Effects of COVID-19 pandemic lockdown on the metabolic control of type 2 diabetes mellitus in patients

Objective

The effects of the COVID-19 pandemic on the control of diabetes mellitus in patients are largely unknown. In this study we aimed to analyze the impact of the pandemic and the ensuing lockdown on the management of type 2 diabetes mellitus.

Subjects and methods

A total of 7,321patients with type 2 diabetes mellitus (4,501 from the pre-pandemic period, 2,820 from the post-pandemic period) were studied retrospectively.

Results

The admission of patients with diabetes melitus (DM) decreased significantly during the pandemic (4,501 pre-pandemic vs. 2,820 post-pandemic; p < 0.001). The mean age of patients was statistically lower (51.5 ± 14.0 vs. 49.7 ± 14.5 years; p < 0.001), and the mean glycated hemoglobin (A1c) level was significantly higher (7.9% ± 2.4% vs. 7.3% ± 1.7%; p < 0.001) in the post-pandemic period than in the pre-pandemic. The female/male ratio was similar in both periods (59.9%/40.1% for pre-pandemic, 58.6%/41.4% for post-pandemic; p = 0.304). As calculated by month the pre-pandemic rate of women was higher only in January (53.1% vs. 60.6%, p = 0.02). Mean A1c levels were higher in the postpandemic period than in the same month of the previous year, excluding July and October (p = 0.001 for November, p < 0.001 for others). Postpandemic patients admitted to the outpatient clinic were significantly younger than prepandemic visits for July (p = 0.001), August (p < 0.001) and December (p < 0.001).

Conclusion

The lockdown had detrimental effects on blood sugar management in patients with DM. Hence, diet and exercise programs should be adapted to home conditions, and social and psychological support should be provided to patients with DM.

Evaluation of oxidative stress in degenerative rotator cuff tears

BACKGROUND

Oxidative stress occurs as a result of the disruption of the balance between the formations of reactive oxygen species and antioxidant defense mechanisms during the conversion of nutrients into energy. Increased body oxidative stress has been reported to be involved in the etiology of several degenerative and chronic diseases. We hypothesized that the body oxidative stress level is higher in patients with atraumatic degenerative rotator cuff tear than that in healthy individuals.

METHODS

The patients who underwent arthroscopic repair for atraumatic, degenerative rotator cuff tear were prospectively evaluated. A total of 30 patients (group 1, 19 females and 11 males; mean age: 57.33 ± 6.96 years; range: 50-77 years) and 30 healthy individuals (group 2, 18 females and 12 males; mean age: 56.77 ± 6 years; range: 51-72 years) were included in the study. The Constant and American Shoulder and Elbow Surgeons scoring systems were used to evaluate the clinical outcomes. Serum oxidative stress parameters of the patients and the control group were biochemically evaluated. Accordingly, thiol/disulfide (DS) balance (DS/native thiol [NT], DS/total thiol [TT]), Total Oxidant Status (TOS), oxidative stress index, and nuclear factor erythroid-2-associated factor-2 values were used as the biochemical parameters indicating an increase in the serum oxidative stress level. Total antioxidant status and NT/TT values served as the biochemical parameters indicating a decrease in the serum oxidative stress level.

RESULTS

The study follow-up duration was 12 months. A statistically significant increase was observed in American Shoulder and Elbow Surgeons and Constant scores of patients who underwent arthroscopic rotator cuff repair relative to that during the preoperative period (P = .01). The values of biochemical parameters (DS/NT, DS/TT, TOS, oxidative stress index, and nuclear factor erythroid-2-associated factor-2), which indicated an increase in the serum oxidative stress, were significantly higher in preoperative patients than those in postoperative patients, albeit the control group values were significantly lower than those of the postoperative patients. The biochemical parameters (NT/TT and total antioxidant status) indicating a decrease in the serum oxidative stress levels were significantly higher in the postoperative patients than those in the preoperative patients and significantly lower than those in the control group.

CONCLUSION

High levels of markers indicating an increase in the serum oxidative stress in patients with degenerative rotator cuff rupture suggested that TOS may be involved in the etiopathogenesis of rotator cuff degeneration. Although the oxidative load decreases during the postoperative period, the fact that it is still higher than that in healthy individuals supports this claim.

Effects of propofol and dexmedetomidine on carnitine metabolism in normal human bronchial epithelial cells

Propofol and dexmedetomidine (DEX) are widely used for anesthesia and sedation. We investigated the effects of propofol and DEX separately and in combination on the metabolic profile of carnitine in cultured normal human bronchial epithelial cells (BEAS-2B). Cells of the propofol group were cultured with 2 µg/ml propofol in RPMI-1640 medium. Cells of the DEX group were cultured with 0.2 ng/m DEX in RPMI-1640 medium. Cells of the propofol + DEX group were cultured with 2 μg/ml propofol + 0.2 ng/ml DEX in RPMI-1640 medium. The control group was untreated. Cells were incubated for 3 h following treatments. The effects of the drugs on cell viability were assessed using the MTT method and by microscopic examination following staining with acridine orange/ethidium bromide. The effects of drugs on carnitine, acetyl carnitine and 25 acylcarnitine derivative profiles were analyzed using liquid chromatography-tandem mass spectrophotometry. Neither propofol nor DEX affected cell viability. Administration of propofol, DEX or propofol + DEX to BEAS-2B cells caused no significant change in the concentrations of carnitine and acylcarnitine derivatives compared to the control group. We found that propofol and DEX exhibit no negative effects on the carnitine metabolism by BEAS-2B cells in vitro at clinically relevant concentrations. Our findings establish a baseline for clinical studies of the effects of propofol and DEX on carnitine metabolism.

