Lymphocyte/mean platelet volume ratio, a new marker; is it effective in predicting the prognosis of COVID-19 cases?

OBJECTIVES: This study aims to determine the prognostic significance of the lymphocyte/mean platelet volume ratio (LMR) in terms of the clinical course of the disease in patients with COVID-19. METHODS: Patients over 18 who were evaluated for COVID-19 during the period from April 1, to April 30, 2020 were retrospectively scanned. Patients with at least 1 positive PCR test result were as assigned to Group 1 while patients with negative test results were assigned to Group 2. The LMR ratio was calculated by dividing the lymphocyte value by that of MPV. The relationship between LMR, severity of patients' CT findings and 28-day mortality was evaluated. RESULTS: A total of 938 patients were included in the study. It was observed that the lymphocyte and LMR levels were significantly different in those who died within 28 days (p < 0.001, p ≤ 0.001). In the ROC analysis for the LMR level, the area under the curve (AUC) was found to be 0.737 (95% CI 0.639‒0.834). When the cut­off value of LMR was 0.045, the sensitivity was found to be 99.0 % and specificity was 15.2 %. CONCLUSION: LMR can be a guide in multiple cases of care provided to critical patients, as is the case in the COVID-19 pandemic and can be used in recognizing critical patients (Tab. 5, Fig. 1, Ref. 21).

Utility of biochemical markers and RVD/LVD ratio in acute pulmonary embolism risk classification in Emergency Department.

OBJECTIVE: We aimed to determine the efficacy of troponin I, D-dimer, and lactate levels and right ventricular diameter (RVD)/left ventricular diameter (LVD) ratio on pulmonary computed tomography angiography (PCTA) in the risk classification of patients who were diagnosed with acute pulmonary embolism (APE) in Emergency Department (ED). PATIENTS AND METHODS: Patients who were diagnosed as having APE by PCTA in ED were included in this retrospective study. Patients were grouped as high-risk (undergoing cardiopulmonary resuscitation or given thrombolytic therapy), moderate-risk (with non-high-risk and positive ECO findings) and low risk (others). Troponin I, D-dimer, and lactate levels of patients were determined. RVD, RVD/LVD ratio, and interventricular septum deviation were calculated from PCTA images. RESULTS: A total of 121 patients were included (35 high, 36 moderate, 50 low risk). Lactate was different in the high-risk group from the other groups, whereas there was no difference between the moderate and low-risk groups. Troponin I levels were not different between the high-risk and moderate-risk groups. There were statistically significant differences between the high, moderate, and low-risk groups in terms of mean RVD/LVD ratios. ROC analyses performed in order to define high-risk group revealed a cut-off value of > 2.3 (AUC = 0.848, sensitivity = 70%, specificity = 90%, + Likelihood ratio (LR) = 7, -LR = 0.33, 95% CI = 0.752-0.943) for lactate and > 1.40 (AUC = 0.695 sensitivity = 71%, specificity = 80%, + LR = 3.6, -LR = 0.36, 95% CI = 0.668-0.822) for RVD/LVD ratio. CONCLUSIONS: Lactate levels and RVD/LVD ratio were shown to be useful in distinguishing high-risk patients from other patient groups. Troponin I is important in terms of showing cardiac involvement, but it is inadequate in distinguishing between high and moderate-risk patients. Lactate, troponin I, and RVD/LVD ratio may be used together for a more accurate separation of patients with high, intermediate and low-risk.

Diagnostic value of copeptin in acute myocardial infarction.

OBJECTIVE: The aim of this study was to investigate the effectiveness of copeptin in the early diagnosis of acute myocardial infarction (AMI), and to compare the diagnostic efficacy of copeptin with other cardiac markers. PATIENTS AND METHODS: A total of 160 cases were enrolled in the study. All were over 18 years of age, and consisted of 54 non-ST elevation MI (NSTEMI), 54 ST segment elevation MI (STEMI), and 52 healthy subjects (controls). Serum troponin-I, CK-MB mass, copeptin and CRP levels were measured in each of the cases, and were compared between the three groups for statistical differences. RESULTS: The copeptin levels in the STEMI (p < 0.001) and NSTEMI (p = 0.042) groups were found to be significantly higher than the control group. Spearman's correlation analysis showed a significant positive correlation between the level of copeptin and the presence of AMI (r = 0.285, p < 0.001), CK-MB mass (r = 0.246, p = 0.002), and troponin-I (r = 0.199, p = 0.012). Sensitivity, specificity, and AUC values of the tests, according to ROC analysis performed for the diagnosis of AMI were; troponin-I > 0.1 ng/mL (71.0%, 100.0%, and 0.855); CK-MB mass > 3.59 ng/mL (77.8%, 92.3%, and 0.911); CRP > 6.37 mg/L (53.7%, 88.5%, and 0.769); and copeptin > 2.47 ng/mL (66.7%, 75.0%, and 0.676), respectively (p < 0.001). CONCLUSIONS: Cardiac troponin remains the gold standard biomarker for the diagnostic evaluation of AMI. Copeptin can be used as a diagnostic marker in patients with suspected AMI in combination with other biomarkers, but, copeptin alone should not be considered as a single diagnostic marker in patients with suspected AMI.

