Diagnostic Role of Platelet to Lymphocyte Ratio and Platelet Parameters in COVID-19 Disease

Backgrounds: This study aimed to analyze the applicability of platelet parameters in assessing the severity of COVID-19 disease. Material(s) and Method(s): Patients with RT-PCR confirmed COVID-19 in the Pathology department of a tertiary care hospital in south India from June to December 2020 were included in this study. Clinical details and laboratory parameters of these patients were obtained. The difference between the studied variables in two groups was assessed using independent t-test. The optimum cut-off value of platelet to lymphocyte ratio (PLR) to differentiate between the tested groups was estimated using ROC (receiver operator curve) analysis. Finding(s): This study was conducted on 218 COVID-19 patients, of whom 17.9% showed thrombocytopenia at the time of admission. Among the hematological parameters, PLR, absolute lymphocyte count (ALC), platelet distribution width (PDW), D-dimer, and erythrocyte sedimentation rate (ESR) were significantly different between the ICU (intensive care unit) and non-ICU groups. Increased PLR values were associated with the disease severity. Conclusion(s): PLR could be used as an additional biomarker in assessing the severity of COVID-19 disease, and a cut-off value of 210.27 is optimal to differentiate severe COVID-19 disease from its mild and moderate forms with 79% specificity.Copyright © 2023, TMU Press.

Comparison of PCR-negative patients with CT findings and PCR-positive COVID-19 patients

Aim: The gold standard diagnostic method for the diagnosis of COVID-19 is based on the demonstration of viral RNA in samples taken from the upper respiratory tract in reverse transcriptase-polymerase chain reaction (RT-PCR). However, in emergencies, the World Health Organization (WHO) also recommends to use computed tomography (CT) in order to reduce the loss of time and to provide rapid diagnosis, treatment and isolation of suspicious cases. In our study, we aimed to compare the laboratory values of patients with PCR negative CT findings and PCR positive patients. Material(s) and Method(s): The medical records of 1280 COVID-19 patients registered at our Family Medicine Center were reviewed retrospectively. Result(s): In our study, it was found that 66,70 % of PCR-negative patients with CT findings were aged 60 years and older, and 50.70% of PCR-positive COVID-19 patients were between the ages of 40-59 years;61.30% of the patients with CT findings and 48% of the PCR-positive patients were male;73% of PCR-positive patients had lung involvement. When CRP, fibrinogen and D-dimer values were examined, it was found that in PCR-negative COVID-19 patients with CT findings these values were statistically significantly higher. Discussion(s): Although the definitive diagnosis of the disease is made using a PCR test, it should not be overlooked that the patients may remain PCR negative, and it should not be forgotten that thoracic tomography findings are a good diagnostic method for this group.Copyright © 2022, Derman Medical Publishing. All rights reserved.

Monocyte Distribution Width (MDW) in Patients with COVID-19: An Indicator of Disease Severity.

Identifying patients with Coronavirus disease-2019 (COVID-19) who may have a severe illness is essential for timely intervention and decreasing the fatality rate. In the present study, we evaluated the performance of Monocyte Distribution Width (MDW) as a prognostic marker for identifying disease severity in COVID-19 patients. We included 145 patients with PCR-confirmed COVID-19 infection in the study. The performance of MDW was evaluated by calculating the area under the receiver operating characteristic curve (AUC), specificity, sensitivity, negative predictive value, and positive predictive value. Further analysis was conducted for the disease outcome, comparing COVID-19 patients discharged (n = 135) to deceased COVID-19 patients (n = 10). As a marker of disease severity, MDW demonstrated an AUC of 0.702 (95% CI 0.620-0.775) in ROC analysis. If MDW is considered a marker of patient outcome, AUC was 0.916 (95% CI 0.862-0.953), comparing deceased COVID-19 patients vs. those who survived. At a cut-off of > 25.4 on admission, MDW correlates well with poor disease outcomes in COVID-19 patients. MDW can be considered a helpful parameter in predicting the severity of COVID-19 disease and patient outcomes. Its role and incorporation in the standard diagnostic algorithm and management of COVID-19 patients need further validation. Supplementary Information: The online version contains supplementary material available at 10.1007/s12288-023-01665-y.

