Polymorphonuclear Leukocyte Count Research Articles

Prognosis and risk factors for mortality in cirrhotic patients with probable spontaneous bacterial peritonitis

To investigate the survival outcomes and risk factors for mortality in cirrhotic patients with probable spontaneous bacterial peritonitis (SBP). We retrospectively analyzed the clinical data of 323 cirrhotic patients with ascites admitted from June 2021 to May 2022, including 115 patients with SBP [ascites polymorphonuclear leucocyte (PMN) count ≥250/mm3], 52 patients with bacterascites (PMN count < 250/mm3 with positive microbiological finding in ascites), 67 patients with probable SBP (PMN count < 250/mm3 with negative microbiological finding in ascites but clinical symptoms of SBP) and 89 patients without infection (PMN count < 250/mm3 with negative microbiological finding without clinical symptoms of SBP). The clinical characteristics, laboratory data and 90-day mortality of the patients were compared among the 4 groups. Cox proportional hazard model and propensity score matching (PSM) in a 1∶1 ratio were used to analyze the risk factors for mortality in patients with probable SBP. The patients with probable SBP had a 90-day mortality rate of 43.28%, similar to those of patients with SBP (46.95%, P=0.121) and bacterascites (48.07%, P=0.805) but significantly higher than that of non-infected patients (11.23%, P < 0.001). In the 46 pairs of patients matched using PSM, the 90-day mortality rates were higher in probable SBP group than in non-infected group both before (43.28% vs 11.23%, P < 0.001) and after PSM (34.78% vs 15.21%, P=0.038). Cox regression analysis indicated that probable SBP was an independent predictor of 90-day mortality in cirrhotic patients with ascites (HR=1.539, 95% CI: 1.048-2.261, P=0.028). A Model for End-Stage Liver Disease (MELD) score > 15 (HR=1.943, 95% CI: 1.118-3.377, P=0.018) and procalcitonin level > 0.48 ng/mL (HR=1.989, 95% CI: 1.111-3.560, P=0.021) at diagnostic paracentesis were both independent risk factors for 90-day mortality in patients with probable SBP. Cirrhotic patients with probable SBP have poor survival outcomes, and their management should be further optimized based on their MELD score and procalcitonin level.

Effect of Dietary Supplementation with a Mixture of Natural Antioxidants on Milk Yield, Composition, Oxidation Stability and Udder Health in Dairy Ewes.

Due to the limitations in the use of antibiotic agents, researchers are constantly seeking natural bioactive compounds that could benefit udder health status but also milk quality characteristics in dairy animals. The aim of the current study was therefore to examine the effects of a standardized mixture of plant bioactive components (MPBC) originated from thyme, anise and olive on milk yield, composition, oxidative stability and somatic cell count in dairy ewes. Thirty-six ewes approximately 75 days after parturition were randomly allocated into three experimental treatments, which were provided with three diets: control (C); without the addition of the mixture, B1; supplemented with MPBC at 0.05% and B2; supplemented with rumen protected MPBC at 0.025%. The duration of the experiment was 11 weeks, and milk production was weekly recorded, while individual milk samples for the determination of composition, oxidative stability, somatic cell count (SCC), pH and electric conductivity were collected. Every two weeks, macrophage, lymphocyte, and polymorphonuclear leukocyte counts were also determined in individual milk samples. It was observed that milk yield was the greatest in the B2 group, with significant differences within the seventh and ninth week (p < 0.05), whereas no significant differences were found for milk composition, with the exception of the seventh week, when protein, lactose and non-fat solid levels were lower in MPBC groups (p < 0.05). Oxidative stability was improved in the groups that received the MPBC, with significant differences at the third, seventh, tenth and eleventh week (p < 0.05). SCC was also significantly lower at the second, eighth and ninth week in B2 compared to the other groups (p < 0.05), while no significant effects on the macrophage, lymphocyte, and polymorphonuclear leukocyte counts were observed. In conclusion, the MPBC addition had a positive effect on sheep milk yield, oxidative stability and somatic cell count, without any negative effect on its composition.

Clinical Significance of Ascitic Fluid Polymorphonuclear Leukocyte Percentage in Patients With Cirrhosis Without Spontaneous Bacterial Peritonitis.

