Higher White Blood Cell Count Research Articles

Catheter-Related Blood Stream Infections and Associated Factors Among Hemodialysis Patients in a Tertiary Care Hospital.

Non-tunneled central venous catheter remains the preferred vascular access at hemodialysis initiation in developing countries despite a high burden of infection complications. The goal of this study was to determine the burden, risk factors, and microbiological spectrum of catheter-related bloodstream infections at a tertiary care center in Ethiopia. A retrospective cross-sectional study design was applied among patients who underwent central venous catheter insertion for hemodialysis between January 2016 and June 2022 with no native arteriovenous fistula and stayed more than 48 hours. Data were collected from the patient's registration book, patient charts, and microbiology registry and analyzed using SPSS 21. Binary logistic regression was applied to assess the relationship between the independent and outcome variables. P-values less than 0.05 with AOR and 95% CI were used as statistically significant variables. In this study, 353 patients were included. The mean age was 39±17.9 years and the average duration of catheter stay was 58 ±95 days. A hundred thirty-five (38.2%) CRBSIs were documented with an incidence rate of 7.74 episodes per 1000 catheter days. The causative microorganism was predominantly gram-negatives (57.6%). Duration of a catheter (AOR: 0.3; P < 0.001), previous CVC infection (AOR: 11.9; P < 0.001), high white blood cell count (AOR: 0.31; P<0.001), urban residence (AOR: 1.92; P<0.05), and low hemoglobin levels (AOR: 2.78; P < 0.05) were independently associated with catheter-related bloodstream infections. In conclusion, the incidence of catheter-related bloodstream infection among patients on hemodialysis was high with gram-negative predominance. Early fistula must be planned to reduce the duration of temporary vascular access.

Ischemia prediction score (IsPS) in patients with strangulated small bowel obstruction: a retrospective cohort study

BackgroundsIntestinal ischemia of strangulated small bowel obstruction (SSBO) requires prompt identification and early intervention. This study aimed to evaluate the risk factors and develop a prediction model of intestinal ischemia requiring bowel resection in SSBO.MethodsThis was a single-center, retrospective cohort study of consecutive patients underwent emergency surgery for SSBO from April 2007 to December 2021. Univariate analysis was performed to identify the risk factors for bowel resection in these patients. Two clinical scores (with contrasted computed tomography [CT] and without contrasted CT) were developed to predict intestinal ischemia. The scores were validated in an independent cohort.ResultsA total of 127 patients were included, 100 in the development cohort (DC) and 27 in the validation cohort (VC). Univariate analysis showed that high white blood cell count (WBC), low base excess (BE), ascites and reduced bowel enhancement were significantly associated with bowel resection. The ischemia prediction score (IsPS) comprised 1 point each for WBC ≥ 10,000/L, BE ≤ -1.0 mmol/L, ascites, and 2 points for reduced bowel enhancement. The simple IsPS (s-IsPS, without contrasted CT) of 2 or more had a sensitivity of 69.4%, specificity of 65.4%. The modified IsPS (m-IsPS, with contrasted CT) of 3 or more had a sensitivity of 86.7%, specificity of 76.0%. AUC of s-IsPS was 0.716 in DC and 0.812 in VC, and AUC of m-IsPS was 0.838 and 0.814.ConclusionIsPS predicted possibility of ischemic intestinal resection with high accuracy and can help in the early identification of intestinal ischemia in SSBO.

The association between schizophrenia and white blood cells count: a bidirectional two-sample Mendelian randomization study

