Total Leucocytic Count Research Articles

Pre- and post -exercise variation of blood parameters on performance endurance horses: a first race study from Algeria

Abstract: This paper presents the first study conducted in Algeria to determine the pre and post-race hematological and biochemical parameters of horses of a 90 km endurance race for eliminated horses’ category and those who completed the races with good performance. This study was conducted on 15 endurance horses (10 Arabian Thoroughbred, 4 Arabian-Barb and 1 Barb). Nine (9) horses successfully completed the endurance race, whereas the other 6 were eliminated. Blood samples were collected from each animal before and after the end of the race. Whole blood samples were used for measuring the blood-biochemical parameters. Our results showed a significant increase in the hematological parameters (RBC, HB, Ht and MCV), the total leucocyte count, neutrophils and platelets for the group of horses who finished the race successfully. A significant decrease was noticed for the lymphocytes and eosinophils numbers while serum biochemical parameters showed a significant increase of Ca, TG, urea, U-A, AST and CK and a decrease of Mg, CHE, GLU and ƔGT. This study showed that, for the eliminated horses, there were significant changes in values of the total leucocytic count, lymphocytes, neutrophils, HB and Ht as compared to good performance horses. Serum biochemical parameters showed a significant increase of TG, U-A, AST and CK and a significant decrease of Ca, Mg, CHE and ƔGT. Most of the hemato-biochemical parameters of both the eliminated horses and those who completed the race successfully depicted significant differences. The results of this study suggested that biochemical findings could help identify horses with an increased risk of developing metabolic alterations before their elimination during competitive endurance races of different distances. Therefore, proper management protocols, standard feeding and watering with proper preparation of animals before the race could prevent electrolytes imbalance and pathological affections during racing.

Prognostic Role of CD200 in Acute Lymphoblastic Leukemia Patients.

Overexpression of CD200 in ALL patients indicates that it may be useful in the characterization of leukemia initiating cells (LIC). We aim at investigating the expression pattern of CD200 on leukemic B cells and the correlation of CD200 expression with various clinical and laboratory findings in 62 newly diagnosed acute lymphoblastic leukemia patients. All patients were subjected to full history taking, a thorough clinical examination, and laboratory investigations, which included complete blood count (CBC), BM aspiration, immunophenotyping of blast cells, and CD200 expression. There is a higher statistically significant mean value of CD200 expression among the cases (66.15 ± 23.08) than the control group (0.37 ± 0.2) (p value ≤ 0.001). CD200 expression shows a significant correlation with total leucocytic count and hemoglobin level (p = 0.001, 0.03, respectively). This study showed that CD200 expression was expressed in 100% of the patients. Correlations between CD200 expression and different laboratory data of patients revealed that there was an impact of CD200 on different diagnostic findings. After the follow-up of the patients, we found that the use of PRISM function of the software could add value to the detection of minimal residual disease.

Does Urinary Vitamin D-Binding Protein Have a Role in the Prediction of Steroid Resistance in Nephrotic Syndrome? A Cohort Study on Egyptian Children

Background: Nephrotic syndrome (NS) is a common glomerular disease in children, for which there are currently no noninvasive markers for predicting responsiveness to steroid treatment. Objectives: This study aimed to analyze the relationship between clinical-laboratory presentations and subsequent response to steroid therapy and to evaluate the role of urinary vitamin D binding protein (uVDBP) as a predictor of steroid resistance (SR). Methods: This was a prospective longitudinal study on 60 children with active NS (30 patients with newly diagnosed NS and 30 with relapsed NS). In addition, 30 control subjects served as a reference group for uVDBP values. The patients were evaluated before starting steroid therapy, and response to steroid therapy was monitored 4 - 8 weeks later. Results: The levels of uVDBP were elevated in patients with NS (33.33 ± 15.6 ng/mL) compared to control subjects (17.35 ± 5.5 ng/mL, P < 0.001). Also, the levels of uVDBP were significantly higher in patients with relapsed NS (37.93 ± 16.2 ng/mL) than in newly diagnosed NS patients (28.73 ± 13.67 ng/mL, P = 0.014). The level of uVDBP on presentation did not significantly differ between patients who had steroid-sensitive nephrotic syndrome (SSNS) (34.91 ± 15.01 ng/mL) and patients who had steroid-resistant nephrotic syndrome (SRNS) after 4 - 8 weeks of steroid treatment (32.60 ± 15.94 ng/mL, P = 0.417). Steroid resistance was significantly associated with a younger age of onset, specifically below 2.1 years (P = 0.023), a longer duration of the illness (P = 0.007), having more relapses (P = 0.002), total leucocytic count on presentation > 8.05 × 103/mm3 (P = 0.031), and platelet counts on presentation > 516.5 × 103/mm3 (P = 0.044). Conclusions: In this study, we found that uVDBP levels could reflect disease severity rather than predict the pattern of steroid responsiveness. Younger age of onset, longer duration of illness, previous relapses, and increased total leukocyte and platelet counts on presentation were associated with SRNS.

