Complete Blood Picture Research Articles

Perioperative effects of desflurane versus propofol on hemostasis guided by thromboelastometry in splenectomy with liver cirrhosis

ABSTRACTBackground: Cirrhotic patients have impaired hemostasis with variable incidence of hypersplenism necessitating splenectomy. Rotation thromboelastometery (ROTEM) facilitates diagnosis and guides management. This study evaluates perioperative effects of desflurane versus propofol on hemostasis in cirrhotic patients undergoing splenectomy guided by ROTEM and laboratory hemostatic tests.Methods: Thirty hepatic Child A patients, ASA II- III, of either sex, aged 25–55 years, undergoing splenectomy were randomly allocated into two equal groups: Group D; anesthetized with desflurane 1 MAC (6%) and Group P; with propofol Target Controlled Infusion 2–5 µg/ml. Six blood samples were collected; preoperatively, after splenic artery ligation, immediately, first, third postoperative day then one month later. The samples were handled to measure complete blood picture, liver and kidney functions, screening coagulation tests (INR, PT and PTT), specific hemostatic factors (P-Selectin/CD62P, fibrinogen and D-dimer) as well as ROTEM criteria; clotting time (CT), clot formation time (CFT) and maximum clot firmness (MCF) via EX-TEM, IN-TEM and FIB-TEM commercial kits.Results: This study displayed postoperative hemoglobin reduction; however, platelet and WBCs as well as CT, CFT and MCF increased versus baseline. Screening and specific hemostatic factors as all other changes were within reference range and comparable between both groups.Conclusions: The current study concluded comparable effects of desflurane and propofol anesthesia on coagulation parameters within acceptable range as monitored by ROTEM and laboratory coagulation tests in cirrhotic patients with hypersplenism. Thus both anesthetics are considered safe in such patients who have high incidence of coagulopathy.

Diabetes as a Risk Factor Hepatic Encephalopathy among Egyptian Cirrhotic Patients

Background: Hepatic encephalopathy (HE) is one of the leading consequences among patients with cirrhotic liver, which influence more than 35% of these patients. It was established that more than 95% of cirrhotic patients were associated with glucose intolerance and approximately 33% of them had type 2 diabetes mellitus (DM). This investigation was conducted to evaluate the possible association between DM and the development of HE. Objective: this study was designed to examine the association of DM with the prevalence and severity of HE in Egyptian patients with decompensated cirrhosis. Patients and methods: This study was carried out prospectively on 100 patients presented with HE. Those further had been classified into diabetic (60 patients group 1) and non-diabetic (40 patients group 2). All patients in this study were subjected to a thorough assessment of history taking, thorough physical examination, laboratory investigations including complete blood picture, kidney and liver function tests, viral HBsAg and HCVAb, serum sodium, potassium, calcium and magnesium, serum ammonia levels, fasting and glycosylated hemoglobin (HbA1C %) and abdominal ultrasonography. Results: Diabetic patients showed a higher incidence of Grades, III, and IV of HE compared to the non-diabetic group with p value < 0.0001 for each grade. Furthermore, there was a statistically significant difference between both groups regarding the Child-Pough classification. A statistically significant positive correlations between fasting blood sugar level, and glycosylated hemoglobin with HE grades (r = 0.430 and p =0.0006), (r = 0.314, p = 0.0145) respectively among diabetic patients group 1. Conclusions: Egyptian diabetic patients have a potential risk of developing HE among cirrhotic liver patients relative to non-diabetic patients.