Absolute polymorphonuclear leukocyte (PMN) count (PMN-C) ≥250 cells/mm 3 in ascites is the diagnostic hallmark of spontaneous bacterial peritonitis (SBP) and is associated with high morbidity and mortality. However, the clinical significance of ascitic PMN percentage (PMN-%) and PMN-C in the absence of SBP as additional biomarkers for mortality and future incidence of SBP has not been determined. This retrospective cohort included adults with cirrhosis undergoing first-recorded paracentesis with initial PMN-C < 250 cells/mm 3 at 2 tertiary medical centers between 2015 and 2020. Patients with prior SBP were excluded. Outcomes were death and SBP development. Cox regression estimated hazard ratios (HRs) for risk of death and SBP development and Akaike information criterion to compare model fit. Three hundred eighty-four adults (73% male, median age 58 years, 67% with alcohol-associated cirrhosis, median PMN-C 14 cells/mm 3 [interquartile range 5-34], and median PMN-% 10% [interquartile range 4-20]) were included in this study. Univariate risk of death increased 10% per 25-unit increase in PMN-C (95% confidence interval 1.01-1.21, P = 0.03) and 19% per 10-unit increase in PMN-% (95% confidence interval 1.06-1.33, P = 0.003) with PMN-% demonstrating better model fit in assessing mortality risk (Akaike information criterion: 1,044 vs 1,048, respectively). In models adjusted for age, chronic hepatitis C virus infection, and Model for End-Stage Liver Disease-Sodium, PMN-% was associated with risk of death (PMN-% 10%-29%, HR 1.17, P = 0.50; PMN-% ≥ 30% group, HR 1.94, P = 0.03; vs PMN-% < 10%) and SBP development (PMN-% 10%-29%, HR 1.68, P = 0.07; PMN-% ≥ 30%, HR 3.48, P < 0.001; vs PMN-% < 10%). Our results suggest PMN-% at first paracentesis represents a better biomarker compared with PMN-C for assessing risk of death and future SBP development in patients with PMN-C < 250 cells/mm 3 .

Are bacterial coinfections really rare in COVID-19 intensive care units?

ObjectivesThere are limited data about nosocomial coinfections of COVID-19 cases monitored in the intensive care unit. This study aims to investigate coinfections in COVID-19 patients followed in an intensive care unit of a university hospital.MethodsThis study analyzed retrospectively the data of coinfections of 351 COVID-19 patients in the period 28.02.2020–15.01.2021 in a tertiary care intensive care unit in a university hospital.ResultsBacterial coinfections were present in 216 of the 351 cases. One hundred and thirty of these cases were evaluated as nosocomial infections. On the third day the Sequential Organ Failure Assessment Score, usage of invasive mechanical ventilation and presence of septic shock were significantly higher in the coinfected group. The neutrophil/lymphocyte ratio, polymorphonuclear leukocyte count, procalcitonin, ferritin, and blood urea nitrogen values were significantly higher in the coinfection group. White blood cells (WBC) (OR: 1.075, 95% CI 1.032–1.121, p = 0.001) and ICU hospitalization day (OR: 1.114, 95% CI 1.063–1.167, p < 0.001) were found to be independent risk factors for coinfection in the multivariate logistic regression analysis. The rates of hospitalization day on the day of arrival, the 21st day, as well as total mortality (p = 0.004), were significantly higher in the coinfected group.ConclusionBacterial coinfections of COVID-19 patients in the intensive care unit remain a problem. Identifying the infectious agent, classifying colonizations and infections, and using the proper treatment of antibiotics are of great importance in the case management of COVID-19 patients in the intensive care unit.

Relapsing and refractory peritoneal dialysis peritonitis caused by Corynebacterium amycolatum

BackgroundPeritonitis is an important complication and cause of morbidity in patients undergoing peritoneal dialysis (PD). Corynebacterium species, often considered skin and mucosal contaminants, are a rare cause of PD-associated peritonitis and have been acknowledged in published guidelines for the diagnosis and treatment of PD peritonitis only over the last decade.Case-Diagnosis/TreatmentWe present two children with difficult-to-treat episodes of PD peritonitis due to Corynebacterium amycolatum. Episodes were associated with fever, abdominal pain and cloudy dialysate, high dialysate polymorphonuclear leukocyte counts, and elevated serum C-reactive protein and procalcitonin concentrations. Symptoms persisted beyond 5 days in 4 of 5 peritonitis episodes, and peritonitis relapsed despite in vitro sensitivity of the bacterial isolates to guideline-recommended antibiotics. C. amycolatum was cultured from the PD catheter tip despite 4 weeks of intraperitoneal glycopeptide therapy and clinical peritonitis resolution suggestive of efficient biofilm formation. Our systematic literature search identified three previous (adult) case descriptions of C. amycolatum peritonitis, all with repeat episodes by the same organism. The incidence of C. amycolatum as a cause of PD peritonitis has not yet been established but is likely underreported due to challenges in species differentiation.ConclusionsC. amycolatum is a rarely identified cause of refractory and/or relapsing PD peritonitis. Species differentiation of non-diphtheriae Corynebacterium isolates is critical, and prolonged antibiotic treatment, preferably with a glycopeptide antibiotic, is recommended, with a low threshold for PD catheter change or removal in case of repeat peritonitis.