Intoxication Induced by Urea Containing Diets in Broiler Chickens: Effect on Weight Gain, Feed Conversion Ratio, Hematological and Biochemical Profiles

Urea as a source of cheap non-protein nitrogen is used to adulterate fish and meat meals which are basic components of broiler diets. The present study was carried out to elucidate the effects of urea on weight gain, and hematological and biochemical profiles. A total of 48 broiler chicks were randomly allotted into 4 groups, designated Groups 1, 2, 3 and 4 of 12 birds each. Birds in Groups 2, 3 and 4 were fed on diets containing urea at the levels of 1%, 2.5% and 4%, respectively. Birds in Group 1 served as control and were not exposed to urea. Experimentation period was for 3 weeks and experiment was terminated when birds were 42 days of age. Body weight of all intoxicated birds at the various intervals was significantly decreased in comparison with that of the untreated control. Compared with control, all intoxicated broilers manifested significant (P ≤ 0.05) decrease in all hematological parameters involving erythrocytic and total leucocytic counts, Hemoglobin (Hb) and Packed Cell Volume (PCV) on a dose- and time-pattern. In comparison with the control levels, biochemical profile of the intoxicated birds disclosed significant decrease in blood glucose level and significant increase in serum uric acid, urea, Alkaline Phosphatase (ALP) and Lactate Dehydrogenase (LDH) levels. Based upon the present data, it was concluded that the addition of urea to broiler diets bears serious sequences concerning the general health condition, performance, weight gain, and hematological and biochemical profiles.

Clinical, hematological, serum biochemical, and acute phase protein indices in pulmonary affected calves

This study was performed on 24 calves aged about 30-100 days old, fourteen calves were suffering from signs of pulmonary affections including fever, bilateral muco-purulent nasal discharge, cough and abnormal lung sounds upon auscultation and these calves were enrolled as pulmonary affected group. The other ten calves were apparently clinically healthy as proved by clinical examination and were used as a control healthy group. Blood and serum samples were collected from healthy and diseased calves (before and after treatment). Hematological analysis of diseased calves before treatment showed a significant decrease in the value of RBCs and Hb, with no significant changes in the value of PCV between healthy and diseased calves before and after treatment. The total leucocytic count showed a significant increase in its value in diseased calves with significant increase in neutrophils and lymphocyte (%) as compared with healthy ones. Serum biochemical analysis of pulmonary affected calves showed hypoproteinemia, hypoalbuminemia, hypoglycemia, hyponatremia, hypochloremia and hyperkalemia as compared with healthy control calves. Activities of serum AST, ALT showed significant elevations in pulmonary affected calves with no significant changes in levels of total and direct bilirubin as compared with healthy calves. Analysis of acute phase protein of diseased calves before treatment showed a significant increase in values of Haptoglobin (Hp), serum amyloid A (SAA), Ceruloplasmin (Cp) and C - reactive protein (CRP) as compared with their levels after treatment and in healthy calves.

Ameliorative effects of 25-hydroxycholecalciferol levels on broiler chickens challenged with infectious bronchitis coronavirus: A novel approach

This study aimed to see how 25-hydroxyvitamin D 3 [25(OH)D] supplementation affected the performance, immunity, and vitamin D status of broilers, with and without infectious bronchitis virus challenge. Day-old chicks (n = 1000) were divided into four dietary treatments. All experimental treatments were containing 5000 IU of D3 and supplemented with 0, 100, 300, or 500 g/tonne of Bio D® containing 0, 13.94, 41.82 or 69.70 mg 25(OH)D, respectively. In unchallenged birds, the inclusion of 25(OH)D significantly improved survival rates and EPEF values, and no significant difference in LBW, BWG, FC, or FCR was observed. In infectious bronchitis virus (IBV)-challenged birds, the 25(OH)D treatment showed less deterioration in BWG, and FC compared with the control, especially 25(OH)D500 group. The lowest mortality was observed in the 25(OH)D500 group. The health status of chicks fed diets supplemented with 25(OH)D post-challenge had significantly better CD4, CD8, and immunoglobulin (IgG, IgM) levels, H/L ratio, total leucocytic count (TLC) in peripheral blood and IBV titers, cytokine (including interleukin (IL) 10) and (IFN)-γ expression, and reduced IBV shedding. After IBV challenge, all 25(OH)D groups recorded higher levels of plasma vitamin D than the control. Furthermore, 25(OH)D groups showed significantly higher antibody titers than the control group. In general, dietary supplementation with different levels of 25(OH)D had a positive effect on inflammatory reaction and stimulated the systemic innate immune responses of chickens during IBV challenge. In turn, recovery in the challenged birds with 25(OH)D rapidly occurred compared with that in the control group.

