Mean Platelet Research Articles

Eosinophilic cationic protein and D-Dimer are potential biomarkers to predict response to antihistamines but not to omalizumab in chronic spontaneous urticaria

ABSTRACT Introduction: Biomarkers that could reliably anticipate the effectiveness of antihistamines and omalizumab in treating chronic spontaneous urticaria (CSU) have not been conclusively identified. Our objective was to examine how eosinophilic cationic protein (ECP), tryptase, D-dimer, and total Immunoglobulin E (IgE) impact the response to antihistamine and omalizumab treatments in individuals with CSU. Methods: In this cross-sectional retrospective study, CSU patients that had undergone treatment with either antihistamines or omalizumab for a minimum of 12 weeks between 2015 and 2021 at an Allergy and Immunology Department were analyzed. Several demographic and laboratory parameters including eosinophil counts, mean platelet volüme (MPV), sedimentation, C-reactive protein (CRP), antinuclear antibodies (ANA) and Anti-thyroperoxidase (Anti-TPO) and total IgE, tryptase, ECP and D-dimer were retrived from patient files. The association of these biomarkers with Urticaria Control Test (UCT) and the effect of these biomarkers on treatment response were evaluated. Treatment response was assessed using the UCT, with a score of UCT ≥ 12 indicating a responder and UCT < 12 indicating a non responder. Results: The patients in the omalizumab group were older, had a longer disease duration and had worse urticaria control (lower baseline UCT scores). 421 patients were treated with antihistamines and 88 patients were treated with omalizumab. ECP was found to be inversely correlated with baseline UCT (p < 0.001 r=−0.268). ECP and D-dimer levels of non-responder patients in the antihistamine group were significantly higher than in responder patients (ECP: 49 ng/mL vs 28.1 ng/mL, p < 0.001) (D-dimer: 0.60 mg/L vs 0.30 mg/L, p < 0.001), while there were no significant difference in terms of tryptase and total IgE. These four biomarkers were similar, in omalizumab responders and non responders. Conclusion: In this study with CSU, we looked at predictors of responses to treatments. ECP can serve as a marker of poor urticaria control and may predict antihistamine refractoriness along with D-dimer.

Intestinal Ultrasound in Diagnosis and Follow up of Patients with Crohn’s Disease

Abstract Background Crohn's disease (CD) causes transmural ulceration of any section of the gastrointestinal tract (GI), with the terminal ileum and colon being the most commonly affected. Aim of the Work The aim of this study is to assess the sensitivity &amp; specificity of Intestinal ultrasound In diagnosis and follow up of patients with Crohn’s Disease, and related possible complications. Patients and Methods A Cross sectional study in Gastroenterology Department of Ain Shams University Hospitals for 30 Patients with Crohn’s disease and The Patients were selected from inpatient and outpatient clinic of gastroenterology department of Ain Shams University Hospitals, in the period from July to December 2021. Results The present study revealed that the mean age of our patients was 54.3± 7.69 years with range from 38-68 years. Male cases were more than females ones, as (70%) were males while (30%) were females, with male to female ratio was 2.33: 1. The present study revealed that the mean hemoglobin level was 11.66 ± 1.46 mg/dl, and the mean RBC, 4.18±0.48. The mean platelets was 267.73±61.94 (K/UL), mean WBCs was 9.94 ± 1.83 (K/UL), neutrophils was 7648.57 ± 1460.02 (/UL), and lymphocytic count was 1356.50 ±469.30 (UL) and neutrophil/ lymphocyte ratio (NLR) was 5.93 ±1.35. Regarding the renal function tests and electrolyte profile, the mean serum urea, creatinine and uric acid were 46.43-±10.18, 1.10-±0.25 and 5.30-±0.68 mg/dl respectively. The mean levels of Na and K were 140.43 ±3.50 and 3.82±0.26 mEq/L respectively, the mean AST was 37.63 ±8.27 U/L, the mean ALT was 26.30 ±8.36 U/L, the mean total bilirubin was 1.01±0.17 mg/dl and the mean direct bilirubin was 0.60 ±0.27 mg/dl. We found that the mean PT was 14.17±2.65 sec. and the mean Serum Albumin was 4.16 ± 0.29 g/dl. In this study the mean CRP was 4.91 ±4.55, the mean ESR at first was 21.67 ±4.22 and 2nd hour was 47.43±10.94. Conclusion Crohn's disease (CD) is a progressive, inflammatory disease that occurs in genetically predisposed individuals and necessitates continuous monitoring and development of various methods for diagnostic and therapeutic treatment options, as well as the discovery of new medications. While colonoscopy is the gold standard in CD, US, CT and MRI, can provide information not only about the luminal side of the bowel but also about the serous side and the peripheral structure; additionally, US is repeatable, safe, and well-accepted, but unlike CT is radiation-free, and unlike MRI is inexpensive, virtually hazard-free, and available to all patients without contraindications.

