PMN Cell Counts Research Articles

A Comparison of Oral and Intravenous Treatments in Managing Spontaneous Bacterial Peritonitis

Abstract Background: In cirrhotics, spontaneous bacterial peritonitis (SBP) is a potentially fatal illness that requires immediate antibiotic administration. This meta-analysis aimed to examine the effectiveness of IV and oral antibiotics in patients with SBP. Objectives: We compared the efficacy, safety, and cost-effectiveness of oral vs intravenous antibiotic therapy for the treatment of SBP using data from a retrospective cohort analysis. Study design: Retrospective cohort study Place and duration of study: A tertiary care Hospital in Peshawar from Jan 2022 to Jan 20243 Methods:At Tertiary Care Hospital Peshawar, a Retrospective Cohort Study was conducted including all patients diagnosed with SBP between January 2022 and January 2023. The patients were split into two groups based on the kind of antibiotics administered: Group B: patients in need of ampicillin, cephalosporines, or IV IV therapy; Group A: patients on oral antibiotics and ciprofloxacin/cotrimoxazole with norfloxacin (patient 44). Patients who were eighteen years of age or older were eligible for inclusion. Based on an ascitic PMN cell count of ≥250 cells/mm³ and positive bacterial cultures, they were diagnosed with hospital-acquired SBP. Secondary peritonitis and serious co-morbidities requiring non-study antibiotic therapy were excluded criteria. Results:Group B, which received metronidazole orally, had an 85% resolution rate and an in-hospital mortality rate.The highest mortality rate and length of hospital stay were determined to be 10% and 7 ±3 days, respectively. With a 90% resolution rate and a roughly 8% overall mortality rate, Group B only needed to stay in the hospital for 10 (±4) days. 15% recurrences in Group A Group B: 12 percent recurrences Conclusion:Oral antibiotics are statistically no different from IV in terms of mortality, length of stay, or other outcomes when used to treat SBP. The proven outcomes back up the introduction of oral therapy for individuals who qualify in order to improve adherence and save costs. Keywords: Oral antibiotics, Systematic & individual, IV therapy

Therapeutic management of non-infectious repeat breeder buffaloes by using phytomedicine

The goal of the current study was to assess the efficacy of powder Harbominvit in non-infectious repeat breeder buffaloes with a selective test such as white side test, cervical pH, PMNs cell count, Fern patten and estimation of serum phosphorous. 24 buffaloes that tested negative for white side test was chosen for the current study out of a total of 51 buffaloes that underwent the test from Nanded and Parbhani districts of Marathwada region in Maharashtra under infertility camps organized by NDDB, Mother dairy, and Collage of animal and veterinary science Parbhani. MAFSU. In the Treatment group at day 0 before treatment repeat breeder buffaloes showed a Mean ± SE cervical pH value was 7.38±0.07 while the Control group showed a Mean ± SE cervical pH value was 7.59±0.08. The white side test was 100% negative for both groups. The mean ± SE value for PMN cell count for the Treatment group is 2.67±0.31 while the Control group was 2.08±0.22. The mean ± SE value for serum phosphorus value for the Treatment group before treatment is 3.81a±0.11 and after treatment is 4.937a±0.18 while the Control group shows before 3.68a±0.09 and after treatment 4.17a±0.20 and mean ± SE value for Fern pattern for Treatment group and Control group was 0.750±0.13 and 0.66±0.14 respectively. The conception rates in buffaloes of Group 1 with the treatment of powder Harbominvit and Group 2 with no treatment serve as control were 75% (09/12), and 41.66 % (05/12) respectively (Table 2). The overall conception rate in the present study was 58.33% (14/24) in non-infectious repeat-breeding buffaloes. As an herbal combination with chelated minerals and some vitamins has best conception rate in non-infectious repeat breeder buffaloes having the advantage of reducing the cost of treatment in repeat breeding as compared to other treatment protocols.

