Transient exposures to high or low concentrations of a single or mixture of pesticides are common in aquatic organisms. Routine toxicity tests disregard transient exposures and the influence of time when examining the toxicity of contaminants. This study investigated the haematological and biochemical responses of juvenile C. gariepinus and O. niloticus to pesticide pulse exposure using three exposure patterns. The patterns include 4-hour pulse exposure to a high pesticide concentration, then 28 days of depuration, continuous exposure to a low pesticide concentration for 28 days, and 4-hour pulse exposure to a high concentration followed by continuous exposure to a low pesticide concentration for 28 days. On days 1, 14, and 28, fish samples were collected for haematological and biochemical analysis. Results showed that red blood cell count, packed cell volume, haemoglobin, platelet count, total protein, and sodium ion decreased, while white blood cell count, total cholesterol, bilirubin, urea, and potassium ion increased in both fish species after pulse, continuous and pulse & continuous exposure to the pesticides (p < 0.05). However, pulse exposure to the pesticides did not significantly affect alanine aminotransferase, aspartate aminotransferase, alkaline phosphatase activity, and creatinine levels. The changes in these biomarkers indicate that 4-hour pulse exposure to high concentration was as hazardous as 24-hour continuous exposure to low pesticide concentration (p > 0.05). The toxic effects of pulse exposure were largely reversible by day 14. Using C. gariepinus and O. niloticus, this study shows that brief exposure to high pesticide pesticides was as hazardous as continuous pesticide exposure. 

Haematological and biochemical toxicity in freshwater fish Clarias gariepinus and Oreochromis niloticus following pulse exposure to atrazine, mancozeb, chlorpyrifos, lambda-cyhalothrin, and their combination.

Abstract Background Hyperkalemia is a common complication of chronic kidney disease (CKD). Hyperkalemia is associated with mortality, CKD progression, hospitalization, and high healthcare costs in patients with CKD. We developed a machine learning model to predict hyperkalemia in patients with advanced CKD at an outpatient clinic. Methods This retrospective study included 1,965 advanced CKD patients between January 1, 2010, and December 31, 2020 in Taiwan. We randomly divided all patients into the training (75%) and testing (25%) datasets. The primary outcome was to predict hyperkalemia (K + &gt; 5.5 mEq/L) in the next clinic vist. Two nephrologists were enrolled in a human-machine competition. The area under the receiver operating characteristic curves (AUCs), sensitivity, specificity, and accuracy were used to evaluate the performance of XGBoost and conventional logistic regression models with that of these physicians. Results In a human-machine competition of hyperkalemia prediction, the AUC, PPV, and accuracy of the XGBoost model were 0.867 (95% confidence interval: 0.840–0.894), 0.700, and 0.933, which was significantly better than that of our clinicians. There were four variables that were chosen as high-ranking variables in XGBoost and logistic regression models, including hemoglobin, the serum potassium level in the previous visit, angiotensin receptor blocker use, and calcium polystyrene sulfonate use. Conclusions The XGBoost model provided better predictive performance for hyperkalemia than physicians at the outpatient clinic. 

Predicting hyperkalemia in patients with advanced chronic kidney disease using the XGBoost model

Introduction: The WHO has recognised iron deficiency anaemia (IDA) as the most common nutritional deficiency in the world, with 30% of the population being affected by this condition. The patient's glycemic status during the past three months is shown by the glycated haemoglobin A1C (HbA1c) test. According to several studies, iron deficiency can increase HbA1C levels without affecting blood sugar levels. HbA1C levels of ≥ 6.5% have been approved by the American Diabetes Association (ADA) as a diagnostic indicator for diabetes mellitus (DM). An imbalance in serum electrolyte levels and anaemia have been linked by several studies. Aim: To analyze the effect of iron deficiency anaemia on HbA1c levels and serum electrolytes in an adult non-diabetic population. Methods: This was a descriptive cross-sectional study conducted in Shri BM Patil Medical College, Hospital and Research Centre, Vijayapura, Karnataka, India from January 2021 to June 2022. A total of 65 moderate to severe normoglycemic iron deficiency anemia patients between 18 to 75 years were enrolled in the study after fulfilling inclusion and exclusion criteria. A detailed history, clinical and biochemical examination was performed including HbA1c levels. The results were pooled and statistical analyses were performed using Statistical Package for Social Sciences (SPSS) version 20 (IBM Corp., Armonk, NY, USA). Results: We found elevated HbA1c levels (5.67±1.1%) in non-diabetic iron-deficient anaemia individuals, and elevation was more in women of reproductive age group (30.8%). There was a statistically significant Spearman negative correlation between hemoglobin and HbA1C levels. Also, 16 patients had hyponatremia with a mean haemoglobin (Hb) of 4.8 g/dL and one patient had hyperkalemia with a mean Hb of 3.2 g/dL which was statistically non-significant. Conclusion: In this study haemoglobin and HbA1c had a statistically significant positive correlation with serum sodium and a negative correlation with serum potassium in moderate to severely iron-deficient anaemic patients, especially females of the reproductive age group.

