Elevated Leukocyte Count Research Articles

Endobronchial tuberculosis simulating a tumor: an interesting case report

Endobronchial tuberculosis (EBTB) is a special form of TB which is associated with significant morbidity and potential mortality. EBTB is the infection of tracheobronchial tree, and continues to remain challenging for clinicians to diagnose. The incidence of EBTB has been reported to be 5.8% to 30% in people with pulmonary TB. 60-year-old male, chronic smoker presented with complaints of dyspnea, cough with expectoration and sore throat for 2 weeks. General examination showed patient to have pallor and respiratory system examination showed decreased breath sounds in left infraaxillary region and bilateral crepitations. Routine blood investigations done showed decreased hemoglobin levels, elevated total leukocyte count, ESR. Sputum AFB was negative. Mantoux-15 mm in duration. Chest X-ray showed homogenous opacities over the left lower zone and elevated right diaphragm. CT thorax done showed a subsegmental peripheral soft tissue density 4.3×2.2 cm in the inferior lingula segment. Bronchoscopy showed whitish plaques over the anterior tracheal wall near carina and over left main bronchus. Endobronchial tissue growth seen occluding the lingula bronchus. Biopsy was taken and histopathology showed a granulomatous lesion, BAL Gene Xpert was positive for MTB. Patient was started on 3 tablets ATT. Clinicians need to be vigilant in patients who are AFB smear negative, with symptoms; bronchoscopy should be considered in those selected cases.

Parona space collection: A serious complication of hand infections

A 61-year-old man presented with erythematous and painful swelling of his left hand, wrist, and distal forearm for five days. He denied any penetrating injury and had no known inflammatory arthropathy or thrombophilia. There was no fluctuance or neurovascular compromise. Investigations revealed elevated leucocyte counts (14.11 × 109/L) and C-reactive protein (228 mg/L).

Morganella morganii: An unusual analysis of 11 cases of pediatric urinary tract infections.

BackgroundThe increase in rare opportunistic microbial infections caused by Morganella morganii is alarming across the globe. It has been reported that in cases of urinary tract infections (UTIs) caused by M. morganii, however, few studies investigated children. Our study aimed to analyze the risk factors, antimicrobial susceptibility, and clinical characteristics, so as to improve the clinical diagnosis and therapy of M. morganii infection.MethodsBetween April 1, 2017 and April 1, 2021, 11 cases of pediatric UTIs caused by M. morganii were included in this retrospective study. Medical records were reviewed and analyzed.ResultsThe study population included 10 males and one female between 11 months and 13 years old (mean age: 4 years 9 months). The most common comorbidity was nephrotic syndrome (72.7%, 8/11). Six patients (54.5%) were in the immunosuppressed state due to chemotherapy or immunosuppressant therapy. Ten cases defined as lower UTIs with no specific clinical manifestations had normal or slightly elevated leukocyte counts and procalcitonin (PCT) levels, and normal C‐reactive protein (CRP) levels. One child diagnosed upper UTIs accompanied with fever, high level of leukocyte counts, CRP, and PCT. The M. morganii presented 100% susceptibility to aztreonam, ertapenem, meropenem, piperacillin/tazobactam, cefepime, ceftazidime, cefotetan, ticarcillin/clavulanic acid, and cefoperazone/sulbactam. Almost all patients had good responses to third‐generation cephalosporins antibiotic therapy.ConclusionClinical vigilance for the possibility of M. morganii in pediatric UTIs in combination with underlying disease or immunosuppression is warranted. Treatment strategies should be proposed according to the clinical condition and the antibiotic susceptibility results.

Clinical characteristics and outcome of neurosarcoidosis-associated myelitis: A retrospective cohort study and review of the literature.

