Idiopathic anomalous congenital band causing small intestinal obstruction in a 5-month-old dog

A 5-month-old, intact male, yellow Labrador retriever was presented with a 24-hour history of anorexia and vomiting. Abdominal imaging revealed the presence of a mechanical obstruction in the jejunum and peritoneal effusion. Cytologic evaluation and culture of the effusion prior to surgery identified a suppurative exudate with bacteria consistent with septic peritonitis and suspected to be related to the intestinal lesion. An exploratory laparotomy was performed, and a segment of jejunum was circumferentially severely constricted by an off-white, fibrous band of tissue. Resection and anastomosis of the strangulated segment of jejunum and excision of the constricting band provided resolution of the clinical signs. The dog made a complete recovery. Histologic evaluation revealed the band to be composed of fibrovascular and smooth muscle tissue, consistent with an idiopathic anomalous congenital band. No other gastrointestinal lesions were observed, either grossly at surgery or histologically in the resected segment of intestine. To our knowledge, a similar structure has not been reported in the veterinary literature.Copyright © 2022 Canadian Veterinary Medical Association. All rights reserved.

Hematological Profile of Patients with Covid-19 at Oran University Hospital in Algeria by Hematology Analyzer Bc-6800

Introduction: COVID-19 is a viral zoonosis caused by the coronavirus strain SARS-CoV-2. Due to the rapid spread of this emerging infectious disease, the WHO has qualified it as an international pandemic. The objective of our study is to describe the haematological characteristics of patients with COVID-19 hospitalized at the CHU of Oran in Algeria. Method(s): This is a prospective study carried out between July 1st and October 15th, 2020, which included patients hospitalized and/or followed up in COVID-19 units of the CHU Oran in Algeria. The blood count was done on a Hematology Analyzer BC-6800. Result(s): Our study included 68 patients of which 67.2% were male and 32.8% female (sex ratio M/F = 2) with a median age of 65 years Check-ups revealed anemia in 38.2% of patients (mean of Hgb =9, 58 +/- 1, 25 g/dl, normal range: male 13-17g/dl, female 12-16 g/dl). Hyperleukocytosis (62.2%,mean of WBC= 18,44 +/- 6,45 G/l, normal range :4-10 G/l), hyperneutrophilia (72.1%, mean= 15,98 +/- 6,59 G/l, normal range 1,7-7G/l), lymphopenia (66.2% mean=0,75 +/- 0,36 G/l, 1,4 - 4 G/l), Eosinopenia (58.8%, mean=0,0038 +/- 0,0049 G/l, normal range = 0,02- 0,52 G/l), monocytopenia (08.8%, mean=0,12 +/- 0,05 G/l), monocytosis (20.6%, mean=1,16 +/- 0,16 G/l, normal range = 0,12 +/- 0,05), Thrombocytopenia (20,6%,mean=80,57 +/- 32,48) G/l ,thrombocytosis (14.7%, mean=480,30+/- 100 G/l, normal range =120- 400G/l), high MPV (Mean Platelet Volume) in 27.9% of cases, with mean=12,42 +/- 1,37, normal range =7-11f and high PPI (Platelet Distribution Index) in all patients (100% ;normal range 16,46 +/- 0,46%). It is also noted that 85% of patients over 50 years of age have an NLR (Neutrophils-to-lymphocyts ratio) >= 3.13. We found also the mean of MLR (Monocytes-to-lymphocytes ratio= 0,64 +/- 0,50) and the mean of PLR(Platelet-to-lymphocytes ratio= 173,75 +/- 155,21). Conclusion(s): Some parameters such as lymphopenia and eosinopenia have an important diagnostic value, while other parameters such as NLR(Neutrophils-to-lymphocyte ratio), MLR (Monocyte -to-lymphocyte ratio) and PLR (Platelet-tolymphocyte ratio) offer a very valuable prognostic value.

Clinical Characteristics of Strongyloidiasis during the Covid-19 Pandemic: Systematic Scoping Review

INTRODUCTION: Reactivation of Strongyloides stercoralis related to COVID-19 infection or treatment has been an emerging topic of interest, although characteristics of Strongyloides infection in COVID-19 patients are not yet well characterized. This study aims to summarize the existing evidence of Strongyloides infection in COVID-19 patients and figure out the future areas of research. METHOD(S): According to the PRISMA Extension for Scoping Reviews, we performed a search on MEDLINE and EMBASE for articles with keywords including"Strongyloides," "Strongyloidiasis," and "COVID-19," from the inception of these databases to June 5, 2022. RESULT(S): A total of 104 articles were found. After excluding duplication and thorough reviews, 11 articles, including two observational studies, one conference , and nine case reports or series, were included. Two observational studies focused on revealing the prevalence of Strongyloides screening in COVID-19 patients and clinical follow-up. One study from Spain, including 227 cases of COVID-19 and Strongyloides co-infection, noted that four patients developed critical hyperinfection leading to the expiration of one patient. Among the included cases, patients were mostly from low- or middle-income countries (LMICs) who suffered from severe or critical COVID-19. 90% received 6mg/day dexamethasone for 7-10 days or higher prednisone-equivalent doses of corticosteroids. 60% and 20% had Strongyloides hyperinfection and disseminated infection, respectively. Interestingly, patients had either eosinopenia or normal eosinophil counts while they were treated for COVID-19, and they were likely to develop eosinophilia later in the course leading to the diagnosis of Strongyloidiasis. CONCLUSION(S): This systematic review summarizes the clinical characteristics of Strongyloidiasis in COVID-19 infection. Likely due to COVID-19-related eosinopenia and the effect of corticosteroids, patients may not necessarily have overt eosinophilia despite the parasitic infection. Developing a Strongyloides screening strategy for COVID-19 patients based on patients' demographics and origins may help diagnose the condition. While further studies to identify risks and precipitants associated with the onset of Strongyloidiasis in crucial, increased awareness of the critical condition is warranted.

