Higher Total Leukocyte Research Articles

EFFECT OF A SUPPLEMENTED DIET WITH MELATONIN ON PERFORMANCE OF JAVAEN BARB Systomus orphoides (Valenciennes, 1842) JUVENILE

Javaen barb is a native fish in Indonesian inland water with economic value and the potential to be developed as cultured fish resources and ornamental commodities. In the development of aquaculture, there are still problems, such as the low adaptability of the larvae, so that their survival is also low. This study was conducted to evaluate the effect of melatonin supplementation on the productivity of Javaen barb fish juveniles in culture containers. This study was conducted experimentally using a completely randomized design consisting of four treatments with different doses of melatonin supplementation, i.e., A) control (without melatonin supplementation), B) 0.2 mg/100 g of feed, C) 0.4 mg/100 g feed, and D) 0.6 mg/100 g feed, each treatment was repeated three times. Javaen barb juveniles were kept in an aquarium measuring 30×36×60 cm with a water level of 40 cm, consisting of 12 units. Each aquarium was stocked with 150 individuals and given an aeration system with the same air pressure intensity. Feeding was carried out ad-libitum with a frequency of three times daily for 180 days of rearing. The results showed that melatonin supplementation of as much as 0.6 mg/100 g of feed was able to increase the growth of Javaen barb fish juvenile with the highest survival rate (81.33 ± 0.54 %) and feed conversion ratio (2.61 ± 0.14). Melatonin supplementation of 0.6 mg/100 g of feed had higher total leukocyte (3.41±0.73×104 cells/mm3) and hemoglobin (5.07±0.12 g%) values and provided the best production performance in Javaen barb juveniles.

Clinical Profile and Outcome of Acute Pancreatitis in a Tertiary Health Care Center of Nepal

IntroductionAcute pancreatitis is the inflammation of pancreatic parenchyma that can cause local and systemic manifestations. This study aimed to find the clinical profile and an outcome of acute pancreatitis among patients attending the Department of Gastroenterology in a tertiary care center.MethodsA cross-sectional hospital based study comprising of 75 patients of acute pancreatitis, enrolled between August 2022 to June 2023. Clinical profile, complications and outcomes including in hospital mortality were studied. Revised Atlanta classification and modified CT severity index were used for diagnosis and classification. Data entry and analysis were done SPSS-17.ResultsMost common age group was 40-60 years (50.7%). The most common etiology was alcohol (46.7%) and almost all presented with abdominal pain (97%) and abdominal tenderness was present in 80%. Majority were mild pancreatitis (54.7%), followed by moderately severe (32%) and severe pancreatitis (13.3%). Factors that are significantly associated with prolonged stay at hospital and mortality were pleural effusion, necrotizing pancreatitis, acute kidney injury, BISAP score ≥ 2, high total leucocyte count, shock, severe CT severity score, multi organ dysfunction syndrome (MODS), acute respiratory distress syndrome (ARDS)(p≤0.05).ConclusionsAcute pancreatitis is predominant in male gender and 40-60 years age group. It is associated with significant complications and mortality. Different parameters including high BISAP score, pleural effusions, acute kidney injury, leucocytosis and high CRP level on presentation were useful markers to predict outcome.

Immuno-endocrine alterations and oxidative stress induced by commercial formulations of pesticides in the tegu lizard (Salvator merianae)

Recent research has shown the risk of environmental contamination by pesticides in Argentina. Salvator merianae is considered as “sentinel species” for monitoring their effects. We intended to investigate growth, immunological and endocrine functions, and oxidative stress in S. merianae exposed to two commercial brands of the herbicide glyphosate: Roundup and Panzer Gold, as well as, to two insecticides: chlorpyrifos, and cypermethrin. Our results showed a higher increase in growth in animals exposed to Roundup and chlorpyrifos and a lower increase in those exposed to Panzer Gold. Higher total leukocyte and lymphocyte count values were observed in lizards exposed to Panzer Gold. The heterophils/lymphocytes ratio decreased in all treated animals. Regarding lobularity index, natural antibodies titers, and complement system activity values, lizards exposed to cypermethrin had higher values. Low corticosterone levels were observed in animals exposed to Roundup. Our results reveal different toxic effects of pesticides contributing to the knowledge of the pesticides’ potential deleterious impact in the habitat of S. merianae.

