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Background/aim In this study, we aimed to evaluate the initial hematological findings analyzed on admission in confirmed COVID-19 patients who were transferred to the intensive care unit (ICU), to predict possible hematological indices. Materials and methods Initial neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR), monocyte to lymphocyte ratio (MLR), red cell distribution width to platelet ratio (RPR), mean platelet volume to platelet ratio, and lymphocyte multiplied by platelet count (LYM × PLT), of 695 patients with laboratory-confirmed COVID-19 were investigated and comparisons were made between the mild/moderate and severe groups. Results The proportion of COVID-19 cases admitted to the ICU was 3.9%. The median age of patients admitted to the ICU was significantly higher than those who were not; [68.5 (interquartile range (IQR); 21.5] years vs. 41.0 (IQR; 15.7) years; P < 0.001. Severe cases had higher NLR (6.6 vs. 2.4; P < 0.001), and MLR (0.40 vs. 0.28; P = 0.004) and lower PLR (180.0 vs. 129.0; P < 0.001) compared to that of mild or moderate patients. Among all of the parameters, the ROC curve of NLR gave us the best ability to distinguish serious patients at an early stage (AUC = 0. 819, 95% confidence interval 0.729–0.910; P < 0.001). Conclusion These data showed that age, initial NLR, PLR, and LYM × PLT were associated with the severity of COVID-19 disease and patients’ need for the ICU. Therefore, initial hemogram parameters may be essential to predict the prognosis of COVID-19 patients.

Glycosaminoglycans (GAGs) are sulfated, negatively charged polysaccharides produced in almost every cell of the human body. As GAGs are extracellularly localized, the changes in body fluids such as blood and urine may reflect pathological changes in the urinary system as observed in other pathologies. In this review, we determined the potential of urinary and/or serum GAG levels as a marker for kidney and urothelial system diseases. We performed a search in the PubMed, MEDLINE, and ScienceDirect databases until September 30, 2019. A number of studies reported changes in the urinary and/or plasma GAG levels or composition in urological diseases and conditions, such as renal cell carcinoma, kidney stone, bladder carcinoma, and overactive bladder. GAGs were found to have a predictive biomarker potential that could be limited by generalizability concerns.

The aim of this study was to examine age-related differences in hemogram parameters and hematologic inflammatory markers in pediatric patients with COVID-19.This retrospective study included children aged 2 months to 18 years (n = 208) who have a confirmed diagnosis of COVID-19 and a control group comprising 117 healthy children between February 2021 and July 2021. The analysis of subgroup hematological values were performed according to the children's age cutoffs.The most significant difference between pediatric patients with COVID-19 and controls were peripheral blood eosinophil counts and eosinophil-to-monocyte ratio (EMR) levels on admission. The levels of monocyte-to-lymphocyte ratio, aggeregate index of systemic inflammation (neutrophil × platelet × monocyte/lymphocyte), neutrophil-to- lymphocyte × platelet ratio, and systemic inflammation response index (neutrophil × monocyte/ lymphocyte) were higher in patients than in controls. EMR had the highest area under the curve (AUC) value of 0.777, with a cutoff value of 0.26. The sensitivity for EMR was 75% under 2 years of age, and between 78.6-87.5% in the other age groups.In children younger than 6 months, the discriminative power of hematological indices is low, while the discriminative power of EMR is high at all ages when age appropriate cutoffs are used. Hematological inflammatory parameters may be particularly practical in pediatric clinics to help identify COVID-19 infection.

Objectives Albumin undergoes structural changes under ischemia and oxidative stress, turning into ischemia-modified albumin (IMA). It has been proposed as an early biomarker for various diseases associated with ischemia. We aimed to investigate the relationship between serum IMA and peripheral artery disease (PAD) and whether it is a risk marker for the severity of PAD. Methods This prospective case-control study included 100 patients with lower extremity PAD and 50 volunteers without. Patients with resting pain, ulcer, and gangrene were excluded from the study. Patients with PAD included in the study were divided into two groups as mild claudication and moderate-severe claudication. Adjusted-IMA levels were calculated according to the median albumin values of the groups. The basic clinical features and laboratory findings of the participants were recorded and compared. Possible risk factors for presence and severity of PAD and IMA levels were examined by logistic regression and receiver-operating characteristic (ROC) curve analyses. Results IMA and adjusted-IMA levels were significantly higher in the PAD group ( p < 0.001, p < 0.001, respectively). IMA and adjusted-IMA levels were significantly higher in PAD group 2, which had moderate-to-severe claudication and more pronounced ischemic symptoms ( p < 0.001, p < 0.001, respectively). Advanced age, presence of hypertension, smoking, low albumin levels, and high adjusted-IMA levels were independent predictors of PAD. There was a negative high correlation between adjusted-IMA levels and ABI ( r: −0.666, p < 0.001, Spearman’s correlation). ROC curve analysis demonstrated that adjusted-IMA cut-off values of 0.802 or above could predict presence and severity of peripheral artery disease with 70% sensitivity and 78% specificity (AUC: 0.825, 95% CI: 0.758–0.893, log rank p: 0.000). Conclusion We determinated that increased adjusted-IMA levels were a predictors of the presence and severity of PAD. In addition, adjusted-IMA values can be a valuable marker in the follow-up of clinical severity of PAD.

