Editorial

INTRODUCTION: Hypercholesterolemia is a serious health concern throughout the world. It is the key risk factor for cardiovascular disease (CVD). The aim of this study was to investigate the antihypercholesterolemic potential of fraxetin on hypercholesterolemic rats given a high-fat diet (HFD).
METHODS: A total of 24 male albino Wistar rats weighing 180-200 g were used in this study and were divided into 4 groups: Control (Group 1), hypercholesterolemia-induced (Group 2), hypercholesterolemia-induced and treated with fraxetin (75 mg/kg) (Group 3), and hypercholesterolemia-induced and treated with simvastatin (10 mg/kg) (Group 4). The plasma lipid profile, status of enzymatic and non enzymatic antioxidants, and the levels of oxidative stress markers of all groups were analyzed.
RESULTS: The plasma level of total cholesterol, triglycerides, very low-density lipoprotein, and low-density lipoprotein cholesterol were significantly increased, and the level of high-density lipoprotein cholesterol was significantly decreased in the hypercholesterolemic rats in comparison with the normal, control rats. Oral administration of fraxetin significantly (p<0.05) reversed these altered parameters to near-normal levels. In addition, fraxetin treatment significantly (p<0.05) increased the status of antioxidants with a concomitant reduction in oxidative stress markers. Oil red O staining of the thoracic aorta revealed widespread deposition of lipid droplets in the hypercholesterolemic rats (Group 2), whereas the hypercholesterolemic rats treated with fraxetin or simvastatin showed only scattered droplets of fat. The effect of fraxetin on various biochemical parameters was comparable to that of simvastatin.
DISCUSSION AND CONCLUSION: The results of this study indicated that the lipid-lowering potential of fraxetin at the dosage of 75 mg/kg was comparable to that of the antihypercholesterolemic drug simvastatin. Further studies on the molecular mechanism of action of fraxetin are warranted and in progress in our laboratory at the time of writing.

INTRODUCTION: Early diagnosis and treatment of oncological disease is extremely important and tumor marker tests are a valuable tool; however, requests for testing should not be used in excess or without sufficient cause. The aim of this study was to analyze and evaluate the appropriateness of requests for tumor marker tests at a single hospital.
METHODS: Tumor marker tests for carcinoembryonic antigen (CEA), cancer antigen (CA) 15-3, CA 19-9, and CA 125 performed by a single biochemistry laboratory between January 1, 2018 and December 31, 2019 were assessed retrospectively. These tumor markers can be used for screening, diagnostic confirmation, estimating prognosis, and monitoring for recurrence. The departments of internal medicine, gastroenterology, endocrine diseases, chest diseases, general surgery, gynecology and obstetrics, and medical oncology were the most common sources of the requests.
RESULTS: There were 1420 (40%) requests for CEA, 671 (19%) for CA15-3, 868 (25%) for CA 19-9, and 585 (16%) for CA 125 during the study period. A significant difference based on gender was determined in requests for CEA and CA 125 (p<0.001 and p=0.033, respectively). In all, 312 (22%) of requests for CEA markers, 202 (30.1%) for CA 15-3, 204 (23.5%) for CA 19-9, and 113 (19.3%) for CA 125 requests were above the reference range. Significant positive correlations were determined between age and CEA, CA 15-3, and CA 19-9 tumor markers (r=0.262, p<0.001; r=0.096, p=0.013; r=0.090, p=0.008, respectively). The preliminary diagnoses supporting the requests included non-specific pain, acute vaginitis, anemia, anxiety disorder, dyspepsia, neoplasia, and thyroid disorder.
DISCUSSION AND CONCLUSION: The results of this study suggest that outpatient clinics made an excessive number of tumor marker requests inconsistent with the preliminary diagnosis. Overutilization of laboratory testing incurs significant costs and affects workload, and may also have other potentially adverse effects on patient care.

