Outcome of COVID-19 in Patients With Autoimmune Hepatitis: An International Multicenter Study

Background and Aims: Data regarding outcome of COVID-19 in patients with autoimmune hepatitis (AIH) are lacking. Approach and Results: We performed a retrospective study on patients with AIH and COVID-19 from 34 centers in Europe and the Americas. We analyzed factors associated with severe COVID-19 outcomes, defined as the need for mechanical ventilation, intensive care admission, and/or death. The outcomes of patients with AIH were compared to a propensity score?matched cohort of patients without AIH but with chronic liver diseases (CLD) and COVID-19. The frequency and clinical significance of new-onset liver injury (alanine aminotransferase > 2 × the upper limit of normal) during COVID-19 was also evaluated. We included 110 patients with AIH (80% female) with a median age of 49 (range, 18-85) years at COVID-19 diagnosis. New-onset liver injury was observed in 37.1% (33/89) of the patients. Use of antivirals was associated with liver injury (P = 0.041; OR, 3.36; 95% CI, 1.05-10.78), while continued immunosuppression during COVID-19 was associated with a lower rate of liver injury (P = 0.009; OR, 0.26; 95% CI, 0.09-0.71). The rates of severe COVID-19 (15.5% versus 20.2%, P = 0.231) and all-cause mortality (10% versus 11.5%, P = 0.852) were not different between AIH and non-AIH CLD. Cirrhosis was an independent predictor of severe COVID-19 in patients with AIH (P < 0.001; OR, 17.46; 95% CI, 4.22-72.13). Continuation of immunosuppression or presence of liver injury during COVID-19 was not associated with severe COVID-19. Conclusions: This international, multicenter study reveals that patients with AIH were not at risk for worse outcomes with COVID-19 than other causes of CLD. Cirrhosis was the strongest predictor for severe COVID-19 in patients with AIH. Maintenance of immunosuppression during COVID-19 was not associated with increased risk for severe COVID-19 but did lower the risk for new-onset liver injury during COVID-19.Fil: Efe, Cumali. Harran University Hospital; TurquíaFil: Dhanasekaran, Renumathy. University of Stanford; Estados UnidosFil: Lammert, Craig. University School of Medicine; Estados UnidosFil: Ebik, Berat. Gazi Yaşargil Education and Research Hospital; TurquíaFil: Higuera de la Tijera, Fatima. Hospital General de México; MéxicoFil: Aloman, Costica. Rush University Medical Center; Estados UnidosFil: Rıza Calışkan, Ali. Adıyaman University; TurquíaFil: Peralta, Mirta. Latin American Liver Research Educational And Awareness Network; Argentina. Gobierno de la Ciudad de Buenos Aires. Hospital de Infecciosas "Dr. Francisco Javier Muñiz"; ArgentinaFil: Gerussi, Alessio. University of Milano Bicocca; Italia. San Gerardo Hospital; ItaliaFil: Massoumi, Hatef. Montefiore Medical Center; Estados UnidosFil: Catana, Andreea M.. Harvard Medical School; Estados UnidosFil: Torgutalp, Murat. Universitätsmedizin Berlin; AlemaniaFil: Purnak, Tugrul. McGovern Medical School; Estados UnidosFil: Rigamonti, Cristina. Azienda Ospedaliera Maggiore Della Carita Di Novara; Italia. Università del Piemonte Orientale; ItaliaFil: Gomez Aldana, Andres Jose. Universidad de los Andes; ColombiaFil: Khakoo, Nidah. University of Miami; Estados UnidosFil: Kacmaz, Hüseyin. Adıyaman University; TurquíaFil: Nazal, Leyla. Clínica Las Condes; ChileFil: Frager, Shalom. Montefiore Medical Center; Estados UnidosFil: Demir, Nurhan. Haseki Training and Research Hospita; TurquíaFil: Irak, Kader. SBU Kanuni Sultan Süleyman Training and Research Hospital; TurquíaFil: Ellik, Zeynep Melekoğlu. Ankara University Medical Faculty; TurquíaFil: Balaban, Yasemin. Hacettepe University; TurquíaFil: Atay, Kadri. Mardin State Hospital; TurquíaFil: Eren, Fatih. Ordu State Hospital; TurquíaFil: Cristoferi, Laura. University of Milano Bicocca; Italia. San Gerardo Hospital; ItaliaFil: Batibay, Ersin. Harran University Hospital; TurquíaFil: Urzua, Álvaro. Universidad de Chile. Facultad de Medicina.; ChileFil: Snijders, Romee. Radboud University Medical Center; Países BajosFil: Ridruejo, Ezequiel. Latin American Liver Research Educational and Awareness Network; Argentina. Cerrahpaşa School of Medicine; Turquía. Centro de Educación Médica e Investigaciones Clínicas "Norberto Quirno"; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentin

Effects of immunosuppressive drugs on COVID-19 severity in patients with autoimmune hepatitis

Background: We investigated associations between baseline use of immunosuppressive drugs and severity of Coronavirus Disease 2019 (COVID-19) in autoimmune hepatitis (AIH). Patients and methods: Data of AIH patients with laboratory confirmed COVID-19 were retrospectively collected from 15 countries. The outcomes of AIH patients who were on immunosuppression at the time of COVID-19 were compared to patients who were not on AIH medication. The clinical courses of COVID-19 were classified as (i)-no hospitalization, (ii)-hospitalization without oxygen supplementation, (iii)-hospitalization with oxygen supplementation by nasal cannula or mask, (iv)-intensive care unit (ICU) admission with non-invasive mechanical ventilation, (v)-ICU admission with invasive mechanical ventilation or (vi)-death and analysed using ordinal logistic regression. Results: We included 254 AIH patients (79.5%, female) with a median age of 50 (range, 17-85) years. At the onset of COVID-19, 234 patients (92.1%) were on treatment with glucocorticoids (n = 156), thiopurines (n = 151), mycophenolate mofetil (n = 22) or tacrolimus (n = 16), alone or in combinations. Overall, 94 (37%) patients were hospitalized and 18 (7.1%) patients died. Use of systemic glucocorticoids (adjusted odds ratio [aOR] 4.73, 95% CI 1.12-25.89) and thiopurines (aOR 4.78, 95% CI 1.33-23.50) for AIH was associated with worse COVID-19 severity, after adjusting for age-sex, comorbidities and presence of cirrhosis. Baseline treatment with mycophenolate mofetil (aOR 3.56, 95% CI 0.76-20.56) and tacrolimus (aOR 4.09, 95% CI 0.69-27.00) were also associated with more severe COVID-19 courses in a smaller subset of treated patients. Conclusion: Baseline treatment with systemic glucocorticoids or thiopurines prior to the onset of COVID-19 was significantly associated with COVID-19 severity in patients with AIH.Fil: Efe, Cumali. Harran University Hospita; TurquíaFil: Lammert, Craig. University School of Medicine Indianapolis; Estados UnidosFil: Taşçılar, Koray. Universitat Erlangen-Nuremberg; AlemaniaFil: Dhanasekaran, Renumathy. University of Stanford; Estados UnidosFil: Ebik, Berat. Gazi Yasargil Education And Research Hospital; TurquíaFil: Higuera de la Tijera, Fatima. Hospital General de México; MéxicoFil: Calışkan, Ali R.. No especifíca;Fil: Peralta, Mirta. Gobierno de la Ciudad de Buenos Aires. Hospital de Infecciosas "Dr. Francisco Javier Muñiz"; ArgentinaFil: Gerussi, Alessio. Università degli Studi di Milano; ItaliaFil: Massoumi, Hatef. No especifíca;Fil: Catana, Andreea M.. Harvard Medical School; Estados UnidosFil: Purnak, Tugrul. University of Texas; Estados UnidosFil: Rigamonti, Cristina. Università del Piemonte Orientale ; ItaliaFil: Aldana, Andres J. G.. Fundacion Santa Fe de Bogota; ColombiaFil: Khakoo, Nidah. Miami University; Estados UnidosFil: Nazal, Leyla. Clinica Las Condes; ChileFil: Frager, Shalom. Montefiore Medical Center; Estados UnidosFil: Demir, Nurhan. Haseki Training And Research Hospital; TurquíaFil: Irak, Kader. Kanuni Sultan Suleyman Training And Research Hospital; TurquíaFil: Melekoğlu Ellik, Zeynep. Ankara University Medical Faculty; TurquíaFil: Kacmaz, Hüseyin. Adıyaman University; TurquíaFil: Balaban, Yasemin. Hacettepe