Effect of Conventional Chemotherapies on Natural Killer Cell Activity

Background:

The effects of chemotherapeutics agents are considered to influence the immune system and cells due to their myelosuppressive and immunosuppressive functions. Natural killer cells are one of the important components of the innate immune system and have a critical role against tumor cells and infections.

Objective:

The study was aimed to demonstrate whether conventional chemotherapies had an effect on Natural Killer (NK) cell activity.

Methods:

Forty-nine adjuvant and 19 first-time metastatic chemotherapy-naïve cancer patients were recruited into the study. Blood samples at pre-chemotherapy and post-chemotherapy, at 1st and 4th cycles, were obtained for NK cell activity.

Results:

We found no difference between baseline and post-chemotherapy NK cell activity levels. In addition, we found no difference between pre-chemotherapy and post-chemotherapy NK cell activity in both adjuvant and metastatic cancer patients separately.

Conclusion:

Conventional chemotherapy seems to have no effect on NK cell activity levels in cancer patients in both metastatic and adjuvant settings.

False Laboratory Test Result Through Colistin Interference in an Intensive Care Patient: Case Report

BACKGROUND

In blood samples taken for testing purposes during drug infusion in the intensive care unit, there is a risk of interference due to drug-reactive interaction during the analysis.

CASE REPORT

A 19-year-old female patient had undergone surgery for intracranial astrocytoma, 12 years ago. Acinetobacter baumannii was found in the blood culture and deep tracheal aspiration fluid of the patient who had a fever (39.2 °C) with a body temperature during the follow-up. The patient was started on colistin 2 * 4.5 million IU. After the colistin infusion, biochemical tests were requested to control the patient's clinical situation. CK-MB mass and ProBNP values were measured in high concentrations. Cardiology consultation was requested to evaluate the increase in the CK-MB mass and ProBNP values. The patient's ECG and echocardiography showed no abnormality. The increase in cardiac markers was neither clinically acceptable nor insignificant. There was no hemolysis in the sample or analytical error in the device. Variability in the tests was thought to be due to the interference. As the bloodletting time was questioned, it was determined that it was taken during colistin treatment. In order to determine the effect of colistin-related interference on the other tests, the laboratory was contacted and additional tests (TSH, FT4, Anti- TPO, B-HCG, Estradiol, Prolactin, CA 125, CA 15-3, CA 19-9, Vitamin B12, C-Peptide, DDimer, PTH, 25 hydroxy vitamin D, PT, INR, APTT) were conducted. During colistin treatment, in many tests, bias was detected between -75 and + 268.80%.

CONCLUSION

Clinicians should consider suspicious test results that are incompatible with the diagnosis for the possibility of erroneous measurements due to colistin interference and review the sampling processes.

Single Nucleotide Polymorphism Analysis in HIV and Kaposi's Sarcoma Disease by Microarray Technique

BACKGROUND

Emergence of Kaposi's Sarcoma in the cases other than HIV, following the use of immunosuppressant drugs, demonstrates that it is related to weak immunity. The fact that this malignancy does not occur in every HIV-positive patient suggests that genetic predisposition may also be effective. Replacement of one of the base pairs of adenine, guanine, cytosine, and thymine that constitute the DNA sequence in the human genome with another base pair can affect susceptibility to disease, response to treatment, and immunity.

OBJECTIVE

The purpose of this study is to analyze the Single Nucleotide Polymorphism that could predispose to Kaposi's sarcoma of an HIV-infected patient and to identify which nucleotides such SNPs correspond to, using the microarray technology.

MATERIALS AND METHODS

The blood samples of individuals, one of whom was diagnosed with Kaposi's Sarcoma HIV (+) visiting the outpatient clinic of infectious diseases polyclinic of Harran University Research and Practice Hospital and of a healthy individual with no Kaposi's Sarcoma, were used in the study. Following the DNA isolation of the blood samples taken from the respective individuals, a SNP analysis was conducted on the microarray device. 204,000 SNPs obtained were scanned later on in the databases in an attempt to identify the SNPs related to Kaposi's Sarcoma.

RESULTS

In the 204,000 SNP screenings, we scrutinized the SNPs that differ in the case of Kaposi's Sarcoma [KS (+) and HIV (+)] on the basis of Control [KS(-) and HIV(-)] and HIV+ [KS(-)], and two SNPs of the ENDRA gene, three SNPs of the ADRA1A gene, six SNPs of the STIM1 gene, four SNPs of the EFNB2 gene, and one SNP of the CD209 gene were found to be different. However, when it comes to all SNPs (all the 204.000 SNPs) screened in terms of allele, it was observed that the AA and BB alleles were lower in the patient with Kaposi's Sarcoma [KS (+) and HIV (+)] compared to other groups and AB alleles were found to be higher than others in the patient with Kaposi's sarcoma [KS] (+) and HIV (+)].

CONCLUSION

In the microarray study we have conducted, 204,000 SNPs were screened for Control (HIV-) HIV (+) and HIV (+) patient with Kaposi's Sarcoma. It was found that 32,362 of those SNPs had different alleles in the Kaposi's Sarcoma [KS + HIV (+)] patient, while they had the same ones in the control [KS (-) and HIV (-)] and HIV + [KS (-)] group. 16 of the 32,362 SNPs took place among the genes related to Kaposi's Sarcoma. In the cases of Kaposi's Sarcoma with suspected diagnosis, it can be used as a beneficial laboratory test.

