Increased WBC Count Research Articles

Prevalence and risk factors for left ventricular diastolic dysfunction in systemic sclerosis: a multi-center study of CRDC cohort in China.

Left ventricular diastolic dysfunction (LVDD) is a common manifestation of cardiac involvement in systemic sclerosis (SSc), which is associated with increased mortality, but little is known about the risk factors. The aim is to determine the frequency and potential predictors of SSc-LVDD. We conducted a prospective multi-center cohort study, enrolling 784 SSc patients assessed by echocardiography between April 2008 and June 2019. Diagnosis of systemic sclerosis was according to the 2013 American College of Rheumatology (ACR)/the European League Against Rheumatism (EULAR) classification criteria. Data were compared between patients with and without LVDD, while univariate and multivariate regression analysis was performed to determine the factors independently associated with LVDD. LV diastolic dysfunction was present in 246/784 (31.4%) of the subjects. There were no significant differences in gender, BMI, or disease duration between the two groups. Around 40% of the patients in the SSc-LVDD group and in the SSc-non LVDD group had diffused cutaneous involvements. Factors independently associated with LV diastolic dysfunction in multivariable analysis included age at onset (OR 1.053, 95%CI 1.021-1.086, p = 0.001), pulmonary arterial hypertension (OR 3.057, 95%CI 1.468-6.367, p = 0.003), positivity of anti-RNP antibody (OR 2.455, 95%CI 1.049-5.745, p = 0.038), increased WBC count (OR 1.156, 95%CI 1.037-1.287, p = 0.009), elevated levels of uric acid (OR 1.003, 95%CI 1.000-1.006, p = 0.036), and triglyceride (OR 1.515, 95%CI 1.106-2.077, p = 0.010). LV diastolic dysfunction was prevalent in the SSc population. Advanced onset age, PAH, positive anti-RNP antibody, increased WBC count, and adverse metabolic status were independent risk factors for SSc-related LVDD. Key Points • In this Chinese multi-center cohort of systemic sclerosis, LVDD is not a rare complication, with a prevalence of 31.4%. • The presence of advanced onset age, PAH, positive anti-RNP antibody, increased WBC count and adverse metabolic status were baseline predictors of developing LVDD in SSc.

Evaluation and Characterization of Indian Chronic Myeloid Leukemia Patients on Imatinib

Background: Chronic myeloid leukemia (CML) is a clonal malignant disorder of hematopoietic stem cell characterized by the classical chromosomal translocation, Philadelphia (Ph) chromosome in more than 90% of the patients. CML is associated with significantly high granulocyte numbers in the bone marrow and peripheral blood. Materials and Methods: This is a retrospective study conducted at the All India Institute of Medical Sciences, New Delhi, India aimed to evaluate the incidence and characteristics of CML patients. We have evaluated the demographic, clinical, and hematological data of 158 consecutive patients who visited the hospital from 2012 to 2014. Results: The diagnosis and stage of CML were determined based on the World Health Organization criteria, followed by the polymerase chain reaction. 158 patients evaluated in this study, consist of males (n = 98, 62%) which was higher than females (n = 60, 38%)( M:F::1.6:1). The mean + SD of male and female was 35.6 + 12.7, mean + SD of males was ( 35.7+ 13.6) and mean + SD of females was ( 35.4+11.3). While 17 (10.7%) patients were below 20 years of age, 94 (59.4%) were between 21–40 years, 40 (25.3%) were between 41–60 years, and 7 (4.4%) were more than 60 years of age. The predominance of younger patients (59.4.%) were belong to the age group of 21-40 years. While the most predominant symptom was fatigue and bone pain, the most common clinical sign was hepato-splenomegaly, followed by remarkable weight loss, and epistaxis. Conclusion: A patient with an increased WBC count, weakness, bone pain, low LAP score and hepatosplenomegaly should clearly be evaluated for CML.

