Total Leukocyte Count Research Articles

Diagnostic Accuracy of C-Reactive Protein in Acute Appendicitis

Objective: To determine diagnostic accuracy of C-reactive protein in acute appendicitis. Study Design: Cross-sectional study. Place and Duration of Study: Surgical unit Combined Military Hospital Gujranwala Pakistan, from Apr 2019 to Jan 2021. Methodology: One hundred and twenty patients were included in the study following the inclusion criteria after their written permission and willingness. C-reactive protein levels were sent pre-operatively to the Pathology department of Combined Military Hospital Gujranwala. Patients were operated on by two classified surgeons. After open and laparoscopic appendectomies, specimens were sent to Histopathologists at Armed Forces Institute of Pathology Rawalpindi. Results were compared to determine the diagnostic accuracy of C-reactive protein. Results: Out of 120 patients, 72(60%) were males and 48(40%) were females. The diagnostic accuracy of C-reactive protein in acute appendicitis was calculated by keeping tissue diagnosis histopathology as the gold standard, where 82(68.33%) were true positive, 7(5.84%) were false positive, 13(10.83%) were true negative, and 18(15%) were false negative. Sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy were 89.13%, 67.86%, 90.11%, 65.52% and 84.17% respectively. Conclusion: The of C-reactive protein level test for the diagnosis of acute appendicitis was very sensitive but not very specific. C-reactive protein levels should be measured routinely in suspected cases of acute appendicitis, along with Total Leucocyte Count and ultrasound abdomen, as a useful marker for early diagnosis, thus reducing negative appendectomy rates.

Evaluation of lipid profile and hematological parameters among patients attending Ram Janaki Hospital, Janakpurdham

Background & Objectives: Hematological and lipid profiles play crucial roles in assessing healthconditions and monitoring physiological abnormalities. Hematological and lipid profiles serve as valuable tools in this context, providing insights into various health conditions. However, due to various factors like diet, socioeconomic status, and literacy, these profiles can differ significantly across populations. Therefore, we aimed to find out the hematological as well as biochemical parameters among the patients attending Ram Janaki Hospital, Janakpurdham.Materials and Methods: This hospital based study involved 140 patients attending the medicineOPD between September 2023 and February 2024. Anthropometric measurements, blood pressure,and BMI was calculated. Venous blood samples were collected. Hematological parameters wereassessed using a fully a utomated hematology analyzer, while lipid profiles were evaluated usingsemi analyzer Erba Chem 7 analyzer with ErbaDiagnostics kits. Data analysis was performedusing SPSS version 21.Results: The study population comprised an equal distribution of males and females. Males exhibitedhigher values in weight, height, BMI, and blood pressure as compared to females. Hematologicalanalysis revealed higher hemoglobin levels, red blood cell counts, and packed cell volume in males,while females showed higher total leukocyte counts. Lipid profile analysis indicated higher totalcholesterol and LDL levels in males, whereas females had higher HDL, triglyceride, and VLDLlevels. Conclusion: The finding highlights significant gender based differences in anthropometric,hematological, and biochemical parameters among patients in Janakpurdham. The findings emphasizethe importance of considering gender differences in clinical evaluations and treatment plans. Theobserved variations from international norms underscore the need for population specificreference ranges.

Comparative Evaluation of Different Antivirals against Lumpy Skin Disease in Cattle

India is facing a new wave of Lumpy skin disease outbreaks since May 2022, spreading in more than 22 states and causing morbidity to more than 29 lakh animals and mortality to more than 2 lakh animals. Lack of specific antiviral treatment restores symptomatic therapeutic interventions. However, in the advent of large no. of cases and severity of disease, investigations on specific antiviral drugs are imperative. This scientific study was conducted on a group of LSD-affected cattle (N = 40) from the trans-Himalayan region of Kashmir (Jammu and Kashmir). The affected cattle were subjected to different treatments, including acyclovir (n = 27), symptomatic treatment (n = 7), and ivermectin (n = 6), along with supportive drugs. The animals were carefully monitored and compared both within and between groups at various intervals (0-96 hr) using a two-way analysis of variance (ANOVA). Significant (P ≤ 0.05) improvement in regaining rectal temperature, respiration rate, and heart rate was noted 48 hours after treatment in a group of LSD-affected animals (N = 27) treated with acyclovir at a dose rate of 1 mg/kg body weight (small cattle) to 1.5 mg/kg (large cattle) intravenously in 500 ml normal saline along with supportive drugs including enrofloxacin (2.5 mg/kg), combination of meloxicam (0.25 mg/kg) and paracetamol (7.5 mg/kg) and pheniramine maleate (0.5 mg/kg) all intramuscularly, compared to group of LSD affected cattle (N = 6) treated with ivermectin (0.2 mg/kg subcutaneously) and supportive drugs and another group of LSD affected cattle (N = 7) treated symptomatically with only supportive drugs. Acyclovir treated group showed a significant (P ≤ 0.05) decrease in total leucocyte count, lymphocyte, and basophil count from 0 hour to 96 hour of treatment (23.00 ± 0.534 to 5.59 ± 0.208; 13.97 ± 0.310 to 3.43 ± 0.126; 0.11 ± 0.003 to 0.03 ± 0.001 respectively). Significant (P ≤ 0.05) decrease in total oxidative status (TOS: 73.31%) and increase in total antioxidant status (TAS: 59.9%) was observed in acyclovir treated group followed by ivermectin treated group (TOS: 68.05% and TAS: 27.16%) compared to symptomatically treated group (TOS: 42.41% and TAS: 18.75%). Acyclovir being comparatively more specific antiviral agent than ivermectin may have helped in amelioration of clinical severity and regaining of normal physiological, hematological, and oxidative indices in LSD-affected animals. The current study demonstrates expedited recovery, diminished clinical severity, and re-establishment of physiological, hematological and oxidative markers in animals subjected to acyclovir treatment, followed by animals administered with ivermectin, when compared to animals receiving symptomatic treatment. However, further studies are required to investigate safety or adverse effects, if any.

