Platelet Levels Research Articles

Effectiveness of sofosbuvir-based treatments for patients with hepatitis C virus genotype 6 infection: a real-world study from East China

BackgroundOver the past decade, the proportion of hepatitis C virus (HCV) genotypes (GT) 1 and 2 has decreased in almost all regions of China, while GT 3 and 6 have emerged as new challenges. GT 6 is unique in many respects, like high genetic variability and emerging resistant variants. This study aims to assess the efficacy of sofosbuvir (SOF)-based treatments in patients with GT 6 chronic hepatitis C (CHC).MethodsA retrospective analysis was conducted on patients with GT 6 HCV infection, who were diagnosed between July 2018 and May 2023. All patients received a 12-week course of SOF-based treatments. The primary efficacy endpoint was sustained virologic response (SVR), which is defined as having undetectable HCV RNA at 12 weeks after treatment completion (SVR12). The efficacy data for SVR12 were analyzed using both the evaluated population (EP) and per-protocol population (PP). For the PP populations, efficacy data were stratified using Forrester plots.ResultsA total of 201 patients were included in the study. In PP population, the end of treatment virological response rate was 99.48% (190/191), the SVR12 rate was 99.31% (143/144), and the SVR24 rate was 100.00% (75/75). Only one patient with genotype 6a experienced a relapse 12 weeks after the completion of treatment, but her HCV RNA was undetectable both at the end of treatment and 24 weeks after the end of treatment. Additionally, the normalization rates of alanine transaminase (ALT) and aspartate aminotransferase (AST) were significantly higher at the end of treatment (EOT) compared to baseline (27.36% vs. 93.03%, 36.32% vs. 95.02%, p < 0.001). Significant improvements were observed in the levels of total bilirubin, ALT, AST, albumin, globulin, albumin/globulin ratio, gamma-glutamyl transferase, alkaline phosphatase, platelet, fibrosis-4 (FIB-4), and aspartate transaminase to platelet ratio index (APRI) between baseline and EOT (p < 0.05).ConclusionSOF-based treatments achieved high virological and biochemical response rates in patients with HCV GT 6 infection.

Analysis of the Relationship between ALBI Score and APRI Score on Severity, Length of Treatment and Mortality in COVID-19 Patients at Dr. Saiful Anwar Hospital, Malang

Background: Covid-19 is an infectious disease caused by the SARS-CoV-2 virus and has resulted in more than 3.8 million deaths worldwide. Covid-19 can cause multiorgan complications, including hepatobiliary organs. Many assessments have been used to determine the severity and prognosis of hepatobiliary disorders, such as the Albumin Bilirubin (ALBI) score and the AST-platelet ratio index (APRI) score. Aim: This study aims to determine the relationship between the ALBI score and APRI score with severity, length of treatment, and mortality in COVID-19 infection. Methods: We conducted a case-control study in a population of adult patients with confirmed COVID-19 who were hospitalized at RSSA in the period January-December 2022. Patients with hepatobiliary and autoimmune disorders were excluded from the sample population for further analysis. Albumin, bilirubin, SGOT, and platelet levels were measured at the beginning of the patient's hospitalization. The correlation between variables was analyzed using the Rank-Spearman test with SPSS 27. Results: The study subjects' characteristics showed that most patients were more than 60 years old (66.67%). Based on the severity of the disease, five patients (16.67%) were mild, ten patients (33.33%) were moderate, and 15 patients (50%) were severe. Of the 30 patients, 16 recovered (53.33%) and 14 died (46.67%). The majority of subjects did not require treatment in the ICU (66.67%). The results of the Rank-Spearman Test showed that the ALBI score [R=0.372; p=0.043 (p<0.05)] and APRI score [R=0.409; p=0.025 (p<0.05)] were significantly correlated with the mortality of Covid-19 patients but not with the severity and length of treatment. Conclusion: The conclusion of this study shows that ALBI score and APRI score have a significant relationship with mortality in COVID-19 patients and have the potential to be further studied as predictive factors in assessing the prognosis of COVID-19 patients.

Unraveling the Complexities of Severe Dengue: Exploring Transfusion Avoidance Strategies with Management of Hematological, Radiological Parameters, Clinical Features

Background: Dengue is an entity caused by mosquito bites in humans. It can change into a life-threatening entity within a very short time. Not every dengue case requires a blood transfusion. While plasma leakage and a drop in platelet count are possible side effects of severe dengue, not all patients suffer from them. The main goals of treatment are to control symptoms such as pain, fever, and dehydration by giving patients enough fluids and medicine. Aim: To identify the various clinical features associated with dengue along with the manifestations not warranting blood transfusion. Methods: This observational study includes a total of 300 laboratory-verified dengue patients who were admitted over two months. Patients with other causes of fever were excluded. Results: The majority of patients (80%) were discovered to be between the ages of 10 and 40, indicating that people in this age bracket are often more afflicted. Males were predominantly affected in comparison to females. Thrombocytopenia is the most prevalent anomaly, present in all the patients. Of these, 3.0 (1.0%) had platelet counts < 10,000/cmm, while 198 (66%) had platelet levels < 10,000–20,000/cmm. Conclusion: We conclude that the main factors influencing the prognosis are intra-abdominal visceral oedema as gall bladder wall edema, leucopenia (TLC count below 2000 cells/cmm), deranged liver functions, capillary leakage leading to peritoneal/pleural effusions as well as shock, and platelets. Platelets do not determine the severity and fatality of dengue infection.