Study of Serum Immunoglobulins G and M Levels in Children with Down Syndrome and Their Relation with Recurrent Lower Respiratory Tract Infection

Background: Children with Down syndrome appear to be more likely susceptible to respiratory tract infections and it is an important cause of morbidity and mortality among them. Aim of the study: It was to investigate the relationship between levels of IgG and IgM in Down syndrome and recurrent lower respiratory tract infections. Subjects and Methods: This study was conducted on 40 children who were categorized into 2 groups: patient group, which includes children with Down syndrome patients presented with LRTIs, their karyotyping revealed trisomy 21 in all cases and their age range from 1 to 13 years. Control group, which includes 20 healthy children matched for sex and age with patient group. They were subjected to full history taking & thorough clinical examination, and they investigated for complete blood picture, C-reactive protein and serum immunoglobulins (IgG & IgM) using ELISA technique. Results: Plasma levels of immunoglobulin G (IgG) were elevated in Down syndrome with significant increase the frequency of lower respiratory tract infections and hospital admission. Plasma levels of immunoglobulin M (IgM) were decrease in down patients with significant increase in the frequency of lower respiratory tract infections and hospital admission. Conclusion: These findings suggest the importance of estimation and follow up of serum levels of IgG &Ig M in cases of Ds with recurrent respiratory tract infections.

Study of Serum Immunoglobulins G and M Levels in Children with Down Syndrome and Their Relation with Recurrent Lower Respiratory Tract Infection

Background: Children with Down syndrome appear to be more likely susceptible to respiratory tract infections and it is an important cause of morbidity and mortality among them. Aim of the study: It was to investigate the relationship between levels of IgG and IgM in Down syndrome and recurrent lower respiratory tract infections. Subjects and Methods: This study was conducted on 40 children who were categorized into 2 groups: patient group, which includes children with Down syndrome patients presented with LRTIs, their karyotyping revealed trisomy 21 in all cases and their age range from 1 to 13 years. Control group, which includes 20 healthy children matched for sex and age with patient group. They were subjected to full history taking & thorough clinical examination, and they investigated for complete blood picture, C-reactive protein and serum immunoglobulins (IgG & IgM) using ELISA technique. Results: Plasma levels of immunoglobulin G (IgG) were elevated in Down syndrome with significant increase the frequency of lower respiratory tract infections and hospital admission. Plasma levels of immunoglobulin M (IgM) were decrease in down patients with significant increase in the frequency of lower respiratory tract infections and hospital admission. Conclusion: These findings suggest the importance of estimation and follow up of serum levels of IgG &Ig M in cases of Ds with recurrent respiratory tract infections.

Effect of Levetiracetam Monotherapy on Hematological Parameters in Children with Idiopathic Epilepsy

AbstractBackground: Levetiracetam is broad spectrum, second generation antiepileptic drug which is highly tolerated in children with minor adverse events. Studies evaluating the effect of levetiracetam on hematological parameters have reported an unexplained increased incidence of infections such as pharyngitis and rhinitis. There have been case reports of pancytopenia, thrombocytopenia, eosinophilia and lympho-penia. However, cases of isolated low red blood cell counts, hemoglobin and hematocrit as compared to placebo are re-ported.Aim of Study: This study aimed to evaluate the changes in complete blood picture, prothrombin time, partial throm-boplastin time and platelet functions in children with idiopathic epilepsy who were treated with levetiracetam as monotherapy.Patients and Methods: This study was conducted on fifty children of both sexes presented with idiopathic epilepsy during the period from June 2016 to May 2017. Patients were assessed by monitoring complete blood picture, prothrombin time, partial thromboplastin time and platelet functions before and 6 months after receiving levetiracetam monotherapy.Results: There were no significant alterations in the evaluated parameters during the study after levetiracetam administration when compared to results before treatment.Conclusion: Levetiracetam monotherapy has proven to be well tolerated in treatment of children with idiopathic epilepsy and does not appear to cause significant changes in complete blood picture, prothrombin time, partial thrombo-plastin time and platelet functions.

