Significant Decrease In Hemoglobin Research Articles

The impact of preoperative fasting time on patients undergoing partial nephrectomy and analysis of risk factors for postoperative hemorrhage.

This study investigates the impact of preoperative fasting time on patients undergoing partial nephrectomy and analyzes the risk factors for postoperative hemorrhage to provide clinical reference for physicians treating patients undergoing partial nephrectomy. A retrospective analysis was conducted on 74 patients who underwent partial nephrectomy for renal tumors between January 2022 and March 2024. Baseline and perioperative data were collected. The effects of long-term and short-term preoperative fasting on patients undergoing partial nephrectomy were compared. Additionally, univariate and multivariate logistic regression analyses were performed to identify risk factors for hemorrhagic complications following partial nephrectomy. Among the patients in this study, 26 (35.14%) underwent short-term preoperative fasting, while 48 (64.86%) underwent long-term preoperative fasting. The hemoglobin difference in the short-term fasting group was 21.08 ± 12.44 ml, compared to 13.65 ± 11.69 ml in the long-term fasting group, showing a statistically significant difference (p = 0.020). Differences in serum calcium (p = 0.003), serum magnesium (p = 0.031), and serum phosphorus (p = 0.001) between the short-term and long-term fasting groups were also statistically significant. Univariate and multivariate regression analyses identified the type of surgery (p = 0.050) and preoperative fasting time (p < 0.001) as independent risk factors for postoperative hemorrhage following partial nephrectomy. Patients undergoing partial nephrectomy with short-term preoperative fasting experience a more significant decrease in hemoglobin compared to those with long-term fasting. The type of surgery and preoperative fasting time are independent risk factors for postoperative hemorrhage in patients undergoing partial nephrectomy.

A Comparison of Postprocedural Hemoglobin in Catheter-Directed Thrombolysis versus Large-Bore Aspiration Thrombectomy for Acute Pulmonary Embolism

PurposeTo compare changes in hemoglobin (HB) following catheter-directed thrombolysis (CDL) versus large-bore aspiration thrombectomy (LBAT) of acute pulmonary embolism (PE). Materials and MethodsA single-center retrospective review of patients with acute high- and intermediate-risk PE treated with CDL or LBAT between December 2009 and September 2023 was performed. The LBAT group was divided according to usage of an autotransfusion device (ATD). There were 166 patients in the CDL group (56 years ± 15). LBAT patients were treated without (LBAT, n = 58, 61 years ± 16) or with (LBATw, n = 47, 62 years ± 15) an ATD. Endpoints included change in HB between preprocedural and postprocedural measurements, the 7-day postprocedural nadir (low point), and adverse events (AEs). ResultsThe mean HB changes between preprocedural and postprocedural measurements in the CDL, LBAT, and LBATw groups were −1.3 g/dL ± 1.3, −1.6 g/dL ± 0.98, and −1.1 g/dL ± 0.9, respectively (P = .098). The mean HB changes to the 7-day postprocedural nadir in the CDL, LBAT, and LBATw groups were −1.7 g/dL (SD ± 1.4), −2.4 g/dL (SD ± 1.3), and −1.8 g/dL (SD ± 1.3), respectively (P = .008). The minor hemorrhagic AE rates were 3.6% in the CDL group, 12.1% in the LBAT group, and 14.9% in the LBATw group (P = .010). There was no significant difference in moderate (P = .079) and major (P = .529) hemorrhagic AEs between the groups. There were no procedure-related mortalities. ConclusionsThe use of LBAT without ATD resulted in a significant decrease in HB to the 7-day postprocedural nadir compared with CDL or LBAT with ATD. This did not translate into significantly higher transfusion rates or moderate or major hemorrhagic events. Findings suggest that the decision between CDL and LBAT should not be based solely on the expected blood loss consideration.

Toxicological profile of Balanites agyptiaca in albino Wistar rats

Background: Balanites aegyptiaca (BAE) is a thorny tree that grows in most arid and semi-arid areas of Africa, the Middle East and India. It is used in traditional medicine for its cardioprotective, deworming, antihelmintic, anti-infectious and antifungal properties. Excessive consumption of this plant's products can present risks of intoxication for consumers. Objective: The aim of this study was to assess the acute and subchronic oral toxicity of the aqueous extract of Balanites aegyptiaca leaves and roots, with a view to ensuring the safety of consumers of this plant. Method: Acute toxicity was carried out in accordance with the OECD experimental protocol. The plant extract tested was administered orally to female rats at a single dose of 2000 mg/kg. These animals were observed for 14 days. For the subchronic toxicity study, the aqueous extract was administered daily orally to male and female rats at different doses (250, 500 and 1000 mg/kg) for 30 days. After the treatment period, the animals were sacrificed for hematological, biochemical and histopathological analyses. Results: The results of the acute oral toxicity test showed that the aqueous extract of Balanites aegyptiaca leaves and roots was non-toxic at a dose of 2000 mg/kg. During the sub-chronic test period, observation of rat signs and behaviour revealed no abnormalities in the groups of animals treated with the extract compared with controls. A significant variation in relative heart and liver weights was observed at 1000 mg/kg. In addition, there was a significant reduction in concentrations of aspartate aminotransferase, total cholesterol, triglycerides and low-density lipoproteins in these rats. Compared with control groups. There was also a significant decrease in hemoglobin and mean corpuscular hemoglobin, with an increase in lymphocytes and white blood cells at the same dose of 1000mg/kg. Histological examinations of the kidneys and liver showed normal renal architecture, and the liver also showed normal hepatic architecture with slight degeneration at a dose of 1000mg/kg of the extract tested. Conclusion: Single administration of the 2000 mg/kg dose did not induce signs of significant toxicity in rats. However, in long-term oral treatment, safety measures must be taken. Thus, sub-chronic oral exposure of BAE to lower doses is recommended, while higher doses, of the order of 1000 mg/kg, should be avoided.