Diagnostic Accuracy of Leucocyte Esterase Dipstick Test for The Diagnosis of Spontaneous Bacterial Peritonitis in Children with Nephrotic Syndrome

Spontaneous bacterial peritonitis (SBP), which has a high fatality rate if antibiotics are not given promptly, is one of the most serious side effects of nephrotic syndrome and ascites. Therefore, it is essential for survival to diagnose and treat SBP early. A quick dipstick test for leukocyte esterase can identify the SBP. Objective: To determine the diagnostic accuracy in detection of SBP using leucocyte esterase dipstick test in children with nephrotic syndrome taking ascitic fluid neutrophil count as gold standard. Methods: A Cross Sectional Study was carried out Khyber teaching hospital and LRH Peshawar Pakistan. This research covered patients of either gender with nephrotic syndrome and ascites. On admission, diagnostic paracentesis was performed. The ascitic fluid collected at the bedside was examined immediately using a reagent strip. The PMN cell count in ascitic fluid was then determined. A positive +3 result on a leukocyte esterase dipstick was declared positive for SBP while absolute neutrophil count more than 250 cells per mm3 was considered confirmatory. Results: A total of 107 patients were enrolled. Age of the patients ranged from 4 to 14 years. Mean age of the patients was 6.68 ± 1.239 years. Male to female ratio was 1.7: 1. The sensitivity, specificity, positive and negative predictive value of leucocyte esterase dipstick test were 86.4%, 92.0%, 73.1% and 96.4% respectively. Conclusion: It is concluded that reagent strips are quick, practical, and low-cost diagnostics with good sensitivity and specificity for identifying SBP in children with nephrotic syndrome

Therapeutic efficacy of ozone insufflations in alleviating endometritis in cows

The present investigation was carried out to study the effect of intrauterine ozone insufflation alone or in combination with cephalexin in treating the postpartum clinical endometritis in dairy cows. A total number of fourteen postpartum clinical endometritic cows selected after screening were allotted randomly into 2 equal groups (n=7). The Group I & II cows were intrauterinely administered with ozone insufflations either alone or in combination with cephalexin (Lixen-IU®). Seven postpartum normal cyclic animals were taken as control. Following treatment the overall reduction in combined mucous character and odour both in group I (82.04%) and group II (87.25%) were similar and highly significant (p<0.01). The most predominant bacteria found was E. coli (28.57%) followed by Pseudomonas spp. (14.28%), Staphylococcus spp. (21.42%), Streptococcus spp. (21.42%), Proteus spp. (7.14%) and Acinetobacter calcoaceticus (7.14%). Overall reduction in bacterial count on pre (day 1) and post treatment (day 7) were highly significant (p<0.01) i.e. 99.60% in group I and 99.72% group II. PMN cell counts of uterine smear were significantly (p<0.01) increased from pre treatment (25.85±3.28 in group I and 22.85±2.77) in group II) to post treatment (77.71±2.86) in group I and 87.14±1.35 in group II) which indicated the infiltration of neutrophils due to action of ozone and cephalexin. The conception rates following first AI were recorded as 42.85% in group I (3/7) and 71.42% (5/7) in group II. Thus intrauterine ozone insufflation has the potential to alleviate postpartum clinical endometritis as an efficacious, cost effective treatment option and an alternative to antibiotics with an overall improvement of fertility rate in dairy cows.

Serum and Synovial Markers in Patients with Rheumatoid Arthritis and Periprosthetic Joint Infection.

Current diagnostic standards for PJI rely on inflammatory markers that are typically elevated in autoimmune diseases, thus making the diagnosis of PJI in patients with rheumatoid arthritis and joint replacement particularly complicated. There is a paucity of data on differentiating PJI from rheumatoid arthritis in patients with previous arthroplasty. In this study, we retrospectively analyzed the cases of 17 patients with rheumatoid arthritis and 121 patients without rheumatoid disease who underwent surgical intervention due to microbiology-positive PJI of the hip or knee joint. We assessed clinical patient characteristics, laboratory parameters, and prosthesis survival rates in patients with and without rheumatoid arthritis and acute or chronic PJI. ROC analysis was conducted for the analyzed parameters. In patients with chronic PJI, peripheral blood CRP (p = 0.05, AUC = 0.71), synovial WBC count (p = 0.02, AUC = 0.78), synovial monocyte cell count (p = 0.04, AUC = 0.75), and synovial PMN cell count (p = 0.02, AUC = 0.80) were significantly elevated in patients with rheumatoid arthritis showing acceptable to excellent discrimination. All analyzed parameters showed no significant differences and poor discrimination for patients with acute PJI. Median prosthesis survival time was significantly shorter in patients with rheumatoid arthritis (p = 0.05). In conclusion, routinely used laboratory markers have limited utility in distinguishing acute PJI in rheumatoid patients. In cases with suspected chronic PJI but low levels of serum CRP and synovial cell markers, physicians should consider the possibility of activated autoimmune arthritis.

