A Bizarre Progression Of Chronic Lymphocytic Leukaemia Into Diffuse Large B-Cell Lymphoma.

A 65-year-old male presented with complaints of weakness, lethargy, abdominal pain, and low-grade fever for the last few months. His examination revealed generalized lymphadenopathy and splenomegaly. A subsequent laboratory workup revealed atypical lymphoid cells with prominent double-bright positivity of CD19 and CD5 markers. Further investigations revealed deletion of the ATM (11q22.3) gene, and by other diagnostic factors, the patient was diagnosed with B-cell chronic lymphocytic leukaemia. Thus, treatment was initiated with oral chemotherapy followed by rituximab-bendamustine. After three weeks, he presented to the emergency room with a fever and worsening abdominal pain. On examination, massive splenomegaly was found. After stabilization, a bone marrow biopsy revealed findings which, in light of the clinical symptoms, were consistent with Richter's transformation of B-Cell chronic lymphocytic leukaemia into Diffuse large B-Cell Lymphoma.

Prolonged jaundice in hepatitis-E patients: Going beyond the optics.

Hepatitis E virus (HEV) is an RNA virus that is transmitted faeco-orally. Due to unhygienic living conditions and unsatisfactory treatment of drinking water, it is a major cause of acute viral hepatitis in Pakistan. Hepatitis E infection in patients with glucose-6-phosphate dehydrogenase (G6PD) deficiency may cause prolonged jaundice resulting in serious complications like, severe haemolysis, acute renal failure, encephalopathy and even demise. Although both these diseases occur frequently in our country there is a dearth of literature on the effect of Hepatitis E infection in G6PD deficient patients, leading to higher rate of complications in such patients. We report the case of a 37 years old male who was referred to our hospital with worsening jaundice. Patient had HEV infection with concomitant G6PD deficiency. This case had a different prospect, since it resulted in prolonged jaundice and severe haemolysis. However the patient's condition improved with conservative management.

Diagnostic Accuracy of Electro-Chemiluminescence Immunoassay Anti-SARS-CoV-2 Serological Test.

OBJECTIVE: To determine the diagnostic accuracy of fully automated electro-chemiluminescence immunoassay (ECLIA) anti-SARS-CoV-2 serological test for detection of past SARS-CoV-2 infection and to be used in seroprevalence surveys. METHOD:  A total of 426 patients who had tested for anti-SARS-CoV-2 from August 1 to 31, 2020 were selected for the study. Informed consent was obtained and a questionnaire including the patient's age, gender, symptoms, and past polymerase chain reaction (PCR) status was filled by the patient. Samples were analyzed for anti-SARS-CoV-2 antibodies on Roche Cobas e601. RESULTS: The mean age of the patients was 42.43±16.67 years. One hundred and five (24.6%) were PCR positive, while 321 (75.4%) were PCR negative. Most patients were males 241 (56.6%) while 185(43.3%) were females. Over 185(43.3%) patients presented with symptoms, and the rest of the patients 241 (56.6%) were asymptomatic. Anti-SARS-CoV-2 had sensitivity 89.5%, specificity 99.06%, positive predictive value (PPV) 96.90%, negative predictive value (NPV) 96.6%, and positive likelihood ratio 4.26, while negative likelihood ratio 0.1. Diagnostic accuracy of anti-SARS-CoV-2 was 96.7% based on receiver-operating characteristic (ROC) curve analysis. CONCLUSION: Anti-SARS-CoV-2 is very useful for the detection of past COVID-19 infection; it can be proved helpful in the identification of post-COVID complications and actual disease burden in a population.