Machine learning approaches classify clinical malaria outcomes based on haematological parameters

In patients with severe malaria, acute respiratory distress syndrome usually develops after the start of drug treatment and is a major cause of death. Its pathogenesis is not well understood. Respiratory symptom, spirometry, and gas transfer analyses were performed longitudinally in adults in Papua, Indonesia, with uncomplicated (n=50) and severe (n=30) falciparum malaria; normal values were derived from 109 control subjects. Gas transfer was partitioned into its alveolar-capillary membrane (D(M)) and pulmonary vascular (Vc) components, to characterize the site of impaired gas transfer. Cough was frequent in both patients with uncomplicated malaria (50%) and those with severe malaria (30%) and resolved by day 14. Reduced midexpiratory flow indicated obstruction of the small airways. Gas transfer was significantly impaired in patients with severe malaria. D(M) was reduced in patients with severe malaria but not in those with uncomplicated malaria and only returned to normal levels after 2 weeks. In patients with uncomplicated malaria, Vc was reduced at presentation but improved thereafter. In patients with severe malaria, Vc decreased with treatment and was lowest at day 7. Our results suggest that pulmonary vascular occlusion occurs in both patients with uncomplicated malaria and those with severe malaria, likely from sequestration of both red blood cells (RBCs) and white blood cells. There was also impaired alveolar-capillary membrane function in patients with severe malaria but not in those with uncomplicated malaria. Persistent impairment long after clearance of parasitized RBCs suggests prolonged posttreatment inflammatory alveolar-capillary injury.

Alterations in the hematological parameters of Tinca tinca were studied after exposure to lead at different concentrations and durations of exposure. Dose of 75/24 (ppm/h) did not cause significant change in any blood parameter. The 300/48 dose caused a significant increase in hematocrit (Hct), mean corpuscular volume (MCV) and mean corpuscular hemoglobin (MCH) and a significant decrease in red blood cell (RBC) count and mean corpuscular hemoglobin concentration (MCHC). The 30/24 dose caused a significant increase in Hct and RBC count only. The 30/96 dose caused a significant increase in Hct and a significant decrease in MCHC only. The 30/504 dose caused a significant decrease in RBC count and a significant increase in MCV and MCH. The 75/96 dose caused a significant increase in Hct and a significant decrease in MCH and MCHC. The 75/504 dose caused a significant decrease in Hct, hemoglobin (Hb) and RBC count, and a significant increase in MCV and MCH. These alterations were attributed to direct or feedback responses of structural damage to RBC membranes resulting in hemolysis and impairment in hemoglobin synthesis, stress related release of RBCs from the spleen and hypoxia, induced by exposure to lead.

BackgroundThis study aimed to evaluate the gap between guidelines and local clinical practice for diagnosis and treatment of uncomplicated and severe malaria, the patient characteristics, diagnostic approach, treatment, and compliance to standard guideline recommendations.MethodsThis was a multicentre, observational study conducted between October 2020 and March 2021 in which patients of all ages with symptoms suggestive of malaria and who visited a healthcare facility were prospectively enrolled in six countries in sub-Saharan Africa (The Democratic Republic of the Congo, Mozambique, Nigeria, Rwanda, The United Republic of Tanzania, and Zambia).ResultsOf 1001 enrolled patients, 735 (73.4%) patients had confirmed malaria (based on overall judgment by investigator) at baseline (uncomplicated malaria: 598 [81.4%] and severe malaria: 137 [18.6%]). Of the confirmed malaria patients, 533 (72.5%) were administered a malaria rapid diagnostic test. The median age of patients was 11 years (range: 2 weeks–91 years) with more patients coming from rural (44.9%) than urban (30.6%) or suburban areas (24.5%). At the community level, 57.8% of patients sought advice or received treatment for malaria and 56.9% of patients took one or more drugs for their illness before coming to the study site. In terms of early access to care, 44.1% of patients came to the study site for initial visit ≥ 48 h after symptom onset. In patients with uncomplicated malaria, the most prescribed treatments were artemisinin-based combination therapy (ACT; n = 564 [94.3%]), primarily using artemether-lumefantrine (82.3%), in line with the World Health Organization (WHO) treatment guidelines. In addition, these patients received antipyretics (85.6%) and antibiotics (42.0%). However, in those with severe malaria, only 66 (48.2%) patients received parenteral treatment followed by oral ACT as per WHO guidelines, whereas 62 (45.3%) received parenteral treatment only. After receiving ambulatory care, 88.6% of patients with uncomplicated malaria were discharged and 83.2% of patients with severe malaria were discharged after hospitalization. One patient with uncomplicated malaria having multiple co-morbidities and three patients with severe malaria died.ConclusionsThe findings of this study suggest that the prescribed treatment in most patients with uncomplicated malaria, but not of those with severe malaria, was in alignment with the WHO recommended guidelines.