Studies on Escherichia coli LPS and Neem oil intra-uterine therapy in infectious repeat breeder cows

The study was undertaken to evaluate the therapeutic efficacy of Escherichia coli LPS and Neem oil in 40 infectious repeat breeder cows. The animals were divided in 2 different groups viz. Group-I 20 and Group-II 20 treated with E. coli LPS @ 100 mcg/ml activity in 30 ml sterile PBS and neem oil @10 mcg/ml in 30 ml distilled water in intrauterine route, respectively. The diagnosis was confirmed by estimation of pH, PMN cell count, White Side Test and Spinnbarkeit test, which indicated 93.00% cows having alkaline pH, PMN cell count >5% and all cases positive for White Side Test. Recovery rate after treatment were found as 16 (80.00%) and 15 (75.00%), respectively. The conception rate was found as 14 (73.68%) and 12 (63.15%) in cows in Group-I and II, respectively. On conclusion, cows treated with E. coli LPS showed higher recovery rate.

Abstract CT204: High cytotoxic T-cell or polymorphonuclear cell infiltrates in the tumor microenvironment correlate with responses to BL8040 plus pembrolizumab combination therapy in metastatic pancreatic tumors: Scientific correlates of a phase II clinical trial

Abstract Background: We recently conducted a clinical trial assessing Pembrolizumab (P) and BL-8040 (BL) in patients with pancreatic cancer. We prospectively collected serial biopsies to help understand the impact of this treatment on the tumor microenvironment (TME). Methods: Twenty patients were enrolled and were treated with BL8040 (1.25mg/kg) monotherapy for 2 weeks followed by dual therapy with BL8040 (d1, 4, 8, 11) plus Pembrolizumab (200 mg IV, d1) every 3 weeks. Biopsies were collected at baseline (T0) and during therapy. Some patients had biopsies after BL monotherapy (Tm) and some after combined therapy (Tc) due to a protocol change mid-study. Malignant cells expressing PD-L1 were assessed using immunohistochemistry (IHC) and TME was studied using 3 multiplex immunofluorescence panels including one each for T-cells subpopulations, macrophages and myeloid-derived suppressor cells (MDSCs). Median densities of the different phenotypes were analyzed in tumor and stromal compartments and correlated with serial biopsies. Results: Of 20 patients enrolled and 15 were evaluable for response of whom 2 had stability and 1 had a partial response. 17 patients had at least one viable biopsy; 4 had biopsies at T0 and Tm, 3 had biopsies at T0, Tm, and Tc, and 2 had biopsies at T0 and Tc. In general, we noted that cytotoxic T cells increased from baseline when measured at Tm or Tc. In contrast, MDSC counts and overall T cells decreased at Tm or Tc from baseline. Additionally, we saw an increase in CD 68+ and PD-L1 expressing macrophages (P=0.059 and P=0.046, respectively). Patients who had clinical benefit (PR/SD) had greater numbers of cytotoxic T-cells (CD3+CD8+, median, 226.08 cells/mm2) and regulatory T cells (CD3+FOXP3+, median, 48.20 cells/mm2) at baseline than PD patients (median, 26.15 cells/mm2, P=0.03; 13.31 cells/mm2, P=0.016, respectively). Conversely, at T0, the lowest numbers of tumor cytotoxic T-cells activated CD3+CD8+GB+ (median, 0.34 cells/mm2) and highest numbers of PMN-cells (CD66b+CD11b+, median, 16.66 cells/mm2) were observed in patients with PD when compared with PR or SD (median, 4.54 cells/mm2, P=0.097; 3.38 cells/mm2, P=0.023, respectively), suggesting that highest densities of PMN-cells may contribute to downregulation of T-cells in those cases. Conclusions: Higher cytotoxic T-cells or PMN-cell counts at T0 may predict changes in the TME and radiologic response to treatment with BL8040+Pembrolizumab therapy in metastatic pancreatic cancer. PMN-cells may play a role promoting immune suppression of T-cells, increase the risk of metastasis and interfering with the treatment. Trial Registration: NCT02907099, Ethics Approval: This study was approved by the M.D. Anderson Institutional Review Board, approval number 2016-0410. Citation Format: Carmelia M. Noia Barreto, Debora A. Ledesma, Swati Gite, Luisa M. Solis, Mei Jiang, Renganayaki K. Pandurengan, Robert Wolff, Milind Javle, Shubham Pant, Gauri Varadhachary, Rachna Shroff, Abi Vainstein-Haras, Ella Sorani, Tzipora M. Lustig, Osnat Kashtan, Yosi Gozlan, Steven M. Townson, Jeanne M. Fahey, James Yao, Ignacio I. Wistuba, Michael Overman, David Fogelman, Edwin R. Parra. High cytotoxic T-cell or polymorphonuclear cell infiltrates in the tumor microenvironment correlate with responses to BL8040 plus pembrolizumab combination therapy in metastatic pancreatic tumors: Scientific correlates of a phase II clinical trial [abstract]. In: Proceedings of the Annual Meeting of the American Association for Cancer Research 2020; 2020 Apr 27-28 and Jun 22-24. Philadelphia (PA): AACR; Cancer Res 2020;80(16 Suppl):Abstract nr CT204.

