Drop In Count Research Articles

Splenic Sequestration in Febrile Pediatric Sickle Cell Disease Patients

Introduction: Acute splenic sequestration is a rare complication of pediatric sickle cell disease (SCD). Acute splenic sequestration crisis (ASSC) is characterized by an acute decrease in hemoglobin and is associated with an increased risk for hypovolemic shock, often requiring blood transfusion during acute episodes and splenectomy to prevent recurrent episodes. Recent studies have also shown that chronic splenomegaly and resultant anemia (described as chronic or subacute sequestration) with potential benefit of splenectomy. However, non-life-threatening splenic sequestration in febrile, hospitalized children with SCD is a frequent occurrence that has not been well-described in current literature. Aim: To estimate the change in WBC, Hemoglobin, platelet count from inpatient and outpatient baseline to lowest recorded value (LRV) for each febrile hospitalization in sickle-cell disease patients while controlling for hydroxyurea use and patient age. Methods: A retrospective chart review was performed on febrile, hospitalized children with a diagnosis of SCD who presented to a tertiary care hospital from 2018-2021. Data including the magnitude of fever, presence of splenomegaly and trends in laboratory parameters such as complete blood count, and chemistries were recorded. Demographics, hydroxyurea use, transfusions and sickle cell phenotype were also recorded. For our primary outcome we estimated the change in Hgb, platelets, and WBC count from inpatient (first day of hospitalization) and outpatient (most recent outpatient values) baselines to the lowest recorded value (LRV) for each hospital encounter. We employed mixed models to account for within-subject correlation and adjusted for hydroxyurea use and categorized patient age. The beta coefficient and corresponding 95% confidence interval (CI) were reported for the model intercept and predictors. Results: Sixty-six unique patients (ages 0-17) accounted for a total of 117 hospital encounters. There was a statistically significant drop in WBC per microliter (-5.40, 95% CI: -6.89 - [-3.91]) , Hgb g/dL (-0.95, 95% CI : -1.25 - [-0.66]), and platelets per microliter (-60.95, 95% CI : -83.18 - [-38.71]) from the inpatient baseline to the LRV. There was a statistically significant drop in estimated Hgb g/dL (-1.83, 95% CI : -2.23 - [-1.42]) and platelets per microliter (-130.50, CI: -169.59 - [-91.41]) from outpatient baseline to the LRV. Hospital encounters with hydroxyurea had a significantly greater drop in estimated platelets per microliter from inpatient baseline to LRV (-54.43 CI : -93.64 - [-15.22]) but significantly greater increase in estimated Hgb g/dL from inpatient baseline to the LRV (1.11 CI : 0.45 - 1.78) compared to hospital encounters without hydroxyurea. Hospital encounters over the age of 8 were associated with a significantly greater decrease in HGB g/dL (-0.59 CI : -1.04 - [-0.14]) from inpatient baseline to the LRV compared to hospital encounters under the age of 8. Conclusion: Our study demonstrated features consistent with acute, non-life-threatening splenic sequestration in febrile pediatric SCD patients, as evidenced by a statistically significant drop in platelets, Hgb, and WBC count from the inpatient baseline. The largest acute drop was observed in platelets, which presents the strongest argument for sequestration, as drops in Hgb may be explained by rehydration or hyperhemolysis, and changes in WBC count may be related to infection. Hydroxyurea use may delay auto-infarction of the spleen, thus predisposing to splenic sequestration at an age later than classically associated with sequestration. The preservation of splenic function probably explains greater decrease in platelet count for patients on hydroxyurea. Our study has treatment implications: children with SCD experiencing non-life-threatening acute splenic sequestration recover spontaneously without the need for blood transfusion in many cases, thus avoiding long-term complications such as RBC alloimmunization or iron overload. Also, as the drop in WBC, hemoglobin, and platelets are not due to myelosuppression, they should not lead to modification of hydroxyurea therapy. Splenectomy should be reserved for the most severe and life-threatening episodes of sequestration. Further research may assist in correlating sickle cell phenotype and history of blood transfusion with the magnitude of sequestration in this population.

The Impact of Laboratory Sample Request Evaluation and the Use of Probability Testing for HIT By Trained Physician on the Decrease of Unnecessary Tests and Increase the Likelihood of Positivity

