INTRODUCTION: Kynurenine is the breakdown product of tryptophan. The tryptophan metabolic pathway increases in COVID-19 infection. This study was designed to reveal the relationship between tryptophan and kynurenine levels and disease severity. Our study also aimed to explore the relationship between tryptophan-kynurenine levels and patient survival, need for mechanical ventilation, and length of hospital stay.
METHODS: All 82 COVID-19 patients were grouped as severe and mild cases. Serum tryptophan and kynurenine levels were measured by the ELISA method. Receiver operating characteristic curves were generated to plot the KYN/TRP ratio and other variables. Multivariate logistic regression analyses were used to assess the strength of associations between risk factors and patient status. Categorical variables were compared.
RESULTS: The kynurenine/tryptophan level was significantly higher (p<0.001), and the tryptophan level was significantly lower (p=0.008) in the severe group. With a cutoff point of 14.2, the kynurenine/tryptophan ratio had 56.1% sensitivity and 80.49% specificity in predicting COVID-19 severity. In the multivariate logistic regression analysis using age, troponin, platelet count, ferritin, and kynurenine/tryptophan levels, with a cut-off value of 0.34, the sensitivity and specificity were 92.6% and 87.8%, respectively. There was no significant difference in tryptophan and kynurenine levels in terms of patient survival, need for mechanical ventilation, and length of hospital stay.
DISCUSSION AND CONCLUSION: The kynurenine/tryptophan ratio is valuable in evaluating clinical outcomes of COVID-19 patients, especially when used in conjunction with age, troponin, platelet count, and ferritin. It is useful in predicting the clinical course at the time of admission to the emergency department. To our knowledge, the kynurenine/tryptophan ratio, together with age, troponin, platelet count, and ferritin parameters, is the best model with the highest AUC that can be used to show early prediction of clinical outcomes in COVID-19.

INTRODUCTION: The Six Sigma methodology is also frequently used by clinical laboratories as an objective and quantitative way to measure quality. In our study, we aimed to evaluate the analytical performance of 80 tests using the Six Sigma methodology according to the CLIA (Clinical Laboratory Improvement Amendments) 2019, RICOS BV (Dr. Carmen RICOS Biological Variation) Desirable, and EFLM BV (European Federation of Clinical Chemistry and Laboratory Medicine Biological Variation) Desirable criteria.
METHODS: The sigma values of 80 tests were calculated according to the TEa (Total Allowable Error) limits allowed by all
three references using internal quality control and external quality control data. They were calculated monthly for 12 months, and the annual average was taken. Sigma values were calculated with the Six Sigma formula.
RESULTS: Considering the total number of goals reached, the highest success rate of 60% was achieved according to the CLIA goals, while the lowest success rate of 36% was obtained according to the EFLM BV Desirable criteria. Although exactly the same laboratory data are used, this gap between the sigma values obtained according to the selected reference is especially noticeable in tests such as Na (Sodium), K (Potassium), Cl (Chloride), Calcium, HbA1c (Hemoglobin A1c), and Troponin T.
DISCUSSION AND CONCLUSION: The Six Sigma protocol is one of the effective and universal tools for evaluating the performance of clinical laboratories. However, one of its biggest limitations is the lack of standardization in tolerance limits. The obtained performance varies according to the preferred reference. Therefore, we think that in the Six Sigma methodology, it is more feasible to select Total Allowable Error criteria from different references according to their suitability for the test.

INTRODUCTION: Theobromine, a naturally occurring alkaloid, is now recognized as a viable option due to its potential therapeutic benefit in many types of cancers. This preliminary study was undertaken to clarify how theobromine affects the viability, apoptosis, and migration of human non-small cell lung cancer (NSCLC) A549 cells.
METHODS: Water-soluble tetrazolium-1 (WST-1) assay was utilized to measure the cytotoxicity of theobromine (5-200 μM) in A549 cells for 24 and 48 hours. Flow cytometry analysis was used to detect apoptosis. A wound healing assay was carried out to evaluate the migration of A549 cells. Cells incubated with the IC50 concentration of cisplatin for 24 hours served as the reference group.
RESULTS: A time- and dose-dependent effect of theobromine on the inhibition of A549 cell viability was dramatically observed. Theobromine treatment led to an increased apoptotic cell population and caspase 3/7 activity (p<0.0001). Furthermore, the migratory capacity of A549 cells was reduced in the cells treated with theobromine.
DISCUSSION AND CONCLUSION: The results suggested that theobromine potently reduced the cell growth and migration capacity of NSCLC A549 cells by inducing caspase 3/7-mediated apoptosis. Additional studies are necessary to comprehend the antitumor mechanisms of theobromine against NSCLC and to provide helpful perspectives for more research.