Significance of leukocyte and platelet counts in hypertensive disorders of pregnancy - A retrospective study in a tertiary care hospital

: Hypertensive disorders in pregnancy are a spectrum of disorders ranging from gestational hypertension, pre-eclampsia to eclampsia and chronic hypertension superimposed by pre-eclampsia. With an incidence of 7-15% complicating pregnancies, several theories have been stated to define the pathogenesis. Inflammation per se is also found to have its part in the pathogenesis of hypertension.: To evaluate and compare the inflammatory mediators namely the leukocyte count, platelet count, absolute neutrophil count, absolute lymphocyte count, neutrophil lymphocyte ratio and platelet lymphocyte ratio among the hypertensive disorders in pregnancy.: This is a retrospective study done at a tertiary care hospital including all women admitted with hypertension in pregnancy from 26th April 2016 to 31 March 2019. Patients with singleton pregnancy with hypertension were included and those with prelabour rupture of membranes or concomitant infection were excluded. Patients were divided into four groups, chronic hypertension, and gestational hypertension, non-severe and severe preeclampsia. The total and differential leukocyte counts at admission were accessed from the medical records and statistical analysis was done.: Out of 4860 deliveries, 294 patients were diagnosed with hypertensive disorders (6.04%). Of the 294, those belonging to chronic hypertension, gestational hypertension, non-severe and severe preeclampsia were 43 (14.6%), 128(43.5%), 52(17.7%) and 71(24.1%) respectively. A p value of < 0.05 was considered significant. It was found that there was a significant difference among the groups in mean age and chronic hypertension was found to have a higher mean age than the other groups. The mean platelet count was also found to be significantly higher in chronic hypertension as compared to other groups. There was no significant difference in both mean total and mean differential leukocyte counts, ANC, ALC, NLR and PLR among the four groups.

Exploring the Relationship between CD66c Expression and Clinico-Haematological Parameters in Pediatric B-Cell Acute Lymphoblastic Leukemia (ALL)

Background: Pediatric B-cell Acute Lymphoblastic Leukemia presents with diverse clinical and hematological manifestations. Understanding these characteristics is crucial for effective management and prognostication.  Methods: This study conducted as prospective observational study at Lady Hardinge Medical College and Kalawati Saran Children Hospital, New Delhi, from November 2017 to March 2019. This study enrolled 30 pediatric patients with B-cell ALL who underwent comprehensive evaluations including routine and specialized hematological tests, bone marrow aspiration (BMA), cytochemistry, and immunophenotyping. Clinical features, hematological parameters, and CD66c expression on lymphoblasts were assessed.  Results: Immunophenotyping revealed that 28 cases (93.3%) were CALLA positive (CD10 positive), while 2 cases (6.7%) were CALLA negative (CD10 negative). The age ranged from 1.5 to 12 years, with a 2:1 male to female ratio. The mean age was 4.8 years.. Common presenting complaints included fever (93.3%) and pallor (60.0%). Hepato-splenomegaly (60.0%) and lymphadenopathy (60.0%) were the most frequent clinical findings. Hematological findings showed moderate to severe anemia (mean hemoglobin 7.19 g/dL), with 56.7% of patients having hemoglobin levels between 4.0-7.9 g/dL. Leukocytosis (>10,000/cumm) was observed in 53.3% of cases, with 20% having total leukocyte counts >50,000/cumm. Thrombocytopenia (platelet count ≤ 25,000/cumm) was noted in 56.7% of patients. Immunophenotyping revealed CD66c expression >20% gated in 46.7% of cases, correlating with more severe clinical features and poorer hematological parameters.  Conclusion: Pediatric B-cell ALL exhibits a spectrum of clinical and hematological features. Elevated CD66c expression correlates with aggressive disease presentation and worse clinical outcomes, suggesting its potential utility as a prognostic marker. Early identification of these parameters can aid in risk stratification and tailored therapeutic approaches.

