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Objectives: Inflammatory disorders including periodontitis have been investigated for their impact on systemic inflammation and bone health. The present study was conducted with an aim to evaluate impact of control of periodontal inflammation through subgingival instrumentation on serum interleukin 6 and serum C-terminal telopeptide of type I collagen (CTX) in premenopausal females with stage II and III periodontitis. Method and materials: In this single-arm prospective study, periodontal parameters, serum interleukin 6, serum CTX, and hematologic parameters (total leukocyte count, differential leukocyte count, platelet count, mean platelet volume, and platelet distribution width) were assessed at baseline. Subgingival instrumentation was done, and oral hygiene instructions were given. At week 4, professional plaque control was performed, and oral hygiene instructions were reinforced. Serum and hematologic parameters were reassessed at 8 weeks after subgingival instrumentation, in individuals meeting the clinical endpoints (ie, bleeding on probing < 10%). Results: There was significant reduction in serum interleukin 6 of 0.168 ± 0.164 pg/mL (P = .000), and serum CTX of 17.459 ± 4.363 pg/mL (P = .000) at 8 weeks after subgingival instrumentation. There was significant decrease in eosinophil count (P = .018) and mean platelet volume (P = .016) at 8 weeks after subgingival instrumentation; however, no significant change was found in other hematologic parameters. Conclusion: Following subgingival instrumentation, biomarkers of both systemic inflammation (interleukin 6) and bone turnover (CTX) were observed to reduce significantly. This finding hints towards a positive impact of periodontal intervention on bone health. [ABSTRACT FROM AUTHOR]

Background: Type 2 Diabetes Mellitus (T2DM) which is now an important public health problem is a prothrombotic state which can lead to macrovascular and microvascular complications; diabetic retinopathy (DR) being one of them. Platelet indices may serve as prognostic markers for these patients. This study was conducted to evaluate the association between platelet indices and diabetic retinopathy. A total of 144 patients were evaluated. They were divided in four groups. Group 1: T2DM with Proliferative DR, Group 2: T2DM with Non-proliferative DR, Group 3: T2DM without DR and Group 4: Healthy adults (Control group). The mean platelet volume (MPV), Platelet distribution width (PDW), large platelets, platelet count and HbA1c were measured in all the groups. We found that MPV, PDW, large cell platelets and HbA1c were significantly raised in all the groups as compared to the control group. It was also observed that PDW and large cell platelets were significantly increased in patients of proliferative DR as compared to non-proliferative DR. Our findings thus suggest an association between platelet indices (MPV, PDW, large platelets) and DR. Also evaluation of PDW and large cell platelets is useful in predicting progression of nonproliferative to proliferative DR (since these values increased with increasing grade of DR) and hence it’s prognosis. Thus we conclude that there is significant association of platelet indices with diabetic retinopathy and these can be used as predictive markers to monitor DR. [ABSTRACT FROM AUTHOR]

Hypertension (HT) is a common chronic disease that often causes target-organ damage and severe complications, contributing to cardiovascular morbidity and mortality worldwide. Accumulating evidence suggests that inflammation plays a prominent role in the initiation and progression of HT. Multiple inflammatory biomarkers have been proposed to predict HT. Several new hematological parameters can reflect the inflammatory response and platelet activation. The major advantage of hematological parameters over conventional inflammatory markers is that they are relatively inexpensive and easily obtained from routine blood tests. Numerous studies have investigated several hematological parameters for their utility as predictive biomarkers for the diagnosis and prognosis of HT. Among them, the neutrophil to lymphocyte ratio (NLR), monocyte to high density lipoprotein cholesterol ratio (MHR), red cell distribution width (RDW), platelet to lymphocyte ratio (PLR), mean platelet volume (MPV), platelet distribution width (PDW), and systemic immune-inflammation index (SII) have recently received attention. We searched PubMed and Embase databases (up to September 18, 2022) to assess the relationships between hematological parameters and HT. This review discusses the diagnostic and prognostic value of these hematological parameters in HT, providing an important basis for early screening, risk stratification, and optimal management of hypertensive patients. [ABSTRACT FROM AUTHOR]

Although transcatheter aortic valve replacement (TAVR) is safe and effective, mortality and bleeding events post procedure are important. The present study investigated the changes in hematologic parameters to evaluate whether they predict mortality or major bleeding. We enrolled 248 consecutive patients (44.8% male; mean age 79.0 ± 6.4 years) undergoing TAVR. In addition to demographic and clinical examination, blood parameters were recorded before TAVR, at discharge, 1 month and 1 year. Hemoglobin levels before TAVR 12.1 ± 1.8 g/dL, 10.8 ± 1.7 g/dL at discharge, 11.7 ± 1.7 g/dL at first month, 11.8 ± 1.4 g/dL at first year (Hemoglobin values compared with pre-TAVR, P <.001, P =.019, P =.047, respectively). Mean platelet volume (MPV) before TAVR 8.72 ± 1.71 fL, 8.16 ± 1.46 fL at discharge, 8.09 ± 1.44 fL at first month, 7.94 ± 1.18 fL at first year (MPV values compared with pre-TAVR, P <.001, P <.001, P <.001, respectively). Other hematologic parameters were also evaluated. Hemoglobin, platelet count, MPV, and red cell distribution width before the procedure, at discharge, and at the first year did not predict mortality and major bleeding in receiver operating characteristic analysis. After multivariate Cox regression analysis, hematologic parameters were not independent predictors of in-hospital mortality, major bleeding, and death at 1 year after TAVR. [ABSTRACT FROM AUTHOR]

Aims: The present study aimed to investigate the relationship between mean platelet volume (MPV) and the risk of type 2 diabetes mellitus (T2DM), among women with and without a history of gestational diabetes mellitus (GDM). Methods: Eight thousand one hundred eighty-one parous women of the '2007–2018 National Health and Nutrition Examination Survey (NHANES)' were classified into GDM and non-GDM groups based on self-reported GDM history. We investigated the independent association between the MPV and the risk of T2DM in these groups via multivariable regression analysis. A subgroup analysis was done for the GDM group. Results: After comprehensive adjustment for potential covariates, a significant positive correlation was observed between MPV and the risk of T2DM in women with a history of GDM (OR = 1.50, 95% CI 1.13–2.01, P = 0.006). There was a linear relationship between MPV and T2DM among women with a history of GDM, with each unit increase in MPV increasing the risk of T2DM by 50%. Subgroup analysis and interaction tests revealed a stronger significant effect on women with GDM history who had HbA1c ≥ 7%. Conclusions: MPV is strongly associated with the incidence of T2DM among U.S. parous women with prior GDM, indicating that MPV may be a potential biomarker of T2DM among women with a history of GDM. [ABSTRACT FROM AUTHOR]

Background: There were limited data investigating platelet indices in predicting peritoneal dialysis (PD) outcomes on comorbidities. The aim of this study was to evaluate the association between platelet indices and new-onset comorbidity and all-cause mortality in PD patients. Methods: A single-center, retrospective observational cohort study was conducted in incident PD patients from 28 December 2011 to 24 January 2018, and followed up until 31 December 2022. Time to the first new-onset cardiovascular disease (CVD) and time to the first new-onset infection event after PD were identified as the primary outcomes. All-cause mortality was identified as the secondary endpoint. The correlation between platelet indices and comorbidities and all-cause mortality were assessed by Cox model. Data of liver disease status was not collected and analyzed. Survival curves were performed by Kaplan-Meier method with log-rank tests. Results: A total of 250 incident PD patients with a median follow-up of 6.79 (inter-quarter range 4.05, 8.89) years was included. A total of 81 and 139 patients experienced the first new-onset CVD and infection event respectively during the follow-up period. High mean platelet volume (MPV) was independently associated with high risk of time to the first new-onset CVD (HR 1.895, 95% CI 1.174–3.058, p = 0.009) and all-cause mortality (HR 1.710, 95% CI 1.155–2.531, p = 0.007). Patients with low mean platelet volume to platelet count ratio (MPV/PC) were prone to occur the new-onset infection events (log rank 5.693, p = 0.017). Low MPV/PC (HR 0.652, 95% CI 0.459–0.924, p = 0.016) was significantly associated with the time to the first new-onset infection event on PD. Conclusions: Platelet indices were associated with the new-onset CVD, infectious comorbidities and all-cause mortality on PD. Low MPV/PC was associated with time to the first new-onset infection event in PD patients. Moreover, high MPV was associated with new-onset CVD and all-cause mortality in the incident PD patients. [ABSTRACT FROM AUTHOR]

Background: Tuberculosis (TB) remains a global health challenge, with India bearing a significant burden. Despite advancements in TB diagnosis and treatment, monitoring TB treatment is challenging, particularly in resource-limited settings. This study aimed to explore the mean platelet volume (MPV) as a potential surrogate marker for monitoring TB treatment and assessing if the neutrophil-to-albumin ratio (NAR) enhances treatment monitoring. Methods: Patients diagnosed with TB following NTEP guidelines were recruited. Participants underwent routine blood tests during the six-month Anti-Tubercular therapy course at the start, end of the intensive phase, and end of the continuous phase. Statistical analyses included Spearman correlation, Friedman test, linear mixed effects (LME) models, and multiple linear regression. Results: 150 individuals were included for analysis. Deviations from normality were noted. Significant associations were found between CRP and sputum grade. MPV mediated between CRP and sputum grade. Significant differences were observed across the three-time points. LME models showed changes in MPV and CRP levels over time. Including NAR enhanced predictive capability. Conclusions: MPV may serve as a promising surrogate marker for monitoring ATT. Personalized approaches are crucial in TB treatment monitoring. LME models revealed MPV and CRP level trends. Future research should explore MPV's treatment response mechanisms and cost-effectiveness. [ABSTRACT FROM AUTHOR]

