Complete Blood Picture Research Articles

Estimation of Serum Hepcidin and Ferritin in Patients with Chronic Liver Disease

Background: Hepatitis C virus affect iron metabolism leading to iron overload which associated with liver damage. Aim: estimation of the level of serum hepcidin and ferritin in chronic hepatitis C, cirrhosis and hepatocellular carcinoma on top of hepatitis C. Methods: this study was conducted on 60 Egyptian patients (study group); Group I comprise 20 patients with chronic HCV infection, Group II comprise 20 patients with HCV cirrhosis, Group III comprise 20 patients with HCC due to HCV infection, and also, control group comprise 20 apparently healthy individuals. All patients and control were subjected to history taking, clinical examination, abdominal ultrasound, computed tomography on abdomen. Laboratory investigations include complete blood picture, renal function tests, liver function tests, and viral hepatitis marker. Antinuclear antibody, Alpha-fetoprotein, serum iron, serum ferritin and serum hepcidin. Results: There was highly significant decreased in S. iron level in group I, II and III in comparison to control group (p=0.000). There was highly significant increase in S. Ferritin level in group II and group III in comparison to control group and in group III in comparison to group I. Also, there was significant increase in S. Ferritin level in group II in comparison to group I. There was highly significant decrease in S. hepcidin level in group II and group III in comparison to control group, in group II and group III in comparison to group I and in group III in comparison to group II. S. Hepcidin has highly significant negative correlation with S. ferritin in group I, II and III. Conclusion: Low levels of serum iron, ferritin and hepcidine were observed in HCV cirrhotic and HCC compared to control group.

Thyroid in patients receiving new direct-acting antiviral agents for treatment of hepatitis C virus

Objective The aim was to judge thyroid dysfunction in patients receiving new direct-acting antiviral agents (DAAs) for treatment of hepatitis C pathogen. Background Persistent hepatitis C is a gradually progressive disease. DAAs provide high sustained viral response rates and much reduced adverse effects and impaired health-related quality of life during treatment. Patients and methods The analysis included 100 patients with persistent hepatitis C contamination with normal thyroid functions before starting treatment with DAAs. After obtaining written informed consent, all patients were analyzed and clinically assessed. Laboratory investigations including complete blood picture, assessment of liver organ and kidney function, thyroid-stimulating hormone, and free thyroxin 4 were done for all patients before the start of the remedy, and by the end of treatment of direct-acting antiviral remedy. Results An evaluation of the analyzed patients who were obtaining direct-acting antiviral drugs for treatment of hepatitis C pathogen before and after remedy with respect to the PCR findings proved significant decrease of PCR values after treatment (P = 0.0001). There is no statistically significant difference before and after remedy with new DAA regarding laboratory findings as serum thyroid-stimulating hormone (P = 0.580) and serum free T4 (P = 0.279). Conclusion Thyroid function in patients with chronic hepatitis C infection was not afflicted with treatment with new direct-acting antiviral drugs for treatment of hepatitis C virus.

Assessment of Renal Functions in Infants and Children with Congenital Heart Diseases

Background: children with congenital heart diseases have a number of risk factors for potential development of chronic kidney diseases later in life such as : including pathophysiological changes related to a structurally abnormal heart, polycythemia, cyanosis and chronic hypoxia change in renal blood flow and intraglomerular hemodynamics with derangements in neurohormonal activation. Objectives:this study aimed to assess renal functions in infants and children with congenital heart diseases and to compare renal functions between children with congenital cyanotic and acyanotic heart diseases. Patients and Methods: this across sectional case control study was carried out on 50 infants and children with congenital heart diseases (25 patients with congenital acyanotic heart diseases (Group A) and 25 with congenital cyanotic heart diseases (Group B) who were attended at the Pediatric Cardiology Units at Al-Azhar University Hospitals (El-Hussein and Bab El-Sheryia Hospitals) and apparently 25 healthy children age and sex matched included as a control group (Group C). Their age ranged from one month to 5 years old. Patients were subjected to full history taking, full medical examination which included the heart and abdomen and laboratory investigations which included complete blood picture, urine analysis, estimation of glomerular filtration rate, urinary albumin creatinine ratio. Data were collected, tabulated and statistically analyzed. Results: comparing both groups A and B by group C as regards renal functions results; group B had higher values in all parameters (Estimated glomerular filtration rate (EGFR) and urinary albumin and creatinine ratio. Conclusion: risk of renal dysfunctions increase by time especially in children with cyanotic CHD which may be due to effect of chronic hypoxia and other conditions such as polycythemia.