Analysis of synovial biopsies in osteomyelitis in a tertiary care center

To differentiate, grade and evaluate the histologic features seen in the biopsy specimens of osteomyelitis patients in a tertiary care centre according to their abundance/severity with the help of a pre-established scoring system and to correlate those features with their radiology and serology findings.52 synovial biopsy specimens of patients suffering from osteomyelitis, from the year 2015 to 2017, were reviewed from the institute’s case files. The histopathological features were analyzed and a diagnostic criterion was set using a grading system involving five histological features to differentiate the same.It was observed that out of the 52 synovial specimens, 9 specimens were graded as acute osteomyelitis, 11 as chronically florid osteomyelitis, 20 as chronic osteomyelitis, 45 as subsided osteomyelitis, and the rest had no histopathological features of osteomyelitis (Table I). The radiology findings showed that 10 specimens showed osteosclerotic lesions, 4 had osteolytic lesions, 7 had osteopenic lesions and 2 of them had both osteosclerotic and osteolytic lesions (Table II). The serology findings revealed increased ESR values (>100mm/hr) in 3 of the specimens, increased WBC counts (>11,000 cells/mm³) in 8 specimens, increased neutrophil counts (>80%) in 3 specimens and increased lymphocyte counts (>40%) in 6 specimens (Table III).This analysis helped to classify osteomyelitis and better the understanding of its histopathological features present in synovial membrane tissue in patients suffering from different grades of osteomyelitis.

A hypodiploid karyotype in childhood B-cell precursor acute lymphoblastic leukemia

The detection of genetic markers associated with poor prognosis is crucial to the selection of an appropriate treatment plan for B-cell precursor acute lymphoblastic leukemia (BCP-ALL). A hypodiploid karyotype in patients with BCP-ALL has an unfavorable impact and serves as a criterion for the stratification of patients into a high-risk group. However, the survival rates of patients with a hypodiploid karyotype remain poor. Russian treatment protocols for childhood acute lymphoblastic leukemia do not include a hypodiploid karyotype in risk stratification criteria. In order to determine the prognostic value of a hypodiploid karyotype and the clinical characteristics of BCP-ALL in patients with a hypodiploid karyotype, we analyzed the survival rates of 2,700 patients included in a multicenter study. Our study was approved by the Independent Ethics Committee and the Scientific Council of the D. Rogachev NMRCPHOI of the Ministry of Healthcare of the Russian Federation. All patients underwent karyotyping and fluorescence in situhybridization (FISH) testing. A hypodiploid karyotype was detected in 27 patients. Eighteen out of 27 patients had a hypoploid clone (according to karyotyping results), 2 patients had a doubled near-haploid clone (according to karyotyping and FISH results); in 7 patients with a normal karyotype or in the absence of mitosis, hypodiploidy was determined only by FISH test. BCP-ALL with hypodiploidy is usually associated with increased WBC count at disease onset. The median WBC count in the study group was 24.2 (3.4–206.0) × 109/l vs 10.3 (0.2–1290.0) × 109/l in the control group. The number of patients with initial leukocytosis < 30 × 109/l in the study group was significantly lower than in the control group (p< 0.062). Remission was achieved in 26/27 patients. The event-free survival rates in patients with hypodiploidy were significantly lower than in those without hypodiploidy: 50 ± 11% vs 72 ± 8% (p< 0.0001). The overall survival was 64 ± 10% and 90 ± 1%, respectively (p< 0.0001). The cumulative incidence of relapse in patients with a hypodiploid karyotype was higher (42.6 ± 10.9%) than in the controls (22.3 ± 8.1%) (p< 0.0001). The patients who received more intense treatment for intermediate- and high-risk groups showed better survival rates than those in the standard-risk group: 62 ± 13% vs 40 ± 15% (р= 0.59); the cumulative incidence of relapse according to the risk group was 26.4 ± 12.1% and 60 ± 16.9%, respectively (р= 0.19).The highest risk of relapse was observed in a group that included patients with near-haploidy and low hypodiploidy (26–39 chromosomes; 52.9 ± 14.4%). The event-free survival in this group was 36 ± 13%. The results of treatment of patients with BCP-ALL and hypodiploidy according to the national guidelines turned out to be comparable to the international ones. Patients with BCP-ALL and hypodiploidy should be initially stratified to the most intense treatment arm. In order to identify patients with hypoploidy, standard karyotyping is required; where needed, it can be supplemented by FISH analysis

Epidemiology, clinical characteristics, and virologic features of COVID-19 patients in Kazakhstan: A nation-wide retrospective cohort study.

