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The patient presented with fever and appetite loss. Computed tomography (CT) revealed a moderate grade 2 pneumonia. Besides, further blood examination showed his HB antigen as negative, anti-HBs/c anti-body as positive, and HBV DNA level as 1.0 LIU/mL. Therefore, he was diagnosed with COVID-19. Administered treatments comprised oxygen inhalation and steroid therapy, including pulses, remdesivir, and baricitinib, which improved pneumonia. Interestingly, one month posttreatment, his HBV DNA level in-creased to 1.4 LIU/mL, followed by a further increase to 1.7 LIU/Ml, showing an improvement. Tenofovir alafenamide fumarate was thus administered. In clinical practice, immunosuppressive therapy is used for patients with moderate-to-severe COVID-19 pneumo-nia. However, close attention should also be paid to the elevation of blood HBV DNA levels during and after treatment.Copyright © 2022 The Japan Society of Hepatology.
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Objective: Hypercoagulation and high incidence of thrombosis during COVID-19 is well established. However, there is a lack of data, how it changes over time. The main purpose of our study was to access different parts of hemostasis in few months after acute disease. Material and methods. Patients discharged from our hospital were invited for follow up examination in 2,3-3,8 (group 1 - 55 pts) or 4,6-5,7 months (group 2 - 45 pts) after admission. Control group (37 healthy adults) had been collected before pandemic started. Standard coagulation tests, aggregometry, thrombodynamics and fibrinolysis results were compared between groups. Result(s): D-dimer was significantly higher, and was APPT was significantly lower in group 2 compared to group 1, while fibrinogen, prothrombin levels didn't differ. Platelet aggregation induced by ASA, ADP, TRAP, spontaneous aggregation didn't differ significantly between groups. Thrombodynamics revealed hypocoagulation in both group 1 and group 2 compared to control: V, mum/min 27,3 (Interquartile range (IQR) 26,3;29,4) and 28,3 (IQR 26,5;30,1) vs. 32,6 (IQR 30,4;35,9) respectively;all p < 0,001. Clot size and density in both group 1 and group 2 were significantly lower than in control group. Fibrinolysis appeared to be enhanced in x2 compared to control and group 1. Lysis progression, %/min was higher: 3,5 (2,5;4,8) vs. 2,4 (1,6;3,5) and 2,6 (2,2;3,4) respectively, all p < 0,05. Lysis onset time in both group 1 and group 2 was significantly shorter compared to control. Conclusion(s): We revealed normalization of parameters of clot formation process in 2-6 months after COVID-19, while fibrinolysis remained still enhanced. Further study is required to investigate the clinical significance of these changes.Copyright © Creative Cardiology 2021.
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The global pandemic of coronavirus infection (COVID-19) has set complex diagnostic tasks for doctors of polyclinics and hospitals. Considering the simultaneous pandemic spread of two infectious diseases - COVID-19 and HIV infection, the problem of studying the clinical features of combined COVID-19/HIV infection becomes urgent. The aim of the study was to determine the features of the diagnosis and course of COVID-19 against the background of HIV infection in patients undergoing inpatient treatment. Material and methods. The study was conducted on the basis of the temporary Clinical Medical Center COVID-19 of the A.I. Yevdokimov Moscow State University of Medicine and Dentistry of the Ministry of Healthcare of the Russian Federation in Moscow from October 2020 to January 2022. The study included 31 233 patients with COVID-19 complicated by pneumonia. To analyze the features of the course of combined COVID-19/HIV infection, a group of 51 HIV-infected patients was identified. The diagnosis of COVID-19 was determined based on the detection of SARS-CoV-2 RNA by PCR in nasal/oropharyngeal smears and/or according to computed tomography of the lungs (CT). During the study, age, gender, anamnesis, objective examination data were analyzed, taking into account the results of CT scans of the chest organs, data from routine laboratory blood tests, oxygen support regimens, treatment outcomes and duration of detection of SARS-CoV-2 RNA. All patients were treated according to the Temporary Clinical Guidelines for the Diagnosis and Treatment of COVID-19, 14 version dated 12/27/2021. Results. The number