Search

Abstract Long Covid results from the damage caused by SARS-CoV-2, involving the release of cytokines and the continuous activation of immune cells. This cross-sectional study investigates leukocyte and cytokine profiles in Long Covid patients in the Amazon, a region where such studies are limited. Blood samples were analysed for differential leukocyte counts and cytokine levels. We suggest elevated lymphocyte counts in hospitalised patients and those with severe COVID-19. Higher eosinophil counts were observed in patients with up to three months of Long Covid, and increased monocyte counts in those with up to six months. IL-2 levels were higher in patients with fewer symptoms and Long Covid duration of more than three months, whereas IL-10 may remain elevated for up to 12 months. We suggest positive correlations between neutrophils, monocytes, eosinophils, and lymphocytes with different cytokines (IFN-γ, IL-6, IL-4, IL-17a, IL-2). Women were associated with lower hospitalisation rates and longer durations of Long Covid; increased lymphocyte counts were linked to hospitalisation due to COVID-19, while higher monocyte counts were associated with Long Covid durations of up to six months. We suggest that Long Covid patients may exhibit alterations in inflammatory markers, indicating a persistently pro-inflammatory microenvironment that tends to diminish after 12 months of Long Covid.

Background: Previous research has suggested that modulated electro-hyperthermia (mEHT) can be used to induce anti-tumor immune effects and to extend patient survival. The use of mEHT in advanced pancreatic cancer is beneficial; however, its immune-mediating effects were never investigated. Methods: A retrospective observational study was conducted. Leukocyte counts, C-reactive protein (CRP), neutrophil-to-lymphocyte ratio (NLR), and granulocyte-to-lymphocyte ratio (GLR) were measured at baseline, midpoint, and after mEHT treatment. Results: A total of 73 mEHT treated pancreatic cancer patients were included. The time elapsed between tumor diagnosis and the first mEHT treatment was 4.40 ± 5.70 months. While no change could be observed between the baseline and the first follow-up visits, the total white blood cell (WBC), neutrophil, and granulocyte count, CRP, NLR, and GLR were significantly higher at the second follow-up compared to both previous visits. Higher levels of the latter parameters following the last mEHT treatment were signaling significantly poor prognostic signs, and so were their longitudinal changes. Conclusions: After the initiation of mEHT, immune markers stabilize with the treatment, but this positive effect is eroded over time by progressive disease. Monitoring the changes in these markers and the occurrence of their increase is a prognostic marker of shorter survival.

Background: End-Stage Renal Disease (ESRD) patients under maintenance hemodialysis are at higher risk for COVID-19 and severe outcomes. This study aimed to investigate the association between ESRD patients who underwent maintenance hemodialysis at 5th Azar and Sayad Shirazi Hospital in Golestan Province in 2019 and their risk of contracting and experiencing severe outcomes from COVID-19. Furthermore, this study aimed to provide insights into the epidemic status of COVID-19 in this specific population, contributing to better insight into the unique challenges faced by ESRD patients on hemodialysis during the pandemic. Methods: This retrospective descriptive cross-sectional study was performed on patients who underwent maintenance hemodialysis. The diagnosis was made based on diagnostic criteria and COVID-19 PCR test. Medical information of all participants was collected. Medical information including clinical, laboratory, and radiological data as well as morbidity and mortality were collected and analyzed by experts. Statistical analysis was performed using SPSS version 21. Normality was evaluated using Shapiro-Wilk test and comparison between groups was analyzed using student T-test and Mann-Whitney U tests (p 0.05). No significant difference was observed between the age and BMI of passed away and discharged patients. None of the laboratory parameters in the two groups of passed away and discharged patients with COVID-19 showed a significant difference (p> 0.05). Patients with COVID-19 who had a history of diabetes and hypertension, clinical symptoms, such as cough (p=0.049), weakness, and lethargy (p=0.05), indicated a significant difference in mortality compared to the group that was discharged (p

Abstract Objective: Included evaluation of the possibility of using the systemic inflammatory indices for preoperative screening for the presence and severity of endometriosis (EM) in comparison to the findings of the exploratory laparoscopy Methods: 88 women with clinical manifestations suggestive of EM were evaluated clinically and by US and gave blood samples for estimation of serum cancer antigen-125 (CA125), platelet and total and differential leucocytic counts for calculation of inflammatory indices; the Systemic Immune-Inflammation index, the Systemic Inflammation Response Index (SIRI), the Neutrophil-Lymphocyte ratio (NLR), the Neutrophil-Monocyte ratio, the Neutrophil-Platelet ratio and the Platelet-Lymphocyte ratio. Then, patients were prepared to undergo laparoscopy for diagnosis and staging. Results: Laparoscopy detected EM lesions in 63 patients; 27 of stage I-II and 36 of stage III-IV. Positive laparoscopy showed significant relation with US grading, high serum CA125 levels, platelet and inflammatory cell counts and indices. Statistical analyses defined high SIRI and NLR as the significant predictors for positive laparoscopy and high serum CA125 and NLR as the most significant predictors for severe EM (stage III-IV) on laparoscopy Conclusion: The intimate relation between EM and inflammation was reflected systematically as high levels of blood cellular components, but indices related to neutrophil especially NLR and SIRI showed highly significant relation to the presence and severity of EM and might be used as routine, cheap and non-invasive screening test before exploratory laparoscopy to guide the decision-making.

Aims/Background We looked at novel hematological composites like the neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, monocyte-to-lymphocyte ratio, red cell distribution width-to-lymphocyte ratio, red cell distribution width-to-platelet ratio, leukocyte-to-C reactive protein ratio, and lymphocyte-to-C reactive protein ratio as explanatory variables for COVID-19 patients´ hospital length of stay (LoS).Methods The association of hematological indices with LoS was analyzed on 2930 COVID-19 patients using the univariate and multivariable Cox proportional hazards regression models with enter method. The Kaplan-Meier survival estimates were applied to LoS.Results The survivors´ mean LoS was 7.8 ± 24.0 days, but the deaths´ mean LoS was 38.6 ± 41.9 days (W = 31338, p

Objective: To determine the possible association between acute fetal stress during labor and maternal blood levels of osteopontin (OPN), white blood cells, sedimentation, and C-reactive protein (CRP). Methods: The study included women with a term pregnancy (37 weeks or more) who had a cesarean section during the active phase of labor. The study included 30 term pregnancies who underwent cesarean section for fetal distress and 30 pregnant women who underwent cesarean section for other indications (prior uterine surgery, head-pelvis incompatibility, large baby, non-progressing plot) as a control group. The levels of OPN and other inflammatory markers (leukocytes, sedimentation, CRP) in the maternal venous blood of 60 pregnant women were compared, and whether there was a significant association between the groups was investigated. Results: OPN levels in the fetal stress group were higher than those in the control group, and the difference was statistically significant (p=0.008). There was no statistically significant difference in white blood cell, blood sedimentation, and CRP levels between the two groups (p>0.005). Conclusion: Placental inflammation plays a role in the etiology of fetal stress, and OPN may be released because of fetal stress. The increase in OPN in maternal blood during labor may be an important marker for predicting fetal stress.

Different studies have suggested that musical enrichment in dairy cattle management reduces animal stress and enhances milk production, management, and disease resistance. Thus, in the present work, we proposed to evaluate the response of a group of Holstein cows to musical stimulation, through the analysis of their leukocyte profile and the recording of voluntary approach to milking parlor. An ABAB design was used, consisting of alternating periods with and without music during the management of 15 Holstein cows for 14 days. At the end of each period, blood samples were collected to determine the number of leukocyte counts. In addition, a voluntary approach to the milking parlor was measured. For statistical analysis, the nonparametric Wilcoxon signed-rank test with an alpha value of 0.05 was used. During periods with music, more cows voluntarily approached the milking parlor and had higher total leukocyte counts. In conclusion, music enrichment improves cattle handling, with a significant positive effect on leukogram profiles

Introduction Different parameters have been established to direct the treatment of patients with human immunodeficiency virus (HIV) infection, such as CD4+ lymphocyte values, and it is of clinical interest to have methodologies that accurately predict these values. Aim of the study was to predict the total values of leukocytes and CD4+ lymphocytes greater than 500 cells/μl3 in HIV-infected patients using the theory of probability and set theory. Material and methods Starting from 7 cases with several records over time, an induction was performed establishing mathematical patterns between CD4+ lymphocyte values and total leukocyte values, while applying the probability theory to calculate predictive accuracy in 43 cases, and subsequently, sensitivity and specificity were calculated in a blinded study. Results In total, 184 records were analyzed for 50 cases. The values of total leukocytes equal to or greater than 3.9 cells/mm3 were predicted to correspond to CD4+ lymphocyte values greater than 500 cells/μl3 in 100% of time, with sensitivity and specificity results of 100%. Conclusions This is the first investigation with the theory of probability, in which predictions were made from leukocyte values equal to or greater than 3.9 cells/mm3 to find CD4+ lymphocyte counts. A predictive probabilistic methodology was developed, and determined results for the calculated ranges were found.

