Complete Blood Picture Research Articles

Clinical and hematological evaluation of geriatric anemia.

ABSTRACTBackground:Anemia in the elderly is a cause of concern. It is not merely physiological due to aging and requires appropriate evaluation. Anemia has a significant negative impact on cardiac function, cognition, sleep, frequent hospitalization, mobility, morbidity, and mortality. Anemia in the elderly is attributable to many causes: nutrient deficiencies, chronic inflammatory diseases, thyroid disorders, diabetes mellitus, gastrointestinal (GI) tumors and bleeding, chemotherapy-induced anemia, and drug-induced hemolysis.Objectives:We aimed to evaluate the clinical and hematological profile of anemia in 100 patients aged above 60 years.Methods and Material:We performed a cross-sectional type of study in a tertiary care center including male and female patients aged 60 years and above and whose hemoglobin was less than 13 g/dl and less than 12 g/dl, respectively. Clinical history, complete blood picture, and peripheral smear were obtained in all patients. Serum iron profile was done in patients with micro-normocytic anemia. Vitamin B12 and folate assays were done in patients with normo-macrocytic anemia and those with pancytopenia. Bone marrow studies and endoscopies were done in cases wherever deemed appropriate.Results:The majority of the patients had either severe or moderate anemia. 49% of the patients had normocytic anemia. The commonest cause for anemia was nutritional deficiencies (45%) followed by anemia of chronic inflammation (40%) and unexplained anemia (8%).Conclusions:It is essential that anemia deserves its due attention in clinical practice in older patients and is not normal always.

Determination of the Association Between Serum Ferritin and C-Reactive Protein in Children Presented with Iron Deficiency Anemia in Combined Military Hospital Pathology Department Multan

Objective: To determine association between Serum ferritin and C-reactive protein (CRP) in children having iron scarcity anemia.
 Study Design: Cross sectional study.
 Place and Duration of Study: Pathology Department, Combined Military Hospital Multan Pakistan, from Jun to Dec 2018
 Methodology: One hundred and thirty-eight (138) children were consecutively selected as per inclusion and exclusion criteria. Each sample of blood was collected from children for serum ferritin, Blood complete picture (Blood CP) which include hemoglobin level and red blood cell indices and serum sample for C-reactive protein (CRP). Sandwich chemilumine-scence immunoassay technique was used to analyze serum ferritin, Blood CP was analyzed on sysmex and C-reactive protein was analyzed immuneturbidi-metric method.
 Result: A total of 138 children were included in our study. Mean age group of our population is 4.5 ± 0.65 years. Out of these 138, 67 (49%) were male children and 71 (51%) were female children. CRP was found negative in 50 (36%) and positive in 88 (64%) children. ANOVA and chi-square test showed association between CRP and anemia was statically significant.
 Conclusion: Increased ferritin level, secondary to inflammation may mask an underlying iron inadequacy in children. CRP in children with normal or high ferritin can be helpful in diagnosing iron deficiency. Serum ferritin was found to be positively correlated with CRP in children.

Assessment of Serum Interleukin-27 and Mean Platelet Volume in Late-Onset Neonatal Sepsis.

Late-onset sepsis (LOS) is a substantial contributor to morbidity and mortality among neonates. The use of nonculture-based tools for early diagnosis is an area of active investigation. Therefore, we aimed to evaluate the diagnostic value of serum interleukin-27 (IL-27) and mean platelet volume (MPV) in full-term neonates with LOS. In this single-center, cross-sectional study, 90 full-term newborns were assigned to two equal-matched groups as follows: (1) culture-proven sepsis and (2) control groups. Clinical data and laboratory findings as complete blood pictures, including MPV, highly sensitive C-reactive protein, and blood culture results, were recorded. Moreover, IL-27 levels were measured using enzyme-linked immunosorbent assay. IL-27 levels (median = 4,364 pg/mL) and MPV (mean = 12.02 ± 1.54 FL) were significantly higher in the culture-proven sepsis group than in the control group (p < 0.001). For IL-27, the optimum cut-off value for the diagnosis of LOS was 283.8 pg/mL with sensitivity and specificity of 97.8 and 100%, respectively. For MPV, the optimum cut-off value was 11.6 FL, with diagnostic sensitivity and specificity of 77.8 and 97.8%, respectively. IL-27 and MPV are promising markers for the diagnosis of LOS in full-term neonates. The diagnostic performance of IL-27 was superior to MPV. · Late-onset neonatal sepsis diagnosis is time consuming.. · Nonculture-based rapid diagnostic tests are much needed.. · IL-27 is superior in LOS diagnosis to MPV..

