Platelet Count Values Research Articles

Improving blood product management in placenta accreta patients with severe bleeding: institutional experience

BackgroundPlacenta accrete spectrum (PAS) is a significant risk factor for postpartum hemorrhage and effective blood product management is critical in ensuring patient safety. In PAS patients undergoing cesarean section (CS) blood transfusion management guided by the combined clinical experience of the anesthesiologist and surgeon with point-of-care coagulation testing appears safe and effective. We describe and evaluate our experience and identify potential areas for improvement with blood product management in this patient population. MethodsA retrospective chart review of peri-operative demographic, anesthetic, and obstetric data was conducted for all patients with PAS undergoing CS between 2012 and 2018 at our center. To facilitate a practical evaluation of blood product management, we divided patients into two groups based on the severity of bleeding. ResultsA total of 221 parturients with PAS underwent CS, with 133 in group 1 requiring excessive amounts of transfusion and 88 in group 2 requiring management similar to other uncomplicated CS cases. There were no deaths or instances of disseminated intravascular coagulation, and intensive care unit admission occurred in five cases (2.2%). Patients in group 1 had higher mean nadir values of intra-operative hemoglobin and platelet count. We observed a high rate of missing data for peri-operative measurement of lactate and fibrinogen, PAS grade documentation, and temperature monitoring. ConclusionGiven no significant morbidity or mortality, clinical judgment in experienced centers appears safe for the management of PAS patients undergoing CS. The adoption of an institutional protocol and point-of-care coagulation testing could decrease over-transfusion and associated complications.

Factors associated with non-invasive positive pressure ventilation failure in a COVID-19 intermediate care unit

BackgroundThe use of non-invasive positive pressure ventilation (NIPPV) in COVID-19 patients with hypoxaemia is still under debate. The aim was to evaluate the efficacy of NIPPV (CPAP, HELMET-CPAP or NIV) in COVID-19 patients treated in the dedicated COVID-19 Intermediate Care Unit of Coimbra Hospital and University Centre, Portugal, and to assess factors associated with NIPPV failure.MethodsPatients admitted from December 1st 2020 to February 28th 2021, treated with NIPPV due to COVID-19 were included. Failure was defined as orotracheal intubation (OTI) or death during hospital stay. Factors associated with NIPPV failure were included in a univariate binary logistic regression analysis; those with a significance level of p < 0.001 entered a multivariate logistic regression model.ResultsA total of 163 patients were included, 64.4% were males (n = 105). The median age was 66 years (IQR 56–75). NIPPV failure was observed in 66 (40.5%) patients, 26 (39.4%) were intubated and 40 (60.6%) died during their hospital stay. The highest CRP (OR 1.164; 95%CI 1.036–1.308) and morphine use (OR 24.771; 95%CI 1.809–339.241) were identified as predictors of failure after applying multivariate logistic regression. Adherence to prone positioning (OR 0.109; 95%CI 0.017–0.700) and a higher value of the lowest platelet count during hospital stay (OR 0.977; 95%CI 0.960–0.994) were associated with a favorable outcome.ConclusionsNIPPV was successful in over half of patients. Highest CRP during hospital stay and morphine use were predictors of failure. Adherence to prone positioning and a higher value of the lowest platelet count during hospital stay were associated with a favourable outcome.

Hepatic fibrosis: a manifestation of the liver disease evolution in patients with Ataxia-telangiectasia

