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Journal of Obstetrics and Gynaecology :... Feb 2018Although it is known that corticosteroid administration causes leukocytosis, the magnitude and length of time this leukocytosis persists is unknown during pregnancy.... (Meta-Analysis)
Meta-Analysis Review
Although it is known that corticosteroid administration causes leukocytosis, the magnitude and length of time this leukocytosis persists is unknown during pregnancy. This study aimed to establish the expected range of maternal leukocytosis in healthy pregnant women at risk for preterm delivery after antenatal corticosteroid administration. PubMed, Embase and ClinicalTrials.gov were searched to identify the studies in healthy women at risk for preterm delivery without signs of clinical infection that reported white blood cell values preceding and after antenatal corticosteroid administration. The inverse variance weighting technique was used to calculate the weighted means and the standard deviation from the mean for each time period. Six studies met inclusion criteria and included 524 patients and 1406 observations. Mean ± standard deviation maternal white blood cell count values prior to antenatal corticosteroid administration and up to 24, 48, 72 and 96 hours after corticosteroid administration were 10.4 ± 2.4, 13.6 ± 3.6, 12.1 ± 3.0, 11.5 ± 2.9 and 11.1 ± 2.5 × 10/L, respectively. Leukocytosis in healthy, non-infected women is expected to peak 24 hours after antenatal corticosteroid administration and the magnitude of increase is small. Impact statement What is already known on this subject: While it is well known that administration of antenatal corticosteroids causes leukocytosis, it is currently unknown the magnitude and length of time the leukocytosis persists. What the results of this study add: This study establishes the expected range and the temporal progression and regression with antenatal corticosteroid administration in healthy pregnant women at risk for preterm delivery without clinical signs of infection. What the implications are of these findings for clinical practice and/or further research: Clinicians may wish to consider further investigation into the clinical cause, whether infectious or non-infectious, for absolute values and changes outside this range.
Topics: Adrenal Cortex Hormones; Biomarkers; Female; Gestational Age; Humans; Leukocyte Count; Leukocytosis; Obstetric Labor, Premature; Pregnancy; Pregnancy Complications, Hematologic; Premature Birth; Risk Factors; Time Factors
PubMed: 28903611
DOI: 10.1080/01443615.2017.1342614 -
Blood May 2020There may be many predictors of venous thromboembolism (VTE) and bleeding in hospitalized medical patients, but until now, systematic reviews and assessments of the... (Meta-Analysis)
Meta-Analysis
There may be many predictors of venous thromboembolism (VTE) and bleeding in hospitalized medical patients, but until now, systematic reviews and assessments of the certainty of the evidence have not been published. We conducted a systematic review to identify prognostic factors for VTE and bleeding in hospitalized medical patients and searched Medline and EMBASE from inception through May 2018. We considered studies that identified potential prognostic factors for VTE and bleeding in hospitalized adult medical patients. Reviewers extracted data in duplicate and independently and assessed the certainty of the evidence using the Grading of Recommendations Assessment, Development, and Evaluation approach. Of 69 410 citations, we included 17 studies in our analysis: 14 that reported on VTE, and 3 that reported on bleeding. For VTE, moderate-certainty evidence showed a probable association with older age; elevated C-reactive protein (CRP), D-dimer, and fibrinogen levels; tachycardia; thrombocytosis; leukocytosis; fever; leg edema; lower Barthel Index (BI) score; immobility; paresis; previous history of VTE; thrombophilia; malignancy; critical illness; and infections. For bleeding, moderate-certainty evidence showed a probable association with older age, sex, anemia, obesity, low hemoglobin, gastroduodenal ulcers, rehospitalization, critical illness, thrombocytopenia, blood dyscrasias, hepatic disease, renal failure, antithrombotic medication, and presence of a central venous catheter. Elevated CRP, a lower BI, a history of malignancy, and elevated heart rate are not included in most VTE risk assessment models. This study informs risk prediction in the management of hospitalized medical patients for VTE and bleeding; it also informs guidelines for VTE prevention and future research.
