Haematological Investigations Research Articles

#2275 Beyond glucose control: SGLT2 inhibitors' impact on hematological parameters in lupus nephritis patients

Abstract Background and Aims There is a broad spectrum of hematologic manifestations in SLE including lymphopenia, anemia, thrombocytopenia, or pancytopenia. Anemia worsens the prognosis of many chronic diseases including lupus nephritis. A recent systematic review and metanalysis showed that hemoglobin and hematocrit levels were significantly increased with SGLT2i therapy when compared to placebo. This study aimed to investigate the effect of SGLT2 inhibitors on hematological parameters including iron profile, hepcidin and erythropoietin levels in lupus nephritis patients. Method Double blind randomized controlled trial. The material of the current study included 79 Lupus nephritis patients who were recruited from Nephrology clinic- Urology and Nephrology Center- Mansoura University. Patients with an estimated glomerular filtration rate (eGFR) >30 ml/min/1.73 m2 had been randomly assigned to 2 groups Study group: included 38 lupus nephritis patients who were randomly assigned to receive dapagliflozin (10 mg once daily) Placebo group: included 41 lupus nephritis who were assigned to receive placebo. The two groups were randomly assigned using computer-generated random tables in a 1:1 ratio and followed up for 12 months. The findings were recorded, tabulated, and analyzed using SPSS22 for windows. Results Both groups had similar ages and gender distribution. BMI, diabetes mellitus, and hypertension rates were comparable between groups. The duration of lupus nephritis and management approaches did not differ. Biopsy results indicated no differences in the class of lupus nephritis. Serum chemistry, including serum creatinine, was similar between groups. The mean hemoglobin levels, MCV and MCH are similar between the control and study groups, with no statistically significant difference (p = 0.5, 0.9 and 0.9 respectively). Regarding iron indices, the median ferritin, TSAT levels show a numerical difference, but it does not reach statistical significance (p = 0.09, 0.05), The mean erythropoietin and hepcidin levels are not significantly different between the groups (p value= 0.1 and 0.9 respectively) also, platelet counts are similar between the groups (p = 0.7). compares hematological investigations before and after the intervention in the study group. There is a statistically significant increase in mean hemoglobin levels post-intervention compared to baseline (p = 0.02) and the mean MCH levels show a numerical increase post-intervention, but the difference is not statistically significant (p = 0.1), but the mean MCV levels do not show a statistically significant change post-intervention (p = 0.7). The median ferritin levels and TSAT values show a numerical increase post-intervention, but the difference is not statistically significant (p = 0.8 and 0.9 respectively). There is a statistically significant decrease in mean hepcidin levels post-intervention (116 ± 15 from baseline 181 ± 76) and (p = 0.001). erythropoietin levels show a numerical increase post-intervention, but the difference is not statistically significant (p = 0.1). there is a slight decrease in platelets counts after intervention but make statistically significant (p = 0.01), but The hematological data after 12 months suggest overall similarity between the control and study groups in terms of hemoglobin, MCV, MCH, ferritin, TSAT, and platelet count, also hepcidin and erythropoietin levels were comparable between both groups (P = 0.7). percentage of participant with anemia (Hgb< 12 g/dl) decreased in study group after intervention from 61% to 42% but with no significant difference with control group (p = 0.3) Conclusion Anemia in lupus nephritis patients is primarily due to iron deficiency, associated with elevated hepcidin levels. Further research is needed to explore these patients' underlying causes of anemia. SGLT2 inhibitors are important add on drugs that has positive effect on varies hematological parameters in lupus nephritis patients in addition to their renal benefits.

