Elevated WBC Research Articles

Antimutagenic and anticoagulant therapeutic effects of Ag/Ag2O nanoparticles from Olea europaea leaf extract: mitigating metribuzin-induced hepato-and nephrotoxicity.

Silver nanoparticles (Ag/Ag₂O NPs) have garnered attention for their potent antioxidant, antimicrobial, and anti-inflammatory properties, showing promise for therapeutic applications, particularly in mitigating chemical-induced toxicity. This study aimed to synthesize Ag/Ag₂O NPs using Olea europaea (olive) leaf extract as a green, eco-friendly reducing agent and evaluate their protective effects against metribuzin-induced toxicity in Wistar rats, focusing on oxidative stress, hematological parameters, and lipid profiles, with specific dose optimization. Ag/Ag₂O NPs were synthesized using Olea europaea leaf extract, and their properties were confirmed via XRD, FTIR, SEM, EDS, and UV-visible spectroscopy. Wistar rats exposed to metribuzin (110mg/kg/day) were treated with two doses of Ag/Ag₂O NPs (0.062mg/kg and 0.125mg/kg). Hematological and biochemical markers were assessed to evaluate the NPs' protective effects. Physicochemical characterization confirmed the successful formation of Ag/Ag₂O NPs loaded with phytochemicals, exhibiting crystallite sizes of 23nm and 19nm, a particle size of 25nm, and significant peaks in XRD, FTIR, and UV-Vis spectra indicating the formation of Ag/Ag₂O. Metribuzin exposure led to significant hematological disruptions (elevated WBC, reduced RBC and hemoglobin) and worsened lipid profiles (increased cholesterol, LDL, and triglycerides). The lower NP dose (0.062mg/kg) improved WBC, RBC, hemoglobin, and platelet counts, normalized lipid levels, and positively influenced biochemical markers such as serum creatinine and uric acid. In contrast, the higher NP dose (0.125mg/kg) showed mixed results, with some improvements but an increase in triglycerides and continued elevation of ASAT and ALAT enzyme levels. Ag/Ag₂O NPs synthesized via green methods using olive leaf extract effectively mitigated metribuzin-induced toxicity, especially at lower doses, by improving oxidative stress markers and hematological and biochemical profiles. Dose optimization is crucial to maximize therapeutic benefits and minimize adverse effects, underscoring their potential in treating chemical-induced toxicity.

Buffy coat removal to mitigate reporting false normal G6PD phenotype results in patients undergoing rasburicase therapy for tumor lysis syndrome

Abstract Glucose-6-phosphate dehydrogenase (G6PD) is the primary source of NADPH in red blood cells (RBCs). NADPH reduces reactive oxygen species (ROS) thereby protecting RBCs from oxidative stress-mediated hemolytic anemia (HA). Individuals with partial or full G6PD deficiency are therefore susceptible to acute HA provoked by medications that generate high ROS loads in vivo, e.g., rasburicase. Rasburicase is an enzyme-based therapeutic used to degrade uric acid (UA) in patients with tumor lysis syndrome (TLS); however, catalysis of UA generates H2O2, a potent ROS, which poses a risk of HA in individuals who are deficient in G6PD activity. Screening G6PD activity prior to rasburicase administration is clinically indicated in ethnic groups with high rates of G6PD deficiency, although reports of HA in rasburicase-treated patients have been reported across low prevalence ethnic groups as well. TLS occurs most commonly during the treatment of highly proliferative neoplasms, such as leukemia and lymphoma. Since WBCs contain significant G6PD activity, an elevated WBC count in these patients can cause the false assurance of low HA risk due to a falsely normal G6PD activity. We sought to establish and evaluate a novel method to mitigate WBC contamination of G6PD measurements in patients undergoing rasburicase therapy. In this study, we first developed and validated an innovative method (“piercing method”) to minimize the interference of WBCs in G6PD measurements. The piercing method demonstrated acceptable accuracy (slope: 1.008; bias: -6.22%) and precision (1.4% CV between 9.9 to 20.7 U/g Hb) and was effective at eliminating a broad range of WBC types and concentrations from whole blood samples (N = 85, tested range = 0.31 – 413.05 K/μL, 93% reduction in WBCs). We compared G6PD activity in rasburicase-treated patients (N = 39) with varying WBC counts before and after buffy coat removal using the piercing method. Average percent change in G6PD activity (post-pierce – pre-pierce) between patients with and without elevated WBCs was substantial (45% versus 12%). In comparing G6PD activity in patients before and after the initiation of rasburicase therapy, there is no evidence that in vivo-generated ROS from rasburicase affect G6PD measurement in vitro in an assay that relies on monitoring absorbance of NADPH (22.2 U/g Hb versus 22.9 U/g Hb, p=0.721). Results demonstrate how WBCs increase risk for false elevation in G6PD activity in patients being considered for rasburicase therapy. At greatest risk are patients with partial G6PD deficiency, e.g., heterozygous females, where G6PD from WBCs could mask deficiency. Literature describing testing of G6PD in specimens with elevated WBCs is lacking. This study shows that the piercing method provides accurate G6PD results in samples with elevated WBCs from patients at risk of TLS, who might develop HA after starting rasburicase therapy.

