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We conducted a review and evaluated the already documents reports for the relationship among diabetes and COVID-19. The review outcome shows that the COVID-19 severity seems to be greater among patients with diabetes as comorbidity. So, strict glycemic control is imperative in patients infected with COVID-19. Thus, world-wide diabetes burden and COVID-19 pandemic must be deliberated as diabetes increases the COVID-19 severity. Established on this, it is precise significant to follow specific treatment protocols and clinical management in COVID-19 patients affected with diabetes to prevent morbidity and mortality.Copyright © 2023 The Authors.
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The new coronavirus infection COVID-19 (Coronavirus Disease 2019) caused by SARS-CoV-2, has posed scientific and public health challenges. The problem of treating COVID-19 still remains, and the pathogenesis of COVID-19 needs to be studied in detail, including the involvement of mast cells (MCs) and their specific proteases. The aim of this study was to characterize the role of mast cell proteases chymase, tryptase, and carboxypeptidase A3 (CPA3) in the lung damage associated with COVID-19. Methods. The study included postmortem lung biopsies from 30 patients who died of severe COVID-19, and biopsies from 9 control group patients. Histological preparations were made and protease profile and degranulation activity of MCs were analyzed. In addition, some demographic, clinical, and laboratory parameters were analyzed. Results. The average number of tryptase-positive MCs without evidence of degranulation and the total number of CPA3-positive MCs were statistically significantly higher in patients with COVID-19, and the number of tryptase-positive and CPA3-positive MCs fragments was lower compared with controls. Negative correlations were established between the numbers of tryptase-positive MCs and red blood cell count. Negative correlations were found between non-granulating tryptase-positive MCs and hemoglobin levels. Positive correlations were noted between tryptase-positive MCs and the leukocytes and eosinophils counts, and negative correlations were noted between the number of CPA3-positive cells and the platelet count. A positive correlation was found between the number of adjoining MCs, as well as fragments of tryptase-positive MCs, and the erythrocyte sedimentation rate (ESR). A negative correlation was also observed between the number of non-degranulated CPA3-positive MCs and the blood level of C-reactive protein. In patients with COVID-19, reduced degranulation activity of tryptase-positive MCs was found along with increased representation of CPA3-positive MCs. Several trends and associations with laboratory test results were noted. The potential involvement of MCs in the development of anemia and thrombocytopenia is considered. Associations were established between tryptase-positive MCs and the peripheral blood counts of leukocytes and eosinophils, as well as ESR. Conclusion. The results obtained are highly contradictory. Since many aspects of the involvement of MCs and their proteases in COVID-19 pathogenesis are still unknown, studies with larger cohorts of patients are needed.Copyright © Budnevsky A.V. et al., 2023.
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Aim of study. To evaluate the influence exerted by additional use of a fixed combination of folic acid with pyridoxine hydrochloride and cyanocobalamin in complex therapy for hospitalised patients with COVID-19-associated lung damage on parameters of inflammation and clinical outcomes. Material and methods. A comparative prospective interventional study included 117 patients with a lung lesion volume caused by the SARS-CoV-2 coronavi-rus corresponding to CT-1 and CT-2. The study group included 78 patients who additionally received a fixed combination of 5mg folic acid, 4mg pyridoxine hydrochloride, and 6mug cyanocobalamin three times a day in combination with standard therapy. The comparison group included 39 patients. Results. By days 14-21 of hospitalisation, the main group showed a decrease in the proportion of patients with CT symptoms of "cobblestone appearance" by 26% (p = 0.005) and an increase in the proportion of patients with transformation of viral lung lesions into areas of consolidation of the pulmonary parenchyma by 23% (p <0.001). The effect of a fixed combination of folic acid with vitamins B6, B12 on the achievement of the level of C-reactive protein <20 mg / l by day 7 depending on the red blood parameters and the number of platelets was established (likelihood ratio test in the logistic regression model: 13.925;P = 0.084) as well as the shortening of the time period required to reach the first negative result of the SARS-CoV-2 RNA test (in the linear regression model, R = 0.437;R2 = 0.191;F = 4.552;p = 0.006). Conclusion. The use of a fixed combination of folic acid with vitamins B6, B12 for patients with COVID-19 is associated with earlier achievement of positive dynamics in CT symptoms of lung damage. The additional use of these micronutrients in combination with restoration of red blood count and platelet count improves the odds ratio of an early decrease in serum C-reactive protein, negative result of the SARS-CoV-2 RNA test.Copyright © 2021, Krasnoyarsk State Medical University. All rights reserved.