In Vitro Demonstration of Drug-Reagent Interactions Among Commonly Used Parenteral Drugs in Cardiology

BACKGROUND

Drug-drug interactions are undesirable, as they reduce drug bioavailability. Drug-reagent interactions in biochemical tests may directly affect the accuracy of test results.

OBJECTIVE

The aim of the present study was to investigate the impact of drug-reagent interactions of drugs used in cardiology on different cardiac markers (troponin I, Nt-proBNP, CK-MB mass, CK, AST, and LDH) and the D-dimer test.

METHODS

Eleven drugs (enoxaparin, tirofiban hydrochloride monohydrate, diltiazem, glyceryl trinitrate, metoprolol, epinephrine, heparin sodium, atropine sodium, furosemide, norepinephrine tartrate, and amiodarone HCl) were tested in an interference study. The interference protocol was applied to the control material of troponin I, CK-MB mass, Nt-proBNP, CK, AST, LDH tests with 11 different drugs and performed with analyzers. Cardiac Markers Plus Control (Bio-Rad, Irvine, CA, USA; Lot: 23662) materials were used to assess the impact of drug-reagent interactions on the accuracy of tests of cardiac markers based on immunoassay methods. The bias rate, defined as the extent of deviation from the target value (bias %), in the interference study was calculated in each test.

RESULTS

For all 11 drugs, positive interference in the range of 43.58% to 130.06% occurred in the CK-MB mass test, whereas positive interference in the range of 11.98% to 107.44% occurred in the troponin I test. All the drugs, except enoxaparin sodium, led to negative interference in the range of - 84.21 to -29.6% in the Nt-proBNP test. In the D-dimer test, amiodarone HCl and diltiazem caused interference (122.87% and 28.08%, respectively). The percentage of interference caused by the other drugs ranged from -1.27% to 11.44%. Minimal deviations in the target values (between -3.31% and 3.86%) were observed in the CK, AST, and LDH tests measured using spectrophotometric methods.

CONCLUSION

Parenteral drugs used in cardiology can significantly interfere with troponin I, CK-MB mass, Nt-proBNP, and D-dimer tests in the analytical phase because of drug-reagent interactions. Minimal deviations in the CK, AST, and LDH tests were observed using spectrophotometric methods. Thus, changes in test results may be due to drug interference rather than the treatment itself. Clinicians should consider the possibility of drug interference in cases of doubtful cardiac test results that do not comply with the diagnosis.

The Relationship Between the Severity of Coronary Artery Disease and Erythrocyte Morphology Parameters Measured by New-Generation Hematology Analyzer

BACKGROUND

There is a possible relation between red blood cell distribution width (RDW) and various clinical conditions. These conditions can render RDW disadvantageous in its relation with cardiovascular disease. There may be a relation between the severity of acute coronary syndrome (ACS) and the percentage of hypochromia (hypo%), percentage of hyperchromia (hyper%), percentage of macrocytosis (MAC%), and percentage of microcytosis (MIC%) values measured using new-generation hematological devices.

OBJECTIVE

We aimed to examine the relation between the SYNTAX score and the hypo%, hyper%, MAC%, and MIC% values in patients admitted with ACS.

METHOD

A group of 55 patients who underwent coronary angiography with diagnosis of ACS (STEMI and NSTEMI) and a control group of 48 patients with normal coronary arteries were included in the study. Venous blood samples were collected in the morning after a fasting of at least 8 h and analyzed using standard laboratory methods. Hemogram parameters were studied using Alinity HQ (Abbott, USA) a completely automated hemogram autoanalyzer. Biochemical parameters were studied using Architect c16000 (Abbott, USA) a completely automated biochemistry autoanalyzer.

RESULTS

Significant difference was observed in erythrocyte morphology-related tests (mean corpuscular volume, mean corpuscular hemoglobin, mean corpuscular hemoglobin concentration, RDW, hypo%, hyper%, MIC%, and MAC%) between the groups. Correlation analysis showed a positive correlation between the SYNTAX score and MAC% (r = 0.315, p = 0.019). Multivariate logistic regression analysis was performed for MAC% to identify the independent predictors of the SYNTAX score (β = 0.315, p = 0.019).

CONCLUSION

Changes in MAC% test can be measured in emergencies with new-generation hematological devices and used as independent predictors of presence of severe coronary artery disease.

Pistachio Green Hull Extract Induces Apoptosis through Multiple Signaling Pathways by Causing Oxidative Stress on Colon Cancer Cells

BACKGROUND

Pistachio is considered to be one of the fifty foods with the highest antioxidant effect. However, the anticancer effect mechanisms of this plant extracts are unknown.

OBJECTIVE

The aim of this study was to investigate the anticancer effect of different extracts from the green hull of pistachio.

METHODS

The cytotoxic effects of different solvent extracts on cancer and normal cells were examined by cell viability assay and flow cytometric analysis. The levels of the apoptotic gene and protein were investigated by Western Blot and ELISA, and qPCR. The intracellular free radical exchange was determined by oxidative and nitric oxide analyses. DNA damage level was measured by the 8-OHdG test. Phenolic and free fatty acid components were examined by LC-MS/MS and GC-MS, respectively.

RESULTS

It was determined that the n-hexane fraction showed a higher cytotoxic effect on cancer cells. Oxidative and cell cycle analyses indicated that the n-hexane fraction arrested cell cycle of HT-29 at the sub-G1 phase by increasing DNA damage through oxidative stress. In addition, gene expression analysis of the HT-29 treated with the n-hexane fraction indicated that apoptotic and autophagic gene expressions were significantly upregulated. LC-MS/MS analysis of the n-hexane fraction revealed the presence of 15 phenolic compounds, containing mainly gallic acid and catechin hydrate, and GC-MS analysis determined the presence of the following fatty acids: 9-octadecenoic acid, 9,12-octadecadienoic acid and hexadecenoic acid.

