Non-severe Cases Research Articles

Assessment of pulmonary function of post-COVID-19 patients of a tertiary hospital at three months following discharge

In this cross-sectional study from October 2020 to September 2021, pulmonary function was assessed in 40 (24 severe and 16 non-severe) post- COVID-19 patients at three months following hospital discharge by convenient sampling in post-COVID follow-up clinic at Department of Respiratory Medicine, Bangabandhu Sheikh Mujib Medical University, Dhaka. Among 40 subjects, 17 (42.5%) had restrictive defect, 1 (2.5%) had obstructive defect and 22 (55%) had normal spirometry. There was reduced total lung capacity (TLC) in 17 (42.5%) subjects and reduced diffusing lung capacity for carbon monoxide (DLCO) in 20 (50%) subjects. Mean six minutes walking distance (6MWD) was low (387.6±99.4 meters). Oxygen desaturation was in 4 (10%) cases. Frequency of restrictive defect was higher in severe than non-severe subjects (54.2% vs. 25%). Reduced TLC was in 62.5% of severe and 12.5% of non-severe cases. There was higher frequency of reduced DLCO in severe than non-severe casese (62.5% vs. 31.3%). 6MWD was lower in severe than non-severe group (354.0±134.9 vs. 438.2±51.4 meters, P=0.02). Pulmonary function was found significantly impaired in post-COVID patients which was more prominent in severe disease group. BSMMU J 2022; 15(3): 192-196

Phenotypical changes of hematopoietic stem and progenitor cells in COVID-19 patients: Correlation with disease status.

Hematopoietic stem cells (HSCs) and hematopoietic progenitor cells (HPCs) play a crucial role in the context of viral infections and their associated diseases. The link between HSCs and HPCs and disease status in COVID-19 patients is largely unknown. This study aimed to monitor the kinetics and contributions of HSCs and HPCs in severe and non-severe COVID-19 patients and to evaluate their diagnostic performance in differentiating between healthy and COVID-19 patients as well as severe and non-severe cases. Peripheral blood (PB) samples were collected from 48 COVID-19 patients, 16 recovered, and 27 healthy controls and subjected to deep flow cytometric analysis to determine HSCs and progenitor cells. Their diagnostic value and correlation with C-reactive protein (CRP), D-dimer, and ferritin levels were determined. The percentages of HSCs and common myeloid progenitors (CMPs) declined significantly, while the percentage of multipotent progenitors (MPPs) increased significantly in COVID-19 patients. There were no significant differences in the percentages of megakaryocyte-erythroid progenitors (MEPs) and granulocyte-macrophage progenitors (GMPs) between all groups. Severe COVID-19 patients had a significantly low percentage of HSCs, CMPs, and GMPs compared to non-severe cases. Contrarily, the levels of CRP, D-dimer, and ferritin increased significantly in severe COVID-19 patients. MPPs and CMPs showed excellent diagnostic performance in distinguishing COVID-19 patients from healthy controls and severe from non-severe COVID-19 patients, respectively. Collectively, our study indicated that hematopoietic stem and progenitor cells are significantly altered by COVID-19 and could be used as therapeutic targets and diagnostic biomarkers for severe COVID-19.

Peripheral blood lymphocyte subset count in COVID-19 patients

Abstract Background: (COVID-19) pathophysiology and the predictive factors are not fully understood, but lymphocyte dysregulation appears to play a role. Aim and Objectives: To explore the clinical value of lymphocyte subset changes in COVID-19 patients’ peripheral blood, which may illustrate the pathogenesis of COVID-19. Methods: This is prospective cohort study of 73 hospitalized patients with confirmed COVID-19 who were classified into two groups: non-severe and severe. Lymphocyte subsets (CD3, CD4, CD8, CD19, and CD56) were assessed using flow cytometry. Results Lymphocyte gate, CD3, CD4, CD8, and CD56 counts were significantly reduced in severe cases compared with nonsevere cases (P0.001, 0.006, 0.016, 0.011, and 0.008 respectively). Patients were divided into two groups according to cut off age (<50 and ≥ 50years) and (NLR) (NLR <4.14 and NLR ≥ 4.14). There was a significant difference in severe illness probability in two groups P0.001 and 0.001 respectively). Then, patients were divided into four groups by both NLR cutoff and age, There also significant difference in severe illness probability between four groups (P<0.001). Conclusion Based on our data, management of patients with COVID-19 pneumonia can be improved based on NLR and age model. We suggest that patients with NLR ≥ 4.14 should be admitted to isolation ward with close follow-up and actively transfer to intensive care unit.