Association of the neutrophil-to-platelet ratio with response to electroconvulsive therapy in adolescents with major depressive disorder

BackgroundMajor depressive disorder (MDD) is one of the most serious mental disorders affecting adolescents worldwide. Electroconvulsive therapy (ECT) is widely acknowledged as a first-line treatment for severe depression, but the clinical response varies. Neutrophils and platelets are both related to the progression of MDD. The aim of this study was to investigate the correlation between the neutrophil-to-platelet ratio (NPR) during the acute phase and the effectiveness of ECT treatment.MethodsA total of 138 adolescent MDD patients who received ECT were included in the study. Neutrophil and platelet levels were obtained upon admission. At the same time, treatment response was the primary outcome measure, defined as a reduction of ≥ 50% in the HAMD-17 score from baseline to treatment endpoint, and the secondary outcome measure was remission of depression, defined as a HAMD-17 score ≤ 7.ResultsAfter receiving ECT, 103(74.6%) of all patients responded to treatment and 72(52.2%) achieved remission. Non-responders/non-remitters to ECT tended to have higher levels of NPR at baseline compared to ECT responders/remitters [Non-responder: 3.4 (2.5-4.8) vs 2.7 (2.2-3.5), P = 0.002; Non-remitter: 0.014 (0.011-0.017) vs 0.011 (0.008-0.015), P = 0.03]. In multiple logistic regression, high NPR (≥ 0.014) remained independently associated with ECT non-response/non-remission after adjusting for confounding factors [Non-responder: OR = 4.911, 95% CI (2.052 - 11.754), P < 0.001; Non-remitter: OR = 2.704, 95% CI (1.262 - 5.796), P = 0.011].ConclusionHigh NPR correlates with poor ECT efficacy in adolescents with MDD, particularly among female and overweight patients.

A Clinical Algorithm for Screening Compensated Advanced Chronic Liver Disease Utilizing Ultrasonography, Platelet Count, and Albumin Levels, With Transient Elastography as Reference.

Background and aims Compensated advanced chronic liver disease (cACLD) refers to asymptomatic patients with advanced fibrosis who do not yet exhibit clinical or radiological signs of portal hypertension. Early detection of cACLD is essential for effective risk stratification and timely management, potentially preventing progression to more severe and irreversible stages of liver disease. Transient elastography (TE) is the primary diagnostic method for cACLD, with several diagnostic thresholds commonly used. Ultrasonography (USG) is widely used as an initial diagnostic tool for liver disease, but its effectiveness in diagnosing cACLD is not well established. To the best of our knowledge, this study is the first to systematically evaluate the diagnostic accuracy of USG in detecting cACLD, using TE as a reference standard based on validated diagnostic thresholds. We also examined whether combining USG findings with platelet count and serum albumin could enhance diagnostic utility. Additionally, we discuss the strengths and limitations of established non-invasive scoring systems, including the Enhanced Liver Fibrosis (ELF) test, Fibrosis-4 (Fib-4) index, and Nonalcoholic Fatty Liver Disease Fibrosis Score (NFS), to determine if our approach offers a more accessible and practical solution in clinical settings Methods This retrospective cross-sectional study was conducted at the Royal Wolverhampton NHS Trust,Wolverhampton, England, including patients with suspected liver disease who underwent USG, TE, and blood tests. Valid TE readings followed manufacturer guidelines, and patients with USG-detected portal hypertension or confounding conditions (e.g., acute hepatitis, heart failure) were excluded. We calculated the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of USG against TE, with TE values >15 kPa confirming and <10 kPa excluding cACLD. Results Among 1,528 patients (mean age 51 years, range 16-89), 982 were male (64.3%) and 546 were female (35.7%). The cohort predominantly comprised Caucasian (n=1,087, 71.1%) and South-East Asian (n=256, 16.8%) patients. USG showed a sensitivity of 64.6% (95%CI: 58.3-70.6%) and specificity of 78.2% (95%CI: 75.6-80.6%) for cACLD, with a PPV of 40.2% (95%CI: 36.7-43.7%) and an NPV of 90.7% (95%CI: 89.2-92.1%). High NPV was consistent across all etiologies. In patients with a normal liver on USG, NPV improved to 92.7% (95%CI: 90.9-94.6%) when serum albumin >35 g/L and platelet count >150 x 109/L were present. In patients with sonographic signs of liver disease, PPV increased to 84.1% (95%CI: 73.3-94.9%) when platelet count and albumin were low but dropped to 20.8% (95%CI: 15.4-26.3%) when both were normal. Conclusions USG alone has limited reliability in diagnosing cACLD but is valuable for ruling out advanced fibrosis in asymptomatic patients due to its high NPV. Adding platelet and albumin levels improves diagnostic accuracy, though TE remains essential for definitive diagnosis. This approach may streamline screening and optimize resource use, particularly in settings with limited TE access. USG combined with platelet count and serum albuminoffers a cost-effective, accessible, and practical solution for the initial assessment of cACLD. Further studies are needed to validate these findings in broader populations.

