Blood Count Research Articles

Effectiveness of azvudine against severe outcomes among hospitalized COVID-19 patients in Xinjiang, China: a single-center, retrospective, matched cohort study

ABSTRACT Background Since the end of 2022, Azvudine was widely used to treat hospitalized novel coronavirus disease 2019 (COVID-19) patients in China. However, data on the clinical effectiveness of Azvudine against severe outcomes and post-COVID-19-conditions (PCC) among patients infected by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) Omicron variants was limited. This study evaluates the effectiveness of Azvudine in hospitalized COVID-19 patients during a SARS-CoV-2 Omicron BA.5 dominance period. Methods From 1 November 2022 to 1 July 2023, we conducted a single-center retrospective cohort study based on hospitalized COVID-19 patients from a tertiary hospital in Shihezi, China, recruiting laboratory-confirmed hospitalized patients with SARS-CoV-2 infection. Patients treated with Azvudine and usual care were propensity-score matched (PSM) at a 1:1 ratio to a control group in which patients undergone usual care only, with matching based on covariates such as sex, age, ethnicity, number of preexisting conditions, antibiotic use upon admission, and complete blood cell count. The primary outcomes were all-cause death and PCC at short-term (60 days) post discharge. The secondary outcomes included the initiation of invasive mechanical ventilation and PCC at long-term post discharge (120 days). Cox proportional hazards (PH) regression models were employed to estimate the hazard ratios (HR) for both all-cause death and invasive mechanical ventilation, and logistic regression models were used to estimate the odds ratios (OR) for short-term and long-term PCC. Subgroup analyses were performed based on the matched covariates. Results A total of 2,639 hospitalized patients diagnosed with COVID-19 were initially identified, and 2,069 patients were screened following the exclusion criteria. After matching, 297 Azvudine recipients and 297 matched controls were eligible for analyses. The incidence rate of all-cause death was lower in the Azvudine group than in the control group (0.007 per person, 95% confidence interval [CI]: 0.001, 0.024 vs 0.128, 95% CI: 0.092, 0.171), and the use of Azvudine was associated with a significant lower risk of death and the use of Azvudine was associated with a reduced risk of death (HR: 0.049, 95% CI: 0.012, 0.205). Subgroup analyses indicated a significant effectiveness of Azvudine against the risk of all-cause death among men, age over 65, patients without the preexisting conditions, and patients with antibiotics dispensed at admission. Statistical difference were not observed between Azvudine group and control group in the invasive mechanical ventilation and short-term and long-term PCC. Conclusions The present findings indicate that receipt of Azvudine was associated with lower risk of all-cause death among hospitalized patients with Omicron BA.5 infection a in real-world setting. Further research is urgently needed to validate the effectiveness of Azvudine on the PCC.

Laboratory features and pharmacological management of early and late-onset primary Sjögren’s syndrome

BackgroundPrimary Sjögren’s Syndrome (pSS) is a systemic chronic autoimmune disorder that contributes to dry mouth (xerostomia) and eyes (xerophthalmia). It mainly affects females between 40 and 60 years old. So far, there is no treatment to cure SS; however, there is a list of medications that can ameliorate the symptoms. In addition, there has been no single test until now to detect pSS, but clinical and immunological investigations are applied as diagnostic tools. Therefore, this study aimed to explore the characteristics of pSS in Saudi patients based on the onset of the disease through laboratory findings and pharmaceutical management.MethodologyThis retrospective study examined diagnosed patients with pSS between 2018 and 2023 from the National Guard Hospital, Saudi Arabia. Data of pSS patients was categorized into two groups: early (under 40 years old) and late-onset (40 years old and above). Data on demographic information, mortality rate, and blood tests such as complete blood count (CBC), creatinine, erythrocyte sedimentation rate (ESR), and vitamin levels, in addition to prescribed medications, were collected from the patient’s medical record. Chi-square and t-tests were mainly used, and statistical significance was determined at a P-value less than 0.05.ResultsA total of 453 patients were included in the study, where the early-onset group comprised 136 and the late-onset group comprised 317 patients. The mean age of the early and late onset was 34.2 and 60.4, respectively. ESR was significantly higher in the early (46.3 mm/hr) and late-onset (49.8 mm/hr). The most common medication used by all pSS patients was hydroxychloroquine. However, artificial tears were mainly observed in the late-onset group. Other medications, such as pilocarpine, methotrexate, and azathioprine, were prescribed to pSS patients to a lesser extent.ConclusionThis study suggests that the onset of pSS could occur even before the age of 40 among Saudi citizens. Notably, elevated ESR levels appeared to be a feature of pSS, which was consistent with other previous findings. The variability of some medications between early-onset and late-onset pSS may indicate disease progression. However, further investigations are required to confirm this observation.

