Laboratory Parameters In Patients Research Articles

Difficulties in differential diagnosis of preeclampsia and acute surgical pathology

Aim: to determine the prevalence of preeclampsia and HELLP syndrome among patients hospitalized in surgical departments with complaints of pain in the epigastrium, right hypochondrium and/or nausea and vomiting. Material and methods. An analysis was carried out of visits from pregnant women over 20 weeks to the surgical department in 2023 and 42 cases of hospitalization of pregnant patients with suspected acute surgical pathology hospitalized in surgical departments No. 6 and No. 7 of the Samara City Clinical Hospital No. 1 named after. N.I. Pirogov." The following parameters were assessed: age, gestational age, complaints at the time of admission, general blood test data, urine, biochemical blood parameters (ALT, AST, total protein, creatinine, urea, total bilirubin, LDH, amylase, alkaline phosphatase, CRP), the presence of protein in urine, the state of the hemostatic system, the condition of the fetus according to ultrasound, ultrasound, CTG, the presence of obstetric and gynecological pathology and somatic diseases. Results. Patients with acute appendicitis (7 out of 42 pregnant women) were excluded from the study. Of the remaining 35 patients, the diagnosis of severe preeclampsia, HELLP syndrome was made in 3 cases (8.6%), in 2 cases gestational hypertension or protineria (5.7%) - the main group. Cholelithiasis, acute cholecystitis - in 2 cases (5.7%), in other cases the diagnosis of acute pancreatitis was made - 28 patients (80.0%). The work provides a comparison of clinical and laboratory parameters of patients in two groups - with obstetric and surgical pathology. An clinical case of a combination of severe PE with the development of HELLP-syndrome and cholecystitis is also presented. Conclusions. Based on numerous literature data and the results of our work, we can confidently say that the differential diagnosis between obstetric complications such as PE and HELLP syndrome and acute surgical pathology still remains a pressing interdisciplinary problem. Severe forms of PE can take the form of acute pancreatitis, acute cholecystitis, or exacerbation of chronic diseases of the abdominal cavity and retroperitoneal space. According to the results of our observation, this phenomenon occurred in 15% of patients hospitalized in surgical departments.

Position paper of DGKL and DIVI on requirements for laboratory services in intensive care and emergency medicine

The timely determination and evaluation of laboratory parameters in patients with acute life- or organ-threatening diseases and disease states in the emergency room or intensive care units can be essential for diagnosis, initiation of therapy, and outcome. The aim of the position paper is to define the time requirements for the provision of laboratory results in emergency and intensive care medicine. Requirements for point-of-care testing (POCT) and the (central) laboratory can be derived from the urgency. Expert groups from the DGKL (Deutsche Gesellschaft für Klinische Chemie und Laboratoriumsmedizin) and DIVI (Deutsche Interdisziplinäre Vereinigung für Intensiv- und Notfallmedizin) developed a classification about the urgency for the determination of laboratory parameters as well as recommendations on the necessary organizational framework and quality assurance measures using national and international guidelines, review articles, and original papers. Three levels of urgency are defined, based on the turnaround time of the most common laboratory parameters: emergency 1, with a turnaround time of no more than 15 min; emergency 2, with a turnaround time of a maximum of 60 min; urgent case, with a turnaround time within 4 h. In addition, a recommendation is made when to provide the results for the main ward rounds in the intensive care unit and the emergency department. The recommendations allow the organizational and technical regulations for each hospital to be aligned with the urgency of the provision of the test results to the medical team based on the medical requirements.

Prognostic potential of standard laboratory parameters in patients with metastatic renal cell cancer receiving first-line immunotherapy