BackgroundPositive associations between the risk of schizophrenia and the level of white blood cells (WBC) count have been suggested by observational studies. However, the causality of this association is still unclear.MethodsWe used a group of bidirectional two-sample Mendelian randomization (MR) analyses to estimate the causal relationship between schizophrenia and WBC count traits (i.e., WBC count, lymphocyte count, neutrophil count, basophil count, eosinophil count, and monocyte count). The threshold of FDR-adjusted P < 0.05 was considered as showing potential evidence of a causal effect. Instrument variables were included based on the genome-wide significance threshold (P < 5 × 10− 8) and linkage disequilibrium (LD) clumping (r2 < 0.01). In total, 81, 95, 85, 87, 76, and 83 schizophrenia-related single nucleotide polymorphisms (SNPs) were used as genetic instruments from Psychiatric Genomics Consortium for six WBC count traits, respectively. And in reverse MR analysis, 458, 206, 408, 468, 473, and 390 variants extracted from six WBC count traits were utilized as genetic instruments, which were obtained from a recent large-scale Genome-Wide Association Study (GWAS).ResultsGenetically predicted schizophrenia was positively associated with the level of WBC count [odds ratio (OR) 1.017, 95% confidence interval (CI) 1.008–1.026; P = 7.53 × 10− 4], basophil count (OR 1.014, 95%CI 1.005–1.022; P = 0.002), eosinophil count (OR 1.021, 95%CI 1.011–1.031; P = 2.77 × 10− 4), monocyte count (OR 1.018, 95%CI 1.009–1.027; P = 4.60 × 10− 4), lymphocyte count (OR 1.021, 95%CI 1.012–1.030; P = 4.51 × 10− 5), and neutrophil count (OR 1.013, 95%CI 1.005–1.022; P = 0.004). WBC count traits are not associated with the risk of schizophrenia in our reverse MR results.ConclusionSchizophrenia is associated with elevated levels of WBC count (i.e., higher WBC count, lymphocyte count, neutrophil count, basophil count, eosinophil count, and monocyte count).

A retrospective study of patients with Stenotrophomonas maltophilia peritonitis undergoing peritoneal dialysis

BackgroundStenotrophomonas maltophilia (S. maltophilia) is being increasingly recognized as an important cause of nosocomial infections, particularly in immunocompromised patients, such as patients undergoing dialysis. S. maltophilia peritonitis is strongly associated with the loss of peritoneal catheter among patients undergoing peritoneal dialysis (PD) owing to its resistance to different groups of antibiotics. Thus, the aim of this study was to investigate the characteristics of and risk factors for S. maltophilia peritonitis in patients undergoing PD.MethodsThis single-center, retrospective, case–control study was conducted between April 2013 and October 2022. Patients who were undergoing PD at Kawashima Hospital and were diagnosed with S. maltophilia peritonitis were included in this study. Controls were randomly selected from among patients who were undergoing PD and were diagnosed with peritonitis caused by microorganisms other than S. maltophilia. The demographic data, clinical characteristics, and initial treatment data of the patients were analyzed to determine the risk factors for PD-related S. maltophilia peritonitis.ResultsFive patients with S. maltophilia peritonitis and 15 controls (three controls to one case) were included in this study. The incidence of S. maltophilia peritonitis was significantly more frequent among patients with diabetes mellitus (80.0% vs. 20.0%; p = 0.031) and among patients with higher white blood cell counts in the dialysate after appropriate antibiotic therapy (2561/µL [349–4654/µL] vs. 20/µL [20–23/µL]; p = 0.0006) than among the control patients. Although all the patients were treated with appropriate antibiotics after the identification of S. maltophilia, they had a significantly higher rate of catheter removal than the controls (80.0% vs. 0.0%; p = 0.001).ConclusionsDiabetes mellitus may be an important risk factor for S. maltophilia peritonitis in patients undergoing PD.

Change in perioperative neutrophil-lymphocyte ratio as a potential predictive biomarker for chronic postsurgical pain and quality of life: an ambispective observational cohort study.

Accurate and accessible predictors of chronic postsurgical pain (CPSP) to identify high-risk postsurgical patients are prerequisite for preventive and interventional strategies. We investigated the incidence and risk factors of CPSP after abdominal surgery, with a focus on plasma immunological markers. This was a retrospective analysis of patients who underwent abdominal surgery under general anesthesia at a tertiary center between January 2021 and January 2022. The preoperative demographics, laboratory test data, and surgical factors of the participants were collected from the electronic medical record system. Postoperative pain intensity and living conditions at 1 year after discharge from the hospital were assessed via a phone survey. Univariate and multivariate analyses were used to explore independent risk factors associated with CPSP. A total of 968 patients were included, and 13.53% (n = 131 of 968) of patients reported CPSP 1 year after surgery. Patients with older age, open surgery, higher American Association of Anesthesiologists classification, patient-controlled intravenous analgesia application, longer surgery duration, higher postoperative absolute neutrophil count, and neutrophil-lymphocyte ratio (NLR), lower postoperative absolute lymphocyte count, and higher white blood cell count, were more likely to suffer from CPSP. A changed ratio of NLR (postoperative to preoperative) ≥ 5 significantly correlated with CPSP, moderate to severe pain, maximum numeric rating score since discharge from the hospital, and affected quality of life. The changed ratio of NLR could be used for the early identification of patients at risk for CPSP and affect the quality of life to alert the clinician to undertake further assessment.