Vulvar necrotizing wounds: Unveiling mortality-associated parameters and assessing the efficacy of VAC therapy

IntroductionVulvar Necrotizing Fasciitis (VNF) is a critical, severe soft tissue infection characterized by aggressive progression and significant morbidity and mortality. Rapid diagnosis and immediate, comprehensive treatment, including antibiotic therapy, meticulous surgical debridement, and multidisciplinary care, are crucial for improving outcomes. This study aimed to investigate mortality-related factors in VNF and evaluate treatment modalities, focusing on Vacuum-Assisted Closure (VAC) therapy versus traditional debridement. MethodsThis retrospective study analyzed data from 22 VNF patients. Criteria included adults diagnosed with vulvar necrotizing infections, excluding those transferred or not completing treatment at the center. The study examined mortality-related factors and the efficacy of VAC therapy compared to debridement, considering treatment costs and outcomes. ResultsAnalysis divided patients into survivors (13) and non-survivors (9). Higher heart rate, elevated WBC and CRP levels, and higher Clavien-Dindo scores were associated with increased mortality. VAC therapy, compared to traditional debridement, resulted in significantly lower CRP levels and reduced treatment costs. However, other parameters such as the length of hospital stay and debridement frequency showed no significant differences. ConclusionThe study highlights that older age, systemic inflammation, and severe postoperative complications are key factors associated with higher mortality in VNF. VAC therapy emerges as a promising modality, effectively reducing systemic inflammation and healthcare costs. Nonetheless, the retrospective nature and the small sample size of the study limit the generalizability of the findings. Future research, particularly larger, multicentric studies, is essential to further explore and validate the effectiveness of VAC therapy in VNF management.

6663 Amputation Rate in Hospitalized Patients With Diabetic Foot Ulcer at Montefiore Medical Center, Bronx, NY

Abstract Disclosure: R. Lopez Fanas: None. A. Herrera Chancay: None. H. Tabassum: None. J. Milosavljevic: None. S. Xu: None. J. Daily: None. A.K. Myers: None. Introduction: Diabetic foot ulcers (DFU) are associated with poor outcomes including lower extremity amputations and death in individuals with diabetes. Our study aims to define health outcomes and explore the association of sociodemographic and clinical factors on amputation rates in patients hospitalized with DFU addressing an existing knowledge gap in our population. Methods: This was a retrospective review of the electronic health record of adult patients hospitalized with DFU at one of the three major Montefiore Medical Center hospitals in the Bronx, New York between 06/01/2016 and 05/30/2021. Patient data extracted from the index admission included demographics, comorbidities, and laboratory values. Survival and amputation rates were calculated for each patient over the five-year study period. Results: In our analysis of 650 patients, 88% self-identified as non-white, and only 23% had commercial insurance. The amputation rate during the initial DFU admission was 44%, with 76% experiencing at least one amputation over five years. Male sex, low BMI, and smoking were associated with amputation during the study period, with an OR of 0.62 (p=0.01), 0.98 (p=0.05), and 1.45 (p=0.05) respectively. Patients with history of osteomyelitis had a higher risk of any amputation during the index admission (OR 2.05, p<0.0001), and the 5-year study period (OR 3.03, p<0.0001). PAD or prior history of amputation increased the risk of any amputation during the study period, OR 2.11 (p=0.0002) and OR 7.92 (p<0.001) ESRD was associated with a higher risk of AKA and BKA during the index admission (OR 2.31, p=0.05). Elevated ESR, CRP, WBC, and low albumin were associated with amputation during admission, with ORs of 1.01 (p=0.0006), 1.05 (p<0.0001), 1.11 (p<0.0001), and 0.41 (p<0.0001), respectively. Discussion: This study revealed a 44% amputation rate during the initial DFU admission, with 76% experiencing at least one amputation within five years. Bivariate analyses identified male sex, lower BMI, and smoking as correlated with a heightened amputation risk, consistent with previous studies. Prior amputation, PAD, ESRD, and osteomyelitis were also associated with an increased risk. Multiple regression analysis found significant associations between elevated ESR, CRP, WBC, and low albumin with amputations. As a result, interventions need to be devised for patients with these characteristics to prevent this high rate of amputation. Presentation: 6/2/2024