Baseline Peripheral Blood Counts and Outcomes in Patients Presenting with Chinese Virus Infection COVID-19

Introduction: SARS-CoV2 Chinese virus pandemic has significant impact on hematopoietic system. Aims & Objectives: To report the incidence and pattern of baseline hematological parameters in patients with COVID-19 and their association with severity of disease and outcome. Material(s) and Method(s): Retrospective observational study. Result(s): A total of 440 patients were included in the study. The mean age of the study cohort was 47.5 +/- 15.8 years. Fifty percent of patients had at least 1 comorbidity. ICU stay was required in 125 (39.6%) patients. Overall mortality in the study cohort was 3.52%. The average age of patients who died was significantly higher than that of patients who were alive (65.1 years vs 46.5 years;p = 0.000). DM, HTN, CAD and CKD were all associated with higher incidence of ICU stay and mortality. Lymphopenia<1 x 109/mul was observed in 24.3% and eosinopenia was noted in 44.3% patients. Leukocytosis > 11 x 109/mul was seen in 8.2% of patients. The median neutrophil lymphocyte ratio (NLR) of whole cohort was 2.63. NLR, Lymphopenia, eosinopenia, leucocytosis, D dimer, lactate dehydrogenase (LDH), ferritin and IL6 levels all were associated with need for ICU transfer and mortality. Hemoglobin, red cell distribution width (RDW), PT and aPTT correlated with need for ICU transfer but not with mortality. Ferritin cutoff >= 751 ng/ml and IL6 levels >= 64 pg/ml was able to identify all deaths. Ferritin (0.989) and IL-6 (0.985) had very high negative predictive value. Conclusion(s): Peripheral blood counts at time of hospitalization is a simple tool to predict outcomes in patients admitted with Chinese virus infection Covid-19. (Table Presented).

Eosinopenia as Predictor of Poor Outcome in Hospitalized COVID-19 Adult Patients from Waves 1 and 2 of 2020 Pandemic.

During SARS-CoV-2 infection, eosinopenia may reflect a hyperactive immune response. In this study of hospitalized COVID-19 patients, we aimed to better understand the prognostic value of severe eosinopenia (absolute eosinophil count = 0 G/L) and decipher its underlying mechanisms. We retrospectively analyzed the records of COVID-19 patients hospitalized from March to June 2020 in three university hospitals in Marseille, France. We assessed the association between severe eosinopenia and a composite poor outcome in these patients, including the need for oxygen supplementation at >6 L/min, ICU admission, and in-hospital death. Among the 551 COVID-19 patients included in this study, severe eosinopenia was found in 228 (51%) of them on admission to hospital and was associated with a composite poor outcome using multivariate analysis (OR = 2.58; CI95 [1.77−3.75]; p < 0.0001). We found a significant association between the presence of severe eosinopenia on admission and the elevation in C-reactive protein, ferritin, IP-10, and suPAR. The histological findings in a series of 37 autopsies from patients who died from severe COVID-19 and presented with severe eosinopenia showed no pulmonary eosinophil trapping. Severe eosinopenia can be a reliable biomarker associated with a composite poor outcome in hospitalized COVID-19 adult patients. It may reflect the magnitude of immune hyperactivation during severe-to-critical COVID-19.

Study of early warning efficiency of different laboratory markers in predicting progression of disease in COVID-19.

Introduction: COVID 19 pandemic has given rise to several challenges to clinicians and one of the keys in this is to predict the set of patients who progress from mild disease to moderate and severe. Apart from the symptomatology and signs, there are several lab parameters varying from biochemical, hematological to radiological parameters which help us in stratifying the stage of disease and also in deciding on which set of patients need close and vigilant monitoring. This would help us in better stratification of disease and utilize the available infrastructure and resources in an optimum way for better management of the disease. Aim: To analyze the early warning efficiency of laboratory parameters individually or in combination in predicting the progress of disease in patients from mild to moderate/severe disease. Materials and Methods: This was taken up as a retrospective study with 100 cases and 100 controls. The demographic details, inflammatory markers, biochemical markers and hematological markers were analyzed. Test of significance was employed to compare categorical variables while student t-test was employed to test the difference in the mean value such as age between case and control (Mann-Whitney U-test in parameters not having normal distribution). Receiver operating characteristic (ROC) curve was constructed for these parameters using cases and controls and area under the curve (AUC) were estimated which was used as an indicator of sensitivity and specificity of the parameter in their early warning efficiency. The critical values for each of the parameters either individually or in combination was estimated as well. Results: Among the parameters C reactive protein (CRP), d-dimers and eosinopenia have the best early warning efficiency. The area under the ROCs curve for neutrophil lymphocyte ratio (NLR), CRP. Ferritin, lactate dehydrogenase, Eosinopenia was 0.609, 0.947, 0.614, 0.554, 0.617 respectively at triage. However, a combination of eosinopenia with CRP (AUC-0.732) or NLR with CRP (AUC-0.728) have a good sensitivity and specificity in predicting the outcome regarding the progression of the disease. Conclusions: Among the parameters, CRP, d-dimers, Eosinopenia and NLR have the best early warning efficiency. However, a combination of Eosinopenia and CRP at triage should also serve as a red flag sign in patients apart from the well-known NLR and IL6 values.

