Blood Smears Research Articles

Soil-Transmitted Helminthiasis, Intestinal Schistosomiasis and Malaria Co-Infections among Children in Rural Communities Around Rwasave and Cyarwa Valleys

Background: Soil-transmitted helminthiasis, schistosomiasis and malaria remain a threat in developing countries, especially to people living in rural areas near large water bodies, valleys or swamps whose daily life activities revolve around those areas. In addition, these parasites affect different groups of people especially those in contact with their breeding sites including children mostly due to their developing immunity compared to that of old people. Methodology: This cross-sectional study was conducted in rural communities near the Rwasave and Cyarwa valleys, with 124 school-aged children participating. Stool samples were tested for the presence of STH eggs and intestinal Schistosoma parasites using the Kato Katz technique, and thick blood smears were made to aid in the identification of plasmodium species in blood. The threshold intensity of infection on STHs and Schistosoma sp. was estimated by counting their eggs microscopically, which aided in classifying infections as light, moderate, or heavy according to WHO standards. Furthermore, Plasmodium species were identified by the presence of schizonts, trophozoites, or gametocytes on Giemsa-stained thick blood smears, and parasitic density was calculated as a result. Results: In this study, the highest prevalence of soil transmitted helminthiasis was 12.7% in Cyarwa valley compared to 12.5% in Rwasave valley. The highest prevalence of Schistosomiasis was 3.2% in Cyarwa valley compared to 1.3% in Rwasave valley. Prevalence of malaria in Cyarwa valley was 3.3% in 63 children. Where children infected were only males falling in 5-8 age group. Conclusion: Results showed high prevalence of soil transmitted helminthiasis which was 12.7% in Cyarwa compared to 12.5% in Rwasave valley especially in children aged 5-8, this due to poor sanitation (P<0.001) that have assessed. Surprisingly, Cyarwa valley is located nearby town. Whereas malaria, intestinal schistosomiasis was low and there were not significantly associated with their risk factors with p-values 0.4, 0.092 respectively which can show that, preventive measures that have been established by government of Rwanda have positive impacts. Furthermore, there was a low prevalence of soil transmitted helminthiasis, intestinal schistosomiasis and malaria co-infection. Keywords: soil transmitted helminthiasis, intestinal schistosomiasis, malaria.

Blood smears examination and prevalence of malaria in Addis Zemen Town, Northwest Ethiopia (2013–2021): a retrospective study

IntroductionIn Ethiopia, malaria is one of the major public health and socioeconomic problems, though tremendous efforts have been made. Currently, the country has a plan to eliminate malaria by 2030. To achieve this plan, epidemiological studies associated with malaria prevalence with gender, age groups, species types, and seasons are essential. Therefore, the aim of this study was to assess the prevalence of malaria from 2013 to 2021 in Addis Zemen town, Northwest Ethiopia.MethodsA retrospective study was conducted at assess the trend of malaria prevalence over the last nine years using recorded blood smear reports in the laboratory logbook from governmental health institutions. Trends in malaria cases and the proportion of genders, age groups, species, and seasons over time were compared. The data were analyzed using the SPSS-23 software package.ResultsThe overall malaria prevalence between 2013 and 2021 was 10.4%. From all confirmed cases, the minimum and maximum prevalence of malaria cases were recorded in 2018 (2%) and 2016 (33.2%) years, respectively. The infectious rate of males (59.3%) was significantly higher than that of females (40.7%) (p < 0.0001). In all survey periods, all age groups were infected by malaria parasites; the majority of the cases were between 15 and 45 years (57%) older than others. Statistically, a greater proportion of P. falciparum (80.1%) was recorded than P. vivax (18.5%) (p < 0.0001). Malaria cases were occurring throughout each month. The relative highest peaks of total malaria cases were observed during the months of September, October, and November. Seasonally, the highest infection rate was observed during spring (40.20%) compared to other seasons.ConclusionsIn conclusion, the study revealed that malaria transmission remained high, which affected males more than females and potentially reproductive ages. Two of the most important Plasmodium species were identified and found during all reviewed months and years, though P. falciparum was the most prevalent. Hence, the problem can be alleviated by using season-based long-lasting insecticide treated nets, regularly overseeing ongoing irrigation activity, overseeing the reduction of the water level of the Sheni River, health education, and providing immediate patient treatment.

Molecular Epidemiology and Phylogeny of Theileria ovis and Theileria lestoquardi in Sheep and Goats from Southern Punjab, Pakistan.

