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Background: The diagnosis of acute appendicitis relies more on the clinical acumen of the surgeon than on the investigations. As the condition is associated with an acute-phase reaction the analysis of WBC, neutrophil percentage and serum level of CRP has been demonstrated to be important diagnostic tools. Surprisingly the level of CRP becomes proportionately raised with increasing severity of the histopathological variety of the appendix. Aim of the study: The aim of this study was to compare the preoperative CRP level with postoperative histological findings and find out a predictive value of CRP as an indicator for surgical intervention in acute appendicitis.Material & Methods:It was a prospective, cross-sectional, observational study executed in the Department of Surgery, Dhaka Medical College Hospital from January to December of 2015 where 107 patients were included in this study. Preoperative level of CRP and WBC count was done in all selected patients. Histopathological severity of the resected specimen of the appendix was determined postoperatively. The correlation between preoperative clinical factors and the actual histological severity and identification of surgical indication markers was assessed to determine whether only the CRP level significantly differs between the surgical treatment necessary group and the possible non-surgical treatment group.Results:54% (58) of the patients were female out of a total of 107. Peak incidence (25.2%) was in the 16-20 years age group. Neither age nor gender had any significance with the type of appendicitis. Among the patients 28.1% (30) had gangrenous appendicitis. In patients with histopathologically proven acute appendicitis, both the WBC count and serum CRP level were raised. But only the CRP level significantly differs between gangrenous appendicitis and uncomplicated appendicitis (p-value<0.0001). The specificity and sensitivity of serum CRP for gangrenous appendicitis were 97% and 71% respectively. The ROC curve indicated that the cutoff value of CRP for gangrenous appendicitis is 6.2 mg/dl. Conclusions:A normal pre-operative serum CRP measurement in patients with suspected acute appendicitis is most likely associated with a normal or uncomplicated inflammation of the appendix. The rate of unnecessary appendectomies would probably reduce in this patient group by deferring surgery. Only the CRP level is consistent with the severity of appendicitis and can be considered to be a surgical indication marker for acute appendicitis.
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Background: Sepsis, a syndrome of dysregulated host response to infection leading to life-threatening organ dysfunction, is having a substantial burden in health system. The outcome in sepsis is often time dependent. None of the clinical manifestations nor the age-old markers like ESR, CRP, etc. have proven diagnostic or prognostic of sepsis. This study aims to assess the role of neutrophil: lymphocyte ratio (NLR) in assessing the severity of sepsis within the initial 24 hrs of admission.Methods: Authors did a retrospective observational study in 208 sepsis patients admitted in the MDICU. The NLR was calculated and the study population was grouped into those with an NLR of more than or equal to 5 and those with less than 5. The patients were also grouped based on the number of organs impaired due to sepsis. The association between these groups were then assessed.Results: 46 patients (60.5%) with single organ involvement had NLR <5; 30 patients (39.5%) had NLR >5; 27 patients (42.2%) with two organ involvement had NLR <5 and 37 patients (57.8%) had NLR >5. Among patients with more than two organ involvement, 8 patients (21.6%) had NLR <5 and 29 patients (78.4%) had NLR >5. It was found that there is statistically significant association between increase in number of organs involved and NLR more than 5. The chi square test value was 15.691 with a p value was less than 0.001.Conclusions: In the current study, we have evaluated the role of NLR in sepsis. NLR calculated on the day of admission is a simple parameter that helps to stratify patients into severe risk category. A significant association was found with higher NLR and the number of organs impairment in sepsis.
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Introduction: Blood transfusion saves millions of lives.Donors undergo certain stringent selection criteria to ensuresafe and quality blood and blood products. During such processit is likely that donors may get deferred either temporarily orpermanently. Deferral leads to precious loss of donors andblood units. Morever rates and reasons of deferral vary fromregion to region. The aim of the study was to analyse rates andreasons of donor deferral in our hospital.Material and Methods: It is a retrospective study done overa period of 6 years from January 2012 to December 2017.Details of donors who were deferred either temporarily orpermanently during the study period was collected from thedonor registry.Results: Out of the 15,807 donors who registered for blooddonation during study period, 971 donors were deferreddue to several reasons both temporarily and permanently.Total deferral rate of 6% as comparable to other studies inliterature.Conclusion: Knowledge about rates and reasons of donordeferral may guide medical personnel to focus on donorscreening. Proper follow up measures can be carried out incase of temporarily deferred donors to bring them back todonor pool.
