Abnormal Laboratory Parameters Research Articles

Characterization of patients with syncope in the emergency department-secondary diagnoses and laboratory parameters of inpatients versus outpatients

Over 1391 patients presented to the emergency department (ED) of a German university hospital with primary diagnosis of syncope from 2019-2022. This monocentric, retrospective study aims to characterize this cohort regarding secondary diagnoses and blood laboratory parameters. Principal focus lay on the differentiation between inpatients (n = 190; 13.7%) and outpatients (n = 1201; 86.3%). Most common secondary diagnoses comprised head injury (n = 188; 13.5%), infection (n = 126; 9.1%), body injury (n = 124; 8.9%), neurological disease (n = 85; 6.1%), arrhythmogenic heart failure (n = 76; 5.5%), cardiovascular risk factors (n = 75; 5.4%), metabolic/nephrological disease (n = 69; 5.0%), and structural heart disease (n = 68; 4.9%). Surgical interventions were performed using catheter (n = 16; 1.2%), percutaneous coronary interventions (n = 15; 1.1%), and pacemaker/defibrillator/event recorders (n = 12; 0.9%). Inpatients had significantly more secondary diagnoses (3.5 vs. 0.3) and higher incidences of abnormal laboratory parameters compared to outpatients. Secondary diagnoses more common in inpatients included cardiovascular risk factors (37.9 vs. 0.2%), arrhythmogenic heart failure (35.3 vs. 0.7%), infection (57.9 vs. 1.3%), and lung disease (6.3 vs. 0.2%). Abnormal blood laboratory values more frequent in inpatients included elevated levels of highly sensitive (hs) troponin T (58.8 vs. 25.7%), creatinine (36.2 vs. 14.8%), leukocytes (43.4 vs. 36.3%), besides decreased hemoglobin (33.3 vs. 16.0%), potassium (5.3 vs. 1.2%), and sodium (2.1 vs. 0.6%).

Assessment of COVID-19 patients’ outcome based on clinical profile, laboratory parameters, and clinical management: A retrospective observational study

ABSTRACT Background: The coronavirus disease 2019 (COVID-19) pandemic has presented an unprecedented challenge to the global healthcare system, prompting an urgent need to understand the factors influencing patient outcomes. Critical to improving treatment protocols and reducing mortality rates is an in-depth assessment of the clinical profile, laboratory findings, and management strategies employed in treating COVID-19 patients. This research provides valuable insights that could influence future therapeutic approaches and public health strategies, ultimately aiming to reduce the morbidity and mortality associated with COVID-19. The study aimed to assess mortality predictors in patients admitted to the intensive care unit (ICU) due to COVID-19. Methods: This study employed a retrospective approach, utilizing patient data from medical records. The collected data encompassed demographic and clinical profiles and details regarding the duration of admission and treatment. The evaluation focused on patients admitted to the ICU for COVID-19 between March 2020 and July 2021, with confirmation through real-time reverse transcriptase polymerase chain reaction (RT-PCR). Rigorous statistical analysis was conducted to compare outcomes between discharged and deceased patients. Results: The study included a total of 202 ICU patients admitted for COVID-19. Among the cases, 147 (72.8%) were males and 55 (27.2%) were females. The mean age was 58.42 years, with a standard deviation of 15.59 years. Fever (92%) emerged as the most frequently encountered symptom, followed by cough (48.5%) and dyspnea (35%). Patients with underlying comorbidities exhibited a higher susceptibility to developing a severe or critical disease. Hypertension (n = 38) was identified as the most prevalent comorbidity, followed by type 2 diabetes mellitus (n = 36). Hypertension has demonstrated a significant association with disease outcomes. Body temperature, respiratory rate, oxygen saturation, and mechanical ventilation played substantial roles in patient outcomes. Conclusion: The study revealed that underlying comorbidities and complications, such as acute respiratory distress syndrome (ARDS), were linked to significantly higher mortality rates among COVID-19 patients. Abnormal laboratory parameters also exhibited significant differences in the outcomes of ICU patients.