Through their involvement in cancer metabolism, alanine aminotransferase (ALAT), aspartate aminotransferase (ASAT), γ-glutamyltransferase (GGT) and lactate dehydrogenase (LDH) reflect the tumor burden and thus could have a prognostic potential for patients treated with immune checkpoint inhibitors (CPI). Therefore, this study investigated the prognostic potential of these parameters in a real-world cohort of patients with metastatic renal cell cancer (mRCC) under first-line CPI-based therapy. The retrospective study cohort included 82 mRCC patients treated with CPI-based first-line therapy between 2019 and 2023. Progression-free survival (PFS), overall survival (OS) and response rates were evaluated according to baseline levels and early dynamic changes of ALAT, ASAT, GGT and LDH. Multivariate Cox proportional hazard regression models were generated to identify independent prognosticators for PFS and OS. High baseline levels and non-normalized kinetics of ALAT, ASAT, GGT and LDH were significantly associated with shorter PFS and OS (p < 0.05), which was also reflected by lower response rates. Combining the four parameters at baseline into a 4-Risk-Score resulted in an enhanced prognostic power, as indicated by a higher C-index of 0.693 for OS compared to the individual parameters (≤ 0.663). Patients with all four risk factors present showed the worst PFS and OS. Overall, baseline levels and early kinetics of the four parameters as well as the 4-Risk-Score were identified as independent prognosticators for PFS and OS by multivariate analysis. As standard laboratory parameters, ALAT, ASAT, GGT and LDH are cost-effective and could be easily used either alone or in combination for therapy monitoring of CPI-treated mRCC patients.

ASSESSMENT OF LABORATORY PARAMETERS IN PATIENTS WITH ACUTE PANCREATITIS OF VARIOUS ETIOLOGIES

Summary. Abstract. Acute pancreatitis remains one of the most prevalent diseases worldwide. Alcoholic and biliary factors are considered the most common causes of AP. The aim of the study was to investigate the laboratory characteristics of patients with AP, taking into account the etiological variant of the disease. Materials and methods: the study is retrospective. Medical records of 677 patients hospitalized for AP in two medical institutions from 2017 to 2022 were analyzed: Vinnytsia сity сlinical emergency hospital and Vinnytsia regional clinical hospital named after M.I. Pyrogov. For further study of laboratory parameters of all AP patients, they were divided into four groups depending on the etiology: alimentary, biliary, alcoholic, and postoperative. The laboratory data obtained within the first 24 hours of hospitalization were analyzed. Results. Intergroup differences in the distribution of laboratory parameters were observed among different etiological variants of AP. Some of them showed only significant intergroup deviations within reference values, while some also deviated from the norm. Specifically, for alimentary AP, there was a significant increase in creatinine levels compared to other groups. For biliary AP, there was a significant increase in leukocyte count, neutrophil-to-lymphocyte ratio, total bilirubin, blood glucose levels, and a significant decrease in lymphocyte count. For postoperative AP, there was a significantly the lowest level of increase of serum amylase levels, significant elevation in ALT and AST levels, and significant increase in stabs neutrophils and ESR compared to other groups. Conclusions. Analysis of blood and urine laboratory parameters in patients with AP allowed to identify intergroup differences in their distribution for different etiological variants of AP without deviation from the norm, as well as deviations from reference values. The obtained data should be taken into account at the stage of hospitalization and the beginning of inpatient treatment of patients with AP for further stratification and development of individualized diagnostic and therapeutic programs.

Characteristics of diabetes mellitus patients with nonviral chronic liver disease who developed hepatocellular carcinoma.

Type 2 diabetes mellitus (T2DM) is a well-known risk factor for hepatocellular carcinoma (HCC). However, HCC is often diagnosed at an advanced stage in patients with diabetes because of the lack of the best criteria for surveillance candidates. The aim of this study was to identify risk factors for HCC development in patients with diabetes with nonviral chronic liver disease. Three hundred thirty T2DM patients with nonviral chronic liver disease who underwent surveillance for HCC by imaging techniques between 2009 and 2020 were enrolled in this multicenter cross-sectional retrospective study. Theclinical and laboratory parameters of patients with and without HCC were compared. Age ≥65years, alcohol intake, lack of hepatic steatosis, triglyceride level <111mg/dL, Mac2 binding protein glycosylation isomer (M2BPGi) ≥0.9 cut-off index (COI), α-fetoprotein concentration ≥5ng/mL, and des-γ-carboxy prothrombin concentration ≥26mAU/mL were independently associated with HCC development. When stratified by age, only alcohol intake (odds ratio [OR] 114.19, p<0.001) was associated with HCC development in patients aged <65years, and medication for diabetes mellitus (OR 5.72, p=0.001), lack of hepatic steatosis (OR 4.47, p=0.002), lactate dehydrogenase ≥198IU/L (OR 2.751, p=0.031), M2BPGi ≥1.18 COI (OR 9.05, p<0.001), and FIB-4 index ≥2.59 (OR 3.22, p=0.017) were associated with HCC development in patients aged ≥65years. In addition to age and advanced liver fibrosis, alcohol intake in younger T2DM patients and medication for DM and lack of hepatic steatosis in older T2DM patients should be considered for HCC surveillance by imaging.

