Peripheral White Cell Count Research Articles

The effect of Dipeptidyl peptidase 4 (DPP-4) inhibitors on hemoglobin level in diabetic kidney disease: A retrospective cohort study.

Anemia typically develops early in the course of diabetic kidney disease (DKD). There are data to show that dipeptidyl-peptidase-4 (DPP-4) inhibitors affect hematopoietic growth factor activity and hemoglobin level. We retrospectively reviewed 443 DKD patients who were started on DDP-4 inhibitor therapy in 2019. Their hemoglobin level at baseline (6-12 months before treatment), pretreatment (0-6 months before treatment), and post-treatment periods (within 6 months after DPP-4 inhibitor), concomitant estimated glomerular filtration rate (eGFR), HbA1c, peripheral blood white cell and platelet counts were reviewed. The severity of kidney failure was classified according to the Kidney Disease: Improving Global Outcomes stages. The hemoglobin level had a small but significant decline from 11.98 ± 2.07 to 11.87 ± 2.12 g/dL from pretreatment to post-treatment period (paired Student t test, P < .0001). From the pre- to post-treatment period, the decline of hemoglobin level was 0.10 ± 0.89 g/dL, which was significantly less than that from baseline to pretreatment period (0.24 ± 0.90 g/dL, P = .0008). The change in hemoglobin level had a positive correlation with the change in HbA1c level (R = 0.218, P < .0001), but did not correlate with the type of DPP-4 inhibitor or pretreatment eGFR. There was no significant change in peripheral blood white cell or platelet count during the same period. DPP-4 inhibitor ameliorates hemoglobin decline in DKD. The effect of DPP-4 inhibitor on hemoglobin is statistically significant but clinically modest, and did not correlate with the concomitant change in kidney function.

Comparison of Suspected and Confirmed Internal External Ventricular Drain-Related Infections: A Prospective Multicenter United Kingdom Observational Study.

BackgroundDiagnosis of internal external ventricular drain (EVD)-related infections (iERI) is an area of diagnostic difficulty. Empiric treatment is often initiated on clinical suspicion. There is limited guidance around antimicrobial management of confirmed versus suspected iERI.MethodsData on patients requiring EVD insertion were collected from 21 neurosurgical units in the United Kingdom from 2014 to 2015. Confirmed iERI was defined as clinical suspicion of infection with positive cerebrospinal fluid (CSF) culture and/or Gram stain. Cerebrospinal fluid, blood, and clinical parameters and antimicrobial management were compared between the 2 groups. Mortality and Modified Rankin Scores were compared at 30 days post-EVD insertion.ResultsInternal EVD-related infection was suspected after 46 of 495 EVD insertions (9.3%), more common after an emergency insertion. Twenty-six of 46 were confirmed iERIs, mostly due to Staphylococci (16 of 26). When confirmed and suspected infections were compared, there were no differences in CSF white cell counts or glucose concentrations, nor peripheral blood white cell counts or C-reactive protein concentrations. The incidence of fever, meningism, and seizures was also similar, although altered consciousness was more common in people with confirmed iERI. Broad-spectrum antimicrobial usage was prevalent in both groups with no difference in median duration of therapy (10 days [interquartile range {IQR}, 7–24.5] for confirmed cases and 9.5 days [IQR, 5.75–14] for suspected, P = 0.3). Despite comparable baseline characteristics, suspected iERI was associated with lower mortality and better neurological outcomes.ConclusionsSuspected iERI could represent sterile inflammation or lower bacterial load leading to false-negative cultures. There is a need for improved microbiology diagnostics and biomarkers of bacterial infection to permit accurate discrimination and improve antimicrobial stewardship.