Association of systemic inflammatory indices with anthropometric measures, metabolic factors, and liver function in non-alcoholic fatty liver disease

The present cross-sectional study aimed to explore the relationship between systemic inflammatory indices (SIIs) and anthropometric measures, metabolic, and liver function biomarkers in patients with non-alcoholic fatty liver disease (NAFLD). This study was carried out on 238 NAFLD patients with overweight or obesity, aged 18–55 years. Anthropometric measurements were done and body mass index (BMI), waist-to-hip ratio (WHR), and waist-to-height ratio (WHtR) were estimated. Metabolic factors including serum glucose, lipid profile, liver function biomarkers, and complete blood cell count were assessed after a 24-h fasting state. SIIs including the ratios of neutrophil to lymphocyte (NLR), monocytes to lymphocyte (MLR), platelet to lymphocyte (PLR), and monocytes to high-density lipoprotein cholesterol (MHR) were calculated. Results indicate that apart from PLR, all of the SIIs significantly changed by increasing steatosis severity (all p < 0.05). Moreover, changes in NLR showed a significant association with anthropometric indices including waist circumference (p = 0.032), BMI (p = 0.047), and WHtR (p = 0.002), as well as levels of fasting blood sugar (p = 0.045), triglycerides, (p = 0.025) and low-density lipoprotein cholesterol (p = 0.006). The findings also indicate the relations between lipid profile and all studied SIIs, notably MHR and MLR. All of the SIIs exhibited associations with some liver function indices as well. MHR was positively correlated with the metabolic risk factors of NAFLD while, oppositely, PLR was considered as a preventive marker of NAFLD.

Impact of intensity modulated proton therapy in reducing radiation induced lymphopenia in glioma patients

Abstract Background Current standard management in adult grade 2-4 gliomas includes maximal safe resection followed by adjuvant radiotherapy (RT) and chemotherapy. Radiation-induced lymphopenia (RIL) has been shown to possibly affect treatment outcomes adversely. Proton beam therapy (PBT) may reduce volume of normal brain receiving moderate radiation doses, and consequently RIL. Our aim was to evaluate the incidence and severity of RIL during proton beam therapy (PBT). Methods We identified patients with grade 2-4 glioma treated with PBT at our center between January 2019 to December 2021. We evaluated the incidence and severity of RIL from weekly complete blood count (CBC) data collected during PBT, and compared it to the patients who were treated with photon-based RT (XRT) at our center during the same time. Results The incidence of any degree of lymphopenia (48% in PBT, vs. 81.2% in XRT, p value = 0.001) and severe lymphopenia (8% in PBT, vs. 24.6% in XRT, p value = 0.093) were both significantly lesser in patients who received PBT. Severe RIL in patients receiving PBT was seen in only CNS WHO Gr-4 tumors. Mean whole brain V20GyE and V25GyE inversely correlated to nadir ALC, and were both significantly lower with PBT. Patients with lymphopenia during PBT showed a trend towards poorer progression-free survival (p=0.053) compared to those with maintained lymphocyte counts. Conclusion Proton therapy seems to have a superior sparing of normal brain to moderate dose radiation than photon-based RT and reduces incidence of lymphopenia. Glioma patients with lymphopenia possibly have worse outcomes than the ones with maintained lymphocyte counts.

Effects of radiation mitigating amino acid mixture on mice of different sexes.

To date, few FDA-approved medical countermeasures are available for addressing hematopoietic acute radiation syndrome (H-ARS). In this study, we present our latest research findings focusing on the evaluation of a novel radiation mitigator known as the mitigating amino acid mixture (MAAM). MAAM is composed of five amino acids as the recently reported amino acid-based oral rehydration solution for mitigating gastrointestinal (GI)-ARS. CD2F1 male and female mice were exposed to 60Co-γ total body irradiation (TBI) at 9.0 or 9.5 Gy. Following irradiation, mice were orally administered with MAAM or a saline vehicle control once daily for a duration of 14 days, commencing 24 h after TBI. Mouse survival and body weight change were monitored for 30 days after irradiation. Complete blood counts (CBCs), bone marrow (BM) stem and progenitor cell survival (clonogenicity), and a serum cytokine antibody array were analyzed using samples from day 30 surviving mice. Our data revealed that MAAM treatment significantly enhanced survival rates in irradiated male CD2F1 mice, and the survival rate increased from 25% in the vehicle control group to 60% in the MAAM-treated group (p < 0.05) after 9.0 Gy TBI. The number of BM colonies significantly increased from 41.8 ± 6.4 /104 cells (in the vehicle group) to 78.5 ± 17.0 /104 cells (in the MAAM group) following 9.0 Gy TBI. Furthermore, MAAM treatment led to a decrease in the levels of six cytokines/proteins [cluster of differentiation 40 (CD40), interleukin (IL)-17A, C-X-C motif chemokine 10 (CXCL10/CRG-2), cutaneous T cell-attracting chemokine (CTACK), macrophage inflammatory protein (MIP)-3β, and IL-1β] and an increase in the levels of five other cytokines/proteins [IL-3Rβ, IL-5, leptin, IL-6, and stem cell factor (SCF)] in mouse serum compared to the vehicle group after 9.0 Gy TBI. However, similar alleviating effects of MAAM were not observed in the irradiated CD2F1 female mice. The serum cytokine profile in the irradiated female mice was different compared to the irradiated male mice. In summary, our data suggest that the beneficial effects of the mitigative amino acid combination treatment after radiation exposure may depend on sex.