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Background: Cholelithiasis is a common problem in day to day surgical practice, which has a prevalence of 10-15%. The prevalence is more here in this part of the country as this is a pocket of sickle cell disease region. Laparoscopic cholecystectomy is the gold standard procedure for gall stone diseases. Out of many complications one of the most important complications of laparoscopic cholecystectomy is bile duct injury particularly in difficult cases. Difficulties arise during creation of pneumoperitonium, releasing adhesion, identifying anatomy, anatomical variations and during extraction of gall bladder.Methods: A prospective study was carried out at VSS institute of Medical Science and Research, Burla, Sambalpur, a tertiary referral centre and a teaching hospital in the western Odisha. One hundred patients with symptomatic cholelithiasis were taken up for the study after due clearance from the institutional ethical committee. They were evaluated for risk factors such as-age of the patient, sex of the patient, previous abdominal surgery, number of previous attacks, total WBC count, gall bladder wall thickness and pericholecystic collection on ultrasonography.Results: Previous abdominal surgery, duration since acute attack, number of previous attacks, ultrasonography findings of increased wall thickness, stone impaction at neck and pericholecystic collection, increased total WBC count are associated with difficult laparoscopic cholecystectomy.Conclusions: The predictors for difficult cholecystectomy will make the surgeon extra cautious during the procedure so as to minimize the complications.
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Context Oral squamous cell carcinoma (OSCC) is one of the most common cancers in human population and has a multifactorial aetiology. It is often preceded by oral potentially Malignant Disorders (OPMDs). Studies have shown that OSCC and OPMDs cause significant variations in various haematological parameters. Aim and objectives To assess the role of haematological parameters like haemoglobin, erythrocyte sedimentation rate, red blood cell count, white blood cell count and differential leukocyte count in OPMDs and OSCC and also to compare these parameters among OPMDs, OSCC and controls. Materials and methods Study comprises 30 diagnosed cases each of OPMDs and OSCC and 10 normal healthy age and sex-related individuals. Blood sample was collected from the patients and was evaluated for various haematological parameters by Sahli's acid haematin method, Westergren method and Coulter Counter ZF-6. Results There was a statistically significant difference in haemoglobin, red blood cell count, erythrocyte sedimentation rate, differential leukocyte count between OSCC, OPMDs and controls. Conclusion In the present study, haematological parameters were significantly altered in OPMDs and OSCC, and these variations may be useful in the prediction of malignant transformation and prognosis.
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Objective To explore the diagnostic and clinical application value of combined detection of C-reactive protein (CRP),serum prealbumin (PA) and white blood cell (WBC) count in neonatal infectious diseases.Methods A total of 187 fullterm newborns were collected in this study,including 92 newborns of bacterial infection as the infection group and 95 newborns of non-infection diseases as non-infection group.The abnormal rates of CRP,PA and WBC in the two groups were measured;the sensitivity,specificity,false positive rate and false negative rate were compared between the single detection and combined detection of WBC,PA,CRP;the changes of the three indexes in the infection group were compared between before and after treatment.Results The abnormal rates of CRP,PA and WBC in the infection group were significantly higher than those in the non-bacterial infection diseases group (P＜0.05).The sensitivity and specificity of combined detection of CRP+ PA + WBC were higher than those of single detection of CRP,PA and WBC;after treatment,the level of CRP in the infection group was significantly decreased,the level of PA was significantly increased and the WBC count returned to normal(P＜0.05).Conclusion The combined detection of CRP,PA and WBC has an important clinical value in the early diagnosis of neonatal bacterial infection.
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Objective: To evaluate the correlation and agreement of erythrocyte and leukocytes count in cerebrospinal fluid (CSF) among two different manual methods and automated method. Methods: We evaluated the correlations and agreements of the CSF RBC counts, WBC counts and WBC differential counts between two manual methods and automated method by using the ADVIA 120 CSF assay. Results: We studied 83 CSF specimens in all methods. Absolute cell counts showed a high correlation and agreement between methods, with correlation coefficient (rs) for all absolute counts of more than 0.89 and intraclass correlation (ICC) more than 0.9. The correlation and agreement of WBC differential counts from CSF specimens which had more than 20 WBCs/µL were also evaluated, which revealed good results only for polymorphonuclear cells, neutrophils and lymphocytes (rs = 0.796, 0.835 and 0.779, respectively and ICC = 0.954, 0.899 and 0.907, respectively). When WBC counts more than 5 cells/µL in automated method were used as a cut-off point, the sensitivity is 100% but specificity is very low (60.87%). The cut-off point of 5 WBCs/µL for manual method and 11 WBCs/µL for automated method gave the highest agreement (Kappa 0.874, sensitivity 91.43% and specificity 95.65%). Conclusion: The ADVIA 120 CSF assay provide a useful and efficient method for excluding the normal CSF specimens at cut-off 5 WBCs/µL.