A STUDY ON EVALUATION OF POTASSIUM ABNORMALITIES IN A TERTIARY CARE HOSPITAL

Objective: To study the occurrence, causes, predisposing factors and management of potassium abnormalities in a tertiary care hospital.&#x0D; Methods: Inour studywhich was for aduration of six months, we recorded patient demographics, electrolyte levels, complete blood picture, liver function tests, renal parameters, comorbid conditions,medication reconciliation and electro cardio gram (ECG) changes. The data was analyzed to find out the cause for potassium abnormality and was categorize based on their severity.&#x0D; Results:A total of 200 cases of potassium abnormalities was normalized during the study period. We observed158(80%)cases with hypokalemia, 37 (17%) cases with hyperkalemia and 5 (3%) caseswith subsequentPotassium abnormalities. We observed the majority of hypokalemiaarewith disease induced 87(55.06%) cases and 118 (74.0%)cases were with mild hypokalemia. Syruppotassium chloride was usedto normalize the serum potassium levels. Majority of the hyperkalemia cases were disease induced and was found in 19(51.35%)cases and 22 (59.45%) casescome under mild categorywhich was managed with injection calciumgluconate.&#x0D; Conclusion: Hypokalemia was the most common potassium abnormality seen in hospitalized patients.Disease inducedpotassium abnormalitieswas found to be more common in both hypo and hyperkalemia. The potassium levels were normalized with no major negative outcomes. Continuous monitoring of electrolyte levels is required for the patient to prevent further complications.

LIVER STIFFNESS MEASURMENT BY FIBROSCAN FOR PREDICTING THE GRADES OF OESOPHAGEAL VARICES IN HCV CIRRHOTIC PATIENTS

Introduction: oesophageal varices is one of the most common and life threatening complications of liver cirrhosis. the need for use of non invasive modalities for its prediction rather than endoscopy is important to decrease burdens and increase patient compliance . Aim: to predict oesophageal varices presence by fibroscan and possible grading by degree of liver stiffness in Hepatitis C Virus related cirrhotic patients. Methods: the study was carried out on 150 patients with HCV related liver cirrhosis attending Ministry of Health outpatient clinics and hospitals after being writtenly consented that they agreed to participate in this study All patients were subjected to full history taking & thorough clinical examination, full laboratory investigations include complete blood picture, liver profile tests , kidney function tests, abdominal ultrasound , liver stiffness measurement by fibroscan and upper GIT endoscopy. The patients were divided according to upper GIT endoscopy results into three groups. Group 1: included 50 patients with liver cirrhosis and without oesophageal varices. Group 2: included 50 patients with liver cirrhosis and small oesophageal varices (Grade II Fibroscan; Grading; Non-invasive methods

The Value of Soluble Transferrin Receptor and Soluble Transferrin Receptor-ferritin Index in Discriminating Iron Deficiency Anaemia from Anaemia of Chronic Disease in Patients With Rheumatoid Arthritis

Background:Anaemia is a common extra-articular manifestation of rheumatoid arthritis (RA) where anaemia of chronic disease (ACD) and iron deficiency anaemia (IDA) are the two most frequent types. The distinction between these two types of anaemia has always been challenging requiring sophisticated techniques. Serum transferrin receptor (sTfR) a truncated soluble form of the transferrin receptor is one of the parameters that is influenced by the Iron content and supply to the erythrons and is not affected by inflammatory status and therefore the use of the sTfR/log ferritin (sTfR-F) index can be a reliable indicator of functional iron deficiency.Aim of the study:This study aims to evaluate the usefulness of sTfR and sTfR-F index in discriminating the most common types of anaemia in patients with RA.Patients and methods:The study included 50 patients with RA and 30 healthy subjects as a control group. Complete blood picture, C-reactive protein, serum Iron, unsaturated iron binding capacity, sTfR and serum ferritin were tested.Results and Conclusion:anaemia was present in 34/50 patients; 19 patients had ACD, 9 had ACD/IDA and only 6 patients had IDA. Both the sTfR and the sTfR-F index showed a significant difference between anaemia groups (P values = 0.037 and 0.001, respectively). sTfR-F index has shown to be a very useful parameter that can discriminate efficiently between IDA and ACD and between ACD and ACD/IDA in patients with RA.