/pdf/assessment-of-serum-electrolytes-and-glycated-hemoglobin-23hwwnal.pdf

Assessment of Serum Electrolytes and Glycated Hemoglobin Level in Non-diabetic Iron-Deficient Anaemic Patients

Introduction: Anaemia is a common problem discovered on routine laboratory tests. Based on red cell morphology, anaemia can be classified as microcytic hypochromic, macrocytic and Normocytic Normochromic Anaemia (NNA). Anaemia is not a diagnosis in itself, but merely an objective sign of underlying disease. The correct treatment requires an understanding of the pathogenesis of the condition. Varied number of clinical disorders manifests as NNA and pose a great challenge to the clinician. Aim: To identify the spectrum of disorders presenting as NNA and to grade anaemia across age and sex of individual using World Health Organisation (WHO) criteria. Materials and Methods: This prospective descriptive study was conducted in a tertiary care teaching hospital, Ernakulam, Kerala, India during one year period of February 2017-January 2018. Total of 514 patients meeting the inclusion criteria were recruited for the study. After taking detailed history and clinical examination, investigations were done including Complete Blood Count (CBC), peripheral smear preparation, reticulocyte count, Renal Function Tests (RFT), Liver Function Tests (LFT) and if necessary, bone marrow study and radiological studies were done. The data obtained was statistically analysed using Microsoft Excel 365. Descriptive statistics viz., number of cases, percentage, concomitant involvement with other disorders, differential involvement with various age groups, male:female ratio, and grade of anaemia were utilised to describe the spectrum of disorders presenting as NNA. Results: Of the 514 patients, 433 were adults and 81 were in paediatric age group. The average age in adult males were 58 years and in females 57 years with Haemoglobin (Hb) being 9.04 g/dL and 8.99 g/dL, respectively. Paediatric population had an average Hb of 10.18 g/dL. A total of 106 conditions were seen among the 514 patients. The disease conditions were further categorised into 10 subtypes. Type 2 Diabetes Mellitus (T2DM) constituted single most common associated disorder (112 cases) seen along NNA followed by Coronary Artery Disease (CAD) (74 cases). Idiopathic cases constituted 79 cases. Conclusion: The NNA constituted 25% of the cases presented to the laboratory during the study period. T2DM was associated with NNA along with CAD. An understanding of the categories of anaemia along with a diagnostic protocol will go a long way in better management of the patient.

Descriptive Study of the Spectrum of Disorders Presenting as Normocytic Normochromic Anaemia from a Tertiary Care Setting at Ernakulam, Kerala, India

Sickle cell disease (SCD) is caused by a point mutation in the beta-globin gene. SCD is characterized by chronic hemolytic anemia, vaso-occlusive events leading to tissue ischemia, and progressive organ failure. Chronic inflammatory state is part of the pathophysiology of SCD. Patients with SCD have extremely variable phenotypes, from mild disease to severe complications including early age death. The spleen is commonly injured in SCD. Early splenic dysfunction and progressive spleen atrophy are common. Splenomegaly and hypersplenism can also occur with the loss of the crucial splenic function. Acute, life-threatening spleen-related complications in SCD are well studied. The association of laboratory parameters with the spleen status including hyposplenism, asplenia, and splenomegaly/hypersplenism, and their implication in vaso-occlusive crisis and long-term complications in SCD remain to be determined. We evaluated the association between the spleen status with clinical and laboratory parameters in 31 SCD patients: Group a) Patients with asplenia/hyposplenism (N = 22) (including auto-splenectomy and splenectomized patients) vs. Group b) patients with splenomegaly and or hypersplenism (N = 9). Laboratory studies included: Complete Blood Count, reticulocyte count, iron metabolism parameters, C Reactive Protein (CRP), Hb variant distribution, and D-dimer. Metabolic and morphological red blood cell (RBC) studies included: density gradient (by Percoll), glucose consumption, lactate release, and K+ leakage, fetal RBC (F-Cells) and F-Reticulocytes, annexinV+, CD71+, oxidative stress measured by GSH presence in RBC and finally Howell Jolly Bodies count were all analyzed by Flow Cytometry. Scanning electron microscopy analysis of RBC was also performed. Patients with asplenia/hyposplenism showed significantly higher WBC, platelet, Hematocrit, hemoglobin S, CRP, D-dimer, Gamma Glutamyl Transferase (GGT), cholesterol, transferrin, annexin V+ RBCs, CD71+ RBCs, together with a markedly lower F Reticulocyte levels in comparison with splenomegaly/hypersplenism patients. In summary, important differences were also found between the groups in the studied RBCs parameters. Further studies are required to elucidate the effect of the spleen including hyper and hypo-splenia on laboratory parameters and in clinical manifestations, vascular pathology, and long-term complications of SCD. The benefits and risks of splenectomy compared to chronic transfusion need to be evaluated in clinical trials and the standard approach managing hypersplenism in SCD patients should be re-evaluated.

The protective effect of the spleen in sickle cell patients. A comparative study between patients with asplenia/hyposplenism and hypersplenism

Introduction Anemia is one of the most prevalent diseases globally. Various diseases have linked anemia with electrolyte disturbance. However, the local data are limited. In this study, we will determine the prevalence of electrolyte imbalance in anemic patients. Methods This case-control study was conducted in a tertiary care hospital from January 2021 to July 2021. A total of 500 anemic patients were enrolled in the study after informed consent. Another 500 non-anemic patients were enrolled as the control group. Blood was taken from both groups and send for assessment of electrolytes. Results Sodium levels were significantly lower in anemic patients compared to non-anemic patients (131.42 ± 0.82 meq/L vs. 135.57 ± 0.42 meq/L; p-value: Conclusion Our study indicates that sodium levels and potassium levels are impacted in patients with anemia compared to patients without anemia. Close monitoring of serum electrolytes is suggested in patients with anemia to avoid complications and life-threatening conditions.

Evaluation of Serum Electrolyte Levels in Patients With Anemia

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Evaluation of Serum Electrolyte Levels in Patients With Anemia