Introduction: Heparin-induced thrombocytopenia (HIT) is an extremely serious and potentially fatal condition that can develop in patients taking heparin-based medications, such as unfractionated heparin (UFH) or low-molecular-weight heparin (LMWH). The laboratory tests for diagnosis of HIT is expensive and time consuming. Clinical assessment (4Ts) followed by testing for Heparin/platelet factor 4 antibody in intermediate and high risk patients is the standard algorithm of pretest for (HIT) which can be later confirmed by serotonin releasing assay if available. Materials and methods: We conducted a retrospective analysis of laboratory practice of pretest evaluation of samples submitted for HIT testing in a cohort of patients treated in a tertiary hospital in Saudi Arabia who had a clinical suspicion of HIT. The 4 T score was a pretest requisite to proceed for electronic request for HIT. It had to be performed by the requesting physicians of different medical specialties. The request then been evaluated by hematopathologist before proceeding. The test will be cancelled if: the 4T score calculated by attending physician is < 4 or if platelet count is normal with no evidence of significant drop in the last 4 days from request or the test was performed at least 2 days before the new request. Additional exercise was performed by two physicians in training after train them to standardize the calculation of the 4T scores without re evaluation by the hematopatologist. The sample proceeded for testing if it met the testing criteria of 4T score > 3 and passed the evaluation by the hematopathologist. All tested sample were performed by immunoglobulin G (IgG) antibodies via an ELISA (Asserachrom HPIA-IgG, Stago Diagnostica STA®) and Optic density ( OD) and was evaluated and considered positive if OD >0.39 with sub classification to low positive 0.4-1, moderate 1-2 and strong if >2. Over a period of 2 years, we received 449 samples for patients who were admitted to our hospital, received prophylactic or therapeutic doses of LMWH or UFH, and underwent an HIT test due to clinical suspicion ( > 50% drop in platelet count from baseline, or ≥ 2 consecutive platelet counts < 150,000 per mm 3 and was defined as possible HIT). The 4 T score was calculated in the hospital system by attending physicians referred to as (system 4T score) and recalculated by trained two physicians and referred to (re calculated 4T score). Descriptive statistics, paired samples statistics, correlations, and analysis of variance (ANOVA) were performed. Results: The test was labeled by the laboratory physician ( hematopathologist ) as not indicated and test was not performed in 156 (35%) for various reasons including low 4 T score <3 in 90 (57%), Normal platelet count > 150 at time of test ( and wrong calculated 4T score) in 28 (18%), duplication of test order in 10 (6.4%%), There was clear other cause of thrombocytopenia in 15 (10%), Bad sample quality 5 (3.2%%) and 8 (5%) for other reasons. The samples for HIT test were for 231(51%) males and 220 (49%) females with mean age 56.3 (1-102) years. The mean platelet count at time of request was 82.9 (2-384) per mm 3. Out of the total cohort 422 (95.1%) patients had received UFH and only 22 (4.9%) received LMWH. There is only 69/449 (15.4%) agreement between the two calculations (system and re calculated score) . Out of the tested samples 293, total positive tests 19 (6.5%), were 11 (3.8%) had low positive for HIT test, moderate positive in 6 (2%) and only 2 strongly positive for HIT. The calculated (system 4T score) of < 4 were 142 (32%) samples while the (re calculated 4T score) were 136 (30%) of which 60 ( 38%) of the cancelled tests by hematopathologist, of which 68 (23%) of tested samples were negative and 7 (37%) of positive tests could have been missed based on this calculation. There were 12 out of 19 had moderate and high score by calculation and positive HIT while there were 17 out of 19 had moderate and high score by system calculation. Conclusion: We are reporting improved detection of HIT and confirmed the value of applying the 4 T score for HIT testing with added value of pre test screening to exclude low probability and cancel samples with no clear indication of HIT due to presence of other causes of thrombocytopenia.The retrospective re calculation even with more trained physicians did not add a value compared to pretest evaluation and screening by hematopathologist which had resulted in cancelation or more than third of the requested tests.

Polyelectrolyte-Complex-Based Hydrogel Inserts for Vaginal Delivery of Posaconazole and Probiotics.

Worldwide, 40 to 50% of women suffer from reproductive tract infections. Most of these infections are mixed infections, are recurrent and difficult to treat with antimicrobials or antifungals alone. For symptomatic relief of infections, oral antimicrobial therapy must be combined with topical therapy. The purpose of this work is to optimize and develop a polyelectrolyte complex (PEC) of chitosan/anion for the formulation of posaconazole- and probiotic-loaded vaginal hydrogel inserts with prolonged release and significant mucoadhesion. PECs were prepared using chitosan as cationic and carrageenan, pectin and polycarbophil as anionic polymers via a lyophilization technique. PEC formation was confirmed by scanning electron microscopy, Fourier transform infrared spectroscopy and differential scanning calorimetry, by observing changes in its surface, physical and thermal properties. The probiotic, Lactobacillus casei, was added to the PEC during the lyophilization process and the effect on the probiotic viability was studied. The PECs were further compressed along with posaconazole to form hydrogel inserts and optimized using a 32 full-factorial design. The hydrogel inserts were assessed for swelling behavior, drug release, in vitro mucoadhesion and in vitro antifungal activity. The chitosan-pectin hydrogel insert demonstrated excellent mucoadhesion (1.25 N), sustained drug release (88.2 ± 2.4% in 8 h) and a swelling index of 154.7%. The efficacy of hydrogel inserts was evaluated using in vitro study with a co-culture of Lactobacillus casei and Candida albicans. This study revealed an increase in Lactobacilli casei count and a significant drop in the viable count of Candida albicans (4-log reduction in 24 h), indicating the effectiveness of hydrogel inserts in alleviating the fungal infection. Overall, our study demonstrated the potential of the hydrogel insert for preventing vaginal infection and restoring normal vaginal microbiota.

Shear Forces Induced Platelet Clearance Is a New Mechanism of Thrombocytopenia.