BACKGROUND: In this study, we aimed to investigate the effects of thiol-disulfide homeostasis in patients undergoing on-pump coronary artery bypass grafting. METHODS: Between January 2018 and October 2018, a total of 51 patients (43 males, 8 females; mean age 61.8±8.7 years; range, 38 to 78 years) who underwent isolated on-pump coronary artery bypass grafting were included. Thiol-disulfide homeostasis parameters were studied in the preoperative period (T1), 30 min after the removal of cross-clamp (T2), and postoperative sixth h (T3). Hemodynamic parameters such as atrial fibrillation and inotropic support requirement of the patients were evaluated in the postoperative period. RESULTS: There were significant differences in the measured thiol-disulfide homeostasis parameters at different time points of surgery (p

In clinical laboratories, a common practice used to verify tests prior to reporting is repeat testing. Our objective was to evaluate the differences between the results of blood ethanol concentration (BEC) test repetitions and report on the role of repeat testing to prevent reporting of incorrect results.We conducted a retrospective study of data retrieved from the Bursa Yuksek Ihtisas Training and Research Hospital's document management system by calculating the percentage change between repeated BEC test runs. To assess for clinical relevance, the bias between two results from the same sample was compared using the 1988 Clinical Laboratory Improvement Amendments' (CLIA) proficiency testing allowable total error (TEa) limits.From a total of 1,627 BEC tests performed between January 2017 and January 2018, 70% (1,133) were repeat tested. Of these, 830 resulted in BECs between 0-5 mmol/L, of which 237 (28.5%) were above the 25% acceptable TEa. Two hundred seventy-six BEC test results were greater than14 mmol/L, and there was a good consensus between the initial and repeat test results (99%). In this group, the mean bias was 0.0% (95%, CI = -9.8-9.8%). However, three of the repeat test results were considered significantly different. There were two discordant results in the 5-14 mmol/L ethanol level, and the mean bias was 2.1% (95%, CI = -15.0-19.1%).The majority of the repeated BEC test values were the same as the baseline value; therefore, there may be limited benefit in continuing such frequent repeated analyses.U kliničkim laboratorijama uobičajena je praksa da se izvrši evaluacija testa koji će biti korišćen. Nama je bio cilj da se izvrši evaluacija testa radi utvrđivanja razlika između rezultata pri određivanju koncentracije etanola u krvi (BESC) ponovljenim određivanjem i da iste objavimo kako bi se izbeglo izdavanje netačnih rezultata.Izučavanja su rađena u Bursa Yuksek Training i Research Hospital primenom menadžment sistema radi izračunavanja procenta odstupanja u ponovljenim određivanjima primenom BEC testa. Odgovarajuća klinička procena između rezultata dobijenih u istim uzorcima upore|ivana je primenom 1988 Clinical Laboratory Improvement Amendments (CLIA) testa koji omogućava izračunavanje granica ukupne greške (TEa).Od ukupno 1 627 BEC testova izvedenih između januara 2017 i januara 2018, 70% (1 133) su bili ponovljeni testovi. Od ovih, 830 BEC rezultata bili su između 0–5 mmol/L, a samo je 237 (28,5%) bilo iznad 25% prihvatljive TEa. Dvesta sedamdeset šest rezultata BEC testova bilo je veće od14 mmol/L, i dobijen je dobar konsenzus izmeđuinicijalnih i ponovljenih rezultata testova (99%). U ovoj grupi, srednje odstupanje je bilo 0,0% (95%, CI = -9,8–9,8%). Međutim, tri od ponovljenih rezultata su se značajno razlikovala. Postojala su dva neslaganja između rezultata kod nivoa etanola 5–14 mmol/L, pa je srednje odstupanje bilo 2,1% (95%, CI = -15,0–19,1%).Većina vrednosti ponovljenih BEC testova bila je ista kao i osnovna vrednost, što znači da nema opravdanja da se često vrednosti testova ponavljaju.

Objectives: The purpose of this study was to evaluate the diagnostic performance of the Dongjui DJ-8602 urinary analyzer for reducing the number of unnecessary urine cultures in patients with suspected urinary tract infection (UTI). Methods: This study was designed as a retrospective study performed in patients with suspected UTI from August 1, 2018 to December 1, 2018. Clinical data, C reactive protein, blood hematologic counts were evaluated. Using positive culture results as the gold standard, the cut-off values by the receiver operating characteristic curve technique, sensitivity, and specificity were calculated. Results: The median values of urine leukocyte levels were 31 cells/high power field (HPF) in the culture-positive group and 5 leukocytes/HPF in the culture-negative group, respectively. The area under the curve for leukocyte and bacteria count were 0.753 (95% Cl, 0.642 to 0.862) and 0.581 (95% Cl, 0.438 to 0.725), respectively. A leukocyte count ≥ 2 cells/HPF, resulting the best sensitivity of 96.3% (95% Cl: 81.03% to 99.48%) and a negative predictive value (NPV) of 96.4% (95% Cl: 79.35% to 99.48%). Conclusions: The use of the Dongjui DJ-8602 urinary sediment and chemistry analyzer did not accurately predict the outcome of urine cultures with an unsatisfactory sensitivity and NPVs of bacteria counts.

Introduction: Despite prophylactic anticoagulant treatments, thrombotic complications may develop in patients with Coronavirus disease 2019 (COVID-19). This study aimed to evaluate the factors influencing anti-Factor Xa activity in COVID-19 patients receiving low molecular weight heparin (LMWH). Materials and methods: We prospectively evaluated 80 COVID-19 patients, diagnosed using polymerase-chain-reaction test, who were admitted to our clinic and administered LMWH; LMWH (enoxaparin) was applied according to the weight, D-dimer levels, and clinical condition of patients. Anti-Factor Xa activity in blood, drawn 4h after the 3rd dose of LMWH, were measured and a activity of Results:Groups 1 and 2 included 13 and 67 patients with subprophylactic (mean±SD: 0.18±0.06) and prophylactic (mean±SD: 0.43±0.23) anti-Factor Xa activity, respectively. The proportion of eosinophils in patients was significantly higher in group 1 than in group 2 (mean±SD; 2.96±2.55 vs 0.90±1.28; p=0.001). At the time of discharge the eosinophilic proportion of patients was significantly higher (eosinophil %, mean±SD; 3.06±1.49 vs 2.07±1.92; p=0.001) but the activated partial thromboplastin time was significantly lower (22.34±1.38 vs 24.38±3.58; p=0.01) in group 1 than in group 2. Of 14 patients with eosinophil content >4%, 6 were in group 1 ((6/13) 46.2%) while 8 were in group 2 ((8/63) 11.9%); (p=0.009), and all had a D-dimer level Conclusions: Elevated eosinophil count is related to lower anti-factor Xa activity in patients with COVID-19 receiving LMWH. (NCT04507282)