INTRODUCTION: Type 2 diabetes mellitus (T2DM), also known as adult-onset diabetes, is caused by insulin resistance or insufficient insulin production. Impaired glucose tolerance (IGT) and impaired fasting glucose (IFG) indicate blood glucose levels that are higher than normal but not enough to be diagnosed as diabetes. An oral glucose tolerance test (OGTT) and the fasting blood glucose (FBG) level, respectively, are used to determine these 2 prediabetic groups. Oxidative stress is the common pathogenic factor leading to insulin resistance, β-cell dysfunction, IGT, and ultimately to T2DM. This study is an evaluation of the concentration of antioxidant and oxidant parameters of total oxidative status (TOS) and total antioxidant status (TAS) as well as paraoxonase-1 (PON1), and ischemia-modified albumin (IMA) in diabetic and prediabetic patients, and a normoglycemic control group.
METHODS: Serum TAS, TOS, PON1, IMA were measured in a total of 117 prediabetic, diabetic, and normoglycemic individuals.
RESULTS: The TAS was lower in the IGT patient group (2.41±0.2 mmol Trolox Eqv/L) than in the IFG group (2.52±0.18 mmol Trolox Eqv/L) and the normoglycemic control group (2.52±0.18 mmol Trolox Eqv/L) (p=0.03 and p=0.006, respectively). The serum IMA level was found to be significantly different between the T2DM patients (0.70±0.11 ABSU) and the IGT patients (0.77±0.14 ABSU) (p=0.045). There was also a significiant difference in the IMA level between the IGT patients (0.77±0.14 ABSU) and the IFG patients (0.68±0.13 ABSU) (p=0.037).
DISCUSSION AND CONCLUSION: The high IMA and low TAS levels in the IGT patient group may have been a result of the high-glucose solution administered in the OGTT causing an increase in reactive oxygen species synthesis. TAS synthesis may not be sufficient to compensate for this rapid increase in blood glucose.

INTRODUCTION: The aim of this study was to evaluate the effect of an autoverification process on test turnaround time (TAT), sample rejection rate, and the sample test repetition rate.
METHODS: The study was carried out in the core laboratory of İstanbul Kanuni Sultan Suleyman Training and Research Hospital. Sysmex XN9000 series middleware (Sysmex Corp., Kobe, Japan) was used to perform the autoverification. The rate of test rejection, test repetition, and TAT of the 3 months preceding use of autoverification were compared with those of a 3-month period following initiation of use of the Sysmex hematology analyzer autoverification process.
RESULTS: A total of 612,639 test results of complete blood count profiles performed between January 2019 and March 2019 were collected to determine the distribution intervals. The sample rejection and test repetition rates and the TAT were significantly reduced (21.18%, 49.62%, and 23.9%, respectively) after implementation of the new analyzer. Reflex testing rates, such as peripheral smear and reticulocyte count, were significantly increased.


DISCUSSION AND CONCLUSION: Autoverification improved laboratory performance parameters. The hematology lab workflow benefitted, and the system decreased the sample rejection and test repetition rate, which reduces extra costs like tubes wasted, time spent, and most importantly, an unproductive patient blood draw. Autoverification tools should be considered in healthcare management.

INTRODUCTION: Glycated hemoglobin (HbA1c) is routinely utilized to monitor long-term glycemic control. The presence of hemoglobin (Hb) variants may lead to a false HbA1c measurement. This study was an investigation of the effects of both common and rare Hb variants on the level of HbA1c measured with high-performance liquid chromatography (HPLC).
METHODS: The HbA1c level of a total of 391 patients without Hb variants (HbAA, n=44) and with Hb variants (HbAS, HbSS, HbSS(A), HbSS(F), HbAD, HbAE, HbAF, HbD-Iran/D-Iran, HbD-Los Angeles/A, HbE-Saskatoon/E-Saskatoon, HbEE, HbG-Coushatta/A, HbOArab/OArab, HbSE, and Hb Stanleyville II, n=347) was measured using an HPLC analyzer.
RESULTS: The HbA1c level of all of the Hb variants but HbStanleyville II and HbG-Coushatta/A was extremely low. However, when the Hb variants were considered as a single group, a statistically significant difference was seen in comparison with the group that had no Hb variants (p<0.001).
DISCUSSION AND CONCLUSION: It was determined that the measurement of HbA1c can be adversely influenced by the presence of some Hb variants. Hemoglobin variants should be investigated when the HbA1c level is incompatible with blood glucose.