Effects of Altitude training on Ethiopian endurance athletes recovery heart rate and hematological variables

Background and Study Aim. A recent study indicates that Ethiopian middle- and long-distance athletes originate from diverse geographical regions, including areas of varying elevation. This study aimed to analyze the impact of altitude training on hematological parameters and recovery heart rates among young male endurance trainees training at sites located at different altitude levels. Material and Methods. The study employed a quasi-experimental, counterbalanced approach involving 15 male trainees. Five individuals from each training center experienced the standard training program across three distinct geographical locations and elevations. Pre- and post-test data were collected on red blood cells, hemoglobin, hematocrit, platelet count, and recovery heart rate before and after six months, from 6:00–8:00 AM. ANCOVA was utilized to analyze the data. Results. Following the intervention, the mean Red Blood Cell (RBC) count was observed to be higher in trainees from low altitude (5.18±0.33) compared to those from moderate altitude (4.48±0.14 and 5.21±0.22), with a significance level of p&lt;0.05. The mean Hemoglobin (HGB) count was found to be higher in moderate altitude trainees (17.00±0.70 and 16.31±0.65) than in low altitude trainees (15.82±1.37), although this difference was not statistically significant (p&gt;0.05). Similarly, the mean Hematocrit (HCT) count was low for both low altitude (46.04±3.49) and moderate altitude trainees (46.46±3.9 and 45.42±1.54), with no significant difference noted (p&gt;0.05). The mean Platelet (PLT) count was 226.8±75.88 for low altitude trainees and 265.8±23.18, 276±53.96 for moderate altitude trainees, with no significant difference between the groups (p&gt;0.05). As for the recovery heart rate, mean values showed no significant difference between the pre-and post-test groups. In the pretest, the mean recovery heart rate was 30.00±14.70 for low-altitude trainees and 43.20±8.90, 43.20±13.68 for moderate-altitude trainees (p&gt;0.05). In the post-test, the mean recovery heart rate was 25.20±7.82 for low-altitude trainees and 32.40±10.04, 36.00±7.35 for moderate-altitude trainees (p&gt;0.05). Conclusions. The findings indicate that training at different altitudes impacts the hematological and cardiovascular systems of endurance athletes in varied ways. This underscores the importance of developing tailored training programs to optimize performance and recovery. These results are particularly relevant for coaches and athletes seeking to enhance endurance training outcomes through altitude training strategies.

Investigation of the predictive value of systemic immune inflammation index (SII) and prognostic nutritional index (PNI) on mortality in patients with endoprosthesis after hip fracture.

In this research, we aimed to investigate the predictive value of the systemic immune inflammation index and prognostic nutritional index on mortality among patients with an endoprosthesis after a hip fracture. In this retrospective, cross-sectional study, a total of 915 patient files applied to our hospital between 2020 and 2023 with an endoprosthesis after a hip fracture were subjected to the study. The patients were divided into 2 groups: alive (n = 396; 43.3%) and deceased (n = 519; 56.7%). The eosinophil-to-lymphocyte ratio, hemoglobin-to-red cell distribution width ratio (HRR), mean platelet volume-to-platelet ratio (MPVPR), neutrophil-to-lymphocyte ratio, monocyte/lymphocyte ratio, platelet-to-lymphocyte ratio, MPV-to-lymphocyte ratio, monocyte-to-eosinophil ratio (MER), neutrophile-to-monocyte ratio, systemic inflammation index (SII), and prognostic nutritional index (PNI) parameters of the patients were evaluated. The mortality rate was higher among male patients, with a statistically significant difference (P < .05). The follow-up duration, albumin, HGB, eosinophil, lymphocyte, eosinophil %, eosinophil-to-lymphocyte ratio, HRR, and PNI means were significantly higher in the living group (P < .05). Age, MPV, MPVPR, neutrophil-to-lymphocyte ratio, monocyte/lymphocyte ratio, platelet-to-lymphocyte ratio, MPV-to-lymphocyte ratio, MER, and systemic inflammation index were significantly higher in the deceased group (P < .05). The predictive value of gender (B = -0.362; P < .01), age (B = 0.036; P < .01), HRR (B = -1.100; P < .01), MPVPR (B = 8.209; P < .01), MER (B = 0.006; P < .01), and PNI (B = -0.078; P < .01) were statistically significant at the multivariate level. The time of death was significantly predicted by gender (B = 0.10; P < .05), age (B = -0.02; P < 0 = 1), HRR (B = 0.61; P < .01), MPVPR (r = -4.16; P < .01), MER (B = -0.01; P < .05), and PNI (B = 0.03; P < .01). The predictive value of PNI for the 30-day mortality rate was statistically significant (AUC: 0.643; P < .01). For a PNI cutoff value of 34.475, sensitivity was 69.7%, and specificity was 51.1%. The PNI has predictive value both in estimating overall mortality and in predicting the 30-day mortality rates among patients undergoing endoprosthesis after a hip fracture.

The Relationship Between Composite Inflammatory Ratios and Complications of Massive Ischaemic Stroke.

To investigate the relationship between complications of massive cerebral infarction (MCI) and composite inflammatory ratios. A case-control study. Place and Duration of the Study: Department of Neurology, Affiliated Hospital of Putian University, Putian, China, from January 2019 to November 2021. Eighty-two patients with MCI underwent blood tests within 24 hours of admission. Complications such as cerebral herniation, haemorrhage transformation (HT), and stroke-associated pneumonia (SAP) were evaluated based on imaging examinations. The prognosis was assessed using the modified Rankin Scale score (mRS) at discharge. Among the 82 patients, the cerebral herniation group had higher levels of systemic immune inflammation index (SII) and neutrophil-to-lymphocyte ratio (NLR) compared to the non-cerebral herniation group. MCI patients who developed HT had higher levels of SII, NLR, mean platelet volume/platelet (MPV/PLT), and platelet-to-lymphocyte ratio (PLR). The SAP group had higher levels of MPV/PLT and NLR compared to the non-SAP group. The poor prognosis group had higher SII and NLR levels but a lower lymphocyte-to-monocyte ratio (LMR) compared to the good prognosis group. NLR showed high accuracy in predicting complications and the short-term prognosis of MCI. SII was linked to cerebral herniation, HT, and the short-term prognosis of MCI. MPV/PLT was found to be related to SAP and HT caused by MCI. LMR may act as a protective factor for the short-term prognosis of MCI. Massive cerebral infarction, Neutrophil-to-lymphocyte ratio, Systemic immune inflammation index, Prognosis.

