Correlation Between Laboratory Findings and Clinical Severity among the COVID-19 Patients in the Tertiary Care Centre

Background : Coronavirus is a highly infectious novel virus we are in urge to know more about their clinical characteristics and laboratory findings for the characterization and selection of treatment protocol. Methods : Prospective, single centre study. Two months data was collected, clinical characteristics data from patient case sheet and the laboratoryvalues from the Hospital Information System (HIS) for the month of July and August 2020. Results : Of 462 patients, 55 (11.9%) are falls under asymptomatic category, 194 (42%) are in mild category, 167 (36.1%) are in moderate category and 46 (10%) in severe category. Fever 230 (49.8%) and cough 211 (45.7%) was most common clinical symptom with p value < 0.01. Non-severe vs severe, 340 (73.6%) and 201 (43.5%) showed decreased in eosinophil count and absolute eosinophil count, 125 (27.1%) and 80 (17.3%) patient showed decrease in lymphocyte count and absolute lymphocyte count, 200 (43.3%) showed increase in neutrophil count with a significance of p value >0.05. 186 (40.3%) patients had one or more co-morbidities. Laboratory findings between Asymptomatic VS symptomatic, showed significance changes in neutrophil, lymphocyte, Aspartate aminotransferase, Alkaline phosphatase, globulin values (p value <0.05). Conclusion : Clinical severity categorization at the time of admission was very helpful for the treating doctors in proper understanding of disease progression and appropriate treatment of the patient. Presence of co-morbidity, abnormal laboratory values, old age group patients, higher Computed Tomography score, higher mortality rate are seen more in patients who were in clinical severity grade severe category than in non-severe category patients.

Early laboratory hematological parameters associated with COVID-19 mortality in an Amazonian population of Peru

Introduction: COVID-19 has a significant impact on the hematopoietic system and hemostasis. Leukocytosis, lymphopenia, and thrombocytopenia are associated with increased severity and even death in COVID-19 cases. Objective: The aim is to examine the laboratory results of COVID-19 patients from a hospital in the Peruvian Amazon and their clinical prognosis. Material and Methods: An analytical cross-sectional study was carried out whose purpose was to identify the laboratory tests of patients with COVID-19 and mortality in a hospital in Ucayali, Peru during the period from March 13 to May 9, 2020, selecting a total of 127 with Covid-19. Mean and the standard deviation was described for age, leukocytes, neutrophils, platelets, RDW-SD; median and interquartile range for the variables lymphocyte, RN / L, fibrinogen, CRP, D-dimer, DHL, hematocrit, monocytes, eosinophils. Results: No differences were observed in this population regarding death and sex (OR: 1.31; 95% CI 0.92 to 1.87), however, it was observed that, for each one-year increase, the probability of death increased by 4% (PR: 1.04, 95% CI 1.03 to 1.05). The IRR (Incidence Risk Ratio) analysis for the numerical variables showed results strongly associated with hematological values such as Leukocytes (scaled by 2500 units) (IRR: 1.08, 95% CI 1.03 to 1.13), neutrophils (scaled by 2500 units) (IRR: 1.08; 95% CI 1.03 to 1.13), on the contrary, it is observed that the increase of 1000 units in lymphocytes, the probability of dying decreased by 48% (IRR: 0.52; 95% CI 0.38 to 071). Conclusions: Parameters such as leukocytes,neutrophils and D-dimer were statistically much higher in patients who died.