MicroRNA-125b Accelerates and Promotes PML-RARa-driven Murine Acute Promyelocytic Leukemia

ObjectiveMost acute promyelocytic leukemia cases are characterized by the PML-RARa fusion oncogene and low white cell counts in peripheral blood. MethodsBased on the frequent overexpression of miR-125-family miRNAs in acute promyelocytic leukemia, we examined the consequence of this phenomenon by using an inducible mouse model overexpressing human miR-125b. ResultsMiR-125b expression significantly accelerates PML-RARa-induced leukemogenesis, with the resultant induced leukemia being partially dependent on continued miR-125b overexpression. Interestingly, miR-125b expression led to low peripheral white cell counts to bone marrow blast percentage ratio, confirming the clinical observation in acute promyelocytic leukemia patients. ConclusionThis study suggests that dysregulated miR-125b expression is actively involved in disease progression and pathophysiology of acute promyelocytic leukemia, indicating that targeting miR-125b may represent a new therapeutic option for acute promyelocytic leukemia.

Quantitative bacterial counts in the bone marrow of Vietnamese patients with typhoid fever.

BackgroundBone marrow culture (BMC) is the reference standard for typhoid fever diagnosis. We studied the additional yield of BMC over blood culture (BC) and the relationship between quantitative BMC counts and severe disease.MethodsHospitalised Vietnamese patients with suspected typhoid fever were prospectively investigated with a BC, BMC, faecal culture and quantitative BMC counts.Results Salmonella typhi was isolated in 195 of 231 patients: from BC and BMC in 144 (73.8%), from BMC alone in 33 (16.9%), from BC alone in 12 (6.2%) and from faeces alone in 6 (3.1%). In 167 patients the median extracellular count of S. typhi was 2.5 cfu/mL (interquartile range [IQR] 0–10) and the intracellular count was 10.5 cfu/mL (IQR 2–42) with a ratio of 1.3 bacteria/cell (IQR 0.6–2.5). The median count of intracellular bacteria in 24 patients with severe disease was 46 bacteria/cell (IQR 9–105) compared with 6.5 bacteria/cell (IQR 2–34) in 143 with non-severe disease (p=0.005). The intracellular BMC count was negatively correlated with the peripheral white cell count and positively correlated with hepatomegaly, splenomegaly, aspartate transaminase, a positive BC and the fever clearance time following treatment with azithromycin, ofloxacin or a combination of the two.ConclusionsBMC gave a moderate additional yield over BC. Intracellular BMC counts may reflect the bacterial load in typhoid fever.

An investigation into DNA methylation patterns associated with risk preference in older individuals

ABSTRACT Risk preference is a complex trait governed by psycho-social, environmental and genetic determinants. We aimed to examine how an individual’s risk preference associates with their epigenetic profile. Risk preferences were ascertained by asking participants of the Northern Ireland COhort for the Longitudinal study of Ageing to make a series of choices between hypothetical income scenarios. From these, four risk preference categories were derived, ranging from risk-averse to risk-seeking. Illumina’s Infinium High-Density Methylation Assay was used to evaluate the status of 862,927 CpGs. Risk preference and DNA methylation data were obtained for 1,656 individuals. The distribution of single-site DNA methylation levels between risk-averse and risk-seeking individuals was assessed whilst adjusting for age, sex and peripheral white cell counts. In this discovery cohort, 55 CpGs were identified with significantly different levels of methylation (p≤x10−5) between risk-averse and risk-seeking individuals when adjusting for the maximum number of covariates. No CpGs were significantly differentially methylated in any of the risk preference groups at an epigenome-wide association level (p<9x10−8) following covariate adjustment. Protein-coding genes NWD1 and LRP1 were among the genes in which the top-ranked dmCpGs were located for all analyses conducted. Mutations in these genes have previously been linked to neurological conditions. Epigenetic modifications have not previously been linked to risk-aversion using a population cohort, but may represent important biomarkers of accumulated, complex determinants of this trait. Several striking results from this study support further analysis of DNA methylation as an important link between measurable biomarkers and health behaviours.

Cortactin Expression is a Novel Biomarker for Risk Stratification of T-Cell Acute Lymphoblastic Leukemia.