Background: Theileria spp. are responsible for ovine and caprine theileriosis, leading to significant morbidity and mortality in small ruminants.The present study aims to investigate Theileria spp. infections in small ruminants from Southern Punjab in Pakistan, and genetic characterize revealed Theileria spp. isolates. Methods: A total of 93 sheep and 107 goats were sampled between May and August 2022. Blood smears were examined microscopically, and PCR amplification targeting the 18S rRNA gene was performed to detect Theileria spp. Additionally, specific PCR assays targeting 18S rRNA and ms1 partial sequences were used to identify Theileria ovis and T. lestoquardi, respectively. Results: The prevalence of Theileria spp. was significantly higher using PCR (13.5%) compared to microscopic screening (5%). Sheep showed a higher prevalence rate (19.4%) compared to goats (8.4%) (p = 0.024). Young sheep aged ≤ 1 year were more commonly infected with Theileria spp. (41%) compared to older sheep (p = 0.006). The prevalence of Theileria spp. was higher in sheep-only herds (37.3%) compared to goat-only herds (18%) or mixed-species herds (8.1%) (p = 0.015). The prevalence rates of T. ovis and T. lestoquardi were 9% and 2.5%, respectively, with four animals (2 goats and 2 sheep) showing co-infection. Phylogenetic analysis revealed that our T. ovis 18S rRNA sequence clustered with previously reported sequences from sheep in Turkey, China, Spain, and goats in Tanzania. The obtained T. lestoquardi ms1 partial sequence formed a distinct cluster from other T. lestoquardi isolates in Pakistan and neighboring countries. Conclusion: Theileria spp. co-circulation in Pakistani small ruminants, particularly the presence of T. ovis and T. lestoquardi, highlights the need for attention from animal health decision-makers due to their financial and health impacts.

Malaria Prevalence and Risk Factors in Outpatients at Teda Health Center, Northwest Ethiopia: A Cross-Sectional Study.

Despite extensive efforts and achievements made in prevention and control, malaria is still a public health problem in Ethiopia. Currently, the case number has been climbing, even changing the epidemiology to the previously low-burden reporting locations. Therefore, our study is aimed at assessing malaria prevalence and associated risk factors in outpatients, Northwest Ethiopia. A facility-based cross-sectional study was conducted among 318 malaria-suspected outpatients from October 22 to December 15, 2022, at Teda Health Center, Northwest Ethiopia. Sociodemographic characteristics and malaria risk factors were assessed by a face-to-face interview using a pretested questionnaire. Plasmodium parasites were detected by using microscopy on a blood film stained with 10% and 3% Giemsa stain. The data were analyzed using Statistical Package for Social Sciences software version 25, and statistical significance was reported at a p value < 0.05. Of the 318 study participants, 124 (39.0%; 95%CI = 33.6% - 44.6%) tested positive for Plasmodium infection. Plasmodium vivax, P. falciparum, and mixed infections were identified in 71 (57.3%), 47 (37.9%), and 6 (4.8%), respectively, among positive study participants. Individuals above the age of 15 (AOR = 2.704, 95% CI 1.370-5.336) were more likely to be infected with Plasmodium than under-five-year-old individuals. Rural residents (AOR = 2.56, 95% CI 1.281-5.098), those who sleep or work outside at night (AOR = 1.99, 95% CI 1.020-3.875), and individuals who did not use long-lasting insecticide-treated net (AOR = 3.26, 95% CI 1.633-6.499) and had a family member with a history of malaria (AOR = 2.902, 95%CI = 1.671 - 5.041) had higher odds of acquiring Plasmodium infection than their counterparts. In our study area, malaria was a major health problem, with P. vivax being the dominant species. Multiple environmental and behavioural factors were associated with the infection acquisition. Therefore, urgent holistic intervention is required.

Exploring the Impact of Batch Size on Deep Learning Artificial Intelligence Models for Malaria Detection.