Introducción: COVID-19 tiene un impacto significativo en el sistema hematopoyético y la hemostasia. La leucocitosis, la linfopenia y la trombocitopenia se asocian con una mayor gravedad e incluso la muerte en los casos de COVID-19. Objetivo: examinar los resultados de laboratorio de pacientes con COVID-19 de un hospital de la Amazonía peruana y su pronóstico clínico. Material y métodos: Se realizó un estudio transversal analítico cuyo propósito fue identificar las pruebas de laboratorio de pacientes con COVID-19 y mortalidad en un hospital de Ucayali, Perú durante el periodo del 13 de marzo al 9 de mayo del 2020, seleccionando un total de 127 con COVID-19. Se describió la media y la desviación estándar para edad, leucocitos, neutrófilos, plaquetas, RDW-SD; mediana y rango intercuartílico para las variables linfocito, RN/L, fibrinógeno, PCR, dímero D, DHL, hematocrito, monocitos, eosinófilos. Resultados: No se observaron diferencias en esta población en cuanto a muerte y sexo (OR: 1,31; IC 95% 0,92 a 1,87), sin embargo, se observó que, por cada aumento de un año, la probabilidad de muerte aumentaba un 4% (RP: 1,04). , IC del 95%: 1,03 a 1,05). El análisis de RIR (Razón de incidencia de riesgos) para las variables numéricas mostró resultados fuertemente asociados con valores hematológicos como Leucocitos (escala de 2500 unidades) (RRI: 1.08, 95% CI 1.03 a 1.13), neutrófilos (escala de 2500 unidades) (RRI: 1.08; IC 95% 1.03 a 1.13), por el contrario, se observa que al aumento de 1000 unidades en linfocitos, la probabilidad de morir disminuyó en un 48% (TIR: 0.52; IC 95% 0.38 a 071). Conclusiones: Parámetros tales como los leucocitos, los neutrófilos y el dímero D fueron estadísticamente mucho más altos en los pacientes que fallecieron.

Anaplasmataceae em gatos (Felis catus) no município de Campos dos Goytacazes, Rio de Janeiro / Anaplasmataceae in cats (Felis catus) in the city of Campos dos Goytacazes, Rio de Janeiro

No Brasil, até o ano 2000, os agentes riquetsiais em felinos domésticos eram poucos conhecidos, existindo somente relatos esporádicos de Ehrlichia sp. As recentes pesquisas envolvendo biologia molecular e agentes riquetsiais confirmam a ideia de que estes agentes estão presentes nesses animais e, por este motivo, demonstram a necessidade de estudos mais detalhados no Brasil. O objetivo do presente trabalho foi a caracterização dos agentes da família Anaplasmataceae que acometem os felinos domésticos e esclarecer a importância dos felinos na cadeia epidemiológica das doenças riquetsiais por métodos moleculares e sorológicos associando a presença das doenças aos parâmetros clínicos e laboratoriais. Foram obtidas amostras sanguíneas de 60 felinos domésticos, independentes de sanidade, provenientes de atendimentos clínicos. Destas amostras foram realizados hemograma e bioquímica sérica, e os dados foram utilizados para preenchimento da ficha laboratorial. As amostras foram processadas para obtenção de concentração de células e soro, para realização da reação em cadeia pela polimerase (PCR) e reação por imunofluorescência indireta (RIFI), respectivamente, para identificação de agentes da família Anaplasmataceae. Os dados foram utilizados para análise descritiva para formação de frequências epidemiológicas e para realização de testes não-paramétricos pelo Qui-quadrado de Pearson (p≤5%) associando as alterações laboratoriais às infecções por Ehrlichia canis, Anaplasma platys e Anaplasma phagocytophilum. Os resultados obtidos revelaram a presença de 33,33% de agentes Anaplamastaceae na amostra populacional, sendo 8,33% para E. canis, 20% para A. platys e 10% para A. phagocytophilum. Foram realizadas as sorologias das amostras, pela imunofluorescência indireta, para verificação de amostras reagentes para A. phagocytophilum, sendo 8,33% amostras reagentes na amostra populacional. As alterações clínicas e laboratoriais mais frequentes em pacientes positivos por agentes Anaplasmataceae foram letargia, linfadenomegalia, mucosas pálidas, desidratação, trombocitopenia, hiperglobulinemia e hipoalbuminemia. Destes dados foram realizadas as correlações não paramétricas e não foram verificadas dependências das alterações laboratoriais com a presença de animais positivos para agentes Anaplasmataceae. A identificação dos agentes E. canis e A. platys visa esclarecer a doença na região, sendo instrumento de orientação da doença pelo médico veterinário ao proprietário para que tenha medidas adequadas de tratamento e prevenção. A presença de agentes A. phagocytophilum é considerada, sem dúvidas, uma notificação importante devido ao potencial zoonótico.(AU)