#1494 Immunotactoid glomerulopathy: a comprehensive analysis of three cases

Abstract Background Immunotactoid glomerulopathy (ITG) is an uncommon cause of glomerular disease encountered in approximately 0.06% of native kidney biopsies. This fibrillary disease is strongly associated with haematologic disorders, including lymphoma (mainly chronic lymphocytic leukaemia/small lymphocytic lymphoma), monoclonal gammopathy, and multiple myeloma. It is usually managed with oral steroids and/or treatment of an underlying lymphoproliferative disorder. Here, we report three cases of ITG, all female patients with varying severity of the disease, timing of malignancy and required treatment. Case Scenarios: Case 1: A 76-year-old lady with no significant medical background presented in May 2020 with confusion and progressive peripheral oedema. She had AKI (serum creatinine 210 µmol/L from baseline 68 µmol/L) and a sodium of 104 mmol/l. Urine PCR was 1182 mg/mmol. She was admitted to the ITU, where hyponatraemia was managed with a good clinical response. Blood screening showed negative immune, myeloma and virology screens. Complement was low. A renal biopsy showed a diagnosis of ITG. She had an extensive malignancy screen, but no malignancy was detected. She was started on prednisolone 60 mg once daily and eventually weaned off the drug by March 2021, as she maintained remission of her disease. Two years after her initial presentation, she was seen by the ophthalmologist for a right lacrimal gland mass. This was excised, and a biopsy revealed a MALT Lymphoma. Case 2: A 50-year-old lady with splenomegaly being investigated under the haematology service was referred to our renal clinic for proteinuria in June 2019. Her serum creatinine was within normal limits, and her UPCR was 302 mg/mmol. She had no paraprotein in her blood, low serum immunoglobulins, low C3 and a negative viral screen. Perindopril, initiated by her GP, was up-titrated. Renal biopsy revealed features in keeping with Immunotactoid Glomerulopathy, and completed haematological investigations revealed Chronic Lymphocytic Leukaemia. Her UPCR peaked at 842 mg/mmol before reducing to 190 mg/mmol within a year after treatment with Veneclotax and Rituximab after not tolerating FCR (Fludarabine, Cyclophosphamide, Rituximab) Chemotherapy. Case 3: A 69-year-old lady presented to the renal clinic with proteinuria in September 2018. She had a background of breast cancer diagnosed in 2007 (She had surgical resection followed by radiotherapy). Her 24-hour urine protein was 2g, and UPCR was 155 mg/mmol. Serum creatinine was 81 µmol/l and eGFR 66 ml/min. P- ANCA was positive, while PR3 and ANA were negative. She had bilateral leg oedema due to long-standing lymphedema. The biopsy report showed immunotactoid glomerulopathy. Regular surveillance of previous breast cancer with mammography and CT-CAP has shown no evidence of malignancy recurrence, hepatitis virology and paraprotein were negative, and C3/C4 were within normal limits. She had improved UPCR and maintained normal kidney function on full-dose Losartan. Conclusion Immunotactoid Glomerulopathy is a rare form of glomerular disease with a strong association with lymphoproliferative malignancies, which may precede, occur concomitantly or present years after the initial diagnosis. This common association highlights the need for diligence in screening for malignancy in each case, and it is a reason for careful follow-up of these patients. Treatment of underlying disorders is associated with positive renal outcomes, and in some cases, there is a good response to steroids.

Seroprevalence and Hematological Investigation of Toxoplasmosis in Women of Lahore, Pakistan

Background. Toxoplasma gondii is responsible for toxoplasmosis infection. Human beings and most warm-blooded animals are infected by this parasite, though the primary host of this parasite is the felid family. The current study was designed to assess the seroprevalence of toxoplasmosis and to investigate the hematological changes in the female human population of Lahore, Pakistan. Methodology. For this research, 150 blood samples were collected from women being treated at Sir Ganga Ram Hospital Lahore, along with other details. Of these, 90 samples were selected for the analysis of hematological changes by using a hematology analyzer. The serum of these samples was analyzed to estimate the seroprevalence of toxoplasmosis by using the ELISA technique. All the information was collected with the help of a questionnaire and analyzed to find out the risk factors. Results. The overall prevalence of toxoplasmosis in the female human population in Lahore was found to be 27%. The prevalence rate was 31% and 24% among pregnant and non-pregnant women, respectively. Similarly, women who underwent abortion had a high prevalence rate (66.6%) as compared to normal pregnant women (25.6%). In pregnant women, infection was more prevalent in the third trimester of pregnancy (43.7%), as compared to the first (28.5%) and second (20%) trimesters. The prevalence rate was higher in those women who had contact with cats or any other pet animal. The hematological parameters of the samples were also examined. In seropositive women, the levels of Hb and PCV declined, while the counts of lymphocytes and neutrophils considerably increased. Abnormal concentration levels of ALT and AST enzymes were also observed in seropositive women. Conclusion. This study revealed a higher prevalence of toxoplasmosis in pregnant women. Therefore, clinical screening should be encouraged for this infection

