Vitamin D and vitamin D binding protein levels in COVID-19 intensive care unit patients: A prospective multicenter study.

Background: Vitamin D binding protein plays a crucial role in regulating vitamin D levels by carrying vitamin D and its metabolites and immunological response by binding to endotoxins and fatty acids. We aimed to compare vitamin D, DBP, and specific inflammatory markers among intensive care unit (ICU) patients with and without the COVID19 virus. Methods: This multicenter study in two training and research hospitals included 37 (13 female) COVID-19positive and 51 (34 female) COVID-19-negative ICU patients. 25(OH) vitamin D, DBP, C-reactive protein (CRP), procalcitonin (PCT), D-dimer, troponin T (TnT), interleukin 6 (IL-6) and ferritin levels, survival, mortality rates, duration of stay (ICU) were examined. Results: We observed higher ferritin and CRP levels, along with lower DBP, TnT, and D-dimer levels, in patients with COVID-19. ICU patients with COVID-19 exhibited elevated mortality rates (Odds Ratio: 3.012, 95% Confidence Interval (1.252-7.248), p=0.013). However, no statistically significant correlation was observed between mortality rates and Vitamin D or DBP levels across the ICU patient cohort. Conclusions: Vitamin D values were found to be low in all intensive care patients, regardless of their COVID-19 status. Contrary to the literature, COVID-19 patients had lower D-dimer and TNT levels than negative controls. However, COVID-19-positive ICU patients have decreased DBP. Further, DBP gene polymorphism studies are needed to explain this situation.

Biological motion perception in the theoretical framework of perceptual decision-making: An event-related potential study.

Biological motion perception plays a critical role in various decisions in daily life. Failure to decide accordingly in such a perceptual task could have life-threatening consequences. Neurophysiology and computational modeling studies suggest two processes mediating perceptual decision-making. One of these signals is associated with the accumulation of sensory evidence and the other with response selection. Recent EEG studies with humans have introduced an event-related potential called Centroparietal Positive Potential (CPP) as a neural marker aligned with the sensory evidence accumulation while effectively distinguishing it from motor-related lateralized readiness potential (LRP). The present study aims to investigate the neural mechanisms of biological motion perception in the framework of perceptual decision-making, which has been overlooked before. More specifically, we examine whether CPP would track the coherence of the biological motion stimuli and could be distinguished from the LRP signal. We recorded EEG from human participants while they performed a direction discrimination task of a point-light walker stimulus embedded in various levels of noise. Our behavioral findings revealed shorter reaction times and reduced miss rates as the coherence of the stimuli increased. In addition, CPP tracked the coherence of the biological motion stimuli with a tendency to reach a common level during the response, albeit with a later onset than the previously reported results in random-dot motion paradigms. Furthermore, CPP was distinguished from the LRP signal based on its temporal profile. Overall, our results suggest that the mechanisms underlying perceptual decision-making generalize to more complex and socially significant stimuli like biological motion.

Evaluation of comorbid diseases in obstructive sleep apnea syndrome.

OBJECTIVE: It is known that obstructive sleep apnea syndrome affects many systems due to hypoxemia and hypercarbia. We aimed to demonstrate with the utilization of well-standardized questionnaire tools and electrophysiological tests that cognitive impairment, depression, autonomic dysfunction, and metabolic syndrome may occur in association with obstructive sleep apnea syndrome. METHODS: The electrophysiological examination protocol of autonomic nervous system functions was performed with sympathetic skin response and R-R Interval. Patients were administered Epworth Sleepiness Scale, Pittsburgh Sleep Quality Index, Montreal Cognitive Assessment, and Hamilton Depression Rating Scale by physicians in face-to-face interviews. RESULTS: This study included 148 participants, consisting of 73 patients and 75 controls. There was a statistically significant difference between the patient group and control group with regard to sympathetic skin response, R-R Interval, post-hyperventilation R-R Interval, and R-R Interval variation (p<0.001). A statistically significant difference was observed between the patient group and control group in terms of median Epworth Sleepiness Scale, Pittsburgh Sleep Quality Index, and Montreal Cognitive Assessment scores. It was observed that the control group achieved significantly better scores than the patient group in delayed recall (p<0.001) and language (p<0.05) categories. CONCLUSION: Obstructive sleep apnea syndrome patients should be screened for diseases, especially in the cardiovascular system, that cause serious morbidity and impair functionality such as dementia and depression. We believe that many comorbid diseases encountered in obstructive sleep apnea syndrome patients can be prevented with early diagnosis and continuous positive airway pressure treatment.

