LDH Values Research Articles

Inflammatory markers in expectant COVID-19 positive patients: A relationship with clinical severity in a tertiary care referral facility.

Background: SARS-Co-V2 infection which was declared as a pandemic by the WHO has caused significant impact on morbidity and mortality to the mother and the fetus, especially the delta variant of the COVID-19. Hence it is important to identify the subgroup of women who are prone to adverse complications and prevent maternal and perinatal mortality. Inflammatory biomarker is one such tool to identify the high-risk expectant mothers. Methods and results: A total of 158 patients were identified in this retrospective study and they were classified based on the clinical signs and symptoms as per the society of maternal fetal medicine. 96.2% belonged to the non-severe group and 3.8% belonged to the severe infection group. Cough and fever were the most common symptoms. Inflammatory markers which were done on admission were correlated with the clinical disease severity. The difference in mean values of CRP, LDH and ferritin between the severe and non-severe group was significant statistically. The markers IL-6 and d-dimer were raised but did not correlate with disease severity. Neutrophil lymphocyte ratio (NLR) calculated from the blood counts was abnormal in all the patients in the severe group and statistically significant. Overall, the maternal outcome was good and maternal mortality rate was 1.89% (3/158). Neonatal outcome was good with stillbirth rate of 3.16% which was higher when compared to non-covid stillbirth rates (0.5%). Conclusion: inflammatory biomarkers like CRP and LDH are sensitive in predicting the adverse maternal fetal outcome. NLR is a simple ratio that has a good positive predictive value in identifying the need for more vigilant monitoring in expectant COVID-19 positive patients.

Correlation between Immune Microenvironment and Clinicopathological Characteristics and Prognosis of Primary Large B-cell Lymphoma of Immune-Privileged Sites

ObjectivesTo explore the correlation between tumor-associated macrophages (TAMs), tumor-infiltrating lymphocytes (TILs), and tumor-associated angiogenesis (TAA) in the tumor microenvironment with the clinicopathological characteristics and prognosis of primary large B-cell lymphoma of immune-privileged sites (LBCL-IP).MethodsA total of 46 cases of LBCL-IP from the Department of Pathology, the Third Affiliated Hospital of Xinjiang Medical University, from January 2010 to February 2024, were collected, along with clinical and follow-up data of LBCL-IP patients. Immunohistochemistry and triple immunofluorescence were used to detect related proteins of TAMs, TILs, and TAA, and to analyze the correlation between TAMs, TILs, TAA, and the polarization of TAMs with the clinical and prognostic factors of LBCL-IP patients.ResultsThere are 30 cases (65.2%) showed high expression of CD68 proteins, 32 cases (69.6%) showed high expression of CD163 proteins, 19 cases (41.3%) showed high expression of CD4 proteins, 34 cases (73.9%) showed high expression of CD8 proteins, and 25 cases (54.3%) showed high expression of CD34 proteins. A total of 27 cases (58.7%) showed CD68+CD163+/CD68+CD86+≥1. The chi-square tests showed that high expression of CD163 proteins was positively correlated with elevated LDH and BMG values, and the count of CD68+CD163+/CD68+CD86+≥1 was positively correlated with ECOG scores ≥2, Ann Arbor staging III-IV, and increased BMG value. High expression of CD8 proteins was positively correlated with a Ki-67 proliferation index ≥70%, and high MVD values were positively correlated with Ann Arbor staging III-IV. The Kaplan-Meier estimator analysis showed that LBCL-IP patients with low expression of CD68 proteins, high expression of CD163 proteins, CD68+CD163+/CD68+CD86+≥1, low expression of CD8 proteins, high MVD values, ECOG scores ≥2, Ann Arbor staging III-IV, LDH ≥250U/L, BMG ≥2.2mg/L, and IPI scores ≥2 had shorter survival times. Multivariate Cox regression analysis showed that low expression of CD8 proteins, CD68+CD163+/CD68+CD86+≥1, LDH ≥250U/L, and ECOG scores ≥2 are independent risk factors affecting the survival of LBCL-IP patients.ConclusionM2-polarized TAMs and low infiltration of CD8+ TILs were more strongly correlated with poor clinical pathological indicators and worse prognosis, and MVD values may serve as an aiding means for the diagnosis and prognostic prediction of LBCL-IP disease.

Evaluation of Biochemical Parameters in Caretta caretta Sea Turtles.