Background and purposeNeurosarcoidosis can affect all parts of the nervous system of which myelitis is relatively frequent. The aim of this study was to describe clinical characteristics, treatment and prognosis of patients with myelitis attributable to neurosarcoidosis.MethodsWe performed a retrospective cohort study and a systematic review and meta‐analysis of neurosarcoidosis‐associated myelitis.ResultsMyelitis was identified in 41 of 153 (27%) neurosarcoidosis patients seen at our clinic from 2015 to 2020. Classification of neurosarcoidosis was definite in three (7%), probable in 29 (71%) and possible in nine patients (22%). The median (interquartile range) age at onset was 49 (41–53) years and 20 of the patients were female (49%). The presenting symptoms included muscle weakness in 31 of 41 patients (78%), sensory loss in 35 (88%) and micturition abnormalities in 30 (75%). Spinal magnetic resonance imaging showed longitudinally extensive myelitis in 27 of 36 patients (75%) and cerebrospinal fluid examination showed an elevated leukocyte count in 21 patients (81%). Initial treatment consisted of glucocorticoids in 38 of 41 patients (93%), with additional methotrexate or azathioprine in 21 of 41 patients (51%) and infliximab in 10 of 41 patients (24%). Treatment led to remission, improvement or stabilization of disease in 37 of 39 patients (95%). Despite treatment, 18 of 30 patients (60%) could not walk independently at the end of follow‐up (median 36 months). A review of the literature published between 2000 and 2020 identified 215 patients with comparable clinical characteristics and results of ancillary investigations.ConclusionSarcoidosis‐associated myelitis is observed in 27% of neurosarcoidosis patients. Although treatment often led to a decrease in disease activity, residual neurological deficits leading to loss of ambulation occurred frequently.

Bilateral Optic Neuritis Caused by Meningococcal Meningoencephalitis

AbstractIn this article, we described a case of pathogen-induced bilateral optic neuritis accompanying meningococcal meningoencephalitis in an adolescent male. A 15-year-old boy presented to our emergency room due to progressive severe headache, stiff neck, diffuse extremity pain, fever, and nausea concerning meningoencephalitis. Intravenous ceftriaxone, metamizole, and ondansetron were started immediately. Due to acute autonomic dysregulation and development of petechiae, he was transferred to the pediatric intensive care unit. Next morning, the patient developed severe visual impairment. Investigations revealed elevated C-reactive protein, procalcitonin and leucocyte count, decreased platelet count, and clotting activation. Cerebrospinal fluid (CSF) analysis revealed increased leucocyte count, protein, and decreased glucose concentration with pathological CSF cytology. Brain magnetic resonance imaging revealed an increased contrast enhancement in the optic nerve sheath, consistent with acute bilateral optic neuritis. He was started on high-dose intravenous pulse methylprednisolone therapy. After treatment with ceftriaxone und pulse steroids, the patient was discharged in good condition without any visual sequel.

Clinical Features and Outcomes of COVID-19 Patients with Acute Kidney Injury and Acute Kidney Injury on Chronic Kidney Disease.

COVID-19 emerged in Wuhan in December 2019 and soon became a worldwide pandemic. We collected and analyzed the data from 1077 patients with COVID-19 who were admitted to the west campus of Wuhan Union Hospital from January 16 to April 16, 2020. Sixty (5.6%) of the 1077 COVID-19 patients were diagnosed with acute kidney injury (AKI) during hospitalization, and 18 of them (30%) had AKI on chronic kidney disease (AKI/CKD). COVID-19 patients with AKI had a worse prognosis, with higher intensive care unit (ICU) admission (28.3%) and fatality (65%) rates than patients without AKI (3.4% and 10.7%, respectively). Among the COVID-19 patients, AKI was more likely to occur in male patients, the elderly, patients with more severe disease states and those with comorbidities (such as hypertension, diabetes, coronary heart disease (CHD), chronic obstructive pulmonary disease (COPD) and CKD). COVID-19 patients with AKI were more likely to develop respiratory failure, gastrointestinal bleeding, acute liver injury, acute myocardial injury, heart failure, acute respiratory distress syndrome (ARDS), cerebrovascular accident, and disseminated intravascular coagulation (DIC) than those without AKI. Compared with patients without AKI, COVID-19 patients with AKI had lower platelet counts, lymphocyte counts, albumin levels and serum calcium levels but had elevated leukocyte counts, neutrophil counts and serum potassium levels. Inflammatory indicators, such as C-reactive protein (CRP), interleukin-6 (IL-6), and procalcitonin (PCT), were significantly higher in patients with AKI than in those without AKI. COVID-19 patients with AKI also exhibited a longer prothrombin time (PT), a longer activated partial thromboplastin time (APTT), and a higher D-dimer level than those without AKI. Survival analysis revealed that COVID-19 patients with AKI had a reduced survival rate compared with those without AKI. Furthermore, COVID-19 patients with AKI/CKD had a lower survival rate than those with AKI or CKD only. Multiple logistic regression indicated that the predictors of AKI in COVID-19 patients included complications, such as respiratory failure and acute myocardial injury, and higher creatinine and PCT levels during hospitalization.