Résumé Introduction: La pandémie covide 19 a relevé plusieurs défis aux cliniciens et l'une des clés dans ce domaine est de prédire l'ensemble des patients qui passent d'une maladie légère à modérée et sévère. Outre la symptomatologie et les signes, plusieurs paramètres de laboratoire variant des paramètres biochimiques, hématologiques à radiologiques qui nous aident à stratifier le stade de la maladie et également à décider quel ensemble de patients nécessite une surveillance étroite et vigilante. Cela nous aiderait à mieux stratification des maladies et à utiliser l'infrastructure et les ressources disponibles de manière optimale pour une meilleure prise en charge de la maladie. Objectif: Analyser l'efficacité d'alerte précoce des paramètres de laboratoire individuellement ou en combinaison pour prédire les progrès des maladies chez les patients d'une maladie légère à modérée / sévère. Matériaux et méthodes: Ceci a été considéré comme une étude rétrospective avec 100 cas et 100 contrôles. Les détails démographiques, les marqueurs inflammatoires, les marqueurs biochimiques et les marqueurs hématologiques ont été analysés. Le test de signification a été utilisé pour comparer les variables catégorielles tandis que le test T des étudiants a été utilisé pour tester la différence de valeur moyenne telle que l'âge entre le cas et le contrôle (test U Mann - Whitney dans les paramètres n'ayant pas de distribution normale). La courbe des caractéristiques de fonctionnement du récepteur (ROC) a été construite pour ces paramètres en utilisant les cas et les contrôles et la zone sous la courbe (AUC) ont été estimés qui ont été utilisés comme indicateur de sensibilité et de spécificité du paramètre dans leur efficacité d'alerte précoce. Les valeurs critiques pour chacun des paramètres individuellement ou en combinaison ont également été estimées. Résultats: Parmi les paramètres C Protein réactif (CRP), les D - dimères et l'éosinopénie ont la meilleure efficacité d'alerte précoce. La zone sous la courbe ROCS pour le rapport lymphocyte des neutrophiles (NLR), CRP. La ferritine, la lactate déshydrogénase, l'éosinopénie était de 0,609, 0,947, 0,614, 0,554, 0,617 respectivement au triage. Cependant, une combinaison d'éosinopénie avec CRP (AUC - 0,732) ou NLR avec CRP (AUC - 0,728) a une bonne sensibilité et spécificité pour prédire le résultat concernant la progression de la maladie. Conclusions: Parmi les paramètres, le CRP, les D - dimères, l'éosinopénie et le NLR ont la meilleure efficacité d'alerte précoce. Cependant, une combinaison d'éosinopénie et de CRP au triage devrait également servir de signe du drapeau rouge chez les patients en dehors des valeurs NLR et IL6 bien connues. Mots-clés: C Protéine réactive, efficacité d'alerte précoce, éosinopénie, progression de la maladie dans Covid ­ 19.

A study to evaluate the role of eosinophil count as a prognostic marker for assessing the outcome in patients with COVID-19 infection.

Background and Objectives: The triaging of COVID-19 patients is of paramount importance to plan further management. There are several clinical and laboratory parameters that help in categorizing the disease severity, triaging, and prognostication. Little is known about the prognostic significance of eosinopenia in predicting the severity of COVID-19 from large hospital data, especially from low- and middle-income countries. The objective of this study is to evaluate the level of eosinopenia as an early prognostic marker for assessing the outcomes in COVID-19 patients and to assess the superiority of eosinopenia as a prognostic marker for assessing the outcomes in COVID-19 patients compared to lymphopenia and neutrophil-to-lymphocyte ratio (NLR). Methods: The study was carried out in a tertiary care hospital. A retrospective longitudinal approach was adopted wherein the hospital records of COVID-19 patients were analyzed. In our study, two separate groups of patients were included for analysis to describe the association between initial eosinophil counts of the patients and the clinical outcomes. In the first group, the disease severity in terms of clinical and radiological parameters was compared in patients of COVID-19 presenting with and without the presence of initial eosinopenia. Commonly used markers for triage, namely lymphopenia and NLR, were compared with the presence of initial eosinopenia among the patients who progressed to moderate and severe disease. In the second group, an analysis of eosinopenia was made among the patients who succumbed to the illness. Results: It was seen that 29.6% of patients with eosinopenia had moderate and severe disease compared to those without eosinopenia where only 10.8% had moderate disease, none had severe disease. It was seen that 19.7% of patients with eosinopenia but no lymphopenia had more severe disease compared to patients with lymphopenia but no eosinopenia where 10.8% of the patients had moderate disease, none had severe disease. In patients younger than 60 years who died of COVID-19, it was found that initial eosinopenia was found in 86%, whereas a high NLR >17 was seen in only 25.6% of patients who died, thus implying that is eosinopenia is an important marker of disease severity in COVID-19. Conclusions: Eosinopenia is an important parameter in the evaluation of COVID-19 and the presence of it should alert the clinicians regarding the further progression of the disease. It is not only an important marker but also an early marker for severe disease.