The Caretta caretta is the only known sea turtle that nests along the coasts of the Mediterranean Sea. It is considered a vulnerable species by the International Union for Conservation of Nature (IUCN) because it is threatened by human activities. The aim of this work was to analyze biochemical parameters in different age groups of C. caretta subjects recovered at the Centro di Referenza Nazionale sul Benessere, Monitoraggio e Diagnostica delle Malattie delle Tartarughe Marine (C.Re.Ta.M.), Sicily. Biometric parameters were recorded for each subject. Peripheral blood was collected and centrifuged, and 18 biochemical parameters were analyzed. Glucose and total proteins showed lower values in juvenile turtles than in sub-adult and adult subjects. Since blood biochemical parameters can be influenced by several factors (age, sex, infectious disease, or trauma), we evaluated differences in the values of some parameters between the reproductive and non-reproductive seasons of adult turtles whose sex and cause of stranding could be determined. Despite the small number of subjects, it would seem that, in adult turtles, the values of ALP, γ-GT, Fe, and LDH are higher during the reproductive season. These biochemical variations showed important differences in the parameters, underlining their importance in assessing the health status of turtles and better understanding their physiology during different stages of their lives.

Approaches to early detection of atypical hemolytic-uremic syndrome after childbirth

Introduction. Differentiating conditions accompanied by the development of thrombotic microangiopathy (TMA) in obstetrics is still rather challenging. Our present opinion is that the effect of childbirth on the TMA symptom regression is the key to differential diagnosis. If hemolysis and thrombocytopenia regress after childbirth, we can talk about HELLP syndrome. If not, we should think about atypical hemolytic uremic syndrome (aHUS). aHUS is an extremely rare disease characterized by TMA predominantly involving acute kidney injury. However, the diagnostic task can also be difficult due to possible overlapping one process with another: for example, HELLP syndrome can trigger aHUS, but which of the patients is more susceptible to this transformation is unclear.Aim. To identify clinical and laboratory criteria that can be used to early detect aHUS immediately after childbirth.Materials and methods. A total of 230 patients were enrolled in the study, of whom 71 women were diagnosed with aHUS, 124 patients with HELLP syndrome, and 35 patients without signs of TMA were enrolled in the control group. We assessed and compared the main clinical, anamnestic and laboratory findings.Results. Women with HELLP syndrome and aHUS were comparable in terms of age, frequency of operative delivery and gestational age at delivery, and adverse perinatal outcomes. Peak serum creatinine and LDH values after delivery were the most useful to early predict aHUS. Serum creatinine > 142 μmol/L and LDH > 1391 U/L were associated with the transformation of HELLP syndrome into aHUS.Conclusion. We concluded that standard laboratory data, most specifically peak serum creatinine and LDH, may be used to aid in the early diagnosis of aHUS.

Comparative assessment of the most important markers of equine myopathy in connection with creatine kinase activity

Purpose: to assess the activity of AST, LDH and HBDH enzymes in relation to different levels of total creatine phosphokinase activity to understand the degree of their diagnostic value in determining the severity of myopathy in horses.Materials and methods. For the study, statistical processing of a data array of the results of a biochemical study of blood serum from 247 horses was carried out. Taking into account the reference intervals of CPK activity, all results were ranked by increasing creatine phosphokinase activity and divided into four groups. In each group, the average values for AST, LDH and HBDH were calculated, and the degree of significance of intergroup differences was calculated using the Student's t test. The correlation between the activity of the enzymes AST, LDH and HBDH with the activity of CPK in each group was also assessed.Results. An increase in the activity of creatine phosphokinase in horses by 59,4—409,6 % is accompanied by an increase in the activity of the enzymes AST by 14,5—77,2 %, LDH by 17,8—33,0 % and HBDH by 17,1—27,1 %. When comparing Pearson's correlation coefficients across the entire study sample, a significant direct relationship is determined between CPK and AST and a moderate direct relationship when comparing CPK with LDH and HBDH. Calculation of the Pearson coefficient in each of the studied groups showed different degrees of correlation between the creatine phosphokinase indicator and other enzymes, but in all cases positive. A study of the percentage contribution of HBDH to the total lactate dehydrogenase activity showed an inversely proportional relationship with respect to the activity of creatine phosphokinase, which indicates massive muscle damage with switching energy metabolism in them.Conclusion. The conducted studies made it possible to more deeply understand the cause-and-effect relationships of changes in the activity of enzymes that are specific to muscle tissue in connection with the severity of myopathy. The data obtained can assist veterinary specialists in analyzing the results of biochemical blood tests in horses.