BackgroundAtaxia-telangiectasia (A-T) is a DNA repair disorder characterized by changes in several organs and systems. Advances in clinical protocols have resulted in increased survival of A-T patients, however disease progression is evident, mainly through metabolic and liver changes.ObjectiveTo identify the frequency of significant hepatic fibrosis in A-T patients and to verify the association with metabolic alterations and degree of ataxia.MethodsThis is a cross-sectional study that included 25 A-T patients aged 5 to 31 years. Anthropometric data, liver, inflammatory, lipid metabolism and glucose biomarkers (oral glucose tolerance test with insulin curve—OGTT) were collected. The Cooperative Ataxia Rating Scale was applied to assess the degree of ataxia. The following were calculated: Homeostasis Model Assessment—Insulin Resistance, Homeostasis Model Assessment—Adiponectin (HOMA-AD), Matsuda index, aspartate aminotransferase (AST): platelet ratio index, nonalcoholic fatty liver disease fibrosis score and BARD score. Liver ultrasonography and transient liver elastography by FibroScan® were performed.ResultsSignificant hepatic fibrosis was observed in 5/25 (20%). Patients in the group with significant hepatic fibrosis were older (p < 0.001), had lower platelet count values (p = 0.027), serum albumin (p = 0.019), HDL-c (p = 0.013) and Matsuda index (p = 0.044); and high values of LDL-c (p = 0.049), AST (p = 0.001), alanine aminotransferase (p = 0.002), gamma-glutamyl transferase (p = 0.001), ferritin (p = 0.001), 120-min glycemia by OGTT (p = 0.049), HOMA-AD (p = 0.016) and degree of ataxia (p = 0.009).ConclusionsA non-invasive diagnosis of significant hepatic fibrosis was observed in 20% of A-T patients associated with changes in liver enzymes, ferritin, increased HOMA-AD, and the severity of ataxia in comparison with patients without hepatic fibrosis.

Novel marker to predict rupture risk in tubal ectopic pregnancies: the systemic immune-inflammation index.

Ectopic pregnancy is a life-threatening condition;delaying treatment can result in mortality or serious complications. Identification of a biomarker that can predict tubal rupture may be helpful for guiding treatment. In this study, we evaluated the association between serum β-hCG, biochemical markers, Systemic Immunity-inflammation Index (SII) score, and the trophoblastic invasion stage. Tubal pregnancy was classified into three groups based on the depth of trophoblastic infiltration: stage I - limited to the mucosa; stage II - invaded the muscular layer, and stage III - invaded the serosa/subserosa of the tuba uterine. The association between groups,serum β-hCG, biochemical markers, and the SII score were assessed. There was no significant difference between the groups, hemoglobin, platelet count, MPV, RDW, NLR or PLR values (p > 0.05). A ROC analysis was performed to evaluate the accuracy of serum β-hCG predictions for infiltration level.At a 95% confidence interval upper limit, cut-off value of the serum β-hCG that best predicted stage III trophoblastic infiltration, was 2799 mIU/mL, with 78.9% sensitivity, 53.8% specificity (positive predictive value was 71.4%, and a negative predictive value was 63.6%). Moreover, ROC curve analysis showed that The SII value of 792 was the best predictor of trophoblastic infiltration at stage III, with a sensitivity of 92.3% and a specificity of 63.1%. A linear relationship exists between depth of trophoblastic infiltration and serum β-hCG and the SII were observed. These findings suggested that the SII score can be used for predicting tubal ectopic pregnancy rupture.

Comparative serum lipid and immunohematological values among adult pulmonary tuberculosis and tuberculosis lymphadenitis cases and their association with sputum bacilli load and time to culture positivity in Northwestern Ethiopia

BackgroundThe serum lipid and immunohematological values of tuberculosis lymphadenitis (TBLN) patients is poorly documented relative to pulmonary tuberculosis (PTB) cases. Therefore, the aim of this study was to investigate the serum lipid and immunohematological values of patients with TBLN in comparison with PTB (PTB) patients.MethodsAn institution-based comparative cross-sectional study was conducted in Northwest Ethiopia from March to December 2021. The study participants were bacteriologically confirmed PTB (n = 82) and TBLN (n = 94) cases with no known comorbidity and whose ages was greater than 18 years and with no current pregnancy. Independent sample t-test, one-way ANOVA, box plot, and correlation matrix were used to analyze the data.ResultsThe body mass index (BMI), CD4 + T cell count, and high-density lipoprotein-Cholesterol (HDL-C) values were significantly higher among TBLN cases compared with PTB cases. Additionally, the total white blood cell (WBC) count, hemoglobin (Hb), total Cholesterol (CHO) and creatinine (Cr) values were relatively higher among TBLN than PTB (P > 0.05). On the reverse, the platelet count and triacylglycerol (TAG) values were relatively higher among PTB than in TBLN cases. While the mean days of culture positivity were 11.6 days for TBLN, the mean days of culture positivity were 14.0 days for PTB. Anemia and serum lipid values showed no correlation with sputum bacilli load and time to culture positivity.ConclusionTuberculous lymphadenitis patients were well-endowed with serum lipid, immunological and nutritional status compared with PTB cases. Hence, the high incidence rate of TBLN in Ethiopia could not be explained by low peripheral immunohematological values, malnutrition, Anemia, and dyslipidemia. Further study for identifying the predictors for TBLN in Ethiopia is highly desirable.