Immune response, oxidative stress, and histological changes of Wistar rats after being administered with Parascaris equorum antigen

Worldwide, particularly in developing nations, helminth infections are the leading causes of livestock illness and mortality. Parascaris (P.) equorum, a parasitic worm from the Ascarididae family, significantly impacts the production, health, and working performance of equines. This study aimed to investigate the impact of intraperitoneal sensitization of P. equorum on the immune system, oxidative stress, and histology in Wistar rats. After acclimatization for 7 days, we divided the rats into five groups, each consisting of six rats. Group I, serving as the control, was administered distilled water, followed by groups II (day 7), III (day 14), IV (day 21), and V (day 33). The rats were euthanized every day mentioned (Days 7–33). On day 0, a dosage of 1ml/100 gm rat (containing 500 μg/ml protein content) emulsified crude antigen extract with an incomplete Freund’s adjuvant (1:1 volume), followed by a second dose of the same antigen concentration on day 7. To assess the allergenicity of this nematode, we measured a whole blood profile, serum levels of IFN-γ, IL-5, IL-10, IL-13, and IL-33, total immunoglobulins IgE and IgG, and oxidative stress markers. Also, we examined histological changes in the liver, kidney, and spleen. The results showed that values of total leukocyte count, granulocytes, monocytes, and lymphocytes were significantly (P < 0.05) increased on day 14 post-infection relative to other days of investigation. It was found that the levels of total immunoglobulins (IgE and IgG) and cytokines (INF-γ, IL-5, IL-13, and IL-33) on days 14 and 21 were significantly higher than in the control group. At all periods of the experiment, the injected group exhibited significantly higher concentrations of MDA and NO compared to the control group (P < 0.05). Conversely, GSH and CAT levels (P < 0.05) dropped significantly on days 7, 14, and 21. Different rat tissues showed alterations. Ultimately, this study described the detrimental effects of P. equorum crude antigen administration on the immune system, oxidative states, and histological changes of Wistar rats at various intervals.

Effect of Age on the Biochemical and Hematological Blood Profile in the Arabian Horses Raised in Libya

Normal hematological and biochemical values need to be defined for each equine age in order to increase diagnostic precision. The present study was aimed to monitor the hematobiochemical characteristics of 65 clinically healthy Arabian horses raised in Libya with an age of less than or equal 3 years (young) or more than 3 years (stallion). The results showed that MCHC were significantly (p&lt;0.0001) higher in the young horses than stallions, while the reverse for HCT, MCV, RDW-CV, RDW-SD, and MPV. On the other hand, Hb, RBC, MCH, PDW and PCT showed non-significant change with the variations between Arabian horse's ages. The total leukocyte and platelet counts were statistically increased in young horses but did not significantly different. Regarding activities of different enzymes (ALT, AST, ALP and LDH activity), there are significantly (p&lt;0.05) increased values in young horses compared with stallions. However, the serum TP, TB and DB were significantly (p&lt;0.005) higher in adult horses than young one. There are significant and non-significant differences in some lipid profile and electrolytes between animals according to age factor. In abbreviate, results of this study showed that both blood and biochemical parameters clearly alterated under the effect of age in this breed of horses.

Cigarette smoking and its effect on coagulation profile, hematological parameters, and oxygen saturation in healthy blood donor

Background: Cigarette smoking causes millions of deaths all around the world each year as it is one of the leading causes of cancer and cardiovascular diseases. Aims and Objectives: The study aimed to study the effect of cigarette smoking on coagulation profile, hematological parameters, and oxygen saturation in healthy blood donors. Materials and Methods: A case–control study was carried out at the Department of Pathology, Era’s Lucknow Medical College which is a tertiary care center, and took place between September 2018 and September 2020 (24 months). Results: Cigarette smoking has adverse effects on hematological parameters (red blood cell count, hemoglobin, hematocrit, mean corpuscular hemoglobin, red cell distribution width, and total leukocyte count) and coagulation profile (prothrombin time, activated partial thromboplastin time, and international normalized ratio). In our study, no adverse effects are seen on oxygen saturation though. Conclusion: Our study shows that hematological parameters and coagulation profile were altered in donors who were smokers and thus, it should be considered during blood donation. Although oxygen saturation was not adversely affected, this study strongly recommends the need for further studies to be done on this parameter of donated blood.