Introduction Malaria is a major public health concern, especially in developing countries. Malaria often presents with recurrent fever, malaise, and other nonspecific symptoms mistaken for influenza. Light microscopy of peripheral blood smears is considered the gold standard diagnostic test for malaria. Delays in malaria diagnosis can increase morbidity and mortality. Microscopy can be time-consuming and limited by skilled labor, infrastructure, and interobserver variability. Artificial intelligence (AI)-based tools for diagnostic screening can automate blood smear analysis without relying on a trained technician. Convolutional neural networks (CNN), deep learning neural networks that can identify visual patterns, are being explored for use in abnormality detection in medical images. A parameter that can be optimized in CNN models is the batch size or the number of images used during model training at once in one forward and backward pass. The choice of batch size in developing CNN-based malaria screening tools can affect model accuracy, training speed, and, ultimately, clinical usability. This study explores the impact of batch size on CNN model accuracy for malaria detection from thin blood smear images. Methods We used the publicly available "NIH-NLM-ThinBloodSmearsPf" dataset from the United States National Library of Medicine, consisting of blood smear images forPlasmodium falciparum. The collection consists of 13,779 "parasitized" and 13,779 "uninfected" single-cell images. We created four datasets containing all images, each with unique randomized subsets of images for model testing. Using Python, four identical 10-layer CNN models were developed and trained with varying batch sizes for 10 epochs against all datasets, resulting in 16 sets of outputs. Model prediction accuracy, training time, and F1-score,an accuracy metric used to quantify model performance, were collected. Results All models produced F1-scores of 94%-96%, with 10 of 16 instances producing F1-scores of 95%. After averaging all four dataset outputs by batch size, we observed that, as batch size increased from 16 to 128, the average combined false positives plus false negatives increased by 15.4% (130-150), and the average model F1-score accuracy decreased by 1% (95.3%-94.3%). The average training time also decreased by 28.11% (1,556-1,119 seconds). Conclusion In each dataset, we observe an approximately 1% decrease in F1-score as the batch size was increased. Clinically, a 1% deviation at the population level can create a relatively significant impact on outcomes. Results from this study suggest that smaller batch sizes could improve accuracy in models with similar layer complexity and datasets, potentially resulting in better clinical outcomes. Reduced memory requirement for training also means that model training can be achieved with more economical hardware. Our findings suggest that smaller batch sizes could be evaluated for improvements in accuracy to help develop an AI model that could screen thin blood smears for malaria.

An Intelligent Telediagnosis of Acute Lymphoblastic Leukemia using Histopathological Deep Learning

Leukemia, a global health challenge characterized by malignant blood cell proliferation, demands innovative diagnostic techniques due to its increasing incidence. Among leukemia types, Acute Lymphoblastic Leukemia (ALL) emerges as a particularly aggressive form affecting diverse age groups. This study proposes an advanced mechanized system utilizing Deep Neural Networks for detecting ALL blast cells in microscopic blood smear images. Achieving a remarkable accuracy of 97% using MobileNetV2, our system demonstrates high sensitivity and specificity in identifying multiple ALL sub-types. Furthermore, we introduce cutting-edge telediagnosis software facilitating real-time support for clinicians in promptly and accurately diagnosing various ALL subtypes from microscopic blood smear images. This research aims to enhance leukemia diagnosis efficiency, which is crucial for the timely intervention and managing this life-threatening condition.

Diagnosis of filariasis: A case report of a reemerging neglected tropical disease

Filariasis is a neglected tropical disease (NTD) of humans caused by the helminthic filarial species Wuchereria (W.) bancrofti, Brugia (B.) timori, and B. malayi. Diverse species of mosquitoes transmit the microfilariae of these worms to cause filaria infection, with the disease presenting classical clinical manifestations such as lymphedema, adenolymphangitis, and hydrocele, which result in permanent disfigurement and psychosocial and economic stigmatization. These sequelae necessitate the need for proper identification and characterization of the etiological agent for therapy and prevention. In this study, we report a case of unilateral lymphedema in a 28-year-old gateman/farmer from the Sabon Gari Local Government Area of Kaduna State, Northern Nigeria. Microscopy of the patient’s blood sample demonstrated the presence of microfilariae, leading to PCR characterization to be W. bancrofti. Upon diagnosis, the patient was treated with tablets of doxycycline 200 mg daily and albendazole 200 mg bid for six weeks, followed by a single dose of ivermectin 150 mg/kg (15 mg) at the 4th week of initiating treatment. This treatment regimen was complemented by a combination of bed rest, use of compression bandage, and limb elevation at night, resulting in remarkable improvement of the patient’s health after six weeks. In conclusion, lymphatic filariasis diagnosis was microscopically confirmed by the demonstration of microfilaria in the blood film obtained at night, leading to molecular characterization by PCR to be W. bancrofti. This is a workup for treating filarial infections in patients with unilateral leg swelling and a history of living in or traveling to endemic areas. This should also be a wake-up call to policymakers and practitioners regarding the possible recrudescence of filariasis in Nigeria.

