Diagnostic value of adenosine deaminase in bronchoalveolar lavage fluid for patients with lung cancer.

BACKGROUND: Lung cancer is both the most common seen malignity and cause of cancer-related deaths worldwide. Adenosine deaminase (ADA) is a hydrolytic enzyme that catalyses the conversion of adenosine to inosine in the purine metabolism pathway. Studies examining ADA levels in bronchoalveolar lavage (BAL) fluids of patients with lung malignancy are very limited in the literature. Our aim examine the clinical significance of ADA levels in BAL fluids of patients with lung malignancy. METHODS: A total of 89 patients undergoing fiberoptic bronchoscopy (FOB) with different indications from December 2017 to December 2018 were included in this study. The patients were divided into two groups as malignancy and non-malignancy groups. Demographic, laboratory data and ADA levels in bronchoalveolar lavage (BAL) were compared between the two groups. In addition, ADA levels in BAL were compared among the histopathological subtypes of patients in the malignant group. RESULTS: The mean age of the patients was 58.2 ± 14.5 years with 86% of male gender. ADA enzyme levels were statistically higher in the malignant patient group compared with the non-malignant group (37.2 [17.6-71] vs 17.1 [9-35.3], P < .001). When the patients in the malignant group were compared in terms of ADA levels according to their histopathological types, a statistically significant difference was obtained in small cell carcinoma patients (49 [12.5-75.3], P = .005). CONCLUSION: ADA levels in BAL may be a diagnostic biomarker in lung malignancies. In patients where a biopsy cannot be taken or histopathological typing cannot be performed because of tissue insufficiency, ADA levels in BAL can be an auxiliary parameter in making malignancy / histopathological diagnosis accompanied by radiological and clinical findings.

Prevalence of Sleep Disorders and Related Factors in Individuals Undergoing Hemodialysis.

BACKGROUND: The quality of life of individuals undergoing hemodialysis is related to many factors, including sleep disorders. OBJECTIVE: To determine the prevalence of sleep disorders in individuals undergoing hemodialysis and to assess the effect of clinical and biochemical parameters on their sleep quality. METHOD: We conducted a cross-sectional descriptive survey in multiple hemodialysis centers. Individuals were interviewed using a questionnaire for obtaining general personal information, the Pittsburgh Sleep Quality Index (PSQI) for assessing sleep quality, and the Epworth Sleepiness Scale (ESS) for assessing excessive daytime sleepiness (EDS). RESULTS: The study included 338 individuals with a median age of 55 years. Poor sleep quality (PSQ) and EDS were present in 41.4% and 6.5% of the individuals, respectively. The individuals' PSQI scores were significantly proportional to their ESS scores. Concerns about the disease and its treatment (60.7%) and poor physical conditions (35.7%) were major reported reasons for PSQ. In a logistic regression analysis, female gender, household income, ESS score, chronic heart failure, and creatinine and parathormone levels were found to be independent predictors of PSQ; household income, PSQ presence, parathormone and potassium levels, and urea reduction ratio were found to be independent predictors of EDS. CONCLUSION: Sleep disorders are common in individuals undergoing hemodialysis and are related to gender, comorbid diseases, poor economic state, altered biochemical values, dialysis timing, and concerns about the disease and its treatment. Improving these individuals' quality of life through adequate psychological and financial support and early diagnosis of sleep disorders should decrease their mortality and morbidity rates.

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.

Self-reported practices of doctors and nurses for the measurement of blood pressure.

BACKGROUND: Hypertension is one of the most common health problems worldwide and can be diagnosed with an accurate blood pressure measurement (BPM). We aim to evaluate the self-reported practices of family physicians and nurses for BPM. METHODS: This study was conducted in the form of a survey administered through face-to-face interviews with 131 physicians and 371 nurses. The survey included questions about devices, patients, and BPM techniques. RESULTS: The mean age was 31 ± 7.4 years. The most commonly used device was the aneroid model (47.8%). The majority of participants reported that they had sufficient technical knowledge about the devices (81.1%), and the devices were regularly calibrated (77.5%). Only 44.8% reported that they had asked patients about caffeine or nicotine use. About half of those in both groups (54%) performed BPM only once during a presentation. The most commonly used position during BPM was sitting. BPM was performed mostly on one arm without preference for any side (67.5%). Approximately half of the respondents reported that they performed BPM by actively supporting the arm at the heart level. CONCLUSION: We found physicians and nurses had lack of adherence to proper techniques related to the use of appropriate positions and other relevant situations that should be considered during BPM. Accurate BPM is the most important factor for proper diagnosis and treatment of hypertension. Thus, BPM should be performed in accordance with the designated guidelines and can be performed with accurate results only as a result of repeated comprehensive training programs.