The Prevalence of Chest Infection in Patients with Heart Failure in Al-Wahadah Teaching Hospital, Dhamar, Yemen

Background: Heart failure is a common clinical manifestation of most organic heart diseases that progress to the end stage. Patients with heart failure are often accompanied by secondary conditions such as pulmonary circulatory congestion and pulmonary edema, which can lead to dyspnea, gas exchange disorders, and other consequences, creating certain conditions for pathogens to invade and colonize the lungs. Therefore, patients with heart failure may have higher risk of pulmonary infection. Aim: This study aimed to assess the prevalence of chest infection among patients with heart failure and to determine the characteristics of the patients with heart failure who had chest infection and the potential risk factors. Methods: A retrospective, descriptive cross-sectional study was carried out at internal medicine department, Al-Wahdah Teaching Hospital, Dhamar, Yemen over six months (June – December 2022). A total of 100 patients were enrolled in our study. A semi-structured questionnaire was designed and used for data collection. Results: A total of 100 heart failure patients including 53 (53%) males, and 47 (47%) females were successfully enrolled in this study. The majority of participated patients were of age group 40 – 60 years (55%), and were of rural residence (83%). Chest infection was documented in approximately two-thirds of included patients (63%). Chest infection was documented in majority of patients who were smokers, Qat chewer, shamma intakes, being obese, had cardiomyopathy, as well as those patients who had dyspnea of NYHA class III &amp; IV, orthopnea, PND, productive cough, high sputum amount, whitish sputum color, peripheral chest pain, fatigue, sweating, fever and high WBC count, such associations were significant statistically. Conclusion: This study revealed that, chest infection in heart failure patients was common with overall prevalence of (63%) among included patients this study was. Based on this, an early prevention and intervention measures should be taken to reduce pulmonary infections in patients with heart failure.

Impact of the Stress Hyperglycemia Ratio on In-Hospital and Long-Term Poor Prognosis in Patients with Acute Myocarditis.

Few studies have focused on the impact of stress hyperglycemia on adverse outcomes in patients with acute myocarditis. We conducted the present study to assess the association between the stress hyperglycemia ratio (SHR) and poor prognosis in patients with acute myocarditis. From 2006 to 2020, 185 patients with acute myocarditis were enrolled. The SHR was defined as glucose at admission divided by estimated average glucose ([(1.59 HbA1c %) - 2.59], glycated hemoglobin [HbA1c]). Participants were divided into two groups according to their SHR values. The primary endpoint was defined as in-hospital major adverse cardiovascular events (MACE), including death, heart transplantation, the need for mechanical circulatory support (MCS), and transfer to the intensive care unit (ICU). The secondary endpoint was defined as long-term MACE. Subjects in the higher SHR group had more serious conditions, including lower systolic blood pressure, higher heart rate, higher white blood cell count, higher levels of alanine transaminase, troponin I, and C-reactive protein, and worse cardiac function. Multivariate logistic analysis showed that SHR 1.12 (hazard ratio (HR): 3.946, 95% confidence interval (CI): 1.098-14.182; p = 0.035) was independently associated with in-hospital MACE in patients with acute myocarditis. Kaplan-Meier survival analysis and multivariate Cox analysis suggested that an SHR 1.39 (HR: 1.931, 95% CI: 0.323-2.682; p = 0.895) was not significantly associated with long-term prognosis. SHR was independently associated with in-hospital adverse outcomes in patients with acute myocarditis but not with long-term prognosis.

Development and Validation of a Prognostic Risk Model for Patients with Advanced Melanoma Treated with Immune Checkpoint Inhibitors.

Risk stratification tools for patients with advanced melanoma (AM) treated with immune checkpoint inhibitors (ICI) are lacking. We identified a new prognostic model associated with overall survival (OS). A total of 318 treatment naïve patients with AM receiving ICI were collected from a multi-centre retrospective cohort study. LASSO Cox regression identified independent prognostic factors associated with OS. Model validation was carried out on 500 iterations of bootstrapped samples. Harrel's C-index was calculated and internally validated to outline the model's discriminatory performance. External validation was carried out in 142 advanced melanoma patients receiving ICI in later lines. High white blood cell count (WBC), high lactate dehydrogenase (LDH), low albumin, Eastern Cooperative Oncology Group (ECOG) performance status ≥1, and the presence of liver metastases were included in the model. Patients were parsed into 3 risk groups: favorable (0-1 factors) OS of 52.9 months, intermediate (2-3 factors) OS 13.0 months, and poor (≥4 factors) OS 2.7 months. The C-index of the model from the discovery cohort was 0.69. External validation in later-lines (N = 142) of therapy demonstrated a c-index of 0.65. Liver metastases, low albumin, high LDH, high WBC, and ECOG≥1 can be combined into a prognostic model for AM patients treated with ICI.