Serum Testosterone Is Associated With the Severity of COVID-19.

Coronavirus disease 2019 (COVID-19) is more likely to be severe in men than in women. Its association with sex hormones as an aggravating factor for male patients has been attracting attention. This study aimed to investigate whether serum testosterone is associated with the aggravation of COVID-19. Serum testosterone concentrations in 116 male patients with COVID-19 and residual serum were measured and examined upon their admission to Sapporo Medical University Hospital between February 1, 2020 and March 31, 2021. Blood samples collected from these patients with COVID-19 were analyzed. The serum testosterone levels were 2.19±1.35, 1.29±0.88, and 0.75±0.58 ng/ml in mild, moderate, and severe groups, respectively. Patients with severe COVID-19 on admission had lower testosterone levels (p<0.001). At a cutoff level of 1.31 ng/ml, the area under the curve for the comparison of severe with non-severe cases was 0.825. Furthermore, serum testosterone levels negatively correlated with C-reactive protein and serum amyloid A levels but positively correlated with calcium, zinc, C3, and C4. In male patients with COVID-19, low serum testosterone levels correlated with disease severity, accompanied by a strong inflammatory reaction and proportion of complement consumption.

Стратегия управления вирус-индуцированным воспалением при COVID-19. Результаты многоцентрового адаптивного рандомизированного двойного слепого плацебо-контролируемого исследования у амбулаторных пациентов

SARS-CoV-2 infection is associated with increased production of pro-inflammatory cytokines and chemokines, followed by the development of immunothrombosis and hypercoagulation, which are important determinants of illness severity, survival prediction and long-term post-infection sequelae. More than that, thrombotic events may even develop in non-severe COVID-19 cases, including following specific thromboprophylaxis administered concurrently with the infection treatment. Therefore, preventing excess inflammation as a cause of subsequent micro- and macro-vascular thrombotic disease is becoming an increasingly important issue today. The objective of the multi-center, adaptive, randomized, double-blind, placebo-controlled trial was to evaluate the efficacy and safety of Aterixen® (ХС221GI) in patients with mild COVID-19. Patients and methods. A total of 274 subjects (age range, 18 to 75 years) with mild COVID-19 were enrolled. The study included 3 stages: screening, drug administration, and follow-up activities. The maximum overall duration of subject participation was 32 days. The subjects were randomized into 2 similar groups receiving Aterixen® (100 mg tablets administered at a dose of 1 tablet twice daily for a total of 14 days) or placebo matching the study drug in addition to the standard treatment in line with the Temporary Guidelines of the Russian Ministry of Health for the prevention, diagnosis and treatment of COVID-19. Results. The ITT and PP efficacy analyses based on the composite primary endpoint showed that Aterixen® was superior to the placebo and had a favorable safety profile. Furthermore, the number of pneumonia cases was nearly 80% lower in Ateriхen® treated subjects who required admission to hospital. Key words: COVID-19, new coronavirus infection, cytokine hyperproduction, immunothrombosis, preventive anti-inflammatory therapy, Aterixen®, ХС221GI

Association of vitamin D receptor Cdx-2 polymorphism with COVID-19: A case-control study

Background: Host genetic variability has been suggested as an important explanation for inter-individual differences in COVID-19 susceptibility and severity. Most vitamin D actions in the regulation of immunity are mediated by vitamin D receptors (VDRs). Polymorphisms in the VDR gene have been associated with several health outcomes; however, their effects on COVID-19 still need more clarification. This study aims to investigate the association of the VDR SNP (rs11568820, Cdx-2) with susceptibility and inter-individual variability of the severity of COVID-19. Methods: A total of 100 confirmed COVID-19 patients and 100 age and sex-matched controls were enrolled in this study between July and September 2021. COVID-19 patients were further subdivided into severe (n=50) and non-severe (n=50) cases. All participants were subjected to genotyping of Cdx-2 SNP using the allelic discrimination of the Real-time PCR technique and assay of serum 25(OH)D levels by ELISA. Results: The results showed that the homozygous ‘GG’ genotype was significantly higher in patients vs. controls, whereas the heterozygous ‘AG’ genotype was significantly lower in COVID-19 patients. Thus, the heterozygous ‘AG’ genotype is considered the protective genotype. This protection was more significant among males vs. females (P=0.02). However, there were no statistically significant differences in the genotype distributions of VDR Cdx-2 SNP between severe and non-severe patients. Moreover, COVID-19 patients with the ‘AG’ genotype presented higher 25(OH)D levels than the ‘GG’ genotype(P=0.02). Conclusions: VDR SNP (rs11568820, Cdx-2) might be a potential risk factor for COVID-19, particularly among male patients.