Gender differences in correlation of biochemical parameters with the severity of COVID pneumonia and the need for oxygen/mechanical support

Background:COVID-19 pandemic had caused a global medical, economic and social problems. High infection rate, heterogenous presentation, lack of previous data and no standardized treatment had led to a need for further analysis, in order to be prepared for any potential new pandemics. We analyzed any possible correlation between gender, laboratory findings and severity of disease with need for oxygen or mechanical ventilation support. Methods: 100 patients with confirmed SARS-CoV-2 virus infection enrolled. Baseline characteristics that included age, sex, smoking history, BMI, oxygen therapy or mechanical ventilation support need were recorded. Type and severity of radiological finding determined by chest CT scan. Results: Majority of our patients were over 61 years old (58.6%), male (57.6%), and had severe radiological finding (bilateral pneumonia 29.3%, ARDS 35.4%), with only 20.2% had not required any oxygen supplementation. Regarding gender and laboratory findings, men have shown statistically significant higher values of CRP, lymphocytes, LDH and ferritin (96.4 vs 87.1, p=0.014; 1.17 vs 0.84, p=0.048; 674.8 vs 609.1, p=0.031; 1263 vs 578.4, p=0.001, respectfully). Severe radiological finding had shown positive correlation with the need for HFNC and/or (N)IMV (p=0.021 and p=0.032. respectfully), as well as with higher values of WBC, LDH and ferritin (p=0.042, p=0.035 and p=0.017. respectfully). Conclusions: There is a difference between presentation of the disease, as well as analyzed laboratory markers between sexes. The difference is most likely multifactorial and should require further research in order to discover other risk and prognostic factors.

Effectiveness of laboratory tests in tracking severely COVID-19 infections

AIM: Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) is a virus that causes COVID-19 (Coronavirus Disease 2019), and poses serious difficulties in terms of healthcare systems and global public health. With the large number of publications on COVID-19, clinicians need a synthesis of evidence to provide guidance when dealing with patients with COVID-19. Emerging studies reveal the existence of numerous demographic, clinical, immunological, biochemical and radiographic data that may be useful for clinicians to predict the severity and mortality of COVID-19. The aim is of this study; To determine laboratory parameters that can predict the course and severity of COVID-19 disease in patients with diagnosed solely SARS-CoV 2 PCR test positivity results and independently of the clinic status of selected patients and based on laboratory findings. MATERIALS AND METHODS: This study is a retrospective cross-sectional study conducted at Karacabey State Hospital between January and April 2022. Among the patients who applied to the COVID-19 outpatient clinic, 469 patients (261 females, 208 males) over the age of 18 and positive for SARS-CoV-2 RT-PCR were included in the study. The patients were divided into groups as outpatients, inpatients and patients in need of intensive care (intensive care unit, ICU). Demographic data (age, gender), COVID-19 RT-PCR results, and simultaneous laboratory parameters of the patients were scanned retrospectively. RESULTS: When CRP, urea, ferritin, LEU, NEU, MONO, RBC, HGB, HCT, MCV, NLR, PLR, CRP-NR, and SII index values were taken into consideration, a statistically significant difference was found between the groups. Creatinine, ALT, AST, LDH, troponin I, mass CK-MB, D dimer, LYM, EOS, PLT, ELR, and PNR values were not significantly different between the groups. CONCLUSIONS: Advantages of this study; Comparing the changes in the patient's other laboratory findings based on a single positive PCR test result and finding meaningful rates in terms of serious covid risk. The disadvantage of this study is that it is a study independent of the patient's clinic and disease stage. CRP, urea, ferritin, and indexes such as NLR, PLR, CRP-NR, and SII index values can be used to predict the severity of the disease.

To investigate the relation between LDH and CRP levels and mortality of COVID-19 (SARS-CoV-2) patients admitted in SURGERY ICU at Shariati Hospital from 19 February 2020 till 19 February 2021