Topics: Adult; Age Factors; Aged; Aged, 80 and over; Comorbidity; Female; Hemorrhage; Hospitalization; Humans; Male; Middle Aged; Prognosis; Risk Factors; Venous Thromboembolism
PubMed: 32092132
DOI: 10.1182/blood.2019003603 -
Medicina (Kaunas, Lithuania) Aug 2021Clozapine is the only antipsychotic approved for treatment-resistant schizophrenia. Despite its superior efficacy profile as compared with other antipsychotics,... (Review)
Review
BACKGROUND AND OBJECTIVES
Clozapine is the only antipsychotic approved for treatment-resistant schizophrenia. Despite its superior efficacy profile as compared with other antipsychotics, clozapine remains underutilized. Clozapine monitoring systems clearly describe the proposed management of clozapine-induced neutropenia; however, no specific mention is made of how to interpret neutrophilic leukocytosis, despite that being a relatively frequent finding. Prescribers unfamiliar with this molecule may misjudge its clinical significance, potentially leading to untimely treatment interruption. Here, we systematically review the literature on the risk of neutrophilic leukocytosis during clozapine treatment, and describe eight additional cases among our patient cohort.
MATERIALS AND METHODS
We performed a systematic review of the literature on PubMed and Embase using the PRISMA 2020 guidelines, and selected all original reports describing either (1) the prevalence of neutrophilic leukocytosis during clozapine treatment, or (2) the clinical significance of neutrophilic leukocytosis. We described eight additional cases of neutrophilic leukocytosis during clozapine treatment while attending an outpatient psychiatric clinic.
RESULTS
Our research ultimately yielded the selection of 13 articles included in this systematic review. The case series highlighted the presence of stable and clinically unremarkable neutrophilia during a follow-up ranging from one to ten years.
CONCLUSIONS
Existing evidence indicates that leukocytosis associated with clozapine treatment can be considered as an asymptomatic and benign condition, suggesting that no change in clozapine treatment is needed upon its detection.
Topics: Antipsychotic Agents; Clozapine; Humans; Leukocytosis; Prevalence; Schizophrenia
PubMed: 34441022
DOI: 10.3390/medicina57080816 -
Arthroscopy : the Journal of... Jul 2015This systematic review assessed the role of hip arthroscopic irrigation and debridement for eradication of infection in native joints to ascertain outcomes and... (Review)
Review
PURPOSE
This systematic review assessed the role of hip arthroscopic irrigation and debridement for eradication of infection in native joints to ascertain outcomes and complications associated with this surgical approach.
METHODS
The Medline, Embase, and PubMed databases were searched on July 20, 2014, for English-language studies that addressed arthroscopic treatment of native septic hip arthritis. The studies were systematically screened and data abstracted in duplicate, with qualitative findings presented.
RESULTS
There were 11 eligible studies (1 case-control study, 8 case series, and 2 case reports) reporting on 65 patients (65 hips) treated by arthroscopic irrigation and debridement for septic hip arthritis. The mean length of patient follow-up was 19.1 months (range, 6 to 84 months). The indications for surgery were as follows: pyrexia, anterior groin or hip pain with limited hip range of motion and an inability to bear weight, associated leukocytosis, an elevated erythrocyte sedimentation rate or C-reactive protein level, and/or hip imaging or aspiration results consistent with infection. Specific contraindications for surgery reported across studies included tuberculous of fungal infection, coexistence of osteomyelitis, immunocompromised individuals, and pre-existing surgery on the affected hip. The initial rate of infection eradication was 100%. All studies reported significant improvements in patient pain and function. Improvements were also observed in range of motion, as well as across both the Bennett radiographic and clinical assessments and Harris Hip Score. No complications, major or minor, were reported, and only 1 of 65 hips (1.5%) required revision arthroscopy for recurrence because of a methicillin-resistant Staphylococcus aureus infection.
CONCLUSIONS
Arthroscopic native hip irrigation and debridement for septic arthritis appear to comprise a safe and effective treatment option for selected patients (e.g., no deformity, no bacterial infections, and not immunocompromised). Timely diagnosis and intervention, however, remain the most critical prognostic factors for successful outcomes.
LEVEL OF EVIDENCE
Level IV, systematic review of Level IV and V studies.
