Editorial

INTRODUCTION: Bone and mineral metabolism disorders are important potential complications after renal transplantation. The purpose of this study was to demonstrate the relationship between vitamin D, 1,25-dihydroxyvitamin D3 [1,25(OH)2D3], calcium, and phosphorus metabolism with graft function in renal transplant recipients.
METHODS: This prospective longitudinal study included 30 renal transplant recipients (10 female, 20 male; mean age: 40.30±12.86 years). Blood and urine samples were collected before and 6 months after transplantation. Serum creatinine, blood urea nitrogen (BUN), calcium, phosphorus, alkaline phosphatase (ALP), glucose, albumin, parathyroid hormone (PTH), 25-hydroxyvitamin D [25(OH)D], and plasma 1,25(OH)2D3 levels were measured. In addition, the urine protein/creatinine (P/C) ratio was calculated. The plasma 1,25(OH)2D3 level was determined using liquid chromatography-tandem mass spectrometry.
RESULTS: The posttransplant level of serum phosphorus, PTH, creatinine, BUN and ALP was found to be significantly decreased (p=0.0001; p=0.011 for ALP). Although the plasma 1,25(OH)2D3 level had significantly increased (p=0.0001) after transplantation, no significant difference in the serum 25(OH)D level was observed. The urine P/C ratio was found to be significantly decreased after transplantation (p=0.007). A deficiency of vitamin D was observed frequently both before (87%) and after (73%) transplantation.
DISCUSSION AND CONCLUSION: Persistent vitamin D deficiency was detected in the recipients even after transplantation, although the serum PTH level decreased. Some studies published to date draw a direct link between serum vitamin D level and graft function; however, evidence for this link was not observed in the present study. Long-term monitoring may be needed to evaluate the correlation between vitamin D level and graft function.

INTRODUCTION: Vitamin D has been associated with extra-skeletal pathologies through mechanisms involving inflammatory and oxidative stress processes. Ischemia-modified albumin (IMA) is one of the earliest indicators of ischemia, and is regarded as a marker of oxidative stress. In the present study, the IMA level in serum samples with various 25-OH vitamin D [25(OH)D] concentrations was examined for signs of oxidative stress as a result of vitamin D deficiency.
METHODS: A total of 80 serum samples requested by clinicians for 25(OH)D testing and analysis were randomly selected and divided into 4 groups (n=20 in each group) according to the 25(OH)D concentration. Group 1: ≤10 ng/mL (severe deficiency), Group 2: 10-20 ng/mL (deficiency), Group 3: 20-30 ng/mL (insufficiency), and Group 4: ≥30 ng/mL (sufficiency) were formed. Serum IMA was measured spectrophotometrically, and the results were expressed in absorbance units (ABSU).
RESULTS: The IMA level in Group 1 through Group 4 was 0.541±0.082 ABSU, 0.515±0.059 ABSU, 0.438±0.085 ABSU, and 0.467±0.102 ABSU, respectively. The IMA level was found to be significantly different in comparisons between Groups 1 and 3, Groups 1 and 4 and Groups 2 and 3 (p=0.001, p=0.032, p=0.022, respectively); no significant difference was found in other comparisons of the groups. There was a weak negative correlation between serum 25(OH)D and IMA level (r= -0.346; p=0.002).
DISCUSSION AND CONCLUSION: The serum IMA level is elevated in severe vitamin D deficiency and vitamin D insufficiency due to increased oxidative stress resulting from the inadequate antioxidant function of vitamin D. The IMA level may have been higher in the vitamin D sufficiency group compared with the insufficiency group due to a possible pro-oxidant effect of vitamin D as its level rises. If this hypothesis is confirmed with future studies, it may be appropriate to consider a serum 25(OH)D level of between 20 and 30 ng/mL sufficient.