Association of Monocyte Distribution Width with the Need for Respiratory Support in Hospitalized COVID-19 Patients.

Background: The monocyte distribution width (MDW), a novel inflammatory biomarker reflecting morphological changes in response to inflammation, has been shown to be useful in identifying COVID-19 infection or predicting death. However, data on the association with predicting the need for respiratory support are still limited. The aim of this study was to determine the association of MDW with the need for respiratory support in patients with SARS-CoV-2 infection. Patients and methods: This is a single-center retrospective cohort study. Consecutive hospitalized COVID-19 adult patients who presented at the outpatient department (OPD) or emergency department (ED) between May and August 2021 were enrolled. Respiratory support was defined as any one of the following: conventional oxygen therapy, high-flow oxygen nasal cannula, noninvasive, or invasive mechanical ventilation. The performance of MDW was measured using the area under the receiver operating characteristic (AuROC) curve. Results: Of the 250 enrolled patients, 122 (48.8%) patients received respiratory support. The mean MDW was significantly higher in the respiratory support group: 27.2 ± 4.6 vs 23.6 ± 4.1 (p < 0.001). The MDW ≥ 25 had the best AuROC characteristics of 0.70 (95% CI: 0.65-0.76). Conclusions: The MDW is a potential biomarker that may aid in identifying individuals at risk of requiring oxygen support in COVID-19 and can be easily implemented in clinical practice. How to cite this article: Daorattanachai K, Hirunrut C, Pirompanich P, Weschawalit S, Srivilaithon W. Association of Monocyte Distribution Width with the Need for Respiratory Support in Hospitalized COVID-19 Patients. Indian J Crit Care Med 2023;27(5):352-357.

Comparison of biomarkers of COVID-19 patients with the alpha variant (B.1.1.7), the delta variant (B.1.617), and no mutation detected

Objectives: We aimed to compare biomarkers of COVID-19 patients with the Alpha variant (B.1.1.7), the Delta variant (B.1.617), and no mutation detected in our study. Method(s): A total of 600 patients with positive COVID PCR test and Alpha, Delta variant and no mutation detected with Covid PCR mutation test were included in the study. Troponin I, creatinine, Alanine Aminotransferase (ALT), Aspartate Aminotransferase (AST), Lactate Dehydrogenase (LDH), fibrinogen, D-dimer, ferritin, number of lymphocytes, lymphocytes (%), platelet (PLT), mean platelet volume (MPV), platelet distribution width (PDW), trombosite ratio in the blood (PCT), C-reactive protein (CRP) values were analyzed retrospectively. The age, gender, and hospitalization of the patients were evaluated concurrently. Result(s): Age, troponin, creatinine, LDH, PLT, MPV, and D-dimer were laboratory parameters that vary significantly with COVID-19 virus mutation. Age, troponin, LDH, and MPV values were lower in patients with Delta variant according to patients with the Alpha variant. Lymphocytes (N) and lymphocytes (%) values were lower in hospitalized patients relative to outpatients while age, troponin, LDH, CRP, and D-dimer values were higher in hospitalized patients than outpatients irrespective of mutation. Creatinine values were higher only in hospitalized patients with no mutation detected while ferritin and fibrinogen values were higher in hospitalized patients with Delta variant and no mutation detected. Conclusion(s): Age, troponin, creatinine, LDH, PLT, MPV, D-dimer, fibrinogen, ferritin, CRP, lymphocytes (N), and lymphocytes (%) values can guide to evaluate the diagnosis and hospitalization of patients with future different mutations.Copyright © 2023 by Prusa Medical Publishing.

