Laboratory Confirmation Research Articles

Isolation and molecular detection of Peste des petits ruminants virus in an outbreak investigation in Benishangul Gumuz, Ethiopia

Peste des petits ruminants (PPR) is a severe and highly communicable disease. It is viral disease that particularly affects shoats. Its domino effects are economic losses through loss of production, deaths, abortions, and the cost of disease control. An outbreak investigation was conducted from May to November 2022 in Bambase district of Benishangul Gumuz regional state to determine the presence of PPR virus, and morbidity, mortality and case fatality rates. Altogether, 180 clinically diagnosed and 32 shoats with typical clinical sign of PPR were identified for laboratory confirmation Nasal and rectal swabs from 32 sheep and goats were collected and cultured on Verodog SLAM (VDS) cell line and tested using then tested using a quantitative real-time polymerase chain reaction (RT_PCR) assay and conventional PCR with 1.5% gel electrophoresis for detection of the N gene. The overall morbidity, mortality and case fatality rate was 17.77%, 2.77% and 15.62% respectively. Meanwhile, goats had a higher morbidity (26.5%), mortality (4.81%) and case fatality rate (18.18%) than sheep (10.3%, 1.03% and 10% respectively). Half (50%; 16/32) of samples were successfully cultivated on Vero dog SLAM cell line, showing cytopathic effects of PPR virus such as rounding cells, foamy vacuolation, aggregation and syncia formation. Out of 32 animals tested, 17 (53.13%) showed positive results for PPR virus by real-time PCR. Further analysis with conventional PCR revealed the presence of the N gene in all 17 positive samples with a 351bp fragment size. The results showed a higher morbidity rate in caprines than in ovines. Based on these findings, it is recommended to carry out a further phylogenetic study to identify the strain of virus circulating in the study area.

Genotype–Phenotype Correlation in Junctional Epidermolysis Bullosa: Signposts to Severity

Junctional epidermolysis bullosa (JEB) is a rare autosomal recessive genodermatosis with a broad spectrum of phenotypes. Current genotype-phenotype paradigms are insufficient to accurately predict JEB subtype and characteristics from genotype, particularly for splice site mutations, which account for over a fifth of disease-causing mutations in JEB. This study evaluated genetic and clinical findings from a JEB cohort, investigating genotype-phenotype correlations through bioinformatic analyses and comparison with previously reported mutations.Eighteen unique mutations in LAMB3, LAMA3, LAMC2 or COL17A1 were identified from seventeen individuals. Seven had severe JEB, nine intermediate JEB and one laryngo-onycho-cutaneous syndrome. Seven mutations were previously unreported. Deep phenotyping was completed for all intermediate JEB cases and demonstrated substantial variation between individuals. Splice site mutations underwent analysis with SpliceAI, a state-of-the-art artificial intelligence tool, in order to predict resultant transcripts. Predicted functional effects included exon skipping and cryptic splice site activation, which provided potential explanations for disease severity and in most cases correlated with lamimin-332 immunofluorescence. RT-PCR was performed for one case to investigate resultant transcripts produced from the splice site mutation.This study expands the JEB genomic and phenotypic landscape. AI tools show potential for predicting functional effects of splice site mutations and may identify candidates for confirmatory laboratory investigation. Investigation of RNA transcripts will help to further elucidate genotype-phenotype correlations for novel mutations.

Delays in Diagnosis and Treatment of Pulmonary Tuberculosis Patients during the COVID-19 Pandemic in Dushanbe, Tajikistan, 2022

The objective: to study delays in provision of medical care to pulmonary tuberculosis patients above 15 years old with laboratory confirmation of the diagnosis before and during the COVID-19 pandemic in Dushanbe, Tajikistan.Subjects and Methods. A retrospective cohort study was conducted among new pulmonary tuberculosis patients above 15 years old with laboratory confirmation of the diagnosis registered by TB Control Centers in Dushanbe in 2019–2021. Information was collected from medical records, medical databases, and patient questionnaires. Two types of delays were detected during the provision of medical care: delays related to the patient (defined as >14 days between onset of tuberculosis symptoms and the first visit to a health unit); delays related to health system (defined as >3 days from the first visit to TB unit to the initiation of tuberculosis treatment).Results. Of the 472 patients enrolled in the study, 276 were registered during the COVID-19 pandemic (2020–2021) and 196 patients were registered before the pandemic (2019). Frequency of delays was similar (83% vs 82%, p=0.8) during and before the COVID-19 pandemic. The frequency of delay related to health system was statistically significantly lower during the pandemic versus the period before the pandemic (34% vs 44%, p=0.023). The median duration of delays associated to the patient before the pandemic (60 days, IQR: 15–541) and during the pandemic (60 days, IQR: 15–360, р=0.6) was also similar as well as delays related to health system (before the pandemic – 7 days, IQR: 4–336) and during the pandemic (7 days, IQR: 4–225, р=0.6).Conclusion. Contrary to the expected result, no significant difference in delays related to the patient before and during the pandemic was found, and the frequency of delay related to health system during the pandemic significantly reduced compared to the period before the pandemic.