Cerebral Malaria: A Vasculopathy

Data-driven rapid detection of Helicobacter pylori infection through machine learning with limited laboratory parameters in Chinese primary clinics

Background: Iron deficiency anemia (IDA) and β-thalassemia trait (β-TT) are the most common microcytic hypochromic anemias in children. Distinguishing between these conditions is essential for accurate management and genetic counseling, especially in resource-limited settings where advanced diagnostic testing may not be readily available. Red cell indices provide a simple and cost-effective method for differentiating between red blood cells. Objective: To determine and compare mean red cell indices in children aged 6 months to 2 years with iron deficiency anemia and β-thalassemia minor. Study Design: Cross-sectional study. Setting: Department of Pediatrics, Unit-C of Khyber Teaching Hospital, Peshawar, Pakistan. Duration of Study: 21-October-2024 to 21-April-2025. Methods: A total of 60 children aged 6 months to 2 years were enrolled, including 30 with IDA and 30 with β-TT. Children were classified as IDA if hemoglobin was <13 g/dL with serum ferritin <10 ng/mL, and as β-TT if hemoglobin was <13 g/dL with HbA2 >7%. Venous blood samples were analyzed for hemoglobin, mean corpuscular volume (MCV), mean corpuscular hemoglobin concentration (MCHC), red cell distribution width (RDW), and red blood cell (RBC) count. Statistical analysis was performed using SPSS (version [insert]), with p < 0.05 considered significant. Results: The mean MCV was significantly higher in IDA (75.04 ± 2.06 fL) compared to β-TT (72.89 ± 1.77 fL; p < 0.0001). MCHC was lower in IDA (31.59 ± 1.49 g/dL) than in β-TT (34.44 ± 1.13 g/dL; p < 0.0001). RDW was markedly elevated in β-TT (19.39 ± 1.71%) compared to IDA (14.32 ± 1.64%; p < 0.0001). RBC counts were higher in β-TT (4.90 ± 0.98 ×10⁶/μL) compared to IDA (4.06 ± 0.62 ×10⁶/μL; p < 0.0001). Conclusion: Red cell indices, including MCV, MCHC, RDW, and RBC count, demonstrated significant differences between IDA and β-TT. These findings support their role as simple, reliable, and cost-effective discriminators in differentiating between the two conditions in pediatric populations.

BackgroundParathyroid carcinoma (PC) is a rare endocrine malignancy, and its preoperative diagnosis remains challenging. This study aimed to evaluate the differential diagnostic value of complete blood count (CBC) parameters for parathyroid tumors.MethodsA total of 68 patients with PC and 340 patients with parathyroid adenoma (PA) were enrolled in this retrospective study. Preoperative CBC results and follow-up data concerning patient outcomes were collected. Logistic regression (LR), machine learning, and Cox regression models were constructed to investigate the diagnostic and prognostic value of CBC parameters.ResultsIn the PC group, the white blood cell (WBC) count, monocyte (MON) count, neutrophil (NEU) count, basophil percentage (BAS%), neutrophil percentage (NEU%), and neutrophil-to-lymphocyte ratio (NLR) in peripheral blood samples were significantly higher than those in the PA group (P<0.05). In contrast, the red blood cell (RBC) count, hematocrit (HCT), basophil (BAS) count, lymphocyte percentage (LYM%), mean platelet volume (MPV), eosinophil percentage (EOS%), and lymphocyte-to-monocyte ratio (LMR) were significantly lower in the PC group (P<0.05). The diagnostic factors for PC were RBC count [odds ratio (OR) 0.443; 95% confidence interval (CI): 0.243–0.809], BAS count (OR 0.000; 95% CI: 0.000–0.001), BAS% (OR 12.314; 95% CI: 3.567–42.514), EOS% (OR 0.732; 95% CI: 0.571–0.937), and NEU count (OR 1.445; 95% CI: 1.139–1.833) (P<0.05). The area under the curve (AUC) was 0.870. When these features were combined with clinical features, the AUC of the model increased to 0.946. For patients with PC, high mean corpuscular hemoglobin concentration (MCHC) (P=0.02), parafibromin staining loss (P=0.003), and high parathyroid hormone (PTH) (P=0.02) were independent risk factors for recurrence.ConclusionsCBC parameters may be useful adjunct markers for the differential diagnosis of PC. They can improve the diagnostic efficiency of clinical parameters for PC.

