Mean White Blood Cell Count Research Articles

Colonic Diverticulitis Complicated by Liver Abscess: Case Series and Review of Literature

Aim: Evaluate patients with colonic diverticulitis complicated by liver abscesses at a single center and provide review of literature.Methods: Patients with colonic diverticulitis and liver abscess were identified via an administrative database and imaging search engine at Cedars Sinai Medical Center (CSMC). Clinical manifestations, laboratory and imaging findings and treatment strategies were assessed.Results: We identified 10 patients with a median age of 59 and a 7:3 male: female ratio. The top presenting signs and symptoms were: fever (90%), malaise (70%), anorexia (60%), nausea (40%), and right upper quadrant abdominal pain (30%). Mean white blood cell count was 22.4 1000/UL, total bilirubin 2.59 mg/DL, and alkaline phosphatase 206.6 IU/L. Of the reported liver abscess cultures, 5 patients grew a single organism and 2 had multiple organisms. Most common bacteria genus was Streptococcus (n=4). Five patients had right hepatic abscesses, 3 had bilobar, and 2 had left hepatic abscesses. Four patients had locally complicated diverticulitis: 2 with paracolonic abscess and 2 with purulent peritonitis. Nine patients had CT-guided drainage of liver abscess, while 2 needed surgical drainage of liver abscess (one required both). Five patients had colectomy: 1 emergently and 4 electively. Two patients who did not have colectomy had recurrent diverticulitis, and underwent colectomy following recurrence.Conclusion: Majority of patients with diverticulitis with liver abscess were males presenting with fever, and leukocytosis. Most had right liver lobe abscesses and most underwent colectomies. Diverticulitis with liver abscess is likely best treated as locally complicated disease and should undergo colectomy.

Complicated Clinical Course and Poor Reproductive Outcomes of Women with Tubo-Ovarian Abscess after Fertility Treatments

Study ObjectiveTo assess the clinical course and surgical and fertility outcomes of patients diagnosed with tubo-ovarian abscess (TOA) after fertility treatment. DesignParallel case series over 10 consecutive years (Canadian Task Force classification II-2). SettingTel Aviv Sourasky Medical Center, a tertiary university-affiliated hospital. PatientsThirty-seven women who were diagnosed with TOA after fertility treatments (in vitro fertilization and intrauterine insemination) were compared with 313 women who were diagnosed with TOA not associated with fertility treatments during the same time period. InterventionMedical records search, chart review, and phone survey were used to assess clinical course and surgical and reproductive outcomes. Measurements and Main ResultsWomen with TOA after fertility treatments had significantly higher inflammatory markers upon admission compared with the nonfertility treatment group (mean white blood cell count, 16.1 × 1000/mm3 [standard deviation [SD], ±4.3] vs 13.8 × 1000/mm3 [SD, ±6.3], p = .001, respectively; and mean C-reactive protein, 149 mg/L [SD, ±78.3] vs 78.2 mg/L [SD, ±68.5], p = .001, respectively). In addition, TOA after fertility treatments was associated with a significantly higher surgical intervention rate and a more complicated clinical course, as evidenced by a shorter time interval from admission to surgery (2.1 days vs 3.2 days, p = .01), higher rates of antibiotic failure, higher conversion rate from laparoscopy to laparotomy (14.2% vs 3.2%, p = .005), increased perioperative complications rate (25.0% vs 3.8%, p = .0001), and a longer hospitalization stay (7.2 days vs 4.8 days, p = .01). Clinical pregnancy rate per cycle in women with TOA after fertility treatments was 9%, and 1 case of live birth was recorded. ConclusionsOur data indicate that TOA after fertility treatment has a substantial effect on the clinical course and surgical outcome. Prophylactic antibiotic treatment before ovum retrieval and deferral of embryo transfer should be considered in patients at risk of infection.