of patients with combined HIV infection and SARS-CoV-2 out of the total number of hospitalized COVID-19 patients (n=31 233) was 0.16%. Upon admission, 30 (59%) patients reported having HIV infection and receiving antiretroviral therapy (ART). HIV infection was first diagnosed in 21 patients at 2-3 weeks of inpatient treatment. The average age of patients with SARS-Cov-2/HIV co-infection was 1.5 times less than in patients without HIV (41.1+/-5.3 and 64.4+/-10.1, respectively) (p<=0.05). Concomitant pathology (hypertension, type 2 diabetes mellitus, chronic kidney disease and chronic lung diseases) was less common (51%) in the group of combined infection than in the group without HIV (83%). However, in 41% of patients with coinfection, chronic viral hepatitis B, C was detected, in contrast to 0.3% of cases of COVID-19 patients without HIV. 26 (51%) patients were discharged with improvement, while the average bed-day did not differ from patients without HIV infection (13.4+/-4.5 days and 11.7+/-5.2, respectively) (p>=0.05). 7 (24%) patients at the time of discharge (16.8+/-4.2 days) with clinical and laboratory improvement maintained a positive result of PCR RNA on SARS-Cov-2. In 22 (43%) patients with coinfection, hospitalization was fatal for 3 to 21 days of treatment, with ARDS with respiratory and multiple organ failure, which is 3.6 times higher than in patients without HIV infection. The analysis showed that, regardless of the result of PCR on SARS-CoV-2 RNA, in non-specialized hospitals, HIV testing is indicated for young patients with fever for more than 14 days, with lung damage in the form of bilateral interstitial changes according to CT, a history of chronic hepatitis C, B, with progressive severity of the condition on against the background of COVID-19 therapy. Early consultation of an infectious disease specialist, examination of sputum/lavage by PCR for pathogens of opportunistic infections and the appointment of ART and drugs for the treatment of opportunistic diseases will improve the quality of medical care for patients in a non-core HIV hospital will improve the prognosis of COVID-19.Copyright © Eco-Vector, 2022.
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Introduction: Apart from clinical symptoms and pulmonary computed tomography (CT) findings in, confirmed COVID-19 patients' Blood tests have an important role in early diagnosis of the disease and they provide valuable information to physicians regarding the inflammatory status in body. Material(s) and Method(s): A retrospective cross-sectional study was conducted from January 2020 to March 2020 in the Pathology Department of Rural Medical College, Loni. Total of 120 patients from different groups, both genders and between 18 and 75-year age were studied. Result(s): TLC, Neutrophil, NLR, PLR, D-Dimer values were found to have statistical significant (p<0.05) positive correlation with Covid -19 severity.Blood investigations like Lymphocyte and Monocyte count have statistical significant (p<0.05) negative correlation with Covid -19 severity. No significant correlation was observed between haematological tests like Hb, HCT, PLT, LMR and tests of coagulation like PT & APTT with Covid -19 severity. Conclusion(s): We concluded that TLC, NLR and D-dimer tests are important to predict about the severity of disease.Copyright © 2022 Pravara Institute of Medical Sciences. All rights reserved.
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Spontaneous pneumomediastinum (SPM) is a decisive complication reported to be associated with COVID-19. Here, we present a case of SPM in a COVID-19positive patient that was not caused by any iatrogenic or known reasons. At the time of admission, the patient was COVID-positive and distressed. He was immediately subjected to hematological and radiological investigations (chest X-ray, HRCT), which confirmed pneumomediastinum. The patient was hypoxic and hypotensive even after receiving ionotropic support. Considering the patient's critical condition, a mediastinal pigtail catheterization was performed instead of a thoracotomy, and the catheter was in situ for nine days. Arterial blood gas was monitored during the hospital stay, and supplementary oxygen therapy was provided accordingly. The patient subsequently recovered and was discharged. Hence, SPM in this COVID patient was treated by pigtail catheterization, and major surgical interventions were avoided.Copyright © 2023 LookUs Scientific. All rights reserved.
