Oxidative stress and decreased Nrf2 level in pediatric patients with COVID-19.

The aim of this study was to investigate the change in nuclear factor erythroid 2-related factor (Nrf2), which plays a critical role in cytoprotection against oxidative stress, in pediatric patients with coronavirus disease 2019 (COVID-19) infection positivity, and to evaluate the relationship between Nrf2 and oxidative balance. The study included 40 children with confirmed COVID-19 infection and 35 healthy children. The groups were compared in respect of Nrf2, total oxidant status (TOS), total antioxidant status (TAS), and oxidative stress index (OSI), in addition to clinical findings of fever, cough, shortness of breath, contact history, and demographic data of age and gender. The mean Nrf2 values and TAS levels were determined to be statistically significantly low (p < 0.001) and the TOS level and OSI were statistically significantly high in the children with COVID-19 compared to the control group. A significant positive correlation was determined between Nrf2 and TAS (p < 0.01); as the Nrf2 value increased, so the TAS value increased. A significant negative correlation was determined between Nrf2 and TOS and OSI (p < 0.01); as the Nrf2 value increased, there was determined to be a significant decrease in the TOS and OSI values. COVID-19 infection in pediatric patients causes a decrease in the Nrf2 level. By causing a decrease in the TAS level and an increase in the TOS and OSI levels, the decrease in Nrf2 may explain the tissue damage which can be caused by COVID-19.

Is mean platelet volume a predictive marker for the diagnosis of COVID-19 in children?

AIM: To investigate the mean platelet volume (MPV) in asymptomatic children infected with COVID-19. METHODS: The study included 55 children infected with COVID-19 and 60 healthy children for the comparison of leukocyte and thrombocyte count, MPV and serum C-reactive protein (CRP) levels. Demographic data and clinical findings of all the participants were recorded, including age, gender, weight, temperature, cough, shortness of breath and contact history. RESULTS: The MPV values were determined to be statistically significantly high (P < .001) and the lymphocyte values were significantly low (p:0.002) in the asymptomatic children infected with COVID-19 compared with the healthy control children. No difference was determined between the groups in respect of CRP level, leukocyte and thrombocyte counts (P > .05). The optimal cutoff point for MPV was determined as 8.74 fl (Area under the curve-AUC:0.932) with 81.82% sensitivity and 95% specificity for the determination of children infected with COVID-19. A cutoff value of <2.12/mm3 for lymphocytes (AUC:0.670) was determined with 49.09% sensitivity and 86.67% specificity for the prediction of COVID-19. Based on the ROC analysis, the sensitivity and specificity of MPV were determined to be higher than that of lymphocyte levels. CONCLUSION: The results of this study indicate that MPV levels are significantly high in asymptomatic children infected with COVID-19 demonstrate that this is an important predictive value and has better predictive capacity than lymphocyte values. The evaluation of MPV and lymphocyte levels together could increase diagnostic success in asymptomatic COVID-19 patients.

False Measurement of Blood Amino Acids by LC-MS/MS in a Patient Dependent on Matrix Effect after Total Parenteral Nutrition Infusion.

BACKGROUND AND AIM: Although it is widely known that the total parenteral nutrition (TPN) used frequently in intensive care units has unwanted side effects, there is little known about how it interferes with the amino acid levels taken during the diagnosis of metabolic diseases. Amino acid can lead to inaccurate measurements with mass spectrometry due to its high molecular content of lipids and carbohydrates, which modifies the blood matrix. The purpose of this study was to emphasize the results of amino acid interference, measured with mass spectrometry, in patients administered with TPN. CASE PRESENTATION: Incorrect clinical interpretation resulted in the case of a pneumonia patient with false positive and negative blood amino acid levels caused by TPN infusion. The amino acid profile had been requested to rule out an amino acid metabolic defect in the two-year-old boy who arrived at the pediatric clinic complaining of respiratory distress, tachypnea and hypoxemia. He was monitored in the intensive care unit for further investigation. The personnel who had performed phlebotomy also carried out the sampling during the TPN infusion administration. This caused the amino acid results and an incorrect interpretation. The following deviation ratios were detected: phenylalanine 102%, leucine 86%, isoleucine 106%, GABA 200%, citrulline 238%, glutamine 178%, ornithine 216%, 1- methyl-l-histidine 1471%, serine 312%, alanine 163%, glycine 355%, homocitrulline and carnosine 444%. The amino acid blood level measurements taken for diagnosis and screening in suspected metabolic disease may lead to involuntary false low or elevated results in patients administered with TPN. CONCLUSION: This case demonstrates that TPN solutions affect the reference method of mass spectrometry measurement methods due to the concentration of ingredients. We suggest that inaccurate results can be avoided by carrying out the sampling prior to TPN infusion in patients whose plasma amino acid levels will be measured.

Neutrophil/Lymphocyte Ratios, Platelet/Lymphocyte Ratios, and Mean Platelet Volume Values in Patients with Measles.

AIM: The purpose of this study was to compare neutrophil/lymphocyte ratio (NLR), platelet/lymphocyte ratio (PLR), and mean platelet volume (MPV) values of patients with measles within the healthy control group and then determine the utility of these parameters for determination of inflammatory situation in patients with measles. MATERIALS AND METHOD: A total of 51 pediatric patients who had visited Harran University Medical Faculty Pediatrics Clinic between June 2018 and May 2019 and who had been diagnosed with measles after anamnesis, clinical, and serological evaluations were included our study; 49 healthy children who visited our clinic for various reasons and had taken hemogram tests were also added to our study as the control group. RESULTS: NLR and PLR values were observed higher than the control group for patients diagnosed with measles; however, the difference between the two groups was not statistically significant (p values 0.515 and 0.796, respectively). When MPV values of patients diagnosed with measles and control groups were compared, it was determined that MPV value was statistically lower in patients diagnosed with measles (p: 0.001). CONCLUSION: Based on the parameters obtained through our study, it can be said that NLR and PLR are not suitable parameters for proving inflammation in patients with measles but MPV can be used as a convenient parameter for that purpose. However, prospective studies conducted with more patients are needed in this respect.