University; TurquíaFil: Atay, Kadri. No especifíca;Fil: Eren, Fatih. No especifíca;Fil: Alvares da-Silva, Mario R.. Universidade Federal do Rio Grande do Sul; BrasilFil: Cristoferi, Laura. Università degli Studi di Milano; ItaliaFil: Urzua, Álvaro. Universidad de Chile; ChileFil: Eşkazan, Tuğçe. Cerrahpaşa School of Medicine; TurquíaFil: Magro, Bianca. No especifíca;Fil: Snijders, Romee. No especifíca;Fil: Barutçu, Sezgin. No especifíca;Fil: Lytvyak, Ellina. University of Alberta; CanadáFil: Zazueta, Godolfino M.. Instituto Nacional de la Nutrición Salvador Zubiran; MéxicoFil: Demirezer Bolat, Aylin. Ankara City Hospital; TurquíaFil: Aydın, Mesut. Van Yuzuncu Yil University; TurquíaFil: Amorós Martín, Alexandra Noemí. No especifíca;Fil: De Martin, Eleonora. No especifíca;Fil: Ekin, Nazım. No especifíca;Fil: Yıldırım, Sümeyra. No especifíca;Fil: Yavuz, Ahmet. No especifíca;Fil: Bıyık, Murat. Necmettin Erbakan University; TurquíaFil: Narro, Graciela C.. Instituto Nacional de la Nutrición Salvador Zubiran; MéxicoFil: Bıyık, Murat. Uludag University; TurquíaFil: Kıyıcı, Murat. No especifíca;Fil: Kahramanoğlu Aksoy, Evrim. No especifíca;Fil: Vincent, Maria. No especifíca;Fil: Carr, Rotonya M.. University of Pennsylvania; Estados UnidosFil: Günşar, Fulya. No especifíca;Fil: Reyes, Eira C.. Hepatology Unit. Hospital Militar Central de México; MéxicoFil: Harputluoğlu, Murat. Inönü University School of Medicine; TurquíaFil: Aloman, Costica. Rush University Medical Center; Estados UnidosFil: Gatselis, Nikolaos K.. University Hospital Of Larissa; GreciaFil: Üstündağ, Yücel. No especifíca;Fil: Brahm, Javier. Clinica Las Condes; ChileFil: Vargas, Nataly C. E.. Hospital Nacional Almanzor Aguinaga Asenjo; PerúFil: Güzelbulut, Fatih. No especifíca;Fil: Garcia, Sandro R.. Hospital Iv Víctor Lazarte Echegaray; PerúFil: Aguirre, Jonathan. Hospital Angeles del Pedregal; MéxicoFil: Anders, Margarita. Hospital Alemán; ArgentinaFil: Ratusnu, Natalia. Hospital Regional de Ushuaia; ArgentinaFil: Hatemi, Ibrahim. No especifíca;Fil: Mendizabal, Manuel. Universidad Austral; ArgentinaFil: Floreani, Annarosa. Università di Padova; ItaliaFil: Fagiuoli, Stefano. No especifíca;Fil: Silva, Marcelo. Universidad Austral; ArgentinaFil: Idilman, Ramazan. No especifíca;Fil: Satapathy, Sanjaya K.. No especifíca;Fil: Silveira, Marina. University of Yale. School of Medicine; Estados UnidosFil: Drenth, Joost P. H.. No especifíca;Fil: Dalekos, George N.. No especifíca;Fil: N.Assis, David. University of Yale. School of Medicine; Estados UnidosFil: Björnsson, Einar. No especifíca;Fil: Boyer, James L.. University of Yale. School of Medicine; Estados UnidosFil: Yoshida, Eric M.. University of British Columbia; CanadáFil: Invernizzi, Pietro. Università degli Studi di Milano; ItaliaFil: Levy, Cynthia. University of Miami; Estados UnidosFil: Montano Loza, Aldo J.. University of Alberta; CanadáFil: Schiano, Thomas D.. No especifíca;Fil: Ridruejo, Ezequiel. Universidad Austral; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Parque Centenario. CEMIC-CONICET. Centro de Educaciones Médicas e Investigaciones Clínicas "Norberto Quirno". CEMIC-CONICET; ArgentinaFil: Wahlin, Staffan. No especifíca

Evaluation of nutritional status in pediatric intensive care unit patients: the results of a multicenter, prospective study in Turkey