Tuning of controller parameters for suppressing low frequency oscillations in electric railway traction networks using meta-heuristic algorithms

Due to the interaction of electric multiple units (EMUs), and the electric traction networks, low frequency oscillations (LFOs) appear leading to traction blockade and overall stability related issues. For suppressing LFOs, coronavirus herd immunity optimiser (CHIO), a recently developed meta-heuristic, has been applied for tuning controller parameters. Controller parameters are tuned to minimise the integral time absolute error (ITAE) that regulates DC-link capacitor voltage. Results obtained using CHIO are compared with those found using other well-established algorithms like symbiotic organisms search (SOS) and particle swarm optimisation (PSO). The supremacy of CHIO over other mentioned algorithms for mitigating LFOs was demonstrated for a diverse range of operating conditions. Results demonstrates that overshoot for the proposed algorithm-based traction unit is 1.0061% whereas those for SOS and PSO based algorithm are obtained as 6.4542 % and 20.6166%, respectively which are quite high. CHIO is more stable than SOS and PSO and requires settling time of 0.1934 s only to reach steady-state condition, which is 50.21% faster than SOS and 65.03% faster than PSO. Also, the total harmonic distortion (THD) for line currents of the secondary side of traction transformer (TT) are obtained as 0.88%, 2.17%, and 12.48% for CHIO, SOS, and PSO, respectively.

A new logistic regression derived combined index for early prediction of in-hospital mortality in COVID-19 patients

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.

Efficacy of N-acetyl Cysteine in Severe COVID-19 Patients: A Randomized Controlled Phase III Clinical Trial

Background: Today, various drugs have been investigated as the primary or complementary treatment for coronavirus disease 2019 (COVID-19). N-acetylcysteine (NAC) has been used as a mucolytic in pulmonary diseases. This drug apparently contributes to the retrieval of the intracellular antioxidant system. Objective(s): This study aimed to determine the efficacy of NAC in severe COVID-19 patients admitted to the intensive care unit (ICU). Method(s): This single-blinded randomized controlled phase III clinical trial included 40 patients with confirmed COVID-19 (based on polymerase chain reaction) admitted to the Shahid Mohammadi Hospital's ICU, Bandar Abbas, Iran, in 2020. All cases had severe COVID-19. They were allocated randomly to two equal groups. Patients in the control group received standard drug therapy based on the treatment protocol of the national COVID-19 committee, while those in the NAC group received a single dose of intravenous NAC (300 mg/kg) upon admission to the ICU in addition to standard drug treatment. Clinical status and laboratory tests were done on admission to the ICU and then 14 days later or at discharge without knowing the patient grouping. Result(s): The two groups were comparable regarding age, gender, and other baseline laboratory and clinical parameters. At the final evaluation, respiratory rate (21.25 +/- 4.67 vs. 27.37 +/- 6.99 /min) and D-dimer (186.37 +/- 410.23 vs. 1339.04 +/- 2183.87 ng/mL) were significantly lower in the NAC group (P = 0.004 and P = 0.030, respectively). Also, a lower percentage of patients in the NAC group had lactate dehydrogenase (LDH) <= 245 U/L (0% vs. 25%, P = 0.047). Although the length of ward and ICU stay was shorter in the NAC group than in controls, the difference was statistically insignificant (P = 0.598 and P = 0.629, respectively). Mortality, on the other hand, was 75% in the control group and 50% in the NAC group, with no statistically significant difference (P = 0.102). Concerning the change in the study parameters, only the decrease in diastolic blood pressure (DBP) was significantly higher with NAC (P = 0.042). The intubation and mechanical ventilation rates were higher, while oxygen with mask and nasal oxygen rates were lower with NAC, but the difference was statistically insignificant. Conclusion(s): Based on the current research, NAC is related to a significant decrease in RR, D-dimer, and DBP in severe COVID-19. Also, LDH was significantly lower in the NAC group than in the controls. More research with larger sample sizes is needed to validate the current study results.Copyright © 2023, Author(s).

