Laboratory Alterations Research Articles

Clinical variations observed among the main hemoparasitosis caused by Rhipicephalus sanguineus in dogs

Hemoparasitosis are diseases of great importance in the practice of a small animal’s veterinarian, due to their high number of cases in the clinical routine of these species, and the wide occurrence of their vectors. Related to hemoparasitosis in dogs, the tick Rhipicephalus sanguineus has the greatest importance due to parasitizing dogs, perpetuating hemoparasitosis in this host group. The present work describes a literature review about the three main hemoparasitosis in the routine of a veterinarian in Brazil, ehrlichiosis, caused by Ehrlichia canis, babesiosis caused by the protozoa Babesia canis and Babesia gibsoni, and anaplasmosis caused by Anaplasma platys, comparing them regarding the differences between clinical signs and laboratory alterations, such as the different types of anemia caused by these conditions that culminate in clinical signs related to them. It also aims to describe the similarity in the diagnostic techniques used and infection treatments, which in all cases is used tetracycline, the most commonly used is doxycycline, and highlight the need for further studies about this topic.

Hematologic and biochemical reference intervals and blood cell morphology in South American pit vipers (Bothrops pubescens).

The maintenance of snakes in captivity for venom extraction and antivenom production is essential due to the high incidence of snake envenomation in Latin America and the Caribbean. Hematology and biochemistry are valuable in the laboratory evaluation of these animals, which indirectly improves their health and welfare. The objective of this study was to determine the reference intervals for hematologic and plasma biochemistry variables in Bothrops pubescens snakes kept in captivity and to examine sex variation. Blood samples from 20 healthy B pubescens snakes were collected for hematologic and biochemistry evaluations and compared between sexes. The sample analysis consisted of a complete blood count using manual methods previously described, and blood cell morphology evaluation. Plasma biochemistry consisted of albumin, uric acid, aspartate aminotransferase, creatine kinase, and total plasma protein measurements. Hematologic and biochemical variables were demonstrated to be different when compared with previously published values. A difference between the sexes was not observed for B pubescens. Given that many illnesses can lead to laboratory alterations, knowledge about the reference intervals of healthy captive animals is essential to evaluate the health status and correct management of these snakes.

Feline obesity: risk factors and clinical and metabolic findings

Excess body fat can cause a series of metabolic and mechanical effects on the body. Therefore, this study aimed to verify the clinical, metabolic, and risk factors of overweight (OW) cats. For the acceptance of participation in the research, the tutors were asked to answer a questionnaire containing 34 questions and to point out the body condition score (BCS) on a sheet containing nine images of different scores (1 to 9 on a 9-point scale). Thereafter, the body evaluations were performed as a classification of the BCS on a scale from 1 to 9, with an ideal score (IS) of BCS 5 and OW for BCS > 5. Further, the lean mass index and morphometric measurements (thoracic and abdominal circumferences and height and length of the patella to calcaneal tuberosity) were performed to estimate the percentage of body fat. Systolic blood pressure was measured using the non-invasive Doppler method and blood was collected for hemogram and serum biochemistry (creatinine, urea, alanine aminotransferase, alkaline phosphatase, gamma-glutamyl transferase, glucose, triglycerides, and cholesterol). After these analyses, we sought to guide and raise the awareness of the tutors to promote the correct nutritional and environmental management of the animals. Thirty adult cats were divided into two groups, based on the classification of the BCS, with eight having an IS and 22 being OW. The OW group was found to have a low level of physical activity, hypercholesterolemia, and higher values of body characteristics. Additionally, there was a median agreement between the perceptions of the clinician and the tutors. Therefore, it was concluded that the main laboratory alteration found in the obese cats was hypercholesterolemia, which was a critical parameter. It was observed that a low degree of physical activity could cause excess weight gain. It was found that the guardians of the cats with ideal weight underestimated the BCS, which could contribute to the supply of excess food and consequently, obesity. Thus, this study was sought to guide and raise the awareness of tutors, to promote the correct nutritional and environmental management thereby providing welfare and quality of life to the animals.