The role of cortactin in T-cell acute lymphoblastic leukemia (T-ALL) tissue infiltration has been previously reported. However, its impact on patients' responsiveness to therapy and patient's outcome was not previously addressed. This study was conducted on 60 T-ALL pediatric patients at diagnosis and 10 nonleukemic controls. Cortactin and HS1 expressions were identified by real-time polymerase chain reaction. Cortactin and HS1 expression were significantly higher in T-All patients as compared with controls as well as postinduction levels (P≤0.001 for both). The high cortactin expression was significantly associated with high peripheral white cell counts (P≤0.001), blood blast cells (P≤0.001) and central nervous system (CNS) infiltration (P≤0.001), and early precursor T-ALL subtype (P≤0.001) as compared with the remaining groups. The induction of remission response was significantly higher in T-ALL patients with lower cortactin expression levels as compared with T-ALL patients with higher one (P≤0.001). The high cortactin and HS1 expressions were significantly predictors of CNS infiltrations (hazard ratios [HR]: 1.051, confidence interval [CI]: 1.02-1.13, P=0.04 and HR: 1.87, CI: 1.23-2.091, P=0.002, respectively) and bone marrow relapse (HR: 1.43, CI: 1.18-1.92, P=0.004 and HR: 1.07, CI: 1.01-1.24, P=0.002, respectively). Furthermore, high cortactin expression levels were associated with shorter B-ALL patients' overall survival as compared with those with lower cortactin levels (P=0.002). In conclusion, high expression of cortactin and/or HS1 at diagnosis is a bad prognostic marker of T-ALL patients' outcome. Moreover, cortactin and/or HS1 expression could be used as a biomarker for refining risk stratification of T-ALL.

Unique Features of Hospitalized Children with Alveolar Pneumonia Suggest Frequent Viral-Bacterial Coinfections.

The World Health Organization Pneumonia Expert Group (WHO-PEG) defined a standardized radiologic endpoint for childhood community-acquired alveolar pneumonia (RD-CAAP), as the most likely to be pneumococcal, not ruling out other bacteria or coinfecting viruses. We aimed to determine the characteristics associated with hospitalization among children <5 years old presenting to the pediatric emergency room (PER) with RD-CAAP. This study was a part of an ongoing prospective population-based surveillance on hospital visits for RD-CAAP. RD-CAAP was determined according to the WHO-PEG. The study was conducted in the prepneumococcal conjugate vaccine era (2004-2008). Of 24,432 episodes with chest radiographs, 3871)15.8%) were RD-CAAP: 2319 required hospitalization and 1552 were discharged (outpatients). Compared with outpatients, hospitalized children had lower temperature, peripheral white cell and absolute neutrophil counts and C reactive protein serum levels, but higher rates of hypoxemia, rhinorrhea, cough and respiratory virus detection. PER visits during the respiratory virus season presented a 1.83 times higher risk of hospitalization than visits during nonrespiratory season. Although RD-CAAP is most often a bacterial infection, the unique characteristics of those visiting the PER and subsequently hospitalized suggest a frequent involvement of respiratory viruses, potentially as viral-bacterial coinfections, compared with outpatients.

Myeloid neoplasms with eosinophilia and abnormal PDGFRA/B: report of three cases and review of literature

Objective To investigate clinical and hematological features of myeloid neoplasms with eosinophilia and abnormal PDGFRA/B and the effect of imatinib. Methods The data of three eosinophilia patients with abnormal PDGFRA/B fusion gene in Changhai Hospital, the Second Military Medical University and 22 Chinese cases reported in Chinese medical journals were analyzed. Thirty-one cases of idiopathic hypereosinophilic syndrome from Changhai Hospital, the Second Military Medical University were used as the controls. Results Compared with idiopathic hypereosinophilic syndrome, no differences were found in age, percentage of bone marrow eosinophils and counts of platelets in peripheral blood in myeloid neoplasms with eosinophilia and abnormal PDGFRA/B (all P > 0.05), but statistical differences were found in gender (χ 2= 5.080, P= 0.016), peripheral blood white blood cell count (t= 4.908, P= 0.001), eosinophilic granulocyte absolute value (χ 2= 17.230, P= 0.001) and hemoglobin concentration (t= 2.770, P= 0.013). The median follow-up time was 17 months (3-108 months) in 24 myeloid neoplasms patients with eosinophilia and abnormal PDGFRA/B from Chinese report. Complete hematopoietic remission (CHR) rate was 91.7% (22/24) after the treatment of imatinib. The total complete molecular remission (CMR) rate was 75.0% (18/24). The median time of remission was 3 months (1-8 months). CMR in patients with PDGFRA and with PDGFRB was 76.5% (13/17) and 85.7% (6/7), respectively. Only one patient (4.2%) died of disease relapse. Conclusion Imatinib has a favorable effect on myeloid neoplasms with eosinophilia and abnormal PDGFRA/B featured by distinct hematologic and clinical manifestations. Key words: Eosinophilia; Gene fusion; Myeloid neoplasms; Remission