Haematological and Innate Immunological Reference Intervals for Farmed Yellow Catfish <i>Horabagrus brachysoma</i> and Their Seasonal Variations

The reference intervals for haematological and innate immune response variables of healthy adult yellow catfish Horabagrus brachysoma raised in captivity were determined. Reference ranges were established for all parameters and significant (P < 0.05) seasonal variations in most of the haematological and innate immune parameters were observed. Total erythrocyte count, packed cell volume, serum lysozyme and myeloperoxidase activities were found to be higher during winter season whereas most of the red blood cell indices, superoxide production by phagocytes, serum ceruloplasmin and anti-protease activities were marked to be significantly higher during rainy season of the year. Except high total leucocyte count and mean corpuscular haemoglobin, other parameters were found to be significantly lower during summer, possibly indicating a higher disease risk in summer months for this species. However, no significant variations in these variables were obtained between male and female catfish during breeding season. The information generated would be indirectly helpful for determining health status of this endangered species.

Bone marrow overexpression of SNAI1 is an early indicator of intrinsic drug resistance in patients with de novo acute myeloid leukemia.

The lack of effectiveness of acute myeloid leukemia (AML) treatment remains a major challenge and resembles a principal cause of AML-related mortality owing to chemotherapy resistance. SNAI1 has been proved to be a leading factor in drug resistance in many cancer types. However, its relation to chemoresistance in AML is not well understood. In addition to standard lab work, the expression level of SNAI1 was determined in bone marrow samples of 109 adult and pediatric patients with de novo acute myeloid leukemia using RT-qPCR. The relation between SNAI1 and AML drug resistance and immunomodulatory genes was investigated using the STRING tool. The SNAI1 expression level was upregulated in AML patients in particular samples with promyelocytic leukemia subtype against control cases. In the treatment response, SNAI1 was significantly higher in resistant patients in comparison with the complete remission group. SNAI1 overexpression was associated with high initial blasts and total leukocyte counts, but with HLA class II histocompatibility antigen DR downregulation. STRING analysis showed that multiple drug resistance and immunomodulatory genes of AML induce SNAI upregulation and activation. Kaplan-Meier analysis indicated that there was no relation between SNAI1 expression level and patient survival status. We conclude that the SNAI1 expression level may be a predictor of intrinsic drug resistance incidence in AML patients.

Characteristics of TP53 mutation in adult precursor B-cell acute lymphoblastic leukemia

Abstract Objectives TP53 is the most intensively studied gene in cancer. However, data on the frequency and prognostic significance of TP53 mutations in acute lymphoblastic leukemia (ALL) are still lacking. This study aimed to determine the characteristics of TP53 mutation, its correlation with clinical and laboratory parameters and other cytogenetic alterations, and their impact on patient outcome on day 21 after induction therapy. Patients and methods This is a prospective cohort clinical study that was conducted on 41 de-novo adult ALL patients, who presented to the Hematology/Oncology Unit of Ain-Shams University Hospitals, where all studied patients were subjected to the treatment regimen. TP53 mutation was investigated in 41 patient samples using the RT-PCR. Results TP53 mutation was detected in 19.5% of studied cases. A highly significant association was detected between 17P deletion and TP53 mutation (P<0.0001). A significant association was detected between TP53 mutation and abnormal karyotyping (P=0.032). The authors found a clear association between TP53 mutation and hypodiploidy (P=0.001) and MYC rearrangements (P=0.001). In contrast, TP53 mutation was clearly underrepresented in ALL patients with t(9;22)(q34;q11). A highly significant association between TP53 mutation and the poor outcome on day 21 (P=0.002) was observed. The patients with TP53 mutation revealed either failure of remission (50%) or incomplete remission (50%). Logistic regression analysis of factors influencing the patient outcome showed that advanced age (>34 years), high total leukocyte count (>40 × 109/l), and abnormal fluorescence in-situ hybridization and karyotyping results due to cytogenetic abnormalities are independent predictors of poor outcome with failure of induction of complete remission on day 21. Conclusion TP53 alterations strongly identify high-risk adult precursor B-ALL patients with poor outcome in this study; yet, this needs further investigation on a larger sample size with a longer follow-up. Investigations of TP53 mutation especially in adult B-cell ALL (accounting 75% of adult ALL) may help with the selection of patients in need of intensive therapeutic strategy or may help with designation of new innovative targeted therapies.