Background: The aim of this study is to investigate the relationship between LDH and CRP levels and the mortality of COVID-19 (SARS-CoV-2) patients admitted to the SURGERY ICU at Shariati Hospital from 19 February 2020 to 19 February 2021. Methods: Our study is a cross-sectional descriptive study. A total of 81 patients were enrolled in this study. We examined lab reports, including CBC parameters (WBC, neutrophil count, neutrophil percentage), other inflammatory markers ESR and CRP, and also studied the medical records of cases to collect details about age, gender, length of stay in SURGERY ICU, BMI, fever, survival status, comorbidity, intubation, and NIV. These patients were referred to Shariati Hospital, Tehran, from 19 February 2020 to 19 February 2021, regarding the relationship between LDH and CRP levels and the mortality of COVID-19 (SARS-CoV-2) patients admitted to the SURGERY ICU. The data obtained was analyzed using SPSS software, and a significance value of < 0.05 was considered. Results: In this study, the data of 81 patients were considered. The data were obtained from the medical records of Shariati Hospital, Tehran. We used 11 variables to compare data from different patients that were recorded in the registry and system of medical records in Shariati Hospital, Tehran. The study population included 81 patients, of which 41 were female and 40 were male, ranging in age from 25 to 89. In total, 80.2% had mild disease versus 18.5% who had severe disease. Sixty-five patients survived, and 16 were admitted to the SURGERY ICU with endotracheal intubation and later died. The length of stay in the SURGERY ICU ranged from 1 to 25 days. Out of 81 patients, 52 (62.4%) had comorbidity, and 29 (35.8%) did not have comorbidity. Twelve patients (14.8%) received NIV, and 69 patients (85.2%) did not receive NIV. Most of the patients did not have a fever. The minimum and maximum levels of CRP were 4 and 416, respectively, and for LDH were 9 and 2401, respectively. The prognostic factors for the severity of COVID-19 infection identified in this study (CRP and LDH) help predict the course of the disease at an early stage. Elevated concentrations of CRP and LDH at admission were found to be associated with a higher risk for COVID-19 severity as they were significant (p-value =0.049 and 0.048, respectively). Conclusions: This study’s laboratory investigation showed that the SURGERY ICU patients had significantly higher values of inflammatory markers CRP and LDH than the non-SURGERY ICU patients. LDH and CRP were superior and effective biomarkers in predicting the severity of COVID-19.

Effect of Boldenone Administration on Some Organ Damage Markers in Trained Rats

The aim of this study was to examine the effects of Boldenone administration on skeletal muscle, liver and heart organs in exercised rats. Rats were divided into 4 groups as Control(C), Exercise (E), Boldenone(B) and Boldenone + Exercise (BE). There are 6 rats in the C and E groups and 7 rats in the other groups. The rats in groups E and BE were given a 45-minute treadmill exercise 5 days a week at a speed of 1.5km/hour for 8 weeks. In the statistical evaluation of the data, the results were given as mean±SD using the SPSS 22 package program. ANOVA and Duncan tests were used to compare the data between groups. At the end of the 8-week study, blood samples taken from rats were found to be significantly higher in AST and CK-MB values in B and BE groups than in C and E groups as a result of the statistical analysis (p0,05), it was observed that the mean values of the B and BE groups were higher than the mean values of the C and E groups in both parameters. LDH values were significantly higher in E, B and BE groups compared to C group (p<0.05). With the result obtained from the findings; It has been observed that the use of AAS increases liver enzyme levels (ALT, AST, ALP, LDH) and CK-MB levels, which is a marker of heart muscle damage. With these findings, it can be said that the use of Anabolic Androgenic Steroids has negative effects on the heart and liver. In addition, the fact that the mean values of the BE group were higher than the other groups in all parameters, as exercise did not reduce the amount of these negative side effects of AASs, indicates that exercise may increase these side effects even more.

Physiological biodistribution on Ga68-PSMA PET/CT and the factors effecting biodistribution

AimThe study aims to determine the physiological and pathophysiological distribution of the radiopharmaceutical (Ga68-PSMA-617) and investigate whether there are differences in distribution according to the laboratory, histopathological and clinical findings that can affect image evaluation. Also, we aimed to determine cut-off values to distinguish physiological and pathological uptake in prostate, bone, and lymph nodes.Materials and Methods229 prostate cancer patients who underwent Ga68-PSMA PET/CT at our department were retrospectively analyzed. The patients were grouped according to PET/CT results, Gleason scores, PSA values, received treatments, metastatic status and other laboratory values. The SUV values of the organs, tissues, and pathological lesions of the patients in these subgroups were compared among themselves.ResultsNo significant difference was detected in the physiological uptake of lymph nodes and bone between the groups. In the group with patients that received androgen deprivation therapy (ADT), the bone metastasis SUV values were found to be higher and the SUV values of the submandibular gland and renal cortex were found to be lower (Mann–Whitney U, p = 0.043; 0.004; 0.01, respectively). In the group with patients who received radiotherapy, the normal prostate tissue SUV values were determined to be higher (Mann–Whitney U, p = 0.009). The SUV values of the submandibular gland, muscle, liver, and blood pool were found to be lower in the group of patients with high serum LDH values. The cut-off SUVmax value was determined to be 6.945 (sensitivity 89.6%, specificity 98.1%) for primary prostate lesion; 4.72 for lymph node metastasis; 4.25 for bone metastasis. The serum PSA cut-off value to distinguish the negative/positive groups was found to be 1,505 (sensitivity 79.7%, specificity 77.3%).ConclusionIn conclusion, PSMA-617 demonstrates a similar biodistribution with other PSMA ligands. The physiological uptake of lymph nodes and bone which are mostly metastasized in prostate cancer, are not affected by the factors we examined. It should be kept in mind that the normal prostate tissue uptake may increase in patients receiving radiotherapy, and the physiological/pathological uptake of the organs may differ due to the changes in PSMA expression in patients receiving ADT, tumor burden, and kidney function may affect the biodistribution.