CONCLUSION

Based on these grounds, we suggest that the n-hexane fraction of pistachio green hull damages DNA, arrests the cell cycle at the G₁ subphase, and induces apoptosis through oxidative pathways in colon cancer.

Effects of Broad Spectrum Antibiotics on Measurement of Immunosuppressant Drugs

BACKGROUND

Antibiotics used parenterally can affect blood drug level measurements, as measured in diagnostic tests.

OBJECTIVE

To investigate the effect of six different antibiotics commonly used in intensive care units on tacrolimus, sirolimus, everolimus and cyclosporin A levels measured by mass spectrometry.

METHODS

Ampicillin + sulbactam (AB1, IV, 1 g), imipenem + cilastatin sodium (AB2, IV, 500 mg), piperacillin + tazobactam (AB3, 4.5 g, IV), ertapenem (AB4, IV, 1 g), meropenem trihydrate (AB5, 500 mg, IV) and ceftriaxone (AB6, 1 g, IV) antibiotics were used for the interference assay. Measurements were performed on the Shimadzu 8045 (Japan) LC-MS/MS instrument. Bias values were calculated.

RESULTS

The least affected immunosuppressant was cyclosporine A (between -6.88% and 3.40%). The most affected were everolimus and sirolimus. Ertapenem caused negative interference on the level of everolimus at the rate of -27.34% and sirolimus at the rate of -26.79%. Piperacillin + tazobactam and imipenem + cilastatin sodium caused positive interferences on sirolimus at the rate of 24.24% and 22.73%, respectively. Ampicillin + sulbactam, meropenem trihydrate and ceftriaxone affected the sirolimus levels at lower rates (-4.49%, 5.93% and 9.86%). Everolimus levels deviated at the rate of -11.21% to -16.99% due to imipenem + cilastatin sodium, meropenem trihydrate and ceftriaxone.

CONCLUSION

This study demonstrated the potential of antibiotic use affecting immunosuppressant levels. Antibiotic interference, especially in transplant patients, may cause erroneous immunosuppression, increasing the likelihood of rejection.

Relationship Between Oxidative Stress, Tau Level and Antioxidant Mechanisms of the KEAP-1/NRF-2/HO-1 in Children with Hydrocephalus

BACKGROUND

Hydrocephalus is a complex neurologic disorder which has a widespread impact on the central nervous system, and a multifactor disease which effect the CSF dynamics and causes severe neurological impairments in children. The pathophysiology of hydrocephalus is not fully understood. However, increasing evidence suggests that oxidative stress may be an important factor in the pathogenesis of hydrocephalus.

OBJECTIVE

The purpose of this study is to investigate the relationship of KEAP-1/NRF-2/HO-1 pathway, one of the main regulators of the antioxidant system in the hydrocephalus pathology, on oxidative stress and tau protein level.

METHODS

The study included 32 patients with hydrocephalus and 32 healthy controls. KEAP-1, NRF-2, HO-1, TAU, and MPO levels are measured using ELISA method TAS, TOS, Total THIOL colorimetric method.

RESULTS

KEAP-1, TAS, Total THIOL levels were found significantly low in the hydrocephalus group compared to the control group. Nevertheless, it is identified in the hydrocephalus group that the NRF-2, HO-1, TAU, MPO, TOS, and OSI levels were significantly elevated.

CONCLUSION

In conclusion, although KEAP-1/NRF-2/HO-1 pathway is activated in patients with hydrocephalus, it is identified that the antioxidant defense system is insufficient, and ultimately leads to elevated oxidative stress. The elevation in the tau level may be an indicator of oxidative stress induced neurodegenerative damage.

Astaxanthin prevents lung injury due to hyperoxia and inflammation

BACKGROUND/AIM

We aimed to ascertain the effects of astaxanthin on the lungs of rat pups with bronchopulmonary dysplasia (BPD) induced by hyperoxia and lipopolysaccharide (LPS).

MATERIALS AND METHODS

Forty-two newborn Wistar rats born to spontaneous pregnant rats were divided into three groups: Hyperoxia (95% O2) + lipopolysaccharide (LPS) group, hyperoxia + LPS + astaxhantin group and control: no treatment group (21% O2). Pups in the hyperoxia + LPS + astaxanthin group were given 100 mg/kg/day oral astaxanthin from the first day to the fifth day. Histopathologic and biochemical evaluations including glutathione (GSH), total antioxidant status (TAS), total oxidant status (TOS), lipid hydroperoxide (LPO), 8-hydroxydeoxyguanosine (8-OHdG), advanced oxidation protein products (AOPP), myeloperoxidase (MPO), total thiol, tumor necrosis factor-alpha (TNF-α), interleukin 1 beta (IL1β) and caspase-3 activities were performed.

RESULTS

A better survival rates and weight gain were demonstrated in the hyperoxia + LPS + astaxanthin group (p <0.001). In the histopathologic evaluation, the severity of lung damage was significantly reduced in the hyperoxia+LPS+astaxanthin group, as well as decreased apoptosis (ELİSA for caspase-3) (p <0.001). The biochemical analyses of lung tissues TAS, GSH, Total thiol levels were significantly higher in the astaxanthin treated group compared to hyperoxia + LPS group (p <0.05) while TOS, AOPP, LPO, 8-OHdG, MPO levels were significantly lower (p <0.001). In addition, unlike the hyperoxia + LPS group, TNF-α and IL-1β levels in lung tissue were significantly lower in the astaxanthin-treated group (p <0.001).

