The role of platelet large cell ratio in determining mortality in COVID-19 patients.

Inflammatory mechanisms have been implicated and have been subject to research in the clinical course of COVID-19 patients. In this study, platelet large cell ratio (P-LCR) has been examined as a novel prognostic and inflammatory parameter. A total of 1992 COVID-19-positive patients admitted to COVID-19 unit of Infectious Diseases were included. In order to identify a potential relationship between P-LCR and mortality, surviving patients were compared with subjects who died as a result of the disease. Although P-LCR levels showed a steady increase in all COVID-19 patients after admission, they were significantly higher in those who eventually died (P < .001), indicating a positive correlation between mortality and P-LCR. The P-LCR levels of patients followed up in the intensive care unit were statistically significantly higher than those followed up in the ward (P < .001). P-LCR levels of patients intubated in intensive care unit were statistically significantly higher than those who were not intubated (P < .001). Also, P-LCR levels were subdivided into 3 categories as normal, low, and elevated. Elevated P-LCR was found to be positively correlated with leukocyte count, neutrophil count, D-dimer, troponin, ferritin, and C-Reactive Protein (CRP) and showed negative correlation with fibrinogen, lymphocyte count, and platelet count. As P-LCR was correlated with the severity of inflammation in all COVID-19 patients, it was significantly higher in those patients who died. Elevated P-LCR was considered to be associated with the risk of severe disease and death. This inexpensive, readily available test may be incorporated into our clinical practice as a novel marker of poor prognosis in addition to other valuable laboratory parameters.

The effect of compliance with PAP therapy on biochemical parameters in patients with obstructive sleep apnea syndrome: A 6-month follow-up study.

Introduction: The gold standard treatment for obstructive sleep apnea syndrome (OSAS) is positive airway pressure therapy (PAP) treatments. PAP treatments reduce complications by reducing apnea and hypopnea attacks by creating airflow at a determined pressure. In our study, we aimed to examine the effect of treatment compliance on kidney and liver functions, apneahypopnea (AHI) index, and lipid profile of patients diagnosed with OSAS and started PAP treatment. Materials and Methods: Patients who were admitted to the sleep laboratory of our hospital between September 2022 and September 2023 and started PAP treatment after PSG were included in our study. Patients who were called for follow-up six months after the initiation of PAP treatment were divided into two groups according to their compliance with PAP treatment. Patients who used the device for at least four hours per night and more than 70% at night were grouped as PAP-compliant patients, while the other patients were grouped as non-PAP-compliant patients. Result: It was observed that uric acid, BUN, triglyceride, total cholesterol, ALT, GGT, ALP, and AHI levels of the patients who started PAP treatment decreased after six months (p= 0.001, 0.006, <0.001, 0.006, 0.01, <0.001, <0.001, <0.001 with). It was observed that HDL cholesterol levels increased (p≤ 0.001). It was observed that the change in uric acid, AHI, total cholesterol, and GGT levels in group 1 (n= 36) patients who were compliant with PAP treatment was statistically higher than in group 2 (n= 30) patients (p< 0.001, <0.03, <0.001, 0.008, respectively). Conclusions: Uric acid, total cholesterol and GGT are biomarkers that may increase in OSAS due to intermittent hypoxia with the involvement of other systems. Since a decrease in these biomarkers can be observed in the early period depending on treatment compliance, these biomarkers can be used practically in the follow-up of treatment compliance and treatment efficacy.

The Potential Impact of Agouti Related Peptide and Asprosin on Metabolic Parameters and Eating Behavior in Attention Deficit Hyperactivity Disorder.

