Principales modificaciones asociadas a la esplenectomía / Main modifications associated with splenectomy

Introducción. El bazo es un órgano linfoide implicado en el reconocimiento antigénico, la depuración de patógenos y la remoción de eritrocitos envejecidos o con inclusiones citoplasmáticas. La esplenectomía es una técnica utilizada tanto para el diagnóstico (linfomas), el tratamiento (trombocitopenia inmune, anemia hemolítica adquirida) y la curación (microesferocitosis hereditaria) de diversas enfermedades. Métodos. Describir los principales cambios hematológicos y complicaciones asociadas al procedimiento de esplenectomía. Discusión. Los cambios posteriores a la esplenectomía pueden ser inmediatos, como la aparición de cuerpos de Howell-Jolly, la trombocitosis y la presencia de leucocitosis durante las primeras dos semanas. Otras complicaciones tempranas incluyen la presencia de trombosis, en especial en pacientes con factores de riesgo secundarios (edad, sedentarismo, manejo hospitalario, obesidad) o un estado hipercoagulable (diabetes, cáncer, trombofilia primaria), siendo tanto el flujo de la vena porta como el volumen esplénico los principales factores de riesgo para su aparición. Las complicaciones tardías incluyen la alteración en la respuesta inmune, aumentando el riesgo de infecciones por bacterias encapsuladas, en conjunto con una reducción en los niveles de IgM secundario a la ausencia de linfocitos B a nivel de bazo. Debido al riesgo de infecciones, principalmente por Streptococcus pneumoniae, la esplenectomía parcial se ha considerado una opción. Conclusión. Una adecuada valoración de la indicación de esplenectomía y la identificación precoz de complicaciones posoperatorias son fundamentales para reducir la mortalidad asociada a la esplenectomía

Introduction. The spleen is a lymphoid organ involved in antigen recognition, pathogen clearance, and removal of aged erythrocytes or those with cytoplasmic inclusions. Splenectomy is a technique used for diagnosis (lymphomas), treatment (immune thrombocytopenia, acquired hemolytic anemia), and cure (hereditary microspherocytosis) of various diseases. Methods. To describe the main hematological changes and complications associated with the splenectomy procedure. Discussion. Changes after splenectomy can be considered immediate: the appearance of Howell-Jolly bodies, thrombocytosis, and leukocytosis during the first two weeks. Other complications include the presence of thrombosis, especially in patients with risk factors (age, sedentary lifestyle, long hospital stay, obesity) or a hypercoagulable state (diabetes, cancer, primary thrombophilia), with both portal vein flow and splenic volume being the main risk factors for its appearance. Late complications include altered immune response, increased risk of infections by encapsulated bacteria, and a reduction in IgM levels secondary to the absence of B lymphocytes in the spleen; due to the risk of diseases mainly by Streptococcus pneumoniae, partial splenectomy has been considered an option. Conclusion. An adequate assessment of the indication for splenectomy and the early identification of complications are essential to reduce the mortality associated with splenectomy

Clinico-Epidemiological Profile and Predictors of Poor Outcome Among Children During a Diphtheria Outbreak in Haryana

Objective: To study the clinico-epidemiological profile and predictors of poor outcome in an outbreak of diphtheria. Methods: Records of 390 children admitted with the diagnosis of clinical diphtheria in a tertiary care teaching hospital in Nuh, Haryana, from January, 2018 to December, 2020 were analysed with respect to demographic details, immunization status, clinical features, complications and mortality. Patients were divided into survivors and nonsurvivors, and various variables were compared between the two groups to identify the factors associated with poor outcome. Results: Out of 390 cases, data of 318 (81.5%) was included. Young children (median age 5 year) were predominantly affected, and only 8 (2.5%) children were fully immunized. Pseudomembrane was present in 245 (77%) cases. Albert staining and culture were positive in 84.6% (269) and 12.9% (41) cases, respectively. Complications developed in 48.4% (n=154) cases and included: airway compromise 22.6% (n=72), diphtheritic cardiomyopathy 12.9% (n=41), acute kidney injury 3.7% (n=12), thrombocytopenia 8.5% (n=27) and hepatitis 0.6% (n=2) cases. Anti-diphtheritic serum (ADS) was administered to all admitted patients. Tracheostomy was done in (n=57) (17.9%) children. Case fatality rate was 17.9%. Conclusion: Diphtheria mostly affected young unvaccinated or partially vaccinated children. Mortality was high in unimmunized or partially immunized young children and those with bull neck, pseudomembrane, delayed (?5 days) administration of ADS, acute kidney injury, thrombocytopenia and leukocytosis. Myocarditis was strongly associated with high mortality.