Clinical and laboratory characteristics of chronic neutrophilic leukemia: analyses of five cases

Objective To investigate the clinical characteristics, cell morphology, genetics, gene mutations of the patients with chronic neutrophilic leukemia (CNL). Methods Five CNL patients from the Second Hospital of Shanxi Medical University between May 2011 and May 2017 who conformed to 2016 World Health Organization (WHO) diagnostic criteria were retrospectively analyzed from clinical characteristics, laboratory features and treatment methods. Results The peripheral blood white blood cell count (WBC) of 5 CNL patients was significantly increased, and the average WBC was 81.26×109/L [(29-217)×109/L]. Morphological analysis of peripheral blood cell showed a sustained increasing number of matured neutrophilia (0.80-0.85). Neutrophil alkaline phosphatase (NAP) activity was increased (144-266). Bone marrow cell morphology typically showed granulocyte proliferation without obvious dysplasia. Gene detection showed 3 patients with CSF3R T618I mutation and 2 patients with JAK2 V617F mutation in 5 WHO-defined CNL patients. Bone marrow biopsy with reticular staining showed that marrow fibrosis (MF) degree in patients with JAK2 V617F mutation (MF≥2) was higher than that in patients with CSF3R T618I mutation(MF<2). Conclusions CNL is a rare type of chronic leukemia, and CSF3R T618I mutation is a specific diagnostic index for CNL. JAK2 V617F mutations alone may be related to myelofibrosis, which remains to be further studied. Key words: Leukemia, myeloid, chronic-phase; Cellular morphology; Genes; Receptors, colony-stimulating factor; Janus kinase 2

Clinical significance of peripheral blood leukocytosis in patients with advanced malignant tumors

Objective To explore the capability of leukocytosis in predicting the survival time of patients with advanced malignant tumors, in order to provide evidences for clinicians to make the best therapy regimen. Methods The clinical data of 103 dead patients with advanced malignant tumors treated from September 2015 to September 2016 were collected. The relationship between peripheral blood white blood cell count (WBC) and survival time of patients was analyzed retrospectively. The survival analysis was performed by Kaplan-Meier and Log-rank test,and Cox regression was used for multivariate analysis. Results An elevated peripheral blood WBC was found in 61.1% (63/103) dead patients with advanced malignant tumors, and the elevated WBC was negatively correlated with the life span (r=-0.569, P= 0.000). Conclusion Elevated WBC in some advanced malignancy patients predicts they are in the end-stage, which can guide clinicians adjust treatment regimens in time, and they may consider palliative care for those patients. Key words: Neoplasms; Leukocyte count; Prognosis

Relationship between Peripheral Blood White Blood Cell Count and Early Death Rate in Patients with Acute Promyelocytic Leukemia

To investigate the relationship between peripheral white blood cell count and early death rate of the patients with acute promyelocytic leukemia (APL). Through retrospective study, the relationship of early death rate in 116 cases newly diagnosed APL patients with maximum of peripheral blood white blood cell count should be analyzed before and after induction therapy as well as in the whole course of disease during the past 8 years. There was a close relationship between the peripheral white blood cell count and the early death rate in APL patients. Peripheral blood white blood cell count in the early died patients was significantly higher than that of the survival patients (P<0.05). ROC analysis showed that the highest risk threshold of peripheral white cell count was 70×109/L (P<0.05) before treatment, while the highest risk threshold after treatment and in the whole course of disease were 96.4×109/L(P<0.05) and 91.5×109/L(P<0.01) respectively. The dealth rate of patients with highest risk threshold was significantly increased (P<0.05). The highest peripheral blood white blood cell count closely relates with the early death rate of patients at different time points in the whole course of disease. Control of peripheral white blood cell count may effectively reduce the early death rate of APL patients.