Successful resolution of acute postrenal azotemia from iatrogenic bilateral ureteric ligation in a cat managed with peritoneal dialysis

This report describes a neutered 1-year-old female Scottish Fold cat exhibiting oliguria, lethargy, and severe depression following ovariohysterectomy (OVH). Laboratory tests showed severe metabolic acidosis, hyperkalemia, and azotemia. Ultrasonography revealed hydronephrosis, hydroureter on both sides, and stenosis near the urinary bladder. Abdominal exploration revealed that both ureters were ligated. Iatrogenic bilateral ureteral ligation was diagnosed based on the abdominal exploration results. Peritoneal dialysis (PD) was performed immediately upon recovery from anesthesia. After three consecutive days of PD, azotemia and anuria resolved by the sixth day post-operation, and the patient was discharged the following day. After 7 months of follow-up, the patient exhibited no clinical signs or abnormal laboratory parameters indicative of azotemia. This report demonstrates that PD is a safe, effective, and easily performed procedure for resolving postrenal azotemia resulting from iatrogenic bilateral ureteral ligation in cats, which can be initiated once the patient has recovered from surgery. Furthermore, this report also describes the patient management protocol, PD drain placement method, and peritoneal dialysis protocol, all of which can be implemented in clinical practice.

Aetiology and Clinical Profile of Acute Pancreatitis in a Tertiary Care Hospital

Background: Acute Pancreatitis is a potentially serious condition with an overall mortality of 10%. Early diagnosis is important for its management. So clinician must carefully evaluate the patient with history, physical examination, laboratory tests and imaging studies before arriving a correct diagnosis. Death is more likely in certain subgroups of patients including elderly, co-morbidity, severe coexisting hospital acquired infection and organ dysfunction. Objectives: To assess aetiology and clinical profile of acute pancreatitis in a tertiary care hospital. Methods: A six-month Cross sectional study carried out at the department of Medicine, Comilla Medical College. Ethical approval from the institutional review board was obtained to ensure patient privacy and confidentiality. Results: The majority of patients are within the age group of 21-60 years (88.4%), with a higher proportion of males (71.2%) than females (28.8%). The most common clinical presentations were abdominal pain (95.6%) and nausea/vomiting (89.6%). Idiopathic (38%) and gallstone-related (38.4%) causes were the most common etiologies, while necrotizing pancreatitis (9.6%) and pancreatic pseudocysts (4.8%) were the most frequent complications. Regarding outcomes, a majority of patients experienced a favorable prognosis, with 64.4% recovering and being discharged. However, the complexity and severity of some cases were evident, as 17.6% of patients required referral to higher levels of care for further management. Additionally, a small percentage of patients left against medical advice (14.8%), and mortality was observed in 3.2% of cases. Laboratory investigations played a crucial role in diagnosing acute pancreatitis, and elevated levels of serum amylase (64.4%) and lipase (95.2%) were prominent diagnostic markers. Other abnormal laboratory parameters, such as elevated transaminase (90.8%) and C-reactive protein (86.4%), provided valuable insights for diagnosis and management. Conclusion: The study found acute pancreatitis with a wide range of clinical presentations and aetiologies. Abdominal pain is the most common symptom and gallstones are the most common causes. The study has evaluated the outcomes and complications of acute pancreatitis indicating that a significant proportion of cases had a favorable prognosis. A notable proportion required referral to higher levels of care, suggesting the complexity and severity of some instances of acute pancreatitis. A smaller percentage left against medical advice, and a few cases resulted in mortality. J Com Med Col Teachers’ Asso July 2023; 27(2): 67-74

Benign Recurrent Intrahepatic Cholestasis: Where Are We Now?