Usefulness of the delta neutrophil index in predicting surgery in patients with foot and ankle infection.

BackgroundIn foot and ankle infections, cases with apparent soft-tissue necrosis or purulent fluid collections definitely require surgical treatments. However, clinicians often have difficulty in determining whether to perform surgery in ambiguous cases without these findings. This study aimed to investigate the impact of the delta neutrophil index as a predictor of surgical treatment in patients with foot and ankle infections.MethodsIn total, 66 patients diagnosed with foot and ankle infections who underwent the delta neutrophil index test were retrospectively investigated. Medical records, including data on diabetes mellitus status, delta neutrophil index values, white blood cell count, polymorphonuclear leukocyte count, erythrocyte sedimentation rate, and C-reactive protein level, were retrospectively investigated. Logistic regression models were analyzed for the correlation between biomarkers, such as the delta neutrophil index and surgical treatment. The area under the curve was investigated to evaluate the cut-off value of the logistic model in predicting surgery.ResultsThe relationship between the delta neutrophil index and surgical treatment was analyzed. The delta neutrophil index, adjusted for diabetes mellitus, was the best predictor of future surgical intervention. Based on the Youden index, the cutoff point (the equation’s adjusted by diabetes mellitus) for the prediction of surgical treatment was defined as a probability of 0.3, with sensitivity and specificity of 82.4% and 77.6%, respectively.ConclusionsBased on the present study, the delta neutrophil index can help clinicians decide the appropriate surgical treatment for foot and ankle infections at the right time.

Telmisartan ameliorates LPS-induced pneumonia in rats through regulation of the PPARγ/NF-κB pathway.

Pneumonia is a common disorder of the respiratory system associated with inflammation. Telmisartan (TEL) has been reported to treat inflammatory-related diseases. The current study aimed to investigate the possible role and action mechanism of telmisartan on lipopolysaccharide (LPS)-induced pneumonia in rats. Forty male Sprague Dawley rats aged 8 weeks were assigned into four groups ad libitum: a control group received saline only, an experimental group received LPS, a group received telmisartan (5 mg/kg), followed by LPS treatment, and a group received telmisartan (10 mg/kg), followed by LPS treatment. The LPS (2 mg/kg) and equal saline were administered intratracheally. Telmisartan was administered orally 5 days before LPS. After LPS treatment for 24 hr, bronchoalveolar lavage fluid (BALF) and serum were collected for the analysis of cell counts and/or cytokines. Lung tissues were used to perform histological examination, to assess oxidative stress levels, and to determine the levels of PPARγ/NF-κB pathway-related proteins. Rats that received LPS treatment exhibited high levels of lung wet/dry ratio, alkaline phosphatase, lactate dehydrogenase, BALF polymorphonuclear leukocytes count, inflammatory cytokines, and oxidative stress. Meanwhile, LPS also resulted in severe interstitial edema and inflammatory cell infiltration. Interestingly, telmisartan by oral administration markedly ameliorated the adverse effects of pneumonia in rats caused by LPS. In addition, western blotting further revealed that telmisartan could activate PPARγ and repress NF-κB (p65). Telmisartan is protective against pneumonia through inhibition of the inflammation and oxidative stress via the PPARγ/NF-κB pathway.

Spontaneous bacterial empyema: a tertiary care center experience and a systematic review

ABSTRACT Background Spontaneous bacterial empyema (SBE) is an infection of a preexisting hepatic hydrothorax (HH). We aim to describe the experience in managing SBE in a liver transplant (LT) referral center and assessing the incidence and mortality rates of SBE after conducting a systematic review. Methods 992 patients with cirrhosis were retrospectively reviewed from 2015 to 2020. SBE was diagnosed by (i) positive microbiological culture and polymorphonuclear leukocyte count >250 cells/µL or (ii) negative microbiological culture, compatible clinical course, and polymorphonuclear count >500 cells/µL in pleural fluid. Furthermore, we conducted a comprehensive literature search of MEDLINE, EMBASE, and Google Scholar for studies evaluating SBE. Results Twelve patients (10.4%) had spontaneous bacterial empyema out of 115 patients with HH. Five patients underwent LT, 6 had died, and 1 did not get transplanted and was alive throughout the duration of follow-up. Ten studies were included in the systematic review. Pooled incidence in patients with HH was 19.03%. Only 20.69% of the patients received a LT. Pooled mortality rate was 46.45%, with only 3.45% of the patients dying post-transplant. Conclusion SBE is a severe complication of cirrhosis and HH. LT may provide a survival benefit. Thus, patients should be considered for early transplant.

