White Blood Cell Count Values Research Articles

The importance of predictive markers in incarcerated abdominal wall hernia.

Emergency abdominal wall hernia repairs play a significant role in general surgical emergencies. In such cases, the time taken to decide on surgery is crucial, as the situation may progress to necrosis, perforation, and organ resection due to strangulation following incarceration. To facilitate the early detection of this condition, studies have been conducted on various predictive markers, most of which are related to similar markers used in acute mesenteric ischemia. This study aims to assess the predictive significance of preoperative laboratory and imaging findings in incarcerated abdominal wall hernia with strangulation. Retrospectively, 122 patients who underwent emergency surgery for incarcerated abdominal wall hernias with a preoperative diagnosis between January 1, 2018, and September 1, 2023, at the General Surgery Clinic of Samsun University Education and Research Hospital were included in the study. According to the examination of the operation notes, Group I was designated for patients who underwent bowel resection, Group II for those who underwent omental resection, and Group III for those without resection. The study investigated the association between patients 'age, gender, hernia type and side, preoperative laboratory parameters (pH, Base Excess (BE), Lactate, White Blood Cell Count (WBC), Neutrophil (N), Lymphocyte (L), Monocyte (M), Platelet (P), C-Reactive Protein (CRP), and pH/BE, pH/Lactate, Lactate/BE, N/L, N/M, L/M, N/CRP, M/P, P/CRP ratios), physical examination (PE), and imaging findings among the resection groups. Out of the 122 patients operated with a preliminary diagnosis of acute incarcerated abdominal wall hernia, 68 were female, 34 were male, and the median age was found to be 67.16 (30-99). In the conducted statistical analysis, mean values of Lactate (p = 0.007), WBC (White Blood Cell) (p = 0.001), Neutrophil (p < 0.001), and NLR (Neutrophil-to-Lymphocyte Ratio) (p = 0.003) were significantly different based on resection groups. Subsequent pairwise comparisons indicated that these differences were attributed to variations in mean values of Lactate, WBC, Neutrophil, and NLR between the Bowel Resection and Resectionless groups. Mean values of Monocytes were also significantly different among resection groups (p = 0.049), and pairwise comparisons revealed that this difference was due to variations in mean values of Monocytes between the Omental Resection and Resectionless groups. The cut-off values were determined as follows in the ROC analysis: 1.2 mmol/L for Lactate, 18.5 (10^9/L) for WBC, 8.1 (10^9/L) for Neutrophil and 10mg/L for CRP concerning bowel resection. In cases of abdominal wall hernia operations due to incarceration, bowel and/or intra-abdominal organ resections related to strangulation can lead to significant morbidity and mortality. Beyond the imaging methods available for preoperative assessment, high levels of laboratory parameters, including Lactate, WBC, Neutrophil, and NLR ratio, may primarily indicate the need for bowel resection, considering that omental resection is associated with lower morbidity and mortality compared to bowel resection, elevated levels of monocytes may primarily indicate the requirement for omental resection in emergency abdominal wall hernia surgery. We recommend that this be prioritized in emergency surgery to prevent complications such as bowel perforation and sepsis and improve clinical outcomes. The surgeon is advised to keep this in mind.

A comparison of scoring systems and biomarkers to predict the severity of acute pancreatitis in patients referring to the emergency clinic.

To investigate scoring systems and biomarkers for determining the severity and prognosis of acute pancreatitis (AP). Between January and July 2023, 100 patients with AP diagnosed and treated in the emergency department were included. AP was divided into 2 groups according to severity: mild AP and moderately severe AP (MSAP-SAP), according to the revised Atlanta Classification in 2012. Demographic characteristics, severity, intensive care unit (ICU) admission, white blood cell count (WBC), hematocrit, red cell distribution width from whole blood taken at admission and 48 hours later, C-reactive protein (CRP) and biochemistry values, Bedside Index for Severity in Acute Pancreatitis (BISAP), Pancreatitis Activity Scoring System (PASS), and harmless AP score scores were recorded retrospectively. Our variables, which were found to be significant in multiple logistic regression results, were found to increase MSAP-SAP expectation by 4.36-, 7.85-, 6.63 and 5.80 times in the presence of CRP > 47.10, WBC > 13.10, PASS > 0, and necrotizing computed tomography findings, respectively. It was detected that the risk factor which was found significant as a single variable affecting the ICU admission increased the risk of ICU requirement by 28.88 when PASS > 0, by 3.96 when BISAP > 1, and it increased the Atlanta score by 9.93-fold. We found that WBC and CRP values at the time of hospital admission and WBC, CRP, and red cell distribution width values after 48 had the highest accuracy in determining AP disease severity. BISAP, which was found to be significant in determining MSAP-SAP expectations, lost its significance in multiple logistic regression results, and PASS was found to be effective. The PASS is an important score in the clinical evaluation of patients with AP and in determining the need for ICU hospitalization.