Introduction. Patients with leukaemia are exposed to infections as long as they are neutropenic. During this period, anorectal pathologies are among the common foci of infection with high mortality. We aimed in this study to investigate the factors that may have a predictive effect for early diagnosis and rapid intervention in perianal complications occurring in neutropenic patients diagnosed with leukaemia. Materials and Methods. A total of 90 patients with acute leukaemia, including 45 patients with anorectal pathology and 45 patients without anorectal pathology, were analysed. Demographics, blood group, BMI, haemogram and biochemical parameters at the time of diagnosis, types of perianal pathology were recorded. Results. In the group of patients with anorectal pathology, WBC, lymphocytes, monocytes, LDH were significantly (p

The literature describes monocyte-lymphocyte (MLR), neutrophil-lymphocyte (NLR), and platelet-lymphocyte (PLR) ratios as prognostic biomarkers. However, in the case of dengue infection, patient clinical management and nonspecific laboratory tests determine the prognosis. Therefore, this study analyzed MLR, NLR, and PLR as prognostic biomarkers of dengue infection. Our study was based on a clinical cohort of dengue patients in Brazil between 2012 and 2013. From 193 patients, 164 (85.0%) were classified as dengue fever (DF), 19 (9.8%) as dengue hemorrhagic fever (DHF), and 10 (5.2%) as intermediate DF/DHF. DHF cases were significantly associated with MLR > 0.13 (OR: 5.72, 95% CI: 1.28-25.60, p < 0.05) and PLR ≤ 80.68 (OR: 4.26; 95% CI 1.60-11.33; p < 0.05). Our results suggest that MLR increase, and PLR decrease indicate a higher likelihood of worsening the clinical status.

BackgroundDiabetes mellitus is a chronic metabolic disorder that causes hyperglycemia and various life-threatening health problems. Although hematological parameters play a significant role in the progression and pathogenesis of diabetes, many studies have explored contradictory findings. Therefore, this evidence-based study aimed to determine the pooled mean difference of white blood cell and red blood cell parameters in diabetic patients in order to investigate hematological dysfunctions in type 1 and type 2 diabetes mellitus.MethodsArticles were extensively searched in bibliographic databases (PubMed, Cochrane library, Scopus, Web of Science, PsycINFO, Embase, online archives and university repositories) using appropriate entry terms. For studies meeting the eligibility criteria, the first author’s name, year of publication, study design and area, type of diabetes mellitus, sample size, and mean and standard deviation of hematological parameters were extracted using Microsoft Excel and exported to Stata 11 for meta-analysis. The pooled standardized mean difference (SMD) was determined using the random effects model, and heterogeneity was quantified using Higgins’ I2 statistics. Egger’s test and funnel plot were performed to measure bias. Furthermore, a sensitivity analysis was performed to determine the small study effect.ResultsInitially 39, 222 articles were identified. After screening of the entire methodology, 22 articles with 14,041 study participants (6,146 T2DM, 416 T1DM patients and 7,479 healthy controls) were included in this study. The pooled SMD in TLC (109/L) was 0.66 and −0.21, in T2DM and T1DM, respectively. Differences in absolute differential WBC counts for neutrophils, eosinophils, basophils, lymphocytes and monocytes in T2DM were 0.84, −1.59, 3.20, 0.36 and 0.26, respectively. The differences in relative differential counts (%) in T2DM were as follows: neutrophils: 1.31, eosinophils: −0.99, basophils: 0.34, lymphocytes: −0.19 and monocyte: −0.64. The SMD of differential counts of WBC (109/L) parameters; neutrophils, lymphocytes, monocytes and basophils in T1DM were −0.10, −0.69, 0.19, and −0.32, respectively. The pooled SMD in RBC parameters in T2DM were as follows: RBC: −0.57 (106/μL), Hb: −0.73 g/dL and HCT: −1.22%, Where as in T1DM RBC, Hb and HCT were −1.23 (106/μL), −0.80 g/dL and −0.29%, respectively.ConclusionPatients with T2DM had significantly increased TLC counts, absolute neutrophil, basophil, lymphocyte, monocyte counts and relative counts of neutrophils and basophils in comparison to controls. On the contrary, the absolute eosinophil count and relative lymphocyte, eosinophil and monocyte counts were decreased. In T1DM, WBC parameters were significantly decreased except monocytes. RBC parameters were found to be significantly decreased in T2DM patients. In T1DM, Hb and HCT were significantly decreased. However, there is no significant difference in RBC as compared with non-diabetic controls. The findings indicated a significant alteration of WBC and RBC parameters in both diabetic patients suggesting the considerable metabolic effect of diabetes on hematologic parameters.Systematic review registrationhttps://www.crd.york.ac.uk/prospero/export_details_pdf.php, identifier [CRD42023413486].

Background: Coronavirus is a virus that attacks the immune system, especially the human respiratory system. The elderly are at high risk of being infected with Coronavirus Disease-19 (COVID-19), and as they get older, they are at risk of experiencing severe symptoms when infected with COVID-19. Leukocytes play a role in the immune system against foreign objects. The leukocyte count will decrease in the elderly. On the other hand, the increase of leukocytes plays a role as a clinical sign that is useful to be a predictor of body immunity when infected with COVID-19. Purpose: To determine the total leukocyte count in elderly patients that were confirmed COVID-19 and hospitalized with and without a ventilator. Method: This study was a cross-sectional design study involving 93 elderly patients in General Hospital Surabaya. Result: The results showed no difference in the total leukocyte count in elderly hospitalized patients with and without a ventilator (p-value = 0.756). Age above 70 years old increases the risk of patients requiring a ventilator up to 1.7 times compared to patients under 70 years old. The highest leukocyte count was 20.880/mm3, and the lowest was 3.760/mm3. The ratio of leukocyte count in elderly patients with a ventilator group is 1 : 3 for low and high leukocyte counts, respectively. Conclusion: Leukocyte count is an important parameter as the predictor of the progression of the disease and helps in the decision regarding treatment strategy to prevent the cytokine storm.

Background Stent thrombosis is a rare but deleterious event. Routine coronary angiography with percutaneous coronary intervention (PCI) is often deferred in the presence of laboratory markers of acute inflammation to prevent complications. The aim of this study was to investigate whether an acute inflammatory state is associated with an increased risk of early stent thrombosis. Methods and Results Within a prospective single‐center registry, the association between preprocedural acute inflammatory activation, defined as C‐reactive protein plasma levels >50 mg/L or a leukocyte count >12 g/L, and occurrence of early (≤30 days) stent thrombosis was evaluated. In total, 11 327 patients underwent PCI and of those, 6880 patients had laboratory results available. 49.6% of the study population received PCI for an acute coronary syndrome and 50.4% for stable ischemic heart disease. In patients with signs of acute inflammatory activation (24.9%), PCI was associated with a significantly increased risk for stent thrombosis (hazard ratio, 2.89; P

Obesity increases the risk of various diseases. Black rice, renowned for its high anthocyanin content, is considered a potential functional food for preventing metabolic disorders. The current study investigated the effects of black rice crunch (BRC) on body weight and haematological profiles in obese rats. Rats were fed with high-fat diet to induce obesity and supplemented with different concentrations of BRC for 4 and 8 weeks. The results showed that high-fat diet effectively induced obesity, as evidenced by significant increase in body weight. Importantly, 75% BRC supplementation resulted in significant weight reduction in obese rats. Further analysis revealed an increase in erythrocyte numbers in obese groups supplemented with 75% BRC, but no significant changes in haemoglobin concentration or haematocrit percentage. Further investigation showed that 75% BRC led to a decrease in mean corpuscular haemoglobin (MCH), mean corpuscular haemoglobin concentration (MCHC), and mean corpuscular volume (MCV), potentially affecting the size and concentration of haemoglobin within erythrocytes. The total leucocytes count increased with the high-fat diet, while BRC supplementation alone did not have significant impact. Lymphocyte percentage remained stable across the groups, indicating minimal influence of the dietary interventions. Neutrophil percentage varied initially but was not specific to BRC or the high-fat diet. Platelet count and distribution width were not significantly influenced, but mean platelet volume (MPV) increased after 8 weeks of BRC treatment, suggesting larger platelet sizes associated with obesity. Overall, the study provides important insights into the effects of BRC supplementation on body weight and haematological parameters related to obesity.

Background and Objective: Considering the prevalence of gastrointestinal cancers in the region and the importance of helpful criteria in the diagnosis of the disease, the present study was conducted to compare the blood parameters neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR) and lymphocyte to monocyte ratio (LMR) in gastric cancer patients in Mazandaran province and its comparison with non-affected people. Methods: This cross-sectional study was conducted in 2019 and 2020 on 62 cancer patients referred to Imam Hospital in Sari in the case group and 124 non-patients from the community in the control group. Convenience sampling was used in the case group and random sampling was used in the control group from among the Tabari Cohort Population. The two groups were matched in terms of age and gender. The required data including age, gender, LMR, NLR and PLR for all subjects as well as pathological indices and chemotherapy status were recorded for the case group. Findings: The gender ratio in both groups was 69.4% males and 30.6% females. The mean age of the examined subjects in the group of cancer patients and the control group was 62.3±12.53 and 51.7±9.02 years, respectively (p=0.105). The mean NLR (2.14 vs. 1.62, p=0.000) and PLR (9.48 vs. 6.27, p=0.000) in the group with gastric cancer were significantly higher than the healthy control group, and the mean LMR (3.42±2.12 vs. 10.9±2.99, p=0.000) was significantly lower than the healthy control group. Conclusion: The results of high NLR and PLR and low LMR showed that these indices can be used in gastric cancer screening studies.

