Association of white blood cell parameters with metabolic syndrome: A systematic review and meta-analysis of 168,000 patients

BACKGROUND

Leukocyte parameters are predicted to be affected in patients with metabolic syndrome (MetS). We conducted a systematic review and meta-analysis to study the association between white blood cell parameters (WBC) in people with and without MetS.

METHODS

PubMed, EMBASE, Scopus and Cochrane Library databases were searched according to the study protocol. The standardized mean difference (SMD) and 95% confidence intervals (CI) of leukocyte markers between individuals with and without MetS were pooled using an inverse variance model. Additionally, a subgroup analysis by sex was performed where possible. Methodological quality assessment was conducted using the Newcastle-Ottawa scale (NOS) for observational studies and the Cochrane Risk of Bias tool 2.0 for Randomized Controlled Trials (RCTs).

RESULTS

Of 6068 articles identified, 63 were eligible for the study. Compared to controls, individuals with MetS showed significantly higher concentrations of total leukocyte count (SMD [95% CI]: 0.60 [0.55-0.65]; P < .00001; I2 = 100%), neutrophil counts (0.32 [0.28-0.37]; P < .00001; I2 = 99%), lymphocyte counts (0.15 [0.07-0.23]; P = .0004; I2 = 100%), basophil counts (0.01 [0.00-0.02]; P = .02; I2 = 98%), monocyte counts (0.05 [0.02-0.09]; P = .003; I2 = 99%), and neutrophil-to-lymphocyte ratio (0.24 [0.15-0.33]; P < .00001; I2 = 98%). There were no significant differences in the eosinophil count (0.02 [-0.01 to 0.05]; P = .19; I2 = 96%) and monocyte-to-lymphocyte ratio (0.06 [-0.05 to 0.17]; P = .27; I2 = 100%) between patients with and without MetS, however, the lymphocyte-to-monocyte ratio (0.52 [-0.81 to -0.23]; P = .0005; I2 = 52%) tended to be significantly lower in patients with MetS.

CONCLUSION

Biomarkers such as total leukocyte count, neutrophil count, lymphocyte count, basophil count, monocyte count and neutrophil-to-lymphocyte ratio are associated with higher levels in patients in MetS and thus can potentially be used for early detection of MetS.

Association of Red Blood Cell and Platelet Parameters with Metabolic Syndrome: A Systematic Review and Meta-Analysis of 170,000 Patients

This systematic review and meta-analysis aims to establish associations between metabolic syndrome (MetS) and erythrocyte and platelet markers, contributing to improved diagnostic tests for identifying individuals at risk. Observational studies and Randomized Controlled Trials (RCTs) were included. The standardized mean difference (SMD) and 95% confidence intervals (CI) of erythrocyte and platelet markers between individuals with and without MetS were used as effect size (inverse variance model). Methodological quality assessment was conducted using the Newcastle-Ottawa scale (NOS) for observational studies and the Cochrane Risk of Bias tool 2.0 for RCTs. The analysis included 51 articles. Compared to controls, individuals with MetS exhibited significantly higher concentrations of mean red blood cell count (Standardized Mean Difference [95% CI]: 0.15 [0.13 - 0.18]; p < 0.00001), hemoglobin (0.24 [0.18 - 0.31]; p < 0.00001), blood platelet count (5.49 [2.78 - 8.20]; p < 0.0001), and red blood cell distribution width (0.55 [0.05 - 1.04]; p = 0.03). Regarding mean platelet volume (0.16 [-0.03 to 0.35]; p = 0.10) and platelet-to-lymphocyte ratio (PLR) (7.48 [-2.85 - 17.81]; p = 0.16), a non-significant difference was observed in patients with MetS. There was no statistically significant difference in hematocrit counts between the two groups (0.47 [-0.40 - 1.34]; p = 0.29). Biomarkers such as mean red blood cell count, hemoglobin, blood platelet count and RDW are associated with higher levels in patients in MetS, whereas mean platelet volume and PLR tend to be lower. These markers can potentially provide new avenues for early diagnosis of MetS.

Role of laparoscopic surgery in the management of gallbladder cancer: Systematic review & meta-analysis

BACKGROUND

This meta-analysis evaluates the safety and short-term oncological outcomes of laparoscopic vs. open surgery for gallbladder carcinoma(GBC).