Thrombocytopenia has been consistently described in patients with extracorporeal membrane oxygenation (ECMO) and associated with poor outcome. However, the prevalence and underlying mechanisms remain largely unknown, and a device-related role of ECMO in thrombocytopenia has been hypothesized. This study aims to investigate the mechanisms underlying thrombocytopenia in ECMO patients. In a prospective cohort of 107 ECMO patients, we investigated platelet count, functions, and glycoprotein shedding. In an ex vivo mock circulatory ECMO loop, we assessed platelet responses and VWF (von Willebrand factor)-GP Ibα (glycoprotein Ibα) interactions at low- and high-flow rates, in the presence or absence of red blood cells. The clearance of human platelets subjected or not to ex vivo perfusion was studied using an in vivo transfusion model in NOD/SCID (nonobese diabetic/severe combined Immunodeficient) mice. In ECMO patients, we observed a time-dependent decrease in platelet count starting 1 hour after device onset, with a mean drop of 7%, 35%, and 41% at 1, 24, and 48 hours post-ECMO initiation (P=0.00013, P<0.0001, and P<0.0001, respectively), regardless of the type of ECMO. This drop in platelet count was associated with a decrease in platelet GP Ibα expression (before: 47.8±9.1 versus 24 hours post-ECMO: 42.3±8.9 mean fluorescence intensity; P=0.002) and an increase in soluble GP Ibα plasma levels (before: 5.6±3.3 versus 24 hours post-ECMO: 10.8±4.1 µg/mL; P<0.0001). GP Ibα shedding was also observed ex vivo and was unaffected by (1) red blood cells, (2) the coagulation potential, (3) an antibody blocking VWF-GP Ibα interaction, (4) an antibody limiting VWF degradation, and (5) supraphysiological VWF plasma concentrations. In contrast, GP Ibα shedding was dependent on rheological conditions, with a 2.8-fold increase at high- versus low-flow rates. Platelets perfused at high-flow rates before being transfused to immunodeficient mice were eliminated faster in vivo with an accelerated clearance of GP Ibα-negative versus GP Ibα-positive platelets. ECMO-associated shear forces induce GP Ibα shedding and thrombocytopenia due to faster clearance of GP Ibα-negative platelets. Inhibiting GP Ibα shedding could represent an approach to reduce thrombocytopenia during ECMO.

Comparative Investigation into the Roles of Imipenem:Cyclodextrin Complexation and Antibiotic Combination in Combatting Antimicrobial Resistance in Gram-Negative Bacteria.

Extensively drug-resistant (XDR), multidrug-resistant (MDR) and pandrug-resistant (PDR) Gram-negative microorganisms (GNBs) are considered a significant global threat. β-lactam and aminoglycoside combinations and imipenem:cyclodextrin inclusion complexes were studied for the treatment of lethal GNBs. This is because of the broad empiric coverage of the two drugs and their possession of different spectra of activity. Two cyclodextrins (β- and hydroxy propyl β-cyclodextrins) were utilized for inclusion complex formation with imipenem using the physical and kneading methods. In silico investigation using the molecular docking and Fourier-infrared spectroscopy (FTIR) were employed to estimate binding constant and confirm complex formation, respectively. The in vitro effects of amikacin and imipenem combination in comparison to the effect of imipenem-β- and hydroxy propyl β-cyclodextrin (CD) complexes against Klebsiella spp. and Acinetobacter baumannii were studied. The isolated microorganisms' antimicrobial responsiveness to various antibiotics (19 antibiotics) was evaluated. It was found that piperacillin/tazobactam and gentamycin (resistance rates were 33.3% and 34%, respectively) were the most effective antimicrobials. The in vitro studies have been performed by the checkerboard technique and time-killing assay. The studied combination of amikacin and imipenem showed a substantial drop in bacterial count (p < 0.05). The in vitro studies demonstrated a synergism for the investigated combination. Conventional PCR was used in molecular studies to identify the resistance genes bla IMP and aac (6')-Ib. The blaIMP and aac (6')-Ib were recorded in 38.2% and 3.6% of the studied isolates, respectively. The in vitro studies showed synergistic effects among the tested antibiotics with FICIs of ≤0.5. Finally, the study compared the reduction in bacterial count between the tested antibiotic combinations and imipenem:CD physical and kneaded mixtures. Imipenem:CD inclusion complexes demonstrated a significant bacterial count reduction over the antibiotic combination. These results highlight the emerging role of CDs as safe biofunctional excipients in the combat against superbug bacterial resistance.

Post-harvest biocontrol of Salmonella Enteritidis on Chicken breast meat and Shell eggs using multiphage cocktail.

The study aimed to evaluate the efficacy of a phage cocktail to reduce Salmonella Enteritidis contamination on perishable food items viz. chicken breast meat and shell eggs using different concentrations. Initially, four bacteriophages €P54, €P59, €P66, and €P72 were isolated from sewage water using Salmonella Enteritidis as a target strain. €P54 and €P66 were found to be Myoviruses while €P59 and €P72 belonged to the Siphoviridae family. A phage cocktail was applied at a concentration of 100 and 10,000 multiplicity of infection (MOI) after artificially contaminating both food items with Salmonella Enteritidis. Results showed that, phage cocktail significantly (p ≤ 0.05) reduced Salmonella Enteritidis count at both concentrations. However, the increased reduction was witnessed at 10,000 MOI. In comparison to untreated control, on chicken breast meat bacterial count was reduced to 1.94 and 3.17 Log10 cfu/g at 100 and 10,000 MOI respectively at 4oC. Similarly, on shell eggs, the bacterial count was reduced to 3.09 and 2.81 Log10 cfu/mL at 10,000 MOI at 4°C and 25°C respectively, while at 100 MOI there was less drop in bacterial count at both 4°C and 25°C. The results showed a better reduction at 4°C as compared to 25°C. Our data showed that the phage cocktail is an effective alternative and additional measure compared to conventional bacterial control methods for meat and eggs.