Perceived Awareness of Clozapine associated with Socio- Demographic status, clinical, and side effect profile among patients from Mental Health Hospital, Taif, Saudi Arabia

Background: The main objective was to investigate the Socio-demographic, clinical, and side effect profile of patients on clozapine from Mental Health Hospital, Taif, Saudi Arabia. This article reports on an observational study. Clozapine is a second-generation atypical antipsychotic used as the drug of choice for the treatment resistant psychosis. It is supposed to be a baseline study from which we will get and understand rate of clinical, and side effect profile of the clozapine taking patients. Physicians, particularly psychiatrists are not only ignoring but also not aware, alert, so they always need to be watchful to the fatality of the drug, and take appropriate therapeutic measures. The aim was to study the socio-demographic status, clinical profile, comorbidity, side effects and outcome of patients treated with clozapine. Methodology: We reviewed all the indoor psychiatric patients of Mental Health Hospital, Taif, Saudi Arabia, from the period of one year between January 2021 to January 2022 (N=29). Our study design focused on prospective and observational studies. Descriptive statistical analysis was explored, and presented as frequencies, and percentages. We also determined crude rates for all adverse outcomes of clozapine. Results: We did a nearly mean follow-up of one year. The majority of patients were male (n=26; 89.65%), with a maximum being unmarried (n=16; 55.17%). Most patients belong to nuclear families due to cultural restrictions in this country (n=23; 79.31%). Among the literacy rate illiterate were (n=2; 6.89%, and unemployed (n=23; 79.31%). Among the study populations, the majority of respondents were found to have treatment-resistant schizophrenia (n=18; 62.06%), and around 79.31% of patients took more than two antipsychotics in adequate doses. Among side effect profiles most of the patients suffered hyper-salivation (n=19; 65.51%), sedation (n=12; 41.37%), and rarely suffered from agranulocytosis. Conclusion: Socio-demographic, clinical, and side effect profiles were the significant indicators of clozapine. Clozapine has been used for treatment-resistant psychosis, but due to fatal side effect profile we used it cautiously. In our study, we found that myocarditis, hematemesis, and leukocytosis, and neutropenia are fatal side effects of clozapine. We also found hyponatremia-induced seizure. The prevalence of blood dyscrasias in our study is rarely seen. Hyper-salivation is the most common side effect reported. Majority of the patients in our study were male, and treatment resistant Schizophrenia was the most common diagnosis. Myocarditis is life-threatening side effect seen in our study

Kawasaki Disease: Highlighting Importance of Laboratory Criteria and Minor Atypical Features of This Enigmatic Entity- A Case Series

@#Introduction: Kawasaki disease (KD) is an acute febrile illness of unknown etiology that primarily affects children younger than 5 years of age. The diagnosis is predominantly clinical and at times difficult, due to the absence of any confirmatory and specific diagnostic test. Early diagnosis of this disease is of paramount importance due to long term cardiovascular complications related to coronary artery aneurysm. Literature search has revealed many atypical presentations of Kawasaki disease not fulfilling the clinical diagnostic criteria. The reason for this could be the diversity in clinical manifestations involving gastrointestinal, endocrinal, musculoskeletal and nervous system. Case Series: Here we describe three cases with non-classic presentation of Kawasaki disease. These three cases presented with persistent fever unresponsive to antibiotics. Two cases (case one and three) later developed perianal rash and peeling that helped in early diagnosis. In the remaining case (case two) sequential appearance of features helped in the establishment of diagnosis. It was interesting to note that all the three cases were having identical laboratory parameters, highlighting the importance of laboratory investigations in case of atypical presentation. Conclusion: This case series culminates the importance of keeping the possibility of atypical Kawasaki disease (KD) as one of the differentials in patients with prolonged fever not responding to antibiotics, in the absence of classical diagnostic criteria.

Hiperglucemia y leucocitosis como predictores de complicaciones intrahospitalarias en pacientes con Infarto del miocardio agudo / Hyperglycemia and leukocytosis as predictive factors of in-hospital complications in patients with Acute myocardial infarction

Introducción: A pesar de las nuevas técnicas para la reperfusión del vaso en el infarto agudo de miocardio, las complicaciones y la mortalidad en estos pacientes es elevada. La hiperglucemia y la leucocitosis se han descrito como factores de riesgo y de peor pronóstico. Objetivo: Evaluar la capacidad predictiva de la hiperglucemia y la leucocitosis de complicaciones intrahospitalarias en pacientes con infarto de miocardio agudo con elevación del segmento ST. Material y Métodos: Estudio prospectivo de cohorte desde 2013 hasta 2020 que incluyó a 507 pacientes consecutivos que ingresaron en la Unidad de Cuidados Coronarios del Hospital Militar Central Dr. Carlos J. Finlay y el Hospital General Docente Enrique Cabrera con el diagnóstico de infarto del miocardio agudo con elevación del segmento ST. Se dividieron los pacientes de acuerdo con la ocurrencia de complicaciones intrahospitalarias. Resultados: Los valores de glucemia y leucograma presentaron diferencias significativas entre los grupos de pacientes (p = 0,002 y p = 0,005; respectivamente). La capacidad discriminativa de ambos exámenes se clasificó como mala. El análisis univariado de regresión logística reveló que la glucemia y el leucograma eran factores de riesgo para la aparición de complicaciones, pero solo el leucograma se consideró un predictor independiente del evento final del estudio. Al asociar los valores de leucograma al modelo multivariado, se elevó su capacidad predictiva (área bajo la curva: 0,735; p < 0,001). Conclusiones: La leucocitosis es un predictor independiente de complicaciones intrahospitalarias en pacientes con Infarto del miocardio agudo con elevación del segmento ST(AU)