ANAPHYLACTIC SHOCK DUE TO PROPHYLACTIC ANTIBIOTICS IN PLANNED SECTIO CESAREAN : A CASE REPORT

Introduction: Anaphylactic reactions during pregnancy are complex to diagnose and manage, potentially ranging from mild symptoms to life-threatening situations for both the mother and fetus. With an incidence varying from 1.44 to 2.7 cases per 100,000 births and subtle, overlapping symptoms with other obstetric emergencies, accurate identification remains a challenge. Despite being underdiagnosed, severe anaphylactic events during pregnancy share symptoms with other critical conditions, making differentiation intricate. Prior reviews and recent data underscore the necessity for guidelines and public health actions, emphasizing the importance of vigilance and specific management strategies in obstetrics. Case report: This case involves Ny. S, a 33-year-old pregnant woman undergoing an elective C-section, who developed an allergic reaction to Cefazolin, necessitating an emergency procedure and subsequent ICU admission due to anaphylactic complications. Patient at 38 weeks pregnant, encountered an unexpected allergic reaction during a planned C-section, necessitating an emergency procedure. Post-surgery, she experienced severe complications, including pulmonary and laryngeal edema, requiring intensive care. With prompt medical attention and a comprehensive treatment plan, including medications and careful monitoring, her condition stabilized over several days. By October 21, 2023, she showed significant improvement, allowing her discharge with scheduled follow-up care. Discussion: The discussion encompasses the complexity of diagnosing anaphylaxis during pregnancy, highlighting challenges in laboratory confirmation, management protocols mirroring non-pregnant guidelines, and the importance of coordinated medical care to avert adverse maternal and fetal outcomes. It emphasizes the need for standardized protocols and consensus among healthcare providers to effectively manage maternal anaphylaxis, reflecting on the rarity of this condition and the potential risks it poses to both the mother and fetus. Conclusion: Anaphylactic reaction during an elective C-section, prompting urgent medical intervention involving mechanical ventilator support and meticulous care. Patient’s subsequent recovery and discharge, along with fluctuating lab results indicating an acute immune response, underscore the complexity of diagnosing and managing maternal anaphylaxis, emphasizing the need for standardized protocols and coordinated healthcare approaches.

Possible laboratory predictors in the diagnosis of brucellosis

Brucellosis is a bacterial disease affecting humans and domestic animals. The pathogenic capacity of Brucella depends on its stealth strategy and ability to replicate within host cells and cause long-lasting infections. The growth of brucellosis in the Russian Federation necessitates the search for new diagnostic approaches and algorithms that allow obtaining valid results in a short time, reducing the risk of chronicity of this pathology. Presently, the diagnosis of brucellosis, due to its pronounced polymorphism, is impossible without objective laboratory confirmation. Search for laboratory predictors is a current trend in modern laboratory medicine.

Factors Affecting the Length of Hospital Stay in COVID-19 Patients: A Retrospective Study in Bam City, Iran

Background: The sudden spread of COVID-19 raised significant concerns about the potential impact of the pandemic on healthcare systems in low- and middle-income nations. The length of hospital stay is a critical health metric with far-reaching implications in healthcare systems and a matter of resource allocation. Hospital beds, ventilators, medications, and the invaluable time and expertise of medical professionals are all finite resources. Understanding the factors influencing the length of hospitalization is essential for the efficient allocation of these resources and the provision of high-quality care. Objectives: To explore the demographic features and clinical presentations of COVID-19 patients and investigate the relationship between patient characteristics and hospitalization length by employing advanced statistical models. Methods: This was a retrospective study in Bam City, Kerman province, on 2096 patients who were admitted to the Pastor Hospital of Bam City with the diagnosis of COVID-19 between March and September 2021. The criterion for inclusion was either laboratory confirmation of SARS-CoV-2 infection by swab sampling or clinical diagnosis. No exclusion criteria were applied. Several variables, including age, gender, history of drug abuse, comorbid diseases, chronic illnesses, and clinical symptoms were gathered. A univariate analysis was performed, and significant parameters were subsequently included in the final multivariable model. We used SPSS 22, STATA 13, and R 4.1.3 software for statistical analysis. Results: A total of 2096 patients admitted to the Pastor Hospital of Bam City from March to September 2021 diagnosed with COVID-19 were included in this study. The results of a negative binomial regression model showed that the factors affecting hospitalization length in COVID-19 patients were advanced age, male gender, contact with COVID-19 patients, PO2, body temperature, cancer, fever, heart disease, coughing severity, and respiratory distress. Conclusions: Elder COVID-19 patients had relatively longer hospitalization periods. Moreover, hospitalization duration was longer in males, those who had contact with a COVID-19 patient, and patients with PO2 below 93 %, higher body temperature and fever, coughing, respiratory distress, heart diseases, and cancer compared to others. Therefore, it is recommended to monitor COVID-19 patients with heart disease and cancer more cautiously. Investigating the factors associated with long hospitalization is important for the suitable management of available resources and demands for hospital beds.