Rising total leukocyte counts correspond with rising platelet counts in thrombotic thrombocytopenic purpura

AbstractThrombotic thrombocytopenic purpura (TTP) is a rare disorder involving pathological platelet–von Willebrand factor interaction, resulting in microvascular thrombosis. The consumption of platelets in TTP microthrombi results in severe thrombocytopenia which resolves with resolution of the microvascular thrombosis. Over the course of treatment, patient platelet counts often rise and fall multiple times before stable remission is achieved. On casual inspection, we noted that total leukocyte counts follow a pattern that appears to correspond to platelet counts. To explore whether changing leukocyte counts track significantly with changing platelet counts, we examined paired daily platelet counts and total leukocyte counts in 27 episodes of TTP in 13 patients across 2 institutions comprising 423 days of data. We modeled the nonlinear behavior in the data using a threshold mixed-effects regression model, in which we found a significant temporal relationship between total leukocyte counts and platelet counts. The model proved that, on a day when platelet counts were rising in previous days, the total leukocyte count is predictive of the rise in platelet count. The higher the total leukocyte count, the greater the rise in platelet count. Our results support the hypothesis that leukocytes play a role in the resolution of TTP microvascular thrombosis.

Inside the Brain: Cerebrospinal Fluid Insights in Meningitis.

Background Our study focused on meningitis, an infection that can spread through the bloodstream as a primary or secondary infection from other body parts, such as sinuses, ears, and lungs. It can affect patients who have experienced trauma or surgery, as well as those with congenital defects like spina bifida. Specifically, we examined bacterial, viral, and tuberculous meningitis (TBM) cases. The primary method for confirming the diagnosis of these types of meningitis is to analyze the cerebrospinal fluid (CSF). Early diagnosis can utilize cytological and biochemical parameters. Our objective is to determine CSF's cytological and biochemical profile in patients with these specific types of meningitis. Methods A study was carried out at the central pathology lab from October 24, 2017, to April 24, 2018.CSF samples from suspected meningitis patients were examined for various parameters, including hematological, biochemical, microbiological, and cytomorphological aspects and specific tests for bacterial, fungal, and TBM. The study focused on patients aged 16 and above, excluding those under 16, non-compliant patients, and individuals with specific health conditions. Data were analyzed using IBM SPSS Statistics for Windows, Version 20 (Released 2011; IBM Corp., Armonk, New York, United States), and the results were presented through the use of mean, standard deviation, and percentages. Statistical tests were utilized to compare categorical variables and mean, with a significance level of p<0.05. Results We included a total of 156 cases, with the mean age of presentation being 56.628 years. The male-to-female ratio was 1.0526:1. Of the patients, 81 (52.1%) had been diagnosed with TBM, had elevated adenosine deaminase (ADA) levels of 48.8733±37.43740 IU/L, and CSF lymphocytosis (99%). Additionally, cases of bacterial meningitis showed markedly raised mean total leukocyte count (TLC) of 2085.50±445.47727 cells/mm3 and mean CSF protein levels of 349.45±113.73105 mg/dL. The study found a significant increase in protein levels and a decrease in glucose levels in the CSF of TBM and bacterial meningitis patients compared to those with other causes of meningitis (p<0.001). Guillain-Barre syndrome (GBS)and multiple sclerosis (MS) patients had TLC and ADA within normal limits.CSF ADA level greater than 6 IU/L showed a sensitivity of 97.53% and a specificity of 96.0%, making it the most specific test. A protein level in the CSF greater than 45 mg/dL demonstrated a sensitivity of 98.78% and a specificity of 24.32%, indicating it is sensitive but less specific in diagnosing TBM. Lymphocytic predominance, defined as TLCof more than 5 cells/mm3 with at least 50% of the cells being lymphocytes in the CSF of TBM patients, showed a sensitivity of 97.53% and a specificity of 6.67%. CSF glucose had a sensitivity of 38.27%, making it the least reliable indicator for diagnosing meningitis. Conclusion The CSF analysis is the primary diagnostic method for detecting meningitis. Its cost-effectiveness is a key factor, especially for patients from lower socioeconomic backgrounds in government medical colleges in India, where access to expensive diagnostic tests is limited. The efficiency of CSF analysis for early diagnosing different types of meningitis aids in management, helping to prevent complications and fatal outcomes.

Predictors of limb saving in diabetic foot ulcer.