CONCLUSION

Astaxanthin was shown to reduce lung damage caused by inflammation and hyperoxia with its antiinflammatory, anti-oxidant, anti-apoptotic properties and to protect the lung from severe destruction.

Measurement of the Cellular Hemoglobin Concentration by Laser Scatter Method from Excessive Lipemic Sample: CASE REPORT

A 33-month old female child presented at a pediatric clinic with acute tonsillitis, and it was subsequently discovered that she had familial hyperlipidemia. Measurement of the patient's whole blood tests was performed by a multiparameter automated hematology analyzer, the CELLDYN Ruby System® (Abbott, Lake Forest, USA) using venous blood extracted from a tube containing 3.0 mL of EDTA. Although her hematocrit levels were within normal limits, the hemoglobin (Hgb) level, mean corpuscular volume (MCH) and mean corpuscular Hgb concentration (MCHC) could not be determined using the spectrophotometric method. The results of these tests could not be measured when repeated using dilution. When the sample was left to rest for several minutes, it was observed to be excessively lipemic. The measurements were repeated using the Alinity HQ Analyzer® (Abbott), which determines Hgb concentration using laser scatter and spectrophotometry. Hgb cellular concentration was incorrectly measured as being 21.9 mg/dL using routine spectrophotometry (denoted by a flag indicating Hgb interference) and correctly found to be 10.8 mg/dL. Thus, in samples of excessive lipemia, Hgb, MCH, and MCHC levels cannot be measured accurately using spectrophotometry. Hematology analyzers that can measure cellular hemoglobin (cHGB) and average erythrocyte hemoglobin concentration (cHCM) by laser scatter method may be recommended when analyzing a blood sample that contains excessive lipemia.

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.

Investigating the Levels of Brain-Specific Proteins in Hydrocephalus Patients

BACKGROUND

Hydrocephalus, a common brain disorder in children, can cause permanent brain damage. A timely diagnosis of this disorder is crucial.

OBJECTIVE

The aim of this study was to evaluate the levels of S-100, CK-18, and NSE brainspecific proteins in patients with hydrocephalus. We examined the levels of these proteins in the blood samples of hydrocephalic patients.

METHODS

The study was conducted on the hydrocephalus (n = 31) patients and a healthy control group (n = 30). A Receiver Operating Characteristic (ROC) curve was used to assess the validity of the NSE, CK-18, and S100B to differentiate between the hydrocephalus and the control groups. The suitability of the data to the normal distribution was tested with the Shapiro Wilk test, and the Student t-test was used to compare the characteristics of the normal distribution in two independent groups. The individuals in the hydrocephalus and control groups had similar values in terms of age, height, and weight.

RESULTS

It was observed that NSE, CK-18, and S100B mean values of the individuals in the hydrocephalus group were significantly higher than NSE, CK-18, and S100B mean values of the control group.

CONCLUSION

Experiments have shown that the levels of these proteins increase significantly in hydrocephalus patients compared to the healthy group. These three parameters can be considered as important markers in the diagnosis of hydrocephalus.

Clinical biochemistry test eliminator providing cost-effectiveness with five algorithms

Objectives: The purpose of this study is to investigate the elimination ratios of requested unnecessary tests and the cost-effectiveness to be achieved by means of 5 different algorithms with clinical validity defined in an artificial intelligence program.Methods: The clinician orders received from the hospital information management system were adapted to eliminate AST, direct bilirubin, chlorine, fPSA and fT3 tests using five different algorithms defined in the ALIN IQ software.Results: In this study, 18387 AST, 9500 direct bilirubin, 61 free PSA, 1127 FT3 and 11172 chlorine tests that were ordered within 45 days were eliminated using 5 different algorithms defined in the ALIN IQ software in the Laboratory of Harran University Faculty of Medicine. USD 5592.76 was saved in 45 days. The annual saving is expected to be 363710 tests and USD 45363.49.Conclusion: Five different tests were successfully eliminated with this study. Open-code smart softwares, which can create indefinite algorithms may be utilized as test eliminators in diagnostic clinical laboratories. Millions of dollars may be saved by means of such artificial intelligence softwares that can be adapted to any analyzer across the world.

Evaluation of Micro-RNA Levels, Apoptosis and Oxidative Stress Markers in Patients Recieving Chemotherapy

OBJECTIVE

The primary objective of this study was to compare oxidative DNA damage markers, apoptosis markers and changes in miRNA levels in patients diagnosed with cancer and treated through chemotherapy. Our secondary objective was also to evaluate tumor responses that can be determined after post-chemotherapy clinical evaluations by physical examinations, laboratory results and radiological imagings, and to compare the clinical results to oxidative stress and apoptosis markers and micro RNA levels.

MATERIALS AND METHODS

To do that we designed a prospective observational cross-sectional study. A total of 34 cancer patients and 27 healthy controls were included in the study from the Harran University School of Medicine Department of Oncology. Newly diagnosed chemotherapy or radiotherapy naive patients without any chronic diseases were included into the study. Patients with a poor performance status (ECOG 2 and 3) and patients who did not meet the inclusion criteria were excluded. The cancer patients received chemotherapy according to their scheduled periods. Blood samples were taken from the patients before the first chemotherapy course and before the second chemotherapy round. Patients were called for toxicity control on the 10th day after the chemotherapy. Pre-chemotherapy, post-chemotherapy and control group miR-29a expression levels, change in apoptosis markers and oxidative DNA damage markers were obtained and compared. We studied 8-hydroxy 2-deoxyguanosine, total oxidant status, total anti-oxidant status, and oxidative status index for oxidative stress markers. We studied M30 and M65 as apoptosis markers. Clinical results of efficiency of the chemotherapy was acquired and compared to biochemical markers based on chemotherapy results. Chemotherapy toxicities were recorded.

