Acoustic Voice Analysis in Subclinical Hyperthyroidism.

OBJECTIVE: To investigate the effect of subclinical hyperthyroidism on voice quality using acoustic analysis. STUDY DESIGN: Cross-sectional comparative study. Place and Duration of the Study: Department of Endocrinology and Metabolism, Ankara Diskapi Yildirim Beyazit Research and Education Hospital, Ankara, Turkey, from January to June 2020. METHODOLOGY: A total of 115 participants, with 60 patients with subclinical hyperthyroidism and 55 healthy volunteers, were evaluated and compared. Healthy volunteers with similar age and gender distributions were also evaluated and compared. Acoustic variables including average fundamental frequency (F0), relative average perturbation (RAP), jitter, shimmer, noise-to-harmonic ratio (NHR), and voice turbulence index (VTI) were measured and recorded. RESULTS: In the patient group, acoustic voice analysis results were obtained for F0 224.97%, jitter 0.85%, RAP 0.51%, shimmer 3.16%, NHR 0.12 dB, and VTI 0.047, respectively. In the control group, these respective values were 219.60%; 0.74%; 0.46%; 3.11%; 0.12 dB; and 0.045, respectively. There was no statistically significant difference between the groups (p>0.05). CONCLUSION: Subclinical hyperthyroidism does not cause a significant change in voice quality. KEY WORDS: Acoustic analysis, Subclinical hyperthyroidism, Voice, Frequency.

Glycemic responses to whole grain sourdough bread versus refined white bread in patients with gestational diabetes.

BACKGROUND: Nutritional therapy remains a key tool for prevention and management of gestational diabetes (GDM). Carbohydrate type and absorption rate rather than the carbohydrate amount have more impact on postprandial glucose (PPG) levels in GDM. The effect of refined white bread and whole grain sourdough bread on glycemic indexes were compared in GDM patients. METHODS: A total of 43 patients with GDM and 38 healthy pregnant women were included. A similar breakfast menu was given to both groups of patients at two different times in consecutive weeks; however, different types of bread with the same weight were used for both breakfasts; 1) white wheat (WW) bread, 2) sourdough whole grain wheat (SWGW) bread. Blood glucose, insulin and C­peptide levels were compared before and after breakfast. RESULTS: Fasting glucose, insulin and c­peptide levels were similar between groups (p > 0.05). While the second hour glucose levels were similar between the groups, the first hour results of glucose, insulin and C­peptide levels were lower in the SWGW group (p < 0.05). In the control patients, first hour glucose, insulin and C­peptide levels were also lower in the SWGW group (p < 0.05). CONCLUSION: The WW bread, which is more preferred in daily life routine, causes 45.5% more insulin secretion and 9.6% more first hour postprandial blood glucose compared to SWGW bread both in GDM patients and healthy pregnant women. According to the results of this study, we recommend that sourdough whole grain bread should be preferred in order to increase the success in the management of GDM.

Association of mortality and endothelial dysfunction with serum ADMA level in COVID-19 patients.

Objectives: To investigate the role of asymmetric dimethylarginine (ADMA) level in predicting intensive care and mortality in patients affected with coronavirus disease 2019 (COVID-19). Methods: This retrospective, cross-sectional study was conducted at Sakarya University Training and Research Hospital (Sakarya, Turkey) between April and August of 2020. We enrolled patients who were diagnosed with COVID-19 via real-time reverse-transcription polymerase chain reaction and admitted to the intensive care (Severe COVID-19; S-COVID) or non intensive care (Moderate COVID-19; M-COVID). We then analyzed the relationship of the ADMA level with various parameters between S-COVID and M-COVID groups. Results: This study included 87 patients, comprising 43 females and 44 males, with a mean age of 61 and 71.50 years, respectively. The male/female distribution was 22/25 (46.8%/53.2%) in the M-COVID group and 22/18 (55%/45%) in the S-COVID group. The hospitalization time, white blood cell count, neutrophil count, lymphocyte-to-albumin ratio, international normalization ratio, D-dimer, troponin, ferritin, lactate dehydrogenase, C-reactive protein, procalcitonin, erythrocyte sedimentation rate, fibrinogen, lactate, ADMA, and mortality rate were significantly higher (p < 0.05). In contrast, lymphocyte, total cholesterol, high-density lipoprotein, calcium, and albumin values were lower (p < 0.05) in the S-COVID group than in the M-COVID group. While the mortality rate was 55% in S-COVID patients, no mortality was detected in M-COVID patients (p < 0.05). Moreover, ADMA level was 6618 ± 3000 (6400) in S-COVID patients and 5365 ± 3571 (3130) in M-COVID patients, indicating a statistically significant difference (p = 0.012). Conclusion: The asymmetric dimethylarginine level increases in severe outcomes; hence, it can potentially predict severity in patients with COVID-19.