Benign recurrent intrahepatic cholestasis (BRIC) stands as a rare genetic contributor to cholestasis, aligning itself within the spectrum of inherited intrahepatic cholestasis syndromes, such as progressive familial intrahepatic cholestasis (PFIC) and intrahepatic cholestasis of pregnancy. Manifesting in infancy or early adulthood, BRIC is marked by recurrent episodes of jaundice accompanied by intense pruritus, enduring from weeks to years across the lifespan. Normal gamma-glutamyl transferase (GGT) levels are a characteristic laboratory finding. Initially considered unlikely to progress to chronic liver disease or cirrhosis, some reports suggest BRIC may evolve into a continuous and progressive form of cholestasis. Moreover, these recurrent cholestatic episodes significantly impact quality of life, and certain mutations elevate the risk of hepatobiliary malignancy. Between episodes, histological findings of centrilobular cholestasis and abnormal laboratory parameters revert to normal, potentially obviating the need for liver biopsy. This review focuses on the genetic aspects of BRIC, its pathophysiology, clinical presentation, and prognosis. Additionally, it outlines triggering factors and available treatment options.

Diagnostic Significance Of Bone Marrow Examination Amongst The Patients With Abnormal Haematological Parameters.

Bone Marrow examination is considered to be the most indispensable diagnostic tool for the evaluation of many neoplastic and non-neoplastic haematological disorders. After an initial assessment of suspicious cases on abnormal laboratory parameters along with the clinical presentation of the patient marrow examination is finally required for diagnosis as well as management of many haematological malignancies as it offers a clear cytological as well as histological picture of Bone Marrow aspirate and biopsy respectively. The Objective was to evaluate the significance of Bone Marrow examination in patients with abnormal haematological parameters. A retrospective study conducted at the Pathology Department of Pak Emirates Military Hospital from (Jan-June 2022) On data from150 patients who were advised to undergo bone marrow examination due to abnormal lab parameters and peripheral smear findings after informed consent and approval from the ethics review committee, to find out the correlation of abnormal haematological parameters and aspirate findings which have led to a definitive diagnosis. Data comprising basic demographic variables (age, gender etc.), Abnormal Haematological Parameters (CBC), peripheral smear findings and Aspirate findings were analyzed using SPSS version 23.0. Out of 150 studied participants with abnormal haematological parameters 24 (16%) were diagnosed on bone marrow examination as acute leukaemia / Hodgkin's and Non-Hodgkin's lymphoma respectively, 13 (9%) cases of aplastic anaemia and Autoimmune HaemolyticAnaemia, 33 (22%)cases of hypersplenism, CML and multiple myeloma. While 22 (15%) cases were diagnosed with BME as CKD and reactive changes. Moreover, 22(15%) cases were found to have Iron Deficiency anaemia respectively. The study revealed that patients with abnormal haematological parameters should undergo bone marrow examination to ascertain the diagnosis for malignant as well as non-malignant conditions that could cause abnormal lab parameters.

CLINICAL & SUBCLINICAL CHARACTERISTICS OF PATIENTS HOSPITALIZED WITH SARS-COV-2 INFECTION IN FIELD HOSPITALS, VINH PHUC PROVINCE

CLINICAL & SUBCLINICAL CHARACTERISTICS OF PATIENTS HOSPITALIZED WITH SARS-COV-2 INFECTION IN FIELD HOSPITALS, VINH PHUC PROVINCE

Post-marketing safety evaluation of recombinant anti-rho (D) immunoglobulin for the prevention of maternal rh-isoimmunization: A prospective, multi-centre, phase IV study

AntiD is a recombinant anti-D immunoglobulin approved as an immunoprophylaxis treatment in Rh-negative mothers carrying an Rh-positive fetus. This study was conducted to assess the safety and tolerability of AntiD in clinical settings. This was a prospective, multicenter, phase IV, post-marketing safety study of AntiD. The study was conducted at 29 hospitals in India as per regulatory requirements. Three hundred eligible Rh-negative women were administered a single intramuscular dose of either 150 mcg or 300 mcg AntiD within 72 hours of a sensitizing event as per the approved indication. Safety and tolerability were evaluated based on the assessment of adverse events (AEs) and serious adverse events (SAEs) reported during the study.Out of the 300 participants enrolled, 290 completed the study procedures. A total of 54 AEs and 34 treatment-emergent adverse events (TEAEs) were reported by 47 (15.7%) and 30 (10.0%) participants, respectively. Most reported TEAEs were mild, unrelated to the study drug, and were completely resolved during the study. Except for two participants with clinically significant hematological and urinalysis findings consistent with their underlying medical conditions, none of the participants exhibited abnormal clinical or laboratory parameters. Based on the assessment of the different safety parameters, AntiD administered at a dose of either 150 mcg or 300 mcg did not raise any new or significant safety concerns. The current study demonstrated that AntiD is well-tolerated and safe to use for anti-D prophylaxis as per product label indications for the prevention of Rh-isoimmunization in a clinical setting.

