This is to certify that the Dissertation entitled " Evaluation Of Haematological Abnormalities In Decompensated Chronic Liver Disease Patients", herewith submittedby Major. Dr.T.Vijay, Post Graduate in General Medicine, Coimbatore Medical College to the Tamilnadu Dr. M.G.R. Medical University is a record of a bonafide research work carried out by him under my guidance and supervision from Jan 2006 to Jun 2007.
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There are limitations to this study, due to its retrospec- tive nature and due to the inclusion criteria resulting in a small number of patients being eligible for review. Addi- tionally, ideally, we would have evaluated a population of canine patients diagnosed with NIME receiving only CA and prednisolone. However, given the retrospective nature of our study this was not possible. Our exclusion criteria dictated that patients receiving drugs known to have myelosuppressive effects were excluded. Ultimately, no patients were excluded due to this criterion; however, all patients received additional drugs, for example, anaes- thetic agents or intravenous fluids in the course of their investigations and treatment. Many patients in our popu- lation also required adjunctive therapy in the manage- ment of their concurrent clinical signs, for example, omeprazole or antiseizure medication, for example, phenobarbitone, the latter of which has been reported to cause idiosyncratic reactions. As we had a plausible expla- nation for all post-treatment haematological abnormali- ties identified, we did not consider that concurrent drug administration was a contributing factor to any post-treat- ment haematological abnormalities.
Results: Sixty three of 164 (38%) patients had a positive ISG score. The 3 measures of IFN α all correlated strongly with each other ( p < 0.0001). There were no differences in mucocutaneous or internal organ involvement between the ISG subgroups. The ISG-positive group had increased frequency of specific autoantibodies and haematological abnormalities which remained significant after adjusting for the SARD subtype. Expression of DDX58, MB21D1 and TLR7 was correlated with the ISG score whilst TLR3, TLR9 and MB21D1 were associated with neutrophil count. Conclusion: In SARD patients, IFN α -positivity was associated with specific autoantibodies and haematological parameters but not with other clinical features. The variable NAR expression suggests that different pathways may drive IFN α production in individual patients. The identification of an IFN α -positive subgroup within a mixed SARD cohort supports a pathology-based approach to treatment.
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This study was conducted mainly to assess the haematological profile in cirrhotic patients. Cirrhosis of liver in various parts of the world presents some what differing clinical picture. Davidson, Sherlock, Turner contrast the behaviour of Cirrhosis in Europe and America where alcoholism is the common factor in the aetiology. Age incidence reported is usually above 35 years. Males preponderate. History of previous hepatitis is rare while ascites and jaundice is the common mode of presentation. Parotid enlargement, gynaecomastia, anaemia are common. The liver is often large. Spleen is palpable in 25% of cases. Ascites is extremely common. Serum albumin is low. In contrast non-alcoholic Cirrhosis which is relatively more common in England is reported to show female predominance. There is no particular age incidence. History of previous hepatitis is present in 30% of cases. Portal Hypertension is common. Gynaecomastia is rare, while liver is small, spleen is palpable as a rule. Coexistent peptic ulcer has been reported. Serum albumin is low in decompensated liver.
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Stages 1 and 2 CKD has not been associated with any symptoms, there may be symptoms from the underlying renal disease itself, such as edema in patients with nephrotic syndrome and signs and symptoms of hypertension secondary to the renal parenchymal disease in individuals even with well-preserved GFR. When GFR declines to stages 3 and 4, all clinical and laboratory complications in CKD become prominent. any organ system could be affected. Anemia usually presents with easy fatiguability, poor appetite and progressive malnutrition, abnormalities in mineral calcium, phosphorus metabolism and hormones, such as 1,25(OH) 2 D3 (calcitriol), parathyroid harmone (PTH), and fibroblast
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The prevalence of Visceral Leishmaniasis have account high worldwide particularly in endemic countries including Ethiopia. Similarly the fatal effect of the disease in relation to hematological features is one concern where attentions have not yet get and there is limited baseline data on Visceral Leishmaniasis related to hematological abnormalities in Ethiopia. Therefore; the goal of this study is to deliver information to clinicians about the prevalence of hematological abnormalities, which may contribute in improving the management of individuals infected with Visceral Leishmaniasis through early diagnosis and preventing complications resulted from such outcome. Besides; the finding of the study may serve as base line data for future researchers who have interested in similar topics.
depression, hence negatively affecting health-re- lated quality of life, not only limited to its men- tal components, but also extending to its physi- cal ones (Table I). The effect on HRQL appears to occur early during treatment and, although hae- matological abnormalities and depression are as- sociated with this impairment, depression seems to be the most consistent predictor (Table II). This TABLE V.
