thiol and native thiol are low in acute urticaria, the levels of disulfide and IMA are high.

Dynamic thiol/disulfide homeostasis as oxidative stress marker in diabetic ketoacidosis

Background/aim: The aim of present study was to investigate the dynamic thiol/disulfide homeostasis as oxidative stress marker in diabetic ketoacidosis (DKA). Materials and methods: A total of 77 participants consisting of 32 patients with DKA and 45 healthy volunteers were included in the study. Thiol/disulfide homeostasis (TDH) [total thiol-native thiol/disulfide changes] were measured in both groups (patient group and control group) using a brand new method developed by Erel and Neselioglu. Half of the difference between total thiol and native thiol concentrations gives the amount of disulfide bond. Results: Total thiol, native thiol, and disulfide levels in blood were found to be low. The levels of total thiol (P < 0.001) and native thiol (P < 0.001 ) were significantly lower in patients with DKA than in the control group. At the same time, the level of disulfide was nonsignificantly lower in the patient group than the control group (P = 0.388). The level of IMA was higher in the patient group than in the control group (P < 0.001). Conclusion: The total thiol, native thiol, and disulfide levels in DKA decrease in favor of oxidative stress.

The thiol-disulphide homeostasis in patients with acute pancreatitis and its relation with other blood parameters.

BACKGROUND: Acute pancreatitis is a common disease seen in emergency departments because of abdominal pain. The present study aims to evaluate the relation between measurements of thiol-disulfide parameters in patients diagnosed with acute pancreatitis and other blood parameters. METHODS: A total of 56 (56%) patients, who were admitted to the emergency department, and 44 (44%) healthy volunteers participated in this study. A total of 100 samples were taken from the participants. Detailed blood samples were taken from the patients at the time of arrival at the hospital. The thiol-disulfide level in serum was examined using a brand new method that was developed by Erel and Neselioglu in the venous blood samples of the patients who were diagnosed with acute pancreatitis during the admission. The data were evaluated in the computer medium. RESULTS: Gallstones were defined as the etiology of AP in 41 patients (73.2%); in one patient, hypertriglyceridemia (1.7%); in four patients, alcohol use (7.1%), and idiopathic 10 patients (17.8%). While the blood thiol levels were low, the disulfide levels were high at a significant level. No statistically significant relations were detected between the amylase, lipase, neutrophil lymphocyte ratio (NLR), which are other blood parameters, and thiol-disulfide balance parameters. CONCLUSION: The disruption of the thiol-disulfide balance may play a role in the pathogenesis of acute pancreatitis. In acute pancreatitis, since the thiol level is decreased in the blood, administration of the complementary therapies for this thiol deficiency may contribute to the treatment of the disease.

Concurrent Spontaneous Sublingual and Intramural Small Bowel Hematoma due to Warfarin Use.

Introduction. We present a case of concurrent spontaneous sublingual and intramural small bowel hematoma due to warfarin anticoagulation. Case. A 71-year-old man presented to the emergency department complaining of a swollen, painful tongue. He was on warfarin therapy. Physical examination revealed sublingual hematoma. His international normalized ratio was 11.9. The computed tomography scan of the neck demonstrated sublingual hematoma. He was admitted to emergency department observation unit, monitored closely; anticoagulation was reversed with fresh frozen plasma and vitamin K. 26 hours after his arrival to the emergency department, his abdominal pain and melena started. His abdomen tomography demonstrated intestinal submucosal hemorrhage in the ileum. He was admitted to surgical floor, monitored closely, and discharged on day 4. Conclusion. Since the patient did not have airway compromise holding anticoagulant, reversing anticoagulation, close monitoring and observation were enough for management of both sublingual and spontaneous intramural small bowel hematoma.

Subcutaneous Emphysema, Pneumomediastinum, and Pneumorrhachis after Cocaine Inhalation.

Introduction. The most prominent complications of cocaine use are adverse effects in the cardiovascular and central nervous systems. Free air in the mediastinum and subcutaneous tissue may be observed less frequently, whereas free air in the spinal canal (pneumorrhachis) is a very rare complication of cocaine abuse. In this report we present a case of pneumorrhachis that developed after cocaine use. Case. A 28-year-old male patient was admitted to the emergency department with shortness of breath, chest pain, and swelling in the neck and face which started four hours after he had sniffed cocaine. On physical examination, subcutaneous crepitations were felt with palpation of the jaw, neck, and upper chest area. Diffuse subcutaneous emphysema, pneumomediastinum, and pneumorrhachis were detected in the computed tomography imaging. The patient was treated conservatively and discharged uneventfully. Discussion. Complications such as pneumothorax, pneumomediastinum, and pneumoperitoneum that are associated with cocaine use may be seen due to increased intrathoracic pressure. The air then may flow into the spinal canal resulting in pneumorrhachis. Emergency physicians should know the possible complications of cocaine use and be prepared for rare complications such as pneumorrhachis.

Posttraumatic pneumocephalus-induced bilateral oculomotor nerve palsy.

Bilateral third nerve palsy often points to the involvement of its nucleus. Third nerve palsy as a result of posttraumatic nuclear involvement is an extremely rare condition. A 23-year-old man presented with a depressed skull fracture after acute head trauma and had Glasgow Coma Scale Score of 9. The diameters of the pupils were 6.5 and 7.5 mm and they were not reactive to light stimulation. There was bilateral ptosis. Computed tomography (CT) relieved bilateral perimesensephalic pneumocephalus. We suggested that bilateral oculomotor nerve paresis might develop in association with posttraumatic bilateral perimesensephalic pneumocephalus, which affected the nucleus of the third nerve.