Presence Of Leukocytosis Research Articles

Appendicular Abscess: An Update on Current Management: Narrative Review Article

Appendicular abscess is a complication from perforation of the appendix, and it is seen in 10% of cases of acute appendicitis. It is diagnosed by clinical examination, the presence of leukocytosis and imaging modalities like ultrasound or computerized tomography. The treatment is usually conservative with intra-venous fluids, antibiotics and percutaneous drainage of the abscess. The introduction of laparoscopic surgery has seen a move towards immediate appendectomy. Interval appendectomy is no longer a routine and is only performed for patients who present with recurrent symptoms. We have conducted this narrative review article to look at the various management options for appendicular abscess.

Prognostic values of neutrophil-to-lymphocyte and platelet-to-lymphocyte ratios in the early prediction of aluminum phosphide-poisoned patients’ outcomes

Background In Egypt, aluminum phosphide (ALP) is one of the most serious health problems that threaten the health system, with a very high mortality rate that ranges from 30%–100% of cases, according to medical facilities. ALP records suicidal deaths related to the toxin ingestion in Egypt, which accounts for 70% of the deaths. Patients usually deteriorate early; death is expected in the first 48 h. The aim of this study is to investigate the early recorded neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) in anticipation of the ALP-intoxicated patients’ outcome. Patients and methods Thirty-three subjects diagnosed with ALP poisoning were divided into two groups according to their need for mechanical ventilation and whether they could survive or not. A complete blood count (CBC) was done immediately after admission, and NLR and PLR were calculated. Patients’ conditions were evaluated by arterial blood gases (ABG), random blood sugar (RBS), sodium (Na+), potassium (K+), and an electrocardiogram (ECG). Results There were significant differences in the need for ICU and mechanical ventilation between the different NLR groups. There was also a highly significant difference in the patient’s fate. Increased NLR was associated with a high incidence of mechanical ventilation and death in ALP-poisoned patients. Conclusion The early assessment of NLR can be valuable in predicting death and the need for ICU admission. NLR ≥ 3.35 can predict death in ALP-poisoned patients. Early CBC and calculation of NLR are promising tools that are easy and more accurate than the presence of leukocytosis or leucopenia.

Severe cholecystitis during the COVID-19 pandemic : Influence of the COVID-19 pandemic on the frequency of surgery and outcome for elective and emergency cholecystectomy: a monocentric retrospective cohort analysis

With the outbreak of the COVID-19 pandemic medical care focused on management of the infectious event. Elective interventions were cancelled and the general advice was to stay at home. How this impacted urgent and elective cholecystectomies is the subject of this work. Urgent and elective cholecystectomy patients during the first year of the pandemic were compared with those of the previous year. The primary endpoint was the frequency of surgery. Furthermore, the American Society of Anesthesiologists (ASA) score, symptom duration until presentation as well as until surgery, preoperative inflammatory parameters, imaging, positive Murphy's sign, type and duration of surgery, intraoperative drain placement, intraoperative and histological severity, need for and duration of postoperative antibiotic therapy, intensive care stay, length of stay and occurrence of postoperative complications were recorded. During the pandemic patients were sicker (ASA2.13 vs. 2.31; p = 0.039), the operating time was prolonged (64.4 min vs. 74.9 min; p = 0.001) and patients were more likely to have concomitant peritonitis (15.4% vs. 29.1%: p = 0.007). Furthermore, there was atrend in the presence of leukocytosis, apositive Murphy's sign, intraoperative drain placement, intraoperative severity of inflammation, duration of postoperative antibiotic therapy and complication rate. During the COVID-19 pandemic cholecystitis presented with more pronounced inflammation, the surgical conditions were more difficult and postoperative recovery was prolonged.

