Association of Red Blood Cell and Platelet Parameters with Metabolic Syndrome: A Systematic Review and Meta-Analysis of 170,000 Patients.

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

Effects of Neural Mobilization in Diabetic Peripheral Neuropathy: A Scoping Review.

Objective: The purpose of this scoping review was to explore the effects of neural mobilization (NM) on outcomes in adults with diabetic peripheral neuropathy (DPN). Methods: Five databases were searched-PubMed, Web of Science (Web of Science Core Collection), Physiotherapy Evidence Database (PEDro), and Scopus-from inception to January 2022. The studies included were randomized controlled trials, pre-post single group design, multiple case studies, controlled case studies, quasi-experimental studies, and single case studies, which are published in full text in English. Results: Six studies were included in this review, and most were of low-level evidence. The sample size of the studies ranges from 20 to 43, except for 1 case study, with a total of 158 participants in all the studies combined. In 4 out of 6 studies, only NM was given, whereas in 2 studies, NM was used along with other treatment strategies. The tibial nerve was the most studied nerve, whereas 1 study administered NM to nerves of the upper limbs, and only 1 trial examined the sciatic nerve. The outcomes included the Michigan Neuropathy Screening Instrument questionnaire, nerve conduction velocity, vibration perception threshold, heat/cold perception threshold, weight-bearing asymmetry and range of motion of lower limb, quality of life, and magnetic imaging changes. Conclusion: At present, only a few low-level studies exist on the use of NM for the treatment of adults with DPN. The evidence for use of NM on DPN is still limited and insufficient.

Effect of Whole-body Vibration on Depression, Anxiety, Stress, and Quality of Life in College Students: A Randomized Controlled Trial.

Objectives: To determine the effects of whole-body vibration (WBV) training on depression, anxiety, stress, and quality of life (QoL) in college students. Methods: The participants comprised college students who led physically inactive lifestyles as revealed by their Medical Outcomes Study Form 36 (SF-36) scores, and with elevated scores of Depression Anxiety Stress Scale (DASS) test. They were randomly allocated to two groups of 15 each: (a) the WBV group (male = 3, female = 12) and (b) the exercise group (male = 6, female = 9). The participants in the WBV group performed prescribed exercises while they stood on a vibrating platform whereas those in the exercise group performed the same exercises but without the vibrating platform. After four weeks of twice-a-week training, DASS and SF-36 were measured. The pre- and post-scores were compared between the groups. Results: Depression (p < 0.001), anxiety (p < 0.001), and stress (p < 0.001) were found to reduce significantly for the WBV group compared to the exercise group. There was also significant within-group improvement in all the components of SF-36 (p < 0.040). Conclusions: Exercising on the WBV platform may reduce depression, anxiety, and stress in college students and improve their overall QoL.

Whole body vibration showed beneficial effect on pain, balance measures and quality of life in painful diabetic peripheral neuropathy: a randomized controlled trial.

PURPOSE: The aim of the study was to determine the efficacy of whole body vibration (WBV) therapy on pain, neuropathy disability score, balance, proprioception and quality of life (QOL) in patients with painful diabetic peripheral neuropathy (PDPN). METHODS: Twenty-six (16 males and 10 females) patients with PDPN were selected on the basis of inclusion and exclusion criteria. Subjects were randomly allocated to an experimental group (n = 13, age = 60.69 ± 5.08) and a control group (n = 13, age = 59.54 ± 4.25). The experimental group was given WBV therapy for six weeks (3 days/week) in addition to standard medical care, dietary advice and lifestyle modifications. Control group was provided only standard medical care, dietary advice and lifestyle modifications. Outcome measures included numeric pain rating scale (NPRS), Leeds assessment of neuropathic symptoms and signs (LANSS), vibration perception threshold (VPT), neuropathy disability score (NDS), proprioception, single-leg stance test (SLST), timed up and go test (TUGT) and short form 36 questionnaire (SF-36). RESULTS: NPRS, LANSS, NDS, SLST and TUGT showed significant time effect (p ≤ 0.022) and time×group interaction (p ≤ 0.007), whereas group effect was found to be significant only in LANSS (p = 0.001). VPT showed significant group effect (p ≤ 0.045) and time×group interaction (p ≤ 0.007) at great toe, metatarsal head and total average score. SF-36 was found to be significant time effect (p ≤ 0.024) in all domains except limitations due to physical health (p = 0.461). SF-36 average score was found be significant for group effect (p = 0.002) and time×group interaction (p < 0.001). CONCLUSION: WBV improves sensory sensations like pain and vibration perception, neuropathy disability score, balance measures and health-related QOL in PDPN.