Abstract Background An increased leukocyte count is a sign of inflammation and has been demonstrated to be a predisposing factor and complication of atrial fibrillation. Similarly, albumin, the major protein in the serum, is also considered an acute phase reactant protein that has osmotic and anti-inflammatory properties, and a low albumin level is a known factor associated with severity in many pathologies, including atrial fibrillation. The neutrophil percentage-to-albumin ratio (NPAR) and other emerging leukocyte counts/albumin ratios have been reliable systemic inflammation-based predictors of mortality and complications in various diseases, but they have not yet been used with atrial fibrillation. This study’s aim was to explore whether the leukocyte to albumin ratio could also serve as a useful index in estimating atrial fibrillation severity, including the severity of atrial fibrillation secondary to stroke, to provide a new and more objective tool than the conventional and medical history-based CHA2DS2–VASc score. Materials and methods Data were retrospectively collected from the Wuhan University Zhongnan Hospital database from January 1st to December 31st, 2021. The patients were classified into 2 groups: Group 1-low severity and Group 2- moderate to high severity, and diverse statistical analyses were conducted to evaluate the relationship between the leukocyte-to-albumin ratio and AF severity. Results Only 2329 test subjects met the inclusion criteria. We had 727 test subjects (381 males and 346 females) categorized into the low severity cohort and 1601 test subjects (932 males and 670 females) in the moderate to high severity group. The difference in mean age between the two groups was significant (95% CI [−2.682 to −0.154] p = 0.028), and the difference in the LAR mean rank between the two groups was significant (p = 0.00). The Chi-square test of association yielded the following results: the relationship between the LAR level and category of severity was statistically significant (p = 0.00), and the Mantel‒Haenszel statistic association odds ratio was OR = 0.657. 95% CI OR [0.549–0.787] p = 0.000. The association between sex and atrial fibrillation severity also reached statistical significance. However, sex and LAR were found to be independent factors in atrial fibrillation (Chi-square p value = 0.564). Conclusion It has been demonstrated throughout this investigation that the leukocyte to albumin ratio could provide key clues in clinical practice and contribute to thromboembolism risk assessment in the setting of atrial fibrillation.

Abstract Background Early death remains a major factor in survival in APL. We aimed to analyze the risk factors for differentiation syndrome and early death in acute promyelocytic leukemia (APL). Methods The clinical data of APL patients who were newly diagnosed at Mianyang Central Hospital from January 2013 to January 2022 were retrospectively analyzed. Results Eighty-six newly diagnosed APL patients (37 males and 49 females) were included in this study. The median age was 46 (17–75) years. Sixty-one patients (70.9%) had low/intermediate-risk APL, and 25 patients (29.1%) had high-risk APL. The incidence of differentiation syndrome (DS) was 62.4%. The multivariate analysis showed that a peak white blood cell (WBC) count ≥16 × 10^9/L was an independent risk factor (OR = 11.000, 95% CI: 2.830–42.756, P = 0.001) for DS in all APL patients, while a WBC count ≥10 × 10^9/L on Day 5 was an independent risk factor for DS in low-intermediate risk APL patients (OR = 9.114, 95% CI: 2.384–34.849, P = 0.001). There were 31 patients (36.5%) with mild DS and 22 patients (25.9%) with severe DS. The multivariate analysis showed that WBC count ≥23 × 10^9/L at chemotherapy was an independent risk factor for severe DS (OR = 10.500, 95% CI: 2.344–47.034, P = 0.002). The rate of early death (ED) was 24.4% (21/86). The multivariate analysis showed that male gender (OR = 7.578,95% CI:1.136–50.551, P = 0.036), HGB 7 × 10^9/L on Day 3 have a higher risk of ED. Leukocyte proliferation is associated with TNF-α rather than IL-6, and TNF-α may be a potential biomarker for predicting ED.

Background/Purpose: Although metronidazole is not recommended to treat Clostridioides difficile infection (CDI) in Western countries, it was still to be recommended for the treatment of non-severe CDI among Taiwanese adults in 2020. This controversy in the clinical role of metronidazole therapy for CDI was examined in a prospective clinical study. Methods: The study was conducted from January 2015 to December 2016 in three hospitals in Taiwan. Metronidazole treatment failure (MTF) was defined as the persistence of diarrhea after six days of treatment, medication modification (shifting to oral vancomycin), or death after five days of therapy. Results: Overall, 325 patients receiving metronidazole for CDI were included. The overall MTF rate was 48.6% (158 patients). Leukocyte counts of >15,000 cells/mL in peripheral blood (odd ratio [OR] 1.81; P = 0.04) and congestive heart failure (OR 3.26; P = 0.02) were independently associated with MTF. The MTF rate for patients with leukocyte counts of ≤15,000 cells/mL and no congestive heart failure, leukocyte counts of >15,000 cells/mL and no congestive heart failure, leukocyte counts of ≤15,000 cells/mL and congestive heart failure, and leukocyte counts of >15,000 cells/mL and congestive heart failure were 44.2%, 51.8%, 73.3%, and 66.7%, respectively. Of note, patients who experienced MTF had a higher recurrence rate of CDI than those with metronidazole treatment success (13.9% vs. 6.0%, P = 0.02). Conclusion: For Taiwanese adults with CDI, the failure rate of metronidazole therapy approached 50%, which suggests the reappraisal of the therapeutic role of metronidazole therapy, especially for patients with leukocytosis or underlying congestive heart failure.

Background Limited data are available in COVID-19 patients on the prediction of treatment response to systemic corticosteroid therapy based on systemic inflammatory markers. There is a concern whether the response to systemic corticosteroid is different according to white blood cell (WBC) counts in COVID-19 patients. We aimed to assess whether WBC count is related with the clinical outcomes after treatment with systemic corticosteroids in severe COVID-19.Methods We conducted a retrospective cohort study and analysed the patients hospitalised for severe COVID-19 and received systemic corticosteroids between July 2020 and June 2021. The primary endpoint was to compare the composite poor outcome of mechanical ventilation, extracorporeal membrane oxygenation, and mortality among the patients with different WBC counts.Results Of the 585 COVID-19 patients who required oxygen supplementation and systemic corticosteroids, 145 (24.8%) belonged to the leukopoenia group, 375 (64.1%) belonged to the normal WBC group, and 65 (11.1%) belonged to the leukocytosis group. In Kaplan-Meier curve, the composite poor outcome was significantly reduced in leukopoenia group compared to leukocytosis group (log-rank p-value < 0.001). In the multivariable Cox regression analysis, leukopoenia group was significantly associated with a lower risk of the composite poor outcome compared to normal WBC group (adjusted hazard ratio [aHR] = 0.32, 95% CI 0.14–0.76, p-value = 0.009) and leukocytosis group (aHR = 0.30, 95% CI = 0.12–0.78, p-value = 0.013). There was no significant difference in aHR for composite poor outcome between leukocytosis and normal WBC group.Conclusion Leukopoenia may be related with a better response to systemic corticosteroid therapy in COVID-19 patients requiring oxygen supplementation.KEY MESSAGESIn severe COVID-19 treated with systemic corticosteroids, patients with leukopoenia showed a lower hazard for composite poor outcome compared to patients with normal white blood cell counts or leukocytosis.Leukopoenia may be a potential biomarker for better response to systemic corticosteroid therapy in COVID-19 pneumonia.

