Early hematological parameters as predictors for outcomes in children with dengue in northern India: A retrospective analysis

Abstract INTRODUCTION: Dengue presents with a variable clinical course, ranging from mild illness to potentially fatal hemorrhage and shock. We aimed to evaluate the capabilities of various hematological parameters observed early in the course of illness for predicting the clinical outcomes of illness. METHODS: We retrospectively analyzed the records of children admitted in the pediatric inpatient services of the institute with dengue between 2017 and 2019. We determined the relationships between the hematological parameters observed during the first evaluation and the various clinical outcomes. RESULTS: We evaluated data from 613 patients (age range, 26 days to 17 years). Of these, 29.85% exhibited fever with warning signs, and 8.97% had severe dengue. Lower values of hemoglobin, platelet count, mean corpuscular volume, mean corpuscular hemoglobin concentration, and mean platelet volume, and higher values of total leukocyte count (TLC), hematocrit, and red cell distribution width variably correlated with numerous clinical outcomes-duration of hospital stay, development of complications, requirement of blood component transfusion, inotropic support, and mortality. Among the parameters, TLC ≥20,000/mL and initial platelet count ≤20,000/mL significantly associated with mortality, with odds ratios (95% confidence interval) of 11.81 (4.21-33.80) and 5.53 (1.90-16.09), respectively. CONCLUSIONS: Hematological parameters observed early during dengue infection may predict its clinical outcomes in infected children. Initial high TLC and low platelet count are potential predictors of fatal outcomes in the course of disease.

Prospective study of accuracy of C-reactive protein and leucocyte count in diagnosis of acute appendicitis in comparison with histopathology

Background: Acute appendicitis is one of the most common surgical emergencies. Approximately 7.0% of the population will have appendicitis in their lifetime with the peak incidence occurring between the age of 10 and 30 years. The classical history of peri umbilical pain at beginning and later shifting to right iliac fossa is present in only 50% cases. C-reactive protein is an acute phase reactant synthesized by liver in response to tissue injury. Serial measurement of CRP can improve the accuracy of diagnosing acute appendicitis.Methods: A prospective study of 70 cases with clinical diagnosis of acute appendicitis admitted in the department of surgery, B. R. D. Medical College Gorakhpur during a period of one year.Results: There was young age predominance (54.2%) and commonest presenting symptom was RIF pain (100%) followed by nausea/vomiting (66%) and fever (60%). Among 48 cases of histopathology proven appendicitis, CRP was raised in 44 cases (91.6%).Conclusions: Serial measurement of CRP is more sensitive and specific than TLC count and the raised value of CRP is directly related to the severity of inflammation. Combining the TLC and CRP increases the diagnostic accuracy and therefore may reduce rate of negative appendectomy.

A prospective study of inflammatory biomarkers in neonatal sepsis at a tertiary level hospital

Background: Sepsis in neonates is a syndrome which is characterized clinically by systemic symptoms or signs of infection and associated with bacteremia in the first 28 days of life. More than 40% of under-five deaths globally occur in the neonatal period, resulting in 3.1 million newborn deaths each year. Procalcitonin (PCT) is an early diagnostic tool for neonatal sepsis.Methods: Present prospective cross- sectional observational study was conducted at NICU of Base hospital, Delhi Cantonment from 1st Dec 2016 to Jan 31st, 2018. Universal sampling technique was followed. SPSS version 21 was used for statistical analysis. A p-value of less than 0.05 was taken as significant.Results: Out of the total 440 cases, 63% were males while rest 37% were females.' Mean gestation age and birth weight of the babies was 35.6 weeks and 2.13 Kg respectively. Raised/ decreased Total Leucocyte Count (TLC) and raised pro calcitonin levels were seen in 23% and 19.8% cases respectively.Conclusions: These results indicated that the sensitivity of procalcitonin was higher than TLC for the diagnosis of culture proven neonatal sepsis. Hence, PCT is a more sensitive and useful biomarker for the diagnosis of neonatal sepsis.

To study the role of hyperbilirubinemia as a marker of gangrenous/ perforated appendicitis

Background: Acute appendicitis is the most common cause of acute abdomen in young adults requiring Emergency Surgery. Diagnosing Acute Appendicitis clinically still remains a common surgical problem. Accurate diagnosis can be aided by additional testing or expectant management or both. These might delay surgery and lead to appendicular perforation with increased morbidity and hospital stay. The aim of the study: To study the incidence of hyperbilirubinemia in cases of acute appendicitis and its complications (Gangrenous/ Perforated). Materials and methods: This Prospective study was done in the Department of General Surgery, Madras Medical College and Rajiv Gandhi Government General Hospital in 2017. Patient admitted with clinical diagnosis of acute appendicitis or its complications (Perforated/ Gangrenous) in the Emergency. Final HPE was considered as a gold standard for diagnosing and categorizing patients as having Normal Appendix, Acute appendicitis and Acute appendicitis with Perforation/Gangrene. Results: Out of 246 cases of Acute appendicitis 42 Cases were Gangrenous/ Perforated Appendix (17.07%). Out of 42 cases of Gangrenous/ Perforated appendix maximum cases seen in the Age group 21-30 years (31%) and least seen in below 10 years (0.0%). Above 50 years no of cases of Gangrenous/ Perforated appendix were 3 (7.1%). Rebound tenderness predominantly present in cases of Gangrenous/ Perforated Appendicitis than Acute appendicitis cases and its statistically significant. Among 246 cases minimum age was 9 and the maximum age was 65 years and the mean age was 24 years. Mean Total leukocyte count was 12687 and Mean polymorph count was 75. Serum mean total T. Avvai, S. Nedunchezian. To study the role of hyperbilirubinemia as a marker of gangrenous/ perforated appendicitis. IAIM, 2019; 6(3): 272-277. Page 273 bilirubin was .92 and maximum was 2.4 Alvarado’s score maximum seen was 10 and least was 5 with mean about 7. Conclusion: Patients with clinical signs and symptoms of Acute appendicitis with raised serum bilirubin should be considered as having high predictive potential for Appendicular gangrene/ Perforation. Serum Bilirubin is an important adjunct in diagnosing the presence of Gangrenous/ Perforated Appendicitis along with other diagnostic aids.