7947 Semaglutide Induced Pancreatitis: A Case Report

Abstract Disclosure: T. Altaweel: None. A. Mathew: None. P. Chalasani: None. L. Lawrence: None. S. Hussain: None. N. Aldaoud: None. Introduction/Background: As semaglutide (GLP1 RA) has become a cornerstone in diabetes and weight management, there have been studies indicating pancreatic inflammation with GLP1 RA use. We report a case of acute necrotizing pancreatitis secondary to semaglutide use.Clinical Case: A 52 year old male with a history of hypertension, morbid obesity with BMI of 40 kg/m2, alcohol induced pancreatitis presented to the hospital complaining of epigastric pain. On presentation, he appeared in distress due to pain but was hemodynamically stable. Physical examination revealed a moderately distended abdomen, tender to palpation over the epigastric area without guarding, and negative Murphy’s sign. The patient reported no alcohol consumption, tobacco usage, or recent abdominal injuries. Laboratory workup revealed elevated WBC 14.6 thous/mcL (4.5-10.5) and lipase 1941 U/L (<60). Abdominal ultrasound showed common bile duct 2 mm without gallstones and CT abdomen revealed acute pancreatitis with suspected necrosis in the pancreatic head and the pancreatic tail. Patient was started on aggressive fluid hydration, pain management and admitted to intensive care. Patient reported that he was started on semaglutide three months ago for weight management by his primary care physician. Patient improved symptomatically with pain control and tolerated oral intake. He was discharged home with recommendations not to resume semaglutide. Conclusion: Semaglutide involves direct stimulation of GLP-1 receptors in pancreatic cells, potentially leading to cell overgrowth, increased pancreatic weight, duct occlusion and inflammation. Despite the SUSTAIN-6 trial indicating no increased risk of acute pancreatitis in diabetic patients using semaglutide, atypical presentations of pancreatitis are noted in patients using the medication for weight management. When all identifiable causes of pancreatitis are eliminated, semaglutide-induced pancreatitis should be a primary consideration in the differential diagnosis. Physicians should exercise caution and give careful consideration when prescribing semaglutide for weight management in patients with conditions that increase risk for pancreatitis. Presentation: 6/2/2024

7435 Thyroid Abscess Post-FNA in an Immunocompetent Host

Abstract Disclosure: B. Gautam: None. M.S. Hossain: None. S. Hossain: None. S.C. Kumar: None. H. liao: None. B. Tiwari: None. D.S. Rosenthal: None. Background: Thyroid Fine Needle Aspiration (FNA) is a common diagnostic procedure for thyroid nodules. Most common post FNA complications are minor pain, bruises and small hematomas. Despite being generally safe, FNA can occasionally lead to rare complications, such as thyroid abscess, especially in immunocompromised individuals. This case highlights the development of a thyroid abscess post-FNA in a 42-year-old immunocompetent female. Case Report: A 42-year-old female presented to ED with painful right sided neck lump. She had undergone FNA of right sided thyroid cyst, 10 days ago without any immediate complications as confirmed on post procedural ultrasonogram. She started having right sided neck pain after FNA which progressively got worse overtime associated with fever, chills and difficulty swallowing without any dyspnea or dysphonia. She denied symptoms of hyperthyroidism or hypothyroidism. Family history was significant for thyroid cancer in her mother and thyroid nodule in a sister. On exam: Temp. 101 F, HR 105 beats/min, BP 113/69 mm Hg, RR 18 breaths/min. Neck exam revealed soft, warm, tender mass in right neck region which was mobile with swallowing without any skin discoloration or discharge. The physical exam was otherwise unremarkable. Laboratory investigations showed elevated WBC 18000 (4.5-11 k/mm3) with absolute neutrophil count 14.4 (1.8-7 k/mm3), normal CMP. Thyroid hormone levels were normal: TSH 0.32 Uiu/ml, FT4 1.0 ng/dl), as were anti-TG ab, TSI and anti-TPO ab. CT scan of Neck with IV contrast showed a 2.8 x 2.5 x 3.8 cm homogeneous right thyroid mass with mass effect on the trachea. US thyroid showed a 3.7 x 2.9 x 3.3 cm right thyroid hypoechoic lesion with increased internal echogenicity and peripheral hyperemia, consistent with a thyroid abscess. Patient underwent IR guided drainage of 30 cc thick, dark brown fluid and started on broad spectrum IV antibiotics which was then modified based on the bacteriology report showing presence of gram-variable rods, specifically Corynebacterium, with significant clinical improvement. Discussion: The thyroid gland is considered resistant to infections because of its characteristics such as encapsulation, high iodine content and rich blood supply. Nevertheless, rarely, patients may develop post FNA complications including bacterial thyroiditis, thyroid abscess and retropharyngeal cellulitis, presenting with acute life-threatening complaints. This case highlights the importance of monitoring for these rare complications along with early diagnosis and treatment which involves drainage and targeted antibiotic therapy. In the presence of suspicious findings on ultrasonogram and a strong family history of thyroid cancer, we also like to emphasize rare cases where a thyroid abscess could originate from necrotizing cancer cell, the likely etiology of thyroid abscess in our patient. Presentation: 6/3/2024

Assessment of Hematological Parameters in Mycobacterium Tuberculosis-Infected Patients at Hayatabad Medical Complex, Peshawar, Pakistan

Background: Mycobacterium tuberculosis is a major causative agent of pulmonary tuberculosis, significantly contributing to morbidity and mortality worldwide. In South Asia, including Pakistan, TB remains a primary cause of prolonged hospital stays and economic burden. It primarily affects the lungs and can alter various hematological parameters.Objective: To assess the prevalence and characterize the hematological features of pulmonary tuberculosis patients at Hayat Abad Medical Complex, Peshawar, Pakistan.Methods: A descriptive cross-sectional study was conducted from April to August 2024. A total of 220 sputum samples were collected from male and female patients of all ages with suspected TB. TB was confirmed in 31 patients using TB PCR. Hematological parameters, including WBC, RBC, Hb, HCT, MCV, MCH, and platelets, were analyzed using a Sysmex hematology analyzer. Data were analyzed using SPSS version 25.Results: The prevalence of TB was 14% (31/220). All confirmed TB patients had elevated WBC and neutrophil counts (100%), decreased Hb and HCT (100%), and reduced MCV (96%). Lymphopenia was present in 90% of the cases.Conclusion: Hematological deviations can be cost-effective markers for early TB diagnosis in resource-limited settings.

