Stability of potassium, calcium and phosphorus electrolytes in three different tubes in patients with essential thrombocytosis.

Proper blood collection and timely analysis are vital steps for reliable results. This study aims to compare potassium(K), calcium(Ca), and phosphorus(P) concentrations in serum separator tube (SST), lithium heparin tube without gel (LiH), and lithium heparin tube with a barrier (Barricor)tubes in essential thrombocytosis(ET) patients. Additionally, we assessed short-term stability of these analytes at room temperature. K, Ca and P concentrations of blood taken from 40 ET patients into SST, LiH and Barricor tubes were measured at 0, 2, 4 and 8 h. We calculated the percentage difference and defined the maximum permissible difference (MPD) using the Biological Variation Database. Intertube comparisons were conducted using Passing-Bablok regression and Bland-Altman analysis. Comparing SST to LiH, the percentage difference values for all tests exceeded the MPD. When comparing Barricor to LiH, K and Ca tests were above MPD, except for P. At the 8th hour, LiH showed clinically significant changes in all three electrolytes. Barricor exhibited stability for K, Ca, and P for up to 8 h, with only Ca levels borderline higher than the MPD. Our study reveals clinically significant alterations in K, Ca, and P concentrations in SST compared to LiH tubes, and in K and Ca concentrations in Barricor compared to LiH tubes. While K, Ca and P concentrations were stable for up to 4 h at room temperature in all tube types tested, significant changes were observed in all electrolytes at 8 h in the LiH tube.

Evaluation of ischemia-modified albumin in the diagnosis and the clinical severity of COVID-19 in children.

BACKGROUND: There is no specific biomarker used in the diagnosis of COVID-19 and predicting its clinical severity. This study aimed to investigate the utility of ischemia-modified albumin (IMA) in diagnosing and predicting clinical severity in children with COVID-19. METHODS: Between October 2020 and March 2021, 41 cases constituted the COVID-19 group and 41 cases constituted the healthy control group. IMA levels were measured at admission (IMA-1) and 48-72 hours (IMA- 2) in the COVID-19 group. In the control group, it was measured at admission. COVID-19 clinical severity was classified as asymptomatic infection, mild, moderate, severe, or critical disease. Patients were divided into two groups (asymptomatic/mild and moderate/severe) to evaluate IMA levels in terms of clinical severity. RESULTS: In the COVID-19 group, the mean IMA-1 level was 0.901±0.099, and the mean IMA-2 level was 0.866±0.090. The mean level of IMA-1 in the control group was 0.787±0.051. When IMA-1 levels of COVID-19 and control cases were compared, the difference was statistically significant (p < 0.001). When clinical severity and laboratory data are compared, C-reactive protein, ferritin and ischemia-modified albumin ratio (IMAR) were statistically significantly higher in moderate-severe clinical cases (p=0.034, p=0.034, p=0.037 respectively). However, IMA-1 and IMA-2 levels were similar between the groups (p=0.134, p=0.922, respectively). CONCLUSIONS: To date, no study has been conducted on IMA levels in children with COVID-19. The IMA level may be a new marker for the diagnosis of COVID-19 in children. Studies with a larger number of cases are needed to predict clinical severity.

Serum Amyloid A Levels and Severity of COVID-19 in Children.

OBJECTIVE: The aim of this study was to determine the availability of serum amyloid A (SAA) in the diagnosis of coronavirus disease 2019 (COVID-19), to asses disease severity and to predict hospitalization status. METHODS: Between March, 2020 and March, 2021, a total of 80 children (40 cases with COVID-19 and 40 cases in healthy group) were included in this study. Patients were divided into two groups (mild and moderate/severe) to evaluate SAA levels in terms of clinical severity and also hospitalization status. RESULTS: Comparisons between the two groups revealed that median SAA values were significantly higher in children with COVID-19 than in their healthy peers (21.45vs3.05 mg/L, P=0.002). There was no significant difference in the median serum SAA levels between mild and moderate/severe clinical disease (P=0.837). The SAA difference between the two groups with regards to hospitalization was not statistically significant (P=0.098). CONCLUSIONS: Although SAA level was found to be higher in children with COVID 19 compared to healthy controls, the sensitivity of SAA for the disease was found to be low. In addition, there was no difference between the groups in terms of clinical severity.