BackgroundThe earliest coronavirus disease-2019 (COVID-19) cases in Central Asia were announced in March 2020 by Kazakhstan. Despite the implementation of aggressive measures to curb infection spread, gaps remain in the understanding of the clinical and epidemiologic features of the regional pandemic.MethodsWe did a retrospective, observational cohort study of patients with laboratory-confirmed COVID-19 hospitalized in Kazakhstan between February and April 2020. We compared demographic, clinical, laboratory and radiological data of patients with different COVID-19 severities on admission. Logistic regression was used to assess factors associated with disease severity and in-hospital death. Whole-genome SARS-CoV-2 analysis was performed in 53 patients.FindingsOf the 1072 patients with laboratory-confirmed COVID-19 in March-April 2020, the median age was 36 years (IQR 24–50) and 484 (45%) were male. On admission, 683 (64%) participants had asymptomatic/mild, 341 (32%) moderate, and 47 (4%) severe-to-critical COVID-19 manifestation; 20 in-hospital deaths (1•87%) were reported by 5 May 2020. Multivariable regression indicated increasing odds of severe disease associated with older age (odds ratio 1•05, 95% CI 1•03-1•07, per year increase; p<0•001), the presence of comorbidities (2•34, 95% CI 1•18-4•85; p=0•017) and elevated white blood cell count (WBC, 1•13, 95% CI 1•00-1•27; p=0•044) on admission, while older age (1•09, 95% CI 1•06-1•13, per year increase; p<0•001) and male sex (5•63, 95% CI 2•06-17•57; p=0•001) were associated with increased odds of in-hospital death. The SARS-CoV-2 isolates grouped into seven phylogenetic lineages, O/B.4.1, S/A.2, S/B.1.1, G/B.1, GH/B.1.255, GH/B.1.3 and GR/B.1.1.10; 87% of the isolates were O and S sub-types descending from early Asian lineages, while the G, GH and GR isolates were related to lineages from Europe and the Americas.InterpretationOlder age, comorbidities, increased WBC count, and male sex were risk factors for COVID-19 disease severity and mortality in Kazakhstan. The broad SARS-CoV-2 diversity suggests multiple importations and community-level amplification predating travel restriction.FundingMinistry of Education and Science of the Republic of Kazakhstan.

Incidence and Risk Factors for Complications and Mortality After Vertebroplasty or Kyphoplasty in the Osteoporotic Vertebral Compression Fracture-Analysis of 1,932 Cases From the American College of Surgeons National Surgical Quality Improvement.

Study Design:Retrospective cohort.Objective:The purpose was to investigate the incidence of and risk factors for complications associated with vertebroplasty (VP) or kyphoplasty (KP) for osteoporotic vertebral compression fracture (OVCF) using the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database.Methods:A cohort of patients undergoing VP/KP was constructed from the 2011-2013 ACS-NSQIP dataset using Current Procedural Terminology (CPT) codes. The incidences of minor complications (i.e. urinary tract infection, pneumonia, renal insufficiency, superficial infection, wound dehiscence), major complications (i.e. reoperation, deep vein thrombosis, pulmonary embolism, sepsis, dialysis, cardiac arrest, deep infection, stroke), and mortality within 30 days post-surgery were investigated, and their risk factors were assessed using logistic regression modeling.Results:Of 1932 patients undergoing VP/KP, 166 (8.6%) experienced a complication, including minor complications in 53 (2.7%), major complications in 95 (4.9%), and death in 40 (2.1%). Multivariate logistic regression analysis indicated that the adjusted odds ratios (95% confidence interval [CI]) of mortality was significantly associated with ASA 4: 16.604 (1.956-140.959) and increased creatinine (≥ 1.3 mg/dL): 3.494 (1.128-10.823). History of chronic obstructive pulmonary disease was associated with minor complications. Increased WBC count and hypoalbuminemia (<3.0 g/dL) were also associated with major complications.Conclusions:The major complication and mortality rates associated with VP/KP were 4.9% and 2.1% respectively, higher than previous reports. Increased creatinine and ASA 4 were independently associated with mortality after VP/KP. Therefore, cautious monitoring and counseling is needed for elderly, patients with preexisting kidney disease or ASA 4 undergoing VP/KP.

Clinical Characteristics and Outcomes of Candidemia Caused by Meyerozyma guilliermondii Complex in Cancer Patients Undergoing Surgery.

Although Meyerozyma guilliermondii complex is an uncommon cause of invasive candidiasis worldwide, reported cases, mainly regarding bloodstream infections, increased over years, and patients with cancer who have undergone recent surgery are most commonly affected. However, the clinical characteristics and outcomes of candidemia caused by M. guilliermondii complex remain poorly understood. A retrospective case-control study was conducted to evaluate the clinical characteristics and mortality of candidemia caused by M. guilliermondii complex in cancer patients undergoing surgery. Demographic and clinical data were collected from the hospital medical records system with a standardized data collection form and were analyzed with SPSS 20.0. Sixty-six cancer patients who have undergone recent surgery and were diagnosed with candidemia caused by M. guilliermondii complex were included in the study. Regarding the clinical manifestations, most patients' body temperatures ranged from 38 to 40°C, with a median fever duration of 4 (IQR: 3-6) days. Multivariate analysis indicated that the presence of central venous catheter (OR: 6.68; 95% CI 2.80-15.94) and gastric tube (OR: 3.55; 95% CI 1.22-10.34) were independent risk factors for M. guilliermondii complex fungemia. The 30-day crude mortality of candidemia caused by M. guilliermondii complex was 12.1%, twice that of the control group. Moreover, increased WBC count, age ≥ 60years, septic shock, and ICU admission were identified as predictors of mortality through univariate analysis. These findings will provide a foundation for the clinical management of candidemia caused by M. guilliermondii complex in post-surgical cancer patients.

