Higher Total Leukocyte Counts Research Articles

Oxygenation Index and Oxygen Saturation Index for Predicting Postoperative Outcome in Patients Undergoing Emergency Surgery: A Prospective Cohort Study.

The OI was originally evaluated as a prognostic tool for acute hypoxemic respiratory failure in children and was an independent predictor for mortality in adult patients with acute respiratory distress syndrome (ARDS). Oxygenation index and OSI of 201 adult patients undergoing emergency surgery were evaluated at different time points. The primary objective of this study was to find the correlation between OI and OSI. The secondary objectives were to find the prognostic utility of OI and OSI for postoperative mechanical ventilation and mortality. Significant statistical correlation was found between OI and OSI both at the beginning (r 2 = 0.61; p < 0.001) and immediately after surgery (r 2 = 0.47; p < 0.001). Oxygen saturation index at the beginning [area under the receiver operating characteristics curve (AUROC) (95% CI) 0.76 (0.62-0.89); best cutoff 3.9, sensitivity 64% and specificity 45%] and immediately after surgery [AUROC (95% CI) 0.82 (0.72-0.92); best cutoff 3.57, sensitivity 79%, and specificity 62%] were reasonable predictors of the requirement of invasive ventilatory support. Exploratory analysis reported that older age (p = 0.02), higher total leukocyte count (p = 0.002), higher arterial lactate (p = 0.02), and higher driving pressure (p < 0.001) were independently associated with hospital mortality. In adult patients undergoing emergency laparotomy under general anesthesia, OI and OSI were found to be correlated. Both metrics demonstrated reasonable accuracy in predicting the need for invasive ventilatory support beyond 24 hours and hospital mortality. Thakuria R, Ernest EE, Chowdhury AR, Pangasa N, Kayina CA, Bhattacharjee S, et al. Oxygenation Index and Oxygen Saturation Index for Predicting Postoperative Outcome in Patients Undergoing Emergency Surgery: A Prospective Cohort Study. Indian J Crit Care Med 2024;28(7):645-649.

HEMATOLOGICAL DYNAMICS IN HEMODIALYSIS: A COMPREHENSIVE EXAMINATION OF PATIENTS WITH CHRONIC RENAL FAILURE IN A TERTIARY CARE HOSPITAL

Background: Chronic kidney disease (CKD) is a significant health burden in developing countries like India, leading to high morbidity and mortality rates. The study aimed to determine the incidence of anemia among patients with CKD and examine its potential association with other predictive markers. Methods: A cross-sectional observational research was undertaken within a tertiary hospital setting to examine the incidence of hematological abnormalities and explore the association between anemia and its many manifestations in patients with stages 3-5 chronic kidney disease (CKD). The markers for anemia encompassed measurements of hemoglobin percentage (Hb%), mean corpuscular volume (MCV), and examination of peripheral smears. The investigation also examined the correlation between stages of chronic kidney disease (CKD) and red cell distribution width (RDW), thrombocytopenia, leucocyte count, and differential count. Result: The study found that 96.8% of participants displayed symptoms of anemia, characterized by normocytic and normochromic observations on peripheral measures. A significant number of patients (57.3% of them) had a higher total leucocyte count (TLC), but there was no statistically significant link between a higher TLC and the worsening stages of CKD. The mean corpuscular volume (MCV) and platelet levels exhibited a predominantly normal range, with relatively few observed fluctuations. However, there is a positive link between the advancement of CKD and an increase in red cell distribution width (RDW). Conclusion: The study highlights the changes in blood parameters observed in individuals with CKD, with particular attention given to the high occurrence of anemia. The findings underscore the importance of comprehensive iron investigations and the timely identification and intervention of anemia. Adopting a comprehensive strategy that includes regular monitoring of blood parameters, specifically focusing on anemia and iron levels, is crucial for effectively managing and enhancing the overall health of individuals with CKD KEY WORDS- Anemia in CKD, Chronic kidney disease, Iron deficiency anemia

HEMATOLOGY AND PLASMA CHEMISTRY COMPARISONS AMONG JUVENILE AMERICAN BLACK BEARS (URSUS AMERICANUS) UNDERGOING REHABILITATION.