COVID-19 Biomarkers at the Crossroad between Patient Stratification and Targeted Therapy: The Role of Validated and Proposed Parameters.

Clinical knowledge about SARS-CoV-2 infection mechanisms and COVID-19 pathophysiology have enormously increased during the pandemic. Nevertheless, because of the great heterogeneity of disease manifestations, a precise patient stratification at admission is still difficult, thus rendering a rational allocation of limited medical resources as well as a tailored therapeutic approach challenging. To date, many hematologic biomarkers have been validated to support the early triage of SARS-CoV-2-positive patients and to monitor their disease progression. Among them, some indices have proven to be not only predictive parameters, but also direct or indirect pharmacological targets, thus allowing for a more tailored approach to single-patient symptoms, especially in those with severe progressive disease. While many blood test-derived parameters quickly entered routine clinical practice, other circulating biomarkers have been proposed by several researchers who have investigated their reliability in specific patient cohorts. Despite their usefulness in specific contexts as well as their potential interest as therapeutic targets, such experimental markers have not been implemented in routine clinical practice, mainly due to their higher costs and low availability in general hospital settings. This narrative review will present an overview of the most commonly adopted biomarkers in clinical practice and of the most promising ones emerging from specific population studies. Considering that each of the validated markers reflects a specific aspect of COVID-19 evolution, embedding new highly informative markers into routine clinical testing could help not only in early patient stratification, but also in guiding a timely and tailored method of therapeutic intervention.

Prospective study of pulmonary embolism in patients with SARS CoV-2 pneumonia with high levels of D Dimer

Pulmonary embolism (PE) is common among hospitalized adults with SARS CoV-2 pneumonia. D-dimer (DD)>1 mug/mL has been found to be a severity risk factor. However, most of the studies are based on retrospective data and the real prevalence is unknown Objectives: To evaluate the prevalence of PE in patients with SARS CoV-2 pneumonia, regardless clinical suspicion. Demographic and laboratory data, comorbidities, and clinical outcomes were compared between patients with and without PE Methods: Single-center prospective study. All consecutive cases of SARS CoV-2 pneumonia with DD>1 mug/mL underwent computed tomography pulmonary angiography Results: 179 patients (64 (55-74 years), 65% male) were included. PE was diagnosed in 71 patients (39.7%), mostly with a peripheral location and low thrombotic load (Qanadli score 10%). We did not find disparity in PE prevalence between men and women, and between obese and not obese patients. There were no differences in the intensive care unit admission rate. Mortality rate was 8.5% in patients with PE vs. 3.7% in those without PE, but the differences were not significant. Patients with PE had more history of cardiovascular disease and required more fractional inspired oxygen. DD, platelet distribution width (PDW), neutrophil-lymphocyte ratio (NLR), DD-lactate dehydrogenase ratio (DD/LDH), and DD-ferritin ratio values were significantly higher among PE patients. ROC analysis showed that PDW and DD/LDH had the greatest area under the curve Conclusion(s): Patients with SARS CoV2 pneumonia and DD>1mug/mL presented a high prevalence of PE, regardless of clinical suspicion. PDW, NLR, DD/LDH and DD/Ferritin may help to identify patients with high risk of PE.

Association of immature granulocytes (IG) with prognosis in severe COVID-19 patients Immature granulocytes and COVID-19

