Leucocyte volume, conductivity, and scatter at presentation in COVID-19 patients.

Background: In COVID-19 patients, besides changes in leucocyte count, morphological abnormalities of circulating blood cells have been reported. Aim: This study aims to investigate the relationship between the morphological and functional properties of leucocytes and the severity of the disease in COVID-19 patients. Materials and Methods: Blood samples were collected from COVID-19 patients (n = 130) at the time of admission. The patients were stratified according to the comorbidity, age, LDH, lymhocyte count score as mild, moderate, and severe. Complete blood count and the cell population data were analyzed by the Volume, conductivity, scatter (VCS) technology on Beckman Coulter LH-780 hematology analyzer. Kruskal-Wal'lis test was used to assess the differences between the groups with subsequent Bonferroni correction. Results: Neutrophil count was increased, and lymphocyte count was decreased in severe patients compared to mild patients. The increase in the percent of neutrophils and the neutrophil/lymphocyte ratio in the severe patient group was significant in comparison to both the moderate and the mild group. The dispersion of the neutrophil volume and conductivity showed significant changes depending on the severity of the disease. The lymphocyte volume, lymphocyte-volume-SD and lymphocyte-conductivity as well as the monocyte-volume and monocyte-volume-SD were significantly increased in severe patients in comparison to mild patients. The increase of lymphocyte and monocyte volume in severe patients was also significant in comparison to moderate patients. Conclusions: COVID-19 infection leads to important changes in cell population data of leucocytes. The volumetric changes in lymphocytes and monocytes are related to the severity of the disease.

Minimally Invasive Approach to Ureteral Stricture in Transplant Kidney by Periodic Retrograde Ureteral Stent Placement and Exchange.

PURPOSE: The aim of the study was to evaluate the effectiveness of minimally invasive treatment of ureteral strictures and describe the technique that we used for retrograde placement of ureteral stent in transplant kidneys. MATERIAL AND METHODS: We reviewed the medical cards of all transplant kidney patients with persistent ureteral strictures who were managed with periodical ureteral stent placement and balloon dilatation between 2008 and 2016. Different maneuvers that were used to overcome the difficulties for retrograde ureteral stent placement and exchange were discussed. Clinical characteristics and treatment outcomes of the study cohort were analyzed. RESULTS: Between 2008 and 2016, a total of 1026 transplantations were performed in our clinic, and ureteral stricture was found in 13 patients (1.26%). Of the 13 patients, 8 were treated with periodic ureteral stent insertion and balloon dilatation. Ureteral stent insertion or stent exchange was performed in 52 transplant renal units. The overall success rate of retrograde ureteral stent insertion at the first attempt was 75% and stent exchange success rate was 100%. Renal function remained stable in all patients during a median follow-up of 41 months (range, 13-60 months). No other local or systemic complication was encountered and no stent encrustation was noted. CONCLUSIONS: Endoscopic management of ureteral stricture by periodical retrograde ureteral stent replacement and balloon dilatation is safe, effective, and highly successful in transplant patients who are not eligible for open reconstructive surgery.

Could "red cell distribution width" predict COPD severity?

BACKGROUND AND OBJECTIVES: Erythrocyte morphology changes not only by primary hematological diseases but also by systemic inflammation, ineffective erythropoiesis and nutritional deficiencies. Red blood cell distribution width (RDW) is a parameter reflecting erythrocyte morphology. We aimed to investigate the relationship of RDW with chronic obstructive pulmonary disease (COPD) stages, BODE index and survival in COPD patients. METHODS: Medical records of 385 COPD patients between July 2004 and November 2005 were studied retrospectively. Demographic features, BODE index factors and oxygen saturation were recorded. Survival analysis of all patients by 2014 was performed. Measured RDW values at the time of the inclusion were evaluated. RESULTS: Mean age of the patients was 65.6±9.6 years. Distribution of the COPD stages of the patients were stage 1: 16%, stage 2: 52%, stage 3: 26%, stage 4: 6%. RDW was found significantly different between stages. The highest RDW was observed in the very severe stage (p<0.001). Median of BODE index was 1 (0-3). As the BODE index increased RDW also increased (p<0.001). When the patients were grouped according to the laboratory upper limit of RDW, survival rate was 31% in the RDW >14.3% group and 75% in the RDW <14.3% group. CONCLUSION: The variability in the size of circulating erythrocytes increases as the COPD severity progresses. Therefore, a simple and noninvasive test, such as RDW, might be used as a biomarker in the evaluation of the severity of COPD. At the same time, there seems to be a correlation between the survival of COPD patients and RDW.

