Pyopneumothorax Secondary to Pulmonary Tuberculosis Superadded by Congenital Factor XIII Deficiency: A Case Report.

Pyopneumothorax is a rare complication of pulmonary tuberculosis, contributing significantly to morbidity and mortality. Additionally, factor XIII deficiency, a rare bleeding disorder, may pose a diagnostic challenge due to normal results in routine coagulation tests. We present the case of an 18-year-old boy who presented with a history of left-sided pyopneumothorax secondary to drug-sensitive Mycobacterium tuberculosis, complicated by congenital factor XIII deficiency. After three months of intercostal drainage placement, the patient developed severe anemia and bleeding tendencies, necessitating a referral to clinical hematology. Genetic testing revealed factor XIII deficiency. This case highlights the complicated interplay between tuberculosis-related complications and a coexisting genetic disorder, highlighting the importance of comprehensive clinical assessment and multidisciplinary management.

Clinicopathological Parameters of Haemophilia Patients at a Tertiary Care Centre in Northern India.

INTRODUCTION: Haemophilia affects a large number of people all over the world, yet very little is known about the clinical manifestations and diagnostic protocols of the condition in areas with limited access to resources in developing countries. Understanding the clinical spectrum and diagnostic approach will help with the design of measures to address the situation in these places. The primary objective of this study was to examine the clinicopathological parameters of haemophiliac patients. MATERIALS AND METHODS: From the departmental archive, a thorough history of each patient was retrieved, including values of bleeding time, prothrombin time, activated partial prothrombin time, and percentage of specific factor activity. RESULTS: Out of a total of 385 cases over the period of six years, 86.75% were classified as haemophilia A and 13.25% of cases were diagnosed as haemophilia B. In terms of the severity of the disease, 44.93% were classified as severe, 42.08% as moderate, and 12.99% as mild. Joint bleeding was the first and most typical clinical manifestation of the disease, accounting for 34.80% of cases, followed by ecchymosis (23.12%), post-traumatic bleeding (12.73%), epistaxis (12.20%), and gum bleeding (8.05%). 1.56% of patients had a positive screening test for the hepatitis C virus, followed by 1.30% for HIV and 0.78% for hepatitis B surface antigen. CONCLUSION: In the presence of joint bleeding, ecchymosis, and post-traumatic bleeding in an otherwise healthy individual, a clinician should be alerted to the possibility that the patient has haemophilia and should request a work-up for the bleeding disorder.

Early and Effective Diagnosis of Sepsis Using Flow Cytometry.

Objective Sepsis is a major global health issue due to its high death and morbidity rates. To avoid the negative effects of sepsis and decrease mortality, it is vital to diagnose and treat it as soon as possible. Blood cultures can take up to 2 days to give result, and they are not always reliable. According to recent studies, neutrophil CD64 expression might be a sensitive and specific option for assessing sepsis. This study aimed to evaluate the diagnostic performance of a flow cytometry analysis for the expression of neutrophil CD64 in sepsis and its comparison with other standard tests in a tertiary care center. Materials and Methods Prospective analysis on 40 blood samples from suspected sepsis patients admitted to intensive care units with criteria for the systemic inflammatory response syndrome on presentation was performed for expression of neutrophil CD64, C-reactive protein, procalcitonin, and complete blood count. Ten healthy volunteers were also enrolled in this prospective study. The laboratory results were compared in different groups. Results The neutrophil CD64 had the highest diagnostic value to differentiate between patients of sepsis and nonsepsis groups with a sensitivity of 100% (95% confidence interval [CI]: 77.19-100%) and 100% (95% CI: 55.32-86.83%); specificity of 90.00% (95% CI: 59.58-99.49%) and 87.24% (95% CI: 66.69-99.61%); and likelihood ratio of 10.00 and 7.84, respectively. Conclusion The neutrophil CD64 expression provides a more sensitive, specific, and novel marker for the early detection of sepsis in critically ill patients.

A Rare Case of Metastatic Small Cell Carcinoma of Lung in a Follow-Up Patient of Chronic Myeloid Leukemia on Imatinib Treatment.

