Significant Decrease In Hemoglobin Research Articles

C-Reactive Protein as an Early Marker of Severity and Outcome in Patients with SARS-CoV-2 Infection

Abstract Background SARS CoV-2 infection is a major cause of morbidity and mortality worldwide. The incidence of SARS CoV-2 infection is rising with millions of people getting infected daily. Mortality rate varies from a country to the other(0.3-6%), most of which are attributed to respiratory failure. Several studies have been performed to identify biomarkers for use in the early identification of patients at risk. Aim of the work This study was done to estimate and evaluate the plasma levels of CRP in patients with SARS CoV-2 and to study the association of CRP levels with severity of disease progression and prognosis of those patients. Patients and Methods This retrospective cohort study was conducted on 100 patients admitted to El-Obour Ain Shams University Specialized Hospital for Isolation during the period between January and October 2020. Results Regarding history patients whom were old or have any of the following comorbid conditons as hypertension, Diabetes mellitus, chronic liver disease and active cancer were statistically more prone to not surviving. Regarding complete blood picture, there was significant decrease in haemoglobin and or increase in total leukocytic count in those who did not survive. Serum Ferritin and D-Dimer were significantly high in those who did not survive. As regard CRP, it was significantly higher in the non-survivor group, Also it correlated with severity as ICU admission and need of respiratory support. Regarding the ROC curve result the best cut-off of CRP to predict mortality was >129mg/l, with Area under the curve = 0.981, Sensitivity = 90.91%, Specificity= 97.75%, positive predictive value = 83.3% and negative predictive value =98.9%. Regarding the ROC curve result the best cut-off of CRP to predict need of respiratory support was >55.3mg/L, with Area under the curve = 0.976, Sensitivity = 100%, Specificity= 86.21%, positive predictive value = 52.0% and negative predictive value =100.0%. Regarding the ROC curve result the best cut-off of CRP to predict need of ICU admission was >55.3mg/L, with Area under the curve = 0.987, Sensitivity = 100.0%, Specificity= 93.75%, positive predictive value = 80.0% and negative predictive value =100.0%. Conclusion Laboratory and clinical medicine groups should actively collaborate and optimize their individual expertise to potentially prove standardized biomarkers assays that will optimize patient care.

Influence of Pre-treatment of Withania somnifera Root Extract and Cow Urine on Hemato-biochemical Parameters in Acetaminophen-induced Toxicity in Swiss Albino Male Mice

Background: The present study was undertaken to investigate protective activity of W. somnifera root extract (W.S.R.E.), cow urine (C.U.) and their combination against acetaminophen (APAP) induced toxicity in male mice. APAP also known as paracetamol, is a well-known drug used for its analgesic and antipyretic effects. However, outside of the therapeutic window, the toxicity may result. W.S. and C.U. are from indigenous sources of plant and animal origins, respectively with several therapeutic activities. Methods: Sixty adult swiss albino male mice were randomly divided into six groups, comprising of ten mice in each group. Group I (control group) received 2% gum acacia suspension for 14 days orally and on day 14, 0.9% NaCl (@300 mg/kg b.wt.) intraperitoneally was administered after 30 min of prior treatment of various agents. Group II, III, IV, V and VI received 2% gum acacia, silymarin (@25 mg/kg b.wt.), W.S.R.E. (@100 mg/kg b.wt.), C.U. (@7.8 mL/kg b.wt.) and W.S.R.E. (@100 mg/kg b.wt.) and C.U. (@7.8 mL/kg b.wt.) co-treatment orally for 14 days and on day 14, APAP (@300 mg/kg b.wt.) intraperitoneally was administered after 30 min of prior treatment of various agents as mentioned. On 15th day, the animals were sacrificed and samples were collected to study various hematobiochemical and growth related parameters. Result: The treatment of acetaminophen caused significant decrease in haemoglobin, total erythrocyte count whereas increase in total leucocyte and prothrombine time. There were significant (p£0.05) decreases in plasma total protein, albumin and globulin values in group II (APAP), as compared to control (group I). Treatment with W.S. +C.U attenuates these alterations. W.S.R.E., C.U. and their combination pre-treatment mildly restored the changes to normal observed following APAP exposure in mice. However, the results of co-treatment group were more pronounced as compared to individual treatment groups. Thus, it was concluded that treatment with W.S.R.E. and C.U. curtailed the toxic effect of APAP, however, co-administration of both potentiated the protective effect.

Can local infiltration analgesia supplemented with tranexamic acid reduce blood loss during total knee arthroplasty?