Immunity Patterns of Covid-19 Recovered Patients in Gilgit Baltistan, Pakistan

The main purpose of this study was to assess the immunity of recovered patients in COVID-19 patients. The idea was to unveil the nexus between the onset of COVID-19 coupled with the virulence of the disease and the immune responses of the target population in tandem with the intake of local/traditional foods. In the current study antibody presence and complete blood profile of 100 individuals were studied for COVID-19, from the Gilgit area. Immunity against COVID-19 recovered patients was observed during this investigation after more than eight months of their recovery. In this study, 78.2% of people were positive for Immunoglobin G antibody and 23.7% for Immunoglobin M antibody. The most infected age group recorded was 31-40 years. The mean blood glucose level in random was 143.38 mg/dL and 128.18 mg/dL in males and females, respectively. The mean cholesterol level in males was 148.82 mg/dL while the female cholesterol mean was 126.49 mg/dL. White Blood Cells were observed within their prescribed ranges. The mean hemoglobin level was 14.580 g/dL and 12.022 g/dL while mean RBC was 4.7838×106 m/µL and 4.2993×106 m/µL and the mean platelets were 238.45×103/µL and 261.91×103/µL in male and female, respectively. It is observed that the A+ blood group was more susceptible to infection. About 75% of individuals consume highly rich and nutritious food. About 55% of people engaged themselves with exercise. 25% of participants used their normal regular diet during the infection phase on the other hand 75% of individuals treated themselves with a specific and highly nutritious diet for their rapid and healthy recovery. More than 65% of people were re-infected after COVID-19 vaccination but the symptoms were not severe. Due to the strong innate immunity of people from this region, they recovered more rapidly. The dietary habits, high hemoglobin levels coupled with regular exercise might have a positive impact on early recovery of COVID-19-infected patients.

Platelet index ratios in HIV: Emerging biomarkers for immune health and disease management.

Human Immunodeficiency Virus (HIV) infection is a global health challenge that requires continuous advancements in diagnostic and prognostic tools. Traditional markers, such as CD4 cell counts and viral load, have played a crucial role in monitoring disease progression and guiding therapeutic interventions. However, emerging research suggests that platelet index ratios may serve as valuable biomarkers in assessing immune health and managing HIV-associated complications. This paper explores the significance of platelet index ratios, including platelet-to-lymphocyte ratio and mean platelet volume-to-lymphocyte ratio, as potential indicators of immune system status in individuals living with HIV. The interplay between platelets, lymphocytes, and their ratios reflects the dynamic nature of the immune response and inflammatory processes during HIV infection. Understanding the role of platelet index ratios in HIV could lead to the development of accessible and cost-effective biomarkers for monitoring immune health. Implementation of these ratios in routine clinical practice may enhance the precision of disease prognosis and guide personalized treatment strategies. Additionally, the exploration of platelet index ratios may pave the way for innovative therapeutic interventions aimed at modulating immune responses in HIV-infected individuals. In conclusion, platelet index ratios represent promising emerging biomarkers for evaluating immune health and managing HIV-related complications. Further research and clinical validation are warranted to establish the utility of these ratios in routine HIV care, potentially revolutionizing the approach to monitoring and improving the health outcomes of individuals living with HIV.

Correlation of Hemoglobin Level With New Inflammatory Markers in the Emergency Department: A Retrospective Study Exploring Neutrophil-to-Lymphocyte, Monocyte-to-Lymphocyte, Platelet-to-Lymphocyte, and Mean Platelet Volume-to-Platelet Count Ratios.

Background Anemia of chronic disease is known to be associated with inflammation. However, the relationship between hemoglobin (Hb) levels and potential inflammatory markers such as neutrophil-to-lymphocyte ratio (NLR), monocyte-to-lymphocyte ratio (MLR), platelet-to-lymphocyte ratio (PLR), and mean platelet volume-to-platelet count ratio (MPV/PC) has not been extensively studied. The primary objective of this retrospective analytical study conducted at Al Zahraa Hospital University Medical Center (ZHUMC), Beirut, was to investigate the correlation between Hb levels andpotential inflammatory markers (NLR, MLR, PLR, MPV/PC) in patients visiting the emergency department (ED), across different genders and age groups. The secondary objectives were to compare Hb levels and inflammatory markers values between the referred medical ward group (thehospitalized patients who were admitted to the medical ward), and the non-referred to medical ward group (the patients who were discharged home from the ED), and to evaluate the predictability of inflammatory markers and Hb levels for referral to the medical ward, including the determination of optimal cutoffvalues for hospital admission to the medical ward. Methods We analyzed the blood parameters of 379 adult patients who presented to the ED with various medical complaints between September 1, 2022, and November 30, 2022 (three months). These patients were included in the study after we checked their eligibility regarding the verification of all our inclusion and exclusion criteria. Results Our findings revealed a significant negative correlation between Hb levels and PLR (r = -0.24) in both genders and across different age groups. The group referred to the medical ward exhibited lower Hb levels and higher NLR, MLR, and PLR values (P < 0.001). NLR/Hb ratio emerged as a predictive factor for admission in genitourinary (R² = 0.158; OR = 5.62) and respiratory groups (R² = 0.206; OR = 5.89), with specific cutoff values of 0.533 (Sensitivity = 57.1% & Specificity = 84.2%) and 0.276 (Sensitivity = 85% & Specificity = 51.1%), respectively. Conclusions Our study demonstrates that hemoglobin level negatively correlates with PLR. NLR, MLR, and PLR stand as important inflammatory markers. Moreover, we present the first study in the literature to show that NLR/Hb ratio can serve as a predictor for referral to the medical ward, particularly in the genitourinary and respiratory patient groups, underscoring its value in risk assessment as a prognostic marker reflecting the need for admission when the case is more serious.