Interstitial lung disease with congenital erythrocytosis

A 45-year-old male weaver, smoker, known case of interstitial lung disease with cor pulmonale on long-term oxygen therapy diagnosed 6 months ago who is on tapering doses of oral steroids presented to our tertiary care teaching hospital with complaints of worsened shortness of breath, cough with expectoration and fever for the past 4 days. The patient had headache, dizziness for the past 6 months. On examination, he was febrile with plethoric facies, conjunctival congestion and digital clubbing were noted. Tachycardia and tachypnoea were noted. Haemoglobin saturation on pulse oximetry was 75% while breathing on room air, 94% with 0.4 fraction of inspired oxygen. On respiratory system examination, bilateral infraaxillary crepts were present, jugular venous pressure was elevated. Remaining systemic examination was unremarkable. Investigations revealed elevated haemoglobin, elevated leucocyte count with neutrophilic leucocytosis, raised packed cell volume and red cell count. Platelet count 1.67 × 105/mm3, erythrocyte sedimentation rate 4 mm at the end of the first hour. Computed tomography (CT) of the chest (plain) showed inter and intralobular septal thickening with honeycombing in the bilateral lower lobes predominantly features suggestive of interstitial lung disease. Ultrasonography of the abdomen showed no hepatosplenomegaly. Two dimensional echocardiography was suggestive of corpulmonale. As patient had hyperviscosity symptoms due to polycythaemia and no improvement in haemoglobin with supplemental oxygen for the past 6 months, patient was further evaluated for alternate cause of polycythaemia. Serum erythropoietin (Epo) levels were normal. Arterial oxygen tension at which oxygen saturation was 50% (P50) was 28 mm Hg. Epo gene receptor mutation was positive suggestive of congenital erythrocytosis. Patient was advised long-term oxygen therapy and regular therapeutic phlebotomy to maintain haemoglobin levels and was discharged in a haemodynamically stable condition.

Haematological Malignancy Presenting in an Unusual Manner

Chronic lymphocytic leukaemia is a haematological malignancy that occurs due to an increased proliferation of mature B lymphocytes. It is considered to be the most common leukaemia in adults. Hyponatremia is commonly seen in such patients. This case report is about a 75-year-old male, who presented with giddiness, followed by altered sensorium. However, the patient had no motor weakness or sensory loss. Initially, a diagnosis of posterior circulation stroke was made but Magnetic Resonance Imaging (MRI) brain did not show associated signs. The routine investigations showed highly elevated total leukocyte count and hyponatremia. The patient was worked up for malignancy and diagnosed with Chronic lymphocytic leukaemia. Oncology reference was taken and treated with tablet Ibrutinib. On discharge, the patient’s mentation improved, and he is on regular follow-up.

Non-Hodgkin's lymphoma presenting with pulmonary involvement

A 25-year-old woman presented with a history of episodes of fever with night sweats, multiple joint pains and breathlessness for 5 months. Eight months before the present episode, she had developed a generalised rash and transient swellings in the groin on both sides. Physical examination revealed pallor, pedal oedema and a hyperpigmented rash over the chest, back and thighs. Pulse was 126 beats per minute and respirations 38/min; while breathing ambient air, the oxygen saturation by pulse oximetry was 83%. On auscultation of the chest, breath sounds were diminished bilaterally and crepitations were heard in both the lung bases. Neurological examination revealed weakness of proximal muscles of both upper and lower limbs on both sides with a power of grade 3/5. Laboratory investigations revealed elevated total leucocyte count with neutrophilic leucocytosis; band forms and metamyelocytes were seen in the peripheral blood smear. Oxygen inhalation and broad-spectrum intravenous antibiotics were initiated. Echocardiogram showed severe tricuspid regurgitation with moderate pulmonary arterial hypertension. Computed tomography (CT) of the chest revealed patchy consolidation in both the lungs, bilateral pleural effusions and pericardial effusion. Bone marrow biopsy showed normocellular normoblastic marrow with erythroid hyperplasia. 18F-fluorodeoxyglucose positron emission tomography-CT showed metabolically active lymphadenopathy both above and below the diaphragm and bilateral patchy lung infiltrates. Biopsy of the inguinal lymph node along with immunohistochemistry staining confirmed the diagnosis as T-cell lymphoma.