Risk factors for thrombocytopenia in patients receiving linezolid therapy: a systematic review and meta-analysis.

The incidence of linezolid-induced thrombocytopenia (LIT) has been reported to vary widely across studies. We performed a meta-analysis to identify the risk factors for thrombocytopenia among patients who received linezolid treatment. The PubMed, Embase and Cochrane Library databases were searched from inception to November 2022 to identify eligible studies. Data on the potential predictors of incidence in LIT were pooled using a random effects model. Sensitivity analyses were performed to determine the robustness of the results when significant heterogeneity was observed. Forty observational studies involving 6454 patients treated with linezolid were included in the analysis. LIT was estimated to occur in 37% of patients. The following important factors were associated with the incidence of LIT: advanced age, body mass index, concurrent renal impairment or liver disease, abnormal laboratory parameters (including white blood cell count, serum creatinine, baseline platelet count, albumin, creatinine clearance rate, and estimated glomerular filtration rate), treatment durationand renal replacement therapy. A variety of risk factors related to the occurrence of LIT were revealed in our analysis. Early identification of these factors could help patients improve clinical outcomes.

Evaluation of Laboratory Follow-up in Acne Patients Treated With Isotretinoin.

There is a lack of consensus of the frequency of follow-up of laboratory parameters during isotretinoin treatment. We conducted a retrospective analysis of the changes in laboratory parameters used in daily practice for patients with acne who were treated with isotretinoin to determine the optimum test repetition frequency. Patient demographic data; cumulative isotretinoin doses; alanin transaminase (ALT), aspartate transaminase (AST), γ-glutamyltransferase (GGT), creatinine kinase (CK), low-density lipoprotein cholesterol (LDL-C), and triglyceride (TG) levels during treatment were recorded. Our findings support the idea that routine monthly monitoring of normal laboratory parameters is unnecessary and wasteful. Periodic monitoring of abnormal laboratory parameters should be considered on an individual basis.

P090 Protocol for the two-cohort, open-label, single-arm EMERALD study of emapalumab, an anti-interferon gamma monoclonal antibody, in patients with macrophage activation syndrome in rheumatic diseases