Usefulness of platelet-rich fibrin as a scaffold for meniscal repair: A non-randomized controlled cohort/follow-up study

BackgroundAlthough regenerative medicine treatment is still in its infancy in Japan, legislation within the past decade has provided opportunities to explore new treatment methods using regenerative medicine. We conducted a 2-year prospective follow-up study to statistically analyze treatment outcomes using platelet-rich plasma (PRP) and platelet-rich fibrin (PRF) as effective scaffolds in meniscal repair.Questions/Purposes.1. Does the use of PRF and PRP for meniscal repair surgery regenerate the meniscus?2. Does augmentation of meniscal repair with PRF effectively improve knee function outcomes? MethodsThirty-five patients underwent arthroscopic meniscal repair with PRP and PRF using new devices with all-inside techniques. Among these, 31 patients were evaluated for clinical outcomes postoperatively, and magnetic resonance imaging (MRI) findings were evaluated. The variables were coded appropriately by creating a new column based on the Kellgren–Lawrence classification over time. Log transformation of different time points (pre, post 6, 12, or 24 months) in relation to Lysholm, International Knee Documentation Committee (IKDC), Japanese Orthopedic Association (JOA), and Tegner scores were performed. Follow-up arthroscopy using a needle scope was performed in some cases 2 years later. The PRP and PRF used were characterized using the Minimum Information for Studies Evaluating Biologics in Orthopaedics classification. ResultsOverall, 31 patients were evaluated (mean age = 39.1 ± 15.7 years; preoperative rehabilitation period = 9.5 ± 7.7 weeks). The PRP had mean platelet and white blood cell concentrations of approximately 5.5- and 3.6-fold, respectively. A significant association existed between sex and deformity deterioration but not in age between the two groups classified by deformity deterioration. Surgical intervention significantly and positively impacted knee function, although no significant changes were found in the activity of the participants over time. MRI findings showed no regeneration of the repaired meniscus; nevertheless, none of them worsened. Furthermore, a case where the traumatic cartilage defect was covered with fibrocartilage-like tissue as a secondary finding was observed. ConclusionsMeniscal repair surgery using PRP/PRF is an effective treatment option for improving knee function in patients with knee deformity. Level of evidenceLevel III, Non-randomized controlled cohort/follow-up study.

Evaluation of hepatic toxicity in autoimmune hemolytic anemia (AIHA) and Evans syndrome patients: a single-center Egyptian study

IntroductionBenign auto-immune illnesses include Evans syndrome (ES) and auto-immune hemolytic anemia (AIHA). Despite being benign in nature, the patients’ livers are burdened by the disease’s chronicity and the accompanying problems beyond the course of treatment. An additional burden stems from HCV infection, of which a significant proportion of Egyptians are positive. The purpose of this study was to identify the hepatotoxicity risks and the variables that influence the prognosis and survival of patients with AIHA/ES. There are 126 AIHA patients in this observational study, which is retrospective. From June 2009 to March 2021, patients visited the Haematology Unit of the Oncology Centre in Egypt. One hundred and sixteen patients have available data.ResultsThere was no significant difference between primary and secondary AIHA groups as regards baseline hemoglobin (Hb), bilirubin, LDH, or reticulocyte count. Thirty-four patients (29.31%) had HCV-positive tests and 1 patient (0.9%) had HBV. There was no difference between HCV-positive and negative cases as regards mean Hb concentration, mean platelet, or immune markers (P > 0.05). AIHA patients with HCV-positive showed a significantly higher relapse rate (56%) than HCV-negative patients (32%) (P = 0.034). HCV positivity and low platelet counts at diagnosis were poor predictors for overall survival (OS) (P 0.022 and 0.04, respectively). Median OS was significantly better in patients with no viral hepatitis infection (1101 days, 95% CI 592–2068) than in patients with positive HCV infection (521, 95% CI 326–1325) (P = 0.019).ConclusionsAzathioprine is the least hepatotoxic in AIHA patients under treatment. Viral hepatitis represents a superadded damage to the liver besides AIHA concerning clinical characteristics and outcomes.

Support Vector Machine Outperforms Other Machine Learning Models in Early Diagnosis of Dengue Using Routine Clinical Data.