ABSTRACT Introduction: Despite the use of novel techniques for reperfusion of the vessel in acute myocardial infarction, complications and mortality in these patients are high. Hyperglycemia and leukocytosis have been described as risk factors and worse prognosis. Objective: To evaluate the predictive capacity of hyperglycemia and leukocytosis for in-hospital complications of myocardial infarction with ST-segment elevation patients. Material and Methods: Prospective cohort study conducted from 2013 to 2020 that included 507 consecutive patients admitted to the Intensive Coronary Care Unit of the Dr. Carlos J. Finlay Central Military Hospital and the Enrique Cabrera General Teaching Hospital with the diagnosis of acute myocardial infarction with ST- segment elevation. The patients were divided into groups according to the occurrence of in-hospital complications. Results: The values of glycemia and leukocyteswere significantly different among the groups of patients (p = 0.002 and p = 0.005; respectively). The discriminative capability of both tests was classified as bad. The univariate analysis of logistic regression revealed that glycemia and leukocytes were risk factors for the appearance of complications, but only the leukocyte test was considered as an independent predictor of the final event of the study. When the values of the leukocyte test were associated with the multivariate model, its predictive capacity increased (area under curve: 0.735; p < 0.001). Conclusions: Leukocytosis is an independent predictor of in-hospital complications of acute myocardial infarction with ST-segment elevation(AU)

Hematúria macroscópica em equinos associada à infecção por Leptospira interrogans / Macroscopic haematuria in horses associated with Leptospira interrogans infection

Hematúria é uma grave manifestação clínica de doença do sistema urinário, ocorrendo sob as formas micro ou macroscópica. Neste artigo relatam-se dois casos de hematúria macroscópica associada à infecção por Leptospira interrogans sorogrupo Canicola. O exame clínico inicial revelou hematúria macroscópica, taquicardia, taquipneia, febre, elevação do tempo de perfusão capilar, hipomotilidade intestinal, além de icterícia da mucosa oral. Leucocitose, proteinúria, glicosúria, piúria e azotemia foram achados comuns aos dois casos. Teste de Soroaglutinação Microscópica foi realizado para titulação de anticorpos contra Leptospira interrogans. Tratamento incluiu medidas terapêuticas de suporte (fluidoterapia), controle da hematúria e antibioticoterapia. Sete dias após manifestação dos sinais clínicos iniciais, ambos animais receberam alta hospitalar após remissão dos sinais clínicos.

Haematuria is a serious clinical manifestation of urinary system disease, occurring in micro or macroscopic forms. In this article two cases of macroscopic haematuria associated with Leptospira interrogans serogroup Canicolainfection are related. The initial clinical examination revealed macroscopic haematuria, tachycardia, tachypnea, fever, increased capillary perfusion time, intestinal hypomotility, in addition to jaundice of the oral mucosa. Leukocytosis, proteinuria, glycosuria, pyuria and azotemia were common findings in both cases. Microscopic serum agglutination test was performed for titration of antibodies against Leptospira interrogans. Treatment included supportive therapeutic measures (fluid therapy), hematuria control and antibiotic therapy. Seven days after the manifestation of the initial clinical signs, both animals were discharged from the hospital without complications.

Hematúria macroscópica em equinos associada à infecção por Leptospira interrogans / Macroscopic haematuria in horses associated with Leptospira interrogans infection

Hematúria é uma grave manifestação clínica de doença do sistema urinário, ocorrendo sob as formas micro ou macroscópica. Neste artigo relatam-se dois casos de hematúria macroscópica associada à infecção por Leptospira interrogans sorogrupo Canicola. O exame clínico inicial revelou hematúria macroscópica, taquicardia, taquipneia, febre, elevação do tempo de perfusão capilar, hipomotilidade intestinal, além de icterícia da mucosa oral. Leucocitose, proteinúria, glicosúria, piúria e azotemia foram achados comuns aos dois casos. Teste de Soroaglutinação Microscópica foi realizado para titulação de anticorpos contra Leptospira interrogans. Tratamento incluiu medidas terapêuticas de suporte (fluidoterapia), controle da hematúria e antibioticoterapia. Sete dias após manifestação dos sinais clínicos iniciais, ambos animais receberam alta hospitalar após remissão dos sinais clínicos.

Haematuria is a serious clinical manifestation of urinary system disease, occurring in micro or macroscopic forms. In this article two cases of macroscopic haematuria associated with Leptospira interrogans serogroup Canicolainfection are related. The initial clinical examination revealed macroscopic haematuria, tachycardia, tachypnea, fever, increased capillary perfusion time, intestinal hypomotility, in addition to jaundice of the oral mucosa. Leukocytosis, proteinuria, glycosuria, pyuria and azotemia were common findings in both cases. Microscopic serum agglutination test was performed for titration of antibodies against Leptospira interrogans. Treatment included supportive therapeutic measures (fluid therapy), hematuria control and antibiotic therapy. Seven days after the manifestation of the initial clinical signs, both animals were discharged from the hospital without complications.

