Hb Values Research Articles

Blood Loss in Women of Childbearing Potential Taking Oral Anticoagulants for Venous Thromboembolism (The BLEED Study).

Oral anticoagulants (OAC) may exacerbate menstrual bleeding in women of childbearing age; however, the existing literature on this issue has several limitations. This study investigates abnormal uterine bleeding (AUB) in women of childbearing age taking oral anticoagulants-Vitamin K antagonists (VKA) or Direct Oral Anticoagulants (DOAC)-for venous thromboembolism through a retrospective analysis of prospectively collected data. Uterine bleeding was assessed using the Pictorial Blood Assessment Chart (PBAC) and hemoglobin (Hb) values during anticoagulation compared to prior therapy. The number of unplanned medical visits for bleeding complications was also calculated. From June 2014 to November 2023, 110 women were recruited (median age, 36 years). PBAC scores correlated with Hb values at baseline and during therapy (ANOVA, p<0.01), with a significant difference in Hb values before and during anticoagulant therapy (Δ Hb) among groups (ANOVA, p=0.034). Seventeen women (15.4%) reported fibroids, experiencing a greater reduction in Hb values during anticoagulant administration than women without fibroids (Δ 0.3, IQR -0.8, 2.9 vs -0.5, IQR -1.2, 0.3; p=0.012). Women with fibroids required more frequent unplanned medical consultations for bleeding (mean visits 5 vs 4 respectively; Poisson regression, p<0.05). Among women with fibroids, those taking apixaban showed smaller Hb changes than those on other oral anticoagulants (ANOVA, p=0.047). This difference persisted even after adjusting for potential confounders (MANOVA, p=0.004). Women of childbearing potential taking OAC frequently experience changes in Hb values and PBAC scores during treatment, with fibroids playing a significant role.

Oxygen extraction–guided transfusion strategy in critically ill patients: study protocol for a randomised, open-labelled, controlled trial

IntroductionIn critically ill patients, individualised strategies for red blood cell transfusion (RBCT) are lacking. The objective of this study is to demonstrate the potential advantages of employing an individualised transfusion...

Anemia Acuity Effect on Transfusion Strategies in Acute Myocardial Infarction

In patients with acute myocardial infarction (MI), limited physiologic adaptation to acute anemia might lead to greater benefit from a liberal red blood cell (RBC) transfusion strategy. Data on such a possible benefit are lacking. To compare acute anemia with chronic anemia and post-MI outcomes and estimate the differential effect of a restrictive RBC transfusion strategy compared with a liberal strategy on post-MI outcomes according to anemia acuity. A prespecified subgroup analysis of the Myocardial Ischemia and Transfusion (MINT) multicenter randomized clinical trial was conducted in 126 hospitals in 6 countries between April 26, 2017, and April 14, 2023, with 30-day follow-up and blinded adjudication of the primary outcome. The analysis included 3144 of 3504 MINT participants (89.7%) with acute MI, a hemoglobin (Hb) level less than 10 g/dL at randomization, and a first Hb measurement available on the day of or the day following hospital admission. The MINT trial randomized participants to a restrictive (Hb <7-8 g/dL) or liberal (Hb <10 g/dL) RBC transfusion strategy. Acute anemia was defined as having a first Hb value greater than 13 g/dL (men) or 12 g/dL (women), or as having a decrease greater than or equal to 2 g/dL between the first Hb measurement and measurement at randomization. Other Hb levels were categorized as chronic anemia. The primary outcome was a composite of death or recurrent MI up to 30 days after randomization. Secondary outcomes were death, recurrent MI, cardiac death, heart failure, pulmonary complications, and major bleeding events. Intention-to-treat analysis was performed. Among 3144 included participants (mean [SD] age, 72.3 [11.6] years; 1715 [54.5%] male; 1307 [41.6%] with type 1 MI), 1078 [34.3%]) had acute anemia. Acute anemia was associated with an increased risk of death or recurrent MI (adjusted risk ratio, 1.25; 95% CI, 1.05-1.48). The effect of a restrictive RBC transfusion strategy compared with a liberal strategy was similar for participants with either acute or chronic anemia for all outcomes. In this secondary analysis of the MINT trial, acute anemia was associated with less favorable post-MI outcomes than chronic anemia but did not modify the effects of the randomized transfusion strategy. In patients with anemia and MI, the acuity of anemia should not influence the choice of transfusion trigger. ClinicalTrials.gov Identifier: NCT02981407.