Hypercalcemia–leukocytosis syndrome from non-schistosomiasis-associated squamous cell carcinoma of the urinary bladder: a case report and review of the literature

BackgroundNon-schistosomiasis-associated squamous cell carcinoma of the urinary bladder is less common in the Western world. Limited information on its possible paraneoplastic syndromes exists. Leukocytosis tends to commonly be regarded by clinicians as an indication of sepsis, rather than a feature of paraneoplasia, potential surrogate marker for recurrence, and prognostic marker. Accompanying hypercalcemia may be missed entirely.Case presentationA 66-year-old Caucasian man presented with visible painless hematuria and symptomatic hypercalcemia. Investigations revealed a squamous cell carcinoma of the urinary bladder with marked leukocytosis. Hypercalcemia and leukocytosis resolved following radical cystectomy, recurred with nodal recurrence and regressed with radiotherapeutic control. Subsequently, serum leukocyte and calcium assays were included in his follow-up protocol. His survival was 20 months by the time of the report.ConclusionThis report highlights hypercalcemia–leukocytosis syndrome as a paraneoplastic manifestation of non-schistosomiasis-associated squamous cell carcinoma to reemphasize the need for clinicians to assay for calcium in the presence of leukocytosis in such patients. Prompt identification and control of the paraneoplastic derangements, with treatment of the cancer recurrence it may connote, is advocated to provide a chance for better long-term outcomes in these patients.

Study the Relationship Physiology and Molecular Biology in Patients of Iraq Drug Use Parameters Acute Leukaemia (AL)

Study of paper is physiology use to analysis total in LDH is an intracellular enzyme whose activity is associated with cellular metabolism, WBCs count in blood to patients which makes it a marker of cell proliferation and cell injury and study with molecular biology of marker parameters use drug the presence of survivin in neoplastic cells contributes to tumor development and its high transcription has been reported as a predictor of poor prognosis in several hematological malignancies. However, despite being frequently present in ALs, the impact of survivin transcription in this type of hematologic malignancy remains undefined. Some studies report that survivin predicts an unfavorable clinical outcome in ALs, while others do not. In the present study, despite the small number of patients evaluated, the transcription of survivin at diagnosis did not seem to be related to a worse response to treatment or a worse prognosis. This is because, of the six patients who expressed survivin, three are in complete remission and, of the three who died, two were already considered to have an unfavorable prognosis regardless of survivin transcription, one due to advanced age and the presence of leukocytosis in the liver. Leukometry at diagnosis was another prognostic factor evaluated in this study. Patients diagnosed with AL may have elevated, normal, or decreased WBC counts at the time of diagnosis and, in general, counts greater than 30,000 WBCs/mm3 are considered to have a poor prognosis.

Presence and Relevance of Emerging Microorganisms in Clinical Genitourinary Samples.

Microorganisms responsible for genitourinary infections increasingly include species other than conventional etiological agents that are of clinical and pathogenic relevance and therapeutic interest. This cross-sectional descriptive study selected samples from clinical genitourinary episodes between January 2016 and December 2019 in which emerging microbiological agents were detected. The patients' epidemiological characteristics, clinical presentation, antibiotic treatment, and outcome were studied to identify their pathogenic role. The emerging microorganisms most frequently detected in urinary tract infections were Streptococcus bovis (58.5%) and Gardnerella spp. (23.6%) in females and S. bovis (32.3%), Aerococcus urinae (18.6%), and Corynebacterium spp. (16.9%) in males, while the most frequently detected in genital infections were S. viridans (36.4%) in females and C. glucuronolyticum (32.2%) and Gardnerella spp. (35.6%) in males. All cases in female children were produced by S. bovis. Symptomatic episodes were more frequent with Aerococcus spp. and S. bovis and the presence of leukocytosis more frequent with Aerococcus spp. Quinolones and doxycycline were most often prescribed antibiotics for genital infections and quinolones and amoxicillin-clavulanic acid for urinary infections. Urinary infection by Aerococcus spp. was more frequent in males of advanced age, Corynebacterium spp. was more frequent in permanent vesical catheter carriers, and episodes of asymptomatic bacteriuria by Gardnerella spp. were more frequent in patients with kidney transplant and chronic consumers of corticosteroid therapy. Lactobacillus spp. should be considered in urinary infections of patients of advanced age and with a previous antibiotic load. Genital infection by Gardnerella spp. was significantly associated with a history of risky sexual relations.

Leukocytosis and C-Reactive Protein Levels as Indicators of Infection in Children With Diabetic Ketoacidosis.