Encefalopatía subaguda en una paciente con policondritis recidivante: caso clínico / Subacute encephalopathy associated with relapsing polychondritis: report of one case

Relapsing polychondritis (RP) is a rare multisystemic autoimmune disorder characterized by the inflammation and destruction of cartilages, with preference for auricular, nasal and laryngotracheal cartilages. RP may also affect proteoglycan-rich structures, such as, blood vessels, eyes, kidneys, and heart. The central nervous system (CNS) is involved in less than 3% of patients. We report a 32-year-old female with RP associated with a progressive subacute encephalopathy characterized by behavioral disturbances, auditory and visual hallucinations. The EEG showed generalized slow activity and a mononuclear pleocytosis with increased protein was found in the cerebrospinal fluid. The brain magnetic resonance imaging showed multiple supra and infratentorial nodular inflammatory lesions. After initiating treatment with corticosteroids and cyclophosphamide, a significant improvement in chondritis and neurological status was observed.

Os preditores da mortalidade em esplenectomias não traumáticas / The predictors of mortality in non-traumatic splenectomies

ABSTRACT BACKGROUND: There are quite a few studies examining prognostic factors in non-traumatic splenectomies compared to traumatic ones. OBJECTIVE: This study aimed to evaluate the predictors of mortality in patients who underwent splenectomy for non-traumatic spleen diseases. METHODS: Medical records of the patients, who had undergone total splenectomy for non-traumatic spleen diseases at a tertiary center between January 2009 and December 2019, were retrospectively reviewed. Exclusion criteria included patients younger than 18 years of age, partial splenectomies, splenectomies applied to facilitate surgery for malignancy on contiguous organs, and splenectomies performed during liver transplantation. Iatrogenic splenic injuries were regarded as trauma and these cases were also excluded. RESULTS: The current study included 98 patients. Nine (9.2%) patients died. In univariate analysis, age, the presence of hematological neoplasia, hematocrit, hemoglobin, white blood cell counts, neutrophil-to-lymphocyte ratio, indications for splenectomy, application of emergency surgery, surgical technique, and transfusion of blood components were all significantly associated with mortality. In multivariate analysis, the presence of hematological malignancy [P=0.072; OR=7.17; (CI: 0.386-61.56)], the application of emergency surgery [P=0.035; OR=8.33; (CI: 1.165-59.595)] and leukocytosis [P=0.057; OR=1.136; (CI: 0.996-1.296)] were found to be positively associated with mortality. CONCLUSION: Hematologic neoplasia, emergency surgery, and leukocytosis were the independent predictors of mortality in patients, who were operated on for non-traumatic spleen diseases. A thorough preoperative evaluation, early therapeutic intervention, and advanced surgical techniques are important and can serve to minimize complications and mortality in case of inevitable splenectomy. Immunological research can provide new therapeutic opportunities that may impact positively on patients by minimizing morbidity and mortality.

RESUMO CONTEXTO: Há alguns estudos que examinam fatores prognósticos em esplenectomias não traumáticas em comparação com os traumáticos. OBJETIVO: Este estudo teve como objetivo avaliar os preditores de mortalidade em pacientes submetidos à esplenectomia para doenças do baço não traumático. MÉTODOS: Os prontuários dos pacientes, submetidos à esplenectomia total não traumática para doenças do baço em um centro terciário entre janeiro de 2009 e dezembro de 2019, foram revisados retrospectivamente. Os critérios de exclusão incluíram pacientes menores de 18 anos, esplenectomias parciais, esplenectomias aplicadas para facilitar a cirurgia para a malignidade em órgãos contíguos e esplenectomias realizadas durante o transplante hepático. As lesões esplênicas iatrogênicas foram consideradas trauma e esses casos também foram excluídos. RESULTADOS: O presente estudo incluiu 98 pacientes. Nove (9,2%) pacientes morreram. Na análise univariada, idade, presença de neoplasia hematológica, hematócrito, hemoglobina, contagem de glóbulos brancos, razão entre neutrófilos-linfócitos, indicações de esplenectomia, aplicação de cirurgia de emergência, técnica cirúrgica e transfusão de componentes sanguíneos foram significativamente associadas à mortalidade. Na análise multivariada, a presença de malignidade hematológica [P=0,072; OR=7,17; (IC: 0,386-61,56)], aplicação de cirurgia de emergência [P=0,035; OR=8,33; (IC: 1,165-59,595)] e leucocitose [P=0,057; OR=1,136; (IC: 0,996-1,296)] verificou-se que estão positivamente associados à mortalidade. CONCLUSÃO: Neoplasia hematológica, cirurgia de emergência e leucocitose foram os preditores independentes da mortalidade em pacientes, operados por doenças não traumáticas do baço. Uma avaliação pré-operatória minuciosa, intervenção terapêutica precoce e técnicas cirúrgicas avançadas são importantes e podem servir para minimizar complicações e mortalidade em caso de inevitável esplenectomia. Pesquisas imunológicas podem fornecer novas oportunidades terapêuticas que podem impactar positivamente nos pacientes, minimizando a morbidade e a mortalidade.

Reliability of Leukocytosis in Diagnosing Acute Appendicitis.