Introduction: We aimed to evaluate Agouti-Related Peptide (AgRP) and asprosin levels in adults with Attention Deficit Hyperactivity Disorder (ADHD), and to examine the relationship between eating behavior, metabolic parameters, AgRP and asprosin. Methods: Forty-five adult ADHD patients and 45 controls were included in the study. The Adult Diagnostic Interview Scale for ADHD (DIVA 2.0) and Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders-5 Clinician Version (SCID-5/CV) were administered to the participants. The Adult Attention Deficit Hyperactivity Disorder Self-Report Scale (ASRS) and the Dutch Eating Behavior Questionnaire (DEBQ) were completed by the participants. Biochemical parameters, AgRP and asprosin levels of the participants were measured. Results: Adults with ADHD had significantly higher HbA1c, body mass index (BMI), and waist circumference. Eating behaviors and lipid profile were impaired in the patients. A significant positive correlation was found between the patients' ASRS/hyperactivity-impulsivity scores and DEBQ/emotional eating and DEBQ/external eating. A significant positive correlation was found between ASRS/total score and DEBQ/emotional eating, DEBQ/external eating, and DEBQ/total eating scores. AgRP and asprosin levels were significantly lower in the patients. The effect sizes of AgRP and asprosin were 0.526 and 0.839, respectively. A negative correlation was found between AgRP and asprosin levels of the patients and BMI. It was seen that AgRP and asprosin were confounding factors for each other, and the significance between the groups was due to asprosin. Asprosin defined ADHD at a higher rate than AgRP. Conclusion: The study emphasizes the link between eating behavior and the hedonic system in ADHD. It also showed that AgRP and asprosin levels are low in adult ADHD. Low AgRP and asprosin levels may be an indication of impaired energy homeostasis and/or a structural cause for ADHD.

Salivary and serum asprosin hormone levels in the 2018 EFP/AAP classification of periodontitis stages and body mass index status: a case-control study.

OBJECTIVES: A newly discovered adipokine known asprosin in serum and saliva in patients with periodontitis has not been explored. The aim of this study was to determine the relationship between serum and saliva asprosin levels and periodontitis by grouping it according to body mass index (BMI). MATERIALS AND METHODS: The study was conducted on 65 systemically healthy patients (35 patients with periodontitis (periodontitis group), 30 periodontally healthy patients (control group)). In each patient, age, BMI, and clinical periodontal parameters (plaque index (PI), gingival index (GI), probing depth (PD), and clinical attachment level (CAL)) were evaluated. Statistical analyses were conducted utilizing the Student t-test, ANOVA, and Pearson correlation analysis. For the significance level of the tests, p<0.05 were accepted. RESULTS: The serum and saliva were collected to assess asprosin levels. Both the serum and saliva asprosin levels were statistically significantly higher in the periodontitis group than in the control group (p<0.001). Saliva and serum asprosin levels were directly proportional to the severity of the periodontal disease (p<0.05). Asprosin levels were higher in patients with a higher BMI (p<0.05). CONCLUSION: Asprosin levels were increased in periodontitis, and even a high BMI status apparently affected the levels of this hormone. It is thought that asprosin may be a useful biomarker in evaluating the relationship between periodontal status and BMI. CLINICAL RELEVANCE: Asprosin may be a useful parameter as a biomarker of periodontal disease progression. However, BMI status should be considered when evaluating asprosin levels in patients with periodontitis.

Serum asprosin levels are increased in patients with periodontitis and ST-segment elevation myocardial infarction and correlated with periodontal parameters: A case-control study.

OBJECTIVE: The study aims to investigate whether patients with ST-elevation myocardial infarction (STEMI)-related periodontitis will experience any changes in asprosin levels. BACKGROUND: Periodontitis is a common, chronic infection of the periodontium that is epidemiologically associated with cardiovascular disease. Although asprosin, a hormone released from adipose tissue, is a protective role in cardiovascular diseases, its effectiveness in periodontitis is unknown. METHODS: The study was conducted on a total of 120 patients, divided into four groups; the group of healthy control (n = 35), the group of periodontitis (n = 35), the group of periodontitis+STEMI (n = 25), and the group of STEMI (n = 25). In each patient, age, serum asprosin, CRP, troponin-I, and clinical periodontal parameters [plaque index (PI), gingival index (GI), bleeding on probing (BOP), probing depth (PD), and clinical attachment level (CAL)] were evaluated. The results were analyzed statistically. RESULTS: Serum asprosin, CRP, and troponin-I levels were statistically higher in the STEMI+periodontitis group compared to the other groups. In addition, as a result of the study, it was observed that there was a correlation between serum asprosin levels, clinical periodontal parameters, and CRP levels. CONCLUSIONS: The results of this study show that STEMI and periodontitis are associated with high asprosin levels. Since the risk of periodontitis is high in STEMI patients, periodontitis should also be considered when evaluating asprosin levels in STEMI patients.