This study was aimed to determine the various factors which could serve as predictor of saving of lower limb from amputation in patients with diabetic foot ulcer (DFU). This three-year retrospective study was conducted in the Diabetes and Endocrinology Unit of Hayatabad Medical complex Peshawar, Pakistan. Demographic, clinical, laboratory and radiological information of the diabetic patients with DFU admitted between January 2020 to December 2022 was retrieved from the hospital files. Information regarding initial and final decision regarding amputation and the outcome of the ulcer was also recorded. A total of 502 patients of diabetes mellitus (DM) with DFU were included in the study, of whom there were 279 (55.6%) males and 223 (44.4%) females. The mean age of the study population, mean duration of DM and mean HbA1c were 55.2 ± 9.8 years, 13.7 ± 6.7 years and 11.2 ± 2.4 %, respectively. Patients who had an amputation of their lower limbs had an increased age (p= 0.034), raised total leucocyte count (TLC) (p= <0.001), higher HbA1c (p= 0.025), had osteomyelitis (p= <0.001), and had a higher-grade ulcer (p= <0.001). On binary logistic regression analysis, ulcer grade (OR=7.4, p= <0.001), osteomyelitis (OR=11.8, p= <0.001), and initial decision of no amputation at the time of admission (OR=33.6, p=<0.001) were independently associated with the lower limb salvage. DFU which were of grade I to II, had no evidence of osteomyelitis and for which an initial decision was of no amputation were more likely to be salvaged.

Ultra-diluted complex additive in the diet reveals benefits in the intestinal tract of nursery-phase piglets.

This study aimed to assess an ultra-diluted (UD) complex, as a replacement for an antimicrobial growth promoter in diets, on growth performance, intestinal health, and inflammatory response of nursery piglets. The experiment lasted 37 days and involved 126 animals weaned at 21 ± 1.3 d, with an initial body weight of 5.62 ± 1.16kg. Piglets were assigned to six dietary treatments in a randomized block design with seven replicates and three piglets per pen as experimental unit. The treatments were: positive control (PC)- basal diet + 120mg/kg of chlorohydroxyquinoline; negative control (NC)- basal diet without additives; and NC containing 4.5; 6.0; 7.5 or 9.0kg of UD additive/ton diet. Performance data were calculated, and daily diarrhea was observed. Blood samples were collected for hematological analysis. At the end of the experiment, one animal per pen was slaughtered for organ weighing, pH, and the collection of intestinal samples for histopathology. Feces and cecal contents were collected for microbiological and antibiogram analyses. There was no difference in the performance between the treatments. Throughout the study, UD levels were equal to those of PC for diarrhea occurrence. Higher levels of UD complex led to higher total leukocyte counts. The 4.5 treatment showed a reduction in total and thermotolerant Enterobacteriaceae populations in piglet feces and an increase in lactic acid bacteria compared to PC. All treatments resulted in fewer duodenal histopathological alterations than those in the NC group. The use of UD additives, especially at 4.5kg/ton, is a good alternative to chlorohydroxyquinoline in piglet diets.

Effectiveness of Oral Azithromycin in Treating Enteric Fever: A Hospital-Based Study on Pediatric Patients.

Introduction Enteric fever is prevalent in underdeveloped and developing countries. It is caused by Salmonella Typhi, which has developed resistance over the years to commonly used antimicrobials. Meropenem is an effective treatment for all complicated and uncomplicated extensively drug-resistant (XDR) bacteria, but it is administered intravenously, three times daily, by infusion, and it is quite expensive for the patient. Oral azithromycin is shown by some authors to be effective in extensively drug-resistant enteric fever. Material and methods This retrospective cross-sectional study was conducted in the outpatient department of Lady Reading HospitalMedical Teaching Institution, Peshawar. The duration of the study was one year. Data was collected after approval from the hospital's Ethical and Research Committee. All pediatric patients meeting the inclusion criteria for extensively drug-resistant enteric fever were included. Data on patient demographics, blood culture and laboratory results, treatment given, and effectiveness were documented in a specialized proforma. Statistical Package for Social Sciences (SPSS) version 23 (IBM Corp., Armonk, NY, US) was used for data analysis. Results Out of the total 106 patients, 72 (67.9%) were male and 34 (32.1%) were female. The mean age was 7.51 ± 2.75 years, with a range of 1 to 15 years. Among them, 66 (62.3%) had anemia (hemoglobin less than 11grams per deciliter for under 5 years and 11.5 for 5-15 years old children), with a mean hemoglobin level of 10.6 ± 1.53 grams per deciliter (g/dl), ranging from 7.2 to 13.8 g/dl. Thrombocytopenia was found in 14 (13%) patients. The mean platelet count was 317 x 103 ± 164 cells per microliter, with a range of 61 x 103 to 834 x 103cells per liter. The mean total leukocyte count was 9.71x 103 ± 4.321 cells per microliter, with a range of 2.01 x 103 to 30.40 x103cells per microliter. However, leucopenia was seen in only 5 (4.7%) patients. In 98.1% of cases, azithromycin was found to be effective in treating enteric fever caused by extensively drug-resistant Salmonella. Conclusion Azithromycin is effective in treating extensively drug-resistant enteric fever. It can be confidently used in patients with no or mild complications with extensively drug-resistant enteric fever. Good compliance and complete dosage should be followed to avoid resistance to this drug. Blood cultures should always be sent when prescribing antibiotics, especially when suspecting enteric fever.