Background and Objective: Klotho is a protein that is closely related to human aging. Soluble Klotho (S-Klotho) is a circulating protein, and its level decreases in response to systemic inflammation. The relationship between the platelet/high-density lipoprotein cholesterol ratio (PHR), an emerging inflammatory index, and S-Klotho concentrations is still unclear. In addition, the mean platelet volume has been confirmed to have a significant negative association with S-Klotho concentrations, but the relationship between the platelet count (PC) and S-Klotho concentrations has not yet been reported. Methods: Data from individuals who participated in the National Health and Nutrition Examination Survey (NHANES) during the five cycles from 2007 to 2016 were retrieved for analysis. Linear regression, two-piecewise linear regression, and restricted cubic spline (RCS) methods were used to analyze the associations of the PHR index and its components with S-Klotho concentrations. In addition, subgroup analysis and effect modification tests were conducted. Results: A total of 11,123 participants (5463 men (48.17%)), with an average age of 56.2 years, were included. After full adjustment, the S-Klotho levels of participants in the highest quartile group of PHR (β: -51.19, 95% CI: -75.41 to -26.97, P < 0.001) and the highest quartile group of PC (β: -72.34, 95% CI: -93.32 to -51.37, P < 0.0001) were significantly lower than those in their respective lowest quartile groups, and a significant downward trend was presented among the four groups (P for trend < 0.05, respectively). However, high-density lipoprotein cholesterol (HDL-C) concentrations were not significantly associated with S-Klotho concentrations. RCS revealed that the PHR and PC were nonlinearly associated with S-Klotho concentrations; two-piecewise linear regression revealed that the inflection points were 175.269 and 152, respectively, and that these associations slightly weakened after the inflection point. According to the subgroup analysis, liver disease status enhanced the association between the PC and S-Klotho concentrations. Conclusions: Both the PHR and PC were significantly negatively associated with S-Klotho concentrations, and these associations were nonlinear. There was no significant association between HDL-C and S-Klotho concentrations. Liver disease status enhances the negative association between the PC and S-Klotho concentrations, and the specific mechanism deserves further exploration. [ABSTRACT FROM AUTHOR]

BACKGROUND: Neonatal septicemia is a clinical syndrome characterized by signs and symptoms of infection with or without accompanying bacteremia in the first month of life. It is characterized by positive blood culture, thrombocytopenia and elevated C-reactive protein. Septic shock is the most dangerous complication of septicemia. Thrombocytopenia (platelet count < 150,000/µL) is one of the most common hematological problems in Neonatal Intensive Care Units (NICUs),. Thrombocytopenia in DIC occurs mainly due to consumption of certain coagulation factors and circulating platelets. There may be a possibility of immune mechanism & Bacteria or bacterial products leads to development of thrombocytopenia in septicemia. AIM: • Platelet count and their indices in neonatal sepsis in relation to specific organisms. • To identify organism involved in proven neonatal sepsis affecting platelet indices. MATERIALS AND METHODS: A Hospital-based cross-sectional study was conducted in the Department of Paediatrics, Santhiram medical college& general hospital for 12 months. RESULTS: A total of 50 neonates with blood culture positive for bacterial cases shows EOS(59%) was more common than LOS(41%). Out of 50 cases 57% cases had growth of gram negative organisms, 40% had growth of gram positive organisms and 3% had growth of fungal. Tachypnea(27%), Lethargy (20%) and refusal of feeds (8%) were the commonest clinical presentation followed by,Fever (6%), convulsions (5%) and jaundice (5%). 60% neonates had thrombocytopenia of varying severity. Staphylococcus aureus was the most common organism associated with thrombocytopenia (43.3%%). MPV was high in 85% of cases and PDW was high in 96% of cases.. CONCLUSION: The present study highlights the association of thrombocytopenia, mean platelet volume and platelet distribution width with causative organism in proven neonatal sepsis. Staphylococcus aureus was the most common organism causing thrombocytopenia in our NICU. [ABSTRACT FROM AUTHOR]

Background: Sepsis is defined as a life-threatening organ dysfunction caused by a dysregulated host response to infection. Sepsis frequently results in dysfunction of the hemostatic system. A humble attempt has been made to see the relation of mean platelet volume to platelet count ratio in predicting immediate outcome in sepsis in this study. Methods: This study was conducted in Silchar Medical College and Hospital. It is a hospital-based prospective observational study. 50 cases diagnosed according to “Sepsis 3” clinical criteria were included in the study. Complete blood count and Blood culture was done for all patients. The clinical outcome was 28-day mortality. Results: According to Chi-square Test (along with Fisher's Exact Test), there was no statistically significant association between MPV/Platelet Ratio and survival of the patients (χ² = 1.247 at df = 1, p = 0.264), which means survival of patients was almost similar in low as well as high MPV/Platelet Ratio values. According to Kaplan-Meier Survival Curve, low MPV/Platelet ratio has comparatively more benefit in survival of the patients than that of high MPV/Platelet ratio. However, according to the Log Rank Test the low MPV/Platelet ratio does not have any statistically significant difference on patient survival than that of high MPV/Platelet ratio (χ² = 0.817 at df = 1, p = 0.366). Hence even if Kaplan-Meier Curve showed some difference in both the lines, it is not statistically significant hence it can be concluded that both low as well as high MPV/Platelet ratio have somewhat similar effect on survival of the patients. Conclusion: The present study could not yield similar results on logistic regression showing that MPV alone as well as MPV/Platelet ratio did not have any significant effect on survival of the sepsis patients. [ABSTRACT FROM AUTHOR]

Background: Sepsis is still one of the leading causes of mortality and morbidity in children worldwide. Consumptive coagulopathy and suppression of thrombopoiesis in the bone marrow resulting from immune dysregulation are pathological mechanisms that cause thrombocytopenia in sepsis. Platelet count (PLT) and indices, such as mean platelet volume (MPV), platelet distribution width (PDW), and plateletcrit (PCT) are markers of platelet activation and are strongly influenced by platelet morphology and proliferation kinetics. We aimed to study the use of platelet count and indices as predictors of mortality in children with sepsis. Methods: This is a cross-sectional study of 45 children diagnosed with sepsis on admission at Haji Adam Malik Hospital, Medan, North Sumatra, Indonesia, between October and November 2022. Blood samples were drawn upon admission, and platelet count and indices were then determined for all children. Subjects were followed up till discharge from hospital or death. Receiver Operating Characteristic (ROC) curve analysis of platelet parameters was done to determine the area under the curve (AUC), optimal cut-off value, sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) in predicting mortality in children with sepsis. Using the cut-off values from ROC curve analysis, the odds ratio with 95% confidence interval was calculated using multiple logistic regression analyses. A P value less than 0.05 was considered statistically significant. Results: MPV, PDW, and PDW/PLT were significantly higher in non-survivors than survivors (P=0.04, P=0.02, and P=0.04, respectively). ROC curve analysis showed that PDW had the largest AUC (0.708 [95% CI=0.549-0.866]) with a cut-off value of 14.1%, sensitivity of 63.6%, and specificity of 82.6%. PDW was also the only parameter that significantly affected the outcome of children with sepsis. PDW≥14.1% at admission increases the risk of mortality by 5.7 times. Conclusion: Admission PDW is a fast and specific tool to predict the outcome of children with sepsis. [ABSTRACT FROM AUTHOR]

AIMS: Individuals with a higher De Ritis ratio (aspartate transaminase/alanine transaminase) and neutrophil-to-lymphocyte ratio (NLR) have an inferior survival in varied malignancies. To our knowledge, the prognostic potential of the De Ritis ratio and NLR to predict the survival in nonmetastatic glioblastoma multiforme (GBM) patients remains unclear. In this study, we aimed to explore the prognostic power of the De Ritis ratio and NLR in patients with nonmetastatic glioblastoma multiforme. METHODS: Data of 262 patients with glioblastoma multiforme have been retrospectively analyzed. Their age, gender, tumor characteristics, AST/ALT ratio, NLR and hemogram values, including age at diagnosis and date of diagnosis were recorded. RESULTS: The median survival time of the study group was 21 months (95% CI: 19-23 months). The first-year and second-year survival rates were 73.0% and 40.5%, respectively. The univariate analysis revealed that the correlation of survival with age, gender, left/right location of tumor, mean platelet volume and De Ritis ratio did not reach the level of significance. The univariate analysis of the prognostic potential of NLR indicated that a 1-unit increase in NLR value translates to a 1.05 times higher risk of death (95% CI: 1.01-1.09). CONCLUSION: The results of this study lead to the observation that NLR value can serve as an effective prognostic marker in predicting the outcomes of patients with glioblastoma multiforme. It can be positioned as an easily accessible and cost-effective biomarker for establishing appropriate therapeutic strategies [ABSTRACT FROM AUTHOR]