METHODS

Meta-analysis was performed on laparoscopic(LG) and open group(OG) studies. Data for survival outcomes were extracted from Kaplan-Meier curves and combined with Tierney's method to estimate hazard ratios(HRs) and 95% CIs.

RESULTS

There was no significant difference in overall survival(HR: 1.01), disease-free survival(HR: 0.84), 30-day mortality(RR:1.10), overall recurrence(RR:0.93), intraoperative gallbladder violation(RR:1.17), operative time(WMD:8.32), number of patients receiving adjuvant chemotherapy(RR:1.06) and blood transfusion(RR: 0.81). A significant difference was seen in survival of T3 subgroup(HR:0.77) and number of lymph node dissections (LND)(WMD: 0.63) favoring OG, along with a decrease in postoperative complications(RR:0.65), greater incidence of R0 resections(RR:1.04), lower volume of intraoperative blood loss(WMD: 128.62), lower time in removing drainage tube(WMD: 1.35), shorter diet recovery time(WMD: 1.88), shorter hospital stay(WMD: 3.51), lower incidence of 90-day mortality(RR:0.49) favoring LG. A higher incidence of port-site recurrence(RR:1.99) was reported in LG.

CONCLUSION

Laparoscopic surgery is non-inferior to the open approach in terms of oncological outcomes and has an improved rate of postoperative complications.

Coronavirus pandemic (COVID-19) and its natural environmental impacts

Coronavirus Disease 2019 (COVID-19) is the official name of a respiratory infectious disease caused by a new coronavirus that started first in Wuhan, China, and outspread worldwide with an unexpectedly fast speed. Flights have been canceled worldwide and transportation has been closed nationwide and across international borders. As a consequence, the economic activity has been stopped and stock markets have been dropped. The COVID-19 lockdown has several social and economic effects. Additionally, COVID-19 has caused several impacts on global migration. On the other hand, such lockdown, along with minimal human mobility, has impacted the natural environment somewhat positively. Overall carbon emissions have dropped, and the COVID-19 lockdown has led to an improvement in air quality and a reduction in water pollution in many cities around the globe. A summary of the existing reports of the environmental impacts of COVID-19 pandemic are discussed and the important findings are presented focusing on several aspects: air pollution, waste management, air quality improvements, waste fires, wildlife, global migration, and sustainability.

Coronavirus pandemic (COVID-19) and its natural environmental impacts

Coronavirus Disease 2019 (COVID-19) is the official name of a respiratory infectious disease caused by a new coronavirus that started first in Wuhan, China, and outspread worldwide with an unexpectedly fast speed. Flights have been canceled worldwide and transportation has been closed nationwide and across international borders. As a consequence, the economic activity has been stopped and stock markets have been dropped. The COVID-19 lockdown has several social and economic effects. Additionally, COVID-19 has caused several impacts on global migration. On the other hand, such lockdown, along with minimal human mobility, has impacted the natural environment somewhat positively. Overall carbon emissions have dropped, and the COVID-19 lockdown has led to an improvement in air quality and a reduction in water pollution in many cities around the globe. A summary of the existing reports of the environmental impacts of COVID-19 pandemic are discussed and the important findings are presented focusing on several aspects: air pollution, waste management, air quality improvements, waste fires, wildlife, global migration, and sustainability.

Female genital tuberculosis revisted

OBJECTIVE

To assess the clinical presentation of genital tuberculosis and to study various modes of diagnosis and treatment.

SETTING

The Aga Khan University Hospital (AKUH), Karachi.

METHOD

A retrospective case review of all index female cases of genital tuberculosis, admitted to AKUH over twelve years of period.

RESULT

A total of 40 cases of genital tuberculosis were reported during this time period. Majority of cases were between 25-45 years. The commonest presenting symptoms were infertility (42.5%) and abdominal pain (42%). Others included fever, ascites, irregular vaginal bleeding, oligomenorrhea, chest pain and pain in the flanks. Main mode of treatment was antituberculous drug therapy for duration of nine months. Only 3 patients had successful pregnancies.

CONCLUSION

Genital tuberculosis should be excluded when managing infertility in females.

Chronic pain management--upper visceral malignancies coeliac plexus block with CT scanning--a case report

Coeliac plexus block has been described more than seventy years ago and is widely used for chronic pain management in upper visceral malignancies. The technique described here is a posterior approach using CT scan guidance with absolute ethyl alcohol. A case illustration of a patient with carcinoma of pancreas managed with coeliac plexus block for pain control is presented.