Prognostic value of platelet to lymphocyte ratio in patients with non-small cell lung cancer

Background: The prognostic value of Platelet-to-lymphocyte ratio (PLR) in patients with non-small-cell lung cancer (NSCLC) is still indistinct. We conducted this study to assess the prognostic significance of pretreatment PLR in patients with unresectable NSCLC.Aim of the Work: To assess the prognostic significance of pre-treatment PLR in patients with NSCLC.Material and Methods: We retrospectively reviewed 130 patients treated for NSCLC with definitive/palliative chemotherapy and/or radiotherapy in Ain-Shams Universit hospital, Clinical Oncology department between January 2014 and December 2016. Pre-treatment CBC was available for the 130 patients to calculate PLR by dividing the absolute platelet count by the absolute lymphocytic count.Results: Out of 130 patients with available pre-treatment complete blood picture, population age ranged from 23 to 87 years. Male to female ratio was 4.8:1. Adenocarcinoma presents 51% of cases. Unresectable stage II and stage III present 2% and 27% respectively, while Stage IV presents 69%. Using a cut-off value of 150, a statistically significant correlation between baseline PLR &gt; 150 and presence of distant metastases was found (p = .043); with a trend towards less advanced stage disease among group of patients with baseline PLR &lt; 150 (p = .064). High PLR &gt; 150 was significantly associated with poor overall survival (OS) (median OS: 10.33 months; 95% CI: 6.23-14.42, compared to patients with PLR &lt; 150; (median OS: 24.63 months, 95% CI:11.5-37.76, p = .008), but not PFS. In multivariate analysis, PLR &lt; 150 was an independent good prognostic factor for OS; (HR = 0.549; 95% CI: 0.314-0.958; p = .035).Conclusion: High PLR is associated with poor OS in patients with unresectable NSCLC.

Utility of Mitrofanoff as bladder draining tool: A single center experience in pediatric patients.

Mitrofanoff procedure has been employed commonly as bladder draining tool in patients unable to do clean intermittent self catheterization through native urethera. Single centre experience of pediatric age group patients undergoing Mitrofanoff procedure has been presented here. It was a retrospective study of 29 children who underwent continent catheterizable conduit (CCC), from January 2009 till March 2017. Charts were reviewed for age, gender, presenting complaints, need for augmentation cystoplasty, Mitrofanoff channel source such as appendix or ileal patch, duration of surgery in minutes, hospital stay in days, per operative and postoperative complications. Preoperative evaluation of the children was done by doing complete blood picture, serum electrolytes, and renal function tests. Radiological evaluation included ultrasound kidney,ureter and bladder, voiding cystourethrography, urodynamic analysis and a nuclear renal scan with 99m Technetium dimercapto-succinic acid or MAG-3 scan. The abdominal end of the conduit was brought through the abdominal wall, and a stoma was fashioned by the V-quadrilateral-Z technique. Twenty nine children having mean age of 9.54±4.88 years underwent CCC. There were 19 males (65.51%) and 10 females (34.48%). Children who underwent CCC included 18 children having neurogenic bladder, 2 cases of urethral trauma/stricture 3 patients with history of posterior uretheral valve and 6 patients with exstrophy bladder. Augmentation cystoplasty plus mitrofanoff was done in 18 children while only mitrofanoff in 11 children. Stuck catheter was seen in one patient which was removed successfully via normal urethral route under general anesthesia. Stomal stenosis in first year was noted in 4 patients (13.79%). Continent catheterizable conduit based on Mitrofanoff principle have durable outcome over long term follow up in terms of urinary continence and complications.

Pathological and hematological studies on the effect of curcumin on manganese chloride-induced neurotoxicity in rats

The current work was undertaken to evaluate the toxicologic effect of manganese chloride (MnCl2) and potential therapeutic effect of curcumin on male albino rats. Ninety-six rats were divided into three groups. MnCl2 toxicity group (I) included 32 rats were administered (MnCl2) at a dose of 5 mg/ml daily in drinking water orally for 8 weeks. Curcumin-treated group (II) included 32 rats were given (MnCl2) in the same dose and route as the first group. Each rat of this group was treated by oral administration of curcumin in a daily dose 100 mg/kg b.w. The control group (III) included 32 rats. Eight rats were randomly selected from groups I, II and III and sacrificed at (2, 4, 6, and 8 weeks) of experiment. Tissue samples from cerebellum and midbrain of all groups were collected for histopathological examination, and neuromorphometrical analysis as well as blood samples were taken for complete blood picture. The histopathological examination in group I showed Purkinje cell loss in the cerebellum with degeneration of motor neurons in midbrain. In group II, curcumin caused significant increase in number of healthy Purkinje cells in cerebellum with prevalence of healthy motor neurons and minimal vascular alterations in midbrain. The hematological results revealed that animals in group I showed a significant increase in WBCs and platelets compared to other groups, while RBCs count significantly decreased. The number of poikilocyts increased in group I compared to group II and group III. In conclusion, curcumin therapy has a powerful neuroprotective effect in Mncl2 toxicity.