Prevalence of Vasculitis among Chronic Venous Insufficiency Patients Attending a Tertiary Care Centre, Tamil Nadu, India: A Descriptive Observational Study

Introduction: Chronic Venous Insufficiency (CVI) is a relatively common condition seen worldwide and also in the Indian population. Vasculitis is a heterogenous group of disorders that affects and destroys blood vessels by inflammation. While both are separate disease entities, the presence of vasculitis in patients who present with CVI often goes unnoticed, thereby complicating the treatment of varicose veins. Aim: To determine the clinical profile and prevalence of vasculitis among patients with CVI attending a tertiary care hospital in India. Materials and Methods: This descriptive study was carried out in the Department of General Surgery among 162 patients (out of which 130 were selected based on inclusion criteria) with CVI attending tertiary care centre in Tamil Nadu, India, from February 2018 to January 2019. Patients with an active or healed ulcer on the long and short saphenous vein of lower limbs were included in the study. They were studied to assess the prevalence of vasculitis among them and the implications it had on the overall morbidity of the patient and their treatment outcome. Descriptive analysis was carried out by mean and standard deviation for quantitative variables, frequency, and proportion for categorical variables. Results: The mean age of the study population was 45.52 years. Out of 130 patients, 33.08% and 23.85% of the study population were diagnosed with Type 2 Diabetes Mellitus (T2DM) and systemic hypertension respectively. Only 3 (2.3%) participants had vasculitis and all of them were smokers and had a painful ulcer, fever, elevated C Reactive Protein (CRP), elevated Erythrocyte Sedimentation Rate (ESR), and elevated total leukocyte count levels. Two (66.7%) of them had an active ulcer at the time of presentation, against 1 (33.3%) who had a healing ulcer. All patients were cured by Bisgaard’s regimen + steroids/no steroids + surgery. Conclusion: The prevalence of vasculitis was 2.3%. This study confirms that patients suffering from CVI may be at a marginal risk of having co-existing vasculitis which may complicate the clinical picture and result in postoperative complications if left unchecked.

Invasive Meningococcal Disease Remains a Health Threat in Vietnam People's Army.

ObjectiveDespite strict surveillance, Neisseria meningitidis still causes life-threatening invasive meningococcal disease (IMD). The study aimed to describe the prevalence, clinical and subclinical features, and treatment outcomes of IMD among young soldiers of the Vietnam People’s Army.MethodsA prospective, population-based surveillance study was conducted in all Vietnamese military hospitals from January 2014 to June 2021. The presence of Neisseria meningitidis was confirmed by PCR or culture from blood or/and CSF. Epidemiological indices (incidence, serogroups, and distribution of cases by length of service), medical history, clinical and sub-clinical features, and treatment outcomes were documented and analyzed.ResultsThere were 69 IMD cases (91% serogroup B) documented, mainly in conscripts (91%). The highest annual incidence was 3.33/100,000 soldiers per year. Of these cases, 44% were meningitis (n=30), 19% septicemia (n=13), and 38% meningococcemia (n=26). The most common clinical symptoms were neck stiffness (61 cases, 88%), petechial rash (51%), and shock (20 cases, 29%). Laboratory findings showed leukocytosis in 96% of IMD cases, PCT >0.05 (ng/mL) in 100%, elevated leukocyte count (>1,000/mm3) in 71%, and high protein >1 g/L in 70%. The overall mortality rate was 9%. Two cases were found to be resistant to ceftriaxone. Prognostic factors of severity included petechial rash (OR = 9.82, p < 0.001), septicemia (OR = 5.83, p < 0.001), meningococcemia (OR = 6.22, p < 0.001), low platelet count, prolonged prothrombin time; high PCT (AUC = 0.84, p < 0.001), and increased creatinine (AUC = 0.86, p < 0.001).ConclusionIMD remains a health threat in the armed forces in Vietnam, especially among new recruits. To the best of our knowledge, this is the first study in Vietnam describing ceftriaxone resistance in Neisseria meningitidis and suggests the need to reconsider standard empiric therapy for IMD.