INTRODUCTION: Cardiovascular diseases are among the leading causes of death worldwide. ST Elevation Myocardial Infarction (STEMI) is one of the most important causes of cardiovascular mortality and morbidity. It has been determined that Elabela (ELA), a member of the apelinergic system, increases myocardial contractility and coronary vasodilation, and decreases blood pressure. The aim of this study was to evaluate the relationship between circulating ELA levels and various clinical, biochemical, and angiographic parameters in STEMI patients undergoing primary percutaneous coronary intervention (PCI).
METHODS: Seventy-four patients hospitalized with the diagnosis of STEMI who underwent coronary angiography and
primary PCI, and seventy-four patients with chest pain but no pathology detected in coronary angiography, were included in the study as the control group. Coronary lesion severity was measured using the SYNTAX score tool. Routine laboratory tests and ELA levels were measured.
RESULTS: Plasma levels of ELA were significantly lower in patients with STEMI (0.68±0.68 ng/mL) than in controls
(1.34±0.88 ng/mL, p<0.001). Glucose, cholesterol, LDL, CRP, troponin I, and SYNTAX score levels were statistically higher in the STEMI group, while ELA and HDL levels were lower. There was a high level of negative correlation between ELA and troponin I, SYNTAX score, cholesterol, LDL, and CRP.
DISCUSSION AND CONCLUSION: In this study, it was determined that the level of ELA decreased in the first 24 hours of STEMI patients. In addition, a highly negative correlation was found between ELA and troponin I and SYNTAX scores.

INTRODUCTION: Diabetes mellitus is a group of chronic diseases in which the body has problems with the use or production of glucose, the main source of energy for metabolism. This condition can affect the metabolism of carbohydrates, fats, and proteins, potentially leading to chronic hyperglycemia (high blood sugar levels). The present study investigated the effects of soybean (Glycine max L.) seed extract on various biochemical parameters and pancreas weight in Wistar rats with experimental diabetes.
METHODS: The study consisted of five groups of rats: control, diabetic, and treated (100, 200, and 400 mg/kg extract). To
induce diabetes in rats, Streptozotocin (STZ) was administered through intraperitoneal injection (35 mg/kg). The rats were orally given water-soluble extracts at the indicated quantities once daily for four weeks. Venous blood was collected from the animals via heart puncture, after which the animals were sacrificed. Biochemical parameters, including blood glucose, were measured using an autoanalyzer.
RESULTS: In diabetic rats, there was a significant increase in serum glucose concentration (p<0.05). However, treatment with soybean resulted in a significant reduction (p<0.05) of the elevated glucose concentration in the treated diabetic rats. It is noteworthy that the glucose concentrations were still significantly higher (p<0.05) than those of the control group. Biochemical parameters, including urea, AST, SGPT/ALT, cholesterol, triglycerides, glucose, LDL-cholesterol, and VLDL-cholesterol, were lower in the treated groups than in the diabetic control group and were considered significant (p<0.05). Moreover, it was observed that the HDL-cholesterol parameter was significantly higher than that of the diabetic control group (p<0.05), while the creatinine parameter was not found to be statistically significant (p>0.05).
DISCUSSION AND CONCLUSION: The results suggest that soybean treatment may have a positive impact on certain biochemical parameters in diabetic rats. These findings are consistent with previous reports on the health benefits of soybean. It can be
inferred that G. max may have a hypoglycemic effect in diabetic rats and could potentially mitigate the complications of diabetes mellitus.

