Predicting the Onset of Acute Encephalopathy With Biphasic Seizures and Late Reduced Diffusion by Using Early Laboratory Data

Background: Acute encephalopathy with biphasic seizures and late reduced diffusion (AESD) often causes various neurological sequelae, necessitating early and objective differentiation of AESD from a febrile seizure (FS). Therefore, we developed a scoring system that predicts AESD onset using only early laboratory data.Methods: We selected patients with AESD or FS admitted to the Tottori University Hospital between November 2005 and September 2020 and collected laboratory data from onset to discharge in patients with FS and from onset to the second neurological events in patients with AESD.Results: We identified 18 patients with AESD and 181 patients with FS. In comparison with patients with FS, patients with AESD showed statistically significant increases in ammonia (NH3), blood sugar (BS), and serum creatinine (Cr) levels, and the white blood cell (WBC) count, and a significant decrease in pH at <3 h from onset. We set the cut-off values and adjusted the weight of each of these parameters based on data obtained <3 h from onset and proposed a scoring system for predicting AESD. This system showed 91% sensitivity and 94% specificity for distinguishing AESD from FS. These accuracies were only slightly improved by the addition of information related to consciousness and seizure duration (sensitivity, 91%; specificity, 96%).Conclusion: NH3, BS, and Cr levels, WBC count, and pH were significantly different between patients with AESD and patients with FS at <3 h from seizure onset. This scoring system using these data may enable the prediction of AESD onset for patients under sedation or without precise clinical information.

Download Full-text

A comparative study of hematological parameters between hypertensive and normotensive individuals in Harar, eastern Ethiopia

PLoS ONE ◽

10.1371/journal.pone.0260751 ◽

2021 ◽

Vol 16 (12) ◽

pp. e0260751

Author(s):

Beza Sileshi ◽

Fekadu Urgessa ◽

Moges Wordofa

Keyword(s):

Blood Cell ◽

Complete Blood Count ◽

Hematological Parameters ◽

University Hospital ◽

Health Concern ◽

Control Group ◽

Eastern Ethiopia ◽

Distribution Width ◽

Wbc Count ◽

Apparently Healthy

Background Hypertension is the major public health concern; leading to cardiovascular disease. It is associated with alteration in hematological parameters which may lead to end-organ damage. Thus, this study aimed to compare hematological parameters between hypertensive and normotensive adult groups in Harar, eastern Ethiopia. Methods A comparative cross-sectional study was conducted from January to March, 2020 at Jugel and Hiwotfana Specialized University hospital, Harar, eastern Ethiopia. Convenient sampling technique was used to recruit 102 hypertensive patients from the two hospitals and 102 apparently healthy blood donors. Participant’s socio-demographic and clinical information were collected using pre-tested structured questionnaire. Blood sample were collected and analyzed by Beckman Coulter DxH 500 analyzer for complete blood count. The data were entered and analyzed using SPSS version 23. Independent t-test and Mann Whitney u-test was used for comparison between groups. Spearman’s correlation was used for correlation test. P values less than 0.05 was considered as statistically significant. Result 102 hypertensive and 102 healthy controls were enrolled in this study. The median ± IQR value of white blood cell (WBC) count, hemoglobin (Hgb), hematocrit (HCT), red cell distribution width (RDW) and mean platelet volume (MPV) were significantly higher in hypertensive group compared to apparently healthy control group. Additionally, RBC (red blood cell) count, HCT and RDW showed statistically significant positive correlations with systolic and diastolic blood pressure. WBC count and RDW were significantly and positively correlated with body mass index (BMI). Platelet (PLT) count had a significant but negative correlation (r = -0.219, P = 0.027) with duration of hypertension illness while MPV showed positive and significant correlation (r = 0.255, P = 0.010). Conclusion The median values of WBC, Hgb, HCT, RDW and MPV were significantly higher in hypertensive patient compared to apparently healthy individuals. Hence, it is important to assess hematological parameters for hypertensive individuals which may help to prevent complications associated with hematological aberrations. However, further studies are required to understand hypertensive associated changes in hematological parameters.

Download Full-text

A Simple Scoring Model Predicting the Outcome of COVID-19 Patients: Tanta COVID score

Endocrine Metabolic & Immune Disorders - Drug Targets ◽

10.2174/1871530321666211126104952 ◽

2021 ◽

Vol 21 ◽

Author(s):

Mohammed Elhendawy ◽

Ferial El-Kalla ◽

Sherief Abd-Elsalam ◽

Dalia ElSharawy ◽

Shaimaa S Soliman ◽

...