Difficulty in the differential diagnosis of peritoneal carcinomatosis and tuberculosis in a young female patient with ascites: a case report

The differential diagnosis between peritoneal tuberculosis and peritoneal carcinomatosis is quite challenging because of the similarity of the clinical picture and laboratory and instrumental examination data. Peritoneal tuberculosis and peritoneal carcinomatosis may present with the development of ascites, lymph nodes, and intestinal loop conglomerates. This article presents the clinical case of a young patient who, after her second childbirth, noted the appearance of intense pain in the neck and between the scapulae. Two months later, she experienced pneumonia with a positive reaction to antibiotic therapy. After another 2 months, she experienced recurrent ascites and gastrointestinal symptoms for the first time. The examination revealed ovarian masses and signs of peritoneal carcinomatosis and lung nodules. However, the clinical presentation was atypical for peritoneal carcinomatosis, and lung lesions were suspicious for tuberculosis, which allowed us to hypothesize the presence of tuberculosis of multiple localizations. The diagnosis was confirmed by laparoscopy with a biopsy of the involved tissues and subsequent histological and laboratory confirmation of the etiological role of Mycobacterium tuberculosis. The described case demonstrates the importance of using all available diagnostic methods to establish the causes of ascites in young female patients for differential diagnosis between specific and neoplastic etiologies.

A deep dive into chickenpox epidemiology and outbreaks: A retrospective study in a tribal-dominated district of Western India

Objectives: This retrospective observational study conducted in the district of Dadra and Nagar Haveli, Western India, over the past 9 years aimed to comprehensively investigate the epidemiology of chickenpox. The objectives were to analyze demographic and clinical characteristics, examine temporal trends, identify outbreak locations, assess outbreak intensity and duration, determine laboratory-confirmed cases, and provide insights for public health interventions. Materials and Methods: The study employed a retrospective approach, gathering data on chickenpox cases in the region. Demographic information, clinical profiles, and outbreak details were analyzed. Temporal variations and seasonal trends were assessed. Laboratory confirmation was achieved through serology and molecular methods. Locations of outbreaks were identified, and their characteristics were evaluated. Results: The study revealed that the 6–10 age groups were most vulnerable, with mild-to-moderate symptoms predominantly observed. Significant variations in cases occurred year round, with peaks between November and February. Out of 25 recorded outbreaks and three early warning signals, Aganwadis, play schools, and schools were common outbreak locations. Most outbreaks were low intensity, and laboratory confirmation identified Clade-1 Varicella-Zoster virus as the causative agent. Conclusion: These findings provide essential insights for public health officials. Identifying the vulnerable age group and high-risk locations allows for targeted vaccination campaigns. Moreover, the study underscores the need for continuous monitoring and surveillance to detect outbreaks early and mitigate their spread effectively, emphasizing the importance of proactive prevention and control measures for chickenpox in the region.

Community Science Strategies Reveal Distributional Patterns of Treponeme-Associated Hoof Disease in Washington Elk (Cervus canadensis)

Treponeme-associated hoof disease (TAHD) is an emerging disease of conservation concern in elk (Cervus canadensis) in the Northwest USA. Elk with TAHD exhibit characteristic hoof lesions that are often accompanied by lameness and limping. The gold standard approach traditionally used for infectious disease surveillance is laboratory confirmation, which for TAHD is a histologic examination of abnormal elk hooves submitted by wildlife agencies. Diagnostic evaluation affords certainty in confirming TAHD; however, these examinations are also labor and resource intensive, and therefore, not conducive to the collection of sufficient data for epidemiologic investigations. In response, two community science (CS) surveillance strategies have been implemented in Washington State: public observations of limping elk from a web-based reporting tool and hunter reports of hoof abnormalities on harvested elk. Surveillance using CS strategies can be implemented widely and may be useful for describing broad distributional patterns of TAHD, despite their unknown relationship to laboratory-confirmed cases. We described and compared the spatial–temporal distribution of TAHD in western Washington game management units (GMU) using the two CS strategies to assess congruences and discrepancies between observed patterns. We used spatial scan statistics to identify possible core-affected and newly emerging areas at the GMU level. Lastly, we contrasted CS observations against confirmed case data to examine possible delays in TAHD detection and co-occurrence among surveillance strategies. We found public observations of limping elk often predated TAHD confirmations in GMUs by several years, while hunter-reported abnormalities predated confirmations in GMUs by several months. High co-occurrence between the presence of apparent and confirmed cases under different surveillance strategies further supports the use of CS sources. This study capitalizes on wide-reaching CS data to provide new and complementary epidemiological information that can help guide future surveillance, management, and research efforts for this novel elk hoof disease.

Accuracy of Umbilical Cord Complete Blood Count in Detecting Early-Onset Neonatal Thrombocytopenia.