Abstract Background/Aims Macrophage activation syndrome (MAS), a form of secondary haemophagocytic lymphohistiocytosis, is a severe, life-threatening complication of rheumatic diseases such as Still’s disease (systemic juvenile idiopathic arthritis or adult-onset Still’s disease) and systemic lupus erythematosus (SLE). Interferon gamma has been implicated in the underlying pathology of both conditions. Standard first-line treatment for MAS is high-dose glucocorticoids (GCs); however, additional treatments are used without a standardised approach in patients who are treatment-refractory. When 9 patients with an inadequate response to high-dose GCs were administered emapalumab in a pilot study (NCT03311854), interferon gamma was rapidly neutralised and MAS was controlled. Emapalumab also had a favourable safety profile. A new study (EMERALD) is currently enrolling patients with MAS in Still’s disease and SLE to further evaluate the efficacy and safety of emapalumab. Methods The open-label, single arm, multicentre, phase 2/3 interventional EMERALD study (NCT05001737) is enrolling paediatric and adult subjects with MAS and an inadequate response to high-dose GCs into two cohorts: MAS in Still’s disease (n = 25) and MAS in SLE (n = 16). Each cohort is a single-arm study comprising two phases: an optional run-in phase and an interventional phase. Key eligibility criteria vary by cohort and phase (Table). During the run-in phase, patients are treated with high-dose GCs and followed until MAS remission or inadequate response, or for a maximum of 12 weeks. Patients enrolled in the interventional phase are treated with intravenous emapalumab (initial dose 6 mg/kg, subsequent doses 3 mg/kg) for 4 weeks or until protocol-defined complete response (CR), then followed up for 1 year. Results The primary endpoint of the study is protocol-defined CR at Week 8 after first emapalumab administration. Secondary efficacy endpoints include GC tapering, survival, time to first CR, overall response (CR and partial response), time to first overall response, MAS recurrence, pharmacokinetic/pharmacodynamic profile of emapalumab and patient-reported outcomes. Safety endpoints include assessments of adverse events, abnormal laboratory parameters and anti-drug antibodies. Conclusion The ongoing EMERALD study is designed to address the unmet need for new efficacious and safe therapies for the treatment of MAS. Disclosure P. Brogan: Consultancies; P.B. has acted as a consultant for Sobi, Novartis, Roche and UCB. A. Grom: Consultancies; A.G. has acted as a consultant for Novartis, AB2 Bio, Novimmune and Sobi. R. Kanceva: Corporate appointments; R.K. is an employee of Sobi. F. De Benedetti: Consultancies; F.D.B. has acted as a consultant for AbbVie, Sobi, Pfizer, Roche, Sanofi, Novartis and Novimmune. Grants/research support; F.D.B has received research grants from AbbVie, Sobi, Pfizer, Roche, Sanofi, Novartis and Novimmune.

Demographic Features and Laboratory Parameters Among Hospitalized Vaccinated Patients With COVID-19 in Istanbul, Turkey

Background The number of COVID-19 cases has been decreasing recently, and the restrictions are waived in many countries. The data about vaccine efficacy are essential to be prepared for the future even if the pandemic ends and the disease becomes endemic. Aims The aim of this study was to define demographic and laboratory data for disease severity among vaccinated COVID-19 cases who were hospitalized. Study Design This is a retrospective cohort study. Methods SARS-CoV-2 polymerase chain reaction–positive patients who were fully vaccinated (2 doses of vaccines and 3 doses of vaccines) and had been hospitalized at least 15 days after the last vaccine dose were enrolled in this study. Patients' data including laboratory parameters were retrieved, and descriptive statistics and comparison of variables were calculated. Results Between September 1, 2021, and February 28, 2022, 685 patients (mean age, 67.84 years; 50.8% female) were hospitalized. Inactivated whole-virion SARS-CoV-2 vaccine (CoronaVac) had been administered to 467 of the patients (68.4%), BNT162b2 mRNA vaccine (Pfizer-Pfizer-BioNTech) had been administered to 107 of the patients (15.6%), and to 111 of the patients (16%), a combination of 2 vaccines had been administered. At least 1 comorbidity was present in 160 participants (23%) and more than 4 comorbidities in 46 patients (6.6%). The most common comorbidity was hypertension (349, 50.2%). The presence of comorbidities was significantly higher in patients having 3 doses of vaccine. Increased ferritin levels were determined in 56.4% of the patients, increased D-dimer levels in 69.9% of the patients, increased C-reactive protein levels in 79.7% of the patients, and increased procalcitonin levels in 61.5% of the patients. A total of 36.4% of the patients had decreased lymphocyte counts, 20% had low lymphocyte/monocyte ratio, and 22% had decreased neutrophil/lymphocyte ratio. The only parameter that was significantly higher in patients having 3 vaccine doses was procalcitonin. Mean duration of hospitalization was 9.68 ± 7.29 days. In the CoronaVac and Pfizer-BioNTech groups, 68.5% and 21.4%, respectively, of the patients were older than 65 years. Seventeen (3.6%) patients in the CoronaVac group, 6 (5.4%) patients in the combination group, and 3 (2.8%) patients in Pfizer-BioNTech group had been admitted to the intensive care unit. Mortality rate was 0.3% (2 of 685 patients). Conclusions The incidence of severe COVID-19 disease among fully vaccinated patients is low even in the presence of comorbidities, older age, and presence of abnormal laboratory parameters, regardless of the vaccine type.