Differences in Prevalence of Haematological Abnormalities on Presentation to Hospital in COVID 19 Infected adult and Paediatric Patients: A Retrospective Multicenter Descriptive Study

Background: It is well known that COVID 19 infection affects multiple systems in the body. Reports have documented many changes in the hematopoietic system in the pathophysiology of the disease. Aim: The aim of the study was to find out the prevalence and any significant difference in routine haematological parameters on presentation in Paediatric and adult patients with COVID 19 infection. Methodology: We conducted a multicenter retrospective descriptive observational study and investigated the prevalence of haematological abnormalities at presentation of 1000 PCR swab confirmed COVID 19 infected randomly selected adult and Paediatric patients admitted to 3 tertiary hospital in Dubai. Data was gathered through their electronic medical records and all analysis was done using the Statistical Package for the Social Sciences software (SPSS). Results: The prevalence of at least one abnormal haematological parameter was 95.1% (794/835) on first presentation to the hospital. After adjusting of age and gender the prevalence of any white cell abnormality was 34.7% (290/835) (5.7% leukopenia, 9.6% leucocytosis, 25.4% lymphopenia, 5.5% neutropenia, 16.4% had neutrophilia, 7.3% monocytosis, and 1.2% eosinopenia). A prevalence of 15.3% (128/835) anaemia, 9.5% (79/835) thrombocytopenia and 4.3% (36/ 835) thrombocytosis was also observed. The prevalence of other abnormal blood parameters: C reactive protein 69.5%(573/835), D dimer 57.5% (280/835), high LDH 52%(383/835), high ferritin 72.1%(452/835), high INR 5.1%(38/835), prolonged PT 32.2% (240/835), and prolonged APTT 35.6%(264/835). A significant difference in prevalence of these abnormalities was evident between adult and Paediatric population, these abnormalities were much more prevalent in adults but interestingly paediatric population tended to have higher incidence of neutropenia, eosinophilia and monocytosis (p<0.001). Conclusion: The effects of COVID 19 infection are different in adult and paediatric patients. Many mechanisms have been hypothesized for this observation. This study revealed another less studied and interesting variation in the manifestation among the two populations.

A REVIEW OF MORPHOLOGICAL ABNORMALITIES ON PERIPHERAL BLOOD FILM: BEYOND ROUTINE ANALYSIS IN THE COVID-19 POPULATION IN THE FIRST WAVE OF THE DISEASE

Background: Vaccination is considered the most promising approach for ending or containing the coronavirus disease 2019 (COVID-19) pandemic. Available vaccines have proven highly safe and effective. The morphology appearance of the blood film is an excellent tool to analyse the disease severity. In late February of 2021, a prothrombotic syndrome was observed in a small number of individuals who received the ChAdOx1 CoV-19 vaccine (AstraZeneca, University of Oxford, and Serum Institute of India), an adenoviral vector-based vaccine. This syndrome has been designated vaccine-induced immune thrombotic thrombocytopenia (VITT) with a particular and intriguing characteristic. Aims: An examination of peripheral blood smear findings in COVID-19 patients was performed in 50 consecutive patients at the first wave of the disease and prior to the full vaccination program instituted with current-acute respiratory syndrome coronavirus 2 (SARS-CoV-2) confirmed disease (PCR)-Pneumonia Methods: A morphology analysis was aimed at identifying the principal abnormalities in patients diagnosed with COVID-19. Interestingly (but not surprisingly) the most severe forms were associated with a more prominent abnormalities, including leukoerythorblastic features and secondary hemophagocytic lymphohistiocytosis, leading to an often fatal outcomes. In this study, absolute lymphopenia (despite non constant) were the predominant feature despite its not specific to COVID-19. A spectrum of variant lymphocytes is seen in COVID-19 cases, albeit constituting less than 1% prolymphocytes in most cases. Plasmacytoid lymphocytes were more common as well as acquired Pelger-Huët were significantly observed (but not representative). Results: A laboratory findings reported in association with COVID-19 included leukopenia, lymphopenia, monocytosis, neutrophilia, eosinopenia, These abnormalities mainly highlight the severe, transitory and reversible perturbation of myelopoiesis, especially in the form of accelerated and disordered granulopoiesis, in patients with COVID19 in severe symptomatic phase. The hypothesis of quantitative and qualitative abnormalities can be related to the cytokine storm and hyperinflammation, which is a pathogenic factor in the evolution of COVID19 pneumonia. Summary/Conclusion: An early identification of severe lymphoid abnormality could represent a high risk factor for poor outcomes with COVID-19. A decreased number of mature lymphocytes, and eosinophils in peripheral blood smear were observed in the severe stage patients (p <0.05). The limitation of the study is in the small numbers of the analysed population and the absent of the control comparative group. The subsequent analysis after patient received at least two dose of the vaccination shows a less severe lymphopenia (P< 0.05) and disease severity.