Serum level of cluster of differentiation 166 as novel biomarker in hepatocellular carcinoma

Background The detection of serum biomarkers associated with hepatocellular carcinoma (HCC) is the most promising approach to improve diagnostic accuracy and to overcome the disadvantages of current diagnostic strategies. The aim of this study was to evaluate the diagnostic value of serum level of cluster of differentiation 166 (CD166) in early detection of patients with HCC. Patients and methods This study was conducted on 90 patients, divided into three groups: group 1 included 30 patients with unstaged HCC; group 2 included 30 patients with HCV-related liver cirrhosis (LC) without HCC, who were subdivided into 2a subgroup (15 patients with compensated liver cirrhosis) and 2b (15 patients with decompensated liver cirrhosis); and group 3 included 30 sex-matched and age-matched apparently healthy individuals as a control group. All patients and control were subjected to detailed history taking and clinical examination, abdominal ultrasonography, and/or computed tomography. Laboratory investigations included complete blood picture, liver function tests, serum viral hepatitis markers, serum urea and creatinine, α-fetoprotein (AFP), antinuclear antibody, and assay of CD166 using enzyme-linked immunosorbent assay. Results CD166 was significantly higher in HCC group, compensated LC patients group, and decompensated LC patient group, when compared with control group (P Conclusion The combination of CD166 and AFP is a better biomarker for diagnosis of HCC, where the combination showed higher diagnostic sensitivity and specificity than AFP alone.

Assessment of Renal Functions in Infants and Children with Congenital Heart Diseases

Background: children with congenital heart diseases have a number of risk factors for potential development of chronic kidney diseases later in life such as : including pathophysiological changes related to a structurally abnormal heart, polycythemia, cyanosis and chronic hypoxia change in renal blood flow and intraglomerular hemodynamics with derangements in neurohormonal activation. Objectives:this study aimed to assess renal functions in infants and children with congenital heart diseases and to compare renal functions between children with congenital cyanotic and acyanotic heart diseases. Patients and Methods: this across sectional case control study was carried out on 50 infants and children with congenital heart diseases (25 patients with congenital acyanotic heart diseases (Group A) and 25 with congenital cyanotic heart diseases (Group B) who were attended at the Pediatric Cardiology Units at Al-Azhar University Hospitals (El-Hussein and Bab El-Sheryia Hospitals) and apparently 25 healthy children age and sex matched included as a control group (Group C). Their age ranged from one month to 5 years old. Patients were subjected to full history taking, full medical examination which included the heart and abdomen and laboratory investigations which included complete blood picture, urine analysis, estimation of glomerular filtration rate, urinary albumin creatinine ratio. Data were collected, tabulated and statistically analyzed. Results: comparing both groups A and B by group C as regards renal functions results; group B had higher values in all parameters (Estimated glomerular filtration rate (EGFR) and urinary albumin and creatinine ratio. Conclusion: risk of renal dysfunctions increase by time especially in children with cyanotic CHD which may be due to effect of chronic hypoxia and other conditions such as polycythemia.

The role of portal congestion index in prediction of esophageal varices in hepatitis C virus-infected patients

Objective To assess the role of portal congestion index (PCI) in prediction of esophageal varices (EV) in hepatitis C virus (HCV)-infected patients. Background Portal hypertension (PH) often develops in HCV-infected patients. EV rupture leads to variceal bleeding, the most lethal complication of cirrhosis. Duplex Doppler ultrasonography of portal vein is a noninvasive method to assess blood flow velocity and portal vein cross-sectional area as a parameter for PH. Patients and methods This study was conducted on 200 HCV-infected patients (116 with EV and 84 without EV). Patients were subjected to complete blood picture, liver and kidney functions, serum electrolytes, viral markers, abdominal ultrasonography, upper gastrointestinal tract endoscopy, and duplex Doppler evaluation of portal vein with calculation of PCI. Results There was a highly significant difference between HCV-infected patients with and without EV regarding PCI (P = 0.0001). At cutoff point of PCI 0.11, the sensitivity, specificity, and accuracy to predict EV were 93, 85.7, and 90%, respectively, with area under the curve 0.889. There was a statistically highly significant positive correlation between PCI and presence of fundal varices and PH gastropathy (P = 0.0001). There was a statistically significant positive correlation between PCI and grades of EV (P = 0.012). Conclusion PCI is useful as a noninvasive predictor of EV in HCV-infected patients.