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Feline Infectious Peritonitis (FIP) is highly mortality disease in cats. The reliable and fast diagnosis is crucial to the best prognosis. The aim of this study to evaluate the hemogram profile in cats infected with effusive FIP. Twenty cats had been diagnosed effusive FIP at Animal Clinic Department of Internal Medicine, Faculty Veterinary Medicine, Universitas Gadjah Mada were used in the study. The diagnosis were based on clinical examination, ultrasound, x-ray, rivalta test, and rapid test. The hemogram profile were analyzed include routine hematology and serum biochemistry. Hemogram profile in effusive FIP showed the decreased hematocrit, hyperproteinemia, and leukocytosis with an average 22.9+or-7.4%;9.0+or-2.2 g/dL;22425+or-4116 cells/mm3 respectively. Erythrocyte, hemoglobin and fibrinogen levels were still in the normal range. The results of differential leukocytes revealed that 90% cats had neutrophilia and 75% lymphopenia with an average 20066+or-3337 cells/mm3 and 1861+or-1818 cells/mm3 respectively. The blood chemistry profile showed 60% of cats experienced increase in SGPT and SGOT with an average 138.4+or-72.3 IU/L and 101+or-60.5 IU/L respectively. Hyperglobulinemia was found in 90% samples with an average 6.7+or-0.8 g/dL. All cats have a low albumin:globulin ratio with an average 0.3+or-0.1. The hemogram profile of effusive FIP were: leukocytosis, neutrophilia, lymphopenia, hyperglobulinemia, and decreased albumin-globulin ratio..
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The new coronavirus infection COVID-19 (Coronavirus Disease 2019) caused by SARS-CoV-2, has posed scientific and public health challenges. The problem of treating COVID-19 still remains, and the pathogenesis of COVID-19 needs to be studied in detail, including the involvement of mast cells (MCs) and their specific proteases. The aim of this study was to characterize the role of mast cell proteases chymase, tryptase, and carboxypeptidase A3 (CPA3) in the lung damage associated with COVID-19. Methods. The study included postmortem lung biopsies from 30 patients who died of severe COVID-19, and biopsies from 9 control group patients. Histological preparations were made and protease profile and degranulation activity of MCs were analyzed. In addition, some demographic, clinical, and laboratory parameters were analyzed. Results. The average number of tryptase-positive MCs without evidence of degranulation and the total number of CPA3-positive MCs were statistically significantly higher in patients with COVID-19, and the number of tryptase-positive and CPA3-positive MCs fragments was lower compared with controls. Negative correlations were established between the numbers of tryptase-positive MCs and red blood cell count. Negative correlations were found between non-granulating tryptase-positive MCs and hemoglobin levels. Positive correlations were noted between tryptase-positive MCs and the leukocytes and eosinophils counts, and negative correlations were noted between the number of CPA3-positive cells and the platelet count. A positive correlation was found between the number of adjoining MCs, as well as fragments of tryptase-positive MCs, and the erythrocyte sedimentation rate (ESR). A negative correlation was also observed between the number of non-degranulated CPA3-positive MCs and the blood level of C-reactive protein. In patients with COVID-19, reduced degranulation activity of tryptase-positive MCs was found along with increased representation of CPA3-positive MCs. Several trends and associations with laboratory test results were noted. The potential involvement of MCs in the development of anemia and thrombocytopenia is considered. Associations were established between tryptase-positive MCs and the peripheral blood counts of leukocytes and eosinophils, as well as ESR. Conclusion. The results obtained are highly contradictory. Since many aspects of the involvement of MCs and their proteases in COVID-19 pathogenesis are still unknown, studies with larger cohorts of patients are needed.Copyright © Budnevsky A.V. et al., 2023.
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BACKGROUND: While the type and the number of treatments for Coronavirus Disease 2019 (COVID-19) have substantially evolved since the start of the pandemic a significant number of hospitalized patients continue to succumb. This requires ongoing research in the development and improvement of early risk stratification tools. METHOD(S): We developed a prognostic score using epidemiological, clinical, laboratory, and treatment variables collected on admission in 130 adult COVID-19 patients followed until in-hospital death (N.=38) or discharge (N.=92). Potential variables were selected via multivariable logistic regression modelling conducted using a logistic regression univariate analysis to create a combined index. RESULT(S): Age, Charlson Comorbidity Index, P/F ratio, prothrombin time, C-reactive protein and troponin were the selected variables. AUROC indicated that the model had an excellent AUC value (0.971, 95% CI 0.926 to 0.993) with 100% sensitivity and 83% specificity for in-hospital mortality. The Hosmer-Lemeshow calibration test yielded non-significant P values (chi2=1.79, P=0.99) indicates good calibration. CONCLUSION(S): This newly developed combined index could be useful to predict mortality of hospitalized COVID-19 patients on admission.Copyright © 2022 EDIZIONI MINERVA MEDICA.