Keyword(s):

Scoring System ◽

Model Building ◽

Cox Regression ◽

Laboratory Data ◽

Discrimination Performance ◽

University Hospital ◽

Severe Illness ◽

Health Providers ◽

Scoring Model ◽

Increased Risk

Background & Aim: COVID-19 is a worldwide pandemic with high rates of morbidity and mortality, and an uncertain prognosis leading to an increased risk of infection in health providers and limited hospital care capacities. In this study, we have proposed a predictive, interpretable prognosis scoring system with the use of readily obtained clinical, radiological and laboratory characteristics to accurately predict worsening of the condition and overall survival of patients with COVID -19. Methods: This is a single-center, observational, prospective, cohort study. A total of 347 patients infected with COVID-19 presenting to the Tanta university hospital, Egypt, were enrolled in the study, and clinical, radiological and laboratory data were analyzed. Top-ranked variables were identified and selected to be integrated into a Cox regression model, building the scoring system for accurate prediction of the prognosis of patients with COVID-19. Results: The six variables that were finally selected in the scoring system were lymphopenia, serum CRP, ferritin, D-Dimer, radiological CT lung findings and associated chronic debilitating disease. The scoring system discriminated risk groups with either mild disease or severe illness characterized by respiratory distress (and also those with hypoxia and in need for oxygen therapy or mechanical ventilation) or death. The area under the curve to estimate the discrimination performance of the scoring system was more than 90%. Conclusion: We proposed a simple and clinically useful predictive scoring model for COVID-19 patients. However, additional independent validation will be required before the scoring model can be used commonly.

Download Full-text

Predictive factors of COVID-19 pneumonia: a retrospective cross-sectional survey in a Japanese university hospital

10.21203/rs.3.rs-855975/v1 ◽

2021 ◽

Author(s):

Sayato Fukui ◽

Akihiro Inui ◽

Takayuki Komatsu ◽

Kanako Ogura ◽

Yutaka Ozaki ◽

...

Keyword(s):

Predictive Factors ◽

Laboratory Data ◽

Vital Signs ◽

Clinical Information ◽

University Hospital ◽

P Value ◽

Cross Sectional Survey ◽

Cross Sectional ◽

Variate Analysis ◽

Complicated Pneumonia

Abstract BackgroundThe predictive factors of coronavirus disease 2019 (COVID-19) pneumonia, including clinical parameters with symptoms, vital signs, and laboratory data, have not been compared directly between cases with and without complicated pneumonia. AimsWe aimed to identify predictive factors for COVID-19 patients with complicated pneumonia, and determine which COVID-19 patients should undergo computed tomography (CT). MethodsThis retrospective cross-sectional survey was conducted at the Juntendo University Nerima Hospital in Tokyo, Japan. We recruited patients diagnosed with COVID-19 between 1 January and 31 December 2020 and all patients underwent blood tests and CT. Clinical information, including vital signs, symptoms, laboratory results, and CT findings, were extracted from medical charts. Factors potentially predicting COVID-19 pneumonia were analysed using Student’s t -test or the chi-squared test, and variables with a p- value of < 0.05 in the bi-variate analysis were entered into multivariate logistic regression models. ResultsAmong 221 included patients (119 males [53.8%]; mean age, 54.59 ± 18.61 years), 160 (72.4%) had pneumonia. The significant factors in the multi-variate analysis were the lactate dehydrogenase (odds ratio [OR], 3.41; 95% confidence interval [CI], 1.47–7.95; p < 0.01) and C-reactive protein (OR, 3.94; 95% CI, 1.05–14.80; p = 0.04) levels. No significant differences were observed in vital signs and the symptoms. ConclusionLDH and CRP level of > 220 IU/L and > 3.0 mg/dL, respectively, are independent risk factors for COVID-19 pneumonia. The present results are extremely useful for deciding whether to perform CT among COVID-19 patients.

Download Full-text

Sharing of Worldwide Spread Knowledge Using Hypermedia Facilities & Fast Communication Protocols (Mosaic and World Wide Web): The Example of ExPASy

Methods of Information in Medicine ◽

10.1055/s-0038-1634588 ◽

1995 ◽

Vol 34 (01/02) ◽

pp. 75-78 ◽

Cited By ~ 5

Author(s):

R. D. Appel ◽

O. Golaz ◽

Ch. Pasquali ◽

J.-C. Sanchez ◽

A. Bairoch ◽

...