Autosomal Dominant Hereditary Spherocytosis In An Elderly Patient

Hereditary spherocytosis (HS) is an autosomal dominant inherited hemolytic anemia that usually manifests in early adolescence. A very small proportion (5%) may undergo de novo mutations and present at an elderly age without any positive family history. The disease is characterized by anemia, jaundice, splenomegaly, and the presence of spherocytes in peripheral blood, which are osmotically fragile. A 55-year-old elderly male presented with generalized weakness and a history of repeated blood transfusions for 5 months. He had recurrent jaundice for 8 years. There was no relevant family or drug history. He was anemic, icteric, and had mild splenomegaly. Investigation revealed persistently low Hb with normal red cell indices. There were a lot of spherocytes with polychromasia on the peripheral blood film. There was also evidence of hemolysis with a high reticulocyte count and higher levels of total and indirect bilirubin. Autoimmune hemolysis was excluded by negative direct and indirect Coomb’s tests, and Hb defect was excluded by normal Hb electrophoresis. We also ruled out other infectious causes. The ultrasound confirmed splenomegaly. The osmotic fragility test showed increased osmotic fragility of the patient’s red cells. History, symptoms, and test results strongly point to autosomal dominant hereditary spherocytosis with new mutations. An eosin-5-Maleimide binding test was advised, along with family screening of the patient. Bangladesh J Medicine 2024; 35: 110-113

Idiopathic Immune Mediated Haemolytic Anaemia (IMHA) in a 2.5-Month-old Puppy: A Case Report

Background: A 2.5-month-old puppy was presented to the Veterinary Clinical Complex of the College of Veterinary Sciences and AH, Jalukie, Nagaland with a complaint of emesis for one week, inappetence, icterus of the lower abdominal area and other visible mucous membrane. Detailed clinical history was collected and clinical examination was conducted. Methods: 4 ml blood peripheral blood was collected from the cephalic vein in the Lev-Lock blood clot activator vacutainer to harvest serum for biochemical analysis. Another 2 ml of whole blood was also collected in Lev-Lock K3 EDTA vacutainer for complete blood count, blood smear examination for blood parasites, morphological changes in the RBC and IDEXX SNAP 4Dx Plus test kit was also used for diagnosis of the blood parasites test. Result: Peripheral blood smear examination and IDEXX SNAP 4Dx Plus test were found to be negative for blood parasites, but spherocytosis could be observed in the blood smears. A complete blood count (CBC) examination revealed severe anaemia of macrocytic normochromic type, neutrophilic leucocytosis and thrombocytopenia. Serum biochemistry revealed a decrease in blood urea nitrogen (BUN) and creatinine with normal alanine transaminase (ALT). Treatment with whole blood transfusion, corticosteroid and other supportive therapy was successful in this case. Based on the clinical presentation, laboratory findings and its response to the treatment with prednisolone, it was diagnosed as an idiopathic immune-mediated haemolytic anaemia (IMHA) with an extravascular mechanism of haemolysis. A follow-up review after 1 year and 4 months post-treatment reported that the dog was still alive and healthy.

Assessment of the selected hematological profiles among malaria and Schistosoma mansoni co-infected patients, Northwest Ethiopia.

Malaria and schistosomiasis are infectious diseases that cause hematological profiles abnormalities. Malaria and Schistosoma mansoni co-infection causes exacerbation of health consequences and co-morbidities. The aim of this study was to assess the selected hematological profiles among malaria and S. mansoni co-infected patients at Dembiya Selected Health Institutions. An institutional-based comparative cross-sectional study was conducted from March 30 to August 10, 2022. A total of 140 individuals were enrolled in the study using a convenient sampling technique. Wet mount and Kato Katz technique were conducted to detect S. mansoni in Stool sample. Blood films were prepared for the detection of plasmodium. The data was coded and entered into EpiData version 3.1 before being analyzed with SPSS version 25. A P-value of less than 0.05 was considered statistically significant. Mean of WBC, neutrophil, lymphocyte, eosinophil, RBC, hemoglobin, and hematocrit [4.IU/L,2.2IU/L, 1.4IU/L, 0.1IU/L, 3.13IU/L, 9.5g/dL, and 28.7%, resepectively] in co-infected were significantly lower than [7.5IU/L, 4.6IU/L, 2.1IU/L, 0.38IU/L, 4.8IU/L, 14.6g/dL, and 43.7%, resepectively] in the healthy control participants. Mean of RBC, hemoglobin, and hematocrit [3.13IU/L, 9.5g/dL, 28.7%, resepectively] in co-infected were significantly lower compared to [3.8IU/L, 11.5g/dL, 33.9%, resepectively] in the malaria monoinfected participants and [3.7IU/L,11.5g/dL, 33.6%, resepectively] in the S. mansoni monoinfected participants. The result of hematological profiles in healthy participants had no significant difference compared to light,moderate and heavy S. mansoni infection intensity in coinfection. The number of S. mansoni eggs per gram of stool had been negatively correlated with hematological profiles of co-infected participants except lymphocyte and monocyte which correlated positively. Hematological profiles status in coinfection were significantly altered compared to malaria monoinfection, S. mansoni monoinfection, and healthy participants.Therefore, hematological tests should be used to monitor and manage coinfection related complications, and to reduce coinfection associated morbidity and mortality.