INTRODUCTION: Compounds with hydroxyl (-OH) attached to the carbon atom in their structure are generally defined as alcohols. People have been producing, consuming, and enjoying alcohol for a very long time. The prevalence of alcohol use disorder in the world is 5.1%. Alcohol toxicity can be life-threatening, and blood alcohol levels must be measured.
METHODS: The 19568 ethanol analysis results were included in this study, performed between 01.01.2021 and
31.12.2022, and were obtained from Ankara Bilkent City Hospital's laboratory information system. Serum ethanol levels <10 mg/dL were accepted as negative. Ethanol analysis results according to positive serum ethanol levels were designed as follows; <10 mg/dL, between 10 mg/dL and ≤30 mg/dl, between 30 mg/dl> and ≤50 mg/dl, between 50 mg/dl> and ≤100 mg/dl, and above 100 mg/dL. Ethanol analysis results according to age were designed as follows ≤10 years, 11–20 years, 21–30 years, 31–40 years, 41–50 years, 51–60 years, and above 60 years. The ethanol analyses were performed by Atellica Chemistry- XPT ® (Siemens Healthineers, Erlangen, Germany) device.
RESULTS: This study included a total of 19568 ethanol analysis results. The number of females and males was as follows:
5595 (%28.3), 13973 (%71.4) Ethanol positivity was higher in males 2735 (%76.5) than in females 839 (%23.5) (p<0.001). The results of the males were higher in each group (p<0.001) when evaluating the ethanol intervals among genders. When the ethanol intervals among age intervals were analyzed, the group aged between 21 to 30 years had the highest number while the group aged between 0 to 10 years had the least number (p<0.001).
DISCUSSION AND CONCLUSION: Alcohol use is stated as a public health problem for the whole world. Our study, which evaluates alcohol analysis results according to gender, different age groups, and different ethanol intervals, may be helpful for future studies.

INTRODUCTION: This study aimed to evaluate the analytical performance of coagulation tests (prothrombin time (PT/INR),
activated partial thromboplastin time (aPTT), fibrinogen, and D-dimer) using the Six Sigma methodology, focusing on identifying areas for improvement to enhance healthcare quality.
METHODS: Internal quality control (IQC) and external quality control (EQC) data from September 2023 to February 2024
were collected for coagulation parameters analyzed by four Cobas T711 analyzers. Sigma values were calculated using IQC, EQC, and total allowable error (TEa) data. The sigma value for each parameter was calculated according to the formula “(TEa%–bias %)/CV%.” The outpatient sample analyzers were labeled A1, A2, and A3. The one that analyzes samples from emergency and intensive care patients was labeled B.
RESULTS: Across analyzers A1, A2, A3, and B, sigma values varied for different coagulation parameters. Notably, the D-dimer parameter consistently exhibited excellent performance (sigma >6) for all analyzers. In contrast, some analyzers showed poor performance for aPTT and PT parameters at level 1 (A1 and A3 for aPTT, B for INR). Fibrinogen performance varied, with some analyzers showing excellent performance (sigma >6) and others falling below acceptable levels.
DISCUSSION AND CONCLUSION: By identifying areas of low performance, particularly in aPTT and INR parameters, this study highlights the importance of continuous quality improvement in laboratory testing. Addressing issues identified through the
Six Sigma methodology can enhance the reliability of laboratory results and ultimately improve patient care. Further research and initiatives focused on analytical process improvement are needed to achieve higher quality standards in laboratory testing.

INTRODUCTION: To identify the association of the rs121912724 polymorphism in the Apolipoprotein A1 gene with diabetic dyslipidemia and its correlation with serum High-density Lipoprotein Cholesterol (HDL), Triglycerides, (TG) and
Low-density Lipoprotein Cholesterol (LDL-C) levels.
METHODS: Two groups were taken, comprising 150 diabetic dyslipidemia (group I) patients and 150 healthy controls (group II). Demographic and biochemical data were analyzed using Statistical Package for Social Sciences 26 by applying the Student independent t-test. DNA samples of both groups were subjected to TETRA-Amplification Refractory System polymerase chain reaction, and allele A and C of the rs121912724 polymorphism were amplified. The association of the rs121912724 polymorphism with the disease was studied using Fisher's exact test and Cochran-Armitage test. The correlation between the polymorphism and levels of lipid levels was determined using Pearson correlation on SPSS version 27.
RESULTS: The levels of HDL-C, LDL-C, and TG were significantly higher than in healthy group (p<0.000). The genotypic
count of homozygous AA was 137, 12 of heterozygous AC, and 1 of homozygous CC in group I. The genotypic count of homozygous AA was 138, 12 of heterozygous AC in group II, with no homozygous CC. There was no association of rs121912724 observed with the development of diabetic dyslipidemia, and a negative correlation of rs121912724 with deranged levels of HDL-C, LDL-C, and TG was observed.
DISCUSSION AND CONCLUSION: The rs121912724 polymorphism in the APOA1 gene was not associated with diabetic dyslipidemia. There was no correlation found between the polymorphism and deranged levels of HDL-C, TG, and LDL-C.