Topics: Arthritis, Infectious; Arthroscopy; Debridement; Hip; Humans; Methicillin-Resistant Staphylococcus aureus; Range of Motion, Articular; Reoperation; Staphylococcal Infections; Therapeutic Irrigation; Treatment Outcome
PubMed: 25703285
DOI: 10.1016/j.arthro.2014.12.028 -
Cureus Jun 2020Chronic myeloid leukemia (CML) represents a common condition in the spectrum of myeloproliferative disorders (MPD). It classically exhibits leukocytosis, but rarely... (Review)
Review
Chronic myeloid leukemia (CML) represents a common condition in the spectrum of myeloproliferative disorders (MPD). It classically exhibits leukocytosis, but rarely presents with isolated thrombocytosis. This paper is designed to review the clinicopathologic features, treatment, and outcomes of patients with CML who present with isolated thrombocytosis. We searched PubMed, MEDLINE®, ScienceDirect, and Scopus for English-language articles about case series and case reports for the period 2000-2020 with the terms "chronic myeloid leukemia" and "thrombocytosis" and pooled them with a case from our institution. Cases were also incorporated from the reference list and screened for inclusion. A total of 20 cases were included in the final cohort. The male-to-female ratio was 1:1.86. The mean age of the patients at the time of initial diagnosis was 40.5 years (range: 9-77 years). Out of 17 cases with available data, seven (41%) were asymptomatic and found to have thrombocytosis incidentally upon routine blood work. Five cases (29.4%) either had a history of thrombotic events or presented with severe thrombotic complications, including ischemic cerebrovascular accidents (CVA), myocardial infarction (MI), pulmonary embolism (PE), and/or miscarriages. Four cases (23.5%) had more than one symptom at presentation, including headache, syncope, and bruising. The average platelet count was 1,923 × 10/L (range: 584-8,688 × 10/L), and one case (5%) had anemia. The bone marrow (BM) examination showed normal cellularity and normal myeloid to erythroid (M/E) ratio in seven (50%) and 11 (84.6%) out of the 14 and 13 cases with reported data, respectively. Moreover, megakaryocytes in the BM were small in 10 cases (71.4%), pleomorphic in three cases (21.4%), and dysplastic in one case (7.1%). Accurate differentiation among MPD subtypes and the exclusion of CML is critical in reaching a proper diagnosis to decide on proper therapy and eventually modify outcomes. Prompt evaluation for the precise diagnosis of patients presenting with isolated marked thrombocytosis will help expedite their diagnosis and initiation of a specific tyrosine kinase inhibitor (TKI) therapy, thereby promptly inducing remission, preventing thrombotic complications, and avoiding adverse drug events, which would eventually improve outcomes.
PubMed: 32596094
DOI: 10.7759/cureus.8788 -
The Surgeon : Journal of the Royal... Aug 2021Severity of cholecystitis can be defined by the presence of histopathological changes such as gangrene, perforation, and empyema. Severe cholecystitis correlates with... (Review)
Review
INTRODUCTION
Severity of cholecystitis can be defined by the presence of histopathological changes such as gangrene, perforation, and empyema. Severe cholecystitis correlates with higher morbidity and longer hospital stay. The present review aimed to identify the predictors of severe cholecystitis.
METHODS
Electronic databases including PubMed, Scopus, and Cochrane library were searched in the period of January 1980 to March 2019. The main outcome of this review was to assess the predictability of pre-operative parameters such as Leukocytosis, fever, tachycardia, gallbladder wall edema, gallbladder distension, serum platelet count, and gallbladder mural striation. The role of patients' characteristics including age, gender, and diabetes mellitus in predicting severe cholecystitis was also assessed.
RESULTS
A total of 8823 patients were analysed. The mean age of patients was 67.14 ± 4.17. The parameters that had the highest Odds ratio in predicting severe cholecystitis were all findings on CT scanning and included attenuation of arterial phase, mural striation of the gallbladder, and decreased gallbladder wall enhancement.
CONCLUSION
We conclude that CT findings were the most significant predictors of severe cholecystitis. Patients with clinical and laboratory predictors of severe cholecystitis should be urgently evaluated with contrast CT scan to rule out any severe complications.