Identifying Subtypes of Acute Lymphoblastic Leukemia Using Blood Smear Images: A Hybrid Learning Approach

Identifying Subtypes of Acute Lymphoblastic Leukemia Using Blood Smear Images: A Hybrid Learning Approach

Automatic classification and segmentation of blast cells using deep transfer learning and active contours.

Acute lymphoblastic leukemia (ALL) presents a formidable challenge in hematological malignancies, necessitating swift and precise diagnostic techniques for effective intervention. The conventional manual microscopy of blood smears, although widely practiced, suffers from significant limitations including labor-intensity and susceptibility to human error, particularly in distinguishing the subtle differences between normal and leukemic cells. To overcome these limitations, our research introduces the ALLDet classifier, an innovative tool employing deep transfer learning for the automated analysis and categorization of ALL from White Blood Cell (WBC) nuclei images. Our investigation encompassed the evaluation of nine state-of-the-art pre-trained convolutional neural network (CNN) models, namely VGG16, VGG19, ResNet50, ResNet101, DenseNet121, DenseNet201, Xception, MobileNet, and EfficientNetB3. We augmented this approach by incorporating a sophisticated contour-based segmentation technique, derived from the Chan-Vese model, aimed at the meticulous segmentation of blast cell nuclei in blood smear images, thereby enhancing the accuracy of our analysis. The empirical assessment of these methodologies underscored the superior performance of the EfficientNetB3 model, which demonstrated exceptional metrics: a recall specificity of 98.5%, precision of 95.86%, F1-score of 97.16%, and an overall accuracy rate of 97.13%. The Chan-Vese model's adaptability to the irregular shapes of blast cells and its noise-resistant segmentation capability were key to capturing the complex morphological changes essential for accurate segmentation. The combined application of the ALLDet classifier, powered by EfficientNetB3, with our advanced segmentation approach, emerges as a formidable advancement in the early detection and accurate diagnosis of ALL. This breakthrough not only signifies a pivotal leap in leukemia diagnostic methodologies but also holds the promise of significantly elevating the standards of patient care through the provision of timely and precise diagnoses. The implications of this study extend beyond immediate clinical utility, paving the way for future research to further refine and enhance the capabilities of artificial intelligence in medical diagnostics.

Case Report: Ehrlichia ewingii Infection in a Shih Tzu Mix Dog

Ehrlichiosis is a dog disease caused by Ehrlichia, a gram-negative intracellular bacterium, and transmitted by ticks of the genus Rhipicephalus sanguineus. This case report aims to identify the infectious agent and describe the treatment for a case of ehrlichiosis. The examination results showed signs of ehrlichiosis in a male shih tzu mix dog aged three months. The dog had been suffering from itching, weakness, decreased appetite, and tick infestations over the entire body for the past month. The physical examination showed that the dog was limping and had pale oral mucosa. Meanwhile, the routine hematological examination showed signs of neutrophilia, hypochromic microcytic anemia, and thrombocytopenia. In addition, the blood smear examination showed intracytoplasmic bodies in the neutrophils of the dog. Blood tests using the test kit showed a positive result for ehrlichiosis. The dog was diagnosed with ehrlichiosis with a good prognosis. The treatment included doxycycline at a dose of 10 mg/kg BW q24h PO for 28 days, Livron B.plex at a dose of 1 tablet per day PO for 14 days, Fufang Ejiao Jiang at a dose of 1 ml per day PO for 14 days, and Bravecto Spot-on. The condition of the dog improved after seven days of treatment. However, the routine hematological examination on day seven still showed signs of anemia and thrombocytopenia, necessitating continued supportive drugs.

Urinary liver-type fatty acid-binding protein level as a prognostic indicator of acute kidney injury secondary to severe falciparum malaria.