Evaluation of blood indices as possible biomarkers for diabetic foot ulcer characteristics

Background: Although complete blood picture is a routine laboratory analysis and widely used, little data are available about the association of hematological indices with different characteristics of diabetic foot ulcer (DFU). Aim of the study: the aim was to evaluate the blood indices as possible biomarkers for diabetic foot ulcers. Methods: this is a cross-sectional study involved 58 DFU patients who attended Al-kafeel Super specialty hospital and Private orthopedic clinics during the period from April 9 to September 6, 2021. All patients were newly diagnosed and scheduled for treatment. Demographic and clinical data were collected by specialist and blood were collected for the laboratory assays. Results: These results indicate that DFU is largely of older male patients with poor glycaemic control. Regarding the characteristics of ulcers, most of patients (81%) had ulcers for more than 20 weeks’ duration. Most of the ulcers (65.5%) associated with swollen feet and the area of ulcers in most of the patients (69%) were equal or less then15cm2. Most of the patients (87. 9%) present with single ulcers and ulcers were new (72.4%) were painless (79.3%) and non-bleeding (62.1%).

Immune and inflammatory cytokines profile in Iraqi patients with acute and chronic myeloid leukemia

Introduction and Aim: Evaluation of the profile of immunological and inflammatory cytokines, IL-6, IL-2 and TNF? in acute myeloid leukemia (AML) and chronic myeloid leukemia (CML) patients compared their level with healthy controls, and assessment of the association of these cytokines with clinical and hematological variables. Patients and Methods: Thirty AML, thirty CML patients, and thirty healthy control individuals were recruited for this study from the National Hematology Center for Research and Treatment in Baghdad for the period of October 2020 to March 2021. Leukemic patients were under chemotherapy. Complete blood picture routine test and cytokines profile test were done. IL-6, IL-2 and TNF-? were quantitatively measured using enzymes linked immunosorbent assay (ELISA) kits. Results: Hematological myeloid cancers affect more males than female, in AML male/female ratio was 17/13 while in CML was 16/14. The range of duration of the disease for both AML and CML was 1-3 years. in both AML group the level of IL-6 59.66 ± 31.99 pg/mL and in CML group 57.07± 16.52 pg/mL were both significantly higher P value &lt; 0.001 than that of control group 37.95± 6.10 pg/mL. TNF? in AML group was significantly higher P value &lt; 0.001 than that of control group. A high significant difference in serum level of IL-2 P value &lt;0.0001 in AML and CML compared to controls. Conclusion: IL-6, TNF? and IL-2 levels were higher in myeloid malignancy groups than controls. Serum cytokines shown to be positively associated with each other and could signify to poor outcome of the myeloid malignancy patients.

Determine Mean Serum Ferritin Level in Children with Febrile Seizures and Compare with Children without Seizures

Objective: To compare the mean serum ferritin level in children with febrile seizures and without febrile seizures. Study Design: Cross sectional/case control Place &amp; Duration: Swat Medical Complex Teaching Hospital Saidu Sharif Swat/CMH Lahore from the period January 2021 to June, 2021 Methods: 140 children with ages 5 to 60 months were enrolled in this study. All the patients were equally divided into two groups. Group I consist of 70 patients with febrile seizures and group II with same patients without febrile seizures. Complete blood picture and serum ferritin level was examined and compare the findings between both groups. Data was analyzed by SPSS 24.0. Results: In group I 42 (60%) patients were male and 28 (40%) were females with mean age 24.26±10.38 months and in groupII 40 (57.14%) were males and 30 (42.86%) were females with mean age 23.65±11.56 months. Mean serum ferritin level was significantly lower in group I patients than group II 24.48±10.82ng/ml Versus 42.45±12.64ng/ml with p-value &lt;0.05. Iron deficiency was higher in patients with febrile seizures than patients with without seizures 22 Vs 10. Conclusion: It is concluded that children with febrile seizure had significantly lower serum ferritin level and higher iron deficiency rate as compared to children without seizure. Keywords: Febile Seizures, Febrile Illness, Serum Ferritin Level, Hemoglobin, Iron Deficiency

Clinical Presentation of Patients of Carcinoma of Rectum and Different Modalites of Treatment