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Background: Vaccination is considered the most effective preventive strategy to fight COVID-19. The aim of this study was to evaluate two critical concerns about: 1) the kinetic response of IgG and IgM, and: 2) the hematological abnormalities in a longitudinal cohort of health-care workers (HCW) who had received 2 doses of BNT162b2 mRNA-based vaccine. Method(s): Blood and nasopharyngeal swabs were collected from 46 volunteers' participants, previous written consensus, with presumable no symptoms of COVID-19. Anti-SARS-CoV-2 serum immunoglobulin G (IgG) and M (IgM) and hematological parameters were examined. Multivariable mixed-effects models for repeated measure analysis were adopted to evaluate time changes in IgG, IgM and hematological parameters, and to investigate associations with vaccination response. Result(s): Forty-six subjects (N.=46;31.8% men;68.2% women;mean age near 36 years-old) were enrolled among healthcare workers of IRCCS MultiMedica (Milan, Italy). Overall, increase in serological IgG concentration appeared mainly between 21-28 days after the 1st dose, whereas IgM did not reach positivity in all cases. Mean blood cells counts were in normal range but we observed a significant reduction of total white blood cells and absolute lymphocyte counts after the 1st dose, persisting until the day 28. The increase of monocytes and neutrophils the day after the 1st dose subsequently decayed significantly. Eosinophils concentration showed a tendency to increase over time. Peripheral blood smear showed a growing frequency of atypical lymphocytes (lympho-variants), and of plasmacytoid forms, whereas no difference was found in large granular lymphocytes (LGL), although a decay after the boost was evident. The stratification of subjects, relative to the timing of IgG increase, showed the occurrence of 3 different patterns after vaccination, namely early-responders (R+), late-responders (R-) and pauci-responders (PR) with a peculiar kinetics of hematological parameters. Lymphocytes were significantly associated with total IgG: lower in R+ and PR compared to R- (P=0.0193 and P=00054, respectively). Conclusion(s): In healthy subjects, anti SARS-CoV-2 vaccination induced a variety of non-pathologic abnormalities. The response to vaccination was not equal in the groups examined. In PR group a major difference occurred with respect to R- and R+. This work adds novel insight into the puzzle of changes induced by SARS-CoV-2 virus.Copyright © 2022 EDIZIONI MINERVA MEDICA.
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Background: Corona virus pandemic pneumonia has caused unmatchable damage to humanity. Early detection and prompt treatment is the only answer for effective control. RT-PCR is the gold standard diagnostic test but displays high false-negative rate. A large number of undetected patients remain a constant source of inadvertent disease dissemination in community, potentiating the ongoing pandemic. Objective(s): To determine the usefulness of transthoracic ultrasonography for early detection of covid-19 pulmonary infection during a pandemic. Methodology: This cross-sectional study was conducted in Pulmonology-OPD of Gulab Devi Teaching Hospital, Lahore-Pakistan, from April 21, 2020 to September 30, 2020. Total 262 patients with dry cough, fever and shortness of breath of sudden onset were included. Patients were investigated with chest x-ray/HRCT, transthoracic ultrasonography, covid-19-PCR and hematological tests. Sensitivity, Specificity, positive predictive value(PPV), negative predictive value(NPV) and diagnostic accuracy was calculated with clinical diagnosis as reference. Data was analyzed by SPSS-24-software. Result(s): Of 262-patients, 248 were detected as covid-19 pneumonia by ultrasound. Bilateral, multifocal, posteriolateral involvement and B-lines were common features. Ultrasound displayed sensitivity 99.60%, specificity, 69.23%, PPV 98.41%, NPV 90.0% and diagnostic accuracy 98.09%. PCR diagnosed 155/228(59.16%) cases. The P-value was 0.00001-significant at P<.05. Conclusion(s): Transthoracic ultrasonography is a tremendous tool furnishing instant detection of covid-19 pneumonia with high sensitivity and provides foundations for evidence based management during pandemic.