In Brazil, by the year 2000, rickettsioses in domestic cats were little known and there were only sporadic reports of Ehrlichia sp. Recent research involving molecular biology and rickettsioses confirm the notion of the presence of theses agents in cats and show the need for more studies in Brazil. The objective of this paper was to characterize agents belonging to the Anaplasmataceae family that affect domestic cats and to clarify the importance of cats in the epidemiology of rickettsioses by molecular and serological methods associating the presence of disease with clinical and laboratory parameters. Blood samples were obtained from 60 healthy domestic cats. Blood count and serum biochemical tests were performed, and the data were registered. The samples were processed to obtain cell concentration and serum to perform the polymerase chain reaction (PCR) and the indirect immunofluorescence assay (IFA) respectively, in order to identify agents of the Anaplasmataceae family. The data were used for descriptive analysis to obtain frequencies and to perform non-parametric tests with the chi-square test (p≤5%), besides the laboratory findings of infection by Ehrlichia canis, Anaplasma phagocytophilum and Anaplasma platys. The results revealed that 33.33% of the agents belonged to the Anaplasmataceae family, 8.33% for E. canis, 20% for A. platys, and 10% for A. phagocytophilum. Serology samples were examined by indirect immunofluorescence to check samples reacting to A. phagocytophilum, with positive reaction of 8.33%. The most frequent clinical and laboratory findings in patients positive for Anaplasmataceae agents were lethargy, enlargement of lymph nodes, pale mucous membranes, dehydration, thrombocytopenia, hyperglobulinemia and hypoalbuminemia. These data had non-parametric correlation and the laboratory changes and presence of positive cats was not interdependent. Identification of E. canis and A. platys revealed the disease in the region of Campos dos Goytacazes/RJ. The presence of A. phagocytophilum is considered an important finding due to its zoonotic potential.(AU)

Clinical and laboratory findings of rhabdomyolysis in opioid overdose patients in the intensive care unit of a poisoning center in 2014 in Iran / 한국역학회지

OBJECTIVES: The aim of this study was to investigate the clinical and demographic characteristics and some laboratory findings of hospitalized patients with acute opioid toxicity and rhabdomyolysis.METHODS: This cross-sectional study investigated 354 patients hospitalized at Baharloo Hospital in Tehran in 2014 with acute illicit drug toxicity. Data were collected using an investigator-made checklist. The collected data (such as mortality rate, demographic data, and renal function tests, as well as serum biochemical findings) were analyzed by descriptive statistics and the chi-square test.RESULTS: A total of 354 patients were admitted to the hospital in 2014 with acute illicit drug toxicity, including 291 males and 63 females. The total number of patients with rhabdomyolysis was 76 (21.5% of the total), of whom 69 (90.8%) were male and 7 (9.2%) were female. Most cases of rhabdomyolysis were associated with methadone abuse, followed by opium abuse. Rhabdomyolysis was most common in those 20–29 and 30–39 years old, with methadone and opium the most commonly abused illicit drugs. The mean blood urea level was 3.8±1.0 mg/dL, and the mean serum potassium and sodium levels were 3.8±0.3 mg/dL and 140.4±4.0 mg/dL, respectively. Five patients, all of whom were male, passed away due to severe renal failure (6.5%).CONCLUSIONS: Toxicity caused by opioids is associated with clinical complications and laboratory disorders, such as electrolyte disorders, which can lead to lethal or life-threatening results in some cases. Abnormal laboratory test findings should be identified in patients with opioid toxicity in order to initiate efficient treatment.

Clinical and laboratory findings of rhabdomyolysis in opioid overdose patients in the intensive care unit of a poisoning center in 2014 in Iran / 한국역학회지

OBJECTIVES: The aim of this study was to investigate the clinical and demographic characteristics and some laboratory findings of hospitalized patients with acute opioid toxicity and rhabdomyolysis. METHODS: This cross-sectional study investigated 354 patients hospitalized at Baharloo Hospital in Tehran in 2014 with acute illicit drug toxicity. Data were collected using an investigator-made checklist. The collected data (such as mortality rate, demographic data, and renal function tests, as well as serum biochemical findings) were analyzed by descriptive statistics and the chi-square test. RESULTS: A total of 354 patients were admitted to the hospital in 2014 with acute illicit drug toxicity, including 291 males and 63 females. The total number of patients with rhabdomyolysis was 76 (21.5% of the total), of whom 69 (90.8%) were male and 7 (9.2%) were female. Most cases of rhabdomyolysis were associated with methadone abuse, followed by opium abuse. Rhabdomyolysis was most common in those 20–29 and 30–39 years old, with methadone and opium the most commonly abused illicit drugs. The mean blood urea level was 3.8±1.0 mg/dL, and the mean serum potassium and sodium levels were 3.8±0.3 mg/dL and 140.4±4.0 mg/dL, respectively. Five patients, all of whom were male, passed away due to severe renal failure (6.5%). CONCLUSIONS: Toxicity caused by opioids is associated with clinical complications and laboratory disorders, such as electrolyte disorders, which can lead to lethal or life-threatening results in some cases. Abnormal laboratory test findings should be identified in patients with opioid toxicity in order to initiate efficient treatment.