PurposeThe aim of this study was to investigate the efficacy of TXA supplemented with local infiltration analgesia (LIA) for reducing blood loss in patients undergoing total knee replacement.MaterialsA retrospective study of 530 individuals with a mean age of 71.44 years was performed after posterior stabilized total knee arthroplasty. Patients were divided into three groups according to the method of bleeding control: I - patients without an additional bleeding protocol (control group); II - patients receiving IV TXA (TXA group); and III - patients receiving the exact TXA protocol plus intraoperative local infiltration analgesia (TXA + LIA group). Blood loss was measured according to the maximal decrease in Hb compared to the preoperative Hb level.ResultsThe mean hospitalization duration was 7.02 (SD 1.34) days in the control group, 6.08 (SD 1.06) days in the TXA group, and 5.56 (SD 0.79) in the TXA + LIA group. The most significant decrease in haemoglobin was found in the control group, which was an average of 30.08%. The average decrease in haemoglobin was 25.17% (p < 0.001) in the TXA group and 23.67% (p < 0.001) in the TXA + LIA group. A decrease in the rate of allogeneic blood transfusions was observed: 24.4% in the control group, 9.9% in the TXA group, and 8% in the TXA + LIA group (p < 0.01).ConclusionsCompared to the separate administration of tranexamic acid, the combination of perioperative administration with local infiltration analgesia significantly reduced blood loss in patients after total knee replacement.

Assessment of Blood Loss during Neuroendovascular Procedures

(1) Background: Neuroendovascular procedures have generally been considered to have minor or inconsequential blood loss. No study, however, has investigated this question. The purpose of this study is to quantify the blood loss associated with neuroendovascular procedures and identify predictors of blood loss, using hemoglobin change as a surrogate for blood loss. (2) Methods: A retrospective review of 200 consecutive endovascular procedures (diagnostic and therapeutic) at our institution from January 2020 to October 2020 was performed. Patients had to have pre- and post-operative hematocrit and hemoglobin levels recorded within 48 h of the procedure (with no intervening surgeries) for inclusion. (3) Results: The mean age of our cohort was 60.1 years and the male representation was 52.5%. The mean pre-operative hemoglobin/hematocrit was significantly lower among females compared to males (12.1/36.2 vs. 13.0/38.5, p = 0.003, p = 0.009). The mean hemoglobin decrease was 0.5 g/dL for diagnostic angiograms compared to 1.2 g/dL for endovascular interventions (p &lt; 0.0001), and 1.0 g/dL for all procedures combined. In a multivariate linear regression analysis, pre-operative antiplatelet/anticoagulant use was associated with a statistically significant decrease in hemoglobin. (4) Conclusions: Our data support that blood loss from diagnostic angiograms is marginal. Blood loss in endovascular interventions, however, tends to be higher. Pre-operative blood antiplatelet/anticoagulant use and increasing age appear to increase bleeding risk and may require closer patient monitoring.

Analysis of Short and Long-Term Impacts of Petrochemical Effluents on Cattla Cattla Fish on Neelambur Pond, Coimbatore, Tamil Nadu, India

The study aimed to assess the impact of petrochemical effluent on fish blood, examining both short- term and long-term exposure periods to evaluate toxicity stress symptoms in the rapidly evolving petroleum industry. Various biochemical and hematological parameters, along with enzymatic changes, were analyzed by exposing different organs of freshwater fish, C. catla, to the petrochemical effluent. The results indicated a significant decrease in hemoglobin (Hb) content, red blood cells, packed cell volume, and mean corpuscular hemoglobin (MCH) values. Conversely, there was a notable increase in white blood cells (WBC) during the exposure periods compared to the control. Hematological parameters, including Hb, RBC, mean corpuscular volume (MCV), and MCH, exhibited fluctuating results, with a consistent decrease observed in both short- term (24, 48, 72, and 96 hours) and long-term (10, 20, and 30 days) exposure periods, suggesting the occurrence of anemia in the exposed fishes due to petrochemical effluent. In the biochemical analysis, exposed fish showed a significant reduction in protein, carbohydrate, and lipid content across all organs, accompanied by increased enzyme activity observed in all organs of freshwater fish, C. catla. Consequently, this survey is instrumental in predicting potential risks to the population and aquatic system.