Clinical and microbiological characteristics of hypervirulent Klebsiella pneumoniae (hvKp) in a hospital from North China.

The clinical and molecular characteristics of hypervirulent Klebsiella pneumoniae (hvKp) in various provinces of China have been reported, however, there have been few reports in Hebei Province, North China. The hvKp was identified by PCR amplification of hypervirulence-related genes, the hypermucoviscous phenotype was determined by the "string test", the drug susceptibility analysis was performed using the VITEK® 2 Compact Bacterial Identification and Monitoring System. Logistic regression was used to identify risk factors for hvKp infection. The molecular epidemiological characteristics of the strains were analyzed by pulsed-field gel electrophoresis (PFGE), and the capsular serotype of hvKp strain was detected by PCR. Overall, 52.21% (59/113) of K. pneumoniae isolates were hvKp, and the ratios of patients with older ages or a higher PMN cell count among hvKp infection were higher than those among classical Klebsiella pneumoniae (cKp) infection. hvKp are more susceptible to antibacterial drugs than cKp, and one ESBLs-producing hvKp strain was detected. The main capsular serotype of hvKp were K2, K57 and K1. PFGE indicated that the 59 strains of hvKp could be classified into 51 PFGE band types, forming 6 PFGE clusters. In this study, the detection rate of hvKp was 52.21% (59/113) identified by virulence genes. People with older ages or a higher PMN cell count are more likely to gain hvKp infection. ESBLs-producing hvKp is emerging, indicating the importance of epidemiologic surveillance and clinical awareness of this pathogen in this region.

Spontaneous Bacterial Empyema in Cirrhotic patients with Hepatic hydrothorax.

Objectives: To determine the frequency of spontaneous bacterial empyema in cirrhotic patients with hepatic hydrothorax. Study Design: Descriptive cross sectional study. Setting: Conducted in gastroenterology unit at Isra University Hospital, Hyderabad. Periods: One year from April 2016 to March 2017. Material & Methods: Sample of 174 patients of Hepatic Hydrothorax was taken. Patients were of both gender and age ≥ 18 years, having diagnosed cirrhosis since last 5 years and currently having child class B & C severity were included. Hepatic hydrothorax was confirmed on ultrasound chest. After aseptic measures 50ml of pleural fluid was aspirated and sent to Isra University Hospital laboratory following the ultrasound guidelines. Spontaneous bacterial empyema was assessed as “polymorph nuclear cell count” more than 500 cells/mm3 or +ve culture with PMN cell count more than 250 cells/mm3 without parapneumonic effusion. All the data was recorded in the proforma. Results: The mean ± SD age of patients was 53.52 ± 5.52 years. Males were 60.92% while 39.08% were females. The frequency of spontaneous bacterial empyema was about 14.9%. Frequency of spontaneous bacterial empyema was little more in male gender than females (p value = 0.391), while it was significantly increased with increasing age as most common in age group of 61-65 years (p-value = 0.017). Conclusion: It was concluded that spontaneous bacterial empyema in cirrhosis patients was 14.9%.