Prevalence and associated Factors of Anemia in Diabetic Patients

Introduction: Diabetes presents a significant global health challenge due to its association with a range of pathological changes, such as metabolic, cellular, and blood disturbances, that lead to long-term microvascular and macrovascular complications. Healthcare providers often underestimate anemia as a co-morbidity in diabetes, despite the wide range of prevalence estimates reported in the literature. Addressing anemia in diabetes patients early can reduce the incidence of these complications, as has been demonstrated. Aim of the study: The study aimed to estimate the prevalence of anemia and its associated factors among patients with type 2 diabetes mellitus (T2DM). Methods: This is a cross-sectional prospective study with a retrospective review of diabetic patient medical records attending family medicine clinics at four military hospitals (King Hussien Medical Center, Prince Rashed Military Hospital, Queen Aliah Military Hospital, and Prince Hashem Military Hospital) at Royal Medical Services. Adult patients over the age of 18 diagnosed with type 2 diabetes mellitus for more than one year will be included in the study. However, those patients with diseases (such as thalassemia and leukemia) or other systemic disorders (such as infectious diseases) that could result in anemia, those with acute conditions such as acute hemorrhage, those who received blood transfusions in the last three months, pregnant women, or type 1 diabetes will be excluded. Anemia will be defined as hemoglobin level &lt; 13 g/dl in men and 12g/dl in females (Harrison TR, 2011). Type 2 DM will be defined glycated hemoglobin (HbA1c &gt; 6.5%), fasting blood glucose (FBG &gt; 126 mg/dl), random blood glucose (RBG &gt; 200 mg/dl) (American Diabetes Association, 2012). Patients’ medical records will be reviewed for patient medications, duration of diabetes, diabetic complications, and glycemic control. Furthermore, to exclude any patients who have one or more of the aforementioned conditions reported in the exclusion criteria. Meanwhile, researcher will collect the following data in the clinic after patients’ agreement to participate in the study which include: age, sex, marital status, smoking status, comorbidities, anthropometric measurements including weight, height and body mass index (BMI). Moreover, patient will ask to withdraw complete blood count (CBC) blood sample which include hemoglobin, mean corpuscular volume (MCV), mean corpuscular hemoglobin (MCH) and mean corpuscular hemoglobin concentration (MCHC) for diagnosing anemia if its present. Patients will be divided into two groups based on the presence of anemia; anemic group and non-anemic group. Regarding study variables. Glycemic control will be classified into two categories based on HbA1c result (controlled diabetic group comprised those whose HbA1c level was equal to or &lt;7.5% and poorly controlled diabetic group comprised those whose HbA1c level was &gt;7.5%). Body mass index will classify according to Center of Disease Control (CDC) as follow: BMI score &lt; 18.5 Kg/m2 is underweight, 18.5–24.9 Kg/m2 is normal, 25–29.9 Kg/m2 is overweight and BMI ≥ 30 Kg/m2 is obese. The sample size will be calculated based on Cohran’s sample size formula as: n=Z2 pq /e2. Here, p will be the anticipation of anemia prevalence in the diabetic population, q=1 - p; e is an acceptable error (5%); and Z= 1.96. A simple random sampling (systematic procedure) will be used to choose patients with type 2 diabetes in order to reduce the possibility of selection bias. With this technique, we randomly choose the first subject and then select the next subjects in a periodic manner according to K (interval). K will be determined based on the sampling frame prepared by researchers divided by n. Descriptive analysis will be used with the mean (standard deviation) for normally distributed variables and the median (inter-quartile range) for highly skewed distributions. The t-test and the Mann-Whitney test will be used to compare the baseline characteristics of quantitative variables between anemic and non-anemic groups for variables with a normal and highly skewed distribution, respectively. Categorical variables will be compared between the groups using the chi-square test. Logistic regression analyses will be employed to find out how these variables are associated with anemia. The results will be given as odds ratios (ORs) with a 95% confidence interval (CI). We will select only covariates with a p-value &lt;0.20 in the univariate analysis to enter the logistic analysis.

Exploring the Potential of Metformin in Mitigating Radiation-Induced Gastrointestinal and Hematopoietic System Injury in Rats after wholebody X-ray Radiation: An Experimental Study.