LIFETIME MANAGEMENT OF AORTIC STENOSIS IN EXTREME SETTING

Abstract A 51–year–old male patient returned to our attention due to symptomatic severe aortic stenosis. Despite the severity of the aortic valve disease, he had been previously turned down from aortic valve replacement by us because of lack of symptoms and very unfavorable anatomy. Indeed he had been irradiated at the age of 3 due to Hodgkin’s Lymphoma and presented with porcelain aorta, small ascending aorta and aortic annulus. The patient returned to us with a 3–month history of progressive dyspnea (NYHA class IIa) and one episode of lipothymia during physical exercise. Physical examination, hematologic and biochemical investigations at admission were normal. Our trans–thoracic echocardiogram confirmed a trileaflet aortic valve (AV) that was severely stenotic and calcified with a mean gradient of 60 mmHg and an AV area of 0.5 cm2 (0.3 cm2/m2), in presence of good left ventricular systolic function with an ejection fraction (EF) of 60%. CT excluded coronary disease but, confirmed severe calcified aortic stenosis and porcelain aorta with small calcific sino–tubular junction and ascending aorta and protruding LVOT calcium. (Ascending aorta 19 mm; STJ 19 mm). The heart–team judged the patient not suitable for AVR and decided to perform a high–risk TAVI, leaving apical conduit as the last resort. From a technical standpoint, the LVOT calcium and the short and narrow STJ were high risk features for rupture with balloon expandable devices. On the other hand the short and narrow STJ with the narrow ascending aorta would represent a serious issue for the expansion of self–expanding devices and an even more troublesome feature for future coronary access and coronary occlusion in the setting of TAVI–in–TAVI down the road. Given the patient’s young age, a balloon expandable SAPIEN ultra 23 mm was chosen to be implanted with a two–step inflation to minimize the risk of STJ rupture. The prosthesis was partially expanded until anchoring was achieved on the aortic leaflets then, on continuous pacing, the balloon was rapidly collapsed, pushed down deeper under the STJ and fully inflated to achieve prosthesis’ inflow expansion. Intra–procedural and post–procedural course were uneventful and the patient was discharged home in 5th Day. Transthoracic echocardiogram at the dismission reveal a trans–aortic mean gradient of 18 mmhg, the absence of significant paravalvular leaks and a preserved ejection fraction. Pre–discharge CT scan confirmed feasibility of future TAVI–in–TAVI in case of need.

AL–AMYLOIDOSIS RELATED ADVANCED HEART FAILURE DIAGNOSED THROUGH F–18–FLUTEMETANOL PET SCAN

Abstract Background Systemic amyloidosis (SA) is a group of rare diseases in which abnormal misfolded proteins, amyloid fibrils, accumulate in tissue. The gold standard for diagnosis is tissue biopsy of the affected organ, but it is invasive and needs specific proteomic or immunohistochemistry analyses to characterize the involved protein. We report a case of a complex diagnosis of SA in an advanced heart failure (HF) patient. Methods and Results A 68–year–old woman with history of recurrent uveitis started to complain dyspnea in 2022, after Covid19. Since her symptoms worsened, in June 2023 she was diagnosed in another center with restrictive cardiomyopathy with preserved left ventricular (LV) ejection fraction. She underwent coronary angiography (unremarkable), cardiac MRI (aspecific fibrosis), and a FDG–PET scan which showed non–homogeneous LV fixation. The patient was treated with steroids for the suspicion of an immunologic–inflammatory disease, without benefit. Fourteen months after the initial presentation, she was admitted to our centre for advanced inotrope–dependent HF. She had mildly increased LV hypertrophy and severe systolic dysfunction with restrictive physiology and, notably, peri–orbital subcutaneous hemorrhages (Figure 1). Hematological screening for amyloidosis showed elevated serum free lambda light chains. Repeated cardiac MRI scan was consistent with infiltrative disease. A total–body PET scan with dual tracer was performed. The control session with F–18–FDG showed mild aspecific cardiac uptake in the basal septum and lateral wall (Figure 2), while off–label use of F–18–Flutemetanol, an Alzheimer‘s disease approved experimental tracer that binds to amyloid fibrils beta sheets with very high sensitivity and specificity, showed intense cardiac, hepatic, pulmonary and muscular uptake, with wash–out–timing diagnostic for AL–SA (Figure 3). Periumbilical fat biopsy confirmed the clinical suspicion of SA. Hematological investigations led to the diagnosis of stage I–A lambda micromolecular multiple myeloma, with systemic amyloidosis and a IIIb cardiac prognostic score. Conclusions Endomyocardial biopsy is an invasive procedure and periumbilical fat biopsy discriminates the amyloid protein type only by proteomic analysis, which is available in very few Italian centres. The off–label use of Alzheimers’ PET tracers could reduce the delay of cardiac AL–SA diagnosis, allowing early disease identification and prompting timely hematological therapy.

Toxicological Evaluation of Sub-Chronic Administration of Ethanol Leaf Extract of <i>Ocimum canum</i> on Lipid Parameters, Heart Histology and Feed Consumption of Wistar Rats

Ocimum canum is a plant that is commonly used in many parts of SubSaharan Africa to treat ailments such as infection, discomfort, and diarrhea. The study was aimed to evaluate the sub-chronic toxicity of Ocimum canum on the heart, lipid profile and feed consumption in Wister rats after oral administration of the leaf extract. Animals of either sexes were chosen. Group 1 received distilled water (10 ml/kg), while groups 2, 3, and 4 received 100, 200, and 400 mg/kg of Ocimum canum, respectively. Animals were kept in conventional cages and provided oral access to the extract, water, and food for 28 days before being weighed and slaughtered. Blood was drawn via heart puncture and immediately sent for hematological and chemopathological investigation. The plant's histological cardiotoxic potential was investigated using the haematoxylin and eosin (H&E) staining technique. There was a significant (P<0.05) drop in RBC, HGB, and MCV, but no change in neutrophils, basophils, eosinophils, or platelets. The extract did not cause a significant (P<0.05) change in cholesterol, LDL, or triglyceride levels, but it did induce a substantial increase in HDL levels. Histological examination of cardiac tissue confirms other parameters. The results indicated that the plant may not be cardiotoxic.