Impact of sepsis in patients admitted with covid-19 infection in a tertiary care center in Delhi. A retrospective cross-sectional study.

COVID-19 pandemic has emerged as one of the worst humanitarian crises in human history. Viral sepsis is implicated as a major source of morbidity and mortality in COVID-19 infection. The study provides an insight into impact of COVID -19 associated sepsis on the patient's clinical course and mortality. The study was conducted on 112 participants admitted with symptomatic COVID -19 infection in a COVID -19 designated center in New Delhi, India between July and October 2020. 41.1% (n=46) of the participants had critical disease which includes sepsis. Out of 46 Critical patients 19 (41.3%) had sepsis, 21(45.7%) had septic shock and 6 (18.8%) had Sepsis with ARDS. Sepsis and septic shock at time of presentation was associated with higher mortality. Severe and critical illness was marked by advance age, comorbidities like Diabetes mellitus, high total leucocyte count and deranged renal and hepatic function in the study. Thus COVID-19 induced sepsis is an important determinant of disease severity precipitating multiorgan dysfunction and adverse outcome in patients.

Molecular investigations on outbreaks of ovine theileriosis among sheep and goats in Haryana, India.

During February 2020 to October 2020, four outbreaks of theileriosis in small ruminants were recorded with overall morbidity, mortality and case fatality rates of 27.95%, 17.46% and 62.5%, respectively. The disease was characterized by high fever (up to 106°F), superficial lymphadenopathy, anaemia, anorexia, lethargy, respiratory distress and death. The presence of pleomorphic intra-erythrocytic piroplasms of Theileria species in Giemsa's stained blood smears was a common finding in all the episodes. Significant haematological alterations including high total leucocyte count and low haemoglobin and packed cell volume were characteristic. Necropsy findings of the icteric liver, enlarged spleen, pulmonary oedema and abomasal ulcerations were observed in three flocks. Smear-positive blood samples from all the episodes were screened by PCR using 18S rRNA gene-specific primer sets for T. lestoquardi, T. luwenshuni, T. uilenbergi and T. ovis. T. lestoquardi which was detected in all four flocks, while there was co-infection of T. ovis in two flocks. Phylogenetic analysis revealed that T. ovis and T. lestoquardi identified in this study had 100% and ~ 99.86% homology, respectively, with the published sequences used for comparison. This is the first confirmed report of outbreaks of malignant ovine theileriosis in the Haryana state of India which caused high morbidity, mortality and case fatality among sheep and goats. Further studies on theilerioses in small ruminants are required to understand epidemiology better.

The Hematological and Biochemical Profiles of Wonosobo Sheep Blood in Various Physiological Conditions

The study aimed at examining the hematological and biochemical profiles of Wonosobo sheep blood in various physiological conditions. There were 32 Wonosobo sheep in the various physiological conditions, including 17 ewe lamb of 1-2 months of age, 5 pregnant female sheep of 12-48 months of age at 3 months of pregnancy, 5 ewe of 12-48 months of age in second lactation period of 1-2 months and 5 ram of 12-48 months of age. Each of the sheep was put in individual sheepfold and given Pakchong-1 grass, dried kangkong, and concentrate. Drinking water was given ad libitum. Blood sample was drawn from jugular vein and put into tubes for blood hematological and biochemical analyses. The results of the study showed that total leukocyte and lymphocyte were high in young sheep, while neutrophils was high in pregnant female sheep (P<0.05). There was not any significant physiological impact on hemoglobin, MCV, MCH, MCHC, RDW, hematocrit, platelet, monocyte, eusinophil, and basophil (P>0.05). The highest ALP activity and Pi levels were found in the ewe lamb, while low creatinine was found in the ram (P<0.05). The parameter of the activities of SGPT, SGOT, LDH, calcium, kalium, chloride, sodium, magnesium, TIBC, UIBC, TS, globulin, albumin, total protein, BUN, creatinine, glucose, cholesterol, triglyceride, HDL and LDL was not affected by physiological conditions (P>0.05). It was concluded that the impact of the physiological conditions of the Wonosobo sheep caused high total leukocyte and lymphocyte in ewe lamb and high neutrophil in pregnant female sheep, the increase in the Pi level and ALP activity of the ewe lamb, and high creatinine in the ram

High blood neutrophil counts and ischemic vascular disease: Observational and genetic studies

Background and Aims : Background: High total leukocyte and neutrophil counts and the ratio between them have been associated with high risk of cardiovascular disease. Specific ischemic vascular endpoints have however not been investigated and the causal potential of such associations remains unexplored. Our aim was to examine the associations between blood leukocyte subpopulation counts and risk of specific ischemic vascular endpoints using observational and genetic studies.