Tagwa Yousif Elsayed Yousif Department of Medical Laboratory Technology, Faculty of Applied Medical Sciences, Jazan University, Gizan, 45142, Saudi ArabiaCorrespondence: Tagwa Yousif Elsayed Yousif, Department of Medical Laboratory Technology, Faculty of Applied Medical Sciences, Jazan University, Gizan, 45142, Saudi Arabia, Email telsayed@jazanu.edu.saBackground: Sickle cell disease (SCD) is a hereditary disease that causes deoxygenated erythrocytes to stiffen, resulting in vaso-occlusive crises, endothelial damage, organ failure and systemic consequences. An abnormal leukocyte count is associated with a worse clinical picture in SCD.Methods: I studied the link between an abnormal leukocyte count and sickle cell disease. I used the PRISMA guidelines to conduct a systematic review of 5 different clinical literatures that discussed the link. Use of databases including Web of Science, Scopus, Cochrane Library, MEDLINE, ScienceDirect, EMBASE, and JSTOR to make our findings.Findings: SCD is a red cell disorder, but an elevated leukocyte count plays a significant role in its pathophysiology. Sickled red cells adhere better to leukocytes when compared to normal red cells, which explains the worse clinical picture seen in sickle cell patients. Hydroxyurea therapy inhibits the recruitment and invasion of neutrophils, which lowers vaso-occlusion.Interpretations: An elevated leukocyte count is responsible for worse clinical manifestations in SCD, eg, clinical stroke, acute chest syndrome, end organ damage, and infarction pain. Leukocytes attach to erythrocytes and vascular endothelium to cause vaso-occlusion, responsible for these effects. They also elaborate inflammatory mediators to aid the process. The higher the leukocyte count, the worse the effects. Hydroxyurea is very helpful in disrupting several pathways of leukocyte contribution to SCD pathophysiology. Therefore, more research on other pharmacologic agents that interfere with this disease process is necessary. Lastly, there is a need for further research into the effects of a reduced leukocyte count in SCD pathophysiology.Keywords: SCD pathophysiology, leukocyte count, infraction, effects, sickle cell

Blood count is crucial for assessing bone marrow’s cell production and differentiation during infections, gaging disease severity, and monitoring therapeutic responses. The profile of blood count in chronic forms of paracoccidioidomycosis (PCM) has been insufficiently explored. To better understand the changes in hematological cells in different stages of the PCM chronic form, we evaluated the blood count, including immature blood cells in automated equipment, before and during the treatment follow-up of 62 chronic PCM patients. Predominantly male (96.8%) with an average age of 54.3 (standard deviation SD 6.9) years, participants exhibited pre-treatment conditions such as anemia (45.2%), monocytosis (38.7%), and leukocytosis (17.7%), which became less frequent after clinical cure. Anemia was more prevalent in severe cases. Notably, hemoglobin and reticulocyte hemoglobin content increased, while leukocytes, monocytes, neutrophils, immature granulocytes, and platelets decreased. Chronic PCM induced manageable hematological abnormalities, mainly in the red blood series. Monocytosis, indicating monocytes’ role in PCM’s immune response, was frequent. Post-treatment, especially after achieving clinical cure, significant improvements were observed in various hematological indices, including immature granulocytes and reticulocyte hemoglobin content, underscoring the impact of infection on these parameters.

Background To explore the relationship between duration of hypertension and inflammatory cell levels and to assess whether long duration might aggravate these inflammatory cells among Chinese urban community residents. Methods A cross-sectional study of 5199 hypertensive and 2675 no-hypertensive participants who registered in community health service centers for physical examination was performed in Tianjin, China. Data of blood pressure and inflammatory cells were collected. Binary logistic regression was performed to assess the effect of hypertensive duration on the level of inflammatory cells before and after adjustment for the potential confounding factors. Results Individuals with hypertension had significantly higher level of leukocyte count, neutrophil proportion, neutrophil-to-lymphocyte ratio (NLR), and lower level of lymphocyte proportion than those without hypertension. Two-way ANOVA showed that hypertension duration, rather than blood pressure control or their interaction, had significant influence on the levels of neutrophil proportion, lymphocyte proportion, and NLR. With the prolongation of the duration of hypertension, the level of neutrophil proportion and NLR increased, and the level of lymphocyte proportion decreased. Long hypertension duration (>10 years) was significantly associated with high level of neutrophil proportion (OR = 1.48, 95% CI: 1.25, 1.75), high level of NLR (OR = 1.53, 95% CI: 1.29, 1.81), and low level of lymphocyte proportion (OR = 1.54, 95% CI: 1.30, 1.82) in comparison with short duration (

Abdullah M Alkahtani,1 Yasser Alraey,2 Gaffar Sarwar Zaman,2 Hajri Al‐Shehri,3 Ibrahim Saeed Alghamdi,3 Harish C Chandramoorthy,1,4 Ahmed M Al-Hakami,1,4 Ahmad M Alamri,2,5 Hassan Ali Alshehri3 1Department of Microbiology and Clinical Parasitology, College of Medicine, King Khalid University, Abha, Saudi Arabia; 2Department of Clinical Laboratory Sciences, College of Applied Medical Sciences, King Khalid University, Abha, Saudi Arabia; 3Central Laboratory, Assir Central Hospital, Ministry of Health, Abha, Saudi Arabia; 4Center for Stem Cell Research, College of Medicine, King Khalid University, Abha, Saudi Arabia; 5Cancer Research Unit, King Khalid University, Abha, Saudi ArabiaCorrespondence: Abdullah M Alkahtani, Department of Microbiology and Clinical Parasitology, College of Medicine, King Khalid University, PO Box 641, Abha, 61421, Saudi Arabia, Email abdalqahtani@kku.edu.saObjective: The present investigation aims on the clinical attributes and haematological parameters between symptomatic (COVID– 19 ICU) and asymptomatic (COVID– 19 homes isolation) patients as predisposing sign for COVID-19 related mortality.Materials and Methods: A retrospective cohort research was conducted of admitted patients to ICU, who were suffering from severe COVID-19 in Aseer Central Hospital, Abha, Kingdom of Saudi Arabia (KSA) from July 2020 until September 2020. The study included individuals with COVID − 19 and ICU admission as symptomatic group and others who are COVID– 19 positives with quarantine as asymptomatic group. Epidemiological, clinical and haematological laboratory data were retrospectively collected, analysed with control subjects.Results: Of the 38 ICU patients studied, the most common symptoms were fever and respiratory distress (100%), cough (86.8%). Majority were of Saudi origin (78.9%). Eighteen (47.4%) COVID-19 ICU patients showed leukocytosis, 6 (15.8%) had severe thrombocytopenia (with most having thrombocytopenia), 18 (47.4%) were anaemic. A significant correlation was observed between the WBC, RBC, Hb, platelets, neutrophil and lymphocyte count between ICU inmates compared with quarantine (p < 0.001) and RBC, Hb, neutrophil and lymphocyte count with control groups (p < 0.001).Conclusion: From the observations it is evident that, the blood tests have potential clinical value in predicting COVID-19 progression. Further, patient characteristics including age, leukocyte count, RBC, platelets and differential leukocyte counts may be significant predictors for monitoring the progression of the critical illness observed in SARS-COV-2 patients. Also, treatment procedures can be re-defined further to reduce COVID– 19 mortalities in more critically ill COVID-19 individuals.Keywords: COVID-19, blood test, ICU, quarantine, leukocyte count, erythrocyte count, platelet count

Introduction: Low accuracy of clinical variables can result in delayed diagnosis and increase the incidence of complicated appendicitis in some cases. This study aimed to determine the value of simple complete blood count (CBC) biomarkers in predicting complicated appendicitis. Methods: This is a single-center retrospective cross-sectional study, which was conducted on cases referred to emergency department following acute appendicitis who underwent appendectomy, to evaluate the accuracy of some cell blood count variables (white blood cell count (WBC), neutrophil percent, neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR), mean platelet volume (MPV)) in predicting complicated cases (gangrenous and ruptured appendicitis). Results: There were 252 (68.3%) patients in the uncomplicated appendicitis group and 117 (31.7%) patients in the complicated appendicitis group. The mean age of patients was 34.1 ± 1.09 (Range: 18 -79) years (55.3% male). There were no differences between groups regarding the mean age (p = 0.053), gender distribution (p=0.07), Alvarado score (p = 0.055), platelet count (p =0.204), PLR (p = 0.115), and MPV (p = 0.205). The complicated appendicitis cases had longer onset of symptoms (p

Introduction: Platelet-rich fibrin (PRF) is a term for autologous platelet concentrates generated from the patient's own blood (PRF). PRF and its derivatives (L-PRF, A-PRF, i-PRF) have been used for delicate tissue restoration in a variety of dental procedures. The quantity of leucocytes and other growth factors in PRF of healthy and post-COVID-19 people differs, according to the literature, and these influence wound tissue healing. Materials and Methods: Thirty healthy volunteers and 30 post-COVID-19 volunteers (age range 24–60 years). For PRF preparation, a REMI PR-23 table centrifuge and a blood collection kit consisting of a 19G needle and 10 ml blood collection tubes were used. The analysis was performed by dividing the subject groups into three test groups (Group 1 – post-COVID-19, 0–30 days; Group 2 – post-COVID-19, 31–90 days; Group 3 – normal patients). Group 1, 2 and 3 consisted of 23, 7 and 30 patients, respectively. Results: The result was statistically significant between the normal and posted COVID-19 patient groups (P = 0.00). Not much statistical significance was found between post-COVID-19 patients from 0–30 days to 31–90 days (P = 0.370). Considering the limitations of the study, our findings imply that typical patients' PRF clots or membranes comprise the majority of platelets and half of the leucocytes present in the first blood collection. Conclusion: Within the fibrin network, platelet growth factors are stuck, but the PRF clot or membrane of the post-COVID-19 patients contains a reduced/negligible number of leucocytes. Thus, the growth factors which is released are also less. Therefore, usage of PRF in post-COVID-19 patients for periodontal regenerative therapies should be avoided, at least for the first 60 days, to replenish the reduced leucocyte count and growth factors in the blood.