Is there any relation between intrauterine growth restriction and platelet distribution width (PDW), platelet crit (PCT), mean platelet volume (MPV)? A prospective study

Aim: Intrauterine growth restriction (IUGR) is still an important pregnancy complication bringing on perinatal mortality and morbidity. Placental vascular dysfunction and subsequent obliteration of placental blood vessels are mostly accepted etiopathological factors of intrauterine growth restriction similar with preeclampsia. We aimed to investigate the possible difference between pregnant women suffering from intrauterine growth restriction and healty pregnant women for parameters of platelet count, platelet crit, platelet distribution crit and mean platelet volume. Material and Method: This case- control study was conducted with 179 pregnant women. The study population was consisted of 94 pregnant women complicated with idiopathic IUGR (study group) and 85 healty pregnant women (control group). IUGR group was divided in two subgroups according to umbilical artery doppler velocimetry measurements. Complete blood count parameters including hemoglobin, platelet count, platelet distribution width (PDW), platelet crit (PCT), mean platelet volume (MPV) and white blood cell count (WBC) were measured. Results: There was no significant difference between the groups for parameters of hemoglobin, PC and PCT. The mean amniotic fluid index of IUGR group was significantly lower than the control group (p=0.000). The mean WBC, MPV and PDW levels of IUGR group were significantly higher than the control group (p=0.013, p=0.047 and 0.035, respectively). The mean MPV level of IUGR group 1(umbilical artery S/D˃3) was significantly higher than that of IUGR group 2 (umbilical artery S/D<3) (p=0.045). Conclusions: In the present study, we observed a significant difference between IUGR and healty pregnant women for platelet parameters of MPV and PDW. Beside this, we also observed higher MPV values in IUGR patients with increased umblical artery resistance compared to that in IUGR patients with normal umblical artery blood flow. Further studies are needed to discuss our results.

195 Intraprostatic Injection of Botulinum Toxin-A in Patients with Refractory Chronic Pelvic Pain Syndrome: The Transurethral vs. Transrectal Approach

To evaluate the outcome of an intraprostatic injection of botulinum toxin-A (BTX-A) in men with refractory chronic prostatitis-associated chronic pelvic-pain syndrome (CP/CPPS) and to compare the efficacy of the transurethral and transrectal routes. In an uncontrolled randomised clinical trial conducted in men with refractory CP/CPPS, the patients were classified into two groups according to the route of BTX-A injection; transurethral (group 1, 28 patients) and transrectal ultrasonography-guided (group 2, 35 patients). The chronic prostatitis symptom index (CPSI), maximum urinary flow rate (Qmax) and white blood cell (WBC) count in expressed prostatic secretion (EPS) were measured before and at 3, 6 and 12 months after the injection. A significant clinical improvement (SCI, defined as a reduction of 4 points or a 25% decrease in total CPSI score) was correlated with patient age, prostate volume and symptom duration. In group 1, the pain and quality-of-life domain scores improved, but statistically significantly only at 6 months. The voiding score improved at all follow-up visits. In group 2 there was a significant improvement in all the CPSI domain scores at all follow-up visits, except for pain, which was insignificantly improved by 12 months. The SCI ratings in groups 1 and 2 were 36%, 79% and 57%, and 49%, 89% and 74% in group 2 at the three follow-up visits, respectively. The Qmax was significantly improved in both groups during the follow-up (except at 12 months in group 1). There was a significant reduction in the mean WBC count in the EPS in patients with inflammatory prostatitis. Both prostate volume and symptom duration were significantly associated with a lower SCI rating.

Physical Stress from Colonoscopy and Polypectomy in Elderly Individuals: Evaluation Using Damage Biomarkers in Blood

Colonoscopy is routinely performed worldwide, but it is still a physically stressful screening method for colorectal cancer, particularly in elderly individuals. No previous study has evaluated physical stress from colonoscopy itself and polypectomy using blood-derived biomarkers. This study aimed to evaluate physical stress from colonoscopy and polypectomy in elderly individuals using white blood cell counts (WBCs) and C-reactive protein (CRP) levels, which are widely used blood-based biomarkers that respond quickly to tissue damage. In this single-center, retrospective observational study, 109 consecutive patients, aged ≥ 80 years, were enrolled. In all patients, WBCs and CRP levels were measured before and half-a-day after colonoscopy. The changes were subsequently compared. Patients were divided into two groups: those with polypectomy (P+) and those without polypectomy (P-). The changes in WBCs and CRP levels were determined and compared between the two groups. In the P + group, correlations between the number of resected polyps and changes in WBCs and CRP levels were also evaluated. Of the 109 patients, there were 48 men and 61 women with a mean age of 83.9 ± 3.1 years (range, 80-91 years); 58 patients received polypectomy. In all patients, the mean WBC after colonoscopy showed no significant change from that before colonoscopy (before: 5400/μL, after: 5200/μL, P = 0.092), and the mean CRP level showed a slight elevation after colonoscopy (before: 0.05 mg/dL, after: 0.08 mg/dL, P < 0.001). Compared to before colonoscopy, the mean WBC after colonoscopy decreased slightly in the P- group (before 5400/μL, after 4900/μL, P = 0.002), but showed no significant difference in the P+ group (5400/μL, 5400/μL, P = 0.48). Conversely, the mean CRP level increased very slightly in both the P- and P+ groups (from 0.06 mg/dL to 0.07 mg/dL, P = 0.003; from 0.04 mg/dL to 0.08 mg/dL, P < 0.001, respectively), but it was not significantly different between the groups. The elevation of both WBCs and CRP levels showed only minor correlations with the number of resected polyps. In conclusion, colonoscopy can be well tolerated even by elderly individuals because physical stress from colonoscopy, with respect to WBCs and CRP levels, was minimal even if polypectomy was performed.

