EPISODE OF ACUTE HEMOLYSIS DUE TO UNDIAGNOSED GLUCOSE-6-PHOSPHATE DEHIDROGENASE DEFICIENCY IN AN ADOLESCENT WITH NEWLY DIAGNOSED TYPE 1 DIABETES MELLITUS: CASE REPORT AND REVIEW OF LITERATURE.

Glucose-6-phosphate dehydrogenase (G6PD) enzyme deficiency is common in the community. The most important clinical manifestation of G6PD deficiency is acute hemolytic anemia due to oxidative stressors. Diabetes Mellitus (DM) can precipitate hemolysis in patients with G6PD deficiency. Here, we described a 15-year-old male with newly diagnosed type 1 DM (T1DM) and unknown G6PD deficiency who suffered from hemolytic anemia during normalization of blood glucose. On admission, the patient did not have ketoacidosis. After the patient's blood sugars were regulated with insulin therapy, he presented five days later with hemolytic anemia. The cause of hemolytic anemia was G6PD deficiency. The patient had no previous episodes of hemolysis and had no relevant family history. Hypoglycemia did not occur during blood glucose regulation. The return of blood sugar to normal after a long period of hyperglycemia was thought to be the possible cause of hemolysis. In conclusion, G6PD deficiency should be considered when there is an episode of hemolysis in newly diagnosed children and adolescents with T1DM, especially in the absence of ketoacidosis and hypoglycemia.

The effect of the visceral adiposity index on the severity of COVID-19 disease: results of a cross-sectional study.

OBJECTIVE: Obesity has been identified as a contributing factor that exacerbates the severity of COVID-19 and is associated with an increased risk of mortality among hospitalized patients. Assessing visceral adipose tissue cannot be solely determined by obesity and body mass index (BMI) alone. In our study, we investigated the relationship between the visceral adiposity index (VAI) and the clinical severity of COVID-19. PATIENTS AND METHODS: A total of 315 adult patients hospitalized with COVID-19 were included in the study. The cohort consisted of 146 male patients, and the median age was 60 (48-74) years. Comparative analyses were conducted to evaluate gender-based differences in VAI levels and the impact of VAI on the extent of radiological lung involvement. RESULTS: The median VAI level was significantly higher in women compared to men (6.1 vs. 4.0, p<0.001). Furthermore, patients with radiologically severe lung involvement demonstrated a higher median VAI level compared to those with mild involvement (5.7 vs. 4.2, p=0.003). This difference was particularly notable among male patients, where the median VAI level was significantly higher. Logistic regression analysis revealed that each integer increase in the median VAI value was associated with a 1.1-fold (1.01-1.14) increase in the severity of radiological lung involvement (p=0.011). CONCLUSIONS: Our study highlights a significant correlation between VAI and the clinical severity of COVID-19, particularly among male patients. The findings suggest that VAI, as an indicator of visceral adiposity, holds potential as a valuable tool for assessing COVID-19 severity and identifying high-risk individuals, particularly males.

Urinary trehalase activitiy in contrast-associated acute kidney injury.

OBJECTIVE: Contrast-associated acute kidney injury (CA-AKI) is the third most common cause of hospital-acquired AKI. Sensitive biomarkers can detect kidney injury early on because kidney damage begins immediately after the administration of a contrast medium. Due to its proximal tubule specificity, urinary trehalase can be a useful and early marker for detecting tubular damage. This study aimed to reveal the power of urinary trehalase activity in diagnosing CA-AKI. PATIENTS AND METHODS: This is a prospective, observational, and diagnostic validity study. The study was performed in an academic research hospital's emergency department. Patients aged 18 years and over who underwent contrast-enhanced computed tomography in the emergency department were included in the study. Urinary trehalase activities were measured before and 12, 24, and 48 hours after the administration of a contrast medium. The primary outcome was the occurrence of CA-AKI, while the secondary outcomes were risk factors for CA-AKI, duration of hospital stay after contrast use, and the mortality rate in the hospital. RESULTS: A statistically significant difference between the CA-AKI group and the non-AKI group was found in the activities measured 12 hours after the administration of the contrast medium. Notably, the mean age of the patient group with CA-AKI was considerably higher than that of the non-AKI group. The risk of mortality was found to be remarkably more elevated in patients with CA-AKI. Further, there was a positive correlation between trehalase activity and HbA1c. In addition, a crucial correlation was found between trehalase activity and poor glycemic control. CONCLUSIONS: Urinary trehalase activity can be useful as a marker of acute kidney injuries due to proximal tubule damage. In the diagnosis of CA-AKI, especially the activity of trehalase in the 12th hour might be useful.