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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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Two female patients (patient 1, 22-year-old;patient 2, 50-year-old) received IV infusion of ribavirin injection (4 g in the first dose and the next day 1.2 g thrice daily), oral 2 lopinavir and ritonavir tablets twice daily, and aerosol inhalation of recombinant human interferon alpha2b for injection for novel coronavirus pneumonia. There was no obvious abnormality in blood routine and liver function before treatment. Laboratory tests showed red blood cell count (RBC) 2.89x1012/L, hemoglobin (Hb) 75 g/L, alanine aminotransferase (ALT) 22.8 U/L, aspartate aminotransferase (AST) 33.9 U/L, total bilirubin (TBil) 71.2 mumol/L, and indirect bilirubin (IBil) 63.5 mumol/L in patient 1 on the 2nd day of treatment, and RBC 3.46x1012/L, Hb 95 g/L, ALT 17.7 U/L, AST 21.3 U/L, TBil 86.1 mumol/L, and IBil 67.1 mumol/L in patient 2 on the 3rd day of treatment. The direct antiglobulin test was positive, indirect antiglobulin test was negative, and antinuclear antibody test was negative in both patients. They were diagnosed as having acute hemolytic anemia. Con-sidering the relationship to ribavirin, ribavirin was given in reduced dose and then finally discontinued in patient 1, and was discontinued directly in patient 2. On the basis of continued use of the other 2 drugs, both of them were treated with ursodeoxycholic acid. The Hb and bilirubin level of the 2 patients gradually returned to normal.Copyright © 2020 by the Chinese Medical Association.
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The purpose of this experiment was to increase poultry meat production by increasing the number of chickens reared in the same area and managing it by using medicinal herbs Salvia officinalis L and Lavandula angustifolia L. in the broiler chicken diet. 705 one-day-old chicks were randomly distributed into to7 treatments with three replicates for an area of two m2 floor system in each replicate for each treatment, during 35 days of the study. T0 negative control 75 chicks, 25 chicks for each replicate 12-13 chicks per m2 fed standard diet. T1 positive control (stocking density without supplementation)105 chicks, 35 each replicate chicks 17-18 per m2 fed standard diet. The same stocking density for T2, T3, T4, T5, and T6 have been given standard feed with supplemented herbals, salvia 0.7%, 0.9%, lavender0.7%, 0.9%, and mixed 0.7% respectively. Depending on the results, chickens reared in stress stocking density with supplementations led to higher improvement of body weight, meat production, body weight gain (BWG), feed conversion ratio(FCR g feed/g weight), production index PI, carcass weight (g) and dressing percentage, RBCs 106cells/mm3, lymphocyte%, of increasing activity of thyroid hormones T3, T4 (nmol/L) boost antibody titers of ND and IBV when compared with positive control. However, heterophil%, stress indicator H/L ratio, glucose mg/ dL and cholesterol mg/ dL significantly reduced. The results showed that adding sage and lavender plants to broiler feed is effective in improving productivity, immunity, and resistance characteristics in reducing the adverse effects of stress caused by increasing the intensity of broiler rearing in the same area.
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Introduction: Typical manifestations of Coronavirus disease 2019 (COVID-19) include respiratory involvement. Gastrointestinal (GI) symptoms have also been reported as early clinical manifestations. The GI involvement can represent with diarrhea, vomiting, and abdominal pain. The present research aimed to identify dysentery as one of the signs of GI involvement in the novel coronavirus infection in children. Case Presentation: We report twelve patients with COVID-19 and dysentery. All these children had positive reverse transcriptionpolymerase chain reaction (RT-PCR) results. None had underlying illnesses or recent travel history. However, all children had contact with a first-degree relative affected by non-digestive COVID-19. In three patients, obvious dysentery was observed, and in the rest, red and white blood cells were evident in the stool exam. Stool exams were negative for bacterial infections, parasites, and the toxin of Clostridium difficile. Abdominal ultrasonography and echocardiographic evaluations to rule out multisystem inflammatory syndrome in children were normal. Supportive treatment, such as zinc supplementation and probiotics, was prescribed. They also received intravenous fluid therapy based on their dehydration percentage. In the end, they were discharged in good general condition without any complications. No GI complications were found in the follow-up series. Conclusion(s): Dysentery in children can be one of the GI manifestations of COVID-19, which is usually self-limiting. It does not require invasive diagnostic measures and antiviral treatments. This symptom is in contrast to other viral infections of the GI tract.Copyright © 2022, Author(s).
