Predictive value of preoperative complete blood count components on the occurrence of surgical site infection after elective cesarean section.

BACKGROUND: To analyze the predictive value of the preoperative complete blood count components on the occurrence of surgical site infection (SSI) after elective cesarean section. METHODS: We conducted a retrospective case control study in a tertiary care hospital located in New York City during the period of November 1, 2018, to October 30, 2020. We included patients who developed SSI after elective cesarean section as cases and patients who did not develop SSI as controls. We tested the ability of neutrophil, lymphocyte, platelet, hemoglobin, hematocrit, total white blood cells, neutrophil to lymphocyte ratio, hemoglobin to platelet ratio, platelet to lymphocyte ratio, platelet to neutrophil ratio, platelet to hemoglobin ratio and neutrophil to hemoglobin ratio to identify the occurrence of SSI after cesarean section. RESULTS: We compared ten cases and 20 controls. The median lymphocyte and lymphocyte to hemoglobin ratio were statistically significantly higher in cases compared to controls (P=0.049 and P=0.04, respectively). A lymphocyte value higher than 1.5 x103/µL was the best cut-off to exclude the occurrence of SSI, with a sensitivity of 95%, a specificity of 50%, a positive predictive value of 5.5% and a negative predictive value of >99%. A lymphocyte to hemoglobin ratio higher than 1.13 was the best cut off to exclude the occurrence of SSI, with a sensitivity of 95%, a specificity of 60%, a positive predictive value of 6.8% and a negative predictive value >99%. CONCLUSIONS: The preoperative lymphocyte and lymphocyte to hemoglobin ratio should be incorporated into patient counseling and preoperative algorithms to identify patients who will develop SSI. The biological mechanisms involved remain to be investigated and our data should be confirmed by further and larger studies.

Utilization of platelet count in prediction of post-embolization syndrome after uterine artery embolization.

OBJECTIVE: To analyze the predictive value of neutrophils, lymphocytes, platelets, neutrophils to lymphocytes ratio (NLR), platelets to lymphocytes ratio (PLR) in identifying the occurrence of post-embolization syndrome (PES) after uterine artery embolization (UAE). METHODS: We conducted a retrospective observational study in a single tertiary care center located in New York City during period of November 2014 - December 2018, for patients who underwent UAE. PES was defined as the occurrence of pelvic pain, nausea or fever within one week after the procedure. RESULTS: We enrolled 62 patients: 12 of them had PES and 50 served as controls. Platelets were statistically significantly higher in patients with PES (p=0.036). Specifically, a platelet count greater than 336×103/uL was identified as cut-off with a specificity of 91.8 %, a sensitivity of 33.3 %, a positive predictive value of 46 % and a negative predictive value of 85 %. The area under the curve (AUC) was 0.721 (CI 0.536-0.907). CONCLUSION: Patients with a preprocedural platelet count less than 336×103/uL were less likely to have PES. If confirmed by larger studies, the platelet count could be incorporated into patient counseling and preoperative algorithms to identify the ideal UAE candidates.

Abnormal uterine bleeding types according to the PALM-COEIN FIGO classification in a medically underserved American community

Objective: To describe the distribution of abnormal uterine bleeding (AUB) type according to the polyp (AUB-P); adenomyosis (AUB-A); leiomyoma (AUB-L); malignancy and hyperplasia (AUB-M); coagulopathy (AUB-C); ovulatory dysfunction (AUB-O); endometrial (AUB-E); iatrogenic (AUB-I); and not yet classified International Federation of Gynecology and Obstetrics classification system in a medically underserved American inner-city population. Our secondary objective was to find an association between risk factors and type of AUB. Material and Methods: We conducted a descriptive cross-sectional analysis at our outpatient women's health clinic located in the Bronx, New York City, from November 2016 to December 2019. Results: Among 390 patients, the most common AUB type was AUB-L (n=185, 47.4%), followed AUB-P (n=100, 25.6%), AUB-A (n=55, 14.1%), AUB-O (n=19, 4.9%), AUB-M (n=15, 3.8%), AUB-E (n=14, 3.6%) and AUB-I (n=2, 0.5%). Race was distributed as follows: Hispanic (68.2%), Black (25.9%), Caucasian (3.3%), and Asian (2.1%). Comorbidities included hypertension (36.4%), diabetes (15.6%), and thyroid disease (6.9%). The median age at diagnosis was significantly higher in AUB-M (59 years old, p<0.001), AUB-P (52.5 years old, p<0.001), AUB-E (51.5 years old, p=0.001) compared to AUB-L (46 years old). The median body mass index (BMI) was significantly higher in AUB-E (34.2 kg/m2, p=0.048) and AUB-O (32.6 kg/m2, p=0.038) compared to AUB-L (30 kg/m2). Race was equally distributed among the AUB types. AUB-M (66.6%, p=0.002), AUB-E (57.1%, p=0.022), AUB-P (47%, p<0.001), and AUB-A (30.8%, p<0.001), had statistically significantly more cases of hypertension compared to AUB-L (28.1%). AUB-P (27%, p<0.001), AUB-M (26.6%, p=0.025), AUB-E (35.7%, p=0.001) and AUB-A (9%, p<0.001) had more patients with diabetes mellitus (DM) than AUB-L (3.3%). Conclusion: In an American population of medically underserved patients, the most common cause of AUB was leiomyoma and the most common race was Hispanic. Women with AUB-L were younger, with lower BMI, and with fewer cases of hypertension and DM when compared to other types of AUB.