RARE CASE OF ESCITALOPRAM INDUCED THROMBOCYTOPENIA- A CASE REPORT

Drug-induced thrombocytopenia can be caused by dozens, perhaps hundreds of medications. Because thrombocytopenia can have many other causes, the diagnosis of drug-induced thrombocytopenia can easily be overlooked. In acutely ill, hospitalized patients, drug-induced thrombocytopenia can be overlooked because thrombocytopenia is attributed to sepsis, the effect of coronary-artery bypass surgery, or some other underlying condition. Although drug-induced thrombocytopenia is uncommon, it can be devastating. Heparin-induced thrombocytopenia is the most common drug-related cause of drop in the platelet count. Because heparin is often given together with certain drugs that are likely to cause drug-induced thrombocytopenia (platelet inhibitors and vancomycin), it is important to distinguish between heparin-induced thrombocytopenia and drug induced thrombocytopenia. Drug-induced platelet destruction is usually caused by drug-induced antibodies, but this can be difficult to prove. Although platelets are the preferred targets of drug-induced antibodies, drugs can also cause immune hemolytic anemia and neutropenia through similar mechanisms.

Change in Blood Counts after Palliative Radiotherapy for Multiple Myeloma

Radiation therapy (RT) can provide effective palliation and prevent symptomatic local progression of multiple myeloma (MM). However, RT is sometimes avoided due to concerns for secondary impact to bone marrow, potentially decreasing blood cell counts and precluding ability to receive future systemic therapies. We reviewed a series of MM patients who received palliative RT to assess changes in blood counts from pre-RT to post-RT, hypothesizing that blood counts would not significantly decline after treatment with modern RT volumes and techniques. We utilized a prospectively maintained departmental database and included patients who received palliative RT for MM from 2015 to 2020. Lab values immediately pre-RT (within one month of RT start date) and post-RT (within three months of RT completion) including hemoglobin, lymphocytes, neutrophils, and platelets were collected. Statistical differences from pre-RT to post-RT were assessed using t-tests. ANOVA was used to compare change in blood counts between common dose fractionation regimens (30 Gy in 10 Fractions, 20 Gy in 5, and 8 Gy in 1). A total of 334 MM patients receiving 424 courses of RT were included in this analysis. The median age at start of first treatment was 67 (IQR: 60-76) years. One-hundred ninety-five (58%) were male. Median RT dose was 20 (IQR: 8-24.5) Gy delivered over a median 5 (IQR: 1-5) fractions. Between pre-RT and post-RT, there was no significant change in hemoglobin (+0.1 g/dL (IQR: -0.8, +0.5), p = .076), lymphocyte counts (-0.3*10^9 cells/L (IQR: -0.6, 0), p = .435), or neutrophil counts (-0.1*10^9 cells/L (IQR: -1.1, +0.9), p = .310). In contrast, platelet counts significantly decreased from pre-RT (median 165*10^9 cells/L, IQR: 112-210) to post-RT (median 146, IQR: 93-194) by a median of 17.5 *10^9 cells/L (IQR: -52.5, +14.0, p<0.0001). There were no differences in changes in hemoglobin, neutrophils, or platelets between the common dose fractionations. However, there was a significantly greater drop in lymphocytes after 30 Gy in 10 fractions (p = .039, mean lymphocyte count change (in 10^9 cells/L) for 30 Gy in 10: -0.87, 20 Gy in 5: -0.47, and 8 Gy in 1: -0.27). In this large dataset of patients receiving modern palliative RT for MM, hemoglobin, lymphocytes, and neutrophils did not significantly decline from pre-RT to post-RT. In contrast, there was a statistically significant drop in platelet count by a median 17.5*10^9 cells/L from pre-RT to post-RT, which may or may not be clinically significant depending on clinical context. Patients receiving 30 Gy in 10 fractions had greater drops in lymphocytes than those receiving lower doses. Further analyses will be performed to determine clinical, dosimetric, and volumetric predictors of decline in blood counts after radiation.

Total Lymphoid Irradiation in the Treatment of Heart Transplant Rejection: Single Institution Long-Term Results

Acute cardiac allograft rejection is a major cause of morbidity and mortality post-transplant. Total lymphoid irradiation (TLI) has been shown to cause long-lasting alterations in lymphocyte sub-sets, and thereby induces a state of partial response that is useful to prevent organ transplant rejection. In our previous report, treatment with TLI resulted in decreased episodes of acute rejection and steroid dosage requirements for up to 9.1 years post cardiac transplantation. In this study, we report an update on the short- and long-term effects of TLI in the treatment of cardiac transplant rejection. We performed a retrospective analysis of patients with intractable cardiac allograft transplantation evaluated in the department of radiation oncology at our institution over 23 years (1998-2021). Cardiac allograft rejection was defined as multiple or persistent episodes of rejection despite aggressive immunosuppressive therapy. The prescribed dose was 8 Gy in 10 fractions to be delivered over 5 weeks. All episodes of pathologic acute cardiac rejection, duration of immunosuppression, and episodes of acute infection requiring treatment before and after TLI were documented. Overall survival (OS) was analyzed using Kaplan-Meier method. The median time to first cardiac allograft rejection and the median time to first acute rejection was monitored. Of the 29 patients included, 21 (72.4%) had ISHLT grade 1R, 5 (17.2%), grade 2R, and 2(6.9%) grade 3R rejection. Rejection grade was unknown for 1 patient. The mean number of acute rejections after transplant was 14.4 episodes per patient (range 1-44) with median time to first rejection of 0.63 months. The median radiation dose was 8 Gy (range 7.2-8 Gy) delivered over a mean of 31 days. Treatment was stopped early in 2 (6.5%) patients (after 7.2 Gy and 7.9 Gy) for severe bone marrow suppression and drop in CD4 counts, respectively. The number of rejections dropped from 14.2 to 3.97 per patient over a median time of 29.0 months vs 28.1 months pre and post TLI (p = 0.01). The frequency of ISHLT acute grade 3R rejections decreased from 0.58 to 0.06 episodes per patient pre and post TLI (p = 0.02). Immunosuppressant requirements decreased from 2.83 before TLI to 2.69 after TLI (p = 0.71). Infection rates per patient were 0.71 pre TLI and remained at 0.63 post TLI. Treatment was well tolerated with 4 (13.8%) grade 2 or higher radiation toxicity. Median follow up was 76.3 months. Median and 3-year OS were 53.4 months and 60.9%, respectively. TLI is a safe and effective treatment for control of intractable cardiac rejection. The episodes of acute rejection and immunosuppressant requirements are decreased, but with long-term follow up, these patients continue to experience rejection. However, TLI lowers the frequency of ISHLT moderate to severe rejection episodes for up to 6.4 years. There was no increased risk of severe infections and there were only minimal short- and long-term grade 2 or higher radiation toxicities.