Blastocystis in ulcerative colitis patients: Genetic diversity and analysis of laboratory findings

OBJECTIVE@#To determine Blastocystis frequency and subtypes (ST) in ulcerative colitis (UC) patients and analyse some laboratory findings between Blastocystis positive and negative cases.@*METHODS@#Faecal samples from 150 UC patients in Adnan Menderes University, Training and Research Hospital were examined by direct microscopy and cultivated in Jones medium. Blastocystis positive cultures were subjected to DNA isolation and subtypes were identified by sequencing of barcode region. A retrospective analysis was conducted on C reactive protein (CRP), leucocyte counts (WBC), neutrophil counts, and sedimentation rates.@*RESULTS@#The overall positive rate of Blastocystis was 8% (12 patients) and the most abundant subtype was ST3 (eight isolates, 66.7%), followed by ST1, ST2 and ST7. Laboratory findings between Blastocystis infected and non-infected UC patients were not significantly different. Blastocystis frequency was 3.8% among the patients in active stage, while it was 11.8% among the patients in remission stage.@*CONCLUSIONS@#The present study confirms previous findings that have indicated the predominance of Blastocystis ST3 in humans and contributes additional evidence that suggests the low colonisation of Blastocystis infection in ulcerative colitis patients during active stage.

Blastocystis in ulcerative colitis patients: Genetic diversity and analysis of laboratory findings

Objective To determine Blastocystis frequency and subtypes (ST) in ulcerative colitis (UC) patients and analyse some laboratory findings between Blastocystis positive and negative cases. Methods Faecal samples from 150 UC patients in Adnan Menderes University, Training and Research Hospital were examined by direct microscopy and cultivated in Jones medium. Blastocystis positive cultures were subjected to DNA isolation and subtypes were identified by sequencing of barcode region. A retrospective analysis was conducted on C reactive protein (CRP), leucocyte counts (WBC), neutrophil counts, and sedimentation rates. Results The overall positive rate of Blastocystis was 8% (12 patients) and the most abundant subtype was ST3 (eight isolates, 66.7%), followed by ST1, ST2 and ST7. Laboratory findings between Blastocystis infected and non-infected UC patients were not significantly different. Blastocystis frequency was 3.8% among the patients in active stage, while it was 11.8% among the patients in remission stage. Conclusions The present study confirms previous findings that have indicated the predominance of Blastocystis ST3 in humans and contributes additional evidence that suggests the low colonisation of Blastocystis infection in ulcerative colitis patients during active stage.

Retrospective analysis of clinics and the prognosis of 58 adult patients with hemophagocytic syndrome in a single center / 中国肿瘤临床

Objective:This study aimed to achieve the early diagnosis and active treatment of adult hemophagocytic syndrome (HPS) and investigate the clinical characteristics and prognostic factors of this syndrome. Methods:A single-center retrospective analysis was performed to analyze clinical characteristics, laboratory findings, and survival data. Results:In 58 patients, the most common clinical manifestations were fever (100%) and splenomegaly (89.7%). The most common laboratory parameters were serum ferritin 500 g/L (100%) and peripheral cytopenia in two or more lineages (96.6%). platelet count, fibrinogen, and lactate dehydrogenase in the death group were significantly lower than in the survival group (P=0.000, 0.001, and 0.000). Survival analysis results showed that infections in the rheu-matological group exhibited good prognosis [the overall survival (OS) time was not reached in 190 d]. Patients with unexplained causes had moderate prognosis (OS time was 60 d);tumor-associated HPS patients had poor prognosis (the OS time was only 30 d). Univariate analysis results showed that patients with Fbg<1.5 g/L, PLT<40×109/L, and LDH≥2000 U/L also exhibited poor prognosis (P=0.000). Multivariate analysis results showed that PLT<40 × 109/L was an independent adverse factor (HR=6.472, 95%CI:1.526-26.065, P=0.011). Conclusion:HPS exhibits complex clinical manifestations and varied etiology. Patients with infection and rheumatism-related HPS had good prognosiss compared with those manifesting tumor-associated HPS. Fbg<1.5 g/L, PLT<40×109/L, and LDH≥2 000 U/L were the univariate factors that affected the survival time of patients. PLT<40×109/L is an independent adverse factor. These patients need systemic treatments as early as possible.