Background: There is a dire need for the establishment of active dengue surveillance to continuously detect cases, circulating serotypes, and determine the disease burden of dengue fever (DF) in the country and region. Predicting dengue PCR results using machine learning (ML) models represents a significant advancement in pre-emptive healthcare measures. This study outlines the comprehensive process of data preprocessing, model selection, and the underlying mechanisms of each algorithm employed to accurately predict dengue PCR outcomes. Methods: We analyzed data from 300 suspected dengue patients in Islamabad and Rawalpindi, Pakistan, from August to October 2023. NS1 antigen ELISA, IgM and IgG antibody tests, and serotype-specific real-time polymerase chain reaction (RT-PCR) were used to detect the dengue virus (DENV). Representative PCR-positive samples were sequenced by Sanger sequencing to confirm the circulation of various dengue serotypes. Demographic information, serological test results, and hematological parameters were used as inputs to the ML models, with the dengue PCR result serving as the output to be predicted. The models used were logistic regression, XGBoost, LightGBM, random forest, support vector machine (SVM), and CatBoost. Results: Of the 300 patients, 184 (61.33%) were PCR positive. Among the total positive cases detected by PCR, 9 (4.89%), 171 (92.93%), and 4 (2.17%) were infected with serotypes 1, 2, and 3, respectively. A total of 147 (79.89%) males and 37 (20.11%) females were infected, with a mean age of 33 ± 16 years. In addition, the mean platelet and leukocyte counts and the hematocrit percentages were 75,447%, 4189.02%, and 46.05%, respectively. The SVM was the best-performing ML model for predicting RT-PCR results, with 71.4% accuracy, 97.4% recall, and 71.6% precision. Hyperparameter tuning improved the recall to 100%. Conclusion: Our study documents three circulating serotypes in the capital territory of Pakistan and highlights that the SVM outperformed other models, potentially serving as a valuable tool in clinical settings to aid in the rapid diagnosis of DF.

Comparison Of The Relationship Between Inflammatory Markers And Saphenous Vein Graft Disease In Patients With Stable Angina Pectoris.

Aim: Coronary artery bypass graft surgery is one of the most commonly used strategies to revascularization of occlusive coronary atherosclerotic lesions. Atherosclerosis is known to be a chronic inflammatory process. Many inflammatory cells and mechanisms are active in this process. Markers such as mean platelet volume-to-lymphocyte ratio (MPVLR) and C-reactive protein-to-albumin (CAR) which may be associated with the severity of inflammation. In this study, it was aimed to determine the relationship between these parameters and saphenous vein graft (SVG) diseases. Methods: In this retrospective study, 314 patients SVG disease with stable angina pectoris were included. Patients were divided into two groups according to the severity of SVG disease. We compared 159 patients who had severe stenosis in SVG and 156 patients who did not,in terms of CAR, NLR, PLR, MPVLR. Results: Patients who ≥50% stenosis in SVG had significantly higher CAR, MPVLR, NLR, and PLR (respectively 9.1 (4.2-16.8) p&amp;lt;0.001, 4.5)0.68) p&amp;lt;0.001, 2.4 (0.69) p=0.002, 153 )6) p=0.048). In line with these data, CAR and MPVLR values were also higher in the group with ≥50% stenosis in SVG, which was highly statistically significant (respectively 3.2 (0.9-4.4) vs 9.1 (4.2-16.8); p&amp;lt;0.001 and 3.64)0.43) vs 4.53)0.68); p&amp;lt;0.001). Conclusion: C-reactive protein-to-albumin and MPVLR can be a useful and easily accessible markers to predict severity SVG stenosis.

Decreased NK cell count is a high-risk factor for convulsion in children with COVID-19

BackgroundThe neurological symptoms caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) are of increasing concern. Convulsions are among the main neurological manifestations reported in children with coronavirus disease-2019 (COVID-19), and cause serious harm to physical and mental health. This study aimed to investigate the risk factors for convulsion in children with COVID-19.MethodsThis prospective study was conducted at the Children’s Hospital of Soochow University. In total, 102 COVID-19 patients with convulsion, 172 COVID-19 patients without convulsion, and 50 healthy controls were enrolled in the study. The children’s clinical and laboratory data were analyzed to assess the risk factors for convulsion in COVID-19 patients.ResultsConvulsions occurred in 37.2% of children, mostly those aged 1–3 years, who were hospitalized with the Omicron variant. The neutrophil count, neutrophil-to-lymphocyte ratio (NLR), monocyte-to-lymphocyte ratio (MLR), platelet-to-lymphocyte ratio (PLR), and mean platelet volume-to-platelet ratio (MPR) were significantly higher in the convulsion group than those in the non-convulsion and control groups (P < 0.01). However, the counts of lymphocytes, eosinophils, platelets, lymphocyte subsets, CD3+ T cells, CD4+ T cells, CD8+ T cells, and NK cells were lower in the convulsion group than those in the non-convulsion and control groups (P < 0.01). Multivariate regression analysis indicated that NK cell count (OR = 0.081, 95% CI: 0.010–0.652) and a history of febrile seizure (OR = 10.359, 95% CI: 2.115–50.746) were independent risk factors for the appearance of convulsions in COVID-19.ConclusionsHistory of febrile seizure and decreased NK cell count were high-risk factors for convulsions in COVID-19 patients.

Mean platelet volume-to-lymphocyte ratio predicts poor functional outcome of acute ischemic stroke patients

Background &amp; Objective: The mean platelet volume-to-lymphocyte ratio (MPVLR) is a novel and easily available marker of poor short-term prognosis in myocardial infarction patients. The present study was to investigate the association between MPVLR and clinical outcome of patients with acute ischemic stroke. Methods: A total of 494 acute ischemic stroke patients were included in this study and received 3-months follow-up. Blood samples for MPVLR were obtained at admission and at 7 days after acute ischemic stroke. Poor functional outcome was defined as a modified Rankin Scale (mRS) score of 3-6 at 3 months after stroke. Results: Compared with good prognosis group, MPVLR level at admission and at 7 days in poor prognosis group was significantly higher, the difference between these two groups was statistically significant (P &lt; 0.001). In multivariate logistic regression analysis, both MPVLR as a continuous (OR 1.13; 95%CI, 1.064-1.190, P=0.001) and categorical variable (OR 3.05; 95%CI, 1.85-5.05, P&lt;0.001) were independently associated with poor outcome at 3 months. ROC analysis revealed the predictive value of MPVLR was better than that of platelet-to lymphocyte ratio (PLR). The nomogram was used for predicting 3-months unfavourable outcome after an acute ischemic stroke. Conclusions: MPVLR at admission and at 7 days after stroke were found to be independently associated with poor functional outcome. MPVLR may serve as an activity marker for poor prognosis in patients with acute ischemic stroke.