Background: Among the individuals with hematological malignancy (HM) complicated with Clostridioides difficile infection (CDI), the variables associated with in-hospital mortality and recurrence of CDI were investigated. Material and methods: Including adults with HM and those without malignancy suffering from CDI from January 2015 to December 2016 in three hospitals in Taiwan. Results: Totally 314 patients including 77 with HM and 237 patients without malignancy were included. HM patients more often had low leukocyte counts (

Objective: To evaluate the independent risk factors for elevated creatine kinase (hyperCKemia) after seizures. Methods: Data included in this retrospective study were obtained from two hospitals from July 1, 2017, to March 31, 2022. Clinical and laboratory data were acquired from the emergency department or within 24 h after patient admission. Variables that exhibited statistical differences (P < 0.05) were selected for further analysis. Associations between body temperature (BT), leukocyte count (LEU), percentage of neutrophils (NEU), and C-reactive protein (CRP) and creatine kinase (CK) levels were assessed using binary logistic regression analysis. Results: One hundred twenty-three patients who exhibited seizures were included in the study, and 39 (31.7%) patients exhibited hyperCKemia based on a CK level that was >1.5 times the upper limit of the normal range for CK. No statistical differences were observed among the patient characteristics, seizure-related parameters, or electrolyte levels. However, BT, LEU, NEU, and CRP were elevated in patients with hyperCKemia compared to patients with normal CK levels. Specifically, a BT ≥ 37.5 °C (fever) and LEU >9.5×109/L (elevated LEU) exhibited positive correlations with hyperCKemia, and presented an adjusted OR of 8.87 (95% CI: 2.11–37.24, P = 0.003) and 3.01 (95% CI: 1.12–8.05, P = 0.029), respectively. Conclusion: In this study, hyperCKemia occurred in 31.7% of patients after seizures. Fever and elevated LEU were independent risk factors for seizure-related hyperCKemia. Earlier recognition of risks for seizure-related hyperCKemia would be beneficial in taking prophylactic measures.

In this study, the value of leukocyte count in the differential diagnosis of culture-negative septic arthritis was investigated. The study was designed retrospectively. Synovial fluid samples sent to Turhal State Hospital Microbiology Laboratory between July 2018 and November 2019 for direct microscopic examination for the differential diagnosis of arthritis were evaluated. In this study, patients who were admitted to Turhal State Hospital between July 2018 and November 2019 and were prediagnosed with septic arthritis and whose synovial fluid samples were sent to the microbiology laboratory for leukocyte count were examined. Synovial fluid samples were counted without centrifugation at 400X magnification under a light microscope in the cell counting chamber. For bacteria isolation, samples were planted on plates of 5% Sheep Blood agar (RDS, Turkey), Chocolate agar (RDS, Turkey) and Eosin Methylene Blue agar (RDS, Turkey) and incubated at 37°C for 24-48 hours. Twenty three (43.3%) of 53 patients included in the study with a pre-diagnosis of septic arthritis were accepted as septic arthritis. Leukocyte was not detected in four (7.5%) and were counted for less than 20,000 in 24 (45.3%), between 20,000-50,000 in nine (17%), between 50,000-100,000 in seven (13.2%), over 100,000 in nine (17%) of the samples. Only three (13%) patients were diagnosed with bacteria isolation. The correlation between high leukocyte count and bacterial isolation was statistically significant (p=0.031). Also, the correlation between the high leukocyte count and the decision to initiate empirical antibiotherapy was statistically significant (p [Med-Science 2021; 10(3.000): 946-50]

Latar Belakang dan Tujuan: Tingkat keparahan dari cedera otak traumatik (COT) dapat dinilai menggunakan Glasgow Coma Scale (GCS). Saat terjadi cedera kepala, tubuh akan melepaskan berbagai mediator inflamasi, leukosit dan penanda radang yaitu C-Reactive Protein (CRP). Tujuan penelitian ini untuk mengetahui apakah terdapat hubungan antara jumlah leukosit dan CRP dengan luaran pasien COT berdasarkan skor GCS di RSUD Ulin Banjarmasin. Subjek dan Metode: Penelitian menggunakan studi desain observasional analitik dengan rancangan potong lintang. Data diambil secara consecutive sampling. Hasil: Didapatkan 45 subjek dengan hasil rerata jumlah leukosit dan kadar CRP tertinggi ada pada pasien COT berat diikuti dengan COT sedang dan COT ringan. Pada hari ke-7, didapatkan 41 pasien dengan luaran yang baik dan 4 pasien dengan luaran yang buruk. Analisis menggunakan uji korelasi Spearman menunjukan terdapat hubungan antara jumlah leukosit (p=0,004; r=0,424) dan CRP dengan luaran pasien COT (p=0,043; r=0,361). Simpulan: Terdapat hubungan antara jumlah leukosit dan kadar CRP dengan luaran pasien COT berdasarkan skor GCS Association of Leukocyte Count and C-Reactive Protein (CRP) Levels with Traumatic Brain Injury (TBI) Patient Outcome based on Glasgow Coma Scale (GCS) Score in Ulin General Hospital Banjarmasin Abstract Background and Objective: The severity of traumatic brain injury (TBI) can be assessed using the Glasgow Coma Scale (GCS). When head injury occurs, the body releases various inflammatory mediators, leukocytes and inflammatory markers, namely c-reactive protein (CRP). The purpose of this study was to determine whether there is a correlation between the leukocyte count and CRP levels with the outcome of TBI patients based on GCS scores in Ulin Hospital Banjarmasin. Subject and Method: This research is an analytic observational with cross-sectional approach. Data acquired with consecutive sampling method. Result: We Obtained 45 subjects with the highest mean of leukocytes count and the highest CRP levels in patients with severe TBI followed by moderate TBI and mild TBI. On the 7th day, 41 patients had good outcome and 4 patients had bad outcome. Analysis using the Spearman correlation test showed that there was a relationship between the leukocyte count (p = 0.004; r = 0.424) and CRP levels with the outcome of TBI patients (p = 0.043; r = 0.361). Conclusion: It was concluded that there is a correlation between leukocyte count and CRP levels with the outcome of TBI patients based on GCS scores

Abstract Background Because of fast leucocyte degeneration in cerebrospinal fluid (CSF) laboratory examinations of CSF samples should be performed approximately within 30 min after withdrawal. This study examines the storage of canine and feline CSF samples in “TransFix®/EDTA CSF Sample Storage Tubes” (Cytomark, Buckingham, UK) for preventing leucocytes from degeneration, so that routine and flow cytometry examinations are feasible up to 3 days after sampling. Results After storage in TransFix® tubes, leukocytes could not be adequately stained with Türk’s solution and differentiating between erythrocytes and leukocytes was cumbersome. In addition, the cell morphology could not be sufficiently assessed on cytospin preparations because of shrunken leukocytes and indistinct cell nuclei. In contrast, by flow cytometry, a significantly higher cell count was measured over the entire study period in the samples stored in TransFix® tubes compared to the untreated samples. The antibodies (AB) against CD3, CD4 and CD21, against CD11b and against CD45 showed a good binding strength and thus enabled a good differentiation of cell populations. However, after storage in the TransFix® tubes, monocytes were no longer detectable using an AB against CD14. Conclusion Based on these results, “TransFix®/EDTA CSF Sample Storage Tubes” can be used for extended storage prior to flow cytometric analysis of lymphocytes and granulocytes in CSF samples but not for detecting monocytes. However, standard examinations, such as microscopic cell counting and morphological cell assessment should be performed on fresh CSF samples.