After establishing the diagnosis patients were evaluated for hematological abnormalities. All blood investigations regarding hematological profile were done in clinical pathology laboratory in Government General Hospital. Some investigations such as MCV, MCH, MCHC were done at outside lab, when the kit for testing was not available, along with all other hematological profiles, to have some control and to prevent the observers error if done separately.
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In our study, of the 13 patients who had an upper GI bleed, 3 patients had normal platelet counts and the rest had average platelet count of 92000. The bleeding time was prolonged only in 12% of patients with thrombocytopenia. This clearly indicates that bleeding time as an insensitive test for platelet function conforming to the result shared by Basili S et al; and functional abnormalities probably play a role. However due to lack of facilities platelet functional studies could not be taken up.
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cell volume will depend on the level of iron supply to the marrow (Hillman and Henderson, 1969; Jacobs and Finch, 1971). The haematological profile of an individual to a large extent reflects her general health status (Focusing on Anaemia, 2004) and many studies have identified the haematological profile of the pregnant woman as one of the factors affecting pregnancy and its outcome (Antenatal Care: routine care for the pregnant woman, 2002; Klebanoff et al., 1991; Allen, 2000; Meng et al., 1991; Reivez et al., 2007; Bothwell and Charlton, 1981). The most common parameter referred to amongst the haematological indices is an indicator of haemoglobin concentration and low haemoglobin (anaemia) is the most widely identified hemoglobin abnormality (Centre for Disease Control and Prevention, 1998). Maternal plasma volume increases by approximately 50% during first and second trimesters of pregnancy whereas the corresponding increase in red cell mass is only 20-30% giving rise to a state of physiological anaemia more profound in mid-pregnancy (Taylor and Lind, 1979; Pirani and Campbell, 1973; Letsky, 1987; Letsky, 1995).
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chromosomal imbalances. Array-CGH permits the identification of novel microdeletion / microdu- plication syndromes, the identification of recipro- cal products, the expansion and characterization of associated phenotypes, the elucidation of the underlying genomic etiology of previously well- known conditions and has accelerated the pace of discovery and confirmation of genes, which are implicated in the manifestation of both conti guous genes and monogenic conditions. According to Siggberg et al. (11), the diagnostic yielding of mo- lecular karyotyping after a negative karyotype is 10.8% with low-resolution arrays and 15.8% with high-resolution arrays. Current guidelines recom- mend the array-CGH testing as the first genetic test for patients with ID / DD or autism (12), detecting >99% of all pathologic chromosomal abnormalities. Karyotype analysis is currently recommended over the array-CGH only for patients with obvious chro- mosomal syndromes (e. g. trisomy 21), in case of known family history of chromosomal rearrange- ment or genotype-phenotype inconsistency.
Cervical cancer is the second most common gynecological malignancy worldwide. According to HPV Information Centre, Spain (Aug’ 2014), in India approximately 1,22,844 women are diagnosed with the disease every year and of them 67,477 die due to the disease. The etiology is multifactorial. Malondialdehyde (MDA) is important peroxide which is a measurement of oxidative stress and can be a predictive in the early detection of cervix cancer or may help in developing a new therapeutic strategy. Cervical cancer has direct impact on the haematological parameters. This study has been undertaken to investigate the malondialdehyde (MDA) level and haematological changes at the first clinical presentation. Thiobarbituric Acid Reactive Substances (TBARS) assay was performed on the blood serum samples taken from the freshly diagnosed cervical cancer patients. For haematological changes, haematocytometer and Sahli’s method was followed. Mean MDA level in the serum of freshly diagnosed cervix cancer patients was found to be elevated than the healthy volunteers and was found to be 37.90 ± 4.23 nmol/ml. Mean RBC count was found to be 3.30 ± 0.49 x10 6 /mm 3 which was comparatively less than the normal and mean WBC was found to be 10.65 ± 1.85x10 3 /mm 3 which was comparatively higher than the normal. The mean hemoglobin content was found to be 10.425 g/dl. MDA may have a predictive role in treatment response. MDA levels are higher in patients of cervical cancer and suffer from haematological derangements. Hence, measures to control oxidative stress and to increase blood profile should be taken. Increased LPO may be taken as associated predictive markers, thus suggesting that CaCx cases should get nutritive supplements to control the blood LPO level and maintain a positive balance of antioxidants for a better outcome in terms of delayed recurrence and better Quality of Life (QoL).