INTRODUCTION: There are few studies on the relationship between glycemic control and the serum uric acid (SUA) level in acute myocardial infarction (AMI). The aim of this study was to investigate the relationship between glycemic control and SUA level in AMI.
METHODS: This was a retrospective study of patients with AMI who were in the coronary intensive care unit at Bakirkoy Dr. Sadi Konuk Education and Research Hospital between January 2017 and April 2017. Only patients with AMI were included. Age and sex data, as well as total cholesterol, triglycerides, high-density lipoprotein cholesterol (HDL-c), low-density lipoprotein cholesterol (LDL-c), glucose, SUA, and glycated hemoglobin (HbA1c) results were obtained for the study. Patients were classified into 3 groups according to the presence and glycemic control status of diabetes mellitus. Group 1 comprised non-diabetic AMI patients (n=62) and was evaluated as control group. Diabetic patients with good or moderate glycemic control were included in Group 2 (n=35) (<8% HbA1c) and those with poor glycemic control (n=32) (≥8% HbA1c) composed Group 3.
RESULTS: The mean age of the study group was 61 years (SD: 13)(min: 34; max: 92 years). There was no statistically significant difference between groups with regard to the distribution of gender characteristics or the mean values of age, total cholesterol, or LDL-c. In addition, no statistically significant difference was found between the values for HDL-c, triglycerides, and SUA between the study groups. There was no statistically significant difference between the SUA level and the HbA1c level between groups.
DISCUSSION AND CONCLUSION: Additional studies should be done in order to make a definite decision about a potential relationship between glycemic control and SUA level in AMI.

INTRODUCTION: Schizophrenia is a chronic psychiatric disease. The present study is a comparison of red blood cell distribution width (RDW) values in schizophrenia patients with those of a control group performed to examine the effect of inflammation on the pathogenesis of schizophrenia.
METHODS: This retrospective study was conducted in the laboratory of the Mental Health Hospital and included data collected between January 2013 and December 2014. All patients who were diagnosed with schizophrenia were included in the study. RDW was examined using a Mindray BC 3000 Plus instrument (Mindray Bio-Medical Electronics Co. Ltd., Shenzen, China) using the electrical impedance method. Statistical analyses were conducted using the Kolmogorov-Smirnov test, Student’s t-test, the Mann-Whitney U-test, chi-square analysis, or Fisher’s exact test.
RESULTS: The red cell distribution width standard deviation value was statistically significantly higher in the schizophrenia group than in the control group (48.43±5.14 fL and 43.75±4.66 fL; p<0.001). Similarly, patients with schizophrenia displayed elevated red cell distribution width coefficient of variation compared with the controls (14.14%±1.16% and 13.71%±1.39%; p<0.001).
DISCUSSION AND CONCLUSION: TRDW, a frequently assessed hematological parameter, may be a useful diagnostic and prognostic marker of schizophrenia, with potential utility in risk estimation and treatment monitoring.

INTRODUCTION: In this study, the effects of pre-analytical storage conditions on 25-hydroxy vitamin D [25(OH)D] samples were examined. The aim was to observe the relative effects of different temperature and time-related storage conditions on the stability of vitamin D.
METHODS: Blood samples from 153 healthy individuals referred to Sakarya Training and Education Hospital polyclinics were stored under different conditions. Serum was obtained by centrifugation and 4 aliquots were stored. One aliquot was analyzed immediately after collection (0-hour sample) and accepted as the reference for the comparison of the other aliquots. Time intervals and different storage conditions for aliquots were categorized as Group 1: 0-hour measurement (n=153), Group 2: 24 hours at 2-8°C (n=153), Group 3: about 2 months at -20°C (n=153), and Group 4: 3 months at -40°C (n=153). Vitamin D analysis was performed using chemiluminescence in the biochemistry laboratory.
RESULTS: There was no statistical difference in 25(OH)D between the 0-hour sample and the 2-8°C, -20°C, or -40°C samples (p=0.462, p=0.958, p=0.063, respectively); 25(OH)D was stable under different storage conditions.
DISCUSSION AND CONCLUSION: Vitamin D is an analyte that is generally not affected by preanalytical variables, and the storage conditions did not affect the acridinium ester magnetic particle chemiluminescence method used.