Non-clinical Safety Evaluation of Camelina Oil: Acute and 12-Week Oral Toxicities.

This study assessed the acute and sub-chronic toxicity of Camelina oil, a well-known oil rich in polyunsaturated fatty acids that enhance cellular immunity and human health, in Wistar rats. Wistar rats, 5 per sex per group, were randomly assigned to three groups for acute (14 days) toxicity studies and five groups for sub-chronic (90 days) toxicity studies. In the acute study, Camelina sativa oil was administered orally at a single dose of 5000 mg/kg of body weight (BW). The positive control group received a single dose of 5 000 mg/kg BW Canola oil by gavage. In the sub-chronic study, Groups III-V received 250, 500, and 1 000 mg/kg BW of Camelina oil, while Groups I and II received ultra-pure water and Canola oil at a dose of 500 mg/kg BW, respectively. Throughout the experiment, clinical signs, mortality, and body weight were monitored. At the end of the sub-chronic study, hematological, biochemical, and histopathological investigations were conducted. Administration of Camelina oil and Canola had no significant effect on daily weight gain (P > 0.05) of the test rats. Serum calcium levels decreased while phosphorous levels increased in male rats treated with Camelina oil. Other hematological and biochemical parameters showed no significant differences or dose-response effects between control and seed oil groups in both sexes (P < 0.05). Moreover, in animal necropsy, there were no apparent lesions in the liver, heart, and kidney organs in any of the doses administered. In conclusion, the results suggest that oral administration of Camelina oil is unlikely to be toxic. Therefore, the possibility for the development of future human nutrition should be considered.

Study of Etiological Spectrums, Symptoms, and Management of Intestinal Obstruction Among Population in Central India

Abstract Introduction: Intestinal obstruction has emerged as a challenging emergency putting unwanted financial as well as clinical burden globally. A study on etiology, symptoms, and management could benefit in treating larger population of the region. Aim: The study aimed to study the demography, etiology, symptoms, and management of intestinal obstruction among a population in central India. Materials and Methods: A single-center prospective observational study of intestinal obstruction was done among patients admitted to various surgical wards, during the period from January 1, 2018, to May 31, 2019. Here, we studied 50 cases of intestinal obstruction. Patients belonged to the age groups ranging from 15 to 85 years were included. Patients were selected on the basis of clinical history, physical findings, and radiological and hematological investigations. For statistical analysis, Chi-square and Fisher exact tests were performed. Results: There were a total of 12,233 admissions among which 228 cases were acute intestinal obstruction, we randomly selected 50 cases for the present study. Males were 72% (n = 36) and females were 28% (n = 14). The age groups 31–40 (20%) and 51–60 (20%) showed the highest incidence. Postoperative adhesions (40%), obstructive hernia (30%), and malignancy (14%) were the major causes of obstruction. Surgical intervention was carried out with release of adhesions in majority of cases (40%), resection anastomosis in 22%, and release of adhesions with herniorrhaphy in 18% of cases. Pain in the abdomen was a major symptom (88%) among the cases. The mortality rate was 14% of the total subjects involved in the study. Conclusion: Acute intestinal obstruction remains an important surgical emergency in the surgical field, success in the treatment depends largely upon early diagnosis and proper management and treatment of pathological effects of the obstruction. Postoperative adhesions are one of the main causes responsible for intestinal obstruction.

Safety profile of Naga Bhasma prepared by two classical methods

Abstract Background: Naga Bhasma (NB) (incinerated lead) has been indicated as a remedy for the treatment of a wide range of diseases including Prameha (diabetes), Kasa (cough), Raktapradara (menorrhagia), Shukradosha (defects in semen), etc., However, improperly prepared NB can cause harmful effects on the human body. In modern science also, lead consumption has been accepted to produce toxicity. Aim: The present study was undertaken to elucidate and compare the toxicity profile of two samples of NB prepared by two different methods to ascertain the safety aspects. Materials and methods: In the first method, NB was prepared by using Parada (mercury), Gandhaka (sulfur), and Nimbu Swarasa (juice of Citrus medica var acida of Watt). In the second method, NB was prepared by using Ashwattha-Twaka-Churna (Ficus religiosa L.), Manahshila (realgar) (Ariloha), and Nimbu Swarasa. In both methods, 30 calcination cycles were given. Charles foster albino rats were used for the pharmacological study. Acute oral toxicity study was carried out as per organization for economic cooperation and development (OECD) 425 and chronic oral toxicity study was carried out as per OECD 408 (90-day oral repeated dose toxicity study). Acute oral toxicity study was conducted at five dose levels, namely 100, 250, 500, 1000, and 2000 mg/kg body weight. Chronic toxicity was carried out at a dose level of 62.5 mg/kg body weight. Animals were sacrificed on the 91st day by cervical dislocation. Blood was collected from the jugular vein and sent for hematological and biochemical investigations were done. Organs were used for histopathological studies. The data were analyzed by unpaired t-test. Results: No mortality was observed in the acute toxicity study. Chronic toxicity study shows that both the test drugs do not produce significant toxicity, but both were not completely free from adverse effects at the dose level studied. Conclusion: The study shows that both the test drugs do not produce significant toxicity, but they are not completely free from adverse effects at the dose level studied.