Efficacy of Bacillus subtilis in Reducing Geotrichum candidum Toxicology in the White Rat Biological Systems

The study aimed to evaluate the presence of Bacillus subtilis in the food dosed to laboratory rats to reduce the effect of G. candidum and its secretions of phenols on the rats’ health indicated by some chemical and biological blood variables. The experiment was conducted using 24 Rattus norvegicus adult male rats randomly divided into 8 groups 3 rats each. As treatments were; untreated control, dosing with 1 ml/Kg of Dimethyl Sulfoxide, pure orange juice, G. candidum infected juice, 1 ml B. subtilis+ 1 ml G. candidum infected juice, 60 mg/Kg fungal phenol, 1 ml B. subtilis+ 60 mg/Kg fungal phenol, or 1 ml B. subtilis. The results showed that dosing experimental rats with orange juice extracted from the orange parts infected with G. candidum, or dosing with phenols extracted from the fungus growth medium, led to a significant increase in blood variables including the numbers of WBC, GOT and GPT enzymes, and levels of blood urea. these two treatments also led to a significant decrease in hemoglobin and hematocrit levels, and blood content of protein. Whereas, the same treatments in the presence of B. subtilis maintained the values of all indicators under study within the normal limits close to control, and no negative effect was detected due to dosing with bacteria alone compared to the dosing with healthy juice.

Novel biochemical markers for the prediction of renal injury in beta-thalassemia major pediatric patients

Beta-thalassemia major is a severe inherited disorder characterized by inadequate production of hemoglobin beta chains, ineffective erythropoiesis, chronic hemolysis and necessitates lifelong transfusions, which lead to iron overload. The disease manifests itself in early childhood and persists throughout an individual’s life with a high risk of developing renal impairment, which cannot be reliably determined using routine markers. The objective of this research was to apply biomarkers to the evaluation of renal injury in pediatric­ patients within the age range of 1–14 years diagnosed with beta-thalassemia major. In the case-control study, the blood samples obtained in the Genetic Hematology Center in Thi-Qar Iraq Province were used: 60 samples from healthy individuals and 60 samples from the patients with beta-thalassemia, subdivided into 1-7 and 8-14 years old groups. The levels of hemoglobin, ferritin, creatinine and potassium were estimated with standard tests, enzyme-linked immunoassay was used to determine the level of neutrophil gelatinase-associated lipocalin (NGAL) and beta-2-microglobulin (β2M) as novel markers of tubular and glomerular dysfunctions. The study revealed a statistically significant decrease in hemoglobin, serum potassium levels and an increase in ferritin, NGAL and β2M levels in the patients from both groups compared to controls and elevation of creatinine level in the 8–14-year-old group. It was concluded that NGAL and β2M levels may be considered indicators for the early diagnosis of renal injury in pediatric patients with beta-thalassemia, as these biomarkers exhibit elevated levels before an increase in creatinine is observed. Keywords: beta-2-microglobulin, beta-thalassemia major, creatinine, ferritin, neutrophil gelatinase-associated lipocalin, renal injury

Evaluating the Effect of Artificial Liver Support on Acute-on-Chronic Liver Failure Using the Quantitative Difference Algorithm: Retrospective Study.

Liver failure, including acute-on-chronic liver failure (ACLF), occurs mainly in young adults and is associated with high mortality and resource costs. The prognosis evaluation is a crucial part of the ACLF treatment process and should run through the entire diagnosis process. As a recently proposed novel algorithm, the quantitative difference (QD) algorithm holds promise for enhancing the prognosis evaluation of ACLF. This study aims to examine whether the QD algorithm exhibits comparable or superior performance compared to the Model for End-Stage Liver Disease (MELD) in the context of prognosis evaluation. A total of 27 patients with ACLF were categorized into 2 groups based on their treatment preferences: the conventional treatment (n=12) and the double plasma molecular absorption system (DPMAS) with conventional treatment (n=15) groups. The prognosis evaluation was performed by the MELD and QD scoring systems. A significant reduction was observed in alanine aminotransferase (P=.02), aspartate aminotransferase (P<.001), and conjugated bilirubin (P=.002), both in P values and QD value (Lτ>1.69). A significant decrease in hemoglobin (P=.01), red blood cell count (P=.01), and total bilirubin (P=.02) was observed in the DPMAS group, but this decrease was not observed in QD (Lτ≤1.69). Furthermore, there was a significant association between MELD and QD values (P<.001). Significant differences were observed between groups based on patients' treatment outcomes. Additionally, the QD algorithm can also demonstrate improvements in patient fatigue. DPMAS can reduce alanine aminotransferase, aspartate aminotransferase, and unconjugated bilirubin. As a dynamic algorithm, the QD scoring system can evaluate the therapeutic effects in patients with ACLF, similar to MELD. Nevertheless, the QD scoring system surpasses the MELD by incorporating a broader range of indicators and considering patient variability.

Redefining Clinically Significant Hematuria After Holmium Enucleation of the Prostate.