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Aim: to build, a predictive model for severe COVID-19 prediction in young adults using deep learning methods. Material(s) and Method(s): data from 906 medical records of patients aged. 18 to 44 years with laboratory-confirmed SARS- CoV-2 infection during 2020-2021 period, was analyzed. Evaluation of laboratory and. instrumental data was carried out using the Mann-Whitney U-test. The level of statistical significance was p<0,05. The neural network was trained, using the Pytorch. framework. Result(s): in patients with mild to moderate SARS-CoV-2 infection, peripheral oxygen saturation, erythrocytes, hemoglobin, total protein, albumin, hematocrit, serum, iron, transferrin, and. absolute peripheral blood, eosinophil and. lymphocyte counts were significantly higher than in patients with severe SOVID-19 (p< 0,001). The values of the absolute number of neutrophils, ESR, glucose, ALT, AST, CPK, urea, LDH, ferritin, CRP, fibrinogen, D-dimer, respiration rate, heart rate, blood, pressure in the group of patients with mild and. moderate severity were statistically significantly lower than in the group of severe patients (p < 0.001). Eleven indicators were identified as predictors of severe COVID-19 (peripheral oxygen level, peripheral blood erythrocyte count, hemoglobin level, absolute eosinophil count, absolute lymphocyte count, absolute neutrophil count, LDH, ferritin, C-reactive protein, D-dimer levels) and. their threshold, values. A model intended, to predict COVID-19 severity in young adults was built. Conclusion. The values of laboratory and instrumental indicators obtained in patients with SARS-CoV-2 infection upon admission significantly differ. Among them, eleven indicators were significantly associated with the development of a severe COVID-19. A predictive model based, on artificial intelligence method, with high, accuracy predicts the likelihood, of severe SARS-CoV-2 course development in young adults.Copyright © 2022 Interregional public organization Association of infectious disease specialists of Saint-Petersburg and Leningrad region (IPO AIDSSPbR). All rights reserved.
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Background: COVID-19 has become a serious health problem worldwide. Objective(s): The current study investigated the prognostic factors associated with demographical parameters, clinical and vital signs, and laboratory results for predicting severity and mortality in patients infected with COVID-19. Method(s): This retrospective analysis was conducted on the medical records of 372 COVID-19-positive patients hospitalized at the Khatam al-Anbiya Hospital, Shoushtar, Iran, from Sep 2020 to Sep 2021. The association of demographic parameters, clinical and vital signs, and laboratory results with severity and patients' outcomes (survival/mortality) was studied. The patients were divided into the non-severe group (n = 275) and the severe group (n = 97). COVID-19 disease severity was determined based on the severity of pulmonary involvement using CT chest images. The collected data were analyzed using IBM SPSS software for Windows (version 18). Logistic regression analysis was employed using the Forward LR method to predict COVID-19 severity and mortality. Result(s): The rates of mortality and the severe form of the disease were 87.1% (n = 324) and 12.9% (n = 48), respectively. A prognostic value was observed in predicting COVID-19 severity and mortality for some clinical and vital signs (diabetes (P < 0.001, P = 0.019), hypertension (P = 0.024, P = 0.012), pulmonary diseases (P = 0.038, P < 0.001), and anosmia (P = 0.043, P = 0.044) and paraclinical parameters (FBS (P = 0.014, P = 0.045), BUN (P = 0.045, 0.001), Cr (P = 0.027, P = 0.047), Neut (P = 0.002, P = 0.005), and SpO2 (P = 0.014, P = 0.001)). Cardiovascular disorders (P = 0.037), fever (P = 0.008), and dyspnea (P = 0.020) were also effective at predicting disease-related mortality. Multiple logistic regression analyses showed that diabetes disease, the place of residence, PCO2, and BUN with R2 = 0.18, and age, pulmonary diseases, and BUN with R2 = 0.21 were involved in predicting the severity and mortality, respectively. Conclusion(s): It seems that in addition to the BUN, diabetes and pulmonary diseases play a more significant role in predicting the severity and mortality due to COVID-19, respectively.Copyright © 2023, Author(s).