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Objective To compare laboratory tests and in-hospital mortality in acute myocardial infarction(AMI)with different infarction size and to seek factors correlate with infarction size.Methods Totally 201 AMI patients were enrolled,87 patients had large size infarction,114 patients had small size infarction.Basic characteristics,the number of ST-segment elevation leads,in-hospital mortality,white blood cell(WBC)count,fasting plasma glucose(FBG),plasma lipids and other laboratory tests in the two groups were compared.All variables were compared their correlations.Results There were statistical differences between the two groups at number of ST-segment elevation leads、 in-hospital mortality、WBC count、FBG、total cholesterol(Tch)and low-density lipoprotein-cholesterol(LDL),P
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BACKGROUND: Disturbances in apoptosis through phosphoinositide 3-kinase(PI3K)/Akt pathway is thought to be crucial in cancer cell immortality. Enhanced expression and activation of Akt was investigated in several malignancies but not in acute leukemia. We investigated the expression of Akt and phospho-Akt in acute leukemia cells and clinical characteristics of expression and non-expression group. METHODS: Bone marrow cells from patients who were newly diagnosed as acute leukemia and healthy volunteer were obtained and analyzed by Western blot analysis using monoclonal antibody against Akt, phospho-Akt (Ser473), and phospho-Akt (Thr308). Clinical data were obtained retrospectively. RESULTS: The expression of Akt was demonstrated in 27 of 43 cases (63%) and phospho- Akt(Ser473) was noted in 24 of 27 (54%) Akt-positive cases, respectively. Phospho-Akt (Ser473)-expression group showed significantly higher initial WBC counts compared to negative group (P=0.003). By chromosomal analysis, patients with Akt expression did not show any good prognostic karyotype (P=0.001). CONCLUSION: This result suggests that Akt overexpression and activation is detected in acute leukemia cells and might have a role in molecular pathogenesis of acute leukemia.
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Humans , Apoptosis , Blotting, Western , Bone Marrow Cells , Healthy Volunteers , Karyotype , Leukemia , Retrospective StudiesABSTRACT
PURPOSE: The total white blood cell count is an unreliable predictor of appendicitis. We focused on the leukocyte count and neutrophil/lymphocyte ratio related to the severity of inflammation for better preoperative diagnosis. METHODS: Five hundred and fifty seven patients with acute appendicitis operated at Kangwon National University Hospital were reviewed retrospectively. Cases were classified into 4 groups according to the pathological grade of inflammation, those are focal (AF), suppurative (AS), gangrenous (AG), and no diagnostic abnormality (NDA). The leukocyte count and neutrophil/lymphocyte ratio were compared according to groups and presence of periappendiceal abscess. RESULTS: Male to female ratio was 1.13: 1 and 2nd and 3rd decades were the most prevalent. Histopathologically, AF cases were 6.3%, AS were 51.29%, AG were 23.9% and NDA were 18.7%. The leukocyte count was abnormally elevated in 411 patients (73.8%). The average counts of leukocyte were different statistically between AS & AG, AF, and NDA (p0.05). The average of neutrophil/lymphocyte ratio of 85 cases with periappendiceal abscess was 6.37, and that of remains 4.85 (p<0.001). CONCLUSIONS: The leukocyte count and neutrophil/lymphocyte ratio may be sensitive parameters for severity of inflammation, and the severity of inflammation in appendix show relation with leukocyte count, and the leukocyte count was valuable for predicting the severity of inflammation in appendix.
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Female , Humans , Male , Abscess , Appendicitis , Appendix , Diagnosis , Inflammation , Leukocyte Count , Leukocytes , Retrospective StudiesABSTRACT
The prediction of possibility which patient will develop vasospasm constitutes a further advance in the management of this complication. So the possible clinical risk factors predicting ischemic complication of subarachnoid hemorrhage were retrospectively investigated in patients with ruptured intracranial aneurysm. A comparative analysis of risk factors contributing to symptomatic vasospasm was carried out between 40 patients with symptomatic vasospasm as DID(Delayed Ischemic Neurologic Deficit) group and 52 patients without symptomatic vasospasm as Non-DID group, those who were selected among 349 cases of ruptured intracranial aneurysm admitted to department of neurosurgery at Presbyterian Medical Center, Jeon Ju for 6 years from August, 1982 to July, 1988. Peripheral WBC count, clinical grade, hematocrit, blood glucose level, EKG findings, age, sex and aneurysm location of admission failed to show a prognostic value as a factor developing delayed ischemic neurologic deficit in the patients. However a statistically significant rise in peripheral WBC count was observed at the beginning of clinical deterioration and also systolic blood pressure at admission were significantly higher in DID than Non-DID group. The results suggest that the increase of peripheral WBC count observed at the time of neurological deterioration of delayed onset and high systolic blood pressure at admission might be a risk factor for developing vasospasm.