Effects of extracorporeal circulation with different time on platelet count after cardiac surgery: a retrospective study based on medical records

Our objective was to observe the effects of extracorporeal circulation (ECC) with different time on platelet count in patients undergoing cardiac surgery. A total of 427 patients who underwent elective cardiac surgery under ECC in affiliated hospital of north Sichuan medical college from January 1, 2018 to July 31, 2021 were divided into three groups according to ECC time. We concluded that thrombocytopenia was common after ECC, maximum drop of the platelet counts after ECC was usually seen on the second day after ECC, and platelet counts started to recover on the fifth day after ECC. With the extension of ECC time, the drop in platelet counts is more pronounced, the volume of perioperative blood loss and blood products transfusion are more, and the recovery level and speed of platelet counts is lower.

Evaluation of some immunological parameters for Staphylococcus xylosus infections in patients with Systemic lupus erythematosus

Purpose: Systemic lupus erythematosus (SLE) is a chronic, systemic autoimmune illness that manifests clinically as well as immunologically and in several lab tests abnormalities. Patients with SLE frequently get infections, which account for 30–50% of morbidity and death. The bacterial species Staphylococcus xylosus is a member of the Staphylococcus genus. This study's objective was to assess several immunological indicators of S.xylosus infections in individuals with systemic lupus erythematosus in the Najaf Governorate of Iraq. Subjects and Methods: Blood samples were taken from 60 SLE patients ranging in age from 16 to 56. Each patient has had a sample of 10 milliliters of blood taken. 5 ml were used to measure immunologic parameters, and another 5 ml were used to diagnose S. Xylosus by culturing a sample on blood agar and mannitol salt agar. culture on mannitol salt agar and blood agar. Results: According to the microbiological tests, 26 specimens (or 43.3%) had isolated bacteria, whereas 34 specimens (or 56.7%) had no sign of bacterial growth. Out of the 26 blood samples collected, S.xylosus was detected in 2 samples. normal amounts of ANA and anti ds-DNA despite SLE sufferers. The results of this study showed that serum levels of CD69, IL-21, and IL-35 significantly increased when compared with controls, despite a substantial drop in Hb, WBC, and platelet counts but an elevated ESR. Conclusions: xylosus produces normal autoantibody levels that are utilized to diagnose SLE. An important factor in the pathophysiology of SLE, which causes the disease to develop, is a high concentration of inflammatory cytokines.

Use of social media data, online reviews and wikipedia page views to measure visitation patterns of outdoor attractions

This study explores the suitability of activity counts extracted from social media platforms (Twitter, Flickr), review portals (TripAdvisor, Google Maps) and Wikipedia article views to model official visitor counts at selected outdoor attractions in Florida (U.S.) and Carinthia (Austria). It applies correlation analysis, multiple regression, and time series analysis to identify which of these user-generated content (UGC) sources and their combinations best match official monthly visitor count patterns for an analysis period of three years (2019–2021). With travel activities being severely hampered during 2020 due to the COVID-19 pandemic, the analysis also aims to analyze to which extent reduced visitor counts are reflected in the respective UGC sources. Results show that the number of Google Maps reviews combined with Wikipedia pageviews best explain the variability of monthly official visitor counts in Ordinary Least Squares (OLS) regression in both study areas. While the comparison analysis was conducted for monthly counts, data from some UGC sources can reflect shorter term activity fluctuations. Time series analysis detected a seasonality of 12 months for Wikipedia pageviews, Google Maps reviews, and official visitor counts for Austria due a clearly distinct summer season. As opposed to this, for Florida, due to a climate that facilitates all-year round park visitations, periodograms yielded different seasonality frequencies for UGC sources and official visitor counts. A short-term drop in visitor counts due to COVID-19 was evident in Florida both in UGC sources and official visitor counts in spring 2020, whereas for Austria attractions reduced activity is only somewhat reflected in UGC sources but not in actual visitor counts due to attractions still being closed in April. Management implicationsThis research explores multiple UGC sources for modeling official visitor counts at outdoor attractions. A combination of several sources has the advantage that it can help mitigate known limitations of UGC from individual sources, such as sparsity of geodata, data retrieval restrictions, sociodemographic bias, and varying popularity across regions. This research also revealed a better model fit of combined UGC data with official visitor counts than using any of the UGC sources alone. Data-rich UGC sources offer daily or weekly activity counts that provide a more refined temporal resolution than typical official visitor counts which are often limited to monthly data aggregations.