Imatinib has an excellent long-term survival rate and significantly ameliorates the treatment of chronic myeloid leukaemia during the past few decades. There is now a concern that first-generation tyrosine kinase inhibitors can cause secondary neoplasms. Here, we describe a case of a 49-year-old non-smoker male who was diagnosed with chronic myeloid leukaemia and treated with imatinib. After 15 years of treatment, an incidental right cervical lymphadenopathy was noted. The fine needle aspiration cytology from the lymph node revealed the small round cell morphology. In order to identify the primary lesion, computerised tomography of the thorax and abdomen was advised, which revealed a diagnosis of small cell carcinoma lung. In the index case report, we will discuss the potential side effects of first-generation tyrosine kinase inhibitors on a long-term basis along with treatment protocols for metastatic small cell carcinoma lung in a disease-free follow-up case of chronic myeloid leukaemia.

Acute Myeloid Leukaemia With Translocation (8;21) Masquerading as Peripheral Blood Eosinophilia Having Dysplastic Features: A Diagnostic Challenge.

Eosinophilia with a modest number of blasts (<20%) in the peripheral blood and bone marrow smears raises suspicion for myeloproliferative neoplasms (MPNs) and acute myeloid leukaemia (AML). Here, we present a case of AML in a 16-year-old boy who presented with high-grade fever, respiratory distress, and generalised weakness. Marked eosinophilia with dysplastic features and occasional blasts were found in the peripheral blood. In view of dysplastic eosinophils and occasional blasts in peripheral blood, a bone marrow examination was requested which revealed increased eosinophils and their progenitors with dysplasia and a modest number of blast cells (<20%). The bone marrow findings suggest MPNs, which were eventually identified as AML having translocation (8;21) with the aid of immunophenotyping and cytogenetic studies. Eosinophilia and its phenotypic anomalies are rarely found in peripheral blood smears of AML patients with translocation (8;21) which may have been related to the leukaemic process.

Prevalence of anemia among reproductive-age females in the Tharu tribe of the Indo-Nepal border region.

Background: India shares the largest number of anemia patients globally. Anemia in reproductive-age female, affects not only the maternal mortality and morbidity but inversely affect the pregnancy outcome also. Tribals in India are geographically isolated and most of them belong to very low socio-economic status. Regarding Tharu tribes, to date, there is no study to find the prevalence of anemia in this community. Aim: We aim to find the prevalence of anemia in the reproductive-age female of the Tharu community. Additionally, we also accessed the severity and possible causes of anemia. Materials and Methods: A total of 440 reproductive age females from the Tharu community were recruited in this study from Tharu predominant Tulsipur tehsil of Balrampur district on 8 December 2019. CBC of each sample was performed by a 3-part basic hematology analyzer. Results: The mean (SD) hemoglobin level of the study group observed was 11.11 (±1.96) gm/dl with a median value of 11.3 gm/dl. Prevalence of anemia was noted in 283 (64.32%) participants. Amongst the anemic subjects, mild, moderate, and severe anemia was noted in 33.57%, 57.24%, and 9.19%, respectively. Microcytic, normocytic, and macrocytic anemia was noted in 53.00%, 44.88%, and 2.12%, respectively. Conclusion: The high prevalence of mild and moderate anemia in reproductive-age women is a matter of concern and should be dealt with priority. Community-based screening for hemoglobinopathies is also needed to evaluate the actual cause of anemia.

Hyperlipidemia and Platelet Parameters: Two Sides of the Same Coin.