The absence of regions of increased FMZVD despite extensive regions of decreased FMZVD and the absence of remote lesions despite abnormalities of overall brain morphology in these subjects, indicate that analysis of such images using SPM does not introduce artefacts, either through spatial normalisation of each image to a standard template or through normalistion of mean global activity. The absence of artefact due to normalisation of mean global activity is not surprising. The calculation is carried out in two automated steps. The first step is the calculation of mean voxel intensity for each entire image. The image is then thresholded at a chosen value, in these studies 80% of the mean voxel intensity. The mean of all voxels above this threshold is calculated and used as the "global" mean in the ANCOVA. This process excludes cerebrospinal fluid (CSF), white matter and extracranial regions so that the voxel values are adjusted relative to mean intensity of grey matter structures. In addition, this process excludes regions of markedly low cortical FMZVD, such that even large regions of reduced FMZVD do not bias the global mean in such a manner that would artefactually increase areas after ANCOVA. This method is identical to that used in the study of MCD described in Chapter 5. In addition, it should be emphasised that the present study and the prior study of MCD are identical in every methodological respect and the same normal control series was used.
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Background: Patients with multiple sclerosis experience various disabilities, depending on the number and placement of lesions in the brain. Red blood cells with impaired membrane fluidity, as has been reported in patients with multiple sclerosis are known to be further targeted by phospholipase A2 during inflammatory activation. Objectives: The objec- tive of the present study was therefore to investigate the haematological profile of patients with multiple sclerosis and to correlate this with their functional disability and inflammatory status. Methods: Differential full blood counts of 31 patients with multiple sclerosis and 30 age- and gender-matched control subjects were determined on a Beckman Coul- ter. The functional disability status of each patient was measured using the Kurtzke Expanded Disability Status Scale. C-reactive protein was determined on a Beckman auto-analyser. Results: The haemoglobin was significantly decreased in patients: 13.9 ± 1.40 g/dl, controls: 14.7 ± 1.60 g/dl, P = 0.01, while platelets were increased in patients: 292 ± 133 × 10 9 /l, controls: 258 ± 88.0 × 10 9 /l, P = 0.04. The number of red blood cells correlated inversely with the Kurtzke Ex- panded Disability Status Scale (R = –0.41; P = 0.02). Platelets correlated inversely with the haemoglobin (P = 0.04) and positively with Visual and Brainstem Scores (P < 0.01, P = 0.07 respectively), but inversely with the Sensory Score (P = 0.02). Conclusions: It is not clear from the results whether the compromised red blood cell profile in patients was due to unknown agents involved in the disease aetiology or from the resulting inflammatory responses, but the inverse cor- relation between the red blood cell count and the Kurtzke Expanded Disability Status Scale, a measure of neuronal function, suggested a relationship between red blood cell count and disease outcome. Furthermore, the inverse correla- tion of platelets with the haemoglobin suggested immunological involvement. Platelets, similar to white blood cells, supply fatty acids for pro-inflammatory eicosanoid synthesis.
An unusually high number of C. krusei findings was recorded in the haematological unit in February 2005. Before recognition of the outbreak, confirmed invasive infections caused by Candida species were rare in the unit: there were four blood culture positive patients with C. albicans and one patient with C. krusei during 2000 – 2004. Prophylactic fluconazole (400 mg po) was given during neutropenia to several patients that were being considered for allogeneic bone marrow transplantation. Empiric treatment with amphotericin B (conventional or liposomal) was started typically on the fourth day of per- sisting neutropenic fever. In order to analyze the possible association between antifungal prophylaxis and occur- rence of C. krusei, data of exposure to fluconazole use was collected from the medical records. The pearson Chi- Square test was used to analyze the significance of fluco- nazole exposure.