Right liver lobe diameter/serum albumin ratio in the prediction of esophageal varices in cirrhotic patients

Objective This study aimed to assess the role of right liver lobe diameter by ultrasound/albumin ratio in the prediction of esophageal varices (OV) in cirrhotic patients. Background OV often develop in cirrhotic patients. Varices rupture leading to variceal bleeding represents the most lethal complication of cirrhosis. Right liver lobe diameter/albumin (RLLD/Alb) ratio is a noninvasive method to predict the presence of OV. Patients and methods A case–control study was carried out on 200 cirrhotic patients (145 with OV and 55 without OV). Patients were subjected to complete blood picture, liver and kidney functions, viral markers, abdominal ultrasonography, upper gastrointestinal tract endoscopy, and calculation of the RLLD/Alb ratio and the platelet count/spleen diameter (PC/SD) ratio. Results The RLLD/Alb ratio was diagnostic for the prediction of OV with high significance (P ≤ 0.0001). At a cut-off point of 3.7, the sensitivity, specificity, and accuracy to predict OV were 95, 76.4, and 90%, respectively, with area under the curve = 0.88. A highly statistically significant difference was also noted in the PC/SD ratio with a sensitivity, specificity, and accuracy of 83.4, 70.3, and 80.9%, respectively, at a cut-off point of 605. A statistically significant positive correlation was found between both the RLLD/Alb ratio and the PC/SD ratio and grades of OV and the risk of bleeding from varices (P = 0.0001). Conclusion The RLLD/Alb ratio and the PC/SD ratio are useful as noninvasive predictors of OV in cirrhotic patients.

Effects of 12 weeks competitive phase specific training on selected biochemical and haematological parameters of male Taekwondo players

The aim of the present study was to find out the effects of 12 weeks of competitive phase specific training on basal levels of selected biochemical and haematological variables in male Taekwondo players. A total of 15 Indian male Taekwondo players (Age: 16.9±1.4 years; Height: 173.5±0.81 cm; Weight: 60.92±11.79 kg, BMI: 20.04±2.44 kg/m2) were volunteered for this study. Twelve weeks of competitive phase specific Taekwondo training was given to the participants for the perfection of technical skills and for the improvement of general physical conditioning abilities. Blood samples were collected from antecubital vein in the morning after overnight fasting and 24 hours of rest, both before and after training. The samples were analyzed for the selected biochemical and haematological parameters such as Lipid profile, Iron Profile, Creatine phosphokinase (CPK) Lactate dehydrogenase (LDH) and Complete Blood Picture (CBP). Data were analyzed by paired-t test by using SPSS software. A significant increase (P<0.05) of Serum Iron, Total cholesterol, HDL-cholesterol, Hematocrit, and Mean Corpuscular Volume were observed after training. Also a significant reduction (P<0.05) in total cholesterol/HDL-cholesterol Ratio, Lactate Dehydrogenase and Mean Corpuscular Hemoglobin Concentration (MCHC) were noted after the training. From this study it is concluded that the competitive phase specific Taekwondo training is effective for improving lipid profile and some of the biochemical parameters in national level male Taekwondo players and biochemical monitoring will be helpful for the evaluation of training effects and training related adaptations at molecular level.

IRON DEFICIENCY ANEMIA

Objective: To determine the association of breath holding spells with irondeficiency anemia in children. Study Design: Case control study. Place and Duration of Study:Military Hospital Rawalpindi from Jun 2012 to Dec 2012. Study Population: Sixty children ofeither gender meeting inclusion criteria aged 6 months to 5 years with 30 of breath holding spells incase group and 30 in control group as healthy children were included in the study after informedconsent from parents. Method: Complete blood picture and serum ferritin levels were performedof all children in both case and control groups. Tests were carried out at AFIP Rawalpindi. All datawas entered and analyzed using SPSS version 10. Frequencies and percentages were calculatedfor categorical (qualitative) variables like sex and children having iron deficiency anemia in casesand controls. Mean and Standard Deviation (SD) was calculated for numerical (quantitative)variable like Age. Odds ratio was calculated from the data of cases and controls. Regarding irondeficiency anemia p value <0.05 was considered as significant. Results: In this study, werecorded 43.33% (n=13) cases were between 0.6-3 years and 56.67% (n=17) were between 4-5years while 53.33% (n=16) controls were between 0.6-3 years and 46.67% (n=14) were between4-5 years. Mean±SD was calculated as 3.3+1.46 years in cases and 2.93+1.48 years in controlgroup. Male children were 60% (n=18) in patient group and 46.67% (n=14) in controls group.Female children were 40% (n=12) in patient and 53.33% (n=16) in control group respectively.Association of breath holding spells with iron deficiency anemia in children revealed as 56.67%(n=17) in cases and 3.33% (n=1) in control group while remaining 43.33% (n=13) in cases and96.67% (n=29) in control group had no findings of this association. P value was calculated as<0.0001 and Odds Ratio was 37.92 which shows a significant difference between the two groups.Conclusions: The association of breath holding spells with iron deficiency anemia in children issignificantly higher than healthy controls. So, it is recommended that every child who present withbreath holding spells should be evaluated for iron deficiency anemia