Biochemical Markers in the Prediction of Pregnancy Outcome in Gestational Diabetes Mellitus.

Background and Objectives: Gestational diabetes mellitus (GDM) may impact both maternal and fetal/neonatal health. The identification of prognostic indicators for GDM may improve risk assessment and selection of patient for intensive monitoring. The aim of this study was to find potential predictors of adverse pregnancy outcome in GDM and normoglycemic patients by comparing the levels of different biochemical parameters and the values of blood cell count (BCC) between GDM and normoglycemic patients and between patients with adverse and good outcome. Materials and Methods: Prospective clinical study included 49 patients with GDM (study group) and 44 healthy pregnant women (control group) who underwent oral glucose tolerance test (OGTT) at gestational age of 24-28 weeks. At the time of OGTT peripheral blood was taken for the determination of glucose levels, insulin, glycated hemoglobin, lipid status, homeostatic model assessment, BCC, iron and zinc metabolism, liver function, kidney function and inflammatory status. Each group was divided into two subgroups-normal and poor pregnancy outcome. Results: Higher RBC, hemoglobin concentration, hematocrit value, fasting glucose, uric acid and fibrinogen were found in GDM patients compared to control group. In GDM patients with poor pregnancy outcome values of fibrinogen, ALT, sedimentation rate, granulocyte and total leukocyte counts were elevated, while the serum level of zinc was significantly lower. Higher level of fibrinogen was found in normoglycemic patients with adverse pregnancy outcomes. ROC curve was constructed in order to assess fibrinogen's biomarker potential. The established AUC value for diagnostic ROC was 0.816 (p < 0.001, 95% CI 0.691-0.941), while the AUC value for assessing fibrinogen's potential to predict poor pregnancy outcome in GDM was 0.751 (p = 0.0096, 95% CI 0.561-0.941). Conclusions: The results of our study demonstrated that the best prognostic potential in GDM showed inflammation related parameters, identifying fibrinogen as a parameter with both diagnostic and prognostic ability.

Biomarker for infection in children with decompensated chronic liver disease: Neutrophilic CD64 or procalcitonin?

ObjectiveBiomarkers with high accuracy for identification of infection in decompensated chronic liver disease (DCLD) are urgently needed. We compared the accuracy of neutrophilic cluster of differentiation 64 (nCD64) with procalcitonin for diagnosis of bacterial infection in children with DCLD. MethodsConsecutive children admitted with DCLD were enrolled prospectively. nCD64 was assessed by flow cytometry and expressed in percentage. nCD64, procalcitonin and hemogram were measured at admission and 7-14 days after treatment in those with infection. Complete work-up for infection was done. Presence, site and severity of infection was classified as per guidelines. Results107 children [64 boys, age 97(18-168) months] were enrolled. 78(72.9%) had infection, 26(24%) had severe sepsis and 60(56%) had systemic inflammatory response syndrome. The commonest site of infection was ascitic fluid (n=37), followed by pneumonia (n=24), urinary tract (n=15), bacteraemia (n=10), cholangitis (n=8) and cellulitis (n=3). nCD64 (cut-off-51%, AUC-0.82) had a higher sensitivity (79.5%) and specificity (82.8%) than procalcitonin (cut-off ≥0.58ng/mL, AUC-0.74, sensitivity-76.9% and specificity-62.1%) for diagnosis of infection. nCD64 and procalcitonin correlated with infection severity, being highest in children with severe sepsis [88(71-97) %and 1.98(0.83-10.36) ng/mL], than in infection alone [72(45-84) % and 1.09(0.45-2.07) ng/mL], and no-infection [36(20.2-48) % and 0.42(0.19-1.08) ng/mL]. There was no difference in diagnostic utility of procalcitonin or nCD64 with different sites of infection. Elevation of all 3 parameters (nCD64, PCT and total leukocyte count) was uncommon but highly specific for presence of infection. ConclusionnCD64 identifies infection better than procalcitonin and correlates well with infection severity in children with DCLD.

Assessment of clinical and histopathological characteristics in COVID-19-associated mucormycosis (CAM) patients correlating with outcome: A hospital-based cross-sectional study.