Long‑term effects of COVID‑19 in sickle cell disease: A case report

Severe acute respiratory syndrome coronavirus 2 (SARS‑CoV‑2) infection can generate a respiratory and systemic disease known as coronavirus disease 2019 (COVID‑19). To date, at least to the best of our knowledge, only a limited number of studies have identified SARS‑CoV‑2 infection in patients with sickle cell disease (SCD). Due to the lack of knowledge of the long‑term effects of COVID‑19, the present study presents the hematological alterations in a patient with SCD during hospitalization due to COVID‑19 and for up to 180 days following SARS‑CoV‑2 clearance and hospital discharge. The present study describes the case of a patient with SCD who was diagnosed with moderate COVID‑19 infection, without the need for invasive mechanical ventilation. Following SARS‑CoV‑2 clearance, long‑term (6 months) follow‑up identified an increase in the reticulocyte frequency, creatinine and D‑dimer levels. On the whole, the present study manuscript presents the case of a patient with moderate COVID‑19 infection with long‑term laboratory alterations at even 6 months following SARS‑CoV‑2 clearance. Further investigations are required however, to focus on the long‑term evaluations in patients who have recovered from COVID‑19, in order to fully determine the extension of possible sequelae.

Effect of multi‐species probiotic administration in Colossoma macropomum juvenile rearing: supplementation and bioremediation

Brazil major probiotics and bioremediators have proven their effectiveness in the cultivation of exotic species. The aim of the study was to evaluate the effects of a commercial multi-species probiotic suitable for shrimp and fish in the feed and as biocontrol in tambaqui rearing through zootechnical performance, water quality, clinical and laboratory alterations and innate immunity evaluations. Colossoma macropomum juveniles were used, distributed: Control (C)—without any probiotic addition; Probiotics added to water (G2)—.004 g/L of probiotics added to each experimental unit; Probiotics in feed (G3)—5 g/kg of probiotics added to the feed. The use of probiotics during the tambaqui breeding phase was proven safe. However, the use of multi-species did not result in any complementary benefit when added to the water or to the feed for 60 consecutive days regarding zootechnical performance, water quality and tambaqui health under the applied experimental conditions. The findings demonstrate the need for further in vitro and in vivo tests regarding microorganism screening and protocols analyses for each culture species, since several factors influence the effects of the administration of probiotics on aquaculture production and health.

Fibromyalgia position paper.

Fibromyalgia syndrome is one of the most common causes of chronic widespread pain, but pain accompanies a wide range of ancillary symptoms. To date, its aetiopathogenesis remains elusive, and diagnosis is exquisitely clinical, due to the lack of biomarkers or specific laboratory alterations in fibromyalgia patients. This position paper has the purpose to summarise the current scientific knowledge and expert opinions about the main controversies regarding fibromyalgia syndrome, namely: (i) fibromyalgia definition and why it is still not recognised in many countries as a distinct clinical entity; (ii) fibromyalgia severity and how to evaluate treatment outcome; (iii) how to treat fibromyalgia and which is a correct approach to fibromyalgia patients.

Traditional weight loss and dukan diets as to nutritional and laboratory results

Traditional weight loss and dukan diets as to nutritional and laboratory results

Effect of Erythropoietin on Cisplatin Induced Nephrotoxicity in Adult Male Albino Rat: Histological, Ultrastructural and Biochemical Study

Introduction: Cisplatin is documented as an effective chemotherapeutic drug with many adverse effects on vital organs, including nephrotoxicity, neurotoxicity and ototoxicity. Erythropoietin is a glycoprotein hormone synthesized by the renal fibroblasts in the interstitial tissue of the renal cortex in response to hypoxia. Recent research work points out that it could to improve the renal dysfunction and histopathological alterations caused by oxidative stress. Aim of work: is to examine the possible protective role of erythropoietin in cases with cisplatin induced nephrotoxicity. Material and method: The present study used fifty adult male albino rats, with their weights within the range of 180-220 g. The rats were divided into five groups: Group I: received a single intraperitoneal injection of a normal saline solution. Group II: injected once with cisplatin intaperitoneally at a dose of 6 mg/kg. Group III: injected with a single dose of erythropoietin; 3000 IU/ kg intaperitoneally, and one day later they were injected with 6 mg/kg of cisplatin intaperitoneally. Group IV: injected with a single dose of erythropoietin; 3000 IU/kg intaperitoneally together with 6 mg/kg of cisplatin. Group V: injected with 3000 IU/kg erythropoietin intaperitoneally, and five days later they were given 6 mg/kg of cisplatin. Results: Cisplatin injection exerted various histopathological and laboratory alterations such as renal tubular cell necrosis, nuclear pyknosis and cytoplasmic vacuolation as well as marked elevation of levels of blood urea and serum creatinine. Erythropoietin could improve all the histopathological and functional deterioration exerted by cisplatin injection especially when given prior to cisplatin administration.