Acute kidney injury (AKI) secondary to severe falciparum malaria possesses a high mortality rate; however, a prognostic marker of renal dysfunction has not yet been identified. Thus, we reported a case of a patient with AKI secondary to falciparum malaria who underwent hemodialysis and a renal biopsy due to prolonged renal dysfunction. The male patient, in his 50s, presented to our hospital with vomiting, diarrhea, fever, and decreased level of consciousness. The Giemsa-stained peripheral blood film revealed approximately 5% parasitemia, and a rapid diagnostic test was positive for Plasmodium falciparum. He was diagnosed with severe falciparum malaria and was started on quinine hydrochloride. Hemodialysis was initiated due to the decreased urine output and fluid retention. Subsequently, he was weaned off hemodialysis. The histopathological analysis of a renal biopsy revealed interstitial fibrosis, tubular atrophy, and chronic inflammatory cell infiltration; thus, malarial nephropathy was diagnosed. Thereafter, his renal function stabilized, and he was discharged from the hospital. The urinary liver-type fatty acid-binding protein (L-FABP) level decreased before renal function improved. Our report highlighted that long-term follow-up is essential for severe AKI secondary to malaria. The urinary L-FABP level may be a useful prognostic indicator of AKI secondary to severe falciparum malaria.

Unrevealing the therapeutic potential of artesunate against emerging zoonotic Babesia microti infection in the murine model.

Babesiosis, a zoonotic blood protozoal disease, threatens humans and animals and is difficult to treat due to growing antimicrobial resistance. The study aimed to investigate the therapeutic efficacy of artesunate (AS), a well-known derivative of artemisinin, against Babesia microti (B. microti) using a murine infection model. Male BALB/c mice (6 weeks old; 15 per group) were chosen and randomly divided into 1) the control group, 2) the B. microti group, and 3) the B. microti + artesunate treatment groups. AS treatment at 2 mg/kg, 4 mg/kg, and 8 mg/kg of body weight significantly (p < 0.05) reduced the B. microti load in blood smears in a dose-dependent manner. Additionally, AS treatment mitigated the decrease in body weight and restored the normal state of the liver and spleen viscera index compared to the B. microti-infected group after 28 days. Hematological analysis revealed significant increases in RBC, WBC, and PLT counts post-AS treatment compared to the B. microti-infected group. Furthermore, AS administration resulted in significant reductions in total protein, bilirubin, ALT, AST, and ALP levels, along with reduced liver and spleen inflammation and lesions as observed through histopathological analysis. AS also elicited dose-dependent changes in mRNA and protein expression levels of apoptotic, proinflammatory, and anti-inflammatory cytokines in the liver compared to the control and B. microti-infected groups. Immunolabeling revealed decreased expression of apoptotic and inflammation-related proteins in AS-treated hepatic cytoplasm compared to the B. microti-infected group. AS also in dose-dependent manner decreased apoptotic protein and increased Bcl-2. Overall, these findings underscore the potential of AS as an anti-parasitic candidate in combating B. microti pathogenesis in an in vivo infection model, suggesting its promise for clinical trials as a treatment for babesiosis.

Sub-microscopic Plasmodium falciparum infections and multiple drug resistant single nucleotide polymorphic alleles in pregnant women from southwestern Nigeria