Aim: Recent research have shown that immature granulocytes (IG) can be utilized to predict severe infection, inflammation, and sepsis. As a result, the ability of IG levels to predict the severity of severe COVID-19 and its association with prognosis were studied in our study. Material and Mthods: A total of 317 patients diagnosed with severe COVID-19 in the emergency department were analyzed retrospectively. IGC and IG% levels were compared statistically between patient groups (survivors and non-survivors, those who received and did not get mechanical ventilation (MV) assistance, patients who required and did not require vasopressors, and hospital stays >=10 and <10 days). Result(s): When compared to patients who survived but did not get treatment, non-survivors who got MV and vasopressor support had substantially higher IGC and IG% values (for all p<0.001). Additionally, it was shown that the IG% of patients with hospital stays of >=10 days was substantially greater than that of patients with hospital stays of <10 days (p<0.001). While the IG% cut-off value was >0.45, it reached 75.5% sensitivity, 81.9% specificity, 87.6% NPV and 66.4% PPV for predicting mortality (AUC:0.86, p<0.001). Discussion(s): IG levels are a low-cost, easily accessible, and strong marker that may be used to predict mortality and prognosis in COVID-19 patients.Copyright © 2023, Derman Medical Publishing. All rights reserved.

Clinical features and prognostic factors affecting survival of ambulatory followed COVID-19 patients aged over 65 years

Aim: The majority of the patients with COVID-19 are followed ambulatory. Determination of prognostic factors of mortality in risky groups is essential to improve patient management. The aim of this study is to describe the clinical presentation in patients over 65 years of age with COVID-19 who are followed up at home by a physician and provide insights into the initial prognostic factors in this distinctive population. Material(s) and Method(s): This is a retrospective and observational study. Clinical records of the patients aged over 65 years who were visited by the filiation team, including a physician at home, due to the diagnosis of COVID-19 disease within 2 months were reviewed. Factors affecting mortality were examined. Result(s): Our study included 51 deceased (mean age: 75,1+/-9,0 years, 40,2% males), and 102 patients with COVID-19 who survived (mean age: 73,0+/-6,9 years, 68,6% male). Platelet count ( < 150.000, OR 7,26, p=0,001), CRP level ( < 4, OR 4,55, p=0,02), albumin level ( OR 3,24, p=0,02), and Troponin I level (OR 0,03, p=0,02) were the strongest predictors for death. When propensity score matching was applied, gender (male, OR 7,14, p=0,02) and platelet count (< 150.000, OR 5,34, p=0,02) were the strongest predictors. Discussion(s): Elderly COVID-19 patients have a high mortality rate. An easily measurable and accessible platelet count may be a predictor of a bad outcome. Close follow-up and timely treatment may significantly reduce mortality in high-risk elderly patients under.Copyright © 2022, Derman Medical Publishing. All rights reserved.

Comparison of first admission hemogram parameters and chest computed tomography findings of pediatric COVID-19 patients Blood parameters of pediatric COVID-19 patients

Aim: We use computed tomography, which is one of the frequently used imaging tests, both as a disease diagnosis method and to follow the clinical course in COVID-19 patients. This also means radiation exposure. Radiation exposure, especially in pediatric patients, can cause life-threatening diseases. Is there a blood parameter that will reduce this undesirable event and allow estimation of computed tomography findings? Are hemogram analysis, one of the most commonly used blood tests, and tomography findings of the disease related? We designed this study based on the questions. Material(s) and Method(s): Among the patients under the age of 18 who applied to the emergency department, those with a positive reverse transcription-polymerase chain reaction (RT-PCR) and chest CT and hemogram were included in the study. Chest CT findings were classified according to the CO-RADS classification. We compared the CO-RADS classification with hemogram parameters and the ratios of these parameters. Result(s): Platelet-to-lymphocyte ratio (PLR) rates were found to be significantly lower as imaging findings became more severe (<0.05). The ratio of MedianPlatelet Volume and Platelet (MPV/Plt) was found to be significantly higher as the imaging findings worsened (p<0.05). When the relationship between laboratory parameters according to imaging groups in our study was evaluated, there was a moderate negative correlation between lymphocyte and platelet levels and imaging findings (p<0.05). A moderate positive correlation with the monocyte level was found (p<0.05). Discussion(s): For the CO-RADS classification, it can be said that the patient was established to classify possible COVID-19 patients only according to chest CT. There is no study in the literature on the classification of pediatric patients with RT-PCR positive definite COVID-19 according to chest CT scans and the comparison of laboratory findings of patients with this classification. The combination of laboratory parameters and CO-RADS classification will guide clinicians in pediatric COVID-19 patient management.Copyright © 2022, Derman Medical Publishing. All rights reserved.