To the issue of vagosympathetic balance assessment in patients with facial phlegmon

Objective. To assess the influence of the autonomic nervous system tone on the activity of the inflammatory process in facial phlegmon. Materials and methods. A group of patients with facial phlegmon (n = 74) was divided into two parts according to the predominant type of ANS. To identify the dominant type of ANS the method of A.M. Vayne was used. The content of leukocytes and their types was assessed in peripheral blood samples. The concentration of glucose, total protein, C-reactive protein was determined in the patients` blood serum. Statistical data processing was carried out using Student's t-test. Results. Significant differences in laboratory parameters of patients with facial phlegmons with different types of the autonomic nervous system are demonstrated. In patients with prevailing sympathetic division, leukocytosis with a shift of the formula to the left was more pronounced. When the parasympathetic division dominated, a higher concentration of C-reactive protein was observed. Conclusion. Assessment of the autonomic nervous system tone in case of facial phlegmons indicates its significant impact on the activity of the inflammatory process, which affects the duration of inpatient treatment.

LABORATORY PARAMETERS IN PATIENTS WITH CHRONIC CEREBRAL ISCHEMIA DEPENDING ON THE PRESENCE OF CONCOMITANT CHRONIC OBSTRUCTIVE PULMONARY DISEASE

This study investigates the laboratory parameters in patients with chronic cerebral ischemia (CCI) in relation to the presence of concomitant chronic obstructive pulmonary disease (COPD). CCI is characterized by a progressive reduction in cerebral blood flow, while COPD can exacerbate hypoxia, potentially worsening brain ischemia. The research evaluates blood biomarkers, including inflammatory markers and oxygenation indices, to determine the impact of COPD on CCI patients. Results suggest that patients with both CCI and COPD present with more severe inflammatory responses and lower oxygenation levels, which may influence the progression of cerebral ischemia and overall prognosis.

Evaluation of the clinical characteristics, laboratory parameters, and antibiotic treatment in patients diagnosed with tularemia

IntroductionThis retrospective, cross-sectional, multi-center study aimed to evaluate the impact of laboratory results and treatments on the treatment response in patients diagnosed with tularemia. MethodsThe study included 190 adult patients diagnosed with tularemia between November 2023 and June 2024. Results67.9 % were female, mean age was 45.8 ± 14.9 years. The most frequently detected symptoms were sore throat (74.2 %), fatigue (71.6 %), and neck swelling (56.3 %). The most common form of tularemia was oropharyngeal (82.6 %) and glandular (14.2 %). The most used monotherapy was ciprofloxacin (80.5 %, n = 136), and combination therapy was streptomycin-ciprofloxacin (81.0 %, n = 17). Treatment failure was observed in 29 patients (15.2 %). No difference was found between patients who responded and didn't respond to treatment regarding laboratory parameters. Lymph node drainage or excision was performed in 47 patients (23 %). Suppurative lymphadenitis, abscess, necrosis, and conglomerate lymphadenopathy were more common in the lymph node drainage group. Reactive lymph nodes were more common in the group without lymph node drainage. There was no difference between the two groups regarding laboratory parameters of patients with and without lymph node drainage. The duration of antibiotic treatment was longer in patients who underwent lymph node drainage than in those who didn't. ConclusionRadiological evaluation of lymph nodes upon hospital admission, in addition to antibiotic therapy during treatment, may help predict which patients are more likely to require surgical drainage. Laboratory parameters may not provide significant benefits in predicting the need for lymph node drainage and long-term treatment did not affect the treatment response.