Aim: This study aimed to assess the platelet parameters and their prognostic value for perinatal outcomes in pregnant women with systemic lupus erythematosus (SLE). Methods: This retrospective study involved 180 participants, 90 pregnant women with SLE and 90 healthy pregnant women. Clinical and demographic variables including routine first-trimester neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR) and platelet parameters such as platelet distribution width (PDW), mean platelet volume (MPV), plateletcrit (PCT) were compared between the groups. The perinatal outcomes of the whole study group were also compared. Results: SLE patients had lower leukocyte (p = 0.001), lymphocyte (p = 0.001) and platelet counts (p = 0.018), higher PDW (p = 0.002), MPV (p = 0.001), NLR (p = 0.008) and PLR (p = 0.015) and lower PCT (p = 0.015) than the control group. The groups had no significant difference in hemoglobin levels (p = 0.936). SLE patients had higher rates of cesarean section (p = 0.002), small for gestational age (SGA) (p = 0.019) and stillbirth (p = 0.017) and lower birth weight (p = 0.001) than the control group. PCT was a significant predictor of stillbirth with a cut-off value of 0.21, sensitivity of 64.3% and specificity of 83.3% (AUC: 0.843, p < 0.001). Conclusion: Pregnant women with SLE have altered platelet parameters and increased inflammatory markers compared to healthy pregnant women. PCT is a simple and useful marker for predicting stillbirth risk in SLE pregnancies. [ABSTRACT FROM AUTHOR]

The list of standard abbreviations for JDS is available at adsa.org/jds-abbreviations-24. Nonstandard abbreviations are available in the Notes. Amputation dehorning (AD) is a common practice performed on calves, causing harmful effects such as pain, distress, anxiety, and fear. These effects extend to behavioral, physiological, and hematological responses, prompting serious ethical concerns regarding animal welfare, even when performed with local anesthesia. Meloxicam, a nonsteroidal anti-inflammatory drug, has been widely used to mitigate the side effects of dehorning and disbudding in calves. However, there is a notable gap in research regarding the effects of meloxicam on calves aged 6 wk to 6 mo undergoing AD procedures. This study was designed to assess the effectiveness of co-administering meloxicam with lidocaine, a cornual nerve anesthetic, in alleviating the adverse effects caused by the AD procedure in calves within this age range, compared with the use of lidocaine alone. Thirty Holstein calves were enrolled and randomly divided into 2 groups. The first group received a subcutaneous injection of 5 mL of lidocaine in the horn area and a subcutaneous injection of 0.9% saline at a dose of 0.025 mL/kg in the neck, administered 10 min before the AD procedure. The second group received a combination of lidocaine and meloxicam: a subcutaneous injection of 5 mL of lidocaine in the horn area and a subcutaneous injection of 20 mg/mL meloxicam at a dose of 0.025 mL/kg in the neck, also administered 10 min before the AD procedure. To avoid subjective bias, the researchers were blinded to the treatment groups. Pain-related behaviors, including tail flicking, head shaking, ear flicking, head rubbing, head crossing bar, and kicking, were observed, and physiological parameters, including heart rate, rectal temperature, respiration rate, mechanical nociceptive threshold (MNT), daily active steps, and food intake were monitored. Hematological conditions were determined using enzyme-linked immunosorbent assays and routine blood tests. The data were processed using a generalized linear mixed model. The outcomes demonstrated that the AD procedure increased the frequencies of ear flicking and resulted in rises in the respiration rate, heart rate, rectal temperature, and daily active steps. It also led to decreases in total food intake, forage intake, hay intake, MNT, and increased concentrations of prostaglandin E2 (PgE2), IL-1β, tumor necrosis factor-α (TNF-α), nitric oxide (NO), and malondialdehyde, as well as glutathione peroxidase activity. However, calves that received meloxicam treatment showed significant improvements in response to the AD procedure, including lower respiration rates, heart rates, and rectal temperatures; higher MNT; and lower intermediate cell ratio. They also had higher red blood counts, hemoglobin levels, hematocrit values; larger mean platelet volumes; and lower concentrations of PgE2, IL-1β, TNF-α, and NO. These results suggest that co-administration of lidocaine and meloxicam may aid in mitigating the adverse effects induced by the AD procedure on these calves, thereby supporting the use of meloxicam in conjunction with a local anesthetic in AD procedures for calves aged 6 wk to 6 mo. [ABSTRACT FROM AUTHOR]

Objective: To evaluate System Inflammation Response Index (SIRI) and Systemic Immune Inflammation Index (SII), which are the inflammatory indices, for the prediction of gestational diabetes mellitus (GDM) in the first trimester. Methods: This was a prospective observational study conducted in a tertiary center from April 2023 to September 2023. Ninety‐four pregnant women with gestational diabetes and 107 healthy pregnant women were included. The two groups were compared according to first‐trimester SIRI and SII values. A receiver operating characteristic (ROC) curve analysis was performed to determine the optimal cut‐off levels of SII and SIRI in predicting GDM. Results: Significantly higher first‐trimester SII and SIRI values were present in the gestational diabetes group (P < 0.001). Optimal cut‐off values in the prediction of gestational diabetes were found to be 1.58 (area under the curve [AUC] 0.71, 67% sensitivity, 65% specificity, 95% confidence interval [CI] 0.64–0.78, P < 0.001) and 875 (AUC 0.70, 66% sensitivity, 65% specificity, 95% CI 0.63–0.77, P < 0.001) for SIRI and SII, respectively. Neutrophil counts, mean platelet volume (MPW), neutrophil to lymphocyte ratio (NLR), and red cell distribution width (RDW) were significantly higher in the GDM group (P < 0.001, P = 0.02, P = 0.01, P < 0.01, respectively). Conclusion: Novel inflammatory indices SII and SIRI may be useful in the prediction of GDM in the first trimester, but their utility in the prediction of insulin requirement is questionable. They may be used as additional tools in routine clinical practice. Synopsis: SIRI and SII indices between the 6th and 8th weeks of gestation were significantly higher in the GDM group than in healthy pregnant women. [ABSTRACT FROM AUTHOR]

Diabetes mellitus is a chronic metabolic disease that affects more than 10.5% of the world's adult population. Biochemical and hematological parameters, such as albumin (ALB) and red cell distribution width (RDW), have been shown to be altered in diabetic patients. This study aimed to correlate hematological and biochemical parameters with glycated hemoglobin (HbA1c). A total of 777 adults (372 women and 405 men, aged 19–85 years) were divided into three groups: 218 participants with HbA1c < 5.7% (group A: non-diabetic), 226 with HbA1c ≥ 5.7% and <6.5% (group B: prediabetic) and 333 with HbA1c ≥ 6.5% (group C: diabetic). Biochemical and hematological parameters were compared among the three groups. An analysis of variance was performed to determine the correlations of the parameters among the groups. The ALB and sodium (Na) levels were significantly lower in group C than in groups A (ALB: 3.8 g/dL vs. 4.1 g/dL, p < 0.0001, Na: 138.4 mmol/L vs. 139.3 mmol/L, p < 0.001) and B (ALB: 3.8 g/dL vs. 4.0 g/dL, p < 0.0001, Na: 138.4 mmol/L vs. 139.6 mmol/L, p < 0.0001), whereas the RDW-standard deviation (RDW-SD) and urea were increased in group C as compared to group A (RDW: 45.8 vs. 43.9 fL, p < 0.0001, urea: 55.6 mg/dL vs. 38.5 mg/dL, p < 0.0001). The mean platelet volume (MPV) was increased in group C as compared to group A (9.3 fL vs. 9.1 fL, p < 0.05, respectively). Τhe increase in RDW-SD in group A as compared to B and C demonstrates the impact of hyperglycemia on red blood cells. Albumin and RDW might improve risk assessment for the development of diabetes. These results highlight the potential role of these parameters as an indication for prediabetes that would alert for measurement of HbA1c. [ABSTRACT FROM AUTHOR]

This article provides information on the characteristics and diagnosis of Wiskott-Aldrich syndrome (WAS), a primary immunodeficiency disorder. It highlights that while low mean platelet volume (MPV) is typical for WAS, normal MPV values can be observed in some patients at the time of diagnosis. The article presents case reports of infants with thrombocytopenia and normal MPV values, emphasizing the importance of accurate diagnosis and distinguishing WAS from other conditions. It also discusses the potential misdiagnosis of WAS in infants with rectal bleeding and eczema, particularly when cow's milk protein allergy (CMPA) is considered. The article concludes by emphasizing the need for further research and awareness of WAS to improve diagnosis and treatment outcomes. [Extracted from the article]

Objective: This study aimed to assess the association between women's platelet indices and bone mineral density to evaluate osteoporosis, which has a significant impact on quality of life throughout the postmenopausal age. Materials and Methods: The study was retrospectively designed, and data from 316 postmenopausal patients who applied to the obstetrics and gynecology outpatient clinic between January 2021 and January 2023, underwent bone mineral density measurements during follow-up, and met the inclusion and exclusion criteria were obtained. The data were evaluated in 3 groups as normal, osteopenia, and osteoporosis according to bone mineral density. Platelet indices, age, body mass index (BMI), and bone mineral density were compared with platelet indices in the hemogram results of the patients on the same day. Results: The mean ages of the osteoporosis, osteopenia, and normal groups were 61.4, 58.4, and 56.2 years, respectively. The mean weight was 72.9 kg in the osteoporosis group, 74.09 kg in the osteopenia group, and 79.4 kg in the normal group. When the groups were compared, no significant difference was observed between age, platelet count, platelet distribution width, mean platelet volume (MPV), platelet-large cell ratio, and thrombocytocrit but a significant difference was found between the osteoporosis and normal groups in terms of BMI (p=0.027). Conclusion: Although numerous studies in the literature have demonstrated a connection between osteoporosis and MPV and platelet count, our investigation revealed no such association and showed that the risk of osteoporosis decreased as BMI increased. [ABSTRACT FROM AUTHOR]

