RESUMEN
OBJECTIVE: Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), was first detected in December 2019 and then spread globally, resulting in a pandemic. Initially, it was unknown if chronic kidney disease (CKD) contributed to the mortality caused by COVID-19. The immunosuppression associated with this disease may minimize the COVID-19-described hyper-inflammatory state or immunological dysfunction, and a high prevalence of comorbidities may lead to a poorer clinical prognosis. Patients with COVID-19 have abnormal circulating blood cells associated with inflammation. Risk stratification, diagnosis, and prognosis primarily rely on hematological features, such as white blood cells and their subpopulations, red cell distribution width, mean platelet volume, and platelet count, in addition to their combined ratios. In non-small-cell lung cancer, the aggregate index of systemic inflammation (AISI), (neutrophils x monocytes x platelets/lymphocytes) is evaluated. In light of the relevance of inflammation in mortality, the objective of this study is to determine the impact of AISI on the hospital mortality of CKD patients. PATIENTS AND METHODS: This study is an observational retrospective study. Data and test outcomes of all CKD patients, stages 3-5, hospitalized for COVID-19 and followed between April and October 2021 were analyzed. RESULTS: Patients were divided into two groups according to death (Group 1-Alive, Group 2-Died). Neutrophil count, AISI and C-reactive protein (CRP) levels were increased in Group-2 [10.3±4.6 vs. 7.65±4.22; p=0.001, 2,084.1 (364.8-2,577.5) vs. 628.9 (53.1-2,275); p=0.00 and 141.9 (20.5-318) vs. 84.75 (0.92-195); p=0.00; respectively]. Receiver operating characteristic (ROC) analysis demonstrated 621.1 as a cut-off value for AISI to predict hospital mortality with 81% sensitivity and 69.1% specificity [area under ROC curve 0.820 (95% CI: 0.733-0.907), p<.005]. Cox regression analysis was used to analyze the effect of risk variables on survival. In survival analysis, AISI and CRP were identified as important survival predictors [hazard ratio (HR): 1.001, 95% CI: 1-1.001; p=0.00 and HR: 1.009, 95% CI: 1.004-1.013; p=0.00]. CONCLUSIONS: This study demonstrated the discriminative effectiveness of AISI in predicting disease mortality in COVID-19 patients with CKD. Quantification of AISI upon admission might assist in the early detection and treatment of individuals with a bad prognosis.
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COVID-19 , Carcinoma de Pulmón de Células no Pequeñas , Fallo Renal Crónico , Neoplasias Pulmonares , Insuficiencia Renal Crónica , Humanos , COVID-19/epidemiología , SARS-CoV-2 , Estudios Retrospectivos , Inflamación , Pronóstico , Neutrófilos , Curva ROCRESUMEN
OBJECTIVE: As an antioxidant and anti-inflammatory agent, Hesperidin was investigated to prove whether it prevents damage to the kidney and lung tissues of rats undergoing renal ischemia-reperfusion injury. MATERIALS AND METHODS: Four groups of rats were set, including eight subjects each as Group 1 (control), Group 2-RIR (renal ischemia reperfusion), Groups 3 and 4 as pretreatment groups (50 HES, 100 HES). RESULTS: According to our results, Hesperidin pretreatment improved the biochemical and histopathological parameters in kidney and lung tissues of rats with ischemia-reperfusion injury. Besides, a 100 mg/kg dose of Hesperidin was found to be more beneficial to the rats than 50 mg/kg. CONCLUSIONS: The study suggests that Hesperidin is protective against renal and lung tissues of rats that underwent ischemia-reperfusion injury.