MiR-302 targets PAK5 and prevents the transition from chronic hepatitis B to liver cirrhosis

Objective: To determine and compare the levels of p21-activated kinase 5 messenger ribonucleic acid and micro-ribonucleic acid 302 in the serum of patients with chronic hepatitis B, liver cirrhosis and healthy individuals, and to analyse the roles and correlation of p21-activated kinase 5 messenger ribonucleic acid and micro-ribonucleic acid 302 in the progression of chronic hepatitis. Method: The observational, clinical, case-control study was conducted at the Department of Laboratory Medicine, Affiliated Hospital of Hangzhou Normal University, Hangzhou, China, from February 2021 to January 2022. Peripheral blood serum samples were collected from healthy individuals undergoing physical examinations, as well as from patients with chronic hepatitis B and hepatitis B-related liver cirrhosis. Total ribonucleic acid was isolated and purified using the magnetic bead method, and the relative expression levels of micro-ribonucleic acid 302 and p21-activated kinase 5 messenger ribonucleic acid were determined using quantitative real-time polymerase chain reaction. Clinical test results were retrospectively analysed, and differences between the groups were assessed. Data was analysed using SPSS 22. Results: Of the 70 participants, 18(25.71%) were healthy individuals with median age 33 years (interquartile range: 25-36.25 years), 18(25.71%) were patients with chronic hepatitis B having median age 34 years (interquartile range: 26-42 years), and 34(48.57%) were patients with cirrhosis having median age 54 years (interquartile range: 44-62 years). Overall, there were 50(71%) males and 20(29%) females with mean age 42.7±13.8 years. Median albumin (p=0.0365) and platelet (p=0.0116) levels were significantly lower in cirrhosis group compared to chronic hepatitis B group. Median aspartate aminotransferase level (p=0.0400) and aspartate aminotransferase/platelet ratio (p=0.0053) of chronic hepatitis B group were significantly higher than the healthy group (n=18). The expression of p21-activated kinase 5 was significantly increased in cirrhosis group compared to chronic hepatitis B group (p=0.0444) and healthy controls (p=0.0089). Compared to the healthy individuals, the expression of micro-ribonucleic acid 302 was significantly increased in both chronic hepatitis B (p=0.0237) and cirrhosis groups (p=0.0428). Conclusions: P21-activated kinase 5 represented a promising therapeutic target for liver disease, and micro-ribonucleic acid 302 could serve as a therapeutic small molecule if an appropriate delivery system is available, particularly for liver fibrosis caused by hepatitis B virus infection. Key Words: MicroRNA, miR-302, PAK5, HBV, Liver fibrosis, Cirrhosis.

Analysis of gastric cancer medication by exploring fluorouracil drugs

Abstract. Gastric cancer (GC), as one of the most important types of cancer with a very high incidence rate in China, is in urgent need of treatment. China has made certain progress, such as the widespread use of fluorouracil and other drugs in the treatment of gastric cancer, as well as the use of various treatment methods such as surgery and chemotherapy. This article aims to explore the efficacy of fluorouracil drugs in the treatment of gastric cancer and their combined application with other drugs. By analyzing the correlation between peripheral blood platelet levels and the efficacy of oxaliplatin combined with fluorouracil chemotherapy in gastric cancer patients, as well as the effects of two chemotherapy regimens, docetaxel combined with oxaliplatin, tigio and docetaxel combined with cisplatin and fluorouracil, on advanced gastric cancer, it was found that fluorouracil drugs, as cell cycle inhibitors, have an inhibitory effect on cell division and have a significant effect in the treatment of gastric cancer. Future research can further deepen the combined application of fluorouracil drugs with other drugs to reduce complications and improve treatment effectiveness. It is suggested that future research should focus on in-depth exploration of targeted drug delivery, combined with new biotechnology, to improve the efficiency and accuracy of gastric cancer treatment.

Cyclosporine plus avatrombopag versus cyclosporine monotherapy for first-line treatment of elderly patients with transfusion-dependent non-severe aplastic anemia: a single center retrospective study

Background Elderly patients with transfusion-dependent non-severe aplastic anemia (TD-NSAA) face limited treatment options owing to transplantation incompatibility and safety concerns. Methods Data from older patients (≥60 years) newly diagnosed with TD-NSAA and had been treated with either avatrombopag (AVA) + cyclosporine (CsA) or CsA monotherapy at our center were retrospectively collected. Results In total, 52 patients were enrolled, with 26 receiving AVA + CsA and 26 receiving CsA monotherapy. The overall response (OR) rate was higher in the AVA + CsA group than in the CsA group at the 1st, 2nd, 3rd, 6th months, and at the end of the follow-up (all p < 0.05). The complete response (CR) rate was higher in the AVA + CsA group than in the CsA group at the 6th month and at the end of follow-up (p = 0.017 and 0.039). Patients receiving AVA + CsA had a shorter time to achieve the first response (p = 0.008) and CR (p = 0.010) than those receiving CsA monotherapy. Furthermore, patients receiving AVA + CsA exhibited a higher rate of platelet transfusion independence at the 3rd (p = 0.041), 6th (p = 0.008) months, and likewise at the end of the follow-up (p = 0.097). Conclusions The addition of AVA to CsA can significantly improve the OR or CR rate and platelet levels with acceptable side effects in elderly patients, which implies that the combination is a viable alternative for elderly patients with TD-NSAA.