AN INTEGRATIVE CONCEPTUAL EXPLORATION ON ETIOPATHOGENESIS OF POST-COVID-EOSINOPHILIA WITH SPECIAL REFERENCE TO VATAJA KASA: A REVIEW

COVID19 has contributed to one of the most concerning issues in the health field because of its extremely high transmission capacity, mortality rate, diverse nature, and adverse effects. Due to the current COVID-19 pandemic, all efforts are currently focused on understanding this new infectious disease, specifically in unravelling the pathophysiological mechanisms for prevention of the disease, literal treatment, and avoiding the lingering symptoms or complications of COVID 19. Eosinophilia is one of the standard laboratory findings after the COVID 19 infection. Out of 242 patients visited at Post-COVID OPD of Kayachikitsa department, ITRA, Jamnagar;in 159 patients, the differential eosinophilic count increased while both differential and the absolute eosinophilic count was raised in 134 patients. Many studies suggest that SARS-CoV-2 was directly or indirectly responsible for eosinophilia due to infection or recovery. The conventional treatment for eosinophilia lowers its count but may not provide satisfactory relief. Also, reducing eosinophil count below the specified limit is not advisable in concern with COVID 19 as eosinopenia may indicate a poor prognosis, and in this way, the eosinophil counts have important value as an indicator of severity as well as complications regarding the patients of COVID-19. Therefore, it is indispensable to understand the precise mechanism of eosinophilia integratively, i.e., by conventional and ancient science, to understand the exact etiopathology and to determine the proper treatment protocol. Considering symptomatology, eosinophilia so far can be correlated with Vataja Kasa from an Ayurvedic point of view. This review aims to illustrate the possible integrative knowledge of eosinophilia with respect to COVID 19.

Hematological profile of COVID-19 patients in Ramanagar district, Karnataka-A cross sectional study

Introduction and Aim: Coronavirus disease 2019 (COVID-19) is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) which rapidly evolved into a pandemic infecting humans all over the world. Whether hematologic and immunologic responses play a crucial role in progression of COVID-19 is still not clear. Increasing scientific evidence has shown that abnormalities in routine hematological tests, have the potential to diagnose SARS-CoV-2 infection in an economical way. Major laboratory changes indicating systemic inflammation and multi-organ impairment including hematopoietic system leading to lymphocytopenia, neutrophilia, eosinopenia, mild thrombocytopenia and ratios derived from these hematological parameters indicated severe disease and/or fatal outcomes. The aim was to study the hematological profile of Covid-19 patients admitted at a tertiary care hospital at Ramanagar district. Materials and Methods: This retrospective study included 260 confirmed cases of Covid-19 diagnosed at a tertiary health care centre. Demographic, clinical, laboratory, treatment, and outcome data were extracted from the institutional electronic medical records after obtaining permission from the concerned authorities. From CBC test results obtained neutrophil lymphocyte ratio was derived. Results: The present study revealed that majority of Covid positive patients presented with lymphopenia. While a significant association was observed between N/L ratio and disease severity, no significant association was seen between platelet count and severity of the disease. Conclusion: Since the results of the present study features lymphopenia among large proportion of patients and elevated N/L ratio among critically ill patients these markers could be utilized as useful prognostic indicators during the initial assessment of disease severity and thus appropriate management can be planned for such patients before the condition of the patient deteriorates.

Assessment of the Level of Protein C in Hospitalized Iraqi Patients with COVID-19 and its Correlation with Hematological and Inflammatory Markers

BACKGROUND: COVID-19 coagulopathy manifests by elevation of certain marker of active coagulation as fibrinogen and this increment associated with increased markers of inflammations. AIM: To measure protein C (PC) level in hospitalized patients with COVID-19 and to find a possible correlation with hematological and inflammatory markers. PATIENTS AND METHODS: Seventy-five hospitalized Iraqi adult patients with COVID-19 were included in a descriptive cross-sectional research. PC, D-dimer, and erythrocyte sedimentation rate (ESR) blood samples were collected, and further information was received from patient’s records. Statistical analysis was conducted using SPSS version 23 and Microsoft Office Excel 2019. RESULTS: Mean age of 75 patients included in the study was 60.13 ± 14.65 years. Sixty-two (62.7%) of patients exhibited neutrophilia, whereas 41 had lymphopenia (54.7%). High ratio of neutrophil/lymphocyte (N/L) was seen in 66 (88.0%), eosinopenia was seen in 46 (61.3%), high lactate dehydrogenase level was seen 68 (90.7%), serum ferritin was high in 66 (88.0%), and high level of C-reactive protein was seen in 68 (90.7%), increased ESR was seen in 69 (92.0%) and high level of D-dimer was seen in 56 (74.7%), while low level of PC was seen in 12 (16.0%) patients. PC had significant negative correlation with prothrombin and partial thromboplastin time but no significant correlation with hematological and inflammatory parameters. CONCLUSION: COVID-19 coagulopathy is common in majority of patients which include significant changes in WBCs counts, inflammatory markers, PC, and D-dimer levels. Such changes may have a great impact on morbidity and mortality and thus need to be monitored throughout treatment and convalescence.