The CXCL9/10/11-CXCR3 axis as a predictor of COVID-19 progression: a prospective, case-control study.

BACKGROUND: This study examined the relationship between levels of the chemokines CXCL9, CXCL10, CXCL11, and CXCR3 and mortality in patients with COVID-19.. METHODS: A total of 71 patients hospitalized with COVID-19 and 35 health workers with no symptoms and negative SARS-CoV-2 PCR results were included in the study. CXCL9, CXCL10, CXCL11, and CXCR3 levels were measured in blood samples using enzyme-linked immunosorbent assays. Participants were divided into three groups: healthy individuals, patients with mild to moderate pneumonia, and patients with severe pneumonia. Patients were also divided into sub-groups according to the outcome: dead and survived. RESULTS: Serum CXCL9, CXCL10, CXCL11, and CXCR3 levels were significantly higher in patients with severe COVID-19 than in those with non-severe COVID-19; were higher in both patient groups than in the control group; and were higher in patients who died than in those who survived. Lymphocyte counts, and fibrinogen and PaO2/FiO2 levels were significantly lower in patients with severe COVID-19 than in those with moderate disease. Patients with COVID-19 also had elevated neutrophil/lymphocyte ratios, neutrophil counts, and lactate dehydrogenase, C-reactive protein, D-dimer, and ferritin levels. CONCLUSIONS: This study confirmed that CXCL9, CXCL10, CXCL11, and CXCR3 levels are associated with disease severity in patients with COVID-19. These laboratory parameters can help to estimate disease severity and predict outcomes, and are useful in clinical decision-making.

Evaluation of Serum Zonulin and Occludin Levels in Bipolar Disorder.

OBJECTIVE: The etiology of bipolar disorder (BD) is still not fully understood. Little is currently known about the relationship between the interaction the gastrointestinal system and brain function and BD. Zonulin is the only known physiological modulator of tight junctions and is a biomarker for intestinal permeability (IP). Occludin is an integral transmembrane tight junction protein involved in the maintenance and assembly of such junctions. The current study aims to determine whether zonulin and occludin levels are altered in BD and whether they can serve as clinical biomarkers of disease. METHODS: Forty-four patients with BD and 44 healthy controls were included in this study. The Young Mania Rating Scale (YMRS) was used to determine the severity of manic symptoms, while the Hamilton Depression Rating Scale (HDRS) was used to determine the severity of depressive symptoms, and the Brief Functioning Rating Scale (FAST) to assess functionality. Venous blood samples were taken from all participants and serum zonulin and occludin levels were measured. RESULTS: The mean serum zonulin and occludin levels of the patients were significantly higher compared to the healthy control group. There was no difference between manic, depressive, and euthymic patients in terms of zonulin and occludin levels. There was no correlation between the total number of attacks, duration of disease, YMRS, HDRS, FAST scores, and zonulin and occludin levels in the patient group. The groups were divided into three according to body mass index as normal, overweight, and obese. Zonulin and occludin levels increased as body mass index increased and were highest in the obese group. CONCLUSION: The study shows that zonulin and occludin levels in BD increase independently of the disease stage. Consideration of the role of IP in the pathogenesis of BD may be helpful in determining the appropriate treatment modality.

Evaluation of the role of serum DcR3 levels in the early clinical prognosis of patients with Crimean-Congo hemorrhagic fever.

BACKGROUND: Crimean-Congo hemorrhagic fever (CCHF) is a zoonotic disease that is transmitted by Hyalomma ticks and is endemic in many parts of the world. This study aimed to determine the relationship between early serum Decoy receptor-3 (DcR3) level and clinical severity in patients with CCHF. METHODS: The study included 88 patients hospitalized for CCHF between April and August 2022 and a control group of 40 healthy individuals. The patients were divided according to clinical course as those with mild/moderate (group 1, n = 55) and severe (group 2, n = 33) CCHF. DcR3 levels were measured by enzyme-linked immunosorbent assay of serum obtained at the time of diagnosis. RESULTS: Fever, hemorrhage, nausea, headache, diarrhea, and hypoxia were significantly more common among patients with severe CCHF than patients with mild/moderate CCHF (p < 0.001, <0.001, 0.02, 0.01, <0.001, and < 0.001, respectively). Group 2 had higher serum DcR3 levels than both group 1 and the control group (p < 0.001 for both). Serum DcR3 levels were also significantly higher in group 1 than in the control group (p < 0.001). Using 98.4 ng/mL as the cut-off value, serum DcR3 had 99% sensitivity and 88% specificity in differentiating patients with severe CCHF from those with mild/moderate CCHF. CONCLUSION: During the high season in our endemic region, CCHF can present with a severe clinical course independent of age and comorbidities, unlike other infectious diseases. Elevated DcR3 observed early in the disease may allow additional immunomodulatory therapies to be tried in addition to antiviral therapy in CCHF, for which treatment options are limited.