Relationship between clinical and pathological signs and severity of canine leishmaniasis / Relação entre sinais clínico-patológicos e gravidade da leishmaniose visceral canina

Canine visceral leishmaniasis (CVL) is a zoonotic disease that presents variable clinical and laboratory aspects. The aims of this study were to identify the main biochemical/hematological status of dogs naturally infected with Leishmania (Leishmania) infantum and to associate theses parameters with clinical forms of CVL. Blood samples were analyzed from 51 dogs, 15 uninfected (control group) and 36 infected, which were classified clinically in three groups: asymptomatic (n=12), oligosymptomatic (n=12) and symptomatic (n=12). All the infected dogs showed lower albumin/globulin ratios (A-G ratio) than the limit of reference. The mean values of total protein, urea, α-globulin 2, globulin and A-G ratio of infected dogs were outside the reference interval and differed significantly from those of the controls. Anemia was detected only in groups that showed clinical signs of the disease, and a statistical analysis indicated a significantly higher frequency of lower eritrogram in these groups than in the asymptomatic group. In addition, a significant association was observed between anemia and the presence of the symptoms, with dogs displaying higher erythrogram values showing better clinical conditions. These results provide additional evidence that the clinical forms of CVL may reflect on the erythrogram status.

A leishmaniose visceral canina (LVC) é uma zoonose com aspectos clínicos e laboratoriais variáveis. O objetivo deste trabalho foi identificar os principais achados hematológicos e bioquímicos em cães naturalmente infectados com Leishmania (Leishmania) infantum e associar esses parâmetros com as formas clínicas da LVC. Foram analisadas amostras sanguíneas provenientes de 51 cães, sendo 15 cães não infectados (grupo controle) e 36 infectados, os quais foram classificados clinicamente em três grupos: assintomáticos (n=12), oligossintomáticos (n=12) e sintomáticos (n=12). Todos os cães infectados apresentaram valores na relação albumina/globulina (A/G) abaixo do limite inferior de referência. Os valores médios de proteína total, uréia, α-2 globulina, globulina e A/G dos grupos de cães infectados permaneceram fora dos intervalos de referências e significativamente diferente quando comparados aos do grupo controle. Anemia foi registrada somente nos grupos de animais que manifestavam sinais clínicos da enfermidade, sendo que nas análises estatísticas constatou-se frequência significativamente maior de alterações no eritrograma quando comparados ao grupo assintomático. Associação significativa foi observada entre anemia e a presença de sinais clínicos, onde os cães com os maiores valores de eritrograma apresentavam a melhor condição clínica. Os resultados fornecem evidência adicional que as formas clínicas da LVC podem refletir no eritrograma.

Laboratory Findings in the Patients with Arthritis / 대한내과학회지

Arthritis is caused by various diseases including rheumatoid arthritis (RA), osteoarthritis, gout and trauma, and joint involvement also occurs in some autoimmune diseases, such as systemic lupus erythematosus and Sjogren's syndrome. Some laboratory tests provide useful information in both diagnosis and prognosis. RF and anti-CCP (cyclic citrullinated peptide) antibody are detected in approximately 70-80% of patients with RA, and often associated with a worse prognosis (e.g., bony erosion and joint deformity). Acute phase reactants, such as erythrocyte sedimentation rate and C-reactive protein, parallel the activity of RA, and their persistent elevation are also associated with a poor prognosis. Crystal examination in synovial fluid is essential to confirm the diagnosis of gout and pseudogout, and the synovial fluid culture is also important in septic arthritis. Anti-nuclear antibody helps to distinguish non-immune arthritis from systemic rheumatic diseases. However, arthritis cannot be diagnosed only with laboratory findings, and physician should consider comprehensive physical examination, clinical findings, and imaging findings as well as laboratory findings. In this topic review, laboratory tests useful for diagnosis of arthritis will be discussed and summarized.

A Q fever case mimicking crimean-congo haemorrhagic fever.

Coxiella burnetii is the bacterium that causes Q fever. Human infection is mainly transmitted from cattle, goats and sheep. The disease is usually self-limited. Pneumonia and hepatitis are the most common clinical manifestations. In this study, we present a case of Q fever from the western part of Turkey mimicking Crimean-Congo haemorrhagic fever (CCHF) in terms of clinical and laboratory findings.