Subclinical Liver Fibrosis is Associated with More Rapid Cognitive Decline in Parkinson’s Disease (P7-11.013)

<h3>Objective:</h3> To determine the impact of liver fibrosis on motor scores and cognition in Parkinson’s disease. <h3>Background:</h3> It is increasingly apparent that even subclinical liver fibrosis is associated with cognitive impairment and frailty. However, it’s impact on motor and cognitive performance in Parkinson’s Disease (PD) is not well understood. <h3>Design/Methods:</h3> We conducted a retrospective cohort study using the Parkinson’s Progression Marker Initiative (PPMI), a longitudinal study collecting data on PD patients. Our exposure was liver fibrosis at baseline, based on the validated Fibrosis-4 (FIB4) score calculated using age, platelet count, aspartate and alanine aminotransferase values. We dichotomized participants as high (≥1.3) versus low (&lt;1.3) FIB4. Our outcomes were the Montreal Cognitive Assessment (MoCA) and Unified Parkinson’s Disease Rating Scale part III (UPDRSIII) on-and off-treatment scores. We used linear mixed models to assess the relationships between FIB4 at baseline and MoCA and UPDRSIII scores, both at baseline and over time during the eight years of available follow-up data. Models were adjusted for demographics, comorbidities, and alcohol use. <h3>Results:</h3> In adjusted models, UPDRSIII on-treatment and off-treatment scores were not significantly different at baseline or over time when comparing participants with high versus low FIB4. High FIB4 score was not associated with low MoCA scores at baseline. However, MoCA scores in the high FIB4 group declined more over time, with an average difference in rate of change of 0.13 (95% CI, 0.06–0.20). This relationship was maintained after adjusting for potential confounders, with a difference in rate of change of 0.12 (95% CI, 0.05–0.20). <h3>Conclusions:</h3> In PD, a high liver fibrosis score was not associated with motor progression but was associated with faster cognitive decline. Liver health may therefore be an under-appreciated determinant of cognitive outcomes in PD. <b>Disclosure:</b> Dr. Zolin has nothing to disclose. Miss Zhang has nothing to disclose. Dr. Ooi has nothing to disclose. Dr. Sarva has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Neurocrine. Dr. Sarva has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Novo Nordisk. Dr. Sarva has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Bluerock Therapeutics. The institution of Dr. Sarva has received research support from Insightec. The institution of Dr. Sarva has received research support from NeuroNext. The institution of Dr. Sarva has received research support from Neuroderm. The institution of Dr. Sarva has received research support from Covance. The institution of Dr. Sarva has received research support from Prevail. The institution of Dr. Sarva has received research support from Bluerock Therapeutics. The institution of Dr. Sarva has received research support from Biogen. The institution of Dr. Sarva has received research support from Roche. Dr. Kamel has received personal compensation in the range of $10,000-$49,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for JAMA Neurology. Dr. Kamel has received personal compensation in the range of $50,000-$99,999 for serving as a Endpoint adjudication committee with Boehringer-Ingelheim. Dr. Parikh has received personal compensation in the range of $10,000-$49,999 for serving as an Expert Witness for cases of neurological illness. The institution of Dr. Parikh has received research support from Leon Levy Foundation. The institution of Dr. Parikh has received research support from Florence Gould Foundation. The institution of Dr. Parikh has received research support from NY State Empire Clinical Research Investigator Program. The institution of Dr. Parikh has received research support from NIA. The institution of Dr. Parikh has received research support from Medtronic.