Clinical analysis of 55 infants with group B streptococcus blood stream infection

Objective To summarize the clinical characteristics and outcome of infants with group B streptococcus (GBS) blood stream infection. Methods The medical records of 55 cases with GBS blood stream infection who were hospitalized in Shenzhen Children's Hospital from 1st January 2010 to 31st December 2015 were retrospectively analyzed. Results There were 30 boys and 25 girls in this study. The age ranged from 1 hour to 78 days. Six cases (10.9%) were early-onset and 49 cases (89.1%) were late-onset. Forty cases (72.7%) were neonates and 15 cases were infants. The meningitis was diagnosed in 20 patients (36.4%). Peripheral white blood cell (WBC) counts declined in 10 cases (18.2%), and elevated in 32 (58.2%) cases. Increased levels C-reactive protein were found in 41 cases (74.5%). All of isolates were susceptible to penicillin, ampicillin, linezolid and vancomycin, while the resistance rates to erythromycin, clindamycin, tetracycline and ciprofloxacin were 56.6% (30/53), 77.4% (41/53), 98.1% (52/53), and 1.9% (1/53), respectively. Meropenem was used in 18 cases, and penicillins or cephalosporins were used in 37 cases. Combined therapy with linezolid was used in 13 cases, combined therapy with vancomycin was used in 3 cases, and combined therapy with two kinds of antibiotics was used in 37 cases (67.3%). In clinical outcome analysis, 54 children (98.2%) were improved and 1 child (1.8%) died of complicated multiple organ dysfunction syndrome and intracranial hemorrhage. Conclusions GBS blood stream infection occurs commonly in the infants aged younger than 3 months, more than one third cases complicated with purulent meningitis. All of isolates are susceptible to penicillin, while the resistant rates are high to erythromycin and clindamycin. The percentage of combination therapy is high. The outcomes are not good. Key words: Streptococcus agalactiae; Infant; Blood stream infection

Correlation between fecal calprotectin levels, disease severity and the hypervirulent ribotype 027 strain in patients with Clostridium difficile infection.

BackgroundClostridium difficile is the most common infectious etiology of nosocomial diarrhea. Fecal calprotectin (fc) is a sensitive marker of intestinal inflammation, found to be associated with enteric bacterial infections and inflammatory bowel disease.MethodsWe evaluated fc levels using a Chemiluminescent immunoassay method, in hospitalized patients with C. difficile infection (CDI) diagnosed by molecular stool examination and assessed correlation with virulent ribotype 027 strain infection, antibiotic susceptibility by gradient Etest strip performed on C. difficile colonies and clinical and laboratory measures of disease severity. Statistical analysis was performed for correlation of fc levels with clinical and laboratory parameters, disease severity and patient outcomes.ResultsOverall 29 patients with CDI were admitted at the Poria medical center in northern Israel, during June 2014-May 2015. Resistance to metronidazole was found in 3 (10.3 %) isolates and to vancomycin in 5 (17.2 %) isolates. Regarding patient outcomes, within 30 days of CDI diagnosis, recurrence of disease occurred in 10 (34.5 %) patients and 2 patients (6.9 %) died. Seven (24.1 %) isolates were C. difficile ribotype 027. Mean fc level was 331.4 μg/g (21–932). Higher fc levels were found in patients with C. difficile ribotype 027 (p < 0.0005). Fc levels were also correlated with elevated peripheral blood white cell count (p = 0.0007). A trend for higher fc levels was found in patients with a higher clostridium severity score index (p = 0.0633). No correlation was found between fecal calprotectin levels and age, sex, functional status, community versus hospital acquired CDI, antibiotic susceptibility, fever, and creatinine levels.ConclusionsOur study highlights the fact that fc has a potential role as a biomarker of disease severity and binary toxin producing ribotype associated disease.