Serum Occludin and Zonulin Levels in Children With Attention-Deficit/Hyperactivity Disorder and Healthy Controls.

OBJECTIVE: To evaluate zonulin and occludin levels, potentially associated with immunological pathways in the gut-brain axis, in children with attention-deficit/hyperactivity disorder (ADHD). METHOD: We examined the association between serum levels of zonulin and occluding, and behavioral/emotional problems in children with ADHD. 40 medication-naïve children meeting Diagnostic and statistical (DSM-5) criteria for ADHD (11 females; mean (SD) age 9.4 (1.6) years) and 39 healthy comparisons (12 females; mean (SD) age 9.3 (1.9) years) were studied. Serum zonulin and occludin levels were measured by (ELISA). RESULTS: We found higher mean (SD) serum zonulin levels [37.1 (28.2) vs 8.1 (4.5) ng/mL; P<0.001) and occludin levels [2.4 (1.6) vs 0.6 (0.4) ng/mL; P<0.001] in the ADHD group compared to control group. Serum zonulin levels had a positive correlation with weight (r=0.452; P=0.003) and BMI (r=0.401; P=0.01) among children with ADHD. Serum zonulin and occludin levels also had a positive correlation with Conners parent rating scale scores (r=0.58; P<0.001), and Strengths and difficulties questionnaire scores (r=0.49; P<0.001). Multiple linear regression analysis revealed that age, sex, weight, conduct problems and oppositional sub-scores were significant predictors of increased serum zonulin levels. CONCLUSION: These data confirm an association between ADHD, and serum zonulin and occludin levels. Pathophysiological and clinical significance of these findings needs to be elucidated.

Total, free, and bioavailable 25-hydroxyvitamin D levels in patients with periodontitis (stage III): a case-control study.

OBJECTIVE: The aim of this study was to investigate the relationship between total, free and bioavailable 25-hydroxyvitamin D levels, and periodontitis. MATERIALS AND METHODS: Thirty-nine patients with periodontitis diagnosis and 44 healthy participants were included in this study. 25-Hydroxyvitamin D, vitamin D-binding protein, procalcitonin, and albumin levels were measured from the serum samples obtained. Free and bioavailable 25-hydroxyvitamin D levels were calculated. Total, free, and bioavailable 25-hydroxyvitamin D levels were compared between the healthy control and periodontitis groups. The association of total 25 (OH)D levels with periodontitis was tested through univariate analysis and multivariate logistic regression. RESULTS: Total 25-hydroxyvitamin D, bioavailable 25-hydroxyvitamin D, and free 25-hydroxyvitamin D levels were significantly lower in the periodontitis group than in the healthy control group (p < 0.001). In the logistic regression analysis, a significant correlation was observed between total 25-hydroxyvitamin D and periodontitis (p<0.001). CONCLUSION: Our study shows that there is a relationship between total, free and bioavailable 25-hydroxyvitamin D levels and periodontitis. In addition, it has been shown that the determination of free and bioavailable 25-hydroxyvitamin D levels does not provide additional advantages in terms of the relationship between periodontitis and vitamin D. CLINICAL RELEVANCE: In this case-control study, we examined the relationship between total, free and bioavailable 25-hydroxyvitamin D and periodontitis. We found lower total, free, and bioavailable 25-hydroxyvitamin D levels in periodontitis patients. It was also found that vitamin D-binding protein may be an important biomarker in the identification of various forms of periodontal disease. TRIAL REGISTRATION: ClinicalTrials.gov Identifier NCT05343273.

Serum endocan levels in children with rheumatic aortic insufficiency: can it differentiate bicuspid aortic valve disease from rheumatic heart disease?