The modern world faces a growing concern about the possibility of accidental radiation events. The Hematopoietic system is particularly vulnerable to radiationinduced apoptosis, which can lead to death. Metformin, a drug used to treat diabetes, has been shown to protect normal cells and tissues from the toxic effects of radiation. This study aimed to evaluate the effectiveness of metformin in mitigating radiation injury to the gastrointestinal and hematological systems of rats. The study involved 73 male rats. After total body irradiation with 7.5 Gy of X-rays, rats were treated with metformin. Seven days later, the rats were sacrificed and blood samples were taken for evaluation. The study found that metformin was not effective in mitigating radiation injury. The histopathological assessment showed no significant changes in goblet cell injury, villi shortening, inflammation, or mucous layer thickness. In terms of biochemical evaluation, metformin did not significantly affect oxidative stress markers, but irradiation increased the mean MDA level in the radiation group. The complete blood count revealed a significant decrease in WBC and platelet, counts in the radiation group compared to the control group, but no significant difference was found between the radiation and radiation + metformin groups. In conclusion, metformin may not be a good option for reducing radiation toxicity after accidental exposure. Despite treatment, there was no improvement in platelet, white blood cell, and lymphocyte counts, nor was there any decrease in oxidative stress. Further research is needed to explore other potential treatments for radiation injury.

The clinical value of complete blood count-based immun parameter in predicting testicular cancer pathology and prognosis

Aim: The management of testicular cancer (TC) requires more specific and applicable biomarkers. We aimed to determine the ability of complete blood count (CBC) based inflammatory markers to predict tumor pathology and prognosis in TC. Methods: Patients who underwent inguinal orchiectomy for testicular germ cell tumors (TGCTs) at our hospital between January 2011 and December 2022 were included in the study. The medical records of patients with pathologically confirmed TC, including demographics, preoperative tumor markers, preoperative CBC, tumor characteristics, pathological outcomes, postoperative follow-up, and survival outcomes, were retrospectively collected. CBC-based inflammatory markers were compared between seminomatous and non-seminomatous TGCTs. To determine the independent prognostic significance of survival, the data were analyzed and fitted to the multivariate Cox proportional risk regression model. Results: The median follow-up was 48 (1-140) months. In our chord, 69 patients had seminomatous TGCTs (Group 1), and 66 had non-seminomatous TGCTs (Group 2). The median ages of Groups 1 and 2 were 35 (22-74) years and 31 (21-72) years(p

Evaluation of Complete Blood Cell Count Parameters and Their Role in Inflammation in Patients with Methamphetamine and Synthetic Cannabis Use Disorder

Evaluation of Complete Blood Cell Count Parameters and Their Role in Inflammation in Patients with Methamphetamine and Synthetic Cannabis Use Disorder

Anemia and associated factors among under-five children attending public Hospitals in Harari Regional State, eastern Ethiopia: A cross-sectional study.

Childhood anemia is a significant global public health problem. It influences the physical and cognitive development, as well as immunity of affected children. This in turn leads to poor academic performance, low working potential, and increased morbidity and mortality. There is limited facility-based data on the magnitude and predictors of anemia among under-five children. This study aimed to determine the prevalence and associated factors of anemia among under-five children attending public Hospitals in Harari Regional State, eastern Ethiopia. Institution-based cross-sectional study was conducted at Hiwot Fana Comprehensive Specialized University Hospital and Jugal Hospital from July 1, 2022, to August 31, 2022. A total of 330 under-five children were involved by systematic random sampling technique. Data on sociodemographic characteristics and other possible factors were collected through face-to-face interviews with children's parents/legal guardians. Four milliliters of venous blood samples were collected for a complete blood cell count. Collected data were checked for completeness, entered into Epi-Data Statistical Software Version 4.6, and exported into the Statistical Package for Social Sciences version 25 for analysis. Bivariable and multivariable logistic regression was conducted and P < .05 were considered statistically significant. The overall prevalence of anemia was 33% (95% confidence interval [CI]: 27.9%-37.9%). Age of children 6 to 11 months (adjusted odd ratio [AOR] = 3.94, 95% CI: 1.55-10.01) and 12 to 23 months (AOR = 2.93, 95% CI: 1.15-7.43), no maternal education (AOR = 4.34, 95% CI: 1.53-12.35), not exclusively breastfeeding (AOR = 1.98, 95% CI: 1.11-3.52), being severely stunted (AOR = 3.39, 95 CI: 1.70-6.75), and underweight (AOR = 2.1, 95% CI: 1.12-3.87) were significantly associated with anemia among under-five children. In this study, anemia among under-five children is a moderate public health problem. This study revealed that young child age, maternal education level, early initiation of complementary feeding, and child undernutrition were factors associated with anemia. Thus, efforts should be made to improve the child's nutritional status as well as enhance maternal awareness of nutrition and child-feeding practice through health education. Regular childhood nutritional screening and appropriate intervention for malnutrition are needed. Besides, further studies assessing serum micronutrient levels should be conducted to differentiate the specific cause and type of anemia.