Arthrocentesis of suspected septic sternoclavicular arthritis: microbial yield and predictors of culture positivity.

Evaluate the microbial yield and factors predicting culture positivity for image-guided arthrocentesis of suspected septic sternoclavicular (SC) arthritis. An electronic health record search identified image-guided SC joint aspirations for suspected septic arthritis. Data was extracted by retrospective chart review including patient demographics, procedure characteristics, pre-procedure lab testing, joint culture results, final SC joint diagnoses and any effect of positive synovial cultures on subsequent antibiotic therapy. Factors associated with positive joint fluid cultures were assessed using a Chi-squared test for categorical predictors and logistic regression for continuous predictors. A total of 31 SC arthrocenteses met inclusion criteria with most (81%) performed using ultrasound guidance. Synovial fluid was successfully aspirated in 19/31 (61%) of cases, and in all other cases lavage fluid was successfully obtained. Synovial cultures were positive in 9/31 (29%) of cases. A final diagnosis of septic arthritis was assigned to 20/31 cases (65%) in which 9/20 (45%) had positive synovial cultures. There was no statistically significant association between synovial culture positivity and risk factors for septic arthritis, positive blood cultures, pre-aspiration antibiotics and whether synovial fluid or lavage fluid was cultured. Serum white blood cell count (WBC) and erythrocyte sedimentation rate (ESR) demonstrated statistically significant positive correlation with positive synovial cultures. Arthrocentesis is effective for microbial speciation in SC septic arthritis, and diagnostic yield may be increased with lavage when encountering a dry tap. Normal serum WBC and ESR values indicate an extremely low likelihood of positive synovial cultures.

Diagnostic cutoff values of synovial fluid biomarkers for acute postoperative prosthetic joint infection: a systematic review and meta-analysis.

Introduction: The assessment of white blood cell (WBC) count and polymorphonuclear cell (PMN) percentage in synovial fluid can help in the diagnosis of acute postoperative peri-prosthetic joint infection (PJI). Their cutoff values, which would differ from those for chronic PJI, have not yet been determined in acute postoperative PJI. The aim of this study was (1)to analyse studies reporting the optimal cutoff values for WBC count and the PMN percentage in synovial fluid and (2)to determine which is the best diagnostic tool for acute postoperative PJI. Methods: We performed a systematic review (SR) of primary studies analysing WBC count and the PMN percentage for diagnosis of acute postoperative PJI. A search was performed in MEDLINE and EMBASE. We studied the risk of bias and quality assessment. We extracted data on cutoff values, sensitivity, specificity, positive and negative predictive value, area under the curve, and accuracy. We calculated the diagnosis odds ratio (DOR), performed the meta-analysis and summarized receiver operating curves (sROCs) for WBC count and the PMN percentage. Results: We included six studies. WBC count showed a DOR of 123.61 (95 % CI: 55.38-275.88), an sROC with an area under the curve (AUC) of 0.96 (SE: 0.009) and a index of 0.917. The PMN percentage showed a summary DOR of 18.71 (95 % CI: 11.64-30.07), an sROC with an AUC 0.88 (SE: 0.018) and a index of 0.812. Conclusion: We concluded that WBC count and the PMN percentage are useful tests for the diagnosis of acute PJI; WBC is the more powerful of the two. Studies centred on other synovial fluid biomarkers not yet studied could help in this diagnosis.

Toplumdan Kazanılmış Pnömoni Hastalarında Prokalsitonin, C-Reaktif Protein, Kan Beyaz Küre Sayılarının ve Hemogram Alt Parametrelerinin Karşılaştırılması

Aims: Pneumonia is a clinically and radiologically detected inflammation of the lungs. Most of the pneumonia patients are community-acquired pneumonia cases. Hemogram and C-reactive protein (CRP) are commonly used to support diagnosis and follow-up of treatment. Procalcitonin is less accessible and expensive. And the use of hemogram subparameters is not very common. The aim of this study was to research the relationship between procalcitonin, CRP, White Blood Cell count (WBC) and hemogram subparameters in patients with CAP and the efficacy of new hematologic rates in differential diagnosis.&#x0D; Methods: Patients who were diagnosed with community acquired pneumonia by applying to the chest diseases outpatient clinic of our hospital were retrospectively analyzed. 67 patients who were clinically and radiologically diagnosed without noticing male or female were included in our study. Anamnesis data and co-morbidities of the cases were questioned. Procalcitonin, CRP and hemogram (platelet-to-lymphocyte ratio (PLR), neutrophil-to-lymphocyte ratio (NLR) and monocyte-to-lymphocyte ratio (MLR) were calculated and WBC value was examined) were recorded. The obtained data were evaluated statistically and compared in terms of variables. &#x0D; Results: The mean age of our patients was 57 (18-71) years; there were 41 (61.19%) female and 26 (38.81%) male patients. 36 (53.73%) of our patients had chronic diseases; 21 (31.34%) had heart disease, 23 (34.32%) had diabetes, and 6 (8.95%) had kidney failure. Patients; 48 (71.64%) procalcitonin, 56 (83.58%) CRP, 38 (56.71%) WBC, 52 (77.61%) NLR, 34 (50.74%) PLR and 38 (56.71%) MLR values were high. Procalcitonin, CRP and NLR values were significantly higher than other subparameters. The CRP and NLR values of patients with an additional chronic disease were higher than patients without co-morbidities. In the correlation analyses, there was a strong correlation between procalcitonin, CRP and NRL, but the correlation between the others was not significant. (p