Flexible Ureterorenoscopy and Laser Lithotripsy for the Treatment of Allograft Kidney Lithiasis.

OBJECTIVE: To evaluate the safety and effectiveness of flexible ureterorenoscopy (F-URS) and laser lithotripsy for the treatment of allograft kidney lithiasis. PATIENTS AND METHODS: In a retrospective analysis of 897 consecutive renal transplantations that were performed at our center between February 2008 and December 2014, 6 patients were found to have allograft lithiasis. F-URS and laser lithotripsy were performed 6 times on 5 patients (twice for 1 patient who had stone recurrence after 6 months). Percutaneous nephrolithotomy was used for the remaining patient. Patient demographics and stone characteristics (age, sex, stone size, stone analysis, location, history of shockwave lithotripsy) and perioperative measures (duration of operation, fluoroscopic imaging, success and complication rates) were reviewed. In addition, the technical difficulties of standard F-URS procedures in transplanted kidneys were reviewed and some facilitative techniques were defined to increase the success rate. RESULTS: A total of 5 patients underwent 6 F-URS procedures and laser lithotripsy operations for renal graft lithiasis. The mean stone size was 9.2 mm (7.5-11 mm). The mean operation and fluoroscopy times were calculated as 55 minutes (40-70 minutes) and 57.5 seconds (40-80 seconds), respectively. Treatment was successful in all patients and no severe complications or mortality occurred. One patient experienced transient hematuria and recovered within 36 hours. CONCLUSION: F-URS is a safe, effective, and minimally invasive treatment modality for small- and medium-sized stones in allograft kidney lithiasis.

Comparison of serum creatinine and spot urine interleukin-18 levels following radiocontrast administration.

Radiocontrast administration is an important cause of acute renal failure. In this study, compared the plasma creatinine levels with spot urine IL-18 levels following radiocontrast administration. Twenty patients (11 males, 9 females) underwent radiocontrast diagnostic and therapeutic-enhanced examinations. The RIN Mehran risk score was low (≤5). The radiocontrast agents used were 623 mg/mL Iopromid (1.5 mL/kg), and 100 mL of 650 mg/mL meglumine diatrizoate as three-way oral and rectal contrast material for abdominal computed tomography (CT) scans. Serum blood urea nitrogen, creatinine, Na, K, Cl, Ca, P, creatinine clearance, and spot urine IL-18 levels were analyzed before and repeated at 24, 48, and 72 h after radiocontrast administration. Six and 24-h urinary IL-18 levels were measured with a human IL-18 ELISA kit following radiocontrast administration. An increase in plasma creatinine 24 and 48 h following radiocontrast administration was observed compared with precontrast values, but it was not statistically significant (P=0.052 and P=0.285, respectively). A statistically significant increase in IL-18 levels was observed at 6 and 24 h, compared with precontrast values (P=0.048 and P=0.028, respectively). A tendency for postcontrast 24-h urinary IL-18 levels to increase was observed compared with 6 h, but the increase was not statistically significant (P=0.808). Our results show that plasma creatinine starts to increase at 24(th) hour; however, spot urine IL-18 levels go up at 6(th) hour following radiocontrast administration implying urine IL-18 to be an earlier parameter for kidney injury.

The clinical significance of parathyroid tissue calcium sensing receptor gene polymorphisms and expression levels in end-stage renal disease patients.

