Objectives: Ensuring result comparability across identical analyzers is critical in high-throughput clinical laboratories. ISO 15189:2022 emphasizes this requirement (clause 7.3.7.4), particularly for assays with low within-subject biological variation (BV), where reference intervals may be insufficient to detect clinically relevant changes. Methods: This study aimed to implement a practical rule-based approach for evaluating result consistency across identical analyzers using only internal quality control (IQC) data. At Dokuz Eylul University Central Laboratory (DEU-CL), IQC results from two Beckman Coulter AU5800 and two UniCel DxI 800 analyzers were collected over 12 months (May 2022-April 2023). Coefficient of variation (CV) and bias were calculated from the first five consecutive working days of each month. Total error (TE) was computed using the RMS method (TE=Bias + 1.65 x CV) and compared to total allowable error (TEa) limits defined by the EFLM BV database and Rili-BAEK guideline. Results: Among the 20 parameters evaluated, blood urea nitrogen (BUN), C-reactive protein (CRP), direct/total bilirubin, triglycerides, and uric acid consistently met EFLM TEa criteria. In contrast, albumin, creatinine, sodium, and total protein frequently exceeded EFLM limits. Sodium exhibited persistent nonconformities across all months. Most parameters fulfilled Rili-BAEK specifications. Conclusions: The proposed model enables continuous monthly performance assessment of identical analyzers using only routine IQC data. This approach supports ISO 15189:2022 compliance, facilitates early detection of analytical discrepancies, and may serve as an efficient, cost-effective quality assurance tool for high-volume laboratories.

Background:In COVID-19 patients, besides changes in leucocyte count, morphological abnormalities of circulating blood cells have been reported. Aim:This study aims to investigate the relationship between the morphological and functional properties of leucocytes and the severity of the disease in COVID-19 patients. Materials and Methods:Blood samples were collected from COVID-19 patients (n = 130) at the time of admission. The patients were stratified according to the comorbidity, age, LDH, lymhocyte count score as mild, moderate, and severe. Complete blood count and the cell population data were analyzed by the Volume, conductivity, scatter (VCS) technology on Beckman Coulter LH-780 hematology analyzer. Kruskal-Wal'lis test was used to assess the differences between the groups with subsequent Bonferroni correction. Results:Neutrophil count was increased, and lymphocyte count was decreased in severe patients compared to mild patients. The increase in the percent of neutrophils and the neutrophil/lymphocyte ratio in the severe patient group was significant in comparison to both the moderate and the mild group. The dispersion of the neutrophil volume and conductivity showed significant changes depending on the severity of the disease. The lymphocyte volume, lymphocyte-volume-SD and lymphocyte-conductivity as well as the monocyte-volume and monocyte-volume-SD were significantly increased in severe patients in comparison to mild patients. The increase of lymphocyte and monocyte volume in severe patients was also significant in comparison to moderate patients. Conclusions:COVID-19 infection leads to important changes in cell population data of leucocytes. The volumetric changes in lymphocytes and monocytes are related to the severity of the disease.