Husain Y Alkhaldy,1,2 Zuhier A. Awan,3,4 Ahmed A Abouzaid,4,5 Hossameldin M Elbahaie,4,6 Saeed M Al Amoudi,4 Mohamed Andarawi,7 Shehata F Shehata8,9 1Department of Internal Medicine, College of Medicine, King Khalid University, Abha, Saudi Arabia; 2Research Center for Advanced Materials Science, King Khalid University, Abha, Saudi Arabia; 3Department of Clinical Biochemistry, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia; 4Department of Clinical Pathology, Al-Borg Medical Laboratories, Jeddah, Saudi Arabia; 5Department of Medical Biochemistry, Faculty of Medicine, Al-Azhar University, Cairo, Egypt; 6Clinical Pathology Department, Suez Canal University, Ismailia, Egypt; 7Department of Pathology, College of Medicine, King Khalid University, Abha, Saudi Arabia; 8Department of Community Medicine, College of Medicine, King Khalid University, Abha, Saudi Arabia; 9High Institute of Public Health, Alexandria University, Alexandria, EgyptCorrespondence: Husain Y AlkhaldyDepartment of Internal Medicine, College of Medicine, King Khalid University, Abha, P.O.Box 641, Aseer 61421, Saudi ArabiaTel +966 72417578Fax +966 72418111Email halkhaldy@kku.edu.saIntroduction: Isolated neutropenia is a common problem in hematology practice. Benign ethnic neutropenia (BEN) is the common form of neutropenia worldwide and it affects mainly African and Middle Eastern ethnicities. Most cases of isolated mild and moderate neutropenia are benign and associated with no clinical significance. The aim of this study was to estimate the prevalence of isolated neutropenia at high-altitude southern Saudi Arabia.Methods: A large dataset of complete blood counts (CBCs) was analyzed for walk-in patients of both genders, of age ranges from 12 to 60 years doing blood tests at a commercial lab for high altitude − 2,270 meters above sea level – (HA) group, and from sea level SL group. Abnormal biochemical or CBC results were excluded before analysis.Results: For HA group, 3123 CBCs were analyzed and for SL group 18,427 CBCs were analyzed. The prevalence of mild neutropenia, defined as absolute neutrophil count (ANC) in the range of 1.0− .5× 109/L, was 12.4% (n=399) versus 5.6% (n=1025), while moderate neutropenia, defined as ANC of 0.5– 1 × 109/L, was present 6% (n=191) versus 1.45% (n=269) in the high altitude and sea level groups, respectively. Severe neutropenia, defined as neutrophil count less than 0.5– 1 × 109/L, was rare in both groups.Conclusion: Isolated neutropenia is common in Saudis living at high altitude. While benign ethnic neutropenia (BEN) is thought to be the major contributing factor to this high prevalence, other factors including environmental factors and altitude are possible contributing factors along with underlying ethnic neutropenia.Keywords: ethnic neutropenia, high altitude, hematological, leukocyte count

Abstract Introduction: The thoracoscopic procedure for tricuspid valve (TV) diseases is a minimally invasive method of treatment. This study focuses on comparing the changes in postoperative inflammatory reaction and myocardial injury markers after thoracoscopic and sternotomy/thoracotomy TV procedures. Methods: We retrospectively analyzed 88 patients (53 males, aged 50.9±16.2 years) with TV diseases (single-valve disease) (72 cases of TV plasty) between January 2018 and April 2019. A total of 56 patients underwent thoracoscopic procedure (50 cases of TV plasty). The leukocyte and C-reactive protein (CRP) levels were monitored as indicators of systemic inflammatory reaction. The lactate dehydrogenase, creatine kinase, creatine kinase myocardial band, aspartate aminotransferase, and troponin-T levels were recorded as markers of myocardial injury. Results: The CRP and white blood cells levels of patients in the sternotomy approach group were continuously higher than those in patients in the thoracoscopic approach group. And the levels of myocardial enzymes in patients in the thoracoscopic approach group were significantly lower than those in patients in the sternotomy approach group. Conclusion: Compared with sternotomy/thoracotomy procedures on TV, the thoracoscopic procedure can reduce postoperative myocardial injury significantly and systemic inflammatory reaction to a certain extent. It is technically feasible, safe, effective, and worthy of widespread adoption in clinical practice.

Background. In December 2019, China has experienced an outbreak of novel coronavirus disease 2019 (COVID-19). Coronavirus has now spread to all of the continents. We aimed to consider clinical characteristics, laboratory data of COVID-19 that provided more information for the research of this novel virus.

Objective: Acute pulmonary thromboembolism (APTE) is one of the life-threatening cardiovascular diseases. Following the diagnosis, it has a broad range of severity and a wide spectrum. Its mortality and morbidity vary depending on its clinical scope and the site of involvement. Neutrophil / lymphocyte ratio (NLR) has previously been studied in many cardiovascular disease processes as an indicator of inflammation and marker of mortality. The aim of our study is to determine the correlation between NLR and the 30-day mortality in APTE. Materials and Methods: 160 APTE patients who applied to the emergency department of Bagcilar Education and Research Hospital between January 2011 and June 2013 were determined retrospectively and hemogram parameters at the time of application were recorded. It was ensured in the selection of patients that all patients had a final diagnosis supported by computed tomography. APTE patients; It was divided into two groups in terms of those who died (n:28) and survived (n:120) within 30 days. Low, medium and high risk APTE patients in both groups were compared in terms of NLR. The utility of NLR as a marker of mortality was investigated in patients with pulmonary embolism Results: NLR was significantly higher in the deceased group (11.40 ± 4.24 vs 18.33 ± 9.06, p < 0.001). It had 57 % sensitivity and 89 % specificity for prediction of mortality (Area Under Curve: 0.736, 95% CI: 0.619–0.853, p < 0.001) in patients with pulmonary embolism. In the multivariate logistic regression analysis; NLR was found to be signifant independent predictor of the 30-day mortality (Odds: 1.132 (1.031-1.243, CI 95%), p=0.009). Conclusion: NLR plays a strong role in determining 30-day mortality in APTE patients. Key Words: Leukocyte Count; Pulmonary embolism; Mortality

Objectives: Approximately 60,000 patients are hospitalised annually due to chemotherapy-induced febrile neutropenia (FN) in the United States alone. Febrile neutropenia is primarily managed by antibiotics and granulocyte-colony-stimulating factors (G-CSFs). However, there are inconsistent recommendations regarding dose, frequency, and duration for G-CSF therapy. We conducted this study to assess the use of G-CSFs in a community-based teaching hospital in compliance with the National Comprehensive Cancer Network (NCCN) guidelines. Methods: We retrospectively reviewed medical records of adult patients diagnosed with non-myeloid malignancies who received filgrastim in a community-based teaching hospital from November 2014 to April 2015. Results: Of 90 patients, 77% received filgrastim for FN treatment, 19% for primary prophylaxis, and 4% for secondary prophylaxis. The dose of filgrastim was appropriate in 93% of patients, while 7% received a sub-optimal dose without the worsening of their clinical outcomes. We could not assess the duration of therapy for 38 patients who either died or were discharged before achieving the desired absolute neutrophil count (ANC). Of the 69 patients treated for FN, only 33% received filgrastim until they achieved the ANC goal (1,500–8,000/μL), while 36% continued to receive filgrastim treatment beyond the desired ANC goal. Conclusion: In our study, filgrastim was correctly prescribed; however, the ANC goal was not achieved in 47% of the patients. If the recommended ANC range had been targeted, a minimum of 28 doses could have been potentially avoided. This approach would have saved approximately $56,000. Therefore, future protocols should focus on pharmacist-led interventions to optimise G-CSF usage.

Objective: This study was an investigation of the severity of inflammation (SOI) in aspirated material and thrombus age to examine any association with pre-discharge and long-term left ventricular (LV) function after ST-elevation myocardial infarction (STEMI). Methods: The study group comprised 25 patients with STEMI from whom an occlusive thrombus was aspirated from the infarct-related artery with a 7-F catheter. The SOI in the aspirate was determined according to the mean leukocyte count in 5 high-power magnification fields and graded as mild in the presence of ≤100 leukocytes per field or significant if there were >100 leukocytes per field. The thrombi were categorized as fresh or lytic/organized (L/O) using predefined criteria. Echocardiographic assessment was performed prior to discharge and at 1 year. Adverse left ventricular remodeling (LVR) was defined as a 20% increase in LV end-diastolic volume in comparison with baseline values. Results: LVR was observed in 8 patients. The mean leukocyte count of the aspirate (127.5+-86.0 vs 227.2+-120.7; p=0.026) and frequency of significant inflammation (35% vs 75%; p=0.046) were significantly higher in the group with LVR. The serum high-sensitivity C-reactive protein (hsCRP) level was significantly correlated with the leukocyte count of the aspirate (r=0.532; p=0.006). An L/O thrombus was related to better pre-discharge and long-term LV volumes and ejection fraction values compared with a fresh thrombus. Conclusion: A significant increase in the leukocyte count in the aspirate and a fresh thrombus might predict long-term LV functional deterioration irrespective of the clinical and procedure-related characteristics. In addition, serum markers of inflammation, like hsCRP, might also reflect the intensity of the local inflammatory response at the site of occlusion.

Introduction: Sputum differential is the most comprehensive, and non-invasive investigation for evaluating airway inflammation because of its reliability, reproducibility and responsiveness. The interpretation of the results of induced sputum examination depends on knowledge of normal values from a healthy population. So far, the reference values of sputum differential cells in Nepalese population are not reported. Neutrophil and eosinophil are used to assess the inflammatory response of the airway. The aim of our study was to detect the eosinophil level in the sputum of healthy individuals with normal pulmonary function. Methods: A descriptive cross-sectional study was conducted in a tertiary care hospital, from November 1, 2021 to December 31, 2021 after taking ethical clearance from Institutional Review Board (Reference number: 1507202106). Convenience sampling was done. Collected data was entered and analysed using Statistical Package for the Social Sciences version 24.0. Point estimate at 95% was calculated along with mean and standard deviation for continuous data. Results: Among 139 induced sputum samples, 7 (5.03%) had eosinophils present in their sputum (1.40 to 8.67 at 95% Confidence Interval). The age range of the participants was 18 years to 79 years with mean age of 39.5 ± 15.06. Prevalence of eosinophilia (percentage of eosinophil ≥3) was 4 (2.88%). Conclusions: The prevalence of eosinophilia in our study was found to be similar to published literature. The results of the present study show that there is a paucity of eosinophils with predominance of neutrophils, macrophages and lymphocytes in induced sputum samples of healthy non-smoker adults with normal pulmonary function test.