Feasibility and Impact of Embedding an Extended DNA and RNA Tissue-Based Sequencing Panel for the Routine Care of Patients with Advanced Melanoma in Spain.

Targeted NGS allows a fast and efficient multi-gene analysis and the detection of key gene aberrations in melanoma. In this study, we aim to describe the genetic alterations in a series of 87 melanoma cases using the oncomine focus assay (OFA), relate these results with the clinicopathological features of the patients, and compare them with our previous study results in which we used a smaller panel, the oncomine solid tumor (OST) DNA kit. Patients diagnosed with advanced melanoma at our center from 2020 to 2022 were included and DNA and RNA were extracted for sequencing. Common mutated genes were BRAF (29%), NRAS (28%), ALK, KIT, and MAP2K1 (5% each). Co-occurring mutations were detected in 29% of the samples, including BRAF with KIT, CTNNB1, EGFR, ALK, HRAS, or MAP2K1. Amplifications and rearrangements were detected in 5% of cases. Only BRAF mutation showed a significant statistical association with sun exposure. For patients with a given genetic profile, the melanoma survival and recurrence-free survival rates were equivalent, but not for stage and LDH values. This expanded knowledge of molecular alterations has helped to more comprehensively characterize our patients and has provided relevant information for deciding the best treatment strategy.

Evaluation of the results of the patients who underwent plasmapheresis in the pediatric intensive care unit.

Therapeutic plasma exchange (TPE) is an extracorporeal treatment method that removes large molecular weight substances from plasma. In our study, we aimed to retrospectively examine the indications and procedural methods of the patients who had undergone TPE, and the complications that occurred during the procedure. Forty-one patients who were monitored in thePICU of Gazi Yaşargil Training and Research Hospital and had indications for TPE between 2017 and 2021 were included in the study. Laboratory parameters were checked before and after the TPE procedure. In addition to these, patients' diagnosis, weight, type of procedure and type of device, where the procedure was performed, duration of the procedure, amount of blood and plasma processed, complications, number of procedures, and death during the procedure or independent of the procedure were evaluated. The median age was 93.0 (14.0-167.0) months. Hemolytic uremic syndrome (HUS) was the most common TPE indication with nine patients. The most common complication related to TPE was fever (11 patients), while no complication was observed in 18 patients.When laboratory results were evaluated according to American Society for Apheresis (ASFA) categories, a significant improvement was observed in the values of platelet, AST, ALT, LDH, urea, and creatinine in ASFA1 after TPE. No significant improvement was observed in ASFA2 (p > 0.05). In ASFA3, a significant improvement was observed in INR, AST, ALT, LDH, total bilirubin, creatinine, pH, and lactate values after TPE (p < 0.05). Five patients died from ASFA1, one from ASFA2, and three patients from ASFA3. Since significant adjustments are observed in clinical and laboratory values in sepsis-MOF, which is in the ASFA3 category, we believe that it should be evaluated in the ASFA2 or ASFA1 category in the early treatment of these diseases. In addition, we think that MIS-C cases, which have not been in any category according to ASFA, should be included in the ASFA2 or ASFA3 category, considering our TPE results.

Clinical characteristics and influencing factors of severe fever with thrombocytopenia syndrome complicated by viral myocarditis: a retrospective study

ObjectiveThis study aimed to investigate the clinical characteristics of severe fever with thrombocytopenia syndrome complicated by viral myocarditis (SFTS-VM) and analyze relevant influencing factors.MethodsRetrospective analysis was conducted on clinical data from 79 SFTS-VM patients, categorized into common (SFTS-CVM, n = 40) and severe groups (SFTS-SVM, n = 39). Clinical manifestations, laboratory results, cardiac ultrasonography, and electrocardiogram features were analyzed. Univariate and multivariate analyses identified significant indicators, which were further assessed using ROC curves to predict SFTS-SVM.ResultsSFTS-SVM group exhibited higher rates of hypotension, shock, abdominal pain, cough with sputum, and consciousness disorders compared to SFTS-CVM group. Laboratory findings showed elevated platelet count, ALT, AST, amylase, lipase, LDH, D-dimer, procalcitonin, TNI, and NT-proBNP in SFTS-SVM. Abnormal electrocardiograms, especially atrial fibrillation, were more prevalent in SFTS-SVM (P < 0.05). Multivariate analysis identified elevated LDH upon admission (OR = 1.004, 95% CI: 1-1.008, P = 0.050), elevated NT-proBNP (OR = 1.005, 95% CI: 1.001–1.008, P = 0.007), and consciousness disorders (OR = 112.852, 95% CI: 3.676 ~ 3464.292, P = 0.007) as independent risk factors for SFTS-SVM. LDH and NT-proBNP had AUCs of 0.728 and 0.744, respectively, in predicting SFTS-SVM. Critical values of LDH (> 978.5U/L) and NT-proBNP (> 857.5pg/ml)) indicated increased likelihood of SFTS progression into SVM.ConclusionElevated LDH, NT-proBNP, and consciousness disorders independently correlate with SFTS-SVM. LDH and NT-proBNP can aid in early identification of SFTS-SVM development when above specified thresholds.