Yükseköğretim kurumları öğrencilerine daha kaliteli hizmet verebilmek adına, onların beklentilerini karşılayacak hem akademik hem de sosyal anlamda stratejiler geliştirmekte ve bu kapsamda gerçekleştirilecek faaliyetleri stratejik planlarına bütünleştirerek, bunların performansını etkin bir şekilde izleyebilmektedir. Öğrencilerin öğrenim gördükleri kurumlardan beklentileri, kurulabilecek doğrudan geribildirim mekanizmalarıyla sağlanabilmekle birlikte, genel olarak tüm hizmetler hakkındaki düşüncelerinin sistematik bir şekilde toplandığı sürdürülebilirliği olan bir sisteme de gereksinim duyulmaktadır. Bu bağlamda çalışmanın amacı, öğrencilerin aldıkları hizmetlerden genel memnuniyet düzeylerinin düzenli olarak ölçülmesini ve ölçüm sonuçlarının belirli bir yapıda kurum yönetimine sunulmasını sağlayacak bir bilgi sisteminin tasarlanmasıdır. Dokuz Eylül Üniversitesi Eğitimde Kalite Ölçme-Değerlendirme ve Güvence Sistemi uygulamaları kapsamında gerçekleştirilen bu tanımlayıcı çalışmada, Dokuz Eylül Üniversitesi Bilgi Sistemi üzerinde kurgulanan elektronik formda, altyapı olanakları, sunulan hizmetler, eğitim ve kariyer gelişimi, kurumun öğrenciye yaklaşımı, öğrenci ile iletişim, kuruma yönelik öğrencinin tutumu vb. sekiz boyut kapsamında sorular bulunmaktadır. Öğrenci dönütlerinin değerlendirilmesi tanımlayıcı istatistikler temel alınarak yapılmıştır ve genel memnuniyet düzeyini birincil öncelikli, ikincil öncelikli, iyileştirmeye açık ve üniversitenin güçlü olduğu alanlar olarak sınıflandırmak ve sıralamak için ilaveten bir ölçme aracı geliştirilmiştir. Bu sistem, gerekli alanları geliştirmek için kararlar almayı sağlayıp, eğitimin kalitesini ve öğrenci memnuniyetini artırmak için politika ve hedefler belirlemek anlamında Dokuz Eylül Üniversitesi’nin stratejik planı için girdi oluşturmaktadır ve bu amaçların gerçekleştirilmesinde sistematik bir şekilde performans değerlendirme imkanı sağlamaktadır. Anahtar Sözcükler: Öğrenci memnuniyeti, Değerlendirme sistemi, Yükseköğretim, Stratejik planlama

BACKGROUND/AIM Low-density lipoproteins (LDLs) have been shown to be a major risk factor for coronary artery disease. Multiple distinct subspecies have been identified among LDL particles on the basis of differences in size, density, and chemical composition. Particles with a diameter of <25.5 nm are defined as small dense LDL (sdLDL) and have been shown to be associated with increased risk of coronary disease. Subjects with predominance of sdLDL (pattern B) tend to have higher levels of triglyceride (TG) and lower levels of high-density lipoprotein cholesterol (HDL-C). In this study, we investigated the distribution of LDL subgroups in subjects with different types of hyperlipidemia, such as hypertriglyceridemia (hyperTG), hypercholesterolemia (hyperCHO), and combined hyperlipidemia (HL). MATERIALS AND METHODS We used gradient gel electrophoresis and a precipitation method with heparin-magnesium reagent to determine LDL subgroups. RESULTS It was found that there was a significant (P < 0.02) association between the lipid panel and LDL subgroups. The percentage of sdLDL in all HL groups was higher than in controls, and the ratio of sdLDL was highest in patients with hyperTG. CONCLUSION The predominance of sdLDL is closely related to hyperTG and low HDL-C levels.

BACKGROUNDS AND AIMS:Paraoxonase 1 (PON1) is a novel marker that has been shown to exert protective functions on atherosclerosis by preventing oxidative modification of serum lipoproteins. In this study, we investigated the effects of PON1 on CA-IMT in renal transplant patients.METHODS:A total of 98 adult renal transplant recipients was enrolled in the study. CA-IMT was determined by B-mode Doppler ultrasonography. PON-1 activity was assessed by the rate of enzymatic hydrolysis of paraoxon to p-nitrophenol.RESULTS:Mean age was 39.4 ± 9.6 years and 10% of the patients were diabetic. Time after transplant was 76 ± 59 months. Mean PON1 level was 62.1 ± 43.3 U/l. PON1 levels were negatively correlated with CA-IMT and positively with HDL cholesterol. Mean CA-IMT was 0.62 ± 0.10 mm (0.40 - 0.98). CA-IMT was positively correlated with age, male gender and negatively with proteinuria and PON1 levels. In linear regression analysis, PON1 levels were associated with CA-IMT.CONCLUSION:Reduced PON1 activity is significantly associated with increased carotid atherosclerosis in renal transplant patients.