Objectives: To determine the clinical presentation of patients of Carcinoma of Rectum and Different modalities of treatment.&#x0D; Methodology: This was a Prospective observational study conducted in from May 2019 to April 2021 at Liaquat University of Medical and Health Sciences (LUMHS) Jamshoro, Sindh, Pakistan. The study comprises 50 patients. All were admitted from Outpatient Department (OPD). All patients were evaluated fully after history &amp; Clinical examinations Digital Rectal Examination (DRE) with Proctoscope and specific investigations of, Stool DR, Fecal occult blood, ultra sound of abdomen and pelvis, Sigmoidoscopy, Colonoscopy with biopsy, Barium enema, C T Scan of Abdomen, chest &amp; pelvis, MRI Abdomen &amp;Pelvis, PECT Scan, Anorectal or Endoluminal Ultra sound, Tumor Marker CEA, Monoclonal Antibodies, LDH level, LFT for liver. and X- Ray chest PA view. Complete blood picture (CBC) Blood urea, sugar, serum electrolyte, HBSAG, HCV, &amp; HIV, COVID -19, LFT, PT, APTT, INR and ECG for fitness purpose and general assessment.&#x0D; Results: In this study 50 patients of carcinoma of Rectum were reported. The maximum number of patients were in age group between 12 to 80 years. Out of 50 patient, 15 patients were presented with Altered Bowel habit (Constipation and Diarrhea) &amp; Spurious Morning Diarrhea , 13 patients were presented with Altered Bowel habit (Constipation &amp; Diarrhea) Spurious Morning Diarrhea ,With Bleeding per rectum. Out of 50 patients 15 patients were diagnosed stage 1 ,13 patients were diagnosed stage 11, 9 patients were diagnosed stage 111, 13 patients were diagnosed stage 1V. Out of 50 patients 28 patients were treated with anterior resection, 15 patients initially treated with New adjuvant therapy followed by patients were treated APR with TME, immunotherapy, gene therapy. 4 patients were treated initially diversion colostomy, then Neo adjuvant therapy, 3 patients were treated laparotomy, colostomy, hart men procedure, Chemo radio therapy, Immunotherapy, Gene therapy.&#x0D; Conclusion: Carcinoma of Rectum is a common problem all over the world. Patients of carcinoma rectum can present diarrhea, constipation, bleeding per rectum, spurious morning diarrhea if not diagnose, and treat the patient in early stage, patients live style will be complicated.

Comparison between Alterations in some Hematological and Biochemical Parameters in COVID-19 and non-COVID-19 Patients Albaida, Libya

The COVID-19 outbreak has resulted in an unexpected health crisis all around the world. It was on March 11, 2020, when the WHO declared it as a pandemic. Ever since an exponential increase in the disease has been seen. The coronavirus disease 2019 or COVID-19 is a beta-coronavirus that has been closely related to the SARS-CoV-2 by means of genetic sequencing methods. This disease is associated with alterations in the complete blood picture and coagulopathies. In this present study, the role of hematological and biochemical parameters of blood in predicting COVID-19 infection w investigated, as these blood analyzes are considered a vital indicator for confirmation of infection. The present work was designed to diagnose COVID- 19 with five basic blood tests: white blood cells (WBC), lymphocytes (LYM), neutrophils (NEUT), platelets (PLT), and clotting factor D–dimer as well as the diagnosis of COVID-19 associated tests. Biochemical blood C-reactive protein (CRP), serum ferritin (FRR), and Lactic dehydrogenase (LDH). It was noted that the hematological and biochemical blood tests included in this study were capable of diagnosing COVID-19, due to their increase or decrease in the normal rates, according to what was shown in the results. N The diagnosis of COVID-19 using blood and blood biochemical tests in people who show some mild clinical symptoms, high and low levels of these parameters have been closely associated with COVID-19 infection and may also serve as biomarkers to predict infection.

Assessment of Wheat Germ Oil Role in the Prevention of Induced Breast Cancer in Rats.