Monocyte distribution width alterations and cytokine storm are modulated by circulating histones.

OBJECTIVES: Extracellular histone levels are associated with the severity of many human pathologies, including sepsis and COVID-19. This study aimed to investigate the role of extracellular histones on monocyte distribution width (MDW), and their effect on the release of cytokines by blood cells. METHODS: Peripheral venous blood was collected from healthy subjects and treated with different doses of a histone mixture (range 0-200 µg/mL) to analyze MDW modifications up-to 3 h and digital microscopy of blood smears. Plasma obtained after 3 h of histone treatment were assayed to evaluate a panel of 24 inflammatory cytokines. RESULTS: MDW values significantly increased in a time- and dose-dependent manner. These findings are associated with the histone-induced modifications of cell volume, cytoplasmic granularity, vacuolization, and nuclear structure of monocytes, promoting their heterogeneity without affecting their count. After 3 h of treatment almost all cytokines significantly increased in a dose-dependent manner. The most relevant response was shown by the significantly increased G-CSF levels, and by the increase of IL-1ß, IL-6, MIP-1ß, and IL-8 at the histone doses of 50, 100, and 200 µg/mL. VEGF, IP-10, GM-CSF, TNF-α, Eotaxin, and IL-2 were also up-regulated, and a lower but significant increase was observed for IL-15, IL-5, IL-17, bFGF, IL-10, IFN-γ, MCP-1, and IL-9. CONCLUSIONS: Circulating histones critically induce functional alterations of monocytes mirrored by MDW, monocyte anisocytosis, and hyperinflammation/cytokine storm in sepsis and COVID-19. MDW and circulating histones may be useful tools to predict higher risks of worst outcomes.

Dental age estimation using the Kvaal method-an evaluation of length and width ratios: a systematic review.

This study aimed to systematically review the correlational accuracy between width ratios and length ratios based on the Kvaal methodology with chronological age. This systematic review followed Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA). The search strategy included ProQuest, PubMed, Science Direct, and Taylor and Francis and Willey online without time or language restriction using Kvaal method of age estimation as key words for the search up to December 2021. A team of two researchers independently selected the studies and extracted the data. The Covidence platform was used to systematically organize all titles. The full texts of eligible studies were analyzed. Risk of bias (RoB) was assessed using a modified (to the specific characteristics of this systematic review) checklist based on Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement checklist for observational studies. A total of 658 articles were initially reviewed, but 22 were selected for inclusion. The risk of bias was estimated to be unclear to low overall. Among the length ratios, ratio R showed a strong association with chronological age, followed by ratio P. For the width ratios, ratio B demonstrated a close association with chronological age, followed by ratio C. The results suggest that width ratios correlate better with chronological age than length ratios. This systematic review suggests the width ratios are more strongly associated with chronological age than the length ratios. Using a width ratio could serve as a convenient and rapid way to estimate dental age. Our results apply equally to all types of ethnic groups.

Utility of monocyte distribution width in the differential diagnosis between simple and complicated diverticulitis: a retrospective cohort study.