Introduction: Despite prophylactic anticoagulant treatments, thrombotic complications may develop in patients with Coronavirus disease 2019 (COVID-19). This study aimed to evaluate anti-Factor Xa levels to determine the anticoagulant activity of low molecular weight heparin (LMWH) in COVID-19 patients.Materials and methods: We prospectively evaluated 80 COVID-19 patients, diagnosed using polymerase-chain-reaction test, who were admitted to our clinic and administered LMWH; enoxaparin was applied according to the weight, D-dimer levels, and clinical condition of patients. Anti-Factor Xa levels in blood, drawn 4h after the 3rd dose of LMWH, were measured and a level of Results:Groups 1 and 2 included 13 and 63 patients with subprophylactic (0.18±0.06) and prophylactic (0.43±0.23) anti-Factor Xa levels, respectively. The proportion of eosinophils in patients was significantly higher in group 1 than in group 2 (2.96±2.55 vs 0.90±1.28;p=0.001). At the time of discharge the eosinophilic proportion of patients was significantly higher (3.06±1.49 vs 2.07±1.92;p=0.001) but the activated partial thromboplastin time was significantly lower (22.34±1.38 vs 24.38±3.58; p=0.01) in group 1 than in group 2. Of 14 patients with eosinophil content >4%, 6 were in group 1 ((6/13) 46.2%) while 8 were in group 2 ((8/63) 11.9%); (p=0.009), and all had a D-dimer level Conclusions: In COVID-19 patients, eosinophil levels could be considered for determining effective prophylactic anticoagulant administration. (NCT04507282)

The major extracellular electrolytes, sodium, and potassium are often requested together and form a large percentage of the requested tests in routine clinical chemistry laboratories. Two types of devices that use direct and indirect ion-selective electrode (ISE) methods are used in hospitals for electrolyte measurements: blood gas analyzers (BGA), which use direct ISE technology, and the indirect ISE method, which is often used in a central-laboratory autoanalyzer (AA). We aimed to summarize the current scientific knowledge based on whether the electrolyte test results, using Na and K test results obtained with BGA and an AA, can be used interchangeably. We searched Medline (PubMed), Google Scholar, and Web of Science up to 31st March 2018. In addition, references of the included studies were also examined. Fourteen studies with a risk of bias were included in the analysis. Limits of agreement differences were variable among BGA and AA sodium and potassium test results in clinical practice. The results of both BGA and AA measures should not be used interchangeably under the assumption that they are equivalent to each other. How to cite this article Ustundag Y, Huysal K, Ozgunay SE, Turkoglu AR. Interchangeability of Sodium and Potassium Result Values of Arterial Blood Gas with Laboratory Analyzer: Narrative Review. Indian Journal of Critical Care Medicine, January 2019;23(1):35-42.

Purpose:To investigate the importance of the Hemoglobin/Red cell distribution widthratio (Hb/RDW) and Neutrophil/Lymphocyte ratio (NLR) in predicting bladderlamina propria invasion before transurethral resection in non-muscular invasivebladder cancer (NMIBC) patientsMethods:The data of the patients whose pathology after transurethral resection of thebladder was NMIBC between January 2010 and June 2016 were evaluatedretrospectively. Group 1 had Ta (mucosa involvement) and Group 2 had T1(submucosa involvement) lesions. The age, gender, tumor size and number oftumors of the patients were identified. The preoperative blood leucocyte (WBC),hemoglobin (Hb), neutrophil (N), lymphocyte (L), monocyte (M), platelet (PLT),mean platelet volume (MPV), and red cell distribution width (RDW) values wereidentified and the NLR, PLR, LMR values calculated. The Hb/RDW ratio wasdetermined. Results: Atotal of 369 patients were evaluated. The mean age was similar between groups.Group 1 (Ta) consisted of 219 patients (66.3±10.7 years) and Group 2 (T1) 150patients (66.9±10.4 years) (p=0.638). NLR was higher in Group 2 than Group 1(2.4 (1.5) and 2.2 (1.5), respectively, p=0.042) and this difference wasstatistically significant. The Hb/RDW ratio in Group 2 was lower than in Group1 (0.89±21 and 0.94±19, respectively, p=0.019) and this difference wasstatistically significant. Conclusion:We believe that a decrease in the Hb/RDW ratio and increase in NLR, which canbe easily determined from the peripheral blood in the preoperative period, canbe associated with lamina propria invasion (T1). These studies should besupported with prospective large series., Amaç: Non-musculerinvazive bladder cancer (NMIBC) hastalarında Hemoglobin-Red cell DistrubitionWidth oranı (Hb/RDW) ve Nötrofil/Lenfosit oranının (NLR) mesanenin transüretralrezeksiyonu öncesi lamina propria invazyonunu önğörmede önemini araştırmak.Materyal–methods: Ocak2010- Haziran 2016 yılları arası mesanenin transüretral rezeksiyonu sonrasıpatolojisi NMIBC olan hastaların verileri retrospektif değerlendirildi.Hastalar Grup 1: Ta (mukoza tutulumu), Grup 2: T1 (submukoza tutulumu) olarak 2gruba ayrıldılar. Hastaların yaşları, cinsiyetleri, tümör boyutu ve tümörsayıları belirlendi. Preoperatif tam kan değerlerinden lökosit (WBC),hemoglobin (Hb), nötrofil (N), lenfosit (L), monosit (M), platelet (PLT), meanplatelet volümü (MPV), Red cell Distrubition Width (RDW) değerleri belirlendiktensonra NLR, PLR, LMR değerleri hesaplandı. Hb/RDW oranı belirlendi.Bulgular: Patolojikevresi NMIBC olan 369 hasta değerlendirildi. Gruplar arasında yaş farkı yoktu.Grup 1 (Ta); 219 hasta, 66.3±10.7yıl olup grup 2 (T1); 150 hasta,66.9±10.4 yıl oldu (p=0.638). NLR grup 2’de grup 1’den yüksekolup (sırasıyla 2.4 (1.5), 2.2 (1.5) ve p=0.042 ) istatistiksel olarak buyükseklik anlamlıdır. Gruplar arasında Hb ve RDW oranları bakımından farklılıkizlenmemesine rağmen Hb/RDW oranı grup 2’de grup 1’den düşüktür (sırasıyla0.89±21, 0.94±19 ve p=0.019) ve istatistiksel olarak bu azalma anlamlıdır. Sonuç: Preoperatifdönemde periferik kandan kolay yolla elde edilebilen Hb/RDW oranında azalma veNLR yükselmenin lamina propria invazyonu (T1) ile ilişkili olabileceğinidüşünmekteyiz. Bu çalışmaların prospektif geniş serili çalışmalarladesteklenmesi gerekir.

