Utility of hematological and inflammatory biomarkers in predicting recovery in critical Covid-19 patients: Our experience in the largest Covid-19 treating center in Lebanon.

BACKGROUND: COVID-19 pandemic has led to a catastrophic shortage of ICU beds. This has resulted in the need to identify patients that can be discharged early before full clinical recovery. We designed this study to determine if in changes routine tests like CBCD and CRP can be a useful complement to clinical status when deciding to discharge patients from ICU. METHODS: This retrospective study was conducted in Rafic Hariri University Hospital. Levels of biomarkers measured at admission (T1) and within 3 days of outcome (T2) were collected and ratios (T2/T1) were calculated. The Odds Ratios of association between the changes in these biomarkers and outcome were estimated. Multivariate analysis and AUC for the performance of these biomarkers were also conducted. RESULTS: We found on multivariate analysis that reduction in counts of lymphocyte and platelets and elevation in counts of neutrophils and level of CRP (T2/T1 ratio > 1) are strongly associated with mortality with respective ORs estimated at 6.74, 3.26, 5.65 and 4.34 [p-values < 0.001]. AUCs were found to lie in a range of 0.68 to 0.81 indicating fair to good performance. Other factors found to impact survival were AKI, AF and ACS [p-values < 0.01]. In contrast to other studies, risk factors didn't show an association with survival when adjusted for effects of complications and changes in biomarker levels. CONCLUSIONS: Our results confirm that inexpensive tests like lymphocyte count and CRP can be reliably used to follow COVID-19 patients in ICU and to support the decision to discharge patients.

Visceral leishmaniasis in Lebanon a report of four cases: case series and review.

INTRODUCTION: Leishmaniasis comprises a complex of vector-borne diseases, caused by more than 20 species of the protozoan genus Leishmania, and ranging from localized skin ulcers to lethal systemic disease. It is endemic in Asia, Africa, the Americas, and the Mediterranean region. In the Middle East countries like Syria reports high incidence of the disease. In addition to the endemicity of the region for leishmaniasis, the Middle East has seen a great deal of human migration either for earning of livelihood or due to political upheaval in the region. Cutaneous form can be disfiguring but visceral form can be lethal. METHODOLOGY: In this article we report the clinical presentation of 4 cases of visceral leishmaniasis; 3 cases were pediatrics and one immunosuppressed adult patient all of them were from Syria from different regions. The diagnosis was made by bone marrow aspirate; PCR was made for 2 of them and was positive for leishmania infantum. All of them were treated with Amphotericn B lipid formulation (ABELCET) with complete response (definite cure). RESULTS: We report in this article 4 cases of visceral leishmaniasis treated with amphotericin B lipid complex (Abelcet) following the guidelines with complete remission. CONCLUSION: Visceral leishmaniasis is a serious disease and if not treated can lead to death. Lebanon is not known to be endemic for leishmania but since the war the ministry of health reported an outbreak of leishmania and mainly cutaneous leishmania. Here we present 4 cases of visceral leishmania and a review of the latest guidelines on the treatment modalities and protocols.