Topics: Cholecystitis; Gallbladder Diseases; Gangrene; Humans; Retrospective Studies
PubMed: 32703731
DOI: 10.1016/j.surge.2020.06.010 -
Cureus Dec 2022Coronavirus disease 2019 (COVID-19) is a worldwide health problem, particularly for pregnant women. This review assesses the effects of COVID-19 on pregnant women and... (Review)
Review
Coronavirus disease 2019 (COVID-19) is a worldwide health problem, particularly for pregnant women. This review assesses the effects of COVID-19 on pregnant women and their infants. A systematic search was performed of studies published on PubMed, Web of Science, Google Scholar, and Embase from January 2020 to January 2021, without restriction by language. This review included 27 studies (22 from China, one from the United States, one from Honduras, one from Italy, one from Iran, and one from Spain), which cumulatively evaluated 386 pregnant women with clinically confirmed COVID-19 and their 334 newborns. Of the 386 pregnant women, 356 had already delivered their infants, four had medical abortions at the time of research, 28 were still pregnant, and two died from COVID-19 before they were able to give birth. Cesarean sections were performed on 71% of pregnant women with COVID-19 to give birth. Fever and cough were common symptoms among women. Premature rupture of membranes, distress, and preterm birth were pregnancy complications. Low birth weight and a short gestational age were common outcomes for newborns. The common laboratory findings among pregnant women were lymphopenia, leukocytosis, and elevated levels of C-reactive protein. Chest computed tomography revealed abnormal viral lung changes in 73.3% of women. Eleven infants tested positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. There was no evidence of vertical transmission. Most infants were observed to have lymphopenia and thrombocytopenia. The clinical features of pregnant women were found to be similar to those of generally infected patients. There is evidence of adverse pregnancy and neonatal outcomes caused by COVID-19.
PubMed: 36694500
DOI: 10.7759/cureus.32787 -
Acute Flaccid Myelitis: Review of Clinical Features, Diagnosis, and Management with Nerve Transfers.Plastic and Reconstructive Surgery Jan 2023Acute flaccid myelitis (AFM) is a devastating neurologic condition in children, manifesting as acute limb weakness and/or paralysis. Despite increased awareness of AFM...
BACKGROUND
Acute flaccid myelitis (AFM) is a devastating neurologic condition in children, manifesting as acute limb weakness and/or paralysis. Despite increased awareness of AFM following initiation of U.S. surveillance in 2014, no treatment consensus exists. The purpose of this systematic review was to summarize the most current knowledge regarding AFM epidemiology, cause, clinical features, diagnosis, and supportive and operative management, including nerve transfer.
METHODS
The authors systematically reviewed the literature based on Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines using multiple databases to search the keywords ("acute flaccid myelitis"), ('acute flaccid myelitis'/exp OR 'acute flaccid myelitis'), and (Acute AND flaccid AND myelitis). Included articles reported on (1) AFM diagnosis and (2) patient-specific data regarding epidemiology, cause, clinical features, diagnostic features, or management of AFM.
RESULTS
Ninety-nine articles were included in this review. The precise cause and pathophysiologic mechanism of AFM remain undetermined, but AFM is strongly associated with nonpolio enterovirus infections. Clinical presentation typically comprises preceding viral prodrome, pleocytosis, spinal cord lesions on T2-weighted magnetic resonance imaging, and acute onset of flaccid weakness/paralysis with hyporeflexia in at least one extremity. Supportive care includes medical therapy and rehabilitation. Early studies of nerve transfer for AFM have shown favorable outcomes for patients with persistent weakness.
CONCLUSIONS
Supportive care and physical therapy are the foundation of a multidisciplinary approach to managing AFM. For patients with persistent limb weakness, nerve transfer has shown promise for improving function in distal muscle groups. Surgeons must consider potential spontaneous recovery, patient selection, donor nerve availability, recipient nerve appropriateness, and procedure timing.
Topics: Child; Humans; Nerve Transfer; Neuromuscular Diseases; Myelitis; Paralysis; Muscle Hypotonia
PubMed: 36219869
DOI: 10.1097/PRS.0000000000009788 -
European Review For Medical and... Nov 2020Hematologic cancer patients with Coronavirus Disease 2019 (COVID-19) tend to have a more serious disease course than observed in the general population. Herein, we...
OBJECTIVE
Hematologic cancer patients with Coronavirus Disease 2019 (COVID-19) tend to have a more serious disease course than observed in the general population. Herein, we comprehensively reviewed existing literature and analyzed clinical characteristics and mortality of patients with hematologic malignancies and COVID-19.