The American black bear (Ursus americanus) is an opportunistic and adaptable species with high rehabilitation success rates. Injured, ill, and orphaned bears across the southeastern United States are examined and treated at the University of Tennessee College of Veterinary Medicine followed by rehabilitation at Appalachian Bear Rescue (ABR). Hematology and biochemistry reference ranges exist for healthy adult black bears; however, most bears presenting to ABR are young and of variable health status. Thus, further investigation into the difference of blood values at varying ages and presentations is warranted. ABR records from 1996 to 2022 included 106 bears with completed hematology and plasma biochemistry panels (22 paired samples at intake and release, 84 at intake only). Intake-only samples consisted of 12 neonates (<3 mon old), 64 cubs (3-12 mon), and 30 yearlings (1-2 yr). Bears presented as orphaned neonates (22%), orphaned cubs (45%), malnourished yearlings (24%), and injured/ill (9%) during fall (16%), winter (13%), spring (32%), and summer (39%). Changes in hematology and plasma biochemistry results between intake and release included an increase in hematocrit and glucose. Injured/ill bears presented with higher total leukocyte count (WBC), absolute neutrophils (ABS segs), alanine aminotransferase (ALT), aspartate aminotransferase (AST), and creatine kinase (P < 0.05). Positive correlation between ALT, AST, proteins, and blood urea nitrogen and negative correlation between absolute lymphocytes and alkaline phosphatase were noted with age. Both WBC and ABS segs were lower during winter (P < 0.05). Understanding what factors affect juvenile black bear blood values improves clinical expectations and evaluation upon intake, clinical evaluation, and treatment.

Clinical significance of platelet membrane glycoproteins in children with primary immune thrombocytopenia

Abstract Objectives To measure CD62p and CD42b levels and to study its correlations with bleeding score, and different prognostic factors in children with primary immune thrombocytopenia (ITP) patients. Methods In all, 60 children with ITP and 30 age- and sex-matched healthy participants were recruited and underwent thorough clinical assessments including bleeding score using the modified Buchanan and Adix bleeding score as well as complete blood count with measurement of mean platelet volume (MPV), platelet distribution width (PDW) and plateletcrit (PCT), coagulation profiles and measurement of platelet glycoproteins (CD62p and CD42b) using a flow cytometer. Results Children with ITP had lower PCT (P&lt;0.001), CD 62 P, and co-expression of CD 42b/CD 62 P and higher MPV (P=0.009), PDW (P&lt;0.001), and CD 42b level. MPV correlates negatively with lymphocyte count and platelet count, while PDW correlates negatively with neutrophil count and positively with hemoglobin. PCT correlates negatively with total leucocyte count, neutrophil count, and positively with platelet count (P=&lt;0.001). Children with chronic ITP usually presented with mild cutaneous bleeding, while those with acute ITP usually suffered from severe mucosal and life-threatening bleeding (P=0.001). Acute ITP cases had the highest total leucocyte count (P&lt;0.001) and the lowest count of platelet (P&lt;0.001); persistent cases had the lowest lymphocyte count (P=0.023) and co-expression of CD42b/CD62p (P=0.039), while chronic cases had the lowest neutrophil count P&lt;0.001) and highest percentage of PCT (P&lt;0.001) and co-expression of CD42b/CD62p (P=0.039). Conclusion Platelet parameters and platelet glycoprotein CD62P and CD42b expression is a simple noninvasive diagnostic tool in ITP children.

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.

A surrogate molecular approach for the detection of Philadelphia chromosome-like B-acute lymphoblastic leukemia.