Breast cancer is the most predominant cause of death in women globally. The current study was performed to evaluate the possible protective role of wheat germ oil (WGO), wheat germ powder (WGP), and vitamin E (Vit E) against breast carcinoma induced by the environmental carcinogen 7,12-dimethylbenz[a]anthracene (DMBA) in Sprague Dawely albino rats. Eighty female rats were divided into eight groups, each of ten rats. All protective agents were taken 21 days prior to DMBA treatment. Group I served as the normal control. Group II received Vit E (100 mg/kg BW/d) by gavage. Group III was fed a 20% WGP enriched basal diet. Group IV received WGO (270 mg/kg BW/d) by gavage. Group V received DMBA (50 mg/kg body weight/subcutaneous injection). Group VI received Vit E + DMBA. Group VII received WGP + DMBA. Group VIII received WGO + DMBA. The investigation focused on bodyweights, complete blood picture (CBC), cancer antigen 15.3 (CA15.3), superoxide dismutase (SOD), catalase (CAT), malondialdehyde (MDA), and histopathological and immunohistochemical analyses. Results showed that all cancer protective agents significantly improved CBC parameters, proliferating cell nuclear antigen (PCNA), and the histopathology picture, with the best improvement in the WGO group. In addition, WGO, WGP, and Vit E decreased the CA15.3 and MDA levels and elevated both the SOD and CAT levels compared to the DMBA group. Consequently, supplementation with WGO, WGP, and Vit E protects against lipid peroxidation and oxidative stress and reduces breast cancer.

Phytochemical Screening and In vivo Antileukemic Activity of Methanolic Extract of Seeds of Nigella Sativa L. on Benzene-Induced Leukemia in Wistar Rats

Nigella sativa is exquisite bounty of nature to humankind. It is an annual flowering plant of family Ranunculaceae majorly found in Southwest Asia, seeds are used as flavor food. The present work was directed to evaluate antileukemic effect of N. sativa seeds extract in benzene-induced leukemia in female Wistar rats. Seed powder was extracted using petroleum ether, chloroform, ethyl acetate, and methanol. OECD guidelines 423 were used to study acute oral toxicity study and intravenous injection of benzene was given on every 2nd day up to 21 days to induce leukemia. To assess burden of leukemia, various parameters analyzed are body weight (B.W), organ weight, complete blood picture, serum potassium, phosphate, uric acid, and glutathione. The presence of alkaloids, carbohydrates, cardiac glycosides, tannins, phytosterols, and flavonoids is confirmed by phytochemical screening. Acute oral toxicity study found 2000 mg/kg as a safe dose of N. sativa seed extract. Significant decrease in potassium, phosphate, uric acid, WBC, and increase in B.W, glutathione demonstrated therapeutic efficacy of extract in leukemia. Our results confirmed significant antileukemic effect of N. sativa seed extract, suggesting role of this herb for the treatment of malignancies such as leukemia.

PREVALENCE OF ANEMIA IN PREGNANT WOMEN

Background: Anaemia is defined as a medical condition in which the red blood count or haemoglobin is lower than normal levels. Deficiency of haemoglobin can be due to lack of vitamin B12, folic acid and iron, extreme blood loss or nutrient-deficit diet. Anaemia during pregnancy is harmful both to mother and foetus. It can cause pre-mature delivery and birth defects. Iron supplementation is often recommended to pregnant women. The aim of study was to find out prevalence of anaemia in pregnant women. Methods: The study was carried out using quantitative methods. A sample of 300 participants was taken using purposive sampling technique. Socio-demographic data was collected from participants after informed consent. Haemoglobin levels were recorded for each participant using Blood Complete Picture already available with them. Results: There exists high prevalence (74.6%) of anaemia in pregnant women. The prevalence is much higher (80.3%) in the 3rd trimester of pregnancy. Low intake of meat was observed in 73% of the anaemic women. Low intake of other iron rich food was also observed in more than 50% of the participants. Only 93 participants had their MCV reports with them (53.7% among them had low MCV). This high rate of prevalence is associated with iron-deficient diet and unawareness about seriousness of the problem. Conclusion: There is high prevalence of anaemia among pregnant women associated with iron-deficient diet and lack of awareness. Introducing screening tests for anaemia, raising public awareness, and educating females about importance of nutrition diet are recommended. Pak J Physiol 2021;18(1):16?9

A Comparative Study of the Incidence of Hypoglycaemia and Hypocalcaemia in Neonatal Seizures Occurring within 72 Hours of Birth Admitted in NICU at a Tertiary Care Centre