Role of Alpha Hemoglobin Stabilizing Protein Expression in Beta Thalassemia Patients

AbstractBackground: Beta (b)-Thalassemia is an autosomal reces-sive inherited disease causing variable degrees of anemia. The molecular defects are owing to point mutations or small deletions leading to diminution or absence of b-globin chain synthesis. The unmatched a-Hb is destructive to itself and other cellular components, resulting in ineffective erythropoi-esis and hemolysis. Alpha-Hemoglobin Stabilizing Protein (AHSP) is a scavenger protein of erythroid that fastly and reversibly attach the a subunit of hemoglobin molecule preventing its precipitation and subsequent hemolysis.Aim of Work: Is to assess AHSP gene expression in thalassemia major and intermedia and its relation to clinical features, laboratory investigations and to determine its role on the severity of thalassemia.Subjects and Methods: This case-control study is consisted of 120 studied subjects categorized into 40 thalassemia major patients, 40 thalassemia intermedia patients and 40 age healthy individuals as a control group. All subjects underwent the following; history, clinical picture, complete blood picture and Hb electrophoresis, serum ferritin and measurement of AHSP, alpha globin and beta globin genes expression by real time PCR.Results: AHSP gene in thal. intermedia group was higher than both thal. major (p<0.001). Beside thal. intermedia group had higher a globin/AHSP ratio versus thal. major group (p=0.011). b globin/AHSP ratio was not significant between both thal. groups. AHSP in thal.major group correlated with a globin and b globin expression and negatively correlated with organomegally, ferritin and no. of blood transfusion. Whereas in thal. intermedia group, was positively correlated with Hb, HCT, MCV, MCH, a globin gene expression, b globin gene expression and b globin/a globin genes ratio.Conclusion: AHSP expression was higher in thalassemia intermedia group than thalassemia major group. Consequently, AHSP can be considered genetic modifier in b thalassemia.

Changing Trends of Angiographic Profiles in Women with Coronary Artery Disease over a Decade

Abstract Background Cardiovascular diseases, especially coronary artery disease (CAD), have assumed epidemic proportions worldwide. CAD is the leading cause of disability and death in women. In woman during postmenopausal years, traditional risk factors tend to become very present and increase the risk for CAD. Patterns in epidemiology of CAD are doubtlessly changing continually in many ways, only some of which are recognized at any given point of time. Aim To identify the changing trends of CAD in female patients who were admitted for coronary angiogram (CAG) over a period of 10 years. Materials and Methods We retrospectively collected the data of female patients from our unit CAG registry. We noted the demographic data (age, ethnicity, socioeconomic status), clinical data (diabetic status, hypertension status, symptoms and their duration, past history), laboratory data (complete blood picture, cardiac enzymes, renal function tests, liver function tests, serum electrolytes), and CAG findings (normal coronaries [NC]/single-vessel disease [SCD]/double-vessel disease [DVD]/triple-vessel disease [TVD]) of the female patients in 2007 and a decade later that was 2017. Results Data of 64 women in 2007 and of 184 in 2017 were analyzed. CAG women in 2017 were older than those in 2007 (53.1 ± 11.7 vs. 57.1 ± 12.3 years; p = 0.024). There was no significant difference found in the parameters such as hypertension (p = 0.797), diabetes mellitus (DM) (37.5% vs. 41.3%; p = 0.59), left ventricular (LV) dysfunction, type of presentation (acute coronary syndrome [ACS] or chronic stable angina [CSA]) and presence of CAD (53.9% vs. 51.1%; p = 0.69). In the 2017 female group, there was increase in detection of the electrographic (ECG) abnormalities (98.4% vs. 62.5%; p = 0.000). Radial route was used more frequently for CAG (98.4% vs. 40.6%; p = 0.000). Subgroup analysis of CAD (proven angiographically) showed a statistically significant difference of occurrence of SVD that was more frequent in 2007 female group (32.8% vs. 20.1%; p = 0.05), whereas TVD (was more frequent in 2017 female group (14.1% vs. 4.6%; p = 0.01). Conclusion This study shows that even though there was no change in the incidence of occurrence of normal coronaries on angiogram over time; however, there was a significant increase in severity of the CAD (TVD) in 2017 female group (p = 0.01).