INTRODUCTION:  Hyperlipidemia is a disorder in which lipid and cholesterol levels in the blood are elevated. Diabetes, coronary heart disease, obesity, and hypertension are commonly linked to hyperlipidemia. Despite this, hyperlipidemia is a widely neglected illness, owing to its asymptomatic nature, ignorance of aberrant lipid profiles on screening, and economic issues in poor countries such as India. Platelets have been shown to have a role in the thrombus consequences of atheromatous damage in hyperlipidemic individuals by initiating and propagating atherosclerotic plaques. Platelets with bigger diameters are thought to be more metabolically, enzymatically, and functionally agile than platelets with lower sizes. In steady-state operation, these bigger platelets release more thromboxane B2 than regular platelets. Platelets with bigger sizes are more hemostatically active and hence have a higher chance of forming a thrombus and thromboembolism. The aim of this study was to compare the values of key platelet parameters and platelet function in hyperlipidemic patients with normal age and sex-matched controls. MATERIAL AND METHODS:  A total of 100 individuals were included in this study, with 68 cases of hyperlipidemia and 32 controls having normal lipid profiles. Platelet volume indices (PVI) such as platelet count (PC), mean platelet volume (MPV), platelet distribution width (PDW), platelet large cell ratio (P-LCR), plateletcrit (PCT), and platelet function (platelet aggregation with adenosine diphosphate, ADP) were compared between hyperlipidemia patients and age sex-matched controls with normal lipid profiles. RESULTS:  The cases had a statistically significant higher mean MPV (10.55 ± 1.81), PDW (14.93 ± 2.82), and P-LCR (30.97 ± 11.74) compared to mean MPV (9.35 ± 1.85), PDW (13.10 ± 2.60), and P-LCR (25.13 ± 12.23) of controls (p-value < 0.05). No significant difference was observed between the study group and control group with respect to mean PC and PCT (p-value > 0.05). In this study, there was a statistically significant increase noted in platelet aggregation percentage in hyperlipidemic patients than in the control group (42.03 ± 25.28 vs 31.25 ± 15.11) (p-value < 0.05). CONCLUSION:  To conclude, platelet parameters are a significant, easy, and cost-effective method for predicting future acute episodes in hyperlipidemic patients that should be utilized more widely. To avoid vascular events, these individuals may require higher antiplatelet dosages and more rigorous hyperlipidemia therapy.

Reticular Skin Rash as an Adverse Effect of 5-Azacitidine.

Azacitidine is a hypomethylating agent used for the treatment of patients with myelodysplastic syndrome (MDS). It has been approved by the Food and Drug Administration (FDA) and the European Medicines Agency for the treatment of MDS and is also indicated for the treatment of acute myeloid leukemia (AML). Injection site erythema, ecchymosis, and petechiae are some of the common cutaneous adverse reactions associated with azacitidine. This article describes a rare adverse cutaneous drug reaction with azacitidine in the form of a reticular generalized skin rash in a 28-year-old female with AML.

Serum Tumor Necrosis Factor-Alpha Levels in Acute Leukemia and Its Prognostic Significance.

Introduction Tumor necrosis factor-alpha (TNF-α) is a pleiotropic cytokine that facilitates malignant cells in immune evasion, survival, and treatment resistance by generating a favorable milieu for them. It is shown to be ectopically produced by malignant/leukemic and immune cells in the tumor microenvironment, providing a tumor-supportive environment and playing an important part in the establishment and progression of malignant cells. It is linked to hyperleukocytosis, high blast count, and poor clinical outcomes in acute leukemia (AL). Considering the varied role and different expression patterns of tumor necrosis factor-alpha in acute leukemia and its clinical relevance, the present study was planned to monitor the level of tumor necrosis factor-alpha in patients with acute leukemia and its correlation with disease outcome. The aim of this study was to monitor the level of tumor necrosis factor-alpha in patients with acute leukemia at the time of diagnosis and after induction chemotherapy. Material and methods The study included cases classified as acute leukemia based on morphological examination, bone marrow analysis, and flow cytometry. In all patients with acute leukemia (n = 90) and controls (n = 10), the serum tumor necrosis factor-alpha level was measured using a Diaclone Human ELISA kit (Diaclone, Besancon, France) (solid phase sandwich ELISA) at diagnosis and after induction chemotherapy. Results Tumor necrosis factor-alpha levels were substantially higher in T-acute lymphoblastic leukemia (T-ALL) cases, followed by acute myeloid leukemia (AML) and B-acute lymphoblastic leukemia (B-ALL), at the time of diagnosis, compared to the control. A significant reduction in serum tumor necrosis factor-alpha level was seen in patients with acute leukemia after induction phase chemotherapy (P < 0.05). Tumor necrosis factor-alpha levels were considerably reduced (P < 0.001) in the majority of acute leukemia cases after the induction phase, while high tumor necrosis factor-alpha levels were positively correlated with incomplete remission status in the remaining cases. Conclusion Tumor necrosis factor-alpha is involved in the progression of acute leukemia and its relapse. High levels of tumor necrosis factor-alpha are linked to leukocytosis, high blast counts, and worse survival in patients with acute leukemia. Monitoring of tumor necrosis factor-alpha may be helpful in patients with acute leukemia in view of available antitumor necrosis factor-alpha therapy.