Risk Factors for Melioidosis Mortality and Epidemics: A Multicentre, 10-Year Retrospective Cohort Study in Northern Hainan.

Burkholderia pseudomallei is a gram-negative environmental bacterium and aetiological agent of melioidosis, a tropical infectious disease with diverse clinical presentations. We aimed to describe the epidemiological and clinical characteristics of melioidosis in northern Hainan and to determine the meteorological factors affecting its morbidity. We conducted a retrospective, multicentre, observational cohort study of 90 patients with melioidosis admitted to four general hospitals in northern Hainan from 2010 to 2020. Epidemiological, clinical presentation, laboratory and treatment outcome data were collected and analysed. The monthly incidence of melioidosis and meteorological data, including precipitation, temperature, humidity, air pressure and wind speed, for the same period were collected to analyse the relationship between meteorological factors and the incidence of melioidosis. Of the 90 patients included in the study, 79 (87.78%) were male. Patient age ranged from 10 to 81years old, but most patients, namely, 78 (86.67%), were middle-aged and elderly people aged 41-81years old. Forty-six patients (51.11%) were farmers. The number of cases increased significantly after 2014, with the highest numbers occurring in 2014 and 2016. The highest number of cases occurred in summer and autumn and were associated with abundant rainfall, and 58 cases (64.44%) occurred from July to December. The patients showed diverse presentations and abnormal laboratory parameters: 69 patients (76.67%) had a history of diabetes mellitus; bacteremia was present in 50 patients (55.56%), sepsis was present in 39 patients (43.33%) and pneumonia in 19 patients (21.11%). An average high-sensitivity C-reactive protein (hs-CRP) level of 149.57 ± 13.65mg/L and a median procalcitonin (PCT) level of 1.31 (0.39, 6.21) ng/mL were observed. Among all the cases, 21 (23.33%) were identified as acute infections, 51 (56.67%) as subacute infections and 18 (20.00%) as chronic infections. Six patients (6.67%) died of illness; five of these patients were male, and five of these patients were middle-aged and elderly patients. The monthly average precipitation was significantly positively correlated with the monthly average incidence of melioidosis (r = 0.74, P < 0.01). Male patients, farmers and especially middle-aged and elderly individuals with a history of diabetes mellitus accounted for most of the patients. The majority of cases were concentrated in coastal areas. Most cases of melioidosis occurred during the rainy seasons, and the monthly average precipitation was an independent factor affecting the average monthly incidence of melioidosis.

Profile of Co-Infection Prevalence and Antibiotics Use among COVID-19 Patients.

Bacterial co-infection in COVID-19 patients significantly contributes to the worsening of the prognosis based on morbidity and mortality. Information on the co-infection profile in such patients could help to optimize treatment. The purpose of this study was to describe bacterial co-infections associated with microbiological, clinical, and laboratory data to reduce or avoid a secondary infection. A retrospective cohort study was conducted at Sant'Anna and San Sebastiano Hospital from January 2020 to December 2021. Bacterial co-infection was detected in 14.3% of the COVID-19-positive patients. The laboratory findings on admission showed significant alterations in the median D-dimer, C-reactive protein, interleukin-6, and lactate dehydrogenase values compared to normal values. All inflammatory markers were significantly elevated. The most common pathogens isolated from blood cultures were E. faecalis and S. aureus. Instead, the high prevalence of respiratory tract infections in the COVID-19 patients was caused by P. aeruginosa (41%). In our study, 220 (82.4%) of the COVID-19 patients received antimicrobial treatment. Aminoglycosides and β-lactams/β-lactamase inhibitors showed the highest resistance rates. Our results showed that older age, underlying conditions, and abnormal laboratory parameters can be risk factors for co-infection in COVID-19 patients. The antibiotic susceptibility profile of bacterial pathogen infection provides evidence on the importance, for the clinicians, to rationalize and individualize antibiotic usage.