Differentiating flare and infection in febrile lupus patients: Derivation and validation of a calculator for resource constrained settings.

Background: Patients with Systemic Lupus Erythematous (SLE) are at an increased risk of infection and it is often difficult to differentiate between infection and disease activity in a febrile patient with SLE. Methods: Patients with SLE (SLICC criteria) presenting with fever between December 2018 and August 2021 were included. Neutrophil to lymphocyte ratio (NLR), NEUT-x, -y, -z indices, Erythrocyte sedimentation rate (ESR), C-reactive protein(CRP), C3, C4, anti-dsDNA antibodies, and procalcitonin(PCT) were tested in addition to investigations as per the treating physician's discretion. Based on the clinical assessment and laboratory data, the febrile episode was classified into infection, disease flare, or both. Statistical analysis was done using GraphPad prism v8.4.2. A novel composite score was devised and validated with a calculator incorporated is a spreadsheet. The performance of a previously proposed model of duration of fever, CRP, and dsDNA (Beca et al) was evaluated and other models using PCT and NEUT-Z were explored. Results: Among 168 febrile episodes in 166 patients with SLE (25 (19-32) years), 46 were due to infection, 77 due to flare, 43 due to both, and two due to other causes. High SLEDAI 2K (0.001), anti-dsDNA (p = 0.004), and low complements(C3, p = 0.001 and C4, p = 0.001) were characteristic of disease flare, whereas high total leukocyte count (TLC) (p = 0.008), NLR (p = 0.008), NEUT-x (p = 0.001), -y (p = 0.03), -z (p = 0.002), CRP (p = 0.001), and PCT (p = 0.03) were observed with infection. A model using age, TLC, and CRP was devised using 80% of the cohort with an AUC of 0.88 (0.78-0.97) which was validated in the remaining 20% to have an AUC of 0.83(0.60-1.0). The model devised by Beca et al yielded an AUC of 0.74. Use of PCT did not improve the discrimination between flare and infection. A Model of C4 and NEUT-z analyzed in a subset performed well and needs further exploration. Conclusion: A composite score of low cost and routinely available parameters like age, TLC, and CRP gives a good discrimination between infection and flare in a febrile patient with SLE.

Outcomes and Predictors of Non-Responsiveness in Treatment of Naïve and Non-Cirrhotic Patients with HCV Genotype 3 Infection – A Third World Perspective

Objective: To assess the clinical outcome in treatment naïve and non-cirrhotic patients with HCV genotype 3 infection after treatment with Sofosbuvir with declastasvir and valpatasvir (in case of non-responsiveness).
 Methods: Study included 263 participants. The inclusion criteria were HCV genotype 3 infection confirmed through PCR, age above 18 years, treatment naïve and non-cirrhotic. HCV PCR below the threshold of quantification at 12th week of treatment was defined as SVR12 (sustained virological response). The patients were started on a fixed dose generic combination of declastasvir 60 mg and Sofosbuvir 400 mg and PCR was performed at 12, 24 and 48 weeks. PCR positive patients at 24 weeks were given valpatasvir with Sofosbuvir.
 Results: There were 162 males and 101 females. PCR performed at 12 weeks showed that 251 patients (95.4%) became PCR negative and 12 (4.56%) remained positive. Repeat PCR of these 12 patients started on valpatasvir and Sofosbuvir at 48 weekswas negative. The treatment was well tolerated by all.Probability of positive HCV PCR at 12 weeks decreases by 0.73 with one unit increase in the hemoglobin, whereas one unit increase in TLC reduces the probability of HCV PCR at 12 weeks, positive by 0.001.
 Conclusion: The combination of Sofosbuvir and declastasvir is a cheap and effective treatment strategy for treatment naïve and non-cirrhotic HCV genotype 3 infections. Those not responding will achieve PCR negativity with a 6 month therapy of Sofosbuvir and valpatasvir combination. A high hemoglobin level and high total leucocyte count are predictors of good treatment response.