Long-term monitoring of circulating progesterone and its relationship to peripheral white blood cells in female false killer whales Pseudorca crassidens.

Long-term monitoring of circulating progesterone levels in three captive female false killer whales, Pseudorca crassidens, was conducted to characterize their reproductive events and to reveal the relationship between their estrous cycles or pregnancies and peripheral white blood cell (WBC) counts. Blood samples were collected at 2–3-day intervals or on a weekly-to-monthly basis for up to 10 years, from 2006 to 2017. In two mature females (initial body lengths of 4.22 and 4.07 m), some cyclic progesterone elevations were detected during the study period; the estimated mean (± SE) estrous cycle length was 40.5 ± 0.7 days (n=12). The seasonality of ovulation, estimated from the elevation of progesterone levels, varied among individuals or years, and ovulation did not occur every year. The third female (3.26 m) showed progesterone elevations, despite irregular cycles after sexual maturity, and became pregnant. The progesterone levels during pregnancy ranged from 7.3 to 42.2 ng/ml, and the gestation period lasted for 14 months until parturition. The mean WBC counts during estrous cycles were the lowest before the progesterone levels began to increase and then gradually increased toward the luteal phase. The WBC counts were significantly higher during pregnancy than before and were particularly high in early pregnancy. To the best of our knowledge, this is the first report of the relationship between the estrous cycle or pregnancy and WBC counts in cetaceans.

Clinical features of eczema herpeticum in atopic dermatitis in a single center

Purpose: This study evaluated the clinical characteristics and risk factors associated with atopic dermatitis patients complicated by eczema herpeticum. Methods: This study included 45 patients under the age of 18 with atopic dermatitis complicated by eczema herpeticum in the dis ease group (ADEH+), and 50 patients under the age of 18 with atopic dermatitis without any episode of eczema herpeticum in the control group (ADEH-). We retrospectively reviewed the clinical features, treatment and prognosis of the 2 groups. Results: In this study, eczema herpeticum occurred in 2.7% of the AD patients. No significant difference in percentage of boys or mean age was found between the ADEH+ and ADEH- groups. In the ADEH+ group, eczema herpeticum occurred more frequently in the head and neck. Severe atopic dermatitis, recurrent impetigo, IgE-mediated atopic dermatitis and food allergy were identified as the risk factors of eczema herpeticum. The mean white blood cell count, erythrocyte sedimentation rate, percent of eosinophils and total serum IgE were higher in the ADEH+ group than in the ADEH- group. More than 2 recurrences were confirmed in 12 pa tients (26.7%). Conclusion: In the ADEH+ group, skin lesions were dominant on the head and neck. We revealed that severe atopic dermatitis, fre quent impetigo, IgE-mediated atopic dermatitis, and food allergy are risk factors for eczema herpeticum. (Allergy Asthma Respir Dis 2018;6:174-178)

White Blood Cell Count Mean Platelet Volume Ratio as A Predictor of Major Adverse Cardiovascular Event in Acute Non St-Elevation Myocardial Infarction (NSTEMI)

White Blood Cell Count Mean Platelet Volume Ratio as A Predictor of Major Adverse Cardiovascular Event in Acute Non St-Elevation Myocardial Infarction (NSTEMI)

The relationship between some biochemical and hematological changes in type 2 diabetes mellitus