Keyword(s):

World Wide Web ◽

World Wide ◽

Relevant Literature ◽

Communication Protocols ◽

Laboratory Data ◽

Central Element ◽

University Hospital ◽

New Information ◽

The University ◽

Link Information

Abstract:The sharing of knowledge worldwide using hypermedia facilities and fast communication protocols (i.e., Mosaic and World Wide Web) provides a growth capacity with tremendous versatility and efficacy. The example of ExPASy, a molecular biology server developed at the University Hospital of Geneva, is striking. ExPASy provides hypermedia facilities to browse through several up-to-date biological and medical databases around the world and to link information from protein maps to genome information and diseases. Its extensive access is open through World Wide Web. Its concept could be extended to patient data including texts, laboratory data, relevant literature findings, sounds, images and movies. A new hypermedia culture is spreading very rapidly where the international fast transmission of documents is the central element. It is part of the emerging new “information society”.

Download Full-text

Association Between White Blood Cell Counts and Brachial-Ankle Pulse Wave Velocity in Chinese Hypertensive Adults: A Cross-Sectional Study

Angiology ◽

10.1177/00033197211021199 ◽

2021 ◽

pp. 000331972110211

Author(s):

Buyun Jia ◽

Chongfei Jiang ◽

Yun Song ◽

Chenfangyuan Duan ◽

Lishun Liu ◽

...

Keyword(s):

Arterial Stiffness ◽

Blood Cell ◽

Pulse Wave Velocity ◽

Wave Velocity ◽

White Blood Cell ◽

Pulse Wave ◽

Final Analysis ◽

Cross Sectional ◽

Cell Counts ◽

Wbc Count

Increased arterial stiffness is highly prevalent in patients with hypertension and is associated with cardiovascular (CV) risk. Increased white blood cell (WBC) counts may also be an independent risk factor for arterial stiffness and CV events. The aim of the study was to investigate the relationship between differential WBC counts and brachial-ankle pulse wave velocity (baPWV) in hypertensive adults. A total of 14 390 participants were included in the final analysis. A multivariate linear regression model was applied for the correlation analysis of WBC count and baPWV. Higher WBC counts were associated with a greater baPWV: adjusted β = 10 (95% CI, 8-13, P < .001). The same significant association was also found when WBC count was assessed as categories or quartiles. In addition, the effect of differential WBC subtypes, including neutrophil count and lymphocyte count on baPWV, showed the similar results. These findings showed that baPWV has positive associations with differential WBC counts in hypertensive adults.

Download Full-text

Procalcitonin Correlates With but Is Not Superior to Other Diagnostic Markers of Bacterial Pneumonia

American Journal of Clinical Pathology ◽

10.1093/ajcp/aqaa148 ◽

2020 ◽

Author(s):

Nadia Ayala-Lopez ◽

David R Peaper ◽

Roa Harb

Keyword(s):

Respiratory Tract ◽

Lower Respiratory Tract ◽

Bacterial Pneumonia ◽

Operating Characteristic ◽

Characteristic Curve ◽

Laboratory Data ◽

Chest Imaging ◽

Wbc Count ◽

Tract Infections ◽

Guided Therapy

Abstract Objectives Despite extensive research on procalcitonin (PCT)-guided therapy in lower respiratory tract infections, the association between PCT and bacterial pneumonia remains unclear. Methods We evaluated retrospectively the performance of PCT in patients presenting with lower respiratory tract infection symptoms and grouped by seven diagnoses. All patients had microbial testing, chest imaging, and CBC counts within 1 day of PCT testing. Results Median PCT level in patients diagnosed with bacterial pneumonia was significantly higher than in patients diagnosed with other sources of infections or those not diagnosed with infections. Median PCT levels were not different among patients grouped by type or quantity of pathogen detected. They were significantly higher in patients with higher pathogenicity scores for isolated bacteria, those with abnormal WBC count, and those with chest imaging consistent with bacterial pneumonia. A diagnostic workup that included imaging, WBC count, and Gram stain had an area under the receiver operating characteristic curve of 0.748, and the addition of PCT increased it to 0.778. Conclusions PCT was higher in patients diagnosed with bacterial pneumonia. Less clear is its diagnostic ability to detect bacterial pneumonia over and above imaging and laboratory data routinely available to clinicians.