Association of neutrophil-to-lymphocyte ratio with early renal dysfunction and albuminuria among diabetic patients.

Neutrophil-to-lymphocyte ratio (NLR) was widely studied as a prognostic marker in various medical and surgical specialties, but its significance in diabetic kidney disease is not yet established. The subjects comprised 199 men aged 73 ± 11 (mean ± standard deviation) years and 187 women aged 77 ± 10years from a rural hospital. We examined the relationship between NLR calculated by analyzing differential leukocyte count in complete blood picture and renal function evaluated by estimated glomerular filtration rate (eGFR) using the Modification of Diet in Renal Disease Study Group equation and urinary albumin excretion (UAE). NLR was negatively related to eGFR and positively related to UAE. Multiple linear regression analysis using eGFR and UAE as an objective variables, adjusted for confounding factors as explanatory variables showed that NLR (β = - 0.101, p = 0.009) as well as age, body mass index, serum uric acid, and presence of uric acid lowing medication were significantly and independently associated with eGFR, and NLR (β = 0.113, p = 0.031) as well as prevalence of cardiovascular disease, systolic blood pressure, presence of antihypertensive medication, presence of antilipidemic medication, and eGFR were significantly and independently associated with UAE. The multivariate-adjusted odds ratios (95% confidence interval) of NLR for stage 3a (eGFR < 60mL/min/1.73m2), stage 3b (eGFR < 45mL/min/1.73m2), and microalbuminuria (UAE ≥ 30mg/gCr) were 1.90 (1.02-3.56) and 2.99 (1.28-6.98), and 1.77 (1.04-3.01), respectively. Next, to examine the consistency of the observed association between NLR and eGFR, we performed subgroup analyses. There was a significant interaction (p = 0.006) only between the two groups regarding antihypertensive medication (absence: β = - 0.272, p < 0.001 and presence: β = - 0.029, p = 0.564). Our data suggested that NLR might be important as a potential factor for evaluating patients with a higher degree of albuminuria among diabetic outpatients.

Alleviation of Lead-Induced Immunotoxicity by Moringa oleifera in Albino Rats

The existing study was designed to evaluate the ameliorative influences of Moringa oleifera on several immune parameters in male rats subsequent to lead administration. Twenty eight adult male rats were randomly assigned equally into 4 groups; control group was given distilled water. Lead treated rats were administrated a dose of 44 mg of lead acetate/kg BW. Moringa group was treated with 50 mg/ kg BW of Moringa oleifera leaf extract. Lead and moringa treated group was given a dose of 44 mg/kg of lead acetate and 50 mg/ kg of moringa extract. Treatments were given orally by gavage tube for one month. By the termination of the experimental period, rats were immolated; spleen and thymus weights were recorded in addition to the collection of blood and tissue samples. Tumor necrosis factor alpha (TNF-α), interferon gamma (IF-γ), interlukin-2 (IL-2) and total antioxidant capacity (TAC) were assayed in serum. Complete blood picture was evaluated for rats. Body weight gain was reduced significantly (P<0.05) in lead and moringa treated rats in comparison to control. A significant (P<0.05) increase in spleen weights was observed in lead and moringa co-administered group compared to moringa treated group. Lead administration produced higher (P<0.001) levels of TNF-α, IL-2 and IF-γ compared to that in other groups. In contrary, the level of TAC was significantly (P<0.001) reduced in lead treated rats. A significant (P<0.01) reduction in RBCs and low level of hemoglobin (P=0.07) were observed in lead-treated rats. Spleen of rats receiving lead showed widespread hyperplasia of lymphoid follicles in white pulp and hemosiderin pigment in red pulp. Thymus of rats receiving lead showed marked proliferation in the cortical region. Spleen and thymus of rats receiving lead showed a higher (P<0.01) immune reactivity for NF-κB and CD8+ parallel to that in other groups. In conclusion, the administration of Moringa oleifera extract ameliorates the immunotoxicity induced by lead exposure in rats.