Introduction: Sputum differential is the most comprehensive, and non-invasive investigation for evaluating airway inflammation because of its reliability, reproducibility and responsiveness. The interpretation of the results of induced sputum examination depends on knowledge of normal values from a healthy population. So far, the reference values of sputum differential cells in Nepalese population are not reported. Neutrophil and eosinophil are used to assess the inflammatory response of the airway. The aim of our study was to detect the eosinophil level in the sputum of healthy individuals with normal pulmonary function. Methods: A descriptive cross-sectional study was conducted in a tertiary care hospital, from November 1, 2021 to December 31, 2021 after taking ethical clearance from Institutional Review Board (Reference number: 1507202106). Convenience sampling was done. Collected data was entered and analysed using Statistical Package for the Social Sciences version 24.0. Point estimate at 95% was calculated along with mean and standard deviation for continuous data. Results: Among 139 induced sputum samples, 7 (5.03%) had eosinophils present in their sputum (1.40 to 8.67 at 95% Confidence Interval). The age range of the participants was 18 years to 79 years with mean age of 39.5 ± 15.06. Prevalence of eosinophilia (percentage of eosinophil ≥3) was 4 (2.88%). Conclusions: The prevalence of eosinophilia in our study was found to be similar to published literature. The results of the present study show that there is a paucity of eosinophils with predominance of neutrophils, macrophages and lymphocytes in induced sputum samples of healthy non-smoker adults with normal pulmonary function test.

An acute inflammatory response following arterial surgery for atherosclerosis, such as balloon angioplasty, stenting, and surgical bypass, is an important driver of neointimal hyperplasia after arterial injury, which leads to recurrent ischemia. However, a comprehensive understanding of the dynamics of the inflammatory infiltrate in the remodeling artery is difficult to attain due to the shortcomings of conventional methods such as immunofluorescence. We developed a 15-parameter flow cytometry method to quantitate leukocytes and 13 leukocyte subtypes in murine arteries at 4 time points after femoral artery wire injury. Live leukocyte numbers peaked at 7 days, which preceded the peak neointimal hyperplasia lesion at 28 days. Neutrophils were the most abundant early infiltrate, followed by monocytes and macrophages. Eosinophils were elevated after 1 day, while natural killer and dendritic cells gradually infiltrated over the first 7 days; all decreased between 7 and 14 days. Lymphocytes began accumulating at 3 days and peaked at 7 days. Immunofluorescence of arterial sections demonstrated similar temporal trends of CD45+ and F4/80+ cells. This method allows for the simultaneous quantitation of multiple leukocyte subtypes from small tissue samples of injured murine arteries and identifies the CD64+Tim4+ macrophage phenotype as being potentially important in the first 7 days post-injury.

Alcohol inhibits platelet function, and platelet count is often reduced in individuals with alcohol use disorder. However, the relation of habitual alcohol drinking with platelet count in a general population remains to be determined. The participants were 6508 men (30 ~ 69 years old) who had received annual health checkup examinations, and most of them (98.6%) were nondrinkers or drinkers with an average ethanol intake of less than 66 g per day. Relationships of platelet count with alcohol intake were investigated by using analysis of covariance and multivariate linear and logistic regression analyses. Platelet count was significantly correlated with age, smoking, γ-glutamyl transpeptidase, body mass index and leukocyte count, which were thus used as explanatory variables in the multivariate analyses. Mean platelet counts in light (

Abstract Background Survival analysis of patients on maintenance hemodialysis (HD) has been the subject of many studies. No study has evaluated the effect of different factors on the survival time of these patients. In this study, by using parametric survival models, we aimed to find the factors affecting survival and discover the effect of them on the survival time. Methods As a retrospective cohort study, we evaluated the data of 1408 HD patients. We considered the data of patients who had at least 3 months of HD and started HD from December 2011 to February 2016. The data were extracted from Shiraz University of Medical Sciences (SUMS) Special Diseases database. Primary event was death. We applied Cox-adjusted PH to find the variables with significant effect on risk of death. The effect of various parameters on the survival time was evaluated by a parametric survival model, the one found to have the best fit by Akaike Information Criterion (AIC). Results Of 428 HD patients eligible for the analysis, 221 (52%) experienced death. With the mean ± SD age of 60 ± 16 years and BMI of 23 ± 4.6 Kg/m, they comprised of 250 men (58%). The median of the survival time (95% CI) was 624 days (550 to 716). The overall 1, 2, 3, and 4-year survival rates for the patients undergoing HD were 74, 42, 25, and 17%; respectively. By using AIC, AFT log-normal model was recognized as the best functional form of the survival time. Cox-adjusted PH results showed that the amount of ultrafiltration volume (UF) (HR = 1.146, P = 0.049), WBC count (HR = 1.039, P = 0.001), RBC count (HR = 0.817, P = 0.044), MCHC (HR = 0.887, P = 0.001), and serum albumin (HR = 0.616, P

Purpose Kawasaki disease (KD) is a common, acute systemic vasculitis in children. Acute phase reactants (APRs) have been used to assist diagnosis, and to predict outcome in children with KD. However, it remains unknown on levels of APRs depending on duration of fever. We aimed to compare APR levels of children with KD who visited with < 5 days duration of fever and with ≥ 5 days. Methods Children (≤ 15 years) with complete KD who visited the emergency department were enrolled from March 2012 through February 2018. The children were divided into the early (fever < 5 days) and late (fever ≥ 5 days) presenters. The baseline characteristics, APR levels, such as platelet count, and outcomes were compared between the 2 groups. Results A total of 145 children with complete KD were enrolled. Median age was 27.0 (interquartile range [IQR], 12.0-46.5) months, and boys accounted for 60.0%. The early presenters (63 [43.4%]) had a younger age (17.0 [IQR, 7.0-45.0] vs. 32.5 [IQR, 14.0-48.0] months; P = 0.006), shorter duration of fever (3.0 [IQR, 2.0-4.0] days vs. 6.0 [IQR, 5.0-7.0] days; P < 0.001), and a lower platelet count (336.7 ± 105.2 [× 103/μL] vs. 381.6 ± 121.8 [× 103/μL], P = 0.02) than the late presenters. The other APR levels, and frequency of resistance to intravenous immunoglobulin and coronary artery abnormalities showed no differences between the 2 groups. Conclusion Children with KD who visited with < 5 days duration of fever had a lower platelet count compared to those with ≥ 5 days. No differences were found in the other APR levels and the outcomes. It may be necessary to consider the differences in APR levels depending on duration of fever when treating children with KD.

Abstract Background Bacterial ventriculitis is a common complication in children with temporary external ventricular drains (EVD) and the diagnosis is challenging. The present study compared the diagnostic accuracy of novel cerebrospinal fluid (CSF) marker - CD64 expression on neutrophils measured as neutrophil CD64 index (CD64in) to routine laboratory CSF and blood markers for bacterial ventriculitis in children with EVD. Methods We conducted a prospective, observational study, enrolling children with EVD. CD64in in CSF together with CSF markers (leukocyte count, percentage of neutrophils, glucose, and proteins) and blood markers (leukocyte and differential count, C-reactive protein (CRP), and procalcitonin (PCT)) were studied at the time of suspected bacterial ventriculitis. CD64in was measured by flow cytometry. Diagnostic accuracy determined by the area under the receiver–operating characteristic (ROC) curves (AUC) was defined for each marker. Results Thirty-three episodes of clinically suspected ventriculitis in twenty-one children were observed during a 26-month period. Episodes were classified into those with microbiologically proven ventriculitis (13 episodes) and into those with microbiologically negative CSF (20 episodes). CD64in and leukocyte count were the only CSF markers that could differentiate between groups with diagnostic accuracy of 0.875 and 0.694, respectively. Among blood markers only CRP and band neutrophils differentiated between groups with diagnostic accuracy of 0.792 and 0.721, respectively. Conclusions CD64in in CSF is a promising diagnostic marker of bacterial ventriculitis in children with EVD as it has higher diagnostic accuracy than routine blood and CSF markers for diagnosing bacterial ventriculitis at the time of clinical suspicion.

The purpose of the present study was to investigate the clinical significance of preoperative hematological parameters in patients with advanced stomach cancer, and to explore who might benefit from adjuvant concurrent chemoradiotherapy (CCRT) compared to chemotherapy alone. Among 1032 patients with node-positive stomach cancer who had a confirmed diagnosis after complete D2 resection, and who received adjuvant chemotherapy alone or CCRT, a total of 692 patients was selected using propensity score matching. Among absolute neutrophil count, absolute lymphocyte count (ALC), absolute monocyte count (AMC), platelet count, neutrophil-to-lymphocyte ratio, lymphocyte-to-monocyte ratio, and platelet-to-lymphocyte ratio, AMC was the most relevant prognostic factor for overall survival and recurrence-free survival (hazard ratio (HR) 1.674, 95% confidence interval (CI) 1.180–2.376; HR 1.908, 95% CI 1.650–2.695, respectively). In a subgroup with a high ALC, patients treated with adjuvant CCRT had a favorable recurrence-free survival (HR 0.620, 95% CI 0.393–0.980) compared to those treated with chemotherapy alone. Further study is needed to confirm our findings and to develop tailored adjuvant treatment.