Purpose: The aim of this study was to investigate the association between serum sex hormone levels and lower urinary tract symptoms in men. Material and Method: Forty-nine men with lower urinary tract symptoms aged 25-45 years (mean: 37.9±2.0 years) and 25 healthy men aged 25-45 years (mean: 35.9±2.0 years) as controls participated in this study. Estradiol (E2), follicle-stimulating hormone (FSH), luteinizing hormone, dehydroepiandrosterone sulfate, insulin-like growth factor-binding protein 3 (IGFBP3), insulin-like growth factor -1 (IGF1), and sex hormone-binding globulin levels were measured using commercially available assay kits. All participants were asked to complete the International Prostate Symptom Score questionnaire. Results: Demographic data were similar between patients and controls. Among the sex steroids studied, only FSH and E2 showed a statistically significant association with lower urinary tract symptoms (p

Müberra Akdoğan,1 Yasemin Ustundag-Budak,2 Kagan Huysal2 1Department of Ophtalmology, 2Department of Clinical Laboratory, Yüksek Ä°htisas Education and Research Hospital, Bursa, Turkey Background: Atherogenic dyslipidemia is particularly common in people with type 2 diabetes (DM2). Platelets from patients with DM2 have increased reactivity and baseline activation. The aim of the present study is to evaluate the relationship between atherogenic index and hematologic inflammatory markers and to evaluate the relationship between these parameters and associated variables in diabetic retinopathy (DR) patients. Methods: The medical records of all patients admitted to the eye clinic between January and December 2014 were evaluated systematically. Laboratory parameters of 278 outpatients with DM2 diagnosed after the age of 30years and 107 healthy subjects were analyzed. Results: The DM2 + DR group consisted of 120 patients (47 males and 73 females; mean age 59.8±9.2years). The DM2 without DR group consisted of 158 patients (59 males and 99 females; mean age 57.3±12.2years). Mean platelet volume, platelet distribution width (PDW), platelet–lymphocyte (P/L) ratio, triglycerides, and atherogenic index were higher in DM2 patients than in control patients, but there was no difference between the DM2 + DR and the DM2 without DR groups. Only P/L ratio was different in the DM2 + DR patients compared to the DM2 without DR patients. Hemoglobin A1c levels correlated very weakly with the mean platelet volume, PDW, P/L ratio, and the red cell distribution width. The atherogenic index was very weakly correlated with the P/L ratio, PDW, and red cell distribution width. Conclusion: Dyslipidemia-induced inflammation contributes to pathological processes that lead to retinopathy in DR patients. Keywords: type 2 diabetes mellitus, diabetes complications, platelets, erythrocyte indices, triglycerides

WOS: 000377907400007 PubMed ID: 27346963 Platelet indices (PI) - plateletcrit, mean platelet volume (MPV) and platelet distribution width (PDW) - are a group of derived platelet parameters obtained as a part of the automatic complete blood count. Emerging evidence suggests that PIs may have diagnostic and prognostic value in certain diseases. This study aimed to summarize the current scientific knowledge on the potential role of PIs as a diagnostic and prognostic marker in patients having emergency, non-traumatic abdominal surgery. In December 2015, we searched Medline/PubMed, Scopus and Google Scholar to identify all articles on PIs. Overall, considerable evidence suggests that PIs are altered with acute appendicitis. Although the role of PI in the differential diagnosis of acute abdomen remains uncertain, low MPV might be useful in acute appendicitis and acute mesenteric ischemia, with high MPV predicting poor prognosis in acute mesenteric ischemia. The current lack of consistency and technical standards in studies involving PIs should be regarded as a serious limitation to comparing these studies. Further large, multicentre prospective studies concurrently collecting data from different ethnicities and genders are needed before they can be used in routine clinical practice.

Introduction: The quality of blood ethanol concentration (BEC) determination is important because of its legal ramifications. Measurement uncertainty provides quantitative information about the quality and reliability of test results. In this study, we aim to calculate the measurement uncertainty for the ethanol test in our laboratory measured with a Synchron Systems Ethanol assay kit by employing an enzymatic rate method on the Beckman-Coulter Olympus AU400 auto analyzer (Beckman Coulter Inc, Melville, USA). Materials and methods: The measurement uncertainty values were calculated in accordance to the Nordtest guidelines. All vehicle drivers involved in a traffic accident were retrospectively inspected for the BEC test conducted during July to December 2016 in our emergency laboratory. Results: A 1034 vehicle drivers had their BEC tested. The results for 181 drivers were > 0.50 g/L and reported as positive. The serum ethanol concentration in those showing a positive result was 2.04 ± 1.01 g/L, over four times the legal limit. The median BEC in those showing a negative result was 0.03 (IQR: 0.03) g/L. The expanded uncertainty obtained was 19.74%. When measurement uncertainty values were added to the results of the 1034 drivers who were retrospectively screened, eight vehicle drivers had results with 95% confidence intervals that exceeded the legal limit 0.50 g/L. Conclusions: The BEC test results for vehicle drivers with values close to legal limits should be reported as the obtained ethanol concentration with corresponding measurement uncertainty.

Introduction: Electrolytes have a narrow range of biological variation and small changes are clinically significant. It is important to select the best method for clinical decision making and patient monitoring in the emergency room. The sigma metrics model provides an objective method to evaluate the performance of a method. Aim: To calculate sigma metrics for electrolytes measured with one arterial blood gas analyser including two auto-analysers that use different technologies. To identify the best approach for electrolyte monitoring in an emergency setting and the context of routine emergency room workflow. Materials and Methods: The Coefficient of Variation (CV) was determined from Internal Quality Control (IQC). Data was measured from July 2015 to January 2016 for all three analysers. The records of KBUD external quality data (Association of Clinical Biochemists, Istanbul, Turkey) for both Mindray BS-2000M analyser (Mindray, Shenzhen, China) and Architect C16000 (Abbott Diagnostics, Abbott Park, IL) and MLE clinical laboratory evaluation program (Washington, DC, USA) for Radiometer ABL 700 (Radiometer Trading, Copenhagen, Denmark) during the study period were used to determine the bias. Results: The calculated average sigma values for sodium (-1.1), potassium (3.3), and chloride (0.06) were with the Radiometer ABL700. All calculated sigma values were better than the autoanalysers. Conclusion: The sigma values obtained from all analysers suggest that running more controls and increasing the calibration frequency for electrolytes is necessary for quality assurance.