OBJECTIVE:Cardiovascular diseases (CVD) are the largest cause of morbidity and mortality in Turkey and in the World. Heart of Balçova Project is a community- based health promotion project that aims to reduce CVD incidence and prevalence through risk factor modification in the individual and population level. This paper presents results of the baseline survey that aimed to define CVD risk factors and risk of developing coronary heart disease (CHD) in the Balçova population.METHODS:The study population included 36,187 people over 30 years of age residing in Balçova in 2007. Individuals were interviewed at their homes. Anthropometrics and blood pressure were measured and in total 12914 fasting blood samples were collected for lipid and glucose analyses. CHD risk was estimated using Framingham risk equation. Student's t test, Chi-square for trend test and ANOVA were used to compare mean levels and percentages of risk factors between age groups and gender.RESULTS:In total 5552 men and 10528 women participated in the study. Smoking prevalence was 38.6% in men and 26.8% in women. The prevalence of obesity was 29.4% among men and 44.2% among women and obesity prevalence increased until the age group 75 years old. While 14.6% of men and 12.6% of women had diabetes, 39.8% of men and 41.8% of women had hypertension. The prevalence of high total cholesterol was 56.0% in men and 50.6% in women. Men had a higher risk of developing CHD compared to women in the following 10 years (13.4% vs 2.5%).CONCLUSION:The prevalence of preventable risk factors for CHD is very high in Balçova population. Community-based interventions should be planned and implemented targeting both the high-risk individuals and whole population.

AIM Paraoxanase 1 (PON 1) has been shown to protect against atherosclerosis by modifying lipoproteins. Its activity decreases in dialysis patients but is restored after transplantation. Whether it affects arterial stiffness is unclear. In this study we aimed to investigate the effects of PON 1 on arterial stiffness in renal transplant patients. METHODS Seventy renal transplant recipients were enrolled. Arterial stiffness was measured using a Syphmocor device. PON-1 activity was assessed from the rate of enzymatic hydrolysis of paraoxon to p-nitrophenol. RESULTS Mean age was 39.0 ± 9.6 years and 5.7% of the patients were diabetic. Post-transplant follow-up time was 46.7 ± 37.9 months. Eighty-five percent received anti-hypertensive and 12.9% anti-hyperlipidemic medication. Mean PON1 activity was 75.9 ± 52.4 U/L. PON1 activity was negatively correlated with systolic and diastolic blood pressure, mean arterial pressure, LDL-cholesterol and carotid-femoral pulse wave velocity (cf-PWV). Mean c-f PWV was 8.10 ± 1.39 m/s. Cf-PWV was positively correlated with age, systolic and diastolic blood pressure, mean arterial pressure, proteinuria and negatively correlated with PON1, PON1/HDL ratio and creatinine clearance. In linear regression analysis, PON1 was a predictor of cf-PWV in a model that included age, gender, diabetes, mean arterial pressure, urine protein level, creatinine clearance and PON 1. CONCLUSIONS Reduced PON1 activity is significantly associated with increased arterial stiffness. The results of this study show the possible role of PON1 for arterial stiffening in renal transplant recipients.

Objectives: Paraoxonase (PON1) is a high density lipoprotein bound serum esterase that is synthesized by the liver which has ability to metabolize lipid peroxides hence playing an important role in protection against atherosclerosis. Our aim was to evaluate the effect of acute and chronic hyperglycemia on PON1 activity in order to clarify the effect of glucose homeostasis. Besides, the relation of hemoglobin A(1c) with triglyceride, total cholesterol, low density lipoprotein-cholesterol, high density lipoprotein-cholesterol and PON1/high density lipoprotein-cholesterol ratios which play role in the development of atherosclerosis was also evaluated.Design and methods: Chronic effects were investigated in Type 2 diabetes patients (n=290) divided into three groups according to their HbA(1c) levels (group 1: <7%, group 2: 7-8.9%, group 3: >= 9%). Oral glucose tolerance test applied 192 subjects were evaluated for acute effects.Results: No significant difference was observed in PON1 activities between the groups (p>0.05) and there was no correlation between PON1 activity, PON1/HDL-C ratio and HbA(1c). PON1 activities decreased during OGTT (p<0.05) and were insignificantly lower in the subjects with normal glucose tolerance.Conclusion: Our findings indicate that although there is a tendency of lowered PON1 activity in long term hyperglycemia, the difference was not significant between different HbA(1c) levels. However, acute hyperglycemia leads to significant decreases in PON1 activity.