Neutrophil-to-Lymphocyte Ratio and Platelet-to-Lymphocyte Ratio in Twins Compared with Singletons.

OBJECTIVES: It is well known that twin pregnancies confer a high degree of adverse perinatal outcomes. Fetal growth restriction, preterm labor/delivery, and hypertensive disorders of pregnancy are among the causal etiologies associated. Hematologic parameters, specifically, the neutrophil:lymphocyte ratio (NLR), the platelet:lymphocyte ratio (PLR), and some of the routine complete blood cell count components denote a peculiar inflammatory and immunologic profile and have been used as clinical markers for specific obstetric syndromes. To our knowledge, no study has ever evaluated NLR/PLR in twins as a distinct population from singletons. Our primary objective was to analyze NLR/PLR in twins compared with singletons. Our secondary objective was to compare white blood cells, neutrophils, lymphocytes, and platelets between twins and singletons. METHODS: We conducted a retrospective case-control study comparing NLR/PLR markers in twin gestations (dichorionic/diamniotic and monochorionic/dichorionic) versus singleton pregnancies, from January 2019 to April 2020. We excluded pregnancies with potential confounding factors such as human immunodeficiency virus, chronic hypertension, smoking, pregestational diabetes mellitus, or cases with miscarriage/intrauterine fetal demise. We included twin pregnancies (two fetuses) as cases and singletons as controls. RESULTS: We recruited 29 twins and 29 singletons, matched for age, body mass index, and parity. NLR was statistically significantly higher in the first trimester in twins compared with singletons (3.3 vs 2.7, P < 0.01) and the platelet value was lower in the second trimester in twins compared with singletons (199 vs 251, P = 0.01). CONCLUSIONS: We speculate that a decrease in NLR from the first to the second trimester and a decrease in platelet in the second trimester reflect both the physiologic inflammatory/immune reaction of early pregnancy and denote a vital response for the development of normal placentation in twin gestations.

Acute necrotising pancreatitis derived from low-dose corticosteroid use: an important reminder of clinical management.

Although the exact mechanism is unknown, incidence of drug-induced pancreatitis from corticosteroids is well established in the medical literature. Commonly reported in chronic steroid-dependent individuals who require large doses for a wide array of pathologies, the incidence of damage to the pancreas from low-doses have not been well described. We report a case of a 68-year-old woman who presented with severe abdominal pain, nausea and vomiting, 3 days after the initiation of low-dose methylprednisolone for osteoarthritis. Inpatient laboratory analysis revealed an elevated lipase of 1770 U/L and CT scan showing extensive necrotising pancreatitis involving the head, body and tail. Cessation of the causative medication and conservative treatment successfully led to resolution of symptoms. We present this case to inform clinicians of the precipitance of pancreatitis from modest strength corticosteroid management, so that more accurate and improved performance in pharmacological decisions can be made for patient care.

Soft tissue injury of the lower extremity complicated by type II necrotising fasciitis highlighting the need for astute clinical practices and proper treatment.

Necrotising fasciitis (NF) is a soft tissue bacterial-derived infection characterised clinically by fulminant tissue destruction of the poorly blood-supplied muscle fascia and overlying subcutaneous fat. Although these infections first appear as minor superficial manifestations, they are capricious in nature and often lead to sepsis, organ failure and high mortality. We report a case of type II necrotising fasciitis in a 39-year-old Caucasian female patient who presented to the emergency department with cellulitis of her right foot and lower leg that rapidly developed into tissue necrosis. The patient course is of unique interest due to progressive history over a 104 days time frame with complications following surgical treatments and outpatient follow-up. We highlight the importance of early detection and pertinent clinical awareness from a wide range of medical specialties that were involved in this case, and how this process is critical, in order to properly diagnose and treat NF-derived tissue infections.

Fever of unknown origin in a patient with confirmed west nile virus meningoencephalitis.

West Nile Virus (WNV), an RNA arbovirus and member of the Japanese encephalitis virus antigenic complex, causes a wide range of clinical symptoms, from asymptomatic to encephalitis and meningitis. Nearly all human infections of WNV are due to mosquito bites with birds being the primary amplifying hosts. Advanced age is the most important risk factor for neurological disease leading most often to poor prognosis in those afflicted. We report a case of WNV meningoencephalitis in a 93-year-old Caucasian male who presented with fever of unknown origin (FUO) and nuchal rigidity that rapidly decompensated within 24 h to a persistent altered mental state during inpatient stay. The patient's ELISA antibody titers confirmed pathogenesis of disease by WNV; he given supportive measures and advanced to an excellent recovery. In regard to the approach of FUO, it is important to remain impartial yet insightful to all elements when determining pathogenesis in atypical presentation.