Blood Immunoproteasome Activity Is Regulated by Sex, Age and in Chronic Inflammatory Diseases: A First Population-Based Study.

Dysfunction of the immunoproteasome has been implicated in cardiovascular and pulmonary diseases. Its potential as a biomarker for predicting disease stages, however, has not been investigated so far and population-based analyses on the impact of sex and age are missing. We here analyzed the activity of all six catalytic sites of the proteasome in isolated peripheral blood mononuclear cells obtained from 873 study participants of the KORA FF4 study using activity-based probes. The activity of the immuno- and standard proteasome correlated clearly with elevated leukocyte counts of study participants. Unexpectedly, we observed a strong sex dimorphism for proteasome activity with significantly lower immunoproteasome activity in women. In aging, almost all catalytic activities of the proteasome were activated in aged women while maintained upon aging in men. We also noted distinct sex-related activation patterns of standard and immunoproteasome active sites in chronic inflammatory diseases such as diabetes, cardiovascular diseases, asthma, or chronic obstructive pulmonary disease as determined by multiple linear regression modeling. Our data thus provides a conceptual framework for future analysis of immunoproteasome function as a bio-marker for chronic inflammatory disease development and progression.

Cytoreductive treatment in real life: a chart review analysis on 1440 patients with polycythemia vera

PurposePatients with polycythemia vera (PV) show an elevated incidence of thromboembolic complications and decreased survival when compared to age-matched healthy individuals. Hypercellularity as indicated by elevated hematocrit, pathophysiological changes induced by the JAK2 driver mutation and cardiovascular risk factors contribute to the increased incidence of thromboembolic events. Higher age and a history of thromboembolic events define a high-risk population of PV patients. Depending on the individual risk profile, phlebotomy or pharmacologic cytoreduction is recommended in combination with low-dose acetylsalicylic acid. Stringent cytoreduction is required for effective risk reduction. However, in recent reports, the rate of thromboembolic complications in PV patients under cytoreductive therapy appears still elevated compared to healthy individuals. This study reports on a chart review to assess for cytoreductive therapy of 1440 PV patients in real life.MethodsForty-two eligible hematologists/oncologists in private practice treating patients with MPN were recruited to participate in a paper–pencil-based survey conducted between January 2019 and March 2020 in Germany. Physicians were asked to report primary documented data obtained from patient charts. Descriptive analyses were conducted to assess for patient characteristics, treatment modalities, risk factors and thromboembolic complications.ResultsData were collected from the patient charts of 1440 individuals diagnosed with PV. The patient population was older than those reported in multicenter trials with a median age of 72.2 years at the time of reporting and 63.5 years at diagnosis. Age was the main factor accounting for high-risk status with 84.7% of patients being above the age of 60 followed by thromboembolic complications reported in 21.3% of patients. The use of pharmacologic cytoreduction was highly variable between participating centers with an average of 60.7% and a range of 10.1–100%. Hydroxyurea was the most frequently used drug followed by ruxolitinib, while interferons were reported for a minority of patients. For 35.4% of patients a persistent need for phlebotomy in addition to cytoreductive treatment was reported. Although presence of high-risk criteria and insufficient disease control were reported as main triggers to initiate pharmacologic cytoreduction, 28.1% had elevated hematocrit values (> 45%) and 38.6% showed persistence of elevated leukocyte count (> 109/l) while on cytoreductive treatment. In contrast, physician-reported symptom burden was lower than published in clinical trials and patient-reported outcomes. The rate of patients experiencing thromboembolic complications was 32.2% at any time and 14.3% after diagnosis with most patients receiving acetylsalicylic acid and 10.8% remaining on oral anticoagulants or heparin.ConclusionsCytoreductive treatment of high-risk PV in real life is highly variable regarding indication for cytoreduction and definition of therapy resistance. This study highlights the need for (i) improved risk stratification for thromboembolic events, (ii) consequent indication of pharmacologic cytoreduction in high-risk PV and (iii) attention to signs of therapy resistance that can trigger an earlier and stringent switch to second line agents.