Effects of edible Terminalia catappa L. seed oil on physiological parameters of Mus musculus L mice

Terminalia catappa L. (TC) trees are grown in many parts of the world including Vietnam, their seeds have high lipids content used as feed, and the yield of Terminalia catappa L. seed oil (TCO) is high. A survey on Mus musculus L mice was conducted, in addition to the diet they were also given TCO daily to evaluate its safety and effects. Results after 72 h of use with the highest oral dose of 21780 mg/kg of mice, all instinctive behaviors of mice were normal, the survival rate was 100%, when increasing the oral dose to the weight of mice, there was a tendency of slight downward tend. Continuously given daily dose of 5445 mg/kg of mice for 14 and 28 days, no abnormalities affecting instinctive behaviors were detected, the weight of mice fluctuated but not much, Mouse death rate is 0%. Analysis results of blood physiological parameters including RBC (Red Blood Cell), HGB (Hemoglobin), HCT (Hematocrit), WBC (White Blood Cell), LYM (Lymphocyte), NEU (Neutrophil), PLT (Platelet Count) values are within the standard limits of healthy mice. Some other findings when prolonging the intake of TCO, the mouse coat was thick, soft, and smooth compared to the short time of 72-h use, the concentration of ALT (alanine aminotransferase), AST (aspartate aminotransferase) decreased to the standard of healthy mice that can regulate liver enzymes to reduce liver damage. Creatinine levels related to kidney function are low, but when observing the microscopic liver and kidney tissue, no lesions or abnormalities are detected.

The effect of cupping therapy combined with high-intensity interval exercise on selected blood parameters of football players

Cupping therapy is a centuries-old and worldwide method that may be found in both the East and the West. The aim of this study was to find out how wet cupping therapy combined with high-intensity interval training affects blood markers and athletic performance in football players. A two-arms, pre- and post-test, parallel randomized controlled trial was carried out. Forty male football players were chosen from Wadi Degla Football Club and were divided into two equal groups (group A and group B) using computerized randomization. Twenty players were assigned to Group A (wet cupping group), which received cupping therapy once a month for three months and high-intensity interval training, including Fifa 11+ protocol six days a week for three months, while twenty other players were assigned to Group B (control group), which received only high-intensity interval training, including Fifa 11+ protocol six days a week for three months. At baseline and after the training program, hematological analysis, blood lactate, and the Yo-Yo level 2 test were performed. Compared with the MCHC (mean corpuscular hemoglobin), PLt (platelet count), and total distance values of the control group after treatment, the wet cupping therapy group showed statistically significant improvement in lactic acid (p = 0.005), MCHC (p = 0.026), PLt (p = 0.014), lymphocytes (p = 0.047), and distance (meter) (p = 0.007). In football players, the mixed technique of using wet cupping with high-intensity interval training has resulted in clinically crystal-clear improvements in lactic acid, MCHC, PLt, and total distance covered.

High platelet count as a predicting factor of histopathological grading among invasive breast cancer individuals: a single centre experience from Indonesia.

The interplay between platelet and breast cancer (BC) pathology may have the potential to represent the malignancy status itself, evidently through predicting the histopathological results of each individual. This study aims to elaborate on the diagnostic value of a higher platelet count or thrombocytosis and the histopathological status of invasive BC in our center, explaining its correlation from the diagnostic perspective. A retrospective cohort study was conducted using breast cancer patients' medical records from January to March 2022 at the Haji Adam Malik General Hospital, Medan, Indonesia. The patients' histopathological records and complete blood counts were collected from the hospital's medical records. We analyzed the risk analysis model in receiver operator characteristics analysis and diagnostic parameters, e.g., sensitivity and specificity, which we analyzed further using the correlation test to fulfill our objective. The mean age of the 69 subjects we included, in the final analysis, was 49.0 ± 11.1 years old, of whom 35 (50.7%) individuals were histologically confirmed to be high-grade BC. By applying the cut-off value of 299 × 103 cells/μL, the diagnostic value of a platelet count was 60.0 % in sensitivity, 61.8% in specificity, and an area under the curve (AUC) value of 0.597 (0.462-0.732) in 95% confidence interval (CI) as presented by receiver operating characteristic (ROC). We also found that a higher platelet count may also predict the diagnosis of invasive BC by 2.423 times as shown in the odd ratio (OR) analysis. Platelet counts investigation is an applicable yet potential hematological biomarker to predict invasive BC histopathological grading.

Investigating the association between various platelet indices and different clinical sub-groups of severe malaria.