Introduction and Objective: Holmium laser enucleation of the prostate (HoLEP) is often offered for symptomatic prostatic enlargement at high risk for bleeding. However, prior studies define clinically significant hematuria (CSH) narrowly as the need for blood transfusion or significant decrease in hemoglobin. We sought to evaluate risk factors contributing to a broader definition of CSH, which may contribute to alteration of clinical course. Methods: We analyzed 164 patients in a prospectively maintained database who underwent HoLEP at a single institution across two surgeons from November 2020 to April 2023. HoLEP was performed using Moses 2.0 (Boston Scientific) laser and the Piranha enucleation system (Richard Wolf). We defined CSH broadly as follows: clot retention, return to operating room, perioperative management variation due to hematuria, or continued gross hematuria past 1 month postoperatively. Univariable and multivariable ANOVAs were used. Multivariable analysis of CSH risk based on the use of antiplatelet (AP) agents or anticoagulants included correction for age, enucleation time (surrogate for case difficulty), and prostate volume. Results: 17.7% (29/164) of our patients developed CSH after HoLEP. Longer enucleation time was a mild risk factor for developing CSH (multivariate odds ratio [OR] 1.01, p = 0.02). The strongest predictor of CSH was the use of anticoagulation or AP agents (OR 2.71 p < 0.02 on univariable analysis, OR 2.34 p < 0.02 on multivariable analysis), even when aspirin 81 mg was excluded. Conclusion: With a broadened definition, 18% of patients developed CSH following HoLEP, which impacted the clinical course. Our data suggest that the current definition of significant hematuria is too narrow and does not capture many patients whose clinical course is affected by hematuria. While safe, anticoagulants and APs significantly predicted an increased CSH risk, and patients should be counseled accordingly.

Wildland Firefighter Critical Training Elicits Positive Adaptations to Markers of Cardiovascular and Metabolic Health.

The purpose of this study was to identify physiologic changes in body composition and resting metabolic markers of health across 2 wk of critical training (CT) in wildland firefighters (WLFFs). Twenty-two male and 3 female participants were recruited from 2 hotshot crews across the western United States prior to the 2022 fire season and monitored over their 80-h CT. Body weight (BW) and skinfolds were recorded before and after CT to estimate body fat (BF) and lean body weight (LBW). Blood was analyzed for changes in hematocrit, hemoglobin, plasma volume, and resting values of a lipid and metabolic panel. The high physical demands of CT resulted in improvements in total cholesterol (-19.3 mg/dL, P<0.001), triglycerides (-34.4 mg/dL, P<0.001), low-density lipoprotein cholesterol (-18.1 mg/dL, P<0.001), very-low-density lipoprotein cholesterol (-5.2 mg/dL, P<0.001), high-density lipoprotein cholesterol (+4.0 mg/dL, P=0.002), non-high-density lipoprotein cholesterol (-19.3 mg/dL, P<0.001), and fasting glucose (-4.3 mg/dL, P=0.008) from before CT to after CT. Significant decreases in hemoglobin and hematocrit were also seen (P<0.001) with corresponding increases in estimated plasma volume (+6.1%, P<0.001). These alterations were seen despite maintenance of BW, LBW, and BF. Lower pretraining BF was associated with a greater magnitude of improvements in fasting glucose and cholesterol markers. The observed improvements in baseline metabolic and cardiovascular markers along with plasma volume expansion suggest a positive response to the physical stress of WLFF CT. It appears that higher preseason fitness was associated with greater adaptations to the CT stressor.

Erythrocyte Indices in Asymptomatic Malaria Infected Pregnant Women

Background: Red blood cell changes are one of the most common complications in malaria and they play a very crucial role in malaria pathogenesis. Malaria infections are one of the common causes of maternal anaemia especially during pregnancy. The aim of this study was to determine red cell indices of pregnant women with asymptomatic malaria.&#x0D; Place and Duration of Study: Department of Haematology and Antenatal Unit both of Enugu State University of Science and Technology Teaching Hospital, between June and September 2022.&#x0D; Methodology: The study population consisted of 90 pregnant women (65 pregnant women positive to malaria parasite without symptoms and 25 pregnant women negative to malaria parasite) and 26 control non-pregnant women. For the whole study population, red cell indices which include hemoglobin (HGB), packed cell volume (PCV), red blood cell count (RBC), mean corpuscular volume (MCV), mean corpuscular hemoglobin (MCH), mean corpuscular hemoglobin concentration (MCHC), red cell distribution width standard deviation (RDW-SD), red cell distribution width coefficient of variation (RDW-CV) were measured by automated haematology analyzer.&#x0D; Results: In the asymptomatic malaria group (AMG), 21 (32.3%) had mild anaemia (HGB level 9.0-10.0 g/dl), 11 (16.9%) had moderate anaemia (HGB level 7.0-8.0 g/dl) and 2 (3.1%) had severe anaemia (HGB level &lt;7.0 g/dl). Also in AMG group, the RDW-SD was 54.22 +/- 11.45 fl, whereas in control group it was 48.75 +/- 10.24 fl (p=0.002). Again in the AMG group the MCHC of those that had two pluses was 318.03 +/- 16.31 g/l, whereas in those that had one plus, it was 309 +/- 20.17 g/l. The comparison between the first, second and third trimester showed significant decrease in HGB (7.63 +/- 1.36 vs 11.64 +/- 0.72 g/dl) and PCV (26.98 +/- 5.14 vs 36.20 +/- 2.19 %) in third trimester compared to first trimester (p= &lt;0.001, &lt;0.001). whereas RDW-CV (18.96 +/- 5.04 vs 15.00 +/- 2.64 %) and RDW-SD (59.04 +/- 15.19 vs 49.16+/- 7.00 fl) (p= 0.002, 0.003) significantly increased in third trimester compared to first trimester&#x0D; Conclusion: This study found anaemia in asymptomatic malaria infected pregnant women, significant decrease in haemoglobin and packed cell volume at third trimester, higher MCHC in those with two pluses of malaria and significant increase in red cell distribution width at third trimester.