Diabetic ketoacidosis (DKA) is one of the serious complications of type 1 diabetes mellitus and may be aggravated by infection. Diagnosing an infection in a patient with DKA is often complicated because of the overlap of symptoms and the presence of leukocytosis in both conditions. Reliable indicators for the diagnosis of bacterial infection in DKA may reduce unnecessary use of antibiotics and enable closer monitoring of patients at risk. This is a retrospective study. The study cohort included 180 children and adolescents with type 1 diabetes mellitus who were admitted to the Pediatric Emergency Department at Shaare Zedek Medical Center and had blood test results. We compared white blood cell count, C-reactive protein (CRP) levels, blood glucose levels, pH, the degree of acidosis, and the incidence of infection in patients with and without DKA. The incidence of probable bacterial infection in the entire cohort was 13.9%: 15.7% in the DKA group and 7.5% in the non-DKA group (P = 0.65). The incidence of leukocytosis was significantly higher in patients with DKA (P = 0.0003), although this was not related to bacterial infection. The CRP levels were higher in the DKA group with infection than without infection, and this was statistically significant (P = 0.008). Our findings suggest that leukocytosis in DKA is not a reliable indicator of concomitant bacterial infection. In contrast, CRP levels were not related to the DKA or degree of acidosis and were significantly higher in patients with infection within the DKA group, and are therefore a more reliable indicator of concomitant infection in these patients.

Yield of Leukocytosis in Predicting Brain Computed Tomography Pathological Findings in Pediatric Patients with Head Traumatic Injuries

BBackground: Head trauma is an urgent medical condition that is prevalent in pediatric patients. The association between white blood cell (WBC) counts and their prognostic value in pediatric traumatic brain injury has been proposed in multiple studies. Hence, WBC count can be used to determine the presence of traumatic brain injury. Thus, we aimed to address this gap by assessing the value of WBC count in predicting pathological CT findings in pediatric patients with traumatic head injuries. Methods: This retrospective cohort study included 108 patients with isolated head trauma aged 0–14 years who underwent brain CT examination and had available data on WBC count upon presentation to the emergency room. Chi-square and Fisher's exact tests were used to determine the statistical significance. Logistic regression analysis was performed to further explore the relationships between the variables. Results: Falls were the most common cause of head trauma (88 [81.48%] patients). Leukocytosis was reported in 35 (32.41%) patients and non-leukocytosis in 73 (67.59%) patients. Sixty-four patients (59.26%) had pathological brain CT findings, whereas 44 (40.74 %) had non-pathological findings. The leukocytosis status differed (odds ratio [OR]=0.99, 95% confidence interval [CI]=2.55–0.38; P= 0.9839) according to the pathological CT findings, but the difference was not significant. Age (0–2 years) and Glasgow Coma Scale score (≤14) were significant predictors of pathological brain CT findings (OR=3.79, 95% CI=9.24–1.55, P=0.0033 and OR=14.04, 95% CI=127.59–1.54, P=0.0189, respectively). Conclusion: The presence of leukocytosis is useful for predicting pathological brain scan findings. Therefore, further multicenter studies with a larger sample size are warranted to determine the benefits of WBC count in patients with head trauma.

Response and Resistance to Cladribine in Patients with Advanced Systemic Mastocytosis: A Registry-Based Analysis