The Elevated De Ritis Ratio on Admission Is Independently Associated with Mortality in COVID-19 Patients.

Liver damage in COVID-19 patients was documented as increased alanine aminotransferase (ALT) and aspartate aminotransferase (AST) levels or an elevated AST/ALT ratio, known as the De Ritis ratio. However, the prognostic value of the elevated De Ritis ratio in COVID-19 patients is still unknown. The aim of our study was to evaluate the prognostic value of the De Ritis ratio compared to other abnormal laboratory parameters and its relation to mortality. We selected 322 COVID-19 patients in this retrospective study conducted between November 2020 and March 2021. The laboratory parameters were measured on admission and followed till patient discharge or death. Of the 322 COVID-19 patients, 57 (17.7%) had gastrointestinal symptoms on admission. The multivariate analysis showed that the De Ritis ratio was an independent risk factor for mortality, with an OR of 29.967 (95% CI 5.266-170.514). In ROC analysis, the AUC value of the the De Ritis ratio was 0.85 (95% CI 0.777-0.923, p &lt; 0.05) with sensitivity and specificity of 80.6% and 75.2%, respectively. A De Ritis ratio ≥1.218 was significantly associated with patient mortality, disease severity, higher AST and IL-6 levels, and a lower ALT level. An elevated De Ritis ratio on admission is independently associated with mortality in COVID-19 patients, indicating liver injury and cytokine release syndrome.

Familial Hemophagocytic Lymphohistiocytosis (Type 2) with solitary neurological presentation due to PRF1 gene mutation

Familial hemophagocytic lymphohistiocytosis (FHLH) clinically manifest with fever, hepatosplenomegaly, pancytopenia, hyperferritenemia, hypofibrinogenemia and/or neurological signs. We report a case of solitary neurological presentation and absence of systemic signs of inflammation which was initially thought to be genetic leukodystrophy but latter turn out to be FHLH type 2 due to mutation in PRF1 gene. Pediatricians should keep FHLH as a differential diagnosis in a patient with solitary neurological presentation due to neuroinflammation even if no signs of systemic inflammation or abnormal laboratory parameters.

Analysis of risk factors associated with fatal outcome among severe fever with thrombocytopenia syndrome patients from 2015 to 2019 in Shandong, China.

To better understand the progression of severe fever with thrombocytopenia syndrome (SFTS), identify early predictors of mortality, and improve the cure rate, the present study aimed to analyze the demographic feature, clinical characteristics, and laboratory parameters of patients with SFTS and to explore the risk factors associated with fatal outcome. We retrospectively analyzed demographic feature, clinical characteristics, and laboratory parameters of 216 laboratory-confirmed SFTS patients in Shandong province between January 2015 and December 2019. Univariate analysis was used to assess the relevance between these factors and fatal outcome. Factors with P < 0.05 in univariate analysis were further analyzed using multivariable logistic regression analysis to identify the independent risk factors for mortality of SFTS. Age, five complications (including CNS symptoms, pulmonary infection, heart failure, arrhythmia, and bleeding events), and ten abnormal laboratory parameters (including serum viral load, blood platelet, ALT, AST, LDH, CK, CK-MB, Cr, serum Ca2+, and APTT) were statistically significant by univariate analysis. These factors were further analyzed by multivariable logistic regression analysis, and the results indicated that coma, pulmonary infection, high viral load, and prolonged APTT were associated with fatal outcome in SFTS patients. Our study identified four independent risk factors associated with fatal outcome for SFTS patients. The results were hoped to provide help for active treatment of SFTS. However, the identification of risk factors is not absolutely associated with fatal outcome. Patients' risk should be assessed by dynamic observation of the changes in risk factor indicators.

What are the long-term holistic health consequences of COVID-19 among survivors? An umbrella systematic review.