PREDICTORS OF MORTALITY OF COVID-19 IN HAEMODIALYSIS PATIENTS

BACKGROUND AND AIMS: The COVID-19 pandemic has disproportionately affected patients with pre-existing comorbidities, particularly dialysis patients. These patients appear to be more susceptible to severe forms of the infection, due to underlying, coexisting pathologies and their immunocompromised status. The aim of this study was to determine predictors of mortality in this population. METHOD: We conducted an observational, retrospective, cohort study collecting data from the electronic medical records of a single dialysis centre at Hygeia Hospital Tirana, Albania. Baseline patient characteristics, including demographic, clinical and laboratory data were recorded. The receiver operating characteristic (ROC) analysis was used to determine predictors of mortality, their respective sensitivity, specificity and cut-off values. RESULTS: Of 170 haemodialysis patients, 52 were diagnosed with COVID-19. The prevalence of COVID-19 infection in haemodialysis patients in our study was 30.5%. The mean age was 61.5 ± 12.3 years and 65.4% were men. The mortality rate in our cohort was 19.2%. Mortality rates were higher in patients with Diabetic Nephropathy (P < 0.04) and Peripheral Vascular Disease (P < 0.01). High BMI (P < 0.024), high RDW (P < 0.03), elevated C-reactive protein (P < 0.018) and elevated serum ferritin (P < 0.021) levels, were found to be risk factors for severe COVID-19 disease. ROC analysis identified lymphopenia and eosinopenia as the strongest predictors of mortality. AUC for lymphopenia was 0.739. It showed a sensitivity of 80% and a specificity of 85.7%, at a cut-off value of 13.15%. AUC for eosinopenia was 0.814. At a cut-off value of 0.185%, it revealed a sensitivity and specificity of 72.7% and 75%, respectively. CONCLUSION: Our study revealed that risk factors for the development of severe COVID-19 infection were high BMI, high RDW, elevated levels of C-reactive protein (CRP) and serum ferritin. Lymphopenia and eosinopenia were determined as the most important predictors of mortality, in our cohort. Early recognition during the course of the infection, of a declining tendency of lymphocyte and eosinophil counts is paramount, in identifying high-risk patients for severe disease and poor outcomes among haemodialysis patients.

Eosinopenia and increased markers of endothelial damage are characteristic of COVID-19 infection at time of hospital admission.

In December 2019, a new virus has been discovered, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), leading to coronavirus disease 2019 (COVID-19). COVID-19 has been defined as an evolving disease with different phases. It starts with a mild or asymptomatic phase in which there is minimal disease. Thereafter, most patients recover, however, in 20% of the cases the infection worsens. It is hypothesized that eosinopenia, endothelial injury and the presence of smooth muscle autoantibodies are associated with the severity of the COVID-19. In a subset of 75 blood samples of patients with a SARS-CoV-2 infection at time of hospitalization and 30 healthy control samples concentrations of eosinophils, VEGF, VCAM, endothelin and smooth muscle autoantibodies were determined with hemocytometry, ELISA and immunofluorescence assays. In the group of patients with COVID-19 eosinophils (IQR = 0.0-0.01*109/L) were significantly decreased (p < .001), whereas markers of endothelial damage VCAM (IQR = 740-1120 ng/mL) and endothelin (IQR = 2.0-3.4 pg/mL) were significantly increased (p < .001) compared to the group of healthy controls (eosinophils IQR = 0.09-0.19*109/L, VCAM IQR = 362-561 ng/mL, endothelin IQR = 0.5-1.0 pg/mL). From the multivariate analysis, it is concluded that at time of hospitalization a combination of eosinopenia and increased markers of endothelial damage VCAM and endothelin are characteristic of COVID-19.