Evaluation of the Impact of a Naturally Occurring Beta Hemoglobin Variant, Hb G-Makassar, on Mature Red Blood Cell Function and Pathology in a Sickle Cell Disease Mouse Model

Background: Gene based therapy may provide a cure for individuals with sickle cell disease (SCD); base editing is a novel strategy with the ability to directly edit the mutation responsible for disease. The sickle hemoglobin (HbS) point mutation cannot be converted to wild-type HBB by an adenine base editor, however it can be converted to a naturally occurring hemoglobin variant, HbG-Makassar (HbG). HbG is a non-pathogenic, non-sickling hemoglobin variant. In vitro crystal structure analysis of HbG shows that it is highly similar to that of wildtype hemoglobin (HbA). However, few HbGG individuals (with no overt red cell disease) and no HbSG individuals have been identified; thus, the red blood cells (RBCs) of HbGG and HbSG individuals have not been evaluated functionally. The Makassar base editing strategy produces greater than 80% homozygous Hb-G product and has been evaluated in vitro, however erythroid culture of edited hematopoietic stem cells do not produce fully mature, enucleated red cells. Therefore, mouse models of HbGG and HbSG could be used to evaluate the function of mature, enucleated HbGG or HbSG RBCs. Methods: A humanized beta globin locus mouse (Townes) with the Makassar allele was created at by knocking-in the Makassar point mutation to generated WT/Makassar heterozygotes (HbAG) which were backcrossed to generated HbGG homozygotes. HbSG genotypes were subsequently generated by crossing to HbSS Townes mice. We analyzed the red cell function of HbAA, HbAS, HbSS, HbGG, and HbSG mice. Whole blood was collected through terminal enucleation. Complete blood counts were measured on a hematology analyzer (Heska and, ADVIA). Red cell deformability (elongation index, EI) was measured using oxygen gradient ektacytometry (LoRRCA) under normoxic (EImax) and hypoxic (EImin) conditions. Viscosity measurements were obtained on a Beckman cone and plate viscometer. Percent sickle cells were quantified through chemically induced sickling with sodium metabisulfite and counted by an individual blinded to genotype using light microscopy. Kidney, liver, and spleen were fixed, preserved in paraffin, stained using hematoxylin and eosin stains and imaged using a Keyence microscope. Flow cytometry was performed on bone marrow and whole blood to determine the erythroid maturation and mitochondrial retention of RBCs. Analysis was performed with Stata 18.0 (College Station) across genotypes using Dunn Pairwise test with statistically significant values being selected at adjusted p &amp;lt; 0.05. Results Homozygous HbG mice (HbGG) had comparable white blood cell count (WBC) and absolute reticulocyte count (ARC) to that of mice with homozygous HbA (HbAA). HbGG mice had lower hemoglobin and mean corpuscular volume (MCV) in comparison to mice with HbAA. HbGG mice had a higher percentage of dense RBCs than HbAA mice. HbSG mice had comparable values to HbAS mice for MCV but had significantly lower hemoglobin and ARC. HbSG mice had significantly higher values for WBC, and % dense RBCs against HbAS mice. HbSS and HbSG mice had comparable values for hemoglobin, and ARC. Hematocrit to viscosity ratio (HVR) shows comparable oxygen transport effectiveness of HbGG, HbSG, HbAS and HbSS RBC. Further red cell function testing is shown in Figure 1 and Figure 2. Mitochondrial retention was highest in HbSS mice, followed by HbSG, while HbAS, HbAA, and HbGG had similar values. Microscopy analysis of renal sections of HbGG and HbSG mice sacrificed at 24-28 weeks did not show the characteristic morphologic changes seen in HbSS mice at 24-28 weeks. Conclusions- HbGG appears functionally similar to HbAA, with minimal sickling under hypoxia, no anemia, normal spleen size, and no organ damage at 24 weeks of age. HbGG does exhibit signs of dehydration, as evidenced by elevated %DRBC and reduced RBC deformability. RBC function, sickling under hypoxia, Hb, WBC, ARC, and mitochondrial retention measures places HbSG as intermediate in severity between HbAS and HbSS. However, organ pathology, spleen and liver weights for HbSG were more comparable to HbAS than HbSS. Base editing strategies to install Makassar therefore can potentially lead to &amp;gt;90% of RBCs that have therapeutic benefit due to rheological properties comparable to HbAA and can be seen as a promising treatment strategy for patients with sickle cell disease.