“Comparative evaluation of cytotoxicity of three herbal endodontic irrigants at three intervals of time” – An in vitro study

Aim: The aim of the study was to evaluate and compare the cytotoxicity of 25% of neem leaf extract (Azadirachta indica), 20% of guava leaf extracts (Psidium guajava), and 20% of cinnamon extract (Cinnamomum zeylanicum) irrigants at three intervals of time. Methodology: Four groups were formed (n = 15), Group 1 (control group) – normal saline solution, Group 2 – 25% of neem extract, Group 3 – 20% of guava extract, and Group 4 – 20% of cinnamon extract. Each group was further divided into three subgroups based on intervals (n = 5). Subgroup A – at 10 min, Subgroup B – at 20 min, and Subgroup C – at 30 min. One hundred microliters of each irrigant was added to 2 mL of the diluted red blood cells suspension obtained from a human volunteer. Hemoglobin (Hb) estimation was done with an automated hematology analyzer after incubating the test samples at 10, 20, and 30 min intervals. Results: The reduction in the mean Hb values was not statistically significant in the normal saline, guava, and cinnamon groups. However, in the neem extract group, the mean Hb values reduced significantly at P &lt; 0.001. Among the subgroups, Subgroup A (10 min) showed the least cytotoxicity. Conclusion: In the present study, 20% guava extract had the lowest cytotoxicity and cytotoxicity increased with time. Hence, 20% guava extract can be used as an alternative to conventional irrigants as it has been shown to have the least cytotoxicity.

Anemia in pregnancy and adverse maternal health outcomes - birth-registry based study from Georgia

Abstract Anemia in pregnancy is an important public health challenge; however, it has not been thoroughly studied in Georgia. We assessed the prevalence of anemia during pregnancy across Georgia and the association between anemia in the third trimester of pregnancy and adverse maternal outcomes. We used data from the Georgian Birth Registry and included pregnant women who delivered between January 1, 2019, and August 31, 2022 (n = 158,668). The prevalence of anemia (hemoglobin (Hb) &amp;lt; 110 g/L) at any time during pregnancy was calculated per region. Women in the third trimester were classified into three groups, based on their lowest measured Hb value: no (Hb ≥ 110 g/L, reference group); mild (Hb 100-109 g/L); and moderate to severe anemia (Hb &amp;lt; 99 g/L). Adjusted odds ratios (aOR) with 95% confidence intervals (CIs) were calculated for the associations between anemia status and post-delivery intensive care unit (ICU) admission and preterm delivery. The prevalence of anemia occurring at least once during pregnancy was 40.6%, with large regional differences in anemia prevalence (25.1%-47.0%). Of 105,811 pregnant women with Hb measurements in the third trimester, 71.0% had no anemia; 20.9%, mild anemia; and 8.1%, moderate or severe anemia. The odds of post-delivery ICU admission did not increase linearly with decreasing Hb value (P for trend .13), and the relationship was inverse for preterm delivery (P for trend .01). Key messages • A considerable proportion of pregnant women in Georgia have anemia during pregnancy, and the prevalence and quality of reporting differ across regions. • To accelerate national progress toward the SDGs and mitigate the consequences of anemia, equal countrywide access to high-quality ANC programs and complete registration of Hb values should be ensured.

HFpEF and glycemic variability: GHIDD Trial

Abstract Background Recently the guidelines of European Association of Preventive Cardiology reported that the prevalence of diabetes mellitus in patients with diastolic heart failure (HFpEF) is around 31%. Glunovo® is a transdermal device capable of detecting and storing the concentration of glucose in the abdominal interstitial fluid 480 times a day for up to 14 consecutive days. Purpose In our study we evaluated the non diabetic patients with HFpEF with Glunovo to evaluate the glycaemic variability in this population Methods 100 patients with HFpEF admitted to cardiology units of 4 Italian centres on the major islands were enrolled consecutively. Glunovo® was applied to each enrolled patient for 7 days. At the end of the glycaemic monitoring were calculated for each patient the glycaemic variability and the incidence of hyperglycaemia and hypoglycaemia. Glycaemic variability refers to a blood glucose value of ≥ 200 mg / dL or ≤ 59 mg / dL detected more than 3 times in a day for at least 4 days. The inclusion criterion was the presence of diastolic heart failure while the only exclusion criterion was the presence of diabetes diagnosis. Overall, 43 males and 57 females were enrolled with a mean age of 69.3 years (39-87 years). All patients underwent a timely glucose measurement at admission which excluded the presence of hyperglycaemia. No potentially hyperglycaemic drugs were added to the treatment during the hospital stay. Continuous glucose monitoring was performed as an integral part of the hospitalization diagnostic routine. Results In 94 of the 100 patients enrolled it was possible to conclude the analysis, detecting the glycaemic variability, the point glycaemia values and the estimated glycated haemoglobin value. A glycaemia ≥200 mg/dL was found in 53 patients (56%) while a high glycaemic variability was found in 51 patients (54%). A blood glucose value &amp;lt;59 mg / dl was found in 48 patients (51%). Only 5 times the estimated glycated Hb values were&amp;gt; 7%. 32 of the patients who had at least 3 punctual glucose values ≥200 mg/dL were prescribed an oral glucose load curve, which in 100% of cases confirmed the diagnosis of diabetes.No statistically significant differences were found based on age group or sex. In the control group, consisting of 10 patients without DHF undergoing continuous glucose monitoring at one of the participating cardiology units, an unknown hyperglycaemia was found in only 1 patient (10%) and a glycaemic variability in only 1 patient (10%). Conclusions Our experience suggests an incidence of hyperglycaemia and glycaemic variability more then 65% in patients affected by HFpEF. If our data were reproducible on a large scale, a so high prevalence of diabetes in patients with HFpEF cold explain the efficacy of SGLT-2 inhibitor and GLP-1 Agonist in this class of patients.