Role of methemoglobin and carboxyhemoglobin levels in predicting COVID-19 prognosis: an observational study.

World Health Organization has declared coronavirus disease-19 (COVID-19) as a pandemic. Although there are studies about this novel virus, our knowledge is still limited. There is limited information about its diagnosis, treatment and prognosis. We aimed to investigate the effect of methemoglobin and carboxyhemoglobin levels on the prognosis of COVID-19. In this observational study, patients who were diagnosed with COVID-19 during March 1-April 31, 2020 in a secondary-level state hospital in Turkey were included in the study. COVID-19 diagnosis was confirmed with reverse transcription polymerase chain reaction method, with nasal, oral or sputum specimens. During the period this study was performed, 3075 patients were tested for COVID-19 and 573 of them were hospitalized. Among the hospitalised patients, 23.2% (133) of them had a positive polymerase chain reaction result for COVID-19. A total of 125 patients, 66 (52.8%) males and 59 (47.2%) females, with an average age of 50.2 ± 19.8 years, were included in the study. The most common findings in chest radiogram were ground-glass areas and consolidations, while one-third of the patients had a normal chest radiogram. Computed thorax tomography was performed for 77.6% (97/125) of the patients. The 24.7% of computed tomographies (24/97) did not reveal any pathological findings, and the most common findings were ground-glass appearance and consolidation. Those who needed intensive care had statistically significantly lower platelet count (P = 0.011) and higher lactate dehydrogenase levels (P < 0.001). No statistically significant difference was found in carboxyhemoglobin (P = 0.395) and methemoglobin (P = 1.000) levels. We found that carboxyhemoglobin and methemoglobin levels had no effect on COVID-19 prognosis, but low platelet level played a role in predicting COVID-19 prognosis. This study was approved by the Ethical Committee of Harran University Faculty of Medicine on May 11, 2020 with approval No. 09.

The Role of Interferences in the Increasing Incidence of Vitamin D Deficiency.

OBJECTIVE: Lipemia is one of the causes of interference in immunoassay and LC-MS/MS methods. Increased prevalence of vitamin D deficiency in the US, where obesity is gradually increasing, raises the suspicion that high levels of fat diet and blood lipid levels interfere with vitamin D measurement results. The focus of this study was to investigate the effect of blood lipid profiles on vitamin D results and prevent the matrix effect. MATERIAL AND METHODS: In this study, 25OH vitamin D3 (25OHD3) levels of 100 samples consecutively accepted to biochemistry laboratory regardless of age and sex were measured by the LC-MS/MS method, and each sample was restudied after 1/10 dilution. After dilution restudy, two groups were obtained-group 1 (results deviating below 20%) and group 2 (results deviating above 20%)-and the difference between the groups was investigated. There were 79 patients in group 1 and 21 patients in group 2. In our study, lipid profiles (triglyceride, total cholesterol, HDL, LDL) from the same samples of consecutive vitamin D patients were studied. RESULTS: It was observed that the triglyceride, total cholesterol HDL, LDL, and 25OHD3 measurements of group 1 and group 2 were similar (p > 0.05). While the mean vitamin D value in the second group was 9.94 ± 7.85, the mean vitamin D value after dilution was measured as 39.23 ± 18.13 and was statistically significant. 25OHD3 concentrations of 21 patients out of 100 were found to be falsely low. Measurements were repeated to confirm the results. CONCLUSION: The matrix effect caused by exogenous and endogenous interferences in the blood could be a hidden factor increasing the prevalence of vitamin D deficiency by causing falsely low 25OHD3 values. Suspicious results should be remeasured by a dilution study.