Research Background: Malaria, predominantly caused by Plasmodium falciparum, continues to be a leading cause of morbidity and mortality among children under five years of age in sub-Saharan Africa. Malaria remains a significant public health challenge in Nigeria, particularly in regions where access to healthcare facilities is limited. Home-based management of malaria has emerged as a critical strategy to reduce disease burden, enabling timely treatment at the community level. Chloroquine, once the cornerstone of malaria treatment, is still utilized in some settings due to its affordability, availability, oral administration, and historical effectiveness against Plasmodium species. However, the widespread emergence of chloroquine-resistant strains of Plasmodium falciparum has necessitated a reevaluation of its role in malaria management. This study investigates the therapeutic effectiveness of oral chloroquine in home-based management, focusing on its ability to reduce parasitemia and alleviate clinical symptoms. Additionally, the study assessed the influence of protein nutritional status and bacterial/viral co-infections on malaria outcomes among children under five years in Jos, Nigeria, providing insights into its current relevance in resource-limited settings. Research Objective: Given the historical use of chloroquine and emerging reports of chloroquine-sensitive strains, this research aims to evaluate the therapeutic effectiveness of oral chloroquine in the home-based management of childhood malaria in Jos, Nigeria, by assessing its impact on parasitemia, symptom alleviation, biochemical and hematological profiles, nutritional status, and interactions with co-infections while providing evidence-based insights to inform policy, community health practices, and contemporary malaria control strategies. Methods: This cross-sectional and analytical study evaluated the role of oral chloroquine in the home-based management of childhood malaria in Jos, Nigeria. A total of 93 children under five years of age, presenting with fever and confirmed Plasmodium falciparum parasitemia, were recruited from two hospitals in Jos. Participants were stratified into three groups: children treated with chloroquine at home prior to hospital presentation, untreated children with uncomplicated malaria, and untreated children with severe malaria. Caregivers were surveyed to assess the use of chloroquine as a first-line home treatment, including dosage and timing of administration. Ethical approval was obtained from the Jos University Teaching Hospital (JUTH) Ethical Committee, and informed consent was secured from caregivers before sample collection and interviews. Parasitemia levels were measured to correlate parasite density with clinical outcomes. Comprehensive assessments included biochemical analysis of serum creatinine, liver enzymes, and protein levels to evaluate organ function and metabolic status. Hematological parameters, including hemoglobin concentration and red blood cell (RBC) count, were measured to assess malaria severity and anemia. Nutritional status was evaluated through anthropometric measurements and serum protein analyses. Co-infections with bacterial and viral pathogens were identified using microscopic examination of blood samples. Statistical analyses were performed to identify significant associations between chloroquine treatment, clinical outcomes, and biochemical indicators. Results: Children treated with chloroquine demonstrated significantly lower parasitemia levels (18.13%) compared to untreated children with uncomplicated malaria (34.35%) and those with severe malaria (43.57%). Hemoglobin levels were notably higher in the chloroquine-treated group (9.60 g/dL) compared to the untreated groups, indicating a reduced burden of malaria-induced anemia. Body temperatures were significantly lower among chloroquine-treated children, underscoring its efficacy in fever reduction. Bacterial co-infections were identified in 54.35% of malaria cases, emphasizing their role in exacerbating disease severity. Liver and kidney function tests revealed no significant differences between the groups, indicating that chloroquine treatment did not result in hepatic or renal toxicity. Additionally, all participants exhibited adequate nutritional status, with no evidence of protein-energy malnutrition. Conclusion: The findings of this study highlight the significant role of oral chloroquine in the home-based management of childhood malaria in Jos, Nigeria. Children treated with chloroquine exhibited substantially lower parasitemia levels and higher hemoglobin concentrations compared to untreated children, demonstrating its effectiveness in reducing parasite burden and mitigating malaria-induced anemia. Additionally, chloroquine treatment was associated with lower body temperatures, reflecting its efficacy in fever control. Bacterial co-infections were present in over half of the malaria cases (54.35%), underscoring their potential contribution to disease severity and the need for integrated management strategies. Importantly, liver and kidney function tests showed no significant differences among the groups, indicating that chloroquine use did not lead to hepatic or renal toxicity. Furthermore, all participants maintained adequate nutritional status, with no signs of protein-energy malnutrition. These results support the continued use of chloroquine as a viable option in the home-based management of uncomplicated malaria while highlighting the importance of addressing co-infections to improve clinical outcomes.