Melanocortin 1 Receptor Deficiency in Hematopoietic Cells Promotes the Expansion of Inflammatory Leukocytes in Atherosclerotic Mice.

Melanocortin receptor 1 (MC1-R) is expressed in leukocytes, where it mediates anti-inflammatory actions. We have previously observed that global deficiency of MC1-R signaling perturbs cholesterol homeostasis, increases arterial leukocyte accumulation and accelerates atherosclerosis in apolipoprotein E knockout (Apoe-/-) mice. Since various cell types besides leukocytes express MC1-R, we aimed at investigating the specific contribution of leukocyte MC1-R to the development of atherosclerosis. For this purpose, male Apoe-/- mice were irradiated, received bone marrow from either female Apoe-/- mice or MC1-R deficient Apoe-/- mice (Apoe-/- Mc1re/e) and were analyzed for tissue leukocyte profiles and atherosclerotic plaque phenotype. Hematopoietic MC1-R deficiency significantly elevated total leukocyte counts in the blood, bone marrow and spleen, an effect that was amplified by feeding mice a cholesterol-rich diet. The increased leukocyte counts were largely attributable to expanded lymphocyte populations, particularly CD4+ T cells. Furthermore, the number of monocytes was elevated in Apoe-/- Mc1re/e chimeric mice and it paralleled an increase in hematopoietic stem cell count in the bone marrow. Despite robust leukocytosis, atherosclerotic plaque size and composition as well as arterial leukocyte counts were unaffected by MC1-R deficiency. To address this discrepancy, we performed an in vivo homing assay and found that MC1-R deficient CD4+ T cells and monocytes were preferentially entering the spleen rather than homing in peri-aortic lymph nodes. This was mechanistically associated with compromised chemokine receptor 5 (CCR5)-dependent migration of CD4+ T cells and a defect in the recycling capacity of CCR5. Finally, our data demonstrate for the first time that CD4+ T cells also express MC1-R. In conclusion, MC1-R regulates hematopoietic stem cell proliferation and tissue leukocyte counts but its deficiency in leukocytes impairs cell migration via a CCR5-dependent mechanism.

The prognostic value of peripheral total and differential leukocyte count in renal progression: A community-based study.

Systemic inflammation is related to chronic kidney disease (CKD) patients. Elevated peripheral leukocyte count may be a herald of increased systemic inflammation and subclinical disease. Inflammation plays an important role in renal progression. The pattern of total and differential leukocyte count in CKD is not well understood. Besides, the association between total and differential leukocyte count and renal progression is still uncertain. We conducted a community-based cohort study with a follow-up period of two years to evaluate the total and differential leukocyte counts and renal progression association. In our study population from the community with a total number of 2128, we found 15.7% (335/2128) CKD patients with a mean estimated glomerular filtration rate (eGFR) around 96 ± 26 ml/min/1.73 m2. The peripheral total leukocyte count and also differential leukocyte count were significantly negatively correlated with eGFR. A total of 56 patients (3%) experienced a rapid progression of the kidney with the definition of eGFR reduction changes of 30% or greater within two years. Univariate analysis indicated that rapid renal progression was significantly associated with male gender, co-morbidity of diabetes mellitus (DM), higher uric acid levels, higher peripheral neutrophil, monocyte, and eosinophil counts. However, only the peripheral neutrophil count was positively and independently associated with rapid renal progression after multivariate analysis. The ROC curve analysis found that the optimal cutoff value of peripheral neutrophil count for rapid progression was 2760/ mm3, with an area under the curve of 0.813. Hyperinflammation with higher peripheral total and differential leukocyte count was noted in CKD patients. The peripheral neutrophil count was the only independent factor significantly associated with rapid renal progression. The optimal cutoff point of the peripheral neutrophil count with 2760/mm3 is useful for determining the high-risk population for rapid renal progression with a satisfying sensitivity and specificity.