Philadelphia chromosome (Ph)-like B-acute lymphoblastic leukemia (B-ALL) is a clinically significant, high-risk genetic subtype of B-ALL cases. There are few data on the incidence, characterization, and treatment outcomes of Ph-like ALL cases from low- and middle-income countries. There is a pressing need to establish a well-organized/cost-effective approach for identifying Ph-like ALL instances. Multiplex reverse transcriptase polymerase chain reaction, nCounter NanoString, and fluorescence in situ hybridization were used to detect and characterize Ph-like ALL cases among recurrent genetic abnormalities (RGA)neg B-ALL cases. At the end of induction therapy, flow cytometry-minimal residual disease (MRD) assay was used to quantify MRD positivity in Ph-like ALL cases. Of 130 newly diagnosed B-ALL cases, 25% (BCR::ABL1), 4% (ETV6::RUNX1), 5% (TCF3::PBX1), 2% (KM2TA::AFF1), and 65% RGAneg B-ALL cases were revealed by multiplex reverse transcriptase polymerase chain reaction. Among RGAneg B-ALL cases, 24% Ph-like ALL cases using nCounter NanoString were identified, with 48% CRLF2high cases with 45% CRLF2::P2RY8 and 18% CRLF2::IGH rearrangements(∼r) revealed by fluorescence in situ hybridization. In 52% of CRLF2low cases, 17% ABL1 and JAK2∼r 8% EPOR::IGH & PDGRFB∼r were identified. Ph-like ALL cases had higher total leukocyte count (p<.05), male preponderance (p<.05), and high MRD-positivity/induction failure compared with RGAneg B-ALL cases. Furthermore, in Ph-like ALL cases, 11 significant genes using quantitative polymerase chain reaction were identified and validated. CRLF2, IGJ, CEACAM6, MUC4, SPATS2L and NRXN3 genes were overexpressed and show statistical significance (p<.05) in Ph-like ALL cases. This study showed the high incidence of Ph-like ALL cases with kinase activating alterations and treatment outcomes from low- and middle-income region. Furthermore, a surrogate cost-effective multiplex panel of 11 overexpressed genes for the prompt detection of Ph-like ALL cases is proposed. Identification of recurrent gene abnormalities (RGA)neg B-acute lymphoblastic leukemia (B-ALL) cases using multiplex-reverse transcriptase polymerase chain reaction. Identification and characterization of Philadelphia (Ph)-like ALL cases using nCounter NanoString gene expression profiling and fluorescence in situ hybridization. Furthermore, Ph-like ALL cases were characterized according to CRLF2 expression and kinase-activating genomic alterations. Minimal residual disease of Ph-like ALL cases were quantified using flow cytometry-minimal residual disease assay. A surrogate molecular approach was established to detect Ph-like ALL cases from low- and middle-income countries.

Haematological and Innate Immunological Reference Intervals for Farmed Yellow Catfish &lt;i&gt;Horabagrus brachysoma&lt;/i&gt; 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 &lt; 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.

Evaluation of vitamin A and E deficiency with severity of SARS-COV-2 disease: a case–control study