ObjectivesThe study evaluated sub-microscopic malaria infections in pregnancy using two malaria Rapid Diagnostic Tests (mRDTs), microscopy and RT-PCR and characterized Plasmodium falciparum dihydrofolate reductase (Pfdhfr) and Plasmodium falciparum dihydropteroate synthase (Pfdhps) drug resistant markers in positive samples.MethodsThis was a cross sectional survey of 121 pregnant women. Participants were finger pricked, blood drops were collected for rapid diagnosis with P. falciparum histidine-rich protein 11 rapid diagnostic test kit and the ultra-sensitive Alere Pf malaria RDT, Blood smears for microscopy and dried blood spots on Whatman filter paper for molecular analysis were made. Real time PCR targeting the var acidic terminal sequence (varATS) gene of P. falciparum was carried out on a CFX 96 real time system thermocycler (BioRad) in discriminating malaria infections. For each run, laboratory strain of P. falciparum 3D7 and nuclease free water were used as positive and negative controls respectively. Additionally, High resolution melt analyses was employed for genotyping of the different drug resistance markers.ResultsOut of one hundred and twenty-one pregnant women sampled, the SD Bioline™ Malaria Ag P.f HRP2-based malaria rapid diagnostic test (mRDT) detected eight (0.06%) cases, the ultra-sensitive Alere™ malaria Ag P.f rapid diagnostic test mRDT had similar outcome in the same samples as detected by the HRP2-based mRDT. Microscopy and RT-PCR confirmed four out of the eight infections detected by both rapid diagnostic tests as true positive and RT-PCR further detected three false negative samples by the two mRDTs providing a sub-microscopic malaria prevalence of 3.3%. Single nucleotide polymorphism in Pfdhps gene associated with sulphadoxine resistance revealed the presence of S613 mutant genotypes in three of the seven positive isolates and isolates with mixed wild/mutant genotype at codon A613S. Furthermore, four mixed genotypes at the A581G codon were also recorded while the other Pfdhps codons (A436G, A437G and K540E) showed the presence of wild type alleles. In the Pfdhfr gene, there were mutations in 28.6%, 28.6%, and 85.7% at the I51, R59 and N108 codons respectively. Mixed wild and mutant type genotypes were also observed in 28.6% each of the N51I, and C59R codons. For the Pfcrt, two haplotypes CVMNK and CVIET were observed. The SVMNT was altogether absent. Triple mutant CVIET 1(14.3%) and triple mutant + wild genotype CVIET + CVMNK 1(14.3%) were observed. The Pfmdr1 haplotypes were single mutants YYND 1(14.3%); NFND 1(14.3%) and double mutants YFND 4(57.1%); YYDD 1(14.3%).

Evaluation of the immune system status and hematological dyscrasias, among amphetamine and cannabis abusers at Eradah Hospital in Qassim, Saudi Arabia

This cross-sectional study aims to evaluate the immune system status and hematological disturbances among individuals who abuse amphetamines and cannabis. Substance abuse, particularly of amphetamines and cannabis, has been associated with various adverse effects on the body, including potential impacts on the immune system and hematological parameters. However, limited research has been conducted to comprehensively assess these effects in a cross-sectional design. Additionally, fungal infections are on the rise internationally, and immune-compromised people are particularly susceptible. The study will recruit a sample of amphetamine and cannabis abusers (n = 50) at the Eradah Hospital in the Qassim Region of Buraydah and assess their sociodemographic and biochemical variables, including blood indices and differential WBC indices, liver, and kidney profiles. Additionally, 50 sputum samples in total were cultured for testing for fungus infections. To obtain the descriptive statistics, the data was imported into Microsoft Excel and subjected to statistical analysis using SPSS 22.0. Amphetamine and cannabis abuser's sociodemographic variables analysis observed that the majority (52%) were aged 18–30, with 56% in secondary school. Unemployment was a significant issue, and most had no other health issues. The majority (50%) had 5–10 years of abuse, while 32% had less than 5 years, and only 18% had been drug abusers for more than 10 years. There were significant changes (p < 0.001) in all different leukocyte blood cells, including neutrophils, lymphocytes, monocytes, eosinophils, and basophils. Furthermore, a microscopic examination of blood films from individuals who misuse the combination of the medications "amphetamine and cannabis" reveals hazardous alterations in Neutrophils. Out of 50, 35 sputum samples showed positive growth on Sabouraud dextrose agar (SDA) with chloramphenicol antibiotic, indicating a unicellular fungal growth. The present study explores the immune system and hematological disturbances linked to amphetamine and cannabis abuse, providing insights into health risks and targeted interventions. The findings complement previous research on drug users' hematological abnormalities, particularly in white blood cells. Routine hematological tests help identify alterations in homeostatic conditions, improving patient knowledge and preventing major issues. Further research is needed on multi-drug abuse prevention, early detection, and intervention. The cross-sectional design allows for a snapshot of the immune system and hematological status among abusers, laying the groundwork for future longitudinal studies. Key Words: Drug Effect, Immunity, Epidemiology, Oxidative Stress, Inflammation.

Comparing the Efficacy of Inhaled Corticosteroid (ICS) Treatment in COPD Patients Based on Blood Eosinophilia: A Clinical Trial Study