To evaluate the ability of platelet count, mean platelet volume, platelet distribution width, and platelet mass index to predict the severity of malaria. This study was conducted as a retrospective cohort study at a tertiary hospital in Somali. Patients grouped as severe and non-severe malaria. We compared groups in terms of platelet count, mean platelet volume, platelet distribution width, and platelet mass index. A total of 131 patients were included in the final analysis. Of the patients, 77 (58.7%) had non-severe malaria, and 54 (41.3%) had severe malaria. The multivariate analysis revealed that there was no significant difference between the groups in terms of platelet count, mean platelet volume, platelet distribution width, and platelet mass index (p: 0.183, 0.323, 0.204, and 0.139, respectively). In the receiver operating characteristic analysis, the area under the curve values for platelet count, mean platelet volume, platelet distribution width, and platelet mass index were 0.699, 0.619, 0.504, and 0.675, respectively. Of the platelet indices, platelet count, mean platelet volume, platelet distribution width, and platelet mass index were not clinically significant markers that could be used to predict the severity of malaria.

Correlation Between Platelets Count, Platelet Index and D-Dimer in Covid-19 Patients

Hypercoagulation in the alveoli of the lungs is one of the causes of death in SARS-CoV2 virus infection. Hypercoagulation is defined by an elevation in D-Dimer, which typically rises on the fifth day of therapy. This parameter is not available in all hospitals and is still relatively expensive in preventing premature death. Platelets count and indices are suggested to describe the thromboinflammatory condition in COVID-19 patients. This research is an observational analytic study with a cross-sectional study design in 59 COVID-19 patients treated at Hassanuddin University Hospital. The patients who are declared COVID-19 based on the results of radiological examinations and PCR swabs underwent routine blood tests and D-Dimer before undergoing therapy. Data were analyzed using the Spearmen test in SPSS version 26 to reveal the correlation between platelet count, platelet indices, and D Dimer in COVID-19 patients with severe and non-severe conditions. Platelet count, platelet indices, especially MPV, and D-Dimer values were found to correlate in both groups COVID-19 using the Spearman rho correlation test (p 0.000) with strengths correlation between -44.6 and 60.5. There was a significant association between platelet count and MPV value with D-Dimer in COVID-19 patients.

Relationship between perioperative cardiopulmonary bypass time, platelet count, fibrinogen level, rotational thromboelastometry data, antithrombin level, and blood loss volume and the effects of deep hypothermic circulatory arrest: An observational study.

We hypothesized that perioperative fibrinogen level, platelet count, and rotational thromboelastometry (ROTEM) data values decrease in proportion to cardiopulmonary bypass (CPB) time, particularly in patients who underwent deep hypothermic circulatory arrest (DHCA). A total of 160 patients were enrolled and divided into the following three groups depending on CPB time: <2-h, 2- 3-h, and >3-h groups. Blood samples were obtained during CPB weaning. Platelet count, ROTEM data, fibrinogen level, and antithrombin level were determined. For propensity matching, we selected 15 patients who underwent DHCA and 15 patients who did not undergo DHCA and used propensity scores to match CPB time and other characteristics. The <2-h, 2-3-h, and >3-h groups included 74, 63, and 23 patients, respectively. No significant differences in platelet count and fibrinogen level were observed between the groups. Antithrombin level and amplitude of clot firmness at 10min in the EXTEM and FIBTEM tests were lowest in the >3-h group. Similarly, blood loss volume and transfusion volume were highest in the >3-h group. Significant differences in platelet count, ROTEM data, lowest esophageal and bladder temperatures, and transfusion volume were observed between patients who underwent DHCA and patients who did not undergo DHCA. The longer the CPB time, the greater the perioperative blood loss volume and transfusion volume, particularly if CPB time is greater than 3hours. Sub-group analysis revealed that DHCA affects perioperative platelet count and function as well as blood loss volume.

Multicenter, retrospective, cohort study shows platelet counts predict hepatocellular carcinoma development in patients with nonalcoholic fatty liver disease.