RESULTS

As a result, we found oxidative DNA damage markers and apoptosis markers were high in the cancer group, demonstrating that oxidative DNA damage and apoptosis might play a direct or indirect role in cancer etiology. However, there were subtle differences between pre-chemotherapy and post-chemotherapy levels. Mir-29a expressions were lower in cancer patients as compared to controls. However, the expression levels were not significantly change in pre- and postchemotherapy status. Moreover, we found no relationship between clinical status of patients (progression and regression) and studied biochemical markers.

CONCLUSION

Thus, checking for DNA damage markers and taking precautions to lower the levels of these markers in individuals with cancer risk may be helpful in preventing cancer.

Enzyme Replacement Therapy may Affect Blood Immunosuppressant Monitoring

BACKGROUND

Although LC-MS/MS is preferred as a reliable method, therapeutic enzyme drugs in the blood matrix may lead to false results.

OBJECTIVE

The purpose of this article is to experimentally investigate the effect of five different enzymes used in the treatment of metabolic diseases on blood immunosuppressant measurement.

METHODS

Five different enzyme drugs (galsulfase, alglucosidase alfa, imiglucerase, elosulfase alfa, laronidase) were added to control materials containing tacrolimus, everolimus, sirolimus, and cyclosporine A drugs. Measurements were performed using an LC-MS/MS instrument (Shimadzu 8040, Japan). The amount of deviations from the target values was calculated.

RESULTS

Blood Immunosuppressant levels significantly changed after the administration of enzyme drugs. Four different enzyme drugs led to false-positive results in the tacrolimus levels at a rate of 10.58% (95% CI, 9.83-11.32) to 37.28% (95% CI, 33.55-41.27). The highest deviations were observed with the administration of galsulfase and alglucosidase alpha in the sirolimus levels at rates of 336.54% (95% CI, 306.25-366.82) and 395.88% (95% CI, 360.25-431.50), respectively. Imiglucerase was the least effective enzyme for the sirolimus level (0.80% (95% CI, 0.71-0.89). Different deviations between the ratios of - 9.37% (95% CI, -10.40 - -8.33) and 8.33% (95% CI, 7.41-9.24) were determined at the cyclosporin A level.

CONCLUSION

Galsulfase, alglucosidase alpha, imigluserase, elosulfase alpha and laronidase can significantly interfere with immunosuppressant measurements with LC-MS/MS. False immunosuppressant results associated with enzyme injection may result in immunosuppression failure, organ rejection. For the measurement of immunosuppressant levels, sampling should be done before the enzyme infusion. Clinicians should question the time of enzyme infusion and sampling when confounding results in immunosuppressant measurement.

Evaluating plasma oxidative stress markers in prelingual profound sensorineural hearing loss

Background and Aim: The etiopathogenesis of sensorineural hearing loss (SNHL) is an ess­ential contributing factor to its morbidity, which cannot be explained entirely so far. The current study aimed to determine the oxidative stress (OS) status by comparing the total antioxidant status (TAS), total oxidant status (TOS) and oxidative stress index (OSI) values in patients with pediatric prelingual profound SNHL. We also evaluated the correlation between OS parameters and audiological test results. Methods: The study included 25 participants (9 females; age range: 6‒34 months) diagnosed with pediatric prelingual profound SNHL and 25 healthy subjects (10 females; age range: 9‒28 months). Their TAS, TOS, and OSI levels were measured in the plasma of both groups. We evaluated the correlation between OS para­meters and audiological test results in the pati­ent group. Results: We found significantly higher serum TOS levels and OSI values in the patient group (mean ± SD of TOS: 16.08 ± 1.88 μmol H2O2 eq/L, p < 0.001; mean ± SD of OSI: 1.71 ± 0.48 arbitrary units, p < 0.001), compared to the controls. Moreover, we found lower serum TAS levels in the patient group (mean ± SD of TAS: 0.99 ± 0.20 mmol Trolox eq/L), compared to the controls. There was a strong correlation between OS parameters and audiological test results of the patient group. Conclusion: We detected significantly higher TOS, OSI, and lower TAS levels in pediatric patients with SNHL, compared to the healthy subjects. The obtained data indicated that pediatric SNHL is under OS influence.

Plasma-Free Amino Acid Profiling of Nasal Polyposis Patients

AIM AND OBJECTIVE

To determine the mechanisms present in the etiopathogenesis of nasal polyposis. It is not clear whether amino acids contribute in a causal way to the development of the disease. Therefore, the aim of this study was to determine the plasma-free amino acid profile in patients with nasal polyposis and to compare the results with a healthy control group.

MATERIALS AND METHODS

This was a prospective controlled study that took place in the Otolaryngology Department at the Harran University Faculty of Medicine between April 2017 and April 2018. Plasmafree amino acid profile levels were studied in serum samples taken from a patient group and a healthy control group. Patients who were diagnosed with bilateral diffuse nasal polyposis and were scheduled for surgical interventions were included in this study. Individuals whose age, gender, and body mass index values were compatible with that of the patient group and who did not have any health problems were included in the control group. All the participants whose levels of plasma-free amino acid were thought to be affected by one or more of the following factors were excluded from the study: smoking and alcohol use, allergic rhinitis presence, the presence of acute or chronic sinusitis, a history of endoscopic sinus surgery, unilateral nasal masses, a history of chronic drug use, systemic or topical steroid use in the last three months for any reason, and liver, kidney, hematological, cardiovascular, metabolic, neurological, or psychiatric disorders or malignancies.