Introduction: The aim of this study was to investigate various biochemical and hematological parameters in patients with type 2 diabetes mellitus (T2DM) and compare those with non-diabetic subjects (control group).&#x0D; Subjects: The study was conducted on 405 subjects (ages ranging from 26-65 years old; sex matched) who were classified into two groups: diabetic (n=205 subjects; males-105, females-100) and non-diabetic subjects (n=200; males-100, females-100). The study was carried out during the period of November 2016 to April 2017 in the Department of Clinical Laboratory Sciences at the College of Applied Medical Science Al-Dawadmi, Shaqra University in Saudi Arabia (with the collaboration of the General Hospital Al-Dawadmi).&#x0D; Methods: The following various parameters were assessed for all subjects: body mass index (BMI), systolic and diastolic blood pressure (SBP-DBP), fasting blood sugar (FBS), serum glutamic pyruvic transaminase (SGPT), alkaline phosphatise (ALP), total cholesterol (T. Ch), triglyceride (TG), low-density lipoprotein (LDL), high density lipoprotein (HDL), hemoglobin (HB), red blood cell count (RBC), hematocrit (Ht), mean corpuscular volume (MCV), mean corpuscle hemoglobin concentration (MCHC), mean corpuscular hemoglobin (MCH), red cell distribution width (RDW), platelet count (Plt), mean platelet volume (MPV), platelet distribution width (PDW), total white blood cell count (WBC), lymphocyte count (L), neutrophil count (N), eosinophil count (E), monocyte count (M), basophil count (B), neutrophil/lymphocyte ratio (N/L), and platelet/lymphocyte ratio (P/L).&#x0D; Results: The results showed an increase in the mean values of SGPT, alkaline phosphatase, urea, serum creatinine, total cholesterol, triglyceride, and LDL in the T2DM group relative to the control group. Meanwhile, the mean value of HDL was significantly decreased in the T2DM group compared to the control group (p&lt;0.05). The mean values of hemoglobin, RBC, MCV, MCHC and MCH were significantly decreased in the T2DM group compared to the control group. In contrast, the red cell distribution width significantly increased in the T2DM group versus control group (p&lt;0.05). The mean platelet count was not significantly changed in the T2DM group compared to the control group (p&gt; 0.05), but the mean values of PDW and MPV were significantly higher in the T2DM group compared to the control group (p&lt;0.05). The mean white blood cell count and differential white blood cell was significantly higher in the T2DM group compared to control group (p&lt;0.05). Lastly, the mean neutrophil/lymphocyte ratio and platelet/lymphocyte ratio was not significantly different in the T2DM group compared to control group (p&gt;0.05).&#x0D; Conclusion: In diabetes mellitus type 2 patients, certain biochemical and hematological changes are distinct from healthy subjects. It is important to follow up and monitor these parameters carefully in diabetic patients.&#x0D; Peer Review Details&#x0D; &#x0D; &#x0D; &#x0D; &#x0D; &#x0D; Peer review method: Single-Blind (Peer-reviewers: 02) Peer-review policy &#x0D; Plagiarism software screening?: Yes&#x0D; Date of Original Submission: 30 September 2017&#x0D; Date accepted: 05 November 2017&#x0D; Peer reviewers approved by: Dr. Lili Hami &#x0D; Editor who approved publication: Dr. Phuc Van Pham&#x0D; &#x0D; &#x0D; &#x0D; &#x0D; &#x0D;

Therapeutic leukocytapheresis in infants and children with leukemia and hyperleukocytosis: A single institution experience.

Hyperleukocytosis, defined as white blood cell (WBC) count above 100×109 /L, has high early morbidity and mortality from leukostasis-related complications, namely intracranial hemorrhage and pulmonary distress. Initiating chemotherapy without prior leukocytoreduction may lead to tumor lysis syndrome (TLS). Therapeutic leukocytapheresis (TL) is used as one leukocytoreductive intervention; however, its safety and efficacy in pediatric leukemia has not been established. The purpose of this study is to evaluate safety of TL in pediatric patients and assess the efficacy of TL in reducing WBC count in pediatric leukemia. Retrospective chart review was conducted on 14 patients with acute lymphoblastic leukemia (ALL) and 5 with acute myeloid leukemia (AML) who underwent TL during the period 2000-2014 at a single institution. Mean WBC count of 19 patients who received TL was 483.2×109 /L (547.1 in ALL, 304.3 in AML); a portion of patients presented with central nervous system symptoms (15%), respiratory symptoms (10%), or both (10%). TL reduced WBC count (mean 50.7% reduction after a single TL procedure; additional 17.1% reduction after a second TL procedure in 6 patients). Short-term survival immediately following TL was 100% without any major procedural complication. Mean survival time in patients with AML was 1.5years and with ALL was 6.5years. TL significantly reduces WBC number in pediatric leukemia patients as young as 22days old. In our retrospective study, TL was not associated with any significant complications and suggests that TL is a safe initial procedure in pediatric leukemia.