Reference guide for the treatment of aplastic anemia: key points of the 2022 revision

The "Reference Guide for the Treatment of Aplastic Anemia" has been revised for the first time in 3 years, and clinical questions have been formulated for the first time. As research demonstrated a benefit to combining antithymocyte globulin (ATG) and cyclosporine with eltrombopag (EPAG), the revised guide recommends that EPAG be started as soon as possible after ATG administration. In addition, it states that starting with immunosuppressive therapy and performing allogeneic bone marrow transplantation in the event of inadequate response or relapse is an option even for young adult patients with severe aplastic anemia who have HLA-matched allogeneic bone marrow donor candidates. The guide also discusses aggressive treatment of non-severe cases, ATG dosage and the maximum age for ATG administration, infection prevention, and G-CSF administration. It is necessary to continue collecting evidence and promoting clinical trials to build evidence in Japan.

A Study of Serum Ferritin Level in Patients of Dengue Fever and Its Correlation with the Se-verity of Dengue Fever in Tertiary Care Hospital of South Gujarat

Introduction In more than 100 endemic countries, there are 50 to 100 million new cases reported per year, according to the WHO. The dengue pandemic has caused significant death. There is usually only supportive care offered and no effective therapy. The purpose of the study was there was any effect on the level of serum ferritin in patients of dengue. Methodology This was an observational, Prospective study conducted at the Surat Municipal Institute of Medical Education and Research General Medicine department among dengue fever cases. Result serum ferritin level from on admission then on day 3 and then day 5 in non-severe and severe dengue cases showed p value &lt;0.001 which was statically significant. Conclusion The use of a serum ferritin level alone with a cut-off value of more than 900 ng/ml is indicated.

Liver chemistries in severe or non-severe cases of COVID-19: A systematic review and meta-analysis

Coronavirus disease (COVID-19) patients exhibit different patterns of liver impairment, according to growing evidence. In this study, we sought to provide a comprehensive analysis of liver test parameters in patients with severe and non-severe COVID-19. We performed a meta-analysis of published liver manifestations and described the liver damage in COVID-19. We searched PubMed, Google Scholar, Embase, Cochrane Library, medRxiv, bioRxiv, and three Chinese electronic databases through April 18, 2020, in accordance with the Preferred Reporting Items for Meta-Analyses. We analyzed pooled data on liver chemistries stratified by COVID-19 severity using a fixed or random-effects model. A meta-analysis of 56 studies, including 11052 patients, found that the pooled mean alanine aminotransferase (ALT) in severe COVID-19 cases was 35.9 IU/L whereas in non-severe COVID-19 cases was 27.3 IU/L. Average aspartate aminotransferase (AST) levels were 44.3 IU/L in severe cases compared to 27.9 IU/L in non-severe cases. In addition, AST levels are often higher than ALT levels regardless of disease severity. The severe cases tended to have a higher gamma-glutamyltransferase level but a lower albumin level than the non-severe cases. Severe COVID-19 was more likely to be associated with abnormal liver test results. Monitoring liver chemistry closely can help detect disease progression early.

Pneumonia in Children During the 2019 Outbreak in Xiamen, China.

To understand the regional epidemiology and clinical characteristics of adenovirus pneumonia in hospitalized children during the 2019 outbreak of respiratory adenoviruses in China. We analyzed the epidemiologic trend of adenovirus in children hospitalized for acute lower respiratory tract infections in Xiamen in 2019. Adenovirus was identified using direct fluorescent antibody detection. During the peak seasons of adenovirus epidemic, 170 adenovirus-positive specimens were obtained for molecular typing, and the clinical data were collected. Among the 9890 children hospitalized for acute lower respiratory tract infection, 609 (6.2%) were tested positive for adenovirus. The detection rate of adenovirus was significantly higher in boys than in grils (9.5% vs. 4.6%, P < 0.05). Adenovirus activity increased markedly between April and August with the prevalence of 7.3%-12.4%. During the outbreak season, type 7 accounted for 70.6%, followed by type 3 (28.8%) and type 4 (0.6%). Of the 155 cases of adenovirus pneumonia, the median age was 3.0 years (range: 4 month to 9 years), 153 (98.7%) had fever with a mean fever duration of 9.04 ± 5.52 days, 28 (16.5%) had wheezing, 93 (60%) showed segmental or lobar consolidation with atelectasis and 13 (8.4%) showed pleural effusion. Forty-six (29.6%) cases developed severe pneumonia, 7 (4.1%) required mechanical ventilation and 2 (1.2%) died. Younger age, longer duration of fever and higher fever spike were more frequently seen in severe cases (P < 0.05). Twenty-five (16.2%) had C-reactive protein ≥ 40 mg/L, and 91 (58.7%) had procalcitonin ≥ 0.25 mg/L. Adenovirus types 7 and 3 caused the outbreak of adenovirus pneumonia in community children during late spring to summer in 2019 in Xiamen. The majority of adenovirus pneumonia resembles bacterial pneumonia. The incidence of severe pneumonia was high when type 7 predominantly prevailed. Adenovirus type 7 was more common in severe cases than in nonsevere cases.