Abstract B014: Cannabis use among cancer survivors and its association with cardiometabolic risk factors: Findings from the All of Us Research Program

Abstract Purpose: Cannabis use has been linked to alleviating symptoms such as sleep issues, mental health, and physical problems resulting from cancer treatment among cancer survivors. However, in the US general population, evidence suggests that an increase in cannabis use increases the risk for cardiovascular disease including high blood pressure, type 2 diabetes, and high cholesterol. This is even more alarming since users who have been diagnosed with cancer have an even greater independent risk of cardiovascular events due to the toxicities of cancer therapeutic drugs. Given the US trend in cannabis legalization and decriminalization and the limited knowledge of the association between cannabis use and cardiometabolic biomarkers among cancer survivors, we aim to assess the independent associations between cannabis use and several cardiometabolic biomarkers and explore racial/ethnic and sex differences among a sample of cancer survivors from the All of Us (AoU) Program. Methods: Cross-sectional cannabis data and cardiometabolic risk factor biomarkers were obtained from adult cancer survivors in the AoU Research Program from 2018-2022. Cannabis use was defined as never use (in a lifetime or past three months), occasional use (twice or monthly in the past three months), and frequent/regular use (weekly or daily). Cardiometabolic outcomes included cardiovascular (e.g., systolic, diastolic blood pressure, hypertension), immune (i.e., White Blood Cell [WBC] counts, C-reactive protein [CRP]), and metabolic systems biomarkers (e.g. waist-to-hip ratio, lipids, HbA1c), were dichotomized from continuous values to elevated vs normal where high values, defined by clinically established cutoffs or >75th percentile, represented elevated biomarkers. Multivariable logistic regression and stratified models if interactions were statistically significant, adjusting for treatment, smoking, hazardous alcohol use, and sociodemographic variables were used. Results: Our cohort (N=6,985) consisted of 7.6% Hispanic, 6.2% Black, and 86.2% White survivors. Overall, 8.2% of survivors reported occasional and frequent/regular cannabis use, with Black survivors (9.7%) reporting a greater proportion of frequent/regular use compared to White (3.2%) and Hispanic (4.7%) survivors. Similarly, female (2.8%) survivors reported a lower frequency of frequent/regular cannabis use compared to male (4.2%) survivors. Compared to never users, frequent/regular users were 3.35(95% CI=1.10-10.53) times as likely to report elevated WBC count. No significant associations were found between cannabis use and CRP, cardiovascular, and metabolic systems biomarkers. Similarly, no race/ethnicity or sex (both pinteraction > 0.05) differences were found in the cannabis and WBC association. Conclusion: Our results underscore that more frequent cannabis use may have a detrimental effect on immune risk factors like WBC counts among survivors. Being that high WBC may be predictive of cardiovascular diseases and mortality, future studies should explore the longitudinal effects of cannabis use on WBC. Citation Format: Angel Arizpe, Claudia M. Toledo-Corral, Carol Y. Ochoa-Dominguez, Stephanie Navarro, Sue E. Kim, Albert J. Farias. Cannabis use among cancer survivors and its association with cardiometabolic risk factors: Findings from the All of Us Research Program [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr B014.

Pneumatic tube transport-induced pseudohyperkalemia in patients with extreme leukocytosis: a retrospective study from a single medical center.

Pseudohyperkalemia (falsely elevated serum potassium) must be distinguished from true hyperkalemia to avoid unnecessary treatment. Some case reports suggest that pneumatic tube transportation may increase the risk of pseudohyperkalemia, but comprehensive research on the topic is lacking. Here, we aimed to assess the association between WBC levels, pneumatic tube transport, and pseudohyperkalemia prevalence. We analyzed 1188 samples collected from 240 patients between 2019 and 2022. Samples with elevated WBC counts (≥ 100 × 103/μL) and potassium levels were included in this study. The method of specimen transportation was documented. Pseudohyperkalemia was observed (7/390) in specimens transported using pneumatic tubes. No pseudohyperkalemia was identified with manually transported specimens (0/132). Every increase in WBC count by 100 × 103/μL in the specimens multiplied the odds ratio of pseudohyperkalemia by 3.75 when delivered with pneumatic tube. The prevalence of pseudohyperkalemia increased as WBC count increased, especially at WBC counts greater than 200 × 103/μL. Pneumatic tube transport poses a risk for pseudohyperkalemia in patients with extreme leukocytosis. Physicians should anticipate odd potassium levels when interpreting blood test results. Redrawing of blood samples, manual specimen transportation, or point-of-care testing are suggested to prevent further misdiagnosis.