The effect of short-term intensive insulin therapy in newly-diagnosed Type-2 diabetic patients.

OBJECTIVES: We aimed to determine the effect of short-term intensive insulin therapy (SIIT) on long-term glycemic control in newly-diagnosed Type-2 diabetes mellitus (nT2DM) patients. METHODS: In this retrospectively study conducted at Sakarya University Medical Faculty Training and Research Hospital Outpatient Clinic between 2016 and 2019, 65 nT2DM patients were enrolled soon after their SIIT was initiated and were followed for at least a year. Intensive insulin treatment was discontinued after three or 12 months in a total of 65 (23-73-year-old) patients who had been newly diagnosed with T2DM. Intensive insulin therapy was discontinued when glycemic control and the target Glycated Hemoglobin (HbA1c) level had been attained, after which oral anti-diabetic drug (OAD), long-term insulin, and diet therapies were pursued. RESULTS: There was a significant decrease in mean HbA1c from 11.25±1.96% to 6.67±1.07%. Fasting plasma glucose (FPG) was found to be an independent predictor of whether intensive insulin therapy could be discontinued after three months in a model that included FPG, HbA1c, and body mass index measured at baseline. Patients with FPG>13.8 mmol/L were 7.6 times more likely to require intensive insulin therapy beyond three months. There were significant decreases in HbA1c and low-density lipoprotein-cholesterol concentration, but no change in C-peptide between baseline and 3 months of therapy. CONCLUSION: These results demonstrate that in nT2DM patients, intensive insulin therapy could be effective on long-term glycemic control and high FPG prior to three months of SIIT may predict poor long-term glycemic control.

The prognostic significance of erythrocyte sedimentation rate in COVID-19.

OBJECTIVE: There are limited data about the significance of erythrocyte sedimentation rate as a single prognostic parameter for the prognosis and mortality of COVID-19. This study aimed to investigate the diagnostic utility of erythrocyte sedimentation rate as a prognostic factor for the disease severity and mortality in patients with COVID-19. METHODS: A total of 148 consecutive patients with a confirmed diagnosis of COVID-19 and hospitalized at the intensive care unit or non-the intensive care unit were included in the study. The patients were allocated to groups as severe/critical disease versus nonsevere disease and survivors and nonsurvivors. The prognostic role and predictable values of erythrocyte sedimentation rate were analyzed. RESULTS: Erythrocyte sedimentation rate was found to be higher among patients with severe/critical disease compared to those with nonsevere disease (p<0.001) and among nonsurvivors compared to survivors (p<0.001). The logistic regression analysis showed that erythrocyte sedimentation rate was an independent parameter for predicting disease severity and mortality. The role of erythrocyte sedimentation rate in the assessment of severity and mortality in patients with COVID-19 was analyzed using the receiver operating characteristic curve and was found to be significant in both. The analyses suggested that the optimum erythrocyte sedimentation rate cutoff point for disease severity and mortality were 52.5 mm/h with 65.5% sensitivity and 76.3% specificity and 56.5 mm/h with 66.7% sensitivity and 72.5% specificity. CONCLUSION: Our results suggest that erythrocyte sedimentation rate was an independent prognostic factor for severity and mortality in patients with COVID-19.

The effect of Thyroid Autoimmunity on Dyslipidemia in patients with Euthyroid Hashimoto Thyroiditis.