INTRODUCTION: The term low-grade inflammation is usually used to indicate chronic conditions in which the findings of classic, clinical inflammation are lacking, but there is an elevated C-reactive protein (CRP) level of 3 to 10 mg/L. Recently, the systemic immune-inflammation index (SII) was developed based on lymphocyte, neutrophil, and platelet counts, which can project the inflammatory and immune imbalances. The aim of this study was to examine the SII and new parameters derived from hemograms to determine if they have the potential to detect patients with subclinical low-grade inflammation in an unselected, elderly, outpatient population.
METHODS: The CRP level was analyzed with a BN II System nepholometer (Siemens Healthineers, Erlangen, Germany). Participants were stratified according to CRP level: Group 1 had a serum CRP result <3.0 mg/L and Group 2 had a serum CRP result 3.0-9.0 mg/L. Blood samples that had been analyzed with an automated hematology analyzer (Mindray BC-5800; Mindray Biomedical Electronics Co., Ltd., Shenzhen, China) were selected for evaluation of the results. The SII (neutrophil  x  platelet / lymphocyte), platelet-to-lymphocyte ratio (PLR), and neutrophil-to-lymphocyte ratio (NLR) were calculated.
RESULTS: The cumulative results of 179 unselected outpatients aged 45 years or older were evaluated. The SII (431 [interquartile range {IQR}: 326] vs 535 [IQR: 291]; p=0.049) and PLR (117 [IQR: 38] vs 126 [IQR: 58]; p=0.031) values were significantly high in Group 2 compared with Group 1. A statistically significant correlation between the SII and the NLR (r=0.807; p<0.001), PLR (r=0.773; p<0.001), and the platelet count (r=0.653; p<0.001) was found. However, there was no correlation between the CRP, SII (r=-0.312; p=0.210), and PLR (r=-0.165; p=0.117).
DISCUSSION AND CONCLUSION: A high PLR and SII appears to be associated with subclinical low-grade inflammation. These data do not support hematological screening parameters as a substitute for CRP. These findings are limited to the cohort studied here, and may not be entirely applicable to other ethnic origins.

INTRODUCTION: Osmolality can be measured with an osmometer, and it can also be calculated using formulas that include the level of some osmotically active serum components. The difference between measured and calculated osmolality is referred to as the osmolal gap. The osmolal gap indirectly indicates the presence of osmotically active substances other than sodium, urea, and glucose. The aim of this study was to calculate the osmolal gap using 6 osmolarity formulas published in the literature and compare the measured ethanol concentrations with various ethanol calculation formulas that include the osmolal gap.
METHODS: Serum ethanol, glucose, potassium, sodium, and urea levels were measured. Serum osmolarity was calculated with 6 formulas and converted to osmolality (mOsmol/L-mOsmol/kg H2O) using a converting factor. The osmolal gap was determined using measured and calculated osmolality with 6 different formulas for each sample. The osmolal gap values were multiplied by the ethanol coefficient used to ascertain the effect of ethanol on serum osmolality in order to obtain the amount of ethanol in the samples.
RESULTS: A positive correlation was observed between the 24 calculated ethanol levels and measured ethanol levels. No statistically significant difference was seen between the measured ethanol levels and 1 of the formulas, but there were systematic differences between them.
DISCUSSION AND CONCLUSION: Estimating the ethanol concentration with this type of approach is particularly inappropriate in forensic cases. The osmolal gap should only be used for screening toxic alcohols as an adjunct to clinical decision-making in emergency departments when ethanol cannot be measured, as in a case of alcohol intoxication.