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BACKGROUND: The COVID-19 pandemic has led to the biggest global health crisis of our lifetime. There is accumulating evidence that a substantial number of critically ill COVID-19 patients exhibit a dysregulated host response manifesting as cytokine storm or cytokine release syndrome which in turn contributes to the high observed rates of mortality. Just as in other hyperinflammatory conditions extracorporeal cytokine removal may have potential beneficial effects in this subgroup of COVID-19 patients. The CytoSorb blood purification device is the most extensively investigated cytokine removal platform with considerable evidence suggesting that early intervention can provide rapid hemodynamic stabilization and improvement in vital organ functions AIM OF THE STUDY: Here we describe 4 cases of severely ill adult patients with coronavirus disease 2019 admitted to intensive care unit who were treated with CytoSorb therapy. METHOD(S): All 4 patients were admitted in the ICU with CT severity score of >15/25. During their clinical course, all patients were prescribed tocilizumab (an interleukin-6 receptor blocker) antivirals hydroxychloroquine azithromycin and other antibiotics and general antipyretic drugs. All patients received low-molecular-weight heparin thromboprophylaxis adjusted to baseline weight and renal function Patient A and C required invasive mechanical ventilation whereas Patients B D were on NIV The mean age of the patients was 67.7 years (range = 29-79) Patients received a median of 2 attempts of hemoperfusion. The median CytoSorb perfusion time was 20hrs. RESULT(S): The level of IL-6 significantly decreased after treatments. It reduced by 95% for Patient A, 70% for Patient B, 99% for Patient D Mean Arterial Pressure improved by 15 mmHg average for Patients A, B, D PaO2/FiO2 Ratio improved by 143 average for Patients A, B, D HsCRP levels fell by average of 39 mg/l for patients A, B, D Patient A expired 2 days after the cytosorb dialysis (Refractory Shock) Patient C expired following Dialysis Albumin mildly decreased after CytoSorb. No significant changes were found in red blood cell counts, white cell counts, and platelets. ICU and in-hospital mortality was 50%. CONCLUSION(S): In this case series, critically ill patients with COVID-19 with severe acute respiratory failure refractory to prone positioning and hypercytokinemia who received adjuvant treatment with cytokine hemoadsorption showed a significant reduction in IL-6 plasma levels and other inflammatory biomarkers. Improvements in oxygenation and MAP were also observed.
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Objective: Vaginal candidiasis is a frequent infection afflicting the female population. Candida co-infections are reported in escalating frequency and can be associated with severe health hazards or even death. People with severe COVID-19, malig-nancies, AIDS, and organ transplants are particularly vulnerable to invasive vaginal candidiasis. Due to the high frequency of infections associated with recurrence, vaginal candidiasis poses a significant medical problem worldwide.Treatments of vaginal candidiasis are limited due to drug resistance, side effects, and toxicity. CIN is a natural compound and its antifungal activity is widely reported. The introduction of cinnamaldehyde (CIN) as the anti-Candidal agent will revolutionize the treatment of vaginal candidiasis. In this study, we investigated the anti-Candida activity of CIN against vaginal candidiasis in Swiss albino mice (C3HHC-Strain). Method(s): Vaginal candidiasis in mice (Swiss albino) was induced under conditions of pseudo-estrus. Persistent vaginal infection wasfound inestrogenized mice aftervaginal challenge withC.albicans.The mice weretreated orallyafter confirmation of infection in mice.The efficacy of CIN treatment was investigated phenotypically by colony-forming unit (CFU) counts in the vaginal smear, fungal load determination in the blood, the ovarian and vaginal tissues and periodic acid-Schiff (PAS) staining of histopathological sections of the vaginal tissues. The hematological parameters of the experimental mice were also evaluated. Result(s): The pseudohyphae and spores of C. albicans were present in the vaginal smear of experimentally infected mice. After treatment, no C. albicans colonies were found in the vaginal lavage of infected mice. The fungal burden was significantly higher inthe vaginaand the ovaries of infectedmice.However, a dose of262.5 mg/kgBW of CINreduced thenumber ofCFUin the vagina and ovaries in treated mice.The histopathology revealed the absence of C.albicans in the vaginal tissue of the treated mice. Nonetheless, the vaginal sections of infected mice exhibited pathological changes. The hematological parameters such as RBC count, WBC count, and percentage of hemoglobin showed significant differences in the treatment groups compared to the infected group. Conclusion(s): Cinnamaldehyde showed good in vivo antifungal potential against vaginal candidiasis. However, evaluation of its pharmacodynamic and pharmacokinetic parameters and complete elucidation of its mode of action are desirous.