Sex differences in inflammatory parameters after shoulder arthroplasty and blood loss.

In many diseases, sex differences in diagnostics and therapy play role that is increasingly becoming recognized as important. C-reactive protein (CRP) and white blood cell (WBC) levels are determined as inflammatory markers to detect inflammation and even infection after total shoulder arthroplasty (TSA). The general course of white blood cell, CRP, and hemoglobin (Hb) levels after TSA is well known, but there is insufficient evidence of a possible association with sex. Therefore, we aimed to investigate whether there is an influence of sex on CRP, WBCs, and Hb after TSA in the first 10 days after surgery in a complication-free course in male and female patients and to re-evaluate the specific postoperative CRP, WBC, and Hb course with their maximums (minimum for Hb) and further course until the end of the inpatient period. We retrospectively studied patients treated with TSA, reverse shoulder arthroplasty (RSA), and prosthesis replacement between 2015 and 2021. Patients with active inflammation, rheumatoid arthritis, secondary osteoarthritis, active cancer, and documented postoperative complications were not included. CRP, WBC, and Hb levels before shoulder arthroplasty (SA) and up to 10 days after SA were recorded and analyzed for sex differences. Data from a total of 316 patients (209 women and 107 men) were finally analyzed. There were no sex differences in the CRP and WBC values, but women had significantly lower preoperative Hb values, postoperative Hb values, and minimum Hb values. There were no significant differences in Hb, CRP, or WBC levels in the prosthesis exchange group. The progression of CRP and WBC levels showed no sex-specific significant differences after TSA within the first 7 postoperative days. The study confirmed a decreased Hb value for women at all stages of SA. Blood loss was significantly higher for RSA than for TSA for both men and women.

Evaluation of Some Hematological Parameters for Patients Infected with Entamoeba Histolytica in Najaf Governorate

General background: Amoebic dysentery caused by Entamoeba histolytica is a significant public health concern, particularly in regions with poor sanitation. It can lead to various complications, including changes in blood parameters. Specific background: Identifying changes in blood indicators during amoebic infections can aid early diagnosis and improve patient outcomes. Knowledge gap: There is limited research exploring gender-based differences in blood parameters of patients with amoebiasis. Aims: This study aimed to evaluate the effect of E. histolytica infection on specific blood parameters in male and female patients and to assess gender-based variations in these parameters. Results: A total of 45 patients (20 males, 25 females) diagnosed with amoebiasis were included, with samples collected between May 2023 and January 2024. Significant differences (P ≤ 0.05) were observed between male and female patients in RBC, HB, HCT, and MCH, while no significant differences were noted for MCV, MCHC, RDW, PLT, WBC, or LYM. Male patients showed higher mean values of RBC (5.01 ± 0.65) and HB (14.6 ± 1.61) compared to females (RBC: 4.5 ± 0.54; HB: 12.28 ± 1.24). Novelty: This study highlights gender-specific alterations in blood parameters during amoebiasis, providing new insights into how gender affects physiological responses to E. histolytica infection. Implications: Regular monitoring of blood parameters, particularly RBC and HB, in patients with amoebiasis is crucial for early diagnosis and treatment. The findings also underscore the importance of gender considerations in clinical management and suggest the need for larger studies to confirm these results and explore their diagnostic and therapeutic implications. Highlights: Gender impacts blood parameters in amoebiasis patients. Males show higher RBC and HB than females. Regular monitoring aids early E. histolytica diagnosis. Keywords: Amoebic dysentery, Entamoeba histolytica, blood parameters, gender differences, early diagnosis

Effects of pH Variations on Growth and Haematological Parameters of Pangasianodon hypophthalmus (Sauvage, 1878)