Background: Recognition of hypoglycaemia and hypocalcaemia in Neonatal seizures is important for to prompt diagnosis and therapeutic implications. Study aimed to analyse the incidence of hypoglycaemia and hypocalcaemia in neonatal seizures occurring within 72 hours of birth in 32-37 weeks preterm and term (37-42 weeks) babies. Subjects and Method: A prospective hospital based observational study enrolled total of 105 neonates presenting with seizures activity within 72 hours of birth admitted to NICU of SV Medical College, Tirupati from September 2013 to October 2014. Samples selected by Simple random sampling method. Detailed antenatal, natal and postnatal history including CNS examination were taken and investigations estimated includes complete blood counts and picture, random blood sugar, and serum ionic calcium. The analysis data was chi square test with SPSS for Windows (Ver 20), SPSS Inc. New York. Results: The results was In neonatal seizures occurring within 72 hours of birth, hypoglycaemia (62.9%) was common, more so in preterm babies both hypoglycaemia 9 (37.5%) and combi­nation of hypo­glycaemia and hypocalcaemia 9 (37.5%). The association between type of delivery and hypoglycaemia/ hypocalcaemia shown significant different (p=0.002). The association between Birth Weight and hypoglycaemia/ hypocalcaemia shown a very high significant different (p&lt; 0.001). Conclusion: In neonatal seizures occurring within 72 hours of birth, hypoglycaemia (62.9%) was common, more so in preterm babies both hypoglycaemia 09 (37.5%) and combination of hypo­glycaemia and hypocalcaemia 09 (37.5%).

Incidental occurrence of neutropenia in children hospitalised for COVID-19

BackgroundInvestigations on haematological alterations in paediatric COVID-19 have been focused mostly on lymphocytes and clotting profiles. Neutropenia has been occasionally reported and its course and impact on the disease have not been elucidated. The aim of this study was to describe the epidemiology, course, and impact of neutropenia in children with COVID-19 hospitalised in a tertiary care referral paediatric ward.MethodsA single-centre retrospective study was conducted. Hospitalised children between 1 month and 18 years with confirmed COVID-19 and neutropenia were included and compared to non neutropenic patients. Complete blood picture with differential blood count, serum biochemistry, clotting profiles were performed; clinical data, length of hospitalisation, and prescription of drugs were collected.ResultsTwelve out of 95 patients (12.63%) with documented SARS-CoV-2 infection were neutropenic and met the inclusion criteria. The mean age was 161 days (range 38—490 days). The mean duration of symptoms in neutropenic children was 3.82 days, while the mean length of hospitalisation was 7.67 days. These findings were not significantly different in the two study groups. All patients had mild clinical manifestations and were discharged without sequelae.ConclusionsWe provided the first comprehensive study on neutropenia in mild paediatric COVID-19 infection. Our findings show that the main features of this haematological disorder in COVID-19 are analogous to the well-known transient benign neutropenia associated with other common viral infections. In our setting, neutropenia does not emerge as a potential negative prognostic factor in paediatric COVID-19.

The ameliorative efficacy of Thymus vulgaris essential oil against Escherichia coli O157:H7-induced hematological alterations, hepatorenal dysfunction and immune-inflammatory disturbances in experimentally infected rats.

The purpose of the present study was to evaluate the possible ameliorative role of Thymus vulgaris (T. vulgaris) essential oil against Escherichia coli O157:H7 (E. coli O157:H7) deleterious effects in both blood and different tissues of rats by assessing the hematological, biochemical and immune-inflammatory parameters besides the histopathological alterations in the different organs. Forty male rats were randomly divided into four equal groups as follows: group I served as control, group II orally inoculated with E. coli O157:H7 at a dose of 1.0 × 109cfu/ml, group III orally received 250mg/kg BW T. vulgaris oil daily for 7days and group IV orally inoculated with E. coli O157:H7 as the same dose of group II and orally received T. vulgaris oil as the same dose and duration of group III. Bacterial challenge in groups II and IV was once at the beginning of experiment and administration of oil began after 72h from bacterial inoculation. At the end of the study, blood was sampled and complete blood picture, liver and kidney function alongside immunoglobulins and cytokines concentrations were estimated and tissues of large intestine (colon), liver and kidneys were collected for histopathological examinations. The results revealed that there was an increase of red blood cells count, hematocrit value and hemoglobin concentration besides white blood cells and thrombocytes counts and substantial increment of serum markers of hepatorenal damage such as the activities of transaminases and concentrations of bilirubin (total, direct and indirect), total proteins, albumin, creatinine and urea in E. coli O157:H7-challenged group. Also, there was a considerable increase in serum immunoglobulins M and G, interleukin 6 and 8 and tumor necrosis factor alpha as well as decreased serum alkaline phosphatase activity. Moreover, T. vulgaris oil could partially improve the hematological, biochemical and histopathological alterations induced by E. coli O157:H7 without any significant alterations in all measured parameters when used alone. The study concluded that the T. vulgaris oil relatively diminished the alterations in hematological parameters, hepatic and renal function markers and immune-inflammatory variables alongside the histopathological changes in different organs induced by E. coli O157:H7. The ameliorative effects of T. vulgaris oil are mediated through its anti-inflammatory, antioxidant and immunomodulatory activities.