AIM: In this study, it was aimed to examine the serum endocan levels in patients with rheumatic aortic regurgitation and to investigate whether it has a value in differentiating it from aortic regurgitation due to bicuspid aortic valve. METHODS: Blood samples were collected from patients with rheumatic aortic regurgitation (Group 1), incidentally diagnosed patients with borderline or definite rheumatic aortic regurgitation (Group 2), children with bicuspid aortic valve accompanied by aortic regurgitation (Group 3) and healthy children (Group 4) of similar age. RESULTS: There were 12 children in Group 1, 13 in Group 2, 25 in Group 3, and 25 in Group 4. Groups were similar in terms of age (p = 0.291). There was no statistically significant difference between median serum endocan levels of Group 1 and Group 2 (p = 0.624), and Group 3 and Group 4 (p = 0.443). Despite that, the median serum endocan levels of Group 1 and Group 2 were significantly higher than that of both Group 3 and Group 4 (p = 0.000 for all). CONCLUSIONS: Our results indicate that serum endocan level can be used to differentiate rheumatic aortic regurgitation from non-rheumatic aortic regurgitation. It is thought that the prognostic role of this marker should be confirmed in long-term, prospective studies with larger samples.

Analysis of Chitinase-3-Like Protein 1, IL-1-Alpha, and IL-6 as Novel Inflammatory Biomarkers for COVID-19.

The aim of our study was to investigate the potential role of IL-1-alpha, IL-6, and chitinase 3-like protein-1 (CHI3L1) as potential biomarkers for COVID-19. Sixty adult SARS Cov-2 PCR-positive patients (22 mild, 25 moderate, and 13 severe) and 50 healthy controls were included in this study. The serum levels of CHI3L1, IL-1-alpha, and IL-6 for all study participants were measured by protein-specific ELISAs. Mean serum CHI3L1 levels in patients with severe disease (7,185.5 ± 1,109.4) were significantly higher than in the moderate (3,977.4 ± 1,260.3), mild (1,379.5 ± 598.8), and control (329.5 ± 128.4) groups (P = 0.001). There was no difference in IL-1-alpha levels between the patient and control groups (P = 0.083). IL-6 levels differed significantly, being lowest in the control group (35.9 ± 13.7), 89.1 ± 23.4 in the mild group, 156.2 ± 29.6 in the moderate group, and the highest in the severe group (214.9 ± 28.1) (P = 0.001). A strong significant correlation was found between disease severity and serum IL-6 and CHI3L1 values (r = 0.894 and r = 0.905, respectively, and P < 0.001 for both). Serum CHI3L1 and IL-6 levels exhibited a linear correlation with the clinical course of COVID-19 infection. These results indicate that inhibitors of IL-6 and/or CHI3L1 may provide useful treatments for COVID-19.

Role of transforming growth factor-beta 1 and connective tissue growth factor levels in coronavirus disease-2019-related lung Injury: a prospective, observational, cohort study.

BACKGROUND: Coronavirus disease-2019 (COVID-19) results in acute lung injury. This study examined the usefulness of serum transforming growth factor-beta 1 (TGF-ß1) and connective tissue growth factor (CTGF) levels in predicting disease severity in COVID-19 patients with pulmonary involvement. METHODS: Fifty patients with confirmed COVID-19 and pulmonary involvement between September 2020, and February 2021 (Group 1) and 45 healthy controls (Group 2) were classified into three subgroups based on clinical severity: moderate, severe, and critical pneumonia. Serum TGF-ß1 and CTGF concentrations were measured on days 1 and 7 of admission in Group 1 using an enzyme-linked immunosorbent assay. These concentrations were also measured in control cases. The mean serum TGF-ß1 and CTGF levels were then compared among COVID-19 patients, based on clinical severity. RESULTS: Significantly higher mean serum TGF-ß1 and CTGF levels were observed on both days in Group 1 than in the control group. The mean serum TGF-ß1 and CTGF levels on day 7 were also significantly higher than those on day 1 in Group 1. The critical patient group had the highest serum TGF-ß1 and CTGF levels on both days, and the difference between this group and the moderate and severe pneumonia groups was significant. Cutoff values of 5.36 ng/mL for TGF-ß1 and 626.2 pg/mL for CTGF emerged as predictors of COVID-19 with pulmonary involvement in receiver-operating characteristic curve analysis. CONCLUSIONS: TGF-ß1 and CTGF are potential markers that can distinguish COVID-19 patients with pulmonary involvement and indicate disease severity. These findings may be useful for initiating treatment for early-stage COVID-19.