For nearly two decades, the off-label treatment with the purine analogue cladribine was considered as the standard-of-care for patients with advanced systemic mastocytosis (AdvSM), which is driven by the KIT D816V mutation in >90% of patients. High response rates and improved progression-free- and overall survival (OS) have favored the use of the multikinase inhibitor midostaurin and the specific KIT D816V inhibitor avapritinib, but cladribine remains a relevant treatment option beyond first-line (1L) treatment due to intolerance, resistance and progression on KIT inhibitors. Based on data from the 'German Registry on Disorders of Eosinophils and Mast Cells (GREM)', we therefore sought to evaluate response and resistance to cladribine in both 1L- and second-line (2L) in 79 AdvSM patients. Prior treatment included midostaurin while subsequent treatment approaches included individually or sequentially midostaurin, avapritinib, acute myeloid leukemia-like intensive chemotherapy and allogeneic hematopoietic stem cell transplantation (HSCT). Treatment options with a low disease-modifying impact (e.g. interferon-alpha) or solely directed towards the associated hematologic neoplasm (e.g. hydroxyurea, azacytidine) were not considered as 1L- or 2L-treatment. This study is an updated and more detailed analysis of a recently published comparative study between midostaurin and cladribine (Lübke et al., J Clin Oncol 2022). Cladribine was used at a dose of 0.14 mg/kg/day subcutaneously or intravenously on days 1-5 of a 28-day course. For 1L- (n=48, 61%) and 2L-treatment (n=31, 39%), a median number of 3 cycles was applied over a median of 3.3 (range 0.1-16.0) and 3.0 (range 0.1-28.5) months, respectively (P=0.612). Three or more cycles were applied in 32/79 (41%) patients (1L, n=21, 66%; 2L, n=11, 34%). The main reason for dose reduction, e.g. application only on days 1-3 or extension of intervals, was prolonged myelosuppression (15/79, 19%). Separating 1L- and 2L-treatment, the overall response rate (ORR), according to modified Valent criteria (46 evaluable patients), was 41% (12/29) and 35% (6/17, P=0.690), and median OS (all patients evaluable) was 1.9 years (48/79), and 1.2 years (31/79), respectively (P=0.311). Independent of the treatment line, application of ≥3 vs. <3 cycles (median OS 2.8 vs. 1.2 years, P=0.038) and response vs. no response after at least 1 cycle (median OS 3.4 vs. 1.5 years, P=0.002) correlated with improved OS. After minimizing confounding effects through treatment with midostaurin, avapritinib, intensive chemotherapy or allogeneic HSCT, multivariable analyses revealed leukocytosis ≥16 x 109/L (hazard ratio [HR] 5.0, 95% confidence interval [CI 1.2-21.0], P=0.026) and eosinophilia ≥1.5 x 109/L (HR 3.0 [CI 1.0-8.8], P=0.048) as independent adverse prognostic markers for OS. There was no impact of other laboratory (anemia, thrombocytopenia, serum tryptase; P>0.517) or genetic markers (mutations in SRSF2, ASXL1 or RUNX1; P=0.412), on OS. Due to an excess mortality of low- and intermediate-risk patients, none of the recently established prognostic scoring systems (MARS, IPSM, MAPS or GPSM) were predictive for OS. In conclusion, cladribine is effective in 1L- and 2L-treatment of AdvSM. The presence of leukocytosis or eosinophilia, application of <3 cycles and a lack of response according to modified Valent criteria are adverse prognostic markers. The various prognostic models for AdvSM are of limited value because of high mortality in low- and intermediate-risk patients. Overall, cladribine remains a relevant sequential treatment option for patients with AdvSM. Figure 1View largeDownload PPTFigure 1View largeDownload PPT Close modal

A Microscopic Study on Morphology of Reactive Thrombocytes in Duckling

Thrombocytes, well known as important clotting factors, and now known to be important as phagocytic cells, might benefit the study of the avian hemogram. Therefore, blood was sampled from 4 late-stage embryos at embryo day 24, and 4 one-day-old hatchlings (d1), and 5 female ducks aged 59 weeks stained by Wright-Giemsa and examined at 100x. Standard differential counts (SDC) of 2 x 200 cells were used to determine total white blood counts (TWBC) and heterophil/lymphocyte (H/L) ratios. Thrombocytes were not included in the SDC but were studied from photomicrographs. Reactive thrombocytes were present in blood films having a normal TWBC or in the presence of leukocytosis (59 weeks). The H/L ratios may or may not be elevated. Reactive thrombocytes can be differentiated from quiescent types on morphologic criteria. These included an increase in the number of magenta “specific granules”, the development of cytoplasmic vacuoles, and a capacity to form aggregates with other Th or with cells of another series. Reactive Th were not necessarily larger in size than quiescent types. In some instances, Th aggregation with RBC (toroid formation) was with sufficient force to distort the RBC cell membrane. It was observed that reactive thrombocytes were accompanied by bacteria, either free-swimming or attached to cell-associated bacteria. Reactive thrombocytes having lost portions of their cell membrane were regularly encountered. As avian thrombocytes are now recognized as important phagocytic cells, as well as having a primary role in hemostasis, they are part of the immune defense mechanism. The presence of reactive thrombocytes in a hemogram should be considered when using hematological data to evaluate immune responses and establish stress status.

Baseline laboratory parameters for preliminary diagnosis of COVID-19 among children: a cross-sectional study.