Impacts of platelet counts at the time of liver biopsy on hepatocellular carcinoma (HCC) development in patients with nonalcoholic fatty liver disease (NAFLD) remain unknown. The aim of this study was to investigate the prognostic value of platelet counts in patients with biopsy-confirmed NAFLD using data from a multicenter study. One thousand three hundred ninety-eight patients were included in this subanalysis of the CLIONE (Clinical Outcome Nonalcoholic Fatty Liver Disease) in Asia study. Liver biopsy specimens were pathologically diagnosed, and histologically scored using the NASH Clinical Research Network system. Demographic, clinical, laboratory, and pathological data were collected. During a median follow-up period of 4.6years (range, 0.3-21.6years), which corresponds to 8874 person-years, 37 patients developed HCC. Using a cut-off baseline platelet count of 192×109/L, the lower platelet group had a higher HCC rate than the higher platelet group (6.7% vs. 0.4%; p<0.001). This cut-off value significantly stratified the event-free rate for HCC. Lower platelet counts were associated with an increased risk of HCC development. Relative to patients with platelet counts of 192×109/L, patients with platelet counts of 100×109/L had an unadjusted hazard ratio (HR) for HCC development of 7.37 (95% confidence interval [CI], 3.81-14.2) and an adjusted HR of 11.2 (95% CI, 3.81-32.7; p<0.001), adjusting for age, sex, NASH,anddiabetes. Baseline platelet counts of 192×109/L and lower are associated with a higher risk of developing HCC in patients with biopsy-confirmed NAFLD and require active surveillance.

Risk Factors for Mortality in Severe Fever with Thrombocytopenia Syndrome Patients with Central Nervous System Complications.

BACKGROUND Severe fever with thrombocytopenia syndrome (SFTS) is a zoonotic viral hemorrhagic fever caused by the SFTS virus (SFTSV), which is a newly identified tick-borne bunyavirus, recently named Dabie bandavirus. In rural China, SFTSV or Dabie bandavirus is commonly transmitted by Haemaphysalis longicornis, the Asian longhorned tick. In recent years, SFTS has been of great concern due to its high morbidity and mortality. The present study investigated the risk factors for mortality in patients with SFTS complicated by central nervous system involvement. MATERIAL AND METHODS We studied 69 SFTS patients hospitalized between 2013 and 2020. We analyzed the laboratory test results and clinical data through univariate and multivariate regression. RESULTS Neurological complications occurred in 59 patients in the survival group and 10 in the mortality group. No significant gender difference was found between the 2 groups. No significant difference was found in age, hospitalization duration, or occurrence of encephalitis between the 2 groups. The mean duration of hospitalization and course of the disease in the mortality group were significantly shorter than those in the survival group (P<0.01). The mean values of platelet count, potassium, and sodium in the mortality group were significantly lower, while the mean values of aspartate aminotransferase, lactic dehydrogenase, creatine kinase-MB (CK-MB) and procalcitonin were higher than those in the survival group. Low platelet count and high CK-MB were independent risk factors for mortality in patients. For each unit increase in platelet count, the risk of mortality decreased by 24.2%, and for each unit increase in CK-MB, the probability of mortality increased by 118.6%. CONCLUSIONS Decreased platelets and increased CK-MB were independent risk factors for mortality in encephalitis patients. SFTS patients with encephalitis should be monitored for changes in these 2 indicators.

A STUDY OF PREVALENCE OF THROMBOCYTOPENIA IN CHRONIC HEPATITIS B PATIENTS AND ITS ASSOCIATION WITH THE SEVERITY OF HEPATIC FIBROSIS IN A TERTIARY CARE HOSPITAL OF NORTH EAST INDIA.

Background: Thrombocytopenia which is dened as circulating platelet count below 150×109/L, is one of the uncommon extra-hepatic manifestation of Chronic hepatitis B infection.1 Thrombocytopenia in Chronic hepatitis B infection mainly attributes to hepatic cirrhosis of liver, autoimmune destruction of direct platelets and megakaryocytes, impaired production of platelets due to impaired thrombopoietin production.2–4 Objective: To assess the platelet count in chronic hepatitis B patients and its association with the severity of hepatic brosis. Materials and methodology: Ahospital based observational study was conducted among 70 chronic hepatitis B patients where chronic hepatitis B infection was conrmed by HbcIg-Total and HbcIgM ELISA kit test. Platelets were being counted with the help of microscope and neubauer slide. Severity of brosis is graded by liver point shear wave elastography machine. Results:Among the 70 Chronic hepatitis B patients 24 patients were found have thrombocytopenia. Value of mean platelet count (in ×109/L) were 327.14±62.07, 224.14±72.56, 191.88±18.89, 157.55±13.24 and 121.43±60.71 in normal hepatic status; mild, signicant, severe brosis and cirrhosis respectively. Conclusion: From the study thrombocytopenia can be considered as one of the extra-hepatic manifestations in CHB patients where the platelet count is found to be inversely proportional to the severity of hepatic brosis with signicant association (p value &lt; 0.0001).