MPN-221 Management Parameters of Myeloproliferative Neoplasm (MPN) With JAKV617F Mutation During Conception Optimizing the Outcome.

Essential thrombocytopenia (ET), polycythemia vera (PV), and myelofibrosis (MF) are heterogeneous groups of clonal hematopoietic cells the major subgroups within MPNs. MPNs can be critical, mainly due to the risk of thrombosis. ET is mainly concerned with increased risk of thrombosis with preserved quality of life, PV affecting both morbidity and also life expectancy; elevated total leucocytic count enhances the TTT with Interferon Alpha due to cytogenetic remission in case of JAKV617F and so pregnancy with MPNs has been reported to be associated with maternal thrombosis, hemorrhage, and placental dysfunction, leading to fetal growth restriction or loss. A retrospective study was held at Ain Shams University (outpatient clinic) and the prenatal care of El Sheik Zayed Al Nahian (MOH). 25 patients aged (18-55) were included 14 patients with ET (56%), 8 patients with PV (32%), 3 patients with MF 12%; those with MF didn't meet the inclusion criteria. Recorded total 118 pregnancies with live birth represented 70% in ET and 62% in PV, 56% spontaneous losses occurred in the first trimester, 24% in the second trimester, and 11% in the third trimester. The aspirin dose was described in all patients with ET and PV with dose 75 mg and was correlated with the pregnancy outcome to show a significant correlation with P>0.5. Low molecular weight (LMWT) heparin was added as a second line in 64% of patients with a significant correlation with pregnancy outcome as regard live birth, P>0.5. Interferon was added in the second trimester in two patients with PV with no impact on the outcome of live birth. Patients with PV continue on aspirin and LMWT heparin (Clexan) postpartum till the end of the puerperium in 4 patients with PV. Incidence of bleeding or thrombosis in patients treated with LMWH vs Aspirin only in the postpartum period showed no significant difference. Preeclampsia was reported in 2 patients 8% and ended in a live birth. To improve outcomes and reduce complications, several strategies have been attempted, including aspirin, heparin, and cytoreductions with interferon.

A STUDY ON CLINICAL CHARACTERISTICS OF ACUTE CHOLECYSTITIS AND ITS RELATION WITH ELEVATED LIVER ENZYMES AND BILIRUBIN

ntroduction: Acute cholecystitis is the most common complication in a gallstone disease and remains one of the most common medical problems leading to surgical intervention. The clinical picture of the patients with acute cholecystitis is further complicated by deranged liver function tests due to inammatory process induced by cholecystitis.74Liver damage in patients with gallstones is thought to be the result of chronic extra hepatic biliary tract obstruction with or without repeated episodes of cholangitis.69However, a few studies have reported the presence of hepatocellular injury in patients with acute cholecystitis without choledocholithiasis.70,38We conducted this study further to demonstrate any relation of gallstones with deranged liver function. This tertiary clinic based prospective observational study on 100 patients of gallMethods: stone disease diagnosed on imaging, was conducted at the Department of Surgery, Silchar Medical College and Hospital from 7th June 2018 to 6th June 2019.All routine tests with special reference to Total Leucocyte and Differential Leucocyte counts and Liver function tests- with special reference to serum bilirubin and fraction, Serum AST, ALT, ALP,GGT were obtained and statistical analysis performed to demonstrate their inter- relationship with gallstone disease. On the day of admission (day-0), 32 patients (15.62% male & 84.37% female) had increased level ofResult: AST. Similarly, ALT was increased in 49 patients (20.4% male & 79.59% female), ALP was increased in 32 patients (15.62% male & 84.37% female), GGT was increased in 38 patients (26.31% male & 73.6% female).All four liver enzymes were increased in 32% patients (12.5% male & 87.5% female). Total Bilirubin was increased in 17 patients out of which 35.29% were Male and 64.7% were Female. Direct Bilirubin was increased in 26% patients (9 Males and 17 Females). Total Leucocytic count was increased in 60 patients out of which 14(23.3%) were Males and 46(76.6%) were Females. On the day of admission, AST was found to be in the range of 19U/L- 116U/L in the study population with a mean value of 48.10+27.59 and median value of 37.50.ALT was found to be in the range of 3U/L-141U/L in the study population with a mean value of 56.33+33.75 and median value of 40. ALP was found to be in the range of 60U/L-234U/L in the study population with a mean value of 117.58+39.64 and median value of 100.50. GGT was found to be in the range of 22U/L- 154U/L in the study population with a mean value of 74.66+30.05 and median value of 69.50. The mean values of Liver enzymes, Bilirubin (Total & Direct) and TLC were found to be signicantly decreased on 6 weeks after admission. Liver enzymes and bilirubin tend to marginally increase in few cases of acute cholecystitis asConclusion: a result of the inammatory process. However, this increase is transient and the levels come down to normal once the inammatory process of acute cholecystitis subsides.