A Study of the Clinical Patterns of Hair Loss in Female Patients

Background: Hair loss is the one of the most common complaints in dermatologic patients. The proper cause of female pattern hair loss is still unclear. Many studies have been done on the individual patterns of hair loss but there are very few studies available about the different clinical patterns of hair loss in females in a single study. Objectives: To evaluate the clinical patterns of hair loss in females which manifest in various disorders. Materials and Methods: 120 subjects were studied in a hospital based descriptive study with detailed history, general physical examination, detailed hair, scalp, cutaneous examination, clinical tests, routine haematological investigations, biopsy where indicated. Results: Maximum subjects were in the age group of 20 – 40 years (66.6%). Majority of the subjects presented with a diffuse hair loss (55.8%). In our study although majority of the cases were not associated with any illness (52.5%), among the ones associated with illness the most common associated illness was history of COVID-19 (25.8%). Very few presented with scarring hair loss (5%). Conclusion: Telogen Effluvium was the most common cause of hair loss with maximum prevalence among females aged 20 to 40 years, with majority having hair loss over a period of 6 weeks to 6 month without any concurrent illness. The findings of this study provide baseline information on common clinical presentation of hair loss among women in our setting, thus helping in early clinical diagnosis and planning appropriate treatment.

Promising role of traditional Indian Ayurvedic medicine in treatment, management and better clinical outcomes of COVID-19 patients: a retrospective study

IntroductionThe Coronavirus disease (COVID-19) has negatively impacted the lives of people globally. To date, no specific treatment has emerged to combat the disease. Hence, there is an urge for immediate therapy against infections like COVID-19 through the inclusion of various traditional medicines including Ayurveda. MethodsThis retrospective study was performed on 300 patients who were treated using the Holistic Ayurveda protocol at the COVID Health Care (CHC) centre. Out of 300 patients, 258 who took the AYURAKSHA Kit regularly along with the other Ayurvedic medicines for treatment were selected for this study. Demographic distribution, viral clearance, and haematological parameters of COVID-19 patients were analysed. ResultsThe maximum number of COVID-19 positive cases (31.4%) were found in the age group 20–29 years whereas the age group 40–49 years (11.52 days) and ≥ 60 years (11.5 days) took the maximum time (P = 0.035) for viral clearance. The haematological investigations showed that the Ayurveda treatment maintained the admitted patients' blood profile and coagulation profile. Strikingly, liver and kidney profiles improved post-treatment as Serum Glutamic-Oxaloacetic Transaminase (P = 0.000), Serum Glutamic Pyruvic Transaminase (P = 0.000), Urea (P = 0.000), and Creatinine (P = 0.002) levels were significantly reduced. Likewise, a significant reduction in inflammation markers like C-reactive Protein (P = 0.000), Erythrocyte Sedimentation Rate (P = 0.003), and serum Ferritin (P = 0.000) was also observed. No adverse treatment effects were observed during follow-up of the patients. ConclusionThe above outcomes showed that the Holistic Ayurveda Protocol in treating COVID-19 patients is safe, acceptable and effective. Thus, suggesting the possible integration of Ayurvedic treatment in combating such deadly diseases.

Evaluation of acute intravenous toxicity of HEPES: Is Good's buffer good and safe enough for clinical utilization in nuclear medicine?

ObjectiveGood's buffer or HEPES has advantages over other buffers commonly used in radiopharmaceutical preparation as it exhibits significantly lower complexation tendency with metal ions. However, use of HEPES buffer for radiolabeling reactions, meant for clinical applications, has been underrated due to the non-availability of sufficient toxicity data. The objective of the present study is to find the evidences towards safety of intravenous administration of HEPES through systemic toxicological studies in small animal model to support its safe application for clinical exploitation. ExperimentalA pilot study was performed to investigate the lethal dose of HEPES in female Sprague Dawley rats by administering seven different doses of HEPES solution (150 to 2000 mg/kg), through intravenous pathway. Similarly, for determining maximum tolerated dose (MTD), gradually increasing doses of HEPES (50 to 950 mg/kg) were administered in the same species via similar pathway. Various hematological and clinical pathological investigations were carried out in order to find out the safe administration dose of HEPES in rats. ResultsNo mortality was observed up to 2000 mg/kg doses of HEPES. The doses beyond 300 mg/kg resulted few temporary adverse effects, though these were found to disappear within 4–5 days of dosing. ConclusionThe amount of HEPES to be administered during clinical intervention is usually much lower (typically 1–2.5 mg per kg of body weight of healthy adult) than the MTD determined in rat model during present report. Hence, the utilization of this buffer for preparation of radiolabeled drugs for human investigation may be safe. However, further detailed investigations may be warranted for supporting the candidature of Good's buffer for regular clinical exploitation.