Effects of sodium butyrate nanoparticles on the hemato-immunological indices, hepatic antioxidant capacity, and gene expression responses in Oreochromisniloticus

Recently, nanotechnology has been greatly developed to provide the aquaculture industry with new beneficial nanomaterials to improve the health and welfare of aquatic animals. Herein, an eight-week experiment was designed to examine the dietary impacts of sodium butyrate nanoparticles (SB-NPs) on the hematological profile, blood proteins, immunological indices, antioxidant capacity, and expression analysis of cytokines and antioxidant-related genes in Oreochromis niloticus. Fish were randomly assigned into 5 experimental groups (3 replicates per group) and were fed diets supplemented with 5 levels of SB-NPs as 0.0 (control), 0.5, 1.0, 1.5, and 2.0 mg kg−1. The results revealed that supplementing diets with SB-NPs (1.0–2.0 mg kg−1) significantly elevated erythrocyte and leukocyte counts, hemoglobin concentrations, hematocrit values, total albumin, globulin, serum lysozyme activities, and total immunoglobulin M values compared with the control group. Notably, the highest levels of the parameters mentioned above were noticed in the group fed diet supplemented with 1.5 mg kg−1 SB-NPs. Moreover, dietary SB-NPs modulated the fish's antioxidant defense mechanisms, whereas there was a significant increase in hepatic superoxide dismutase, catalase, and glutathione peroxidase enzyme activities along with a significant decline in hepatic malondialdehyde concentrations in fish groups fed diets supplemented with SB-NPs (1.0–2.0 mg kg−1). A significant upregulation of antioxidant enzyme genes (gpx and sod), anti-inflammatory cytokine (il-10), and pro-inflammatory cytokines (il-1β and il-8) were noticed in liver tissues of SB-NPs groups (0.5–1.5 mg kg−1). The highest mRNA expression folds of the above genes were recorded in the fish group fed diet supplemented with 1.5 mg kg−1 SB-NPs. In this context, we hypothesized that dietary supplementation with SB-NPs can boost the antioxidant status and immunity of O. niloticus. However, further research studies are still recommended.

Gallbladder volvulus:\xa0 a\xa0case report

BackgroundGallbladder volvulus is a rare pathology first reported by Wendel in 1898. Although the main pathological process associated with gallbladder volvulus is not known, there is clinical evidence suggesting that lack of gallbladder adhesions to the liver leads to an eventual twisting around the cystic bile duct (a process that seems to favor older female populations).Case presentationIn this report, an 81-year-old Caucasian elderly female presented to the emergency department with acute/severe right upper quadrant pain, which was also accompanied by an elevated leukocyte count. Relevant imaging showed a distended gallbladder with gallbladder wall thickening and a dilated common bile duct. The patient was subsequently admitted to the hospital for acute cholecystitis and scheduled for surgery the next day. Upon laparoscopic surgery, the gallbladder was black and gangrenous with no visible adhesions to the liver. Further inspection demonstrated that the gallbladder had twisted clockwise around the cystic bile duct.ConclusionsWhile many previous cases have been reported since Wendel, further case studies are nevertheless important to help guide proper clinic evaluation and pinpoint the potential for a gallbladder volvulus.

Correction

Abdominal pain is a common cause of emergency department visits. It often poses a diagnostic challenge for physicians given the broad spectrum of its possible medical and surgical etiologies. We report the case of a 32-year-old man who presented to the emergency department with a complaint of lower abdominal pain for one week. Abdominal examination revealed suprapubic mass and tenderness. Laboratory investigation revealed elevated leukocyte count and inflammatory markers. An abdominal ultrasound examination showed a collection with poorly defined borders. Additionally, CT demonstrated a soft tissue mass adjacent to the anterior abdominal wall with an upward track to the umbilicus, conferring the diagnosis of a urachal abscess. The patient underwent successful management of the abscess with surgical excision. This case highlights the importance for clinicians to be aware of congenital urachal anomalies since early recognition of the urachal cyst is essential to determine the proper surgical management.