Laboratory inflammatory parameters depending on the COVID-19 test result

Introduction: The diagnosis of coronavirus disease 2019 (COVID-19) disease is necessary for the further treatment of patients with the present symptoms, and molecular diagnostics is considered the gold standard. However, it is already known that patients with symptoms of the disease can have a negative test due to various factors. The purpose of this study is to evaluate the laboratory parameters in patients with symptoms of COVID-19 infection who have both positive and negative test results. Methods: The study included 101 samples from patients who tested positive for COVID-19 and 101 samples from patients who tested negative, both groups presenting symptoms of COVID-19. Data on the complete blood count, the absolute values of the differential blood count, and the D-dimer values were collected from the samples that were taken. Using blood count data, neutrophil-to-lymphocyte ratios, platelet-to-lymphocyte ratios, and systemic immune-inflammatory index (SII) were calculated. Results: Based on the examination and research, a significant increase and change in the values of inflammatory indices and D-dimer were determined. In addition to the increase of these values above the reference value, a positive correlation was confirmed between the inflammation index value and the D-dimer value. Conclusion: COVID-19-negative patients with characteristic symptoms of COVID-19 had higher values of lymphocytes and the determination of platelets and SII in these patients can be added to the diagnostic algorithm.

The relationship between optic nerve sheath diameter and demographic and clinical findings in patients diagnosed with clinically isolated syndrome

Aim: This study aimed to assess optic nerve sheath diameter (ONSD) levels in patients diagnosed with clinically isolated syndrome (CIS) who were being followed in the demyelinating diseases clinic, as well as to examine their relationship with demographic characteristics and clinical findings. Material and Methods: In this cross-sectional prospective study, 14 patients diagnosed with CIS who underwent lumbar puncture for specific cerebrospinal fluid (CSF) analysis were included between January 2024 and August 2024. The ONSD were measured by transorbital sonography. All patients' demographic characteristics, clinical parameters (CSF protein, CSF albumin, serum albumin, immunoglobulin G index, and vitamin D) were recorded. Results: The patients had a mean age of 39.4 ± 12.8 years, and the majority were women. Oligoclonal bands were positive in all patients. The mean disease duration was 23.5 ± 7.6 days. The ONSD measurements for all patients ranged between 3.1 and 5.9 mm in the sagittal and axial planes of both eyes. There was a strong negative correlation between ONSD levels and age, diseases duration, CSF protein, CSF albumin, serum albumin, and immunoglobulin G index. Conclusion: This study demonstrated a significant relationship between ONSD and various clinical and laboratory parameters in patients diagnosed with CIS. These findings suggest that ONSD may serve as a valuable, non-invasive marker in assessing disease severity and progression in CIS patients.

The effectiveness of phytosomal curcumin on clinical and laboratory parameters of patients with multiple trauma admitted to the intensive care unit: a double-blind randomized placebo-controlled trial

BackgroundMultiple trauma has serious complications, which increases the risk of morbidity and mortality in the patients. This study aimed to evaluate the impact of supplementation with phytosomal curcumin on clinical and laboratory factors in critically ill patients with multiple trauma.MethodsIn this double-blind trial, 53 patients with multiple trauma, who were admitted to the intensive care unit (ICU) were randomized to receive either 2 capsules, each capsule containing 250 mg phytosomal (a total of 500 mg daily) as an intervention group or 2 identical capsules (placebo capsules), each containing 250 mg maltodextrin for 7 days. Clinical and laboratory were parameters assessed before and after the intervention.ResultsAfter seven days of intervention, the mean increase from baseline in the Glasgow coma scale (GCS) score was significantly higher in the curcumin compared with the placebo group (P-value: 0.028), while the reduction in the APACHE-II score in the curcumin group was greater than that the placebo group in a marginally non-significant fashion (P-value: 0.055). Serum total bilirubin (P-value: 0.036) and quantitative C-reactive protein (CRP) (P-value: 0.044) levels significantly decreased while potassium (P-value: 0.01) significantly increased in the curcumin compared with the placebo group. Moreover, supplementation with phytosomal curcumin significantly increased platelet count (P-value: 0.024) as compared with placebo. The 28-day mortality rate was 7.7% (n: 2 patients) and 3.7% (n: 1 patients) in the placebo and curcumin groups, respectively (P-value > 0.05).ConclusionPhytosomal curcumin had beneficial effects on several clinical and laboratory factors including GCS, APACHEII, serum total bilirubin, CRP, and platelet count in ICU-admitted patients with multiple trauma.Trial registrationIRCT20090306001747N1, Available on: https://www.irct.ir/trial/52692. The first registration date was 12/01/2021.