Predictors for coronary artery ectasia

Background: Coronary artery ectasia (CAE) is characterized by dilation of an arterial segment to a diameter ≥1.5 times that of the adjacent normal coronary artery, 10%–20% of CAE have been described in association with inflammatory or connective tissue diseases. The underlying mechanisms of ectasia formation are not yet entirely known, so the aim is to assess the validity of the high-sensitivity C-reactive proteins (Hs-CRP) and the hematological parameters (platelet to lymphocyte ratio [PLR], mean platelet volume [MPV], and neutrophil-to-lymphocyte ratio [NLR]) to predict CAE. Patients and Methods: 60 patients with chronic stable angina were classified into three groups as follows: Group 1: CAE without coexisting atherosclerotic coronary arteries (20 patients), Group 2: CAE with coexisting atherosclerotic coronary arteries (20 patients), and Group 3: Normal coronary angiography (20 patients) as control group. Our patients were submitted to: (1) complete history taking, (2) thorough clinical examination, (3) electrocardiography, (4) laboratory investigation with special interest in complete blood picture and Hs-CRP, (5) transthoracic echocardiography, and (6) coronary angiography. Markis classification was used for classification of CAE. Results:(1) NLR ≥2.65 can predict CAE with sensitivity 52.5% and specificity 100% (P

Metabolic response to maxillofacial trauma revisited: A retrospective study.

Purpose:Management of a trauma patient aims at stabilization or resuscitation and revival from critical condition resulting from various sequences of systemic pathophysiological responses in the body. Hematological changes are the first signs reflecting the homeostasis mechanisms starting in the body after injury. The aim of the current study is to evaluate the physiological changes following maxillofacial trauma and extrapolate the findings to understand the posttrauma responses.Patients and Method:This is a retrospective study involving 192 subjects divided into two groups, trauma group and control group. In both the groups, baseline vitals and complete blood picture were recorded for comparison. In trauma group, the recordings were made within 24 h after maxillofacial injury.Results:All the parameters were analyzed using SPSS version 18. Independent sample t-test was used to assess the nature of data distribution and statistical significance was considered only at P value < 0.05. On comparison of complete blood picture mean values of hemoglobin (13.63 vs 12.18), RBC count (4.51 vs 4.10), WBC count (8835.48 vs 8336.56) were seen to be higher in trauma patients compared to control subjects. The mean bleeding times are almost equal (2.35 vs 2.47) but the clotting times (5.42 vs 5.26), random blood glucose (94.78 vs 90.13), and blood urea (27.14 vs 26.30) were marginally higher in trauma group but were statistically insignificant. The mean value of serum creatinine (0.84 vs 0.80) was comparatively higher in trauma patients and was statistically significant. Study of vitals revealed that mean systolic blood pressures were almost equal (120.65 vs 121.08) in both the groups. The mean diastolic blood pressures (79.46 vs 88.49) and oxygen saturation (93.73 vs 98.86) in trauma patients are comparatively reduced. The mean values of temperature (99.30 vs 98.50) and pulse rate (102.38 vs 97.14) were on relatively higher side in trauma group compared with control group.Summary and Conclusion:Using basic blood parameters and vitals in the present study, the compensatory mechanisms happening in the body after maxillofacial trauma can be seen. These changes although significant on side by side comparison can still fall within the normal physiological range provided by various diagnostic setups. Hence, the need for maxillofacial surgeon to be sensitive to minor variations in these aspects to ensure safety of the patient cannot be overemphasized.