Risk factors and early biomarkers of nephrotoxicity associated with the use of anti-VEGF drugs.

e24079 Background: Anti-angiogenic anticancer drugs that block VEGF can cause kidney damage (Fujii et al., 2019). Among the mechanisms of nephrotoxicity thrombotic microangiopathy (TMA) of renal vessels can be distinguished (Estrada et al., 2019). TMA can be accompanied the development of anemia, excessive schistocytes, as well as increased LDH levels and a low platelet count, which indicated the occurrence of endothelial dysfunction and microangiopathic processes (Hauser et al, 2009). The goal of this study was to assess the risk factors of early nephrotoxicity and the utility of NGAL, KIM-1, HIF-1α and nephrin levels in urine as early biomarkers of nephrotoxicity. Methods: The study included 50 patients who received anti-VEGF drugs (aflibercept, bevacizumab or ramucirumab). Nephrotoxicity was determined as a decrease in glomerular filtration rate (GFR) to &lt; 60 ml/min/1.73m2 at 8 weeks from the initiation of therapy. The laboratory parameters and the levels of KIM-1, NGAL, HIF-1α and nephrin in urine samples were determined by ELISA before treatment and after 1, 2, 4 and 8 weeks of treatment. To assess risk factors for nephrotoxicity we analyzed primary clinical and laboratory parameters. Results: Nephrotoxicity at 8 weeks was achieved in 21 (42%) of patients. A statistically significant decrease in hemoglobin and platelet count by 20 and 26%, respectively, from the initial level was observed. An increase in the number of schistocytes and a slight increase in LDH levels were also observed. The increase in NGAL, KIM-1 and nephrin levels was statistically significant in 1 weeks and the increase of HIF-1α in 2 weeks after the start of therapy (p = 0.001). The unfavorable predictors of nephrotoxicity as well as the favorable predictors in terms of decreasing renal function are presented in Table. ROC analysis demonstrated high sensitivity and specificity: NGAL – AUC 0.7; KIM-1 – AUC 0.69; HIF-1α – 0.7; nephrin – AUC 0.7. Conclusions: We report a significant increase in the parameters of microangiopathic hemolysis and in urine biomarkers of tubular and podocytic damage as well as hypoxia by the 8th week of treatment. We suggest that the TMA process can take part in renal damage. Increased levels of NGAL, KIM-1, HIF-1α and nephrin in the urine reflect the renal damage processes and have higher sensitivity and specificity then serum creatitine. The independent risk factors for nephrotoxicity are determined. [Table: see text]

РЕТИКУЛОЦИТАРНЫЕ И ЭРИТРОЦИТАРНЫЕ ИНДЕКСЫ В ОЦЕНКЕ АНЕМИЧЕСКОГО СИНДРОМА ПРИ ЮВЕНИЛЬНОМ ИДИОПАТИЧЕСКОМ АРТРИТЕ

The article presents the results of a study of erythrocyte and reticulocyte indi-ces in patients with juvenile idiopathic arthritis (JIA). The aim of the study was the possibility of early diagnosis of anemic syn-drome in patients with JIA based on the study of reticulocyte indices. Materials and methods. 118 patients with JIA at the age of 11 (6; 14) years underwent a general blood test with the determination of reticulocyte parameters. The comparison group included 30 healthy children. Results and conclusions. Revealed a significant decrease in hemoglobin (p = 0.001) less than 120 g/l in 22.9 % of patients with JIA. A statistically signif-icant difference from the comparison group was a decrease in the average concen-tration of hemoglobin in an erythrocyte (p = 0.03). An increase in the content of reticulocytes with a predominance of immature forms was found in 28.8 % of pa-tients with JIA. A decrease in the hemoglobin content in the reticulocyte and erythrocyte was detected in 28.8 and 44.9 % of cases. The systemic form of the disease affects erythropoiesis in the form of an increase in the content of reticulo-cytes with an increase in the content of immature forms (37.5 %), a decrease in the concentration of hemoglobin in the reticulocyte and erythrocyte (25 and 58.8 %).