The second wave of the COVID-19 pandemic led to a very dreaded complication of mucormycosis. Immunosuppressive action of the COVID-19 virus, co-morbidities, for example, diabetes mellitus (DM), hypertension, use of steroids, and humidified oxygen, are among the important factors that make the patients susceptible to developing mucormycosis. The present study was conducted to identify and understand all the significant histological changes including the type and extent of tissue involvement, the pattern of inflammation, the volume of fungal hyphae, hemorrhage, etc., in patients with COVID-19 associated mucormycosis (CAM) and correlate with clinical outcome. It was a retrospective cross-sectional observational study involving all the patients of CAM, who underwent debridement or biopsy over a period of 5 months, from April 01, 2021, to August 31, 2021. CAM was classified based on the radiological evaluation, clinical features, and organs involved. Different demographic, clinical, laboratory, and histologic parameters were recorded. The variables were assessed for their association with poor clinical outcomes using multiple logistic regression. P < 0.05 was considered statistically significant. A total of 146 patients were included in the study with a mean age of 49.4 years and 71.2% were male. Sino-naso-palatal was the most common type of CAM (32.9%), while sino-naso-cerebral was the least common (14.3%). DM was present in 54.1% of patients, out of which 26.6% were recently diagnosed. The death occurred in 21.9% of patients. Maximum mortality was observed in CAM of sino-naso-cerebral involvement (42.9%). Total leucocyte count (TLC) [OR = 0.87; 95%CI: 0.76-0.97; P = 0.02] and C-reactive protein (CRP) [OR = 0.97; 95%CI: 0.96-0.99; P = 0.008] were significantly associated with poor outcomes. Other factors, that is, high prothrombin time, DM, ferritin, and the involvement of muscle, skin, and cartilage, were also associated with poor clinical outcomes but were not statistically significant. Similarly, high fungal volume and the presence of thrombosis were also associated with poor outcomes but were not statistically significant. CAM more commonly affects males with co-morbidities. TLC and CRP were significantly associated with poor outcomes. Histologically, the involvement of skin, muscle, and cartilage and the presence of excessive fungal hyphae and thrombosis were also associated with poor outcomes.

Clinicohematological Profile of Patients with Bicytopenia

Abstract Background Bicytopenia (BC) is a reduction in counts in any of two cell lineages of blood, which can be a combination of anemia with thrombocytopenia, anemia with leukopenia, or leukopenia with thrombocytopenia. The etiology of BC can be a malignancy, nonmalignant disease, infectious cause, or drug-induced. Aim To assess the clinicohematological profile in patients with BC. Materials and Methods This prospective study was conducted in the hematology laboratory at the Justice K.S. Hegde Charitable Hospital. Patients with BC detected during the analysis of blood for any clinical condition were included in the study. Blood parameters assessed were hemoglobin, red blood cell count, total leukocyte count, and platelet count. Results In this study, 86 patients' samples with BC were collected, out of which 55.8% were male, and 44.2% were female. The most common BC was anemia with thrombocytopenia (69.8%). The most common etiology of BC was found to be nonmalignant (37.2%), followed by malignant (37.2%), infectious (25.6%), and drug-induced (4.7%) cases. Most of the patients with BC presented with fever, pallor, and generalized weakness. Conclusion Anemia with thrombocytopenia emerged as the predominant form of BC in the nonmalignant group, while the malignant etiology group presented with anemia with leukopenia. The infectious etiology group presented with leukopenia with thrombocytopenia. Neonatal sepsis emerged as the most prevalent cause of BC in the age group younger than 10 years, viral fever in the age group of 10 to 39 years, acute lymphoblastic leukemia in the age group of older than 70 years, and chronic liver disease in patients aged between 40 and 69 years.

Comparative Efficacy of Inhaled and Intravenous Corticosteroids in Managing COVID-19-Related Acute Respiratory Distress Syndrome.