Acute appendicitis is a frequently encountered surgical disease. Detection is difficult even with imaging and blood investigations. Total leukocyte count is a promising investigation. Its role in the confirmation of acute appendicitis is investigated and analysed in the present study. MethodsPatients having acute appendicitis treated by surgical intervention (appendicectomy) were included in the study. The leukocyte count measured before surgery was compared with histopathology findings of the appendix. Parameters of diagnostic accuracy of leukocytosis were measured by standard formulae. ResultsThe sensitivity and specificity of leucocytosis were found to be 76 percent and 12.5 percent respectively. The positive predictive value and negative predictive value of leucocytosis was 65 percent and 20 percent respectively. Overall diagnostic accuracy was 56 percent. The results were compared with histopathology of acute appendicitis. ConclusionsLeukocytosis is a helpful investigation to support the diagnosis of acute appendicitis.

Study of the association of serum procalcitonin with leukocytosis in predicting complicated acute appendicitis

Background: Delay in the diagnosis of complicated appendicitis and its treatment results in an increased rate of postoperative morbidity, mortality and hospital stay. The diagnosis of appendicitis rests on a combination of signs of inflammation such as fever, pain and tenderness; leukocytosis, and elevated C-reactive protein levels, interleukin-6 (IL6) and procalcitonin. Raised level of serum procalcitonin in bacterial infection has been used to further improve the diagnosis of complicated AA.Methods: One-hundred ten patients of appendicitis confirmed by intra-operative findings and final pathologist report, who underwent appendectomy consisting 25 women (22.73%) and 85 men (77.27%) with a mean age of 25 years (age range 15-55 years) were included in this study. Serum procalcitonin value was measured by chemi E411 Cobas method (chemilumiscent immunoassay system) using the B.R.A.H.M.S PCT kit. Serum PCT level >0.5 ng/ml was consider as risk for progression to severe systemic disease.Results: At a 0.5 ng/dl cut-off value of PCT, the sensitivity and specificity of PCT level measurement for acute complicated appendicitis prediction was 90% and 97.14% respectively. Association between WBC count and PCT value shows the sensitivity and specificity in 40 case of acute complicated appendicitis prediction was 86% and 75% respectively.Conclusions: Both the higher PCT values and leukocytosis correlates well with  infectious post-operative complications for acute appendicitis and it can help to carry out timely surgical intervention which is highly recommended in complicated appendicitis(correlates PCT >0.5 ng/dl).

Clinical profile of Dengue fever in children of Nellore city, Andhra Pradesh, India

Background: India especially Andhra Pradesh is endemic for dengue, in dengue fever mortality and morbidity is more in children when compare to adults. Authors objective was to assess the clinical profile of the Dengue fever in children.Methods: Children below 14 years with serologically positive for dengue included in this study from June 2017 to June 2018, data was collected and analyzed with MS office 2016.Results: In 100 children 84 were suffering with Non Sever dengue , 16 were suffering with severe dengue. In the study population 68 were male children and 32 were female children, more children 68 were in the above 11 age group, 52 children stay in hospital for 3-6 days.Conclusions: Health education and anti-larval measures and anti-adult measures for mosquito control is effective measures.

Severe pertussis in childhood: update and controversy - systematic review / Coqueluche grave na infância: atualização e controvérsias - revisão sistemática

ABSTRACT Objective: Through a systematic review, this essay aimed at revising the concepts of severe pertussis, updating the epidemiology, pathophysiology, clinical presentation, antibiotic therapy and auxiliary therapeutic options for symptomatology and complications. Data sources: This review considered publications from the last 30years in the databases US National Library of Medicine (PubMed), Scientific Electronic Library Online (SciELO), Literatura Latino-americana e do Caribe em Ciências da Saúde (LILACS), Cochrane, Google Scholar, as well as protocols of the Ministry of Health and recommendations of the Centers for Disease Control and Prevention, related to childhood pertussis (whooping cough), with emphasis on its severe form. This research was based on keywords derived from the terms "pertussis", "azithromycin", "antitussives", "leukocyte reduction" in Portuguese and English. Duplicate studies and those with unavailable full-text were excluded. Data synthesis: Among 556 records found, 54 were selected for analysis. Pertussis, as a reemerging disease, has affected all age groups, evidencing the transient immunity conferred by infection and vaccination. Severe cases occur in neonates and infants, with secondary viral and bacterial complications and malignant pertussis, a longside hyperleukocytosis, respiratory failure and shock. Macrolides continue to be the chosen antibiotics, while antitussives for coughing remain without efficacy. The prompt treatment in Intensive Care Units improved the prognostic in severe cases, and transfusion was promising among procedures for leukoreduction. Conclusions: Approaching severe pertussis in childhood remains a challenge for diagnostic and therapy, as the available therapeutic options are still unsatisfactory. Strategies of prevention are expected to reduce the occurrence of severe cases, while new studies should confirm the role of auxiliary therapies.