Diagnóstico laboratorial da deficiência de ferro: [revisão] / Laboratory diagnosis of iron deficiency anemia: [review]

A deficiência de ferro é a causa mais comum de anemia e, em geral, o diagnóstico laboratorial é feito sem grandes dificuldades, usando-se testes simples e rotineiramente disponíveis pelos laboratórios em geral. A interpretação dos resultados, no entanto, deve ser feita cuidadosamente, tendo em mente as limitações e interferentes de cada reação. Nessa revisão serão apresentados os testes que auxiliam na investigação da deprivação de ferro, com algumas noções técnicas e comentários sobre a interpretação dos mesmos.

Iron deficiency is the most common cause of anemia and, in general, the diagnosis is easily established by simple tests that are routinely available in general laboratories. The interpretation of results, however, must be carefully carried out keeping in mind the limitations and interference in each reaction. This review presents the tests that assist in the investigation of iron deficiency, with some technical aspects and comments on their interpretation.

Clinical presentation of leptospirosis: a retrospective study of 201 patients in a metropolitan city of Brazil

INTRODUCTION: leptospirosis is a zoonosis of worldwide importance. The disease is endemic in Brazil. This study was conducted to describe the clinical and laboratory presentation of leptospirosis in a metropolitan city of Brazil. METHODS: this is a retrospective study including 201 consecutive patients with leptospirosis admitted to tertiary hospitals in Fortaleza, Brazil, between 1985 and 2006. All patients had clinical and epidemiological data suggestive of leptospirosis, and positive laboratorial test for leptospirosis (microscopic agglutination test, MAT, higher than 1:800). RESULTS: a total of 201 patients were included, with mean age of 38.9 ± 15.7 years; 79.1 percent were male. The mean length from onset of symptoms to admission was 7 ± 3 days. The main clinical signs and symptoms at admission were fever (96.5 percent), jaundice (94.5 percent), myalgia (92.5 percent), headache (74.6 percent), vomiting (71.6 percent) and dehydration (63.5 percent). Hemorrhagic manifestations were present in 35.8 percent. Acute kidney injury was found in 87 percent of the patients. Platelet count was less than 100,000/mm³ in 74.3 percent. Hematuria was found in 42.9 percent. Death occurred in 31 cases (15.4 percent). CONCLUSIONS: leptospirosis is a globally relevant disease with potential fatal outcome. Signs and symptoms suggestive of leptospirosis must be known by any physician in order to institute early adequate treatment to improve outcome. Early indication and daily hemodialysis seems to be beneficial in this group of patients.

Dengue: alertas clínicos e laboratoriais da evolução grave da doença / Dengue: clinical and laboratory alerts of the evolution of the serious illness

JUSTIFICATIVA E OBJETIVOS: A dengue é um importante problema de saúde pública, sendo necessário qualificar a assistência no seu atendimento, objetivando reverter quadros potencialmente graves, com redução do risco de morte. O objetivo deste estudo foi buscar correlação entre sinais e sintomas clínico-laboratoriais que indiquem a sua gravidade, aumentando assim a sensibilidade da triagem da equipe de saúde para um caso grave em potencial, tentando traçar condutas eficazes e apresentar marcadores laboratoriais que possam indicar essa evolução. MÉTODO: Estudo descritivo, retrospectivo, baseado no banco de dados do Sistema Nacional de Agravos de Notificação (SINAN) e de dados primários obtidos a partir da revisão dos prontuários dos óbitos ocorridos no município do Rio de Janeiro em 2007. RESULTADOS: Considerando-se os óbitos confirmados sorologicamente (26), 8 (30,7%) foram por dengue com complicações, 14 (54%) por febre hemorrágica da dengue e 4 (15,3%) síndrome do choque da dengue. A dor abdominal estava presente em 57,7% dos casos, a hipotensão postural em 63,7%, as manifestações hemorrágicas ocorreram em 69,3% (sangramento gastrintestinal: 42,3%; petéquias: 26,1%; epistaxe: 19,2% e gengivorragia: 11,5%); extravasamento plasmático foi evidenciado em 61,5%. Houve plaquetopenia em 92,3%, leucocitose em 66,6%, leucopenia em 12,5% e hemoconcentração em 56,5%. Todos os pacientes com provas de função hepática realizada (7) apresentaram alteração de transaminases. CONCLUSÃO: Mostraram-se relevantes como fatores preditivos de mau prognóstico os sinais e sintomas: dor abdominal, hipotensão postural, manifestações hemorrágicas e extravasamento plasmático. Entre os exames laboratoriais a leucocitose, transaminases elevadas e plaquetopenia.