Circulating Type I Interferon Levels and COVID-19 Severity: A Systematic Review and Meta-Analysis.

IntroductionCoronavirus disease 2019 (COVID-19) is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections, resulting in a range of clinical manifestations and outcomes. Laboratory and immunological alterations have been considered as potential markers of disease severity and clinical evolution. Type I interferons (IFN-I), mainly represented by IFN-α and β, are a group of cytokines with an important function in antiviral responses and have played a complex role in COVID-19. Some studies have demonstrated that IFN-I levels and interferon response is elevated in mild cases, while other studies have noted this in severe cases. The involvement of IFN-I on the pathogenesis and outcomes of SARS-CoV-2 infection remains unclear. In this study, we summarize the available evidence of the association of plasma protein levels of type I IFN with the severity of COVID-19.MethodsThe PRISMA checklist guided the reporting of the data. A systematic search of the MEDLINE (PubMed), EMBASE, and Web of Science databases was performed up to March of 2021, looking for articles that evaluated plasma protein levels of IFN-I in mild, severe, or critical COVID-19 patients. Comparative meta-analyses with random effects were performed to compare the standardized mean differences in plasma protein levels of IFN-I of mild versus severe and mild versus critical patients. Meta-regressions were performed to test the moderating role of age, sex, time that the IFN-I was measured, and limit of detection of the assay used in the difference between the means.ResultsThere was no significant difference in plasma levels of IFN-α when comparing between mild and severe patients (SMD = -0.236, 95% CI -0.645 to 0.173, p = 0.258, I2 = 82.11), nor when comparing between patients mild and critical (SMD = 0.203, 95% CI -0.363 to 0.770, p = 0.481, I2 = 64.06). However, there was a significant difference between healthy individuals and patients with mild disease (SMD = 0.447, 95% CI 0.085 to 0.810, p = 0.016, I2 = 62.89).ConclusionsPeripheral IFN-α cannot be used as a severity marker as it does not determine the clinical status presented by COVID-19 patients.

Investigation of SARS-CoV-2 infection in dogs and cats of humans diagnosed with COVID-19 in Rio de Janeiro, Brazil.

Infection by SARS-CoV-2 in domestic animals has been related to close contact with humans diagnosed with COVID-19. Objectives: To assess the exposure, infection, and persistence by SARS-CoV-2 of dogs and cats living in the same households of humans that tested positive for SARS-CoV-2, and to investigate clinical and laboratory alterations associated with animal infection. Animals living with COVID-19 patients were longitudinally followed and had nasopharyngeal/oropharyngeal and rectal swabs collected and tested for SARS-CoV-2. Additionally, blood samples were collected for laboratory analysis, and plaque reduction neutralization test (PRNT90) to investigate specific SARS-CoV-2 antibodies. Between May and October 2020, 39 pets (29 dogs and 10 cats) of 21 patients were investigated. Nine dogs (31%) and four cats (40%) from 10 (47.6%) households were infected with or seropositive for SARS-CoV-2. Animals tested positive from 11 to 51 days after the human index COVID-19 case onset of symptoms. Three dogs tested positive twice within 14, 30, and 31 days apart. SARS-CoV-2 neutralizing antibodies were detected in one dog (3.4%) and two cats (20%). In this study, six out of thirteen animals either infected with or seropositive for SARS-CoV-2 have developed mild but reversible signs of the disease. Using logistic regression analysis, neutering, and sharing bed with the ill owner were associated with pet infection. The presence and persistence of SARS-CoV-2 infection have been identified in dogs and cats from households with human COVID-19 cases in Rio de Janeiro, Brazil. People with COVID-19 should avoid close contact with their pets during the time of their illness.

Platynosomum fastosum in domestic cats in Cuiabá, Midwest region of Brazil.