Risk Factors of Pulmonary Tubercuosis and its Hematological Parameters

Objective: The purpose of this study is to determine the different peripheral blood parameters and risk factors in pulmonary tuberculosis patients. Study Design: Case Control study Place and Duration: Mayo Hospital Lahore. Feb 2021-Aug-2021 Methods: There were 70 patients of both genders were presented in this study. Age of the patients was between 20-70 years. After obtaining informed written agreement, the demographics of enrolled patients were recorded, including age, sex, physique mass index, socioeconomic status, residence, and employment. All the patients had confirmed tuberculosis. As a precaution, a little amount of venous blood was drawn. Sysmex KX 21 haematology analyzer and a peripheral smear were used to analyse around 2 ml of blood in an EDTA tube. Only 2 cc of the patient's blood were utilised to calculate ESR using the Westergren tube technique. Patients filled out a questionnaire that asked them about their symptoms, and the information was then entered into a database. SPSS 21.0 was used to analyze complete data. Results: Among 70 cases, 38 (54.3%) were males and 32 (45.7%) were female patients with mean age 42.61 ±11.43 years. Majority of the patients 52 (75.7%) had lower socio-economic status and 50 (71.4%) patients were from rural areas. 45 (64.3%) patients were jobless. Smoking and alcohol abuse was the most common cause among all cases. There were significant differences between the sexes patients and normal level in the hematocrit (Hb), PCV, RBC count, MCV, MCH values (p-value 0.05). Cases had a considerably lower platelet count. Patients had considerably higher total leukocyte, ESR readings compared to normal level (p-value 0.05), and the difference was statistically significant.ad considerably higher total leukocyte, ESR readings compared to normal level (p-value 0.05), and the difference was statistically significant. Conclusion: We concluded that ESR, platelets, and leukocytes are all haematological markers that may be used to identify patients at an early stage of the illness. Common risk factors for TB transmission in the target group were malnutrition, cigarette use, living in crowded conditions, illiteracy, and poverty. Keywords: Tuberculosis , Hemoglobin, Hematology, ESR, Risk factors

Importance of High C-Reactive Protein (CRP) And Total Leukocyte Count (TLC) In Odontogenic Space Infections

Background: An acute inflammatory homo-pentameric plasma protein, C-reactive Protein, discovered in 1930, is found in small amounts in healthy persons and plays an important role in natural immune system, activation of compliment system and phagocytosis and antigen clearance. Aim: To determine high C - reactive protein (CRP) and Total Leukocyte Count (TLC) in patients suffering from odontogenic space infections. Methods: Present study was carried out in the department of Oral Surgery at Islam Dental College, Sialkot from Sept. 2020 to Oct 2021. A total of 151 male and female patients of 22-65 years age range with odontogenic space infection were included. Patients suffering from chronic disease like diabetes, chronic renal failure, and pregnant women were excluded. Sample of patient’s blood was sent to the hospital laboratory for measurement of serum C - reactive protein (CRP) and Total Leukocyte Count (TLC) levels. Results: Patient’s age range in our study was 22 to 65 years with mean age of 54.5±14.68 years. Out of 151 patients, 93 (61.58%) were male and females were 58 (38.42%) showing male to female ratio of 1.6:1. Mean CRP levels were 3.52±1.23 mg/L and Mean TLC levels were 13670 ± 1890 cells/mm3. In our study, frequency of raised CRP levels was found in 100% and TLC in 71.82% of patients with odontogenic space infections. Conclusion: This study concluded that frequency of raised C-Reactive Protein (CRP) levels are found in 100% patients, indicating CRP to be an effective biomarker in infected patients. Keywords: Odontogenic Infections, C-Reactive Protein (CRP), Total Leukocyte Count (TLC).

Is Fatty Liver Associated with Increased Mortality and Morbidity in Coronavirus Disease 2019 (COVID-19) Pneumonia?