Immunomodulatory, cyto-genotoxic, and growth regulatory effects of nerolidol on melon fruit fly, Zeugodacus cucurbitae (Coquillett) (Diptera: Tephritidae)

Insects have evolved a robust immune system consisting of humoral and cellular branches and their orchestrated response enables insect to defend against exogenous stressors. Exploration of underlying immune mechanisms of insect pest under allelochemical stress can give us new insights on insect pest management. In this study, nerolidol, a plant sesquiterpene was evaluated for its insecticidal, growth regulatory, immunomodulatory, and cyto-genotoxic effects against melon fruit fly, Zeugodacus cucurbitae (Coquillett). First, second, and third instar larvae of Z. cucurbitae were fed on artificial diet containing different concentrations (5, 25, 125, 625, and 3125 ppm) of nerolidol. Results revealed a significant reduction in pupation and adult emergence as well as prolongation of developmental duration of treated larvae. Decline in growth indices showed remarkable growth inhibitory effects of nerolidol. Pupal weight and nutritional parameters viz. Larval weight gain, food assimilated, and mean relative growth rate declined after treatment. Immunological studies on second instar larvae depicted a drop in total hemocyte count and variations in proportions of plasmatocytes and granulocytes of LC30 and LC50 treated larvae. Phenoloxidase activity in nerolidol treated larvae initially increased but was suppressed after 72 h of treatment. The frequency of viable hemocytes decreased and that of apoptotic and necrotic hemocytes increased with both the lethal concentrations of nerolidol. Comet assay revealed a significant damage to DNA of hemocytes. The findings of the current study indicate that nerolidol exerts its insecticidal action through growth regulation, immunomodulation, and cyto-genotoxicity thus revealing its potential to be used as biopesticide against Z. cucurbitae.

Refining medical clearance protocol for patients with primary psychiatric complaints in the emergency department.

Medical clearance for patients with primary psychiatric complaints presenting to the emergency department has been debated for decades. Emergency physicians have argued that clearance labs are unnecessary, yet psychiatrists may still order or require them. A retrospective review was conducted to evaluate the continued need for labs of psychiatric patients and help identify high risk groups that may need additional intervention prior to medical clearance. Charts of 163 patients from Ochsner LSU Shreveport Psychiatric Crisis Unit (PCU) were reviewed with data collected of history, physical examination, review of systems, vitals and routine lab work including complete blood count (CBC), comprehensive metabolic panel (CMP), urine drug screen (UDS), serum ethanol level (EtOH), urinalysis (UA), creatine kinase (CK), urine pregnancy test (UPT), and rapid COVID-19. Review identified 82 patients (50.3%) that received interventions prior to medical clearance. Most common intervention was intravenous (IV) fluids (n = 59; 45%) followed by admission to other service (n = 15; 8.4%), imaging (n = 10; 7.6%), antihypertensive medication (n = 3; 3.1%), cardiac workup (n = 3; 2.3%), antibiotics (n = 3; 2.3%), lorazepam for undocumented reasons (n = 2; 1.5%). Additional interventions completed once included immunizations, antiseizure medication, pain medication, and additional lab work. Causes for IV fluids were reviewed with elevated creatine kinase (CK) (n = 31; 50.8%) being most common. Additional causes included undocumented (n = 12; 19.7%), tachycardia (n = 6; 9.8%), elevated EtOH level (n = 3; 4.9%), dehydration (n = 2; 3.3%), acute kidney injury (AKI) (n = 2; 3.3%), leukocytosis following a seizure (n = 1; 1.6%), elevated CK and leukocytosis (n = 1; 1.6%), and AKI and elevated CK (n = 1; 1.6%). Most common cause for medical admission was elevated CK being cited in 8 out of 15 admissions (53.3%). Additional causes for admission included AKI (n = 2; 14.3%), seizures and leukocytosis (n = 1; 6.7%), rule out of acute coronary syndrome (ACS) (n = 1; 6.7%), alcohol withdrawal (n = 1; 6.7%), encephalopathy with drop in hemoglobin and white blood cell count (n = 1; 6.7%), and encephalopathy with elevated CK (n = 1; 6.7%). Our results support the recommended guidelines set by AAEP for laboratory testing in addition to history, vital signs and physical examination prior to medical clearance. Certain laboratory testing such as CK and CMP were identified to have higher utility for medical intervention while other lab work such as UA and UDS had less of an impact. Further, we suggest that specifically a CK and CMP be obtained on patients presenting with any of the following: agitation, abnormal vital signs, intoxication, or a history of or current stimulant use as these were factors correlated with lab abnormalities that led to interventions.

Characteristics of the post-surgical decrease in platelet counts in orthopedic surgery patients, observations and insights

IntroductionA reduced platelet count (PLT) is a frequent post-operative finding in orthopedic surgery patients. Despite its prevalence, the characteristics of post-surgical thrombocytopenia have not been well described. MethodsA retrospective chart review was conducted on patients who underwent a knee or hip replacement from 2012 to 2015. Patients who received heparin were excluded. ResultsA total of 56 patients were analyzed on post-operative days 0 to 4. By day 1, 90.9% of the patients experienced a reduction in their platelet counts. The lowest mean platelet count (nadir) occurred on day 2 (201.3 × 109/L). The average decrease in the platelet count from the baseline was 24% (95%CI: 20.6 - 27.2). The change in the platelet count from the baseline ranged from a 49.6% drop to a 14.2% increase. A substantial portion of patients experienced thrombocytopenia, with 28% occurring on day 2. Platelet counts less than 100 × 109/L occurred only once. The percent decrease in the platelet count from the baseline to any other time point was significantly larger in patients aged > 65 years, compared to patients aged ≤ 65 years (p = 0.007). Specifically, the average drop in the platelet count at the nadir (day 2) relative to the baseline was 27.8% in patients aged > 65 years, compared to 19.5% in patients aged ≤ 65 years. ConclusionsA reduction in the platelet count is a frequent post-operative finding in orthopedic surgery patients, even after removing confounding factors, such as heparin exposure, but clinical thrombocytopenia is uncommon. Alternative etiologies should be considered when the platelet count is less than 100 × 109/L. Vigilance should also be considered regarding elderly patients.