Clinical features of pneumocystis pneumonia in non-human immunodeficiency virus-infected patients: A systemic review and meta-analysis

Objectives: Pneumocystis pneumonia (PCP) is an opportunistic disease that causes potentially fatal pneumonia in immunocompromised individuals. The clinical features of PCP without HIV remain incompletely understood. Methods: This study aimed to identify the clinical features of PCP without HIV in a systematic review following a meta-analysis. Results: 65 articles that included 10,133 PCP patients without HIV infection were enrolled. PCP occurred most commonly at age 59.2 years (95%CI: 57.7, 60.7) in a gender ratio of approximately 3 to 2 (males to females). Dyspnea, fever, cough, and sputum were nonspecific clinical findings in 73% (95%CI: 69, 79), 73% (95%CI: 65, 81), 56% (95%CI: 48%, 64%), and 32% (96%CI: 16, 48) of patients, respectively. Viral, bacterial, and fungal co-infection were observed in 28% (95%CI: 13, 44), 19% (95%CI: 13, 25), and 11% (95%CI: 6, 16) of patients, respectively. Laboratory data showed a trend of elevated WBC, LDH, CRP, β-D glucan, and KL-6. Ground glass opacity (GGO) was found in 87% (95%CI: 83, 91) of patients. In-hospital mortality was 41% (95%CI: 35, 46). Conclusions: PCP is a life-threatening disease in immune-compromised patients. Despite being a nonspecific clinical finding, GGO might offer a clue to diagnosing PCP in high-risk patients.

Development and validation of machine learning-based prediction model for severe pneumonia: A multicenter cohort study

Severe pneumonia (SP) is a prevalent respiratory ailment characterized by high mortality and poor prognosis. Current scoring systems for pneumonia are not only time-consuming but also exhibit limitations in early SP prediction. To address this gap, this study aimed to develop a machine-learning model using inflammatory markers from peripheral blood for early prediction of SP. A total of 204 pneumonia patients from seven medical centers were studied, with 143 (68 SP cases) in the training cohort and 61 (32 SP cases) in the test cohort. Clinical characteristics and laboratory test results were collected at diagnosis. Various models including Logistic Regression, Random Forest, Naïve Bayes, XGBoost, Support Vector Machine, and Decision Tree were built and evaluated. Seven predictors—age, sex, WBC count, T-lymphocyte count, NLR, CRP, TNF-α, IL-4/IFN-γ ratio, IL-6/IL-10 ratio—were selected through LASSO regression and clinical insight. The XGBoost model, exhibiting best performance, achieved an AUC of 0.901 (95 % CI: 0.827 to 0.985) in the test cohort, with an accuracy of 0.803, sensitivity of 0.844, specificity of 0.759, and F1_score of 0.818. Indeed, SHAP analysis emphasized the significance of elevated WBC counts, older age, and elevated CRP as the top predictors. The use of inflammatory biomarkers in this concise predictive model shows significant potential for the rapid assessment of SP risk, thereby facilitating timely preventive interventions.

Neutrophil/Lymphocyte Ratio as a Biomarker of Response to H1-Antihistamine Therapy in Patients with Chronic Spontaneous Urticaria

Abstract Backgrounds: A large proportion of patients with chronic spontaneous urticaria (CSU) are resistant to a standard dose of antihistamine. Acknowledged biomarkers for identifying these patients have not been determined. The neutrophil/lymphocyte ratio (NLR) has been considered as an important indicator of inflammation in chronic diseases. Aims: To explore whether NLR could serve as a biomarker for predicting the response to H1-antihistamine in patients with CSU. Methods: This hospital-based, retrospective study included 109 patients with CSU diagnosed from 2017 to 2020 in our clinic and divided them into two groups by their responses to the 2-week antihistamine therapy of standard-dose: 69 with H1-antihistamine-refractory and 40 with non-H1-antihistamine-refractory CSU. The laboratory test results were collected from the hospital information system and integrated with SPSS software. Results: Patients refractory to H1-antihistamine had significantly higher median NLR (P = 0.039), age (3 P = 0.021), complement C3 (P = 0.026), presence of elevated WBC (P = 0.026) and elevated monocytes (MONO) (P = 0.045) and significantly lower IgM (P = 0.022). The binary logistic regression model revealed that NLR was significantly associated with H1-antihistamine-refractory of CSU (odds ratio (OR) 1.717, 95% confidence interval (CI) 1.065–2.766, P = 0.026), which was consistent with that after adjusted for potential confounding factors including age, complement C3, presence of elevated WBC and MONO, and IgM (OR 1.681, 95% CI 1.019–2.773, P = 0.042). Conclusion: Our results showed a strong and significant association between higher NLR and H1-antihistamine resistance in CSU, suggesting that NLR may be a potential biomarker for predicting the response to H1-antihistamine therapy in patients with CSU.