The Value of Neutrophil to Lymphocyte Ratio and Platelet to Lymphocyte Ratio for Detecting Early Onset Neonatal Sepsis

Introduction: For neonates, early-onset sepsis is still a prevalent and deadly disease. In adult studies, the neutrophil to lymphocyte ratio (NLR) and platelet to lymphocyte ratio (PLR) have been shown to have relevant relationships with inflammatory markers and the severity of various disorders. Aim: The purpose of this study was to see how useful the neutrophil to lymphocyte ratio (NLR) and platelet to lymphocyte ratio (PLR) are as diagnostic adjunct tests for term infants with neonatal early-onset sepsis (EOS). Methodology: A case-control study, comprised 150 newborns (100 newborns with neonatal sepsis who were admitted to NICU (Menoufia University Hospital, from December 2019 to February 2021) within the first three postnatal days as a case group and 50 healthy newborns as a control group). History taking, full clinical examination, complete blood picture, C-reactive protein and blood culture, neutrophil to lymphocyte ratio(NLR) and platelet to lymphocyte ratio (PLR) were done for all newborns. Results: There were no significant differences between patient and control groups as regard gestational age, gender, mode of delivery, gestational age and birth weight. Respiratory distress and tachycardia were the most common clinical sign so fearly onset sepsis (EOS). As regard the vital data patient group had higher respiratory rate and heart rate of SPO2 neutrophil there was significant difference between patient and control groups as regard immature to total ratio. Patient group had higher neutrophil count, NLR and PLR ratios and CRP ratio than control group. As regard blood culture, Klebsiella, Pseudomonas and Staphaureus were the most common organism. Additionally, the sensitivity of NLR and PLR to diagnose sepsis were100%, 83.3%, respectively. Specificity was 100% and 100%, respectively, at cutoff value of ≥6.79 and &gt;27.24, with accuracy of96%,85.6%, respectively. Conclusion: As diagnostic indicators for early-onset newborn sepsis, the neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR), I/T ratio, and serum CRP levels demonstrated good sensitivity a

Gastrointestinal Complications and its Association with Common Risk Factors of Cerebrovascular Accident: A Retrospective Observational Study from Central India

Introduction: Patients with Cerebrovascular Accidents (CVA) may present with Gastrointestinal (GI) complications, negatively affecting the prognosis. However, the whole spectrum of GI complications in CVA patients is unknown. Aim: To assess GI complications in CVA patients and their association with risk factors of CVA. Materials and Methods: The retrospective, facitlity-based, observational study was conducted in Department of Medicine at Gandhi Medical College and associated Hamidia Hospital, Bhopal, Madhya Pradesh, India, from March 2019 to August 2021. Total 100 patients with CVA (age &gt;13 years) were studied based on their medical records and laboratory examinations. Details on socio-demographic variables and clinical history were obtained. Detailed general and systemic examination and vitals were documented. Complete blood picture, liver function test, renal function test, lipid profile and magnetic resonance imaging scan was also performed. A Chi-square t- test was applied to assess the association of GI complications with various variables. A p-value &lt;0.05 was considered statistically significant. Results: Most CVA patients were males (51%). Mean age of study population was 71.49±11.46 years. A history of hypertension and diabetes mellitus was observed in 60% and 54% of cases. Constipation (43%) was the most common GI complication, followed by dysphagia (25%). No significant association of GI complications with age (p-value=0.261), gender (p-value=0.217), hypertension (p-value=0.540) and diabetes mellitus (p-value=0.257) was observed in CVA patients. However, raised serum bilirubin, serum glutamic-oxaloacetic transaminase, and serum glutamic pyruvic transaminase in 47%, 23%, and 37% cases with CVA was observed. Conclusion: Gastrointestinal complications are commonly observed in stroke patients irrespective of stroke but are more common in patients with ischemic stroke. Constipation and dysphagia were the most common. Fecal incontinence, abdominal pain, hiccups, and melena may also be seen in patients with CVA.