Effect of cottonseed milk on growth performance, hematological and semen characteristics in male Wistar albino rats

Various plant based milk extract is appropriate for human nutrition among which cottonseed is one of the potential crops with the advantages of stable milk emulsion, improved nutrient profile with affordable waste utilization. Although cottonseed milk is a popular indigenous beverage, it has not been exploited worldwide for regular consumption owing to the presence of gossypol. The gossypol toxicity and associated gossypol-iron complex formation in the intestine lead to changes in hematological characteristics and alternation of sperm motility in monogastric animals. Male Wistar albino rats weighing 60 to 70 g were divided into four groups of five animals each. The group fed the standard diet (STD) served as control, and the experimental groups included the group (i) rats fed cottonseed diet (CSD) supplemented at 10% of cottonseed level (ii) rats fed conventional aqueous extracted cottonseed milk (CCM) diet (CAD) and (iii) rats fed enzymatic assisted aqueous extracted cottonseed milk (ECM) diet (EAD). The CAD and EAD feed was administrated @ 1 ml/100 g of animal body weight /day for the study period of 45 days among the experimental groups and control group. A significant difference in weight gain of the experimental rats was noticed between the CCM and ECM cottonseed milk extracts fed experimental groups compared with the standard and cottonseed fed groups. The rats fed with CSD, CCM and ECM diet exhibited higher white blood cell counts, also reducing the red blood cells count, hemoglobin hematocrit and platelet in the group compared with STD. No significant difference in semen motility characteristics was noticed among the CSD, CCM and ECM fed groups. In conclusion, the intake of less than the permissible level of gossypol from selected cottonseed and its aqueous extracted milk samples has influenced the hematological parameters and whereas an improved effect was shown in semen characteristics.Graphical

Prognostic value of serum vimentin in adult Egyptian patients with acute lymphoblastic leukemia

Abstract Background Vimentin is a type III intermediate filament protein that is normally expressed in mesenchymal cells. Vimentin is recognized as a marker of epithelial–mesenchymal transition. It is overexpressed in cancer cells such as breast cancer, prostate cancer, melanoma, and gastrointestinal cancers. It plays an important role in tumor growth, invasion, and metastatic progression. Its role in hematological malignancy is still under investigation. Aim To measure serum vimentin level in the peripheral blood of adult patients with acute lymphoblastic leukemia (ALL) and correlating it with clinical outcome and prognosis of the disease. Patients and methods Serum vimentin was measured using enzyme-linked immunosorbent assay in 40 patients with ALL recruited from the hematology unit and compared with 20 healthy controls, with follow-up of 12 months. Results Vimentin levels were significantly higher in patients with ALL than in controls (P&lt;0.001). Vimentin levels were also positively correlated with high white blood cell count (P=0.030). Patients were divided into two groups using the median value of their vimentin (18 ng) into high vimentin group and low vimentin group. We found that patients with high vimentin level have shorter median overall survival than patients with low vimentin level (5.18 vs. 6.73 months) but with no statistical significance detected (P=0.598). Regarding disease-free survival, the patients with high vimentin level has shorter disease-free survival than patients with low vimentin level (1.67 vs. 7 months), with no statistical significance (P=0.588). Conclusion Vimentin is overexpressed in patients with ALL and associated with poor clinical outcome.

IL-6 at the center of cytokine storm: Circulating inflammation mediators as biomarkers in hospitalized COVID-19 patients.