White blood cell count at first depression diagnosis as predictor for risk of subsequent hospitalization with depression

ObjectiveStudies have indicated that both increased and suppressed immune system activity may affect depression severity. We tested the hypothesis that higher or lower white blood cell (WBC) count at first depression diagnosis is associated with an increased risk of hospitalization with depression. MethodsWe identified individuals in a hospital-affiliated primary care network with a WBC count at the first-time depression diagnosis in 2006–2011. Outcome was subsequent hospitalization with depression. We followed individuals for three years and performed Cox regression analyses adjusted for age, gender, race, Charlson comorbidity score, obesity, and smoking. Significance was set at p < 0.025 for the association between either low or high WBC with subsequent hospitalization. ResultsWe identified 2400 individuals with a mean WBC count of 7.1 × 109/L at first-time depression diagnosis, of which 55 were hospitalized with depression. Compared to WBC between 4.5–6 × 109/L, individuals with WBC of 1–4.5 × 109/L were associated with a hazard rate (HR) of 3.56 (95%CI = 1.02-12.39; p = 0.046) for the risk of hospitalization with depression. Individuals with WBC of 6–10 × 109/L were associated with a HR of 2.62 (95%CI = 1.02-6.71, p = 0.044) whereas no association was found among individuals with WBC of 10–25 × 109/L (HR = 1.81; 95%CI = 0.54-6.07). ConclusionsOur results are in line with previous clinical findings showing that the severity of depression differs based on WBC counts, particularly concerning low WBC levels. Future large clinical trials need to investigate whether WBC may help in prediction of antidepressant treatment outcome.

Pharmacokinetic Effect of Anti-tumor Necrosis Factor-alpha Agents on Thiopurine Drug Metabolism in Inflammatory Bowel Diseases

Introduction: Thiopurines and anti-tumor necrosis factor-alpha (anti-TNF) drugs are commonly used in treatment of inflammatory bowel diseases (IBD). Studies have established that thiopurines, when used in combination with anti-TNF drugs, affect the metabolism of anti-TNF drugs, resulting in higher serum drug concentrations. However, the data on the effect of anti-TNF drugs on thiopurine metabolism is limited. Methods: All adult IBD patients followed at our IBD center who had thiopurine metabolite concentrations measured between 2000-2016 were eligible for inclusion if they had at least 1 level measured while on thiopurine monotherapy, and 1 level measured while on combination therapy with an anti-TNF and thiopurine drug with the same thiopurine drug dose. Thiopurine metabolite concentration, white blood cell (WBC) count, mean corpuscular volume (MCV) and serum alanine aminotransferase (ALT) levels were compared on monotherapy and combination therapy. Paired t-test and Wilcoxon rank sum test were used for analysis of variables with normal and non-normal distribution, respectively. Results: 30 patients met the inclusion criteria (Table 1). Mean 6TGN level (in pmol/8 x 108 RBCs) on monotherapy and combination therapy were 201 and 267 respectively (% increase 33%; 95% CI 30.1-105.8; p 0.0004). There was a corresponding decrease in mean WBC count (in x1000/mL) from 7.6 to 6.1 (% decrease 20%; 95% CI 0.49-2.85; p 0.01) (Figure 1). There was no significant difference in 6-MMP levels, MCV and ALT levels on monotherapy and combination therapy (Table 2). On subgroup analysis, patients with therapeutic 6TGN levels >230 (n=13) had a significant increase in 6TGN levels (301 vs 369; p 0.03), and a corresponding decrease in WBC count (8.0 vs 5.7; p 0.07) on combination therapy. One patient developed leukopenia (WBC 2.8) after starting infliximab with an increase in 6TGN levels from 425 to 516.Figure: Thiopurine metabolite concentration and WBC count on monotherapy and combination therapy.Table: Table. Baseline CharacteristicsTable: Table. Lab parameters on monotherapy and combination therapyConclusion: In patients with IBD on thiopurine monotherapy, the addition of an anti-TNF agent can lead to an increase in 6-TGN concentration, thereby increasing the risk of leukopenia. Hence, elective thiopurine dose reduction should be considered prior to starting an anti-TNF agent, particularly in patients with therapeutic 6TGN concentration on thiopurine monotherapy. Our findings also suggest that benefits of combination therapy may be, in part, due to increase in thiopurine metabolite concentration with addition of an anti-TNF agent.