A study to assess the therapeutic role of GM-CSF (EMGRAST -M) on augmentation of total leucocyte count and total platelet count in cancer patients after chemotherapy

Background: The aim of the present study was to assess the therapeutic role of GM-CSF (EMGRAST -M) on augmentation of total leucocyte count and total platelet count in cancer patients after chemotherapy.Methods: The total leucocyte count (TLC) and total platelet count (TPC) of thirty patients on chemotherapy were obtained before and after the administration of GM-CSF. The results were analysed retrospectively for the effect of GM-CSF on these parameters. Statistical analysis was done, and graphs were made by Libre office calc and Student’s T Test was used for comparison of data.Results: The study showed that EMGRAST-M had an impressive effect on both the platelet count and the leucocyte count.Conclusions: GM-CSF has a great therapeutic role in the enhancement of platelet count and leucocyte count in patients of cancer chemotherapy.

The Use of Laboratory and Physiological Parameters in Predicting Mortality in Sepsis Induced Hypotension and Septic Shock Patients attending The Emergency Department

Introduction: In this study, we sought to determine whether laboratory and physiological parameters can be useful in predicting mortality in patients with sepsis-induced hypotension and septic shock. Methodology: This prospective cohort study was carried out in the emergency department at an academic medical center. A total of 51 patients met enrollment criteria during the study period and 41 of them were included in the study. Inclusion criteria were patients 18 years old or older, diagnosed to have either sepsis-induced hypotension or septic shock and investigated sepsis marker (blood lactate and leukocytes) measured. Other physiological variables were also measured in this study. The main outcome measure was 30-day mortality. Kaplan-Meier, Log-rank and Cox's methods were used for statistical analysis using SPSS version 12.0.1. Results: 61% were diagnosed to have sepsis-induced hypotension and 39% were diagnosed with septic shock. Twenty two (54%) deaths occurred within the 30 day follow up. The overall mean blood lactate level and leukocyte counts were 3.52 mmol/L (SD=2.29) and 11.37 x 109 (SD=6.38) respectively. A Cox Proportional Hazard Analysis revealed an increase in blood lactate levels in the ED was associated with an increased risk of death (B=0.35, HR=1.45, 95% CI 1.22,1.73, p<0.001). However no significant correlation between the physiological parameters and the 30-day mortality. Patients with septic shock state prior to initial presentation has a lower 30 day survival compared to any other septic conditions. Conclusion: Our results support blood lactate level as a promising risk stratification tool when compared with leukocytes counts and other physiological parameters. The multivariate analysis showed that for every increment of lactate value of 1 mmol/L, the hazards of dying are expected to increase by 1.5 times (p<0.001).

Recuento leucocitario y riesgo cardiovascular tras un síndrome coronario agudo / Leukocyte count as a risk factor for coronary adverse events among patients admitted for an acute coronary syndrome

Background: Leukocytosis occurs as a response to a variety of infammatory processes. Aim: To determine if white blood cell count (WBCC) at admission among patients who suffer an acute coronary syndrome (ACS) has an independent prog-nostic value for the occurrence of new cardiovascular adverse events (CAE). Patients and Methods: Prospective study of 558 patients aged 68 ± 13 years (122 women) admitted to the hospital for an acute coronary syndrome. WBCC was measured at admission. A logistic regression model was used to assess the association of WBCC with the occurrence of CAE during the next six months after admission (post infarction angina, re-infarction, cardiac failure and mortality). Results: An univariate analysis showed that patients with a WBCC > 15.000 cell/mm³ had a signifcantly higher mortality and occurrence of CAE. The multivariate analysis showed that subjects with WBCC < 10.000 cell/mm³ experienced fewer CAE than subjects with a WBCC > 15.000 cell/mm³, with an odds ratio of 0.46 (95 percent confdence intervals = 0.21-0.97, p = 0,042). Conclusions: An elevated WBCC at admission among patients with an ACS is associated with a higher incidence of CAE in the ensuing six months.

Study on the association of serum matrix metalloproteinase-9 and white blood cell count to type 2 diabetes mellitus with macroangiopathy and the interventing treatment / 中华内分泌代谢杂志

Objective To evaluate the relationship between serum matrix metalloproteinase-9(MMP-9), white blood cell(WBC)count and type 2 diabetes mellitus with macroangiopathy and to investigate the mechanism of the protective effects of rusiglitazone(RSG)on blood vessel.Methods Serum MMP-9 was determined by ELISA in 30 normal controls and 80 type 2 diabetic patients(including 40 cases with macroangiopathy and 40 without maeroangiopathy).WBC count and other clinical parameters were also determined.32 type 2 diabetic patients received RSG(4rag qd)for 12 weeks.All parameters were determined after 4 weeks(17 patients)and after 12 weeks(all patients)to observe the changes in MMP-9,WBC and other parameters.Results In the diabetic patients,serum MMP-9 and WBC were markedly higher as compared with normal controls;and MMP-9 and WBC in patients with macroangiopathy[579(440-949)?g/L,(7.51?1.47)?10~9/L]were higher than those [324(275-423)?g/L,(6.22?0.79)?10~9/L]in the cases without macroangiopathy(P