C-reactive protein as a prognostic marker and guidance for use of antibiotic therapy in patients presenting with lower respiratory tract manifestations in intensive care unit in tertiary care centre

Introduction: C-reactive protein is a acute phase reactant protein synthesized in the liver and in response to various stimuli. It is a simple blood test to distinguish between viral and bacterial pneumonia. It is a cheap and easily available useful adjunctive test to limit the use of antibiotics in patients presenting with lower respiratory tract manifestations. Materials and Methods: It is a prospective study of 60 patients admitted with lower respiratory signs and symptoms in Intensive Care Unit of Mallareddy institute of medical sciences, Hyderabad, Telangana. Serum CRP level measured by latex agglutination method and other markers of infection like Complete blood count, Sputum microscopy culture and sensitivity and chest X-ray were done on presentation. CRP concentration of more than 20mg/l taken as positive. Number of CRP positive patients were correlated with patients of increased WBC count and positive sputum routine culture and sensitivity and results were compared using chi -square test. Result: Total 60 patients were taken for study out of which 38 were male and 22 were female. Out of which 24(40%) were diagnosed with pneumonia,6(10%) with pulmonary koch’s,7(11.6%) with acute exacerbation of asthma,11(18.3%) were COPD,4(6%) with congestive cardiac failure, 5(8.3%) with autoimmune disorder and 3(5%) with interstitial lung disease. Among them 29(48.3%) patients were found to have CRP value of more than 20mg/dl which is considered as positive, out of these 29 patients, 16(55.17%) were having pneumonia which was confirmed on imaging and sputum culture and sensitivity. Out of these 29 patients with CRP positive 21(72.4%) were found to have sputum culture and sensitivity as positive for bacteria in which 4(19%) were diagnosed as autoimmune disorder,2(9%) with bronchial asthma, 10(47.6%) with pneumonia, 3(14.2%) with COPD, 2(9.5%) with pulmonary Koch’s. Among 29 patients with positive CRP,18(62%) patients have the WBC count of >11,000cells/mm3. Patients with

Phytochemical and toxicological evaluations of Prosopis africana (GUILL. and PERR.) extract on albinowistar rats.

In this study, we investigated the phytochemical and toxicological impacts of the ethanol leaf extract of Prosopis africana in albino rats. Preliminary phytochemical analysis was done using established methods. Acute and 28-day sub-chronic toxicity evaluations of the extract were carried out in wistar rats. Five groups made up of 8 rats per group were used and treated with 500, 1000, 1500 and 2000mg/kg b.wt. respectively; while the control group received 1ml of 10% Tween-20 solution. Phytochemicals detected include tannins, saponins, flavonoids, alkaloids, anthocyanin, quinones, terpenoids and steroids. There were no signs of toxicity in the acute toxicity study neither was any death recorded. Weight loss and death wererecorded after 18days of treatment in groups treated with 1500 and 2000mg/kg b.wt. No significant alteration of haematological parameters was observed, however increased WBC count was recorded. Liver and kidney function parameters were significantly (p < 0.05) reduced, while significant (p < 0.05) increase in triglycerides with lowered cholesterol wasseen when compared with the control group. Histological evaluations of the liver, kidney, heart and testicular tissues revealed normal sections in majority of the animals; however, mild vascular congestions were observed at random doses (liver and heart at 1500mg/kg b.wt.; kidney at 500mg/kg b.wt.). Our study shows that ethanol leaf extract of P. africana would probably not cause significant toxic effects as indicated by haematological and biochemical parameters. However, there may be need to apply caution in its use at high doses given that death occurred at 1500mg/kg b.wt. during the repeat-dose toxicity study.