BackgroundCoronavirus disease 2019 can cause severe inflammation and damage to the lungs. Vitamins A and E are essential in the enhancement of immunity and they tend to decrease in cases with inflammation. Determination of serum levels of vitamins A and E in COVID-19 patients was the aim of the study.MethodsThis case–control study was carried out on 30 ICU–admitted SARS-CoV-2–infected individuals (group A), 30 ward–admitted SARS-CoV-2–infected individuals (group B) and 30 healthy controls (group C). High-performance liquid chromatography was used to measure vitamin A and E levels.ResultsMedian levels of vitamin A in group A [0.16 (0.08–0.23) µg/ml] were significantly lower than those in group B [0.4 (0.15–0.65) µg/ml] and in group C [0.81 (0.70–1.16) µg/ml] with P value < 0.001, while there was no significant difference between groups concerning vitamin E levels (P value = 0.535). Vitamin A deficiency showed significant correlation with lower hemoglobin levels, lower platelet counts, higher total leucocyte counts, higher C- reactive protein levels, and higher D-dimer levels. ROC curve construction showed that vitamin A level with cut off < 0.65 µg/ml increases risk of acute respiratory distress syndrome (ARDS) development with sensitivity 90% and specificity 83.3%. Logistic regression analysis showed that cases with vitamin A levels < 0.65 µg/ml were more prone to develop ARDS (OR = 0.003 [0.000–0.036] P < 0.001).ConclusionLevels of vitamin A were reduced in COVID-19 patients particularly in ICU–admitted cases. This ensures the association of decreased vitamin A with disease morbidity and the importance of vitamin A supplementation as part of disease management.Trial registrationClinicaltrial.gov, NCT05946499. Registered 12 July 2023—Retrospectively registered. https://register.clinicaltrials.gov/prs/app/action/SelectProtocol?sid=S000DGLS&selectaction=Edit&uid=U00070DC&ts=2&cx=gieusm.

Evaluation of Some Haematological Metrics among Smokers in Port Harcourt, Rivers State, Nigeria

Introduction: Smoking is extremely toxic and has had a significant negative impact on society. One of the leading contributors to preventable illness and mortality has been found to be cigarette smoking.&#x0D; Aim: The goal of this study is to evaluate a few haematological metrics among smokers in Port Harcourt, Rivers State, and to verify the idea that smoking cigarettes either has a negative or favorable impact on these variables.&#x0D; Methodology: In this cross-sectional study, 100 participants between the ages of 20 and 45 were included, 50 of whom were smokers and 50 non-smokers. Venipuncture was used to obtain blood samples from the patients, which was then put into an EDTA vial for a full blood count (FBC) and other haematological analysis. The full blood count and erythrocyte sedimentation rate (ESR) were done using Haemo Auto Analyzer, Model XP-300 KOBE Japan by SYSMEX and the Westergreen method respectively. In order to analyze the data, Graph Prism Pad 6.2 and Microsoft Office Excel 2016 were both used. Using the student's independent t-test, a comparative study of mean and standard deviation values for the various parameters for test and reference ranges was conducted.&#x0D; Results: According to the findings, the average age of 50 smokers was 43.6200± 9.7250 years and that for the 50 non-smokers was 42.7800± 6.5440 years, which was statistically insignificant with p valve of 0.6130. Smokers’ haemoglobin level was 14.5080 ± 1.5590 (g/dL) and non-smokers was 12.1340 ± 0.70410 (g/dL). According to statistics, the level of Hb was significantly higher in smokers compared to non-smokers (P&lt;0.0001). In comparison to non-smokers, the RBC count dramatically increased in smokers (P&lt;0.0001) greater than in non-smokers at 5.2550 ± 0.6629 (x1012/L) and 4.6340 ± 0.5530 (x1012/L) respectively. While the total leucocyte count (TLC) in smokers is 8.0500 ± 1.8796 (x109/L), compared to 6.8580 ± 1.2454 (x109/L) in non-smokers. Statistics show that smokers have a higher total leucocyte count than non-smokers (P&lt;0.0002). Smokers' platelet count is 255.7600±61.8351 (x109/L) while non-smokers' is 216.5800±35.5752 (x109/L).The study has statistically shown that smokers' platelet counts rose considerably in comparison to non-smokers (P&lt;0.012).&#x0D; Conclusion: It may be concluded that uninterrupted smoking has an undue negative impact on haematological parameters such that increase occur in values of Hb, RBC, TLC and platelets. Significantly, these changes may increase the risk of serious health issues such as heart related defects, hardening of the arteries, Vaquez-Osler disease. It is recommended that smokers have these metrics regularly monitored.