Hyperglycemia and Red Cell Distribution Width for Prediction of Mortality in Preschool Children with Community Acquired Pneumonia (CAP)

Background Community acquired pneumonia (CAP) is a major infectious cause of mortality in preschool children especially in developing countries. Red Cell Distribution Width (RDW) has been associated with poor outcomes of CAP. We aimed to determine whether admission stress hyperglycemia and RDW can predict mortality in preschool children with CAP for early identification of patients at risk of mortality. Materials and Methods This is a prospective cohort analysis of a single-center study conducted in the pediatric department and Pediatric Intensive Care Unit (PICU) of Minia Children’s University hospital, El-Minia, Egypt during the period from September 2016 to February 2017. The patients were 1-59 months old children, with community acquired pneumonia. Measurement of admission serum glucose and RDW in addition to complete blood picture was done to all participating children. Assessment of the severity of CAP was done using Pediatric Respiratory Severity Score. Results: The male gender consumes a high percentage in the Non survivors group (72.7%). The hyperglycemias patients had a statistically significant risk of developing septic shock and respiratory failure than the other groups (23.8%, p 17.4, sensitivity 90.9% and specificity 92.1%, followed by admission serum glucose at cutoff point >110 mg/dl, sensitivity 90.9%, and specificity 78.95 %. Conclusion According to the results, elevated RDW and admission hyperglycemia are reliable predictors of mortality in preschool children with community acquired pneumonia.

Role of Complete Blood Picture in Predicting the Etiology of Extrahepatic Cholestasis

AbstractBackground: Extrahepatic cholestasis is a common prob-lem worldwide and faced in daily practice however it's etiology has a wide range, before starting treatement it is mandatory to reach the cause of the disease. Investigative tools such as computerized tomography, magnetic resonance cholangiopan-creatography etc are expensive, not available in every centers, moreover their accuracy not reaching 100%.Aim of Study: To analyse the role of complete blood count parameters namely RDW, MPV, PDW, PCT, N/L ratio, P/L ratio which are cheap and already available in 1ry care centers in assessment of extrahepatic cholestasis.Patients and Methods: It is a cross-sectional comparative descriptive study conducted during a period of one year starting from 1/3/2016 to 28/2/2017 at Al-Rajhy Liver Hospital, Assiut University Hospitals, on patients presented with defin-itive evidence of extrahepatic cholestasis by clinical exami-nation, laboratory evidence and trans-abdominal ultrasonog-raphy.Results: Thirty eight patients having extrahepatic cholesta-sis were included in the final analysis with a mean age of 47 years of them 14 patients were male. And 10 cases were taken as a control group of them 6 cases were male. Comparing between different etiological types of extrahepatic cholestasis as regards six parameters of the complete blood pictures namely RDW, MPV, PDW, PCT, N/L ratio, P/L ratio shows no significant differences between them. But MPV and PDW were significantly elevated in malignant distal group than control group.Conclusion: Complete blood count parameters namely RDW, MPV, PDW, PCT, N/L ratio, P/L ratio have no significant role in the differentiation between different etiologies of extrahepatic cholestasis. But MPV and PDW were significantly elevated in malignant distal extrahepatic cholestasis than cases without hyperbilirubinemia.

Clarithromycin-Induced Acute Liver Failure (ALF)

Clarithromycin is a macrolide antibiotic widely used to treat respiratory, skin, and soft tissue infections. Although elevated liver enzymes and cholestatic hepatitis have been infrequently reported, comprehensive literature review reveals only 6 cases of clarithromycin-induced ALF (fig 2). 60-year-old male with history of hypertension and hypothyroidism presented to the hospital with acute asthma exacerbation secondary to respiratory tract infection. Complete blood picture, and liver and kidney function tests were within normal limits. Clarithromycin, prednisone and albuterol inhaler were prescribed, and he was discharged. 10 days later, he represented and physical examination revealed stable vital data but soft, diffusely tender abdomen with hypoactive bowel sounds and no peritoneal signs. Laboratory analysis revealed WBC=12.2bil/L, hemoglobin(hb)=14.5 g/dL and platelets=129bil/L, lipase=33 U/L, lactic acid=0.6 mmol/L, ammonia=22 mcmol/L and normal coagulation profile. Figure 1 highlights the trend of liver function tests (LFTs) during hospitalization. CT of the abdomen with contrast, abdominal ultrasound with doppler and echocardiography were all normal. Viral hepatitis panel (anti-HAV, anti-HBs, anti-HBc, HBs antigen, anti-HCV, HCV-RNA, & anti-HEV), autoimmune hepatitis panel (ANA, AMA, smooth muscle antibody, liver-kidney microsomal antibody, and total immunoglobulin) and atypical viruses (HIV, CMV, and HSV) were insignificant. On third day, he developed altered mental status; Hb dropped to 5.5 g/dL, platelets dropped to 35 bil/L and LFTs worsened. Liver biopsy was canceled due to hemodynamic instability and coagulopathy. Massive transfusion was initiated, but despite aggressive resuscitation, the patient had cardiac arrest and expired. On autopsy, histopathologic analysis of the liver revealed diffuse hepatocellular necrosis with occasional sparing of periportal hepatocytes (fig 3) consistent with the prior reported cases and the pattern of idiosyncratic drug induced liver injury (DILI). There was no evident lobular or portal inflammation, fibrosis, viral cytopathic effect, thromboemboli, or malignancy.2304_A Figure 1. Trend of liver function testsProminent eosinophils in the portal tract or lobules can suggest a drug-induced hypersensitivity reaction but are rarely seen in cases of idiosyncratic drug reactions. There are no defined pathognomonic histopathologic findings of DILI and a high index of clinical suspicion in combination with histopathologic findings are needed for the diagnosis.2304_B Figure 2. Reported cases of acute liver failure from Clarithromycin2304_C Figure 3. A: Low power photomicrograph of H&E section of liver showing geographic areas of necrosis and marked sinusoidal congestion. B: High power photomicrograph of H&E stain of liver showing a central vein (*) with adjacent marked sinusoidal congestion and extensive hepatocyte necrosis.