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Background: IgA nephropathy (IgAN) flairs with gross hematuria after COVID-19 vaccination have been recently reported as adverse events of immunization, but no study to date has examined the incidence and clinical course of IgAN patients with gross hematuria following vaccination. Method(s): A single-center retrospective observational study included 301 patients with biopsy-proven IgAN and followed-up for more than 6 months with therapeutic intervention and received at least one dose of COVID-19 vaccination. We examined from medical records the incidence of gross hematuria following vaccination and also evaluated the clinical course of eGFR, spot urine protein/Cr ratio (UPCR), urinary erythrocyte count (URBC) /hpf among IgAN patients with gross hematuria following COVID-19 vaccination. Result(s): We identified 7 (3.0 %) patients with gross hematuria following COVID-19 vaccination. 6 patients were female. The median age was 42 (range, 33 to 48). Median time to develop gross hematuria after vaccination was 1 (range, 0 to 4) day and gross hematuria resolved within 3 (range, 1 to 7) days. 6 patients presented gross hematuria after the second dose. Mean baseline eGFR and UPCR before vaccination were 73.7 (IQR, 61.3 to 86.0) ml/min/1.73m2 and 0.23 (range, 0.01 to 0.70) g/g Cr, respectively, and median grade of hematuria was URBC 10-19/hpf. With mean follow up of 238.7 (range, 184 to 282) days after the onset of gross hematuria, 4 patients were introduced steroid therapy. Within one month after the onset of gross hematuria, mean eGFR decreased -13 (range, -29.2 to -5.2) % and UPCR increased +0.70 (range, +0.02 to + 2.59) g/gCr from baseline, and median grade of hematuria increased to URBC 50- 99/hpf as compared to baseline. At 6 months, mean eGFR and UPCR improved to 73.9 (IQR, 60.2 to 88.0) ml/min/1.73m2 and 0.30 (range, 0.06 to 0.74) g/g Cr, respectively, and median grade of hematuria decreased to URBC 5-9/hpf. Conclusion(s): Our study revealed the incidence of gross hematuria following vaccination in IgAN patients and also suggested that eGFR, proteinuria and hematuria may transiently worsen but improve almost to baseline with appropriate therapeutic intervention or careful follow-up.
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The proceedings contain 52 papers. The topics discussed include: cardiac presentation of multisystem inflammatory syndrome in children (MIS-C);monitoring of the patient with shock;factors influencing the prognosis of HIE of the newborn;problems and solutions in the field of neonatal research;new biomarkers in the diagnosis of hypoxic ischemic encephalopathy;is umbilical cord nucleated red blood cell count related to a premature baby prognosis?;COVID-19 and children with renal disease;accuracy of ultrasound in the diagnosis of skull fractures in the pediatric emergency department;comparing emergency residents with pediatric residents for their skills of ECG interpretation;adolescent's spiritual health in COVID-19 pandemic: a qualitative study;fluid challenge in children patients with COVID-19 disease;and drug-induced pulmonary toxicity: lots of drugs and chemical agents can cause acute and chronic lung injury.