MiR-124-3p targeting PDE4B attenuates LPS-induced ALI through the TLR4/NF-κB signaling pathway

BackgroundA large number of studies have found that microRNAs (miRNAs) and phosphodiesterase 4 (PDE4) are crucial regulators of inflammatory responses in acute lung injury (ALI). ObjectiveThis study will explore the protective effect of miR-124-3p on ALI and its related mechanism. MethodsThe ALI mouse model was established by intratracheal administration of lipopolysaccharide (LPS) and evaluated by haematoxylin and eosin (HE) staining, lung injury score, inflammation factors, polymorphonuclear leukocyte (PMN) count, total protein and lung wet weight/dry weight (W/D) ratio. MiR-124-3p was overexpressed in vivo by intratracheal administration of miR-agomir, and PDE4B was expressed at low level in vivo by intratracheal administration of a PDE4B inhibitor. The mRNA expression level was detected by qRT–PCR, and the protein expression level was detected by Western blot. The relationship between miR-124-3p and PDE4B was detected by dual-luciferase activity assay. ResultsWe found that miR-124-3p was downregulated in LPS-induced ALI. Overexpression of miR-124-3p alleviated lung injury by inhibiting the Toll-like receptor 4 (TLR4)/nuclear factor-kappa B (NF-κB) signaling pathway. Furthermore, we confirmed that miR-124-3p suppressed the TLR4/NF-κB signaling pathway by directly targeting PDE4B. ConclusionmiR-124-3p targeting PDE4B had a protective effect on LPS-induced ALI by inhibiting the TLR4/NF-κB signaling pathway.

Diagnostic role of procalcitonin serum level in hepatitis C virus-infected patients with spontaneous bacterial peritonitis

ObjectiveWe aimed at the evaluation of the role of quantification of serum procalcitonin (PCT) in the detection of spontaneous bacterial peritonitis (SBP) in hepatitis C-related cirrhosis before and after initiation of antibiotic therapy.BackgroundSBP is a lethal consequence of advanced cirrhosis. The outcome is heavily affected by early detection and treatment. PCT has been evaluated during acute bacterial infections and sepsis.Patients and methodsWe included 60 patients with ascites due to hepatitis C-related cirrhosis, who were divided in two groups: group 1 included 40 naïve patients with SBP, and group 2 included 20 patients with sterile ascites as a control. After history taking and clinical examination, full blood count, liver test profile, and renal functions were done. Moreover, C-reactive protein and erythrocyte sedimentation rate levels were measured. Serum PCT was measured by immunoassay. Diagnostic ascitic sample analysis was done for the polymorphonuclear leukocyte (PMNL) count, albumin levels, and ascetic fluid culture.ResultsSerum PCT was significantly elevated in group 1 before treatment than after treatment, as well as when compared with group 2. There was no statistically significant correlation between the change in the C-reactive protein level and that of the serum PCT before and after treatment in group 1. There is no significant correlation between increases in the serum PCT and the results of bacterial growth of ascetic fluid culture group before and after treatment.ConclusionPCT levels in the serum appear to provide a good diagnostic certainty in the diagnosis of SBP in cirrhotic patients at a cutoff value of 0.17 ng/ml for patients with either culture-positive or negative SBP.

52-Year-Old Woman With Palpitations, Abdominal Distension, and Severe Abdominal Pain

52-Year-Old Woman With Palpitations, Abdominal Distension, and Severe Abdominal Pain

The evaluation of the relationship of clinical and laboratory evidence with renal damage in the pediatric patients that had urinary tract infections

Purpose: Urinary tract infection (UTI) is one of the important infectious diseases of childhood age. It causes serious late-term complications by leading to development of renal scarring in some pediatric patients. In the present study, it was aimed to determine the risk factors in development of renal damage in the pediatric patients that admitted with clinical of acute pyelonephritis. Materials and methods: In our study, the medical files of the patients were admitted to the pediatric nephrology polyclinic of Pamukkale University Medical Faculty and followed-up with the diagnosis of urinary tract infection were retrospectively evaluated. The study included 197 patients diagnosed with acute pyelonephritis (confirmed by urine culture and clinical evidence) and undergoing dimercaptosuccinic acid (DMSA) scintigraphic imaging. The clinical evidence (fever, recurrent UTI, voiding dysfunction etc.), laboratory evidence (C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR), white blood cell (WBC) count, polymorphonuclear leukocyte (PNL) count, mean platelet volume (MPV), platelet count, serum urea and creatinine levels) and imaging evidence (urinary tract system ultrasonography (USG), voiding cystourethrography (VCUG) and DMSA scintigraphy) of the patients detected at admission and obtained by anamnesis were evaluated. Results: The number of the female patients (n=153) was found significantly higher than number of the male patients (n=44) (p<0.001). It was detected that pretreatment fever of 38ºC and over, persisting clinical evidence for 2 days or longer, the presence of recurrent UTI and high levels of WBC, PNL, ESR and CRP significantly increased renal damage in the patients (p<0.001). It was determined that USG and VCUG have low sensitivity regarding prediction of renal damage. Conclusion: Determination of renal damage rate by clinical and laboratory data detected at patient admission may contribute to a reduction in morbidity and mortality rates by applying an appropriate follow-up and treatment modality.