Hematological Changes in the Second Wave of SARS-CoV-2 in North India.

Background COVID-19 is a rapidly spreading pandemic caused by SARS-CoV-2. India experienced a second wave peak in mid of April 2021, and it emerged as a medical crisis. This study was taken up to show if the hematological and peripheral blood changes can be used as a readily available tool to demarcate the patients needing ICU care so that the ICU can be utilized more prudently.  Material and method One hundred reverse transcription-polymerase chain reaction (RT-PCR) confirmed cases of COVID-19, 50 each from ICU and non-ICU wards, were included in this observational study. At the time of admission blood sample was collected for evaluation of hematological parameters. Results We noted that 74% of patients admitted in ICU were males and 28% were more than 60 years of age. In ICU patients, the absolute neutrophil count (ANC) was significantly raised when compared to non-ICU cases (p=0.023). The nadir absolute lymphocyte count (ALC) was 0.11x109/L in ICU patients and 0.95x109/L in non-ICU patients. There was a significant increase in neutrophil-lymphocyte ratio (NLR; p<0.001) in ICU patients with a proposed cut-off value of 7.73. Platelet-lymphocyte ratio (PLR) was also raised in ICU patients; however, this increase was not significant (p= 0.623). The proposed cut-off value of PLR is 126.73. A significant reduction in a lymphocyte-monocyte ratio (LMR) was observed in ICU patients when compared to non-ICU cases (p<0.001). Thrombocytopenia was more commonly seen in ICU patients; however, this was not statistically significant. Viral-induced cytopathic effects like plasmacytoid lymphocytes with cytoplasmic granules, the presence of toxic changes in neutrophils, and large-sized platelets were commonly observed in ICU patients. Conclusion Our results suggest that hematological parameters like ANC, absolute lymphocyte count (ALC), platelet count, NLR, PLR, and peripheral smear changes are simple assessment factors that can serve as indicators for the severity of COVID-19 and will demarcate the patients who need ICU-care. This will help in the judicious use of ICU facilities for patients who are actually in need.

Bleeding Versus Thrombotic Tendency in Young Children With Beta-Thalassemia Major.

Introduction Bleeding and thrombotic events are known to occur in beta-thalassemia major (BTM) patients and have been attributed to hepatic iron overload associated with multiple blood transfusions. We evaluated hemostatic parameters in children with BTM who had no previous history of bleeding or thrombotic episodes. Materials and Methods Hemostatic parameters including prothrombin time (PT), activated partial thromboplastin time (APTT), platelet aggregation, protein C and S, iron profile, and liver function tests were evaluated in 54 children (median age = 12 months, age range = 4-144 months) with BTM and 15 age and sex-matched controls. Results The mean PT and APTT of patients were significantly higher (P=0.016 and P <.001) than that of controls. Mean protein C, protein S activity and platelet aggregability with adenosine 5-diphosphate (ADP) as an agonist in patients were significantly lower (P <.001, P <.001 and P=0.007, respectively) than that in controls. Mean serum ferritin in BTM children was not significantly elevated to be associated with hepatic dysfunction. Conclusion Deranged hemostatic parameters indicative of bleeding and thrombotic tendencies are observed in BTM children from an early age and may not be solely due to hyperferritinemia-associated hepatic dysfunction. Despite the presence of deranged hemostatic parameters, a state of balance exists between bleeding and thrombosis, and an imbalance may lead to bleeding or thrombotic events at a later age.