Correlation between total leukocyte count (TLC) and c-reactive protein (CRP) in paediatric bronchiolitis patients

Objective: The primary objective of this study was to investigate the correlation between Total Leukocyte Count (TLC) and C-Reactive Protein (CRP) levels in paediatric bronchiolitis patients to assess the prognostic significance of these markers in disease severity and patient outcomes. Study Design: A retrospective correlational study was conducted using patient records from a six-month period to analyze the relationship between TLC and CRP levels in paediatric bronchiolitis patients. Study Setting: The study was conducted at different centres including Department of Paediatrics, Social Security MNCH Hospital, Dera Ghazi Khan, Punjab and Sahara Medical College Narowal, Punjab in the period from August, 2022 to January, 2023. Methods: Data of paediatric patients aged 1 month to 2 years diagnosed with bronchiolitis was extracted from electronic medical records. The study included patients with complete data on TLC and CRP levels. Pearson's correlation coefficient was used to determine the association between TLC and CRP levels, while logistic regression analysis was performed to identify potential predictors of disease severity. Results: The study found a significant positive correlation between TLC and CRP levels in paediatric bronchiolitis patients (p&lt;0.05). Higher TLC and CRP levels were associated with increased disease severity and longer hospital stay.

TO STUDY IN-HOSPITAL MORTALITY OF ALUMINIUM PHOSPHIDE POISONING IN RELATION TO TOTAL LEUCOCYTE COUNT

Background: Pesticide poisoning is a major problem worldwide. The incidence of aluminium phosphide poisoning has increased over decades. Phosphine, active form, binds cytochrome oxidase, induces oxidative stress with release of free oxygen radicals, lipid peroxidation, resulting acute inflammation leads to alteration of various haematological/biochemical parameters, including total leucocyte count (TLC). Objectives: 1.To study TLC in aluminium phosphide poisoning 2.To study severity of toxicity in relation to TLC 3.To study in-hospital mortality in relation to TLC Methods: A hospital based cross sectional study with sample size of 65. In-patients with aluminium phosphide poisoning attending Medicine Department in KR Hospital, Mysuru were studied. The parameters like complete hemogram including TLC, liver/renal function tests, electrolytes, electrocardiogram were assessed and correlated. With a confidence interval of 95%, level of significance was kept at 5% Results: Of the 65 subjects, mean age was 34.11 ±11.55 years and mean TLC was 10467.5 ±2991.2 . Subjects were categorised into non-severe(29%), severe(26%) and death(45%) groups. Mean TLC in non severe(8140.7±2445.9), severe(10980.3± 2471.1) and death(11691.4 ±2780.4). A high TLC was found in 15.8% non-severe, 41.2% severe and 69% death cases. A significant positive correlation of TLC with severity of toxicity and mortality of aluminium phosphide poisoning was obtained (p&lt;0.005). Conclusion: Total leucocyte count can be used as one of the easily available cost effective predictive variable to assess the outcome of aluminium phosphide poisoning.

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.

Clinical characteristics of patients with diffuse alveolar hemorrhage diagnosed by cytological examination of 1000 bronchoalveolar lavage samples.

Diffuse alveolar hemorrhage (DAH) is a life-threatening condition due to the extravasation of blood in the alveoli, resulting in hypoxemia and even acute respiratory distress syndrome. This study aimed to describe the clinico-radio-pathological profile of patients diagnosed with DAH and classify it into immune and nonimmune DAH. This was a retrospective analytical study. Of a total of 1000 cases of bronchoalveolar lavage fluids (BALF) received for cytological examination, patients fulfilling the clinical, radiological, and laboratory details of cases satisfying the clinical and cytological criteria of DAH (n=47) were studied. The most common cause of immune DAH was ANCA-associated vasculitis (n=13, 27.6%), and that of nonimmune DAH was infections (n=10, 21.3%). Twenty-nine patients (61.7%) had hemoptysis. The most common radiological finding was ground-glass opacities (n=33, 70.2%). In univariate analysis, female sex, mean hemoglobin at admission, total leucocyte count (TLC), platelet count, and erythrocyte sedimentation rate (ESR) were significantly associated with immune-DAH. However, in multivariate analysis, female sex, higher TLC, high platelets, and high ESR were significantly associated with immune DAH. Patients were treated with corticosteroids (n=25, 46.3%), intravenous cyclophosphamide (n=12, 22.2%), plasma exchange (n=7, 13.0%), intravenous immunoglobulin (n=5, 9.3%) and rituximab (n=5, 9.3%). The overall mortality was 8.5% (n=4). DAH is a life-threatening syndrome that may be classified into immune and nonimmune DAH. Immune-DAH requires aggressive management, whereas nonimmune DAH cases respond best to conservative management.