Clinical and Immunological Factors Associated with the Progression of Lupus Nephritis in a Population from the Colombian Caribbean.

to identify clinical and immunological factors associated with the progression of lupus nephritis in a population from the Colombian Caribbean. we evaluated 401 patients diagnosed with SLE and lupus nephritis, treated at a reference center in the Colombian Caribbean, gathering data recorded in medical records. A proportion of 87% were female, with a median age of 42 years. Most patients presented with proliferative classes (90%), with class IV being the most common (70%). A proportion of 52% of patients did not respond to treatment, which is described as the lack of complete or partial response, while 28% had a complete response. A significant decrease in hemoglobin, glomerular filtration rate, and proteinuria was identified by the third follow-up (p < 0.001), along with an increase in creatinine, urea, and hematuria (p < 0.001). Patients with initial proteinuria > 2 g/day were found to be 27 times more likely to be non-responders (p < 0.001). Mortality was associated with the presence of serum creatinine >1.5 mg/dL (p = 0.01) (OR: 1.61 CI 95% 0.75-3.75) and thrombocytopenia (p = 0.01) (OR: 0.36; CI 95% 0.12-0.81). identifying factors of progression, non-response, and mortality provides an opportunity for more targeted and personalized intervention, thereby improving care and outcomes for patients with lupus nephritis.

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 &amp;gt;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 &amp;gt;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 &amp;gt;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.

Design and Rationale of the Phase 2 Baricitinib Study in Apolipoprotein L1–Mediated Kidney Disease (JUSTICE)

Individuals of recent West African ancestry develop focal segmental glomerulosclerosis (FSGS) and hypertension-attributed end-stage kidney disease (HTN-ESKD) at 4 times the rate of White Americans. Two protein-coding variants of the Apolipoprotein L1 (APOL1) gene, G1 and G2, explain 50% to 70% of the excess risk of HTN-ESKD and FSGS among this group. Increased expression of G1 and G2 in the kidney, mediated by Janus kinase/signal transducer and activator of transcription (JAK-STAT) signaling, drive pathogenesis of these kidney diseases. Baricitinib is an orally active inhibitor of JAK1/2 that blocks APOL1 synthesis. The Janus kinase-STAT Inhibition to Reduce APOL1-Associated Kidney Disease (JUSTICE) trial is evaluating the antiproteinuric efficacy and safety of baricitinib in patients with APOL1-associated FSGS and HTN-attributed chronic kidney disease (HTN-CKD). JUSTICE is a single-center, randomized, double-blind, placebo-controlled, pilot phase 2 trial of baricitinib in patients with proteinuria, APOL1-associated FSGS or APOL1-associated HTN-CKD without diabetes. A total of 75 African American patients with APOL1-associated CKD, including 25 with FSGS and 50 with HTN-CKD, aged 18 to 70 years will be randomized 2:1 to daily treatment with baricitinib or placebo, respectively. The primary efficacy end point will be percent change in urine albumin-to-creatinine ratio (UACR) from baseline to end of month 6. The primary safety end point will be incidence of clinically significant decreases in hemoglobin of≥ 1g/dl. The phase 2 JUSTICE study will characterize the antiproteinuric efficacy and safety of JAK1/2 inhibition with baricitinib in patients with APOL1-associated FSGS and APOL1-associated HTN-CKD.

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.

Effect of co-treatment of COVID-19 with Remdesivir

Background: Due to the COVID-19 pandemic, randomized clinical studies were conducted with Remdesivir in combination with Bariticinib or Dexamethasone, which have shown effectiveness for the treatment of COVID-19. Objective: We analyzed the effect of co-treatment with Remdesivir in a retrospective in Mexico. Methods: Thirty-four patients treated with Remdesivir in combination with Baricitinib or Dexamethasone were included. Age, sex, comorbidities, signs, and symptoms were recorded at hospital admission, intubation needs, intensive care unit (ICU) requirements, days of hospital stay and their evolution, as well as laboratory data upon admission and upon admission terminate Remdesivir treatment. Results: Most were male, with an age of 56.5 years (49 years-60.3 years), whose main comorbidity was obesity. The main symptoms on admission were dyspnea and cough. Thirty-two patients received the short Remdesivir regimen, 22 were co-treated with Baricitinb and 12 with Dexamethasone. Most did not require ICU care, 9 patients died, 19% of those co-treated with Baricitinib and 42% of those co-treated with Dexamethasone. A significant decrease in hemoglobin, protein, albumin and LDH levels was observed. Conclusion: In this study, we observed lower mortality in patients co-treated with Baricitinib vs those co-treated with Dexamethasone, and a hospital stay similar to that reported in randomized clinical studies.

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.