ABSTRACTBACKGROUND:Clinical judgment of initial baseline laboratory tests plays an important role in triage and preliminary diagnosis among coronavirus disease 2019 (COVID-19) patients.OBJECTIVES:To determine the differences in laboratory parameters between COVID-19 and COVID-like patients, and between COVID-19 and healthy children. Additionally, to ascertain whether healthy children or patients with COVID-like symptoms would form a better control group.DESIGN AND SETTING:Cross-sectional study at the Institute for Child and Youth Health Care of Vojvodina, Novi Sad, Serbia.METHODS:A retrospective study was conducted on 42 pediatric patients of both sexes with COVID-19. Hematological parameters (white blood cell count, absolute lymphocyte count and platelet count) and biochemical parameters (natremia, kalemia, chloremia, aspartate aminotransferase [AST], alanine aminotransferase [ALT], lactate dehydrogenase [LDH] and C-reactive protein [CRP]) were collected. The first control group was formed by 80 healthy children and the second control group was formed by 55 pediatric patients with COVID-like symptoms.RESULTS:Leukocytosis, lymphopenia, thrombocytosis, elevated systemic inflammatory index and neutrophil-lymphocyte ratio, hyponatremia, hypochloremia and elevated levels of AST, ALT, LDH and CRP were present in COVID patients, in comparison with healthy controls, while in comparison with COVID-like controls only lymphopenia was determined.CONCLUSIONS:The presence of leukocytosis, lymphopenia, thrombocytosis, elevated systemic inflammatory index and neutrophil-lymphocyte ratio, hyponatremia, hypochloremia and elevated levels of AST, ALT, LDH and CRP may help healthcare providers in early identification of COVID-19 patients. Healthy controls were superior to COVID-like controls since they provided better insight into the laboratory characteristics of children with novel betacoronavirus (SARS-CoV-2) infection.

Prognostic factors for patients with anal cancer treated with conformal radiotherapy—a systematic review

AimsAnal cancer is primarily treated using concurrent chemoradiotherapy (CRT), with conformal techniques such as intensity modulated radiotherapy (IMRT) and volumetric arc therapy (VMAT) now being the standard techniques utilised across the world. Despite this, there is still very limited consensus on prognostic factors for outcome following conformal CRT. This systematic review aims to evaluate the existing literature to identify prognostic factors for a variety of oncological outcomes in anal cancer, focusing on patients treated with curative intent using contemporary conformal radiotherapy techniques.Materials and methodsA literature search was conducted using Medline and Embase to identify studies reporting on prognostic factors for survival and cancer-related outcomes after conformal CRT for anal cancer. The prognostic factors which were identified as significant in univariable and multivariable analysis, along with their respective factor effects (where available) were extracted. Only factors reported as prognostic in more than one study were included in the final results.ResultsThe results from 19 studies were analysed. In both univariable and multivariable analysis, N stage, T stage, and sex were found to be the most prevalent and reliable clinical prognostic factors for the majority of outcomes explored. Only a few biomarkers have been identified as prognostic by more than one study – pre-treatment biopsy HPV load, as well as the presence of leukocytosis, neutrophilia and anaemia at baseline measurement. The results also highlight the lack of studies with large cohorts exploring the prognostic significance of imaging factors.ConclusionEstablishing a set of prognostic and potentially predictive factors for anal cancer outcomes can guide the risk stratification of patients, aiding the design of future clinical trials. Such trials will in turn provide us with greater insight into how to effectively treat this disease using a more personalised approach.

P-1 PREVALENCE AND EPIDEMOLOGY OF BACTERIAL INFECTIONS IN PATIENTS WITH ALCOHOLIC HEPATITIS: A RETROSPECTIVE STUDY OF PATIENTS ADMITTED AT THE SAN RAFAEL DE ALAHUELA HOSPITAL, COSTA RICA

Bacterial infections in patients with alcoholic hepatitis have a high incidence and can contribute to the developments of organ failure and death. To determinate the prevalence and epidemiology of bacterial infections in patients with alcoholic hepatitis; to evaluate the epidemiological and clinical characteristics in patients with alcoholic hepatitis; to identify predictive factors associated with infections in patients with alcoholic hepatitis; to determinate the proportions of patients with positive microbiological cultures; and to investigate the mortality in patients with alcoholic hepatitis with and without infection. This is a retrospective and observational study that included patients admitted to the San Rafael de Alajuela Hospital-Costa Rica; between November 2019 and February 2020. The medical records of all the patients who met the selection criteria were reviewed. 41 patients (80% male, mean age: 50 years ± 10) were analyzed. A high prevalence of concurrent sepsis was observed (73%, 36% nosocomial), with a proportion of culture positivity of 45%. Only the presence of leukocytosis and neutrophilia was associated with an increased risk of infection. The AUROC of the presence of leucocytosis was 0.86 (95% CI: 0.73-0.98) and the cut-off was 9520/mm 3 presented the best diagnostic accuracy (S: 90%, E: 72.7%). Acute on chronic liver failure and severe alcoholic hepatitis was associated with high mortality. The results confirm the high prevalence of bacterial infections in patients with alcoholic hepatitis. Leucocytes value was a risk factor for the development of infection and acute on chronic liver failure was associated with higher mortality.