Highly selective sodium-glucose co-transporter type 2 inhibitor empagliflozin as means of brain protection in conditions of chronic brain dyscirculation

Chronic brain dyscirculation is one of the frequent type 2 diabetes mellitus (DM) complications and leads to patients' disability. Sodium-glucose co-transporter type 2 inhibitors (SGLT-2i) have been proven to have advantages for cardiovascular system, but their effect on the central nervous system (CNS) has not been studied enough. To study empagliflozin effect on CNS damage functional and laboratory parameters in patients with type 2 DM and, under experimental conditions, to investigate the mechanisms of the drug neurotropic effect. The clinical part of the study included patients with type 2 DM on metformin monotherapy (n=39). Patients with a target glycated hemoglobin level formed the "MET" group (n=19), in patients with a non-target glycated hemoglobin level empagliflozin was co-administered for the following 6 months (the "MET+EMPA" group, n=20). Healthy volunteers comprised the control group (n=16). The cognitive status and neuron-specific enolase (NSE) and neurofilament light chains (NLC) concentration were studied. DM was modeled in rats, thereafter the rats were treated with empagliflozin for 8 weeks. Microglia activation was assessed using anti-Iba-1 antibodies and morphological changes in neurons when stained by the Nissl method. Both in the "MET+EMPA" and the "MET" groups cognitive deficits were observed, according to the Montreal Cognitive Assessment (MOCA) (24.0 (23.0; 27.0) and 25.0 (21.0; 27.0) points) and the Mini-Mental State Examination (MMSE) (23.75 (23.0; 27.0) and 25.0 (21.0; 27.0) points). Empagliflozin therapy led to the cognitive status normalization after 6 months (26.5 (24.0; 27.0) points according to the MOCA scale and 27.5 (24.0; 28.0) points according to the MMSE). Initially, all patients had a significant increase of NSE (3.60 (2.66; 3.76) ng/ml in the "MET" group, 3.22 (2.94; 3.54) ng/ml in the "MET+EMPA» group, 2.72 (2.13; 2.72) ng/ml in the «Control» group) and NLC (4.50 (3.31; 5.56) ng/ml in the «MET» group, 5, 25 (3.75; 6.25) ng/ml in the «MET+EMPA» group comparing with 3.50 (2.25; 3.50) ng/ml in the «Control» group). Empagliflozin therapy led to a significant decrease in NLC already after 3 months (3.80 (3.25; 3.87) ng/ml), without significant influence on the NSE level. In the experiment, DM was characterized by an increased number of activated microgliocytes and destructured neurons and a decreased number of neurons with a normal structure. Empagliflozin therapy was accompanied by a decrease in the number of immunopositive microgliocytes in the CA1 zone of the hippocampus and an increase in the number of structured neurons. Type 2 diabetes mellitus is characterized by functional and biochemical changes in the central nervous system even under satisfactory glycemic control. Therapy with empagliflozin has a neuroprotective effect, manifested in an improvement in cognitive status and a decrease in NLC level. Empagliflozin reduces neuronal damage and abnormal microglial activation.

Efficacy of Cytokine Hemoadsorption with Efferon CT in Severe Acute Pancreatitis

The aim of the study was to evaluate the effect of cytokine hemoadsorption on clinical manifestations and laboratory parameters in patients with severe acute pancreatitis (SAP).Materials and methods. The single-center, observational, controlled pilot study included 34 patients, 25 men (73.4%) and 9 women (26.4%), treated for severe acute pancreatitis (SAP) at the N. V. Sklifosovsky Emergency Care Research Institute from May 2022 to August 2023 (ClinicalTrials.gov ID NCT05695001). The mean age of the patients was 42.7±12.6 years. Participants were divided into two groups. In the main group (8 men and 1 woman], mean age 37.2±9.4 years), standard care was supplemented by selective cytokine hemoadsorption (SCH) and renal replacement therapy (RRT) using continuous veno-venous hemofiltration (CVVH) in the first 72 hours after the onset of abdominal pain syndrome (APS). In the control group (N=25, 18 men and 7 women], mean age 44.7±13.2 years), patients were managed similarly except for SCH.Results. After 24 hours in the ICU, the study group had significantly lower levels of lactate (P=0.045) and IL-6 (P&lt;0.001) than the control group. Lactate and IL-6 concentrations remained significantly different between groups at 72 hours (P&lt;0.001 and P&lt;0.05, respectively). ICU stay was significantly shorter in the study group, with a median of 6 days [95% CI, 4–25] before transfer to the general ward, whereas patients in the control group spent 37 days [95% CI, 22–73] in the ICU (P&lt;0.001).Conclusion. CVVH is an effective method of extracorporeal detoxification in the management of SAP, but it is less specific than cytokine adsorption in terms of elimination of proinflammatory markers. The data obtained provide sufficient evidence to consider the combination of these two modalities as the most effective approach for the management of SAP.