Role of Inflammatory and Prognostic Markers and Its Outcome Among Patients with Pre and Post-Operative Colorectal Carcinoma

Colorectal carcinoma is a significant health concern, often presenting with symptoms like bleeding per rectum, mucous discharge, tenesmus, altered bowel habits, and weight loss. This study examines the influence of inflammatory and prognostic markers on the outcomes of patients undergoing per and post-operative treatment for colorectal carcinoma. Objective: To evaluate the role of inflammatory and prognostic markers on the outcomes of patients with per and post-operative colorectal carcinoma. Methods: This cross-sectional study included 112 patients aged 20-60 years, of either gender, with symptoms such as bleeding per rectum, mucous discharge, tenesmus, altered bowel habits, and weight loss for ≥1 month, diagnosed with colorectal cancer regardless of stage and grade. Results: The mean age of the patients was 45.16 ± 10.52 years, with 51.8% males and 48.2% females. Common symptoms included abdominal pain, per rectal bleeding, and weight loss, with 89.3% presenting with anemia. Tumors were located in the colon (84.8%) and rectum (28.6%). Pre-operative markers showed elevated WBC in 59.8%, CRP in 87.5%, decreased serum albumin in 77.7%, raised ESR in 61.6%, ferritin in 65.2%, and LDH in 60.7%. Post-operative markers indicated elevated WBC in 92.9%, CRP in 94.6%, decreased serum albumin in 82.1%, raised ESR in 68.8%, ferritin in 69.6%, and LDH in 73.2%. Complications included wound infection, pneumonia, sepsis, and prolonged hospital stays, with a mortality rate of 3.6%. Conclusions: Serum inflammatory markers significantly influence prognoses and predict adverse outcomes in patients undergoing surgical treatment for colorectal carcinoma.

Clinical Characteristics and Maternal and Neonatal Outcomes of Pregnant Women Positive, Negative, and Recovered With COVID-19 Pneumonia

Background: The pandemic of coronavirus disease 2019 (COVID-19) has caused serious concerns about its potential adverse effects on pregnancy. There are limited data on maternal and neonatal outcomes of pregnant Hispanic women with COVID-19. Methods: This study was a retrospective chart review. This cohort included pregnant females between the ages of 18-60 who had tested positive for COVID-19 and tested negative for COVID-19 from the electronic medical records of Texas Tech Health Sciences Department of OB/GYN clinics, University Medical Center (UMC), and El Paso Children’s Hospital (EPCH) from March 2020 to June 2021, in addition to their neonates. Records were analyzed to collect information on demographics, BMI, gestational age, COVID status at the time of delivery, history of exposure to COVID, signs and symptoms of COVID, presenting symptoms, comorbidities, and treatment of COVID before and after delivery. Further, mode of delivery, pregnancy complications, complications during labor, and adverse outcomes (maternal death, admission to ICU, length of stay in ICU). We also collected diagnostic data. The control group included age-matched pregnant individuals without a diagnosis of COVID. The control group was evaluated for the same variables and outcome assessment. For the neonatal outcomes, the mothers were matched to the neonate. Data collected on neonatal outcomes included demographics, date of delivery, APGAR score, admission to the newborn nursery or NICU, the reason for NICU admission, birthweight, length, head circumference, fetal abnormalities, prematurity, neonatal death, COVID test results, breastfeeding (expressed or direct), and length of hospital stay. We also collected diagnostic data for neonates. Statistical analyses was performed using descriptive statistics for the various variables, a t-test to determine differences between the two groups for the continuous variables, and a chi-square test for the categorical variables. Results: During the period March 21, 2020 - June 15, 2021, 370 pregnant women, out of which 100 women were COVID-positive, 71 women who were recovered, and 188 controls. COVID-positive women had more elevated fibrinogen, WBC, alkaline phosphatase, aspartate aminotransferase, and alanine transaminase but nonsignificant CRP levels. Most of the COVID-positive and COVID recovered women had preeclampsia during pregnancy, 29.24% COVID positive women delivered via C-section, while 68.42% of women delivered vaginally. The mean length of stay was 2.97 days for both groups. There 79.41% of women chose to breastfeed. One maternal death was recorded, while only two women had ICU admissions. Compared to the COVID-positive, the recovered women still had significantly elevated fibrinogen but not ALP, ALT, AST, and CRP. The COVID recovered women had lower counts of vaginal delivery (56.3%) and higher C-section rates (39.4%) among the three groups. The recovered group had higher premature deliveries (18%) than the other two groups (8%, 17%). Among the neonatal outcomes, there were four neonatal deaths in the COVID group, two neonates had COVID transmission during delivery, and 19.4 % of neonates were admitted to the NICU. Among neonatal vitals, blood pressure was higher in the positive (41%) and recovered (32.39%) groups than in controls (27.6%). Neonatal hypoglycemia was also higher in the recovered group (27.5%) than in the positive (17.11%) and control group (18.4%). Conclusions: Severe maternal and neonatal complications were not observed in pregnant women with COVID-19 pneumonia who had a vaginal or cesarean delivery. There were complications observed in women who recovered from COVID during pregnancy.