Non operative conservative management of blunt trauma to the spleen in Children: A Single Tertiary Hospital Experience

Background: Splenic injury is the leading cause of major bleeding in the patients of blunt abdominal trauma. In earlier medical practice, the blunt splenic injury was managed surgically in most cases, but the increased understanding of the splenic function in the immunological process and the identification of post-splenectomy complications have led physicians to prefer the non-operative management . Material and methods: A retrospective study of the patients with blunt trauma to the spleen in the pediatric age group between the year 2015 and 2018. The study was conducted in (Nasser Institute Hospital for research and treatment). Management of the patients was done using hypovolemic resuscitation and serial follow up. Abdominal ultrasound, complete blood picture and Abdominal CT were done. Data was tabled and analyzed. Results: A total of 123 blunt splenic trauma patients were identified. Traffic-related accident and falling from height were the main mechanisms of injury. Splenic contusion and hematoma were the most frequent finding on initial computerized tomography (CT) scans, followed by shattered spleen, blush, and devascularization. Non-operative management failed in 6 patients who underwent splenectomy. (95.12%) of the patients managed successfully using hypovolemic resuscitation without need for surgical interference. Discussion: Non-operative management is considered for patients with low-grade splenic injuries, unless operated upon for other associated injuries. In fact, higher-grade injuries could also be managed non-operatively. Splenic angioembolization of bleeding vessels increased the success rate of non-operative management in hemodynamically stable patients. In our study, although we didn`t use splenic angioembolization we were able to reach high rates of success. In comparison with the operative management of blunt splenic trauma, the nonoperative management has the added benefit of preserving the splenic functions. Conclusions: Most blunt splenic trauma patients were successfully treated non-operatively, with a low failure rate. The severity of injury and presence of associated lesions should be carefully considered in developing the management plan.

ADENOVIRUS INFECTION IN A SAMPLE OF IRAQI KIDNEY TRANSPLANT RECIPIENTS: MOLECULAR AND HEMATOLOGICAL STUDY

Background: Human Adenovirus (ADV) is one of highly prevalent viruses worldwide, after primary infection, it remains latent and then might reactivate in immunocompromised patients. High ADV viremia seen in renal transplant recipients (RTR) with clinical presentations range from asymptomatic viremia to respiratory and gastrointestinal disease hemorrhagic cystitis, graft dysfunction and severe disseminated disease. Objective: The objectives of this study are to determine the rate of occurrence of ADV viremia by quantitative Real time PCR (QRT-PCR) in RTR and correlate them with urine cytology results, renal function tests and patients' hematological parameters. Methods: Seventy-one renal transplant recipients (RTR) were enrolled in this study. Whole blood samples (3 ml) divided into two parts, one part for complete blood picture and differential count and other part from which plasma separated and subjected to viral DNA extraction and then ADV Taqman QRT-PCR analysis for viral load measurement. Five ml urine specimens were collected for Pap-stained urine cytology. Results: Out of 71 RTR, 15 (21.12%) had positive ADV viremia by QRT-PCR, with a mean viral load 4.0 x107± 1.9 x108 copies/ml, and 80% (12 out of the 15) of positive viremia patients aged more than 40 years (p=0.011). All of RTRs 15/15 (100%) had symptomatic urinary tract infection (UTI) (p=0.039), and 5 out of 9 patients who had lymphopenia had positive viremia (p=0.007). Pap-stained urine cytology smears showed that 39/71 (55.71%) of the RTRs had positive decoy cells (DC), but there was no significant correlation between ADV viremia and the presence of DC (p=0.107). Conclusion: The present study showed the prevalence of ADV viremia in RTRs, with very high viral load, which is associated with lymphopenia and overt clinical features, this suggests that ADV might be an important cause of morbidity in RTRs. Keywords: Adenovirus, renal transplantation, real-time PCR, urine cytology Citation: Ahmed HM, Al-Obaidi AB, Hussein MR, Kadhim HS, Ghazi HF. Adenovirus infection in a sample of iraqi kidney transplant recipients: molecular and hematological study. Iraqi JMS. 2018; 16(3): 279-288. doi: 10.22578/IJMS.16.3.7