Serum hepcidin levels and erythropoietin resistance in hemodialysis patients

Introduction Erythropoietin (EPO) resistance is an important cause of anemia in patients with chronic kidney disease. Enhancement of erythropoiesis by EPO requires intact EPO signaling and effective mobilization of iron stores. Enhanced synthesis of hepcidin leads to reduction of iron absorption in the small intestine and sequestering of iron in macrophages. Hepcidin may contribute to EPO resistance through a direct inhibitory effect on erythroid progenitor proliferation and survival. Objective To assess serum hepcidin levels in patients undergoing hemodialysis (HD) treatment and to distinguish its analogous association with anemia parameters and EPO resistance. Patients and methods A cross-sectional study was carried out among HD patients at Nephrology Unit of the Zagazig University Hospital from 2017 to 2018. The study included 90 participants, meeting our inclusion criteria, who had end stage renal disease (ESRD) and were on regular HD three times weekly. All patients were subjected to full history taking and clinical and laboratory assessment. It included routine investigations, with complete blood picture, calcium, phosphorus, parathyroid hormone (PTH), lipid profile, iron panel, and c reactive peptide (CRP). Specific investigations included the EPO resistance index and serum hepcidin measurement. Results Hepcidin is positively related to EPO resistance index. EPO resistance index as well as ferritin were significant determinants of hepcidin in HD patients. Conclusion Hepcidin is associated with anemia, iron status, and microinflammation in HD patients. If used as a diagnostic tool, it might improve iron therapy during periods of reticuloendothelial blockage of iron transport. This is important to avoid iron overload and to improve EPO response in patients with ESRD.

Tumor lysis syndrome in pediatric acute lymphoblastic leukemia at tertiary care center.

Objectives:Tumor lysis syndrome (TLS) is common complication of acute lymphoblastic leukemia (ALL). It is characterized by presence of two or more of hyperkalemia, hyperuricemia, hyperphosphatemia and hypocalcemia. TLS may cause acute kidney injury (AKI), arrhythmias and seizures. Our objective was to determine the frequency of TLS and its biochemical abnormalities in children with ALL.Methods:A retrospective study on 91 children, aged 2-13 years with ALL was carried out in Nephrology and Oncology departments of National Institute of Child Health, Karachi from January 2016 to December 2017. Patients already received chemotherapy were excluded. Data including risk categories, immunophenotyping, laboratory parameters like complete blood picture, serum creatinine (SCr), potassium(K), calcium (Ca), phosphorus(P) and uric acid (UA) on day 0,3 and 7 after chemotherapy were collected. Data analyzed on SPSS using descriptive statistics. Independent t- test was applied to compare means and P- value<0.05 was taken as significant.Results:Ninety-one children with mean age of 6.39±3.08 years were studied. Male were 57% and 43% female. High risk ALL were 61.5%. Pre –BALL were 82.4% and 17.5% had T-cell ALL. All patients had anemia (hemoglobin7.69±2.66 g/dl) and thrombocytopenia (43.61± 18.6 x109) where as hyperleukocytosis and blast cells were observed in 20.87% and 73.6% respectively. Comparing the biochemical parameters of ALL, the difference in SCr from D0 vs D3 (0.46±0.16 vs0.54± 0.35 and D7, 0.44±0.22) was significant (p=0.001). Similarly, difference in UA (D0, 4.12±2.40 vs D3, 3.82±1.73 and D7, 3.56±1.42), SP (D0, 4.24±1.34 vs D3, 4.61±1.76 and D7,4.13±1.07mg/dl)and for K (p=0.038) was significant. There was no difference in Ca from D0 vs D3 (0.092) and D7 (0.277). TLS was found in 62.6% children, it was chemotherapy induced in 72% and spontaneous in 28%. Clinical-TLS was observed in 14% and all CTLS had AKI. Hyperuricemia and hyperphosphatemia were the most common biochemical abnormalities in laboratory-TLS and CTLS.Conclusion:TLS was found in 62.6% despite preventive measures. Early recognition and treatment is essential to avoid morbidity and mortality.