#1818 Association of combined systemic inflammatory indices with the severity and outcome of tunnelled hemodialysis catheter-related bacteremia

Abstract Background and Aims Systemic inflammation plays a critical role in sepsis. Multiple inflammatory parameters have been used in clinical practice to diagnose and predict outcomes. More recently, systemic inflammatory indices derived from the complete blood count (CBC) such as the neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), lymphocyte-to-monocyte ratio (LMR) and red blood cell distribution width (RDW) have shown a diagnostic and prognostic value in several critical infectious diseases such as pneumonia, endocarditis, osteomyelitis, COVID-19, severe sepsis and septic shock. The aim of our study was to evaluate NLR, PLR, LMR and RDW in tunnelled hemodialysis catheter-related bacteremia and investigate their predictive value regarding in-hospital mortality and 30-day survival. Method We performed a retrospective study that included patients with tunnelled hemodialysis catheters in our dialysis unit between January 2003 and March 2023 that presented with hemodialysis catheter-related bacteremia. Demographic data, comorbidities, dialysis vintage and catheter vintage and type were registered. The baseline systemic inflammatory indices (NLR, PLR, LMR and RDW) were calculated from the CBC at presentation of bacteremia. Primary outcome was in-hospital mortality and mortality after 30 days. Secondary outcomes were complications during follow-up such as development of septic shock, ICU admission, endocarditis or septic embolic complications, need for catheter removal and the time elapsed till blood cultures were negative. Results The study included 58 patients with tunnelled hemodialysis catheter-related bacteremia. Mean age was 63.8 ± 17 years, and median catheter vintage was 122 days (IQR 84-387). The main causative organism was Staphylococcus aureus in 29 (50%) of the cases, followed by Serratia marcescens (12.1%) and Staphylococcus epidermidis (6.9%). Four patients (6.9%) presented with septic shock, 7 patients (12.1%) developed endocarditis and/or septic emboli, and 47 patients (81%) required removal of the catheter. In-hospital mortality was 6.9% and 30-day mortality was 12.1%. There was a positive correlation between NLR, PLR, LMR and RDW. NLR and RDW were significantly higher in Staphylococcus aureus bacteremia. In the regression analysis, higher tertile of NLR and RDW were associated with Staphylococcus aureus bacteremia. A NLR cutoff of &amp;gt;7 was predictive of Staphylococcus aureus bacteremia (AUC 0.75 [95% CI 0.61-0.89], p = 0.005) with an 86% sensitivity and 60% specificity. There were no differences in these inflammatory indices between survivors and non-survivors during hospital admission. However, RDW was significantly higher in patients who did not survive after 30 days (17.8% [15.7-19.4] vs 15.9% [15-17.1], p = 0.043). An RDW of &amp;gt;16.9% was determined as the predictive cutoff value of 30-day mortality (AUC 0.73, 95% CI 0.54-0.92, p = 0.049) with a sensitivity of 71.4% and specificity of 70%. Conclusion In our cohort of patients with tunnelled hemodialysis catheter-related bacteremia, higher RDW was associated with a poor 30-day survival and a NLR &amp;gt;7 was predictive of Staphylococcus aureus bacteremia. These results suggest that NLR may be useful as a diagnostic index of Staphylococcus aureus bacteremia and RDW can be used to predict 30-day mortality in hemodialysis catheter-related bacteremia.

#622 Baseline inflammatory indexes and clinicopathological features to predict the outcome of acute interstitial nephritis

Abstract Backgrounds-and-aims Acute tubulointerstitial nephritis(AIN) is a rare cause of acute kidney injury(AKI). We aimed to investigate the characteristics of AIN patients and predictive factors for treatment response. Method 31 patients diagnosed with AIN by biopsy between 2006-2021 were included in this retrospective study. Baseline clinical, pathological, and laboratory findings, including CBC(complete blood count), creatinine, serum-immune-inflammation-index(SII), neutrophil-to-lymphocyte ratio(NLR), and platelet-to-lymphocyte ratio(PLR) were evaluated. Also, treatment response and creatinine levels at the last follow-up were noted. Results Median age was 46 years, and 80.6% of the patients were female. Median baseline creatinine and proteinuria levels were 4.1 mg/dL and 0.84 g/g or g/day. Median follow-up was 14 months. 93.5% of patients received immunosuppressives. End-stage-kidney-disease(ESKD) developed in five patients. Renal recovery(creatinine &amp;lt; 1.4 mg/dL) was observed in 17 (54.8%) patients. Global glomerulosclerosis percentage, interstitial fibrosis(IF), tubular atrophy(TA), granuloma formation, and higher baseline hemoglobin levels were associated with poor renal outcomes(non-responder). Also, ESKD-developed patients had higher baseline hemoglobin(p = 0.033) and lymphocyte(p = 0.044) and lower PLR levels(p = 0.016), as well as higher degrees of global glomerulosclerosis(p = 0.014), IF(p = 0.042), and TA(p = 0.030). Conclusion Treatment rates are low for AIN, which may lead to ESKD. Besides chronicity in pathology specimens, higher baseline hemoglobin levels and lower PLR might be prognostic for AIN. Further studies should be conducted on new markers for AIN.