Objective. Chronic inflammation might favour platelet hyperactivity, which leads to inter-individual variability in antiplatelet resistance. The aim of this study was to test the hypothesis that there is a relationship between some hematological parameters reported as measures of systemic inflammation, the atherogenic index of plasma (AIP), and antiplatelet responsiveness. Methods. This retrospective study included patients receiving aspirin (100 mg) and clopidogrel (75 mg) daily before and after stenting. Platelet inhibition was assessed using the VerifyNow P2Y12 point-of-care test. Resistance to antiplatelet therapy was defined as P2Y12 reactivity exceeding 240 units (for clopidogrel) or aspirin reaction units exceeding 550 units (for aspirin). The AIP was calculated as the logarithm of triglyceride/high density lipoprotein cholesterol. The white blood cell (WBC), platelet (P), neutrophil (N), and lymphocyte (L) counts, red cell distribution width (RDW), hemoglobin (Hb), plateletcrit, mean platelet volume (MPV), platelet distribution width, and N/L and P/L ratios were evaluated. Results. Of 232 patients (73% male; median age, 63 years; range, 38-87 years), 52 (22%) were aspirin resistant and 82 (35%) were clopidogrel resistant; 7.7% were both aspirin and clopidogrel resistant. Median RDW levels were significantly higher (14.4% [interquartile range (IQR) 3] vs. 13.9% [IQR 1.3]; p=0.01) and Hb levels significantly lower (12.0±1.6 g/dL vs. 13.2±1.7 g/dL; p0.05). Multivariate logistic regression showed that Hb (odds ratio [OR]=0.73; 95% confidence interval [CI], 0.60-0.88; p=0.001) and RDW (OR=1.26; 95% CI, 1.02-1.55; p=0.02) were independent predictors of clopidogrel resistance. Conclusion. Both RDW and Hb were independent variables associated with clopidogrel resistance, but antiplatelet resistance cannot be predicted based on other hematological parameters or AIP.

WOS: 000383902000021 PubMed ID: 27466137 Background: The level and activity of indoleamine 2,3-dioxygenase (IDO) and the concentrations of L-tryptophan and its metabolite L-kynurenine were determined in association with various renal diseases. However, there have been no data regarding these parameters in patients on peritoneal dialysis compared to those undergoing hemodialysis or kidney transplantation.Methods: This study investigated the level and activity of IDO and determined oxidative balance by calculating the total oxidant status (TOS), total antioxidant status (TAS), and oxidative stress index (OSI). We enrolled 60 kidney disease patients, including 20 on peritoneal dialysis (PD group), 19 on hemodialysis (HD group), and 21 with kidney transplantation (KT group), as well as 21 control group.Results: IDO levels were increased in the PD, HD, and KT groups compared to the control group. The concentration of kynurenine was significantly increased in the PD group compared to the other groups (p

Objective. The total antioxidant capacity (TAC) of a sample can be measured with a ferric reducing antioxidant power (FRAP) assay. There are commercially available kits for FRAP assays, however they are more expensive than in-house kits. We aimed to evaluate a FRAP direct measurement method under our laboratory conditions using a microplate reader and establish reference values to use in future research projects. Methods. An in-house microplate adaptation of the FRAP method was evaluated. Reference values of FRAP were established for one hundred and twenty subjects aged between 25-55 years. FRAP levels were estimated in 30 serum samples with high glucose concentration, 44 hyperbiluribinemic neonatals and 16 patients receiving renal replacement therapy (RRT). Results. The mean FRAP level was 890±235 µmol/L. The median TAC level was 904 µmol/L. This method was found to be linear up to at least 2000 µmol/L. The intra- and inter-assay coefficients of variation were 2.7-6.7% and 5.3-10.1%, respectively. The mean FRAP level was lower than normal in diabetes and RRT patients and higher in hyperbiluribinemic neonatals (687±209 µmol/L, 609±250 µmol/L and 945±187 µmol/L, respectively). Conclusions. Our reference values give comparable results with the literature. This method is simple, reliable, and inexpensive. It could be used for studies of oxidative stress-related diseases.

The purpose of this study was to determine paraoxonase-I activity (PON 1), lipid profile and hsCRP in type 2 diabetic patients with and without retinopathy who had the same duration of the disease (10 years), to determine the correlations among these parameters and to compare these values with those measured in normal control subjects. Fifty four subjects (mean age 58 ± 7 years, men / women 25/29) with type 2 diabetes (T2DM) with proliferative diabetic retinopathy (PDR) (N = 25) and without retinopathy (nonDR) (N = 29) were included in the study. Twenty four healthy subjects were selected as control group (61 ± 6 years, men / women 10/14). Paraoxonase and arylesterase activities were measured spectrophotometrically. The DM + PDR group had lower paraoxonase activity (199 ± 39 vs. 258 ± 60 U/L, P

Introduction: Glucose meters are used routinely in hospital wards to manage blood glucose levels in patients requiring frequent monitoring of blood glucose. Objective: Our institution has 50 POC instruments utilized by diverse population of all ages and medical conditions. The primary objective of our study was to investigate whether all these CareSens glucose meters (I-sense Inc, Seoul, South Korea) results in hospitalized patients during routine clinical care jointly satisfy the specified quality specifications, as defined by Clinical and Laboratory Standards Institute (CLSI) guideline POCT12-A3. Materials and Methods: The records of hospitalized patients who underwent simultaneous measures of glucose levels with both glucose meters and a central laboratory analyser between January and June 2013 were retrospectively analysed. We also performed a prospective evaluation of the accuracy of the CareSens glucose Strip. Results: Glucose concentrations measured in 840 patients ranged from 1.66 to 31.72 mmol/L The Bland–Altman difference plot between the auto analyser and all the 50 CareSens glucosemeters revealed a mean bias of -2.2%, with analytical biases for the two methods varying from −31.1% to 26.8%. Eighty four percent of the glucose meter's glucose values were within ± 12.5% for values 5.54 mmol/L of the comparative laboratory glucose values and 93% of the results were within 20% of the reference for glucose >4.2 mmol/L and 65% of the results were within 0.8 mmol/L for glucose