S2874 A Tale of Two Cultures: A Case of a Recurrence of Multi-Drug-Resistant Spontaneous Bacterial Peritonitis

Introduction: Spontaneous bacterial Peritonitis (SBP) is an ascitic fluid infection that is potentially life threatening in cirrhotic patients. A diagnosis is confirmed with a polymorphonuclear leukocyte (PMN) count of ≥ 250 and a positive culture in sampled ascites. Current guidelines recommend SBP screening in all admitted cirrhotic patients, and third generation cephalosporins are commonly used in prophylaxis and treatment. With widespread use of antibiotics, a rise in bacterial resistance has been noted. Here we present a case of two resistant SBP infections developing in a patient over two months. Case Description/Methods: A 52-year-old male with a history of chronic lyme disease requiring multiple antibiotic infusions and recently diagnosed alcoholic hepatitis presented with abdominal pain. Blood workup revealed a total bilirubin of 34.2 mg/dL, alanine transaminase of 120 U/L, and aspartate transaminase of 244 U/L. Paracentesis was performed after vancomycin, cefepime and zosyn were administered at an outside hospital prior to transfer. The ascitic fluid PMN count was 24,492. Ceftriaxone was empirically started, and cultures then identified Escherichia Coli resistant to amoxicillin-clavulaunate, ampicillin-sulbactam, cefazolin, cefotaxime, and ceftazidime. Ceftriaxone was switched to ertapenem and ultimately levofloxacin. The patient improved clinically and serial paracenteses showed a downtrend in PMNs and no further culture positivity. The patient then underwent an outpatient paracentesis 12 days later revealing a PMN count of 1,972. He was admitted, and ertapenem was started empirically as per prior hospitalization. Paracentesis was repeated 2 days later yielding a PMN count of 15,853 and the culture grew Enterococcus facieum resistant to ampicillin and vancomycin. Ertapenem was continued during admission and the patient was discharged with linezolid to complete the antibiotic course. Discussion: SBP is a potentially life threatening infection. Signs and symptoms may be nonspecific. While 3rd generation cephalosporins are commonly used for therapy and prophylaxis, our case sheds light on some of the therapeutic challenges in treating SBP effectively, particularly with regards to potential selection for drug-resistant gram-positive organisms. As resistant organisms and gram-positive organisms are encountered more frequently in SBP, it is imperative that antibiotics are selected and used appropriately.

Geranylgeranyl diphosphate synthase 1 knockdown suppresses NLRP3 inflammasome activity via promoting autophagy in sepsis-induced acute lung injury