• Study shows ruptured endometriomas have higher pre-op biomarkers than non-ruptured cases. • Post-op MPV and NLR significantly higher in ruptured endometrioma patients. • Biomarkers in clinical management may improve diagnosis and treatment outcomes. To compare the outcomes between patients undergoing surgery for ruptured endometrioma versus non-ruptured endometrioma. The study was conducted at Health Sciences University, Etlik Zübeyde Hanım Training and Research Hospital Infertility Clinic. All patients who had a histopathology report of endometrioma between January 2014 and December 2020 were recruited. Patient files, surgery notes and laboratory values were extracted from the electronic recording system and patients with ruptured endometriomas (RE) or non-ruptured endometriomas (NRE) were compared. Overall, 181 patients were recruited to the study. No rupture was detected in 146 (80.7 %) patients while 35 patients (19.3 %) underwent surgery for RE. Pre-operative CRP, CA 125, CA 19–9, CA 15–3, CEA and mean platelet volume (MPV) values and postoperative MPV and neutrophil/lymphocyte ratio (NLR) values were statistically significantly higher (p < 0.01) in the RE group compared to the NRE group. Post-operative lymphocyte (p = 0.029) and eosinophyl (p = 0.015) values were significantly lower in the RE group compared to the NRE group. Among the preoperative biomarkers that are evaluated for prediction of rupture; MPV, CA 19–9 and CA-15.3 had a high specifity (>75 %) but a rather low sensitivity (<60 %), meanwhile CRP, CA-125 and CEA had high sensitivity but a low specifity. RE patients had significantly higher preoperative CRP, CA 125, CA 19–9, CA 15–3, CEA, and MPV values and postoperative MPV and NLR values while postoperative, lymphocyte and eosinophyl values were significantly lower compared with the NRE patients. Prospective studies with larger sample sizes are needed to determine biomarkers and parameters that can be used for non-invasive diagnosis of endometriosis and predict the possibility of endometrioma rupture. [ABSTRACT FROM AUTHOR]

Objective: Obstructive sleep apnea syndrome (OSAS) is a common sleep disorder characterized by repeated upper airway collapse. As types of surgical modalities have been defined according to the level of airway obstruction, uvulopalatal flap and anterior palatoplasty are 2 of the main surgical options for patients with collapse in the soft palate and oropharynx region. The aim of our study is to show the effect of surgery on neutrophil-lymphocyte ratio, platelet-lymphocyte ratio, and mean platelet volume values in OSAS patients. Methods: The medical records of 125 patients with OSAS diagnosis in between January 2012 and December 2014 were evaluated retrospectively. Age, gender, body mass index, polysomnography results, Epworth Sleepiness scale (ESS), complete blood count values, and surgical results of the patients were evaluated. Results: A statistically significant decrease was observed in the mean apnea-hypopnea index, oxygen desaturation index, and ESS scores in the postoperative period (P < .001). Considering all patients, a statistically significant decrease was observed in th mean platelet volume (MPV) values in the postoperative period (P < .001) and no statistically significant change was observed in the mean neutrophil-lymphocyte ratio (NLR) and platelet-lymphocyte ratio (PLR) values (P = .808 and P = .117). In patients whose anterior palatoplasty (78 patients) results were considered successful, a statistically significant decrease was observed in MPV and PLR values (P < .001 and P = .038), while no significant change was observed in NLR values (P = .185). In those with successful uvulopalatal flap (47 patients) results, a statistically significant decrease was observed in MPV values (P < .001), while no significant change was observed in NLR and PLR values (P = .809 and P = .154). Conclusion: While it was observed that MPV values were associated with OSAS, no clear relationship was found between NLR and PLR values. [ABSTRACT FROM AUTHOR]

Air purifier use, shift work, and long-term exposure to fine particulate matter (PM2.5) are linked to platelet abnormality. However, the role of air purifier use and shift work in the individual or joint associations of PM2.5 and its components with platelet indices are largely unknown. A total of 8772 participants were recruited from a population of subway workers in China. PM2.5 and its component data were obtained from the Tracking Air Pollution in China dataset. The role of air purifier use and shift work in the association between PM2.5 and its components and platelet indices were analyzed. Among shift workers without air purifier use, positive associations of PM2.5 and each component in PM2.5 with the mean platelet volume (MPV) or platelet counts (PLT) were observed, whereas negative associations of PM2.5 and each component in PM2.5 with the platelet distribution width (PDW) were observed. Furthermore, estimated changes (95%CIs) in PLT, MPV, and PDW in response to each 10th percentile increment in the mixture of PM2.5 and its components were 0.8657 (0.2496, 1.4819), 0.0192 (0.0054, 0.0329), and −0.0648 (−0.0945, −0.0351), respectively, and sulfate in PM2.5 was the major contributor to those associations. Long-term exposure to PM2.5 and its components was related to increased platelet disorders among shift workers without air purifier use, and those associations were mainly attributed to sulfate in PM2.5. [ABSTRACT FROM AUTHOR]

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Background Methods Results Conclusion Mean platelet volume (MPV) is a widely available laboratory index, however its prognostic significance in patients with coronary artery disease (CAD) is still unclear. We intended to investigate and pool the evidence on the prognostic utility of admission MPV in predicting clinical outcomes in patients with CAD.PubMed, Web of Science, and Scopus were the major databases used for literature search. The risk of bias was assessed using the quality in prognostic factor studies. We used random‐effects pairwise analysis with the Knapp and Hartung approach supported further with permutation tests and prediction intervals (PIs).We identified 52 studies with 47,066 patients. A meta‐analysis of nine studies with 14,864 patients demonstrated that one femtoliter increase in MPV values was associated with a rise of 29% in the risk of long‐term mortality (hazard ratio [HR] 1.29, 95% confidence interval [CI] 1.22–1.37) in CAD as a whole. The results were further supported with PIs, permutation tests and leave‐one‐out sensitivity analyses. MPV also demonstrated its stable and significant prognostic utility in predicting long‐term mortality as a linear variable in patients treated with percutaneous coronary intervention (PCI) and presented with acute coronary syndrome (ACS) (HR 1.29, 95% CI 1.20–1.39, and 1.29, 95% CI 1.19–1.39, respectively).The meta‐analysis found robust evidence on the link between admission MPV and the increased risk of long‐term mortality in patients with CAD patients, as well as in patients who underwent PCI and patients presented with ACS. [ABSTRACT FROM AUTHOR]

Background: The white blood cell count to mean platelet volume ratio (WMR) is considered a promising inflammatory marker, and its recognition is increasing. Inflammation is closely related to metabolic diseases such as diabetes and its complications. However, there are currently no reports on the correlation between WMR and type 2 diabetic peripheral neuropathy (DPN). This study aims to explore the correlation between WMR and DPN in type 2 diabetes patients. By understanding this association, we hope to provide a theoretical basis for preventing DPN through the improvement of inflammatory responses. Methods: This was a cross-sectional study involving 2515 patients with T2DM. Logistic regression analysis was conducted to assess the associations between WMR and DPN. Finally, the receiver operating characteristic curve (ROC curve) was employed to evaluate the predictive efficacy of WMR for DPN. Results: Patients in higher WMR quartiles exhibited increased presence of DPN. Additionally, WMR remained significantly associated with a higher odds ratio (OR) of DPN (OR 4.777, 95% confidence interval [CI] 1.296–17.610, P < 0.05) after multivariate adjustment. Moreover, receiver operating characteristic curve analysis indicated that the optimal cutoff value for WMR in predicting DPN presence was 0.5395 (sensitivity: 65.40%; specificity: 41.80%; and area under the curve [AUC]: 0.540). Conclusions: In patients with T2DM, WMR was significantly increased in DPN and independently associated with an increased risk of DPN presence in Chinese patients. This suggests that WMR may serve as a useful and reliable biomarker of DPN, highlighting the importance of paying more attention to T2DM patients with high WMR to further prevent and reduce the development of DPN and related unfavorable health outcomes. [ABSTRACT FROM AUTHOR]

BACKGROUND: Thromboelastography plays an important role in identifying the hypercoagulable state of blood and thrombosis in humans. Recent studies have shown a correlation between an increase in mean platelet volume and thrombosis. We can therefore ask whether the combined diagnosis of thromboelastography and mean platelet volume is a more accurate predictor of thrombosis. OBJECTIVE: To predict the status of blood and the occurrence of thrombosis after total knee arthroplasty by means of mean platelet volume combined with thromboelastography. METHODS: One hundred and twenty patients who underwent unilateral total knee arthroplasty between May 2015 and March 2022 were collected. Patients were divided into 60 patients in the thrombosis group and 60 patients in the control group based on ultrasound findings on postoperative day 7. Whole blood cell and thromboelastography were performed 1 day before, 1 and 7 days after surgery, respectively. Multifactorial analysis was used to investigate independent predictors of thrombosis after total knee arthroplasty. The receiver operating characteristic curve and area under the curve were measured in the subjects. RESULTS AND CONCLUSION: Mean platelet volume correlated most strongly with maximum amplitude, followed by coagulation angle. Mean platelet volume and coagulation angle on postoperative day 1 were independent predictors of thrombosis. Mean platelet volume tended to rise and then fall in patients with thrombosis. The best critical value for mean platelet volume to predict thrombosis was 10.73 fL. The area under the receiver operating characteristic curve of subjects was 0.665 (95%CI: 0.568-0.762, P < 0.05]; whereas the area under the receiver operating characteristic curve for subjects using mean platelet volume combined with coagulation angle was 0.815 (95%CI: 0.750-0.879, P < 0.05). In addition, the maximum amplitude, coagulation angle, coagulation index and mean platelet volume were significantly higher in the thrombosis group than in the control group postoperatively (P < 0.05). The results suggest that the mean platelet volume can reflect the hypercoagulable state of blood after surgery, and the combination of mean platelet volume and coagulation angle on day 1 after total knee arthroplasty can improve the prediction of thrombosis. [ABSTRACT FROM AUTHOR]