Clinical evaluation of Ageratum houstonianum Mill intoxicated goats

Ageratum houstonianum Mill (A. houstonianum) is a widespread, highly invasive, and drought-resistant annual semi-shrub easily found in the pasture fields. It is called Gandhey Jhar locally. This study was conducted at the livestock farm of Rampur Campus, Rampur, Chitwan, Nepal, to determine the clinical progression and clinical parameters in A. houstonianum intoxicated goats to diagnose its toxicosis in small ruminants. Full blossomed A. houstonianum was fed ad libitum to six goats until the death of the animals. The time to develop the clinical signs and symptoms in goats ranged from 22 to 49 days. All the goats exhibited similar symptoms and signs such as stiffness of the neck, low temperature, respiratory distress, low pulse, anorexia, ruminal atony, general weakness, and finally, recumbency till death. After the onset of clinical symptoms, the entire clinical course persisted for 10-15 hours, followed by death. Two goats died on the 22nd day, and the rest goats died on 27th, 46th, 48th, and 49th days respectively. Hematologic examination revealed a significant decrease in hemoglobin and an increase in total WBC count. The serum biochemical values showed substantial alterations in ALT, AST, ALP, GGT, albumin, direct bilirubin, total bilirubin, glucose, urea nitrogen, and creatinine concentrations. These biochemical changes suggested hepatic and renal dysfunction. Therefore, clinical signs, hematology, and serum biochemistry can be of optimal diagnostic value for the A. houstonianum intoxication in goats.

Downregulation of UBA1 in Myelodysplastic Syndrome

Somatic loss-of-function mutations of major E1 ubiquitin activating enzyme gene UBA1 were identified in VEXAS (vacuoles, E1 enzyme, X-linked, autoinflammatory, somatic) and myelodysplastic syndromes (MDS) recently, suggesting that impairment of UBA1 activity contributes to pathogenesis of these diseases that have systemic inflammatory disorders. We sought to determine whether abnormal expression of UBA1 also occurs in MDS and contributes to development of disease. We analyzed RNA sequencing results obtained from the CD34+ bone marrow hematopoietic stem and progenitor cells (BM HSPC) in a cohort containing treatment naive MDS (N=55), chronic myelomonocytic leukemia (CMML, N=22), and heathy donors (N=12). Since UBA1 is an X-chromosome linked gene that escapes X-chromosomal silencing in females, all donors in this cohort were males. Results indicated that the level of UBA1 RNA was significantly downregulated in MDS but not in CMML. In the subtypes of MDS-low blasts (N=23, including MDS with ring sideroblasts, multilineage dysplasia, and single lineage dysplasia), forty-eight percent (N=11) had an over 1.5-fold downregulation of UBA1 RNA expression. Based on gene set enrichment assay, the UBA1 downregulation in MDS-low blasts was associated with altered autophagy and innate immune signaling such as complement, IL6, and TNF signals. Moreover, we also identified that the UBA1 downregulation in BM CD34+ cells of MDS-low blasts co-occurred with SF3B1 mutations detected by targeted next generation sequencing in BM mononuclear cells: Among the 11 MDS-low blasts patients with downregulated UBA1 expression, six patients (55%) carried mutant SF3B1, whereas none of the 12 patients with normal UBA1 expression had SF3B1 mutation. In another word, all SF3B1 mutant patients with MDS-low blasts (N=6) presented decreased UBA1 RNA. To characterize whether impairment of UBA1 affects hematopoietic functions of BM HSPC, we applied TAK-243, an UBA1 specific inhibitor, to BM CD34+ cells isolated from healthy donors (N=5, all males) and cultured in vitro. Colony formation unit (CFU) assays were performed to evaluate hematopoietic repopulating activity. Results indicated the CFU in CD34+ cells treated by TAK-243 was significantly reduced compared with cells treated by vehicle control (P<0.05). Moreover, when hematopoietic colonies formed by CD34+ cells were collected from methylcellulose plates and characterized by flow cytometry analysis, the frequency of CD71-/ CD235+ erythroid cells in TAK-243 treated plates was significantly lower than that in control plates (P<0.05). These results implicated that impairment of UBA1 activity perturbed hematopoietic functions of BM HSPC, particularly the erythropoietic function. We next evaluated in vivo hematopoietic impact of UBA1 impairment by applying TAK-243 to wildtype male B6 mice. Compared to vehicle control treated mice (N=4), mice treated by TAK-243 (N=4) exhibited significant decreases in hemoglobin and white cell counts (P<0.05) in peripheral blood (PB) and splenomegaly. In BM compartment, TAK-243 treated mice had decreased CD71+ and Ter119+ erythroid populations and increased Gr1+/ CD11b+ myeloid population (P<0.05). TAK-243 treatment also altered BM HSPCs, including reduced megakaryocyte-erythroid progenitor (MEP) and increased granulocyte-monocyte progenitor (GMP) in BM, as well as reduced CD150+/ CD48- stem cells in the BM Lin-/ Sca1+/ cKit+ (LSK) population. Moreover, BM LSK isolated from TAK-243 treated mice (N=4) formed significantly reduced number of colonies compared to vehicle control treated mice (N=4) in CFU assay. Consistently, in competitive transplantation assay, repopulating activity of BM cells of TAK-243 treated mice was significantly impaired, as measured by the donor-derived CD45.2 chimerism in PB of the CD45.1 recipients. Moreover, we performed bulk RNA-Seq in BM LSK of drug treated mice, which revealed that the ribosomal function and cell cycle regulation signals in TAK-243 treated mice were significantly affected. In summary, our study indicated that, in addition to somatic mutations, there was also a significant downregulation of UBA1 expression in BM HSPC of MDS. Compromised UBA1 function impairs hematopoietic function of BM HSPC, which could be an important mechanism for pathogenesis of MDS.