Introduction: Glycosylated hemoglobin (HbA1c) concentrations measured in clinical chemistry laboratories show large differences between their interlaboratory reported values. Laboratory measurements of quality performance should be based on quantitative data. The sigma metrics model provides an objective method for the assessment of current HbA1c assays and is useful in quality management planning. The aim of our study was to evaluate the analytical performance of the MQ-2000 PT HbA1c analyzer test results in the context of our operating conditions on the sigma scale. Materials and methods: The coefficient of variation was determined from the calculated mean and standard deviation evaluated from internal quality control (QC) (N = 168 days) (Shanghai Huachen Biological Reagent Co. Ltd, China) data, and records of external quality data (KBUDEK, Istanbul, Turkey) measured in the period from May to November 2013 were used to determine the bias. The resulting data and total allowable error rate (TEA = 10%) from the Clinical Laboratory Improvement Amendments of 1988 (CLIA’88) were used to calculate the sigma level. Results: The calculated coefficient of variations (CVs) at the two levels, normal (QC1 = 36.6 ± 2.38 mmol/mol) and pathological (QC2 = 84.7 ± 2.68 mmol/mol), were 6.5% and 3.1%, respectively. The average bias between the external QC and MQ-2000 PT during the study period was 4.3%. The calculated average sigma value was 1.19. Conclusions: The MQ-2000 PT HbA1c is a new analyser in the market; there is need for improvement and the method should be controlled with greater attention to ensure quality.

Background Intoxication due to carbon monoxide (CO) is one of the most common types of poisoning. Cardiac effects of carboxyhemoglobin (COHb) range from simple arrhythmias to myocardial infarction. Objectives The current study aimed to investigate the relationship between blood carboxyhemoglobin and high-sensitivity cardiac troponin T (hs-cTnT) level with a highly sensitive assay in patients with acute carbon monoxide poisoning. Patients and Methods This retrospective study was conducted on 141 (54 males and 87 females) patients, with acute CO intoxication, admitted to the Sevket Yilmaz research and education hospital emergency unit during a one-year period (January 2012 - January 2013). The patients were divided into three groups based on COHb levels: Group I, mild COHb level < 15%; Group II, COHb between 15% and 25%; Group III, severe acute CO intoxication COHb levels > 25%. COHb, hs-cTnT (Stat), creatine kinase (CK) and creatine kinase-myocardial band (CK-MB) levels were measured on admission. Results The mean age of the patients was 38 ± 16 years. COHb levels ranged from 8 to 35. hs-cTnT levels on inclusion in this study were slightly different between the groups (P = 0.05). COHb levels with hs-cTnT values were weakly correlated (r = 0.173, P = 0.041); on the other hand, CK-MB levels were not correlated with COHb (r = 0.013, P = 0.883). Conclusions In patients without clear signs of myocardial infarction, even mild CO poisoning was associated with quantifiable circulating levels of hs-cTnT when TnT was measured using a highly sensitive assay in the current study patients. Plasma levels of the hs-TnT and CK-MB assays were not correlated with the COHb levels in the current study patients.

Background In our emergency department, we collect blood in Rapid Serum Tubes (RSTs; Becton Dickinson, Franklin Lakes, NJ), in which clotting times are reduced. We investigated the influence of RST use on cardiac troponin T (hs-cTnT) and creatine kinase-MB (CK-MB) test results, in comparison with the use of tubes featuring a separator gel containing a clotting activator (SSTs; Green-vac, Yongin, Korea). Methods Samples from 60 patients were divided into equal aliquots and placed into RSTs and SSTs; hs-cTnT and CK-MB concentrations were determined using an autoanalyzer (Elecsys 2010) running commercial assays (Roche Diagnostics, Penzberg, Germany). Between-tube differences in CK-MB and hs-cTnT values were compared using the paired t-test, and correlations among variables were evaluated by calculation of Spearman correlation coefficients (r values). Deming regression analysis was performed and Bland-Altman plots were constructed. Results The hs-cTnT and CK-MB test results obtained from samples placed into RSTs and SSTs did not differ (p > 0.1). The correlations between the concentrations of hs-cTnT and CK-MB in samples placed into RSTs and SSTs were good; both r values were unity (p

Introduction: Urinary tract infection (UTI) is one of the most common types of infection. Currently, diagnosis is primarily based on microbiologic culture, which is time- and labor-consuming. The aim of this study was to assess the diagnostic accuracy of urinalysis results from UriSed (77 Electronica, Budapest, Hungary), an automated microscopic image-based sediment analyzer, in predicting positive urine cultures. Materials and methods: We examined a total of 384 urine specimens from hospitalized patients and outpatients attending our hospital on the same day for urinalysis, dipstick tests and semi-quantitative urine culture. The urinalysis results were compared with those of conventional semiquantitative urine culture. Results: Of 384 urinary specimens, 68 were positive for bacteriuria by culture, and were thus considered true positives. Comparison of these results with those obtained from the UriSed analyzer indicated that the analyzer had a specifi city of 91.1%, a sensitivity of 47.0%, a positive predictive value (PPV) of 53.3% (95% confi dence interval (CI) = 40.8-65.3), and a negative predictive value (NPV) of 88.8% (95% Cl = 85.0-91.8%) . The accuracy was 83.3% when the urine leukocyte parameter was used, 76.8% when bacteriuria analysis of urinary sediment was used, and 85.1% when the bacteriuria and leukocyturia parameters were combined. The presence of nitrite was the best indicator of culture positivity (99.3% specifi city) but had a negative likelihood ratio of 0.7, indicating that it was not a reliable clinical test. Conclusions: Although the specifi city of the UriSed analyzer was within ac ceptable limits, the sensitivity value was low. Thus, UriSed urinalysis results do not accurately predict the outcome of culture.