BACKGROUND & OBJECTIVE: The relationship between thyroid disorders and dyslipidemia has now been clearly demonstrated, but the relationship between thyroid autoimmunity and dyslipidemia in euthyroid patients is still controversial. Our aim in this study was to determine whether there is a risk of dyslipidemia in our patients with euthyroid hashimoto thyroiditis. METHODS: Fifty-five autoantibody positive hashimoto patients and 55 antibody negative control groups who came to Sakarya University Medicine Faculty Endocrinology Outpatient Clinics between January 2018 and November 2019 were included in our case control study. The groups were similar in terms of age, cardiovascular risk factors and BMI. Both groups were compared according to the lipid profile results. RESULTS: All type of lipids; including LDL (p = 0.008), HDL (p = 0.041), triglyceride (p = 0.045) and total cholesterol (p = 0.002), were higher in the patient group, and these differences were statistically significant. Anti-TPO and Anti-TG antibody titers and lipid levels were evaluated by separate correlation analysis. There was a significant positive correlation between Anti-TPO and LDL (r = 0.331, p <0.001), triglyceride (r = 0.267, p = 0.005) and total cholesterol (r = 0.316, p = 0.001), however no significant correlation was observed between Anti-TPO and HDL. Similarly, there was a significant positive correlation between Anti-TG and LDL (r = 0.318, p = 0.001), triglyceride (r = 0.218, p = 0.022), and total cholesterol (r = 0.301, p = 0.001), but HDL correlation relationship was not detected. CONCLUSION: The relationship between thyroid autoimmunity and dyslipidemia has been demonstrated in our study even in the euthyroid phase. Whether antibody positive patients should be followed more closely for dyslipidemia and cardiovascular events is still controversial. This question will be answered with larger randomized controlled trials.

Has the COVID-19 Pandemic Increased Mortality Among Patients with Cancer Receiving Systemic Anticancer Treatments?

OBJECTIVE: To evaluate the mortality rates in patients receiving anticancer therapy in the coronavirus disease-19 (COVID-19) pandemic period. STUDY DESIGN: Descriptive study. PLACE AND DURATION OF STUDY: Department of Medical Oncology, Sakarya University Training and Research Hospital, Sakarya, Turkey, from December 2017 to May 2020. METHODOLOGY: Only patients who received chemotherapy and immunotherapy were selected and enrolled in the study. All patients (n=3,204) were divided into three groups, namely the first group (1st December 2017-31st May 2018, n=918), second group (1st December 2018-31st May 2019, n=1,147), and the pandemic period group (PPG) (1st December 2019-31st May 2020, n=1,139), according to the period during which they received anticancer treatment. The clinical and demographic characteristics and mortality rates of these three groups of patients were compared. RESULTS: The median age of the total of 3,204 patients was 61 (53-69). In this study, 51.1% (n=1,636) were females and 48.9% were males. The mortality rates were 13.5% (n=124) in the first group, 13.4% (n=154) in the second group, and 13.0% (n=148) in the PPG, respectively. Overall mortality rates did not differ among patients with cancer in the three different six-month periods analysed (p = 0.931). CONCLUSION: There was no unexpected increased in mortality rate among patients undergoing cancer therapy during the COVID-19 pandemic as compared to the previous years of the same timeline. No increase in monthly mortality rates among patients receiving anti-cancer treatment were demonstrated during the pandemic period.

The prognostic significance of erythrocyte sedimentation rate in COVID-19

SUMMARY OBJECTIVE: There are limited data about the significance of erythrocyte sedimentation rate as a single prognostic parameter for the prognosis and mortality of COVID-19. This study aimed to investigate the diagnostic utility of erythrocyte sedimentation rate as a prognostic factor for the disease severity and mortality in patients with COVID-19. METHODS: A total of 148 consecutive patients with a confirmed diagnosis of COVID-19 and hospitalized at the intensive care unit or non-the intensive care unit were included in the study. The patients were allocated to groups as severe/critical disease versus nonsevere disease and survivors and nonsurvivors. The prognostic role and predictable values of erythrocyte sedimentation rate were analyzed. RESULTS: Erythrocyte sedimentation rate was found to be higher among patients with severe/critical disease compared to those with nonsevere disease (p<0.001) and among nonsurvivors compared to survivors (p<0.001). The logistic regression analysis showed that erythrocyte sedimentation rate was an independent parameter for predicting disease severity and mortality. The role of erythrocyte sedimentation rate in the assessment of severity and mortality in patients with COVID-19 was analyzed using the receiver operating characteristic curve and was found to be significant in both. The analyses suggested that the optimum erythrocyte sedimentation rate cutoff point for disease severity and mortality were 52.5 mm/h with 65.5% sensitivity and 76.3% specificity and 56.5 mm/h with 66.7% sensitivity and 72.5% specificity. CONCLUSION: Our results suggest that erythrocyte sedimentation rate was an independent prognostic factor for severity and mortality in patients with COVID-19.