B-143 Distribution of Uricemia Levels in the Population of a Third-level Hospital. Study of the Prevalence of Hypouricemia

Abstract Hypouricemia is a serum uric acid concentration ≤2.0 mg/dL. The causes may be congenital or acquired. Despite not being recognized as a relevant biomarker, the knowledge of the importance of uric acid in redox homeostasis and the hierarchization of hyperuricemia as an independent risk factor in metabolic diseases justifies a reassessment of the significance of the state of acquired hypouricemia. We aimed to study the prevalence of hypouricemia and its relationship with the referred patients’ ages, genders, and morbidities. A descriptive, quantitative study was carried out, through the survey and analysis of biochemical records and clinical records. We worked with the database of the laboratory’s system between January and October 2019, with the data groups of adult patients (≥16 years) that included serum uric acid dosage. The concomitant biochemical parameters (Urea, creatinine, white blood cell count, glucose) were evaluated, and the diagnoses and treatments were collected in the electronic medical record. To define the prevalence, we worked with the first analysis group of each patient. All statistical analyzes were carried out with the Statistix™ software version 7. The criteria for statistical significance were P &amp;lt; 0.05. We found that of the total 159 971 data groups from January to October 2019, 17 983 were selected. There were 234 patients with hypouricemia analyzed. The prevalence of patients with hypouricemia was 2.22%. In our population, postmenopausal women did not match the distribution of uricemia levels to that of men, nor did the mean values of each distribution. Men had higher levels of uric acid than women in any age situation. The prevalence of hypouricemia agrees with what is described in the literature. Of women with hypouricemia, 39% were in the process of pregnancy. Besides that, most patients had a pathology, less than 10% were present for health control, or did not have data in the clinical record. The prevalence of oncological pathology (46%) as a comorbidity in patients with hypouricemia (oncohaematological tumors more frequent than solid ones) and diabetes (22%) was striking. Hypouricemia values were more frequent in outpatients (70%) than in hospitalized patients, however, the last ones showed lower values (1.46 ± 0.4 mg/dL vs 1.52 ± 0.35 mg/dL). The white blood cell count values (0.1–26 * 103 cells/µL) and glucose (0.3–3.76 g/L) that accompany the hypouricemia situation behold pathological values, and the urea and creatinine values were normal. Because this is a retrospective work, we do not have studies of fractional excretion of uric acid, which could delve into the causal research of hypouricemia. Further studies are needed to elucidate the causes of hypouricemia and to clarify its value in diagnosing and treating diseases.

Diagnosis of periprosthetic joint infections in patients who have rheumatoid arthritis.

To investigate the optimal thresholds and diagnostic efficacy of commonly used serological and synovial fluid detection indexes for diagnosing periprosthetic joint infection (PJI) in patients who have rheumatoid arthritis (RA). The data from 348 patients who had RA or osteoarthritis (OA) and had previously undergone a total knee (TKA) and/or a total hip arthroplasty (THA) (including RA-PJI: 60 cases, RA-non-PJI: 80 cases; OA-PJI: 104 cases, OA-non-PJI: 104 cases) were retrospectively analyzed. A receiver operating characteristic curve was used to determine the optimal thresholds of the CRP, ESR, synovial fluid white blood cell count (WBC), and polymorphonuclear neutrophil percentage (PMN%) for diagnosing RA-PJI and OA-PJI. The diagnostic efficacy was evaluated by comparing the area under the curve (AUC) of each index and applying the results of the combined index diagnostic test. For PJI prediction, the results of serological and synovial fluid indexes were different between the RA-PJI and OA-PJI groups. The optimal cutoff value of CRP for diagnosing RA-PJI was 12.5 mg/l, ESR was 39 mm/hour, synovial fluid WBC was 3,654/μl, and PMN% was 65.9%; and those of OA-PJI were 8.2 mg/l, 31 mm/hour, 2,673/μl, and 62.0%, respectively. In the RA-PJI group, the specificity (94.4%), positive predictive value (97.1%), and AUC (0.916) of synovial fluid WBC were higher than those of the other indexes. The optimal cutoff values of synovial fluid WBC and PMN% for diagnosing RA-PJI after THA were significantly higher than those of TKA. The specificity and positive predictive value of the combined index were 100%. Serum inflammatory and synovial fluid indexes can be used for diagnosing RA-PJI, for which synovial fluid WBC is the best detection index. Combining multiple detection indexes can provide a reference basis for the early and accurate diagnosis of RA-PJI.