Impact of sex on clinical and laboratory parameters in patients with heart failure: insights from the Colombian Heart Failure Registry (RECOLFACA)

Introduction Heart failure (HF) is one of the leading causes of morbidity and mortality worldwide. This study aimed to assess the impact of sex on sociodemographic, clinical, and laboratory parameters in patients with HF who were included in the Colombian Heart Failure Registry (RECOLFACA). Methods This was a cross-sectional analytical research. All 2528 patients included in RECOLFACA were analysed. The Mann–Whitney U test was used to compare median values as well as first and third quartiles (Q1–Q3). The age-related trend of NT-proBNP levels for both men and women groups was statistically evaluated. Results The study included 2528 patients with HF (1072 women and 1456 men). The echocardiographic evidence showed that men presented reduced left ventricular ejection fraction (LVEF) (79.63 vs. 69.75%, respectively; p < 0.001) more often than women, which had a significantly higher proportion of preserved LVEF (20.46 vs.11.24%, respectively; p < 0.001). Women displayed a higher value of systolic blood pressure (p < 0.001) and heart rate (p = 0.014) compared to men. Haemoglobin, creatinine, and sodium levels were significantly higher in men. Men had a considerably lower glomerular filtration rate value, with the median reaching a G3a value for chronic renal failure. According to age, the levels of NT-proBNP in each sex increased equivalently with age. Conclusion Sex differences presented in this study are comparable to those discovered in other nations. However, certain variations show that these sex differences may differ by geographical area, which should encourage further investigations to describe them.

The Correlation of β-Adrenoreactivity of Erythrocyte Membranes with Clinical and Laboratory Parameters in Patients with Resistant Hypertension in the Presence and Absence of Type 2 Diabetes Mellitus

The peculiarity of the conjugation of β-adrenoreactivity of membranes (β-ARM) erythrocyte, as an indicator of the state of autonomic regulation of the cardiovascular system, with other clinical and laboratory indicators in drug-resistant arterial hypertension (RAH) with the absence and presence of type 2 diabetes mellitus (DM2) was investigated. It was shown that patients with RAH, regardless of the presence of DM2, were characterized by reduced adrenoreactivity, while the beta-ARM index of erythrocytes was more than 2 times higher than the reference values. The intergroup difference in the mean values of beta-ARM erythrocytes and the frequency of cases of exceeding the established reference values by this indicator did not have significant differences. In RAH, regardless of the presence of DM2, the beta-ARM erythrocytes index of erythrocytes is statistically significantly associated with the variability of blood pressure, the volume of daily diuresis and increased contractile capacity of the left ventricle. In addition, in the presence of DM2, the association of β-ARM erythrocyte with an increase in left ventricular elastance, heart rate variability, duration of arterial hypertension and DM2 was revealed. Thus, with the development of RAH in humans, the β-ARM erythrocyte indicator can be a new biomarker for personalized assessment of the activity of autonomic regulation of the cardiovascular system. CD2 expands the conjugacy of β-ARM erythrocyte with clinical and laboratory parameters.

Real-world study on the effect of nab-paclitaxel treatment on clinical outcomes and laboratory parameters in patients across metastatic tumor sites

Objectives: PacliALLTM is the first and only indigenously developed brand of nab-paclitaxel in India that has shown bioequivalence to the global reference (Abraxane®). However, real-world Evidence is scarce about the use of it in different tumor sites beyond approved indications. This study assessed the effects of nab-paclitaxel (PacliALLTM) on clinical outcomes in patients diagnosed with different metastatic cancers in a tertiary care hospital in India. Material and Methods: In this retrospective study, data on demographics, medical history, and laboratory investigations were collected from medical records of patients with metastatic cancer. Patients on nab-paclitaxel were included, and data on laboratory findings, including hematological, liver, and kidney function tests and prognostic outcomes, were evaluated. Results: The study population consisted of 73 patients with metastatic cancer (mean age- 54.6 years). Primary sites of cancer in most patients were the oral cavity (40.8%), followed by breast and ovary (15.3%, each). The Eastern Cooperative Oncology Group score was 0 in 84.3% and 1 in 14.3% of patients. Weekly analyses showed no significant differences in hemoglobin, neutrophil, creatinine, random blood glucose (RBG), and serum glutamic-oxaloacetic transaminase levels. A significant proportion of patients reported anemia and RBG &gt;125 mg/dL at baseline (97.1% and 63.4%, respectively) and week 17 (85.1% and 88.1%, respectively). Most patients had a partial response at week 17 (76.8%), respectively. No serious adverse reactions were reported, requiring a change in treatment. Conclusion: Nab-paclitaxel showed manageable tolerability and favorable response rates in metastatic cancer patients. It is widely used beyond approved indications in a significant proportion of patients across various tumor sites.