IntroductionMalnutrition is defined as a pathological condition arising from deficient or imbalanced intake of nutritional elements. Factors such as increasing metabolic demands during the disease course in the hospitalized patients and inadequate calorie intake increase the risk of malnutrition. The aim of the present study is to evaluate nutritional status of patients admitted to pediatric intensive care units (PICU) in Turkey, examine the effect of nutrition on the treatment process and draw attention to the need for regulating nutritional support of patients while continuing existing therapies.Material and MethodIn this prospective multicenter study, the data was collected over a period of one month from PICUs participating in the PICU Nutrition Study Group in Turkey. Anthropometric data of the patients, calorie intake, 90-day mortality, need for mechanical ventilation, length of hospital stay and length of stay in intensive care unit were recorded and the relationship between these parameters was examined.ResultsOf the 614 patients included in the study, malnutrition was detected in 45.4% of the patients. Enteral feeding was initiated in 40.6% (n = 249) of the patients at day one upon admission to the intensive care unit. In the first 48 h, 86.82% (n = 533) of the patients achieved the target calorie intake, and 81.65% (n = 307) of the 376 patients remaining in the intensive care unit achieved the target calorie intake at the end of one week. The risk of mortality decreased with increasing upper mid-arm circumference and triceps skin fold thickness Z-score (OR = 0.871/0.894; p = 0.027/0.024). The risk of mortality was 2.723 times higher in patients who did not achieve the target calorie intake at first 48 h (p = 0.006) and the risk was 3.829 times higher in patients who did not achieve the target calorie intake at the end of one week (p = 0.001). The risk of mortality decreased with increasing triceps skin fold thickness Z-score (OR = 0.894; p = 0.024).ConclusionTimely and appropriate nutritional support in critically ill patients favorably affects the clinical course. The results of the present study suggest that mortality rate is higher in patients who fail to achieve the target calorie intake at first 48 h and day seven of admission to the intensive care unit. The risk of mortality decreases with increasing triceps skin fold thickness Z-score

Citrate, oxalate, sodium, and magnesium levels in fresh juices of three different types of tomatoes: evaluation in the light of the results of studies on orange and lemon juices

Batislam, Ertan/0000-0002-7493-4573WOS: 000279897900001PubMed: 20113185Fruit and vegetable juices containing citrate may be recommended as an alternative in mild to moderate level hypocitraturic calcium stone formers who cannot tolerate pharmacological treatment. Tomato has been proved a citrate-rich vegetable. Tomato juice usage as citrate sources in hypocitraturic recurrent stone formers were evaluated in the light of the results of studies on orange and lemon juices. Ten 100 ml samples were prepared from three different tomato types processed through a blender. These samples were examined in terms of citrate, oxalate, calcium, magnesium, and sodium contents. No difference was detected between the parameters tested in three different tomato juices. Fresh tomato juice may be useful in hypocitraturic recurrent stone formers due to its high content of citrate and magnesium, and low content of sodium and oxalate. As the three different types of tomatoes did not differ in terms of citrate, magnesium, sodium, and oxalate content, they may be useful for clinical use if also supported by clinical studies

Acute and chronic impact of smoking on salivary and serum total antioxidant capacity

KISA, Ucler/0000-0002-8131-6810; Kurku, Huseyin/0000-0002-1083-4151WOS: 000349195700012PubMed: 25842552Objective: To investigate increased oxidative stress in saliva of smokers along with their serum. Methods: The case-control study was conducted from September to December 2008 in the Department of Biochemistry of the Medical School, Kirikkale University, Kirikkale, Turkey. A blood sample and saliva samples before and after smoking were collected from the smokers, while blood and saliva samples were taken from the controls. All samples were taken concurrently. The samples were measured for total antioxidant capacity, total oxidant stress, oxidative stress index, malondialdehyde, nitric oxide and total sulfhydryl groups. Levels of superoxide dismutase and glutathione peroxidase were also measured on saliva samples. SPSS 13 was used for statistical analysis. Results: Of the 54 subjects in the study, 27(50%) were smokers with a mean age of 28.4+/-5.42 years, and 27(50%) were controls with a mean age of 29.7+/-8.03 years. Total oxidant stress, oxidative stress index, malondialdehyde and nitric oxide levels were found higher in the serum samples of smokers (p<0.05), and the levels of total sulfhydryl groups in smokers were lower compared with the controls (p<0,05). Among the smokers, salivary malondialdehyde levels were higher before and after smoking (p<0.05), glutathione peroxidase levels were lower than the controls, and salivary nitric oxide levels after smoking were higher than both those of the control group and the levels before smoking (p<0.05). Conclusion: Both acute and chronic increased oxidative conditions may be a significant sign of the destructive effects of smoking. The investigation of disorders in smokers concerning oxidative stress will be beneficial in terms of novel approaches and treatment modalities