Cytogenetic Pattern in Adult Patients with de novo Acute Myeloid Leukaemia: A Single Centre Study in Bangladesh

Background: Cytogenetic analysis performed at diagnosis is considered to be the most important prognostic factor in AML. Objective: The purpose of this study was to observe the pattern of cytogenetic abnormalities in adult patients with de novo AML. Method: Total fifty-two newly diagnosed de novo AML patients were selected for the study. Six cytogenetic abnormalities including t(8;21), t(15;17), inv(16), BCR-ABL1, FLT3-ITD &amp; NPM1 mutations were detected by Real-Time PCR. Results: In this study, 36 (69.2%) patients showed different cytogenetic abnormalities. The t(15;17) was found to be the most common. t(15;17), t(8;21) and inv(16) were found only in M3, M2 and M4 FAB subtypes, respectively. Significant association was found with increasing age and cytogenetic risk groups. BCR-ABL1 mutation showed significant relation with increased age. FLT3-ITD mutation showed significant association with increased WBC count and inv16 was significantly associated with relatively less bone marrow blast percentage. Conclusion: Cytogenetic study should be performed routinely in all cases of AML for proper diagnosis, prediction of prognosis and implementation of effective therapeutic measures.

A Case Report of Rickettsial Meningitis

Rickettsial diseases are a group of infections caused by the obligate intracellular bacteria Rickettsia. Rickettsial infections are common in southern Europe. The disease is usually characterized by the classical triad of fever, eschar and rash. Complications including neurological involvement are rarely described. We report an unusual case of meningitis in a 55 years old man presenting with high grade fever for 8 days associated with persistent headache. The patient was suspected to have enteric fever and treated with injection ceftriaxone. Forty-eight hours after admission, the presence of continued high grade fever, conjunctival congestion, headache, cough, low platelet and increased WBC count, and elevated transaminase raised the possibility of a different aetiology. Finally, Rickettsial meningitis was confirmed due to history of field visit, presence of eschar, neck rigidity, raised titre of WF OX-K antigen and the cerebrospinal fluid analysis revealed increased cellularity, hypoglycorrhachia, and hyper proteinorrhachia (106 mg/dL). Patient was treated with capsule doxycycline and other supportive therapy and became afebrile within 48 hours. This uncommon clinical scenario should be taken into account in the management of patients with high grade fever on admission.&#x0D; Delta Med Col J. Jul 2019 7(2): 100-103

Evaluation and characterisation of Chronic myeloid leukemia and various treatments in Saudi Arabia: A retrospective study

BackgroundChronic myeloid leukemia (CML) is a clonal BCR–ABL1-positive myelo-proliferative disorder resulting from an acquired genetic mutation, characterized by the presence of the Philadelphia (Ph) chromosome. CML is associated with significantly high granulocyte numbers in the bone marrow and peripheral blood. Materials and MethodsThis retrospective study conducted at the Hematology Unit of King Saud University Medical City aimed to evaluate the incidence and characteristics of CML and the various treatments in Saudi Arabia. We have evaluated the demographic, clinical, and hematological data of 56 consecutive patients who visited the hospital from Jan 2012 to Jan 2018. ResultsThe diagnosis and stage of CML were determined based on the World Health Organization criteria, following polymerase chain reaction analysis of bone marrow aspirates. Our study group had equal numbers of genders with a age mean of 43.3+18.1 years. The predominance of younger patients and equal incidence in males and females could be due to the racial and socioeconomic disparities among our patients compared to those in previous studies. While the most predominant symptom was fatigue and bone pain, the most common clinical sign was hepato-splenomegaly, followed by remarkable weight loss, and epistaxis. ConclusionA patient with an increased WBC count, abdominal pain, left side distension, and hepato-splenomegaly should clearly be evaluated for CML.

Carotid and femoral intima-media thickness in adults with sickle cell disease

Background: This study was conducted to evaluate Carotid Intima Media Thickness (CIMT) and Femoral Intima Media Thickness (FIMT) in adults with SCD.Methods: The present prospective cross-sectional study with control group was carried out in Department of Medicine at Acharya Vinoba Bhave rural hospital over a period of 6months from January to June 2018. A total of 100 (50 cases of SCD, 50 normal subjects) were studied. In the SCD group, 35 cases were patients regular follow up cases and 15 patients were in sickle cell crisis. CIMT of both left and right carotids were taken and the mean of the two values were recorded. The IMT was also measured in the right common femoral artery (RCFA) and left common femoral artery.Results: SCD patients in steady state had significantly decreased Hb%, increased WBC counts and platelet counts as compared to healthy controls. The mean right FIMT, left FIMT, right CIMT and left CIMT the patients with SCD with crisis were significantly higher than that of the patients without SCD (P&lt;0.001). One way showed that there were significant differences in duration of disease in mean level of Hb%, WBC count, platelet count of the patients in the three groups (p&lt;0.01).Conclusions: CIMT and FIMT can pick up the macrovascular involvement early and can be utilized as screening tools to predict vascular injury so that at risk individuals would be subjected to proper treatment protocols, especially hydroxyurea therapy early on.