Subcapsular renal haematoma after ureteroscopic lithotripsy: a single-centre, retrospective study in China

ObjectivesTo investigate the incidence, predisposing factors, diagnosis and management of subcapsular renal haematoma (SRH) after ureteroscopic lithotripsy (URSL).DesignRetrospective observational study.SettingShandong Provincial Hospital, a 4500-bed tertiary hospital in China.ParticipantsThe data from...

The pattern of hematological parameters in type 2 diabetes.

Objective: To study the pattern of hematological parameters in Type 2 diabetic patients. Study Design: Observational Cross Sectional. Setting: Creek General Hospital, Karachi. Period: June to December 2021. Material &amp; Methods: Two hundred and five diabetic patients were selected by convenient sampling technique. Inclusion Criteria was individuals more than 30 years old, diagnosed with Type 2 DM greater than 3 months. Exclusion Criteria was patients with other chronic diseases including renal, cardiac, respiratory, hepatic or autoimmune disease, with Type 1 DM or less than 30 years old or diagnosed less than 3 months ago. Complete blood count parameters were recorded and analyzed. Results: Mean hemoglobin value was 11.5gm/dl. Hemoglobin was decreased in 121(59%). Out of 65 males the hemoglobin was decreased in 38(58.5%) and in 140 females decreased in 83(59.3%). (p=0.339). The TLC was increased in 50(24.4%), normal in 148(72.2%) and decreased in 7(3.4%). Among 65 males 11(16.9%), had increased TLC and in females in 39(27.9%). (p=.213). The platelet count is increased in 15(7.4%), normal in 173(84.8%) and decreased in 16(7.8%). In males the platelet count was increased in 2(3%), and in females in 13(9.4) (p=.180). Decreased hemoglobin and increased white cell count was highest in middle aged group. Microcytic anemia was common. There was a significant decrease in hemoglobin, an increase in white blood cell and platelet count in those on oral hypoglycemic in contrast to those on insulin or mixed therapy. Conclusion: Adult diabetics have a higher probability of having decreased hemoglobin and increased leucocyte count.