Study of prognostic factors associated with in hospital mortality in patients of liver cirrhosis with spontaneous bacterial peritonitis.

Introduction: Patients with liver cirrhosis and ascites requires prompt recognition and treatment of spontaneous bacterial peritonitis (SBP). The model for end stage liver disease (MELD) score and integrated MELD (iMELD) has been used as predictors of mortality in patients with SBP along with other laboratory parameters. Material & Methods: This prospective observational study was done over a period of two years (Jan 2018 to Dec. 2019). In the present study 60 adult patients both male and female having cirrhosis with Spontaneous bacterial peritonitis (SBP) were included. Laboratory variables included were serum creatinine, total bilirubin, Prothrombin time, serum albumin, serum sodium, and ascitic fluid PMN cell count, MELD & iMELD score was calculated according to the United Network for Organ Sharing (UNOS) formula Results: In hospital mortality in our study came out to be 40%. 25% patients fall under Child-Turcotte-Pugh B and 75% patients fall under Child-Turcotte-Pugh score C .The mean MELD and iMELD score in survivors group patients were 17.88±3.17 and 44.86 ± 4.18 compared from non-survivor group patients who died was 24.75±4.6 and 48.41±4.18 which was highly significant ( P≤ 0.00). We identified MELD and iMELD score have high predictive value of mortality than other laboratory parameters. Conclusion: MELD score, iMELD score, PMN cell count in ascitic fluid , total bilirubin, serum creatinine, serum sodium,INR were found as prognostic factors for prediction of mortality in patients with SBP.

Ascitic fluid polymorphic nuclear cell count impacts on outcome of cirrhotic patients with ascites.

Spontaneous bacterial peritonitis (SBP) is defined as an ascitic polymorphonuclear cell count (A-PMN) > 250 cells/µl. We aimed to investigate the prognostic value of ascitic fluid cell counts in patients without SBP. A total of 178 patients were included and stratified by ascitic cell counts at index paracentesis: A-LEUK-low (<250/µl), A-LEUK-intermediate (250-500/µl) and A-LEUK-SBP (>500/µl) for leukocytes; A-PMN-low (<125/µl), A-PMN-intermediate (125-250/µl) and A-PMN-SBP (>250/µl) for PMN cells. One-year mortality was comparable between group A-LEUK-SBP (53.9%) and patients with subclinical cell counts (34.5% for A-LEUK-low, 43.5% for A-LEUK-intermediate, log-rank p = 0.547). However, we observed an increase in one-year mortality already in group A-PMN-intermediate with 75% and A-PMN-SBP with 80.9% (vs 40.5% for A-PMN-low, log-rank p = 0.016).Importantly, increases of A-PMN cell counts between two paracenteses were associated with increased mortality: per 100 cells/µl increase of absolute A-PMN cell count: hazard ratio (HR): 1.03 (95% confidence interval (CI): 1.01-1.06), p = 0.005; per 5% increase of relative PMN cell count: HR: 1.15 (95% CI: 1.06-1.26), p = 0.001. Patients with PMN cell counts of 125-250/µl are at high risk for mortality, which was very similar to SBP patients with PMN cell counts >250/µl. This highlights the need for preventive strategies. The prognostic value of changes in relative ascitic PMN cell counts should be evaluated in future studies.

