Amaç: Korona virüs hastalığı (COVID 19) 4,5 milyondan fazla insanın ölümüne sebep olmuş küresel bir halk sağlığı sorunudur. Bu çalışmada, yataklı servis ve yoğun bakım ünitesinde tedavi alan COVID-19 hastalarının tiyol ve iskemi modifiye albumin (İMA) düzeylerinin, hastaların mevcut klinik durumu ve hastalığın seyri ile olan ilişkisinin değerlendirilmesi amaçlanmıştır.
Materyal ve metod: Bu çalışmaya, PCR testi ile pozitif olduğu doğrulanmış, COVID-19 enfeksiyonu tanısı alan 300 hasta dahil edilmiştir. Hastalar tedavi edildiği birim esas alınarak iki gruba ayrılmıştır. Bu hastaların 160’ı serviste (grup 1), 140’ı yoğun bakım birimlerinde (grup 2) tedavi edilmiştir. Hastaların numunelerinde tiyol, İMA, CRP, ferritin ve lenfosit düzeylerinin ölçümü gerçekleştirilmiştir.
Bulgular: Gruplar karşılaştırıldığında grup 2’nin tiyol düzeyleri önemli derecede düşük bulunmuştur (p<0,001). Ayrıca grup 2’nin İMA düzeylerinin, grup 1’e göre anlamlı düzeyde yüksek olduğu gözlenmiştir (p<0,001). Diğer laboratuvar testleri değerlendirildiğinde, grup 2’nin CRP ve ferritin düzeyi yüksek (p<0,001), lenfosit sayısı ise düşük (p<0,001) olarak belirlenmiştir. Tiyol düzeyleri ile CRP, ferritin, lenfosit ve İMA düzeyleri arasında anlamlı korelasyon saptanmıştır (sırasıyla r=-0,58; p<0,001, r=-0,41; p<0,001, r=-0,32; p<0,001, r=-0,39; p<0,001 ). Ayrıca İMA düzeyleri ile CRP, ferritin, lenfosit ve tiyol düzeyleri arasında anlamlı korelasyon gözlenmiştir (sırasıyla r=0,19; p=0,02, r=0,18; p=0,043, r=-0,15; p=0,047, r=-0,39; p<0,001).
Sonuç: COVID-19 hastalarında güçlü bir antioksidan olan tiyol düzeyinin azalması, oksidatif strese sebep olan mevcut inflamatuvar süreçten kaynaklanmakla beraber tromboza sekonder gelişen iskemik şartlara bağlı oksidatif stresin etkisi ile de ortaya çıkmış olabileceğini düşündürmektedir. Dolayısıyla inflamatuvar sürecin ve trombotik olayların daha şiddetli olarak gözlendiği yoğun bakım hastalarında İMA düzeylerinin artması, tiyol düzeylerinin azalmasını destekleyecek niteliktedir. Sonuç olarak yataklı serviste ve yoğun bakım ünitesinde tedavisi gerçekleştirilen COVID-19 hastalarının tiyol ve İMA düzeylerinin belirlenmesi, hastaların mevcut klinik durumu ve hastalığın seyri hakkında yardımcı olabilecek bir potansiyele sahip olduğunu düşündürmektedir.