INTRODUCTION: Testosterone is present in both genders; however, the level is low in women, whereas it is high in men. A measurement of total testosterone (TT) is widely requested by clinicians in daily practice, and is used in both diagnosis and treatment. The aim of this study was to calculate the measurement uncertainty of TT and to make a contribution of new research to the literature.
METHODS: The identification of measurement, factors that can affect the measured value, laboratory reproducibility bias (uRw2), laboratory and method bias measurement uncertainty (Ubias), uncertainty of calibration (uCref), uncertainty of external quality control data (uEQA), combined measurement uncertainty (Uc), and extended measurement uncertainty (U) were evaluated and reported.
RESULTS: The results of determining the measurement uncertainty of TT measurement in this laboratory were as follows: 1) uRw2 = (RSDlevel 12 + RSDlevel 22 + RSDlevel 32) / n: (20.902 + 17.482 + 7.002) / 3 = 263.79; 2) uCref = 0.012; Cref = 2.35; k=2. RuCref = (100 x uCref) / (k x Cref): (100 x 0.012) / (2 x 2.35) = 0.255; RuCref2 = 0.065; 3) Ubias2 = RuCref2 + uEQA2: 0.065 + 105.60 = 105.67; 4) Uc=√ (uRw2 + ubias2): √ (263.79 + 105.67) = 19.22; 5) U = 2√ (uRw2 + ubias2): 2 x 19.22 = 38.44%; 6) Result report (serum TT): ± 38.44%.
DISCUSSION AND CONCLUSION: The measurement uncertainty result for TT calculated using the top-down method was ± 38.44% with a 95% confidence interval. The individual measurement uncertainty result for each test should be given to the clinician and the patient together with the test results. The TT measurement uncertainty of other methods should also be known at the international level.

Cold agglutinin disease (CAD) is an autoimmune hemolytic disease in which antibodies for erythrocyte surface antigens are activated by low temperatures, causing agglutination of erythrocytes. Most of the published cases in the literature are related to the clinical presentation of the disease. Cold agglutinins can also interfere with laboratory tests. In this case, unexpected haptoglobin (Hp) and glycated hemoglobin (HbA1c) results, as well as complete blood count (CBC), were reported. A 55-year-old woman with joint paint presented at the rheumatology polyclinic. Blood samples were collected into anticoagulated and gel separation tubes for CBC, HbA1c, and biochemistry tests. The automated hematology analyzer results indicated a very low hematocrit (7%) and erythrocyte count (0.57x106 mm³). The erythrocyte indices, platelet count, and mean platelet volume could not be measured. Hp was undetectable. The HbA1c value was below the reference threshold. The patient’s file revealed that she had been diagnosed with CAD 5 years earlier. The samples were reanalyzed after warming in a Benmarie for 25 minutes to 37°C. While the CBC results improved, the HbA1c and Hp results did not change. Informing the laboratory when samples to be used are from patients with CAD and providing the proper temperature conditions during transportation will ensure accurate results, as well as decrease workload and laboratory costs.

The clinical diagnosis of heart failure (HF) is based on a history and a physical examination. Circulating molecules, such as troponin, B-type natriuretic peptide, and N-terminal pro-B-type natriuretic peptide are useful in the management of HF. Recently, it has been reported that a new biomarker, suppression of tumorigenicity (ST2), was associated with the prognosis of HF. ST2 is a cytokine and has 2 isoforms, a soluble (sST2) and a transmembrane receptor (ST2 ligand, or ST2L). The effects of ST2 are related to it binding to interleukin 33, which is a proinflammatory cytokine. sST2 acts as a decoy receptor in these interactions. sST2 plays a role not only in the pathogenesis of HF, but also in the pathogenesis of atherosclerosis. Additionally, an increased blood concentration of sST2 has been reported in several diseases. The most commonly used method is enzyme-linked immunoassay. However, there have been some methodological problems in the analysis of sST2. The aim of this review was to explore the biology and analytical considerations of ST2 and its clinical importance in HF.