Role of ascitic fluid study in early detection of spontaneous bacterial peritonitis in asymptomatic patients of cirrhosis of liver

Spontaneous bacterial peritonitis (SBP)is an acute bacterial infection of ascitic fluid and one of the commonest complication of patients with cirrhosis presented with ascitis. Routine analysis of ascetic fluid particularly for polymorphonuclear leukocyte is an important tool for detecting spontaneous bacterial peritonitis including clinically unsuspected and asymptomatic patients also. Thus it helps in reducing mortality and morbidity by early and effective detection of spontaneous bacterial peritonitis. Objective: This study was carried out to evaluate the role of ascitic fluid analysis in early detection of spontaneous bacterial peritonitis and to document the proportion of spontaneous bacterial peritonitis present asymptomatically.&#x0D; Study design: This was a cross sectional observational study prospective in nature on 50 cases of diagnosed chronic liver disease patients in indoor of department of medicine of Sir Salimullah medical college Hospital, Dhaka from 02/01/13 to 01/07/13, for a period of 6 months.&#x0D; Result: The study showed that age frequency 5(10%) were from 21-30 years, 15(30%) were from 31- 40 years, 15(30%) were from 40 -50years and 15(30%) were from &gt;50 years of age. Out of 50 patients, 38(76%) were male and 12(24%) were female patients. The etiology of liver cirrhosis was hepatitis B virus in 22(44%), hepatitis C virus in 4(8%), alcohol in 1 (2%) and others in 23(46%) patients. Among 50 patients, 16(32%) were spontaneous bacterial peritonitis and 34(68%) were non spontaneous bacterial peritonitis. The symptoms of spontaneous bacterial peritonitis were upper GI bleeding in 8 patients (50%), fever in 12 patients (75%), abdominal pain in 10 patients (62.5%), abdominal tenderness in 7 patients (43.75%), hepatic encephalopathy in 9 patients (56.25%), jaundice in 10 patients (62.50%), splenomegaly in 16 patients (100%), ascites in 16 patients (100%) and 5 (10%) patients were asymptomatic spontaneous bacterial peritonitis. According to Child Pugh’s, 2(12.5%) patients were at stage-A, 5 (31.25%) patients were at stage-B and 9 (56.25%) patients were at stage- C. Ascitic fluid characteristics (mean +SD) of all patients were, Total cell counts/mm3 (571+499.9), Neutrophil counts/mm3 (144.8+445.1), Sugar (112+38.19) mg/dl, Protein (1.85+1.09). Among SBP patients, 7 (43.75%) have PMN cell counts 250-750/mm3, 6 (37.50%) have 750-1750/mm3 and 3 (18.75%) have &gt;1750/mm3.&#x0D; Conclusion: Spontaneous bacterial peritonitis is a common complication of decompensated cirrhotic patients. The classical signs of SBP (e.g. abdominal tenderness or fever) may not be present. We observed the trend towards more frequent occurrence of the infection in patients suffered from severe liver disease (e.g. Child Pugh’s –C) and the role of ascitic fluid analysis is statically significant.&#x0D; Bangladesh J Medicine Jan 2019; 30(1) : 9-18

Elastin degradation products in acute lung injury induced by gastric contents aspiration

BackgroundGastric contents aspiration is a high-risk condition for acute lung injury (ALI). Consequences range from subclinical pneumonitis to respiratory failure, depending on the volume of aspirate. A large increment in inflammatory cells, an important source of elastase, potentially capable of damaging lung tissue, has been described in experimental models of aspiration. We hypothesized that in early stages of aspiration-induced ALI, there is proteolytic degradation of elastin, preceding collagen deposition. Our aim was to evaluate whether after a single orotracheal instillation of gastric fluid, there is evidence of elastin degradation.MethodsAnesthesized Sprague-Dawley rats received a single orotracheal instillation of gastric fluid and were euthanized 4, 12 and 24 h and at day 4 after instillation (n = 6/group). We used immunodetection of soluble elastin in lung tissue and BALF and correlated BALF levels of elastin degradation products with markers of ALI. We investigated possible factors involved in elastin degradation and evaluated whether a similar pattern of elastin degradation can be found in BALF samples of patients with interstitial lung diseases known to have aspirated. Non-parametric ANOVA (Kruskall-Wallis) and linear regression analysis were used.ResultsWe found evidence of early proteolytic degradation of lung elastin. Elastin degradation products are detected both in lung tissue and BALF in the first 24 h and are significantly reduced at day 4. They correlate significantly with ALI markers, particularly PMN cell count, are independent of acidity and have a similar molecular weight as those obtained using pancreatic elastase. Evaluation of BALF from patients revealed the presence of elastin degradation products not present in controls that are similar to those found in BALF of rats treated with gastric fluid.ConclusionsA single instillation of gastric fluid into the lungs induces early proteolytic degradation of elastin, in relation to the magnitude of alveolar-capillary barrier derangement. PMN-derived proteases released during ALI are mostly responsible for this damage. BALF from patients showed elastin degradation products similar to those found in rats treated with gastric fluid. Long-lasting effects on lung elastic properties could be expected under conditions of repeated instillations of gastric fluid in experimental animals or repeated aspiration events in humans.