The management of hospitalized COVID-19 patients depends largely on controlling the intensified inflammatory response known as the cytokine storm. Candidate inflammatory cytokines can serve as new biomarkers for the management of hospitalized COVID-19 patients. Patients (80) were recruited into three groups: room air (RA), oxygen (OX) and mechanical ventilator (MV). Blood analysis was performed for RBC, WBC, Hb, Platelets, serum albumin and creatinine, INR, PTT, and hematocrit. ELISA was used to quantify a panel of inflammatory mediators including GM-SCF, IFN-α, IFNγ, IL-1β, IL-1R, IL-2, IL-2Ra, IL-6, IL-8, IL-10, IL-12p70, IL-13, MCP-1, MIP-1a, and TNF-α. Correlations between laboratory results and the levels of circulating inflammation mediators were investigated. Patients on MV had low RBC, Hb, albumin, and HCT and high WBC count, PTT, and INR when compared to RA and OX groups. A statistical positive correlation was found between WBC and the levels of IL-6 and MCP-1. RBCs correlated negatively with IL-6 and IL-10 and positively with IL-8. Higher TNF-α correlated with lower platelet counts while higher levels of IL-1Rα and IL-10 were associated with lower Hb levels. Increases in IFN-γ and TNF-α were indicative of compromised kidney functions as creatinine levels increased significantly. Most significant correlations were found between IL-6 and lab results, showing positive correlation with WBC and INR, and negative correlation with RBC, albumin, and HCT. Having the most significant correlations, IL-6 high levels in mechanically ventilated patients were shown to affect laboratory results, and, therefore, is suggested as a severity biomarker of COVID-19.

ACCURACY OF AUTOMATED CELL ENUMERATION METHOD FOR VARYING CONCENTRATION OF WBCS FOR VARIOUS BODY FLUID SAMPLES

Background: Body fluids (BF) including peritoneal, pericardial, pleural, synovial and cerebrospinal fluids are now being analyzed by fully automated methods that are replacing the manual methods. The aim of this study is to assess the accuracy of automated instrument at varying concentrations of WBCs of various body fluid samples. Material and Methods: This cross-sectional study was conducted at the section of Hematology, Department of Pathology and Laboratory Medicine, the Aga Khan University, Karachi, Pakistan from November 2020 to April 2021. Forty body fluid samples with suspicion of infection including peritoneal, pericardial, pleural, synovial and cerebrospinal fluids (CSF) were analyzed to verify accuracy of white blood cells counts on fully automated XN-1000TM hematology analyzer (Sysmex Corporation, Kobe, Japan) against Neubauer chamber method (a manual method of differentiating WBCs via microscopy). The culture results of the body fluid samples were also analyzed. EP Evaluator version 10.3.0.556 (Data Innovations, LLC, VT, US) was used for statistical analysis with other supporting statistics such as Correlation Coefficient (R), Bias, Mean and Standard Deviation were included. Results: Eleven (n=11) of forty (n=40) body fluid samples showed high WBC count above the normal range. Samples with normal WBC (n=29) were also included in accuracy study to assess instrument performance at varying concentration of analyte. An average Error Index of -0.27 (-0.99 to 0.74) for WBC was obtained. Microbiological cultures grew Escherichia. Coli in 1 and Acinetobacter species in 1 CSF samples and Staphylococcus Aureus in 1 pleural sample. Conclusion: The study verified accuracy of varying concentration of WBC counting by fully automated Sysmex XN-1000 analyzer for various body fluid samples. Keywords: Body fluids, Validation, Automated analyzer, Performance specifications, Accuracy verifications, High white blood count, Infectious.

Evaluation of the Hematological Patterns from Up to 985 Days of Long COVID: A Cross-Sectional Study.

Long COVID affects many individuals following acute coronavirus disease 2019 (COVID-19), and hematological changes can persist after the acute COVID-19 phase. This study aimed to evaluate these hematological laboratory markers, linking them to clinical findings and long-term outcomes in patients with long COVID. This cross-sectional study selected participants from a 'long COVID' clinical care program in the Amazon region. Clinical data and baseline demographics were obtained, and blood samples were collected to quantify erythrogram-, leukogram-, and plateletgram-related markers. Long COVID was reported for up to 985 days. Patients hospitalized in the acute phase had higher mean red/white blood cell, platelet, and plateletcrit levels and red blood cell distribution width. Furthermore, hematimetric parameters were higher in shorter periods of long COVID than in longer periods. Patients with more than six concomitant long COVID symptoms had a higher white blood cell count, a shorter prothrombin time (PT), and increased PT activity. Our results indicate there may be a compensatory mechanism for erythrogram-related markers within 985 days of long COVID. Increased levels of leukogram-related markers and coagulation activity were observed in the worst long COVID groups, indicating an exacerbated response after the acute disturbance, which is uncertain and requires further investigation.