Prevalence of trypanosomiasis in relation to some haematological parameters in cattle, Ohafia LGA, Abia State, Nigeria

Trypanosomiasis is a debilitating disease of man and animals in Africa, Asia and South America, caused by a group of extracellular protozoan haemoflagellates of the genus Trypanosoma and transmitted by the tse-tse flies (Glossina spp) to man, cattle, pigs, goats, sheep among others. A study on trypanosomiasis in cattle was carried out at Ndi Okala shed Ohafia, in Ohafia LGA, Abia State. A total of one hundred and fifteen (115) cattle made up of 90 males and 25 females had their blood examined for the presence of trypanosomes using wet films, giemsa stained thin and thick films method. Out of this number, thirty (30) were infected giving a prevalence rate of 26.09%. The mean white blood cell count (WBC) was higher in the infected group and gave an indication of the presence of infection while the mean packed cell volume (PVC) was lower in the infected group, an indication of anaemia. Two species of trypanosome namely T. vivax (6.09%) and T. brucei (20.0%) were encountered. Periodic surveillance, treatment and control measures are advocated to avert the high medical and socioeconomic complications that may arise from the disease.Keywords: Trypanosomiasis; cattle; Ohafia; Abia State; Nigeria

Clinical profile of children with Fanconi anemia from a tertiary center in Southern India

Objectives: The aim of this study is to observe the clinical spectrum of presentation of Fanconi anemia (FA) in children presenting to the Hematology Department of Victoria Hospital, Bangalore Medical College and Research Institute. Materials and Methods: This observational study was carried out from February 2010 to December 2016 on all the 16 consecutive children &lt;18 years of age, with FA. Those with high frequency of chromosomal breakage in G-banded metaphases from mitomycin-treated cultures were considered as positive cases. Results: The mean age at presentation was 6.79±1.34 years, but for those with dysmorphic featureson examination, it was 4.77±0.98 years. Symptoms of anemia were seen in 14 (87.5%) and of bleeding in 8 (50%) cases. There was a history of prolonged fever at presentation in 5 (31.2%) cases. Dysmorphic features on examination were seen in 10 (62.5%) cases. Short stature and microcephaly and microphthalmia were the most common features. Pancytopenia was seen in 68.7% of the subjects at presentation and anemia in 87.5% of cases while thrombocytopenia was universal (100%). The mean hemoglobin was 5.33±0.36 g/dL, mean white blood cell count was 3429.37±477.65/mm3, and mean platelet count was 28156.25±4199.44/mm3. The bone marrow was hypoplastic in 14 (87.5%). Pelvic kidney seen in 5 (31%) was the most common ultrasound finding. Parentalconsanguinity was seen in 50% of cases. Conclusion: Parental consanguinity was common, and there was a male preponderance in our study. The most common presenting manifestations were anemia followed by bleeding. Two-third of the patients had pancytopenia at diagnosis while thrombocytopenia was universal (100%). In the presence of a family history and/or dysmorphic features, even mono- or bi-cytopenias should be evaluated for inherited bone marrow failure syndromes.

Adverse health effects among nurses and clinical pharmacists handling antineoplastic drugs: Adherence to exposure control methods.

Chronic exposure to antineoplastic drugs (ADs) may result in reproductive, liver, renal, lung, and cardiac toxicity. Moreover, bone marrow suppression, mucosal ulcers, and cancer may develop. In developing countries, adverse health effects owing to occupational exposure to ADs and adherence to safe handling guidelines are not well documented.This study was conducted to determine the health effect of occupational exposure to ADs and evaluate adherence to control methods.A comparative cross-sectional approach was adopted. ADs-exposed nurses and clinical pharmacists (n=54) were compared with nonexposed group (n=54). Self-reported clinical manifestations. and use of exposure controls were reported via an interview questionnaire. Blood samples were collected for complete blood count and liver and kidney function tests.Significantly higher rate of impaired fertility (31%) and oral ulcers (36.36%) were reported by ADs-exposed nurses and clinical pharmacists compared with nonexposed group (3.8 and 7.4%, respectively; P=0.01 and P=0.00, respectively). Moreover, ADs-exposed group had significantly lower mean white blood cell count (6518±2064.79/μl) and significantly higher mean creatinine level (056±0.13 mg/dl) compared with nonexposed group (7307±2001.4/μl and 0.51±0.12 mg/dl, respectively; t=2.02, P=0.04; and P=0.04, respectively). Inadequate controls were reported, mainly lack of medical surveillance (100%), lack of training (69.1%), insufficient handling practices, and low usage of personal protective equipment, particularly among nurses.The study highlighted chronic adverse effects associated with occupational exposure to ADs and inadequate implementation of exposure control methods. Findings necessitate raising awareness among ADs-exposed nurses and clinical pharmacists to introduce engineering controls, conduct hazard awareness training, initiate medical surveillance program, and ensure adherence to safe handling practices.