BackgroundHematological abnormalities are common features in falciparum malaria but vary among different populations across countries. Therefore, we compared hematological indices and abnormalities between Plasmodium falciparum-infected patients and malaria-negative subjects in Kosti city of the White Nile State, Sudan.MethodsA comparative, cross-sectional study was conducted at the Clinical Laboratory Unit of Kosti Teaching Hospital from June to December 2018. A total of 392 participants (192 P. falciparum-infected patients and 200 malaria-negative subjects) were recruited in the study. Hematological indices of hemoglobin (Hb), red blood cells (RBCs), white blood cells (WBCs) and platelets were measured, and their median values were statistically compared.ResultsThe majority of P. falciparum-infected patients (67.6%) showed a low-level parasitemia. The median values of Hb concentration, RBC count, mean corpuscular volume (MCV), mean corpuscular Hb (MCH) and mean corpuscular Hb concentration (MCHC) were significantly lower in P. falciparum-infected patients, while the median red cell distribution width (RDW) was significantly higher in the patients compared to malaria-negative subjects. Anemia, low MCV, low MCH, low MCHC and high RDW were significantly associated with falciparum malaria, but parasitemia level was not significantly associated with anemia severity. The median total WBC count was non-significantly higher in P. falciparum-infected patients, with neutropenia being significantly associated with falciparum malaria. The median platelet count was significantly lower in P. falciparum-infected patients, with thrombocytopenia being significantly associated with falciparum malaria.ConclusionsFalciparum malaria among patients in Kosti city of the White Nile State, Sudan is predominantly of low-level parasitemia. It is significantly associated with anemia, low MCV, low MCH, low MCHC, high RDW, thrombocytopenia and neutropenia. However, parasitemia level is not a significant predictor of anemia severity. On the other hand, leucopenia is not useful to predict falciparum malaria. Further large-scale studies in community and healthcare settings and inclusion of patients with complicated or severe malaria and those with high parasite densities are recommended.

Interleukin-6 (IL-6) is generated by immune cells during infection with malaria parasites and they are associated with the immunopathogenesis of malaria. The present systematic review and meta-analysis aimed to compare the differences in IL-6 levels between several groups of patients with malaria and healthy control groups. The systematic review was registered at PROSPERO with a registration number: CRD42021290753. Systematic literature searches were conducted in PubMed, Web of Science, and Scopus until November 7, 2021 to obtain studies that documented IL-6 levels in patients with malaria. The quality of the included studies was assessed using critical appraisal tools from the Joanna Briggs Institute. Differences in the mean IL-6 levels among patients with: (1) severe and non-severe malaria, (2) uncomplicated malaria and controls, (3) uncomplicated and asymptomatic malaria, (4) asymptomatic malaria and healthy controls, and (5) those that died or survived were estimated using a random-effects model. Forty-three of 1,969 studies were included in the systematic review. Results of the meta-analysis showed that patients with severe malaria had higher mean IL-6 levels than those with non-severe malaria [P = 0.04, weight mean difference (WMD) = 96.63 pg/mL, 95% confidence interval (CI) = 0.88 − 19.38 pg/mL, I2 = 99.9%, 13 studies]. Patients with uncomplicated malaria had higher mean IL-6 levels than the controls (P < 0.001, WMD = 42.86 pg/mL, 95% CI = 30.17 − 55.56 pg/mL, I2 = 100%, 17 studies). No differences in the mean levels of IL-6 were found between patients with uncomplicated malaria and those with asymptomatic malaria (P = 0.063, WMD = 42.07 pg/mL, 95% CI = − 2.23 pg/mL to − 86.37 pg/mL, I2 = 99.1%, 8 studies), or between patients with asymptomatic malaria and healthy controls (P = 0.45, WMD = 1.67 pg/mL, 95% CI = − 2.73 pg/mL to − 6.07 pg/mL, I2 = 98.1%, 2 studies). A higher mean level of IL-6 was observed in patients who died compared with the levels of those who survived (P = 0.007, WMD = 1,399.19 pg/mL, 95% CI = 384.16 − 2,414.2 pg/mL, I2 = 93.1%, 4 studies). Our meta-analysis of the pooled evidence can be used to guide future studies in which IL-6 levels are measured during malaria outbreaks to monitor malaria severity. Heterogeneity of the effect estimate among the included studies was the main limitation of this analysis. In conclusion, significantly increased levels of IL-6 were observed in patients with severe malaria compared with those in patients with non-severe malaria, which indicates that IL-6 is a candidate marker for severe malaria. Future studies should investigate the sensitivity and specificity of increased IL-6 levels to determine the effectiveness of assessments of IL-6 levels monitoring of malaria infection and severity.