To develop and validate a diagnostic prediction model based on blood parameters for predicting the pertussis in children. A retrospective study of 477 children with suspected pertussis at Zigong First People's Hospital was performed between January 2020 and December 2021. The patients were randomly divided into training cohort and validation cohort. Stepwise regression and R software was performed to develop and validate the model. Stepwise regression analysis showed that white blood cell (WBC), hematocrit (HCT), lymphocyte (LYMPH), C-reactive protein (CRP) and platelet distribution width to mean platelet volume ratio (PDW-MPV-R) were found to be independent factors associated with pertussis. The model containing WBC, CRP and PDW-MPV-R had the best performance. The area under curve (ROC, 0.77 for the training cohort and 0.80 for the validation cohort) of the model indicated satisfactory discriminative ability. The sensitivity and specificity of the model were 72.1% and 72.6% in training cohort and 74% and 72.1%, respectively, in validation cohort. Based on the ROC analysis, calibration plots, and decision curve analysis, we concluded that the model exhibited excellent performance. A model based on blood parameters is sufficiently accurate to predict the probability of pertussis in children, and may provide some reference for clinical decisions. [ABSTRACT FROM AUTHOR]

Background: Some important hematological indices implement acute phase reactions. They can be used to assess disease activity and therapeutic response in many inflammatory conditions. This work aimed to determine whether different hematological indices can be used to assess disease activity and therapeutic response in patients with ankylosing spondylitis (AS) on biological drugs. Patients and methods: Ninety-seven AS patients and a similar number of controls were involved in the current study. The Ankylosing Spondylitis Disease Activity Score (ASDAS) was used to assess the disease activity. Different complete blood count parameters and indices were assessed. Results: There was a significant difference between the patients and controls as regards mean corpuscular volume, mean corpuscular hemoglobin, red blood cells count, red cell distribution width, mean platelet volume, platelet-to-lymphocyte ratio (PLR), and systemic immune-inflammation index (SII). Moreover, there was a statistical correlation between ASDAS on one side and hemoglobin (Hb), hematocrit (HTC), lymphocyte count, neutrophil-to-lymphocyte ratio (NLR), PLR, and SII on the other side. When the patient group was divided into 2 subgroups according to ASDAS, with patients with inactive and low disease activity in one subgroup and those with very high and high disease activity in another subgroup, there was a significant difference as regards Hb, HTC, mean corpuscular hemoglobin concentration, NLR, PLR, SII, and also ESR and CRP levels. Moreover, there was a significant correlation between PLR and SII levels on one side and ESR on the other side. Conclusion: Hematological indices such as PLR, NLR, and SII might be potential markers for follow-up of disease activity and therapeutic response in AS patients treated with biological therapy. This emphasizes the significance of a comprehensive approach for AS patient assessment and follow-up of therapeutic drugs, considering inflammatory markers, hematological indices, and disease activity scores. [ABSTRACT FROM AUTHOR]

Background: Platelets play a significant role in the innate and adaptive processes of immunity and inflammation. Inflammatory bowel disease (IBD) is an autoimmune disease that is widely understood to be caused by a combination of genetic predisposition, aberrant immune responses, etc. Methods: To examine the relationships between genetically determined platelet indices and IBD, we conducted a Mendelian randomization (MR) study. Data associated with platelet count (PLT), mean platelet volume (MPV), platelet distribution width (PDW), plateletcrit (PCT) were used from the UK Biobank. The outcome data, including IBD, Crohn's disease (CD), ulcerative colitis (UC), were from the FinnGen database. The inverse variance-weighted (IVW), MREgger, weighted median methods were used for MR analyses. Results: The MR estimations from the IVW approach show a significant connection between PLT and IBD. Similarly, PCT and IBD have a relationship following the IVW and MR-Egger approaches. While PLT and PCT have strong relationships with CD, according to the findings of all three approaches respectively. Nevertheless, PDW was the only relevant indicator of UC. The only significant result was IVW's. Conclusion: Our findings suggest that the fluctuation of platelet indicators is of great significance in the development of IBD. PLT and PCT have a close association with IBD and CD, respectively; PDW only has a connection with UC. Platelets play an important role in the progression of IBD (UC, CD). [ABSTRACT FROM AUTHOR]

Trauma is the leading cause of death in individuals up to 45 years of age. Alterations in platelet function are a critical component of trauma-induced coagulopathy (TIC), yet these changes and the potential resulting dysfunction is incompletely understood. The lack of clinical assays available to explore platelet function in this patient population has hindered detailed understanding of the role of platelets in TIC. The objective of this study was to assess trauma patient ex vivo flow-dependent platelet hemostatic capacity in a microfluidic model. We hypothesized that trauma patients would have flow-regime dependent alterations in platelet function. Blood was collected from trauma patients with level I activations (N = 34) within 60 min of hospital arrival, as well as healthy volunteer controls (N = 10). Samples were perfused through a microfluidic model of injury at venous and arterial shear rates, and a subset of experiments were performed after incubation with fluorescent anti-CD41 to quantify platelets. Complete blood counts were performed as well as plasma-based assays to quantify coagulation times, fibrinogen, and von Willebrand factor (VWF). Exploratory correlation analyses were employed to identify relationships with microfluidic hemostatic parameters. Trauma patients had increased microfluidic bleeding times compared to healthy controls. While trauma patient samples were able to deposit a substantial amount of clot in the model injury site, the platelet contribution to microfluidic hemostasis was attenuated. Trauma patients had largely normal hematology and plasma-based coagulation times, yet had elevated D-Dimer and VWF. Venous microfluidic bleeding time negatively correlated with VWF, D-Dimer, and mean platelet volume (MPV), while arterial microfluidic bleeding time positively correlated with oxygenation. Arterial clot growth rate negatively correlated with red cell count, and positively with mean corpuscular volume (MCV). We observed changes in clot composition in trauma patient samples reflected by significantly diminished platelet contribution, which resulted in reduced hemostatic function in a microfluidic model of vessel injury. We observed a reduction in platelet clot contribution under both venous and arterial flow ex vivo in trauma patient samples. While our population was heterogenous and had relatively mild injury severity, microfluidic hemostatic parameters correlated with different patient-specific data depending on the flow setting, indicating potentially differential mechanistic pathways contributing to platelet hemostatic capacity in the context of TIC. These data were generated with the goal of identifying key features of platelet dysfunction in bleeding trauma patients under conditions of flow and to determine if these features correlate with clinically available metrics, thus providing preliminary surrogate markers of physiological platelet dysfunction to be further studied across larger cohorts. Future studies will continue to explore those relationships and further define mechanisms of TIC and their relationship with patient outcomes. [ABSTRACT FROM AUTHOR]

Background: Dengue fever is a prevalent mosquito-borne viral illness with potential complications, including thrombocytopenia. Objective: This study aimed to investigate the relationship between platelet indices and the presence of thrombocytopenia in individuals diagnosed with dengue fever. Materials and Methods: A total of 100 dengue-confirmed cases were enrolled, and their platelet count, platelet distribution width (PDW), and plateletcrit (PCT) were measured during the acute phase of the disease. Results: The findings of this study revealed a substantial incidence of thrombocytopenia among the participants, aligning with the well-established association between dengue infection and platelet reduction. Notably, a modest but significant correlation was demonstrated between PDW and PCT and the severity of thrombocytopenia. Subgroup analysis based on dengue virus serotypes unveiled varying patterns of platelet indices, hinting at potential differences in disease pathogenesis. Conclusion: The results of this study underscore the potential utility of platelet indices as informative markers for assessing the degree of thrombocytopenia in dengue fever cases. The observed correlations between platelet count, PDW, and PCT provide insights into the complex interplay between platelet dynamics and dengue infection. Further prospective investigations are warranted to elucidate the underlying mechanisms driving these correlations, which could contribute to enhanced understanding, diagnosis, and management of dengue-associated thrombocytopenia. [ABSTRACT FROM AUTHOR]

Pregnancy‐associated atypical hemolytic uremic syndrome (P‐aHUS) is a rare disease. There are only few reports in the literature, and most are in the puerperium period. It is a thrombotic microangiopathy (TMA) characterized for microangiopathic hemolytic anemia, thrombocytopenia, and renal dysfunction. We report the case of a pregnant patient at 26.3 gestation weeks, who developed clinical features of TMA, neurological alterations, and septic shock; then after fetus and placental delivery, no clinical improvement was observed; a diagnostic protocol was performed due to suspicion of P‐aHUS, showing improvement after the plasma exchange sessions and eculizumab. We present here a brief review of the case since it is an entity that needs to be suspected during pregnancy when TMA features and requires an immediate diagnosis to provide timely treatment. [ABSTRACT FROM AUTHOR]