The role of the platelet-to-lymphocyte ratio and neutrophil-to-lymphocyte ratio in the prediction of length and cost of hospital stay in patients with infected diabetic foot ulcers: A retrospective comparative study.

OBJECTIVE: The aim of this study was to determine the role of new inflammatory markers, including the platelet-to-lymphocyte ratio (PLR) and neutrophil-to-lymphocyte ratio (NLR), in the prediction of length and cost of hospital stay in patients with infected diabetic foot ulcers (DFUs). METHODS: A total of 78 patients with DFUs who were admitted to our endocrinology clinic between January 2016 and July 2017 were included. Patients were then divided into three groups according to the Wagner DFU classification system: group 1: 18 patients with grade 2 DFU (11 men, 7 women; mean age = 57.5±7 years); group 2: 44 patients with grade 3 DFU (18 men, 26 women; mean age = 59.7±8.7 years); and group 3: 16 patients with grade 4 DFU (10 men, 6 women; mean age = 59.9±11.6 years). Laboratory findings were retrospectively obtained from hospital records; the PLR and NLR were calculated in all groups. Length and cost of hospital stay were recorded. Hospital costs were estimated in Turkish Lira (TL) based on the evaluation of glucose regulation, wound care, and antibiotic treatment. RESULTS: The mean NLR was significantly lower in group 1 (2.8±0.9) than in group 2 (6.0±5.2; p=0.017) and group 3 (6.9±5.3; p=0.011). The mean PLR was significantly lower in group 1 (140.8±42.6) than in group 3 (222.1±95.5; p=0.006). The mean length of stay was 7.9±2.7 days in group 1, 15.0±8.9 days in group 2, and 12.5±8.9 days in group 3. The mean cost was 1,310.8±500 TL in group 1, 2,966.9±2105 TL in group 2, and 3,488.1±3603.1 TL in group 3. Length and cost of stay were both significantly lower in group 1 than in groups 2 and 3 (p=0.011 and p=0.002, respectively). Comparative results showed that the length and cost of hospital stay increased with increasing severity of DFUs. Furthermore, correlation analyses demonstrated no correlation of length of stay with PLR and NLR but an obvious correlation between cost of stay and PLR (r=0.412; p<0.001). Additionally, there was no correlation between cost of stay and NLR (r=0.158, p>0.05). CONCLUSION: The PLR is inflammatory marker that can be measured by an inexpensive and easily accessible test and can aid in the prediction of length and cost of hospital stay in patients with DFUs. LEVEL OF EVIDENCE: Level III, Therapeutic study.

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.

Urotensin-II and endothelin-I levels after contrast media administration in patients undergoing percutaneous coronary interventions.

BACKGROUND: Contrast induced kidney injury is an acute renal dysfunction that is secondary to the administration of radio contrast media. The purpose of this study was to evaluate the levels of urotensin-II (UT-II) and endothelin-I (ET-I) after contrast media administration in patients undergoing percutaneous coronary interventions. MATERIALS AND METHODS: In this prospective cohort study, we evaluated 78 patients with coronary artery disease who were scheduled for and ultimately underwent percutaneous coronary interventions. As a contrast material, nonionic contrast media was used in various amounts (70-480 mL). Blood and urine samples were obtained to measure U-II, ET-I just before and at the twenty-fourth hour of percutaneous coronary interventions. RESULTS: Compared to baseline, twenty-fourth hour creatinine levels were significantly increased (P < 0.001). The twenty-fourth hour serum and urine levels of both UT-II and ET-I were also significantly increased compared to baseline (P < 0.001 for all) and 24(th) hour serum and urine UT-II (r = 0.322, P = 0.004; r = 0.302, P = 0.007 respectively), ET-I (r = 0.511, P < 0.001; r = 0.266, P = 0.019 respectively) levels were significantly correlated with the amount of contrast media. CONCLUSION: Our study indicates that; increased UT-II and ET-I levels seem to be a consequence of hazardous effects of contrast media on blood vessels and the kidney.