Conduite à tenir devant une ascite

Ascites is the most common complication of cirrhosis. Approximately 50% of patients with compensated cirrhosis will develop ascites over a 10-year period. Ascites is associated with increased risks of infections, renal failure and poor long-term outcome. Abstinence from alcohol, salt restriction and diuretics are the mainstays of the therapy, and these measures are effective in approximately 90% of the patients. Treatment options for diuretic-resistant patients include serial therapeutic paracentesis and transjugular intrahepatic portosystemic stent-shunts. Patients eligible for liver transplantation should undergo evaluation for this procedure after development of ascites. A diagnostic paracentesis should be performed on hospital admission in any cirrhotic patient with ascites to investigate the presence of spontaneous bacterial peritonitis. In patients with an ascetic fluid PMN cell count > 250/mm 3, antibiotic therapy (cefotaxime or amoxicillin-clavulanic acid) and albumin infusion need to be started before obtaining the results of ascites or blood cultures. Prophylactic antibiotic administration is recommended in cirrhotic patients hospitalized with upper gastrointestinal haemorrhage or low ascites protein (i.e. < 10 g/l) and in patients recovering from an episode of spontaneous bacterial peritonitis.

Use of Vaginal Polymorphonuclear to Epithelial Cell Ratios for the Prediction of Preterm Birth

To compare the use of midtrimester vaginal polymorphonuclear cell (PMN) counts on Gram-stain preparations with PMN to epithelial cell (EPI) ratios for the prediction of subsequent spontaneous preterm birth. From a prospective cohort study, 83 women with a spontaneous preterm birth at less than 35 weeks of gestation (cases) were compared with a control group of 108 women who delivered at term. Vaginal Gram-stain preparations were obtained at the initial study visit (20-25 weeks). Vaginal PMN and epithelial EPI cell counts were assessed on 5 nonadjacent oil immersion fields under x 1,000 magnification. Vaginal PMN/EPI ratios for each evaluated slide field were calculated to control for intraslide variation in cellular density. Mean delivery gestational age was 31.5 +/- 3.5 weeks for the cases and 39.8 +/- 1.2 weeks for the controls. Mean PMN counts were similar in the cases (13 +/- 20 cells per oil immersion field) and the controls (10 +/- 14 cells per oil immersion field) (P = .17). The mean PMN/EPI ratio, however, was significantly higher among the cases (3.4 +/- 6.0) than among the controls (1.8 +/- 2.4, P = .01). When PMN counts and PMN/EPI ratios were dichotomized by the 95th percentile cutoff (based on control values), the PMN/EPI ratio was significantly associated with subsequent development of spontaneous preterm birth at less than 35 weeks of gestation (odds ratio 3.8, 95% confidence interval 1.3-11.2), whereas PMN counts were not (odds ratio 2.1, 95% confidence interval 0.7-6.1). Midtrimester vaginal PMN counts on Gram-stain preparations were not significantly associated with subsequent spontaneous preterm birth in this population. However, the ratio of PMN to EPI counts, which provides internal standardization of variation in slide cellular density, was significantly higher in women with subsequent spontaneous preterm birth at less than 35 weeks.

Neutrophil activation and lung injury associated with chronic endotoxemia in rabbits.