The Promising Role of Dynamic 18F-NaF PET-CT in Diagnosing Symptomatic Joint Prosthesis

Our purpose was to establish proof of principle case study for the use of dynamic 18F-NaF PET-CT in the assessment of knee and hip prostheses. Approval was granted by the research ethics committee and informed&lt;br /&gt;consent was obtained. This is a case study investigating the role of dynamic 18F NaF PET-CT in a patient with ilateral knee prostheses (1 symptomatic/painful and 1 asymptomatic). Both knees were studied with dynamic 18F-NaF PET-CT technique to demonstrate the different pattern of uptake in normal/asymptomatic joint as well as painful joints with aseptic loosening. In addition, a knee aspirate was obtained from the symptomatic knee and serum C-reactive protein and erythrocyte sediment rate levels as well as a peripheral white cell count were&lt;br /&gt;obtained in addition to 12 month clinical follow up. Images were obtained with multi-sequential dynamic image acquisition in list mode using GE Healthcare® volume imaging protocol (ViP) after an intravenous injection of 250 MBq 18F-NaF. The images were interpreted as normal, loosening or septic loosening based on the graphical pattern of tracer uptake produced at the bone-prosthesis interface. A final diagnosis was made by a combination of joint aspiration microbiology and clinical follow-up for 1 year; in addition to C-reactive protein and erythrocyte sediment rate levels as well as peripheral white cell count. NaF PET results were compared with 3-phase dynamic bone scan results and plain radiographs. The degree of uptake in the symptomatic joint exceeded background&lt;br /&gt;levels and also levels of uptake in the asymptomatic knee. The pattern of uptake and curve slope in both the asymptomatic and symptomatic joints matched the pattern of uptake in our hypothesis. Dynamic 18F-NaF PET-CT is a useful imaging modality for assessing painful joint prosthesis. It can differentiate between asymptomatic joints and aseptic loosening. However, more work is required for the detection of septic loosening.

Moderate Exercise Training Attenuates Inflammation in Transgenic Sickle Cell Mice

Sickle cell disease (SCD) is a monogenic disorder characterized by severe systemic and vascular inflammation. There is strong evidence that moderate exercise training reduces inflammation in healthy people as well as in multiple diseases conditions. The aim of this study was to characterize the effects of moderate exercise training in a humanized transgenic mouse model of SCD (Townes) in mice expressing exclusively human sickle hemoglobin (SS). The SS mice display many of the features of human SCD including systemic inflammation and chronic anemia. We designed a treadmill training protocol of 1hr/day, 5 days a week for 8 weeks. Prior to the training, the maximal oxygen uptake (V̇O2max) was assessed by an exhaustive incremental exercise. SS mice (n=22) had lower V̇O2max (mean ± SEM: 7,068 ml/kg/hr ± 133 vs. 8,407 ml/kg/hr ± 224.5, p<0.0001) and lower maximal speed (14.3 m/min ± 0.7 vs. 29.3 m/min ± 1.7, p<0.0001) than control AA mice expressing exclusively normal human hemoglobin (n=12). Together these results indicate SS mice have an inherently reduced aerobic exercise capacity; nonetheless, they tolerated a training regimen at 60% of V̇O2max. After eight weeks of training, SS mice had a lower hematocrit (20.3% ± 0.8% vs. 24.4% ± 1.8%, p=0.04; n=8) than untrained SS littermates that were exposed to all other experimental conditions except training. There were only moderate changes in red blood cell count (Trained: 4.8.106/µL ± 0.2, Untrained: 5.7.106/µL ± 0.5, p>0.05) or total hemoglobin (Trained: 5.6 g/dL ± 0.2 vs 6.3 g/dL ± 0.4, p>0.05) between the two groups suggesting the low hematocrit in the trained mice was probably due to increased plasma volume, which is a normal physiological response to exercise training. The spleen/body mass ratio was significantly lower in the trained SS mice compared to the untrained littermates (5.7 mg/g body weight ± 0.3 vs. 7.0 mg/g body weight ± 0.9, p=0.04). Importantly, the spleen was less congested in the trained SS mice, and the magnitude of congestion in all animals (trained and untrained) correlated very strongly with the relative spleen mass (r=0.7, p=0.009). Exercise training significantly increased the percent of oxyhemoglobin in the venous blood of SS mice (Trained: 39% ± 4.3, Untrained: 22.3 ± 4.1, p=0.016). And, there was a corresponding decrease in the percent carboxyhemoglobin (Trained: 2.3% ± 0.7, Untrained 6.2% ± 0.5, p=0.001). These data suggest moderate exercise training may reduce the proportion HbS that is deoxygenated in the venous circulation. In addition, exercise training significantly reduced the peripheral blood white cell count in the SS mice (Training: 14.7.103/µL ± 0.9, Untrained: 21.6.103/µL ± 3.1, p=0.03); this change was reflected by a corresponding lower lymphocyte count in the trained mice (12.103/µL ± 0.8 vs. 17.3.103/µL ± 2.3, p=0.028). Finally, running decreased the liver expression of heme oxygenase-1 (HO-1) mRNA (p=0.04) and the plasma concentration of macrophage inflammatory protein-1β (MIP-1β, p=0.03). Interestingly, HO-1 is implicated in metabolic inflammation and MIP-1β promotes endothelial adhesion of CD8+ T cell through a VCAM-1 dependent pathway. Together with the reductions in leukocyte counts, we suggest that moderate exercise training may reduce sequestration of sickle erythrocytes/congestion, resting blood deoxygenation and inflammation in SCD. DisclosuresNo relevant conflicts of interest to declare.