Molecular and haematological investigations on Anaplasma ovis infection in goats in Ahvaz, Iran: Insights into infection rate, haemolytic effect and breed influences.

Anaplasma ovis (A. ovis) is the predominant causative agent of anaplasmosis in goats and sheep in most tropical and subtropical regions of the world. However, there is considerable variation in reported infection rates, breed susceptibility, and controversial findings regarding the haemolytic effects of A. ovis infection in goats. Thus, we investigated the molecular and haematological aspects of A. ovis infection in goats from Ahvaz city. One hundred and fifty apparently healthy goats (74 blacks and 76 Najdi goats) were randomly sampled from six flocks in the Ahvaz suburb during ticks' activity season. Haematological evaluation, smear microscopic (SM) examination and PCR assay were performed to assess A. ovis infection. Additionally, the percentage of parasitemia was determined from blood smears. SM examination revealed that 25.7% of the goats displayed erythrocyte Anaplasma-like inclusion bodies. PCR analysis indicated that 54% of the goats were positive for A. ovis infection (44.6% of blacks and 63.2% of Najdi goats). No significant difference in haematological values was observed between healthy and infected goats based on PCR testing. However, a significant difference in haematological indices was observed between the group with parasitemia level of 0.01-0.02% (SM and PCR positive) compared to the healthy goats (SM and PCR negative), particularly concerning Hb, PCV and RBC count (p < 0.01). When the parasitemia exceeds 0.01%, A. ovis infection may disrupt haematological parameters in infected goats. The high prevalence of A. ovis infection (54%) among the studied goats underscores the importance of giving special attention to implementing necessary measures for disease control in the Ahvaz suburb.

Hepatoprotective Activity of &lt;i&gt;Flueggea virosa&lt;/i&gt; Against d-Galactosamine Induced Liver Damage in Rats

Flueggea virosa belonging to the family Phyllanthaceae, commonly known as White berry bush was traditionally used for the treatment of rheumatism, sterility, and rashes, and an infusion of the root is taken to relieve malaria. The study was intended to evaluate the hepatoprotective effect of hydroethanolic extract of the roots of Flueggea virosa (200, 400, and 600 mg/kg) against d-Galactosamine-induced liver damage in rats. Silymarin (100 mg/kg) was used as a reference drug. Blood samples were collected after 24 h for haematological and biochemical investigation before the rats were euthanized, and liver samples were taken for histopathology. Oral administration of the HEFV at a dose of 200 mg/kg displayed a significant hepatorenal protective effect against d-Galactosamine by lowering liver biomarkers (SGPT, SGOT, and ALP), kidney biomarker levels (urea and creatinine) and hematological parameters when compared with the disease control group. These findings were strongly supported by the histopathological results of liver sections with fewer pathological changes in comparison with the group treated by the standard drug silymarin and verified the protective effect of the plant extract. The LCMS report of the extract revealed the presence of hepatoprotective ingredients like Tocopherol, Fraxetin, Glaucine, Kaempferol, Methicillin, Capsaicin, and Austinol in the hydroethanolic extract of Flueggea virosa root. The results show that the selected dose of Flueggea virosa (200 and 400 mg/kg) showed dose-dependent hepatoprotective effects on d-Galactosamine-induced hepatotoxicity in rats. The protection of Flueggea virosa against d-Galactosamine-induced liver damage and restoration of biochemical values could result from the content of tocopherols and tetrahydroxy flavones.