Chronic endotoxemia produces emphysematous lung destruction in several animal models. The present study was designed to examine changes in the polymorphonuclear leukocytes (PMN) and the lung parenchyma of rabbits that received either saline (control, n = 6) or Escherichia coli endotoxin (LPS, n = 6) 2-3 times weekly for 15 to 28 weeks. Peripheral blood was collected just before and after each intravenous injection and lung tissue was processed at the end of the experiment. PMN myeloperoxidase was stained with diaminobenzidine tetrahydrochloride (DAB)-H2O2, and CD11/CD18 was detected with immunogold. The changes in the PMN and the lung parenchyma were quantitatively analyzed. The results show that each dose of LPS produced an initial fall, followed by a rise in the circulating mature and immature PMN cell counts. Repeated doses of LPS induced PMN activation, degranulation, and an increase in the mean thickness of the alveolar wall (control, 4.1 +/- 0.2; LPS, 5.1 +/- 0.5; p < .05) at 28 weeks without evidence of alveolar septa destruction. Morphometric analysis of intravascular PMN showed an increase in the volume (V) of myeloperoxidase-containing azurophil granules (control, 6.1 +/- 1.3 microns3; LPS, 13.1 +/- 2.8 microns3; p < .05); a trend for a decrease in the V of specific granules (control, 15.8 +/- 3.4 microns3; LPS, 10.2 +/- 1.5 microns3; p = .09); an increase in the V of the cytoplasm (control, 37.3 +/- 6.4 microns3; LPS, 54.5 +/- 7.1 microns3; p < .05); and an increase in CD11/CD18 expressed as the number of gold particles per micrometer of cell surface membrane (G/micron) (control, 7.1 +/- 1.4 G/micron; LPS, 18.1 +/- 7.8 G/micron; p < .05). The results indicate that chronic endoxemia in rabbits, accelerates the release of PMN from the bone marrow, enhances the retention of both mature and immature activated PMN in the pulmonary microvessels, and causes alveolar wall thickening rather than emphysematous lung destruction.

PMN cell counts and phagocytic activity of highly trained athletes depend on training period

We tested the hypothesis that polymorphonuclear leukocyte (PMN) cell counts and phagocytic activity determined by latex ingestion and superoxide anion production are influenced by different training periods. We investigated long-distance runners before and up to 24 h after a graded exercise test to exhaustion during moderate training (MT) and intense training (IT) and compared them with untrained (control) subjects. Cell counts and phagocytic activity at rest and after exercise did not differ significantly between MT and control. On the contrary, IT showed a significant (P < or = 0.05) decrease in PMN cell count at rest (2.55 +/- 0.3 cells/nl) compared with MT (3.63 +/- 0.2 cells/nl) and control (3.41 +/- 0.8 cells/nl). Furthermore, phagocytic activity was significantly reduced (P < or = 0.05) in IT at rest and after exercise compared with MT and control. A strong inverse correlation (r = -0.75; P < or = 0.01) between epinephrine and superoxide anion production was found. These results provide evidence that the phagocytic activity depends on the training period and indicate impaired PMN functions during IT, which might lead to increased susceptibility to infection.

Unsatisfactory performance of the leukocyte esterase test of first voided urine for rapid diagnosis of urethritis.

The objective of this study was to determine the performance characteristics of a dipstick test for leukocyte esterase (LE), (Chemstrip 2LN, Boehringer Mannheim) in predicting the presence of urethritis and urethral pathogens in men presenting to a busy sexually transmitted disease clinic and to street outreach facilities. Urethral swabs for polymorphonuclear (pmn) cell count, gonorrhoea culture and chlamydia enzyme immunoassay (EIA) as well as 15 ml of first voided urine (FVU) were collected from 737 symptomatic and 726 asymptomatic men. Gonorrhoea cultures and pmn counts were processed according to standard methods. Either Abbott Chlamydiazyme EIA (confirmed) or Syva Microtrak EIA (confirmed) test was employed to detect C trachomatis. The LE test was immediately dipped in FVU, read after 60-120 seconds by the clinician and considered positive if trace, 1+ or 2+. Microscopic evidence of urethritis (> or = = 4 pmn cells per 1000 x field) was found on urethral smear of 782 (53.5%) patients. Chlamydia, gonorrhoea or both were present in 104 (7.1%) patients. Performance characteristics of the LE test were as follows: (table below) The LE test did not have adequate sensitivity to be considered a reliable rapid diagnostic test for urethritis or urethral pathogens, particularly in the asymptomatic portion of this STD clinic population.