Food Faddism Complicating Jaundice in Gilbert’s Syndrome PatientsA Prospective Cohort Study

Introduction: Food faddism is a term that refers to a particular food or food group that is overemphasised in the regular diet or omitted to cure a specific condition. It affects an individual's health by complicating the health status of already infected individuals, which harms their nutritional status in particular, causing macro and micronutrient deficiencies. In the present study, authors have analysed the effect of food faddism in Gilbert’s syndrome patients. The state of vitamin B12 deficiency (Megaloblastic anaemia) is observed because of dietary restrictions due to food myths causing ineffective erythropoiesis prolonging hyperbilirubinemia in Gilbert's syndrome patients. Aim: To study the effect of food faddism on haematological parameters in recently diagnosed Gilbert’s syndrome patients. Materials and Methods: A prospective cohort study was conducted in a tertiary care centre of north coastal Andhra Pradesh, India, from June 2019 to June 2021. A total of 125 consecutive patients, who are newly-diagnosed with Gilbert’s syndrome, were enrolled. A constant rise in the indirect bilirubin levels between 2-5 mg/dL with normal serum liver transaminases was considered for diagnosing Gilbert’s syndrome. On monthly follow-up for six months, 21 patients presented with extreme fatigue and limb paresthesia. Every month during the follow-up, thorough history about any recent changes in food habits was noted. Blood investigations like complete blood pictures and Vitamin B12 levels were done at the time of diagnosis, after six-month follow-up, and after treatment with co-methyl (Cyanocobalamin) B12 injections. Comparison of study variables at the time of diagnosis of Gilbert's syndrome, before and after the treatment with co-methyl (Cyanocobalamin) B12 injections was done using paired t-test based on nature of distribution, and p-value was calculated. Results: Out of 125 Gilbert’s syndrome patients with a mean age distribution of 36.15±11.82 in (109) males and 36.06±11.93 in (16) females, 21 patients presented with symptoms after six months of follow-up, a habit of practicing a fad diet was noted, along with depression of cell lines showing pancytopenia. There was a significant decrease in the mean values of Haemoglobin (Hb) % (12.68 to 7.95), Total Count (TC) (8219.05 to 3819 cells/ cu.mm), Mean Corpuscular Haemoglobin Concentration (MCHC) (33.30 to 32.17) and Vitamin B12 (391.63 to 125.68) and increase in mean value of Mean Corpuscular Volume (MCV) (91.33 to 101.18), at the time of diagnosis and after six months of follow-up. On treatment of the patients with co-methyl (Cyanocobalamin) B12 injections a significant improvement in the mean values of Hb % (7.95 to 13.28), TC (3819 to 8652 cells/cu.mm), MCHC (32.17 to 33.43) and Vitamin B 12 (125.68 to 311.81) along with decrease in the mean value of MCV (101.18 to 90.0) was noted. Conclusion: The most common fad diet followed by Gilbert’s syndrome patients is the restriction of high protein diet (mainly non vegetarian) and bland diet consumption leading to Vitamin B12 deficiency and worsening jaundice. By taking thorough dietary history, considering cultural practices, one can tailor the therapy accordingly. A simple measure like dietary education and busting the myths can improve quality of life by accelerating recovery

Diagnostic role of simple indices in HCV-related liver cirrhosis outcomes: a prospective cross-sectional study.