Platynosomum fastosum, which is distributed in tropical and subtropical regions, is the main parasite in the biliary system of domestic cats. Cats can be asymptomatic or show severe signs of cholangitis. Although the infection is reported throughout Brazil, only post-mortem studies are available from the Midwest region of the country. This cross-sectional study investigated the frequency of P. fastosum parasitism in domestic cats treated at the University Veterinary Hospital in Cuiabá city, Mato Grosso, Brazil, by three coproparasitological techniques (formalin-ether sedimentation, Faust, and Hoffmann), associating clinical, laboratory (haematological, biochemical) and ultrasonographic alterations. Based on the sample calculation, 171 cats were evaluated in the clinical and laboratory and a semi-structured epidemiological questionnaire was designed and used by the tutors. The prevalence observed was 26.90%, with no significant association with sex, reproductive status, age, hunting habit, access to the street, recent anthelmintic treatment, and the guardian's lack of knowledge regarding parasitism. Of the 171 cats evaluated, 55 (32.16%) showed clinical signs suggestive of cholangitis, with a significant association of this variable. Regarding the clinical and pathological variables, mild neutrophilia and elevated serum activity of alanine amino transferase and alkaline phosphatase was observed (but not significantly), while the mean values of eosinophils, leucocytes, total protein, albumin, and globulin were normal. The ultrasound findings were like those previously described. Thus, it was observed that P. fastosum occurs in moderate prevalence in cats from Cuiabá-MT, with a significant association with clinical signs and a regular agreement between the parasitological techniques employed.

Diagnosis of Hereditary TTP Caused by Homozygosity for a Rare Complex ADAMTS13 Allele After Salmonella Infection in a 43-Year-Old Asylum Seeker.

A 43-year-old Armenian patient was diagnosed with salmonella infection and thrombotic microangiopathy (TMA). The clinical course was benign with resolution of all laboratory alterations after antibiotic treatment. Constantly deficient ADAMTS13 activity without ADAMTS13 inhibitors and evidence of homozygosity for a rare complex ADAMTS13 allele led to the diagnosis of congenital thrombotic thrombocytopenic purpura (cTTP). Half-life of ADAMTS13 after plasma infusion was calculated (27,6h) and double blinded plasma infusion as well as ergometric exercise with and without prior plasma infusion undertaken to investigate suspected smoldering TTP activity.

Spleen preserving distal pancreatectomy in a situs inversus totalis patient

Purpose: Solid pseudopapillary tumor (SPT) of the pancreas is an uncommon neoplasm with a low malignant potential that generally occurs in young women. Surgical resection is the gold standard treatment for this entity. When possible, laparoscopic resection is advisable. We present the case of a 26 years old patient with situs inversus totalis diagnosed with a SPT located in the tail of the pancreas. Methods: A 25-year-old woman presented after being study for renal pain and incidentally finding a distal pancreatic mass. CT-Scan showed a rounded hypodense mass of 25 mm located in the tail of the pancreas and a situs inversus totalis. None laboratory alteration was founded. Histology by USE confirmed the presence of a solid pseudopapillary tumor. A laparoscopic distal spleen preserving pancreatectomy was proposed. Results: The usual trocar position was changed like a mirror and the surgeon was located between the patient's legs. The first visualization showed a complete inverted position of all abdominal organs. An extra 5 mm trocar was used to remove the gallbladder due to stones and recurrent upper right quadrant pain. The cystic duct and artery had to be dissected with the left hand to be able to dissect from medial to lateral. Completion of cholecystectomy did not present any extra complexity. After opening the lesser omentum, an intraoperative ultrasonography of the pancreas was performed that showed a hypoechogenic mass on the tail of the pancreas located on the right of the patient. The splenic artery and vein were dissected and were also in a mirror position. The dissection of the superior border of the pancreas, as well as the splenic artery, resulted easy as the right hand was straightforward while splenic vein dissection that was very encircled in the posterior face of the pancreas resulted in an increased difficulty. After the division of these vessels and the neck of the pancreas, spleen preserving distal pancreas were completed as usual. The patient was discharged on the 5 th postoperative day with drainage after a biochemical pancreatic leakage. Conclusion: Despite technical difficulties when operating situs inversus totalis patients, laparoscopic spleen preserving pancreatectomy is a safe and feasible technique.