Platelet count, temperature and pH value differentially affect hemostatic and immunomodulatory functions of platelets

Platelets are primarily recognized for their role in hemostasis, but also regulate immune responses by interacting with leukocytes. Their highly sensitive nature enables platelets to rapidly respond to micro-environmental changes, which is crucial under physiological condition but can jeopardize in vitro analyses. Thus, we tested how platelet count and changes in pH and temperatures, which are commonly experienced during inflammation and infection but also affected by ex vivo analyses, influence platelet-leukocyte interaction and immunomodulation.Reducing platelet count by up to 90 % slightly decreased platelet activation and platelet-leukocyte aggregate formation, but did not affect CD11b activation nor CD62L shedding of monocytes or neutrophils. Acidosis (pH 6.9) slightly elevated platelet degranulation and binding to innate leukocytes, though pH changes did not modulate leukocyte activation. While platelet responsiveness was higher at room temperature than at 37 °C, incubation temperature did not affect platelet-leukocyte aggregate formation. In contrast, platelet-mediated CD11b activation and CD62L expression increased with temperature.Our data thus demonstrate the importance of standardized protocols for sample preparation and assay procedure to obtain comparable data. Further, unspecific physiologic responses such as thrombocytopenia, acidosis or temperature changes may contribute to platelet dysfunction and altered platelet-mediated immunomodulation in inflammatory and infectious disease.

Sepsis and Septic Shock: Are Initial mSOFA Score, Point-of-Care Lactate, Neutrophil-Lymphocyte Ratio and Platelet Count Good Predictors for Mortality?

Background: Sepsis is a common life threatening medical problem and first leading cause of death in Myanmar. This study was aimed to determine the predictive values of initial mSOFA score, point-of-care lactate, neutrophil-lymphocyte ratio and platelet count for mortality in patients with sepsis and septic shock. Method: A hospital based prospective observational study done in No.(1) Defence Services General Hospital, Yangon, from January 2021 to October 2022. All patients above 18 years old admitted with sepsis and qSOFA ≥ 2 were enrolled and sample size was 121 patients. The predictors were mSOFA score, point-of-care lactate, neutrophil-lymphocyte ratio and platelet count, which were assessed within 24 hour of admission and the mortality was observed for 28 days. Logistic regression was used to find out the predictive value and the predictors were compared by receiver operating characteristic curve analysis.

Role of Inflammatory/Immune Response and Cytokine Polymorphisms in the Severity of Chronic Hepatitis C (CHC) before and after Direct Acting Antiviral (DAAs) Treatment.

Host regulatory immune response is involved in the hepatic inflammatory process caused by the hepatitis C virus (HCV). We aimed to determine if HCV clearance with direct-acting antivirals (DAAs) changes the hepatic fibrosis stage, biochemical parameters of liver injury, and inflammatory/immune responses. Sample: 329 chronic hepatitis C (CHC) patients, 134 of them treated with DAAs. Liver fibrosis was evaluated by transient elastography (FibroScan), biochemical and cellular parameters were determined by standard methods, cytokine concentration by enzyme-linked immunoabsorbent assay (ELISA), and genetic polymorphisms by polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) or endpoint genotyping. Before DAA treatment, severe fibrosis or cirrhosis (F3/4) was associated with higher values of tumor necrosis factor-alpha (TNF-α) and genotypes transforming growth factor-beta-509 C/T_CC (TGF-β-509 C/T_CC), interleukine-10-1082 T/C_CC (IL-10-1082 T/C_CC), and IL-10-592 G/T_GT. After DAA treatment, fewer F3/4 patients and lower values of TNF-α were found. Patients with TNF-α-308 G/A_GG and IL-10-592 G/T_GT were at risk for F3/4. Lack of improvement of liver fibrosis was associated with lower baseline values of platelet count for genotypes TNF-α-308 G/A_GG and haplotype TT/GG of IL-10-1082 T/C and IL-10-592 G/T. Our study showed decreased liver fibrosis/inflammation and normalization of liver injury biomarkers after DAA treatment. It also points to the importance of suppressing the pro-inflammatory response by DAAs in the resolution of hepatitis C, contributing to the improvement of liver damage evaluated by transient elastography.

The correlation between hemostatic blood parameters and sepsis in patients with gunshot wounds referred to a training and research hospital.

