The Prognostic Significance of Established Hematological Parameters and Inflammatory Biomarkers in Assessing Dengue Infection Severity and Progression among Patients Ages 5 to 14 in a Tertiary Government Hospital in Pampanga, Philippines

Introduction/Objective

Dengue virus (DENV) is an arthropod-borne virus which imposes a significant burden on the health system in most tropical and subtropical countries. In 2009, WHO classified Dengue into Dengue Without Warning Signs (DNWS), Dengue With Warning Signs (DWWS), and Severe Dengue (SD). This study aims to establish the prognostic value of predetermined hematological parameters and inflammatory biomarkers in assessing severity and progression of dengue infection among ages 5-14.

Methods/Case Report

A retrospective study was conducted to evaluate the Complete Blood Count, Inflammation biomarkers, and severity of dengue patients (5-14 of age). The diagnosis must be serologically confirmed by a positive NS1/IgM.

Results (if a Case Study enter NA)

A total of 36 patients participated in the study, having 18 from each groups of DWWS and SD. The mean age of Dengue cohort was 13.9 years with 59% (19/36) being male. Laboratory findings reveal SD to have lower platelet count (<100.00x109/L) during day 1-3 (p<0.001). Low WBC count (<4.00x109/L), Relative Eosinophil (<2.00%), and Absolute Lymphocyte count (<1.52x109/L) were evident on days 1-3 among DWWS and SD cases (p=0.023; p=0.045; p=0.033). Low relative neutrophil (<0.45%) was a constant finding in both clinical types throughout disease progression. SD group had significantly higher Neutrophil to Lymphocyte ratio (NLR) values among SD cases on days 4-6 (p<0.001). In contrast, Platelet to Lymphocyte ratio (PLR) was significantly lower among DWWS cases on days 4-6 (p=0.020). Monocyte to Lymphocyte (MLR) ratio had poor discriminative power (p=0.560).

Conclusion

The findings highlight decreased platelet, WBC, relative eosinophil, and absolute lymphocyte count to be common among Dengue patients. NLR and PLR were found to be good predictors of dengue severity during the initial phase of infection. Evaluating these values may aid clinicians in early diagnosis of severe dengue. However, larger samples are needed to further validate the predictive values of these parameters.

Impact of Hypercalcemia and Parathyroid Hormone Level on the Sensitivity of Preoperative Sestamibi Scanning for Primary Hyperparathyroidism

Technetium 99m sestamibi scanning (MIBI) can direct unilateral parathyroidectomy. However, the clinical application remains variable with sensitivities ranging from 55 to 100 per cent. We examined whether patient factors including serum calcium (Ca) and parathyroid hormone (PTH) levels impact the sensitivity of MIBI. We completed a retrospective review of 102 patients with primary hyperparathyroidism and mild hypercalcemia who underwent preoperative MIBI. All patients underwent bilateral neck explorations with abnormalities confirmed by histopathology. MIBI sensitivity was correlated with preoperative Ca and PTH levels using univariate and logistic regression analysis. The mean preoperative Ca was 11.0 mg/dL and the mean PTH was 158 pg/mL. More than 95 per cent of patients with Ca greater than 11.3 mg/dL had a positive scan as compared with 60 per cent of those with lesser values ( P = 0.0024). Similarly a serum PTH level greater than 160 pg/mL correlated with positive scans in 93 per cent as opposed to 57 per cent in those with lower levels ( P = 0.006). Using a scan-directed approach 65 of 74 patients would have undergone unilateral exploration; this would yield a 7.7 per cent operative failure rate because of contralateral multigland disease. Lower Ca and PTH levels seem to correlate with reduced sensitivity of MIBI. Increasing acceptance of surgery for hyperparathyroidism with minimal hypercalcemia may make MIBI less attractive without ancillary diagnostic measures such as rapid parathormone assays.