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Hesperidina , Daño por Reperfusión , Ratas , Animales , Hesperidina/farmacología , Hesperidina/uso terapéutico , Daño por Reperfusión/tratamiento farmacológico , Daño por Reperfusión/prevención & control , Riñón , Isquemia , Antioxidantes/farmacología , Estrés OxidativoRESUMEN
OBJECTIVE: COVID-19 may cause thrombosis in both venous and arterial systems. Familiarity with the signs and symptoms of thrombosis and its treatment is essential in treating COVID-19 infection and its complications. D-Dimer and mean platelet volume (MPV) are measurements related to the development of thrombosis. This study investigates whether MPV and D-Dimer values could be used to determine the risk of thrombosis and mortality in the COVID-19 early stages. PATIENTS AND METHODS: 424 patients who were COVID-19 positive, according to the World Health Organization (WHO) guidelines, were randomly and retrospectively included in the study. Demographic and clinical characteristics such as age, gender, and length of hospitalization were obtained from the digital records of participants. Participants were divided into living and deceased groups. The patients' biochemical, hormonal, and hematological parameters were analyzed retrospectively. RESULTS: White blood cells (WBC), neutrophils, and monocytes were significantly different in the two groups (p-value <0.001), and their values were lower in the living group than in the deceased group. MPV median values did not differ according to prognosis (p-value = 0.994). While the median value was 9.9 in the survivors, it was 10 in the deceased. Creatinine, procalcitonin, ferritin, and the number of hospitalization days in living patients were significantly lower than in patients who died (p-value <0.001). Median values of D-dimer (mg/L) differ according to prognosis (p-value <0.001). While the median value was 0.63 in the survivors, it was found as 438 in the deceased. CONCLUSIONS: Our results did not show any significant relationship between the mortality of COVID-19 patients and their MPV levels. However, a significant association between D-Dimer and mortality in COVID-19 patients was observed.
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COVID-19 , Trombosis , Humanos , Volúmen Plaquetario Medio , Pronóstico , Estudios RetrospectivosRESUMEN
OBJECTIVE: This study aims at determining the significance of a novel inflammatory biomarker, presepsin, in predicting disease prognosis in patients with COVID-19. PATIENTS AND METHODS: This retrospective study was concluded at the University Hospital between April and August 2020. The study involved 88 COVID-19 patients (48 men and 40 women). The patients were categorized into two groups: the patients admitted to the COVID-19 clinic, described as the moderate COVID-19 patients (Group-1; n=44), and those admitted to the internal medicine outpatient clinic, who were the mild COVID-19 patients (Group-2; n=44). The groups were compared using inflammatory markers: presepsin, C-Reactive Protein to Albumin Ratio, Neutrophil to Lymphocyte Ratio, and procalcitonin. RESULTS: Serum presepsin levels (195.29 vs. 52.12 pg/ml) were significantly higher in the Group-1 compared to the Group-2 (p=0.001). The gender distribution and average age were similar in both groups (p > 0.05). While ferritin, lactate dehydrogenase, D-Dimer, platelet lymphocyte ratio, C-Reactive Protein to Albumin Ratio (p=0.001), erythrocyte sedimentation ratio, C-Reactive Protein and presepsin were significantly higher in the Group-1 compared to Group-2 (p<0.05), while hemoglobin and lymphocyte were significantly lower in the Group-1 than in Group-2 (p<0.05). CONCLUSIONS: Serum presepsin levels were found to be significantly higher in moderate clinical group COVID-19 patients compared to mild group. Presepsin, a new inflammatory biomarker, may be useful in predicting the prognosis and early treatment of COVID-19 infection.
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Proteína C-Reactiva , COVID-19 , Masculino , Humanos , Femenino , COVID-19/diagnóstico , Estudios Retrospectivos , Pronóstico , Biomarcadores , Albúminas , Fragmentos de Péptidos , Receptores de LipopolisacáridosRESUMEN
OBJECTIVE: Our study aimed at investigating the impacts of demographic, hematological, and biochemical factors on the clinical course and the prognostic outcome in adult COVID-19 patients. PATIENTS AND METHODS: This retrospective study was performed in the internal medicine departments of two hospitals, and data were extracted from the medical files of 1,700 adult COVID-19 patients (836 females, 49.2%; 864 males, 50.8%) with an average age of 48.23 ± 16.68 (range: 18-93). Clinical data included baseline descriptives, prior medical history, admission date, treatment, and hematological and biochemical blood test results. The relationship between the survival, length of hospitalization, hematological, and biochemical parameters was investigated. RESULTS: Advanced age (p<0.001), presence of at least on comorbid disease (p=0.045), increased length of hospitalization (p=0.006), elevated white blood cell (p=0.001) and neutrophil (p=0.002) counts, increased serum levels of glucose (p=0.027), blood urea nitrogen (p<0.001), AST (p=0.006), LDH (p<0.001), CRP (p>0.001), and D-dimer (p=0.001). In contrast, diminution of serum levels of albumin (p<0.001), ALT (p=0.028), calcium (p=0.022), and platelet count (p=0.010) were associated with increased mortality. There was a positive and weak relationship between serum D-dimer levels and length of hospitalization. CONCLUSIONS: Our data imply that identifying and validating indicators that predict COVID-19 disease progression to improve health outcomes is crucial. Age, comorbidities, immunological response, radiographic abnormalities, laboratory markers, and signs of organ dysfunction may all predict poor outcomes individually or collectively. Identifying characteristics that predict COVID-19 problems is critical to guiding clinical management, improving patient outcomes, and allocating limited resources.