BACKGROUND AND OBJECTIVES: Dengue is an important public health problem, being required to qualify for assistance in caring for this disorder, to revert tables potentially serious, with reduced risk of death. This study aimed to look for signs and symptoms correlation between clinical and laboratory showing its seriousness, thereby increasing the sensitivity of the screening of the healthcare team to a serious potential, trying to map out effective and present conduct laboratory markers that may indicate that evolution. METHODS: Descriptive study, retrospective, based on a database of SINAN and primary data obtained from the review of medical records of the deaths occurred in Rio de Janeiro in 2007. RESULTS: Considering the serologically confirmed deaths (26), 8 (30.7%) were by dengue with complications, 14 (54%) due to dengue hemorrhagic fever and 4 (15.3%) of dengue's shock syndrome. The abdominal pain was present in 57.7% of cases, the postural hypotension in 63.7%, the hemorrhagic manifestations occurred in 69.3% (gastrointestinal bleeding: 42.3%; petechiae: 26.1%; epistaxis: 19.2% and gengivorragia: 11.5%), plasma extravasation was evidenced in 61.5%. There was 92.3% in thrombocytopenia, leukocytosis in 66.6%, leukopenia in 12.5% and 56.5% in hemoconcentration. All patients with evidence of liver function performed (7) showed change in transaminases. CONCLUSION: They were important as predictors of poor prognosis the signs and symptoms: abdominal pain, postural hypotension, hemorrhagic manifestations and plasma extravasation and between laboratory tests to leukocytosis, thrombocytopenia and elevated transaminases.

Extraosseous multiple myeloma presenting as repeated intracranial bleeding and relapsing high fever with respiratory failure : A case report

Multiple myeloma can usually be identified by non-traumatic vertebral fracture or signs of recurrent infection. Without these clinical signs, detection is unlikely. We briefly report a case of extraosseous multiple myeloma presenting as repeated intracranial bleeding and relapsing high fever. In doing so, we highlight the importance of subtle changes in laboratory findings. A 67-year-old man presented with spontaneous acute epidural hematoma, and hematoma evacuation was performed at the same site 3 times. A radiologic work-up failed to reveal any osseous lesions and he made a gradual recovery. In the meantime, he suffered unexplained fever up to 39oC despite normal chest and abdominal radiograms. Blood chemistry showed mild leukocytosis, high ESR and CRP, and a slightly elevated globulin. On his 15th hospital day, immunoglobulin studies confirmed the diagnosis of multiple myeloma. He was treated in the ICU for difficult breathing and uncontrolled fever. In spite of intensive critical care, his leukocyte count fell to below 2,000 and he died on postoperative day 28. Apparently normal laboratory and radiologic findings can hamper swift discovery and ultimate management of multiple myeloma. When there is unexplained repeated intracranial bleeding and accompanying fever, the possibility of hidden malignancy should be assessed to avoid delaying or missing treatment.

When one is mistaken for the other: Distinguishing DM 1 and DM 2 (Discussion of a case)

In many instances, the differences between the two types of Diabetes may not always be easily perceived. What is seen in current practice is a combination of signs and symptoms that make diagnosis a bit more complex. This is an illustration of such. Clinical judgment alone may not be enough and laboratory findings will be extremely helpful. The clinician has to develop the skill in decision-making based on all the available data.

Symptom Questionnaire and Laboratory Findings in Subjects with Airflow Limitation: a Nation-wide Survey / 결핵및호흡기질환