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Introduction: Clinical presentation is an undependable prognostic indicator of Coronavirus disease 2019. So, a more objective predictor is needed to precisely evaluate and classify the prognosis. Immune dysregulation to lymphocytes, mainly T-lymphocytes, have been noticed between Coronavirus disease 2019 patients. This study was planned to determine the role of platelet-to-lymphocyte count ratio and neutrophil-to-lymphocyte ratio in assessment of COVID-19 prognosis. Method(s): 70 hospitalized patients with confirmed COVID-19 were included in this study. All included patients underwent a consistent clinical, radiological and blood examination. Laboratory analysis was made by means of a commercially accessible kit. Blood cells ratios were computed by dividing their absolute counts. Result(s): Non-significant association was found between laboratory data and COVID-19 clinical severity. A significant association between CT classification and platelet-to-lymphocyte count ratio (higher value in L type p=0.001) was detected. Platelet-to-lymphocyte count ratio was significantly higher among intubated cases. However, Nonsignificant association was found between neutrophil-to-lymphocyte ratio and need of endotracheal intubation. Conclusion(s): Routine blood values are abnormal in patients with COVID-19. Platelet-to-lymphocyte count ratio ratios could be used as more meaningful biomarker than other values in predicting the prognosis of COVID-19. LMR helpful in COVID-19 severity.
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Clinical presentation is an undependable prognostic indicator of COVID-19 (COronaVIrus Disease 2019). So, a more objective predictor is needed to precisely evaluate and classify the prognosis. Immune dysregulation to lymphocytes, mainly T-lymphocytes, have been noticed between COVID-19 patients. The aim. This study was planned to determine the role of platelet-to-lymphocyte count ratio and neutrophil-to-lymphocyte ratio in assessment of COVID-19 prognosis. Methods. 70 hospitalized patients with confirmed COVID-19 were included in this study. All included patients underwent a consistent clinical, radiological and blood examination. Laboratory analysis was made by means of a commercially accessible kit. Blood cells ratios were computed by dividing their absolute counts. Results. Non-significant association was found between laboratory data and COVID-19 clinical severity. A significant association between CT classification and platelet-to-lymphocyte count ratio (higher value in L type;p = 0.001) was detected. Platelet-to-lymphocyte count ratio was significantly higher among intubated cases. However, Non-significant association was found between neutrophil-to-lymphocyte ratio and need of endotracheal intubation. Conclusion. Routine blood values are abnormal in patients with COVID-19. Platelet-to-lymphocyte count ratio ratios could be used as more meaningful biomarker than other values in predicting the prognosis of COVID-19. LMR helpful in COVID-19 severity.
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BACKGROUND AND AIM: Multisystem inflammatory syndrome in children (MIS-C) is a syndrome of fatal multisystem inflammation. This case report aims to describe our successful experience in managing children with MIS-C associated with previous SARS-CoV-2 infection and to help clinicians identify the spectrum of MIS-C signs and symptoms. METHOD(S): Case Reports RESULTS: A 6-year-old previously healthy boy was referred to our hospital with fever, dyspnea, vomiting, and abdominal pain for seven days before admission. Leucocytosis, elevated inflammatory and cardiac biomarkers were noted. Renal and liver function decreased. An echocardiogram showed dilated LV with EF 30% and a normal chest x-ray. High anti-SARSCoV- 2 titer (>250 U/mL) with negative for SARS-CoV-2 RTPCR was in accordance with the previous infection 8 weeks prior. He received intravenous furosemide, dobutamine, ceftriaxone, intravenous immunoglobulin (IVIG), and heparin in the pediatric intensive care unit and was discharged on the 11th day of treatment. The second case was a 10-yearold boy admitted to the hospital with a high fever (41.5O C), conjunctival hyperemia, diarrhea, and diffused abdominal pain for two days before hospitalization. History of COVID-19 was noted in the previous 4 weeks. Laboratory blood examination showed thrombocytopenia, elevated inflammatory markers, D-dimer, NT-pro BNP, negative for SARS-CoV-2 RT-PCR, and positive for IgG SARS-CoV2. Echocardiogram and chest x-ray were unremarkable. He received ceftriaxone, IVIG, Methylprednisolone, and enoxaparin. The patient was discharged after eight days of hospitalization. CONCLUSION(S): These two cases presented MIS-C following a history of mild COVID-19 infection. The successful management relied on the proper and timely administration of IVIG, corticosteroid, and anticoagulant.