An experiment was carried out with an aim of enhancing culture of Pangasianodon hypophthalmus. Juveniles with an average length of 13.35±0.14 cm and 17.52±0.16 g of body weight were subjected to various pH levels of 7.5 (Control), 6, 9 and 9.5 to determine their growth and hematological changes. The control group exhibited the highest growth in both length (14.70±1.04 cm) and weight (21.12±2.67 g), while the lowest length (13.87 ± 0.43 cm) and weight (18.92 ± 1.11 g) in pH 9.5. The highest (1.24 ± 0.15) and lowest (0.56 ± 0.15) value of SGR was noticed in control and pH 9.5 respectively. The highest value of PER (3.79 ± 0.38) was observed in control and the lowest (1.66 ± 0.31) in pH 9.5. The highest (2.59 ± 0.47) and lowest (1.11 ± 0.16) value of FCR observed in pH 9.5 and control respectively. The highest count (26.80 ± 1.01 (103/µl)) of TLC was observed in pH 9.5 and the least (22.26 ± 0.53 (103/µl)) in control. The highest count (2.47 ± 0.15 (106/µl)) of TEC was observed in control and the least (1.97 ± 0.23 (106/µl)) in pH 9.5. The highest value (9.42 ± 0.14 g/dL) of Hb was observed in control and the least (9.5 with 5.77 ± 0.56 g/dL) in pH 9.5. The highest value (29.06 ± 0.46%) of Ht was observed in control and the least (22.41 ± 2.11%) in pH 9.5. The highest value (124.93 ± 9.99 fL) of MCV was observed in pH 9 and the lowest (114.45 ± 11.98 fL) in pH 9.5. The highest value (32.42 ± 0.76 g/dL) of MCHC was observed in control and the lowest (25.73 ± 0.87 g/dL) in the pH 9.5. The study revealed that P.hypophthalmus juveniles showed significant difference (p &lt; 0.05) between the control and treatments. Study inferred that alterations in the growth and haematological parameters were occurred at higher pH levels compared to lower pH levels.

A-143 Comparative Evaluation of K2EDTA Performance in Multinational Vacutainers: A Case Study of “DBO” by Schraubg and “BD” by Becton, Dickinson

Abstract Background This research paper presents a thorough comparison of the anticoagulant properties of K2EDTA in two multinational vacutainer brands, “DBO” by Schraubg and “BD” by Becton, Dickinson, with a specific focus on critical hematological parameters. The study encompassed the analysis of 50 samples, spanning a wide range of values from 60 fl to 110 fl, evaluating key parameters such as Hemoglobin (Hb), Hematocrit (HCT), Mean Corpuscular Volume (MCV), Mean Corpuscular Hemoglobin Concentration (MCHC), and Red Blood Cell (RBC) count. Methods Peripheral blood samples were gathered from 50 outpatient participants using the specified tubes. The samples underwent assessment for six hematological analytes, including RBC Count, hemoglobin, HCT, MCV, MCH, and MCHC. Comparative analysis was performed using the paired t-test. Differences exceeding the total allowable error were considered clinically significant. To assess stability, initial results were compared with those obtained from samples preserved for a duration of 2 hours Results Our findings indicate that the use of “DBO” vacutainers resulted in slightly higher values for Hb, HCT, MCV, MCHC, and RBC count compared to the “BD” vacutainers. Notably, the statistical significance was observed in MCV, HCT, and MCHC across nearly all samples, while Hb and RBC parameters showed no significant changes. Given the crucial role of K2EDTA as an anticoagulant in maintaining the hypotonicity of Red Blood Cells (RBCs), ensuring accurate hematological analyses is imperative. Conclusions Although the T-value for Hemoglobin did not exhibit statistical significance, the study identified notable differences in Hematocrit (HCT) and Mean Corpuscular Volume (MCV). This underscores the importance of selecting the appropriate vacutainer brand to ensure reliability and accuracy in hematological measurements, particularly when assessing MCV, where even slight variations can carry clinical implications. The results underscore the necessity for clinicians and laboratories to carefully consider the choice of vacutainers based on their specific requirements and the critical nature of the hematological parameters under analysis.

Micronutrient intake and status in young vegans, lacto-ovo-vegetarians, pescatarians, flexitarians, and omnivores.