Malignant Melanoma Metastasizes to Colonic Polyp.

Malignant tumors metastasizing to the colon has been observed rarely. Gastrointestinal metastasis can present as benign, unpigmented polyps endoscopically. Most patients do not display any symptoms, and if symptomatic, they usually present with gastrointestinal bleeding. For patients with the history of melanoma, histopathology of polyp can change or alter the course of management. This is a case of a 74-year-old male diagnosed with recurrent melanoma of left ear. Colon cancer screening found blood in his stool. Colonoscopy displayed to have three polyps, one polyp was found to be malignant melanoma. The patient was started on Pembrolizumab, and was tolerating immunotherapy well with no new complaints three months later.

Improving Blood Transfusion Practices in a Community Hospital Setting: Our Experience with Real-Time Clinical Decision Support.

There is good evidence that 50% or more of red blood cell (RBC) transfusions are unnecessary. To curtail inappropriate RBC transfusions at our hospital, real-time clinical decision support was implemented in our electronic medical record (EMR) that alerts clinicians to the patient's most recent pretransfusion hemoglobin value upon order entry and provides Best Practice Advisory. This is a soft pop-up alert which is activated when the hemoglobin exceeds 7 g/dL. The ordering clinician can either honor (by cancelling the order) or override the alert. We studied the impact of the alert on blood utilization during a 3-month period (November 2016 to January 2017). For patients who were transfused despite the alert, a retrospective review of the medical chart was performed to determine whether or not the transfusion was clinically indicated. During the study period, 178 of the 895 RBC transfusion orders (20%) triggered the alert. After excluding duplicates, 144 orders were included in our analysis. Most of these orders (124/144, 86%) were carried out despite the alert. According to our chart review, 48% of the alert transfusions could be considered inappropriate, with hemodynamically stable, asymptomatic anemia being the leading indication. Of clinical services, orthopedic surgery had the highest rate of overriding the alert with no clinical justification (70%). The number of RBC transfusions dropped from 313.5 units per month (preintervention period) to 293.2 units per month (postintervention period)-a 6.5% decrease. Real-time clinical decision support may reduce the number of inappropriate RBC transfusions in a community hospital setting, though in our study, the decrease in blood utilization (6.5%) did not reach statistical significance.

Spindle Cell Carcinoma of the Lung/Pleura: An Incidental Finding.

A 59-year-old male with a medical history of abdominal aortic dissection underwent a follow-up computed tomography (CT) scan abdomen, which showed an incidental pleural-based mass in the left lung base. The patient underwent an ultrasound (US)-guided biopsy and the histology was consistent with spindle cell carcinoma (SpCC). Staging workup was concerning for a metastatic lesion on the adrenal gland. The patient refused surgery and was subsequently started on chemotherapy. SpCC is a rare histological variant of sarcomatoid carcinoma. The prognosis is generally poor and treatment is the same as for other non-small cell lung cancers (NSCLC). The literature on disease progression and treatment is limited.

Subcutaneous Heparin Leads to Rectus Sheath Hematoma: A Rare Complication.

Rectus sheath hematoma (RSH) is a rare complication that usually occurs in patients receiving anticoagulation therapy. It can mimic an acute abdomen and be life-threatening. RSH can develop even with prophylactic dose of heparin. Early recognition is necessary to decrease morbidity and mortality. RSH should be considered in anticoagulated patients who develop sudden onset of abdominal pain. RSH is usually managed conservatively, but sometimes requires surgery. Patients who are taking antiplatelet require careful monitoring with the use of anticoagulation (AC). It is important to identify them early. This is a case of 69-year-old female who presented with epigastric pain secondary to rectus sheath hematoma. She was receiving subcutaneous injections of heparin for left lower quadrant pain and swelling for venous thromboembolism prophylaxis. Ultrasound of abdomen revealed large rectus sheath hematoma.

Atypical presentation of type B aortic dissection mimicking appendicitis managed medically.

This is a case of a 53-year-old male patient with a history of hypertension who developed sudden onset of right lower quadrant pain. On arrival, chest X-ray showed prominent aortic arch without cardiomegaly. CT of the abdomen/pelvis showed aortic dissection in descending aorta without rupture. CT of the chest displayed sparing of ascending and aortic arch. Ultrasound Doppler of the kidney displayed mild renal artery stenosis. Differential diagnosis was acute appendicitis, acute ureteric and severe gastroenteritis. The patient was started on oral blood pressure (BP) medicine to titrate off intravenous nicardipine and esmolol drip. After 10 days, he was switched to oral BP medicine. His leg pain was resolved with normal palpable pulse. One week later, his kidney function worsened. Thus, Lasix and minoxidil were stopped. The patient had no chest/abdominal pain and was tolerating the medicine well during his 2-week follow-up. Acute aortic dissection can be a fatal clinical emergency. Timing is critical during diagnosis and management of patients.