RESULTS

In patients with nasal polyposis, 3-methyl histidine (3-MHIS: nasal polyposis group (ng) = 3.22 (1.92 - 6.07); control group (cg) = 1.21 (0.77 - 1.68); p = 0.001); arginine (arg: ng = 98.95 (70.81 - 117.75); cg = 75.10 (54.49 - 79.88); p = 0.005); asparagine (asn: ng = 79.84 (57.50 - 101.44); cg = 60.66 (46.39 - 74.62); p = 0.021); citrulline (cit: ng = 51.83 (43.81 - 59.78); cg = 38.33 (27.81 - 53.73); p = 0.038); cystine (cys: ng = 4.29 (2.43 - 6.66); cg = 2.41 (1.51 - 4.16); p = 0.019); glutamic acid (glu: ng = 234.86 (128.75 - 286.66); cg = 152.37 (122.51 - 188.34); p = 0.045); histidine (his: ng = 94.19 (79.34 - 113.99); cg = 74.80 (62.76 - 98.91); p = 0.018); lysine (lys: ng = 297.22 (206.55 - 371.25); cg = 179.50 (151.58 - 238.02); p = 0.001); ornithine (ng = 160.62 (128.36 - 189.32); cg = 115.91 (97.03 - 159.91); p = 0.019); serine (ser: ng = 195.15 (151.58 - 253.07); cg = 83.07 (67.44 - 92.44); p = 0.001); taurine (tau: ng = 74.69 (47.00 - 112.13); cg = 53.14 (33.57 - 67.31); p = 0.006); tryptophan (trp: ng = 52.31 (33.81 - 80.11); cg = 34.44 (25.94 - 43.07); p = 0.005), homocitrulline (ng = 1.75 (1.27 - 2.59); cg = 0.00 (0.00 - 0.53); p = 0.001); norvaline (ng = 6.90 (5.61 - 9.18); cg = 4.93 (3.74 - 7.13); p = 0.021); argininosuccinic acid (ng = 14.33 (10.06 - 25.65); cg = 12.22 (5.77 - 16.87) p = 0.046); and plasma concentrations were significantly higher than in the healthy control group (p <0.05). However, the gamma-aminobutyric acid (gaba: ng = 0.16 (0.10 - 0.24); cg = 0.21 (0.19 - 0.29); p = 0.010) plasma concentration was significantly lower in the nasal polyposis group than in the healthy control group.

CONCLUSION

In this study, plasma levels of 15 free amino acids were significantly higher in the nasal polyposis group than in the healthy control group. A plasma level of 1 free amino acid was found to be significantly lower in the nasal polyposis group compared to the healthy control group. Therefore, it is important to determine the possibility of using the information obtained to prevent the recurrence of the condition and to develop effective treatment strategies. This study may be a milestone for studies of this subject. However, this study needs to be confirmed by further studies conducted in a larger series.

How Do Contrast Agents Affect Cardiac Markers and Coagulation Tests? Experimental Study

Background:

The discovery that biotin interferes with results of troponin and Nt-proBNP led some commercial firms to update their measurement methods. In particular, the clinical incompatibility of cardiac test results may affect the risk of morbidity and mortality.

Objective:

The aim of this study is to investigate the interference effects of 7 different contrast agents on cardiac markers (Troponin-I, Nt-proBNP, Mass CK-MB, CK, AST, LDH) and in coagulation tests (PT, APTT).

Methods:

Seven different contrast media were added into control materials by using interference protocol. The concentrations of PT, APTT, CK, AST, LDH, Mass CK-MB, Troponin-I, and Nt-proBNP were measured by Sysmex CS-2100, Abbott c16000, Siemens Centaur XP and AFİAS-6 analyzer. The number of deviations from target values was calculated.

Results:

The 7 different contrast media caused negative interference in troponin levels between 57.43% and 62.87%. It was found that different contrast media produced false negativity in the Nt-proBNP test, ranging from 6.11% to 96.01%. Enzymes and coagulation tests were less affected.

Conclusion:

Different contrast media may cause false negatives in cTnI and Nt-proBNP. The contrast medium that causes the least interference should be preferred. The results of samples taken in the first hour after contrast imaging should be interpreted with care.

False Immunosuppressant Measurement by LC-MS/MS Method Due to Radiopaque Agents

BACKGROUND

Although liquid chromatography coupled with tandem mass spectrometry (LC-MS/MS) is preferred as a reliable method, some molecules in the blood matrix may lead to false positive or false negative results. False positive or negative results show the direction of the deviation rate from the target value.

AIM

The aim of this study was to investigate the effect of seven different radiopaque agents on four immunosuppressant drugs.

METHODS

Every agent coded with RM1 to RM7 was added to control materials containing tacrolimus, everolimus, sirolimus, and cyclosporine A drugs. Measurements were performed using an LC-MS/MS instrument. Bias values were calculated to detect the deviation rates.