INTRODUCTION: Vitamin D level has been associated with mortality and length of hospitalization (LOH) in critically ill patients in the intensive care unit (ICU). This study is an investigation of the vitamin D level of patients in a neurology ICU, the LOH in the ICU, bacterial growth observed in a hemoculture, and mortality.
METHODS: Eighty-four patients whose vitamin D level was measured at the time of admission to the ICU and 85 controls were enrolled in the study. Details of the reason for hospitalization, additional diseases, LOH, the presence of bacterial development in a hemoculture during hospitalization, and 30-day and 90-day mortality after diagnosis were recorded and analyzed.
RESULTS: The mean vitamin D value was 20.29±12.82 ng/mL in the control group, while it was 12.72±9.48 ng/mL in the patient group, which was significantly lower (p<0.001). The mean vitamin D level (12.36±8.85 ng/mL) in hospitalized patients with an ischemic cardiovascular event (CVE) was lower than that of the hemorrhagic CVE group (16.69±12.75 ng/mL). There was no statistically significant difference between 30-day and 90-day mortality according to the vitamin D group (p≥0.05); however, those with an adequate vitamin D level had a lower 90-day mortality. The vitamin D level of patients who died in the non-CVE group was significantly lower at 90 days compared with that of survivors (p<0.024).
DISCUSSION AND CONCLUSION: The results indicated that vitamin D may be associated with etiology in ischemic CVEs and may have a relationship to prognosis in cases of infection or immunological events. A sufficient level of vitamin D may reduce the risk of ischemic CVE in older age and contribute to a life with fewer comorbidities.

INTRODUCTION: The aim of this study was to investigate the serum concentration of vitamin D in patients with obstructive sleep apnea syndrome (OSAS) alone and with coexisting fibromyalgia syndrome (FMS) and to assess the relationship to pain.
METHODS: A total of 60 patients diagnosed with OSAS and 40 healthy individuals whose age and sex were analogous to the patient group were included in this study. The OSAS patients were examined for FMS according to the American College of Rheumatology criteria, and 27 cases were identified. Group 1 consisted of patients with OSAS alone (n=33) and Group 2 comprised patients with FMS+OSAS (n=27). Serum samples were analyzed using an ultra-performance liquid chromatography analyzer (Thermo Dionex Ultimate 3000; Thermo Fisher Scientific, Inc., Waltham, MA, USA).
RESULTS: A comparison of the OSAS and FMS+OSAS groups with the healthy individuals revealed that the vitamin D level was significantly lower in the patient groups (Group 1: p=0.001, Group 2: p=0.038). No statistically significant difference was found in the vitamin D level between the subgroups of OSAS and FMS+OSAS. A weak negative correlation was determined between the number of the tender points (r=-0.428) and the vitamin D level in the subjects with FMS (p=0.013). In addition, the oxygen desaturation values of the FMS+OSAS and OSAS patient groups were significantly different (p=0.001).
DISCUSSION AND CONCLUSION: Patients with OSAS and FMS+OSAS had a low vitamin D level, which should be considered when planning treatment strategies.