Objective: To determine the association between the preoperative Bioenergetic Health Index (BHI) of platelets and the occurrence of postoperative delirium (POD) in elderly patients. Methods: Elderly patients scheduled for major abdominal surgery under general anesthesia were included. The presence of POD was assessed within the 3 days after surgery. Seahorse XF analysis and transmission electron microscopy were utilized to evaluate the mitochondrial metabolism and morphology of platelets. Results: A total of 20 out of 162 participants developed POD. Participants with POD showed lower preoperative Mini‐Mental State Examination scores and total protein levels, fewer educational years, longer surgery duration, higher mean platelet volume, and lower platelet BHI compared with those without POD. Damaged mitochondria with swollen appearance and distorted cristae was detected in platelets from participants with POD. Preoperative platelet BHI was independently associated with the occurrence of POD after adjusting for age, education, preoperative Mini‐Mental State Examination score, preoperative mean platelet volume and total protein levels, surgical type and duration, and lymphocyte counts on the first postoperative day (OR 0.11, 95% CI 0.03–0.37, p < 0.001). The areas under the receiver operating curves for predicting POD were 0.83 (95% CI 0.76–0.88) for platelet BHI. It showed a sensitivity of 85.00% and specificity of 73.24%, with an optimal cutoff value of 1.61. Using a serial combination (mean platelet volume followed by BHI) yielded a sensitivity of 80.00% and specificity of 82.39%. Interpretation: Preoperative platelet BHI was independently associated with the occurrence of POD in elderly patients and has the potential as a screening biomarker for POD risk. ANN NEUROL 2024;96:74–86 [ABSTRACT FROM AUTHOR]

Background and Objectives: The phenomenon of aggregates in apheresis‐derived platelet concentrates (APCs) has not yet been fully elucidated. Initially, visible aggregates (IVA) usually dissolve within 24 h after collection, but some persist till the end of the shelf life (persistent aggregates, PA). A study conducted at the Croatian Institute of Transfusion Medicine aimed to identify factors that influence the aggregate occurrence in APCs. Materials and Methods: We conducted a cross‐sectional study for the 2018–2022 period and collected data on APCs with IVA. We analysed APCs discarded due to PA separately for two apheresis technologies and compared them to the control group. Results: Significantly more donations were discarded in the IVA group compared with the control group and total number of discarded APCs. A total of 205 APCs were discarded due to PA (14.7% of IVA APCs and 1.27% of all APCs collected). Amicus APCs with PA had a significantly lower platelet count and mean platelet volume. They were obtained by procedures with less anticoagulant used. In contrast to Amicus APCs, Haemonetics APCs with PA had a significantly higher platelet count. None of the donor‐related factors examined was predictive of PA. Conclusion: APCs with IVA are more often discarded, not only due to aggregates, but also for impairment of other quality control parameters. Type of apheresis technology, being one of the most common risk factors for IVA, was not confirmed as the main risk factor for PA. There seem to be some donor‐related causal factors. [ABSTRACT FROM AUTHOR]

Background: Platelet dysfunction plays a critical role in the pathogenesis of inflammatory bowel disease (IBD). Despite clinical observations indicating abnormalities in platelet parameters among IBD patients, inconsistencies persist, and these parameters lack standardization for diagnosis or clinical assessment. Methods: A comprehensive search was conducted in the PubMed, Embase, Web of Science, and Cochrane Library databases for relevant articles published up to December 16th, 2023. A random-effects model was employed to pool the weighted mean difference (WMD) and 95% confidence interval (95% CI) of platelet count (PLT), mean platelet volume (MPV), platelet distribution width (PDW), and plateletcrit (PCT) between IBD patients and healthy controls, and subgroup analyses were performed. Results: The meta-analysis included 79 articles with 8,350 IBD patients and 13,181 healthy individuals. The results revealed significantly increased PLT and PCT levels (WMD: 69.910, 95% CI: 62.177, 77.643 109/L; WMD: 0.046%, 95% CI: 0.031%, 0.061%), and decreased MPV levels (WMD: -0.912, 95% CI: -1.086, -0.739 fL) in IBD patients compared to healthy individuals. No significant difference was found in PDW between the IBD and control groups (WMD: -0.207%, 95% CI: -0.655%, 0.241%). Subgroup analysis by disease type and disease activity showed no change in the differences for PLT, PCT, and MPV in the ulcerative colitis and Crohn's disease groups, as well as the active and inactive groups. Notably, the active group exhibited significantly lower PDW levels than the control group (WMD: -1.138%, 95% CI: -1.535%, -0.741%). Conclusions: Compared with healthy individuals, IBD patients display significantly higher PLT and PCT and significantly lower MPV. Monitoring the clinical manifestations of platelet abnormalities serves as a valuable means to obtain diagnostic and prognostic information. Conversely, proactive measures should be taken to prevent the consequences of platelet abnormalities in individuals with IBD. Systematic review registration: PROSPERO CRD42023493848. Key messages: • It is known that inflammatory bowel disease (IBD) is related to various alterations in platelets, but there are variations in reported results of platelet parameters in the IBD population in clinical studies. • To elucidate the diagnostic and prognostic value of platelet parameters in IBD, we conducted a meta-analysis of 79 studies to provide more comprehensive conclusions on changes in platelet parameters in IBD. • This meta-analysis reveals that individuals with IBD exhibit significantly elevated platelet count (PLT) and plateletcrit (PCT), alongside a significant decrease in mean platelet volume (MPV) compared to healthy individuals. • The platelet parameters can offer reliable insights for assessing the severity of IBD and understanding potential pathophysiological mechanisms. [ABSTRACT FROM AUTHOR]

This systematic review and meta-analysis aim to establish associations between metabolic syndrome (MetS) and erythrocyte and platelet markers, contributing to improved diagnostic tests for identifying individuals at risk. Observational studies and Randomized Controlled Trials (RCTs) were included. The standardized mean difference (SMD) and 95% confidence intervals (CI) of erythrocyte and platelet markers between individuals with and without MetS were used as effect size (inverse variance model). Methodological quality assessment was conducted using the Newcastle-Ottawa scale (NOS) for observational studies and the Cochrane Risk of Bias tool 2.0 for RCTs. The analysis included 51 articles. Compared to controls, individuals with MetS exhibited significantly higher concentrations of mean red blood cell count [Standardized Mean Difference (95% CI): 0.15 (0.13−0.18); p<0.00001], hemoglobin [0.24 (0.18−0.31); p<0.00001], blood platelet count [5.49 (2.78–8.20); p<0.0001], and red blood cell distribution width [(0.55 (0.05–1.04); p=0.03]. Regarding mean platelet volume [0.16 (– 0.03 to 0.35); p=0.10] and platelet-to-lymphocyte ratio (PLR) [7.48 (–2.85–17.81); p=0.16], a non-significant difference was observed in patients with MetS. There was no statistically significant difference in hematocrit counts between the two groups [0.47 (–0.40 to –1.34); p=0.29]. Biomarkers such as mean red blood cell count, hemoglobin, blood platelet count, and RDW are associated with higher levels in patients in MetS, whereas mean platelet volume and PLR tend to be lower. These markers can potentially provide new avenues for early diagnosis of MetS. [ABSTRACT FROM AUTHOR]

Objective Late-onset sepsis (LOS) is a substantial contributor to morbidity and mortality among neonates. The use of nonculture-based tools for early diagnosis is an area of active investigation. Therefore, we aimed to evaluate the diagnostic value of serum interleukin-27 (IL-27) and mean platelet volume (MPV) in full-term neonates with LOS. Study Design In this single-center, cross-sectional study, 90 full-term newborns were assigned to two equal-matched groups as follows: (1) culture-proven sepsis and (2) control groups. Clinical data and laboratory findings as complete blood pictures, including MPV, highly sensitive C-reactive protein, and blood culture results, were recorded. Moreover, IL-27 levels were measured using enzyme-linked immunosorbent assay. Results IL-27 levels (median = 4,364 pg/mL) and MPV (mean = 12.02 ± 1.54 FL) were significantly higher in the culture-proven sepsis group than in the control group (p < 0.001). For IL-27, the optimum cut-off value for the diagnosis of LOS was 283.8 pg/mL with sensitivity and specificity of 97.8 and 100%, respectively. For MPV, the optimum cut-off value was 11.6 FL, with diagnostic sensitivity and specificity of 77.8 and 97.8%, respectively. Conclusion IL-27 and MPV are promising markers for the diagnosis of LOS in full-term neonates. The diagnostic performance of IL-27 was superior to MPV. Key Points Late-onset neonatal sepsis diagnosis is time consuming. Nonculture-based rapid diagnostic tests are much needed. IL-27 is superior in LOS diagnosis to MPV. [ABSTRACT FROM AUTHOR]