Many people who have survived COVID‐19 have experienced negative persistent impacts on health. Impacts on health have included persistent respiratory symptoms, decreased quality of life, fatigue, impaired functional capacity, memory deficits, psychological impacts, and difficulties in returning to paid employment. Evidence is yet to be pooled to inform future directions in research and practice, to determine the physical, psychological, social, and spiritual impacts of the illness which extend beyond the acute phase of COVID‐19 survivors. This umbrella review (review of systematic reviews) critically synthesized physical (including abnormal laboratory parameters), psychological, social, and spiritual impacts which extended beyond the acute phase of COVID‐19 survivors. The search strategy was based on the sample, phenomena of interest, design, evaluation, research model and all publications were double screened independently by four review authors for the eligibility criteria. Data extraction and quality assessment were conducted in parallel independently. Eighteen systematic reviews were included, which represented a total of 493 publications. Sample sizes ranged from n = 15 to n = 44 799 with a total of n = 295 455 participants. There was incomplete reporting of several significant data points including the description of the severe acute respiratory syndrome coronavirus 2 variant, COVID‐19 treatments, and key clinical and demographic data. A number of physical, psychological, and social impacts were identified for individuals grappling with post‐COVID condition. The long term sequalae of acute COVID‐19 and size of the problem is only beginning to emerge. Further investigation is needed to ensure that those affected by post‐COVID condition have their informational, spiritual, psychological, social, and physical needs met in the future.

Risk Prediction Model for 6-Month Mortality for Patients Discharged to Skilled Nursing Facilities.

Hospitalized patients discharged to skilled nursing facilities (SNFs) for post-acute care are at high risk for adverse outcomes. Yet, absence of effective prognostic tools hinders optimal care planning and decision making. Our objective was to develop and validate a risk prediction model for 6-month all-cause death among hospitalized patients discharged to SNFs. Retrospective cohort study. Patients discharged from 1 of 2 hospitals to 1 of 10 SNFs for post-acute care in an integrated health care delivery system between January 1, 2009, and December 31,2016. Gradient-boosting machine modeling was used to predict all-cause death within 180days of hospital discharge with use of patient demographic characteristics, comorbidities, pattern of prior health care use, and clinical parameters from the index hospitalization. Area under the receiver operating characteristic curve (AUC) was assessed for out-of-sample observations under 10-fold cross-validation. We identified 9803 unique patients with 11,647 hospital-to-SNF discharges [mean (SD) age, 80.72 (9.71) years; female sex, 61.4%]. These discharges involved 9803 patients alive at 180days and 1844 patients who died between day 1 and day 180 of discharge. Age, comorbid burden, health care use in prior 6months, abnormal laboratory parameters, and mobility status during hospital stay were the most important predictors of 6-month death (model AUC, 0.82). We derived a robust prediction model with parameters available at discharge to SNFs to calculate risk of death within 6months. This work may be useful to guide other clinicians wishing to develop mortality prediction instruments specific to their post-acute SNF populations.

Recurrent syncope with hyponatremia as presentation of COVID-19 viral pneumonia

Syncope is the most common neurological presentation in intensive care setting and has diverse etiological factors ranging from ischemic and nonischemic neurovascular, cardiac dysfunction related, infectious, electrolyte imbalance, inflammatory factors to simple viral fever, and other system-related illnesses. Coronavirus disease-19 (COVID-19) is known to cause pulmonary and extrapulmonary complications including effects on cardiovascular, gastrointestinal, renal, and neurovascular systems. In this case report, we have documented a 70-year-old male presented with recurrent syncope with flu-like illness, HRCT thorax suggestive of pneumonia involving bilateral lower lobe, COVID-19 real-time polymerase chain reaction (RT-PCR) positive, with abnormal laboratory parameters such as platelet count, CRP, serum sodium, and vitamin B12 level. Further investigations such as echocardiography, MRI brain and MRI angiography, and carotid Doppler were inconclusive. We have observed excellent clinical and radiological response to steroids, anticoagulants, antiplatelets, and remdesivir with other supportive care in critical care unit.