The effect of positive pressure ventilation on serum ischemia-modified albumin levels in obese patients with obstructive sleep apnea syndrome.

Introduction: Respiratory abnormalities in obstructive sleep apnea syndrome (OSAS) are corrected with positive pressure ventilation treatments. We investigated the effect of positive airway pressure (PAP) treatment on the serum level of ischemia-modified albumin (IMA), an oxidative stress product, in OSAS patients with higher body mass index (BMI) and indication for PAP treatment. Materials and Methods: Seven consecutive female and 23 male patients with a BMI of ≥30 kg/m2 who were diagnosed as having OSAS according to ICSD3 criteria and were planned for PAP, were included. The Epworth Sleepiness Scale and STOP-Bang Questionnaire were performed. Morning arterial blood gas, hemogram, biochemistry, insulin, and IMA were measured after polysomnography and after three months of PAP. Result: There were no significant changes in lactate, CRP, and serum electrolyte levels measured before and after PAP, except for potassium. When 30 patients were compared in terms of serum IMA levels at baseline and after treatment, the mean baseline value was 0.56 absorbance units (ABSU), and the 3rd-month follow-up IMA value was 0.53 ABSU (p= 0.537). The mean serum fasting insulin level was 15.85 µIU/mL and 11.6 (p= 0.002) and the mean HOMA index was 4.4 and 3.0 (p= 0.001), respectively. Conclusions: Serum IMA levels seem not to be an appropriate marker for the evaluation of PAP treatment in OSAS patients with higher BMI. PAP is associated with a decrease in the fasting insulin level, HOMA index, and hematocrit, but not with serum electrolytes except potassium.

Galectin-3 levels and inflammatory response in patients undergoing bariatric surgery.

PURPOSE: Obesity, a low-grade systemic inflammatory disease, causes inflammation in metabolic tissues. Galectin-3(Gal-3) is one of the lectin molecules involved in inflammatory processes. We evaluated the possible relationship between Gal-3 level and the metabolic inflammatory process before and after obesity surgery. METHODS: One hundred participants were included in the study and classified as normal weight, overweight, Class I, II, and III obese. Class III obese group underwent bariatric surgery and evaluated in the 3rd and 6th months after surgery. Glucose, insulin, glycated hemoglobin A1c (HbA1c), homeostatic model assessment of insulin resistance (HOMA-IR), high sensitivity C-reactive protein (hsCRP), Gal-3, interleukin (IL)-6, IL-10, adiponectin, and leptin levels were determined. RESULTS: Gal-3 levels were higher in Class III obese compared to the normal weight group. Postoperative leptin and hsCRP levels were decreased significantly, but the decrease in IL-6 and Gal-3 levels were not significant. Postoperative increased adiponectin and IL-10 levels were significant. Gal-3 was found significantly higher in insulin resistant group. The correlation between Gal-3 with BMI, adiponectin, leptin, hsCRP levels, and HOMA-IR was found weak. CONCLUSION: These findings might support the fact that Gal-3 is one of the molecules involved in the linkage between insulin resistance and meta-inflammation in morbid obese.

First-trimester placental function in levothyroxine-using pregnant women: a case-control study.

We aimed to compare the pregnancy-associated plasma protein-A (PAPP-A) and the uterine artery pulsatility index (UtA PI) levels of euthyroid pregnant women using levothyroxine vs. a control group of uncomplicated pregnancies and to evaluate the effects of different levothyroxine dosages on pregnancy outcomes. We retrospectively evaluated 206 levothyroxine-using pregnant women by looking at their basic placental function markers and obstetric outcomes. A sample of 449 women whose pregnancies concluded with uncomplicated term deliveries composed of our control group. To examine the relationship between the levothyroxine dosages and the frequency of pregnancy complications, levothyroxine users were divided into different groups according to the 75, 100, and 150 mcg cutoffs. The median PAPP-A MoM levels of levothyroxine users were significantly lower at 0.94 vs. 1.11 (p < .001) and the median mean UtA PI was significantly higher than the control group at 2.08 vs. 1.74 (p < .0001). The median birth weight was significantly lower for the levothyroxine users' group at 3292 g vs. 3427 g (p < .0001). Using 75, 100, and 150 mcg dose cutoffs, PAPP-A MoM, mean UtA PI and obstetric complication frequencies were not significantly different among levothyroxine users. Significant changes in placental function markers have been observed in euthyroid levothyroxine-using pregnant women during the first trimester. However, the frequency of obstetric complications does not appear to be dose dependent.