Neuroimaging Features in Eclamptic Encephalopathy and their Correlation with Clinical and Laboratory Parameters: a Prospective Observational Study.

New onset seizures in pregnancy and postpartum are considered eclampsia as the default diagnosis. Other causes, such as intracranial haemorrhage, subarachnoid haemorrhage, cerebral venous sinus thrombosis or acute ischaemic stroke, have a similar mode of presentation, but need prompt diagnosis and institution of specific measures to decrease the risk of mortality and morbidity. Neuroimaging plays an important role in providing a specific diagnosis and hence aids in proper management. We hypothesised to find any correlation of laboratory parameters with neuroimaging abnormalities along with providing an insight to specific diagnoses in patients of new onset seizures in pregnancy with a presumptive diagnosis of eclampsia. This was a hospital-based descriptive observational study conducted in SCB Medical College, Odisha, in the year 2018-2020 with a total of 70 clinically confirmed cases of eclampsia. They were subjected to cranial MR imaging along with routine investigations with no change in the emergency treatment protocol followed in the department. Data was compiled using Microsoft Excel 2016 and IBM SPSS statistics for Windows, version 27, and comparisons among MRI normal and abnormal group were stated. 58 (82.86%) were MR imaging positive or abnormal, while 12 (17.14%) were MR imaging negative or normal. Cortical venous thrombosis without infarction was diagnosed in 25 (43.1%) patients, 6 (10.34%) had infarction, posterior reversible encephalopathy syndrome was seen in 19 (32.76%) cases, and 8 (13.79%) had hypertensive leukoencephalopathy. The mean gestational age at the time of presentation was significantly lower in the MRI abnormal group (p = 0.012). The AST and LDH values were found to be significantly higher in the MRI abnormal group, with p = 0.02 and 0.01, respectively. Patients with imaging abnormalities have a severe form of disease in eclampsia. Neuroimaging in provisionally diagnosed cases of eclampsia will modify the management and hence prognosis in these patients.

LITHOTRIPTIC AND ANTI-LITHOGENIC EFFECT OF TILA-DHATRI KSHARA ALONG WITH GOKSHURA KASHAYA IN ETHYLENE GLYCOL-INDUCED NEPHROLITHIASIS IN ADULT MALE CHARLES FOSTER RATS

Objectives: Thirty-five adult Charles Foster rats were taken in the study to assess the lithotriptic and anti-lithogenic activity of the Trial drug. Methods: Thirty-five were divided into seven groups of five animals each. One group was kept as normal control; one group was given ethylene glycol 0.75% alone for 28 days. In the next three groups, Trial drug, kshara with distilled water, and the Standard drug were given, respectively, for 28 days after induction of calculi using ethylene glycol. In the next two groups, to assess the anti-lithogenic activity, simultaneously stone inducing agents and trial/standard drugs were given for 28 days. At the end, blood, urine, and histopathology of rat kidneys were done. Results: Tila-Dhatri kshara with Gokshura Kashaya and standard drug, Potassium Magnesium Citrate B6 showed equal lithotriptic and anti-lithogenic activity as depicted from blood, urine biochemistry, urine microscopy, and histopathology of rat kidneys. Trial drug-treated group showed more diuresis than other groups. Furthermore, serum LDH values were significantly reduced in trial drug-treated group. Conclusion: The trial drug showed significant nephroprotective property when compared to the standard drug as depicted from the serum LDH values and histopathological evaluations.

Risk association model for atelectasis complication in Mycoplasma pneumoniae pneumonia patients following standardized treatment.