Whether youth who follow plant-based diets in Nordic countries meet their dietary needs for micronutrients remains unclear. This study aims to evaluate micronutrient intake and status in Norwegian youth following vegan, lacto-ovo-vegetarian, pescatarian, flexitarian and omnivore diets. Cross-sectional design, with healthy 16-to-24-year-olds (n = 165). Participants were asked to complete a questionnaire and four 24-hour dietary recalls. Dried blood spots (DBS) and spot-urine samples were collected for analysis of methyl malonic acid (MMA) (n = 65), haemoglobin (Hb) (n = 164) and urinary iodine concentration (UIC) (n = 163). Vegans reported highest habitual supplement usage of multivitamin (58%), B12 (90%) and macroalgae consumption (32%), while flexitarians reported highest habitual usage of omega-3 supplements (56%). For daily supplement usage, vegans reported highest use of multivitamins (42%), B12 (79%), iodine (37%) and iron (63%). Increased risk of inadequate intake (energy-adjusted) were found for vitamin D (60% within lacto-ovo-vegetarians), selenium (70% within lacto-ovo-vegetarians, 65% within omnivores), and iodine (63% within vegans). Median MMA levels suggest low risk of insufficient B12 status across all groups (MMA 0.04‒0.37µmol/l) and 2% had MMA levels indicating possible B12 deficiency and 8% had elevated levels. Median Hb levels indicated low risk of anemia across all groups (≥ 12.0 females, ≥ 13.0g/dl males), though 7% had Hb values indicating risk of mild anemia and 4% risk of moderate anemia. The median UIC indicates mild iodine deficiency in all groups (UIC < 100µg/l), except vegans, who were moderately iodine deficient (UIC < 50µg/l). Our study indicated that the participating youth had low risk of inadequate intake of most micronutrients, partly due to high supplement usage. However, for iodine, vitamin D, and selenium higher risk of inadequate intake was found. UIC corroborated the low iodine intake among vegans. Thus, we suggest iodine status of youth in Norway should be monitored, especially among young fertile women who omits dietary iodine sources, until a mandatory iodine fortification program is implemented. Furthermore, we suggest that food education on how to secure sufficient nutrients from food in general should be provided to the Norwegian youth population, especially how to secure adequate intake of vitamin D, selenium and iodine.

Optimal cut-off values and diagnostic significance of clinical laboratory indicators in newly diagnosed multiple myeloma

ObjectiveThis study aims to identify clinical laboratory parameters for the diagnosis of newly diagnosed multiple myeloma (NDMM), establish optimal cutoffs for early screening, and develop a diagnostic model for precise diagnosis.MethodsThe study conducted a retrospective analysis of 279 NDMM patients and 553 healthy subjects at Zhejiang Province People’s Hospital between January 2008 and June 2023. Multifactor LR was employed to explore clinical laboratory indicators with diagnostic value for NDMM, determine optimal cutoff values and contract a diagnostic model. The diagnostic efficacy and clinical utility were evaluated using receiver operating characteristic curves (ROC), sensitivity, specificity, and other indicators.ResultsMultifactor analysis revealed that hemoglobin (Hb), albumin (Alb), and platelet distribution width (PDW) were significant diagnostic factors for NDMM. Optimal cutoff values for Hb, Alb, and PDW in MM diagnosis were determined, and the results showed a significant increase in the probability of NDMM diagnosis when Alb was below 39.3 g/L, Hb was below 11.6 g/dL, and PDW was below 14.1 fL. The diagnostic model constructed from the development cohort demonstrated a high area under the ROC curve of 0.960 (95% CI 0.942–0.978) and exhibited good sensitivity (0.860), specificity (0.957). The area under the curve (AUC) value of the diagnostic model in the external validation cohort was 0.979, confirming its good diagnostic efficacy and generalization.ConclusionsThe optimal cutoff values for Hb, Alb, and PDW and the diagnostic model designed in the study provided good accuracy and sensitivity for the initial screening and diagnosis of NDMM.

Towards a national model of humus (carbon) budget management in soils of agroecosystems in the Russian Federation

The prospect of adapting two methods for monitoring the fertility of agricultural soils (humus balance, HB) under spring and winter wheat crops (hereinafter referred to as grain crops) developed in the Russian Federation (RF) for the purposes of climate projects has been studied. It was revealed that the RosNIIzemproekt method (1998) underestimates the HB average value to -7.7 c/ha for RF. The RosNIIzemproekt method (1998) has logical errors in the calculation model and is not recommended for use. The TsINAO method (2000) has a more logical calculation model. According to this method, the average value of HB in soils for RF is generally positive and amounts to 3.3 c/ha (0.71 tCO2-eq/ha carbon units). This value constitutes ≈0.3% of average humus reserves in arable soils of the RF (108 tС/ha). The annual value of change in humus content under spring and winter wheat is incommensurably less than the total humus reserves in the soil. Statistically reliable assessment of changes in humus content requires a huge number of soil samples. This makes the verification procedure economically inexpedient. Another option is proposed to increase the time of humus accumulation. It is considered (IPCC, 2003) that a 20-year accumulation period is sufficient, which corresponds to the duration of soil climate projects. A coefficient (0.216) has been proposed for converting humus reserves (c/ha) to the value of a carbon unit (tCO2-eq/ha). The total sequestration of carbon by soils under grain crops in 2022 was about 11 million 914 thousand tCO2-eq. HB accounting significantly compensates for calculated emissions from agricultural production and reduces them by almost 10% (from 116 to 105 million tons CO2-eq in 2022). For both models of fertility monitoring, an assessment was made of the quality of the regression dependence of HB on the total biomass of photosynthesis (TBP) in soils under grain crops. It is shown that according to Fisher's t-test at a 5% significance level, the studied relationship is significant and characterized by the squares of the correlation coefficient (R2) equal to 0.554 and 0.998. In accordance with the Chaddock scale, the closeness of the correlative relationship between HB and TPB for winter wheat is assessed as high, and for spring wheat as very high.