BACKGROUND: Colonic diverticulitis is a leading cause of abdominal pain. The monocyte distribution width (MDW) is a novel inflammatory biomarker with prognostic significance for coronavirus disease and pancreatitis; however, no study has assessed its correlation with the severity of colonic diverticulitis. METHODS: This single-center retrospective cohort study included patients older than 18 years who presented to the emergency department between November 1, 2020, and May 31, 2021, and received a diagnosis of acute colonic diverticulitis after abdominal computed tomography. The characteristics and laboratory parameters of patients with simple versus complicated diverticulitis were compared. The significance of categorical data was assessed using the chi-square or Fisher's exact test. The Mann-Whitney U test was used for continuous variables. Multivariable regression analysis was performed to identify predictors of complicated colonic diverticulitis. Receiver operator characteristic (ROC) curves were used to test the efficacy of inflammatory biomarkers in distinguishing simple from complicated cases. RESULTS: Of the 160 patients enrolled, 21 (13.125%) had complicated diverticulitis. Although right-sided was more prevalent than left-sided colonic diverticulitis (70% versus 30%), complicated diverticulitis was more common in those with left-sided colonic diverticulitis (61.905%, p = 0.001). Age, white blood cell (WBC) count, neutrophil count, C-reactive protein (CRP) level, neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and MDW were significantly higher in the complicated diverticulitis group (p < 0.05). Logistic regression analysis indicated that the left-sided location and the MDW were significant and independent predictors of complicated diverticulitis. The area under the ROC curve (AUC) was as follows: MDW, 0.870 (95% confidence interval [CI], 0.784-0.956); CRP, 0.800 (95% CI, 0.707-0.892); NLR, 0.724 (95% CI, 0.616-0.832); PLR, 0.662 (95% CI, 0.525-0.798); and WBC, 0.679 (95% CI, 0.563-0.795). When the MDW cutoff was 20.38, the sensitivity and specificity were maximized to 90.5% and 80.6%, respectively. CONCLUSIONS: A large MDW was a significant and independent predictor of complicated diverticulitis. The optimal cutoff value for MDW is 20.38 as it exhibits maximum sensitivity and specificity for distinguishing between simple and complicated diverticulitis The MDW may aid in planning antibiotic therapy for patients with colonic diverticulitis in the emergency department.

Are platelet volume indices of clinical use in COVID-19? A systematic review.

Background: The incidence of thrombotic complications is high in COVID-19 patients with severe disease. As key regulators of thrombus formation, platelets likely play a crucial role as mediators of severe acute respiratory syndrome coronavirus 2 associated pathogenesis. Studies have reported that parameters reflecting platelet size, known as platelet volume indices (PVI), are raised in patients with thrombosis and can predict poor outcomes. This systematic review evaluates the potential for PVI to be used as a predictor of COVID-19 morbidity and mortality. Methods: English and Chinese databases were searched electronically to identify studies reporting data on mean platelet volume, platelet distribution width or platelet-large cell ratio in COVID-19 patients. Included articles underwent a quality rating and descriptive narrative analysis. Results: Thirty-two studies were included in the systematic review. The results show a general trend for PVI to be raised in severe COVID-19 patients and non-survivors, with 14 studies reporting significant differences of baseline PVI between severe and mild disease. Nonetheless, longitudinal studies showed varying PVI trends over the course of the disease and evidence for PVI to be associated with disease progression was limited. The quality rating of 12 studies was poor, 16 were rated fair and four were good. Most studies were retrospective in design, used small study populations and did not consider confounding factors that influence platelet volume. Studies also contained technical flaws in PVI measurement, limiting the reliability of the results. Conclusion: The evidence on the clinical usefulness of PVI is greatly limited by the lack of prospective evaluation, together with technical problems in measuring PVI. Carefully designed prospective studies are warranted. Systematic review registration: https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=304305, identifier CRD42022304305.

Clinical outcomes at medium-term follow-up of COVID-19.