INTRODUCTION: The immune response depends on T cell activation, which is triggered by signals from receptors such as CD28 and TCR/CD3, resulting in T cell proliferation and programmed cell death (AICD). This control avoids disorders
like immunity and cancer. These receptors are stimulated by Antigen-Presenting Cells (APCs), which set off a signaling cascade that activates the important transcription factor NF-κB. Degrading inhibitory proteins is necessary for NF-κB activation, which permits it to reach the nucleus and regulate gene expression.
METHODS: Semi-quantitative RT-PCR was used to assess the levels of metallothionein 2A mRNA in primary T cells to validate the results of the microarray analysis. Five- to six-week-old male C57BL/6 wild-type mice were used in the investigation. Mouse primary T cells from lymph nodes were suspended aseptically, and anti-CD3/CD28 was used to activate the cells. The cells were transfected with plasmid DNA using a Gen Pulser, and the T cells were separated by magnetic cell sorting. Following the synthesis of cDNA from total RNA, microarray analysis was used to assess variations in gene expression. The microarray results were validated by RT-PCR. Western blotting was used to confirm protein expression, and flow cytometry with CD69 was used to measure cell death. Immunoreactive bands were visible in co-immunoprecipitation assays using monoclonal anti-MT2A and FADD antibodies.
RESULTS: This work focused on FAS-associated Death Domain (FADD), MT2A, and NF-κB gene expression profiles in
mouse primary T cells before and after anti-CD3/CD28 stimulation, utilizing microarray analysis. The results shed light on these genes' functions in AICD and T cell activation. The cascade triggers the activation of transcription factors necessary for T cell proliferation and cytokine production, such as NF-κB. Degradation of inhibitory IκB proteins is necessary for NF-κB activation, which permits NF-κB to reach the nucleus and control gene transcription. The involvement of PLC-γ1 in CD3/CD28-induced NF-κB activation has been highlighted by recent studies.
DISCUSSION AND CONCLUSION: The processes that determine whether T cells divide or undergo apoptosis are still unknown, despite advances. To compare the gene expression of FADD, MT2A, and NF-κB in mouse primary T cells before and after anti-CD3/CD28 stimulation, this work used microarray analysis. The purpose of our research is to shed light on these genes' functions in T cell activation and activation-induced cell death (AICD).

INTRODUCTION: Chronic Kidney Disease (CKD) is a long-standing metabolic disease manifested by renal impairment, high
morbidity and mortality, and causing a huge financial burden. Systemic inflammation and local intrarenal inflammation are found to exacerbate this irreversible condition. White blood cells, platelets, and their derived indices may aid in the assessment of the progression of CKD. This study aimed to assess the alterations of complete blood count and their derived indices in the various stages of chronic kidney disease.
METHODS: The retrospective cross-sectional study was conducted in the Department of Biochemistry at a tertiary care hospital, Chennai, India. The data were collected from the Medical Records Department from July 2022 to June 2023. The study included chronic kidney disease patients aged 35 to 70 years of both genders. Children, pregnant women, and patients with heart and liver diseases were excluded. The data of the renal profile and complete blood count were collected. Statistical analysis was performed using SPSS software version 16. A p≤0.05 was considered statistically significant.
RESULTS: Among the study participants, 65% were male and were more than 50 years of age. All the derived inflammation index parameters, such as neutrophil-to-lymphocyte ratio (NLR), monocyte-to-lymphocyte ratio (MLR), platelet-to-lympho- cyte ratio (PLR), systemic immune-inflammation index (SII), and systemic inflammation response index (SIRI). were significantly increased in stage 5 of CKD. Also, SII and SIRI were found to be correlated with other inflammatory variables.
DISCUSSION AND CONCLUSION: Chronic inflammation is considered to be prevalent among CKD patients. Inflammatory markers such as SII and SIRI are simple and cost-effective parameters to routinely assess the staging of CKD and thus initiate appropriate management to improve the quality of life.