Problem: Achieving pregnancy through in vitro fertilization (IVF) remains a challenge, with less than one‐third of women succeeding. There is a pressing need for reliable predictive tools to assess the likelihood of post‐IVF pregnancy. While some serum inflammatory biomarkers have been investigated for their predictive potential, substantial knowledge gaps persist. This study examined the utility of different inflammatory markers in predicting IVF outcomes. Method of Study: Inflammatory markers including the white blood cell count, neutrophil‐to‐lymphocyte ratio (NLR), platelet count, mean platelet volume, platelet distribution width, platelet‐to‐lymphocyte ratio (PLR), C‐reactive protein (CRP), erythrocyte sedimentation rate, and vitamin D3 were assessed. Study outcomes were chemical pregnancy (positive serum beta‐human chorionic gonadotropin 2 weeks post‐embryo transfer), clinical pregnancy (detection of pregnancy sac via transvaginal ultrasonography), and viable pregnancy (detection of fetal heart rate). Univariate and multivariate logistic regression analyses were conducted, with multivariate analysis incorporating age, body mass index, infertility duration, type, and etiology, as well as all studied serum inflammatory markers, embryo count, stage, quality, and endometrial thickness. Results: Lower NLR (p < 0.001, odds ratio [OR] = 0.372 [0.247–0.559]) and CRP (p = 0.035, odds ratio = 0.956 [0.916–0.997]) predicted chemical pregnancy in univariate analysis, with NLR maintaining significance in multivariate analysis (p = 0.022, OR = 0.319 [0.120–0.848]). Lower NLR (p < 0.001, OR = 0.309 [0.198–0.482]) and PLR (p = 0.013, OR = 0.994 [0.990–0.999]) predicted clinical pregnancy, with NLR surviving multivariate analysis (p = 0.005, OR = 0.217 [0.075–0.626]). Lower NLR (p < 0.001, OR = 0.320 [0.198–0.516]) also predicted viable pregnancy, maintaining statistical significance in multivariate analysis (p = 0.002, OR = 0.177 [0.058–0.541]). Other studied inflammatory markers did not predict IVF outcomes. Conclusions: NLR emerged as a robust independent predictor of pregnancy attainment after IVF. [ABSTRACT FROM AUTHOR]

Background: Acute cerebral infarction (ACI) is a complication of upper gastrointestinal bleeding (UGIB), but the risk factors for ACI in UGIB patients have not been fully explored. The purpose of the current study was to investigate the risk factors for ACI in UGIB patients. Methods: Upper gastrointestinal bleeding patients admitted to Nanchang University Affiliated Ganzhou Hospital from January 2019 to December 2021 were included. Patients were divided into an ACI group and a non-ACI group according to whether they had a complication of ACI. Propensity score matching was used to match the data between the two groups. The risk factors for ACI in UGIB patients were analyzed by conditional multivariate logistic regression analysis, and receiver operator characteristic (ROC) curves were used to test the performance of risk factors. Results: There were 1379 UGIB patients included in this study: 50 patients in the ACI group and 1329 patients in the non-ACI group. Forty-eight pairs werematched after propensity scorematching according to sex, age, smoking, drinking, hypertension, coronary heart disease (CHD), diabetes, previous history of cerebral infarction, gout, peptic ulcer, chronic obstructive pulmonary disease (COPD), chronic kidney disease (CKD), and hepatic cirrhosis. Univariate analysis showed that RBC transfusion was a risk factor for ACI. Compared with middle rate pressure product (RPP) at admission, low RPP and high RPP were risk factors for ACI in UGIB patients. Hemoglobin, mean platelet volume (MPV) and albumin were protective factors for ACI. Conditional multivariate logistic regression showed that red blood cell (RBC) transfusion (OR 3.136, 95% CI 1.711-5.750, p < 0.001)was an independent risk factor for ACI. Compared with middle RPP at admission, low RPP and high RPP were independent risk factors for ACI in UGIB patients. The ROC curve analysis showed that the areas under the curve (AUCs) of the RPP at admission and after RBC transfusion were 0.625 (0.513-0.737, p < 0.05) and 0.688 (0.580-0.795, p < 0.01), respectively. Conclusions: Compared with middle RPP at admission, low RPP and high RPP were independent risk factors for ACI in UGIB patients, and RBC transfusion was also an independent risk factor for ACI in UGIB patients. [ABSTRACT FROM AUTHOR]

Introduction: Atopic dermatitis (AD) is a common chronic skin disease with an inflammatory pathophysiology that includes the activation of the innate and adaptive immune systems. We aimed to investigate the neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), eosinophil-to-lymphocyte ratio (ELR), and eosinophil-to-neutrophil ratio (ENR) in AD patients, according to age and disease severity. Methods: This is a retrospective, population-based cohort study conducted between the years 2005 and 2020, comparing hematological markers of AD patients and sex-age-ethnicity-matched controls. AD patients were further divided by age and disease severity (mild, moderate-to-severe AD). We created a decision tree to predict moderate-severe AD. Results: A total of 13,928 patients with AD were included in this study: 6,828 adults and 7,100 children, with 13,548 controls. NLR, PLR, and ELR were lower in children compared to adults (p values <0.001). NLR, PLR, ELR, and ENR were increased in moderate-severe AD patients compared to mild AD patients (p values <0.001). PLR, ELR, and ENR were increased in AD patients versus controls (p values <0.001), with an additional increase in the NLR of moderate-to-severe AD patients. Patients with an ELR <0.21, a PLR >161, and ENR ≤0.016 should be considered high risk for developing severe AD, as well as patients with an ELR >0.21 and age at diagnosis <30 or age >30 years and mean platelet volume ≤9. Conclusion: Hematological ratios were significantly higher in moderate-to-severe AD patients, compared to mild AD patients. Hematological markers were lower in children with AD compared to adults, except for ENR, likely reflecting age-related changes in blood count parameters. These markers can assist in the management and follow-up of AD patients. [ABSTRACT FROM AUTHOR]

Abstract Aims The present study aimed to investigate the relationship between mean platelet volume (MPV) and the risk of type 2 diabetes mellitus (T2DM), among women with and without a history of gestational diabetes mellitus (GDM). Methods Eight thousand one hundred eighty-one parous women of the ‘2007–2018 National Health and Nutrition Examination Survey (NHANES)’ were classified into GDM and non-GDM groups based on self-reported GDM history. We investigated the independent association between the MPV and the risk of T2DM in these groups via multivariable regression analysis. A subgroup analysis was done for the GDM group. Results After comprehensive adjustment for potential covariates, a significant positive correlation was observed between MPV and the risk of T2DM in women with a history of GDM (OR = 1.50, 95% CI 1.13–2.01, P = 0.006). There was a linear relationship between MPV and T2DM among women with a history of GDM, with each unit increase in MPV increasing the risk of T2DM by 50%. Subgroup analysis and interaction tests revealed a stronger significant effect on women with GDM history who had HbA1c ≥ 7%. Conclusions MPV is strongly associated with the incidence of T2DM among U.S. parous women with prior GDM, indicating that MPV may be a potential biomarker of T2DM among women with a history of GDM.

Abstract Background Tuberculosis (TB) remains a global health challenge, with India bearing a significant burden. Despite advancements in TB diagnosis and treatment, monitoring TB treatment is challenging, particularly in resource-limited settings. This study aimed to explore the mean platelet volume (MPV) as a potential surrogate marker for monitoring TB treatment and assessing if the neutrophil-to-albumin ratio (NAR) enhances treatment monitoring. Methods Patients diagnosed with TB following NTEP guidelines were recruited. Participants underwent routine blood tests during the six-month Anti-Tubercular therapy course at the start, end of the intensive phase, and end of the continuous phase. Statistical analyses included Spearman correlation, Friedman test, linear mixed effects (LME) models, and multiple linear regression. Results 150 individuals were included for analysis. Deviations from normality were noted. Significant associations were found between CRP and sputum grade. MPV mediated between CRP and sputum grade. Significant differences were observed across the three-time points. LME models showed changes in MPV and CRP levels over time. Including NAR enhanced predictive capability. Conclusions MPV may serve as a promising surrogate marker for monitoring ATT. Personalized approaches are crucial in TB treatment monitoring. LME models revealed MPV and CRP level trends. Future research should explore MPV’s treatment response mechanisms and cost-effectiveness.

Abstract Background Platelet dysfunction plays a critical role in the pathogenesis of inflammatory bowel disease (IBD). Despite clinical observations indicating abnormalities in platelet parameters among IBD patients, inconsistencies persist, and these parameters lack standardization for diagnosis or clinical assessment. Methods A comprehensive search was conducted in the PubMed, Embase, Web of Science, and Cochrane Library databases for relevant articles published up to December 16th, 2023. A random-effects model was employed to pool the weighted mean difference (WMD) and 95% confidence interval (95% CI) of platelet count (PLT), mean platelet volume (MPV), platelet distribution width (PDW), and plateletcrit (PCT) between IBD patients and healthy controls, and subgroup analyses were performed. Results The meta-analysis included 79 articles with 8,350 IBD patients and 13,181 healthy individuals. The results revealed significantly increased PLT and PCT levels (WMD: 69.910, 95% CI: 62.177, 77.643 109/L; WMD: 0.046%, 95% CI: 0.031%, 0.061%), and decreased MPV levels (WMD: -0.912, 95% CI: -1.086, -0.739 fL) in IBD patients compared to healthy individuals. No significant difference was found in PDW between the IBD and control groups (WMD: -0.207%, 95% CI: -0.655%, 0.241%). Subgroup analysis by disease type and disease activity showed no change in the differences for PLT, PCT, and MPV in the ulcerative colitis and Crohn’s disease groups, as well as the active and inactive groups. Notably, the active group exhibited significantly lower PDW levels than the control group (WMD: -1.138%, 95% CI: -1.535%, -0.741%). Conclusions Compared with healthy individuals, IBD patients display significantly higher PLT and PCT and significantly lower MPV. Monitoring the clinical manifestations of platelet abnormalities serves as a valuable means to obtain diagnostic and prognostic information. Conversely, proactive measures should be taken to prevent the consequences of platelet abnormalities in individuals with IBD. Systematic review registration PROSPERO CRD42023493848.