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&lt;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 (&gt;34 years), high total leukocyte count (&gt;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.

Utility of a Novel Clinical Scoring System and its Association with Procalcitonin in Patients of Acute Heart Failure with Respiratory Infections: A Limited Resource Perspective

Abstract Background: Heart failure (HF) is a global health burden that is usually simple to diagnose, but concomitant respiratory infections are difficult to distinguish clinically. Inflammatory markers can be used to differentiate between the two conditions, especially procalcitonin (PCT), one of the most specific markers for bacterial infections. PCT-guided antibiotic treatment has shown good results and could help in decreasing the indiscriminate prescription of antibiotics in HF patients. Methodology: A prospective observational study was carried out in a tertiary care hospital in Western India. Three hundred HF patients were separated into either high- or low-PCT level groups. A novel clinical score for clinically suspecting superimposed respiratory infection in acute HF patients was devised and its association with PCT level was measured. Results: 62.87 years was the average age of the study population with a male preponderance. While breathlessness was the presenting complaint in all 300 patients, the presence of fever and edema was significantly associated with raised PCT. A higher total leukocyte count and neutrophil count were seen in patients with high PCT. A higher incidence of consolidation, pulmonary edema, and pulmonary hypertension was noted in those with high PCT. A significant association was found between the clinical scoring system and the PCT level. Conclusion: The novel clinical scoring system has a satisfactory sensitivity, specificity, positive predictive value, and negative predictive value in diagnosing superimposed respiratory infections in acute HF patients. It can aid in the judicious use of the PCT test in resource-limited settings.

Leukemia-associated aberrant immunophenotype: A flow cytometry-based experience of 110 cases from a tertiary care center in Northern India.

Leukemic cells express a characteristic set of "cluster of differentiation" (CD) markers, which forms the basis of the current WHO classification. Leukemia-associated aberrant immunophenotype (LAIP) refers to expression of unusual CD markers by leukemic cells, which are not normally expressed by their respective lineage. The incidence of LAIP varies considerably, and its clinical implications, prognostic relevance, and sensitivity to therapy are still debatable. This study was conducted to identify the immunophenotypic aberrancies in newly diagnosed leukemias in our Institute. This was an observational study, which included newly diagnosed leukemias on flow cytometry. Aberrant immunophenotypic expressions were recorded whenever present and were correlated with prognostic factors like age, gender, and total leucocyte count (TLC). The study included 110 newly diagnosed cases of leukemias (85 acute and 25 chronic) over 1.5 years. Immunophenotypic aberrancies were detected in 40.4% of the cases. The highest incidence of aberrations was detected in acute myeloid leukemia (60.7%). LAIPs were detected in 50% of T-acute lymphoblastic leukemia and 25% cases of in B-cell acute lymphoblastic leukemia (B-ALL). Aberrant CD33 and CD56 expression in B-ALL correlated with poor prognostic factors like higher age and higher TLC, respectively. Immunophenotypic aberrancies were present in 28% cases of chronic lymphocytic leukemia. The results of this study have generated valuable baseline data on the incidence of LAIPs in this region. This information is vital because establishing LAIPs at the time of diagnosis is crucial for disease monitoring. Some LAIPs are associated with underlying cytogenetic abnormalities and hence impact the management and prognosis.