CAUSE AND EFFECT RELATIONSHIP OF BLOOD LOSS AND CAUSE OF DEATH IN INJURIES AND DISESSES

Forensic medical practice shows that the death of a person can be accompanied by blood loss, which is the result of an injury, or a manifestation of a disease, and therefore, during the forensic medical examination, it is necessary to establish a causal relationship between it and the cause of death. In order to solve these issues, the results of the autopsy, histological examination, analysis of clinical and laboratory hematological data, as well as morphological changes in the heart muscle play a leading role.&#x0D; Aim of the work. Forensic-medical substantiation of the cause of death and features of establishing a cause-and-effect relationship with blood loss in injuries and diseases.&#x0D; Materials and methods. The material of the study was cases of death due to injuries and diseases accompanied by the development of blood loss, which were analyzed in accordance with the instructive forensic and clinical materials.&#x0D; Results. Severe injuries to the human body are accompanied by the development of blood loss, the consequences of which can cause a shock reaction. Clinically, the body's reaction to blood loss occurs when more than 15 % of BCC is lost, and severe shock develops in case of blood loss of more than 25 % of BCC, which is approximately 1,25-1,5 liters of blood. In addition, the speed of blood loss is also important, as a result of which the body's protective mechanisms do not have time to compensate for it. In the case of forensic substantiation of acute blood loss as the cause of death, autopsy and histological examination data are usually used. However, blood loss of varying degrees can also accompany a number of diseases, as a result of which the body develops anemia with hypoxia, which affects the state of the cardiovascular system. In such cases, blood loss does not directly lead to death, but causes disorders in the function of the heart, in particular, exacerbation of the course of coronary disease. This pathogenetic mechanism indicates the absence of a direct causal relationship between blood loss and the onset of death. In such cases, to justify the cause of death, it is necessary to pay attention not only to the presence of clinical indicators confirming blood loss, but also to laboratory hematological data – the content of erythrocytes, the amount of hemoglobin, hematocrit, and most importantly – morphological changes of the heart, which must be described by the most thorough way&#x0D; Conclusions. Complex analysis of all morphological changes and findings during examination of corpse, clinical symptoms of diseases, results of gradual hematological investigations are used to estimate the cause of death. To avoid occurrence or exacerbation of the course of the ischemic heart diseases the monitoring of function of the cardio-vascular systems and electrocardiography in patient with blood loss as symptom of diseases should be used in clinical practice.

A mysterious hematochezia in an adolescent boy: atypical presentation of childhood systemic lupus erythematosus

Thrombosis is a well-known entity in presence of antiphospholipid antibody (APLA) associated with systemic lupus erythematosus (SLE) as a hematological complication. Bleeding manifestations instead of thrombosis is hardly found in literature in presence of APLA seromarkers in SLE. Since these can range from minor bleeding like epistaxis to major life-threatening intracranial bleeding, early diagnosis and prompt treatment is essential to manage such condition. We report a 12 years old boy with no significant past history presented with hematochezia and epistaxis along with pallor requiring blood transfusion. Hematological investigations were normal except for elevated PT, aPTT and INR. Common causes of coagulopathy were ruled out. Upon suspecting systemic diseases, the investigations were carried out which revealed ANA 4+ along with high titre of dsDNA, low C3 and C4 complement and positive anti-β2 glycoprotein, anticardiolipin antibody and lupus anticoagulant. Diagnosis of SLE was made according to ACR-EULAR criteria with no renal involvement. Immunological basis was considered for coagulopathy in this child. He was started on oral prednisolone, hydroxychloroquine and methotrexate. He is now under close monitoring of the coagulation profile for titration of steroid dose. We want to create awareness about the uncommon hematological manifestation of SLE presenting as bleeding diathesis instead of thrombosis through this case report and that can be life threatening too if not treated promptly. A high index of suspicion and careful follow-up may help in preventing adverse outcome of the disease.

AYURVEDIC INTERVENTION IN THE MANAGEMENT OF PANDU ROGA (DIMORPHIC ANAEMIA)

Pandu Roga is an Ayurvedic ailment clinically comparable to many types of Anaemia. This study was done to establish the effect of Ayurvedic management on the patient of Pandu Roga (Dimorphic Anaemia). In the IPD, Arogyashala Rugnalaya, Nashik, from 08/01/2022 to 17/01/2022, A 69-year Male patient, suffering from Pandu Roga (Dimorphic Anaemia) was treated with Ayurvedic management. Shamana Chikitsa (ayurvedic medicinal treatment) And Virechana Karma (Therapeutic Purgation) were administered. The patient felt a significant increase in Hb g% and other hematological investigations. Symptoms were assessed as per the criteria of assessment, and improvement was seen in symptoms. Panduta (Pallor) 75%, Daurbalya (General weakness) 75%, Ayasaja Shwasa (Dyspnoea on exertion) 66.66%, Pindikodveshtana (Leg cramps) 50%, Nidraluta (Sleepiness) 50%, Shiroruk (Headache)100%, Bhrama (Giddiness)0%, Sadana (Fatigue) 66.66%, Gatra Shoola (Body aches) 66.66%, Agnimandya (Impaired appetite) 66.66%, Aruchi (Anorexia) 66.66%. This case study demonstrates that Ayurvedic management was significant in Pandu Roga (Dimorphic Anaemia).