Utility of hydroxychloroquine laboratory monitoring in dermatologic and rheumatologic patients

Hydroxychloroquine (HCQ) is an immunomodulator used in dermatology and rheumatology. Side effects may be observed on routine monitoring studies before they become clinically apparent. The goal of this retrospective chart review was to assess laboratory abnormalities in dermatologic and rheumatologic patients taking HCQ. Medical records of patients prescribed HCQ were retrospectively reviewed. Demographics, reported side effects, and parameters on baseline and follow-up complete blood count (CBC) and comprehensive metabolic panel (CMP) were recorded and graded. Laboratory abnormalities were considered severe if they were grade 3 or greater according to Common Terminology Criteria for Adverse Events v3.0 and persistent if they continued beyond subsequent laboratory testing. Of 646 eligible charts, 289 had monitoring studies for review. There were 35 severe (grade 3 or 4, 35/289; 12%) adverse events that developed, as noted on CBC or CMP. Of these 35 severe adverse events, 25 self-corrected on subsequent testing, and 10 (10/289, 3%) across 9 patients were persistent, including glomerular filtration rate, alanine transferase, alkaline phosphatase, glucose, hemoglobin and lymphopenia abnormalities. Of these 10 abnormalities, 7/10 (70%) were unlikely due to hydroxychloroquine use according to the calculated Naranjo score for each patient. Severe laboratory abnormalities while taking hydroxychloroquine are rare, even in a population with a high rate of comorbidities. Among the abnormalities observed, the majority of them (70%) were likely due to disease progression or a medication other than hydroxychloroquine. CBC and CMP monitoring for the reason of observing abnormalities while on HCQ should be at the discretion of the prescribing physician.

Effect of Breed on Hematological and Biochemical Parameters of Apparently Healthy Dogs Infected with Zoonotic Pathogens Endemic to the Mediterranean Basin.

Dogs are considered the main reservoir of several zoonoses endemic to the Mediterranean Basin. In this study, a prevalence of infections and coinfections of canine vector-borne diseases was analyzed in apparently healthy dogs of different canine pure breeds in Sicily (Italy), where these diseases are endemic. The seroprevalence of Leishmania infantum, Ricketsia ricketsii, Anaplasma phagocytophilum, and Erlichia canis was assessed, as single and coinfections. Biochemical and hematological parameters were evaluated, and epidemiological factors, including sex, age, and canine breed, were recovered. The most frequent infection was L. infantum (45.61%), following R. ricketsii (36.84%), both as single, double, or triple coinfections. Coinfections change the biochemical and hematological parameters of the host, and canine breeds are related to the infection frequency and the parameters observed during infections. Changes in the complete blood count (CBC) and biochemical values also differ between canine breeds, with the Cirneco dell'Etna dogs infected with L. infantum being the animals presenting the most interesting results in our study. High values of RBC, hemoglobin, hematocrit, mean corpuscular hemoglobin (MCH), the albumin/globulin (A/G) ratio, and albumin and low levels of β-2 globulin and γ-globulin were found only in this canine breed, suggesting some resistance to infection in these dogs. Future studies about the immune response of this canine breed could be interesting to determine their possible resistance to zoonotic pathogens, such as L. infantum.

INFECTION CONTROL IN COVID-19 PATIENTS BASED ON POLYMORPHISMS OF TMPRSS2 (rs12329760), FGB (rs1800790), AND NOS3 (rs2070744) GENES

Objective of this study is to investigate the potential of anti-infective protection in patients with COVID-19 by analyzing the absolute and relative number of the main populations of immunocompetent peripheral blood cells depending on the polymorphism of the genes of transmembrane serine protease 2 (TMPRSS2, rs12329760), fibrinogen beta (FGB, rs1800790) and endothelial nitric oxide synthase (NOS3, T-786C, rs2070744). Materials and methods. A total of 204 patients with mild, moderate, and severe COVID-19-associated pneumonia were included in the single-center study. Among the patients were 51.97% (106) women and 48.03% (98) men. Among the patients, there were 51.97% (106) women and 48.03% (98) men, with an average age of 55.93±8.75 years. Anti-infective protection was assessed based on an extended complete blood count (CBC) with the calculation of the main populations of immunocompetent cells. The polymorphism of the TMPRSS2 (rs12329760), FGB (rs1800790) and NOS3 (rs2070744) genes was investigated by real-time polymerase chain reaction (Real Time PCR). Results. There were no differences in the absolute and relative number of most populations of immunocompetent peripheral blood cells between the genotypes of the TMPRSS2 (rs12329760) gene. The absolute and relative number of immunocompetent peripheral blood cell populations between the genotypes of the FGB (rs1800790) gene also did not differ significantly. However, in AA genotype carriers, there was a tendency to decrease the number of neutrophilic granulocytes due to mature segmented nucleated forms against the background of an increase in eosinophilic granulocytes by 27.27% (p=0, 038) and 55.55% (p=0.007) and agranulocytes due to lymphocyte sprouting and monocytes by 8.87-20.09% that implies a more severe course of the disease and a stronger stress of non-specific immunity than in G-allele holders. Conclusions. Inflammatory changes in the complete blood count of the main populations of immunocompetent cells in patients with COVID-19 do not show a consistent dependence on the genotypes of the TMPRSS2 (rs12329760) and NOS3 (rs2070744) genes. However, the presence of the AA genotype of the FGB gene (rs1800790) in patients with COVID-19 is associated with a more severe course of the disease and increased stress on the monocyte-macrophage system.