Positive Pulmonary Tuberculosis Patients with Acute Respiratory Failure.

Pulmonary tuberculosis (PTB) coupled with Acute Respiratory Failure (ARF) usually heralds a dismal patient outcome1. Admission to the Intensive Care Unit (ICU) along with Invasive mechanical ventilation (IMV) in PTB patients is usually associated with very high mortality2. Non-invasive Ventilation (NIV) when applied early in such patients has the potential to prevent intubation and improve prognosis in terms of reduced morbidity and/or mortality 3. We conducted a prospective study in our Institute where NIV was applied to 35 patients with smearpositive PTB who had concurrent ARF. Fourteen patients (40%) improved on NIV and were later discharged on treatment (survivors). The remaining patients (60%) were candidates for IMV but none survived. Statistically significant predictors of mortality in our study were multiple courses of anti-tubercular treatment in the past, advanced disease as assessed radio-graphically, presence of leucocytosis, drug resistance and pH<7.25. Our study is unique in the fact that it has addressed NIV in active PTB on which very scant literature is available. Our results indicate that a significant proportion of PTB patients with ARF may benefit from NIV based on astute and diligent patient selection and prompt institution of the procedure along with ATT and other supportive therapy. Our study also provides some tentative evidence that patients who fail NIV may not benefit from IMV. How much of this is due to the advanced lung disease and poorer metabolic status of the patient along with co-existent nosocomial infections needs to be elucidated by further studies [1-5].

The Complete Blood Count Modified Results in Patients with Complicated Colorectal Cancer

Abstract Introduction Among the factors on which the long-term survival of patients with colorectal cancer depends, the biological status at admission is essential and it is well reflected by a simple, routine analysis: The complete blood count (CBC). The link between the values of the hemoleukogram parameters and the diagnosis of colorectal cancers, but also between the changes in the hemoleukogram and the prognosis of patients with colorectal cancer is well documented in the literature. The aim of this study is to show the link between CBC changes at admission and the survival of patients with complicated colorectal cancer. Patients and methods We conducted a retrospective study that included 431 patients admitted and operated in emergency for complicated colorectal cancer, in the Surgery II Clinic of the Clinical Emergency County Hospital "St. Ap. Andrei" from Galati between 2008-2017. We made statistical correlations between the 4 types of emergency operations (external derivations, Hartmann, internal derivations and resections with anastomosis) and CBC changes, as well as a survival analysis depending on the presence of these changes. Results The presence of anemia at admission is statistically significant correlated with the practice of emergency colostomies and the presence of leukocytosis is correlated with Hartmann operations. In our study, only the anemia was a negative prognostic factor for the long-term survival of patients with complicated colorectal cancer. Conclusions The complete blood count is a routine, simple, cost-effective laboratory test that can be a very useful tool in assessing the prognosis of patients with complicated colorectal cancer.

Clinical features and outcomes of COVID-19 in patients with solid tumors: Turkish National Registry Data.

We present demographic, clinical, laboratory characteristics and outcomes of the patients with solid malignancies and novel coronavirus disease (COVID-19) collected from the National COVID-19 Registry of Turkey. A total of 1523 patients with a current or past diagnosis of solid tumors and diagnosed with COVID-19 (confirmed with PCR) between 11 March and 20 May 2020 were included. The primary outcome was 30-day mortality. Median age was 61 (range: 18-94), and 752 (49%) were male. The most common types of cancers were breast (19.8%), prostate (10.9%) and colorectal cancer (10.8%). 65% of the patients had at least one comorbidity. At least one COVID-19-directed therapy was given in 73% of the patients.. Hospitalization rate of the patients was 56.6% and intensive care unit admission rate was 11.4%. Seventy-seven (5.1%) patients died within 30 days of diagnosis. The first multivariate model which included only the demographic and clinical characteristics showed older age, male gender and presence of diabetes and receipt of cytotoxic therapy to be associated with increased 30-day mortality, while breast and prostate cancer diagnoses were associated with lower 30-day mortality. In the second set, we further included laboratory parameters. The presence of leukocytosis (OR 6.7, 95% CI 3.3-13.7, P < .001), lymphocytopenia (OR 3,1, 95% CI 1,6-6,1, P = .001) and thrombocytopenia (OR 3,4 95% CI 1,5-8,1, P = .005) were found to be associated with increased 30-day mortality. Relatively lower mortality compared to Western countries and China mainly results from differences in baseline risk factors but may also implicate the importance of intensive supportive care.