The effect of varicocele on seminal plasma and serum inhibin-B levels in adolescent and adult men

KISA, Ucler/0000-0002-8131-6810WOS: 000275991900008PubMed: 19590975In the present study, the relationship between serum/seminal plasma and serum FSH and seminal parameters was evaluated in adults and adolescent varicocele patients and compared with normal fertile cases. A total of 50 adult patients with varicocele (Group-1) and 50 adolescents with varicocele (Group-2) were enrolled into the study. Fifty fertile cases without any scrotal pathology were accepted as control group (Group-3). Serum gonadotropin, sex steroids and serum and seminal plasma inhibin-B levels were measured, and semen analysis was performed after 2 and 5 days of sexual abstinence. All parameters were compared among three groups by using one-way ANOVA test. There were statistically significant differences among three groups on seminal parameters due to disturbed spermatogenesis in patients with varicocele (P < 0.05). However, there were not statistical differences between serum and seminal plasma Inhibin-B levels among groups. In varicocele patients, serum inhibin-B levels showed negative and significant correlation only with FSH levels (r = -0.253, P = 0.011). On the contrary, neither serum nor seminal plasma inhibin-B levels showed significant correlation with seminal parameters. While varicocele affects different mechanisms in the regulation of spermatogenesis in testes, serum and seminal plasma inhibin-B have not any role in decreased spermatogenesis in varicocele.Research Found of University of KirikkaleKirikkale University [03/08.03.17]This study was supported by Research Found of University of Kirikkale (03/08.03.17). This study was presented in the 28th Congress of SIU in Cape Town

Procalcitonin Level and Its Predictive Effect on Mortality in Crimean-Congo Hemorrhagic Fever Patients

KISA, Ucler/0000-0002-8131-6810WOS: 000366006700009PubMed: 25866108Crimean-Congo hemorrhagic fever (CCHF) is a potentially fatal disease which is endemic to Turkey. We aimed to investigate the procalcitonin levels and their prognostic value over fatality in CCHF patients. The sera were harvested from patients who were diagnosed with CCHF within the first 2 days of the onset of their symptoms. The patients were divided into 2 groups according to their survival status: fatal or non-fatal. The biochemical and hematological parameters were studied in the Biochemistry Laboratory of Sorgun City Hospital. The sera were stored at -80 degrees C until testing for procalcitonin, and the procalcitonin levels were assayed by ELISA at the Biochemistry Laboratory of Kirikkale University. Forty- eight patients were included in the study, with 8 and 40 patients in the fatal and non-fatal groups, respectively. While the procalcitonin level was high in all patients in the fatal group, the same was observed in 30 patients in the non-fatal group (75%). The mean value of procalcitonin was 1.12 ng/ml in the fatal group and was 0.21 ng/ml in the non-fatal group (P = 0.003). According to the results of our study, the procalcitonin levels in the first 2 days of the onset of the symptoms might be helpful for predicting fatality in CCHF patients

Verotoxin production in strains of Escherichia coli isolated from cattle and sheep, and their resistance to antibiotics