Background β-Thalassemia trait (BTT) often shows microcytosis, a normal or an increased red blood cell (RBC) count, and an elevated level of HbA 2 , which provide the basis for laboratory screening. BTT is an important differential diagnosis of iron deficiency anemia (IDA). Donors with BTT have hemoglobin values comparable with normal; hence, they are accepted for donation and they usually escape diagnosis. Aim The aim of this work was to differentiate BTT from IDA through blood indices performed in routine complete blood count. Patients and methods A total of 200 samples were obtained from apparently healthy adult Egyptian blood donors randomly. Complete blood count and mean corpuscular volume (MCV) were performed to all individuals. Hemoglobin electrophoresis and/or serum ferritin was performed to samples with MCV less than 78 fl. Results Prevalence of BTT in this study was 6%, whereas IDA represented 4.5% of total 200 samples investigated. The cutoff value of MCV 73 fl was 91.7% sensitive and 100% specific in differentiating BTT from IDA. Red blood cell distribution width at level 14.5% or below can differentiate BTT from IDA with 83.3% sensitivity and 100% specificity. RBCs count at value above 5.47 million/mm 3 can differentiate BTT from IDA with 100% sensitivity and 100% specificity.Conclusion The cutoff values of MCV 73 fl or less, RBC count above 5 × 10 6 /mm 3 , and red blood cell distribution width 14.5% or less were suggested to be associated with a high probability of BTT.

Effects of FSH extracted from in vitro cultured anterior pituitary cells of male buffalo calves on body and testes weight, serum FSH and total cholesterol and hematological variables in male rabbits

Reference values for the erythrocytic indices are vital for the diagnosis of anaemia and polycythemia and also for the assessment of efficacy of therapy instituted to correct these abnormalities. This study determined the reference values for the packed cell volume (PCV), haemoglobin concentration (HbC), red blood cell (RBC) counts, mean corpuscular volume (MCV), mean corpuscular haemoglobin (MCH) and mean corpuscular haemoglobin concentration (MCHC) of Anak 2000 broilers (A2B) at 14-day intervals for 84 days and Lohmann brown pullets (LBP) at 21-day intervals for 147 days. A total of 120 chickens were used for the study (60 A2B and 60 LBP), and all haematological determinations followed standard procedures. Results of the determinations on the A2B showed that PCV and HbC did not significantly vary (p > 0.05) with age and had a low correlation with age (r = −0.22 and r = 0.15, respectively), but RBC counts increased with and positively correlated with age (r = 0.78), while MCV and MCH decreased with and were strongly inversely correlated with age (r = −0.80 and r = −0.84, respectively), and MCHC did not follow a definite pattern. For the LBP, there were no significant variations (p > 0.05) associated with age in the PCV, RBC counts, MCV, MCH and MCHC up to 105 days of age; the significant variations (p 0.05) all through the study. When compared with findings in similar studies as reported by other investigators, some of the values obtained in this study and the patterns of change in relation to age were in agreement while some others contrasted, probably because of differences between the strains and the climatic/environmental conditions under which the chickens were raised.

Microvascular function and oxygen consumption affect oxygen homeostasis but have not been assessed in African children with malaria. Microvascular function in Tanzanian children with severe malaria (SM) or uncomplicated malaria were 39% and 72%, respectively, of controls (P < .001). Uncomplicated malaria (P = .04), not SM (P = .06), children had increased oxygen consumption compared with controls.

Patient posture for blood collection by venipuncture: recall for standardization after 28 years