Migraine is a complex neurological disorder characterized by recurrent headaches accompanied by sensory disturbances. It involves a combination of genetic, environmental, and neurovascular factors. The objective of this systematic review and meta-analysis was to investigate the correlation between migraine and specific mutant genes by examining the association of Pituitary Adenylate Cyclase-Activating Peptide-38 genes with migraine. A comprehensive search was conducted in major scientific databases, such as PubMed, Scopus, and Embase, to identify relevant studies published up until September 2023. The inclusion criteria encompassed studies that examined the genes (PACAP-38) and various aspects of migraine. Two independent reviewers performed data extraction and quality assessment to ensure the accuracy and reliability of the collected information. Seven studies, comprising 737 patients, were included in the final analysis. The random effects model yielded a standardized mean difference (SMD) of 0.55 (95% CI: -0.15 to 1.25, t=1.45, p=0.19). Heterogeneity among the studies was substantial, with I² indicating 93% variability (95% CI: 84.6% to 96.5%). The heterogeneity was statistically significant (Q= 87.2, df=6, p<0.001). The prediction interval ranged from -1.40 to 2.51. This systematic review and meta-analysis establish a strong link between PACAP-38 and susceptibility to migraine. These findings highlight the significance of genetic factors in migraine development, emphasizing the need for further investigation to elucidate underlying mechanisms and explore the clinical implications of these genetic associations.

As awareness of the environmental impact of healthcare facilities, including laboratories, grows, there is a pressing
need to adopt sustainable practices within laboratory medicine. Sustainability is therefore a key goal in the quickly
evolving healthcare landscape. This review explores forward steps in green medical laboratory practices and offers perspectives on sustainability in healthcare, specifically within the context of laboratory medicine. The review assesses the environmental footprint of laboratory operations, considering factors such as energy consumption, resource utilization, chemical usage, and waste generation. Technological advancements and educational initiatives aimed at fostering a culture of sustainability are also discussed as essential components of the transition toward greener medical laboratory practices. This review underscores the importance of integrating sustainability principles into laboratory medicine to mitigate environmental impact while ensuring the delivery of high-quality healthcare services for present and future generations.

Multiple myeloma (MM) is a hematological malignancy marked by the abnormal proliferation of plasma cells that invade the bone marrow and, in most cases, secrete a monoclonal protein. While typically diagnosed in older individuals with an average age of 70, MM is rarely observed in young adults. Here, we present a unique case of MM in a 27-year-old
man with nodular lesions on the trunk, histologically confirmed as cutaneous MM. Laboratory investigations revealed
acute renal impairment, hypercalcemia, and the presence of IgG-Lambda paraprotein. The myelogram confirmed plasmacytosis in more than 12% of the bone marrow mononuclear cells. This case highlights the relevance of considering MM in the differential diagnosis of young patients with unusual cutaneous manifestations.

Naphthalene, an aromatic hydrocarbon prevalent in mothballs and deodorizers, poses significant health risks upon exposure, primarily through ingestion or dermal absorption. Herein, we report the case of a previously healthy 28-year-old male who presented with hemolysis, methemoglobinemia, and acute renal failure. The patient had a history of ingestion of mothballs, mistaking them for candy, prompting consideration of naphthalene intoxication as the clinical diagnosis, which was subsequently confirmed by laboratory findings. Given concurrent hepatic dysfunction and a diagnosis of glucose-6-phosphate dehydrogenase (G6PD) deficiency, N-acetyl cysteine was administered instead of methylene blue. The patient’s condition improved after he was managed with aggressive fluid resuscitation, noninvasive ventilation, blood transfusions, and hemodialysis. Naphthalene ingestion can result in hemolysis, methemoglobinemia, and acute kidney injury, with heightened susceptibility observed in patients with G6PD deficiency.