EOSINOPENIA COMO FATOR PREDITIVO DE GRAVIDADE EM PACIENTES PEDIÁTRICOS INTERNADOS POR COVID-19

Objetivo: Avaliar o primeiro hemograma realizado de crianças entre zero a 10 anos de idade com COVID-19 e relacionar seus parâmetros com a gravidade clínica. Materiais e métodos: Estudo de coorte retrospectivo (15/03/2020 a 15/09/2020) com dados do hemograma e PCR do prontuário à admissão hospitalar em dois hospitais na cidade de São Paulo, um privado e um hospital universitário. Foram avaliados, além de valores numéricos, dados categóricos quanto a presença ou não de alterações respeitando as referências para cada faixa etária. Feita avaliação das razões entre as células do leucograma e plaquetas: razão plaquetas/linfócitos, razão neutrófilos/linfócitos (NLR), razão neutrófilos/monócitos, razão linfócitos/neutrófilos, razão linfócitos/monócitos, razão monócitos/neutrófilos e razão monócitos/linfócitos. Resultados: Foram incluídas 93 crianças (idade entre 0,30–126 meses, mediana 19 meses), sendo destes 56 meninos (60,2%). Receberam alta após avaliação no pronto-socorro 24/93 (25,8%) pacientes, ficando internados 69 (74,2%). Não houve associação entre idade, sexo e valor de PCR com internação ou com a gravidade clínica. Doença de base esteve presente em 29/69 (42%) pacientes internados, enquanto que nos 24 que não internaram, esteve presente em 3 (12,5%). As crianças com alguma doença de base têm 5,08 (95% IC 1,56–22,9) vezes mais chance de internar em relação àquelas sem doença de base;no modelo ajustado para a idade, a OR foi de 4,63 (95% IC 1,36–21,59). As crianças com NLR maior (média 2,42 para o grupo internado contra 1,20 para o grupo não internado) tem 54% mais chance de internação (OR 1,54, 95% IC 1,10–2,41). Do total das crianças internadas, 21/69 (30,4%) evoluíram para uma condição crítica (sepse, síndrome inflamatória multissistêmica pediátrica – SIM-P, suporte ventilatório avançado ou óbito). A proporção de crianças críticas com eosinopenia é 3,05 vezes maior que aquelas sem eosinopenia (OR 3,05, 95% IC 1,07–9,39);ajustando o modelo para a idade, houve aumento para 5,27 (95% IC 1,62–19,35). Um óbito ocorreu nessa população por SIM-P em criança com neuropatia de base. Discussão: O conhecimento das alterações no hemograma de crianças entre 0 e 10 anos de idade ainda é escasso e possíveis fatores preditivos para gravidade que sejam de fácil acesso aos sistemas de saúde devem ser investigados. A NLR é um fator preditivo importante para doença grave e mortalidade em adultos com COVID-19. Neste estudo, na avaliação inicial no pronto socorro, as crianças com NLR maior têm maior probabilidade de apresentar um quadro clínico que exija internação. Os eosinófilos, por sua vez, têm papel na resposta imune adaptativa e na imunidade inata, com capacidade pro-inflamatória e destrutiva, estando sua presença no hemograma inicial relacionada como marcador infeccioso. A eosinopenia foi descrita em adultos com COVID-19 como um fator de pior prognóstico, sendo frequente nos pacientes com êxito letal. Este estudo demonstrou que, uma vez internadas, a eosinopenia também esteve relacionada com a gravidade da COVID-19 em crianças. Conclusão: Crianças com COVID-19 e doença de base ou NLR maior no pronto socorro são mais propensas a internar. Existe relação entre eosinopenia no hemograma à admissão hospitalar como fator preditivo de gravidade para crianças internadas com COVID-19.

CARACTERÍSTICAS DE PACIENTES PEDIÁTRICOS INTERNADOS COM DIAGNÓSTICO DE DOENÇA FALCIFORME INFECTADOS E NÃO INFECTADOS POR SARS-COV-2

Objetivo: Descrever e comparar as características epidemiológicas, clínicas e laboratoriais dos pacientes < 18 anos com doença falciforme (DF)infectados ou não por SARS-CoV-2 e identificar alterações do hemograma (HMG) daqueles infectados no momento da admissão comparado ao último exame antes da internação. Método: Estudo de coorte, unicêntrico, retrospectivo-prospectivo, com dados de prontuário de pacientes internados (março a novembro de 2020), com SARS-CoV-2 positivo (GP) ou SARS-CoV-2 negativo (GN) de acordo com PCR-RT. Foram coletados: idade, sexo, raça, índice de massa corpórea (IMC), genótipo da DF, uso de hidroxiuréia (HU), transfusão crônica (TC), presença de comorbidades, sintomas e complicações, uso de antibiótico, antiviral e anticoagulante, necessidade de oxigênio (O2), UTI, ventilação mecânica (VM) e ventilação não invasiva (VNI), HMG da internação e de antes da admissão para o GP. Resultados: Foram internados 57 pacientes, dos quais 11 (19,3%) tiveram resultado positivo. O genótipo HbSS foi o mais comum e as características: idade, IMC, sexo e raça foram semelhantes (p>0,05). No GP, 81,8% estavam recebendo HU ou TC e no GN, 63%. Durante a internação, o uso de antibiótico, O2 e Oseltamivir foi semelhante. Comorbidades foram identificadas em 63,6% dos pacientes do GP e em 30,4% do GN (p = 0,046– Fisher).A média de dias de internação foi 6 para o GP e 7 para o GN. Em relação aos sintomas e complicações, não houve diferença estatisticamente significativa, porém febre durante a internação foi mais frequente no GP (90,9% vs. 60,9;p = 0,055-Fisher).Um paciente do GP recebeu anticoagulação profilática devido a suspeita de embolia pulmonar, que foi descartada com exame de imagem. Nenhum paciente do GP e um paciente do GN necessitou de UTI por síndrome torácica aguda grave e necessidade de VNI. Nenhum paciente precisou de VM ou teve óbito como desfecho. O resultado dos HMGs foi semelhante e no GP a contagem de eosinófilos foi menor na admissão quando comparada ao último exame ambulatorial(p=0,008-Wilcoxon). Discussão: Os pacientes com DF e infecção pelo SARS-CoV-2 podem evoluir com desfecho desfavorável e dados de revisão em hemoglobinopatia em pacientes pediátricos com DF e COVID-19 apontam maior prevalência de necessidade de UTI neste grupo (Vilella TS et al., 2020). Neste estudo, SARS-CoV-2 demonstrou causar infecção leve e nenhum paciente necessitou de UTI. Quando comparados com adultos, a COVID-19 se mostrou menos agressiva em crianças. No GP houve diminuição significativa da contagem de eosinófilos no HMG antes e após a admissão. Esse achado sugere que a contagem de eosinófilos possa ser um marcador biológico potencial para COVID-19. A eosinopenia também foi evidenciada em estudos em pacientes adultos com COVID-19 (Li Q et al. 2020;Jafarzadeh A et al. 2020). Uma das principais limitações deste estudo foi o pequeno número de pacientes infectados. Até o presente momento, não havia na literatura estudos que comparassem simultaneamente pacientes pediátricos com DF internados com e sem COVID-19 e o HMG no GP antes e após a admissão hospitalar. Conclusão: Os pacientes com DF infectados por SARS-CoV-2 apresentaram quadro leve mesmo apresentando maior prevalência de comorbidades do que os não infectados. Não foram observadas diferenças clínicas ou laboratoriais entre os dois grupos.