Evaluation of serum YKL-40 level among clinical risk scores for early mortality in acute pulmonary thromboembolism.

INTRODUCTION: Pulmonary embolism (PE) often occurs secondary to deep vein thrombosis and is an important cause of mortality and morbidity. This study aimed to evaluate the relationship between YKL-40 level and clinical risk score in patients with PE. METHODS: The study included a total of 100 patients, 80 patients diagnosed with PE in the emergency department and 20 healthy controls. Patients with PE were divided into four groups: high-risk patients (n = 20), high-intermediate-risk patients (n = 20), low-intermediate-risk patients (n = 20), and low-risk patients (n = 20). Serum YKL-40 levels were measured by enzyme-linked immunosorbent assay. Pulmonary artery obstruction index (PAOI) was calculated from computed tomography angiography images. RESULTS: PAOI increased in correlation with PE risk and differed significantly between all patient groups (p < 0.001). Troponin-I levels were significantly higher in the high-risk and high-intermediate-risk groups compared to the other groups (p < 0.001), but did not differ significantly between high-risk and high-intermediate-risk patients (p = 0.09). YKL-40 level was significantly higher in the high-risk PE group than the high-intermediate-risk group (p < 0.001). In receiving operator characteristic curve analysis assessing the discriminatory value of YKL-40 for high-risk PE patients, a cut-off value of 227.2 ng/mL had sensitivity of 85 % and specificity of 70 %. DISCUSSION: YKL-40 may be an important biomarker in decisions regarding early thrombolytic treatment in patients with high-intermediate-risk PE. In addition, medical treatments targeting YKL-40 may also reduce thrombotic tendency in high-risk patient groups.

Relationship Between Dental Caries and YKL-40 Levels in Saliva.

OBJECTIVE: YKL-40, a new biomarker of localized inflammation, is secreted by macrophages and regulates inflammation and immune responses. The aim of this study was to investigate YKL-40 levels in saliva and compare the level of this mediator in healthy and unhealthy oral cavity. STUDY DESIGN: 80 children (42-girl, 38-boy), aged 6-15 (mean±SD: 9.35±2.08) were included in this cross-sectional study. The children were divided into four groups: Group-I (control, n=20, dmft/DMFT=0), Group-II (n=20, exist of dental caries), Group-III (n=20, exist of advanced dental caries without pulp exposure), and Group-IV (n=20, exist of advanced dental caries with pulp exposure). The dmft/DMFT, dmfs/DMFS, and the number of advanced dental caries according to the ICDAS and pufa/PUFA index were recorded. Saliva was collected and YKL-40 concentrations were measured. RESULTS: The highest level of YKL-40 was obtained in Group IV, followed by Groups III, II, and I, respectively (p<0.01). There was a positive correlation between YKL-40 and the number of caries There were no statistically significant difference in YKL-40 levels in terms of age and gender (p>0.05). CONCLUSIONS: The advanced dental caries with pulp exposure may play an important role in the increasing levels of YKL-40 in saliva.

Can Endocan Be a Novel Marker in the Diagnosis of Brucellosis?