Prediction of ischemic placental diseases during the first trimester combined test period: a retrospective cohort of low-risk pregnancies in search of the link between parity and disease.

Objective: To assess the predictive power of a multifactorial model established on maternal characteristics, placenta-associated plasma protein A (PAPPA), and the mean uterine artery pulsatility index (Ut A PI) levels for the development of ischemic placental diseases (IPD) during the first-trimester combined test (FTCT) period and to evaluate the strength of some generally accepted clinical risk factors.Method: The studied data were obtained from a retrospective cohort of low-risk singleton pregnancies in the FTCT between 1 August 2016 and 1 December 2017. After routine 11-13-week examinations for FTCT, the Ut A PI was measured and stored electronically. The PAPPA multiple of median (MoM) was obtained as a routine component of aneuploidy screening.Results: A sample of 2493 pregnancies with clearly documented outcomes was studied. Early-onset preeclampsia, late-onset preeclampsia and fetal growth restriction (FGR) were observed in 9 (0.36%), 27 (1.08%), and 41 (1.64%) cases, respectively. With optimum cut-off levels of 0.69 for PAPPA MoM and 2.05 for mean Ut A PI and a false positive rate of 4.9%, IPD cases could be predicted with 83.3% sensitivity and 73.7% specificity. Nulliparity, previous abortion in nulliparous women and first pregnancy from second marriage were not independent risk factors. Maternal age, an interval from the last delivery longer than 6 years, and body mass index were found to be independent risk factors.Conclusion: The IPD showed some common and distinct clinical, laboratory and Doppler findings during the FTCT and were predictable with the help of multifactorial analysis. Some widely accepted risk factors could be affected by various confounders. Because of the increased IPD frequencies, parous women with a time interval from the last delivery of 6 years or longer should be screened as a high-risk group for placental dysfunction-related diseases.

Vitamin B12 and folic acid associated megaloblastic anemia: Could it mislead the diagnosis of breast cancer?

CA 15-3 is a tumor-associated antigen and is overexpressed in breast tumors, and may also be high in some other non-cancerous conditions. The aim of this study was to investigate the effect of megaloblastic anemia due to vitamin B12 or folic acid deficiency on the levels of tumor markers. Five-year patient data were retrospectively analyzed. The associations between megaloblastic anemia due to vitamin B12 deficiency and CA 15-3, CA 125, CA 19-9, CEA, and AFP levels were analyzed. Furthermore, association between CA 15-3 level and megaloblastic anemia due to folic acid deficiency was evaluated. Median CA 15-3 level was 38.1 U/mL in the group with megaloblastic anemia due to vitamin B12 deficiency(n = 15), 46.7 U/mL in the group with megaloblastic anemia related to folic acid deficiency (n = 3), and 17.8 U/mL in the normal group(n = 1724). CA 15-3 levels were significantly higher among patients with vitamin B12- and folic acid-associated megaloblastic anemia compared to the normal group (p = 0.001 and p = 0.005, respectively). Megaloblastic anemia due to vitamin B12 deficiency was not associated with any significant differences in CA 125, CA 19-9, CEA, or AFP levels compared to the normal group (p = 0.777, p = 0.327, p = 0.577, and p = 0.197, respectively). The numbers of anemic and normal subjects compared in these tests were 12 vs. 1501, 17 vs. 1827, 4 vs. 897, and 8 vs. 1041, respectively. In conclusion, megaloblastic anemia results in ineffective erythropoiesis, and increased levels of CA 15-3 may be associated with this issue. Clinicians should take this into account when evaluating for a pre-diagnosis of breast cancer.

All-trans retinoic acid prevents cisplatin-induced nephrotoxicity in rats.