BACKGROUND:Paraoxonase-1 (PON-1) may play an important role in atherosclerosis. Atherosclerosis is an inflammatory disease and C-reactive protein is a marker for inflammation. The aim of this study was to determine serum PON-1 activity and high-sensitivity C-reactive protein (hs-CRP) levels and assess carotid intima-media thickness, a marker of early atherosclerotic changes, in patients with subclinical hypothyroidism.MATERIAL/METHODS:hs-CRP concentrations and PON-1 activity with respect to carotid intima-media thickness were evaluated in 38 subclinical hypothyroidism patients (normolipidemic, mean age: 49.79+/-10.04 years) before and after 3 months of stable euthyroidism and compared with those of 19 euthyroid normolipidemic healthy individuals (mean age: 49.95+/-8.12 years).RESULTS:At baseline, the patients with subclinical hypothyroidism had similar levels of PON-1 activity and hs-CRP and a similar lipid profile as the controls; however, the carotid intima-media thickness was greater than in the controls. Levothyroxine treatment had no effect on serum PON-1 activity and hs-CRP level, but it resulted in a significant reduction in carotid intima-media thickness in the subclinical hypothyroidism patients.CONCLUSIONS:PON-1 activity and hs-CRP levels did not significantly differ between subclinical hypothyroid patients and controls. Although levothyroxine treatment might have the potential to reverse the progression of atherosclerosis in subclinical hypothyroid patients, PON-1 activity and hs-CRP levels were not affected by this treatment. The reduction in carotid intima-media thickness was independent of the decrease in serum lipid profile or other variables.

Objective: Ischemia reperfusion (IR) injury can cause severe organ failures. Remote and direct ischemic preconditioning can be used to prevent ischemia-reperfusion injury. Present study compares the effects of remote and direct ischemic preconditioning in the rat model of hepatic ischemia-reperfusion injury. Material and Methods: Four groups, each including seven rats were included. In the sham group only laparotomy was performed. In the ischemia reperfusion group 25 minutes of total hepatic ischemia was induced followed by 120 minutes of reperfusion. The leg was subjected to three cycles of ischemic preconditioning (IP) before hepatic ischemia reperfusion in the remote IP + IR group. One cycle of hepatic ischemic preconditioning was performed before hepatic ischemia reperfusion in the direct IP+IR group. The length of the experiment was the same in all groups. At the end of the experiment blood and Liver samples were collected. Results: Levels of serum aspartate transaminase (AST) and alanine transaminase (ALT) were significantly lower in the sham group compared to other groups (p<0.001). Levels of serum AST and ALT in the remote IP + IR group were significantly lower than in the direct IP + IR (p<0.001, p<0.001, respectively) and IR groups (p<0.001, p=0.002, respectively). Hepatic tissue malondialdehid level and the histological score of liver injury were significantly lower than in the direct IP + IR group (p<0.001, p=0.002, respectively). Conclusion: Present study showed that when serum AST-ALT levels and hepatic histological score are considered, remote ischemic preconditioning protects the liver from ischemia reperfusion injury better than direct ischemic preconditioning. The effects and mechanisms of these two preconditioning methods must be compared in clinical and experimental studies.