Introduction: Brucellosis remains an important public health problem in many developing countries. This study examines the serum levels of endocan, a novel immune-inflammatory marker, in this potentially difficult to diagnose disease, and their predictive diagnostic value. Methods: Fifty patients under follow-up with diagnoses of brucellosis between May 1, 2020, and December 1, 2020, and 50 healthy individuals constituting the control group were included in the study. Cases were classified as acute, subacute, or chronic, depending on the duration of their symptoms. Patients' plasma specimens were collected before the initiation of brucellosis treatment. Results: Serum endocan levels were higher among the patients with brucellosis than in the healthy control group (p < 0.001). Endocan levels also differed significantly among the patients with acute, subacute, and chronic brucellosis (p < 0.001 for all). Comparison of C-reactive protein (CRP) and the erythrocyte sedimentation rate (ESR) in the patients with acute, subacute, and chronic brucellosis revealed a significant difference only in terms of CRP levels between the acute and chronic patients (p = 0.018). No significant association was observed between serum endocan levels and growth in blood culture or serum agglutination test results in the patients with brucellosis (p > 0.05). However, a significant correlation was found between patients' CRP and ESR values and endocan levels (r = 0.572, and r = 0.415, respectively, p < 0.001). At a cutoff value of 597.35 pg/mL, serum endocan levels exhibited 90% sensitivity and 85% specificity in differentiating patients diagnosed with brucellosis from healthy individuals (area under the curve = 0.927, p < 0.001, 95% confidence interval = 0.877-0.977). Conclusion: Endocan may be a useful guide in differentiating patients with brucellosis from healthy individuals, and in distinguishing between acute, subacute, and chronic brucellosis. Ethics committee approval No: B.30.2.ATA.0.01.00/203.

Endocan as a potential marker in diagnosis and predicting disease severity in COVID-19 patients: a promising biomarker for patients with false-negative RT-PCR.

BACKGROUND: Endothelial-specific molecule 1 (endocan) has emerged as an inflammatory biomarker in recent years. The purpose of this study was to investigate the diagnostic value of serum endocan levels in the prediction of COVID-19 disease among patients with a false-negative reverse transcription polymerase change reaction (RT-PCR) test, and also to determine its correlation with the clinical severity of the disease. METHODS: Thirty patients with positive RT-PCR results and 30 with false-negative RT-PCR results, both with suspected COVID-19 in terms of clinical, radiological, and laboratory findings, were included in the study. Thirty healthy controls were also enrolled. RESULTS: Serum endocan levels were estimated to be 821.8 ± 99.3 pg/mL in COVID-19 RT-PCR (+) patients, 803.9 ± 97.0 pg/mL in RT-PCR false (-) patients with suspected COVID-19, and 382.9 ± 37.5 pg/mL in the control group. No significant difference was observed between RT-PCR (+) and RT-PCR false (-) patients (P = 0.68). However, serum endocan levels differed significantly between patient groups and control group (P < 0.05). With a cut-off value of 444.2 pg/mL serum endocan levels differentiated COVID-19 cases from healthy individuals with 92% sensitivity and 80% specificity. Moreover, a significant positive correlation was observed between serum endocan levels and clinical severity (P < 0.01, r = 0.94). CONCLUSIONS: There is a need for different laboratory markers capable of assisting diagnosis and showing COVID-19 infection in suspected COVID-19 RT-PCR false-negative patients. Endocan levels can be used as an assistant blood test for identifying COVID-19 patients with false-negative RT-PCR tests and in determining the clinical severity of the disease.

Role of transforming growth factor-beta 1 and connective tissue growth factor levels in coronavirus disease-2019-related lung Injury: a prospective, observational, cohort study

ABSTRACT Background: Coronavirus disease-2019 (COVID-19) results in acute lung injury. This study examined the usefulness of serum transforming growth factor-beta 1 (TGF-β1) and connective tissue growth factor (CTGF) levels in predicting disease severity in COVID-19 patients with pulmonary involvement. Methods: Fifty patients with confirmed COVID-19 and pulmonary involvement between September 2020, and February 2021 (Group 1) and 45 healthy controls (Group 2) were classified into three subgroups based on clinical severity: moderate, severe, and critical pneumonia. Serum TGF-β1 and CTGF concentrations were measured on days 1 and 7 of admission in Group 1 using an enzyme-linked immunosorbent assay. These concentrations were also measured in control cases. The mean serum TGF-β1 and CTGF levels were then compared among COVID-19 patients, based on clinical severity. Results: Significantly higher mean serum TGF-β1 and CTGF levels were observed on both days in Group 1 than in the control group. The mean serum TGF-β1 and CTGF levels on day 7 were also significantly higher than those on day 1 in Group 1. The critical patient group had the highest serum TGF-β1 and CTGF levels on both days, and the difference between this group and the moderate and severe pneumonia groups was significant. Cutoff values of 5.36 ng/mL for TGF-β1 and 626.2 pg/mL for CTGF emerged as predictors of COVID-19 with pulmonary involvement in receiver-operating characteristic curve analysis. Conclusions: TGF-β1 and CTGF are potential markers that can distinguish COVID-19 patients with pulmonary involvement and indicate disease severity. These findings may be useful for initiating treatment for early-stage COVID-19.