Impact of COVID-19 on digestive system: prevalence, clinical characteristics, outcome, and relation to the severity of COVID-19

BackgroundCoronavirus disease 2019 (COVID-19) is commonly associated with respiratory symptoms. However, gastrointestinal (GI) symptoms are increasingly recognized in COVID-19 patients. The aim is to study the prevalence and features of gastrointestinal manifestations in severe acute respiratory coronavirus 2 (SARS-CoV-2) infected patients and evaluate the outcome among the studied population.ResultsWe enrolled adult patients with laboratory-confirmed COVID-19 admitted to Ain Shams University designated hospitals, Cairo, Egypt, from March 2021 to June 2021. The patients were assigned to a GI group and a non-GI group based on the presence or absence of one or more digestive symptoms. A total of 300 hospitalized COVID-19 patients were included, of which 104 (34.7%) had one or more digestive symptoms. They were compared with 196 COVID-19 patients without GI symptoms. The most common reported GI symptom was diarrhea (82.7%). GI symptoms’ presence was higher in moderate cases. Patients with digestive symptoms presented for care later than those without (7.9±3.8 vs 7.4±7.2 days, P=0.5). Moreover, they have lower mortality, though non-significant (7.7 vs 12.8%, P=0.18). Patients with digestive symptoms had lower total leucocytic count (TLC), neutrophil count, neutrophil to lymphocyte ratio (NLR), platelet count, and higher serum sodium than those without digestive symptoms.ConclusionGI symptoms are prevalent among COVID-19 patients, and the most common was diarrhea. The presence of GI manifestations was not associated with increased mortality.

ASSESSMENT OF LAPAROSCOPIC APPENDECTOMY IN PATIENTS OF COMPLICATED APPENDICITIS IN TERTIARY CARE TEACHING HOSPITAL OF CENTRAL INDIA

Background: Appendicitis is the commonest abdominal surgical emergency in the world which may lead to complications like appendicular abscess or mass, gangrene, perforation and peritonitis. Present research aimed to evaluate the wellbeing and the effectiveness of laparoscopy for managing complicated appendicitis.
 Material and methods: Present study was carried out on 50 patients at tertiary care institution of Chhattisgarh in Central India for the period of 2 year. This study is including patients of complicated appendicitis undergoing laparoscopic management. Parameters studied included Age, Gender, WBC count, wound infection and hospital stay.
 Results: There was increase of total leucocytic count in most of the patients; Mean WBCs was 12.71±5.37. 33 patients had pus free IPF collection and perforated appendicitis (PA), 11 patients had turbid free IPF collection with AA (highly inflamed appendix), 2 case was mucocele of the appendix, 2 cases of appendicular abscess (3.3%) and 2 cases of gangrenous appendix.
 Conclusion: Management of complicated appendicitis laparoscopically is practicable, secure and can present a small occurrence of infectious impediments, fewer post-operative pain, fast revival and improved cosmesis on the cost of extended operating time than Open Appendectomy