Electron microscopic examination of the effects of methyl parathion exposure on the ovaries.

OBJECTIVE: In our study, we aimed to investigate histopathological effects of chronic methyl parathion exposure on ovaries at electron microscopic level. MATERIALS AND METHODS: In this study, Wistar albino type, adult, female rats with an average weight of 190-250 g were used. 30 female rats, included in this study, were divided into 3 groups. Group I received only saline and was evaluated as the control group, whereas Group II received 1/50 percent of LD50 dose of methyl parathion and Group III received 1/20 percent of LD50 dose of methyl parathion every day at 130 pm orally by gavages during two estrus cycles (8 days). The rats at proestrus stage on the morning of 9th day of the study underwent bilateral ovariectomy. Ovarian tissues of the control and drug groups were examined under the electron microscope; primordial and growing follicles were included in the evaluation, however, corpora lutea were excluded taking into account the presence of remaining regressive corpora lutea from the previous cycles. RESULTS: Following examination of ovarian tissues of rats exposed to 1/50 and 1/20 percent of LD50 dose of Methyl parathion at electron microscopic level, it was detected that significant structural changes had occurred in developing follicles and ovarian stroma in both drug groups, and that primordial follicles had not been affected significantly from methyl parathion but necrosis had been developed in oocyte and granulosa cells of developing follicles, and that in 1/20 group in addition to these changes, apoptotic changes had been found in granulosa cells of developing follicles. CONCLUSIONS: As a result of chronic exposure to methyl parathion, rat ovaries are significantly affected and follicular development is impaired. This state may explain the cause of infertility due to chronic pesticide exposure.

The relationship between blood lactate, carboxy-hemoglobin and clinical status in CO poisoning.

AIM: We aimed to determine the relationship between blood lactate, carboxy-hemoglobin (COHb) levels and the severity of clinical findings in patients with CO poisoning. PATIENTS AND METHODS: Patients over 18 years old and of both gender who were admitted to Emergency Department with the diagnosis of CO poisoning between 10.02.2008 and 17.03.2011 were enrolled in this study. Detailed physical examination of each patient was performed, patients and their relatives were informed about the study and written consents were noted. The levels of consciousness, physical examination findings, electrocardiographic findings, Glasgow Coma Scale (GCS) scores, laboratory results (lactate, COHb, CK-MB, Troponin-I levels) and applied treatments [normobaric oxygen therapy (NBOT), hyperbaric oxygen therapy (HBOT)] were recorded to standart data entry form for each patient. "SPSS for Windows version 18" package program was used for statistical analysis of the data. RESULTS: Total 201 patients were included in this study. Thirty five patients (17.4%) received HBOT and lactate; COHb, CKMB, Troponin-I levels of this group were higher than the other patients. Lactate and COHb levels were statistically significantly higher in patients with GCS < 15 than the ones with GCS = 15 (p < 0.01). The patients whose both Troponin-I and CK-MB levels increased have higher lactate levels (p = 0.038), but COHb levels of these patients did not change (p = 0.495). CONCLUSIONS: According to our study, blood lactate and COHb levels were both correlated with the changes of consciousness in CO poisoning. Blood lactate levels together with COHb in defining indications for HBO treatment might be suggested.

Acute-phase reactants and cytokines in ischemic stroke: do they have any relationship with short-term mortality?

BACKGROUND: Many unknown risk factors play a role in the etiopathogenesis of stroke. The appearance of inflammatory cells within the damaged tissue after cerebral ischemia suggests that an inflammatory response may play a role in stroke pathogenesis. In our study, we examined whether an association exists between the acute-phase reactants and the levels of cytokines, the volume and diameter of the stroke, and short-term mortality in patients who were diagnosed as acute ischemic a stroke after admission to the Emergency Department. PATIENTS AND METHODS: A total of 50 consecutive patients who applied to the Emergency Service with acute ischemic stroke were enrolled in the study. Their stroke volume were calculated and serum samples were obtained as soon as they arrived into the Emergency Service. The patients were evaluated according to the Glasgow Coma Scale (GCS) and National Institutes of Health Stroke Scale (NIHSS). RESULTS: There was no significant correlations between stroke volume and levels of cytokine and acute-phase reactants in dead patient group or in living patient group. A correlation and statistical significance was found between stroke volume and hospital stay time in living patient group. In addition, GCS and NIHSS scores were correlated with stroke volume and was found a significant statistically. CONCLUSIONS: Scales such as GKS and NIHHS, which evaluate the functional state of patients, are the best indicators for defining prognosis in our daily practices. In addition, we found a positive correlation between levels of CRP (C reactive protein) and prognosis. However, we did not observe a statistically significant correlation between prognosis and other acute-phase reactants such as TNF-alpha, IL-6, IL-8, IL-10, fibrinogen, and leukocytes.