Treating Otohematomas in Dogs with Intra-Lesional Corticotherapy

Background: Otohematoma is common in dogs and is characterized by blood accumulation between the skin and cartilage of the outer ear. While the etiology is related to trauma, most cases have a predisposing condition. Treatment must drain the hematoma and maintain appropriate skin apposition to the ear cartilage. Treatment can be surgical, but there are also conservative options such as puncture drainage, followed by intralesional injection of glucocorticoids. This alternative method is less invasive than surgery, with an equivalent success rate. This study aimed to describe intralesional injection of corticosteroids for the treatment of dogs with otohematoma at a veterinary clinic.Materials, Methods & Results: Otohematoma was diagnosed and treated in 23 dogs (14 males and 9 females, weighing 9.6 ± 2.7 kg) at a reference private veterinary clinic. The dogs were chemically restrained, and their ears were cleaned with chlorhexidine. The lower face of each ear with otohematoma was then punctured with a needle coupled to a syringe to drain the liquid. Following drainage, the equipment was removed and the collected liquid volume was measured. A 0.5 mg/kg dose of methylprednisolone acetate was prepared and diluted in saline (0.9% NaCl) to a volume equivalent to 1/10 of the previously drained content volume from the otohematoma. The prepared solution was then injected into the drained ear. Additionally, each patient was treated for the original cause of the otohematoma, according to conventional protocols. Eight animals (34.78%) had bilateral otohematoma and 15 (65.22%) presented with unilateral lesions. Leukocytosis was observed in most patients. Other laboratory alterations present in the studied dogs were thrombocytopenia, leukopenia, and anemia. Twenty (86.96%) patients presented with otitis externa. All patients were reassessed one week after the initial treatment, and 19 (82.60%) fully recovered. The remaining 4 (17.40%) required a new procedure to drain a small accumulation of liquid. Patients were then reassessed on the 15th day when full recovery was observed in 2 (8.7%). The remaining two (8.7%) underwent new drainage on the 15th day, accompanied by a new infusion of corticosteroids, returning recovered on the 21st day.Discussion: Consistent with the previous reports, unilateral otohematomas were more frequently observed in the present study. In most animals, the cause of otohematoma was otitis externa. This disease causes intense itching that leads to autotrauma, resulting in the rupture of vessels and accumulation of fluid between the skin and cartilage of the ear. Leukocytosis detected in the majority of patients was related to external otitis. The other hematological changes observed are common in the disease. The objectives of otohematoma therapy in dogs are to identify and eliminate the source of auricular pruritus, provide adequate drainage of the hematoma content, and maintain the appropriate apposition between the skin and cartilage in the ear. In all 23 patients in this study, these aims were met, culminating in favorable outcomes. The described method led to recovery for most patients (82.60%) in the first week and a success rate of 100% by the end of 21 days. These results observed in animal patients are similar to those seen in humans, where drainage leads to total regression of the disease. Glucocorticoids were chosen for treatment of otohematoma because of their anti-inflammatory effects. Additionally, methylprednisolone acetate, an ester whose absorption was very slow, was used to allow for a longer anti-inflammatory effect.

Doença renal crônica em cão da raça Teckel: relato de caso

Chronic kidney disease (CKD) is a disease characterized by the gradual and functional loss of renal mass, affecting its physiology leading to clinical manifestations. The CKD reaches dogs of several breeds causing important clinical alterations. Some laboratory tests are determinant for the correct diagnosis and thus for the implementation of the most appropriate treatment. The urinalysis, urinary protein-creatinine ratio (UPC) evaluation, urea, and creatinine dosage together with the symmetric dimethylarginine dosage (SDMA), urinary tract ultrasonography and blood pressure monitoring, are the main methods used for diagnosis. In this way, this work aimed to report a case of CKD in a Teckel dog attended at the Veterinary Hospital of the Federal University of Jataí (UFJ), discussing the main clinical manifestations, laboratory, and image alterations, as well as the correct staging according to IRIS (Interest Renal International Society), from which the best treatment option to be adopted is determined.

Clinical and laboratory aspects found in canine with trypanosoma spp infection in north Mato Grosso

Trypanosoma is a hemoflagellate protozoan that infects a variety of animal species and is transmitted in different ways. It is a zoonosis and anthropozoonosis of great importance in veterinary medicine. The present work aims to describe the clinical and laboratory alterations in a free-living dog in a rural area, infected by Trypanosoma spp, treated in the municipality of Sinop, north of Mato Grosso. Blood samples were collected for blood count, alanine aminotransferase (ALT) activity, creatinine, creatine kinase concentrations. The results found were a normochromic microcytic anemia, lymphopenia, trypomastigote forms of Trypanosoma spp. ALT and creatinine measurements were normal, but the serum creatine kinase level was above normal limits. Imidocarb dipropionate at a dose of 7 mg / kg subcutaneously in a single dose was prescribed.