Neonatal thrombocytopenia (NTCP) is a common hematological disorder whose platelet count falls below the normal limitof 150 x 109/L. NTCP can causelate complications if left untreated. The current study aimed to evaluate the accuracy of the umbilical cord complete blood count (UC CBC) in detecting early-onsetneonatal thrombocytopenia(EO-NTCP). Further, the prevalence of NTCP was also investigated. Methods: A cross-sectional study with a matched control was conducted on all newborns delivered at a tertiary care center in Jeddah, Saudi Arabia, between May 2016 and 2019. After exclusions, 40 neonateswith EO-NTCP (cases) and 80 without EO-NTCP (controls) were included. The case-to-control ratio was 1:2. The results of UC CBC were compared with those of follow-up CBC, performed within 72 hours.A p-value of <0.05 was considered statistically significant. All data were analyzed using IBM SPSS version 28 for Windows (IBM Corp., Armonk, NY). The prevalence of NTCP was approximately 1.02% (111/10,936). Lack of antenatal care was found in12 (30%) neonates with EO-NTCP vs. 10 (12.5%)neonates without EO-NTCP (p = 0.02). Neonates with EO-NTCP were more likely to have experiencedintrauterine growth restriction (5 (37.5%) vs. 5 (6.3%), p < 0.001)and oligohydramnios (5 (12.5%) vs. 0 (0%), p = 0.003). Neonates who developed EO-NTCP were more likely to be admitted to the NICU (34 (85%) vs. 35 (43.8%), p < 0.001) and receiveantibiotics (22 (55%) vs. 25 (31.3%), p = 0.012). Also, neonates with EO-NTCP were more frequently diagnosed with neonatal sepsis (7 (17.5%) vs. 3 (3.8%), p = 0.015)and more likely to receiveplatelet transfusions (15 (37.5% vs. 1 (1.3%), p < 0.001). They also had a higher median length of hospital stay(13 (interquartile range (IQR) 3-28) vs. 4(IQR 2-9) days, p = 0.006). The mortality rates of neonates with EO-NTCP and those without were 6 (15%) vs. 2 (2.5%) neonates (p = 0.016). The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of UC CBC were 62.50%, 97.50%, 20.40%, and 99.61%, respectively. The prevalence of EO-NTCP in King Abdulaziz Medical City is comparable to international and national figures, and itis associated with preceding maternal comorbidities, serious neonatal morbidity, and even mortality. Therefore, proper antenatal care is vital in preventing maternal and neonatal morbidities, including the risks of NTCP and itsrelatedcomplications. With high NPV, using UC CBC as a universal screening method could assist in safely discharging newborns. However, because of its low sensitivity, a comprehensive clinical examination with confirmatory laboratory tests are stillthe cornerstone in diagnosing EO-NTCP. Future trials should aim to study the cost-effectiveness of universal UC CBC and the long-term outcomes of infants diagnosed with EO-NTCP.

What is the relevancy of a surveillance of mumps without a systematic laboratory confirmation in highly immunized populations? Epidemiology of suspected and biologically confirmed mumps cases seen in general practice in France between 2014 and 2020

BackgroundIn France, mumps surveillance is conducted in primary care by the Sentinelles network, the National Reference Centre for Measles, Mumps and Rubella and Santé publique France. AimThe objective of this study was to estimate the incidence of suspected mumps in general practice, the proportion of laboratory confirmed cases and the factors associated with a virological confirmation. MethodsGeneral practitioners (GPs) participating in the Sentinelles network should report all patients with suspected mumps according to a clinical definition in case of parotitis and a serological definition in case of clinical expression without parotitis. All suspected mumps cases reported between January 2014 and December 2020 were included. A sample of these cases were tested by real time reverse transcriptase polymerase chain reaction (RT-PCR) for mumps biological confirmation. ResultsA total of 252 individuals with suspected mumps were included in the study. The average annual incidence rate of suspected mumps in general practice in France between 2014 and 2020 was estimated at 11 cases per 100,000 population [CI95%: 6–17]. A mumps confirmation RT-PCR test was performed on 146 cases amongst which 17 (11.5 %) were positive. Age (between 20 and 29 years old), the presence of a clinical complication and an exposure to a suspected mumps case within the 21 days prior the current episode were associated with a mumps biological confirmation. ConclusionIf these results confirm the circulation of mumps virus in France, they highlight the limits of a surveillance without a systematic laboratory confirmation in highly immunized populations.

Adult Male Hypogonadism: A Laboratory Medicine Perspective on Its Diagnosis and Management.

Testosterone (T), the principal androgen secreted by the testes, plays an essential role in male health. Male hypogonadism is diagnosed based on a combination of associated clinical signs and symptoms and laboratory confirmation of low circulating T levels. In this review, we have highlighted factors, both biological and analytical, that introduce variation into the measurement of serum T concentrations in men; these need to be considered when requesting T levels and interpreting results. There is an ongoing need for analytical standardisation of T assays and harmonisation of pre- and post-analytical laboratory practices, particularly in relation to the laboratory reference intervals provided to clinicians. Further, there is a need to share with service users the most up-to-date and evidence-based action thresholds for serum T as recommended in the literature. Estimation of free testosterone may be helpful. Causes of secondary hypogonadism should be considered. A comprehensive approach is required in the management of male hypogonadism, including lifestyle modification as well as medication where appropriate. The goal of treatment is the resolution of symptoms as well as the optimisation of metabolic, cardiovascular, and bone health. The advice of an endocrinologist should be sought when there is doubt about the cause and appropriate management of the hypogonadism.