Impact of hypercalcemia and parathyroid hormone level on the sensitivity of preoperative sestamibi scanning for primary hyperparathyroidism

Technetium 99m sestamibi scanning (MIBI) can direct unilateral parathyroidectomy. However, the clinical application remains variable with sensitivities ranging from 55 to 100 per cent. We examined whether patient factors including serum calcium (Ca) and parathyroid hormone (PTH) levels impact the sensitivity of MIBI. We completed a retrospective review of 102 patients with primary hyperparathyroidism and mild hypercalcemia who underwent preoperative MIBI. All patients underwent bilateral neck explorations with abnormalities confirmed by histopathology. MIBI sensitivity was correlated with preoperative Ca and PTH levels using univariate and logistic regression analysis. The mean preoperative Ca was 11.0 mg/dL and the mean PTH was 158 pg/mL. More than 95 per cent of patients with Ca greater than 11.3 mg/dL had a positive scan as compared with 60 per cent of those with lesser values (P = 0.0024). Similarly a serum PTH level greater than 160 pg/mL correlated with positive scans in 93 per cent as opposed to 57 per cent in those with lower levels (P = 0.006). Using a scan-directed approach 65 of 74 patients would have undergone unilateral exploration; this would yield a 7.7 per cent operative failure rate because of contralateral multigland disease. Lower Ca and PTH levels seem to correlate with reduced sensitivity of MIBI. Increasing acceptance of surgery for hyperparathyroidism with minimal hypercalcemia may make MIBI less attractive without ancillary diagnostic measures such as rapid parathormone assays.

Postoperative surveillance of differentiated thyroid carcinoma: a selective approach

This review was conducted to evaluate the selective use of 131I whole-body scanning (WBS) and radioablation (RA) after thyroidectomy for patients with differentiated thyroid carcinoma (DTC). A review of patients undergoing thyroidectomy for DTC between July 1, 1980 and December 31, 1999 was performed. Postoperative surveillance involved a selective RA protocol based on a modification of the AMES criteria (age, metastases, extent of cancer, size, and multifocality of tumor). Lower-risk patients were followed by yearly thyroglobulin (Tg) levels and physical examinations (PE) whereas higher-risk patients additionally underwent WBS and RA when appropriate. Three hundred forty-three patients were identified; of these 27 per cent had positive lymph nodes or metastatic disease at their initial operation. Two hundred thirteen (64%) patients underwent postoperative WBS with 174 (82%) requiring RA. One hundred thirty (36%) low-risk patients were followed with yearly Tg and PE that when abnormal led to WBS and RA. No additional patient morbidity or mortality resulted from this protocol. Factors identified during multivariate analyses as being predictive of occult metastasis and recurrence (P < 0.05) included tumor size and lymph node status. These data support a selective approach to the postoperative surveillance of DTC using Tg and PE to monitor low-risk patients and WBS for those with a higher risk of recurrence.

Postoperative Surveillance of Differentiated Thyroid Carcinoma: A Selective Approach

This review was conducted to evaluate the selective use of 131I whole-body scanning (WBS) and radioablation (RA) after thyroidectomy for patients with differentiated thyroid carcinoma (DTC). A review of patients undergoing thyroidectomy for DTC between July 1, 1980 and December 31, 1999 was performed. Postoperative surveillance involved a selective RA protocol based on a modification of the AMES criteria (age, metastases, extent of cancer, size, and multifocality of tumor). Lower-risk patients were followed by yearly thyroglobulin (Tg) levels and physical examinations (PE) whereas higher-risk patients additionally underwent WBS and RA when appropriate. Three hundred forty-three patients were identified; of these 27 per cent had positive lymph nodes or metastatic disease at their initial operation. Two hundred thirteen (64%) patients underwent postoperative WBS with 174 (82%) requiring RA. One hundred thirty (36%) low-risk patients were followed with yearly Tg and PE that when abnormal led to WBS and RA. No additional patient morbidity or mortality resulted from this protocol. Factors identified during multivariate analyses as being predictive of occult metastasis and recurrence ( P < 0.05) included tumor size and lymph node status. These data support a selective approach to the postoperative surveillance of DTC using Tg and PE to monitor low-risk patients and WBS for those with a higher risk of recurrence.