The aim of this study is to investigate the effects of all-trans retinoic acid (ATRA) use on cisplatin (CP)-induced nephrotoxicty. Twenty-eight rats were randomly divided into four groups. The rats in the control group were injected a single dose of 1 ml/kg saline intra-peritoneally (IP) during 10 days. The rats in the ATRA group were injected a single dose of ATRA during 10 days. The rats in the ATRA+CP group were injected a single dose of CP on the fourth day of the 10 days of ATRA treatment. The rats in the CP group were injected a single dose of CP on the fourth day of 10 days without administering a treatment. After treatment, the groups were compared with regard to total antioxidant status (TAS), total oxidant status (TOS), and oxidative stress index (OSI) levels in renal tissue and renal histopathology. The serum creatinine and urea values were statistically significantly higher in the CP group compared to the other groups. The serum creatinine and urea values were statistically significantly lower in the ATRA+CP group when compared to the CP group. Although the TOS and OSI levels were found to be lower in the ATRA+CP group compared to the CP group, the difference was not statistically significant. Administration of ATRA together with CP was observed to reduce the histopathologic destruction in the kidney and lead to mild tubular degeneration, vacuolization, and necrosis (57.1% grade 1; 28.6% grade2, and 14.3% grade 3 necrosis). The results of the present study have revealed that ATRA administration ameliorates CP-induced nephrotoxicity; however, further studies are required to identify this issue before clinical application.

The effect of intradetrusor botulinum neurotoxin type A on urinary NGF, TGF BETA-1, TIMP-2 levels in children with neurogenic detrusor overactivity due to myelodysplasia.

AIMS: The aim of this study was to determine the value of urine nerve growth factor (NGF), transforming growth factor beta 1 (TGF-Beta-1), tissue inhibitor of matrix metalloproteinase 2 (TIMP-2) levels to predict the urodynamic profile before and after botulinum neurotoxin type A (BoNT-A) treatment in children with myelodysplasia. METHODS: This prospective study included 15 children with myelodysplasia who underwent intradetrusor BoNT-A injections due to neurogenic detrusor overactivity (NDOA). Urine samples of each child were collected before and after BoNT-A injections, specifically at the first and third postoperative months. Urine samples were analyzed with ELISA method and NGF, TGF-Beta-1, and TIMP-2 levels were measured. Urine marker levels and clinical findings were assessed for statistical significance with Wilcoxon Signed Ranks Test and Friedman Test. RESULTS: A total of 15 children (5 boys and 10 girls) were assigned as the study group. Mean age of the patients was 7.1 ± 2.5 years (range 2.5-11). A statistically significantly decline was observed in urinary TGF-Beta-1 and NGF levels following BoNT-A injections, compared to the preoperative levels (P < 0.05). TIMP-2 levels also tend to decrease following BoNT-A injections but this was not statistically significant compared to the preoperative levels. CONCLUSION: This preliminary study, suggests urinary TGF-Beta-1 and NGF as a potent marker in children with NDOA, as they decline following BoNT-A injection. Further studies are needed in identifying their special role in assessing treatment success after invasive interventions.

Can Pentraxin-3 be a Candidate Marker in the Follow-Up of the Patients With Behçet's Disease?

OBJECTIVES: This study aims to assess the level of pentraxin-3 (PTX-3) as an inflammatory marker and compare it with C-reactive protein (CRP) levels in patients with Behçet's disease (BD). PATIENTS AND METHODS: Forty-two patients with BD (15 males, 27 females; mean age 39.7±8.6 years; range 20 to 64 years) and 42 age- and sex- matched healthy controls (14 males, 28 females; mean age 40.8±8.2 year; range 25 to 60 years) were included in the study. Serum CRP and plasma PTX-3 levels were measured. Subgroup analyses were performed according to clinical manifestations of patients with BD. RESULTS: Both PTX-3 and CRP levels were significantly higher in patients with BD than controls (1.33±0.29 vs 0.85±0.12, p<0.05 for PTX-3 and 0.71±0.13 vs 0.27±0.03, p<0.001 for CRP, respectively). Area under the curve was 0.633±0.062 vs 0.729±0.05, respectively. Mean PTX-3 and CRP levels were 1.1 vs 1.5, p=0.5; 0.5 vs 0.9, p=0.5; respectively, in patients with mucocutaneous involvement alone and with other involvements, whereas they were 0.9 vs 1.6, p=0.1; 0.5 vs 0.8, p=0.3; respectively, in patients with and without peripheral arthritis, and were 1.7 vs 0.9, p=0.06; 1.0 vs 0.5, p=0.07; respectively, in patients with and without uveitis. CONCLUSION: Although PTX-3 levels were higher in patients with BD than healthy controls, sensitivity and specificity of PTX-3 was not different than CRP in patients with BD.