Development of Cattle Disease Diagnosis Expert System (CaDDES): A web application for the diagnosis of cattle diseases

In the present study, an attempt was made to develop an expert system for the diagnosis of cattle diseases under field conditions by Veterinarians. A questionnaire tool was developed and used for collecting the scores for symptoms or signs of 13 cattle diseases for diagnosis. The tool was tested for face validity by pilot survey with experts and content validity by calculating Aiken’s value index. The scores for the signs or symptoms were collected from 178 field veterinarians from different states in India. The scores obtained were tested for reliability and consistency by using the split-half test [88.7%] and Cronbach’s alpha coefficient [92.7%], respectively. The weighted matrix was calculated for the 51 signs or symptoms obtained for 13 cattle diseases. The CaDDES, a web application wasdeveloped using PHP, HTML, JavaScript, and MySQL computer programming languages. This web application contains Home, Introduction, About CaDDES, Disease Diagnosis, Development Team, and Contact pages. The Veterinarians need to enter the basic details of cattle and select the signs or symptoms observed in the particular cattle under field conditions. The results page will display the three probable diseases diagnosed for the selected signs or symptoms. Further, the necessary samples to be collected for laboratory confirmation and preventive measures to be undertaken were also provided. This web application will be useful for field level diagnosis of cattle diseases by Veterinarians and later by farmers. It may also be useful as a surveillance application, which will improve cattle disease reporting in the future.

Guidance for assessment of the inflammation etiologic criterion for the GLIM diagnosis of malnutrition: A modified Delphi approach

The Global Leadership Initiative on Malnutrition (GLIM) approach to malnutrition diagnosis is based on assessment of three phenotypic (weight loss, low body mass index, and reduced skeletal muscle mass) and two etiologic (reduced food intake/assimilation and disease burden/inflammation) criteria, with diagnosis confirmed by fulfillment of any combination of at least one phenotypic and at least one etiologic criterion. The original GLIM description provided limited guidance regarding assessment of inflammation and this has been a factor impeding further implementation of the GLIM criteria. We now seek to provide practical guidance for assessment of inflammation in support of the etiologic criterion for inflammation. A GLIM-constituted working group with 36 participants developed consensus-based guidance through a modified-Delphi review. A multi-round review and revision process served to develop seven guidance statements. The final round of review was highly favorable with 99% overall "agree" or "strongly agree" responses. The presence of acute or chronic disease, infection or injury that is usually associated with inflammatory activity may be used to fulfill the GLIM disease burden/inflammation criterion, without the need for laboratory confirmation. However, we recommend that recognition of underlying medical conditions commonly associated with inflammation be supported by C-reactive protein (CRP) measurements when the contribution of inflammatory components is uncertain. Interpretation of CRP requires that consideration be given to the method, reference values, and units (mg/dL or mg/L) for the clinical laboratory that is being used. Confirmation of inflammation should be guided by clinical judgement based upon underlying diagnosis or condition, clinical signs, or CRP.

Estimating the Burden of Venous and Arterial Thrombotic Events in Hospitalized Adults with COVID-19; A National Multicenter Cohort Study

Background: Patients infected with Coronavirus Disease 2019 (COVID-19) have clinical and laboratory features consistent with a hypercoaguable state, particularly in more severely ill patients that require hospitalization. However, estimates of thrombotic complications in this high risk population vary widely. A geographic representative cohort to explore the rates of thrombotic events in patients hospitalized with COVID-19 in the United States would be useful to better understand the burden of thrombosis in this population. We aimed to assess the rates of venous and arterial thrombosis events during hospitalization in patients with COVID-19 in a national multicenter cohort study. Methods: We conducted a retrospective cohort study of hospitalized patients diagnosed with COVID-19 from January 1 2020 to January 2023. IRB approval was obtained at each site. Inclusion criteria included adults (&amp;gt; 21 years), hospitalized for &amp;gt;1 day and laboratory confirmation of polymerase chain reaction testing of severe acute respiratory syndrome coronavirus 2. Data were extracted by participating centers in a pre-specified instrument from the electronic medical record at each institution and pooled prior to analysis. Data sources included manual extraction by study investigators in 7 sites and electronic extraction based on billing codes at one site (Cleveland Clinic). Primary outcome was venous thrombotic events, including deep vein thrombosis (DVT), pulmonary embolism (PE). Unusual sites including splanchnic vein thrombosis and cerebral venous thrombosis were included if objectively demonstrated on imaging. Arterial thrombotic events including ischemic stroke, acute coronary syndrome were included as secondary outcomes. Data are presented as proportions, with binomial 95% confidence intervals (CI). Results: We included 33,769 patients from eight medical centers across the United States. Participating hospitals included all four census regions from the North East (Beth Israel Deaconess Medical Center, MA (n=1021) Rochester Regional Hospital, NY (n=99)), South (John Hopkins Medical Institute, ML (n=334); Baycare Health System, FL (n=3734), MidWest (Cleveland Clinic Foundation, OH (n=25467); Henry Ford Health System, MI (973); University of Illinois, IL (1192)) and West (University of California, CA (n=613)). (Figure) Of the total 33,433 hospitalized patients with COVID-19 included, 1684 patients developed a venous thrombotic event during the index hospitalization (5.0%, 95% CI 4.8-5.2) and 261 developed an arterial thrombotic event (0.8%, 95% CI, 95% CI 0.7-0.9). Rates of venous events by individual sites ranged from 2.6-8% and arterial events from 0.3-6.6%. Conclusion: In this national multicenter cohort study that included academic and community hospitals from all four US census regions, we estimated the rates of VTE were over five times more frequent than arterial events in hospitalized patients with COVID-19. Accurate estimates of thrombotic rates and trends can help plan targeted interventions related to strategies around thromboprophylaxis interventions and resource allocation for future surges of COVID-19 cases.