Perioperative Complications in Percutaneous Nephrolithotomy: Predictive Risk Factors and Hemodynamic Alterations.

Background Percutaneous nephrolithotomy (PCNL) is one of the most frequently used methods of treating large and/or complex kidney stones. Despite the growing interest in this area, there are relatively few papers that report studies of the changes in hemodynamics in the perioperative period and the potential factors that might influence the patient's condition. This aspect, however, has not been well described in the current literature, although fluctuations in blood pressure, temperature, and electrolyte balance during surgery may also lead to development of complications. Objectives In this study, variations in vital signs during surgery and between surgeries of 134 patients who underwent PCNLwere analyzed in relation to other predisposing factors such as hypothermia and the need for blood transfusion. Methods Biochemical data such as systolic blood pressure (SBP) and diastolic blood pressure (DBP), temperature, hemoglobin (Hb), hematocrit (Hct), and serum sodium and potassium were assessed at admission, during PCNL, and at 24 hours after surgery in 134 patients. In this study logistic regression was used to assess the influence of factors such as age, BMI (body mass index), surgery duration, volume of irrigation fluid, number of tracts, estimated blood loss, hypothermia, and requirement of red blood cell transfusions. Results The mean arterial pressure declined during surgery as compared to the preoperative value, reaching a value of 97.34 during the operation. The monitored mean temperature of the patient during the perioperative period was therefore reduced, with a small increase towards the end of the surgery. In the plasma concentrations, there was a decrease compared to pre- and postoperative values, and there was also a decline in 48-hour Hb, Hct, and sodium values. The analysis identified the volume of irrigation fluid as a predictor of mild hypothermia risk. A longer surgery time along with more tracts and worse condition of the patient meant that the patient needed more blood transfusion. It was also noted that none of them influenced the amount of Hb that was lost. Conclusion Variability in the recorded ABCs (airway, breathing, and circulation) before and after PCNL procedures was normative. Despite hypothermia being associated with the volume of irrigation fluids used in surgeries, most of the transfusions were administered in patient-complicated operations and critical states. This suggested that there was potential in defining the modifiable factors that worsen clinically reported outcomes to assist in enhancing protocol.

Analysis of Erythrocyte Parameters in Multiple and Long-Term Blood Donors from Northern Pomerania (Poland)

Background/Aims: Assessment of the levels of vital blood parameters in donors is essential to evaluate their health status, ensure their suitability for donation, preserve the integrity of the circulatory system, and facilitate comprehensive health monitoring. The aim of our study was to analyse the levels of haemoglobin, haematocrit, erythrocyte count, MCV, MCH, and MCHC in 12 groups of first-time donors and experienced donors of both sexes at the John Paul II Regional Blood Donation and Treatment Centre in Słupsk, northern Poland. The donors were divided into three age groups (18-30 years, 31-45 years, and 46-65 years). Methods: Using MANOVA multivariate significance tests, we examined the main effects of donor-related factors (age, sex, donor stage) on morphological blood parameters to evaluate different haematological parameters, such as Hb, Ht, RBC, MCV, MCH, and MCHC, and identified statistically significant relationships between all variables. Results: The multivariate analysis of these three main factors showed that the variation in haemoglobin (Hb) levels accounted for 46% of the explained dependence in this statistical model. In particular, approximately half of the variability in the multivariate statistical analysis was attributed to the role of Hb and haematocrit (Ht). In addition, the β-coefficient values for Hb and Ht were statistically higher in relation to donor sex and donor type (single versus repeat). These β-coefficient values from our data represent the strength and direction of the relationship between the haematological parameters (Hb and Ht) and the specific donor characteristics. A higher β-coefficient indicates a stronger influence of donor sex and donor type on these parameters, suggesting that these factors contribute significantly to the variation in the Hb and Ht levels. Based on our results, the comprehensive analysis of the entire statistical model of metabolic biomarkers revealed the following hierarchy: Hb &gt; Ht &gt; MCHC &gt; MCV &gt; RBC &gt; MCH. The results obtained showed strong statistical relationships, as indicated by the high values of the key statistical indicators in our analysis. The coefficient of determination (R²) showed that the model explained a significant proportion of the variance in the data, while the F-test statistic confirmed the significance of the predictors. Conclusion: These strong statistical dependencies provided a clear justification for selecting this model over others, as it effectively represented the underlying relationships within the data. These statistics help to assess how well the model matches the actual data, thereby helping to reduce the risks associated with blood donation, optimise donor safety, and maintain the quality and efficiency of blood transfusion services.