This study aimed to characterize the epidemiology and clinical outcomes of patients with bloodstream infections (BSIs) due to carbapenem-resistant Klebsiella pneumoniae (CRKP) in an OXA-48-predominant environment. This was a retrospective single-centre cohort study including all consecutive patients with CRKP BSIs treated between 1 January 2014 and 31 December 2018. Multivariate analysis, subgroup analysis and propensity-score-matched analysis were employed to analyse 30-day mortality as the primary outcome. Clinical cure at day 14 was also analysed for the whole cohort. In total, 124 patients with unique isolates met all the inclusion criteria. OXA-48 was the most common type of carbapenemase (85.5%). Inappropriate therapy was significantly associated with 30-day mortality [70.6% vs 39.7%, adjusted odds ratio (aOR) 4.65, 95% confidence interval (CI) 1.50–14.40, P=0.008] and 14-day clinical failure (78.5% vs 56.2%, aOR 3.14, 95% CI 1.09–9.02, P=0.033) in multivariate analyses. Among those treated appropriately, the 30-day mortality rates were similar in monotherapy and combination therapy arms (OR 2.85, 95% CI 0.68–11.95, P=0.15). INCREMENT CPE mortality score (aOR 1.16, 95% CI 1.01–1.33, P=0.029), sepsis at BSI onset (aOR 2.90, 95% CI 1.02–8.27, P=0.046), and inappropriate therapy (aOR 4.65, 95% CI 1.50–14.40, P=0.008) were identified as independent risk factors for 30-day mortality. Colistin resistance in CRKP had no significant impact on 30-day mortality. These results were also confirmed in all propensity-score-matched analyses and sensitivity analyses. Appropriate regimens were associated with better clinical outcomes than inappropriate therapies for BSIs with CRKP predominantly possessing OXA-48.

The reperfusion following liver ischemia results in hepatocyte damage and apoptosis. The aim of this study was to investigate the effects of two antioxidant agents, carnosine and melatonin, in rat liver ischemia-reperfusion injury. Five study groups were formed; I. sham, II. ischemia-reperfusion, III. ischemia-reperfusion+melatonin, IV. ischemia-reperfusion+carnosine, V. ischemia-reperfusion+melatonin+carnosine. Then 250 mg/kg carnosine and 10 mg/kg melatonin were administered intraperitoneally 30 min before ischemia and immediately after the reperfusion. Sinusoidal dilatation, congestion and neutrophil infiltration were observed in the ischemia-reperfusion group while these symptoms were less pronounced in the treatment groups. Alanine aminotransferase, aspartate aminotransferase and myeloperoxidase levels were increased in the ischemia-reperfusion group while they were lowered in the treatment groups. Glutathione level was low in the ischemia-reperfusion group while it tended to increase in the ischemia-reperfusion+carnosine administered and ischemia-reperfusion+carnosine+melatonin administered groups. There was an increase in the number of apoptotic cells in the ischemia-reperfusion group while this number was lowered in the treatment groups. Carnosine was more effective than melatonin in the reversal of structural and biochemical alterations that resulted from ischemia-reperfusion injury. The administration of melatonin and carnosine together yielded better outcomes compared to the sole administration of each agent.

The use of C-reactive protein (CRP) assays is increasing for a wide range of clinical conditions, and consequently the analytical performance requirements for CRP assays are also changing. For this reason, manufacturers have been developing CRP assays based on different methodologies to provide both high sensitivity and a wide measuring range. However, it is questionable whether these methods can meet the desired requirements for CRP assays. CRP Latex on the Cobas Integra 400 and CRP Tina-quant Latex on the Modular Analytics-P were evaluated in terms of detection limit, linearity, intra- and interassay precision, and comparability with 268 patient samples. The intra- and interassay precision of the two methods was <4.1% in the three pools with CRP concentrations ranging from 6.9 to 215 mg/L, and >10% in the pool with concentrations of approximately 0.60 mg/L. The detection limits for CRP Latex and Tina-quant Latex were 0.20 and 0.22 mg/L, respectively. Both methods were linear up to 215 mg/L. There was a good agreement between the two assays, except for a scattering at concentrations near the detection limits. Deming regression analysis for CRP Latex (x-axis) and Tina-quant Latex (y-axis) yielded a slope of 1.067+/-0.018, an intercept of -0.148+/-0.358, and an S(y/x) of 5.10 (r=0.996, P<0.0001). The two assays gave comparable results. Low precision was determined for both assays, except for the low pool with a concentration of approximately 0.60 mg/L. We concluded that both of these assays should be improved to meet high-sensitivity criteria.