RESULTS

All RMs led to false negative results in the tacrolimus and cyclosporine A levels at a rate of -19.77% (95% CI, -27.16 to 12.52) to -44.45% (95% CI, -49.20 to -39.69). The smallest deviations were seen in the everolimus levels with the administration of RM6 (gadodiamide) and in the sirolimus levels with RM1 (gadobutrol) at the rates of 4.04% (95% CI, -11.36 to -3.17) and 2.11% (95% CI, -7.18 to 7.11), respectively. The most affected drug by RM4 (gadopentetate dimeglumine salt) was sirolimus at the rate of 114.01% (95% CI, 97.31 - 130.76). RM5 (gadodiamide) interfered cyclosporine A at the most. The highest deviations were observed with the administration of RM3 (iohexol) in the everolimus and sirolimus levels at the rates of 153.72% (95% CI, 142.44 to 164.78) and 171.41% (95% CI, 157.91 to 184.97), respectively.

CONCLUSION

Radiopaque agents interfered the measurement of immunosuppressant drugs. Especially, everolimus and sirolimus levels were affected due to using iohexol. The choice of gadodiamide or ioversol is important to reduce the risk of interference for everolimus measurement. The blood samples should be obtained for measurement of drug levels before contrast-enhanced imaging.

Comparison of the cytotoxic, genotoxic and apoptotic effects of Sugammadex and Neostigmine on human embryonic renal cell (HEK-293)

Acetylcholinesterase inhibitors, including Neostigmine, have been used to reverse neuromuscular blockage for many years. Sugammadex reverses this blockage using its gamma cyclodextrin ring, a mechanism that differs from that of cholinesterases and so circumvents the side effects of Neostigmine. Although the superiority of Sugammadex to Neostigmine has been outlined in several clinical studies, to our knowledge, there is not any research into cell culture that compares the cytotoxic, genotoxic and apoptotic effects of the two drugs. Hence, this is the first study to compare the cytotoxic, genotoxic and apoptotic effects of different dosages of both drugs on human embryonic renal (HEK-293) cells. In this study, the cytotoxicity, genotoxicity and apoptotic effects of Sugammadex and Neostigmine on HEK-293 cells were analyzed with using the MTT, Comet Assay and Flow Cytometric Annexin-V methods, respectively. The results demonstrate that Neostigmine at 50, 100, 250, and 500 µg/mL is more cytotoxic than equivalent dosages of Sugammadex. Neostigmine at 500 and 1000 µg/mL was found to be more genotoxic, and Neostigmine at 500 µg/mL had a statistically higher risk of causing apoptosis and necrosis than Sugammadex (p&lt;0.05). Neostigmine administered in-vitro in the same doses as Sugammadex had greater cytotoxic, genotoxic and apoptotic effects on HEK-293 cells.

Comparison of cytokines and prooxidants/antioxidants markers among adults with refractory versus well-controlled epilepsy: A cross-sectional study

PURPOSE

This study aims to investigate the serum adiponectin, interleukin (IL)-6 and oxidative stress in epilepsy patients who are refractory or non-refractory to treatments.

METHOD

The study comprised 31 refractory epilepsy, 29 well-controlled epilepsy patients and control group including 29 healthy individuals. The serum adiponectin, IL-6, total antioxidant status (TAS), total oxidant status levels (TOS) and oxidative stress index (OSİ) were determined.

RESULTS

The mean serum adiponectin and TAS levels were significantly lower in the refractory epilepsy patients than in the healty controls, and mean IL-6, TOS and OSİ levels were significantly higher. The serum adiponectin, IL-6, TAS, TOS and OSI levels were not significantly different between the well-controlled epilepsy patients and the healthy controls.

CONCLUSIONS

The mean serum IL-6 and oxidative stress levels in refractory epilepsy patients were higher and the serum adiponectin level was lower than the healthy control group. These findings may be associated with an increased risk of seizures, atherosclerosis and cardiovascular disease in refractory epilepsy patients.

Synthesis and Characterization of the Hemi-Salen Ligands and Their Triboron Complexes: Spectroscopy and Examination of Anticancer Properties

The synthesis, spectroscopic properties, and in vitro cytotoxicity activity of a series of various salen-based triboron complexes have been designed and prepared from hemi-salen (L₁ H₃  - L₄ H₃ ) ligands and BF₃ ·Et₂ O or BPh₃ under simple reaction conditions. The hemi-salen (L₁ H₃  - L₄ H₃ ) ligands and their BF₂ or BPh₂ chelating triboron complexes were characterized by means of NMR (¹ H, ¹³ C, ¹⁹ F, and ¹¹ B) spectra, FT-IR spectra, UV/VIS spectra, fluorescence spectra, mass spectra, melting point, as well as elemental analysis. The triboron [L_(1 - 4) (BF₂ )₃ ] and [L_(1 - 4) (BPh₂ )₃ ] complexes were investigated for their absorption and emission properties, and these complexes are also good chelates towards boron(III) fragments such as BF₂ or BPh₂ quantum yield in solution reaching up to 38%. The hemi-salen (L₁ H₃  - L₄ H₃ ) ligands and their BF₂ or BPh₂ chelating triboron complexes were tested for the in vitro anticancer activity against various cancer and normal cells (HeLa, DLD-1, ECC-1, PC-3, PNT-1A, and CRL-4010), and it was found that the cell viability of cancer cells was decreased while most of the healthy cells could still be viable. Also, the cytotoxicity studies showed that anticancer activity of hemi-salen (L₁ H₃  - L₄ H₃ ) ligands is higher than that of triboron [L_(1 - 4) (BF₂ )₃ ] and [L_(1 - 4) (BPh₂ )₃ ] complexes. The hemi-salen (L₁ H₃  - L₄ H₃ ) ligands showing the strongest cytotoxic effect in PC-3 cells were found to exhibit anticancer activity with apoptosis by increasing the level of ROS in the PC-3 cells.