1376. A Retrospective Analysis of Intravenous Fluid Therapy Practice at Hospital Admission for Adults with Dengue

Abstract Background Dengue epidemics in Asia was almost exclusively a childhood disease but recently dengue in adults have become increasingly prevalent. Yet intravenous fluid replacement (IVFR), the main supportive therapy for dengue, was developed for pediatric dengue. Evidence-based guidance for fluid replacement, especially for older adults with concomitant chronic diseases that both increases risk of severe dengue and complicate fluid replacement, is lacking. We retrospectively analyzed the use of IVFR in adult dengue patients at admission to a tertiary hospital. Methods Medical records of patients diagnosed with dengue (confirmed by rapid NS1 kit or laboratory confirmation of RT-PCR, NS1 or IgM) from January 2020 to December 2022 were analyzed. Recovery phase was defined as fever defervescence for &amp;gt;12 hours with rising platelet count. Appropriateness of IVFR was based on disease severity according to the 2009 WHO dengue classification scheme. Results Preliminary analysis of the first 30 patients found an almost equal number of males (47%) and females. The median age was 52.5 years (range 15.0-83.0). 20 patients had at least one comorbidity with hyperlipidemia (33%), hypertension (23%) and ischemic heart disease (10%) being the most common. Average time from onset to presentation was 4.3 days (95% CI: 3.8-4.9). 16 (53%) met the WHO classification scheme as requiring IVFR at admission; 4 hypotension, 5 acute kidney injury (AKI), 2 hypotension with AKI, 4 hemoconcentration, 1 AKI with hemoconcentration. Of these 16, one also had altered mental status and another had hemophagocytic lymphohistiocytosis-like presentation. Despite 47% having uncomplicated dengue, all patients had IVFR at admission. Total fluid volume administered during hospitalization varied across the population and fluctuated daily for each patient, with 8 patients receiving IVFR beyond the recovery phase. One developed fluid overload while another had IV cannula-related thrombophlebitis. There was no mortality. Conclusion Preliminary findings of our on-going study suggest excessive use of IVFR and the lack of standardization possibly contributed to two iatrogenic complications. We call for development of evidence-based protocol on fluid management in older dengue patients. Disclosures All Authors: No reported disclosures

Position Statement on In-hospital/Clinic Point-of-care Coagulation Testing for Anticoagulation Monitoring in Saudi Arabia.

Hospital overload is a persistent occurrence in daily practice. Interventions such as point-of-care testing (POCT) are needed to alleviate the pressure faced by healthcare providers and administrators. An invited panel of experts from Saudi Arabia was formed under the auspices of the Saudi Heart Association in order to discuss local treatment gaps in the management of patients receiving anticoagulation therapy. This was done in a series of meetings, which resulted in the development of official recommendations for the implementation of POCT for anticoagulation monitoring in the country. Recommendations were based on a comprehensive literature review and international guidelines taking into consideration local clinical practice, clinical gaps, and treatment/testing availabilities. Vitamin K antagonist (VKA)-based anticoagulation therapy requires routine monitoring. POCT is a promising model of care for the monitoring of International Normalized Ratio (INR) in patients receiving oral anticoagulation in terms efficacy, safety and convenience. The availability of POC INR testing should not replace the use of standard laboratory anticoagulation monitoring. However, there are several indications for implementing POCTINR monitoring that was agreed upon by the expert panel. POCT for anticoagulation monitoring should primarily be used in the warfarin (or other VKA) monitoring clinic in order to ensure treatment efficiency, cost-effectiveness of care, patient satisfaction, and quality of life improvement. The expert panel detailed the requirements for the establishment of a warfarin (or other VKA) monitoring clinic in terms of organization, safety, quality control, and other logistic and technical considerations. The limitations of POCT should be recognized and recommendations on best practices should be strictly followed. Core laboratory confirmation should be sought for patients with higher INR results (>4.7) on POCT. Proper training, quality control, and regulatory oversight are also critical for preserving the accuracy and reliability of POCT results. POCT enables more rapid clinical decision-making in the process of diagnosis (rule-in or rule-out), treatment choice and monitoring, and prognosis, as well as operational decision-making and resource utilization. POCT thus can fulfill an important role in clinical practice, particularly for patients receiving VKAs.