Apoptosis-inducing Effect of a Palladium(II) Complex-[PdCl(terpy)](sac).2H2O] on Ehrlich Ascites Carcinoma (EAC) in Mice.

BACKGROUND/AIM: New compounds for cancer treatment are needed due to persistenly unsatisfactory management of cancer. [PdCl(terpy)](sac)·2H2O] (sac=saccharinate, and terpy=2,2':6',2"-terpyridine) is a compound synthesized for this purpose. We investigated its anti-proliferative and pro-apoptotic effects on Ehrlich Ascites Carcinoma (EAC) in vivo. MATERIALS AND METHODS: 42 Balb-c female mice were subcutaneously (s.c.) injected with EAC cells (1st day) and then randomly divided into 5 groups: control (0.9% NaCl), complex (2 mg/kg), complex (3 mg/kg) cisplatin (4 mg/kg) and paclitaxel (12.5 mg/kg). On the 5th and 12th day animals were drug administrated. At 14th day, animals were sacrificed. Expression of cell death and/or cell cycle-related markers (Bcl-2, Bax, active caspase-3, p53, PCNA) and apoptosis were investigated immunohisto-chemically. Survival-related markers (Akt, GSK-3ß, IGF-1R, IR, IRS-1, p70S6K, PRAS40) were evaluated by luminex analysis. RESULTS: Expression of p53, PCNA, Bcl-2 was found decreased (p<0.001) and that of active caspase-3, Bax, and apoptotic cells was found increased (p<0.001) in all groups. The survival-related markers did not show any statistical difference in complex groups. CONCLUSION: The Pd(II)-complex seems to have a strong anticancer activity on EAC by inducing apoptosis via both suppression of proliferation and activation of apoptosis in vivo, similar to the effects of cisplatin and paclitaxel.

C-reactive protein but not hepcidin, NGAL and transferrin determines the ESA resistance in hemodialysis patients.

BACKGROUND: Erythropoiesis-stimulating agents (ESA) are commonly used for the treatment of anemia in hemodialysis (HD) patients, however, 5-10% of these patients have resistance to ESA treatment. Hepcidin and neutrophil-gelatinase associated lipocalin (NGAL) are induced by inflammation and these proteins may take role in ESA resistance. Herein, we aimed to investigate the effects of serum hepcidin, NGAL, transferrin and C-reactive protein (CRP) levels on ESA resistance in HD patients. METHODS: A total of 63 chronic HD patients (6.0 ± 17 years, M/F:44/19) and 20 healthy controls (6.0 ± 4 years, M/F:14/6) were enrolled. ESA resistance index (ERI) was calculated as weekly ESA dose (IU)/body weight (kg)/hemoglobin level (g/dL). Patients on ESA treatment were divided into two groups depending on the median ERI value as low and high ERI groups. RESULTS: Serum ferritin, hepcidin and NGAL levels were significantly higher in HD patients compared with controls. Serum transferrin levels were lower in high ESA index group compared with patients without ESA treatment and healthy controls. ERI was significantly correlated with serum CRP levels (r = 0.55, p < 0.001). In HD patients, serum hepcidin levels were associated with ferritin (r = 0.55, p < 0.01) and creatinine (r = 0.27, p = 0.03). Dose of ESA was significantly associated with serum CRP (r = 0.34, p = 0.02), total protein (r = -0.34, p = 0.01), transferrin (r = -0.28, p = 0.04) and ferritin (r = 0.31, p = 0.02). In linear regression analysis to predict ERI, age, gender, serum CRP, hepcidin, NGAL, albumin, ferritin and BMI were included (Model R = 0.62, R(2) =0 .38, p = 0.02). Serum CRP was the only significant factor predicting ERI. CONCLUSION: CRP was the only predictor of ESA resistance index in HD patients. Hepcidin, NGAL and transferrin were not found to be markers of ESA resistance.