The role of neutrophil-lymphocyte ratio and red blood cell distribution width in the classification of febrile seizures.

OBJECTIVE: Most febrile seizures occur outside of hospitals, and in most cases, information about the characteristics of the seizures is obtained from the parents. This makes it difficult to differentiate between simple and complex seizures. The aim of this study is to evaluate the significance of the Neutrophil-Lymphocyte Ratio (NLR) and the red blood cell (erythrocyte) distribution width (RDW) in distinguishing between simple and complex febrile seizures. PATIENTS AND METHODS: The files of 142 patients between the ages of 6 months and 5 years who were admitted to the Emergency Department with the diagnosis of first febrile seizure were reviewed retrospectively. Complete blood count and C-reactive protein (CRP) parameters obtained from the venous blood samples collected from the patients at admission were evaluated. RESULTS: The average values of NLR for simple and complex seizure groups were 2.38 ± 1.60 and 3.42 ± 1.77 respectively, and the difference was statistically significant (p < 0.001). The average values of RDW for simple and complex seizure groups were 16.15 ± 1.37 and 16.27 ± 1.53, respectively; the difference was not significant (p = 0.631). We used receiver operating characteristic (ROC) analysis and chose a cutoff value of 2.315 for the NLR, and we found that the sensitivity and specificity were 62.7% and 53.8%, respectively (area under the curve [AUC]: 0.665, p = 0.001, confidence interval [CI] 0.573-0.756). CONCLUSIONS: We suggest that NLR may provide clinicians with an insight into differentiating between simple and complex febrile seizures; however, it does not produce a clear-cut distinction. We found that the RDW ratio is not useful in this differentiation.

Hydrated sodium calcium aluminosilicate for reduction of aflatoxin in quails (Coturnix coturnix japonica).

The purpose of the present study was to evaluate the toxic effects of aflatoxin (AF) on growth performance and various processing parameters of quails and to determine the preventive efficacy of hydrated sodium calcium aluminosilicate (HSCAS). One hundred and eighty 1-d-old quails of both sexes were randomly divided into 4 experimental groups with 5 replicates and 45 birds following weighing. The experimental design consisted of four dietary treatments: 1) control with 0 mg AF/kg of diet and 0% HSCAS; 2) 0.5% HSCAS; 3) 2.5 mg AF/kg of diet; 4) 2.5 mg AF/kg of diet plus 0.5% HSCAS. The chicks were housed in electrically heated battery cages and exposed to light for 24 h from hatching to 3 weeks of age. Quails consumed the diets and water ad libitum. Body weight (BW) was significantly (p < 0.001) increased by addition of HSCAS to AF diet. The lowest BW gains in groups received AF alone was observed at all periods. The reduction in BW gain caused by 2.5 mg AF/kg of diet was significantly (p < 0.001) diminished by the addition of 0.5% HSCAS to the diet. The addition of HSCAS to the AF diet significantly (p < 0.001) protected against decrease of feed intake at all periods with exception of the first period. None of the treatments altered significantly the feed conversion ratio (FCR). The relative weights of the liver, kidney and spleen were increased in the chickens consuming the AF alone diet. However, light microscopic examination demonstrated the addition of HSCAS to quail feed to partially decrease fat deposition caused by the toxin, and besides, electron microscopic examination of indicated a reorganization in the endoplasmic reticulum and increase in the number of ribosomes and polisomes. Furthermore, the decrease in the antibody titre induced by Newcastle vaccine, due to aflatoxins, was relatively prevented. No significant differences were observed for serum total protein, total cholesterol and glucose levels. The results of indicate that HSCAS is effective in preventing the deleterious effects of AF.