Abstract 4136085: The Prognostic Impact of Thrombocytopenia at 6 months after Transcatheter Aortic Valve Replacement: A Retrospective Multicenter Study

Background: Transient thrombocytopenia after transcatheter aortic valve replacement (TAVR) is a common phenomenon. Thrombocytopenia after TAVR during the perioperative period has been reported to impact prognosis. However, the impact of thrombocytopenia in the mid-term post-TAVR period is currently unknown. Methods: A retrospective observational study was conducted on 1405 patients who underwent TAVR from May 2016 to February 2023 at four institutions. Of these, 850 patients were analyzed. Patients who underwent dialysis (67), converted to an open chest surgery (8), had a Valve-in-Valve procedure (30), underwent a direct aortic approach (16), had a malignant tumor (66), and patients whose platelet levels could not be measured at 6 months after TAVR due to death or dropout were excluded from the analysis. The clinical follow-up occurred at 1, 6, and 12 months after the procedure. Laboratory testing was conducted before TAVR, during the perioperative period, 1 month post-procedure, and 6 months later. The decrease in platelet count (DPC) 6 months after TAVR was calculated by the following formula: [(Baseline platelet – 6 months platelet)/baseline platelet *100]. A receiver operating characteristics curve was plotted for all-cause mortality at 1 year and DPC at 6 months. The calculated cutoff value for the DPC at 6 months (28.68%) was utilized to classify and compare the two groups. Multivariate logistic regression models were also used to examine the association between the DPC at 6 months and all-cause mortality at 1 year. Adjusted for propensity score matching, the DPC was compared at 6 months in self-expandable and balloon-expandable prosthetic valves. Result: Of the 850 eligible patients (age: 85.5 ± 4.9 years), 31 (3.4%) died between 6 months and 1 year after TAVR. The DPC at 6 months after TAVR was 11.9 ± 22.5%. Multivariate logistic regression analysis including the DPC at 6 months, age, gender, and STS score showed that the DPC at 6 months was independently associated with all-cause mortality at 1 year (odds ratio: 1.03, 95% confidence interval: 1.005-1.046, p=0.01). After adjustment for propensity score matching, the balloon-expandable prosthetic valve had a higher rate of thrombocytopenia at 6 months (15.0% vs. 9.6%, p=0.04). Conclusion: The DPC at 6 months after TAVR may predict all-cause mortality at 1 year.

Abstract 4138620: Assessment of the Accuracy of the Perioperative Mortality Risk in Adults with Congenital Heart Disease (PEACH) Score

INTRODUCTION: Previous mortality risk scores for adult cardiac surgery patients did not include adult congenital heart disease (ACHD) patients. Development of ACHD specific mortality risk scores include the procedure-specific ACHS score and recently derived PEACH score. While validated in Europe, further evaluation of the PEACH score in additional settings is necessary. RESEARCH QUESTION: We assessed the efficacy of the PEACH score to predict mortality in ACHD patients undergoing congenital cardiac surgery at our institution. We compared the PEACH score to the ACHS and STS scores and assessed for additional risk factors which may further augment the PEACH score. Methods: A retrospective cohort study was conducted of patients who underwent congenital cardiac surgery at the University of Colorado Hospital and Children’s Hospital Colorado between 2010-2022. Patients were identified by the institutional STS congenital cardiac surgery database and were eligible if 18 years or older and underwent congenital cardiac surgery. Components of the PEACH score and additional postulated risk factors were evaluated by univariate analysis. A receiver operating characteristic (ROC) curve was used to compare the PEACH score to existing risk models. Logistic regression analysis determined additional risk factors to augment the PEACH score. Results: A total of 516 patients were included with a median age of 30 (IQR 23-42) and 51% were male. There were nine deaths overall. The PEACH score was predictive of mortality (OR: 2.09, p&lt;0.001) with a score of 0: 0 deaths/240 patients (0%); 1-2: 6 deaths/229 patients (2.6%); 3+: 3 deaths/41 patients (7.3%). Of additional risk factors tested, platelets less than 184,000 per mcL (OR: 8.36, p=0.01) was significantly associated with mortality. Comparison of the models revealed PEACH score AUC 0.832 (95% CI: 0.740,0.924), ACHS score AUC 0.869 (95% CI: 0.806, 0.932), and STAT AUC 0.769 (95% CI: 0.616, 0.922, Figure 1). The addition of platelet level improved the predictive ability of the PEACH score (AUC 0.881). Conclusion: In this single-center analysis, the PEACH score provided strong predictive ability for peri-operative mortality. The addition of platelet levels may further augment this score.