Clinical characteristics and prognostic significance of DNA methylation regulatory gene mutations in acute myeloid leukemia

BackgroundDNA methylation is a form of epigenetic modification that regulates gene expression. However, there are limited data on the comprehensive analysis of DNA methylation regulated gene mutations (DMRGM) in acute myeloid leukemia (AML) mainly referring to DNA methyltransferase 3α (DNMT3A), isocitrate dehydrogenase 1 (IDH1), isocitrate dehydrogenase 2 (IDH2), and Tet methylcytidine dioxygenase 2 (TET2).ResultsA retrospective study of the clinical characteristics and gene mutations in 843 newly diagnosed non-M3 AML patients was conducted between January 2016 and August 2019. 29.7% (250/843) of patients presented with DMRGM. It was characterized by older age, higher white blood cell count, and higher platelet count (P < 0.05). DMRGM frequently coexisted with FLT3-ITD, NPM1, FLT3-TKD, and RUNX1 mutations (P < 0.05). The CR/CRi rate was only 60.3% in DMRGM patients, significantly lower than in non-DMRGM patients (71.0%, P = 0.014). In addition to being associated with poor overall survival (OS), DMRGM was also an independent risk factor for relapse-free survival (RFS) (HR: 1.467, 95% CI: 1.030–2.090, P = 0.034). Furthermore, OS worsened with an increasing burden of DMRGM. Patients with DMRGM may be benefit from hypomethylating drugs, and the unfavorable prognosis of DMRGM can be overcome by hematopoietic stem cell transplantation (HSCT). For external validation, the BeatAML database was downloaded, and a significant association between DMRGM and OS was confirmed (P < 0.05).ConclusionOur study provides an overview of DMRGM in AML patients, which was identified as a risk factor for poor prognosis.

Diagnosis of Bacterial Tracheostomy-Associated Respiratory Tract Infections in Pediatric Patients.

To identify demographic and clinical characteristics of children with fever and/or respiratory illness associated with a diagnosis of bacterial tracheostomy-associated respiratory tract infections (bTARTI). Secondary objectives included comparison of diagnostic testing, length of stay (LOS), and readmission rates between children diagnosed with bTARTI and others. We performed a retrospective chart review of encounters over 1 year for fever and/or respiratory illness at a single academic children's hospital for children with tracheostomy dependence. Patient characteristics, features of presenting illness, and laboratory and imaging results were collected. Generalized linear mixed models were employed to study associations between patient characteristics, diagnosis of bTARTI, and impact on LOS or readmission rates. Among 145 children with tracheostomies identified, 79 children contributed 208 encounters. bTARTI was diagnosed in 66 (31.7%) encounters. Significant associations with bTARTI diagnosis included chest radiograph consistent with bacterial pneumonia (odds ratio [OR], 1.77; 95% confidence interval [CI], 1.50-2.08), positive tracheal aspirate culture (OR, 1.3; 95% CI, 1.05-1.61), higher white blood cell count (16.4 vs 13.1 × 103/µ; P = .03), change in oxygen requirement (OR, 1.14; 95% CI, 1.00-1.31), telephone encounter (OR, 1.41; 95% CI, 1.09-1.81), and living at home with family (OR, 1.42; 95% CI, 1.06-1.92). LOS for admitted patients with bTARTI was 2.19 times longer (CI, 1.23-3.88). In our single-center study, we identified several clinical and nonclinical factors associated with a diagnosis of bTARTI. Despite widespread use, few laboratory tests were predictive of a diagnosis of bTARTI. There is need for standardization in diagnosis.

Indexing hematological and serum biochemical reference intervals of Himalayan snow trout, Schizothorax esocinus to instrument in health assessment.