Download Full-text

Artificial intelligence matches subjective severity assessment of pneumonia for prediction of patient outcome and need for mechanical ventilation: a cohort study

Scientific Reports ◽

10.1038/s41598-020-79470-0 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Shadi Ebrahimian ◽

Fatemeh Homayounieh ◽

Marcio A. B. C. Rockenbach ◽

Preetham Putha ◽

Tarun Raj ◽

...

Keyword(s):

Artificial Intelligence ◽

Patient Outcome ◽

Mechanical Ventilation ◽

Oxygen Saturation ◽

Laboratory Data ◽

Qualitative Assessment ◽

Smoking History ◽

Lung Edema ◽

Strong Positive Correlation ◽

Wbc Count

AbstractTo compare the performance of artificial intelligence (AI) and Radiographic Assessment of Lung Edema (RALE) scores from frontal chest radiographs (CXRs) for predicting patient outcomes and the need for mechanical ventilation in COVID-19 pneumonia. Our IRB-approved study included 1367 serial CXRs from 405 adult patients (mean age 65 ± 16 years) from two sites in the US (Site A) and South Korea (Site B). We recorded information pertaining to patient demographics (age, gender), smoking history, comorbid conditions (such as cancer, cardiovascular and other diseases), vital signs (temperature, oxygen saturation), and available laboratory data (such as WBC count and CRP). Two thoracic radiologists performed the qualitative assessment of all CXRs based on the RALE score for assessing the severity of lung involvement. All CXRs were processed with a commercial AI algorithm to obtain the percentage of the lung affected with findings related to COVID-19 (AI score). Independent t- and chi-square tests were used in addition to multiple logistic regression with Area Under the Curve (AUC) as output for predicting disease outcome and the need for mechanical ventilation. The RALE and AI scores had a strong positive correlation in CXRs from each site (r2 = 0.79–0.86; p < 0.0001). Patients who died or received mechanical ventilation had significantly higher RALE and AI scores than those with recovery or without the need for mechanical ventilation (p < 0.001). Patients with a more substantial difference in baseline and maximum RALE scores and AI scores had a higher prevalence of death and mechanical ventilation (p < 0.001). The addition of patients’ age, gender, WBC count, and peripheral oxygen saturation increased the outcome prediction from 0.87 to 0.94 (95% CI 0.90–0.97) for RALE scores and from 0.82 to 0.91 (95% CI 0.87–0.95) for the AI scores. AI algorithm is as robust a predictor of adverse patient outcome (death or need for mechanical ventilation) as subjective RALE scores in patients with COVID-19 pneumonia.

Download Full-text

Predictive values of Alvarado score, serum C-reactive protein, and white blood cell count in the diagnosis of acute appendicitis: a prospective study

Annals of Pediatric Surgery ◽

10.1186/s43159-021-00074-y ◽

2021 ◽

Vol 17 (1) ◽

Author(s):

Ademola Olusegun Talabi ◽

Tewogbade Adeoye Adedeji ◽

Oludayo Adedapo Sowande ◽

Olusanya Adejuyigbe

Keyword(s):

Acute Appendicitis ◽

Blood Cell ◽

Cell Count ◽

White Blood Cell Count ◽

White Blood Cell ◽

C Reactive Protein ◽

Blood Cell Count ◽

Alvarado Score ◽

Reactive Protein ◽

Wbc Count

Abstract Background The diagnosis of acute appendicitis in children is quite challenging as the rate of negative appendectomy varies between 15 and 57%. Increased utilization of imaging diagnostic facilities in advanced countries seems to have reduced the incidence of operating on normal appendix to a single digit. In low- and middle-income countries, the incidence remains unacceptably high (double digits). Inflammatory markers and scoring systems may be a suitable adjunct to increase diagnostic yield in most third world countries. Thus, the aim of this study was to evaluate the diagnostic value of Alvarado score, white blood cell count, and serum C-reactive protein in children with acute appendicitis. Results The ages of patients ranged between 4 and 15 years with a mean of 11.2 ± 2.8 years. The male to female ratio was 1.4 to 1.0. Nineteen percent of patients had negative appendiceal findings on histological examination. The sensitivity and specificity of Alvarado score, C-reactive protein estimation, total white blood cell count in diagnosing acute appendicitis were 86.4% and 63.2%, 98.8% and 36.8%, and 51.9% and 89.5% respectively. Alvarado score has the highest area under ROC curve analysis 0.824, 95% CI of 0.724 to 0.924 compared with CRP, 0.769. 95% CI of = 0.647 to 0.891 and WBC count, 0.765, 95% CI of 0.643 to 0.887. Both CRP and WBC count showed higher discriminatory values between complicated and uncomplicated appendicitis, p < 0.001. Conclusion Alvarado score outperformed other tests in setting the diagnosis of acute appendicitis. However, none of the tests can be relied on wholly for operative decision. Clinical judgement remains the bedrock for diagnosis and operative management.