Hematological Profile of Patients Having Malaria-positive Peripheral Blood Smears: A Cross-sectional Study at a Diagnostic Research Center in Khyber Pakhtunkhwa, Pakistan.

Malaria is a life-threatening infectious disease that, in severe cases, is associated with calamitous complications and far-reaching consequences within a community. It is usually manifested by abnormalities in various hematological indices with anemia and thrombocytopenia being the most frequent ones. The present study sheds light on the laboratory profile of patients suffering from malaria and provides a comprehensive analysis and correlation with the available literature worldwide. The study was carried out as a cross-sectional study at OK Diagnostic Lab and Research Center in Peshawar from October 2010 to October 2013. All malaria parasite (MP)-positive cases reported at OK Lab during the study period were employed in the study, making a total of 136 MP positive cases. Complete blood pictures with platelet counts were obtained in all patients and various hematological indices were analyzed according to the World Health Organization (WHO) criteria. Thrombocytopenia was defined as a platelet count of < 150 × 103/cmm and anemia as an hemoglobin (Hb) < 13 g/dL in males and < 12 g/dL in females. Among the 136 MP positive patients, 74 (55.4%) had associated thrombocytopenia while 105 (77.2%) patients showed anemia on a peripheral blood smear. This was followed by leukopenia in 8.8% of cases. Among patients with Plasmodium falciparum (P. falciparum) infection, anemia was present in 80% of cases as compared to 74% cases with P. vivax infection (p = 0.5). Thrombocytopenia was associated with P. vivax infection in 71.4% of cases in contrast to P. falciparum infection, where 26% of cases had associated thrombocytopenia (p = 0.01). On the contrary, leukopenia was more prevalent in P. falciparum patients (18%), followed by P. vivax (2.6%), and mixed parasitemia (11.1%) (p < 0.001). In addition, the study showed statistically significant variations in hematocrit (Hct), mean corpuscular volume (MCV), mean corpuscular hemoglobin concentration (MCHC), and platelet counts across different malarial species (p < 0.05). Likewise, variations within mean Hct levels among males and females were statistically significant, with females showing lower mean Hct levels than males (p < 0.05).

The Relationship between Plasma ADAMTS 7 Level and Left Ventricular Remodeling after Acute Myocardial Infarction

AbstractBackground: Left Ventricular (LV) dysfunction is the single strongest predictor of mortality following ST elevation myocardial infarction and is one of the most frequent and deadly complications of non ST elevation myocardial infarc-tion. Degradation of Extracellular Matrix (ECM) causes progressive thinning and dilatation of infarct zone and con-tributes to serious complication as ventricular dilatation, dysfunction, aneurysm and even rupture. The matrix metallo-proteinase-mediated degradation and remodeling of ECM plays an essential role in these disease processes.Aim of the Study: It was to evaluate the relationship between plasma ADAMTS 7 level and left ventricular remod-eling after acute myocardial infarction.Patients and Methods: This study was carried on fifty cases that were divided into two main categories according to their health status. Diseased group included twenty five patients diagnosed as acute myocardial infarction with newly S-T segment elevation. Based on their echocardiographic examination, patients were classified into two groups patients; a group of 16 patients with ejection fraction of more or equal 40 (group I; G1) and 9 patients with an ejection fraction of less than 40 (group II; G2). Control group included twenty five apparently healthy persons serving as controls (group III; G 3). All studied cases were subjected to detailed clinical history, thorough clinical examination, Electrocardiogram (ECG), trans-thoracic Echocardiography (ECHO), routine laboratory investigation included: Cardiac markers, renal function tests, liver function tests, lipid profile, serum elec-trolytes, complete blood picture and special laboratory inves-tigation: Plasma adamts-7 levels measurement by ELISA technique.Results: There was statistically significant increase in ADAMTS 7 concentration in group II (patients with ejection fraction _40) and group III (controls), while there was no statistically significant difference between group I and group III. There was a statistically significant negative correlation between ADAMTS 7 concentration and both ejection fraction and fractional shortening in acute myocardial infarction patients. While there was a statistically significant positive correlation between ADAMTS 7 concentration and both left ventricular end diastolic diameter and left ventricular end systolic diameter in acute myocardial infarction patients.Conclusion: The results of this research showed that there was a significant increase in the mean value of ADAMTS 7 levels in patients with ejection fraction _40%, so it may be used as a strong predictor for the development of left ventricular remodeling after acute myocardial infarction and this may be of a great value as a therapeutic target.