RESUMO Objetivo: Rever os conceitos de coqueluche grave, atualizar epidemiologia, fisiopatologia e apresentação clínica, verificar as recomendações de antibioticoterapia e conhecer opções terapêuticas auxiliares na sintomatologia e complicações, por meio de revisão sistemática. Fontes de dados: Foram pesquisados trabalhos publicados nos últimos 30 anos nas bases US National Library of Medicine (PubMed), Scientific Electronic Library Online (SciELO), Literatura Latino-americana e do Caribe em Ciências da Saúde (LILACS), Cochrane e Google Scholar, bem como protocolos do Ministério da Saúde e recomendações do Centers for Disease Control and Prevention, relacionados à coqueluche na infância, com ênfase na forma grave. Apesquisa baseou-se em palavras-chave derivadas dos termos "coqueluche", "azitromicina", "antitussígenos" e "redução de leucócitos", nos idiomas português e inglês. Foramexcluídos estudos em duplicata ou texto integral indisponíveis. Síntese dos dados: Dos 556 registros encontrados, foram selecionados 54 para análise. A coqueluche, como doença reemergente, tem acometido todas as faixas etárias, evidenciando a imunidade transitória conferida pela infecção e pela vacinação. Quadros graves ocorrem em neonatos e lactentes, com complicações virais e bacterianas secundárias e pertussis maligna, com hiperleucocitose, insuficiência respiratória e choque refratário. Os macrolídeos continuam como antibióticos de escolha. Os sintomáticos da tosse não demonstraram eficácia. O suporte precoce em Unidade de Terapia Intensiva melhorou o prognóstico dos casos graves e a exsanguineotransfusão se mostrou a mais promissora entre os procedimentos para leucorredução. Conclusões: A abordagem da coqueluche grave na infância segue como desafio diagnóstico e terapêutico. As opções terapêuticas disponíveis ainda são insatisfatórias. Espera-se que as estratégias de prevenção reduzam a ocorrência de casos graves e que novos estudos confirmem o papel das terapias adjuvantes.

Correlação de alterações hematológicas em doenças parasitárias / Correlation of hematological changes in parasitic diseases

Os enteroparasitos causam aos seus portadores, entre outros agravos, desnutrição seguida por perda de peso, diarreias, vômitos, desidratação, anemia e enterites. Todos esses sintomas podem desencadear distúrbios dos índices hematológicos como contagem de hemácias, hematócrito, hemoglobina, leucócitos totais e eosinófilos. Este estudo teve como objetivo avaliar e analisar as alterações hematológicas em indivíduos com diagnóstico parasitológico positivo para enteroparasitos. Foi realizado um estudo com base nos dados laboratoriais, em que se analisou o hemograma de 412 indivíduos positivos para enteroparasitoses. Os dados demonstraram que existem relações entre as alterações hematológicas, principalmente a anemia, leucocitose e a eosinofilia, com as infecções parasitárias intestinais. Verificou-se também a frequência de poliparasitismo e suas alterações mais frequentes. O estudo apresentou uma possível contribuição para futuros trabalhos que relatem a importância da prevenção e tratamento das doenças parasitárias em humanos.

The enteroparasites cause to their carriers, among other damages, malnutrition followed by weight loss, diarrhea, vomiting, dehydration, anemia and enteritis. All these symptoms can trigger hematological indices disorders such as red blood cell count, hematocrit, hemoglobin, total leukocytes and eosinophils. This study aimed to evaluate and analyze the hematological alterations in individuals with positive parasitological diagnosis for enteroparasites. A study was carried out based on the laboratory data, in which the hemogram of 412 positive individuals for enteroparasitoses was analyzed. The data demonstrated that there are relationships between hematological changes, mainly anemia, leukocytosis and eosinophilia, with intestinal parasitic infections. The frequency of polyparasitism and its most frequent alterations were also verified. The study presented a possible contribution to future studies that report the importance of the prevention and treatment of parasitic diseases in humans

Haematological Parameters Associated with Malaria and Its Controls

Aims: This research aimed to evaluate the haematological parameters associated with malaria and its controls.Materials and Methods: A convenient cross-sectional technique was used for the study for which the sample size was determined by using the formula; n= Z² (P) (1-P) / (A) ². The haematological profile was performed using the Sysmex 2000i automated blood cell counter machine.Results and Discussion:The erythrocyte profiles (RBC, HB, HCT, RDW-SD and RDW-CV) are highly affected by malaria, whereas MCH, MCHC, and MCV did not show significant variations between the positive malaria cases and negative malaria cases. Means of haemoglobin concentrations, RBC count and HCT values for cases with positive malaria were significantly lower than negative malaria cases and controls for all the age groups and sexes. Conclusion:The study showed that there were haematological profiles between the positive and negative malaria cases and this can be used in conjunction with clinical and microscopic parameters to heighten the suspicion of malaria as well as prompt initiation of therapy for diagnosing malaria

Gall stones: a fundamental clinical review

Formation of stones in the gall bladder is known as cholelithiasis. About 10% to 20% of Western population are suffering from gall stones and this percentage is increasing day by day. Biochemically gall stones are classified into black pigment stones, brown pigment stones and cholesterol stones. Gall stones can be anatomically located at two possible sites; in the gall bladder known as cholelithiasis and in the common bile duct known as choledocholithiasis. Gall stones may present with symptoms known as symptomatic gallstones or without symptoms known as asymptomatic gallstones. The major causes of gallstones are high cholesterol diet, low bile salt levels, decreased gall bladder motility etc. Obesity, female gender, family history, rapid weight loss and vitamin B12 or folic acid deficiency are considered as important risk factors in the development of gall stones. The clinical presentations include acute cholecystitis and febrile illness with pain and tenderness in the right upper quadrant (Murphy sign). Generalized body weakness and weight loss are considered as generalized symptoms of gallstones. The complications include cholangitis, empyema of gall bladder, pancreatitis, abscess formation, porcelain gall bladder and gall bladder perforation. The differential diagnosis of gall stones is carried out based on endoscopy, ALT and AST serum levels. Non-surgical treatment for gall stones is oral dissolution therapy. The standard surgical treatment for gall stones is cholecystectomy.