Retrospective Evaluation of Primary Bone Tumors and Their Incidence in the “Ignacio García Téllez” Specialty Hospital CMN IMSS

In 1948, Steiner conducted an analysis of cancer registries in the United States of America, estimating that primary bone tumors constituted approximately 1% of all fetal malignancies. For its part, in Great Britain, a similar incidence of primary bone tumors is observed, fluctuating between 0.8% and 0.9%. A later statistic from the United States at v of 1.87:1000 000 deaths among children under 14 years of age, increasing to 11.97:1000 000 deaths in people aged 11 to 19 years. Since all bone components are derived from the mesoderm, they have the potential to be composed of any of the four basic types of cells: fibroblasts, chondroblasts, osteoblasts and the reticulo-myelogenous series, to achieve a correct diagnosis it is necessary to have the complementary radiological and pathological support to part of biochemical and hematological investigations. The present investigation focused on a retrospective, observational, quantitative, risk-free study, based on the review of records and tracking of histological reports of patients who were treated at the “Ignacio García Téllez” CMN IMSS Specialty Hospital in a period of 5 years, including all those cases with primary tumors of bone or cartilage origin, both benign and malignant of bone marrow and vascular, in addition to pseudotumor lesions such as fibrous dysplasia, metaphyseal fibrous defect, solitary bone cyst. A total of 182 histological records and reports were recorded in a period of 5 years where a total of 93 women and 89 men were recorded, with ages ranging from 3 months of extrauterine life to 87 years. With a mean of 56.53 years and a standard deviation of 18.48 years. 129 benign tumors were reported in 63 men and 66 women; Meanwhile, a total of 53 malignancies were counted in 26 men and 27 women. The current study facilitates the evaluation of the most common neoplasms in our environment, with the aim of raising awareness about the importance of having adequate resources to develop a timely diagnosis and treatment plan for the benefit of patients.

Association between hematological parameters, serum retinol, and glycemic indices in diabetes mellitus: a preliminary case-control study

Background: The global prevalence of type 2 diabetes mellitus (T2DM) is on the rise. Hyperglycemia, free radical damage, and inflammation are commonly implicated as the etiopathological factors of diabetes mellitus. This preliminary study aims to investigate the association of the disease with serum retinol and hematological parameters and compare these parameters with non-diabetic controls. Methods: The biophysical profiles of 85 subjects with diabetes and the same number of healthy controls were recorded using standard techniques. Biochemical and hematological investigations were carried out. The data are expressed as median with interquartile range (IQR) values. Mann–Whitney U-test was conducted to assess the difference between the two groups. Results: There were a significant increase in median values of glycated hemoglobin (HbA1c), fasting blood glucose (FPG), and white blood cells (WBC) and a significant decrease in median values of monocytes in subjects with T2DM as compared to controls. There was a significant negative correlation between eosinophils and FPG in subjects with T2DM. In healthy controls, there was a significant positive correlation between serum retinol, certain hematological parameters, and HbA1c; and there was a significant negative correlation between WBC and FPG. The T2DM group had a significant negative correlation between eosinophil count and FBG. Conclusion: Our study shows that serum retinol levels are not reflective of oxidative stress, but a routine WBC and differential count can shed light on the chronic inflammatory status. These results help with the formulation of targeted treatment to delay progression of the disease and prevent its complications. Relevance for Patients: Vitamin A plays a pivotal role safeguarding the immunity and eye health for diabetic patients, but serum retinol estimation is not reflective of inflammatory or glycemic control status in diabetic patients. They would benefit from a hematocrit test.

Automated Hematological Approach and Protein Electrophoretic Pattern in Tilapia (Oreochromis niloticus): An Innovative and Experimental Model for Aquaculture

This study aimed to assess the usefulness of two innovative automated methods (automated blood count counters and flow cytometry) for hematological investigation in Tilapia to make a contribution to the clinical diagnostics of this farmed species. Moreover, serum total proteins and their electrophoretic fractions (prealbumin, albumin, α-, β-, and γ-fraction), as health condition indicators, were assessed. The analysis of serum total proteins and electrophoretic fraction showed a normal and typical electrophoretic pattern of healthy fish (serum total proteins, 3.70 ± 0.62 g/dL; prealbumin, 0.44 ± 0.20 g/dL; albumin, 1.17 ± 0.66 g/dL; α-fraction, 1.49 ± 0.64 g/dL; β-fraction, 0.32 ± 0.16 g/dL; and γ-fraction, 0.29 ± 0.13 g/dL). The relationships between the values of red blood cells (RBCs), white blood cells (WBCs), and thrombocytes (TCs) obtained with the two automated methods were determined using Pearson correlation analysis. The results showed a significant positive correlation between automatic blood cell counting and flow cytometry analysis for RBCs (r = 0.97, p &lt; 0.0001) and WBCs (r = 0.91, p &lt; 0.0001), whereas no correlation was found for TCs (r = −0.11, p = 0.66). The preliminary results gathered in this study seem to highlight the usefulness of the new analytical techniques herein investigated in tilapia, suggesting their application in the hematological investigation of farmed fish species and their usefulness for monitoring the health and well-being of fish reared in aquaculture.