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SESSION TITLE: Problems in the Pleura Case Posters 1 SESSION TYPE: Case Report Posters PRESENTED ON: 10/17/2022 12:15 pm - 01:15 pm INTRODUCTION: Ibrutinib is an irreversible inhibitor of Bruton's tyrosine kinase (Btk), approved for treatment of a variety of B-cell malignancies, including chronic lymphocytic leukemia (CLL). There is an association of increased risk of bleeding with ibrutinib due to platelet dysfunction caused by the medication. Bleeding is usually non-life threating such as subcutaneous or mucosal bleeding, epistaxis, and ecchymosis. But major bleeding has been reported such as intracranial hemorrhage and gastrointestinal hemorrhage. Thoracic complications from ibrutinib are rare. Below is a case report discussing a hemorrhagic pleural effusion thought to be caused by Ibrutinib. CASE PRESENTATION: Patient is a 78-year-old male initially diagnosed with CLL on flow cytometry showing a low-grade B cell lymphoproliferative process. Patient was monitored by Hematology and when kappa light chain numbers began to rise, a bone marrow biopsy was performed showing 90% infiltration of the marrow with lymphoid cells. Patient was started on Ibrutinib therapy and responded well to treatment. A year after starting therapy, patient presented to the emergency room with increased shortness of breath and fatigue. Patient was found to be COVID-19 positive and chest x-ray showed a large right sided pleural effusion. Thoracentesis was performed draining 1650cc of bloody fluid. Fluid studies revealed a lymphocytic effusion with RBC count 1,185375, WBC of 1751. Cultures and cytology were negative. On further history, patient was without recent trauma or surgery, CTA chest was negative for pulmonary embolism. QuantiFERON Gold test was negative, indicating low likelihood of tuberculosis. Patient was not on any antiplatelet or systemic anticoagulation medications. Ibrutinib therapy was held during hospitalization and pleural effusion did not reaccumulate. Patient passed away during hospital stay secondary to respiratory failure due to COVID-19. DISCUSSION: Ibrutinib is an orally bioavailable bruton tyrosine kinase inhibitor (BTKi) and forms an irreversible covalent bound to BTK at the Cysteine-481 residue. Ibrutinib predisposes to bleeding by inhibiting BTK and Tec, which play a role in the inhibitory signaling pathway of platelet collagen receptors such as glycoprotein VI (GP VI) and C-type lectin-like receptor 2 (CLEC-2). Our patient had no other risk factors for developing a hemorrhagic effusion. CLL itself can cause malignant effusions, one study found the incidence of malignant effusions among patients with CLL to be 9%, but the effusion was noted to be serous or serosanguinous and there was pleural involvement in all patients which was not the case in our patient. CONCLUSIONS: There is currently a minimal amount of data to guide clinicians regarding the use of ibrutinib in patients at high risk of bleeding or on anticoagulant or antiplatelet therapy. It is important to realize bleeding complications related to ibrutinib therapy can occur. Reference #1: Shatzel JJ, Olson SR, Tao DL, McCarty OJT, Danilov AV, DeLoughery TG. Ibrutinib-associated bleeding: pathogenesis, management and risk reduction strategies. J Thromb Haemost. 2017;15(5):835-847. doi:10.1111/jth.13651 Reference #2: Burger JA, Tedeschi A, Barr PM, et al. Ibrutinib as Initial Therapy for Patients with Chronic Lymphocytic Leukemia. N Engl J Med. 2015;373(25):2425-2437. doi:10.1056/NEJMoa1509388 Reference #3: Paydas S. Management of adverse effects/toxicity of ibrutinib. Crit Rev Oncol Hematol. 2019;136:56-63. doi:10.1016/j.critrevonc.2019.02.001 DISCLOSURES: No relevant relationships by fatima ali No relevant relationships by Joan Wiley
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In this study, it was aimed to evaluate the relationship between the clinical course of the disease and hematological data, serum 25-hydroxyvitamin D (25 (OH) D), iron (Fe), free iron-binding capacity (UIBC), and D-dimer levels in calves with diarrhea in the neonatal period. Within the scope of the study, 10 healthy calves (group-I) and 30 diarrheal calves in the neonatal period of different races, ages and genders were used. Calves with diarrhea were divided into mild (group-II, n=10), moderate (group-III, n=10) and severe (group-IV, n=10) groups. Blood samples were taken from calves in all groups at once. Hematological analyzes were performed using a veterinary-specific hematology analyzer device. In serum samples, 25 (OH) D3, Fe and UIBC levels were determined with an autoanalyzer, and D-dimer levels were determined with an automatic immunoassay analyzer. In the hematological analysis, an increase was observed in the number of LYMs (lymphocytes) in group-II (5.04±1.3) and III (5.2±3.3) compared to group-I (4.47±1.2), and a decrease was observed in group IV (2.76±0.9) (P<0.05). Fe levels in group-II (59±56), group III (56±52) and group IV (72±63) were found to be decreased compared to group-I (131±66) (P<0.05). It was determined that the 25 (OH) D3 level of group IV (13.4±8.5) was higher than that of group-I (6.12±2.73) (P<0.05). D-dimer levels of group-III (1.15±1.13) and group-IV (0.96±0.88) were found to be higher than group-I (0.10±1.46) (P<0.05).