Correlation between venous blood gas indices and radiological involvements of COVID-19 patients at first admission to emergency department.

BACKGROUND: The purpose of this study was to investigate the relation between venous blood gas and chest computerized tomography findings and the clinical conditions of COVID-19 pneumonia. METHODS: A total of 309 patients admitted to the emergency department and subsequently confirmed COVID-19 cases was examined. Patients with pneumonia symptoms, chest computerized tomography scan, venous blood gas findings, and confirmed COVID-19 on reverse transcription-polymerase chain reaction (PCR) were consecutively enrolled. Multiple linear regression was used to predict computerized tomography and blood gas findings by clinical/laboratory data. RESULTS: The median age of patients was 51 (interquartile range 39-66), and 51.5% were male. The mortality rate at the end of follow-up was 18.8%. With respect to survival status of patients pCO2 and HCO3 levels and total computerized tomography score values were found to be higher in the surviving patients (p<0.001 and p=0.003, respectively), whereas pH and lactate levels were higher in patients who died (p=0.022 and p=0.001, respectively). With logistic regression analysis, total tomography score was found to be significantly effective on mortality (p<0.001). The diffuse and random involvement of the lungs had a significant effect on mortality (p<0.001, 95%CI 3.853-38.769, OR 12.222 and p=0.027; 95%CI 1.155-11.640, OR 3.667, respectively). With linear regression analysis, the effect of pH and lactate results were found to have a positive effect on total tomography score (p=0.003 and p<0.001, respectively), whereas pCO2 was found to have a negative effect (p=0.029). CONCLUSION: There was correlation between venous blood gas indices and radiologic scores in COVID-19 patients. Venous blood gas taken in emergency department can be a fast, applicable, minor-invasive, and complementary test in terms of diagnosing COVID-19 pneumonia and predicting the prognosis of disease.

Comparison of real-life data of abiraterone acetate and enzalutamide in metastatic castration-resistant prostate cancer.

To compare enzalutamide (E) and abiraterone acetate (AA) in terms of efficacy, survival and to characterize prognostic factors affecting survival in metastatic castration-resistant prostate cancer (mCRPC) patients. A total of 250 patients treated with E or AA in 5 centers were included. The number of patients with no prostate specific antigen (PSA) decline was higher in the AA group than that in the E group, and the proportion of patients with a PSA decline of ≥ 50% was higher in the E group (p = 0.020). Radiological progression free survival (rPFS) and overall survival (OS) were significantly longer in the E group when compared to that in the AA group (p < 0.001 and p = 0.027, respectively). In the E group, rPFS was significantly longer than that in the AA group in both pre- and post-docetaxel settings (p = 0.010 and p = 0.003, respectively). OS was similar in the pre-docetaxel setting; but in the post-docetaxel setting, E group had a significantly longer OS than the AA group (p = 0.021). In the multivariate analysis performed in the whole patient group, we found that good prognostic factors for rPFS were E treatment, being ≥ 75 years and a PSA decline of ≥ 50% while there was no factor affecting OS. With longer OS and PFS, E seems to be more suitable for mCRPC patients in the post-docetaxel setting than AA.

Does Macrophage Migration Inhibitory Factor predict the prognosis of COVID-19 disease?

INTRODUCTION: The aim of this study is to investigate whether macrophage migration inhibitory factor (MIF) predicts the prognosis of COVID-19 disease. METHODOLOGY: This descriptive and cross-sectional study was conducted on 87 confirmed COVID-19 patients. The patients were separated into two groups according to the admission in the ICU or in the ward. MIF was determined batchwise in plasma obtained as soon as the patients were admitted. Both groups were compared with respect to demographic characteristics, biochemical parameters and prediction of requirement to ICU admission. RESULTS: Forty seven patients in ICU, and 40 patients in ward were included. With respect to MIF levels and biochemical biomarkers, there was a statistically significant difference between the ICU and ward patients (p< 0.024). In terms of ICU requirement, the cut-off value of MIF was detected as 4.705 (AUC:0.633, 95%CI:0.561-0.79, p= 0.037), D-dimer was 789 (AUC:0.779, 95%CI: 0.681-0.877, p= 0.000), troponin was 8.15 (AUC: 0.820, 95%CI:0.729-0.911, p= 0.000), ferritin was 375 (AUC: 0.774, 95%CI:0.671-0.876, p= 0.000), and lactate dehydrogenase (LDH) was 359.5 (AUC:0.843, 95%CI: 0.753-0.933, p= 0.000). According to the logistic regression analysis; when MIF level > 4.705, the patient's requirement to ICU risk was increased to 8.33 (95%CI: 1.73-44.26, p= 0.009) fold. Similarly, elevation of troponin, ferritin and, LDH was shown to predict disease prognosis (p< 0.05). CONCLUSIONS: Our study showed that MIF may play a role in inflammatory responses to COVID-19 through induction of pulmonary inflammatory cytokines, suggesting that pharmacotherapeutic approaches targeting MIF may hold promise for the treatment of COVID-19 pneumonia.