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Background and Aims: In this study, we investigated the usefulness ofthe ascites sodium level for prognostic purposes and its association with2-year mortality, spontaneous bacterial peritonitis, hepatic encephalopathy, and hepatorenal syndrome. Material and Methods: This study wasperformed between July and October 2018 in patients with liver cirrhosis in whom the ascites sodium level was studied. Patients with severeheart failure, nephrotic syndrome, or electrolyte disturbance; patientswho had spontaneous bacterial peritonitis, hepatic encephalopathy orhepatorenal syndrome at admission; and patients who used diureticsfor another reason were excluded from the study. Results: The studypopulation consisted of 72 cirrhotic patients [32 females (44.4%) and 40males (55.6%)]. The patients were followed up for 2 years, and mortalitydeveloped in 33 patients (45.8%). During follow-up, hepatic encephalopathy developed in 13 patients (18.1%), hepatorenal syndrome in 13patients (18.1%), and spontaneous bacterial peritonitis in 32 patients(44.4%). Hepatic encephalopathy, hepatorenal syndrome, and the spontaneous bacterial peritonitis ratio were higher in the deep hyponatremiagroup compared with other hyponatremia groups (p < 0.05). The meanChild-Pugh and Model for End-Stage Liver Disease-Na scores were similarin the moderate and deep hyponatremia groups, and they were higherthan in the other groups (p < 0.05). The mortality rate was found to behigher in the deep hyponatremia group than in the other hyponatremiagroups (p < 0.05). Hyponatremia in ascites was found to be an independent predictor of mortality, and patients in the deep hyponatremiagroup had a 29.55-fold increased risk of mortality compared with thosepatients without hyponatremia. Conclusion: In this study, it was shownthat deep hyponatremia less than 125 mEq/L in ascites was associatedwith increased cirrhotic complications and mortality
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İSHAK ŞAN ,
Emin GEMCİOĞLU ,
Mehmet DAVUTOĞLU ,
Ramis ÇATALBAŞ ,
Berkan KARABUĞA ,
Enes KAPTAN ,
ABDULSAMET ERDEN ,
Orhan KÜÇÜKŞAHİN ,
İhsan ATEŞ ,
Selma KARAAHMETOĞLU ,
İmran HASANOĞLU ,
Osman İNAN ,
Büşra Nur ÜNAL ,
Ecem ERDEMİR ,
Fatih KAHRAMAN ,
Rahmet GÜNER
Background/aim: Coronavirus 2019 disease (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), is a pandemic infectious disease that causes morbidity and mortality. As a result of high mortality rate among the severe COVID-19 patients, the early detection of the disease stage and early effective interventions are very important in reducing mortality. Hence, it is important to differentiate severe and nonsevere cases from each other. To date, there are no proven diagnostic or prognostic parameters that can be used in this manner. Due to the expensive and not easily accessible tests that are performed for COVID-19, researchers are investigating some parameters that can be easily used. In some recent studies, hematological parameters have been evaluated to see if they can be used as predictive parameters. Materials and methods: In the current study, almost all hematological parameters were used, including the neutrophil/lymphocyte ratio, platelet/lymphocyte ratio, monocyte/lymphocyte ratio, mean platelet volume to lymphocyte ratio, mean platelet volume to platelet ratio, plateletcrit, and D-dimer/fibrinogen ratio, neutrophil/lymphocyte/platelet scoring system, and systemic immune-inflammation index. A total of 750 patients, who were admitted to Ankara City Hospital due to COVID-19, were evaluated in this study. The patients were classified into 2 groups according to their diagnosis (confirmed or probable) and into 2 groups according to the stage of the disease (nonsevere or severe). Results: The values of the combinations of inflammatory markers and other hematological parameters in all of the patients with severe COVID-19 were calculated, and the predicted values of these parameters were compared. According to results of the study, nearly all of the hematological parameters could be used as potential diagnostic biomarkers for subsequent analysis, because the area under the curve (AUC) was higher than 0.50, especially for the DFR and NLR, which had the highest AUC among the parameters. Conclusion: Our findings indicate that, the parameters those enhanced from complete blood count, which is a simple laboratory test, can help to identify and classify COVID-19 patients into non-severe to severe groups. Key words: COVID-19, SARS-CoV-2, hematological tests, predictive values of tests
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Background/aim: Thiol status is a good reflector of the cellular redox and have vital roles in various cellular signaling pathways. The purpose of the study was to investigate thiol status in patients with SARS-CoV-2 infection. Materials and methods: A total of 587 subjects (517 patients/70 healthy controls) were enrolled in the study.The patients were categorized into the groups regarding to the severity of disease (mild, moderate, severe, and critical).Thiol status of all groups were compared. Results: The patients had significantly diminished thiol levels compared to controls. Thiol levels were gradually decreased as the severity of the disease increased. Logistic regression analyses identified that thiol concentrations were an independent risk factor for the disease severity in each phase (mild group OR 0.975, 95%CI 0.965-0.986; moderate group, OR 0.964, 95%CI 0.953-0.976; severe group OR 0.953, 95%CI 0.941-0.965; critical group OR 0.947, 95%CI 0.935-0.960).Thiol test exhibited the largest area under the curve at 0.949, with the highest sensitivity (98.6%) and specificity (80.4%). Conclusions: Depleted thiol status was observed in SARS-CoV-2 infection. Decline of the thiol levels by degrees while the severity of infection increased was closely related to the progression of the disease. This outcome highlights that thiols could be an impressible biomarker for predicting of the severity of COVID-19. Key words: COVID-19, inflammation, immune response, severity, thiol
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