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Objective: The present investigation aims on the clinical attributes and haematological parameters between symptomatic (COVID-19 ICU) and asymptomatic (COVID-19 homes isolation) patients as predisposing sign for COVID-19 related mortality. Materials and Methods: A retrospective cohort research was conducted of admitted patients to ICU, who were suffering from severe COVID-19 in Aseer Central Hospital, Abha, Kingdom of Saudi Arabia (KSA) from July 2020 until September 2020. The study included individuals with COVID -19 and ICU admission as symptomatic group and others who are COVID-19 positives with quarantine as asymptomatic group. Epidemiological, clinical and haematological laboratory data were retrospectively collected, analysed with control subjects. Results: Of the 38 ICU patients studied, the most common symptoms were fever and respiratory distress (100%), cough (86.8%). Majority were of Saudi origin (78.9%). Eighteen (47.4%) COVID-19 ICU patients showed leukocytosis, 6 (15.8%) had severe thrombocytopenia (with most having thrombocytopenia), 18 (47.4%) were anaemic. A significant correlation was observed between the WBC, RBC, Hb, platelets, neutrophil and lymphocyte count between ICU inmates compared with quarantine (p < 0.001) and RBC, Hb, neutrophil and lymphocyte count with control groups (p < 0.001). Conclusion: From the observations it is evident that, the blood tests have potential clinical value in predicting COVID-19 progression. Further, patient characteristics including age, leukocyte count, RBC, platelets and differential leukocyte counts may be significant predictors for monitoring the progression of the critical illness observed in SARS-COV-2 patients. Also, treatment procedures can be re-defined further to reduce COVID-19 mortalities in more critically ill COVID-19 individuals.
ABSTRACT
Introduction: Evidence regarding thrombotic microangiopathy related to covid-19 is reported in the literature, particularly in severe cases. We describe a case recovered from previous asymptomatic covid-19, presenting with acute renal failure, hemolytic anemia, and low platelets. Thrombotic microangiopathy (TMA) was confirmed by renal biopsy, without immunofluorescence staining for C3c and C1q, suggesting this case is not complement-mediated. Anticoagulant therapy led to kidney function improvement. Methods: Case report. Results: A 72-year-old women with a past medical history of primary hypertension was referred to the hospital for the diagnosis of acute renal failure. Three days prior to admission, she suffered abdominal pain, decreased urine output, her blood test revealed elevated serum creatinine of 393 umol/L, and low platelets of 43.6 K/uL. She denied history of hematologic or renal disorders, yet mentioned that she found asymptomatic covid-19 one month before admission. On admission, the vital signs was significant for a blood pressure of 140/80 mmHg. Physical examination was noted with facial oedema, upper abdominal pain, otherwise unremarkable. Laboratory test confirmed acute renal failure with the ongoing increase of serum urea 30.4 mmol/L and creatinine 575 umol/L. Her total blood count discovered thrombocytopenia and anemia, with the platelet count of 50 k/uL, and the hemoglobin of 94 g/L. Lactate dehydrogenase was in upper limit of 434 U/L, and the bilirubin level was in normal range. The peripheral blood smear showed “fragmented” RBCs. Coombs’ test was negative for both direct and indirect method. Stool examination failed to detect either red or white blood cell. Haptoglobin level was 1.14 g/L, which was in normal range (0.41-2.58 g/L). Ddimer was elevated 1376 ng/mL, and the fibrinogen 6.37 g/L. Immunology investigation was conducted with the result of normal level for both complement C3 and C4, negative reaction for anti-cardiolipin IgM and IgG, anti MPO, anti PR3, RF, anti-streptolysin O. Bone marrow aspiration did not show abnormalities. There were Forrest III gastric ulcers found by gastric endoscopy (two ulcers with diameter of 9mm and 10mm, with pseudo-membrane covered). Initially she was treated symptomatically with amlodipin, intravenous PPI, and IV furosemide. As the kidney function was getting worse, hemodialysis was initiated at day 1, day 3, day 6, and day 10 of admission. Renal biopsy was performed and showed active thrombotic microangiopathy. Given the normal complement profile, and negative C3c staining on immunofluorescence of renal biopsy investigation, complement mediated TMA may not be the pathogenesis of this case. The patient was started for anticoagulant therapy, initially subcutaneous low molecular weight heparin and then oral anti-vitamin K. She obtained dramatic recovery with dialysis off, increased urine output, normalized platelets and red cell count, and serum urea and creatinine back to nearly normal range at discharge. Conclusions: Complement related thrombotic microangiopathy is a rare and severe condition. This case of TMA after covid-19 reveals a non-complement mediated pathogenesis, with different treatment. Anticoagulation is an effective therapy in hypercoagulation induced TMA. No conflict of interest