BackgroundNOD-like receptor protein 3 (NLRP3) inflammasome activation has emerged as a crucial contributor to sepsis-induced lung injury. Geranylgeranyl diphosphate synthase 1 (GGPPS1) reportedly exerts the pro-inflammatory capability via activation of NLRP3 inflammasome. However, little is known about the role and mechanism of GGPPS1 in sepsis-induced lung injury. MethodsMice underwent cecal ligation and puncture (CLP) surgery to establish the in vivo model of sepsis. The lung injury of mice was assessed by analyzing the histological changes, the lung wet/dry ratio, PaO2/FiO2 ratio, myeloperoxidase (MPO) activity, total protein content, total cell, and polymorphonuclear leukocyte counts. Mouse alveolar macrophages MH-S were exposed to LPS for developing in vitro model of sepsis. The mRNA and protein expression levels of GGPPS1, beclin-1, and autophagy and inflammasome-related genes were detected using quantitative reverse transcription-polymerase chain reaction and western blot assays. Enzyme-linked immunosorbent assay was conducted to determine the levels of interleukin (IL)-1β and IL-18. ResultsWe successfully established sepsis-induced acute lung injury in vivo by CLP surgery. GGPPS1 was upregulated in the lung tissues of CLP-induced septic mice. The activation of autophagy and NLRP3 inflammasome were found in the lung tissues of CLP-induced septic mice. The addition of exogenous GGPP (synthesis products catalyzed by GGPPS1) and autophagic inhibitor 3-MA aggravated sepsis-induced hypoxemia, alveolar inflammatory response, intrapulmonary hemorrhage, and pulmonary edema, as evidenced by increased lung injury score, lung wet/dry weight ratio, MPO activity, total protein content, total cell, and PMNs counts, and decreased PaO2/FiO2 ratio. While NLRP3 inhibitor MCC950 exerted the opposite effects. Additionally, administration of exogenous GGPP could inhibit the activation of autophagy, enhance the activity of NLRP3 inflammasome, and the production of IL-1β and IL-18. Inhibition of autophagy by 3-MA treatment also promoted the activity of NLRP3 inflammasome and the production of IL-1β and IL-18. While MCC950 restrained the activity of NLRP3 inflammasome, but did not affect the activation of autophagy. Notably, the expression of GGPPS1 was unaltered in CLP-induced mice following GGPP, 3-MA, or MCC950 treatment. Moreover, GGPPS1 was upregulated in MH-S cells stimulated with LPS, and GGPPS1 knockdown enhanced the activation of autophagy and inhibited the activity of NLRP3 inflammasome in vitro. Importantly, depletion of GGPPS1 could alleviate LPS-induced inflammatory response by inducing autophagy-dependent NLRP3 inflammasome inhibition. ConclusionGGPPS1 knockdown suppressed NLRP3 inflammasome activity via promoting autophagy and then attenuated sepsis-induced acute lung injury, revealing a novel target for treating sepsis-induced lung injury.

GASTRIC ASPIRATE: A SCREENING TOOL FOR DETECTION OF EARLY NEONATAL SEPSIS-A PROSPECTIVE STUDY IN TERTIARY CARE CENTRE, INDORE

Background: Infections in early neonatal period are one of the important factors responsible for high mortality and morbidity in neonates in developing countries. Although it is being frequently observed by pediatricians in neonates, still insufficient relevant studies are documented. The objective of the present study was to evaluate the utility of gastric aspirate cytology as a screening tool for neonatal sepsis, and to determine the polymorphonuclear leukocyte count present in smear of gastric aspirate and correlating it with blood culture proven sepsis.&#x0D; Methods: The study was conducted on 100 neonates suspected with septicemia in inborn patients in Index medical college hospital and research centre. Gastric aspirate sample was collected within 6 hours of birth for septic screening of neonates. All the collected data was statistically analysed by applying Chi-square test using SPSS 2.0 software.&#x0D; Results: Gastric aspirate cytology has sensitivity 0f 53.19% and specificity of 62.28% with positive predictive accuracy of 51.33% and negative predictive accuracy of 63.4%.The relationship between gastric aspirate cytology and maternal risk factors like PROM are found to be highly significant.&#x0D; Conclusions: We conclude that gastric aspirate cytology in neonates is an excellent screening technique for neonatal sepsis added to a detailed perinatal history and clinical examination. The chances of positivity of gastric aspirate increase as the duration of rupture of membranes increased.&#x0D; Keywords: Gastric aspirate cytology, Neonatal sepsis, Blood culture, Polymorphonuclear leukocytes.

Variants of Ascitic Fluid Bacterial Infection in Children with Chronic Liver Disease in a tertiary care hospital in Bangladesh

Introduction: Ascitic fluid bacterial infection is an infection of preexisting ascites in the absence of abdominal source. Ascitic fluid bacterial infection may presents in both symptomatic and asymptomatic children with chronic liver disease (CLD). Culture negative neutrocytic ascites(CNNA) is the commonest type of infection in children with CLD. Objective: To observe the variants of ascitic fluid bacterial infection in children with CLD. Methods: Thirty five consecutive children with clinical features suggestive of CLD, aged between 2-14 years of both sexes with clinically detected ascites and admitted at the Department of Paediatric Gastroenterology and Nutrition, Bangabandhu Sheikh Mujib Medical University (BSMMU) from January 2013 through June 2013 were enrolled in this cross sectional study. Children who had features of ascitic fluid infection like l fever, abdominal pain with tenderness were categorized as symptomatic and children who had no features of ascitic fluid infection were categorized as asymptomatic children. Demographic, clinical, haematological, biochemical and ascitic fluid study were done for both symptomatic and asymptomatic children. Variants of ascitic fluid bacterial infection was identified by ascitic fluid polymorphonuclear leucocyte count and culture report. Results: Among 35 children, majority 17 (48.6%) were between 6-10 years of age group with male predominance. About 12 (34.3%) were symptomatic and among the symptomatic children 7 (58.4%) were infected and 5 (41.6%) were non-infected, 16 (45.7%) had culture negative neutrocytic ascites (CNNA) variant of ascitic fluid bacterial infection as evident by ascitic fluid polymorphonuclear leucocyte count of  250/mm3 and negative culture report. Mean ascitic fluid polymorphonuclear neutrophil count was 515177.82/HPF among infected children and 85.4770.60/HPF among non-infected children, which is statistically significant (p-0.001). Wilson’s disease was the commonest 11(30) cause of the ...