Background Electrolyte values are measured in most critically ill intensive care unit (ICU) patients using both an arterial blood gas analyzer (ABG) and a central laboratory auto-analyzer (AA). The aim of the present study was to investigate whether electrolyte levels assessed using an ABG and an AA were equivalent; data on sodium and potassium ion concentrations were examined. Methods We retrospectively studied patients hospitalized in the ICU between July and August 2011. Of 1,105 test samples, we identified 84 instances of simultaneous sampling of arterial and venous blood, where both Na+ and K+ levels were measured using a pHOx Stat Profile Plus L blood gas analyzer (Nova Biomedical, Waltham MA, USA) and a Roche Modular P autoanalyzer (Roche Diagnostics, Mannheim, Germany). Statistical measures employed to compare the data included Spearman's correlation coefficients, paired Student’s t-tests, Deming regression analysis, and Bland-Altman plots. Results The mean sodium concentration was 138.1 mmol/L (SD 10.2 mmol/L) using the ABG and 143.0 mmol/L (SD 10.5) using the AA (p + and Na+, with biases of 0.150-0.352 and −0.97-10.05 respectively; the associated correlation coefficients were 0.88 and 0.90. Conclusions We conclude that the ABG and AA do not yield equivalent Na+ and K+ data. Concordance between ABG and AA should be established prior to introduction of new ABG systems.

Introduction: The aim of the present study was to validate prothrombin time (PT) international nor-malized ratio (INR) results obtained using Steelex test reagents and a Steelex coagulometer (Steelex Scientific Instrument Company, Beijing, China), in comparison with use of a well-established standard test employing Pacific Hemostasis reagents (Fisher Diagnostics, Middletown, VA, USA) and Teco Coatron A4 coagulometer (Teco Medical Instruments GmbH, Neufahrn, Germany). Materials and methods: Between- and within-day coefficients of variation (CVs) of both assays were calculated using control samples provided by the test manufacturers. Samples from 90 subjects were collected and INR values were determined in a double-blind parallel manner employing both systems. Results: The within-day coefficients of variation (CVs) in INR estimates ranged from 2.6% (INR = 1.12) to 3.1% (INR = 2.51) for the Steelex system and from 2.1% (INR = 1.09) to 1.8% (INR = 2.8) for the Pacific test; the between-day values ran from 3.4% (INR = 1.16) to 7.9% (INR = 2.64) and from 3.3% (INR = 1.1) to 2.3% (INR = 2.7), respectively. Passing-Bablok fit of the of the Steelex and Pacific methods yielded the equation: Steelex INR = 0.85 (0.79-0.91) × Pacific INR + 0.12 (-0.02-0.21), whereas the CUSUM linearity P value was

Urine analysis is an essential component of patient assessment, used in screening, diagnosis, and the planning of care. Automated urinalysis systems can save labor and time, and are valuable in high-volume laboratories. The aim of this study was to compare the diagnostic performance of three automated urinalysis systems--Iris iQ200 (AX-4280), the Sysmex UF-1000i (Urisys 2400), and the UriSed LabUMat.A total of 412 urine samples sent for urinalysis were assessed using all three automated systems.Correlation between the three instruments, represented as results within one grading unit showed an overall concordance level of more than 80% for chemical urinalysis systems. When we compared microscopy features, red blood cell detection correlation was best between the iQ200 and UriSed instruments (92%). The UF-1000i and iQ200 data on white blood and epithelial cell counts were optimally correlated (86% and 90%, respecttively).The three automated urinalysis systems demonstrated acceptable correlations in chemical data between instruments. However, whereas the automated microscopy units could be used for initial screening, some manual microscopy was still necessary.

We evaluated the effects of endothelial dysfunction and inflammation on slow coronary flow (SCF).The study included 26 patients (group 1; 13 females, 13 males; mean age 58.8 years) who had normal coronary arteries but SCF in three coronary vessels and 25 subjects (group 2, 14 females, 11 males; mean age 62.7 years) with normal coronary arteries and normal flow. Coronary flow was quantified according to the TIMI (Thrombolysis In Myocardial Infarction) frame count method for the left anterior descending (LAD), circumflex (Cx), and right coronary (RCA) arteries. Endothelial function was assessed by plasma asymmetric dimethylarginine (ADMA) levels, brachial artery endothelium-dependent flow-mediated dilatation (FMD), and nitroglycerin-mediated dilatation (NMD). Inflammation was assessed by high-sensitivity C-reactive protein (hs-CRP) levels.TIMI frame count was significantly higher in group 1 compared to group 2 for each artery (p0.001). In group 1, the mean FMD was significantly lower (6.6±1.6% vs. 11.2±1.6%, p0.001) and the mean ADMA level was significantly higher (0.8±0.2 µmol/l vs. 0.5±0.1 µmol/l, p=0.002), whereas NMD and hs-CRP levels did not differ significantly between the two groups (p0.05). There was a significant correlation between plasma ADMA level and TIMI frame count (RCA: r=0.50, p=0.001; cLAD: r=0.46, p=0.004; Cx: r=0.32, p=0.04) and a significant negative correlation between FMD and TIMI frame count (cLAD: r=-0.68, p=0.0003; Cx: r=-0.54, p=0.0004; RCA: r=-0.46, p=0.004), but hs-CRP level was not correlated with TIMI frame count. In multivariate analysis, only ADMA (p=0.009) and FMD (p=0.02) were significant parameters to predict SCF.Our results suggest that endothelial dysfunction as determined by increased ADMA level and impaired FMD, rather than inflammation, plays a role in the etiopathogenesis of SCF.

Aim The aim of this study was to determine whether primary nocturnal enuresis (PNE) leads to alterations in glycosaminoglycan (GAG) excretion. Methods Twenty subjects (mean age 8.7 years, M/F 15/5) with PNE were included in the study. Twenty-two healthy subjects were selected as a control group (mean age 8.7 years, M/F 14/8). Urinary GAG excretion was measured using a modified dimethylmethylene blue (DMD) assay of 24-hour urine. Results The mean urinary GAG content was 33.9 mg/g and 23.8 mg/g creatinine in patients with PNE and controls, respectively; patients with PNE thus had a higher mean GAG excretion than did age-matched controls (p < 0.05). The association between GAG level and enuresis frequency bordered on significance (p = 0.068). Conclusions GAG excretion in patients with PNE was significantly higher than in normal children, suggesting that measurement of urinary GAG may be useful in evaluating physiopathological conditions of the bladder wall. Further studies are needed to confirm this finding.