Clinical and Genetic Characteristics of 30 Patients Misdiagnosed As Having ITP with Non-Muscle Myosin Heavy Chain 9-Related Disease (MYH9-RD): A Retrospective Analysis in China

Introduction : Non-muscle myosin heavy chain 9-related diseases (MYH9-RD) are rare autosomal dominant platelet (PLT) disorders presenting as nonsyndromic forms characterized by macrothrombocytopenia with giant PLTs and leukocyte inclusion bodies or as syndromic forms combining these hematological features with deafness, nephropathy, or cataracts. Owing to its low incidence and similar clinical manifestations, it is easily misdiagnosed as immune thrombocytopenia (ITP), leading to inappropriate treatment. To improve the diagnosis of this rare thrombocytopenic disease and minimize the misdiagnosis rate, we retrospectively analyzed the clinical, treatment, and genetic characteristics of patients with MYH9-RD who were initially misdiagnosed with ITP and compared the differences between pediatric and adult patients. Methods: Patients from various sites in China were enrolled. The inclusion criteria were macrothrombocytopenia on peripheral blood smear, MYH9 gene mutation detected by next-generation sequencing or whole exon sequencing and verified by Sanger sequencing, and absence of other acquired thrombocytopenia diseases. We collected basic information, clinical manifestations, and laboratory test results via medical records and telephone interviews. Results: Of the 30 patients, 17 were male, 13 were female, 14 were children, and 16 were adults. There was no significant difference in the mean PLT count (×10 9/L) at the time of diagnosis between children and adults (50.5 vs. 33.4, P=0.188). However, the median duration of misdiagnosis was significantly shorter in children (0.1 y vs. 9 y, P=0.000) (Table 1). Overall, 5 patients showed no signs of bleeding, while 25 presented with bleeding manifestations: 11 with skin bleeding spots and ecchymosis, 15 with epistaxis, 6 with gingival bleeding, and 3 with increased menstrual volume. Moreover, 21 patients showed no non-hematological manifestations, while 9 presented with non-hematological manifestations, which occurred exclusively in adult patients. Among the latter, 6 patients had nephropathy (2 underwent renal transplantation, and 2 underwent regular dialysis), 5 had hearing impairment (4 underwent high-frequency hearing impairment, and 1 received a cochlear implant due to deafness), and 1 had a congenital cataract. All patients received first- or second-line treatment for ITP. The most common treatment in children was immunoglobulins (12/14), followed by steroids (5/14) and traditional Chinese medicine (2/14). No children received &amp;gt;3 types of treatment, 4 children received &amp;gt;1, and 6 adult patients received &amp;gt;3. The highest number of treatment type for a single patient was up to 7. The median duration of ITP treatment was 1.5 y for adults and 0.1 y for children ( P=0.002). All patients presented heterozygous missense mutations in MYH9; 17/30 were spontaneous mutations, 7/30 were familial mutations (involving 6 paternal and 1 maternal origin), and 6/30 cases had an unknown inherited type. Fourteen cases were located in the N-terminal globular head region, and 16 cases were located in the C-terminal tail domain (Figure 1). Two novel mutations (not recorded in the Global Variome database), p. G1517V and p. K1674Q, were identified. In 2 adult patients with p.R702C mutations, proteinuria occurred in adolescence, followed by chronic renal failure (CRF), end-stage renal failure, and hearing loss. The 3 children with p.R702C mutation were aged &amp;lt;4 years and exhibited no non-hematological symptoms. Three of the 5 adults with p.E1841K mutations had CRF and underwent kidney transplantation. Conclusion s : Compared with pediatric patients, adult patients are more likely to be misdiagnosed with ITP, receive more types of inappropriate treatment for a longer period of time, and have more common non-hematological manifestations. To improve diagnostic accuracy and reduce the misdiagnosis rate for patients with thrombocytopenia, especially those with a poor response to ITP treatments, attention should be paid to mean PLT volume, family history, and genetic screening. Consistent with previous reports, patients with the p.R702C mutation showed early-stage kidney injury and hearing loss. The incidence of spontaneous mutations (56.7%) was significantly higher than previously reported (25-35%). The genetic characteristics of MYH9-RD and genotype-phenotype relationships in China require further clarification.

In vitro quality parameters of whole blood-derived platelets pooled using two different platelet pooling sets and stored up to 7 days are similar.