Effect of Spironolactone on Doxorubicin Induced Cardiomyopathy in Adult Male Albino Rat: Histological, Pharmacological and Biochemical Study

Abstract Background: Doxorubicin, an anthracycline drug, is an effective chemotherapeutic agent for treatment of solid tumors and hematological malignancies. However, its clinical use is limited by cardiotoxicity, such as irreversible degenerative cardiomyopathy, electrocardiographic changes, and congestive heart failure. The studies have been proved that spironolactone can ameleorate cardiac fibrosis. This drug is already indicated in treatment of doxorubicin-induced cardiotoxicity to prevent further deterioration. Aim of Study: Is to elucidate protective and therapeutic effect of spironolactone on doxorubicin induced cardiomy-opathy. Material and Methods: Fifty adult male albino rats weigh-ing 180-220g were used in this study. The rats were divided into five groups 10 rats each: Group I (Normal control): Rats received single injection of saline solution 0.9% intraperito-neally once daily for 14 days. Group II (Doxorubicin admin-straion group): Rats were injected once with doxorubicin intaperitoneally at a dose of 10mg/kg once daily for 14 days. Group III (Doxorubicin and spironolactone pre-administration group): Rats were injected once with doxorubicin intaperito-neally at a dose of 10mg/kg once daily for 14 days and pretreated with spironolactone for seven days before doxoru-bicin administration Group IV (Doxorubicin and spironolactone co-administration group): Rats were injected once with dox-orubicin intaperitoneally at a dose of 10mg/kg once daily and co-treated with spironolactone for 14 days Group V (Doxoru-bicin and spironolactone Post-administration group): Rats were injected once with doxorubicin intaperitoneally at a dose of 10mg/kg once daily for 14 days and followed by spironol-actone for 7 days. The dose of spironolactone was 40mg/kg given by oral gavage. Results: Doxorubicin injection exerted various histological and laboratory alterations such as myocardial fibrosis, bal-looned mitochondria and elevated cardiac enzymes. Spironolactone could improve all histological and functional deterio-ration exerted by doxorubicin injection especially when given before doxorubicin administration. Conclusion: It could be concluded that Spironolactone could prevent the adverse histological and functional alterations induced by intraperitoneal injection of doxorubicin in the myocardium of adult male albino rat.

Anakinra combined with methylprednisolone in patients with severe COVID-19 pneumonia and hyperinflammation: An observational cohort study

BackgroundImmunomodulants have been proposed to mitigate severe acute respiratory syndrome coronavirus 2–induced cytokine storm, which drives acute respiratory distress syndrome in coronavirus disease 2019 (COVID-19).ObjectiveWe sought to determine efficacy and safety of the association of IL-1 receptor antagonist anakinra plus methylprednisolone in severe COVID-19 pneumonia with hyperinflammation.MethodsA secondary analysis of prospective observational cohort studies was carried out at an Italian tertiary health care facility. COVID-19 patients consecutively hospitalized (February 25, 2020, to March 30, 2020) with hyperinflammation (ferritin ≥1000 ng/mL and/or C-reactive protein >10 mg/dL) and respiratory failure (oxygen therapy from 0.4 FiO2 Venturi mask to invasive mechanical ventilation) were evaluated to investigate the effect of high-dose anakinra plus methylprednisolone on survival. Patients were followed from study inclusion to day 28 or death. Crude and adjusted (sex, age, baseline PaO2:FiO2 ratio, Charlson index, baseline mechanical ventilation, hospitalization to inclusion lapse) risks were calculated (Cox proportional regression model).ResultsA total of 120 COVID-19 patients with hyperinflammation (median age, 62 years; 80.0% males; median PaO2:FiO2 ratio, 151; 32.5% on mechanical ventilation) were evaluated. Of these, 65 were treated with anakinra and methylprednisolone and 55 were untreated historical controls. At 28 days, mortality was 13.9% in treated patients and 35.6% in controls (Kaplan-Meier plots, P = .005). Unadjusted and adjusted risk of death was significantly lower for treated patients compared with controls (hazard ratio, 0.33, 95% CI, 0.15-0.74, P = .007, and HR, 0.18, 95% CI, 0.07-0.50, P = .001, respectively). No significant differences in bloodstream infections or laboratory alterations were registered.ConclusionsTreatment with anakinra plus methylprednisolone may be a valid therapeutic option in COVID-19 patients with hyperinflammation and respiratory failure, also on mechanical ventilation. Randomized controlled trials including the use of either agent alone are needed to confirm these results.