MYELOLIPOMA COEXISTENCE WITH GLUCOCORTICOID AND ANDROGEN SECRETING ADRENOCORTICAL CARCINOMA: SLOW AND BENIGN CLINICAL COURSE.

We present a case of androgen and glucocorticoid secreting adrenocortical carcinoma with concomitant myelolipoma. A giant adrenal tumor which was initially nonfunctional was reassessed four years later due to the patient's refusal to treat. The patient was a 48-year-old woman with hypertension and acne lesions on the face. Laboratory findings were consistent with glucocorticoid and androgen hypersecretion. Computed tomography revealed a heterogeneously contrasting mass of 145x118x100 mm with lobular contour and soft tissue areas. The patient underwent left laparoscopic transperitoneal adrenalectomy with three port technique. There were no complications in the perioperative period. The resected specimen weighed 850 grams. Pathological findings showed a combination of myelolipoma-adrenal cortical cancer. In the postoperative period, hypertension improved and the hormone panel was normalized. Postoperative computed tomography and PET-CT showed no residual mass and metastasis. Although imaging is compatible with benign masses such as myelolipoma, coexistence of ACC-myelolipoma should be kept in mind and functional evaluation should be performed.

Has the COVID-19 Pandemic Increased Mortality Among Patients with Cancer Receiving Systemic Anticancer Treatments?

OBJECTIVE: To evaluate the mortality rates in patients receiving anticancer therapy in the coronavirus disease-19 (COVID-19) pandemic period. STUDY DESIGN: Descriptive study. PLACE AND DURATION OF STUDY: Department of Medical Oncology, Sakarya University Training and Research Hospital, Sakarya, Turkey, from December 2017 to May 2020. METHODOLOGY: Only patients who received chemotherapy and immunotherapy were selected and enrolled in the study. All patients (n=3,204) were divided into three groups, namely the first group (1st December 2017-31st May 2018, n=918), second group (1st December 2018-31st May 2019, n=1,147), and the pandemic period group (PPG) (1st December 2019-31st May 2020, n=1,139), according to the period during which they received anticancer treatment. The clinical and demographic characteristics and mortality rates of these three groups of patients were compared. RESULTS: The median age of the total of 3,204 patients was 61 (53-69). In this study, 51.1% (n=1,636) were females and 48.9% were males. The mortality rates were 13.5% (n=124) in the first group, 13.4% (n=154) in the second group, and 13.0% (n=148) in the PPG, respectively. Overall mortality rates did not differ among patients with cancer in the three different six-month periods analysed (p = 0.931). CONCLUSION: There was no unexpected increased in mortality rate among patients undergoing cancer therapy during the COVID-19 pandemic as compared to the previous years of the same timeline. No increase in monthly mortality rates among patients receiving anti-cancer treatment were demonstrated during the pandemic period.

Relationship between serum osteopontin levels and the severity of COVID-19 infection.

BACKGROUND: Coronavirus disease 2019 (COVID-19) is an acute inflammatory respiratory disease. Osteopontin (OPN) is a glycoprotein expressed in various cell types, such as bone, immune, smooth muscle, epithelial and endothelial cells. It also acts as a regulator of immune response. The aim of the present study was to reveal the place of serum osteopontin levels in predicting severity among patients with COVID-19. METHODS: This study included 84 patients, 43 female and 45 male. Patients were divided into 2 groups, group 1 non-severe group (n: 48), group 2 severe (n: 40). Demographic data, neutrophil, lymphocyte, platelet, white blood cell counts, albumin, procalcitonin, C­reactive protein (CRP) and OPN levels were recorded. The OPN levels and these inflammatory parameters of the two groups were compared. RESULTS: There were no significant differences in terms of gender (female/male 25/23 vs. 18/22) and platelet count (178 K/µL vs. 191 K/µL) between the groups (p > 0.05). Ages (57.7 ± 17.0 years vs. 71.4 ± 12.8 years), procalcitonin (0.07 vs. 0.24 ng/mL), CRP (17 vs 158 mg/l), neutrophil count (3.7 vs 5.64 K/µL), WBC counts (5.38 vs 7.85 K/µL) and number of deaths (0 vs 26) (p < 0.001). The OPN levels (98.5 vs 13.75 ng/mL, p = 0.002) were found to be statistically higher, in group 2 than group 1. CONCLUSION: The present study showed that OPN can be used to predict the severity in patients with COVID-19.