BACKGROUND: The calcium sending receptor (CaSR) allows parathyroid and kidney tubular cells to regulate PTH secretion and tubular calcium reabsorption. In the present report, we examined the relationship between CaSR gene polymorphisms and parathyroid CaSR expression and serum calcium/parathyroid hormone (PTH) levels and clinical progress in ESRD patients in the Turkish population. METHODS: We genotyped the CaSR R990G and Q1011E variants in 192 end-stage renal disease (ESRD) patients by allele-specific PCR. CaSR expression in parathyroid tissues of operated 33 patients was quantified with quantitative reverse transcription-PCR. RESULTS: Compared with other genotypes, the ratio of both codon 990-AA and 1011-CC polymorphisms was found higher in operated patients (p = 0.001). In the total patient group PTH levels were found higher in patients with CC1011 genotype than those with CG1011 (1015.15 +/- 925.41 pg/ml; 523.84 +/- 544.6 pg/ml, respectively, p = 0.002). There were statistically important higher Ca2+ levels in the AA990 allele carrying cases than AG990 positive ones (9.3 +/- 1.0 mg/dl vs. 8.8 +/- 0.9, p = 0.006). On the other hand, the expression of CaSR in parathyroid tissue was found inversely proportional with serum PTH level (r = -0.71). CONCLUSION: Present data suggest that co-presence of CaSR gene AA990 and CC1011 alleles is a possible risk factor for bad prognosis in secondary hyperparathyroidism. Patients carrying this genotype have tendency to require operation early in their medical therapy period and need postoperative close follow up for possible recurrences.

Outcome of renal allograft in Turkish patients with pretransplantation hepatitis C virus infection.

BACKGROUND: The aim of the present study was to investigate the impact of hepatitis C virus (HCV) infection on the long-term survival of renal transplant recipients. METHODS: Outcomes and survivals among 325 patients who received renal allografts from July 1991 to September 2005 were compared between those known to have pretransplantation HCV infection (Group I, HCV+ group, n = 33) versus a matched cohort of those without this infection (Group II, HCV- control group, n = 33). Allograft performance, liver function, cholesterol, and glucose levels were determined both at transplantation and at a mean of postgrafting year 8. A one-way analysis of variance (ANOVA) statistical method was used for multivariate analysis. RESULTS: Thirty-three patients (10.15%, 19 women and 14 men) were positive for HCV antibody. The mean follow-up period was 8 years (range, 0.5-14 years). The mean survival rates were similar in Groups I and II (96.6% and, 100%, respectively). Although the allograft survival rate was lower in Group I (84.8% vs 90.9%), the rejection rate among the HCV- group was 6%; only 1 patient died of hepatic failure. In spite of a significant rise in both total and direct bilirubin values (P < .01) in both groups, we failed to observe an adverse effect on graft survival. A significant rise in the fasting glucose level was seen in both HCV+ and HCV- patients. CONCLUSIONS: Chronic HCV infection before transplantation did not have a significant impact on graft survival or mortality compared with noninfected patients.

Airway disease risk from environmental tobacco smoke among coffeehouse workers in Turkey.

OBJECTIVES: To examine the effect of ETS exposure on respiratory symptoms and pulmonary function and to compare workers in coffeehouses to those in other occupations in order to assess the risk of respiratory illness in this occupation. DESIGN: Cross sectional study. SETTING: The study area consisted of the three metropolitan districts of the city of Izmir, Turkey. 86 coffeehouses and 80 other small scale shops which had no known respiratory risk factor, located in the same area, were taken as the study group. SUBJECTS: 207 workers were assessed. MAIN OUTCOME MEASUREMENTS: Subjects answered a questionnaire about demographic and working characteristics, respiratory symptoms, and smoking behaviour. Physical examinations and spirometric measurements were carried out at the workplaces. RESULTS: There was a significant increase in respiratory symptoms in coffeehouse workers. Working in a coffeehouse showed a significant risk for chronic bronchitis (odds ratio (OR) 4.3). In coffeehouse workers, forced expiratory volume in one second (FEV(1)) decreased 5.1%, forced vital capacity (FVC) 3.4%, FEV(1)/FVC 1.6%, peak expiratory flow (PEF) 6.45%, and forced expiratory flow (FEF(25)) 7.2%, FEF(50) 10%, and FEF(25-75) 9.8%. Among workers who were described as having an "airway disease", coffeehouse workers were significantly greater in number. When age, body mass index, and smoking behaviour were controlled, working in a coffeehouse was strongly associated with "airway disease" compared to other workers (OR 5.35, 95% confidence interval 2.41 to 11.87). CONCLUSIONS: Workers in coffeehouses showed significant increases in respiratory symptoms and decreased pulmonary function. All workers need to gain an awareness of these occupational risks and working conditions should be improved immediately.