Association between blood inflammatory indices and heart failure: a cross-sectional study of NHANES 2009-2018

Background Inflammation plays a pivotal role in the pathogenesis of heart failure (HF). This study was aimed to the potential association between complete blood cell count (CBC)-derived inflammatory biomarkers and HF. Methods Data from the National Health and Nutrition Examination Survey (NHANES) 2009-2018 were utilised. We evaluated the associations between HF and five systemic inflammation markers derived from CBC: systemic immune-inflammation index (SII), systemic inflammatory response index (SIRI), neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and monocyte-to-lymphocyte ratio (MLR). Demographic characteristics, physical examinations, and laboratory data were systematically collected for comparative analysis between HF and non-HF individuals. Fitted smoothing curves and threshold effect analysis delineated the relationship. In addition, Spearman correlation and subgroup analyses were further conducted. Results A total of 26,021 participants were categorised into HF (n = 858) and non-HF (n = 25,163) groups. After adjusting for confounding variables, SIRI, NLR, and MLR had significant positive correlations with the risk of HF. Participants in the highest quarter groups of SIRI, NLR, and MLR showed a increased risk of developing HF compared to those in the lowest quarter group. Furthermore, subgroup and sensitivity analyses indicated that SIRI, NLR, and MLR had a stronger correlation to HF (all p < 0.05). Smoothing curve fitting highlighted a nonlinear relationship between CBC-derived inflammatory biomarkers and HF. Conclusions Our results illustrated a significant association between elevated levels of SIRI, NLR, and MLR and an increased risk of HF. SIRI, NLR, and MLR could potentially serve as systemic inflammation hazard markers for HF.

Association of low vitamin D level and full-term early-onset neonatal sepsis; a case-control study

BackgroundSepsis is one of the main causes of death in newborns worldwide. Vitamin D levels during fetal and neonatal periods have a significant role in the development of the immunological system. The study aims to evaluate the association between vitamin D levels and the risk of early-onset neonatal sepsis in full-term neonates in a developing country.MethodsThis case–control study was conducted at the Neonatal Intensive Care Units (NICUs) of Kasr Alainy Hospital, Cairo, Egypt. The study was composed of two groups; the sepsis group involved full-term neonates appropriate for gestational age with sepsis-related clinical signs. The control group included newborns with no signs of clinical/laboratory infection within 72 h of life. Blood samples were collected on admission during the first three days of life in both groups for the measurement of 25-hydroxyvitamin D levels, Complete Blood Count (CBC), C reactive protein (CRP), and blood culture.ResultsForty-five newborns with clinical and laboratory findings of early-onset neonatal sepsis within 72 h of life were enrolled, and the control group included forty-five newborns with no evidence of sepsis. Vitamin D levels in the sepsis group were significantly lower than in the control group. Apgar score at the first minute was significantly lower in the sepsis group. 57.8% of neonates with sepsis had positive blood cultures. There was a statistical difference between deficient, insufficient, and sufficient vitamin D levels regarding the duration of the NICU stay, which was longer in neonates with deficient vitamin D levels. CRP was significantly higher in neonates with deficient vitamin D levels. The area under the receiver operating characteristic curve for serum vitamin D in the prediction of neonatal sepsis was 0.76 at a cutoff < 19.7(ng/ml).ConclusionIn the current study, full-term newborns with EOS had considerably lower vitamin D levels than healthy controls. Through appropriate vitamin supplementation of the mothers during pregnancy, it could be possible to ensure adequate vitamin D levels for newborns. This may contribute to the reduction of the risk of EOS, together with the other well-known preventive measures (i.e. breastfeeding and intrapartum antibiotic prophylaxis).

Establishing reference intervals for common hematology test parameters from apparently healthy geriatrics in Asella town, Southeast Ethiopia, 2020: a community-based cross-sectional study.

Reference intervals are an important method tool for identifying abnormal laboratory test results. Complete blood count reference values are useful to interpret complete blood count (CBC) results and make clinical decisions, but these values have not been established for geriatrics in Asella town. Therefore, this study aimed to establish reference intervals (RIs) for complete blood count (CBC) parameters from geriatric participants/subjects in Asella town, Southeast Ethiopia. A community-based cross-sectional study was conducted from December 2019 to May 2020. An interviewer-administered questionnaire was used to collect data on sociodemography and other characteristics from 342 eligible geriatric participants. Weight, height, and vital signs were measured, and 8 mL of blood sample was collected. Screening tests such as HIV, HBsAg, HCV, syphilis, stool examination, and urinalysis were performed. The hematological parameter was measured using a Sysmex kx-21 hematology analyzer. The data were analyzed using SPSS version 21 software. The non-parametric independent Kruskal-Wallis test and Wilcoxon rank-sum test (Mann-Whitney U test) were used to compare the parameters between age groups and genders. The 97.5 and 2.5th percentile were the upper and lower reference limit for the population. According to the study's findings, the reference intervals of red blood cell, white blood cell, platelet count, hemoglobin (HGB), and hematocrit (HCT) in male geriatrics were 3.8-5.85 × 1012/L, 3.1-9.66 × 109/L, 115.8-353 × 109/L, 12.4-17.76 g/dL, and 35.06-50.2%, respectively. The respective values for women were 3.94-5.48 × 1012/L, 3.13-8.4 × 109/L, 137.5-406 × 109/L, 12.5-16.4 g/dL, and 36.09-48.2%. Most of the hematological parameters showed significant differences between the two genders (p value <0.05). Accurate gender and age-specific reference intervals are crucial in managing patient health. The current study offers essential CBC hematological parameters that can assist clinicians in interpreting laboratory results and can improve healthcare quality in the geriatric population. Therefore, it is more relevant to use the current RIs in the geriatric set-up.