WOS: 000250919100003In this study, 130 Escherichia coli strains isolated from 306 cattle and sheep fecal samples were studied for their resistance to 10 antibiotics, verotoxin production, and hemolyzation. The antibiotic resistance rates of the E. coli strains were as follows: tetracycline. 51.6%; streptomycin, 24.2%: ampicillin, 13.1 %: amoxicillin/clavulanic acid, 5.2%; gentamycin. 4.6%; ciprofloxacin, 4.6%; trimethoprim-sulfamethoxazole, 4.3%: cefotaxime, 0.7%. None of the strains were resistant to cefepime or ceftazidime. Of all the antibiotics tested, only resistance to streptomycin was higher in the strains isolated from cattle than in the sheep strains (P = 0.043). The evaluation of the cattle strains, based on gender and age, indicated that the resistance to tetracycline and streptomycin was higher in the female cattle than in male cattle, whereas in cattle under 2 years of age resistance to tetracycline was significantly higher than in 3-year-old cattle. Among the cattle strains there were 4 (2.2%) of the VTEC O157 serotype. All were sensitive to the antibiotics tested, and the isolation rate of VTEC non-O157 serotypes was 14.5%. The overall verotoxin production rate of the E. coli strains was 36.9%, while it was 61.1 % in sheep strains and 19.7% in cattle strains. Verotoxin production in sheep strains was significantly higher than in cattle strains (P < 0.001). No correlation was detected between verotoxin production in the cattle strains and antibiotic resistance; however, resistance to ampicillin and streptomycin in the sheep strains that did not produce verotoxin was higher than that observed in the sheep strains that did (P = 0.048 and P = 0.009. respectively). The most common hemolysis type in the isolated E. coli strains was gamma hemolysis (46.2%). Ampicillin and amoxicillin/clavulanic acid resistance was significantly higher in the strains that hemolyzed than in the strains that did not. In conclusion, sheep carry higher risks of verotoxin produced by E. coli strains than cattle do. Furthermore, due to higher resistance rates to such antibiotics as tetracycline and streptomycin, careful antibiotic selection for infections, particularly those caused by verotoxigenic E. coli, is of extreme importance

Evaluation of Clinical and Radiological Results of Humeral Diaphyseal Fractures with Treated Sarmiento Brace

WOS: 000515092400005PubMed: 32226678Aim in our study, we aimed to evaluate the duration and rate of the union of adult humerus diaphysis fractures treated with a functional brace. Methods Forty-six adult patients admitted to our hospital with humeral diaphyseal fracture between January 2010 and April 2014 and treated with a functional brace were evaluated retrospectively. the demographic data, fracture type, level of fracture, and presence of bone union of the patients were evaluated from clinic records. the Disabilities of the Arm, Shoulder and Hand (Quick-DASH) questionnaire score of the patients was registered for patients and analyzed, and its correlation with parameters such as patient age and fracture bone union time was evaluated. Results It was observed that of the patients with the mean age of 45.5 years, six (13.6%) had non-union and five had delayed bone union (10.86%). Three (6.5%) patients had radial nerve injury, and all recovered without sequelae. Out of the patients with the bone union, 12 (30%) had an angulation above give degrees, and 3 (7.5%) had radiological shortness. the mean Quick-DASH score was 6.7, and there was no statistically significant correlation with parameters such as fracture type, level, angulation, radiological shortness and radial nerve involvement (p>0.05). Conclusions A functional brace is a good treatment choice with low complication rates and has satisfactory bone union rates in humerus diaphyseal fractures

Oxidative and nitrosative stress in patients with ischemic stroke

KISA, Ucler/0000-0002-8131-6810; Kurku, Huseyin/0000-0002-1083-4151WOS: 000448627600006Background: Oxidative and nitrosative stress is well believed to play a role in the pathogenesis of ischemic stroke. This study aims to evaluate the time course of oxidative and nitrosative stress in ischemic stroke. Methods: In total, 27 healthy individuals, 22 individuals with high risk of ischemic stroke due to hypertension and diabetes mellitus, and 20 patients with acute ischemic stroke hospitalized at the Neurology Department of the Kirikkale University School of Medicine were enrolled in the study. Venous blood was collected at admission (hour 0) and again at hours 24, 48, 72, and 96. Nitric oxide (NO), malondialdehyde (MDA), total oxidative stress (TOS), oxidative stress index (OSI), and total antioxidant status (TAS) were measured and compared among stroke patients and control groups. Results: Blood NO was significantly higher in the patient group at 0, 24, 48, and 72 h compared to the healthy and high-risk control groups, and lower at 96 h than at early times within the patient group (p<0.001). MDA was higher in patients than the healthy control group at all times. Conversely, TOS and OSI were significantly lower in the patient group than the healthy control group at 96 h and the high-risk control group at 72 and 96 h (p <0.05). There was a significant correlation between initial NO (0 h) and duration of hospitalization (r= 0.71; p= 0.0003). Conclusions: These findings suggest a substantial early increase in oxidative and nitrosative stress in ischemic stroke patients during the first 2 days post-admission. However, TOS was lower by days 3-4, likely due to pathological recovery and local/systemic defense systems. The correlation between elevated serum NO during the acute phase of stroke and duration of hospitalization suggests NO as a potentially valuable predictor of ensuing oxidative damage and clinical outcome