GCT-24. ISOLATED PITUITARY STALK THICKENING

Abstract BACKGROUND Few studies have examined predictive factors and outcome of isolated pituitary stalk thickening (iPST) in children. We aim to describe our institutional cohort to determine predictors of future proliferative disease. METHODS A search of the radiology, endocrinology and neuro-oncology databases was performed to identify patients with iPST diagnosed between January 2000 and June 2019. Clinical data was collected along with detailed radiology review of MRIs in a blinded fashion. RESULTS Forty-seven patients were identified, with 40 meeting criteria for inclusion. Median age of baseline MRI was 9.6 years (range 0.9-17.5). Twenty-five (63%) were female. Median follow up time was 5.2 years (range 0.3-18.6). Indication for MRI was symptoms of diabetes insipidus (DI) in 29 patients followed by concerns for anterior endocrine disturbance (6), headache (1) or visual impairment (1). Thirty-four (85%) subjects had pituitary dysfunction, including 31 with DI however DI was not predictive of future development of proliferative disease (69% with presumed hypophysitis vs 93% with proliferative disease, p=0.12). Fourteen (35%) patients developed proliferative disease, with germinoma (8), Langerhans cell histiocytosis (5) and lymphoma (1) at median of 1.3 years (range 0.3-4.0), 2.2 years (range 0.3-9.4) and 1.1 years after initial MRI respectively. Lumbar puncture was performed in 24 patients with elevated white blood cell count (>5 x 106/L) found in 6 (75%) patients with germinoma, 1 (100%) patient with lymphoma, 0 patients with LCH and 3 of 11 (27%) patients with presumed hypophysitis (p=0.015). Thickening of the entire stalk at time of diagnosis and radiographic progression were more likely to be seen in those that developed proliferative disease. CONCLUSION In this cohort 35% of children with PST were eventually diagnosed with a proliferative disease. Importantly, central DI was not associated with risk of proliferative disease. Several radiographic features and elevated CSF WBC were predictive of this outcome.

The role of peripheral white blood cell counts in the association between central adiposity and glycemic status

AimsAlthough central adiposity is a well-known risk factor for diabetes, the underlying mechanism remains unclear. The aim of this study was to explore the potential mediation role of circulating WBC counts in the association between central adiposity and the risk of diabetes.Materials and methodsA cross-sectional study was conducted using data from the Fuqing cohort study, which included 6,613 participants aged 35–75 years. Logistic regression analysis and Spearman’s rank correlation analysis were used to examine the relationships between waist-to-hip ratio, WBC counts and glycemic status. Both simple and parallel multiple mediation models were used to explore the potential mediation effects of WBCs on the association of waist-to-hip ratio with diabetes.ResultsThe study revealed a positive relationship between waist-to-hip ratio and risk of prediabetes (OR = 1.53; 95% CI, 1.35 to 1.74) and diabetes (OR = 2.89; 95% CI, 2.45 to 3.40). Moreover, elevated peripheral WBC counts were associated with both central adiposity and worsening glycemic status (P < 0.05). The mediation analysis with single mediators demonstrated that there is a significant indirect effect of central adiposity on prediabetes risk through total WBC count, neutrophil count, lymphocyte count, and monocyte count; the proportions mediated were 9.92%, 6.98%, 6.07%, and 3.84%, respectively. Additionally, total WBC count, neutrophil count, lymphocyte count, monocyte count and basophil count mediated 11.79%, 11.51%, 6.29%, 4.78%, and 1.76%, respectively, of the association between central adiposity and diabetes. In the parallel multiple mediation model using all five types of WBC as mediators simultaneously, a significant indirect effect (OR = 1.09; 95% CI, 1.06 to 1.14) were observed, with a mediated proportion of 12.77%.ConclusionsCentral adiposity was independently associated with an elevated risk of diabetes in a Chinese adult population; levels of circulating WBC may contribute to its underlying mechanisms.

Reactive leuco-thrombocytosis in a post splenectomized pregnant woman in labour: A case report

Post-splenectomy diagnosis of infection based on WBC and platelet elevation is confounded by the fact that leucocytosis is a physiologic response to splenectomy, similar to the phenomenon of post-splenectomy platelet count elevation. Previous reports suggest that the WBC post-splenectomy in patients with sepsis is greater and more persistent than the WBC in patients without sepsis. However, specific values that can be used at the bedside to distinguish between a "normal" and "pathologic" WBC or platelet elevation are lacking. The clinician is often challenged to identify an infection in a post-splenectomy patient with an elevated WBC and prevent thrombotic events in case of thrombocytosis.

Association of systemic chronic inflammation during pregnancy in different periods and its trajectories with preterm birth.