BackgroundFatty liver has been shown to be associated with severe COVID-19 disease without any impact on mortality. This is based on heterogenous criteria for defining both fatty liver as well as the severity parameters. This study aimed to study the impact of fatty liver on the mortality and severity of disease in patients with COVID-19 pneumonia.MethodsIn a case control study design, patients with COVID-19 pneumonia (COVID-19 computed tomography severity index [CTSI] on high-resolution computed tomography chest of ≥1) with fatty liver (defined as liver to spleen attenuation index ≤5 on noncontrast computed tomography cuts of upper abdomen) were compared with those without fatty liver. The primary outcome measure was in-hospital mortality, and the secondary outcome measures were CTSI score, need for intensive care unit (ICU) care, need for ventilatory support, duration of ICU stay, and duration of hospital stay.ResultsOf 446 patients with COVID-19 pneumonia, 289 (64.7%)admitted to Max Hospital, Saket, India, between January 1, 2021, and October 30, 2021, had fatty liver. Fifty-nine of 446 patients died during the index admission. In-hospital mortality was not different between patients with fatty liver (38 [13.24%]) or without fatty liver (21 [13.81%]). COVID-19 CTSI score was found to be significantly higher among patients who had fatty liver (13.40 [5.16] vs 11.81 [5.50]; P = 0.003). There was no difference in the requirement of ICU (94 [32%] vs 62 [39.49%]; P = 0.752), requirement of ventilatory support (27 [9.34%] vs 14 [8.91%]; P = 0.385), duration of ICU stay (8.29 [6.87] vs 7.07 [5.71] days; P = 0.208), and duration of hospital stay (10.10 [7.14] vs 10.69 [8.13] days; P = 0.430) between the groups with fatty liver or no fatty liver. Similarly, no difference was found in primary or secondary outcomes measure between the group with severe fatty liver vs mild/moderate or no fatty liver. High total leucocyte count and Fibrosis-4 (FIB-4) index were independently associated with mortality.ConclusionsFatty liver may not be associated with increased mortality or clinical morbidity in patients who have COVID-19 pneumonia.

Haematological parameters in COVID-19 disease

Background: The coronavirus disease 2019 (COVID-19) is an infectious disease caused by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) and was declared as a pandemic by World Health Organization. Various haematological parameters alteration has been documented in SARS-CoV-2 infection. However, there is a need for research to evaluate the pattern of the haematological parameters of COVID-19 patients. Aims: The main aim of this study was to determine demographic characteristics, to study various haematological parameters and their relation with the outcome of the disease. Materials and Methods: A total of 150 patients who tested positive for COVID-19 were included in the study. A prospective study was done in the Department of Pathology, GCS Medical College, Hospital and Research Centre, Ahmedabad, for the period of 15 days (01 August 2020–15 August 2020). Patients were categorised according to severity, oxygen (O2) requirement and their the outcome. Haematological parameters and clinical data were obtained. Median values of age and haematological parameters were compared between these groups. Results: Patients who needed oxygen support had higher median age, absolute neutrophil count and platelet-to-lymphocyte ratio. Patients in the intensive care unit (ICU) had higher age, leucocytosis with absolute lymphopoenia and a high neutrophil-to-lymphocyte ratio. The parameters found to be associated with a poor outcome were higher median age with low haemoglobin, low mean corpuscular volume and absolute lymphopoenia. Conclusions: Males and older people are more prone to COVID-19 infection. Parameters such as high total leucocyte count, high absolute neutrophil count, low absolute lymphocyte count and high neutrophil-to-lymphocyte ratio may be considered cardinal laboratory findings with prognostic potential for the requirement of O2, ICU admission and poor outcome of COVID-19 disease.

Novel Risk Classification Based on Pyroptosis-Related Genes Defines Immune Microenvironment and Pharmaceutical Landscape for Hepatocellular Carcinoma.

Simple SummaryIt has been indicated that pyroptosis functions in the development of cancer as well as the orchestration of cancer cell death. Nonetheless, specific roles of pyroptosis-related genes in tumor progression, immune response, prognosis and immunotherapy have, to date, not been thoroughly elucidated. After a comprehensive evaluation of pyroptosis patterns, unsupervised clustering was performed to generate three distinct clusters of 26-gene profiles from HCC. We aimed to establish an efficiency criterion for classifying and predicting patients’ prognosis. After comprehensive analysis of the clustering and risk scoring system, satisfactory sensitivity and specificity are demonstrated, and new insights into the molecular characterization of pyroptosis-related subtypes are contributed.Growing evidence has indicated that pyroptosis functions in the development of cancer. Nonetheless, specific roles of pyroptosis-related genes in tumor progression, immune response, prognosis, and immunotherapy have not been thoroughly elucidated. After a comprehensive evaluation of pyroptosis genes, unsupervised clustering was performed to generate three distinct clusters from hepatocellular carcinoma (HCC) samples. Three distinct pyroptosis-related molecular subtypes comprising three gene clusters that had differential prognostic effects on patient survival were then identified. Immune characteristics analyses revealed diversified immune cell infiltration among the subtypes. Two clusters served as immune-hot phenotypes associated with significantly poorer survival compared to a remaining third immune-cold cluster. Among these, the immune-hot clusters were characterized by abundant adaptive immune cell infiltration, active CD4+ and CD8+ T cells, high total leukocyte counts and tumor growth status, and lower Th17 cell and M2 macrophage densities. Then, risk scores indicated that low-risk patients were more sensitive to anti-tumor therapy. Subsequently, we found a significant correlation between pyroptosis and prognosis in HCC and that pyroptosis genes drive the heterogeneity of the tumor microenvironment. The risk scoring system, based on pyroptosis-related differentially expressed genes, was established to evaluate the individual outcomes and contribute to new insights into the molecular characterization of pyroptosis-related subtypes.