Microclimate analysis of Ganga riverfront in Patna: spatial form perspective

ABSTRACT The investigation in this research scrutinizes the influence of spatial form factors on thermal comfort along the Ganga riverfront trail during the spring season. Understanding how spatial form factors impact local climate parameters and PET values is crucial for optimizing thermal comfort in urban waterfronts. The research addresses the need to improve thermal comfort in rapidly urbanizing areas through strategic urban design. Data were collected from eight measurement points along the riverfront, analyzing Air Temperature (Ta), Relative Humidity (RH), Wind Velocity (v), Surface Temperature (Ts), Global Radiation (G) and Mean Radiant Temperature (Tmrt). The study employs a combination of field measurements and statistical analysis to assess the correlation between spatial form factors and thermal comfort indicators. Findings reveal that lower building height (Hb) values are associated with more favorable thermal comfort conditions, while higher Hb negatively impacts thermal comfort. The study also highlights that building spacing (ADb) influences thermal comfort, with findings contrasting those from composite climates, suggesting a need for context-specific design strategies. The research underscores the significant role of Ta and v in shaping Physiological Equivalent Temperature (PET), aligning with previous studies in diverse urban contexts. The results emphasize the critical impact of spatial form on microclimate and thermal comfort, informing urban design and planning to enhance livability along the Ganga riverfront. This study contributes to the field by providing empirical evidence and practical insights for developing thermally comfortable walking trails.

Predictive factors of hemoglobin drop after robot-assisted radical prostatectomy: a single center prospective study.

Robotic surgery provides precise control, allowing for optimal dissection and cutting of tissues while minimizing bleeding. However, a significant drop in hemoglobin (Hb) after robot-assisted radical prostatectomy (RARP) is often recorded. The current study aimed to examine the postoperative Hb drop and its predictive factors in prostate cancer (PCa) patients who underwent RARP. From our tertiary care center's prospectively maintained database, all PCa patients who underwent RARP from January 2022 to January 2023 were identified. For each patient, baseline, anesthesiologic, and surgical characteristics, as well as blood samples before and after surgery, were collected. Multivariable linear and logistic regression models were fitted to investigate potential predictive factors of linear Hb drop or Hb drop ≥ 2g/dl between preoperative and postoperative day (POD) one, after RARP. Overall, 110 RARP patients were enrolled. Considering the Hb, the median preoperative and POD1 values were 14.6 and 12.7g/dl respectively (∆ = 1.9, p < 0.001); between POD2 and POD3, no statistically significant difference was recorded (12.4 vs 12.5g/dl, ∆ = 0.1, p = 0.1). After multivariable analyses, age, BMI, prostate volume, nerve-sparing approach, anesthesia time, intraoperative fluids, intraoperative blood loss, and intraoperative diuresis did not show a statistically significant predictive value (all p > 0.05). The current prospective study showed a statistically significant Hb drop until POD1. After that, a quick stabilization of the Hb value was recorded. This reduction was not correlated with pre- and intraoperative variables. These observations might play an important role in postoperative inpatient RARP management, in both large and low-volume centers.

Assessment of Reticulocyte Count as a Prognostic Indicator for Canine Ehrlichiosis: Implications for Diagnostic and Therapeutic Strategies

Canine ehrlichiosis is increasingly recognized in India, with significant implications for canine health. It is a tick-borne disease, caused by Ehrlichia canis. It is prevalent in various regions, particularly in areas with high tick populations. Anaemia is one of the most common and important manifestation of this disease. Anemia results from the destruction of red blood cells and bone marrow suppression. The prevalence of canine ehrlichiosis correlates with the density of tick vectors and can be exacerbated by environmental factors. Canine anemia can be classified as either regenerative or non-regenerative. Objective of the study was, investigating the prognostic value of reticulocyte counts in dogs with ehrlichiosis. The study involved 212 dogs screened between February 2023 and March 2024. Risk factors such as age, sex, breed, and season were recorded. Canine ehrlichiosis was diagnosed by finding morula stages in monocytes and neutrophils in thin blood smear examination. The pathogen was confirmed through PCR-based molecular examination. Reticulocyte count was performed through supravital stain new methylene blue (NMB). Reticulocytes contain ribosomal RNA, which is less condensed than in mature erythrocytes. NMB has a high affinity for ribosomal RNA, resulting in a blue coloration of these immature cells. This staining reaction makes reticulocytes clearly distinct compared to mature red blood cells under a microscope, facilitating their identification and quantification. The study found that the haematological parameters of infected dogs were significantly lower than healthy dogs. The mean ±SE values of Hb, TEC, PCV, and corrected reticulocyte were significantly lower (p&lt;0.001) in infected dogs compared to healthy dogs. These findings suggest that significantly lower values of Hb, TEC, PCV, MCV, MCH, MCHC, and corrected reticulocyte indicate anaemia, normocytic, normochromic anaemia, and non-regenerative anaemia. It can be concluded than in canine ehrlichiosis, anemia is one of the most common finding accounting aprox 28% of total diagnosed cases. Accurate anemia characterization is key for diagnosing and treating ehrlichiosis.