Hematological Abnormalities in COVID-19 Disease: Association With Type I Interferon Pathway Activation and Disease Outcomes.

Increased expression of interferon (IFN)-stimulated genes (ISGs) in peripheral blood, has been previously reported in viral infections, as well as in autoimmune disorders, in association with reduced leukocyte and platelet counts. Though cytopenias are common in patients with COVID-19 disease and predict severe outcomes, the underlying mechanisms have not been fully elucidated. In the current study, we aimed to determine the prevalence of hematological abnormalities in the setting of active COVID-19 infection and to explore whether they associate with disease outcomes and activation of type I IFN pathway. One-hundred-twenty-three consecutive SARS-CoV2 infected patients were included in the study. Clinical and laboratory parameters were recorded for all study participants. In 114 patients, total RNA was extracted from whole peripheral blood and subjected to real time PCR. The relative expression of three interferon stimulated genes (ISGs; IFIT1, MX-1, and IFI44) was determined and a type I IFN score reflecting peripheral type I IFN activity was calculated. The rates of anemia, leukopenia, and thrombocytopenia were 28.5, 14.6, and 24.4%, respectively. Among leukocytopenias, eosinopenia, and lymphopenia were the most prominent abnormalities being found in 56.9 and 43.1%, respectively. Of interest, patients with either eosinopenia and/or thrombocytopenia but no other hematological abnormalities displayed significantly increased peripheral type I IFN scores compared to their counterparts with normal/high eosinophil and platelet counts. While eosinopenia along with lymphopenia were found to be associated with increased risk for intubation and severe/critical disease, such an association was not detected between other hematological abnormalities or increased type I IFN scores. In conclusion, hematological abnormalities are commonly detected among patients with COVID-19 infection in association with severe disease outcomes and activation of the type I IFN pathway.

Eosinopenia;a Predictor of Non-Respiratory COVID-19

Aims: Eosinopenia is a form of agranulocytosis where the number of eosinophil granulocytes is lower than expected, which is observed in many viral and bacterial infections. This study aimed to investigate eosinopenia in non-respiratory COVID-19 patients. Materials & Methods: This experimental study was conducted on COVID-19 patients who had the positive PCR test in an outpatient clinic in Al-Feiha Teaching Hospital in Basrah, Iraq. One hundred four patients were selected from June to November 2020. Full blood counts and estimation of the inflammatory marker C-reactive protein were done. The Chi-square statistical test in SPSS 20 software was used for data analysis. Findings: Eosinopenia observed in 47 patients (45.1%);20 patients (19%) were respiratory COVID-19 and 27 patients (26%) were non-respiratory COVID-19. Total white blood cell count reduced in 17 patients & increased in 30 patients while normal in 57 patients. Logistic regression analysis indicated that eosinopenia is a significant independent predictor of nonrespiratory COVID-19 infection (p=0.008;B=0.0001). Conclusion: Eosinopenia is a predictor of COVID-19 infection in patients with non-respiratory illnesses. Copyright © 2021 The Authors.

Study of Haematological Parameters in Patientswith COVID-19 during Second Wave: Experience from a Tertiary Care Institute in Northern India

Introduction: The Coronavirus disease is a systemic infection associated with changes in haematological parameters, which have asignificant role in early risk stratification and prognostication in theaffected patients.Aims &Objectives: To study the haematological parameters Hemoglobin(Hb), Mean Corpuscular Volume(MCV),Red celldistribution width(RDW),total leukocyte count(TLC), NeutrophilLymphocyte ratio (NLR), Absolute eosinophil count(AEC), Absolutelymphocyte count(ALC) and platelet count(PC)] in patients ofCOVID-19 s wave, at our tertiary care institute.Materials &Methods: The study was conducted on 214 COVID-19patients admitted to our institute from April 2021 to June 2021.Data was collected from Central laboratory records in Microsoft exceland analysed using student SPSS version 26.0.Result: The mean age of the patients was 53.46 ± 13.09 years with amale to female ratio of 1.9:1. Anemia was observed in 143 patients(66.82%).Normal MCV was observed in 128 (59.81%) and RDW wasincreased in 159(74.29%) while TLC was normal in 109(50.93%)followed by leukocytosis in 99 (46.26%) and leukopenia in 6(2.8%)patients. NLR was raised in 207 (96.72%) patients. Eosinopenia in205(95.79%), lymphopenia in 156(72.89%) while normal PC wasobserved in 140(65.42%), decreased in 69 (32.24%) and increased in5(2.42%) patients.Conclusions: Anaemia, increased RDW, increased NLR, lymphopenia and eosinopenia were associated with COVID 19 disease.