Concordance of 24- and 48-h diagnostic follow-up ascitic fluid polymorphonuclear leukocyte count in the guidance of the antibiotic therapy in spontaneous bacterial peritonitis

BackgroundSpontaneous bacterial peritonitis (SBP) is an ascitic fluid infection in patients with liver cirrhosis in the absence of surgical causes. The drop of the ascitic fluid polymorphonuclear leukocyte count (AFPC) ≥25% of baseline 48h post-start of antibiotics is a predictor of antibiotic response. This study was designed to compare the diagnostic accuracy of AFPC 24h of antibiotic to the standard 48h. Three hundred ninety-nine SBP patients were classified into 2 groups. Group I (31.1%) are patients that lacked ≥25% drop and group II (68.9%) the opposite.ResultsThe average age was 51.99 ±11.21 years. Most patients were males (70.9%), normotensive (75.8%), non-diabetics (50.8%), and without recent intake history of proton pump inhibitors (75.8%) and B-blockers (77%). Group II patients had statistically significant (p <0.05) serum sodium 129 (7) vs. 128 (8) and history of diabetes mellitus 60.3% vs. 39.7%. The baseline AFPC did not differ statistically between groups I and II (p>0.05). Group II patients compared to group I had statistically (p =0.001) lower AFPC 24h [800 (970) vs. 1100 (1700) cell/mm3], higher percent drop of the AFPC 24h [28.09 (24) vs. −10.17 (35)], and ≥25% drop [154 (90.6%) vs. 16 (9.4%)]. The 24h AFPC >980 cell/mm3 was associated with AFPC 48h non-response (AUROC =0.634, p =0.001, 58.87% sensitivity, 64.36% specificity). The 24-h AFPC percent drop >8% was associated with AFPC 48h response (AUROC =0.849, p=0.001, 85.82% sensitivity, 80.49% specificity).ConclusionConcordance of 24- and 48-h diagnostic follow-up ascitic fluid polymorphonuclear leukocyte count in the guidance of the antibiotic therapy.

Umbilical Cord Separation Time and Influencing Factors in Very-Low-Birth-Weight Preterm Neonates.

The average time for umbilical cord separation in term neonates is 7 to 10 days. Prematurity, phototherapy, prolonged duration of antibiotic treatment, and parenteral nutrition are other factors which were demonstrated to delay cord separation. In the previous studies including greater premature infants, the time of separation of the umbilical cord was shown to vary 2 to 3 weeks. We aimed to determine the cord separation time and associated factors in very-low-birth-weight (VLBW) infants. In this retrospective study, VLBW infants (birth weight [BW] <1,500 g, gestational age [GA] < 32 weeks) without umbilical catheterization were included. Specific cord care was not applied. The cord separation time, gender, mode of delivery, presence of sepsis, duration of antibiotic treatment, serum free thyroxine, free triiodothyronine (FT3), thyroid-stimulating hormone, lowest leukocyte, polymorphonuclear leukocytes (PMNLs), and platelet counts were recorded. The study included 130 infants (GA: 29 ± 2 weeks, BW: 1,196 ± 243 g). Mean cord separation time was 14 ± 5 days, while 95th percentile was 22nd day of life. A positive correlation was demonstrated between duration of antibiotic treatment and cord separation time (p < 0.001, r: 0.505). Cord separation time did not differ regarding gender or mode of delivery. Corrected leukocyte count (p = 0.031, r: -0.190) and PMNL count (p = 0.022, r: -0.201), and serum FT3 level (p = 0.003, r: -0.261) were found to be negatively correlated with cord separation time. The cord separation time was found to be delayed in the presence of sepsis (with sepsis: 18 ± 7 days and without sepsis: 13 ± 3 days; p = 0.008). Sepsis was found to delay the cord separation time beyond second week (odds ratio = 6.30 [95% confidence interval: 2.37-15.62], p < 0.001). The 95th percentile for cord separation time was 22nd day. Sepsis might be either the reason or the consequence of delayed cord detachment. The exact contribution of low serum FT3 levels to the process of cord separation should be investigated in further studies. · Mean cord separation time was 14 ± 5 days, while 95th percentile was 22nd day, in VLBW infants.. · Sepsis was found to delay the cord separation time by sixfold beyond second week.. · Serum free triiodothyronine level was negatively correlated with cord separation time..