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COVID-19 , Masculino , Adulto , Femenino , Humanos , Persona de Mediana Edad , COVID-19/terapia , Estudios Retrospectivos , Índice de Severidad de la Enfermedad , Pronóstico , Resultado del TratamientoRESUMEN
OBJECTIVE: SARS-CoV-2 infection primarily affects T-lymphocytes, particularly CD4+ and CD8+ T cells. However, there is a need for simpler and less expensive laboratory tests with predictive values comparable to CD4+ cell counts. Thus, the goal of this study was to investigate the role of neopterin levels in predicting intensive care and mortality in coronavirus disease patients in 2019. PATIENTS AND METHODS: This retrospective study included 87 hospitalized patients who were diagnosed with COVID-19. Patients were divided into two groups: those receiving intensive care (Severe COVID-19; S-COVID-19) and those receiving non-intensive care (Moderate COVID-19; M-COVID-19). Patients' clinical characteristics, serum neopterin levels, and other laboratory data were compared across groups. RESULTS: The average age was 63.9±155.2 years, and 44 (%) of the participants were male. WBC (p = 0.008), neutrophil (p = 0.002), HDL (p = 0.009), ferritin, calcium, albumin, LDH, APTT, lymphocyte, INR, D-dimer, troponin, prothrombin time sedimentation, and PaO2 (p = 0.001) were all associated with death. The neopterin level in the M-COVID-19 group was 3 (min-max; 3.1-5.9) and 3.2 (2.3-7) in the S-COVID-19 group, with no statistically significant difference (p = 0.456). Gender differences between groups were not significant (p = 0.183). According to the ROC analysis, if parameters such as age, D-Dimer, troponin, ferritin, albumin, LDH, CRP, procalcitonin, and PaO2 exceed the cut-off values and lymphocyte levels are below, it can predict the need for intensive care and mortality in COVID-19 patients. CONCLUSIONS: Although we did not find statistically significant results with neopterin in terms of mortality in COVID-19 individuals in our study, more thorough, prospective, randomized controlled studies with expanded patient populations at various phases of the disease are needed.
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COVID-19 , Albúminas , Biomarcadores , COVID-19/diagnóstico , Femenino , Ferritinas , Humanos , Masculino , Neopterin , Oxígeno , Estudios Prospectivos , Estudios Retrospectivos , SARS-CoV-2 , TroponinaRESUMEN
OBJECTIVE: Inflammation forms the basis of cancer development and progression. It causes changes in complete blood count parameters, such as neutrophil counts. Low albumin levels are associated with poor prognosis in cancer patients. We aimed to investigate the association between neutrophil to albumin ratio (NAR) and the stage of non-small cell lung cancer (NSCLC). PATIENTS AND METHODS: 257 NSCLC patients (24 females and 198 males) were included in the study. Patients were divided into two groups. Group 1 (n=61) included patients with early stage cancer (stage 1 and 2), while group 2 (n=196) included those with advanced stage cancer (stage 3 and 4). Demographic data, neutrophil, lymphocyte, platelet, white blood cell counts (WBC), C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), ferritin and albumin levels at the time of diagnosis were recorded. The NAR of 2 groups were compared. RESULTS: There were no significant differences between the lymphocyte count (2.0 vs. 2.0 103/mm3) and platelet count (291 vs. 311 103/mm3) of the two groups (p > 0.05). ESR (38.8 vs. 57.5 mm/h), CRP (158 vs. 57 mg/l), ferritin (85 vs. 261 ng/ml), WBC count (8.6 vs. 10.6 103/mm3), neutrophil count (5.6 vs. 7.5 103/mm3), albumin values (2.9 vs. 3.7 gr/dl), and (p < 0.05) NAR levels (1.6 vs. 2.3) (p < 0.05) were significantly higher in group 2. CONCLUSIONS: NAR can be used in predicting the stage of NSCLC.