Effect of Slum Water on Physiology of Heteropneustes fossilis Collected from Silchar, Assam

Poverty and overpopulation are not just prevailing in big cities, but have also become a matter of concern in small towns. Safe drinking water is considered a basic human need, yet millions of people do not have access to an adequate and safe water supply. The present study is focused on the quality assessment of water bodies of slum areas of Silchar, Assam, India and to evaluate the physiological stress on Heteropneustes fossilis from household water pollution. Water samples from six different sites were collected and their physical parameters were tested. Fishes (n=35) of approximately similar size (15.8±0.84 cm) and weight (30.0±1.2 gm) were exposed to each water samples for a period of 10 days and their morphological and behavioural changes were observed. The RBC and WBC counts of the fishes were also determined. Physical properties of the water samples revealed that the pH ranges from 4.79-6.10; conductivity 0.07-0.46 mS/cm; total dissolved solids 0.03-0.29 ppm; free CO2 13-26 ppm and dissolved oxygen 2.2-3.5 ppm. An abundance of bacteria was observed in the water samples and the predominant isolates were identified as Escherichia coli, Klebsiella sp., Bacillus sp. and Pseudomonas sp. Fishes exposed to pond water were initially active with no morphological and behavioural changes. However, from day-5 onwards, their swimming had become idle and lethargic, their dark black skin had gradually attained a pale texture and the mucus content of skin had gradually reduced. Despite providing food and air regularly, the fishes had gradually stopped eating, with swimming pattern changed from dorsal to ventral side upward and decreased opercular activity. Hematological studies showed decreased RBC count and increased WBC count in pond water treated fishes, inferring blood balance disturbance and infection in fishes. Adequate measures should be taken by the respective residents of the selected areas to minimise the degree of water contamination and use of proper disinfectants, or else the hazardous condition of the water will deteriorate the aquatic biodiversity and create serious health problems in humans.

Haematopoietic Potential of Jatropha tanjorensis Leaf Extract in &amp;lt;i&amp;gt;Plasmodium berghi-berghi&amp;lt;/i&amp;gt; Infected Mice Treated with &amp;lt;i&amp;gt;Hippocratea africana&amp;lt;/i&amp;gt; Root Bark Extract

The haematopoietic potential of <i>Jatropha tanjorensis</i> leaf extract in <i>Plasmodium berghi-berghi</i> infected mice treated with <i>Hippocratea africana</i> root bark extract was investigated. Thirty (21) adult mice weighing 27 – 33g were divided into seven (7) groups with three (3) animals in each group. Group 1 served as normal control while Groups 2 – 7 were parasitized with <i>Plasmodium berghi-berghi</i> and Group 2 was the test control (parasitized and untreated) group. Group 3 was administered 8mg/kg bw of artemether-lumefantrine for 3 days. Group 4 and 5 received daily, 200mg/kg bw and 300mg/kg bw of extracts of <i>Hippocratea africana </i>and <i>Jatropha tanjorensis</i> respectively for 4 days. Group 6 received 8mg/kg bw of artemether-lumefantrine for 3 days followed with 300mg/kg bw of <i>Jatropha tanjorensis</i> leaf extract for 4 days. Group 7 was treated with 200mg/kg bw of <i>Hippocratea africana</i> root extract for 4 days followed by 300mg/kg bw of <i>Jatropha tanjorensis</i> leaf extract for 4 days. Significant anti-plasmodial activity was observed with artemether-lumefantrine and <i>Hippocratea africana</i> root bark extract administration. <i>Plasmodium berghi-berghi</i> infection induced alterations in haematological indices such as decreased RBC count, platelet count, haemoglobin concentration and heamatocrit and increased WBC count. Administration of <i>Jatropha tanjorensis</i> leaf extract showed improved haematological indices particularly in the red blood cell counts and haemoglobin concentration. <i>Jatropha tanjorensis</i> has haematopoietic activity in <i>Plasmodium berghi-berghi</i> infected mice treated <i>Hippocratea africana</i> root bark extract.