Correlation between venous blood gas indices and radiological involvements of COVID-19 patients at first admission to emergency department

SUMMARY The purpose of this study was to investigate the relation between venous blood gas and chest computerized tomography findings and the clinical conditions of COVID-19 pneumonia. METHODS: A total of 309 patients admitted to the emergency department and subsequently confirmed COVID-19 cases was examined. Patients with pneumonia symptoms, chest computerized tomography scan, venous blood gas findings, and confirmed COVID-19 on reverse transcription-polymerase chain reaction (PCR) were consecutively enrolled. Multiple linear regression was used to predict computerized tomography and blood gas findings by clinical/laboratory data. RESULTS: The median age of patients was 51 (interquartile range 39-66), and 51.5% were male. The mortality rate at the end of follow-up was 18.8%. With respect to survival status of patients pCO2 and HCO3 levels and total computerized tomography score values were found to be higher in the surviving patients (p<0.001 and p=0.003, respectively), whereas pH and lactate levels were higher in patients who died (p=0.022 and p=0.001, respectively). With logistic regression analysis, total tomography score was found to be significantly effective on mortality (p<0.001). The diffuse and random involvement of the lungs had a significant effect on mortality (p<0.001, 95%CI 3.853-38.769, OR 12.222 and p=0.027; 95%CI 1.155-11.640, OR 3.667, respectively). With linear regression analysis, the effect of pH and lactate results were found to have a positive effect on total tomography score (p=0.003 and p<0.001, respectively), whereas pCO2 was found to have a negative effect (p=0.029). CONCLUSION: There was correlation between venous blood gas indices and radiologic scores in COVID-19 patients. Venous blood gas taken in emergency department can be a fast, applicable, minor-invasive, and complementary test in terms of diagnosing COVID-19 pneumonia and predicting the prognosis of disease.

Comparative evaluation of memory T cells in COVID-19 patients and the predictive role of CD4+CD8+ double positive T lymphocytes as a new marker.

BACKGROUND: The COVID-19 pandemic has affected the entire world, posing a serious threat to human health. T cells play a critical role in the cellular immune response against viral infections. We aimed to reveal the relationship between T cell subsets and disease severity. METHODS: 40 COVID-19 patients were randomly recruited in this cross-sectional study. All cases were confirmed by quantitative RT-PCR. Patients were divided into two equivalent groups, one severe and one nonsevere. Clinical, laboratory and flow cytometric data were obtained from both clinical groups and compared. RESULTS: Lymphocyte subsets, CD4+ and CD8+ T cells, memory CD4+ T cells, memory CD8+ T cells, naive CD4+ T cells, effector memory CD4+ T cells, central memory CD4+ T cells, and CD3+CD4+ CD25+ T cells were significantly lower in severe patients. The naive T cell/CD4 + EM T cell ratio, which is an indicator of the differentiation from naive T cells to memory cells, was relatively reduced in severe disease. Peripheral CD4+CD8+ double-positive T cells were notably lower in severe presentations of the disease (median DP T cells 11.12 µL vs 1.95 µL; p< 0.001). CONCLUSIONS: As disease severity increases in COVID-19 infection, the number of T cell subsets decreases significantly. Suppression of differentiation from naive T cells to effector memory T cells is the result of severe impairment in adaptive immune functions. Peripheral CD4+CD8+ double-positive T cells were significantly reduced in severe disease presentations and may be a useful marker to predict disease severity.