Persistent inflammatory syndrome in pneumococcal meningitis

Reactive extrameningeal involvement in children infected with Streptococcus pneumonia is very rare. We report the case of a previously healthy 2 1/2 year old girl presenting with a history of fever, vomiting and headache for 3 days. On admission the child was febrile (temperature, 39◦C), but hemodynamically stable. She was irritable. She had nuchal rigidity but no focal neurologic deficits. Ear nose and throat examination was normal. Her peripheral blood white cell count was 20,300/mm with 85% neutrophils. The Creactive protein (CRP) was 138 mg/L, and the erythrocyte sedimentation rate (ESR) 120 mm in the first hour. Examination of the cerebrospinal fluid (CSF) revealed 147 white blood cells/mm with 90% neutrophils, with a protein level of 800 mg/dL, and a glucose level of 3.6 mg/dL (serum level 100 mg/dL). A Gram stain revealed gram-positive diplococci. A latex agglutination test was positive for pneumococcus. The CSF culture grew S. pneumoniae, the organisms were susceptible to ampicilline, cefotaxime, ceftriaxone, and vancomycin, but resistant to penicillin. Blood and urine cultures were negative. The child was treated with intravenous

Bone and Joint Infections in Children: Septic Arthritis.

The pathological invasion of a joint and subsequent inflammation is known as septic arthritis. The knee and hip are the most frequently involved joints. Staphylococcus aureus is the most common cause of septic arthritis in children. An acute onset of illness with an inflamed painful joint and restricted movements and inability to use joint (pseudoparalysis) clinically indicates septic arthritis. The diagnosis is difficult in a neonate or young child where refusal to feed, crying, discomfort during change of diaper (if hip is involved) or attempted joint movement may be the only findings. Fever and other systemic signs may also be absent in neonates. Septic arthritis is diagnosed clinically, supported by appropriate radiological and laboratory investigations. The peripheral blood white cell count is frequently raised with a predominance of polymorphonuclear cells. The acute phase reactants such as C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) are often markedly raised. Ultrasonography and MRI are preferred investigations in pediatric septic arthritis. Determination of infecting organism in septic arthritis is the key to the correct antibiotic choice, treatment duration and overall management. Joint aspirate and/or blood culture should be obtained before starting antibiotic treatment. Several effective antibiotic regimes are available for managing septic arthritis in children. Presence of large collections, thick pus, joint loculations and pus evacuating into surrounding soft tissues are main indications for surgical drainage. Joint aspiration can be a practical alternative in case the lesion is diagnosed early, with uncomplicated presentations and superficial joints.