Decrease of haemoconcentration reliably detects hydrostatic pulmonary oedema in dyspnoeic patients in the emergency department – a machine learning approach

BackgroundHaemoglobin variation (ΔHb) induced by fluid transfer through the intestitium has been proposed as a useful tool for detecting hydrostatic pulmonary oedema (HPO). However, its use in the emergency department (ED) setting still needs to be determined.MethodsIn this observational retrospective monocentric study, ED patients admitted for acute dyspnoea were enrolled. Hb values were recorded both at ED presentation (T0) and after 4 to 8 h (T1). ΔHb between T1 and T0 (ΔHbT1-T0) was calculated as absolute and relative value. Two investigators, unaware of Hb values, defined the cause of dyspnoea as HPO and non-HPO. ΔHbT1-T0 ability to detect HPO was evaluated. A machine learning approach was used to develop a predictive tool for HPO, by considering the ability of ΔHb as covariate, together with baseline patient characteristics.ResultsSeven-hundred-and-six dyspnoeic patients (203 HPO and 503 non-HPO) were enrolled over 19 months. Hb levels were significantly different between HPO and non-HPO patients both at T0 and T1 (p < 0.001). ΔHbT1-T0 were more pronounced in HPO than non-HPO patients, both as relative (-8.2 [-11.2 to -5.6] vs. 0.6 [-2.1 to 3.3] %) and absolute (-1.0 [-1.4 to -0.8] vs. 0.1 [-0.3 to 0.4] g/dL) values (p < 0.001). A relative ΔHbT1-T0 of -5% detected HPO with an area under the receiver operating characteristic curve (AUROC) of 0.901 [0.896–0.906]. Among the considered models, Gradient Boosting Machine showed excellent predictive ability in identifying HPO patients and was used to create a web-based application. ΔHbT1-T0 was confirmed as the most important covariate for HPO prediction.ConclusionsΔHbT1-T0 in patients admitted for acute dyspnoea reliably identifies HPO in the ED setting. The machine learning predictive tool may represent a performing and clinically handy tool for confirming HPO.

Could exhaled methane be used as a possible indicator for hemodynamic changes in trauma induced hemorrhagic shock? Scientific basis supported by a case study

IntroductionIdentification of severe blood loss and hemorrhagic shock in polytrauma patients poses a key challenge for trauma teams across the world, as there are just a few objective parameters, on which clinicians can rely. We investigated the relationship between exhaled air methane (CH4) concentration and blood loss in a polytrauma patient. Decreased blood flow in the superior mesenteric artery (SMA) is one of the first compensatory responses to blood loss. Gases produced by the anaerobic flora of the intestinal segment supplied by the SMA are the primary source of exhaled CH4, which diffuses through the intestinal microvessels into the circulation and is finally eliminated through the lungs. We hypothesized that diminution of exhaled CH4 indicates blood loss and tested our theory in a severely injured patient. MethodsExhaled CH4 concentrations of a severely injured patient were measured using a photoacoustic spectroscope (PAS) attached to the exhalation side of the breathing circuit. The primary objective was to investigate the relationship between exhaled CH4 and conventional indicators of hemorrhage including hemoglobin (Hb) levels, base deficit (BD) values and vital parameters (heart rate and systolic blood pressure) in the early phase of in-hospital care (first 4 h). ResultsA severely injured patient was admitted with unstable hemodynamic parameters and incomplete left lower limb amputation, (Injury Severity Score: 38, 74/36 mmHg, 76 bpm). At the time of arrival, considerably lower CH4 levels were detected (22,800 PAU) in the exhaled air. During the first 4 h fluid and massive blood resuscitation, the exhaled CH4 levels were continuously rising in parallel with Htc and Hb values. Corresponding to these changes, BD values displayed a decreasing tendency. DiscussionOur study was conducted to characterize the changes in exhaled air CH4 concentration in response to hemorrhagic shock and to provide data on a viable clinical use of an experimental technique. According to our results, the real-time detection of exhaled air CH4 concentration is an applicable and promising technique for the early detection of bleeding and hemorrhagic shock in severely injured patients. Further research on large sample size and refinement of the PAS technique is required.