Evaluation of oxidative stress parameters and metabolic activities of nurses working day and night shifts.

The aim of this study was to evaluate the oxidative stress and metabolic activities of nurses working day and night shifts. Intensive care unit (ICU) (n=70) and ordinary service (OS) nurses (n=70) were enrolled in the study. Just before and the end of the shifts, blood samples were obtained to measure the participants' oxidative stress parameters. Metabolic activities were analyzed using the SenseWear Armband. Oxidative stress parameters were increased at the end of the shifts for all OS and ICU nurses compared to the beginning of the shifts. Compared to the OS nurses, the ICU nurses' TAS, TOS, and OSI levels were not significantly different at the end of the day and night shifts. The metabolic activities of the OS and ICU nurses were found to be similar. As a result, the OS and ICU nurses' oxidative stress parameters and metabolic activities were not different, and all of the nurses experienced similar effects from both the day and night shifts.

Evaluation of oxidative stress parameters and metabolic activities of nurses working day and night shifts / Avaliação de parâmetros de estresse oxidativo e as atividades metabólicas das enfermeiras trabalhando em turnos diurnos e noturnos / Evaluación de parámetros de estrés oxidativo y actividades metabólicas de enfermeras trabajando en turnos diurnos y nocturnos

O objetivo deste estudo foi avaliar o estresse oxidativo e as atividades metabólicas das enfermeiras em turnos diurnos e noturnos. Enfermeiras da Unidade de Tratamento Intensivo (UTI) (n=70) e do serviço comum (SC) (n=70) participaram do estudo. Logo no início e ao final dos turnos, amostras de sangue foram obtidas para medir parâmetros de estresse oxidativo. Atividades metabólicas também foram analisadas com o uso da braçadeira SenseWear. Parâmetros de estresse oxidativo aumentaram no fim dos turnos de todas as enfermeiras SC e UTI quando comparados ao início dos turnos. Comparados às enfermeiras SC, os níveis de TAS, TOS e OSI das enfermeiras de UTI não eram significativamente diferentes no final dos turnos diurnos e noturnos. Além disso, as atividades metabólicas das enfermeiras de SC e UTI se revelaram como sendo similares. Assim, os parâmetros de estresse oxidativo e as atividades metabólicas das enfermeiras SC e UTI não eram diferentes, e todas as enfermeiras sofrem efeitos semelhantes dos turnos, tanto no dia quanto na noite.

The aim of this study was to evaluate the oxidative stress and metabolic activities of nurses working day and night shifts. Intensive care unit (ICU) (n=70) and ordinary service (OS) nurses (n=70) were enrolled in the study. Just before and the end of the shifts, blood samples were obtained to measure the participants' oxidative stress parameters. Metabolic activities were analyzed using the SenseWear Armband. Oxidative stress parameters were increased at the end of the shifts for all OS and ICU nurses compared to the beginning of the shifts. Compared to the OS nurses, the ICU nurses' TAS, TOS, and OSI levels were not significantly different at the end of the day and night shifts. The metabolic activities of the OS and ICU nurses were found to be similar. As a result, the OS and ICU nurses' oxidative stress parameters and metabolic activities were not different, and all of the nurses experienced similar effects from both the day and night shifts.

Se objetivó evaluar estrés oxidativo y actividades metabólicas de enfermeras en turnos diurnos y nocturnos. Participaron enfermeras de Unidad de Terapia Intensiva (UTI, n=70) y del servicio común (SC, n=70). Se obtuvieron muestras sanguíneas al inicio y al final de los turnos para medir parámetros de estrés oxidativo. Las actividades metabólicas también fueron analizadas utilizando brazaletes SenseWear. Los parámetros de estrés oxidativo aumentaron hacia el final de los turnos de todas las enfermeras SC y UTI, comparados con la medida de inicio. Los niveles de TAS, TOS y OSI no eran significativamente diferentes entre enfermeras SC y UTI al cierre de los turnos diurnos y nocturnos. Las actividades metabólicas de enfermeras SC y UTI se mostraron similares. Consecuentemente, los parámetros de estrés oxidativo y las actividades metabólicas de enfermeras SC y UTI no resultaron diferentes, y todas las enfermeras sufren efectos semejantes en sus turnos, tanto diurnos como nocturnos.