FLT3 Gene Mutations in Acute Myeloid Leukemia

This study was aimed to detect the FLT3 gene mutation in patients with de-novo acute myeloid leukemia (AML), and to investigate its prognostic value and clinical significance. Polymerase chain reaction (PCR) was used to detect FLT3 gene mutation, in bone marrow samples of 54 patients with de novo AML. The incidence of FLT3-ITD mutation in 54 de-novo AML patients was 22.22%, 10 out of 12(83.3%) AML patients were identified with normal karyotype, while 16.7% patients were identified as with abnormal karyotype. The peripheral blood white cell count and bone marrow blast cells were significantly higher in the patients with FLT3-ITD mutation than those in patients without FLT3-ITD mutation (P<0.05), but there was no statistically significant difference in sex, age, CR rate of the first course induction chemotherapy, survival rate and so on between the two groups. Two cases had FLT3-TKD gene mutation; as compared with FLT3-TKD negative AML patients there was no statistical difference in sex, age, white blood cell count, the percentage of marrow blasts and CR rate of the first course of treatment at the initial diagnosis. FLT3-ITD mutation positive likely occurs in AML patients with normal karyotype, the FLT3-ITD mutation is associated with higher peripheral white cell count and higher percentage of bone marrow blast cells.

Burnt sugarcane harvesting is associated with acute renal dysfunction

Sugarcane harvesting has been associated with an epidemic of chronic kidney disease in Central America mainly affecting previously healthy young workers. Repeated episodes of acute kidney dysfunction are hypothesized to be one of the possible mechanisms for this phenomenon. Therefore, this exploratory study aimed to assess the acute effects of burnt sugarcane harvesting on renal function among 28 healthy non-African Brazilian workers. Urine and blood samples were collected at the beginning and at the end of the harvesting season and before and at the end of a harvesting workday. All individuals decreased their estimated glomerular filtration rate by ∼20% at the end of the daily shift, and 18.5% presented with serum creatinine increases consistent with acute kidney injury. Those changes were associated with increased serum creatine phosphokinase (a known marker for exertional rhabdomyolysis) and oxidative stress-associated malondialdehyde levels, increased peripheral blood white cell counts, decreased urinary and serum sodium, decreased calculated fractional sodium excretion, and increased urine density. Thus, burnt sugarcane harvesting caused acute renal dysfunction in previously healthy workers. This was associated with a combination of dehydration, systemic inflammation, oxidative stress, and rhabdomyolysis.

Differences in the Distribution of Peripheral Blood Leukocyte and Lymphocyte Subsets in Pulmonary Tuberculosis Patients

Abstract Introduction: It has been suggested that individuals exposed to Mycobacterium tuberculosis can eliminate the infection through the innate immune response without the participation of the acquired immunity. However, T helper type 1 immune response is critical to control persistent infection. Objective: The purpose of this study was to evaluate the distribution of leukocyte and lymphocyte subsets in peripheral blood of individuals with pulmonary tuberculosis (TB) and positive Tuberculin Skin Test (TST). Methodology: In order to achieve that goal, we have collected blood sample from thirty-four treatment-naive TB patients, fifty TST-positive and forty-one TST-negative individuals. Results: The evaluation has shown a significant reduction in the number of total lymphocytes, B cells, CD4+ and CD8+ T cells and percentage increase of NK cells, neutrophils and monocytes in TB patients, when compared to TSTpositive and TST-negative individuals. There was no statistical difference for leucocyte and lymphocyte subsets between TST-positive and TST-negative groups. Peripheral blood white cell counts change significantly at diagnosis. Conclusion: The quantification of these cells may support the diagnosis and monitoring of patients with pulmonary tuberculosis. Keywords: Leucocytes. Lymphocyte subsets. Tuberculosis.