The Epidemiology, Clinical Manifestations, Radiology, Microbiology, Treatment, and Prognosis of Echinococcosis: Results of NENEHATUN Study.

Aim: Echinococcosis, caused by Echinococcus species, is an important zoonotic disease causing major health problems in humans and animals. Herein, we aimed to evaluate the epidemiology, clinical and laboratory parameters, radiological, serological, pathological, and treatment protocols of followed-up cases of hydatidosis. Methods: A total of 550 patients diagnosed with hydatid cyst disease were included in this study. Patients who were positive for one or more of the enzyme-linked immunosorbent assay or indirect hemagglutination test, pathological results, or radiological findings were examined. The data analyzed were collected from nine centers between 2008 and 2020. Records were examined retrospectively. Results: Among the patients, 292 (53.1%) were women and 258 (46.9%) were men. The patients' mean age was 44.4 ± 17.4 years. A history of living in rural areas was recorded in 57.4% of the patients. A total of 435 (79.1%) patients were symptomatic. The most common symptoms were abdominal pain in 277 (50.4%), listlessness in 244 (44.4%), and cough in 140 (25.5%) patients. Hepatomegaly was found in 147 (26.7%), and decreased breath sounds were observed in 124 (22.5%) patients. Radiological examination was performed in all cases and serological methods were also applied to 428 (77.8%) patients. The most frequently applied serological test was IHA (37.8%). A single cyst has been found in 66% patients. Hepatic involvement occurred in 327 (59.4%), pulmonary involvement was found in 128 (23.3%), whereas both of them were recorded in 43 (7.8%) patients. Splenic involvement was only detected in nine (1.6%) patients. Echinococcus granulosus (72.5%) was most frequently detected. Cyst diameters of 56.9% of the patients were in the range of 5-10 cm. A total of 414 (75.2%) patients received albendazole as an antiparasitic. Mortality was noted in nine (1.6%) patients. Conclusion: Echinococcosis is an important public health problem in Turkey. It can affect the social, economic, and political structures of the community. Public education and awareness are extremely important.

An evaluation of ischaemia-modified albumin levels in the development of diabetic foot ulcer.

INTRODUCTION: This study investigated the status of serum ischaemia-modified albumin (IMA) levels in the development of diabetic foot ulcer (DFU) in patients with diabetes mellitus (DM) and in predicting ulcer formation and ulcer grading. MATERIALS AND METHOD: Thirty patients with DM, 30 with DFU and 30 healthy controls were included in the study. All participants' demographic characteristics and serum IMA, C-reactive protein (CRP), erythrocyte sedimentation rate (ESR) and white blood cell (WBC) levels and DFU infection grades were recorded. RESULTS: Nine (30%) patients with DFU were grade 2 according to the grading of International Working Group of the Diabetic Foot, 14 (46.7%) were grade 3 and seven (23.3%) were grade 4. Significant, powerful and positive correlation was determined between serum IMA and albumin-adjusted IMA levels and degrees of DFU (r = 0.878 and r = 0.846, P < .001 for both). Serum IMA levels in the DFU group were significantly higher than in the DM and control groups (P < .001). The optimal cut-off values for IMA in predicting DFU was 23.5 ng/mL (sensitivity 96%, specificity 87% and AUC = 0.97, P < .001). Additionally, at a cut-off value of 20.6 ng/mL, serum albumin-adjusted IMA differentiated cases of DFU from healthy individuals with 90% sensitivity and 83% specificity (AUC = 0.95, P < .001) Serum IMA levels exhibited significant, positive correlation with CRP, ESR, WBC, fasting plasma glucose and HbA1c (r = 0.575, r = 0.592, r = 0.597, r = 0.68 and r = 0.74, respectively, P < .001). Serum albumin levels were significantly negatively correlated with IMA, CRP, ESR and WBC values (r = -0.49, r = -0.56, r = -0.62 and r = -0.53, respectively, P < .001). CONCLUSION: Our study findings indicate that together with CRP, ESH, WBC and albumin, increased IMA levels in patients with DM can be useful in the early prevention of DFU development and in predicting the severity of DFU infection.