Sarcopenia is associated with new-onset acute biliary infection within 1 year in patients with hepatitis B virus-related decompensated cirrhosis.

Malnutrition and sarcopenia are prevalent complications in cirrhosis. The relationship between sarcopenia and biliary infection in cirrhotic patients is not well understood. Our study aims to clarify this association. In this study, we leveraged data from a tertiary care hospital, enrolling patients with hepatitis B virus (HBV)-induced cirrhosis from 2022. An acute biliary tract infection was defined as the onset of acute cholecystitis or cholangitis within a year. Sarcopenia was identified based on established criteria and assessed using the L3 skeletal muscle index (SMI). A multivariate logistic regression model was constructed to analyze the relationship between sarcopenia and acute biliary tract infection. Receiver operating characteristic (ROC) curve analysis and smooth curve fitting were also conducted. This study enrolled a total of 262 patients with HBV-related cirrhosis, with an average age of 60 years and including 173 males. The primary causes for hospital admission were ascites and hepatic encephalopathy. Within the group with biliary infection, patients typically presented with higher white blood cell counts, lower platelet levels, and poorer indicators of liver and kidney function. In the multivariate analysis, after adjusting for various confounding factors, sarcopenia was associated with an odds ratio of 1.55 (P = 0.002) for acute biliary infection. Smooth curve fitting revealed an approximately linear positive relationship between L3 SMI and acute biliary infection, with the area under the ROC curve for L3 SMI reaching 0.89, indicating a strong predictive value. Sarcopenia is associated with acute biliary infection in patients with HBV-related cirrhosis.

Analysis of ultrasound and magnetic resonance imaging characteristics of kaposiform hemangioen dothelioma

ObjectiveThe present study aims to investigate the ultrasound and magnetic resonance imaging (MRI) characteristics of kaposiform hemangioen dothelioma (KHE).MethodsA retrospective analysis was conducted on the clinical data of children diagnosed with KHE through postoperative pathology. Patients were divided into two groups: the KHE group and the KHE with Kasabach-Merritt Phenomenon (KMP) group (KMP group). Laboratory indicators, ultrasound, and MRI data were collected and analyzed statistically to summarize the imaging characteristics of the disease.ResultsThe levels of platelets and fibrinogen in the KHE group were significantly higher than those in the KMP group, while D-dimer levels, prothrombin time, and activated partial thromboplastin time were lower (P < 0.05). Ultrasound characteristics comparison revealed that lesions extending to the fat layer (42.47% vs. 54.24%) and invading the muscle layer (38.36% vs. 69.49%) were less common in the KHE group compared to the KMP group, with the lesion diameter being smaller in the KHE group (P < 0.05). The Adler grading predominantly showed Grade II (45.21%) in the KHE group, whereas Grade III (93.22%) was more prevalent in the KMP group (P < 0.05). MRI analysis indicated that the incidence of lesions invading the muscle layer and the presence of flow voids were lower in the KHE group compared to the KMP group (P < 0.05).ConclusionKHE patients with KMP exhibit lesions that are more prone to extending into the fat layer and invading the muscle layer, with larger diameters and abundant blood flow. Additionally, the MRI images of the lesions may exhibit flow voids.

Changes in clinical features and seasonal variations of Crohn's disease at diagnosis: a 10-year observational study in China.

The clinical aspects of Crohn's disease (CD) at diagnosis determine its therapy and management. The onset of CD follows a seasonal pattern. We aimed to analyze changes in the clinical features and seasonal variations of newly CD patients over the last decade. CD patients were divided into cohort 1 (2012-2016) and cohort 2 (2017-2021). The clinical characteristics were collected and the trends according to the year and season of diagnosis were analyzed. A total of 2038 patients were included. Cohort 1 had a considerably greater proportion of diarrhea, fever, hematochezia, weight loss and extraintestinal manifestations. The levels of platelet and C-reactive protein were higher in cohort 2 patients, but the opposite was true for albumin levels (p<0.05). The rate of increased eosinophils, increased gangliocyte and abundant lymphoplasmacytic infiltrate significantly decreased over the years. Patients with granulomas were diagnosed with CD at an earlier age (p = 0.006). Cohort 1 patients used more conventional drugs, while cohort 2 patients apply more biologics (p<0.05). The diagnosis occurred more frequently in summer and less frequently in winter. Patients diagnosed in winter had notably higher BMI, lower frequency of perianal disease and lowest incidence of asthenia and weight loss. The clinical phenotype, laboratory and pathological characteristics of CD has changed over time in China. The diagnosis of CD tends to have a seasonal trend with the highest incidence in summer. CD patients diagnosed in winter appear to have a milder form of the disease.