Comparative evaluation of memory T cells in COVID-19 patients and the predictive role of CD4+CD8+ double positive T lymphocytes as a new marker

SUMMARY BACKGROUND: The COVID-19 pandemic has affected the entire world, posing a serious threat to human health. T cells play a critical role in the cellular immune response against viral infections. We aimed to reveal the relationship between T cell subsets and disease severity. METHODS: 40 COVID-19 patients were randomly recruited in this cross-sectional study. All cases were confirmed by quantitative RT-PCR. Patients were divided into two equivalent groups, one severe and one nonsevere. Clinical, laboratory and flow cytometric data were obtained from both clinical groups and compared. RESULTS: Lymphocyte subsets, CD4+ and CD8+ T cells, memory CD4+ T cells, memory CD8+ T cells, naive CD4+ T cells, effector memory CD4+ T cells, central memory CD4+ T cells, and CD3+CD4+ CD25+ T cells were significantly lower in severe patients. The naive T cell/CD4 + EM T cell ratio, which is an indicator of the differentiation from naive T cells to memory cells, was relatively reduced in severe disease. Peripheral CD4+CD8+ double-positive T cells were notably lower in severe presentations of the disease (median DP T cells 11.12 µL vs 1.95 µL; p< 0.001). CONCLUSIONS: As disease severity increases in COVID-19 infection, the number of T cell subsets decreases significantly. Suppression of differentiation from naive T cells to effector memory T cells is the result of severe impairment in adaptive immune functions. Peripheral CD4+CD8+ double-positive T cells were significantly reduced in severe disease presentations and may be a useful marker to predict disease severity.

RESUMO OBJETIVO: A pandemia de COVID-19 tem afetado o mundo todo, constituindo uma ameaça grave para a saúde humana. As células T desempenham um papel crítico na imunidade celular contra infecções virais. Procuramos desvendar a relação entre sub grupos de células T e a severidade da doença. MÉTODOS: Um total de 40 pacientes com COVID-19 foram aleatoriamente recrutados para o presente estudo transversal. Todos os casos foram confirmados por RT-PCR quantitativo. Os pacientes foram divididos em dois grupos equivalentes, um grave e um não-grave. Os dados da avaliação clínica, laboratorial e da citometria de fluxo foram obtidos para ambos os grupos e comparados. RESULTADOS: Os subconjuntos de linfócitos, células T CD4+ e CD8+, células T de memória CD4+, células T de memória CD8+, células T CD4+ virgens, células T efetoras CD4+, células T de memória central CD4+ e células T CD3+ CD4+ CD25+ estavam significativamente mais baixas nos pacientes graves. A razão células T virgens/células T efetoras TCD4+, que é um indicador da diferenciação entre células T virgens e células de memória, estava relativamente reduzida em casos graves da doença. As células T duplo-positivas CD4+CD8+ periféricas estavam notavelmente mais baixas em casos graves da doença (mediana das células T DP: 11,12 µL vs. 1,95 µL; p< 0,001). CONCLUSÃO: Conforme aumenta a gravidade da doença nos casos de COVID-19, o número de subconjuntos de células T diminui significativamente. A supressão da diferenciação de células T virgens para células T efetoras é o resultado do comprometimento grave das funções imunológicas adaptativas. As células T duplo-positivas CD4+CD8+ periféricas estavam notavelmente mais baixas em casos graves da doença e podem ser um marcador útil para predizer a severidade da doença.

Neutrophil count to albumin ratio as a new predictor of mortality in patients with COVID-19 infection.

BACKGROUND: Coronavirus Disease 2019 is an acute inflammatory respiratory disease. It causes many changes in hemogram parameters. Low albumin levels are associated with mortality risk in hospitalized patients. The aim of the present study is to reveal the place of neutrophil count to albumin ratio in predicting mortality in patients with COVID-19. METHODS: 144 patients, 65 females and 79 males, were included in the study. Patients were divided into 2 groups. Group 1 was the non-severe group (n:85), and Group 2 was severe (n:59). Demographic data, neutrophil, lymphocyte and platelet counts, albumin and C-reactive protein (CRP) levels were recorded. Neutrophil count to albumin ratio (NAR) was calculated by dividing the absolute neutrophil counts by the albumin levels. The NAR and levels of the two groups were then compared. RESULTS: There were no significant differences in gender and platelet count (201 vs. 211 K/mL) between the groups (p>0,05). Ages (62.0 ± 14.3 vs 68.6 ± 12.2 years), albumin (33.1 vs 29.9 gr/L), CRP (33 vs 113 mg/l), neutrophil count (4 vs 7.24 K/mL), WBC counts (6.70 vs 8.50 K/mL), NAR values (113.5 vs 267.2) and number of Death (5 vs 33) were found to be statistically higher (p <0.001) in Group 2 than in Group 1. The NAR value of 201.5 showed mortality in all patients with COVID-19 to have 71.1% sensitivity and 71.7% specificity (AUC:0.736, 95% CI: 0.641-0.832, p<0.001). CONCLUSION: The present study showed that NAR levels can be a cheap and simple marker for predicting mortality in patients with COVID-19.