Revisiting the complete blood count and clinical findings at diagnosis of childhood acute lymphoblastic leukemia: 10-year experience at a single center

Abstract Background Heterogeneity regarding clinical and laboratory findings at diagnosis of acute lymphoblastic leukemia exists. The frequency of complete blood count abnormalities and its combinations, symptoms and physical findings were investigated in Hispanic children from an open population at the diagnosis of acute lymphoblastic leukemia. Methods The patient charts and electronic records of under 16-year-old children diagnosed with acute lymphoblastic leukemia over 10 years at a regional hematology center of a university hospital were analyzed to retrieve data concerning the complete blood count at first evaluation. Type and distribution of abnormal data, frequency of symptoms and physical findings at presentation were documented. Results The records of 203 children aged 0-15 years diagnosed with acute lymphoblastic leukemia from 2006 to 2016 were revisited. The results of the blood workup showed a median white blood cell count of 7120 × 109/L (range: 450-600,000 × 109/L), and a median hemoglobin concentration of 7.5 g/dL (range: 2.4-15.3 g/dL), whereas the median platelet count was 47,400 × 109/L (range: 4000-544,000 × 109/L). Leukocytosis and leukopenia were present in 36.6% and 36.1% of cases, respectively; anemia was diagnosed in 82.9% children. The order of frequency for major clinical symptoms was fatigue 62%, fever 60%, bone and joint pain 39%, hyporexia 33% and weight loss 21%, while main physical findings were hepatomegaly 78%, splenomegaly 63%, lymphadenopathy 57%, pallor 48%, and purpura 30%. Conclusion Data differing from those classically expected at diagnosis of acute lymphoblastic leukemia in children were documented in a cohort of Hispanic children over one decade with a wide spectrum of complete blood count abnormalities, forms of presentation and frequency of physical findings.

Leukostasis by hyperleukocytic childhood acute leukemia: pathophysiology, clinical presentation, and emergency care

Hyperleukocytosis (HL), defined by a peripheral white blood cell (WBC) count exceeding 100,000/mm³, is occasionally observed in childhood acute leukemia. The increased viscosity in the micro-circulation by HL and the interaction between the leukemic blasts and endometrium of blood vessels sometimes result in leukostasis. Leukostasis can incur life-threatening manifestations, such as respiratory distress, brain infarction and hemorrhage, and renal failure, needing an emergency care. Although early stage of leukostasis is difficult to detect due to nonspecific manifestations, an emergency care is mandatory because leukostasis can proceed to a fatal course. Initial management includes an aggressive fluid therapy that can reduce WBC count, and prevent other metabolic complications implicated by HL. Packed red blood cells should be judiciously transfused because it increases blood viscosity. Conversely, transfusion of platelet concentrates or fresh frozen plasma, which does not affect blood viscosity, is recommended for prevention of hemorrhage. To reduce tumor burden, leukapheresis or exchange transfusion is commonly performed. However, the efficacy is still controversial, and technical problems are present. Leukapheresis or exchange transfusion is recommended if WBC count is 200,000–300,000/mm³ or more, especially in acute myelocytic leukemia, or manifestations of leukostasis are present. In addition, early chemotherapy is the definite treatment of leukostasis.

Correlación de la leucocitosis y lesión intracraneal en pacientes con traumatismo craneoencefálico / Correlation of leukocytosis and intracranial injury in patients with traumatic brain injury / Correlação de leucocitose e lesão intracraniana em pacientes com traumatismo crânioencefálico

Resumen: El daño microvascular difuso se asocia a pérdida de la autorregulación vascular cerebral y a pérdida de integridad de la barrera hematoencefálica. El TCE (traumatismo craneoencefálico) está asociado a un aumento en los niveles séricos de catecolaminas. Las catecolaminas son responsables de los depósitos de neutrófilos. Las catecolaminas aumentan la cuenta leucocitaria, introduciendo las células marginadas al pool circulante. La respuesta de fase aguda también se caracteriza por leucocitosis al ingreso, por lo que es probable que la cuenta de células blancas sirva como indicador adicional al diagnóstico y pronóstico del trauma de cráneo. Material y métodos: Estudio de cohorte prospectivo longitudinal. Se incluyeron pacientes atendidos con TCE, se recopilaron estudios de imagen y de laboratorio. Resultados: De los pacientes atendidos con hemorragia subaracnoidea (HSA), se encontró a su ingreso una media de leucocitos de 17,718 10^3/µl y de 13,970 10^3/µl a las 24 horas del trauma, con una p = 0.000 y 0.001, respectivamente. En pacientes con hematoma subdural (HSD) se observó a su ingreso una media de leucocitos de 18,212 10^3/μl y de 13,319 10^3/µl a las 24 horas, con una p = 0.000 y 0.003, respectivamente. En pacientes con contusión hemorrágica se detectó a su ingreso una media de leucocitos de 13,225 10^3/µl y de 12,501 10^3/µl a las 24 horas, una p = 0.091 y 0.027, respectivamente. En pacientes con hematoma epidural (HE) se observó a su ingreso una media de leucocitos de 16,527 10^3/µl y de 13,240 10^3/µl a las 24 horas, con una p = 0.000 y 0.019, respectivamente.