Rapid developing empyema by group F beta Streptococcus anginosus group.

A 43-year-old male had progressive pleuritic left-sided chest tightness with shortness of breath. He had dental caries and tenderness on palpation of the left lateral chest. Complete blood count showed leucocytosis. CT scan of the chest with pulmonary emboli protocol showed multiple pulmonary nodules and nodular pleural thickening at left posterior lateral pleura. Forty-eight hours post CTPE scan, CT scan of the chest, abdomen and pelvis displayed right lower lobe consolidation and left-sided pleural effusion with superimposed compressive atelectasis. Ceftaroline intravenous was initiated, with CT-guided pigtail chest tube insertion. Pleural fluid later grew group F beta-haemolytic Streptococcus anginosus Patient improved significantly and was discharged 11 days later with intravenous ertapenem. Patients with group F beta-haemolytic streptococci should be managed aggressively with early and accurate diagnosis, antibiotics, drainage and possible surgery.

Malaria and pregnancy: the perspective in Pakistan.

OBJECTIVE: To study the effects of malaria on pregnancy outcome. METHODS: A case control study conducted on patients identified by ICD-9 coding system of the hospital medical records. Demographic and clinical data recorded on standardized data sheet and analyzed using SPSS 11.5 software. RESULTS: Of the total patients, 67.4% were multigravid and 32.6% were primigravid with 78.6% of patients having platelets < 150,000. Mean haemoglobin was 9.4 gm/dl in patients and 12.2 gm/dl in controls. Plasmodium Vivax was accounted for 55.8%, P. Falciparum for 41.9%, and P. Ovale 2.3% of infections. In all, 48.8% of patients received oral Chloroquine, 16.3% oral Quinine, 30.3% intravenous Quinine, 20.9% of patients received combination treatment with IV Clindamycin, and one each patient received oral Artemether or oral halofantrine. Two patients had an abortion. One of the following complications including, threatened abortion, preterm labour, ARDS or Cerebral malaria, was observed in one patient each. Mean weight of babies born to cases was 2.8 kg (range 1.4-3.8) and of control babies was 3.2 kg (range 2.5-4.0 kg). No congenital malformations were reported. CONCLUSION: Plasmodium falciparum sp, moderate parasitic load, haemoglobin < 10 gm/dL, platelet count < 50,000/mm3 and IV quinine with loading dose of 20 mg/kg are identified as few of the potential risk factors for poor outcome in pregnancy.

Septic arthritis in a tertiary care hospital.

OBJECTIVES: To study the epidemiological features of septic arthritis in the adult population and to identify the risk factors for mortality in septic arthritis. METHODS: A five year reterospective study was performed on cases with septic arthritis admitted in our hospital between January 1999 and December 2004. Patients were identified according to ICD codes, 711.00. Data was recorded on a standardized data sheet and analyzed by SPSS 11.5 software. RESULTS: A total of 116 patients were identified, 69 were male (59.5%) and 47 female (40.55%). Mean age of patients was 49.22 years. The most common presenting clinical features were joint swelling (99.1%) and fever (60.3%), Knee joint was the most common joint involved (65.5%) followed by hip (11.2%). Gram stains of synovial fluid was done in 67.2% of cases out of which 22.4% had positive stains. Staphylococcus aureus was the most common organism isolated from blood as well as synovial fluid (18.8%). Mean haemoglobin was 10.83gm/dl and 57.8% of patients had total leukocyte count less than 11,000/cumm. Platelet count was greater than 150,000/cumm in 90.5% patients. Hypertension, renal failure, chronic liver disease and elevated ESR were identified as some of the potential risk factors for higher mortality in a cohort with septic arthritis. CONCLUSION: Septic arthritis is associated with significant morbidity and mortality. These results highlight the importance of obtaining cultures before starting any treatment.

Hemolytic uremic syndrome with systemic lupus erythematosus.

Hemolytic uremic syndrome (HUS) as an initial presentation of systemic lupus erythematosus (SLE) is a rare finding. We report a 25-year-old female patient who presented to our hospital with complaint of fever, joint pain, anasarca, hematuria and nose bleed. Her diagnostic workup revealed renal failure, microangiopathic hemolytic anemia and thrombocytopenia due to SLE with HUS. The patient initially responded well to treatment with steroids, plasmapheresis with cryosupernatant and cyclophosphamide but finally succumbed to enterococcus septicemia.