Schizothorax esocinus, commonly known as snow trout, is one of the main contributors of food and livelihood in the colder zone of Himalayan region. The comprehensive information on its hematological and serum biochemical reference intervals is not reported yet. In the present study an attempt has been made to elucidate the hematological and serum biochemical reference intervals of S. esocinus from River Jhelum using protocols of the American Society of Veterinary Clinical Pathology (ASVCP). Wild fish were sampled over a period of 2years from the pollution free sites of river Jhelum. Fish blood was harvested through caudal venipuncture and hemato-biochemical analysis performed thereof. Data values from a total of healthy 432 adult fish specimens (216 male, 216 female) were systematically recorded. The reference intervals for hematological and serum biochemical parameters of S. esocinus were established using Reference Value Advisor software v 2.1. RIs for hematological and serum analytes ranged as: hemoglobin (Hb) 78.38-116.35 (g/L); white blood cells (WBC) 10-20 (×109/L); red blood cells (RBC) 1.30-2.15 (×1012/L); packed cell volume 27.00-39.45 (%); total protein 39.21-61.62 (g/L); albumin 8.20-22.02 (g/L); globulin 27.58-49.55 (g/L); glucose 3.25-7.18 (mmol/L); urea 0.96-2.38 (mmol/L); cholesterol 3.80-6.90 (mmol/L). The study also depicted that certain blood measurands were influenced with respect to sex. Significantly (p < 0.05) higher values of Hb, red blood cells count and serum glucose were noted in male as compared to female which, on the other hand, registered higher white blood cells count and serum cholesterol level (Mann Whitney U test, p < 0.05). The work, therefore, provides baseline information on hematological and serum biochemical analytes of this species which holds high commercial importance. RIs reported here can help monitor the health status of fish by improving the use of non-lethal diagnostic methods in piscine medicine.

Associations of Plasma BDNF and BDNF Gene Polymorphism with Cardiometabolic Parameters in Thai Children: A Pilot Study.

Childhood obesity is an important public health crisis worldwide. The brain-derived neurotrophic factor (BDNF) has been demonstrated to play a role in controlling energy homeostasis and cardiovascular regulation. To examine brain-derived neurotrophic factor (BDNF) levels and anthropometric-cardiometabolic and hematological parameters in obese and nonobese children and to determine whether two BDNF gene polymorphisms (G196A and C270T) are linked to BDNF levels, obesity, and anthropometric-cardiometabolic and hematological parameters among Thai children. This case-control study included an analysis of 469 Thai children: 279 healthy nonobese and 190 obese children. Anthropometric-cardiometabolic and hematological variables and BDNF levels were measured. Genotyping of BDNF G196A and C270T was performed using the polymerase chain reaction-restriction fragment length polymorphism technique. Children in the obese group had significantly higher white blood cell counts and some cardiometabolic parameters. Although the difference in BDNF level between the nonobese and obese groups was not significant, BDNF level was significantly positively correlated with hematological and cardiometabolic parameters, including blood pressure, triglycerides, and triglycerides and the glucose index. The BDNF G196A polymorphism in children was only associated with decreased systolic blood pressure (p < 0.05), while the BDNF C270T polymorphism was found not to be related to BDNF levels, obesity, or other parameters after adjusting for potential covariates. These findings in Thai children suggest that obesity is associated with increased cardiometabolic risk factors, but not with BDNF levels or the two BDNF polymorphisms studied, while the BDNF G196A polymorphism is a beneficial marker for controlling blood pressure among Thai children.

Does leukocytosis remain a predictive factor for survival outcomes in patients with acute promyelocytic leukemia receiving ATRA plus a chemotherapy-based regimen? A prospective multicenter analysis from TALWG

ABSTRACTIntroductionAcute promyelocytic leukemia (APL) is a distinct subtype of acute myeloid leukemia (AML) with a unique clinical presentation and prognosis. This study aimed to investigate the epidemiology, clinical characteristics, treatments, and clinical outcomes of Thai APL patients dominantly treated with all-trans-retinoic acid (ATRA) combined with a chemotherapy-based therapy.MethodsThis was an eight-year prospective, observational study from nine academic hospitals in the Thai Acute Leukemia Working Group (TALWG) of the Thai Society of Hematology, which included newly diagnosed Thai APL patients, aged 18 years or older. The web-based registration collected baseline charateristic, and clinical outcomes.ResultsFrom 992 newly diagnosed AML patients, 79 APL patients were enrolled in this study. Almost all subjects were de novo APL (94.9%), while the others were therapy-related APL. The commonest clinical presentation was disseminated intravascular coagulation (38%). One-third of the patients were categorized as high risk according to the initial WBC. Almost all patients received ATRA combined with idarubicin regimen. The complete response rate was as high as 95.7%, which translated into excellent four-year overall survival (OS) (75.6%) and four-year leukemia-free survival (LFS) (75.4%). The multivariate analysis demonstrated that the older age and WBC count >20 × 109/L conferred a significantly unfavorable OS with the hazard ratios of 3.03 (95% confidence interval [CI]: 1.14–8.05) and 4.18 (95%CI: 1.69–10.35), respectively. Similarly, these two parameters remained independent of the poor prognosis factors for LFS.ConclusionThis report confirmed that APL had a favorable prognosis. However, advanced age and high WBC count >20 × 109/L contributed to a worse outcome.AbbreviationsAPL; acute promyelocytic leukemia; ATRA; all-transretinoic acid; CR; complete remission; DS; differentiation syndrome; ECOG; Eastern Cooperative Oncology Group; ED; early death; HR; hazard ratio; IQR; interquartile range; LFS; leukemia-free survival; OS; overall survival; WBC; white blood cell.