CLINICAL AND LABORATORY FINDINGS AMONG NAPHTHALENE BALLS MANUFACTURING WORKERS

Introduction: Exposure to naphthalene is associated with many toxic effects in humans and laboratory animals. Aim of work: To assess the clinical and laboratory changes among workers occupationally exposed to naphthalene during manufacturing of naphthalene balls. Materials and Methods: This study was conducted on fifty workers in naphthalene balls manufacturing factory. They were compared with fifty non-exposed individuals. Full history was taken and clinical examination was performed. Complete blood picture, reticulocyte count and G6PD activity, urinary naphthalene, albumin and α1 microglobulin in urine were measured in both groups. Environmental assessment of naphthalene in air at workplace was done. Results: The level of urinary (1- and 2-naphthol), urinary albumin and urinary α 1-microgloblin were significantly higher (p< 0.001) among the exposed group compared to the control one. Hemoglobin levels and hematocrit percentage were significantly decreased (p< 0.001) among the exposed group compared to the control. A statistically significant positive correlations among exposed workers were found between the level of urinary (1-and 2-napthanol) and each of duration of employment, urinary albumin and α 1-microgloblin . There were a statistically significant negative correlation between urinary (1 and 2-napthanol) and hemoglobin level. The geometric means of the measurement of naphthalene at workplace were 100 mg/m3 which exceeded the occupational exposure limits according to Egyptian Environmental law (50 mg/m3). Conclusion: Occupational exposure to naphthalene leads to increased risk of health hazards with possible renal and hematological impairment. Therefore environmental control measures and good work practices are recommended at the workplace.

Urinary Kidney Injury Molecule 1 (U-KIM-1) as a Predictor of Lupus Nephritis

AbstractBackground: Early detection of kidney affection in sys-temic lupus erythrematosus patients and proper monitoring of lupus nephritis activity is very important step in improving lupus nephritis outcome. Urinary kidney injury molecule-1 is considered as a promising biomarker of kidney injury.Aim of Study: Use of urinary kidney molecule-1 as an early biomarker of lupus nephritis in systemic lupus erythre-matosus patients and detection of correlation between U– KIM-1 and disease activity lupus nephritis.Methods: Our study included 45 systemic lupus patients and 15 controls. Patients divided into 3 groups ; group A (SLE without lupus nephritis), group B (SLE with inactive lupus nephritis) & group C (SLE with active lupus nephritis). All patients included in this study are subjected to the following investigations: Urinary Kim-1, complete blood picture, serum urea &creatinine, urine analysis, 24 hour urinary proteins, estimated GFR by CKD-EPI Creatinine Equation, complement 3 & 4, serum albumin, Anti-dsDNA antibody & ESR.Results: Generally U-KIM-1 was significantly higher in our patients with SLE compared with the healthy control group. Also, patients with nephritis had significantly higher level in comparison to those without nephritis. Our study also showed that patients with active nephritis had significantly higher level of U–KIM-1 in comparison to those patients with inactive nephritis. U-KIM-1 had negative moderate significant correlation with eGFR [–0.62 (0.001)], and Complement C3 [–0.51 (0.001)] and had positive moderate significant corre-lation with serum creatinine [0.44 (0.001)], and renal SLEDAI [0.62 (0.001)]. There was also a strong positive significant correlation between U–Kim-1 and 24h-urinary proteins col-lection [0.71 (0.001)]. Although there was negative weak correlation between U–Kim-1.Conclusion: Urinary kidney injury molecule -1 (KIM–1) is considered a promising biomarker that can be used in early detection and initial diagnosis of renal affection in systemic lupus erythrematosis, monitoring of activity of lupus nephritis. And hence, can also be used in monitoring response to treat-ment.Recommendation: Wider studies are recommended to detect cut off points of U-Kim-1 in lupus nephritis & active lupus nephritis.