Alkaline phosphatase interference in immuno-enzymatic assays.

Background: Alkaline phosphatase (ALP) enzymes are widely used as signal amplifiers in immunoenzymatic methods. Conditions that cause ALP elevations, such as bone or liver diseases, can cause interference in immunoenzymatic methods. We aimed to examine ALP's effect on immunoenzymatic assay by adding isolated pure ALP to the prepared serum pool. Methods: We prepared a serum pool and divided it into 4 groups. By adding isolated pure ALP at different concentrations to each group, we obtained sample groups containing ALP enzyme at concentrations of 85 U/L, 340 U/L, 870 U/L, and 1570 U/L. 20-repetition of bhCG, ferritin, FT4, TSH, troponin I, and Vit B12 tests were performed in each group. The coefficient of variation, bias, and total error was calculated. All groups were compared by using the Friedman test for paired samples. Results: After ALP addition, the calculated total error values of FT4, bhCG and troponin I tests were above the acceptable error limits. There were statistically significant differences in bhCG, FT4, troponin I, and Vit B12 tests compared to the baseline ALP level (P<0.0125). Conclusions: Isolated ALP elevations can be a source of interference for immunoenzymatic methods.

Headache in idiopathic/genetic epilepsy: Cluster analysis in a large cohort.

OBJECTIVE: The link between headache and epilepsy is more prominent in patients with idiopathic/genetic epilepsy (I/GE). We aimed to investigate the prevalence of headache and to cluster patients with regard to their headache and epilepsy features. METHODS: Patients aged 6-40 years, with a definite diagnosis of I/GE, were consecutively enrolled. The patients were interviewed using standardized epilepsy and headache questionnaires, and their headache characteristics were investigated by experts in headache. Demographic and clinical variables were analyzed, and patients were clustered according to their epilepsy and headache characteristics using an unsupervised K-means algorithm. RESULTS: Among 809 patients, 508 (62.8%) reported having any type of headache; 87.4% had interictal headache, and 41.2% had migraine. Cluster analysis revealed two distinct groups for both adults and children/adolescents. In adults, subjects having a family history of headache, ≥5 headache attacks, duration of headache ≥ 24 months, headaches lasting ≥1 h, and visual analog scale scores > 5 were grouped in one cluster, and subjects with juvenile myoclonic epilepsy (JME), myoclonic seizures, and generalized tonic-clonic seizures (GTCS) were clustered in this group (Cluster 1). Self-limited epilepsy with centrotemporal spikes and epilepsy with GTCS alone were clustered in Cluster 2 with the opposite characteristics. For children/adolescents, the same features as in adult Cluster 1 were clustered in a separate group, except for the presence of JME syndrome and GTCS alone as a seizure type. Focal seizures were clustered in another group with the opposite characteristics. In the entire group, the model revealed an additional cluster, including patients with the syndrome of GTCS alone (50.51%), with ≥5 attacks, headache lasting >4 h, and throbbing headache; 65.66% of patients had a family history of headache in this third cluster (n = 99). SIGNIFICANCE: Patients with I/GE can be clustered into distinct groups according to headache features along with seizures. Our findings may help in management and planning for future studies.

Involvement of Sphingolipid Metabolism Enzymes in Resveratrol-Mediated Cytotoxicity in Philadelphia-Positive Acute Lymphoblastic Leukemia.

Targeting the key enzymes of sphingolipid metabolism including serine palmitoyltransferase (SPT), sphingosine kinase (SK) and glucosylceramide synthase (GCS) has a therapeutic importance. However, sphingolipid metabolism-mediated anti-leukemic actions of resveratrol in Philadelphia-positive acute lymphoblastic leukemia (Ph + ALL) remain unknown. Therefore, we explored potential mechanisms behind resveratrol-mediated cytotoxicity in SD1 and SUP-B15 Ph + ALL cells in the context of sphingolipid metabolism and apoptosis induction. The anti-proliferative and apoptotic effects of resveratrol alone and in combination with SPT inhibitor (myriocin), SK inhibitor (SKI II), GCS inhibitor (PDMP) were determined by MTT cell proliferation assay and flow cytometry, respectively. The effects of resveratrol on PARP cleavage, SPT, SK and GCS protein levels were investigated by Western blot. Resveratrol inhibited proliferation and triggered apoptosis via PARP activation and externalization of phosphatidylserine (PS). Resveratrol increased the expression of SPT whereas it downregulated SK and GCS. Resveratrol's combinations with SKI II and PDMP intensified its anti-leukemic activity by increasing the relocalization of PS while its combination with myriocin suppressed apoptosis. Therefore, resveratrol inhibited cell proliferation and induced apoptosis through modulating SK, GCS and SPT expression, which may be considered as novel biomarkers of resveratrol-induced cytotoxicity in Ph + ALL.