Background: Inhaled corticosteroids (ICSs) have been widely used in the maintenance therapy of chronic obstructive pulmonary disease (COPD). Eosinophilic airway inflammation is a recognized inflammatory endotype in COPD. Nevertheless, the benefits and risks of ICS treatment remain controversial. Objectives: Therefore, in this study, we determine the frequency of eosinophilia in COPD patients and compare the effects of ICSs in patients with and without eosinophilia referring to the lung clinics of Zahedan University of Medical Sciences. Methods: In this study, 58 COPD patients were examined. Peripheral blood smears (PBS) were collected from all patients, and they were randomly divided into 2 groups. First, a 6-minute walking test (6MWT) was performed on all patients. Thereafter, two groups of patients received standard treatment with the Symbicort spray for 3 months. They were followed for this period, and the 6MWT was performed again at the end of the 3 months. Results: The mean results of the 6MWT test before and after intervention in the eosinophilia-positive group were 164.02 meters and 192.11 meters, respectively. Therefore, there was a significant difference in patient activity levels before and after ICSs (P = 0.017). In the eosinophilia-negative group, there was a significant difference in patient activity levels based on the 6MWT test before and after taking ICSs (P &lt; 0.001). However, there was no difference in activity levels between the two groups before and after the intervention (P = 0.68 and P = 0.36). Conclusions: Our finding showed that treatment with inhaled β2-agonists plus corticosteroids did not affect the response to this treatment in subjects' groups with and without eosinophilia compared to the pre-treatment conditions.

HAEMATOLOGICAL PROFILE AND MENTZER INDEX IN PEDIATRIC PATIENTS PRESENTING WITH ANEMIA

Objective: The objective of this study was to analyze clinical and hematological profile of children with anemia and determine the Mentzer index of all cases presenting with anemia. Methods: This was a cross-sectional observational study conducted in the Department of pediatrics of a tertiary care medical college. Eighty pediatric age group patients diagnosed to be having anemia on clinical examination were included in this study. Demographic details such as age and gender were noted in all cases. A through history was obtained and a clinical examination was done. Presenting complaints were also noted. Complete blood count with peripheral blood smear examination was done in all cases. The Mentzer index was determined from complete blood count reports. Results: Out of 80 studied cases, there were 57 (71.25%) boys and 23 (28.75%) girls. The mean age for boys was 9.12±3.14 years and for girls, it was slightly higher at 10.24±3.46 years. Fatigue (73.75%), pallor (71.25%), and anorexia (56.25%) were common complaints. About 55% had mild anemia 22.5% had moderate anemia and 22.5% suffered from severe. Mean hemoglobin concentration of studied cases was found to be 8.42±3.98 g/dL. The most prevalent blood picture was the normocytic normochromic blood picture, representing 60% of cases. Mentzer index ranged from a minimum of 10.83 to a maximum of 27.76, with the mean value being 17.40±2.92. Notably, the vast majority of patients (97.5%) had a Mentzer Index &gt;13, suggesting a high prevalence of iron deficiency. Conversely, only 2.5% of the patients had a Mentzer Index at or below 13, indicating a much smaller subset in whom Hb electrophoresis was needed to rule out thalassemia trait. Conclusion: Although most of the children with anemia are secondary to iron deficiency Mentzer index should be determined in all patients of anemia so as to avoid inadvertently prescribing iron supplementation in cases of thalassemia trait.

Pseudo-NRBC in the Mindray BC-6800Plus analyzer: A clue for diagnostic anticipation of fungemia. Experimental and preliminary clinical reports.

Candidemia can be a significant cause of death in immunosuppressed or debilitated patients particularly. Abnormalities of the instrumental cytograms of some hematological analyzers, such as Mindray BC-6800Plus, can be related to circulating Candida. We studied the possible diagnostic usefulness of this information. A fungal bloodstream infection has been simulated by adding aliquots of Candida albicans, Candida parapsilosis, and Candida glabrata to 75 leftovers and anonymized peripheral blood samples. Cytographic abnormalities like those of experimental samples were used to select patients with possible fungemia. The microscopic review of peripheral blood smears constituted the confirmatory method. In all experimental samples, the various Candida types caused pseudo-NRBC and morphological abnormalities of WNB and DIFF cytograms. Circulating blastospores, free or engulfed by neutrophils, were the microscopic findings in the peripheral blood smears. In the clinical verification, 72 patients were recruited based on the presence of an evocative cluster in the WNB and DIFF cytograms. The microscopic review of 39 out of 72 samples was positive for NRBC. According to blood cultures, light microscopy revealed fungal forms of several Candida or non-Candida types in the remaining 33 samples. Nine of these cases were not yet known to suffer from bloodstream infection. Although further confirmatory clinical studies are required for these diagnostic abilities, the BC 6800Plus cytographic abnormalities related to fungemia have proven helpful in rapidly monitoring persistent fungemia in already diagnosed patients. In unknown or undiagnosed cases, they could be the trigger point for the subsequent diagnostic-therapeutic pathway.