War injuries are different among the causes of trauma compared to cases in normal life. Patients with multi-trauma due to war injury are prone to develop infective complications such as sepsis or septic shock. Septic complications are one of the leading causes of late death in multi-trauma patients. Prompt, appropriate, and effective management of sepsis has been shown to prevent multiorgan dysfunction and improve mortality and clinical outcomes. However, there is no ideal biomarker to predict sepsis. The aim of this study was to determine whether there is a correlation between hemostatic blood parameters and sepsis in patients with gunshot wounds (GSW). This descriptive study was conducted as a retrospective analysis of patients who were referred to the adult emergency department of a training and research hospital between October 1, 2016, and December 31, 2017, with a diagnosis of GSW and who developed sepsis (n=56) and did not develop sepsis (n=56) during follow-up. Demographic data such as age, sex, and blood parameters obtained from the hospital information system in the emergency department were recorded for each case. The statistical difference in hemostatic blood parameters between the two groups with and without sepsis was evaluated with Statistical Package for the Social Sciences 20.0 program. The mean age of the patients was 26.9±6.67. All of the patients were male. Of the patients who developed sepsis, 57% (n=32) were injured with improvised explosive devices (IEDs), 30% (n=17) were injured with firearms and when the anatomical injury sites were analyzed, 64% (n=36) had multiple injuries. In patients who did not develop sepsis, 48% (n=27) had IED, 43% (n=24) had GSW and 48% (n=27) had multiple injuries and 32% (n=18) had extremity injuries. Among the hemostatic blood parameters, platelet count (PLT), PTZ, INR, and Ca values showed a statistically significant difference between patients with and without sepsis, and when analyzed with the receiver operating characteristics curve, PTZ and INR showed the best diagnostic performance compared to the tested values. Increased PTZ and INR values and decreased Ca and PLT values in patients with GSW may alert clinicians to sepsis and direct them to initiate or change antibiotic therapy.

PS-C26-1: USEFUL MARKERS FOR RENAL PROGNOSIS IN HYPERTENSIVE EMERGENCIES WITH SEVERE RENAL DYSFUNCTION

Background: Hypertensive emergencies are poor prognosis conditions associated with rapid blood pressure (BP) elevation and various organ damage. The frequency of dialysis induction due to nephrosclerosis is high and early detection and appropriate therapeutic intervention are important. Methods: We selected 15 patients diagnosed as hypertensive emergencies with severe renal dysfunction (serum creatinine level &gt; 2.5 mg/dL) admitted to our hospital between 2005 and 2019. These were divided into two groups: those who received a renal replacement therapy (RRT) after 3 years and those who were not received (non-RRT). The clinical features and laboratory data between the two groups were reviewed and compared retrospectively. Results: The median age was 48 years old and the male to female ratio was 3:1. All the patients lacked medical examination and regular checkups after diagnosis of hypertension. 33% of them were obese with body mass index &gt; 25. Six patients resulted in end-stage renal disease and received RRT. On admission, about 80% had elevated plasma renin activity and serum aldosterone levels, while there were no cases of renal artery stenosis. Between two groups, there was no significant difference in serum creatinine levels. Serum LDH levels in the non-RRT group were higher than those in the RRT group. Serum potassium levels and platelet counts were lower, respectively. These data at post-antihypertensive treatment was improved significantly in the non-RRT group. Serum values of LDH, potassium, and platelet in the comparison of pre-and post-treatment data of the two groups showed significantly improved by two-way analysis of variance. Discussion and Conclusion: The mechanism of the onset of hypertensive emergencies is still unclear. Severe hypertension causes severe vascular injury and multiple organ damages. In our study, there were young or middle-aged adults and some of them were obese. Therefore, taking health-checkup is helpful for the prevention of the risk of hypertension and appropriate treatment. Higher LDH levels and decreased platelet counts in the non-RRT group suggested the development of severe endothelial damage with rapid BP elevation in the short term. Severe renal dysfunction in these cases can be improved to some extent by appropriate antihypertensive therapy. Furthermore, the lower potassium level suggested the aggravation of the renin-angiotensin-aldosterone system (RAAS) and early induction of RAS inhibitors would be beneficial for the maintenance of BP and renal protection. In conclusion, the value of serum LDH, platelet count, and serum potassium would be predictors of renal prognosis.