Endocan: A Novel Predictor of Endothelial Dysfunction in Silent Brain Infarction.

Silent brain infarction (SBI) has been considered as a subclinical risk factor for symptomatic possible future stroke. We investigated the association between serum inflammatory markers and SBI. Patients (n = 54) diagnosed with SBI as the study group and 52 individuals as the control group were included in this study. Silent brain infarction is defined as a hyperintense lesion that was ≥3 mm in 1 dimension on fluid-attenuated inversion recovery T2-weighted magnetic resonance image, if the patient had normal neurological examination or had an abnormality that was not consistent with the brain lesion locations, after being evaluated by a neurologist. Serum endocan levels (P = .036) and high-sensitivity C-reactive protein (hsCRP; P = .022) were significantly higher in patients with SBI than the controls. Pentraxin 3, erythrocyte sedimentation rate, white blood count, lymphocyte, monocyte, neutrophil, low-density lipoprotein, and triglyceride levels were not significantly different when comparing the groups with and without SBI. There was a significant correlation (r = -0.196; P = .16) between hsCRP and endocan levels in the SBI group. Endocan, a novel biomarker of endothelial pathology, was significantly increased in patients with SBI and may be useful to predict the future risk of stroke.

Impaired Visual Habituation in Idiopathic Generalized Epilepsy with Photosensitivity Patients.

INTRODUCTION: In this study, our goal was to analyze further the cortical excitability levels in idiopathic generalized epilepsy (IGE) patients with and without photosensitivity. METHODS: Forty-two patients (16 men and 26 women; mean age 30±8 years; range: 18-43 years) with IGE and thirty healthy age-matched control subjects (15 men and 15 women; mean age 35±3 years; range: 20-45 years) were enrolled for the investigation. We investigated the following two groups: 18 subjects with IGE with photosensitivity (IGE+PS), and 24 patients with IGE without photosensitivity (IGE-PS). Pattern reversal and potential inter-peak amplitudes, N75-P100 and P100-N145, as well as the corresponding latencies (N75, P100, and N145) for one hundred responses were measured 6 times. A linear regression slope was used for N75-P100 and P100-N145. RESULTS: Statistical analysis showed difference between groups where the IGE+PS had reduced N75-P100 compared to IGE-PS and controls. In IGE+PS group, the amplitude of N75-P100 was drastically reduced receiving antiepileptic therapy compared to those not receiving any anti-epileptic treatment (p=0.035). CONCLUSION: These results show that the IGE+PS group has a different photoparoxysmal response phenotype driven by an unknown and distinct molecular mechanism. Pre-activation cortical excitability may be increased in IGE+PS patients compared to the IGE-PS or in healthy group. PR-VEP habituation may project the pathophysiological mechanisms underlying photosensitivity and it may be potential biomarker in patients with IGE+PS.

Vitamin D Deficiency and Insufficiency According to the Current Criteria for Children: Vitamin D Status of Elementary School Children in Turkey

Objective: This study aimed to determine the ratio of seasonal vitamin D deficiency and insufficiency in elementary school children aged between 6-9 years old, living in one of the largest metropols of Europe, Istanbul. Methods: Serum 25(OH)D levels of 640 children aged 6-9 years old were scanned retrospectively from the hospital information system records between September 2017-August 2018 period. Vitamin D deficiency was defined as a serum 25(OH)D level less than 12 ng/mL (30 nmol/L) and insufficiency as levels between 12 and 20 ng/mL (30-50 nmol/L). Results: Serum 25(OH)D levels ranged from 3.90 to 64.60 ng/mL, the median value was 25.95 ng/mL for all subjects. Of all the primary school children, 485 (75.78%) had adequate levels of 25(OH)D. Vitamin D deficiency was observed in 36 of children (5.62%), whereas insufficient levels of 25(OH)D were found in 119 children (18.60%). The ratio of vitamin D insufficiency and deficiency together was highest in spring (31.87%) and lowest in summer (13.12%). Conclusion: Vitamin D deficiency is a widely observed and preventable public health problem among children of different ages. It is necessary to increase the awareness among health professionals, and providing 25(OH)D supplements will yield generations with healthy bone structure and well growth.