N-acetylcysteine fails to prevent renal dysfunction and oxidative stress after noniodine contrast media administration during percutaneous coronary interventions.

INTRODUCTION: Oxidative stress is believed to have a role in contrast-induced nephropathy. Based on this assumption, several known antioxidants have been studied to assess their effect on nephropathy, especially N-acetylcysteine (NAC). However, its usefulness has yet to be confirmed. OBJECTIVES: We aimed to assess whether NAC has any protective effect on contrast-induced renal dysfunction, and whether NAC affects the parameters of oxidative stress in serum and urine. PATIENTS AND METHODS: Sixty patients with coronary artery disease, who presented for an elective percutaneous coronary intervention (PCI), were randomized into 2 groups in an age- and gender-matched fashion: one group received 600 mg intravenous NAC and the other did not. Before and 24 hours after the procedure, blood and urine samples were obtained to assess total oxidant capacity (TOC), total antioxidant capacity (TAC), oxidative stress index (OSI), and renal function. RESULTS: Twenty-four hours after PCI, TOC and OSI levels were significantly increased and TAC levels significantly decreased, both in serum and urine. However, we did not observe any differences in oxidative parameters between patients who received NAC and those who did not. Multivariate analyses identified no protective effect of NAC on renal function, and no effect on oxidative parameters in either serum or urine. CONCLUSIONS: In this first clinical study that determined TOC and TAC levels in both serum and urine after exposure to contrast media, NAC was not found to affect oxidant parameters or protect against contrast nephropathy, at least in patients without the risk factors for nephropathy, such as diabetes mellitus or baseline renal or cardiac dysfunction.

Oxidative stress increased in healthcare workers working 24-hour on-call shifts.

INTRODUCTION: Long work hours, night shifts, stressful situations and insufficient social support increase levels of anxiety and depression and decrease motivation to perform among healthcare professionals. In this study, we evaluated oxidative stress levels in medical residents working 24-hour on-call shifts, and in nurses, relative to non-healthcare hospital staff in sedentary positions. We also measured serum prolidase activity, a measure of collagen turnover, as an objective proxy for level of physical activity. METHODS: Fifty-five male and 15 female medical residents on 24-hour, in-house, on-call duty, and 45 nurses and 30 (15 male/15 female) non-healthcare staff working 8-hour shifts were recruited. All were healthy nonsmokers. Parameters of oxidative stress and serum prolidase activity were measured twice for each subject, upon arising at 8 am after an overnight fast; and then again near the end of the work shift, or after 16 hours of consecutive work (at 12 pm) for residents. RESULTS: After hours of continuous work, serum total oxidative status and the oxidative stress index increased significantly, whereas total antioxidant status decreased (all P < 0.0001) in healthcare staff (nurses, male and female residents). All these variables remained virtually unchanged in non-healthcare staff. Similarly, serum prolidase activity increased in healthcare staff (P < 0.0001), but failed to increase statistically in non-healthcare staff. CONCLUSIONS: Healthcare workers suffer increased oxidative stress after prolonged work hours, especially while still on duty. Possible mechanisms for this include increased workload and, perhaps, psychological stress as well. However, long-term studies are needed to clarify the effects of sustained exposure to oxidative stress.

Acute renal failure with the combined use of rosuvastatin and fenofibrate.

Among the lipid-lowering drugs, the statins and fibrates are the most commonly used agents. Either class of drug is considered relatively safe. Though a variety of albeit uncommon adverse side effects have been observed with both classes, most of these therapeutic complications can be managed without discontinuation of the offending drug. Sometimes, especially in patients with extremely high cholesterol and/or triglyceride levels, a combination regimen is deemed necessary. However, the combined use of lipid-lowering drugs increases the incidence and severity of adverse events. In this article, we report an unusual case of acute renal failure (ARF) in a patient who had been prescribed both a statin (rosuvastatin) and a fibrate (fenofibrate).