E-dengue System Insights: Exploring the Factors Influencing Dengue-related Deaths in an Urbanized State in a Low-Middle Income Country (LMIC)

BackgroundDengue has emerged as a rapidly escalating health issue in low- and middle-income countries, with its burden and geographic spread increasing over the years. Malaysia, in particular, has witnessed a significant rise in dengue cases, accompanied by a spike in mortality rates. Several studies have identified various factors, primarily focusing on the 27 clinical aspects of severe dengue infection and the development of dengue-related fatalities. Expanding on this focus, this study aims to identify the demographic, clinical, and environmental factors contributing to dengue mortality, providing a more comprehensive understanding of the variables influencing dengue-related fatalities.MethodsThis study utilized a 1:2 case-control design, analyzing data from the E-dengue system database and medical records from January 2015 to December 2022, involving 219 participants (73 dengue fatalities as cases and 146 recovered patients as controls). Dengue deaths were confirmed by the Penang State Mortality Review Committee, and controls were randomly selected from laboratory-confirmed dengue cases. Statistical analyses were performed using SPSS software, including descriptive statistics, chi-square tests, and multivariable logistic regression to identify predictors of dengue mortality, with variables included in the multivariable model if p < 0.05.ResultsSeveral significant predictors of dengue-related mortality, including clinical and environmental factors were identified. Key predictors were a platelet count below 50,000/µL (OR 15.70; 95% CI: 5.65–43.53), presence of one comorbid condition (OR 2.90; 95% CI: 1.22–6.90), more than two comorbid conditions (OR 10.15; 95% CI: 3.53–29.23), bronchial asthma (OR 12.00; 95% CI: 1.08-132.13), and outbreak locality status (OR 2.3; 95% CI: 1.11–4.79). An interaction was also found between locality status and platelet levels.ConclusionThe study emphasizes the need for developing risk profiles for dengue patients by integrating factors such as platelet levels, comorbidities, and locality status to improve clinical care. Nuanced protocols are needed to address the specific challenges of single-case and outbreak areas. In single-case localities, patients with low platelet counts (below 100,000/µL) should be prioritized for rapid intervention to mitigate severe outcomes. In outbreak areas, healthcare systems should bolster resources and apply comprehensive triage approaches considering platelet levels and other risk factors. Implementing predictive models that account for geographical factors can enhance resource allocation and preparedness for dengue outbreaks. These recommendations aim to empower public health personnel, healthcare providers, and communities to collectively reduce dengue-related mortality rates.

Increased risk of vascular complications in patients with type 2 diabetes and fatty liver disease

BackgroundThe prevalence of steatotic liver disease (SLD) in patients with type 2 diabetes (T2DM) exceeds 50%. This study aimed to investigate the clinical characteristics of SLD and liver fibrosis in Chinese patients with T2DM.MethodsInpatients from 2021 to 2023 were included in the study. Fatty liver index (FLI) and fibrosis-4 (FIB-4) were calculated to assess hepatic steatosis and fibrosis respectively. Statistical analysis was completed by SPSS v25 and GraphPad Prism v8.0.1.ResultsOf the 1466 participants, about one-third of the patients in T2DM-SLD group were diagnosed with liver fibrosis (LF), and the percentage of patients over 50 years old was 85.9%. Patients with SLD had higher levels of BMI, blood pressure, liver enzymes, fasting blood glucose (FBG), HbA1c, C-peptide, total cholesterol (TC) and triglyceride (TG) (P<0.05 for all). Patients with liver fibrosis had lower TC, TG, hemoglobin (Hb), erythrocyte count (RBC), leukocyte count (WBC) and platelet (PLT) levels (P<0.05 for all). Compared with simple T2DM and SLD-NLF (non-liver fibrosis) groups, for patients over 50 years old, the prevalence of coronary heart disease, stroke, tumor, and diabetic nephropathy was higher in patients with liver fibrosis. Liver fibrosis might be the risk factor of arterial stiffness, stroke, coronary heart disease and numbness based on multivariable logistic regression analysis.ConclusionHepatic steatosis and fibrosis were common in patients with T2DM. Liver fibrosis was relevant to many macrovascular and microvascular diabetic complications.

Comparing quality parameters of apheresis and pooled platelet concentrates

Introduction. Harvesting of pooled platelet concentrates (PC) significantly expands the volume of transfusion support and could be used to create strategic platelet reserve.The aim of work. To compare the quality of pooled and apheresis platelet concentrates.Materials and methods. We studied platelet fractions (PF), isolated from the whole blood of cadre donors with Reveos system, platelet concentrates, obtained by pooling PF (Pooled PC), and platelet concentrates harvested by automatic apheresis. In all cases 2 days passed from the moment of blood donation to the platelet examination. In PC samples we studied cellular composition, morphofunctional parameters of platelets, pH and electrochemical parameters, hypotonic shock response.Results. The morphofunctional platelet rate in PF was significantly reduced, comparing to the normal levels. At the same time, the morphofunctional parameters of platelets did not significantly differ in PF and pooled PC. The pH values, the total content of platelets and leukocytes in the pooled PC corresponded to the requirements of The rules for procurement, storage, transportation and clinical use of donated blood and its components (2019). The total platelet count, the level of annexin-positive platelets, did not significantly differ in apheresis PC and pooled PC, hypotonic shock response was correct in apheresis PC and pooled PC. On the other hand, the level of platelets with granules in pooled PC was 1,8 times lower than in apheresis PC, other morphofunctional parameters of platelets in pooled PC were also reduced. Pooled PC were characterized by more positive level of open circuit potential and lower antioxidant capacity compared with apheresis PC on the same storage time.Conclusions. Platelet pooling with Reveos system is acceptable for obtaining PC doses that comply with Technical Regulations. Nevertheless, methods of pooled PC harvesting need further optimization.