Aim of the studyTo evaluate the diagnostic performance of neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR), albumin-bilirubin ratio (ABR) and albumin-bilirubin score (ALBI) in different outcomes of liver cirrhosis, including decompensated liver cirrhosis (DLC), acute-on-chronic liver failure (ACLF), hepatocellular carcinoma (HCC), and spontaneous bacterial peritonitis (SBP). A second objective was to find their cut-off values. Finally, we aimed to correlate these indices with the severity of liver cirrhosis.Material and methodsThe study included 149 patients with hepatitis C virus (HCV)-related liver cirrhosis. They were categorized into 3 groups according to severity of cirrhosis as compensated cirrhosis, decompensated liver cirrhosis and acute-on-chronic liver failure based on Child-Turcotte-Pugh (CTP) and MELD-Na scores. Patients were categorized according to presence of HCC and spontaneous bacterial peritonitis. All patients had a complete blood picture and liver profile. NLR, PLR, ALBI and ABR were calculated.ResultsNLR, PLR, ALBI and ABR correlated with CTP, and MELD-Na scores. NLR > 6.27 can be used to predict SBP in patients with ascites. NLR cut-off value > 3.61 and > 5.26 can be used to predict DLC and ACLF respectively in liver cirrhosis. ABR < 0.90 discriminated ACLF from DLC with OR = 2.93 (95% CI).ConclusionsThe simple inflammatory scores NLR and PLR together with simple ABR and ALBI scores can be used as quick tools to assess severity of liver cirrhosis. NLR can predict the presence of SBP in patients with ascites. ABR is superior to ALBI in discriminating ACLF from DLC.

PROFILE OF B-CELL NON-HODGKIN LYMPHOMA AND RESPONSE TO CHEMOTHERAPEUTIC REGIMENS IN A TERTIARY CARE CENTER IN SOUTH INDIA

Abstract: Introduction: Non‐Hodgkin lymphoma’s (NHL) are a group of malignant lympho-proliferative disorders arising predominantly in lymph nodes with different patterns of behavior and responses to treatment. NHL clinical presentation varies with histology sub type and with sites of involvement. Accurate staging is important, which helps in risk stratification and management decisions. Aim: Aim was to study the clinical profile of patients with B-cell NHL and to assess response to various chemotherapeutic agents. Materials and methods: We evaluated data of patients diagnosed with B-cell NHL between 2015 and 2019 at a tertiary care cancer hospital in Andhra Pradesh, India. Data regarding demographic variables, clinical features and examination findings were collected using a pre-designed study proforma. Lab investigations including complete blood picture, liver and renal function tests, bone marrow examination, immunohistochemistry and treatment details were noted. Results: A total of 91 patients with B-cell NHL were managed. Mean age was 53yrs,with males accounting for 60%. Mean duration of presentation was 4.32 months. Most common presentation was lymphadenopathy,followed by loss of appetite, weight loss, fever and night sweats.Majority of study subjects were diagnosed as Diffuse large B Cell Lymphoma 70 (76.9%), followed by Follicular lymphoma 10 (11.0%), Small lymphocytic lymphoma 7(7.7%). Bone marrow involved in 22 (24.2%); Stage IV accounted by 34 (37.4%) followed by Stage III. CHOP regimen of 6 cycles was received by 30 (33.0%) patients, out of which 23 patients had complete response; 61 (67.0%) patients received R-CHOP, out of which 58 had complete response. Conclusion: B-cell NHL has an early onset in India compared to western literature. Accurate staging is important, which helps in risk stratification and management decisions. Treatment with R-CHOP is superior to CHOP regimen with better prognosis and survival. Monitoring at periodic intervals for possible relapse is important as many patients whose disease recurred can be salvageable.

Hematological manifestations in patients newly diagnosed with pulmonary tuberculosis

Objective:To determine the frequency of various hematological manifestations among newly diagnosed cases of pulmonary tuberculosis on complete blood counts.Methods:This retrospective cross-sectional study was conducted on 500 newly diagnosed patients of pulmonary tuberculosis in hematology department of Nishtar Medical University from 1st November 2020 to 30th April 2021 using consecutive sampling. Detailed history and complete general physical examination findings, complete blood picture including erythrocyte sedimentation rate were retrieved from hospital electronic medical records system. Data was collected on a specially designed Proforma, entered into SPSS version 23.0 and analyzed. Data is presented as mean±SD and frequency and percentages for numerical and categorical variables respectively using tables and figures.Results:In this study the mean age of patients was 34.36 ± 6.41 years with male to female ratio 2.52: 1. Frequency of anemia was 82.6% (n=413), leukocytosis was 46.2% (n=231) and leucopenia in 102 patients (20.4%). Thrombocytosis was detected in 131(26.2%) patients. Raised ESR was observed in 495(99%) of the patients. No association of age and gender was observed with hematological manifestations. However, thrombocytosis was significantly more common in male patients (p-value = 0. 008).Conclusion:Hematological parameters like high Erythrocyte Sedimentation Rate (ESR) and anemia were commonly detected in newly diagnosed patients with pulmonary tuberculosis. Thrombocytosis was seen more commonly in male patients of pulmonary tuberculosis.