Clinical use of polyvalent intravenous immunoglobulins during intensive polychemotherapy in children with acute lymphoblastic leukemia.

Acute lymphoblastic leukemia (ALL) is seen in almost 30% of cases of cancer among children. Drop in absolute neutrophil count (ANC) and immunosuppression during chemotherapy are causing the significant increase in the risk of other complications, which can lead to prolonged hospitalization, higher costs of therapy and increased mortality. The analysis concerned 78 patients treated for ALL at the Department of Pediatric Oncology, Hematology and Transplantology. The indications for the use of immunoglobulins, the regimen of administration, the dose and adverse reactions were analyzed. Intravenous immunoglobulins (IVIGs) were used in 66 (85%) of 78 patients. The standard risk group (SR) was represented by 10 (15%) patients, intermediate (IR) - 29 (44%), and high (HR) - 27 (41%). The most common were 1 and 2-day administrations - 60% and 28%, respectively, of transfusions. The spread of the IVIG doses used ranged from 43 mg to 882 mg/kg body weight. In the SR and IR groups, preparations were transfused at the reinduction stage, while in the HR-consolidation. Among the indications for IVIG, the most common was hypogammaglobulinemia-117 (42%), neutropenia-69 (25%) and infection-62 (22%). During the implementation of 279 patterns of immunoglobulin preparations, 8 (3%) post-transfusion reactions were registered. The vast majority of ALL patients required immunoglobulin substitution during polychemotherapy. The supply of preparations is safe, however, there are no unambiguous guidelines regarding their dosage.

Large Volume Paracentesis in Patients with Liver Cirrhosis Temporarily Diminishes Blood Cell Count.

Large-volume paracentesis is the preferred treatment for patients with severe and refractory ascites. Several complications were reported during therapeutical paracentesis. However, there are very few published studies on the change in blood cell count after paracentesis. This study aimed to evaluate any changes in blood cell counts after ascites fluid drainage. This study was conducted on patients with severe ascites and chronic liver disease who underwent large-volume paracentesis at Namazi Hospital, in Shiraz, Iran, between March 2021 and February 2022. A data gathering form containing the patient's medical history, cause of cirrhosis, ascites fluid volume, as well as routine tests including primarily sodium, potassium, and basal creatinine, was filled out. Before and after the surgery, the total blood cell count was measured. Before the procedure, adjustment was made in the case of coagulopathy and albumin deficiency. The effect of factors such as the volume of drained fluid, splenomegaly, antibiotics, and steroid use was assessed on the changes in the number of blood cells. Using the JAMOVI 2.3.9 software, a paired t test and multiple regression were applied for statistical analysis (P<0.001). The study included 37 patients. After the paracentesis procedure, the number of blood cells significantly decreased in all groups (P<0.001). The followings are the amounts of each type of blood cells before and after the procedure: Platelet=153837±91862 and 115648±69136, red blood cells=3.53±0.784 and 3.22±0.705, white blood cells=12.3±7.78 and 8.6±5.5. None of the study variables, including drained volume, splenomegaly, antibiotics, and steroid use, were significant predictors of the changes in the blood cell count after paracentesis (P>0.001). The findings of the present study showed that children with tense ascites who had large-volume paracentesis might experience a sharp drop in blood cell count after the procedure, which was a transient physiological condition.

#3944 COMPARISON OF CLINICAL PERFORMANCE AND HEMOCOMPATIBILITY OF DIALYZERS APPLIED DURING POST-DILUTION ONLINE HEMODIAFILTRATION (HDF) – EMPORA III STUDY