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Point of care (POC) are tests conducted near the site of patient care, outside of laboratory, usually performed by patients or healthcare personnel not trained in laboratory medicine. POC testing (POCT) require small sample volumes, minimize pre-analytical errors, and reduce alterations of labile analytes. Furthermore, when used appropriately, could improve the patient's outcomes providing faster results and earlier therapeutic strategies. Instead, its over or incorrect use could lead to a patient risk and potential increase of healthcare costs.In the Province of Modena, a decentralized and multi-professional POCT diagnostic system was developed to integrate the clinical and diagnostic pathways supporting fast clinical decisions, to improve outcomes and to optimize the clinical patient pathways. We installed 129 POCT (77 emogasanalyzers, 9 coagulometers, 9 instruments for haematological tests, 9 instruments for chemical analyses, 10 counters, 6 for immunoassay, 3 cube-PCR and 6 for rapid diagnosis of COVID-19). These instruments were installed not only in emergency rooms of three Hospitals but also in specific setting as the OSCO-Community hospital, oncological and emergency setting and Neonatal Intensive Care. Furthermore, 264 glucometers were located in various departments of three hospitals. This system provides multiple advantages for: (i) patients reducing waiting time and long-distance travelling from home, (ii) healthcare professionals improving skills, autonomy and responsibility, reducing workload and promoting collaboration, and (iii) the healthcare system giving continuity in the therapeutic and assistance pathways ensuring a high analytical quality and costs reduction. To implement a successful POCT network is vital to develop a multidisciplinary team composed by physicians, nurses and laboratory technicians working together. Furthermore, the continuous training and education of operators guarantees the efficiency and productivity of the system.In conclusion, the POCT network represent an opportunity for the health care system to consolidate the patients-based laboratory medicine, reducing for diagnostic response, clinical decision and the hospitalization.
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Background/Aim. Coronavirus disease 2019 (COVID-19) is a predominantly respiratory disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The aim of this study was to determine whether there were parameters that could predict the development of a severe clinical picture and fatal outcomes in COVID-19 patients. Methods. The study involved 632 patients treated at the Clinic for Infectious Diseases, University Clinical Center Kragujevac, from June 2020 to February 2021. All patients were divided into two groups according to the need for oxygen therapy (Sat 02 < 94 %). Results. Our results showed that high body mass index (BMI) was singled out as a risk factor for the development of a severe clinical picture (BMI, ORadjusted = 1.263;95% CI = 1.117-1.427;p < 0.001). Prothrombin time (ORadjusted = 1.170;95% CI = 1.004-1.364;p = 0.045), as well as low albumin values (ORadjusted = 0.878;95% CI = 0.804-0.958;p = 0.003), had a predictive significance for the development of a severe clinical picture. Factors that were of predictive importance in patients with fatal outcomes were C-reactive protein (CRP) (ORadjusted = 1.010;95% CI = 1.001-1.019;p = 0.031), lactate dehydrogenase (LDH) (ORadjusted = 1.004;95% CI = 1.001-1.006;p = 0.002), and X-ray of the lungs (ORadjusted = 1.394;95% CI = 1.170-1.661;p < 0.001). Conclusion. The study showed that routine, clinical laboratory parameters can be important in the early detection of patients with a potentially severe clinical picture and fatal outcomes. In patients with a mild clinical picture, CRP, LDH, ferritin, and serum albumin levels may timely indicate disease progression. Monitoring these parameters is of essential importance for the timely clinical assessment of patients with COVID-19 and, thus, the prompt application of adequate therapeutic protocols in the treatment of these patients. Copyright © 2022 Inst. Sci. inf., Univ. Defence in Belgrade. All rights reserved.
