A rare non-hemolytic case of ıdiopathic cold agglutinin disease

Background: Cold agglutinin disease is a very rare condition associated with agglutination of erythrocytes in cold environment usually due to IgM type antibodies. Other than hemolytic anemias, it may interfere with routine hemogram tests due to miscalculation of red blood cell count (RBC) and other hemogram parameters calculated with involvement of RBC. Awareness of the condition is important to overcome laboratory errors. Methods: We studied a peripheral blood smear and repeated the hemogram test at 37°C to establish the diagnosis of cold agglutinin disease. Results: Initial hemogram test results of the fifty-eight year-old man was as follows: RBC: 1.34 M/µL, hemoglobin (Hb): 12.4 g/dL, hematocrit (Htc): 11.8%, mean corpuscular hemoglobin (MCH): 92.4 pg, and mean corpuscular hemoglobin concentration (MCHC): 105 gr/dL. Despite the standard indirect Coombs test being negative, repeated tests at room temperature was 4+. We suspected cold agglutinin disease and repeated the hemogram test using the Bain-Marie method at 37°C and the test results showed RBC: 3.4 M/µL, hemoglobin: 12.6 g/dL, hematocrit: 30.2%, MCH: 31.7 pg, and MCHC: 41.8 g/dL. Conclusions: Inappropriate hemogram results may be a sign of underlying cold agglutinin disease. Hemolytic anemia not always accompanies the disease; however, cold exposure may trigger erythrocyte agglutination in vitro and may cause erratic laboratory results

Fever of Unknown Origin: Report of 82 Cases

Fever of unknown origin (FUO), is defined as a temperature higher than 38.3ºC that lasts three weeks or longer and remains undiagnosed after one-week of investigation. A total of 82 patients who were hospitalized between 1980-1999 with the diagnosis of FUO were included in this retrospective study. The mean age of the patients was 39 years (range 17-87 years). Thirty eight (46%) patients were females and 44 (54%) males. Infections were found in 49 (59%) patients, neoplasms in 9 (10.9%) patients, collagen vascular diseases in 6 (7%) patients, and miscellaneous diseases in 2 (2.4%) patients. Sixteen (19.5%) of the FUO cases remained undiagnosed. Brucellosis (11 cases, 13%) and tuberculosis (10 cases, 12%) were the most common two causes of infections. Lymphomas were the most common causes of neoplasms. Clinical recovery occured in 47 (57.3%) patients, clinical state remained unchanged in 30 (36.5%) patients and death was observed in 5 (6.2%) patients. In conclusion, the most common cause of FUO is infections in our series. The cases of FUO must be followed up with a multidisciplinary approach for correct diagnosis with in the shortest time and at low cost

Którą z metod diagnostycznych należy stosować w celu rozpoznawania przerostu migdałka gardłowego u dzieci w poszczególnych grupach wiekowych?

Aim: This study aims to determine the age interval for which the flexible nasopharyngoscopy (FNP) and lateral nasopharyngeal X-ray radiography (LNX) used in the diagnosis of adenoid hypertrophy more effectively in a pediatric population. Study Design: Prospective Cohort Study. Materials and Methods: 281 pediatric patients (1 to 15 years old) who were admitted to our ENT outpatient clinic with the complaints of nasal obstruction, snoring, sleep apnea through April 2016 and February 2017 and who were examined with FNP with the pre-diagnosis of adenoid hypertrophy were included in our study. All FNP examinations were evaluated by a single physician. The degree of choanal obstruction was recorded as percentage (%) with the help of the adenoid tissue image. The patients were divided into four groups according to the quality of the endoscopic examination performed during FNP examination; optimal assessment (group-1), assisted optimal assessment (group-2), assisted suboptimal assessment (group-3), and inability to assess despite assistance (group-4). LNX was performed for the re-evaluation of adenoid tissue in the patients in Group-3 and 4. Statistical analysis was performed among the groups according to the ages of the patients. Results: Optimal images were obtained with FNP in the patients aged between 1 and 2 years and 8-15 years and the expected images were obtained for choanal obstruction. However, no image could be obtained with FNP for assessment of choanal obstruction in more than 30% of patients between the ages of 3 and 8 years (31.2% and 33.3%, respectively), also in more than 50% of the patients who were 4,5,6 and 7 years old (60.6%, 56.7%, 55.8%, 66 , 6%, respectively). For this reason, their degrees of choanal obstruction were determined with LNX. Conclusion: For the optimal assessment of adenoid hypertrophy, we suggest that using LNX for the pediatric patients who are 4, 5, 6 and 7 years old and using FNP for the other age groups are more appropriate methods respectively in order not to disturb the polyclinic process of physician and for patient compliance

Responses of Two-Row and Six-Row Barley Genotypes to Elevated Carbon Dioxide Concentration and Water Stress