The effect of a nurse-led low carbohydrate regimen on anthropometric and laboratory parameters of patients with metabolic syndrome: a quasi-experimental study.

Metabolic syndrome is a global health concern. It is a condition that includes a cluster of various risk factors for type 2 diabetes and cardiovascular disease. This quasi-experimental study investigates the effect of a nurse-led low-carbohydrate regimen on anthropometric and laboratory parameters in metabolic syndrome patients. The study used a quasi-experimental design conducted at the University of Mosul; 128 participants meeting the metabolic syndrome criteria were recruited and divided into the intervention and control groups. The intervention group received personalized counseling and support in implementing a low-carb regime, while the control group received standard advice. The study participants were assessed by anthropometry, and laboratory parameters were evaluated pre- and post-intervention. Statistical data analysis was conducted using IBM-SPSS 27, including chi-square, Fisher's exact test, t-tests, and the Mcnemar test, which were performed to compare the changes within and between groups. The mean age of the participants in the intervention and control groups was 50.72 ± 6.43 years and 49.14 ± 6.89 years, respectively. Compared to the control group, the intervention group experienced a significant positive reduction in anthropometric measures and laboratory parameters, including weight, body mass index (BMI), waist circumference, lipid profiles, and HbA1c. A tangible effect of nurse-led interventions based on low-carbohydrate regimens in managing metabolic syndrome was empirically authenticated. Positive changes were observed in the intervention group regarding anthropometric measures and laboratory parameters. However, future research may require a larger sample size and a longer follow-up to confirm these effects and evaluate long-term metabolic impacts.

Clinico-mutational profile and the impact of splenectomy in children with glucose-6-phosphate isomerase deficiency

BackgroundThere is a lack of literature on the role of splenectomy in hemolytic anemias due to glucose-6-phosphate isomerase (GPI) deficiency. GPI deficiency is a rare red blood cell (RBC) enzymopathy of the glycolytic pathway. Most present with severe disease requiring frequent transfusions. In this study, we report the effect of splenectomy in the world's largest cohort of GPI deficiency patients. The study aimed to describe the clinical, mutational, and laboratory parameters of patients with GPI deficiency. A comparison of the transfusion requirement pre- and post-splenectomy is also included. Material and methodsThe ambispective study was performed from 2017 to 2023. Patients with congenital non-spherocytic hemolytic anemia (CNSHA) were screened for GPI deficiency. Detailed history, including demographic, clinical data, and transfusion details, were noted. Hematological parameters and RBC enzyme activity were estimated using spectrophotometry. The genetic study was done using restriction fragment length polymorphism, and confirmation was obtained through Sanger's sequencing. Patients were followed up after splenectomy. ResultsEighteen patients were diagnosed with GPI deficiency. About 3/4th (14/18; 77.7 %) had significant hepatosplenomegaly. Median serum ferritin levels were 890 ng/ml. Seven patients were on oral iron chelation. The nutritional status assessed as per the Indian Academy of Pediatrics growth charts revealed significant growth retardation. All the patients had severe anemia (mean Hb: 6.4 g/dl) and macrocytosis (mean MCV: 129.2 fl). Laboratory features of hemolysis were evident with reticulocytosis, raised serum lactate dehydrogenase, and indirect bilirubin. The mean GPI enzyme activity was 28.75 IU/g Hb.Ten (55.5 %) patients underwent splenectomy at a median age of 7 years. Five remain transfusion-free post-splenectomy at a median follow-up of 54 months. Other 5 had a significant reduction in transfusion requirement post-splenectomy (p < 0.05). Post-splenectomy, the mean hemoglobin levels increased from 6.2 to 8.1 gm%, and the mean reticulocyte counts reduced from 7.4 % to 4.8 %. Fifteen of 18 had the pathogenic c.1040G > A(p.Arg347His) homozygous mutation. ConclusionThe study demonstrates the benefit of splenectomy in patients with GPI deficiency.