Increasing the number of collections of whole blood-derived platelets (WBDP) and lengthening the allowable storage time may alleviate platelet (PLT) shortages. There is a need for new PLT pooling sets that can provide acceptable quality on Day 7 of storage. This pool-and-split study compared WBDP prepared using the platelet-rich plasma method with the novel IMUGARD WB PLT pooling set and a control pooling set. After pooling and filtration, PLT products were tested on Days 1, 5, and 7. Large volume delayed sampling (LVDS) cultures were taken on Day 2. The median postfiltration residual white blood cell (rWBC) content was 0.18 million per product (maximum 1.26 million; n = 69) with mean PLT recovery of 88.5 ± 2.8% for the new set and median 0.23 million (maximum 1.83 million) rWBC with 87.5 ± 2.5% recovery for the control. Day 5 mean pH22°C were 7.18 ± 0.12 and 7.13 ± 0.10 for the new and control set, respectively. Day 5 in vitro quality parameters were within 20% between the two pooling sets. The new set Day 7 pH22°C was acceptable (7.07 ± 0.17, 100% ≥ 6.3), and most parameters were within 20% of Day 5 values. WBDP quality for the new pooling set is acceptable across a battery of in vitro tests when stored up to 7 days and meets FDA regulatory criteria. The quality parameters were similar between the new pooling set and the control set on Day 5. This new set is compatible with LVDS.

Aorta Dilatation in Unrepaired Tetralogy of Fallot.

Background Aortic root dilation is an increasingly recognized feature in repaired tetralogy of Fallot (TOF) patients. However, the dilation at the aortic root and ascending aorta in unrepaired TOF is rarely studied. This study aims to confirmwhether aortic dilation is a common feature in unrepaired TOF andinvestigate the factors attributed to aortic dilation. Methodology Patients with an echocardiographic diagnosis of TOF undergoing computed tomography angiography were retrospectively studied. Diameters and z scores of aortic annular (Ao1), aortic sinotubular junction (Ao2), ascending aorta (Ao3), and distal transverse aortic arch (Ao4) were measured. Preoperative body surface area (BSA), hemoglobin (Hb), hematocrit (HCT), arterial oxygen saturation (SaO2), and platelet (PLT)count were recorded. Results A total of 101 TOF patients aged 6.8 ± 9.5 years were included in this study, whose mean BSA (m2), Hb (g/L), HCT, SaO2(%), and PLT (109/L)were 0.7 ± 0.4, 162.1 ± 3.8, 0.5± 0.1, 85.1 ± 9.3, and 238.1 ± 101.1, respectively. The mean z score of Ao1, Ao2, Ao3, and Ao4 were 10.3 ± 3.5, 4.7 ± 2.9, 4.0 ± 2.7, and 4.1 ± 2.4, respectively. Age and BSA were positively correlated with the z scores of Ao1 and Ao2. Preoperative Hb and HCT were positively correlated with the z scores of Ao1, Ao2, Ao3, and Ao4. Preoperative SaO2and PLT were negatively correlated with the z scores of Ao1, Ao2, Ao3, and Ao4. Conclusions Aortic dilation is common in unrepaired TOF patients.The dilation of different levels of the aorta was correlated with age, BSA, preoperative Hb, HCT, SaO2,and PLT.

Time to Achieve Platelet Count Response after Intravenous Efgartigimod in Adults with Primary Immune Thrombocytopenia: A Phase 3, Multicenter, Double-Blinded, Placebo-Controlled, Randomized Clinical Trial (ADVANCE IV)

Background In primary immune thrombocytopenia (ITP), immunoglobulin G (IgG) anti-platelet autoantibodies contribute to platelet clearance and impair platelet production. IgG homeostasis is regulated by the neonatal Fc receptor (FcRn), which binds to IgG in a pH-dependent manner and recycles bound IgG. Efgartigimod (EFG), a human IgG1 Fc fragment, is a natural ligand of FcRn engineered to bind competitively to FcRn with high affinity, preventing recycling of endogenous IgG, thereby reducing IgG levels, including pathogenic IgG autoantibody levels. Methods Intravenous (IV) EFG was evaluated in ADVANCE IV, a phase 3, multicenter, randomized, double-blinded, placebo (PBO)-controlled trial (NCT04188379) in adults with persistent or chronic ITP (Broome CM, et al. ASH 2022). Participants who received 2 prior or 1 prior and 1 concurrent ITP therapy with an average of 2 platelet (PLT) counts of &amp;lt;30×10 9/L during screening were randomized 2:1 to receive EFG IV 10 mg/kg or PBO IV for 24 weeks. Concurrent oral corticosteroids, immunosuppressants, dapsone, danazol, fostamatinib, and oral thrombopoietin receptor agonists were permitted but required to remain at the entry dosage and frequency. Participants received weekly dosing of either EFG or PBO (weeks 1-4) followed by response-dependent weekly or every-other-week dosing (weeks 5-16) and then maintained their dosing regimen from weeks 17-24. PLT counts were measured weekly starting at day 7 after treatment initiation. The extent of disease control, defined as cumulative weeks with PLT counts of ≥50×10 9/L in the chronic ITP population, was assessed as a key secondary endpoint. This analysis evaluates trends in time to response in ADVANCE IV. The time to achieve 2 consecutive PLT counts of ≥50×10 9/L was evaluated as a secondary endpoint. Time to 2 consecutive PLT counts of ≥100×10 9/L and time to single counts of ≥50×10 9/L and 100×10 9/L were analyzed as defined a priori. Post hoc Kaplan-Meier (KM) analyses, including time to a single PLT of ≥30×10 9/L and time to the International Working Group (IWG) response, were also performed. Change from baseline in mean PLT counts over time was evaluated based on a mixed model for repeated measurements. Results One hundred thirty-one participants (118 chronic ITP, 13 persistent ITP) were randomized (86 EFG, 45 PBO). Least-squares mean estimate changes from baseline in PLT counts were significantly different in EFG group compared with PBO group starting at day 7 (22×10 9/L vs -1×10 9/L; P=0.0293) and remained significant at most time points throughout the study. 38.4% of EFG-treated participants compared with 11.1% of PBO treated participants achieved a PLT count of ≥30×10 9/L in 7 days. The EFG group showed a higher proportion of PLT count responders ≥50×10 9/L on ≥4 occasions until week 12 compared with PBO (34.9% vs 4.4%, respectively). Based on KM analysis, 31.8% of participants receiving EFG and 2.2% of those receiving PBO achieved 2 consecutive PLT counts of ≥50×10 9/L by day 42 (Figure). 41.5% of participants receiving EFG vs 11.4% of those receiving PBO achieved the first PLT count ≥50×10 9/L by day 42. 22.5% of participants receiving EFG vs 2.2% of those receiving PBO achieved the first PLT count ≥100×10 9/L by day 42 (Table). The cumulative number of weeks in disease control was significantly higher in the EFG group compared with PBO (mean [SD]: 6.1 [7.66] vs. 1.5 [3.23]; P=0.0009) (Broome CM, et al. ASH 2022).KM estimates for IWG response by day 42 in the overall (chronic and persistent ITP) population were 29.7% in participants receiving EFG vs 4.6% in those receiving PBO. Overall, EFG was well tolerated; most adverse events were mild or moderate in severity. Conclusions In ADVANCE IV, EFG demonstrated a rapid PLT count increase, as early as the first time point measured (7 days after EFG treatment). Irrespective of the specific measure of response utilized, these data demonstrate that at all time points evaluated more participants in the EFG group achieved response compared with the PBO group. In addition to this early response, significantly more sustained responses were observed in the EFG group compared with the PBO group. The response rate, regardless of definition, in participants who received EFG continued to increase over time suggesting that some participants may have delayed responses to EFG. These data further demonstrate early and sustained responses with EFG in ITP.