Withdrawal of inhaled corticosteroid therapy in long-term, stable, mild to moderate, persistent asthmatic patients.

We aimed to evaluate the effect of withdrawal of inhaled corticosteroid (ICS) therapy on the course of mild to moderate asthma. Nineteen cases with stable, mild to moderate asthma were included in this study. Patients had used ICSs regularly during the past year and had no symptoms and signs for the last 3 months prior to the study. The patients were randomized into two groups. Group 1 included 11 patients who were followed after withdrawal of ICS therapy (mean age 48.8 +/- 13.1 years; M/F: 2/9), while Group 2 included 8 patients still taking ICS therapy (mean age 47.2 +/- 14.8 years; M/F: 4/4). All subjects were seen at the end of the 1st (V2), 2nd (V3), 3rd (V4), 6th (V5), and 12th (V6) months. Symptom scores and FEV1 measurements were evaluated during these visits. Patients with relapses were excluded from the study. Bronchial challenge test was applied in all cases at V0, V4, V5, and V6. In 10 of 11 cases (90.9%) in which ICS therapy was discontinued, relapse was observed in 1.55 +/- 0.86 months, while in 2 of 8 subjects (25%) still taking ICSs, relapse occurred after 3.76 +/- 1.99 months. In Group 1, "mean symptom score" and "mean PC20FEV1" values measured during the whole follow-up period were found to be lower than in Group 2. We concluded that withdrawal of ICS therapy could increase the possibility of relapse in mild to moderate asthma even in asymptomatic and stable cases.

Prevalence of byssinosis and respiratory symptoms among cotton mill workers.

BACKGROUND: While the prevalence of byssinosis is decreasing in industrialized countries and persists at high levels in developing countries, this prevalence is remaining constant in Turkey. OBJECTIVE: In order to determine the effects of past cotton dust exposure on the respiratory tract, a total of 223 persons working in a cotton mill were included in this study. METHODS: A questionnaire was used to inquire about respiratory symptoms. Participants underwent several spirometric measurements, which were performed on the 1st, 3rd and 5th day of the working week. Cotton dust measurements were performed in different divisions of the factory. RESULTS: The most common respiratory symptom was chest tightness (20.3%). The prevalence of byssinosis was 14.2% in cotton-processing workers. Among these cases, 28.6% had symptoms on the 1st day of the week, and 71.4% had symptoms on all days of the week. An acute effect was seen in 53.6% of the workers with byssinosis. Mean respirable dust levels were between 0.095 and 0.413 mg/m(3). CONCLUSIONS: In spite of technological improvements, respirable dust concentrations are still above the permissible limits, and thus the risk of byssinosis remains. Workers in the cotton industry where obsolete technology is used and standardized protection measures are not applied should be followed for byssinosis.

CT and MRI appearance of a fistula between the right and left main bronchus caused by tracheobronchial tuberculosis.

Tuberculosis of the trachea and main bronchi is a relatively rare disease seen predominantly in elderly patients. We present a case of a fistula between the right and left main bronchus owing to tuberculosis. We describe the CT and MRI appearances.

Attitudes of medical faculty physicians about taking occupational history.

OBJECTIVES: To evaluate occupational history taking, as a detailed occupational history is the most effective means for proper diagnosis of occupational illness. METHODS: In order to determine the attitudes of 66 physicians working in Dokuz Eylül Medical Faculty Hospital about taking occupational history, 269 patient records were examined. RESULTS: It was detected that 43.9% of physicians took no occupational history from any of their patients. Occupational history was obtained from 81.8% of the patients in clinics where standard examination forms were in regular use. CONCLUSION: We found that physicians were not in the habit of taking occupational histories.