Barley (Hordeum vulgare L.) is a crucial cereal crop globally, and its productivity is influenced by environmental factors, including elevated carbon dioxide (CO2) levels and water stress. The aim of this study is to investigate the effects of water stress and increased CO2 concentration on the growth, physiological responses, and yield of two-row and six-row barley genotypes. Univariate data analysis revealed significant effects of CO2 concentration on most traits except chlorophyll a (Chla), crop antioxidant capacity as evaluated by the activity of plant extracts to scavenge the 2,2-diphenyl-1-picrylhydrazyl (DPPH), and on the maximum quantum yield of photosystem II (Fv/Fm). Mean comparisons showed that elevated CO2 increased certain traits such as shoot dry weight (ShDW) (34.1%), root dry weight (RDW) (50.8%), leaf area (LA) (12.5%), grain weight (GW) (64.1%), and yield-related traits and combination of significant indices (CSI) (72.5%). In comparison, Proline (−19.3%), Malondialdehyde (MDA) (−34.4%) levels, and antioxidant enzyme activities, including ascorbate peroxidase (APX) (−39.1%), peroxidase (POX) (−26.1%), and catalase (CAT), (−34.4%) decreased. Water stress negatively affected ShDW (−40.2%), GW (−43.7%), RDW (−28.5%), and LA (−28.8%), while it positively affected DPPH (36.0%), APX (54.8%), CAT (85.1%), and MDA (101%). Six-row barley genotypes (Goharan and Mehr) had the highest yield under normal humidity and elevated CO2 concentrations, while under water stress conditions, their yield decreased more than two-row genotypes (Behrokh and M9316). Principal component analysis and heatmapping revealed that two-row barley genotypes exhibited the highest stress resistance under elevated CO2 concentrations, with the highest levels of secondary metabolites

The longitudinal evolution of post-COVID-19 outcomes among hemodialysis patients in Turkey

Introduction: Hemodialysis (HD) patients have increased risk for short-term adverse outcomes of COVID-19. However, complications and survival at the post-COVID-19 period have not been published extensively.Methods: We conducted a national, multicenter observational study that included adult maintenance HD patients recovered from confirmed COVID-19. A control HD group without COVID-19 was selected from patients in the same center. We investigated the characteristics and outcomes in the follow-up of HD patients and compare them with the non-COVID-19 group.Results: A total of 1223 patients (635 patients in COVID-19 group, 588 patients in non-COVID-19 group) from 47 centers were included in the study. The patients' baseline and HD characteristics were almost similar. The 28th-day mortality and mortality between 28th day and 90th day were higher in the COVID-19 group than non-COVID-19 group (19 [3.0%] patients vs. none [0%]; 15 [2.4%] patients vs. 4 [0.7%] patients, respectively). The presence of respiratory symptoms, rehospitalization, need for home oxygen therapy, lower respiratory tract infection, and arteriovenous (AV) fistula thrombosis was significantly higher in the COVID-19 group in both the first 28 days and between 28 and 90 days. In the multivariable analysis, age (odds ratio [OR] [95% CI]: 1.029 [1.004-1.056]), group (COVID-19 group vs. non-COVID-19 group) (OR [95% CI]: 7.258 [2.538-20.751]), and vascular access type (tunneled catheter/AV fistula) (OR [95% CI]: 2.512 [1.249-5.051]) were found as independent parameters related to 90-day mortality.Conclusion: In the post-COVID-19 period, maintenance HD patients who have had COVID-19 have increased rehospitalization, respiratory problems, vascular access problems, and high mortality compared with the non-COVID-19 HD patients

The longitudinal evolution of post–COVID-19 outcomes among hemodialysis patients: A nationwide multicentre controlled study

BACKGROUND AND AIMS: Haemodialysis (HD) patients are at increased risk for adverse short-term consequences of COVID-19. In this study, we investigated the characteristics of chronic HD patients in the post-COVID-19 period and compared them with the control group. METHOD: We conducted a national multicentre observational study involving adult chronic HD patients recovering from COVID-19. The control HD group was selected from patients with similar characteristics who did not have COVID-19 in the same center. SARS-CoV-2 RT-PCR negative patients and patients in the active period of COVID-19 were not included. RESULTS: A total of 1223 patients (635 COVID-19 groups, 588 control groups) were included in the study from the data collected from 47 centres between 21 April 2021 and 11 June 2021. The patients' baseline demographics, comorbidities, medications, HD characteristics and basic laboratory tests were quite similar between the groups (Table 1). 28th-day mortality and between 28th day and 90th day mortality were higher in the COVID-19 group than in the control group [19 (3.0%) patients and 0 (0%) patients;15 (2.4%) patients and 4 (0.7%) patients, respectively]. Presence of respiratory symptoms, rehospitalization, need for home oxygen therapy, lower respiratory tract infection and A-V fistula thrombosis were significantly higher in the COVID-19 group in the first 28 days of illness and between 28 and 90 days. Mortality was significantly associated with preexisting COVID-19, age, current smoking, use of tunneled HD catheter, persistence of respiratory symptoms, rehospitalization, need for home oxygen support, presence of lower respiratory tract infection within 28 days and persistence of respiratory symptoms. CONCLUSION: In the post-COVID-19 period, mortality, rehospitalization, respiratory problems and vascular access problems are higher in maintenance HD patients who have had COVID-19 compared to control HD patients. (Table Presented)