The effects of favipiravir on hematological parameters of covid-19 patients.

INTRODUCTION: This study aims to evaluate changes in hematological parameters after the follow-up of patients who received treatment with favipiravir due to COVID-19 infections. METHODS: Sixty-two cases receiving favipiravir treatment for at least five days due to COVID-19 infection were evaluated retrospectively. Parameters including age, gender, nasopharyngeal swab positivity, and chronic diseases were analyzed. Hematologic parameters were analyzed before and after the treatment. RESULTS: The mean age of the patients receiving treatment with favipiravir was 63.7±12.3 years. Nasopharyngeal swab positivity was detected in 67.7%. The most common comorbid conditions detected in patients were hypertension in 25 cases (40.3%) and diabetes in 16 cases (25.8%). In the statistical analysis of the hematological parameters before and after treatment with favipiravir, WBC, PT-PTT-INR levels were found to be unaffected; the mean RBC was found to have decreased from 4.33 ± 0.58 M/uL to 4.16 ± 0.54 M/uL (p:0.003); the median hemoglobin level was found to have decreased from 12.3 g/dl to 11.9 g/dl (p:0.041); the hematocrit level decreased from 38.1% ± 4.8 to 36.9% ± 4.2 (p:0.026); the median neutrophil count decreased from 4.57 K/uL to 3.85 K/uL (p:0.001); the mean lymphocyte count increased from 1.22 ± 0.53 K/uL to 1.84 ± 1.19 K/uL (p:0.000); and the mean platelet count increased from 244.1 ± 85.1 K/uL to 281.9 ± 103.3 K/uL (p:0.005). CONCLUSION: We concluded that the pathological effect of treatment with favipiravir on the hematologic system was the suppression in the erythrocyte series, and there were no adverse effects in other hematologic parameters.

The role and importance of auxiliary tests in differential diagnosis in patients with mildly high basal 17-OH-progesterone levels in the evaluation of hirsutism

Background/aim: In the differential diagnosis of hirsutism, early follicular basal 17-OH-progesterone levels sometimes overlap with the diagnosis of late onset congenital adrenal hyperplasia (LOCAH) and other causes of hyperandrogenism. This study aims to investigate the role of some common tests and clinical findings in differential diagnosis in such cases. Materials and methods: One hundred seventy-five female patients with hirsutism and mildly high initial 17-OH-progesterone levels (2-10 ng/mL) were included in the study. The cases were divided into three groups according to their diagnosis: LOCAH (n = 16, mean age = 26.1 ± 6.9), polycystic ovary syndrome (PCOS) (n = 122, mean age = 23.9 ± 5.1), and intracranial hypertension (IH) (n = 37, mean age = 25.2 ± 7.3). Clinical signs and symptoms, such as menstrual irregularity and hirsutism score, and hormone levels including total testosterone and dehydroepiandrosterone sulfate (DHEAS), were compared between the groups. Results: There was no difference between the groups with PCOS, LOCAH, and IH for total testosterone level results (P = 0.461). The DHEAS level was higher in the PCOS group than in the LOCAH group (449.6 ± 151.14 vs. 360.31 ± 152.40, P = 0.044). While there was no difference between the PCOS and LOCAH groups in terms of menstrual irregularity (P = 0.316), the hirsutism score for IH was significantly lower than those of PCOS and LOCAH (9.2 vs. 12.2 and 11.1, respectively; P < 0.001). Basal 17-OH-progesterone levels were higher in the LOCAH group than in the other groups (P = 0.016). Conclusion: While DHEAS level was lower in LOCAH than in PCOS, it was not different from that in IH. While the severity of hirsutism was higher in LOCAH than in IH, it was not different from that in PCOS. Menstrual irregularity was similar between PCOS and LOCAH. According to these results, although the auxiliary tests and clinical findings for the diagnosis of LOCAH contribute to the clinical interpretation, they are not superior to the 17-OH-progesterone level for diagnosis.