Biomarkers of viral and bacterial infection in rhinovirus pneumonia.

Rhinovirus (RV) is often detected in children hospitalized with pneumonia, but the role of RV in causing pneumonia is still unclear. White blood cell count, C-reactive protein, procalcitonin, and myxovirus resistance protein A (MxA) levels were determined from blood samples in children (n = 24) hospitalized with radiologically verified pneumonia. Respiratory viruses were identified from nasal swabs by using reverse transcription polymerase chain reaction assays. Among RV-positive children, the cycle threshold value, RV subtyping by sequence analysis, and the clearance of RV by weekly nasal swabs were determined. RV-positive children with pneumonia were compared to other virus-positive children with pneumonia, and to children (n = 13) with RV-positive upper respiratory tract infection from a separate earlier study. RV was detected in 6 children and other viruses in 10 children with pneumonia (viral co-detections excluded). All RV-positive children with pneumonia had high white blood cell counts, plasma C-reactive protein or procalcitonin levels, or alveolar changes in chest radiograph strongly indicating bacterial infection. The median cycle threshold value for RV was low (23.2) indicating a high RV load, and a rapid clearance of RV was observed in all. Blood level of viral biomarker MxA was lower among RV-positive children with pneumonia (median 100 μg/L) than among other virus-positive children with pneumonia (median 495 μg/L, p = 0.034) or children with RV-positive upper respiratory tract infection (median 620 μg/L, p = 0.011). Our observations suggest a true viral-bacterial coinfection in RV-positive pneumonia. Low MxA levels in RV-associated pneumonia need further studies.

Analysis of NPM1 and FLT3 Mutations in Patients with Acute Myeloid Leukemia in Jeddah, Saudi Arabia: A Pilot Study

Background: The outcome of acute myeloid leukemia (AML) is influenced by ethnicity, geographic variations, and the patient’s molecular profile. We aimed to explore the mutation frequencies of the nucleophosmin 1 (NPM1) and the FMS-like tyrosine kinase 3 (FLT3) internal tandem duplication (ITD) or tyrosine kinase domain (TKD) with correlation to the cytogenetic profiles in patients with AML. Methods and Results: Bone marrow/whole blood samples from 33 patients with AML were screened for NPM1/FLT3-ITD mutations by fragments analysis using a GeneScan analyzer. Depending on the fragment size, the NPM1 and FLT3 wild type (Wt) (170bp and 330bp) vs. mutated (170/174 bp and 330/351 bp) alleles, respectively, can be distinguished. The allelic ratio of FLT3-ITD⁺ was calculated. FLT3-TKD⁺ mutation was detected by Sanger sequencing. Samples were tested for chromosomal aberrations. According to the French-American-British (FAB) classification, the predominant type in the present cohort was AML-M5, accounting for 30.3%. NPM1⁺, FLT3-ITD⁺, and double mutations were found in 12.1%, 3.1%, and 6.1% of cases, respectively. The combined NPM1⁺/FLT3-ITD⁺/FLT3-TKD⁺ profile was presented in one patient (3.1%). The dual positivity group (NPM1⁺/FLT3⁺) significantly had a higher WBC count with a median of 81.3×103/µL. A total of 63.6% of patients had abnormal cytogenetics. The NPM1⁺/FLT3-ITD⁺ patients had normal karyotypes. Patients with NPM1-/FLT3- showed complex karyotype (24%) and t(8;21) (8%). The FLT3-ITD⁺ patient had trisomy 8. Conclusion: The frequency of NPM1/FLT3 mutations in the study cohort showed less rate than in other studies with a distinct pattern. Due to the preliminary nature of the present work, more extensive screening is warranted to evaluate their usefulness as prognostic indicators in this region.