Interleukin-4 gene intron 3 VNTR polymorphism in adult acute myeloid leukemia

BackgroundThe proliferation of acute myeloid leukemia (AML) blast into the bone marrow microenvironment is controlled by cytokines. Interleukin-4 (IL-4) has recently been discovered to suppress the development and persistence of AML cells selectively. Intron three of the Interleukin-4 (IL-4) gene contains a 70-bp minisatellite region polymorphism that may influence gene transcriptional activity and subsequently affect the production level of IL4. We investigated the IL-4 gene intron three variable number tandem repeat (VNTR) polymorphism as a molecular marker in AML associated with clinical and laboratory variables and a prognostic factor for therapeutic response and disease outcome.ResultsIL-4 gene intron three minisatellite regions polymorphism was assessed in 60 adult AML patients and 60 healthy controls, comparable concerning age and gender, using polymerase chain reaction. Three study marker genotypes were detected in AML patients; P1/P1 (3%), P1/P2 (40%), and P2/P2 (56.7%). The frequency of P2 alleles was significantly more in AML patients than in healthy controls (76.7% versus 25%; P < 0.001). Compared to the heterozygous group and P1/P1 carriers, AML patients with the homozygous P2/P2 genotype had a higher total leucocytic count and increased blast percentages in bone marrow or peripheral blood, besides a lower platelet count. P2P2 genotype was also significantly associated with poor therapeutic response, higher susceptibility to disease recurrence and shorter overall survival and disease-free survival.ConclusionThe IL-4 intron 3 VNTR polymorphism could be included in the molecular risk stratification of AML to predict poor disease. This information can be utilized in incorporating biological therapy into the present therapeutic protocols to enhance chemotherapy regimens’ current low response rates.

Comparison of COVID-19 characteristics in Egyptian patients according to their Toll-Like Receptor-4 (Asp299Gly) polymorphism

Toll-like receptor (TLR)-4 plays a vital role in recognizing viral particles, activating the innate immune system, and producing pro-inflammatory cytokines.This cross-sectional study aimed to compare COVID-19 severity, progression, and fate according to TLR-4 (Asp299Gly) polymorphism in Egyptian patients.A total of 145 COVID-19 patients were included in this study. TLR-4 (Asp299Gly) genotyping was done using the PCR restriction fragment length polymorphism (PCR-RFLP) approach.The most commonly encountered TLR-4 genotype in relation to the amino acid at position 299 was the wild-type AA (73.1%); meanwhile, the homozygous mutant GG genotype (8.3%) was the least encountered. At hospital admission, 85.8% of the AA group had free (with no ground glass opacities) chest computed tomography (CT) examination, and 16.0% were asymptomatic. On the other hand, of the AG and GG groups, 81.5% and 83.3%, respectively showed bilateral ground-glass opacities in chest CT, as well as 25.9% and 75.0%, respectively were dyspneic. Values of the total leucocytic count, C-reactive protein (CRP), ferritin, and D dimer increased in the AA<AG<GG sequence. In contrast, hemoglobin values and the absolute lymphocyte counts decreased in the AA>AG>GG sequence. ICU admission (83.3%) and in-hospital death (33.3%) rates were significantly higher in the GG group.In COVID-19 patients, the TLR-4 mutant G allele may be associated with a more aggressive disease course and in-hospital death. New therapeutic alternatives could be aimed at this area.

Impact of Systemic Inflammatory Response Syndrome on Clinical, Echocardiographic, and Computed Tomographic Outcomes Among Patients Undergoing Transcatheter Aortic Valve Implantation.

BackgroundSystemic inflammatory response syndrome (SIRS) is a systemic insult that has been described with many interventional cardiac procedures. The outcomes of patients undergoing transcatheter aortic valve implantation (TAVI) are thought to be influenced by this syndrome not only on short-term, but also on long-term.ObjectiveWe assessed the association of SIRS to different clinical, echocardiographic, and computed tomographic (CT) outcomes after TAVI.MethodsTwo hundred and twenty-four consecutive patients undergoing TAVI were enrolled in this study. They were assessed for the occurrence of SIRS within the first 48 h after TAVI. Patients were followed-up for short- and long-term clinical outcomes. Serial echocardiographic follow-ups were conducted at 1-week, 6-months, and 1-year. CT follow-up at 1 year was recorded.ResultsEighty patients (36%) developed SIRS. Among different parameters, only pre-TAVI total leucocytic count (TLC), pre-TAVI heart rate, and post-TAVI systolic blood pressure independently predicted the occurrence of SIRS. The incidence of HALT was not significantly different between both groups, albeit higher among SIRS patients (p = 0.1) at 1-year CT follow-up. Both groups had similar patterns of LV recovery on serial echocardiography. Long-term follow-up showed that all-cause death, cardiac death, and re-admission for heart failure (HF) or acute coronary syndrome (ACS) were significantly more frequent among SIRS patients. Early safety and clinical efficacy outcomes were more frequently encountered in the SIRS group, while device-related events and time-related valve safety were comparable.ConclusionAlthough SIRS implies an early acute inflammatory status post-TAVI, yet its clinical sequelae seem to extend to long-term clinical outcomes.