Abstract Background and Aims Performance and hemocompatibility are the two main functions of a hemodialyzer. Synthetic dialysis membranes made from polysulfone (PSU) or polyethersulfone (PES) are mainly used for dialysis treatments and are blended with the hydrophilic agent polyvinylpyrrolidone (PVP), to improve hemocompatibility during dialysis treatments. A novel PSU-based dialyzer (FX CorAL) with an increased and stabilized PVP content has been developed and has shown strong performance and a favourable hemocompatibility profile within previous short term clinical studies. In the present clinical study, we now investigated the performance and hemocompatibility of the FX CorAL vs. two comparators over a longer follow-up time and applied an extended panel of hemocompatibility biomarkers. This allowed us to analyse treatment-specific performance as well as an extensive intra- and interdialytic hemocompatibility profile. Method eMPORA III was a prospective, open, controlled, multicentre crossover trial with randomized treatment sequences conducted in DE, CZ and HU. It randomized stable patients receiving regular post-dilution online HDF to FX CorAL 600, FX CorDiax 600 (both Fresenius Medical Care) and xevonta Hi 15 (B. Braun), each for 4 weeks. The primary outcome was β2-m removal rate (RR) during 4 hrs HDF. Non-inferiority (margin: 5%) and superiority of FX CorAL 600 versus comparators were tested at α = 2.5% (one-sided), with adjustment for multiple tests. Secondary endpoints were RR and/or clearance of β2-m and other molecules, as well as intra- and interdialytic changes of markers of complement activation (C3a, sC5b-9), cell activation / inflammation (white blood cells (WBC), PMN elastase, IL-6, IL-8, LTB-4, sICAM-1, hsCRP), platelet activation (platelet count, β-TG, TxB-2), and oxidative stress (MDA, GSH-Px). Intradialytic hemocompatibility markers were analysed descriptively as differences vs. the values determined at the start of the HDF session (LS means). Results Eighty-two patients were included and analysed in the safety population, with n = 76 presenting data for the primary outcome (ITT population). FX CorAL 600 showed the highest β2-m RR (LS mean: 76.31%), followed by FX CorDiax 600 (75.71%) and xevonta Hi 15 (74.49%). Non-inferiority to its comparators was statistically significant (p&amp;lt;0.0001 each). Superiority was shown vs. xevonta Hi 15 (p&amp;lt;0.0001), but not vs. FX CorDiax 600 (p = 0.0606). The secondary endpoints β2-m clearance as well as myoglobin clearance and RR affirmed these results; small molecule clearances and/or RR were similar between dialyzers. Analyses of hemocompatibility markers within one HDF session, found the following significant differences: Complement activation • C3a 15 min: FX CorAL: 31%; FX CorDiax: 59% (p = 0.003 vs. FX CorAL); xevonta: 41% (p = 0.029 vs. FX CorAL) • sC5b-9 60 min: FX CorAL: 24%; FX CorDiax: 25% (p = 0.337); xevonta: 41% (p&amp;lt;0.0001) Cell activation/ Inflammation • WBC 15 min: FX CorAL: -7.7%; FX CorDiax: -11.1% (p = 0.015); xevonta: -10.1% (p = 0.246) • Monocytes 15 min: FX CorAL: -30.9%; FX CorDiax: -30.3% (p = 0.533); xevonta: -38.2% (p = 0.012) • Neutrophils 15 min: FX CorAL: -3.0%; FX CorDiax: -7.5% (p = 0.019); xevonta: -6.1% (p = 0.258) • PMN elastase 60 min: FX CorAL: 18%; FX CorDiax: 42% (p = 0.003); xevonta: 52% (p = 0.0003) • LTB-4 15 min: FX CorAL: 170%; FX CorDiax: 217% (p = 0.047); xevonta: 186% (p = 0.539) Platelet activation • β-TG 60 min: FX CorAL: -15%; FX CorDiax: 4% (p&amp;lt;0.0001); xevonta: 18% (p&amp;lt;0.0001) Hemocompatibility markers showed no interdialytic changes, i.e., no significant changes within treatment periods. Nine serious adverse events occurred in this study, none of which was dialyser related. Conclusion FX CorAL 600 efficiently removed middle and small molecules and was non-inferior to both comparators and significantly superior to xevonta Hi 15 in β2-m RR. The typical drop in WBC, monocyte, and neutrophil count during dialysis as well as the rise of complement (C3a, sC5b-9) and cell / platelet activation markers (PMN elastase, LTB-4 and β-TG) were lower or comparable during treatment with FX CorAL vs. both comparators, indicating superior hemocompatibility properties.

Automated IV Infusion Control System Design and Development for Medical Use

For patients suffering from pathological conditions, Intravenous infusion serves to be the go-to treatment, it requires for a medical practitioner to set up the IV infusion device up as per the doctors’ instructions, followed by periodic supervision as abnormalities may occur. The objective of this paper is to demonstrate the construction of an automated intravenous infusion control system. Medical and laboratory fluid control has previously been achieved using pressure-based flow sensing, ultrasonic flow measurement, optical flow sensors, capacitive flow sensing, and thermal flow sensing. Due to its reduced susceptibility to external factors, our approach utilizing an IR sensor is particularly advantageous in IV scenarios for accurately detecting fluid drops. An IR sensor, microcontroller, servo motor/peristaltic pump, and an affordable microcontroller are used in this system to allow precise saline circulation rate control. An input control system can be implemented through either a matrix keypad or a single control network server. Controls the drops per minute and allows internet-based server-side control via IR sensor, 3x4 matrix keypad, and Bluetooth module. To accurately measure the saline flow rate and count drops, an IR sensor is integrated into the drip chamber of the saline container. In order to achieve the desired blood flow rate, the microcontroller continuously compares the sensor readings with the commands and adjusts the servo motor/peristaltic pump accordingly. Testing of the completed hardware provided satisfactory results, proving the device's ability to enhance patient care.

Use of SafeGraph visitation patterns for the identification of essential services during COVID-19

Abstract. Mobility was severely impacted during the COVID-19 pandemic due to travel restrictions, curfews, and closed locations, such as businesses, schools, administrative offices, and other points of interest (POIs). This study uses SafeGraph visitation data to identify which POI categories experienced a significant drop in visitation counts and distance travelled from home between March/April 2019 (pre-pandemic) and March/April 2020 (during the pandemic) in Florida and California. The analysis identified a small set of POI categories for which visitation counts and travel distance did not change significantly. They can be characterized as essential services which are needed for a community’s everyday operations. This study provides insight into the effect of COVID-19 on people’s travel behavior to different types of trip destinations during the pandemic.