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The aim of this study is to evaluate the effect of blood groups (BGs) on Covid-19 contraction and prognosis and to reveal the coefficients. Patients who referred to Covid-19 outpatient clinics and had an established diagnosis of Covid-19 were included in the study. Their BGs, previous diagnoses and blood examination findings were retrospectively analyzed. Duration of hospitalization, clinical course and survival were recorded. The mean age of 365 subjects, 210 female and 155 male, was 45,5 years. Subjects with BG A developed Covid-19 at significantly higher rates (p = 0.001), while BG O was found associated with lower rates (p = 0.005). Lymphocyte count was found lower (p = 0.035) and rate of lung parenchymal involvement was higher (p = 0.003) in patients with Rh antigen. It was found that a higher percentage of patients with B BG required treatment in the intensive care unit (ICU) compared to other ABO BGs (p = 0.015). These results suggest a higher risk of Covid-19 contraction in the population with BG A and lower risk for BG O population while indicating poorer prognosis for patients with BG B. Copyright © 2022 Ondokuz Mayis Universitesi. All rights reserved.
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Introduction: With the increase of COVID-19 vaccinations, the development of nephrotic syndrome (NS) after vaccination is one of the new concerns. Most NS cases after vaccination are accompanied by minimal change, while others include focal segmental glomerulosclerosis (FSGS). Although an association between COVID-19 infection and collapsing FSGS has been reported especially in patients with APLO1 risk variants, no cases of childhood collapsing FSGS cases after COVID-19 vaccination have been reported up to now. Case Description: Twelve-year-old Japanese girl had been administered BNT162b2 (Pfizer/BioNTech) vaccine. Soon after that, edema had gradually appeared and 15 days after the injection, she was referred to our hospital because of severe edema. She did not have any past nor family history. Blood examination showed severe hypoalbuminemia (sAlb 1.4 g/dL) without kidney disfunction (eGFR 118.0 mL/min/1.73m2) or hypocomplementemia. Urinalysis showed severe proteinuria (urine protein/Cr 12.8 g/gCr) with hematuria, indicating nephrotic syndrome. Prior to treatment, collapsing FSGS was confirmed by kidney biopsy. Prednisolone (PSL) 60 mg/day was started according to the clinical guidelines for pediatric nephrotic syndrome. She had not achieved the complete remission 28 days after administration of PSL, and cyclosporine and lisinopril treatment was started. In addition, we administered two cycles of methyl prednisolone pulse therapy. Finally, she achieved the complete remission after 2.5 months treatment. Comprehensive genetic testing revealed no variant in genes causing steroid resistant NS or asymptomatic proteinuria. Discussion(s): The new onset of NS after vaccination, including COVID-19 vaccination, has been reported. The actual mechanism has not been clarified yet, but some immunological impact is reported to be associated the onset after the vaccination. Interestingly, this patient showed collapsing FSGS which is common as a secondary FSGS, especially in patients with the APOL1 risk variants suffered viral infection. Collapsing FSGS accompanied by COVID-19 infection had been reported to be associated with interferon activation or VEGF activation. Patients with collapsing FSGS after COVID-19 vaccination may have a common etiology.
ABSTRACT
The patient presented with fever and appetite loss. Computed tomography (CT) revealed a moderate grade 2 pneumonia. Besides, further blood examination showed his HB antigen as negative, anti-HBs/c anti-body as positive, and HBV DNA level as 1.0 LIU/mL. Therefore, he was diagnosed with COVID-19. Administered treatments comprised oxygen inhalation and steroid therapy, including pulses, remdesivir, and baricitinib, which improved pneumonia. Interestingly, one month posttreatment, his HBV DNA level in-creased to 1.4 LIU/mL, followed by a further increase to 1.7 LIU/Ml, showing an improvement. Tenofovir alafenamide fumarate was thus administered. In clinical practice, immunosuppressive therapy is used for patients with moderate-to-severe COVID-19 pneumo-nia. However, close attention should also be paid to the elevation of blood HBV DNA levels during and after treatment.