Effects of African Swine Fever infection on blood of Pigs from Selected Local Government Areas in Kaduna State, Nigeria

Indirect Enzyme-linked immunosorbent assays (ELISA) was carried out to detect antibodies against African Swine Fever (ASF) virus and haematological investigations were also carried out on blood samples collected from 299 pigs from selected Local Government Areas in Kaduna State Nigeria. The serum samples from 10 pigs (3.34%) were positive by ELISA haematological investigations consisted of packed cell volume (PCV), red blood cell count (RBC), white blood cell count (WBC). The mean PCV, RBC and WBC values of pigs negative for ASF were 34.84+9.611, 6.299+6.093 9.953+5.565/ml respectively while the values of pigs positive for ASF were 32.30+6.464, 5.160+1.182 and 9.740+4.37 /ml respectively. It was observed that the mean PCV values of the sero-positive pigs and seronegative pigs were not significantly different from the normal value, it was also observed that the sero-positive pigs had higher mean WBC count than the normal and also mean seronegative pigs.. In conclusion, African Swine Fever infection caused increase in the mean values of PCV, RBC and WBC count.

Inflammatory-like status and acute stress response in horses after road transport

This study aimed to evaluate the change of white blood cell count, serum concentration of cortisol, C-reactive protein, albumin and globulin fractions in horse after road transport, and to assess the linkage among hypothalamic–pituitary–adrenal axis (HPA) and inflammatory reaction. From 10 horses blood samples were collected at rest, before road transport (218 km) (BT); after unloaded (AT), 30 and 60 min after unloaded (AT30 and AT60) in order to assess white blood cell count (WBC), serum cortisol, C-reactive protein (CRP), total proteins, albumin, α1-, α-2, β1-, β2- and γ-globulins. WBC, cortisol, CRP, α1-, α-2 and β2-globulins values increased after road transport than rest condition (p < 0.001). Albumin and A/G ratio showed lower values after road transport than rest (p < 0.001). Pearson’s test showed a negative correlation between cortisol and the values of WBC, CRP, α1-, α2-, β1-, β2- globulins, and a positive correlation between WBC and serum concentration of CRP, α1- and α2-, β1-, β2-globulins at AT and AT30. The results showed that road transport evokes an inflammatory like-status in horses. Moreover, the activation of HPA and the onset of acute phase reaction in response to road transport seem to be interconnected with effects on horse’s immune status.

Challenging the Interpretation of White Blood Cell Counts in Patients with Sepsis Following Packed Cell Transfusion.

Critically ill patients with sepsis often require packed cell transfusions (PCT). However, PCT may affect white blood cell (WBC) counts. We conducted a population-based retrospective cohort study to trace changes in WBC count following PCT in critically ill patients with sepsis. We included 962 patients who received one unit of PCT while hospitalized in a general intensive care unit, and 994 matched patients who did not receive PCT. We calculated the mean values of WBC count for the 24 h before and 24 h after PCT. Multivariable analyses using a mixed linear regression model were performed. The mean WBC count decreased in both groups, but more in the non-PCT group (from 13.9 × 109/L to 12.2 × 109/L versus 13.9 × 109/L to 12.8 × 109/L). A linear regression model showed a mean decrease of 0.45 × 109/L in WBC count over the 24 h following the start of PCT. Every 1.0 × 109/L increase in the WBC count prior to PCT administration showed a corresponding decrease of 0.19 × 109/L in the final WBC count. In conclusion, among critically ill patients with sepsis, PCT causes only mild and clinically non-prominent changes in WBC count.

Effects of African Swine Fever infection on blood of pigs from selected local government areas in Nasarawa State, Nigeria

African Swine Fever (ASF) is a notifiable highly infectious lethal haemorrhagic disease in domestic pigs. Indirect enzyme-linked immunosorbent assays (ELISA). was carried out to detect antibodies against ASF virus and haematological investigations were also carried out on blood samples collected from 127 pigs from various piggeries and slaughter houses from selected Local Government Areas in Nassarawa State Nigeria. 1(0.79%) pig was positive to ELISA haematological investigations consisting of packed cell volume (PCV), red blood cell count (RBC), and white blood cell count (WBC). The mean PCV, RBC and WBC values of pigs sero-negative for ASF were 32.64+6.509, 12.97+ 3.653 and 10.30+5.397/ml respectively while the values of pig sero-positive for ASF was 32.80+ 0.00 , 13.00+0.00 and 20.60+0.00/ml respectively. It was observed that the PCV values (32.800+ 0.00) of the sero-positive pig and sero-negative pigs (32.64+6.509) were not significantly different from the normal value; it was also observed that the sero-positive pig had higher mean WBC count than the normal and also mean sero-negative pigs. There was increase in the mean values of PCV, RBC and WBC count caused by African Swine Fever infection due to response to the disease infection.