Post-covid syndrome in women of different ages with laboratory-proven and non-confirmed COVID-19

Background. It is of interest to study in detail the consequences of COVID-19 in women, since there is evidence that female sex is a risk factor for post-COVID syndrome. The aim of the study. To study the subjective and laboratory manifestations of post-COVID syndrome in women depending on age and results for SARS-CoV-2. Materials and methods. One-time retrospective analysis of 281 medical records of women aged 20 to 91 was performed; WHO age groups are divided into test and control subgroups (confirmed and unconfirmed COVID-19, respectively). The questionnaire for post-covid syndrome, biochemical and clinical blood tests were evaluated. Statistical analysis was done using the Mann-Whitney test, Pearson’s χ2, analysis of variance, Spearman’s correlation. Results. Women with proven COVID-19 were 1.5–2.0 times more likely to report a decrease in quality of life, exercise tolerance, cough, cardiac symptoms, edema, hair loss, skin rash, arthralgia. Laboratory-proven COVID-19 is associated with the severity of COVID-19, most of the above symptoms, increased ESR. The test subgroup of young women had higher ALT levels. In the test subgroup of middle age, a decrease in the quality of life and working capacity, hair loss and skin rash were 1.5 times more common. In the test subgroup of the elderly, diabetes mellitus was detected 2 times more often, and lower platelet counts were observed. Old women of the test subgroup have higher ESR, D-dimer and lower hemoglobin. Conclusions. The severity of post-COVID syndrome in women depends on the severity and laboratory confirmation of the transferred COVID-19, in contrast to the duration of its subjective manifestations. The greatest decrease in the quality of life after a significantly transferred COVID-19 is observed in middle-aged women. The control of laboratory parameters in post-covid syndrome in women should be differentiated depending on age.

3Ts Score, an Attempt for Less Testing in Thrombocytopenia Patients with Suspected Heparin Induced Thrombocytopenia (HIT): Retrospective Analysis in a University Hospital Setting

Background: Heparin-induced thrombocytopenia (HIT) is a prothrombotic and potentially fatal adverse drug reaction mediated by platelet-activating antibodies against multimolecular complexes of platelet factor 4 (PF4) and heparin. The 4Ts is a pretest scoring system for HIT that was developed to improve and standardize clinical diagnosis. The strength of the 4Ts score lies in the negative predictive value of a low pretest probability score. Those with a 4T score ≥4 is considered to have moderate to high probability of HIT and should undergo confirmatory laboratory test. Delays in treatment are associated with risk of thrombosis. Immediate cessation of heparin and initiation of a non-heparin anticoagulant is therefore standard of care. Method: This is a single institutional retrospective study. We reviewed the charts of 219 patients with thrombocytopenia with suspected HIT to evaluate the appropriateness of ordering the HIT testing based on the pretest probability of the 4Ts scoring system. All patients had enzyme linked immunosorbent assay (ELISA) test for HIT antibodies (the screening test). We studied tests that were sent from 03\16\2021 through 07\03\2023. The serotonin release assay (SRA) which is the confirmatory test for HIT was only sent for patients who had a positive ELISA test. 4T scores were calculated retrospectively using chart's information available to clinicians at the time of the HIT tests were sent. Results: Out of the 219 patients, 80(36.5%), 120(54.7%) and 19(8.6%) patients had a low, intermediate and high pretest probability respectively. The HIT ELISA test was positive in 33 (15.7%) patients and 196 (84.9%) patients had negative results. HIT ELISA had 100% and 93.5% sensitivity and specificity respectively while the positive and negative predicative values were 60% and 100% respectively. A positive SRA test was reported in 23 patients (10.5% of the total study population). Seventy-nine patients (36% of our total sample) scored 4 points which represents intermediate pretest probability. Out of these 79 patients only 6 (11.3%) patients had a positive ELISA test, and 5 (6.3%) patients had a positive SRA test. Aiming to minimize the HIT over testing we examined the increase in the cutoff point of the intermediate pretest probability from 4 points to 5 points which resulted in significant increase in the sensitivity and positive predictive value of the intermediate pretest probability (75.4% and 21% versus 39% and 12.9% respectively). However, the sensitivity dropped from 90% to 65%. The 4th part of 4Ts score gives points based on the probability of HIT versus other pathology as a cause of the thrombocytopenia. Most of the patients with suspected HIT will score one point out of the 4th part of 4Ts score which makes this part of the score is less helpful in distinguishing between patients with suspected HIT and will result in higher overall pretest probability and more testing. We studied the 3Ts score (the 4Ts scoring system after elimination of the 4th part) effect on the intermediate pretest probability. The cutoff points for the 3Ts score are 1-3, 4-5 and 6 for low, intermediate and high pretest probability respectively. The 3Ts score model resulted in significant increase in the specificity and the positive predictive value (76% and 21.7% versus 39.2% and 12.9% respectively) however the sensitivity dropped from 90% to 65%. The average turnaround time for HIT ELISA test and the SRA test was 2.3 days and 4.4 days respectively. Fifteen patients (21% out the patient had low pretest probability on the 4Ts score), 41 patients (59% of the patient who had an intermediate pretest probability on the 4Ts score) and 13 patients (18.8% of the patients who had high pretest probability on the 4Ts score) started on non-heparinoid anticoagulation meanwhile awaiting on the HIT testing result. Conclusion: Over testing of HIT is common secondary to underuse of 4Ts scoring system. Multicomponent educational interventions to increase the awareness and utility of the 4Ts score in addition to implantation of clinical decision support based on HIT computerized score will help to reduce unnecessary diagnostic testing of HIT in patients with low pretest probability. Increasing the cutoff point of the intermediate pretest probability or applying the 3Ts score model resulted in significant increase in the specificity and the positive predictive value of the 4Ts scoring system on expense of the scoring system sensitivity.