ABSTRACT
Curvularia species are dematiaceous filamentous fungi that can cause a variety of infections in both immunocompetent and immunocompromised hosts. We present 2 cases of severely immunosuppressed patients with acute invasive fungal sinusitis due to Curvularia species. Both patients had a history of hematologic malignancy with refractory disease and prolonged neutropenia. They presented with facial and sinus pain, which prompted maxillofacial computed tomography that showed acute sinusitis. Subsequently, they underwent nasal endoscopy with a biopsy that revealed a definitive diagnosis of invasive fungal sinusitis. Dematiaceous fungi are responsible for most fungal sinusitis cases, with Curvularia being one of the most common species isolated. Generally, invasive fungal rhinosinusitis may follow a relatively innocuous and nonspecific course. In addition, fungal infections may complicate chronic allergic sinusitis. Computed tomography scan is the first imaging modality of choice, and magnetic resonance imaging has a role in prognostication in acute invasive fungal rhinosinusitis. Endoscopic sinus surgery with biopsy yields a definitive diagnosis and is therapeutic. Management typically includes a combination of surgery and antifungal agents. Severe neutropenia is a significant risk factor for infection and is associated with poor outcomes. Aggressive surgical debridement, combined with antifungal therapy, should be emphasized in leukemic patients despite their prolonged neutropenia and bleeding tendency.
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Introduction: Peritonitis is a major complication of Peritoneal Dialysis (PD), inadequate response to treatment, and the inflammatory state inherent in PD patients may result in hospitalization time and mortality. This Study aims to observe prognosis patients who Peritoneal Dialysis-Associated Peritonitis (PDAP) by Neutrophil-to-Lymphocyte Ratio (NLR). Methods: We have performed observation the incidences of peritonitis, causative organisms, clinical outcomes and mortality between patients undergoing Continuous Ambulatory Peritoneal Dialysis (CAPD) during pandemic era from January 2020-September 2021 in Central General Hospital Dr. Sardjito. Outcomes and clinical course of treatment in the selected patients were reviewed. Results: The Latest case, Male, 22 years old,the Peritoneal Equilibration Test (PET) results are Low. Since the end of August 2021 felt pain in the abdomen accompanied by cloudy dialysis fluid and sometimes there is fibrin. From routine blood examination, the results NLR is 2. The patient received Ceftriaxone and Gentamicin with the results of dialysate fluid culture obtained Klebsiella Pneumonia. The symptoms of peritonitis improved but on the 14th day the symptoms started to reappear, the antibiotics were continued and a re-culture was performed on the 15th day, Burkholderia Cepacia bacteria were sensitive to Meropenem, Trimethoprim/Sulfamethoxazole, and Ceftazidime. Next case, male, 71 years old, since 2014 using CAPD with the last evaluation of PET was High Average. Complaints were felt in early October 2020 with same symptoms. The NLR is 21 and the results of culture Staphylococcus Capitis. Patients receiving therapy with Vancomycin and evaluation of culture results negative. But in December 2020 the signs and symptoms appeared again with NLR 25. Because of the weakness condition, the patient was hospitalized with the culture results Pseudomonas Aeruginosa, sensitive to Ciprofloxacin, because of improvement, the patient was allowed outpatient. The results of the culture evaluation showed the bacteria were the same as sensitive to the same antibiotic group as well, but was replaced with Ceftazidim and Fluconazole. After 14 days of administration antibiotics, the complaints improved and the culture results were negative. In March 2021 the patient came back with the same complaints again related to recurrent peritonitis, with culture results showing Pseudomonas Aeruginosa infection and only sensitive to Ciprofloxacin and Gentamicin. The patient received both antibiotic therapy in an outpatient condition but in the course of his illness the patient died because COVID-19 in other hospital. For last case, the patient was 51 years old with PET Low Average results and NLR 6. The patient presented with persistent symptoms peritonitis 3 times continously after the evaluation but the culture results were always negative. In the treatment of the first infection, the patient had received therapy Ceftazidime and Gentamicin, but because the symptoms did not improve, the patient's antibiotics were then replaced with Ciprofloxacin, and the third evaluation was given Vancomycin even though the bacteria did not grow. Due to the condition of recurrent peritonitis infection in this patient, access to CAPD was then withdrawn and back to HD. Conclusions: According to our findings, the incidence of symptomatic PDAP maybe related with NLR, it can be a prognostic factor but still unclear. No conflict of interest