Early diagnosis of severe combined immunodeficiency (SCID) in Turkey: a pilot study

Objective: Severe combined immunodeficiency (SCID) is a neonatal emergency. As the T-cell receptor excision circles (TREC) test is not cost effective for neonatal screening of SCID in developing countries, this pilot study’s objective aimed at identifying preliminary data to enable SCID identification in the general population.Methods: This observational study was performed in Bagcılar Training and Research Hospital, Istanbul, Turkey. Cord-blood complete blood count (CBC) was recorded in all neonates included in the study. Absolute lymphopenia was considered in cord-blood samples if the absolute lymphocyte count was less than 2500/mm3. A control blood count was performed 1-month later for cases with detected lymphopenia.Results: A total of 2945 term neonates were included in the study. Absolute lymphopenia was found in nine (0.3%) neonates, while 2936 (99.7%) had an absolute lymphocytic count above 2.5 × 103/mm3. The mean counts of red blood cells (RBC), hemoglobin (HGB), hematocrit (HCT), platelets (PLT), and monocytes in the lymphopenia group were not found to significantly differ from the non-lymphopenia group. However, there were significantly lower mean white blood cell (WBC), lymphocyte, and neutrophil counts between the groups (p < .05).Conclusion: Absolute lymphopenia detected using CBC analysis is a simple, easier, more non-invasive, and cheaper method than the TREC method for detection of SCID neonates, and this method may prove to be a useful alternative, especially in developing countries.

White blood cell count and C-reactive protein together remain useful for diagnosis and staging of acute appendicitis in children.

Acute appendicitis (AA) is the most common acute surgical condition of the abdomen, and the most commonly misdiagnosed. To analyse the white blood cell count (WBCC) and C-reactive protein (CRP) contribution to the diagnosis of AA in children. This was a retrospective study of 943 consecutive patients operated on with the preoperative diagnosis of AA, in whom preoperative WBCC and CRP had both been measured. Postoperatively, the patients were divided into three groups: normal appendix (no AA), simple AA and complicated AA. Of the 943 patients, 616 (65.3%) had simple AA. The mean (standard deviation (SD)) age for this group was 9.8 (3.2) years (p&lt;0.01 v. complicated AA), the mean WBCC was 16.5 (5.0) × 109/L (p&lt;0.01 v. complicated AA and no AA), and the mean CRP level was 304.8 (409.5) nmol/L (p&lt;0.01 v. complicated AA). The mean age of the patients with complicated AA (283/943, 30.0%) was 7.9 (3.7) years, the mean WBCC was 17.7 (6.2) × 109/L (p&lt;0.01 v. no AA) and the mean CRP level was 1 076.2 (923.8) nmol/L (p&lt;0.01 v. no AA). The mean age of the patients with no AA (44/943, 4.7%) was 8.8 (3.2) years, the mean WBCC was 13.1 (5.3) × 109/L and the mean CRP was 361.9 (447.6) nmol/L. The WBCC was normal in 113/899 patients with appendicitis (12.6%) and CRP in 139 (15.5%). Both the WBCC and CRP were normal in 17patients with appendicitis (1.9%). The best receiver operating characteristic (ROC) curve was obtained for WBCC when comparing all AA with no AA: cut-off point 15.0 × 109/L, sensitivity 65%, specificity 68%, area under the curve 0.70. The best ROC curve for CRP was obtained when comparing simple AA with complicated AA: cut-off point 361.9 nmol/L, sensitivity 74%, specificity 74%, area under the curve 0.81. The WBCC is helpful in diagnosing simple AA and CRP in diagnosing complicated AA. If both are normal, AA is very unlikely. Together the WBCC and CRP are useful tools in diagnosing and staging AA.