Abstract Background Bacterial meningitis is a paediatric emergency with high mortality and morbidity requiring prompt diagnosis and treatment. Clinically, it is often difficult to differentiate between bacterial and non-bacterial meningitis. Several studies have demonstrated the raised values of serum procalcitonin (PCT) in bacterial infections including meningitis but without definite cut-off guidelines. Hence, this study was done to evaluate serum PCT as a marker to differentiate bacterial and non-bacterial meningitis in children and assess its efficacy. Methods It was a cross-sectional study done over a period of 5 months (Aug 2016-Dec 2016) in the department of Paediatrics, B P Koirala Institute of Health Sciences (BPKIHS). Fifty children aged 3 months to 15 years with suspected meningitis were enrolled and investigated with relevant investigations like complete blood counts, and cerebrospinal fluid (CSF) analysis along with serum PCT. Patients were classified into bacterial (22) and non-bacterial meningitis (28) according to clinical & CSF findings and data analysed using SPSS software. Results Serum PCT levels were significantly higher in bacterial meningitis group (median = 2.04 (1.2–3.18) ng/ml) compared with non-bacterial meningitis (median = 0.35 (0.18–0.35) ng/ml); p

INTRODUCTION: Organophosphorus poisoning (OPP) is a major public health problem in developing countries like India. Leukocyte count is a simple and inexpensive test, and elevated count is associated with acute inflammation and increased oxidative stress-like OPP. This study was done to correlate the severity of acute OPP with leukocyte count and also to assess the prognosis. MATERIALS AND METHODS: A prospective, observational clinical study was done on 80 patients suspected of OPP of age >15 years admitted to emergency unit at a tertiary rural teaching health-care center of Central India. Serum cholinesterase level and leukocyte count were estimated at the time of admission in all patients and severity of OPP was assessed according to Peradeniya organophosphorus poisoning (POP) scale. RESULTS: The mean age of the patients was 33.52 years (standard deviation [SD] 11.62) in males and 27.30 years (SD 7.33) in females. Among them, 57 (71.25%) were males and 23 (28.75%) were females. The severity of poisoning was directly correlated with serum cholinesterase level (P = 0.0001). Leukocyte count had a sensitivity of 60%, specificity of 76%, and negative predictive value of 85% if counts were more than 12,000 and 30% sensitivity, 95% specificity, and 80% negative predictive value if counts were more than 15,000 in predicting mortality in patients with OPP. CONCLUSION: Leukocyte count levels on admission can be used a prognostic marker in patients with OP poisoning.

Epidemiological and clinical studies suggest that elevated leukocyte count within the normal range can predict cardiovascular and total mortality in older adults. These findings are remarkable because this simple and common laboratory test is included in routine medical check-ups. It is well known that chronic systemic inflammation (inflammaging) is one of the hallmarks of aging and an important component of obesity-associated insulin resistance that can lead to type 2 diabetes and other health problems in both overweight individuals and elderly people. To understand the molecular mechanisms linking increased systemic inflammation with aging-associated diseases and elevated leukocyte counts in the elderly is to unravel the multiplicity of molecular factors and mechanisms involved in chronic low-grade systemic inflammation, the gradual accumulation of random molecular damage, age-related diseases, and the process of leukopoiesis. There are several possible mechanisms through which chronic low-grade systemic inflammation is associated with both higher leukocyte count and a greater risk of aging-associated conditions in older adults. For example, the IL-6 centric model predicts that this biomediator is involved in chronic systemic inflammation and leukopoiesis, thereby suggesting that elevated leukocyte count is a signal of poor health in older adults. Alternatively, an increase in neutrophil and monocyte counts can be a direct cause of cardiovascular events in the elderly. Interestingly, some authors assert that the predictive ability of elevated leukocyte counts with regard to cardiovascular and allcause mortality among older adults surpass the predictive value of total cholesterol. This review reports the recent findings on the links between elevated but normal leukocyte counts and the increased risks of all-cause, cardiovascular, and cancer mortality. The possible molecular mechanisms linking higher but normal leukocyte counts with increased risk of aging-associated diseases in the elderly are discussed here.

BackgroundWe examined whether white blood cell (WBC) count levels within normal range, could be associated with hemoglobin A1c (HbA1c) levels.MethodsAmong the 11,472 people (≥19 years of age) who participated in the 2011 to 2012 Korea National Health and Nutrition Examination, subjects with chronic disease or illness, including 807 patients with diabetes currently taking anti-diabetic medications and/or 1,149 subjects with WBC levels 10,000/µL were excluded.ResultsOverall, adjusted HbA1c levels increased across the WBC quartiles (5.55%±0.01%, 5.58%±0.01%, 5.60%±0.01%, and 5.65%±0.01%, P

Amaç: Epidemiyolojik araştırmalar periferik kandaki lökosit sayısı ile Tip 2 Diyabetes Mellitus (T2DM) arasında ilişki bulunduğunu göstermesine rağmen bu ilişki sistematik olarak incelenmemiştir. Bu çalışmada, T2DM tanısı olan hastaların (T2DM(+)) lökosit sayımı ve biyokimya tetkik sonuçlarının diyabeti olmayan hastaların (T2DM(-)) sonuçlarıyla karşılaştırılması amaçlanmıştır.Materyal ve Metot: Çalışmaya; 02.02.2015-30.09.2015 tarihleri arasında Dışkapı Yıldırım Beyazıt Eğitim ve Araştırma Hastanesi Aile Hekimliği Poliklinikleri’ne başvuran hastalar alınmıştır. Hastaların antropometrik ölçümleri, tam kan sayımı ve biyokimyasal testlerinin sonuçları kaydedilmiştir ve bu değerler T2DM(+) ile T2DM(-) grupları arasında karşılaştırılmıştır.Bulgular: Çalışmaya dâhil edilen 286 hastanın yaş ortalaması 58,7±10,5 yıl olarak saptandı. T2DM(+) (n=108) ve T2DM(-) (n=178) gruplarının yaş ve cinsiyet dağılımları arasında fark yoktu. T2DM(+) grubun ortalama lökosit sayısının T2DM(-) grubundan yüksek olduğu saptandı (7,73 × 103/ml; 7,17 × 103/ml; p=0,001). T2DM(+) grubun bel çevresi, vücut kitle indeksi (VKİ), açlık kan şekeri (AKŞ), alanin aminotransferaz (ALT) ve trigliserid değerleri T2DM(-) grubuna göre anlamlı olarak yüksek olduğu, düşük yoğunluklu kolesterol (LDL) ve yüksek yoğunluklu kolesterol (HDL) değerlerinin ise anlamlı olarak daha düşük olduğu bulundu. Sonuç: Lökosit sayısı normal sınırlar içerisinde dahi T2DM hastalarında diyabeti olmayan bireylerden daha yüksektir. Bizim sonuçlarımız kronik inflamasyonun Tip 2 diyabetteki rolünü desteklemektedir. İnflamasyonun diyabetteki rolünü açıklayacak daha kapsamlı çalışmalara ihtiyaç vardır.

Purpose To investigate the predictors of perforated appendicitis (PA) in pediatric patients with appendicitis seen in the emergency department. Methods We retrospectively reviewed 564 pediatric patients (< 16 years) who visited the emergency department and subsequently had pathologically confirmed appendicitis from 2005 through 2014. Clinical features, inflammatory markers, including the white blood cell (WBC), neutrophil, and lymphocyte counts, neutrophil-to-lymphocyte ratio, C-reactive protein (CRP) concentration, erythrocyte sedimentation rate (ESR), and the Alvarado score were compared between the patients with and without PA regarding their predictability of PA. Results Of 564 pediatric patients with appendicitis, 204 (36.2%) had PAs. The patients with PA had longer duration of symptoms and median length of hospital stay, more frequent nausea and vomiting, and higher median WBC and neutrophil counts, neutrophil-to-lymphocyte ratio, ESR, and CRP concentration. Overall, WBC count showed the highest sensitivity of 79.9% and negative predictive value of 82.6%, and CRP concentration had the highest area under the receiver operating characteristic curve of 0.72. Multivariable logistic analysis showed that WBC count > 13.5 × 109/L (odds ratio [OR], 3.27; confidence interval [CI], 1.49-7.18; P = 0.003) and ESR > 15 mm/h (OR, 3.18; 95% CI, 2.13-4.74; P < 0.001) are independent predictors of PA. Conclusion WBC count and ESR might be better predictors of PA in pediatric patients with appendicitis in the emergency department than the Alvarado score and CRP concentration.