Association between bariatric surgery and anemia

ObjectivesSeveral studies have recently conducted to investigate the link between anemia and bariatric surgery (BS). The results from these studies, however, were inconsistent. Therefore, a meta-analysis was conducted to determine whether BS for weight loss is a risk factor for anemia. MethodsStudies were identified relevant papers published a cutoff date of May 2022 for meta-analysis by searching four electronic databases (PubMed, EMBASE, Web of Science and Cochrane Library). Pairs of authors conducted title and abstract, full-text assessment, data extraction and risk of bias assessment, and quality of articles. Random-effects models were used to estimate the pooled effect size and evaluated the overall quality of evidence. The sources of heterogeneity were assessed with I2. The Newcastle-Ottawa scale (NOS) was used to assess the methodologic quality of selected studies. The publication bias was assessed using funnel plots and Egger's test statistics. ResultsIn all, eight studies comprising 3150 patients were finally included in the final study analysis. Of these, pooled analysis of eight studies detecting association between anemia and BS for weight loss yield a statistically significant correlation (SMD −1.12 (−1.46—−0.78, I2=93%). Subgroup analyses were performed according to postoperative follow-up time and operation method. Before 24 months postoperatively, no patient had a significant decrease in hemoglobin. More than 24 months after BS, patients show a significant reduction in hemoglobin. In addition, the hemoglobin level was not changed after sleeve gastrectomy (SG) and adjustable gastric banding (AGB) (SMD −0.19 (−1.04—0.67, I2=0% for SG; SMD −0.30 (−0.82—0.22 for AGB), but the hemoglobin level was significantly reduced after Roux-en-Y gastric bypass (RYGB) (SMD −1.19 (−1.52—−0.87, I2=94.2%). ConclusionThis current meta-analysis found that at 24 months after RYGB, the patient's hemoglobin level was significantly reduced, increasing the risk of anemia. Therefore, attention should be paid to the occurrence of anemia after BS. A large, placebo-controlled, multi-center study is needed to clarify the role of BS for weight loss in this patient anemia.

Ethanol Leaf Extract of Synsepalum dulcificum Schumach. &amp; Thonn. (Sapotaceae) Induces Distortions in Renal, Hepatic and Reproductive Indices in Sprague-Dawley Rats

Background and Purpose: Synsepalum dulcificum (Sapotaceae) is used in traditional medicine for treatment of diabetes, cough and cancer. This study was designed to investigate the in vivo toxicological endpoints of the ethanol leaf extract of S. dulcificum in male and female rats.&#x0D; Methods: After estimating the LD50 in mice, forty-eight rats were randomly assigned to four groups of twelve rats each in a sex ratio of 1:1 and were orally administered 10 mL/kg distilled water (control) and 118, 237, 475 mg/kg/day of the extract respectively for forty-five days. The animals were thereafter euthanized and blood samples collected for haematological, biochemical and antioxidant assays. Sperm parameters were evaluated and testis, liver, heart and ovary were harvested for histopathology. Constituents of the extract were determined by GC-MS.&#x0D; Result: The LD50 (oral) was estimated to be 4750 mg/kg in mice. There was a significant decrease in haemoglobin but lymphocytes and monocytes were significantly increased compared to control. Aspartate transaminase and alanine transaminase were significantly increased compared to control. Creatinine increased, high density lipoprotein (HDL) and albumin decreased significantly in treated rats. There was a significant increase in enzymatic and non-enzymatic antioxidants and a significant reduction in malondialdehyde (MDA). There were significant increases in reproductive markers of sperm count, motility and abnormality. Renovascular congestion and preserved cytoarchitecture in other organs were observed. Twenty-one compounds including n-hexadecanoic acid, oleic acid, 2,3-dihydro-3,5-dihydroxyl-6- methyl-4H-pyran-4-one (DDMP) and phytol were identified.&#x0D; Conclusion: Prolonged use of the ethanol leaf extract of S. dulcificum could result in hepatic and renal dysfunctions and may increase the risk for male infertility and cardiovascular diseases.

Clinical, hematological and some biochemical alterations during diarrhea in Friesian calves naturally infected with E. coli and Salmonella

BackgroundThis study aimed to assess the clinical and hemato-biochemical changes associated with diarrhea in E. coli and Salmonella pathogens in Friesian bovine calves less than one month old as well as to examine the relationship between Vit D3 and cardiac biomarkers.ResultsThe study was carried out on 43 Friesian calves from a private farm in Ash Sharqia Governorate, 33 diarrheic calves aged 1–14 days with an average body weight 43.7 ± 1.2 kg, and 10 apparently healthy calves were kept as a control group to investigate the clinical and hemato-biochemical profiles. E. coli and Salmonella pathogens were isolated from the diarrheic calves where 76% were E. coli and 24% were Salmonella. Diarrheic calves showed signs of anorexia, weakness, dullness, staggering gait, pale mucous membranes with sunken eyes and dehydration. Analysis of clinical and hemato-biochemical profile of the diarrheic calves revealed significant increase in body temperature, respiratory rate, heart rate, white blood cells, neutrophils, serum potassium, urea, creatinine, ALT, AST, cardiac NT-proBNP and cardiac troponin I with significant decrease in hemoglobin, packed cell volume, erythrocytes, serum Vit D3, sodium, glucose, total protein and albumin concentrations.ConclusionsIt could be concluded that bacterial diarrhea has a severe negative impact on the clinical and hemato-biochemical profile of the neonatal calves with diarrhea. Serum cardiac biomarkers such as cardiac troponin I (cTn-I) and NT-proBNP were significantly higher in neonatal calves with diarrhea, and there is an important relationship between cardiac biomarkers and vitamin D levels.