Systemic chronic inflammation (SCI) is a prevalent characteristic observed in various diseases originating from different tissues, while the association of SCI with preterm birth (PTB) remains uncertain. This study aimed to analyze the association between a nonspecific biomarker of SCI and PTB, while also exploring the trajectories of SCI in pregnant women at risk of PTB. The study used data from the Electronic Medical Record System (EMRS) of a hospital in Zhejiang, China and 9226 pregnant women were included. The duration of pregnancy was categorized into four distinct periods: the first, early-second, late-second, and third trimester. Latent class trajectory modeling (LCTM) was used to identify the trajectories of SCI during pregnancy. The elevated WBC counts in the late-second (OR=1.14, 95% CI: 1.06-1.23) and third (OR=1.16, 95% CI: 1.09-1.24) trimester were both positively associated with an evaluated risk of PTB. Moreover, significant dose-response relationships were observed. There were three distinct SCI trajectories found: progressing SCI (2.89%), high SCI (7.13%), and low SCI (89.98%). Pregnant women with progressive SCI had the highest risk of PTB (OR=3.03, 95% CI: 1.47-6.25). In conclusion, elevated SCI after 23weeks was a risk factor for PTB in healthy women, even if the SCI indicator was within normal range. Pregnant women with progressive SCI during pregnancy had the highest risk of PTB.

Long-Term Survivability of Surgical and Non-Surgical Management of Spinal Epidural Abscess

Spinal epidural abscess (SEA) is a rare and life-threatening infection within the epidural space with significant functional impairment and morbidity. Active debate remains over whether to operate for SEAs, with limited existing data comparing the long-term survivability after surgical versus nonsurgical management. This study aims to determine the long-term survival of patients who underwent surgical and nonsurgical management for SEA. Retrospective cohort study. A total of 250 consecutive SEA patients. Survival and mortality rates, complications. All patients treated at a tertiary medical center for a primary SEA from January 2000 to June 2020 are identified. Data collection is by retrospective chart review. Cox proportional hazards regression models are used for all survival analyses while controlling for potential confounding variables and with multiple testing corrections. A total of 35 out of 250 patients died with an overall all-cause mortality of 14%. More than half of all deaths occurred within 90 days after treatment. The 90-day, 3-year, and 5-year survival rates are 92.8%, 89.2%, and 86.4%, respectively. Among surgery patients, the all-cause mortality was 13.07%, compared to 16.22% for medically-managed patients. Surgical treatment (decompression, fusion, debridement) significantly reduced the risk of death by 62.4% compared to medical therapy (p=.03), but surgery patients experienced a significantly longer mean length of stay (p=.01). Risk factors of short-term mortality included hypoalbuminemia (<3.5 g/dL), American Society of Anesthesiologists (ASA) 4+, and cardiac arrest. Risk factors of long-term mortality were immunocompromised state, elevated WBC count >12,000, sepsis, septic shock, ASA 4+, and cardiac arrest (p<.05). In terms of complications, surgically-managed patients experienced a higher proportion of deep vein thrombosis (p<.05). The overall long-term survivability of SEA treatment is relatively high at (86% at 5-year) in this study. The following SEA mortality risk factors were identified: hypoalbuminemia (short-term), immunocompromised state (long-term), leukocytosis (long-term), sepsis and septic shock (long-term), ASA 4+ and cardiac arrest (overall). For primary SEA patients, surgical management may reduce mortality risk compared to nonsurgical management.

Evaluation of predictive factors of septic wrist to avoid overdiagnosis

BackgroundThe existing diagnostic criteria for septic wrist are nonspecific, exposing patients with noninfectious etiologies to surgical morbidity. This study aimed to identify predictors differentiating septic wrist from other etiologies. MethodsAn institutional review board-approved retrospective review was conducted on patients with a presumed diagnosis of septic wrist (2003–2022). Bivariate and multiple regression analyses were performed to identify correlation between confirmed septic wrist and comorbidities (autoimmune diseases, immunosuppression, crystalline arthropathy, intravenous [IV] drug use, smoking), penetrating trauma, fever, multi-joint involvement, inflammatory markers (erythrocyte sedimentation rate [ESR]/C-reactive protein [CRP]/white blood cells [WBC]), serum uric acid level, blood cultures, imaging findings, and synovial fluid analysis. Categorical data were reported as median [interquartile range]. ResultsHundred and sixty-eight (58 females and 110 males) patients were included. The median length of hospitalization and follow-up were 6[7] days and 1[3] months. Eighty-nine (53%) patients had septic wrist confirmed with Gram stain/culture, 48 (29%) patients received alternative diagnoses, and 31 (18%) patients had undetermined diagnoses. Concomitant septic wrist and crystalline arthropathy were identified in 9 patients (6.6% of total patients). Out of the 48 patients who received alternative diagnoses, 12 (25%) underwent open drainage. Elevated synovial WBC count (95,409.4 ± 85,926.2) showed a trend of association with septic wrist (p = 0.08). Negative synovial crystals (p = 0.01), positive blood culture (p = 0.04), negative history of crystalline arthropathy (p = 0.08), and multi-joint involvement (p = 0.05) were identified as predictors of septic wrist with a combined sensitivity of 87.5%, specificity of 86.2%, and area under the curve 0.93. ConclusionsCurrent diagnostic criteria for septic wrist have low specificity. Negative history of crystalline arthropathy, multi-joint involvement, absence of synovial crystals, and positive blood culture are helpful indicators for predicting septic wrist in patients presenting with a painful, erythematous, and swollen wrist.