Perioperative care of a patient with immune thrombocytopenia purpura undergoing tubo-ovarian abscess incision and drainage: Case report.

Tubo-ovarian abscess (TOA) is a serious health hazard for women, causing severe sepsis. Antimicrobial treatment is effective, but one-third of patients experience unfavorable outcomes. ITP, an autoimmune condition, can lead to bruising and bleeding. Diagnosing TOA in women of childbearing age is crucial, and combining emergency surgery with ITP patients can increase treatment costs and reduce quality of life. ITP can lead to severe complications, including postoperative hemorrhage, and may require platelet transfusions, glucocorticosteroids, and immunoglobulin. These treatments increase costs, decrease quality of life, and impact prognosis. Preventing ITP is crucial. Patients should be administered blood products based on platelet count and anemia or spontaneous bleeding tendencies. Perioperative blood management should aim for a target platelet level of 30 × 109/L and a hemoglobin concentration of 80 g/L before surgery. Post-surgery, perioperative care is crucial and vigilant for secondary bleeding. A tubo-ovarian abscess (TOA) is a frequently encountered inflammatory mass in therapeutic settings. TOA is a serious consequence of pelvic inflammatory disease (PID) that can lead to severe sepsis. In recent years, the incidence of TOA has increased, presenting a significant health hazard for women. To effectively target the diverse range of bacteria responsible for TOA, it is essential to use antimicrobial medicines that have a wide spectrum of activity. Nevertheless, the efficacy of antibiotic treatment stands at approximately 70%, while a significant proportion of patients, around one-third, experience unfavorable clinical outcomes necessitating drainage or surgical intervention. Immune thrombocytopenia (ITP) is an autoimmune condition characterized by a marked decrease in the quantity of platelets present in the bloodstream. ITP is characterized by thrombocytopenia, which leads to a heightened susceptibility to bruising and bleeding. The diagnosis of ITP and the prediction of treatment response continue to pose important and persistent issues in the field of hematology. The platelet count is commonly employed as a surrogate indicator of disease severity in patients with ITP and thus plays a crucial role in determining the necessity of treatment. A 25-year-old woman with a history of sexual activity underwent open abdominal exploration due to the sudden onset of lower abdominal pain. During the operation, a left TOA was discovered, and an incision and drainage were performed. Symptomatic treatments, such as anti-infectives and abdominal drainage, were administered. The culture of pus in the abdominal cavity suggested the presence of Escherichia coli. However, the patient presented with ITP and had a platelet count of less than 50 × 109/L before the operation. After the operation, the patient developed incisional and pelvic hematomas with signs of infection. As a result, the patient was discharged from the hospital after undergoing another laparotomy and receiving platelet transfusions and immunotherapy. Clinicians should be vigilant when diagnosing TOA in women of childbearing age, even in the absence of high-risk factors. A timely antibiotic or surgical intervention is necessary to preserve fertility and ensure quality of life. Combining emergency surgery with ITP patients poses a significant challenge for clinicians in terms of treatment. ITP can lead to serious complications, such as postoperative bleeding, which may require platelet transfusions, glucocorticoids, and immunoglobulin. This can increase the cost of treatment, reduce the quality of life, and seriously affect the prognosis. Therefore, preventing ITP is crucial. It is important to pay attention to the perioperative care of patients after surgery and be alert to the possibility of secondary hemorrhage.

Safety and Efficacy of 177Lu-PSMA Therapy Following 223Radium Treatment: A Retrospective Multinational Real-World Analysis