The modulatory effect of carvacrol on viral shedding titer and acute phase response in broiler chickens experimentally infected with infectious bronchitis virus

Infectious bronchitis virus (IBV) is one of the major respiratory diseases of broiler causing huge economic losses. The inability to control IBV using different vaccination programs owing to the high mutation rate and recombination ability of the RNA genome generates IBV variants. This study was designed to give a specific perspective of carvacrol effect on early immune response, viral shedding titer, oxidative stress, serum biochemical parameters and clinical consequences in broilers experimentally infected by IBV. One hundred and twenty-one-day old commercial broiler chicks were equally divided into 4 groups. First group was considered as control. Second group was given carvacrol, third group was infected with IBV and fourth group was given carvacrol and infected with IBV. Infection with variant IBV induced significant upregulation of chicken interferon-inducible transmembrane protein 3 (chIFITM3) gene in trachea, elevations in serum levels of Alpha-1 acid glycoprotein (α1-AGP) and Interleukin 6 (IL-6), total leucocytic count (TLC), heterophil/lymphocyte (H/L) ratio and oxidative stress in lung and kidney tissues. Beside, histopathological changes in trachea, lung and kidney induced by IBV, elevation of kidney function tests was detected. The pretreatment with carvacrol significantly reduced viral shedding titer, chIFITM3 gene expression, IL-6 and α1-AGP levels, leucocytic response and H/L ratio with minimization of clinical signs intensity. Also, carvacrol relieved oxidative stress, ameliorated the increased uric acid level and histopathological alterations in kidney and lung caused by viral infection.

Noninvasive Predictors of Coronary Slow Flow Phenomenon in Patients Presenting with Chronic Coronary Syndrome

Background: Patients with coronary slow flow phenomenon (CSFP) exhibit the following characteristics: Predominantly middle-aged males, the majority have mixed pattern angina, persistent chest pain sensations after therapy, and many have had repeated invasive and non-invasive examinations.&#x0D; Objectives: Our study aimed to determine the base of non-invasive predictors of coronary slow flow phenomenon in patients presenting with chronic coronary syndrome.&#x0D; Patients and Methods: This a case-control study included 100 participants of suspected coronary artery disease were divided into two groups matched in age and sex group I: 50 patients with primary CSFP and group II: 50 patients with normal coronary angiography. Each patient was undergoing to demographic data taking, physical investigation, good hydration, restrict fasting hours requested for coronary angiography, 12 lead-Electrocardiogram (ECG)s were obtained for each patient at rest, laboratory parameters, coronary angiography, treadmill exercise ECG, transthoracic echocardiography to assess the thickness of the left ventricle’s (LV) wall, its interior dimensions, as well as the LV’s ejection fraction (EF) using M-mood method and the aortic propagation velocity.&#x0D; Results: male sex and the Canadian Cardiovascular Society Angina grade’s (CCSA) class 3 were significantly decreased in group I compared to group II and male sex, Diabetes mellitus (DM), smoker and CCSA class 4 were substantially increase in group I compared to group II (P &lt;0.05). P wave max, P Wave dispersion (PWd), corrected QT dispersion (QTcd) at resting ECG, T wave inversion and ST Waves segment depression at stress ECG were significantly increase in group I compared to group II. QTc min was significantly lower in group I compared to group II (P &lt;0.05). LA diameter was significantly increased in group I than group II. Aortic propagation velocity was significantly decreased in group I than group II (P &lt;0.05). Hematocrit, total leucocytic count, mean platelet volume and High-sensitivity C-reactive protein (hsCRP) were significantly increase group I compared to group II (P &lt;0.05).&#x0D; Conclusions: Patients suspected of having a coronary artery disease who are diagnosed with coronary slow flow, male sex, dilated LA, CCSA class 3 or 4, elevated hematocrit value, elevated total leucocytic count, increased mean platelet volume, increased HsCRP, P max, PWd, QTcd, T wave inversion, ST segment depression, and decreased aortic propagation were statistically higher in CSFP patient compared to controls.