Initially, it was believed that hiPSCs were similar to hESCs [52,57], but subsequent studies argued otherwise as differential gene expression , as well as DNA methylation patterns , could be distinguished between hiPSCs and hESCs (Table 2). However, these differences were proposed to be a consequence of comparing cells of different genetic origins , laboratory-to-laboratory variation , and the iPSC passage number . Later, hiPSCs were described to contain genomic abnormalities, including gene copy number variation [63,64], point muta tions  and chromosomal duplications  (Table 2). However, whether these genomic instabilities are inherent in hiPSCs only, or a consequence of culture- induced mutations, as previously described in hESCs, is still not certain . Extended passages of iPSCs appeared to reduce such aberrant genomic abnormalities, possibly via growth outcompetition by healthy iPSCs , but this was contradicted by a separate study that found that parental epigenetic signatures are retained in iPSCs even after extended passaging . Indeed, this ‘epigenetic memory’ phenomenon was also reported in two earlier studies, whereby donor cell epigenetic memory led to an iPSC differentiation bias towards donor-cell- related lineages [62,69]. The mechanism behind this residual donor cell memory found in iPSCs was attri- buted to incomplete promoter DNA methylation . Surprisingly, knockdown of incompletely repro gram med somatic genes was found to reduce hiPSC generation, suggesting that somatic memory genes may play an active role in the reprogramming process .Differences in ncRNA expression were also found between iPSCs and ESCs (Table 2). For instance, the aberrantly silenced imprinted Dlk1-Dio3 gene locus in iPSCs results in the differential expression of its encoded ncRNA Gtl2 and Rian, and 26 miRNAs, and consequent failure to generate ‘all-iPSC’ mice . Upregulation of lincRNAs specifi- cally in hiPSCs was also reported . Expression of lincRNA-RoR with OSKM could also enhance iPSC formation by twofold, suggesting a critical function of lincRNA in the reprogramming process .
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During the time period covered by the present study, several novel therapies for critically ill haematological malignancy patients have been introduced, such as noninvasive ventilation and recombinant colony-stimulating factors. The use of these therapies may have improved the survival of many patients included in this study . In addition, the management of sepsis has been improved by the introduction of the Surviving Sepsis Campaign in 2002. It has been suggested that cancer patients with severe sepsis have a better chance of survival than in the past [30,31]. Despite this, the unit and hospital mortality rates of patients in this study did not change signifi- cantly over time (data not shown). Finally, lead-time bias may have affected the results. Lead-time bias results from patients'
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Other epidemiological studies have indicated a close relationship between the WBC count and components of metabolic syndrome . These abnormalities have been shown to markedly increase blood viscosity that unfavourably affects the microcirculation, leading to mi- croangiopathy . It was revealed that higher WBC count, is one of the major components of inflammatory process that contributes to atherosclerotic progression and CVD [22, 24]. Haematological indices are therefore im- portant indicators for the evaluation of variations in size, number and maturity of different blood cells and for the as- sessment and management of patients with DM [24, 25]. Therefore, this study which is aimed at determining haem- atological indices among type-2 DM patients will go a long way in assisting in their management.
This is to certify that the Dissertation entitled "A Hospital Based Cross-Sectional Study On The Prevalence Of Various Haemotological Abnormalities In Patients With Decompensated Chronic Liver Disease", herewith submitted by Dr.Irfan Ismail Ayub, Post Graduate in General Medicine, Chengalpattu Medical College to the Tamilnadu Dr. M.G.R. Medical University is a record of a bonafide research work carried out by him under my guidance and supervision from Sept 2010 to Nov 2010.
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It is highly documented that the hematological conse- quences of HIV infection is dominated by peripheral blood cytopenia. This has become more common with the advent of antiretroviral therapy and related treat- ments for HIV-associated infections and malignancies [14,15]. Generally, in patients undergoing ART, anaemia may occur in approximately 60-70%, neutropenia in 50% and thrombocytopenia in 40% . It is common that the incidence and severity of low cell count increases with advancing HIV disease. An exception to this is thrombocytopenia which maybe an early manifestation of HIV infection occurring in 3 to 12% of asymptomatic patients [17,18]. In addition myelo suppressive therapies and marno-infiltrating opportunistic diseases may fur- ther contribute to the development of cytopenia similar to the anaemia of HIV infection. An interesting clinical significance observed in Zidovudine (ZDV) and some drugs used for the treatment of opportunistic diseases is that they may produce therapy with HIV-induced neu- tropenia (a haematological abnormality) .