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Carcinoma de Pulmón de Células no Pequeñas , Neoplasias Pulmonares , Albúminas , Proteína C-Reactiva/análisis , Carcinoma de Pulmón de Células no Pequeñas/diagnóstico , Femenino , Ferritinas , Humanos , Recuento de Leucocitos , Neoplasias Pulmonares/diagnóstico , Recuento de Linfocitos , Linfocitos , Masculino , Neutrófilos , Estudios RetrospectivosRESUMEN
Familial Hypocalciuric Hypercalcemia (FHH) is a rare benign condition inherited in an autosomal dominant pattern with high penetrance. This rare genetic condition is detected in approximately 2% of cases examined as primary hyperparathyroidism (PH). The Calcium Sensing Receptor (CaSR) gene's inactivating mutations result in a calcium-parathormone level-saturation curve shift to the right. Generally, the calcium level does not exceed 11,5 mg/dl and the PTH is seen normal. In our case and in her family, extreme high blood calcium levels up to 14 mg/dl and accompanying advanced parathyroid hormone levels rising up to five times the upper limit of normal were detected. Due to these high PTH levels and advanced hypercalcemia, she was thought to have PH as a primary diagnosis. The case and her family are an interesting phenomenon that do not clinically fit classical FHH.
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Hipercalcemia , Hiperparatiroidismo Primario , Calcio , Femenino , Humanos , Hipercalcemia/congénito , Hipercalcemia/diagnóstico , Hipercalcemia/genética , Hiperparatiroidismo Primario/complicaciones , Hiperparatiroidismo Primario/diagnóstico , Hiperparatiroidismo Primario/genética , Mutación , Hormona Paratiroidea , Receptores Sensibles al Calcio/genéticaRESUMEN
In the presented study, the etiology was defined in geriatric patients who received transfusions with erythrocyte suspension due to anemia; the amount of transfusion was investigated and practical systems and methods to prevent the overuse of transfusions were developed. A retrospective patient records analysis was performed for a total of 328 patients aged ≥65 who received transfusions for any reason between July 2015 and 2018 at Sakarya Research and Training Hospital. Laboratory data at initial presentation, number of erythrocyte transfusions (NES), and total volume of erythrocyte suspension transfusions (TNES) performed during all admissions over the study period were recorded. Also recorded were the demographic data, concurrent conditions, and laboratory values. Patients were divided into two groups based on their age and hemoglobin levels. Age group A1 consisted of patients between 65 and 75 years of age (inclusive), while age group A2 consisted of patients over 75 years of age (exclusive). Based on the hemoglobin levels, the patients were identified as those with a hemoglobin <8 g/dl severe anemia (group H1), hemoglobin level ranging 8-9,5 g/dl moderate anemia (H2), and hemoglobin >9,5 g/dl - mild anemia (H3). The amount of transfusion and etiological factors responsible for anemia were examined. With respect to the incidence of iron deficiency, volume of transfused erythrocyte suspensions (ES), and total number of erythrocyte suspensions (TNES) were significantly higher in the H1 group, compared to the H2 group (p:0.012 and p:0.001, respectively). Comparing H2 and H3 groups, in terms of B12 deficiency, ES, and TNES were significantly higher in the H3 group than in the H2 group (p:.0001, p:.001, p:.001, respectively). In our study, transfusion indications in patients between 65 and 75 years of age and patients aged over 75 years differed significantly in terms of cardiac conditions and hypertension. The age groups were not significantly different in terms of transfusions performed for gastrointestinal bleeding. Also, the gender distribution across these two age groups was well balanced. No significant differences were noted related either to the age or to comorbid conditions between two groups. The higher average NES and TNES values in Group A2 (> 75 years) compared to Group A1 (65-75 y) were attributed to the need for achieving cardiovascular hemodynamic stability, and to the reduced tolerance of anemia due to accompanying comorbid conditions. Despite a wide array of etiological factors in anemic geriatric patients requiring transfusions, it is of utmost importance to develop a management plan for the underlying cause of anemia in order to reduce the indications for repeated transfusions. The anemia threshold for identifying the need for transfusion should be individualized based on the physiological status of each case.
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Transfusión Sanguínea , Anciano , Anemia , Transfusión de Eritrocitos , Hemoglobinas , Humanos , Estudios RetrospectivosRESUMEN
Priapism is a painful medical condition in which the erect penis does not return to its flaccid state, despite the absence of both physical and psychological stimulation, within 4 h. Priapism is considered a medical emergency, which should receive proper treatment by a qualified medical practitioner. Treatment initially involves conservative measures, such as corporeal aspiration and irrigation with saline or dilute phenylephrine. If this fails, embolization or surgical shunting may be required. Priapism is more commonly associated with sickle cell hemoglobinopathy. However, hyperviscosity resulting from leukemia is a rare cause of priapism. We report a case of a 19-year-old man with an 18-h history of priapism secondary to undiagnosed chronic myeloid leukemia. We discuss the method of leukapheresis (mechanical white cell depletion) to reduce viscosity.