Down Protein C and S Antigen Could Be Predictor of Mortality Outcome in Critical Egyptian COVID-19 Illness

Background: One of the most serious morbidity and mortality features in COVID-19 is thrombo-embolic manifestation with disturbed hemostasis in natural anticoagulant. Protein S plays a critical role in cytokine storming and acts as cross talk between immune status and coagulation process. So, we aimed to address its role in addition to protein C in severity and outcome of disease, with its role in vaccinated people by AstraZeneca. Methods: The present study was conducted on 70 COVID-19 positive by real-time PCR. 40 of patients had moderate symptoms of respiratory, 30 cases were admitted into ICU of Mansoura University Hospital, some of them under mechanical ventilator. In addition to 40 healthy volunteers after first dose of vaccinated AstraZenka as reference, assessment of protein C&S antigen was done by ELIZA. Results: Significant increase in total leucocytic count in COVID-19 than vaccinated volunteer with significant reduction in absolute lymphocytosis, increased neutrophilia. First significant observation was higher MPV in COVID-19 than vaccinated, in addition to significantly higher C-reactive protein in severe cases than moderate and vaccinated. Prominent interesting finding in our study was significant reduction in Protein C&S in severe cases than moderate and vaccinated. Logistic regression analysis revealed that both could be predictor of mortality outcome as CRP in COVID-19 illness. Conclusion: There was significant reduction in protein C&S in severe cases than moderate and vaccinated. Regression analysis shows that could be predictor of mortality as well as CRP, D-dimer. Large extended study and follow up are needed to assess the incidence of thromboembolism and role of protein C&S in different variety protocols of vaccination programs.

Co-infections in patients with COVID: A case series.

Dear Editor, Respiratory viruses may be associated with varying rates of microbial co-infections. There is previous evidence to show lack of bacterial co-infections following Middle East respiratory syndrome and only a small incidence with the severe acute respiratory syndrome-associated coronavirus-1.[1] We are reporting three patients of severe acute respiratory illness (fever and bilateral pneumonitis) with laboratory-confirmed (RT-PCR) COVID, who developed microbial co-infections. All had received protocolized pharmacological therapy including remdesivir/oral hydroxychloroquine, subcutaneous low molecular weight heparin, intravenous dexamethasone, prophylactic antibiotics as well as vitamin C and oral zinc supplementation in the ICU. All three patients had presented with raised total leucocytic count (TLC: 19,600; 23,600; and 23,400/mm3, respectively) in contrast to the expected immunosuppression and decreased TLC associated with COVID. The microbial organisms detected in the patients upon blood culture included Enterococcus faecium (sensitive to vancomycin, teicoplanin, and linezolid); Staphylococcus xylosus (resistant to erythromycin, ceftriaxone, ciprofloxacin, and tetracycline; sensitive to teicoplanin, vancomycin, linezolid, and cotrimoxazole) and non-albicans candida without any bacterial growth, respectively. An adequate response was seen with vancomycin in a patient with E. faecium, and with teicoplanin to S. xylosus as evidenced by an improvement in clinical condition, fall in TLC, and negative repeat blood cultures. The patient with candidemia, however, succumbed to COVID-induced acute respiratory distress syndrome within next couple of days. A systematic review showed a 14% incidence of laboratory-confirmed bacterial co-infection among the patients with COVID admitted to ICU.[1] Thus, our findings help to emphasize that co-infections in patients with COVID are a clinical problem. The bacterial organisms detected by us are not commonly encountered otherwise. E. faecium was reported as the least common of co-infections in COVID with an incidence of 1/3834 patients.[1] Within the Enterococcus species, only 10% of infections are constituted by E. faecium.[2] It is more likely to be seen in immunosuppressed, elderly, critically ill, those on mechanical ventilation or long-term antibiotic therapy, for causing infections and multi-systemic manifestations.[23] S. xylosus-induced sepsis also presents an uncommon occurrence. The organism is usually incriminated in infections among animals, with very few case reports amongst humans. It is a normal commensal on the skin and mucosa and becomes a cause of infections either as part of nosocomial pathology or in immunosuppressed individuals.[4] Lastly, invasive candidemia reported in the third case by us is also known to have a predisposition for immunosuppressed patients. Thus, it is possible that the microbial co-infections in COVID are preferential of flora that thrives in immunocompromised patients. It is interesting to note that all of these patients with co-infections during COVID illness presented with raised TLC, even though the neutrophil–lymphocyte ratio was high and suggestive of COVID. There are previous data to show that raised TLC in COVID is associated with a poor prognosis.[5] Thus, surveillance for microbial co-infections, even uncommon ones, is required in patients with COVID and the role of raised TLC remains pertinent for the same. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.