INTRODUCTION: The aim of this study was to investigate the effect of chemical changes in the follicular fluid and histological changes in the cumulus cells of the oocyte microenvironment on the number of oocytes in infertile patients.
METHODS: A total of 50 female patients aged 18-35 who presented at the Atatürk University Research Hospital Infertility Clinic and for infertility treatment were included. The patients were divided into 3 groups: Patients with fewer than 5 oocytes were classified as Group 1, patients with 5-20 oocytes comprised Group 2, and Group 3 was made up of patients with >20 oocytes. During the oocyte collection process, follicular fluid was aspirated from the follicles and the cumulus cells were collected. The follicular fluid was stored at -80°C for use in biochemical analysis of malondialdehyde (MDA), total antioxidant status (TAS), total oxidant status (TOS), superoxide dismutase (SOD), glutathione (GSH). Immunohistochemical staining was performed to examine caspase-3 and mechanistic target of rapamycin (mTOR) immunoreactivity at the stereological level.
RESULTS: The MDA level and total oxidant capacity (TOC) in the follicular fluid were higher in Group 1 patients than in the other 2 groups, while the SOD was lower (p<0.05). In Group 2 patients, the MDA level and TOS were higher than those of Group 3, while the SOD level was lower (p<0.05). The total antioxidant capacity (TAC) and GSH levels did not vary significantly according to the number of oocytes (p<0.05). Immunohistochemical staining showed that mTOR and caspase-3 immunoreactivity were more intense in Group 1 than in the other groups.
DISCUSSION AND CONCLUSION: The increase in mTOR expression may activate the caspase-3 pathway, which could lead to oxidative stress. The mTOR pathway may affect the oocyte count.

INTRODUCTION: In recent years, cannabinoids have been shown to have beneficial effects on diabetic vascular complications. Vascular complications due to fructose-induced hyperinsulinemia (HI) and diabetic vascular complications have similar mechanisms. The aim of this experimental study was to observe whether the cannabinoid agonist delta-9-tetrahydrocannabinol (THC) has an ameliorating effect on fructose-induced HI and vascular responses in the aortic ring of rats with HI.
METHODS: A total of 24 rats were categorized into 4 groups: control (standard food pellets and water), HI (water containing 10% fructose provided for 12 weeks), THC (1.5 mg/kg/day intraperitoneal administration for 4 weeks), and THC+HI. Body weight was measured again on the last day of the study and the serum insulin level was measured with an enzyme-linked immunosorbent assay. The acetylcholine (ACh) maximum relaxant effect in aortic rings pre-contracted with noradrenaline (NA) was evaluated.
RESULTS: The body weight of THC and THC+HI groups was lower compared with that of the controls (p<0.01). Increased insulin level as a result of fructose consumption decreased with THC administration (p<0.01) while the glucose level increased in all other groups compared with the control group (p<0.01, p<0.05). The NA Emax value decreased in the group receiving THC treatment (p<0.01). The increased ACh pD2 value in the HI groups also decreased in the THC treatment group (p<0.0001). The decreased maximum inhibition value in the HI group increased significantly with THC administration (p<0.001).
DISCUSSION AND CONCLUSION: THC demonstrated beneficial effects on fructose-induced HI. THC improved ACh-induced endothelialdependent relaxation in HI rat aortic rings.

This report describes the case of a patient with ethylenediaminetetraacetic acid- (EDTA) and citrate-dependent pseudothrombocytopenia (PTCP). An EDTA tube (BD Vacutainer K2 EDTA; Becton, Dickinson and Company, Franklin Lakes, NJ, USA) platelet count indicated thrombocytopenia (15x109/L and 8x109/L), which was inconsistent with his clinical condition, and prompted further investigation. A repeat sample was drawn into both EDTA tubes and tubes containing 3.2% sodium citrate 9NC coagulation sodium citrate 3.2%, 3.5 mL, Vacuette®, (Greiner Bio-One International GmbH, Kremsmunster, Austria) and immediately measured in the laboratory. The platelet count was 157x109/L and 171x109/L in the EDTA and citrated samples, respectively. Simultaneous peripheral blood smear examinations were performed with capillary, EDTA, and citrated samples. Platelet clumps were observed only in the EDTA sample. The tubes were kept at 25°C and measurements were repeated at 10, 15, 60, 90, and 120 minutes. The platelet counts had decreased by 63% and 76% at the end of 120 minutes in the EDTA and citrated samples, respectively. After 20 minutes at 37°C, the number of platelets had increased by 76% and 87% in the EDTA and citrated samples, respectively. In cases of this kind of a contradiction between laboratory results and clinical status, laboratory specialists should suspect PTCP and be prepared to manage these findings. Close communication between the clinician and the laboratory helps to avoid unnecessary investigation and inappropriate treatment.