Abstract: Diffuse microvascular damage is associated with loss of cerebral vascular self-regulation and loss of integrity of the blood-brain barrier. Traumatic brain injury is associated with an increase in serum levels of catecholamines. Catecholamines are responsible for neutrophil deposits. Catecholamines increase the leukocyte count by introducing the marginal cells into the circulating pool. The acute phase response is also characterized by leukocytosis on admission. Therefore, the white cell count is likely to serve as an additional indicator to the diagnosis and prognosis of TBI. Material and methods: Longitudinal prospective cohort study. Patients treated in the emergency room with TBI were included, blood test and imaging studies were collected. Results: Of the patients treated with subarachnoid hemorrhage (SAH), a mean of leukocytes on entry of 17,718 10^3/µl on admission and 13,970 10^3/µl on 24 hours of trauma, with p = 0.000 and 0.001. In patients with subdural hematoma, a mean number of leukocytes was found at 18,212 10^3/µl and 13,319 10^3/µl at 24 hours, with p = 0.000 and 0.003. For patients with hemorrhagic contusion, leukocytes were found on admission on average 13,225 10^3/µl and at 12,501 10^3/µl at 24 hours, a p = 0.091 and 0.027. In patients with epidural hematoma, a mean of 16,527 10^3/µl leukocytes was found on admission, at 24 hours 13,240 10^3/µl, with p = 0.000 and 0.019.

Resumo: O dano microvascular difuso está associado à perda da autorregulação vascular cerebral e à perda da integridade da barreira hematoencefálica. O TCE está associado a um aumento nos níveis séricos de catecolaminas. As catecolaminas são responsáveis pelos depósitos de neutrófilos. As catecolaminas aumentam a contagem de leucócitos introduzindo as células marginais no pool circulante. A resposta de fase aguda também é caracterizada por leucocitose na admissão. Assim, a contagem de células brancas provavelmente servirá como um indicador adicional do diagnóstico e prognóstico do trauma craniano. Material e metodos: Estudo de coorte prospectivo longitudinal. Incluiram-se pacientes atendidos com TCE, foram coletados estudos de imagem e laboratório. Resultados: Dos pacientes atendidos com hemorragia subaracnoide (HSA), uma média de leucócitos de 17,718 10^3/µl na admissão e 13,970 10^3/µl em 24 horas após o trauma. Com P = 0.000 e 0.001, respectivamente. Em pacientes com hematoma subdural (HSD), encontramos uma média de leucócitos na admissão de 18,212 10^3/µl e 13,319 10^3/µl às 24 horas, com p = 0.000 e 0.003. Para os pacientes com contusão hemorrágica, encontramos na admissão uma média de leucócitos de13,225 10^3/µl e às 24 horas de 12,501 10^3/µl, com p = 0.091 e 0.027. Nos pacientes com hematoma epidural (HE) foi encontrada uma média de 16,527 10^3/µl leucócitos à admissão, às 24 horas 13,240 10^3/µl, com p = 0.000 e 0.019.

Application of leukoreduction therapy in severe pertussis with leukocytosis and pulmonary hyperten-sion:3 infant cases reports and literatures review / 中国小儿急救医学

Objective To investigate the efficacy and safety of leukoreduction therapy in severe per-tussis in infants. Methods Therapeutic processes of 3 cases of severe pertussis in PICU of Shanghai Children′s Medical Center were retrospectively studied from October 2017 to May 2018. We reviewed the related literatures and summarized the time and effectiveness of leukoreduction therapy in severe pertussis. Results All 3 cases had leukocytosis,respiratory faliure,pulmonary hypertension and right heart failure. One case had multiple organ failure before undergoing exchange transfusion therapy and eventually died. Two cases that had pulmonary hypertension during the period of WBC′s rising accepted leukopheresis therapy before multiple organ failure,and eventually survived. We reviewed the foreign literatures which was almost case reports,leukoreduction therapy might improve the prognosis of severe pertussis in infants,but the time of using it had no conclusion. Conclusion This is the first report of leukoreduction therapy for the severe per-tussis in infants in China. It provides a new method for the treatment of severe pertussis in infants. It is worth looking forward to use this method combined with continuous renal replacement therapy and extracorporeal membrane oxygenation technology. In the future,multicenter clinical research should be done to explore the effectiveness and safety of leukoreduction therapy in the severe pertussis in infants.