MATERIALS AND METHODS
Through searching PubMed until June 03, 2020, we identified 16 relevant case studies (33 cases) from a total of 45 studies that have reported on patients with COVID-19 and hematologic malignancies. We investigated the clinical and laboratory characteristics including type of hematologic malignancies, initial symptoms, laboratory findings, and clinical outcomes. Then, we compared those characteristics and outcomes of patients with hematologic malignancies and COVID-19 to the general population infected with COVID-19.
RESULTS
The median age was 66-year-old. Chronic lymphocytic leukemia was the most common type of hematologic malignancy (39.4%). Fever was the most common symptom (75.9%). Most patients had normal leukocyte counts (55.6%), lymphocytosis (45.4%), and normal platelet counts (68.8%). In comparison to patients with COVID-19 without underlying hematologic malignancies, dyspnea was more prevalent (45.0 vs. 24.9%, p=0.025). Leukocytosis (38.9 vs. 9.8%, p=0.001), lymphocytosis (45.4 vs. 8.2%, p=0.001), and thrombocytopenia (31.3 vs. 11.4%, p=0.036) were significantly more prevalent and lymphopenia (18.2 vs. 57.4%, p=0.012) less prevalent in patients with hematologic malignancies. There were no clinical and laboratory characteristics predicting mortality in patients with hematologic malignancies. Mortality was much higher in patients with hematologic malignancies compared to those without this condition (40.0 vs. 3.6%, p<0.001).
CONCLUSIONS
Co-occurrence of hematologic malignancies and COVID-19 is rare. However, due to the high mortality rate from COVID-19 in this vulnerable population, further investigation on tailored treatment and management is required.
Topics: Adolescent; Adult; Aged; Aged, 80 and over; COVID-19; Child; Child, Preschool; Dyspnea; Female; Fever; Hematologic Neoplasms; Humans; Leukemia, Lymphocytic, Chronic, B-Cell; Leukocytosis; Lymphocytosis; Lymphoma, Non-Hodgkin; Lymphopenia; Male; Middle Aged; Multiple Myeloma; Thrombocytopenia; Young Adult
PubMed: 33275265
DOI: 10.26355/eurrev_202011_23852 -
Clinica Chimica Acta; International... Oct 2020Since December 2019, coronavirus 2019 (COVID-19) has spread worldwide. Identifying poor prognostic factors is helpful for risk stratification. In this meta-analysis, we... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Since December 2019, coronavirus 2019 (COVID-19) has spread worldwide. Identifying poor prognostic factors is helpful for risk stratification. In this meta-analysis, we investigated the association between severe COVID-19 and a change in white blood cell (WBC) count, an elevation of C-reactive protein (CRP), and fever. Moreover, we aimed to evaluate the diagnostic accuracy of leukocytosis and an elevation of CRP.
METHODS
We performed a systematic search of PubMed, EMBASE, Scopus, and the Cochrane Library through April 20th, 2020. The odds ratios (ORs) and 95% confidence intervals (CIs) were calculated. A sensitivity analysis was conducted according to the study size (>200 or <200) and median age (>55 or <55). Meta-regression analyses were conducted to examine possible sources of heterogeneity. We calculated the diagnostic accuracy of leukocytosis and CRP.
RESULTS
Eighteen studies with 3278 patients were selected. Fever, leukocytosis, and elevated CRP were associated with poor outcomes (OR (95% CI) 1.63 (1.06-2.51), 4.51 (2.53-8.04), and 11.97 (4.97-28.8), respectively). Leukopenia was associated with a better prognosis (OR 0.56, 95% CI 0.40-0.78). Sensitivity analyses showed similar tendencies. Meta-regression analysis for leukocytosis indicated that age, dyspnea, and hypertension contributed to heterogeneity. The pooled area under the leukocytosis and CRP curves were 0.70 (0.64-0.76) and 0.89 (0.80-0.99), respectively.
CONCLUSION
In patients with COVID-19, fever, leukocytosis, and an elevated CRP were associated with severe outcomes. Leukocytosis and CRP on arrival may predict poor outcomes.
Topics: Betacoronavirus; Biomarkers; C-Reactive Protein; COVID-19; Coronavirus Infections; Humans; Leukocytosis; Leukopenia; Pandemics; Pneumonia, Viral; Prognosis; Retrospective Studies; SARS-CoV-2
PubMed: 32533986
DOI: 10.1016/j.cca.2020.06.008