LEFT VENTRICULAR DYSFUNCTION IN END STAGE RENAL DISEASE PATIENTS ON REGULAR HAEMODIALYSIS CORRELATED TO DIFFERENT VARIABLES

Background: Patients with chronic kidney disease (CKD) manifest an increased prevalence of cardiovascular morbidity and mortality compared with age-matched persons, and this relationship is directly proportional to the severity of CKD. After age, left ventricular hypertrophy (LVH) is considered to be the strongest independent predictor of cardiovascular disease and events, cardiovascular death and total mortality. In CKD patients, LVH contributes to diastolic dysfunction, congestive heart failure, arrhythmia and sudden death. Aim of the Work: The aim of this study is to clarify the relationship between ESRD and left ventricular dysfunction Methods: All patients were subjected to the following :: Complete history and physical examination, Routine laboratory investigations including: Complete blood picture,Blood urea and serum creatinine, Random blood suger, calcium, phosphors,, uric acid urine analysis, PTH Special investigations in the form of 2D echocardiography. Results: The collected data were computerized and statistically analyzed using SPSS program (Statistical Package for Social Science) version 24.

Simple Red Cell Indices in Screening and Discrimination of Iron Deficiency Anemia and Beta Thalassemia Trait in Egyptian Patients

Background: The most common causes of microcytic hypochromic anemia are iron deficiency anemia (IDA) and the beta-thalassemia trait (β-TT). The aim of the work is to compare the validity of the various simple indices to differentiate between iron deficiency anemia and β-thalassemia trait. Subjects and methods: A total of 2000 individuals were screened, by complete blood picture, measurement of serum iron, serum ferritin and hemoglobin separation; 224 patients were detected as having hypochromia and microcytosis. Among them 166 cases were IDA and 58 cases were β-TT. We calculated 11 discrimination indices. The number of correctly identified cases were determined, sensitivity, specificity, positive and negative predictive value and Youden’s index (YI) of each discrimination index was calculated. Results: The percentage of correctly diagnosed patients is highest for Matos and Carvalho index (MCI) (95.5%) which is closely followed by Red cell distribution width index (RDWI) (93.7%). The third high index was Green and King (GKI) (91.9%). Sensitivity, specificity of MCI for detection of IDA was found 98.8%, 87.9% respectively. For β-TT, sensitivity and specificity was found 86.2% and 98.8% respectively. The YI of MCI was found 85.9%. It is followed by RDWI; its sensitivity and specificity for detection of IDA was found 97.6%, 85.3%. For β-TT, sensitivity and specificity was found 82.7% and 97.6% respectively. The YI of RDWI was 81.6%. Conclusion: Matos and Carvalho index and RDWI are easily available automated cell-count-based indices coming out as good discriminator between IDA and β-TT in our study.

Toxicity assessment of the green Dunaliella salina microalgae.

The chronic toxicity of the Dunaliella salina microalgae was examined to evaluate its toxicity by the exposure of laboratory animals to high doses of Dunaliella salina and to estimate the possibility of using it as a safe supplement. Different hematological and biochemical analysis including complete blood picture (CBC), liver function enzyme activities; aminotransferases (ALT and AST), alkaline phosphatase (ALP), total bilirubin, kidney function tests; urea, creatinine, and albumin, as well as blood glucose level, were measured. The histopathological investigation was also carried out on hepatic, renal and cardiac architectures to examine its safety. Treatment with the dose 100 mg /kg body weight of D. salina powder daily for three consecutive months did not show any signs of toxicity in both genders and in mice and rats (no mortality, no hair loss, no diarrhea, no patches of yellow color appearance, etc…..). Moreover, abnormalities on behavior, food and water intakes and health status among the treated animals were not observed. CBC profile revealed a significant increase in hemoglobin (Hb) level in treating male and female mice and rats compared to their related control levels. The biochemical analysis clearly showed an insignificant change in liver enzyme activities, blood glucose level at a dose of 100 mg/kg. Also, an insignificant reduction in total urea and creatinine levels in both genders of mice and rats were noticed. Histopathological investigation showed normal architectures of all organs. Hence we can conclude that Dunaliella salina has been proven a safe profile up to 100 mg/kg body weight, however, it succeeded to stimulate the Hb synthesis compared to control groups, showing its benifits to be used safely as food additives or protective and curative agent in different diseases in future.