The aim of this study is to investigate if serum asymmetric dimethylarginine (ADMA) levels can predict restenosis and major adverse cardiac events (MACE) in patients who undergo percutaneous coronary interventions. The most important cause of restenosis following percutaneous coronary intervention is neointimal hyperplasia. Nitric oxide (NO) prevents the neointimal hyperplasia growing. Asymmetric dimethylarginine is a competitive inhibitor of NO synthesis. The effect of ADMA on the restenosis has not yet been investigated. A total of 105 (80 male and 25 female) patients were included in our study. All patients underwent elective percutaneous transluminal coronary angioplasty (PTCA) with bare metal stent implantation or direct stenting for one coronary artery between September 2004 and January 2006. All patients were clinically followed for a period of 6 months, and a control angiography was performed at the end of this period. The probrain natriuretic peptide (pro-BNP), high-sensitivity Creactive protein (hs-CRP), and ADMA levels of the patients were evaluated before the procedure and 6 months afterwards. Biochemical parameters and angiographic features were evaluated in order to determine if they could predict the development of restenosis and MACE by using univariate and multivariate Cox regression analysis. The 65 (61.9%) patients (50 males and 15 females) who had not developed restenosis were designated as Group 1. The 27 (25.7%) patients (21 males and 6 females) who had developed restenosis were designated as Group 2. In terms of predicting the development of restenosis, the presence of diabetes mellitus (hazard ratio [HR]: 2.78; confidence interval [CI]: 1.25-6.20; P = 0.01), type of lesion (HR: 1.89; CI: 1.01-3.55; P = 0.04), form of procedure (HR: 0.30; CI: 0.11-0.81; P = 0.01), and ADMA (HR: 4.08; CI: 1.73-9.62; P = 0.001) were found to be significant in univariate Cox regression analysis. In contrast, only the levels of ADMA were found to be a significant predictor of restenosis in the multivariate Cox regression analysis (HR: 3.02; CI: 1.16-7.84; P = 0.02). The restenosis prediction of ADMA levels continued after excluding the patients with diabetes mellitus in the univariate and multivariate Cox regression analysis (HR: 5.23; CI: 1.99-13.76; P = 0.001 and HR: 5.61; CI: 1.79-17.62; P = 0.003, respectively). Regarding the development of cardiac events, hs-CRP (HR: 1.03; CI: 1.00-1.06; P = 0.01) and ADMA (HR: 17.1; CI: 3.06-95.8; P = 0.001) were found to be significantly correlated with adverse cardiac events in univariate Cox regression analysis, whereas only ADMA levels were significant in the multivariate Cox regression analysis (HR: 2.83; CI: 1.27-6.31; P = 0.01). The levels of ADMA obtained before the procedure predict the development of restenosis and MACE in patients who underwent elective PTCA and bare metal stent procedures.

Background The antioxidant melatonin effectively scavenges highly toxic hydroxyl radicals. Decreases in circulating melatonin levels have been reported in patients with diseases that become more serious with advancing age. The purpose of the present study was to explore the relationship between circulatory melatonin level and the extent of senile cataracts. To this end, we assessed the urinary excretion levels of 6-sulphatoxymelatonin (aMTS6), a major metabolite of melatonin. Methods A total of 22 patients (aged 64 ± 7 years; 12 males and 10 females) with senile cataracts and 22 healthy controls (aged 61 ± 8 years, 12 males and 10 females) were studied. aMTS6 urine levels were measured using commercial ELISA kits. Each aMTS6 level was expressed as [aMTS6] (in ng)/[mg] creatinine. As the data were not normally distributed, the Mann–Whitney U-test was employed to assess the statistical validity of the difference observed. Results The aMT6 level in nocturnal urine was 17.87 ± 14.43 ng aMTS6/mg creatinine (mean ± SD) in senile cataract patients; this was 76% of the level measured in age- and gender-matched controls (23.28 ± 16.27 ng aMTS6/mg creatinine). This difference in nocturnal urine aMTS6 level between senile cataract patients and controls was not statistically significant (p = 0.358). Conclusion The urinary aMTS6 level did not differ between subjects with and without senile cataracts.

Background The aim of this study was to investigate the use of prophylactic magnesium sulphate and amiodarone in treating arrhythmias that may occur following coronary bypass grafting operations. Methods The study population consisted of 192 consecutive patients who were undergoing coronary artery bypass grafting (CABG). Sixty-four patients were given 3 g of magnesium sulphate (MgSO4) [20 ml = 24.32 mEq/L Mg+2] in 100 cc of isotonic 0.9% solution over 2 hours intravenously at the following times: 12 hours prior to the operation, immediately following the operation, and on postoperative days 1, 2, and 3 (Group 1). Another group of 64 patients was given a preoperative infusion of amiodarone (1200 mg) on first post-operative day (Group 2). After the operation amiodarone was administered orally at a dose of 600 mg/day. Sixty-four patients in group 3 (control group) had 100 cc. isotonic 0.9% as placebo, during the same time periods. Results In the postoperative period, the magnesium values were significantly higher in Group 1 than in Group 2 for all measurements. The use of amiodarone for total arrhythmia was significantly more effective than prophylactic treatment with magnesium sulphate (p = 0.015). There was no difference between the two drugs in preventing supraventricular arrhythmia, although amiodarone significantly delayed the revealing time of atrial fibrillation (p = 0.026). Ventricular arrhythmia, in the form of ventricular extra systole, was more common in the magnesium prophylaxis group. The two groups showed no significant differences in other operative or postoperative measurements. No side effects of the drugs were observed. Conclusion Prophylactic use of magnesium sulphate and amiodarone are both effective at preventing arrhythmia that may occur following coronary by-pass operations. Magnesium sulphate should be used in prophylactic treatment since it may decrease arrhythmia at low doses. If arrhythmia should occur despite this treatment, intervention with amiodarone may be preferable.