Therapeutic implications of granulocyte colony stimulating factor in patients with acute-on-chronic liver failure: increased survival and containment of liver damage.

Mobilization of bone marrow-derived stem cells by granulocyte colony stimulating factor (G-CSF) supports hepatic regeneration and may augment clinical improvement in patients with acute-on-chronic liver failure (ACLF). The aim of this study is to assess the impact of G-CSF on complications and transplant-free survival in patients with ACLF. Thirty-two patients with ACLF defined by Asian Pacific Association for the Study of the Liver (APASL) criteria were openly randomized to control (groupA) or intervention (groupB) receiving G-CSF (5μg/kg/day, for 6 consecutive days) in addition to standard medical therapy with antiviral drugs. The patients were followed for 90days. Simultaneous use of G-CSF and antiviral drugs in hepatitisB virus (HBV) ACLF significantly improved survival over antiviral drugs alone. Incidence of hepatorenal syndrome and hyponatremia were reduced due to use of G-CSF. Baseline parameters of the two groups of patients were comparable. Child-Turcotte-Pugh (CTP) and Model for End-Stage Liver Disease (MELD), disease severity scores improved in patients treated with G-CSF, with significant difference only for the CTP score at 90days follow-up. In addition, mean white blood cell (WBC) count at day15 was significantly higher in G-CSF group in absence of infection compared with control group. G-CSF therapy improved survival and clinical recovery in HBV-ACLF. G-CSF therapy also prevented renal failure and hyponatremia. We strongly recommend use of G-CSF therapy in addition to standard medical therapy.

Patolojik servikal lenfadenopatili çocuklarda nötrofil/lenfosit ve trombosit/lenfosit orantılarının araştırılması

Objective: To reveal whether if neutrophil to lymphocyte ratio (NLR) and platelet to lymphocyte ratio (PLR) rates are useful or not in children followed-up due to pathological cervical lymphadenopathy (LAP) of unknown etiology who have a normal hematologic examination. Methods: A total of 100 children admitted to the otorhinolaryngology clinic between 2014 and 2017 with the complaint of swelling in the neck without any etiology revealed on examination and established with the diagnosis of idiopathic pathological LAP were retrospectively included in the study. The control group consisted of 100 children who did not have any infectious condition and could be considered healthy in terms of examination and laboratory findings. Patients' and the control group's age, gender, clinical history, disease course and examination findings were screened from the patients' records in the clinic. Results: Mean white blood cell and lymphocyte count parameters in the patient group were higher than the control group, and the difference was statistically significant (p=0.008 and p=0.001, respectively). In the patient group, mean NLR and PLR values were significantly lower than the control group (p=0.009 and p=0.020, respectively). Conclusion: NLR and PLR rates may be well correlated with inflammation in children followed-up due to pathologic cervical LAP with unknown etiology.

Depression and anxiety symptoms are associated with white blood cell count and red cell distribution width: A sex-stratified analysis in a population-based study

BackgroundDepression and anxiety are two common mood disorders that are both linked to systemic inflammation. Increased white blood cell (WBC) count and red cell distribution width (RDW) are associated with negative clinical outcomes in a wide variety of pathological conditions. WBC is a non-specific inflammatory marker and RDW is also strongly related to other inflammatory markers. Therefore, we proposed that there might be an association between these hematological inflammatory markers and depression/anxiety symptoms. ObjectiveThe primary objective of this study was to examine the association between depression/anxiety symptoms and hematological inflammatory markers including WBC and RDW in a large population-based study. MethodsSymptoms of depression and anxiety and a complete blood count (CBC) were measured in 9274 participants (40% males and 60% females) aged 35–65 years, enrolled in a population-based cohort (MASHAD) study in north-eastern Iran. Symptoms of depression and anxiety were evaluated using the Beck Depression and Anxiety Inventories. ResultsThe mean WBC count increased with increasing severity of symptoms of depression and anxiety among men. Male participants with severe depression had significantly higher values of RDW (p<0.001); however, this relationship was less marked among women (p=0.004). In addition, men (but not women) with severe anxiety symptoms had significantly higher values of RDW (p<0.001). Moreover, there was a negative association between red blood cell (RBC) and mean corpuscular hemoglobin (MCH) and symptoms of depression/anxiety. ConclusionOur results suggest that higher depression and anxiety scores are associated with an enhanced inflammatory state, as assessed by higher hematological inflammatory markers including WBC and RDW, even after adjusting for potential confounders.