Atypical Chronic Myeloid Leukemia

Introduction: Atypical chronic myeloid leukemia (aCML), BCR-ABL1 negative is a rare myelodysplastic syndromes (MDS)/myeloproliferative neoplasm (MPN) for which no current standard of care exists. We present one of the rare presentations of aCML in an elderly patient.Case: A 76 year old male presented to the Hematology clinic for consultation after discharge from local hospital for elevated WBC count. Past medical history was significant for COPD, acid reflux, peripheral arterial disease and hypertension. Physical exam was unremarkable. Initial labs were significant for leukocytosis of 30 k/cu mm, anemia with Hb 10 gm/dl, thrombocytosis 695,000 with neutrophilia of ANC 25,200. Peripheral blood was negative for JAK2 V617F and BCR-ABL. Peripheral blood flow cytometry showed granulocytic left shift with 1.5% myeloblasts. Bone marrow biopsy suggestive of hypercellular marrow (100%) with myeloid predominance, atypical megakaryocytes, increased ring sideroblasts (49% of NRBC), increased blasts (5%) and dysgranulopoeisis over all suggestive of Myelodyplastic Syndrome/Chronic Myeloproliferative Disorder (MDS/MPD). Cytogenetics were positive for U2AF1 positive, CSF3R T6181, CSF3R Q776 pathognomonicof atypical CML and negative for BCR-ABL, FLT3. He was considered transplant ineligible. He was started on Azacitadine and is currently receiving 2nd cycle therapy. He is also receiving darbepoeitin periodically to avoid frequent transfusions. He is currently transfusion independent.Discussion: Increased WBC count (e.g., cutoffs of >40×109/L or 50×109/L), increased percentage of peripheral blood myeloid precursors, female sex, and older age are adverse prognostic factors for overall survival or leukemia-free survival in aCML. aCML cases lack in Philadelphia chromosome. Overall 50-65% of patients show cytogenetic abnormalities. The most frequent is +8 (25%). Other changes such as -7 and del(12p) have also been recurrently observed. Patients with aCML have an estimated median survival between 14 and 30 months. aCML tends to exhibit a more aggressive clinical course than other MDS/MPN subtypes. DisclosuresNo relevant conflicts of interest to declare.

Predictors of Adverse Outcome in Sickle Cell Disease Patients from Oman

Introduction: Sickle cell disease (SCD) is a major public health problem in Oman with high morbidity and mortality. The ability to identify the risk factors that are associated with mortality among SCD patients would permit accurate prognostication and provide an opportunity to use effective prophylactic management.Objective: The study aimed at identifying the risk factors associated with mortality in SCD patients by studying the clinical course of 86 patients who died at two tertiary care hospitals in Oman.Methods: We analyzed the electronic records of 86 SCD patients who died between 2006 to 2016. These data included cardiac parameters, SCD manifestations like frequency of painful crisis, acute chest syndrome, splenic and hepatic sequestration, dactylitis, and stroke. Furthermore, we also analyzed the haematological, biochemical and radiological parameters as well as use of antibiotics and exchange blood transfusion. Data were transcribed to Excel and later analyzed by IBM SPSS Ver23.Results±13.7. Previous complications prior to death included acute chest syndrome in 66.3% cases, followed by stroke in 20.9%, hepatic sequestration in 6.9%, splenic sequestration in 3.5% and dactylitis in 2.3% cases. At the terminal event, patients presented with fever, cough and crepitation in 47%, 29% and 36% respectively, while abnormal pulse, blood pressure, respiratory rate and O2 saturation were seen in 55%, 64%, 46% and 55% respectively. Further abnormal chest x-ray, CT scan and abdominal ultrasound were seen in 57.5%, 88.5% and 50% respectively. Amongst the haematology parameters, there was a significant drop in the mean hemoglobin and platelet counts from baseline, whereas there was a significant rise in the WBC counts (p<0.05, student's t test). The biochemical parameters showed a significant rise in the LDH and CRP levels (p<0.05). All patients received antibiotics, 88% received blood transfusions, 35.7% received exchange transfusions, whereas 87.5% required NIV/ventilation. Finally, all patients presented with multi-organ terminal events that varied in the severity, but sepsis showed the commonest cause of death (54.3%).Conclusion: Multi-organ failure was mostly associated with the terminal events relating to mortality. Although sepsis played a major role as a cause of death in association with multiorgan failure, low hemoglobin, and low platelet counts with increased WBC counts along with elevated LDH and CRP played a significant role in the terminal event in this cohort of SCD patients. DisclosuresNo relevant conflicts of interest to declare.