Epidemiology and Laboratory Investigations in Children with Chronic Liver Diseases in Sohag University Hospital

Background: Chronic liver diseases encompasse metabolic, genetic, drug-induced and inflammatory diseases. The causes of liver disease in children vary with age. In countries where HBV is endemic, perinatal transmission remains the most important cause of chronic infection. The prevalence of hepatitis C infection was much higher in individuals receiving blood products for conditions such as thalassemia or haemophilia. Glycogen storage disorders may present with chronic liver disease. Objectives: To study epidemiological features and laboratory investigations that may affect the incidence in children with chronic liver disease. Patients and methods: Our study included 30 treatment-naive patients with chronic liver disease of different aetiologies referred to the Department of Pediatrics, Sohag University Hospital. All patients were subjected to history taking, general and local examinations, laboratory investigations and measurement of serum ceruloplasmin. Results: The mean age of children was 10.23 years in case group and 10.75 years in control group, ranging between 5.5 to 15 years. The majority of patients were females (53.3%) and the remained patients were males (46.7%). There was significant difference between patient and control groups as regard total leucocytic count. Also, there were significant differences between the two groups regarding ALT, AST, total bilirubin, direct bilirubin and concentration and high significant differences regarding serum albumin and prothrombin time. Conclusion: Total leucocytic count, AST, ALT, bilirubin, and serum albumin concentration, and prothrombin time are significant investigations to rule out diagnosis and anticipate complications in patients with chronic liver diseases. ALT and PT are early sensitive markers that anticipate liver decompensation.

Long term survival outcome of childhood acute lymphoblastic leukemia treated with modified TXIIIB protocol at South Egypt Cancer Institute

Background: The survival of children with acute lymphoblastic leukemia (ALL) has greatly improved in recent decades. Aim: We aimed at evaluating the outcome of children with ALL and their prognostic factors. Materials & Methods: A prospective study included 200 newly diagnosed pediatric ALL patients from 2009 to 2017. All patients were treated according to the modified total therapy study XIIIB for higher risk ALL adopted from St. Jude Children's Research hospital (SJCRH), USA. Results: Favorable age (< 10 y) and total leucocytic count (TLC) (≥ 50x109/L) occurred in 75% and 69%, respectively. B-precursor ALL represented 82.5%. Central nervous system (CNS) involvement occurred in 4.5%. High-risk patients represented 47%. Complete remission was achieved in 92.5% and was significantly affected by the early morphologic response of BM d15, while it wasn’t related to the phenotype. Eight- year overall survival, disease-free survival, and event-free survival were 77 ± 3%, 70 ± 4%, and 66 ± 3%, respectively. Adverse events included induction deaths (4.5 %(, refractory leukemia (3%), relapse (23.2%), secondary AML (0.5%), and deaths in remission (3.5%). By multivariate analysis, unfavorable age group ≥ 10 years, hyperleukocytosis, and patients with slow early response were the only ones associated with unfavorable impact on the outcome. There was statistical significant difference between standard and high risk for B-precursor ALL but not for T- precursor ALL. Conclusion: We concluded that treating children with ALL through modified TXIIIB protocol improved the survival at our institute than previous and the early response to treatment has a strong implication on the outcome.

Serum Visfatin as a Diagnostic Marker of Active Inflammatory Bowel Disease.

Inflammatory bowel diseases (IBD) have been reported to be caused by a complex interplay of immunological, infectious, and genetic factors. Previous studies have suggested that adipokines play a role in IBD by inducing proinflammatory cytokines. We aimed to evaluate the role of visfatin in the diagnosis algorithm of active IBD. 85 newly diagnosed IBD patients [56 diagnosed with ulcerative colitis (UC) and 29 with Crohn's disease (CD)] and 30 healthy controls were included. IBD phenotypes were described accordingly to Montreal classification. Hemoglobin, total leucocytic count (TLC), erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), albumin, fecal calprotectin and serum visfatin were measured. The serum visfatin level was found to be significantly higher in patients with IBD than those in the control group (p<0.001). It was significantly positively correlated with CRP, ESR, and FC in both IBD groups. Receiver operating characteristic curve analysis of visfatin in diagnosis of UC revealed an area under curve of 0.911. At cutoff ≥1.4 ng/ml, the sensitivity was 92.9% and the specificity was 86.7%.. In CD group, at the same cutoff, AUC was 0.974, sensitivity was 96.6% and specificity was 86.7%. There was a statistically significant elevation of serum visfatin in extensive UC (E3) as compared to the other groups. A cutoff ≥3.25 ng/ml revealed 88.9% sensitivity, and 100% specificity in detection of E3 UC. Serum visfatin was significantly increased in CD stricturing phenotype (B2) as compared to non-stricturing non-penetrating CD (B1). A cutoff ≥3.5 ng/ml revealed 83.3% sensitivity, and 100% specificity in detection of B2. The serum visfatin level were significantly higher in patients with IBD than in controls. Serum visfatin might be a novel noninvasive marker to detect activity in IBD patients and can be used as predictor of disease extension in patients with UC.