Acute respiratory distress syndrome (ARDS) is a life-threatening condition in which the lungs fail to provide sufficient oxygen to the body's vital organs. It is commonly associated with COVID-19 patients. Severe cases of COVID-19 can lead to lung damage and organ failure due to an immune response in the body. To mitigate these effects, corticosteroids, which are known for their anti-inflammatory properties, have been suggested as a potential treatment option. The primary focus of this study was to assess the impact of various corticosteroid administration methods on the outcomes of patients with COVID-19. Methods: The current study was conducted on COVID-19 patients divided into three groups. The first group was administered 6 mg of intravenous (IV) dexamethasone; the second group received 1 mg/kg of IV methylprednisolone (methylprednisolone); and the third group received budesonide respirable solution at a dosage of 1mg twice daily. The neubilizer used was a vibrating mesh nebulizer (VMN). All patients received standard care. We found that dexamethasone administered intravenously led to a significant reduction in C-reactive protein levels, surpassing the effectiveness of both IV methylprednisolone and inhaled budesonide. Oxygen saturation without mask change over time showed statistically significant differences (p = 0.004) in favor of the budesonide and dexamethasone groups for all days. Individuals who received methylprednisolone showed a significant decrease in mortality rate and an extended survival duration, with statistical significance observed at p = 0.024. The rest of the parameters, including ferritin, lymphocytes, total leukocyte count, platelets, hemoglobin, urea, serum potassium, serum sodium, serum creatinine, serum glutamic-pyruvic transaminase, serum glutamic-oxaloacetic transaminase, uric acid, albumin, globulin, erythrocyte sedimentation rate, international normalized ratio, oxygen saturation with flow, and oxygen flow, showed no statistically significant differences between the three drugs. In conclusion, treatment with IV methylprednisolone (1 mg/kg) resulted in a shorter hospital stay, decreased reliance on ventilation, and improved health outcomes for COVID-19 patients compared to using dexamethasone at a daily dosage of 6 mg or budesonide respirable solution at a dosage of 1mg twice daily.

Hemolytic uremic syndrome in children: Clinical characteristics and predictors of outcome

BackgroundHemolytic uremic syndrome (HUS) is the most common thrombotic microangiopathy (TMA) occurring in children. ObjectivesTo study the clinico-laboratory profile and identify the potential outcome predictors in children with hemolytic uremic syndrome. MethodologyA retrospective observational study was conducted at a tertiary center in South India. Children diagnosed with HUS during the study period of 10 years were included. The demographic, clinical, and laboratory details, complications, and outcomes were recorded. Predictors of mortality were analyzed. ResultsAmong 44 children with HUS, 14 (31.8 %) children were diagnosed with D + HUS while 30 had D-HUS. The median age at diagnosis was 6.3 years. Male preponderance (55.9 %) was observed. Presenting symptoms included oliguria in 36 (86.4 %), followed by fever, observed in 34 (77.3 %). 12 (27.2 %) children had anuria. Seizures and altered sensorium were present in 12 (27.35) and 16 (36.4 %) children respectively. Hypertension was observed in 33 (75 %) children. Plasmapheresis was performed in 18 (13.6 %) children. 17 (38.6 %) children underwent hemodialysis, and 7 (15.9 %) underwent peritoneal dialysis. The median duration of hospital stay was 18 (9.7, 27.7) days. Complications observed during the study were CNS involvement was seen in 16 (36.4 %) children, while coagulopathy was observed in 3 (6.8 %) children. Mortality was observed in 16 children (36.4 %). Anuria at admission was more prevalent in non-survivors (10 out of 16 children; p 0.003). The median albumin and C3 levels were significantly low in non-survivors (p-value <0.001 and 0.008 respectively). A total leucocyte count >15,000 X 109 cells/L was independently associated with mortality even after adjustment with duration of symptoms before diagnosis >10 days and low C3 levels (adjusted OR [95 % CI]: 1.12 [1.02, 1.92] (p-value 0.03). ConclusionHypoalbuminemia and hypocomplementemia were observed in higher proportions among non-survivors. Elevated leucocyte count at admission was an independent predictor of mortality.

Study on the Toxic Effects of Deltamethrin on Hematological Parameters of a Fresh Water Fish, Common Carp (Cyprinus carpio L.)

Fish health is adversely affected by pesticide contamination, which is a significant cause of pollution in freshwater ecosystems. One helpful technique for assessing the general health of different fish species is the analysis of blood parameters. Present study investigated the detrimental effects of deltamethrin on different hematological parameters of a fresh water fish, common carp (Cyprinus carpio). An experiment with a 28-day exposure to 1/20th and 1/10th of the 96-hour LC50 value (0.114µl/L) was conducted in order to investigate the effects of sub-lethal concentrations. On the 7th, 14th, 21st, and 28th day of exposure, several hematological parameters like Total Erythrocyte Count (TEC), Total Leukocyte Count (TLC), Hemoglobin (Hb), Hematocrit/Packed Cell Volume (Hct/PCV), Mean Corpuscular Volume (MCV), Mean Corpuscular Hemoglobin (MCH) and Mean Corpuscular Hemoglobin Concentration (MCHC) were analyzed in comparison to control. After the exposure of different concentrations of deltamethrin significant decline (P*&lt;0.05 and P**&lt;0.01) in Hb, TEC, PCV and MCHC was noted as compared to control. On the contrary TLC, MCV and MCH showed increasing trend after the treatment of pesticide. This study showed that deltamethrin considerably altered the hematological markers of fish, even at sub-lethal concentrations.