Efficacy and safety of partial splenic embolization for hypersplenism in pre- and post-liver transplant patients: A 16-year comparative analysis

PurposeTo report the effect of partial splenic embolization (PSE) on hematological indices and the procedure's safety in pre- and post-liver transplant (LT) patients. Materials and methodsA single-center retrospective study evaluating all patients who underwent PSE over a 16-year period was performed. Inclusion criteria were splenomegaly confirmed by imaging and at least one of the following cytopenias: hemoglobin ≤10 g/dL, WBC count ≤1500 μL−1, or platelet count ≤100,000 μL−1. 38 of 102 patients (37%) met criteria (24 pre- and 14 post-LT) for a total of 40 PSEs. ResultsNo effect was seen on median hemoglobin beyond 2 weeks post-PSE. There was a significant and sustained increase in median WBC counts (from 3400 μL−1 to 5400 μL−1 at 2 years) and platelet count (from 65,000 μL−1 to 117,000 μL−1 at 3.5 years). In 6 out of 40 PSEs (15%) a major complication occurred which included pleural effusion, ascites, spontaneous bacterial peritonitis, pneumonia, and inferior vena cava thrombus. Similar efficacy was observed in pre- and post-LT cohorts, with a trend toward higher complication rate in pre-LT patients. ConclusionsPSE is efficacious in increasing WBC count out to 2 years and platelet count out to 3.5 years in patients with hypersplenism. Efficacy and safety appeared independent of pre- or post-LT status. The intervention is associated with major complications and special care should be taken when selecting patients for PSE.

Mucormycosis: the clinical spectrum

Background: Mucormycosis is a rare opportunistic fungal infection typically affecting diabetic or immunosuppressed patients. In most of the cases, infection is caused by inhalation of fungal spores. The aim of the study is to assess the different modes of presentation, risk factors management and prognosis of patients with mucormycosis.Methods: It is a retrospective study conducted in Father Muller medical college hospital between January 2016 to October 2017 and included all patients hospitalized for mucormycosis confirmed by mycological and /or histological findings. This study was approved by the institutional research and ethics committee. All case records were identified from in patient MRD with the diagnosis of mucormycosis over the last one year. For each case taken, the clinical information was recorded from case sheetResults: Out of the 7 cases studied 5 (71.4%) had rhinoorbital involvement 28.6% had pulmonary involvement with hemoptysis being the primary symptom. The mean age of the affected population was 55.7 years. Uncontrolled diabetes mellitus was the most common predisposing factor as seen in 71.4% cases with mean Hba1c levels 13. The mean ESR in present study was 79. There was increased WBC count in all the cases studied with neutrophilic predominance. Urine ketones was positive (++) in all the cases of diabetes with rhinoorbital involvement.Conclusions: Uncontrolled diabetes mellitus is a predisposing factor for mucormycosis. Elevated ESR was noted in all the cases.

Clinical factors associated with intestinal strangulating obstruction and recurrence in adhesive small bowel obstruction: A retrospective study of 288 cases.

Postoperative adhesions are a common cause of adhesive small bowel obstruction (ASBO), and recognition of intestinal strangulation is important. The aim of this study is to analyze the clinical factors for strangulating obstruction and to identify the predictors for recurrence of ASBO.A retrospective study was conducted using the database in our department. Patients with ASBO from January 2013 to April 2016 were included in the study and were subject to follow-up. The clinical factors associated with strangulating obstruction and recurrence after treatment were analyzed by using univariate and multivariate logistic regression model.In total, 288 ASBO patients were included in the study. Of these, 37 (12.9%) patients had occurred strangulating obstructions, and 251 (87.1%) patients had simple obstructions. Four clinical parameters, including increasing heart rate (>100 bpm), increasing WBC count (>15 × 109/L), CT findings of thickening or swelling of the mesentery, and CT showing seroperitoneum were detected as independent clinical factors for intestinal strangulation. Eighty-four (29.2%) patients experienced recurrence of obstruction during the median 24 months of follow-up. Recurrence rates were reduced in patients who underwent surgical treatment compared with those who received conservative management [21.3% (26/122) vs 34.9% (58/166) (P = .010)]. Nevertheless, the recurrence rates were not significantly increased in patients with strangulating obstructions compared with those with simple ASBO [34.3% (12/35) vs 27.7% (72/253) (P = .186)].Four clinical parameters including tachycardia, leukocytosis, along with CT findings of thickening or swelling of the mesentery and CT showing seroperitoneum, associated with occurrence of intestinal strangulation in ASBO. ASBO patients who underwent surgical treatment had a reduced recurrence rate, but ASBO patients with strangulating obstructions had not increase the recurrence rates than those of patients with simple ASBO.