Pathogenic role leukotriene B4 in lung injury induced by lung-protective mechanical ventilation in rabbits

To elucidate the pathogenic role of leukotriene B4 (LTB4) in pulmonary hyper-permeability and inflammation induced by lung-protective mechanical ventilation (LPMV) in rabbits. Thirty-two healthy Japanese white rabbits were randomized into 4 groups for treatment with vehicle or bestatin (a leukotriene A4 hydrolase inhibitor that inhibits LTB4 production) administered intragastrically at the daily dose of 8 mg/kg for 5 days, followed by sham operation (group S and group BS, respectively, in which the rabbits were anesthetized only) or LPMV (group PM and group BPM, respectively, in which the rabbits received ventilation with 50% oxygen at a tidal volume of 8 mL/kg for 5 h). The concentrations of LTB4 and cyclic adenosine monophosphate (cAMP) in the lung tissues were analyzed by ELISA. cAMP content, protein kinase A (PKA) protein expression and the Rap1-GTP protein to total Rap1 protein ratio were determined to assess the activities of cAMP/PKA and Rap1 signaling pathways. The lung injury was evaluated by assessing lung permeability index, lung wet/dry weight ratio, polymorphonuclear leukocyte (PMN) count in bronchoalveolar lavage fluid (BALF), pulmonary myeloperoxidase (MPO) activity and lung histological scores. None of the examined parameters differed significantly between group S and group BS. All the parameters with the exception of lung histological score increased significantly in group PM and group BPM as compared to those in group S (P < 0.05). Compared with those in PM group, the rabbits in group BPM showed significantly reduced LTB4 production in the lungs (P < 0.05), up-regulated cAMP/ PKA and Rap1 signaling pathway activities (P < 0.05), and alleviated lung hyper-permeability and inflammation (P < 0.05). LPMV can induce LTB4 overproduction to down-regulate cAMP/PKA and Rap1 signaling pathways in the lungs of rabbits, which results in lung hyper-permeability and inflammation. Bestatin can inhibit LTB4 production in the lungs to protect against LPMV-induced lung hyper-permeability and inflammation.

S1502 A Rare Case of Raoultella planticola-Associated Spontaneous Bacterial Peritonitis in a Patient With Decompensated Cirrhosis

INTRODUCTION: Raoultella planticola (RP) is a rare human pathogen, the incidence and prevalence of which is likely underreported due to its frequent misidentification as a Klebsiella species. To our knowledge, three cases have been reported of RP causing peritoneal infections. We present a case of RP causing spontaneous bacterial peritonitis (SBP) in a patient with decompensated cirrhosis, the first case of RP infection in a patient with cirrhosis secondary to nonalcoholic steatohepatitis (NASH). CASE DESCRIPTION/METHODS: 53-year-old female patient with cirrhosis, presented with ascites and abdominal pain. Medical history is significant for multiple sclerosis, gastric bypass surgery, breast cancer status post lumpectomy, chemo and radiation 10 years prior, with recent diagnosis of cirrhosis due to NASH (biopsy confirmed). On presentation, the patient was afebrile, markedly hypotensive, hypokalemic, neutropenic (WBC 2.84), anemic, thrombocytopenic, and with lactic acidosis. CT scan was notable for cirrhotic morphology, known innumerable hepatic lesions (biopsy negative for malignancy), as well as large volume ascites with a nodular omentum. Patient underwent diagnostic and therapeutic paracentesis with removal of 4 liters of ascitic fluid. Fluid analysis revealed WBC count of 4,524 with 98% neutrophil predominance and a polymorphonuclear leukocyte count greater than 250. Cytology was negative for malignancy. The patient was started on metronidazole and fluoroquinolone based therapy and later switched to Vancomycin and Meropenem for broad spectrum coverage. Cultures from the ascitic fluid returned positive for RP. Antibiotics were narrowed to Aztreonam on day 4 to complete a 7-day course of treatment. Subsequent collection of ascitic fluid revealed 228 WBC per mcL and fluid differential of 16% neutrophils indicating good response to Aztreonam with resolution of SBP. DISCUSSION: RP is an extremely rare cause of SBP even in immunocompromised patients. Risk factors include heavy alcohol abuse, seafood consumption, diabetes, and chemotherapy. Our patient is unique in that she had clear evidence of RP in ascitic fluid and is the only documented cirrhotic patient with RP cultured in ascitic fluid with no known alcohol abuse history or history of peritoneal dialysis. Given that our patients peritoneal fluid was positive for RP alone, it is likely that the isolate was the pathogenic cause of SBP rather than a colonizing organism.