Is automated kinetic measurement superior to end-point for advanced oxidation protein product?

BACKGROUND: Advanced oxidation protein product (AOPP) was first described as an oxidative protein marker in chronic uremic patients and measured with a semi-automatic end-point method. Subsequently, the kinetic method was introduced for AOPP assay. We aimed to compare these two methods by adapting them to a chemistry analyzer and to investigate the correlation between AOPP and fibrinogen, the key molecule responsible for human plasma AOPP reactivity, microalbumin, and HbA1c in patients with type II diabetes mellitus (DM II). The effects of EDTA and citrate-anticogulated tubes on these two methods were incorporated into the study. METHODS: This study included 93 DM II patients (36 women, 57 men) with HbA1c levels > or = 7%, who were admitted to the diabetes and nephrology clinics. The samples were collected in EDTA and in citrate-anticoagulated tubes. Both methods were adapted to a chemistry analyzer and the samples were studied in parallel. RESULTS: In both types of samples, we found a moderate correlation between the kinetic and the endpoint methods (r = 0.611 for citrate-anticoagulated, r = 0.636 for EDTA-anticoagulated, p = 0.0001 for both). We found a moderate correlation between fibrinogen-AOPP and microalbumin-AOPP levels only in the kinetic method (r = 0.644 and 0.520 for citrate-anticoagulated; r = 0.581 and 0.490 for EDTA-anticoagulated, p = 0.0001). CONCLUSIONS: We conclude that adaptation of the end-point method to automation is more difficult and it has higher between-run CV% while application of the kinetic method is easier and it may be used in oxidative stress studies.

Evaluation of MDRD, Cockcroft-Gault, and CKD-EPI formulas in the estimated glomerular filtration rate.

BACKGROUND: The aim of this study was to compare the use of the ideal weight with the use of the patient's actual weight in the C-G (Cockcroft-Gault) formula for the measurement of the GFR (Glomerular Filtration Rate). We also aimed to compare the results of the calculations explained above with the results of the MDRD (Modification of Diet in Renal Disease) formula and CKD-EPI (Chronic Kidney Disease Epidemiology Collaboration) results of the classical 24-hour creatinine clearance method. METHODS: Creatinine clearance values, which were obtained from 24-hour urine collection, were compared with the values from the C-G formula in which each patient's ideal weight was used, with the values from the C-G for- mula in which each patient's actual body weight was used, and with the MDRD Formula and CKD-EPI. RESULTS: The correlation analysis between 24-hour creatinine clearance and the GFR obtained from the C-G formula with adjusted ideal weight in the Control group, Group I (patients with diabetes mellitus) and Group II resulted in values of r = 0.526, 0.576, and 0.850 (p < 0.0001), respectively. The correlation analysis between 24-hour creatinine clearance and the MDRD formula among the same groups resulted in r = 0.814, 0.682, and 0.861 (p < 0.0001), respectively. The correlation analysis between creatinine clearance and the CKD-EPI formula among the same groups resulted in r = 0.821, 0.679, and 0.871 (p < 0.0001), respectively. CONCLUSIONS: The results of the CKD-EPI formula were the most compatible with the results of 24-hour urine cre- atinine clearance which is used in clinical practice, especially in the control and diabetic group.

Incidence of epilepsy in a defined area of Central Anatolia, Turkey, after 15 years of age.

BACKGROUND: The aim of this study was to establish the incidence rate, incidence-related characteristics, and epidemiological profile of epilepsy in Eskisehir, Turkey. METHODS: Cases were prospectively recorded by utilizing multiple data sources, including case records obtained through the Hospital Information System, files kept by family physicians, and files kept by private neurologists. Patients diagnosed with epilepsy between July 1, 2007, and June 30, 2008, and above the age of 15 years were included in the study. RESULTS: 219 new cases were diagnosed with epilepsy. The adjusted incidence rate was 33.51/100,000 cases in males and 42.22/ 100,000 cases in females, for a total of 37.59/100,000 persons. The incidence rates according to age were found to be highest in the 15-19-year age group and in the ≥70-year age group. Partial seizures were observed more than generalized seizures after the age of 40. Unknown etiology accounted for 77.2% of the epilepsies. Stroke was the most common etiological cause of epilepsy among the symptomatic group. CONCLUSIONS: The incidence rate of epilepsy in Eskisehir was comparable with the rates reported for developed countries.