Clinical characteristics, course and outcome of critically ill COVID-19 patients with previous or current TB admitted in ICU of a tertiary care COVID centre of Indian subcontinent.

Clinical characteristics, course and outcome of critically ill COVID-19 patients with previous or current TB admitted in ICU of a tertiary care COVID centre of Indian subcontinent.

Blood counts and homocysteine in acute stroke: What is the relation?

Objectives: Stroke is the second-leading cause of death and the third-leading cause of death and disability combined in the world. We need to find easy, available, and reliable parameters on which we can depend to prevent stroke, predict outcome, and determine prognosis. This will help in stroke management in the future. Materials and Methods: We noted blood counts and serum homocysteine levels in acute stroke patients after the exclusion of confounding factors. Our team recorded the detailed demographic and blood parameters (blood counts and homocysteine) of acute stroke patients who got admitted to different departments of our hospital in 5 months. We later correlated or tried to find the association between these parameters and stroke severity (NIHSS), other clinical parameters such as dysarthria and stroke outcome (Modified Rankin Score (mRS) at discharge and at 3 months). The team also tried to find relationships, if any, with different stroke subtypes as per the Trial of ORG 10172 in Acute Stroke Treatment classification. Results: Out of 100 patients (34 females and 66 males), we had 28 patients with hyperhomocysteinemia (HHcy). The high neutrophil count and total leukocyte count correlated with stroke severity, dysarthria, and outcome at 3 months (poor mRS). While, it was the opposite in the case of lymphocyte count. Homocysteine level did not correlate with stroke severity or outcome but with dyslipidemia. HHcy was more prevalent among patients with large artery atherosclerotic disease. Conclusion: Findings of our study were agreeable to earlier studies on the relationship between blood counts and stroke prognosis. Although high homocysteine level was associated with stroke, its level was not found to be related to stroke severity or outcome. However, further study with a larger sample size is required to draw a confident conclusion.

CLINICAL AND BLOOD PARAMETERS IN RELATION TO THE OUTCOMES OF COMMUNITY ACQUIRED PNEUMONIA

Background: Risk stratification of Community acquired pneumonia (CAP) is challenging for physicians. Though various biomarkers are available, they are costly or not readily available in all health care settings. This study aimed to analyze the prognostic value of routinely available clinical and blood parameters in relation to the outcome of patients admitted with community acquired pneumonia. Methods: This was a hospital-based observational study of the patients admitted to Chitwan Medical College (CMC), Nepal between August 2021 and December 2021. We enrolled patients 18 years old and above with the diagnosis of CAP in the study and excluded patients with COVID and active pulmonary tuberculosis. The outcomes of the patients were recorded as improved, not-improved, or dead. Fischer exact, Kruskal-Wallis or Mann-Whitney tests were used for analysis wherever appropriate. Results: Total 92 patients with mean age 58.2 years were enrolled in the study. Patients who were not improved or were dead had higher age (p=0.029), respiratory rate (p&lt;0.001), shock index (p=0.013), total leukocyte count (TLC) (p=0.019), urea (p=0.046), creatinine (p&lt;0.01), potassium (p&lt;0.001), bilirubin (p=0.029), and lactate (P&lt;0.05) and lower SpO2 (p&lt;0.01), SpO2/FiO2 (p=0.018), pH (p=0.0497), and PaCO2 (p&lt;0.001). Patients with nervous (p&lt;0.001), cardiovascular (p=0.032) and renal system (p=0.019) involvement were also found to be associated with poor outcome. Conclusions: CAP patients with higher TLC, urea, creatinine, bilirubin and lactate, with lower SpO2, SpO2/FiO2, pH and PaCO2 and with involvement of more than one organ systems were found to have unfavorable prognosis. Higher potassium level was also found to be a potential marker of CAP severity.