Yunhan Zhang,1,&ast; Yuyun Chen,2,&ast; Jilin Lv,1 Xiao Xiang,1 Peiyao Wang,1 Wei Feng,1 Zhenhua Guo1 1Department of Neonatal Surgery, Children’s Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development, Chongqing Key Laboratory of Structural Birth Defect and Reconstruction, Chongqing, People’s Republic of China; 2Fujian Children’s Hospital, Fujian Branch of Shanghai Children’s Medical Center, College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, People’s Republic of China&ast;These authors have contributed equally to this workCorrespondence: Zhenhua Guo, Department of neonatal surgery, Children’s Hospital of Chongqing Medical University, 20 Jinyu Road, Yubei District, Chongqing, 400025, People’s Republic of China, Tel +86-23-68370286, Email zhguo@cqmu.edu.cnBackground: This study aims to investigate the potential significance of mean platelet volume (MPV) and platelet distribution width (PDW) in predicting surgical neonatal necrotizing enterocolitis (NEC) and establish the correlation between MPV/PDW levels and the severity/prognosis of NEC.Methods: A retrospective study was conducted on a cohort of 372 patients diagnosed with NEC. The patients were categorized into two groups based on whether they underwent surgical therapy. Univariate /multivariate analysis were employed to compare the MPV and PDW between the two groups. Moreover, patients in surgical group were categorized into multiple subgroups based on intraoperative findings and postoperative prognosis, and the levels of MPV and PDW were compared among these subgroups.Results: Of the 372 patients, the operative group exhibited significantly higher levels of MPV and PDW than the nonoperative group (P < 0.05). Logistic regression analysis revealed that MPV (OR = 4.895, P < 0.001) and PDW (OR = 1.476, P < 0.001) independently associated with surgical NEC. The analysis of the receiver operating characteristic (ROC) curve revealed that the area under the curve (AUC) was 0.706 for MPV alone, with a cut-off value of 11.8 fL. Similarly, the AUC was 0.728 for PDW alone, with a cut-off value of 16%. However, when MPV and PDW were combined, the AUC increased to 0.906 for predicting surgical NEC. In accordance with the intraoperative findings, the levels of MPV and PDW were found to be higher in the large area necrosis group than in the partial or mild necrosis group (P < 0.01). Furthermore, the MPV and PDW values in the death group were significantly greater than those in the survival group (P =0.040, P =0.008).Conclusion: MPV and PDW may serve as potentially valuable indicators for determining the need for surgical intervention and predicting the prognosis of patients with NEC.Keywords: mean platelet volume, platelet distribution width, necrotizing enterocolitis, neonatal

Background: The aim of this study is to determine the correlation between the blood serum mean platelet volume (MPV) and the dynamics of the OF course during the early phase in patients with moderately severe and severe acute pancreatitis (AP). Methods: The predetermined criterion was the presence of the OF according to the revised Atlanta criteria 2012 for moderately severe and severe AP. A prospective sample of patients was stratified by severity, and two groups were defined based on MPV. Demographic indicators, comorbidities and clinical outcomes were compared between these groups. Multifactorial analysis determined whether an elevated MPV is independently associated with early OF and other unfavorable outcomes. Results: Out of 108 patients, 20 had moderately severe AP and 88 had severe AP. The blood serum MPV, measured within 72 h of the onset of AP symptoms was lower 11.8 fL in 32 patients and equal to or greater 11.8 fL in 76 patients. Patients with elevated MPV were older (63 vs. 48 years), had obesity (59.2 % vs. 25 %), diabetes mellitus (DM) (51.3 % vs. 12.5 %), ischemic heart disease (70.8 % vs. 28.1 %) and more frequently experienced persistent OF (93.4 % vs. 53.1 %) compared to those with MPV lower 11.8 fL. The incidence of early OF increased proportionally with the severity of MPV (81.6 % vs. 34.4 % in the group with MPV lower 11.8 fL, Ptrend

Background: Recent studies show the role of inflammatory and immunological changes in the body in schizophrenia (SZ) and bipolar disorder (BD). The levels of mean platelet volume (MPV), platelet distribution width (PDW), and red cell distribution width (RDW) are raised in inflammatory conditions. A very few studies have compared these parameters in patients of SZ and BDs. Our objective was to explore the inflammatory origins and biological distinctness between SZ and BDs through assessment of blood parameter levels. Materials and Methods: A hospital-based retrospective study was done on 141 SZ and 164 BD patients admitted during previous 3 years (2018–2021). Control data were obtained from the records of 93 age- and sex-matched nonpsychiatric hospital admissions. The hospital information system records of the patients were used to collect the information in the predesigned format. Results: The mean age of the patients of SZ and BD blood pressure (BP) was 34.48 ± 10.54 and 32.85 ± 12.68 years, respectively. The one-way analysis of variance test showed a significant difference in the MPV (mean square 13.68, P < 0.001) as well as PDW (mean square 36.84, P = 0.01) among the three groups. The RDW in the patient group was higher than the controls, but the difference was not statistically significant (mean square 3.25, P = 0.799). Conclusion: The elevation of hemogram parameters in the patients of SZ and BDs adds to the evidence of neuroinflammatory origins of these illnesses. In addition, a significant difference in these parameter levels between SZ and BP may imply the biological distinctness of these conditions.

Background: There is no surrogate biological marker for detecting stroke. Because of this, mean platelet volume (MPV) and RDW may be used to predict the occurrence of stroke. Aim: This study aims to see if there is a link between platelet volume and acute ischemic stroke, as well as between red cell distribution width and acute ischemic stroke. Setting and Design: This was a cross-sectional study from February 2021 to January 2023. Materials and Methods: The present cross-sectional study was conducted to assess the role of mean platelet volume and red cell distribution width in acute ischemic stroke. Statistical Analysis: For the analysis, SPSS version 20 was utilized. Results: A total of 300 patients were included in this study. The small vessel infarct (9.05 ± 1.24 fL) had less MPV than the large vessel infarct (9.10 ± 1.10 fL), but there was no statistically significant difference between the two (P = 0.74). The average red blood cell width was lower in minor stroke infarcts (15.06% ±2.01%) than in large stroke infarcts (15.5% ±7.26%), but no statistically significant difference was found in the study. Fifty-three (17.67%) patients had a deadly outcome, and 247 (82.33%) had been cured when a final diagnosis was made. Conclusions: Stroke is the world’s leading cause of mortality, caused by cerebral vascular blockage or hemorrhage. However, there is no biological substitute marker for stroke diagnosis. RDW and MPV are potential biomarkers for this function and can forecast the incidence of stroke.

摘要： 急性脑梗死是常见的缺血性脑血管病，与血小板活性密切相关。血小板活性在急性脑梗死发病、进展、治疗及预后等环节均存在重要影响。平均血小板体积（mean platelet volume，MPV）和血小板分布宽度（platelet distribution width，PDW）是反映血小板活性的两个重要指标，体积大的血小板因能分泌更多的促血栓因子、表达更多的P-选择素和血小板糖蛋白Ⅱb/Ⅲa受体而被认为拥有更高的活性；活化的血小板因伸出大小不一的伪足而使得PDW增大，因此高MPV值和高PDW值都是血小板活化的标志。本文对血小板活化对急性脑梗死的发生、发展及预后等方面的影响进行综述，以期为后续研究血小板活性和急性脑梗死的关系提供参考。 Abstract: Acute cerebral infarction is a common ischemic cerebrovascular disease and is closely related to platelet activity. Platelet activity has significant impact on occurrence, development, treatment and prognosis of acute cerebral infarction. Mean platelet volume (MPV)and platelet distribution width (PDW) are two important indicators that reflect platelet activity. Platelets with larger volume are considered to have higher activity for they can secrete more thrombosis factors and express more P-selections and platelet glycoprotein Ⅱb/Ⅲa receptors. Activated platelets increase PDW by protruding pseudopodia of varying sizes. Thus, both high MPV and PDW are the indications of platelet activation. This paper reviewed the effects of platelet activation on the occurrence, development and prognosis of acute cerebral infarction, in order to provide references for the subsequent study of the relationship between platelet activity and acute cerebral infarction.

Background: Platelet is the important factor in the pathogenesis of atherosclerotic complications, contributing to thrombus formation. As there is a significant correlation found between acute ischaemic stroke and platelet indices including platelet count with their prognostication, but no similar study has been documented from this area of the country, which has drawn attention to conducting this study. Methods: This is an observational, case-control study. Patients with acute ischaemic stroke and aged 18 years or above were included involving a total of 156 subjects (78 cases and 78 controls). They were examined clinically radio-logically and pathologically by platelet count and different indices like mean platelet volume (MPV), platelet distribution width (PDW), platelet to large cell ratio (P-LCR). Results: In the present study, mean PDW of cases is 17.69 fl with a SD of 3.22 fl and means PDW of the control group is 13.67 fl with a SD of 3.15 fl. There is statistically insignificant (p=0.26, CI-95%) changes in value of plateletcrit (PCT) among cases and control group (mean PCT of cases is 0.27% with a SD of 0.O7% and the mean PCT of control subjects is 0.29% with a SD of 0.07%). Conclusion: The observations here suggest a role for larger platelets in the genesis of cerebral thrombosis and are likely to represent changes occurring at the time of thrombopoiesis. Patients with larger platelets can easily be identified during routine haematological analysis. Hence, these indices serve as an important and cost-effective tool in predicting an impending ischemic event and can be used in the future, especially in resource poor countries like India.