BACKGROUND: The long coronavirus disease 2019 (COVID-19) syndrome is defined as persistent physical, cognitive and/or psychological symptoms that continue for more than 12 weeks following the acute illness. METHODS: In all, 2,646 patients were randomly selected from all individuals who were diagnosed with COVID-19. They were interviewed so as to assess the persistence of symptoms and health-related quality of life. Blood investigations were also taken. RESULTS: The median (interquartile range (IQR)) age was 44 (31-55) years and 48.6% were males. Five per cent had been hospitalised. Follow-up was for a median of 142 days (IQR: 128-161). Twenty-two per cent of the participants claimed that they were feeling worse than they felt before COVID-19. The most common symptoms were anosmia, ageusia, fatigue, shortness of breath, headaches and myalgia. The Short Form-36 questionnaire revealed that 16.4% felt that they were somewhat worse than in the previous year and that hospitalised patients fared worse in all domains except for role-emotional. New-onset diabetes was similar to the rate of undiagnosed diabetes in the background population. Hospitalised patients had significantly higher liver transaminases, fasting plasma glucose, glycated haemoglobin, uric acid, red cell distribution width, mean platelet volume, triglyceride levels and troponin levels but lower estimated glomerular filtration rate and high-density lipoprotein-cholesterol at follow-up. DISCUSSION: A significant proportion of patients were symptomatic at a median follow-up of 142 days and felt worse than 1 year previously. Hospitalised patients had more biochemical and haematological abnormalities compared to non-hospitalised ones, suggesting ongoing inflammation in subjects who were more severely affected by the disease.

Retrospective study on the efficacy of monocyte distribution width (MDW) as a screening test for COVID-19.

BACKGROUND: Pathogenic genetic testing for coronavirus disease 2019 (COVID-19) can detect viruses with high sensitivity; however, there are several challenges. In the prevention, testing, and treatment of COVID-19, more effective, safer, and convenient methods are desired. We evaluated the possibility of monocyte distribution width (MDW) as an infection biomarker in COVID-19 testing. METHODS: The efficacy of MDW as a screening test for COVID-19 was retrospectively assessed in 80 patients in the COVID-19 group and 232 patients in the non-COVID-19 group (141 patients with acute respiratory infection, 19 patients with nonrespiratory infection, one patient with a viral infection, 11 patients who had received treatment for COVID-19, one patient in contact with COVID-19 patients, and 59 patients with noninfectious disease). RESULTS: The median MDW in 80 patients in the COVID-19 group was 23.3 (17.2-33.6), and the median MDW in 232 patients in the non-COVID-19 group was 19.0 (13.6-30.2) (P < 0.001). When the COVID-19 group was identified using the MDW cut-off value of 21.3 from the non-COVID-19 group, the area under the curve (AUC) was 0.844, and the sensitivity and specificity were 81.3% and 78.2%, respectively. Comparison of MDW by severity between the COVID-19 group and patients with acute respiratory infection in the non-COVID-19 group showed that MDW was significantly higher in the COVID-19 group for all mild, moderate I, and moderate II disease. CONCLUSIONS: MDW (cut-off value: 21.3) may be used as a screening test for COVID-19 in fever outpatients. Trial registration This study was conducted after being approved by the ethics committee of National Hospital Organization Omuta National Hospital (Approval No. 3-19). This study can be accessed via https://omuta.hosp.go.jp/files/000179721.pdf .

Enhancing Bandwidth Utilization of IP Telephony over IPv6 Networks

The demand for the telecommunication services, such as IP telephony, has increased dramatically during the COVID-19 pandemic lockdown. IP telephony should be enhanced to provide the expected quality. One of the issues that should be investigated in IP telephony is bandwidth utilization. IP telephony produces very small speech samples attached to a large packet header. The header of the IP telephony consumes a considerable share of the bandwidth allotted to the IP telephony. This wastes the network's bandwidth and influences the IP telephony quality. This paper proposes a mechanism (called Smallerize) that reduces the bandwidth consumed by both the speech sample and the header. This is achieved by assembling numerous IP telephony packets in one header and use the header's fields to carry the speech sample. Several metrics have been used to measure the achievement Smallerize mechanism. The number of calls has been increased by 245.1% compared to the typical mechanism. The bandwidth saving has also reached 68% with the G.28 codec. Therefore, Smallerize is a possible mechanism to enhance bandwidth utilization of the IP telephony. © 2023 CRL Publishing. All rights reserved.