A Retrospective Analysis of Acute Appendicitis in Children Treated with Laparoscopic Appendectomies at a Single Center in Dubai, UAE

Background: Appendicitis is one of the most common emergency conditions that occur in the pediatric population. The condition is usually suspected clinically, and the diagnosis is confirmed by radiological investigations such as ultrasound, CT scan, or MRI. This study was conducted to contribute to global databases by presenting data from the Middle East with an objective of identifying the clinical characteristics of children who were diagnosed with acute appendicitis and underwent laparoscopic appendectomy at a single pediatric surgery center in Dubai. Methods: A 2-year hospital-based retrospective cohort study was conducted at Mediclinic Parkview Hospital, Dubai, enrolling all patients younger than 14 years who were diagnosed with acute appendicitis and who underwent laparoscopic appendectomy. Demographic data, clinical presentation, laboratory, radiological and pathology findings, postoperative complications, and readmission rates were analyzed. Results: Fifty-six patients were operated on and enrolled in this study. All patients (56/56) presented with abdominal pain, while an associated fever was present in 44.6% (25/56); 78.5% (44/56) of the patients had nausea but 64.3% (36/56) had vomiting. On examination, all patients had abdominal tenderness, while rebound tenderness in the right iliac fossa (RIF) was found in 92.8% (52/56) of the patients. Laboratory investigations showed elevated leukocyte count in 76.7% (43/56) of patients. Appendicitis was diagnosed on ultrasound in 57.4% (31/54) of the patients, and free fluid was visualized in 40.7% (22/54) of the patients. Appendicitis was diagnosed on CT scan in all 25 patients, and free fluid was visualized in 64% (16/25) of the patients. The number of admission days ranged from 1 to 5 days, with a median of 2 days. And 62.5% (35/56) of patients were discharged in the first 2 days from admission. Major and minor complications after surgery were documented in 4 and 14 patients, respectively. Pathology reports showed features of acute appendicitis in all the resected appendices. Conclusions: Acute appendicitis in children should be suspected in all children with acute abdominal pain. This study can help guide the management of pediatric appendicitis and allow proper and standardized documentation of findings and judicious use of laboratory and radiological investigations.

Etiologies of Hospitalized Acute Bronchiolitis in Children 2 Years of Age and Younger: A 3 Years' Study During a Pertussis Epidemic.

Objective: In recent years, the incidence of Bordetella pertussis infection in infants and young children has been increasing. Multiple studies have suggested that B. pertussis may be one of the pathogens of bronchiolitis in infants and young children. However, the prevalence and clinic characteristic of B. pertussis in bronchiolitis is controversial. This prospective descriptive study evaluated the prevalence and clinical manifestations of infants and young children hospitalized for bronchiolitis with B. pertussis.Methods: Children hospitalized with bronchiolitis were eligible for a prospective study for 36 months from January 1, 2017, to December 31, 2019. Besides B. pertussis, 10 common respiratory viruses and Mycoplasma pneumoniae (MP) were confirmed by laboratory tests. Medical records of patients were reviewed for demographic, clinical characteristics, and laboratory examination.Results: A total of 1,092 patients with bronchiolitis were admitted. B. pertussis was detected in 78/1,092 (7.1%) patients. Of the 78 patients with B. pertussis bronchiolitis, coinfections occurred in 45 (57.7%) patients, most frequently with human rhinovirus (28/78, 35.9%), followed by MP (9/78, 11.4%), and human bocavirus (6/78, 7.7%). The peak incidence of B. pertussis infection was in May. A high leukocyte count could help distinguish B. pertussis–associated acute bronchiolitis from other acute bronchiolitis etiologies. After excluding coinfections, children with B. pertussis–only bronchiolitis exhibited a milder clinical presentation than those with RSV-only infection; also, children with MP-only and other pathogen infections revealed similar severity. The morbidity of B. pertussis was common (31/78, 39.7%) in infants with bronchiolitis under 3 months.Conclusion: In summary, B. pertussis is one of the pathogens in children with bronchiolitis, and coinfection of B. pertussis with other viruses is common in bronchiolitis. B. pertussis should be considered when patients hospitalized with bronchiolitis present a longer course and have an elevated leukocyte count. Patients with B. pertussis–associated bronchiolitis present a milder clinical presentation.