Effect of African Swine Fever Infection on Some Blood Parameters in Pigs from Selected Local Government Areas in Benue State, Nigeria

African swine fever (ASF) is a notifiable highly infectious lethal haemorrhagic diseasein domestic pigs. Indirect enzyme-linked immunosorbent assays (ELISA). was carried out to detect antibodies against ASF virus and haematological investigations were also carried out on blood samples collected from one hundred and eighty seven pigs from various piggries and slaughter houses from selected Local Government Areas in Benue State Nigeria. Thirteen (6.95%) pigs were . positive to ELISA haematological investigations consisting of packed cell volume (PCV), red blood cell count (RBC), and white blood cell count (WBC). The mean PCV, RBC and WBC values of pigs negative for ASF were 32.38 +10.94, 7.49 +5.32, 8.38 +10.64/ml. respectively while the values of pigs positive for ASF were 35.50 +11.35, 10.03 +4.05 and 9.10 +-6.-25/ml. respectively. It was observed that the mean PCV values (35.50+11.35) of the sero-positive pigs and sero-negative pigs (32.38+10.94) were not significantly different from the normal value; it was also observed that the sero-positive pigs had higher mean WBC count than the normal and also mean seronegative pigs. In conclusion, ASF infection caused increase in the mean values of PCV, RBC and WBC counts.

Expression of interleukin-17A in serum of children with intravenous immunoglobulin-resistant Kawasaki disease and its clinical significance

To study the expression of interleukin-17A (IL-17A) in the serum of children with intravenous immunoglobulin (IVIG)-resistant Kawasaki disease (KD) and its clinical significance. A total of 143 children with KD who were hospitalized in Wuhan Children's Hospital, Tongji Medical College, Huazhong University of Science and Technology, from June 2021 to June 2022 were enrolled in this prospective study, among whom 115 had IVIG-sensitive KD and 28 had IVIG-resistant KD. After matching for sex and age, 110 children with acute respiratory infectious diseases (fever time ≥5 days but without KD) were enrolled as the control group. The enzyme-linked immunosorbent assay was used to measure the serum level of IL-17A. The levels of white blood cell count (WBC), neutrophil count (NE), platelet count, erythrocyte sedimentation rate, and C-reactive protein (CRP) were measured. The receiver operating characteristic curve was plotted to analyze the value of WBC, NE, CRP, and IL-17A in the prediction of IVIG-resistant KD. The multivariate logistic regression analysis was used to evaluate the predictive factors for resistance to IVIG in children with KD. Before IVIG treatment, the KD group had a significantly higher serum level of IL-17A than the control group (P<0.05), and the children with IVIG-resistant KD had a significantly higher serum level of IL-17A than those with IVIG-sensitive KD (P<0.05). The receiver operating characteristic curve analysis showed that WBC, NE, CRP, and IL-17A had an area under the curve of 0.718, 0.741, 0.627, and 0.840, respectively, in the prediction of IVIG-resistant KD. With serum IL-17A ≥44.06 pg/mL as the cut-off value, IL-17A had a sensitivity of 84% and a specificity of 81% in the prediction of IVIG-resistant KD. The multivariate logistic regression analysis showed that a high serum level of IL-17A was a predictive factor for resistance to IVIG in children with KD (OR=1.161, P=0.001). Serum IL-17A levels are elevated in children with IVIG-resistant KD, and serum IL-17A level (≥44.06 pg/mL) may have a predictive value for resistance to IVIG in children with KD.

Abstract P602: Complete Blood Count Analysis in the Risk Underlying Rural Areas Longitudinal (RURAL) Cohort Study With a Point of Care Instrument

Background: The RURAL cohort study is a uniquely designed study using a Mobile Examination Unit (MEU) to study heart and lung disorders in rural counties in the southeastern US. Complete blood counts (CBC) are included in the participant baseline examination. We wanted to use an instrument in the MEU for onsite blood counts and chose the Pixcell Hemoscreen, a point-of-care instrument using a unique technology. Before using the Hemoscreen in the RURAL study, it was necessary to ensure that the CBC results would be comparable to laboratory generated results. Methods: We compared CBC results from the Hemoscreen to those from the Sysmex XN9000 at the University of Vermont Medical Center. CBC measurements include erythrocyte count (RBC), white blood cell count (WBC), hemoglobin concentration (HGB), hematocrit value (HCT), and platelet count (PLT). Blood from ten volunteers was analyzed on the Hemoscreen and the Sysmex. Statistics included average, standard deviation, and coefficient of variance (CV) for each of the parameters analyzed. Blood from ten volunteers was assayed on both the Hemoscreen and the Sysmex to compare for accuracy. Blood from three volunteers was analyzed ten times on the Hemoscreen to assess variability. Results: The Hemoscreen and Sysmex reported similar values for WBC, RBC, HCT, HGB and PLT counts, as shown in Figure 1. Between repeat measures conducted on the same sample on the Hemoscreen WBC, RBC, HCT, HGB and PLT showed little variance (%CV = 5.9, 2.7, 2.8, 2.7, and 4.0 respectively). Conclusions: The Hemoscreen data correlated with data generated in a hospital laboratory on the same samples. Variability between multiple measures of the same samples on the Hemoscreen showed acceptable variance. To date over 730 RURAL participants have been seen and the Hemoscreen has proven to be quick, accurate, and reliable.

Inflammatory Markers as Predictors for Prolonged Duration of Hospitalization in Maxillofacial Infections.