Atypical Kawasaki disease in an early infant, a diagnostic challenge: Case report

A 4.5-month-old girl presented to us with continuous fever for 10 days and loose stools for 2 days. She received short courses of multiple oral antibiotics during this period however, was not relieved. Initial investigations were suggestive of urinary tract infection for which broad spectrum antibiotics were started. However, fever persisted even after 72 h of antibiotics. Blood counts showed persistently high total leukocyte count and increasing platelet count, along with high C-reactive protein. Consequently, a diagnosis of Kawasaki disease (KD) was suspected, which was supported by echocardiographic findings. After she received intravenous immunoglobulins, her fever subsided and lab parameters showed significant improvement. This case highlights an unusual presentation of KD in an uncommonly young age group without much clinical pointers except for persistent fever.

PREVALENCE OF PSEUDOMONAS CAUSING SECONDARY INFECTION IN PULMONARY TUBERCULOSIS PATIENTS

Background: Secondary bacterial infection is one of the most common complications in pulmonary tuberculosis (PTB) patients. Gram negative bacteria were commonly isolated from from adults hospitalized with secondary bacterial infection. So we conducted this study to assess the prevalence of secondary infection caused by Pseudomonas among active pulmonary tuberculosis patients. Materials and Method: It is a single centre hospital based observational study. 115 pulmonary tuberculosis patients aged above 14 years, with suspicion of secondary infection clinically or having complaints of fever, productive cough, chest pain, shortness of breath, and increased sputum purulence, inspite of taking antitubercular therapy or pulmonary tuberculosis patients with high total leucocyte counts were included. Results: Out of 115 samples sent for sputum pyogenic culture, approximately one fth (17.39%) were positive for Pseudomonas. Mean age was 46.69 ± 16.40 years in our study. Conclusion: Pseudomonas species are a major cause of secondary bacterial infection in patients with PTB on treatment.

Identification of predictors and model for predicting prolonged length of stay in dengue patients.

Purpose: Our objective is to identify the predictive factors and predict hospital length of stay (LOS) in dengue patients, for efficient utilization of hospital resources. Methods: We collected 1360 medical patient records of confirmed dengue infection from 2012 to 2017 at Max group of hospitals in India. We applied two different data mining algorithms, logistic regression (LR) with elastic-net, and random forest to extract predictive factors and predict the LOS. We used an area under the curve (AUC), sensitivity, and specificity to evaluate the performance of the classifiers. Results: The classifiers performed well, with logistic regression (LR) with elastic-net providing an AUC score of 0.75 and random forest providing a score of 0.72. Out of 1148 patients, 364 (32%) patients had prolonged length of stay (LOS) (> 5 days) and overall hospitalization mean was 4.03 ± 2.44 days (median ± IQR). The highest number of dengue cases belonged to the age group of 10-20 years (21.1%) with a male predominance. Moreover, the study showed that blood transfusion, emergency admission, assisted ventilation, low haemoglobin, high total leucocyte count (TLC), low or high haematocrit, and low lymphocytes have a significant correlation with prolonged LOS. Conclusion: Our findings demonstrated that the logistic regression with elastic-net was the best fit with an AUC of 0.75 and there is a significant association between LOS greater than five days and identified patient-specific variables. This method can identify the patients at highest risks and help focus time and resources.Supplementary InformationThe online version contains supplementary material available at 10.1007/s10729-021-09571-3.