COVID-19 and the gastrointestinal tract: what do we already know?

ABSTRACTThe new coronavirus disease pandemic is defining 2020, with almost 17.5 million infected individuals and 700 thousand deaths up to beginning of August. It is caused by SARS-CoV-2 and the transmission is through the respiratory tract. Those infected may be asymptomatic, present typical symptoms (fever, dry cough and dyspnea), gastrointestinal symptoms (diarrhea, nausea, vomiting and abdominal pain) and viral RNA in stools. The objective of this work was to review the literature related to the prevalence of gastrointestinal symptoms, and to check the possibility of fecal-oral transmission. We searched PubMed® database on COVID-19 and gastrointestinal tract and selected articles using the PRISMA method. We eliminated articles based on titles and abstracts, small number of patients and the mechanism of infection, leaving 14 studies. Comorbidities and laboratory alterations (elevation of hepatic aminotransferases and bilirubin) were related to worsening of the disease. The prevalence of gastrointestinal symptoms ranged from 6.8% to 61.3%, including diarrhea (8.14% to 33.7%), nausea/vomiting (1.53% to 26.4%), anorexia (12.1% to 40.0%) and abdominal pain (0% to 14.5%). The presence of viral RNA in stools was rarely tested, but positive in 0% to 48.1%. The gastrointestinal tract is affected by COVID-19, causing specific symptoms, laboratory alterations and viral presence in the feces. However, the results of prevalence and possibility of fecal-oral transmission were varied, requiring further studies for more assertive conclusions. It is important that healthcare professionals draw attention to this fact, since these changes can help make diagnosis and initiate early treatment.

Diagnosing Organic Causes of Schizophrenia Spectrum Disorders: Findings from a One-Year Cohort of the Freiburg Diagnostic Protocol in Psychosis (FDPP).

Introduction: Secondary schizophrenia spectrum disorders (SSDs) have clearly identifiable causes. The Department for Psychiatry and Psychotherapy at the University Hospital Freiburg has continued to expand its screening practices to clarify the organic causes of SSDs. This retrospective analysis was carried out to analyze whether a comprehensive organic diagnostic procedure could be informative in patients with SSDs. Methods and Participants: The “Freiburg Diagnostic Protocol in Psychosis” (FDPP) included basic laboratory analyses (e.g., thyroid hormones), metabolic markers, pathogens, vitamin status, different serological autoantibodies, rheumatic/immunological markers (e.g., complement factors), cerebrospinal fluid (CSF) basic and antineuronal antibody analyses, as well as cranial magnetic resonance imaging (cMRI) and electroencephalography (EEG). The findings of 76 consecutive patients with SSDs (55 with paranoid–hallucinatory; 14 with schizoaffective; 4 with hebephrenic; and 1 each with catatonic, acute polymorphic psychotic, and substance-induced psychotic syndromes) were analyzed. Results: Overall, vitamin and trace element deficiency was identified in 92%. Complement factor analyses detected reduced C3 levels in 11%. Immunological laboratory alterations were detected in 76%. CSF analysis revealed general alterations in 54% of the patients, mostly with signs of blood–brain barrier dysfunction. cMRI analyses showed chronic inflammatory lesions in 4%. Combination of EEG, cMRI, and CSF revealed alterations in 76% of the patients. In three patients, autoimmune psychosis was suspected (4%). Discussion: On the basis of these findings, we conclude that a comprehensive diagnostic procedure according to the FDPP in patients with SSD is worthwhile, considering the detection of secondary, organic forms of SSDs, as well as alterations in “modulating factors” of the disease course, such as vitamin deficiency. Larger studies using comprehensive diagnostic protocols are warranted to further validate this approach.