Despite the progress made in diagnosing and treating maxillofacial infections, the course of infection can be unpredictable, leading to severe complications, prolonged hospitalization, and substantial financial costs to health care services. It is important to determine whether various serum inflammatory marker levels on admission may predict a prolonged hospital stay in these patients. To analyze the role of CRP, white blood cell count (WBC), and neutrophil-to-lymphocyte ratio (NLR) in predicting the prolonged duration of hospitalization in maxillofacial infections, we performed a retrospective study by collecting paper records data from 108 patients who met our inclusion criteria. The patients were divided into two groups according to the duration of hospitalization (group A < 5 days and group B ≥ 5 days). The predictor variables were CRP, WBC, and NLR, and the outcome variable was the duration of hospitalization. This study confirmed a positive linear correlation (p < 0.001) between the predictors and the outcome variable. The optimal cut-off values for WBC are 11,030 white blood cells/μL and 63 mg/L for CRP. Levels that exceed these optimal values predict a duration of hospitalization of over (≥) 5 days. Serum WBC and CRP on admission may predict the duration of hospitalization in patients with MFI.

Yield of Leukocytosis in Predicting Brain Computed Tomography Pathological Findings in Pediatric Patients with Head Traumatic Injuries

BBackground: Head trauma is an urgent medical condition that is prevalent in pediatric patients. The association between white blood cell (WBC) counts and their prognostic value in pediatric traumatic brain injury has been proposed in multiple studies. Hence, WBC count can be used to determine the presence of traumatic brain injury. Thus, we aimed to address this gap by assessing the value of WBC count in predicting pathological CT findings in pediatric patients with traumatic head injuries. Methods: This retrospective cohort study included 108 patients with isolated head trauma aged 0–14 years who underwent brain CT examination and had available data on WBC count upon presentation to the emergency room. Chi-square and Fisher&amp;apos;s exact tests were used to determine the statistical significance. Logistic regression analysis was performed to further explore the relationships between the variables. Results: Falls were the most common cause of head trauma (88 [81.48%] patients). Leukocytosis was reported in 35 (32.41%) patients and non-leukocytosis in 73 (67.59%) patients. Sixty-four patients (59.26%) had pathological brain CT findings, whereas 44 (40.74 %) had non-pathological findings. The leukocytosis status differed (odds ratio [OR]=0.99, 95% confidence interval [CI]=2.55–0.38; P= 0.9839) according to the pathological CT findings, but the difference was not significant. Age (0–2 years) and Glasgow Coma Scale score (&amp;le;14) were significant predictors of pathological brain CT findings (OR=3.79, 95% CI=9.24–1.55, P=0.0033 and OR=14.04, 95% CI=127.59–1.54, P=0.0189, respectively). Conclusion: The presence of leukocytosis is useful for predicting pathological brain scan findings. Therefore, further multicenter studies with a larger sample size are warranted to determine the benefits of WBC count in patients with head trauma.

Analgesic and anti-inflammatory effects of oral Centella asiatica (L.) urban extract in cats undergoing ovariohysterectomy

BackgroundCentella asiatica Linn Urban (CA) is a medicinal herb used in traditional medicine for its anti-inflammatory and antinociceptive properties. Feline species usually exhibit toxicity toward nonsteroidal anti-inflammatory drugs, and thus the analgesic potential of CA is worth investigating in domestic cats. PurposeThe objective of this study was to evaluate the efficacy of CA extract in oral formulation for controlling postoperative pain and inflammation in cats undergoing ovariohysterectomy. Study DesignRandomized, prospective, blind, placebo-controlled study. MethodsThis study included 18 healthy female cats randomized into three groups: control, low-dose group (100 mg/kg), and high-dose group (200 mg/kg). Accordingly, subjects were given orally administered placebo jelly or CA mixed jelly 12 h before surgery and 4, 24, 48, and 72 h after surgery. Serum amyloid A (SAA) and white blood cell count (WBC) were tested 23 h after surgery. Postoperative pain was evaluated at 4, 8, 24, 48, and 72 h after extubation by using the UNESP-Botucatu multidimensional composite pain scale (UFEPS). Wound scores were assessed using an infrared thermal imaging camera and normal pictures token at right after the surgery and at 1, 2, and 3 days after the surgery. SAA and WBC values were compared between groups via ANOVA (p < 0.05). The Scheirer-Ray-Hare test was used to analyze the ordinal score: pain score and wound-healing score (p < 0.05). ResultsThe high-dose group had a significantly lower UFEPS score than the control group (p = 0.007). In the high-dose group, few cats had a high temperature at the surgical wound after surgery. The level of SAA, WBC, and wound scores showed no significant difference among groups. No adverse side effects were found after receiving the CA extract. ConclusionCA extract powder can be used as an analgesic in domestic cats for preventing and treating postoperative pain. The dosage and frequency of CA oral administration should be further studied.