Expanding scrub typhus beyond territories with a varied presentation in the holy Himalayas (DPST–AIIMS Rishikesh study)

Background: Scrub typhus, a rickettsial zoonosis, is endemic in Indian sub-continent, but is rare in holy Himalayan region due to natural adverse to both organism and vector. The study sought to describe the clinical profile of scrub typhus in the Himalayan region and adjoining plain lands. Methods and materials: We did a retrospective observational study of the positive cases from July 2018 to June 2019 in a tertiary care center. All possible risk factors, demographic details, clinical presentations, laboratory parameters, treatment, and outcomes were analyzed. Results: A total of 80 cases were analysed. Maximum cases were observed in month of September (post-monsoon). Major symptoms noted were fever, abdominal pain, headache, cough, breathlessness, and myalgia. Atypical presentations included were capillary syndrome and demyelinating polyneuropathy. Eschar detection rate was low. Among organ involvement, hematology system (70%) was most commonly observed followed by liver, kidney, brain, lungs, and heart respectively. Case fatality rate was 6.82%. Himalayan and non-Himalayan cohorts (n = 32 vs 48 respectively) did not show any statistically significant differences in clinical profile, although one could observe that Himalayan cohorts had higher incidences of leukopenia, splenomegaly, and myocarditis, while fever for >7days at admission, hepatomegaly, acute respiratory distress syndrome (ARDS) and requirement of mechanical ventilation, and major organ involvement and resulting admission in high definition unit and mortality were higher in the non-Himalayan cohorts. Uncontrolled diabetes, leucocytosis, liver and lung involvements were found to be predictor of hospital stay of >5days. Leucocytosis, kidney, liver, and brain involvements were found predictor for high dependency unit admission while development of shock was associated with liver, kidney, heart, and lung involvements. Similarly smoking >40 pack-years and presence of leucocytosis, kidney and brain involvements were significantly associated with mortality. Conclusion: The study reveals several atypical presentations and complications differing from the classical description, calling for redefining the clinical profile of scrub typhus. Himalayan cohorts have higher incidences of leukopenia, splenomegaly, and myocarditis compared to sub-Himalayan populations who have more incidence of ARDS. Brain and kidney involvements are found to have a higher incidence compared to other Indian scrub typhus cases. Ongoing study will answer more hidden truths of emerging scrub typhus.

MPN-334: Is There a Correlation Between Levels of Reactive Oxygen Species and the Platelet-to-Leukocyte Ratio in Essential Thrombocythemia?

Objective: Essential thrombocythemia (ET) is a BCR-ABL1-negative chronic myeloproliferative neoplasm characterized by a sustained proliferation of megakaryocytes that results in an elevated number of circulating thrombocytes. The complete blood count in ET can also reflect the presence of leukocytosis. ET is also characterized by increased levels of reactive oxygen species (ROS). Thus, our aim was to investigate whether ROS levels correlate with the platelet-to-leukocyte ratios in patients diagnosed with ET. Methods: ROS levels were measured by flow cytometry. The complete blood count was evaluated by standard methods. Spearman's Rho test was used to investigate the association between ROS levels and the platelet-to-leukocyte ratio. Results: A total of 62 patients diagnosed with ET were enrolled in the study. All patients had thrombocytosis at diagnosis (n=62, 100.0%), whereas only 51.61% (n=32) also had leukocytosis. The mean platelet count value in the thrombocytosis + leukocytosis subgroup was 802250.00±253573.30 platelets/mmc versus 673166.67±253053.37 platelets/mmc in the thrombocytosis-only subgroup (P=0.0495). The mean leukocyte count value in the thrombocytosis + leukocytosis subgroup was 15159.06±5321.99 leukocytes/mmc versus 7402.33±1565.30 leukocytes/mmc in the thrombocytosis-only subgroup (P Conclusions: According to our findings, there is a negative correlation between ROS levels and platelet-to-leukocyte ratio in patients with ET whose complete blood count shows both thrombocytosis and leukocytosis. Further studies are needed to elucidate whether the platelet-to-leukocyte ratio can accurately reflect oxidative stress levels in patients with ET.