Burden of Chronic Kidney Disease in Californians with Sickle Cell Disease

Introduction: Chronic Kidney Disease (CKD) is a known complication of sickle cell disease (SCD). Data from contemporary adult cohorts estimating prevalence and burden of CKD in the aging sickle cell population are limited. We used administrative data from the Sickle Cell Data Collection (SCDC) program to estimate the burden of CKD in adults with SCD in California over a 10-year period. We also report mortality data and examine access to specialized care (hematology and nephrology) for SCD patients with and without CKD. Methods: This is a retrospective cohort study of Medicaid-enrolled individuals with SCD in California. Data sources included Medicaid claims, Emergency Department, hospitalization data from 2011 to 2020, and vital records data obtained from the California SCDC program. Individuals aged 18 years or older in 2011, meeting either the confirmed SCD case definition, defined as the presence of laboratory confirmation of SCD, or the SCDC probable case definition of 3 or more SCD-coded encounters during any 5-year period were eligible to be included. We ascertained individuals' CKD status (none versus any, the latter encompassing stages 1 through 5, unspecified stage, and End Stage Renal Disease (ESRD)), based on International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) and ICD-10-CM diagnosis codes. Hematologist and nephrologist encounters were identified using the National Provider Identifier (NPI) of the rendering provider. Linked death records were used to identify deaths that occurred during the study period. Results: We identified 2,992 individuals with SCD who met inclusion criteria, with 2,311 (77.2%) in the non-CKD group and 681 (22.8%) in the CKD group. The mean age of the cohort at the mid-point of the study was 40.1 years. The CKD population was older in age, and the majority (67.9%) were 30-60-years of age, whereas the non-CKD cohort had majority (61.6%) in the 18-40-year age category. Males had a higher prevalence of CKD when compared to females (26.7% vs. 20.4%). The period prevalence of CKD increased from 8% in the 18-29 year group, to 17% in the 30-39 year group, 24% in the 40-49 year group, 44.6% in the 50- 59 year group and 51.1% for the &amp;gt; 60 years age group. The mean age at first recorded CKD code was 48 years, males were significantly (p&amp;lt;0.05) younger at their first recorded CKD code than females, at 46 and 49 years of age respectively. By first recorded CKD code, one third (33.4%) of individuals had stages 1-2, 39% had stages 3-5, and 4% had ESRD. In contrast, by the latest recorded CKD stage in the 10-year period, more than one-third (35%) had CKD stages 3-5, and 40% reached ESRD. By latest CKD stage, males had more ESRD (40.2%) than stage 3-5 (34.7%), while females had similar burden of ESRD and CKD 3-5 at 37.6% and 38.7% respectively. A total of 478 deaths (15.9%) occurred during the study period, with 50.8% of deaths occurring in the CKD cohort. The median age at death was 53 years for the CKD cohort and 43 years for the non- CKD cohorts, possibly indicating that CKD occurred in patients who did not die of other causes at a younger age. When examining access to care, the median number of visits per year with a hematologist was 0.11 and 0 for the CKD vs. entire cohort respectively. The median number of visits per year with a nephrologist for those with CKD was 0. The proportion of individuals with CKD who had zero visits per year with a hematologist or a nephrologist over the study period was 48% and 61% respectively. Individuals with CKD who died during the study period had a significantly lower number of mean annual visits with a hematologist than those who were alive (1.37 vs 1.23, p&amp;lt;0.001) at the end of the study period. Individuals with CKD who died during the study period had a higher number of visits with a nephrologist than those who were alive (1.56 vs. 2.23, p&amp;lt;0.05) at the end of the study period. Conclusion: CKD poses a significant burden on adults with SCD. In our cohort, males had a higher prevalence of CKD, and the prevalence of CKD increased with age. 40% of individuals with CKD had a latest recorded stage of ESRD. Half of the deaths that occurred during the study timeframe occurred in the CKD cohort. Californians with CKD and SCD had severe restrictions in access to both hematology and nephrology care. Further prospective studies are needed to understand the natural history of CKD in SCD and identify risk factors for progression.