Mycoplasma pneumoniae pneumonia (MPP) is a common disease of childhood pneumonia, and atelectasis is a serious comorbidity. Traditional diagnostic methods for MPP are limited by low accuracy, emphasizing the need for improved diagnostic approaches. This study aimed to establish a predictive scoring model for early detection of MPP complicated with atelectasis following standardized treatment. A total of 572 children were retrospectively enrolled, including 40 patients with MPP complicated by atelectasis despite standardized treatment and 532 patients in the non-atelectasis group. Clinical, laboratory, and imaging data within 24 h of admission were collected, including demographic information and various biomarkers. Multivariate logistic regression analysis was employed to identify risk factors and construct a predictive model, evaluated using receiver operating characteristic (ROC) curve analysis. Significant differences were observed between the MPP complicated with atelectasis group and the non-atelectasis group in terms of age, hospital admission time, fever duration, neutrophil percentage and count, CRP, ALT, and LDH levels (P < 0.05). According to the multivariate logistic regression analysis, length of fever, neutrophil ratio, platelet count, ALT, LDH, age were incorporated into the nomogram. The predictive model exhibited a sensitivity of 87.97% and specificity of 77.50% according to the ROC curve. Our study presents a preliminary risk association model incorporating clinical indicators such as fever duration, neutrophil ratio, platelet count, ALT value, LDH value, and age to aid in the early prediction of atelectasis in children with MPP. Given the methodological limitations, the generalizability of our findings is constrained, and this model should be viewed as an initial framework for clinical assessment rather than a definitive tool.

Multifaktorska etiologija atipičnog hemolitičko uremijskog sindroma - prikaz slučaja

Abstract: Introduction: Hemolytic uremic syndromes are characterized by the simultaneous occurrence of hemolytic anemia, microangiopathy, thrombocytopenia, and acute renal insufficiency. In terms of the clinical prodrome, they can be classified as typical, which is more common and occurs in 90% of cases, often preceded by diarrheal syndrome induced by enterohemorrhagic Escherichia coli. Alternatively, there is an atypical and rarer form associated with pneumococcal infection, dysregulation of the alternative complement pathway, and cases involving the use of cyclosporine. Hemolytic anemia is confirmed in laboratory analyses (presence of fragmented red blood cells, decreased hemoglobin, undetectable haptoglobin values, and elevated LDH values), along with thrombocytopenia and an increase in nitrogenous substances (urea and creatinine). Case report: The report details the case of an 18-month-old girl who experienced acute renal insufficiency subsequent to a respiratory infection. Ten days preceding admission, the patient exhibited nasal discharge, and during the seven days leading up to hospitalization, she presented with fever. Furthermore, two days prior to admission, the onset of persistent vomiting and abdominal pain occurred. Suspected of bowel intussusception, the patient underwent a surgical assessment where acute surgical pathology was ruled out. The absence of urination, coupled with heightened urea and creatinine levels, prompted consideration of hemolytic-uremic syndrome, later confirmed as atypical during hospitalization. This was grounded in the clinical presentation, devoid of diarrhea syndrome but marked by nasal discharge over the preceding ten days. The administration of fresh frozen plasma yielded no improvement, and there were decreased values of the C3 complement component, H factor, and reduced ADAMTS13 activity. The lack of verotoxins from enterohemorrhagic Escherichia coli further supported the diagnosis of atypical hemolytic-uremic syndrome. After the first dose of eculizumab, a terminal complement C5 component inhibitor, the girl recovered renal function and established diuresis. Conclusion: The prompt diagnosis of atypical hemolytic-uremic syndrome is challenging due to nonspecific symptoms like nasal discharge, vomiting, fatigue, and abdominal pain. Laboratory analyses, lacking specific criteria, make it difficult to conclusively identify aHUS at the disease's onset. In Serbia, pneumococcal immunization is recommended as a preventive measure, administered through a conjugated vaccine in three doses starting from the second month of life. Rapid and accurate differentiation between typical and atypical HUS is crucial for effective treatment and prognosis. Typical HUS requires hemodialysis and plasmapheresis, whereas atypical HUS is managed with plasmapheresis, immunosuppressive therapy, and eculizumab. Administering eculizumab heightens the risk of meningococcal infection by inhibiting the C5 complement component. Therefore, it is crucial not to disregard the importance of meningococcal immunization.