Background177Lu PSMA therapy is increasingly used for metastatic castration-resistant prostate cancer (mCRPC) treatment. However, data on its efficacy and safety in patients previously treated with 223Ra remain limited. MethodsThis retrospective, multicenter study evaluated 233 mCRPC patients treated with 177Lu PSMA at five European centers. The cohort included 27 patients previously treated with 223Ra and 206 Radium-naive patients. Statistical analyses, including Chi-squared, Mann-Whitney U tests, and multivariate logistic regression, were used to assess response and mortality. Predictors of response and mortality were identified using multivariate models. ResultsPatients who experienced a longer interval between castration resistance and the initiation of 177Lu PSMA therapy demonstrated better responses (median 17 months in responders vs. 8.5 months in progressors, p=0.001). Platelet counts were significantly lower in the progressive group compared to the responsive group (p=0.01). Multivariate regression confirmed lower platelet levels as a predictor of poor response (p=0.029). The overall response rate to 177Lu PSMA was 54%, similar between the 223Ra-pretreated and Radium-naive groups. However, mortality was significantly higher in the 223Ra-pretreated group (86%) compared to the Radium-naive group (51%, p=0.003). ECOG performance status (p=0.004) and ALP levels (p=0.030) were significant predictors of mortality, while CRP showed a trend towards significance (p=0.064). Tolerability of 177Lu PSMA was comparable to the safety profile reported in the literature, with 44% of 223Ra-pretreated patients experiencing AEs and 22% experiencing severe AEs (Grade ≥3). Conclusions177Lu PSMA therapy is effective and well-tolerated in mCRPC patients pretreated with 223Ra. However, higher mortality was observed in the 223Ra-pretreated group. ECOG PS, ALP, and platelet counts were significant predictors of response and mortality, and a longer interval between therapies was associated with better outcomes. These findings underscore the importance of treatment sequencing and monitoring prognostic markers. Micro-abstractEven in a real-world setting, 177Lu PSMA remains an effective treatment for mCRPC, achieving response rates up to 54% even in patients previously treated with 223Ra. Our findings indicate that 177Lu PSMA is well-tolerated after 223Ra, with no significant increase in adverse events. However, higher mortality rates were observed in the 223Ra cohort, suggesting a potentially poorer prognosis for patients who received 223Ra as an initial treatment.

Thrombocytopenia Predicts Poor Prognosis of Liver Transplantation

Background/AimPlatelets not only participate in physiological hemostasis but also play a major role in liver ischemia-reperfusion injury, liver damage, tissue repair, and liver regeneration. A decrease in platelet count can lead to spontaneous bleeding, infection, and other complications that can seriously impact patient prognosis. Thrombocytopenia has been associated with increased complications after partial hepatectomy, although the effects of thrombocytopenia on patient outcomes remain unclear. Therefore, this study aimed to examine the impact of thrombocytopenia on short- and long-term prognosis following liver transplantation (LT). MethodsThis was a retrospective analysis comprising 234 adult liver transplant recipients and conducted from January 2019 to June 2022. Preoperative and postoperative daily platelet counts were recorded up to the 30th postoperative day (POD). We defined people with platelet counts <70 × 109/L as the low platelet group, and people with platelet counts >70 × 109/L as the high platelet group. Multivariate analysis was carried out to determine whether low perioperative platelet count was a risk factor for postoperative complications, graft failure, and patient survival. ResultsOf the 234 patients analyzed in this study, approximately half (n = 112, 47.9%) developed persistent thrombocytopenia after LT. The most substantial decrease in platelet levels occurred on POD7. The cumulative survival rates at 1, 2, and 3 years in the high platelet group were higher than those in the low platelet group, 94%, 87%, and 85%, respectively, while those of the low platelet group were 84%, 78%, and 70% (P = .0014). In addition, the high platelet group had a lower incidence of biliary complications compared with the low platelet group (8% vs 19%, P = .020). At the same time, the high platelet group had a lower incidence of posttransplant lung infection (55% vs 75%, P = .040). ConclusionsThrombocytopenia is a common complication of LT. It indicates the severity of the postoperative course and is closely associated with patient survival. In particular, patients who undergo orthotopic liver transplantation (OLT) and have a platelet count <70 × 109/L on the POD7 have significant negative prognostic implications and should be further investigated.

Pre-diagnostic trajectory of pediatric hemophagocytic lymphohistiocytosis: observations from hematological and hepatic parameters.

Understanding the early features and characteristics of hemophagocytic lymphohistiocytosis (HLH) is essential for identifying high-risk individuals and also providing valuable pathological insights. This study aims to investigate the characteristics and trends of blood and hepatic parameters before an HLH diagnosis was established. Longitudinal hematological and hepatic test results from pediatric patients with HLH and an age- and sex-matched control group were analyzed. According to the length of time between hospital admission and the establishment of the HLH diagnosis, the HLH cases were divided into early-onset (≤ 7 days) and late-onset (> 7days) groups. Among the 229 pediatric HLH patients, the length of time between hospital admission and the establishment of an HLH diagnosis ranged from 0 to 41 days (median = 4 days). Over 80% of pediatric HLH patients presented abnormal laboratory results for aspartate aminotransferase (AST), triglycerides, lactate dehydrogenase (LDH), and hemoglobin at admission. The abnormal rates in the initial platelet count, neutrophil count, and fibrinogen tests were 67.3%, 48.3%, and 52.2%, respectively. The initial test results for AST, alanine aminotransferase (ALT), LDH, serum sodium, and albumin showed AUCs > 80% for discriminating early-onset HLH. For the discrimination of late-onset HLH, the performance of initial test results was poor. To conclude, abnormalities in AST, triglycerides, LDH, and hemoglobin are early presentations of pediatric HLH; platelet, neutrophil, and fibrinogen levels may become abnormal at a relatively late stage of the HLH disease trajectory; and the initial test results for AST, ALT, LDH, serum sodium, and albumin can be used to identify suspected early-onset HLH.