Time to Look for Another Infectious Source? White Blood Cell Trends during Ventilator-Associated Pneumonia

Background: Ventilator-associated pneumonia (VAP) continues to plague patients in intensive care units (ICUs) throughout the world. Persistent leukocytosis despite antibiotic treatment for VAP can have many etiologies including normal inflammatory response, inadequate VAP antimicrobial therapy, and the presence of additional infectious diagnoses. Hypothesis: Surgical patients with VAP and a second infectious source have a different white blood cell count (WBC) trend than patients with VAP alone. Patients and Methods: Retrospective, single-center study of surgical ICU patients diagnosed with VAP (>104 CFU/mL on semi-quantitative culture) between January 2019 and June 2020. Chart review identified additional infections diagnosed during VAP treatment. White blood cell count values were compared between patients treated for VAP alone (VAP-alone) and those with additional infections (VAP-plus) using a Wilcoxon test. Univariable analysis compared admission type, surgeries, and steroid use between cohorts. Results: Eighty-eight VAPs were included for analysis; 61 (69%) were VAP-alone and 27 (31%) VAP-plus. Average age was 47.1 ± 16.7 years, 78% were male, and 93% were trauma admissions. Median hospital day of VAP diagnosis was six (interquartile range [IQR], 4-10). Nearly all patients (99%) were started on initial antibiotic agents to which the VAP organism was sensitive. Daily WBC was higher for VAP-plus compared with VAP-alone on days five, six, and seven of treatment. The maximum WBC was higher for VAP-plus (21.6 k/mcL vs. 16.1 k/mcL; p = 0.02). There were no differences in admission types, number of surgeries, or steroid use between groups. Conclusions: Providers should have increased suspicion for additional sources of infection when ICU patients with a VAP continue to have elevated WBC despite appropriate antibiotic therapy.

Against the Norm: Do Not Rely on Serum C-Reactive Protein and White Blood Cell Count Only When Assessing Eradication of Periprosthetic Joint Infection.

Introduction: Periprosthetic joint infections (PJI) following primary arthroplasty continue to be a serious complication, despite advances in diagnostics and treatment. Two-stage revision arthroplasty has been commonly used as the gold standard for the treatment of PJI. However, much discussion persists regarding the interim of the two-stage procedure and the optimal timing of reimplantation. Serology markers have been proposed as defining parameters for a successful reimplantation. The objective of this matched-pair analysis was to assess the role of serum C-reactive protein (CRP) and white blood cell count (WBC) in determining infection eradication and proper timing of reimplantation. We investigated the delta (∆) change in CRP and WBC values prior to both stages of two-stage revision arthroplasty as a useful marker of infection eradication. Methods: We analyzed 39 patients and 39 controls, matched by propensity score matching (BMI, age, ASA-classification), with a minimum follow-up of 24 months and treated with a two-stage revision THA or TKA in our institution. Data of serum CRP and WBC values were gathered at two selected time points: prior to the explantation of the implant (preexplantation) and following the completion of antibiotic treatment regimen, both systemic and with a drug-eluting cement spacer (prereimplantation). Patient records were reviewed electronically for preexisting comorbidities, overall health status, synovial fluid cultures, inflammatory serologies, revision surgeries, and recurrent or persistent infection based on the modified Musculoskeletal Infection Society criteria. Patient demographics, ∆CRP, ∆WBC, and time interval to reimplantation were statistically analyzed using receiver operator curves (ROC), Pearson’s correlation coefficient, Levene’s test, and Student’s t-test. Results: Infection-free patients exhibited higher mean CRP and WBC than did patients who were reinfected at both time points. When comparing preexplantation with prereimplantation values, the median ∆CRP was 9.48 mg/L (interquartile range (IQR) 2.3–36.6 mg/L) for patients who did not develop a reinfection versus 2.74 mg/L (IQR 1.4–14.2 mg/L) for patients who developed reinfection (p = 0.069). The median ∆WBC was 1.5 × 109/L (IQR 0.6–4.0 × 109/L) for patients who remained infection-free versus 1.2 × 109/L (IQR 0.8–2.2 109/L) for patients who developed reinfection (p = 0.072). Analysis of areas under the curve (AUC) using ROC demonstrated poor prediction of persistent infection by ∆CRP (AUC = 0.654) and ∆WBC (AUC = 0.573). Although a highly significant correlation was found between the interim interval and infection persistence (r = 0.655, p < 0.01), analysis using ROC failed to result in a specific threshold time to reimplantation above which patients are at significantly higher risk for reinfection (AUC = 0.507). Conclusion: No association could be determined between the delta change in serum CRP and WBC before and after two-stage revision arthroplasty for PJI and reinfection risk. Even though inflammatory serologies demonstrate a downtrending pattern prior to reimplantation, the role of CRP and WBC in determining the optimal timing of reimplantation seems to be dispensable. Planning a second-stage reimplantation requires assessing multiple variables rather than relying on specific numeric changes in these inflammatory marker values.