Clinicopathological and oncological outcomes in upper extremity Ewing's sarcoma: A single institutional experience

BackgroundEwing's sarcoma is highly aggressive bone tumor having predilection for younger age groups with t (11,22) translocation, recombines the FLI-1 and EWS genes on chromosome 22. This disease requires multi-disciplinary treatment withneo-adjuvant chemotherapy followed by surgery or radiotherapy and adjuvant chemotherapy. This study was aimed to assess the demographic distribution, clinical behaviour and oncological outcome of Ewings Sarcoma involving upper extremity. MethodsFrom 2015 to 2022, 45 patients of upper extremity Ewing's sarcoma underwent treatment at a territory cancer centre. A total of 26 patients treated with surgical management were included in the study comprising 15 males (57.7 %) and 11 females (42.3 %). Mean age of presentation was 26 years (3–43 years). The most common site for Ewings sarcoma of upper extremity was Humerus(42 %) followed by Scapula(27 %), Radius(15 %), Ulna(8 %), Metacarpals(4 %) and Clavicle(4 %). Out of 26 cases, 19 (73%) underwent limb salvage surgery and 7 (27%) underwent ampuation surgery. ResultsIn limb salvage group reconstruction with Extra-corporeal radiotherapy (ECRT), Ulna centralization, Megaprosthesis and 3D printed scapula was performed following wide resection of tumor. In Amputation group ray resection in one case and forequarter amputation was performed in six cases. Mean serum LDH value was 335 IU/L (2.3X Normal value) and serum albumin was 4.04 gm/dl. Mean tumour necrosis after neo-adjuvant chemotherapy was 68 %. Out of 26 cases, 19(73 %) cases underwent limb salvage and 7 patients underwent amputation surgery. Out of 26, 13 (50 %) patients developed metastasis on follow up. The Event free survival (EFS) in current study was 70 % at 12 months and 40 % at 24 months. Mean Event free survival (EFS) in current study was 33.5 months (22.3–44.6) and Median Event free survival (EFS) in current study was 25 months (19.7–30.2). ConclusionThis study characterises demographic and oncologic outcomes of upper extremity ewings sarcoma in Indian subpopulation. Pain and swelling were prominent clinical findings at presentation in patients with upper extremity Ewing's sarcoma. The survival rate following limb salvage surgery in Ewings sarcoma of upper extremity was comparable to that of patients with amputation surgery. Ewings sarcoma of upper extremity was associated with higher LDH level which was raised more than twice the normal range and can led to worse oncologic outcomes. A comparative study on upper extremity and lower extremity ewings sarcoma will be of help to improve literature on this rare disease.

Lymphocyte subsets and soluble forms of MIC-A and MIC-B are prognostic factors in non-Hodgkin lymphoma patients.

MIC-A and MIC-B are the natural ligands for NKG2D, an activator receptor expressed in NK cells. Soluble isoforms of MIC-A and MIC-B (sMICA, sMICB) have been identified in different malignancies, affecting NK cells' cytotoxicity. The study was performed to determine the levels of sMICA, sMICB, the expression of MIC-A, and MIC-B on tumor tissues, and lymphocyte subpopulations (CD4 + , CD8 + , NK, NKT, Tγδ cells, B cells, monocytes) in 94 patients with non-Hodgkin's lymphoma (NHL) and 72 healthy donors.The most frequent lymphoma was diffuse large B cell lymphoma (48%). Patients with NHL had decreased numbers of CD4 T cells, CD8 T cells, B cells, monocytes, NK cells, type 1 dendritic cells, γδ T cells, and increased iNKT cells. Patients showed higher levels of sMIC-A and similar serum levels of sMIC-B.Survival was poorer in patients having higher LDH values and lower numbers of CD4 T cells, type 1 dendritic cells, gamma-delta T cells, and high levels of sMIC-A.In conclusion, high levels of sMIC and decreased numbers in circulating lymphocyte subsets are related to poor outcomes in NHL.

Immune-Suppression Modulation in Solid Organ Transplant Recipients Admitted for COVID-19

SARS-CoV-2 infection has significantly impacted solid organ transplant (SOT) recipients, who are at high risk of disease and worse outcomes. Moreover, therapeutic management in this population is not precise yet. Our study aimed to evaluate the overall survival of SOT recipients and predictive factors for mortality. We also aimed to assess the impact of antiviral treatments and immunosuppressant changes on overall mortality and to evaluate the length of hospital stay of SOT compared to the general population. This is a retrospective monocenter study. We included all SOT recipients with laboratory-confirmed SARS-CoV2 infection admitted at Niguarda Hospital in Milan from February 2020 through January 2022. We enrolled 74 solid organ transplant recipients with a median age of 59. The overall mortality rate was 19%. Older age, male sex, diabetes, and high LDH values were associated with an increasing fatality rate. The median length of stay (LoS) was 17 days. Low white blood count and lymphocyte levels were associated with 19 days LoS. Changes in immunosuppression and SARS-CoV-2 antiviral therapies had no impact on mortality and LoS. In this study, we confirm previously described risk factors for worse outcomes. We did not observe beneficial therapies in terms of mortality rate and LoS. Seven patients received antiviral treatment. More studies are needed to assess the best therapeutical options, including immunosuppressant modulation, in SOTs.