BACKGROUND: Chronic obstructive pulmonary disease (COPD) is characterized by airflow limitation that is not fully reversible. COPD has systemic effects, such as skeletal muscle dysfunction and abnormal weight loss. It also has been suggested that COPD is related to other chronic disease, such as cardiovascular disease, osteoporosis, and anemia. The aim of this study was to evaluate a symptom questionnaire and laboratory findings in subjects with air flow limitation. METHODS: We evaluated a symptom questionnaire and laboratory findings in subjects with airflow limitation detected by spirometry in conjunction with the Second Korean National Health and Nutrition Examination Survey. A total of 9,243 adults over the age of 18 were recruited. Among the adults, we finally analyzed 2,217 subjects who met the acceptability and repeatability criteria of spirometry, showed normal findings on chest radiography, and were older than 40 years of age. RESULTS: There were 288 subjects with airflow limitation as determined by spirometry. The frequency of respiratory symptoms such as cough, sputum and wheezing were significantly higher in subjects with airflow limitation (p<0.01). Hemoglobin and hematocrit levels were higher in subjects with airflow limitation (hemoglobin level 13.98 mg/dL vs. 13.62 mg/dL, hematocrit 42.10% vs. 40.89%; p<0.01). The HDL cholesterol level was lower in subjects with airflow limitation (44.95 mg/dL vs. 45.60 mg/dL; p<0.01). There was no significant difference in the total cholesterol, triglyceride, blood urea nitrogen, creatinine, and fasting glucose levels. CONCLUSION: In subjects with airflow limitation, prevalence of respiratory symptoms was higher than in normal spirometry subjects and the levels of hemoglobin and the hematocrit were higher. The HDL cholesterol level was lower in subjects with airflow limitation.

Abnormal Laboratory Findings in Emergently Injected Psychiatric Inpatients: A Preliminary Report / 대한정신약물학회지

OBJECTIVE: Psychiatric patients often require emergency injection and they are sometimes received psychotropic medication injection before the completion of a medical history and laboratory studies. The aim of this study is to find out laboratory differences between patients with severe psychomotor agitation who were injected emergently and those who were not. METHODS: Medical records of all patients 18 years or older admitted to psychiatric unit were reviewed. Subjects in this study were patients who showed psychotic symptoms, psychomotor agitation or violent behavior within 7 hospital days. Demographic and laboratory variables were compared between injected and non-injected patients. RESULTS: One hundred twenty three patients were included. Twenty seven patients received emergency injection and ninety six patients didn't receive. Patients received emergency injection had lower platelet count (p<0.01), and potassium level (p<0.05) and higher electrocardiogram QTc interval (p<0.05). They are also more likely to have abnormal levels of platelet count (p<0.05), and creatine phosphokinase (p<0.05). CONCLUSION: Emergently injected patients in the psychiatry service were more likely to have abnormal laboratory results before injection. These findings suggest that patients who need emergency injection may have additional physical problems which require further medical attention. Therefore before injection, we consider that emergently injected patients may have risks.

Reactivity to Autologous Serum Skin Test and Clinical Features in Chronic Idiopathic Urticaria / 대한피부과학회지

BACKGROUND: Although the pathogenesis of chronic idiopathic urticaria (CIU) has not yet been fully elucidated, previous studies have identified functional, histamine-releasing autoantibodies against either alpha subunit of the high affinity IgE receptor (Fc epsilon RI alpha) or IgE in the serum of some patients with CIU. Therefore an autologous serum skin test (ASST) can be used as a predictive clinical test to determine the presence of circulating histamine-releasing factors in the serum of CIU patients, and there are some reports stating that patients with positive ASST tend to have more severe symptoms of urticaria than patients with a negative result. OBJECTIVE: This study was designed to determine the incidence of positive ASST in CIU patients and examine whether there are significant differences in the clinical features and laboratory findings between groups of positive and negative responses to ASST. METHOD: We prospectively performed ASST and laboratory tests on 70 patients with CIU, and also checked clinical features. RESULTS: Intradermal injection of autologous serum or plasma induced a wheal and flare response in 44 out of 70 CIU patients (62.9%). However, no significant difference in the clinical features and laboratory findings, other than angioedema, was noted between ASST-positive and negative groups. CONCLUSION: According to our results, the incidence of positive ASST was high in CIU patients, but ASST is not helpful to predict the severity or clinical course of CIU.

Clinical and laboratory findings of type IV lupus glomerulonephritis

Clinical and laboratory findings was investigated on 46 patients who had diagnosis of lupus glomerulonephritis type IV. The obtained results showed that clinical features are severe with 45.7% patients had hypertension, 34.8% patients had acute nephritis syndrome and 56.5% had nephrotic syndrome. Especially, there were 95.7% patients have renal insufficiency. Among them, 26.1% had a severe renal failure (blood creatinine level >300mmol/I). But after 1 month of treatment, 100% of renal insufficiency patients have blood creatinine level 300mmol/l had improvement in renal function