Diagnostic and prognostic values of immunocyte ratios in patients with sepsis in the intensive care unit.

The aim of this study was to evaluate the diagnostic and prognostic values of neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), platelet-to-neutrophil ratio (PNR), monocyte-to-lymphocyte ratio (MLR), neutrophils-to-lymphocytes and platelets ratio (N/LPR), mean platelet volume-to-platelet count ratio (MPV/PC), red blood cell distribution width-to-platelet count ratio (RDW/PC), and platelet volume distribution width-to-platelet count ratio (PDW/PC) in patients with sepsis. A total of 203 patients with sepsis admitted to an emergent intensive care unit (EICU) were enrolled in this retrospective study. Basic data, inflammatory factors, NLR, PLR, PNR, MLR, N/LPR, MPV/PC, RDW/PC, PDW/PC were compared between survival and non-survival groups. Receiver operating characteristic (ROC) curve was used to assess the diagnostic values. The univariate and multivariate regression analyses were used for constructing a prognostic model for sepsis. There were significant differences in acute physiology and chronic health evaluation (APACHEII) score, mechanical ventilation, use of vasopressors, acute kidney injury (AKI), continuous renal replacement therapy (CRRT), long-term antiplatelet drug use, lymphocyte, monocyte, hemoglobin, procalcitonin (PCT), interleukin-6 (IL-6), C-reactive protein (CRP)*PCT, and N/LPR. APACHE II had the highest diagnostic value [Area Under Curve (AUC) = 0.999], followed by CRP*PCT (AUC = 0.718). The prognoses were different between patients stratified according to CRP, IL-6, lactic acid (Lac), PNR, PLR, PDW/PC, and APACHEII. Lac, CRP*PCT, PDW/PC, MPV/PC and APACHE II were independent prognostic factors of sepsis. Both N/LPR and CRP*PCT had high values to predict mortality in sepsis patients. CRP*PCT, PDW/PC and MPV/PC were independent factors to predict the prognosis of sepsis.

Neutrophil Lymphocyte Ratio as an Inflammatory Marker in Rheumatoid Arthritis

Objective: To determine the role of Neutrophil Lymphocyte Ratio as an inflammatory marker in Rheumatoid Arthritis. Study Design: Cross-sectional analytical study. Place and Duration of Study: Rheumatology Department, National Hospital and Medical Center, Lahore Pakistan, from Mar to Sep 2021. Methodology: After approval from Institutional Ethical Review Board, 160 patients diagnosed with rheumatoid arthritis, aged 21-80 years, were enrolled. Demographic information and medical history were obtained and divided into two groups: Active disease (DAS-28 score&gt;3.2) and LDA/remission (DAS-28 score&lt;3.2). Clinical parameters of the DAS-28 score and CBC, including NLR, were assessed and recorded. Results: Out of 160 patients, there were 132(82.5%) females. The duration of disease was 8.4±6.8 years. Mean VAS score, tender joint count, swollen joint count, and DAS-28 score were 3.8±2.6, 4.2±4.1, 2.4±2.7 and 4.0±1.6 respectively. RA Factor was positive in 121(75.6%) and Anti-CCP antibody in 102(63.8%). Anaemia was found in 45(28.1%). Mean platelet and TLC were 357.1+99.3 ×109/L and 9.0+2.9 ×109/L respectively. On division into groups, the mean NLR in LDA/Remission-Group and Active Disease-Group were 2.5±1.4 and 3.9±2.1, respectively. High NLR was seen in 46 (57.5%) with Active Disease-Group compared with 13 (16.3%) in LDA/Remission-Group (p-value&lt;0.001). Conclusion: High NLR was more common in active RA than LDA/remission, and NLR is useful in indicating disease activity.