Associations of CBC-Derived inflammatory indicators with sarcopenia and mortality in adults: evidence from Nhanes 1999 ∼ 2006

BackgroundIt has been proposed that inflammation plays a role in the development of sarcopenia. This study aimed to investigate the links of complete blood cell count (CBC) parameters and CBC-derived inflammatory indicators with sarcopenia and mortality.MethodsData pertaining to sarcopenia were extracted from the 1999–2006 National Health and Nutrition Examination Survey (NHANES), and mortality events were ascertained through the National Death Index up to December 31, 2019. The CBC-derived inflammatory indicators assessed in this study included the neutrophil-to-lymphocyte ratio (NLR), derived neutrophil-to-lymphocyte ratio (dNLR), monocyte-to-lymphocyte ratio (MLR), neutrophil-monocyte to lymphocyte ratio (NMLR), systemic inflammatory response index (SIRI), and systemic immune-inflammation index (SII). The prognostic significance of these CBC-derived inflammatory indicators was evaluated using the random survival forests (RSF) analysis.ResultsThe study encompassed a cohort of 12,689 individuals, among whom 1,725 were diagnosed with sarcopenia. Among individuals with sarcopenia, 782 experienced all-cause mortality, and 195 succumbed to cardiovascular causes. Following adjustment for confounding variables, it was observed that elevated levels of NLR, dNLR, NMLR, SIRI, and SII were associated with an increased prevalence of sarcopenia. Among participants with sarcopenia, those in the highest quartile of NLR (HR = 1.336 [1.095–1.631]), dNLR (HR = 1.274 [1.046–1.550]), MLR (HR = 1.619 [1.290–2.032]), NMLR (HR = 1.390 [1.132–1.707]), and SIRI (HR = 1.501 [1.210–1.862]) exhibited an elevated risk of all-cause mortality compared to those in the lowest quartile of these inflammation-derived indicators. These associations were similarly observed in cardiovascular mortality (HR = 1.874 [1.169–3.003] for MLR, HR = 1.838 [1.175–2.878] for SIRI). The RSF analysis indicated that MLR exhibited the highest predictive power for both all-cause and cardiovascular mortality among individuals with sarcopenia.ConclusionsOur findings underscore the association between CBC-derived inflammatory indicators and mortality in adults with sarcopenia. Of note, MLR emerged as the most robust predictor of all-cause and cardiovascular mortality in this population.

Unlocking the complete blood count as a risk stratification tool for breast cancer using machine learning: a large scale retrospective study

Optimizing early breast cancer (BC) detection requires effective risk assessment tools. This retrospective study from Brazil showcases the efficacy of machine learning in discerning complex patterns within routine blood tests, presenting a globally accessible and cost-effective approach for risk evaluation. We analyzed complete blood count (CBC) tests from 396,848 women aged 40–70, who underwent breast imaging or biopsies within six months after their CBC test. Of these, 2861 (0.72%) were identified as cases: 1882 with BC confirmed by anatomopathological tests, and 979 with highly suspicious imaging (BI-RADS 5). The remaining 393,987 participants (99.28%), with BI-RADS 1 or 2 results, were classified as controls. The database was divided into modeling (including training and validation) and testing sets based on diagnostic certainty. The testing set comprised cases confirmed by anatomopathology and controls cancer-free for 4.5–6.5 years post-CBC. Our ridge regression model, incorporating neutrophil–lymphocyte ratio, red blood cells, and age, achieved an AUC of 0.64 (95% CI 0.64–0.65). We also demonstrate that these results are slightly better than those from a boosting machine learning model, LightGBM, plus having the benefit of being fully interpretable. Using the probabilistic output from this model, we divided the study population into four risk groups: high, moderate, average, and low risk, which obtained relative ratios of BC of 1.99, 1.32, 1.02, and 0.42, respectively. The aim of this stratification was to streamline prioritization, potentially improving the early detection of breast cancer, particularly in resource-limited environments. As a risk stratification tool, this model offers the potential for personalized breast cancer screening by prioritizing women based on their individual risk, thereby indicating a shift from a broad population strategy.