Advanced maternal age impacts physiologic adaptations to pregnancy in vervet monkeys.

The trend to delay pregnancy in the USA has resulted in the number of advanced maternal age (AMA) pregnancies to also increase. In humans, AMA is associated with a variety of pregnancy-related pathologies such as preeclampsia (PE). While AMA is known to be a factor which contributes to the development of pregnancy-induced diseases, the molecular and cellular mechanisms giving rise to this phenomenon are still very limited. This is due in part to lack of a preclinical model which has physiologic relevance to human pregnancy while also allowing control of environmental and genetic variability inherent in human studies. To determine potential physiologic relevance of the vervet/African green monkey (Chlorocebus aethiops sabaeus) as a preclinical model to study the effects of AMA on adaptations to pregnancy, thirteen age-diverse pregnant vervet monkeys (3-16 years old) were utilized to measure third trimester blood pressure (BP), complete blood count, iron measurements, and hormone levels. Significant associations were observed between third trimester diastolic BP and maternal age. Furthermore, the presence of leukocytosis with enhanced circulating neutrophils was observed in AMA mothers compared to younger mothers. Moreover, we observed a negative relationship between maternal age and estradiol, progesterone, and cortisol levels. Finally, offspring born to AMA mothers displayed a postnatal growth retardation phenotype. These studies demonstrate physiologic impairment in the adaptation to pregnancy in AMA vervet/African green monkeys. Our data indicate that the vervet/African green monkey may serve as a useful preclinical model and tool for deciphering pathological mediators of maternal disease in AMA pregnancy.

HELLP Syndrome or Acute Fatty Liver of Pregnancy: A Differential Diagnostic Challenge: Common Features and Differences.

HELLP syndrome and the less common acute fatty liver of pregnancy (AFL) are unpredictable, life-threatening complications of pregnancy. The similarities in their clinical and laboratory presentations are often challenging for the obstetrician when making a differential diagnosis. Both diseases are characterised by microvesicular steatosis of varying degrees of severity. A specific risk profile does not exist for either of the entities. Genetic defects in mitochondrial fatty acid oxidation and multiple pregnancy are considered to be common predisposing factors. The diagnosis of AFL is based on a combination of clinical symptoms and laboratory findings. The Swansea criteria have been proposed as a diagnostic tool for orientation. HELLP syndrome is a laboratory diagnosis based on the triad of haemolysis, elevated aminotransferase levels and a platelet count < 100 G/l. Generalised malaise, nausea, vomiting and abdominal pain are common symptoms of both diseases, making early diagnosis difficult. Clinical differences include a lack of polydipsia/polyuria in HELLP syndrome, while jaundice is more common and more pronounced in AFL, there is a lower incidence of hypertension and proteinuria, and patients with AFL may develop encephalopathy with rapid progression to acute liver failure. In contrast, neurological symptoms such as severe headache and visual disturbances are more prominent in patients with HELLP syndrome. In terms of laboratory findings, AFL can be differentiated from HELLP syndrome by the presence of leucocytosis, hypoglycaemia, more pronounced hyperbilirubinemia, an initial lack of haemolysis and thrombocytopenia < 100 G/l, as well as lower antithrombin levels < 65% and prolonged prothrombin times. While HELLP syndrome has a fluctuating clinical course with rapid exacerbation within hours or transient remissions, AFL rapidly progresses to acute liver failure if the infant is not delivered immediately. The only causal treatment for both diseases is immediate delivery. Expectant management between 24 + 0 and 33 + 6 weeks of gestation is recommended for HELLP syndrome, but only in cases where the mother can be stabilised and there is no evidence of foetal compromise. The maternal mortality rate for HELLP syndrome in developed countries is approximately 1%, while the rate for AFL is 1.8 – 18%. Perinatal mortality rates are 7 – 20% and 15 – 20%, respectively. While data on the long-term impact of AFL on the health of mother and child is still insufficient, HELLP syndrome is associated with an increased risk of developing cardiovascular, metabolic and neurological diseases in later life.