Association between glycosylated hemoglobin and newly diagnosed hypertension in a non-diabetic kosovar population: a cross-sectional analysis

Diabetes mellitus is a common disease followed by cardiovascular complications, it is a metabolic syndrome with multiple etiology that is characterized by chronic hyperglycemia. Hypertension is a serious health condition that is significantly associated with the risks of heart, brain, kidney, and other diseases. Glycosylated hemoglobin (HbA1c) is diagnostic means of diabetes when fasting (venous) glycemia figures are 126 mg/dl (7.0 mmol/l). The purpose of this study is to focus on the diagnosis, and the treatment of the population with diabetes, identifying the necessary targets to guarantee clinical efficacy. Managing diabetes is challenging, and smoking can complicate it. People with diabetes who smoke often need larger doses of insulin to keep their blood sugar near normal levels. To assess the amount of vitamin D bound to hemoglobin, the study analyzed a number of laboratory parameters in patients with type 2 diabetes. The importance of this study is the estimation of the amount of enzyme-linked immunosorbent vitamin D. Laboratory parameters of diabetic patients were divided into three categories based on increased levels of glycosylated hemoglobin. Vitamin D levels were analyzed in these categories with increased HbA1c values. The influence of smoking and hypertension on laboratory parameters of diabetic patients was analyzed. The observations were carried out in the form of a database, and the methods that allowed the results for all parameters were followed. The data on the homogeneity of the selected information groups cover 150 patients diagnosed with diabetes mellitus, 40.67% were men, 59.33% were women. Similarly, (in fasting patients), a high OGTT-2-hour glucose level, the hemoglobin test indicates [A1C(HbA1c)] level, cardiovascular disease, and serum vitamin D. Overall, 47.33% of the patients were deficient in vitamin D. Decreased levels of vitamin D were associated with increased levels of glycosylated hemoglobin, while 22% were deficient. As a result, 74.67% of tobacco users had hypertension. Vitamin D deficiency may increase in patients with diabetes, with increased levels of glycosylated hemoglobin.

Left Ventricular Remodeling after Percutaneous Coronary Intervention in Acute Myocardial Infarction Complicated by Acute Heart Failure

The aim. To establish the relationship between structural-functional and laboratory parameters in patients with myocardial infarction (MI) and heart failure (HF) undergoing percutaneous coronary intervention (PCI). Materials and methods. We examined 308 MI patients who were divided into 3 groups: 161 patients without signs of acute heart failure (AHF) (group I), 99 with Killip class II-III AHF (group II) and 48 with Killip class IV (cardiogenic shock) (group III). All the patients underwent general clinical examinations: complete blood count, lipid profile, creati-nine, quantitative determination of troponin I, D-dimer, creatine kinase-MB, electrocardiography, coronary angiography with PCI, focused cardiac ultrasound and standard echocardiography over 3-5 days. Results. According to the focused cardiac ultrasound, the majority of MI patients with signs of AHF had preserved left ventricle function, and only 8.2% of patients had left ventricle ejection fraction (LVEF) ˂40%. The most significant structural and functional changes were observed in group II. After PCI, a significant increase in left ventricle contractility was found in all groups, but in the group II, the increase in LVEF was more pronounced. The severity of HF manifestations increased depending on the severity of diastolic dysfunction. Many correlations were established: an inverse relationship between LVEF and the presence of HF, the number ofaffected vessels, proximal left anterior descending artery lesions, low-density lipoprotein cholesterol, and atrium fibrilla-tion; a direct relationship between LVEF and hemoglobin levels and glomerular filtration rate. Conclusions. The vast majority of patients with MI and signs of AHF had preserved left ventricle contractile function. High-grade HF manifestations increase depending on the severity of diastolic dysfunction. Myocardial revascularization in MI pa-tients significantly improves functional and volumetric parameters of myocardial function. Numerous correlations between structural-functional and laboratory parameters in patients with MI and HF who underwent PCI have been established.