Download Full-text

Factors Enhancing Serum Syndecan-1 Concentrations: A Large-Scale Comprehensive Medical Examination

Journal of Clinical Medicine ◽

10.3390/jcm8091320 ◽

2019 ◽

Vol 8 (9) ◽

pp. 1320

Author(s):

Kazumasa Oda ◽

Hideshi Okada ◽

Akio Suzuki ◽

Hiroyuki Tomita ◽

Ryo Kobayashi ◽

...

Keyword(s):

Large Scale ◽

Prospective Observational Study ◽

Nitrogen Concentration ◽

Laboratory Data ◽

University Hospital ◽

Endothelial Glycocalyx ◽

Sample Collection ◽

Blood Samples ◽

Triglyceride Concentration ◽

Medical Examinations

Endothelial disorders are related to various diseases. An initial endothelial injury is characterized by endothelial glycocalyx injury. We aimed to evaluate endothelial glycocalyx injury by measuring serum syndecan-1 concentrations in patients during comprehensive medical examinations. A single-center, prospective, observational study was conducted at Asahi University Hospital. The participants enrolled in this study were 1313 patients who underwent comprehensive medical examinations at Asahi University Hospital from January 2018 to June 2018. One patient undergoing hemodialysis was excluded from the study. At enrollment, blood samples were obtained, and study personnel collected demographic and clinical data. No treatments or exposures were conducted except for standard medical examinations and blood sample collection. Laboratory data were obtained by the collection of blood samples at the time of study enrolment. According to nonlinear regression, the concentrations of serum syndecan-1 were significantly related to age (p = 0.016), aspartic aminotransferase concentration (AST, p = 0.020), blood urea nitrogen concentration (BUN, p = 0.013), triglyceride concentration (p < 0.001), and hematocrit (p = 0.006). These relationships were independent associations. Endothelial glycocalyx injury, which is reflected by serum syndecan-1 concentrations, is related to age, hematocrit, AST concentration, BUN concentration, and triglyceride concentration.

Download Full-text

Spironolactone-Induced Agranulocytosis

Annals of Pharmacotherapy ◽

10.1177/106002809703100511 ◽

1997 ◽

Vol 31 (5) ◽

pp. 582-585 ◽

Cited By ~ 11

Author(s):

Anna M Whitling ◽

Pablo E Pérgola ◽

John Lee Sang ◽

Robert L Talbert

Keyword(s):

Risk Factors ◽

Adverse Effect ◽

Bone Marrow ◽

Leukocyte Count ◽

Laboratory Data ◽

University Hospital ◽

Drug Induced ◽

Bone Marrow Biopsies ◽

Case Summary ◽

Before And After

OBJECTIVE: TO report a case of agranulocytosis secondary to spironolactone in a patient with cryptogenic liver disease. CASE SUMMARY: A 58-year-old Hispanic woman with cryptogenic cirrhosis was admitted to University Hospital on October 31, 1995. Laboratory data revealed a leukocyte count of 1.0 × 103/mm3 and an absolute neutrophil count (ANC) of 10 cells/mm3. Prior to treatment with spironolactone, the leukocyte count was 10.2 × 103/mm3 and ANC 8400 cells/mm3. Agranulocytosis resolved 5 days following the discontinuation of spironolactone. Results from the bone marrow biopsies before and after treatment with spironolactone suggested that agranulocytosis was caused by the drug's toxic effect on the bone marrow. DISCUSSION: Drug-induced agranulocytosis is a serious adverse effect, occurring at a rate of approximately 6.2 cases per million persons each year. In addition to the case reported here, three other reports of agranulocytosis secondary to spironolactone have been published in the literature. Several factors have been identified that may increase a patient's risk for developing agranulocytosis, including increased age, hepatic or renal impairment, drag dosage and duration, and concurrent medications. CONCLUSIONS: Agranulocytosis secondary to spironolactone is a serious potential adverse effect. Patients with risk factors for developing this adverse effect should be closely monitored since early detection and discontinuation of spironolactone can improve prognosis.

Download Full-text