Implementation of a Pediatric Telemedicine and Medication Delivery Service in a Resource-limited Setting: A Pilot Study for Clinical Safety and Feasibility

Determine the clinical safety and feasibility of implementing a telemedicine and medication delivery service (TMDS) to address gaps in nighttime access to health care for children in low-resource settings. We implemented a TMDS called 'MotoMeds' in Haiti as a prospective cohort study. A parent/guardian of a sick child ≤ 10years contacted the call center (6 PM-5 AM). A nurse provider used decision support tools to triage cases (mild, moderate, or severe). Severe cases were referred to emergency care. For nonsevere cases, providers gathered clinical findings to generate an assessment and plan. For cases within the delivery zone, a provider and driver were dispatched and the provider performed a paired in-person exam as a reference standard for the virtual call center exam. Families received a follow-up call at 10days. Data were analyzed for clinical safety and feasibility. A total of 391 cases were enrolled from September 9, 2019, to January 19, 2021. Most cases were nonsevere (92%; 361); household visits were completed for 89% (347) of these cases. Among the 30 severe cases, 67% (20) sought referred care. Among all cases, respiratory problems were the most common complaint (63%; 246). At 10 days, 95% (329) of parents reported their child had "improved" or "recovered". Overall, 99% (344) rated the TMDS as "good" or "great". The median phone consultation time was 20minutes, time to household arrival was 73minutes, and total case time was 114minutes. The TMDS was a feasible health care delivery model. Although many cases were likely self-limiting, the TMDS was associated with high rates of reported improvement in clinical status at 10days. clinicaltrials.gov: NCT03943654.

Risk factors for severe disease and impact of severity on pregnant women with COVID-19: a case–control study based on data from a nationwide survey of maternity services in Japan

ObjectiveTo identify independent risk factors for severe COVID-19 in pregnant women and to evaluate the impact of disease severity on preterm birth.DesignA case–control study based on data from a nationwide...

Demographic, Clinical and Hematological Parameters of Patients with Severe and Non Severe Dengue Infection

Background: There has been a remarkable rise in the worldwide frequency of dengue in recent decades owing to the ineffectiveness of existing management methods including vaccinations and pesticides. Objective: To assess the demographic, clinical and hematological parameters of patients infected with severe and non severe dengue Methodology: This cross sectional study was carried out at the Medicine department, Khalifa Gul Nawaz Teaching Hospital, Bannu Medical College Bannu from May 2022 to October 2022. All the data like demographic, clinical and data related to hematological parameters was recorded on pre-designed Performa. The data was analyzed using SPSS 23. Results: In the current study, totally 180 patients were enrolled. The patients were categorized into NSDI and SD1 group. There were 96 (67.8%) males and 46 (32.4%) females’ patients in NSDI group while there were 28 (73.7%) males and 10 (26.3%) females in SD1 group. Fever was observed in 138 (97.2%) patients in NSDI group and 38 (100%) patients in SDI group. Platelet transfusion was needed in 55 (38.7%) patients in NSDI group while it was needed in 26 (68.4%) patients in SDI group. The mean ±SD Platelet Count x 103mm3 was 39 ±52.5 in NSDI group and 31.5±67.6 in SDI group. The mean ±SD Lowest Platelet Count x 103 mm3 was 28±42 and 21.5± 17 in NSDI group and SDI group respectively. The mean ±SD HCT % was 40.8± 6.7 in NSDI group and 36.0± 12.1 in SDI group. The mean ±SD Leukocytes Count x 103 mm3 was 4400±5425 and 8050±9350 in NSDI group and SDI group respectively. Conclusion: The key to treating and predicting dengue as severe and non-severe cases is to be aware of clinical aspects as well as test results such hematological parameters. Keywords: Demographic, clinical and hematological parameters, severe and non severe dengue infection

Comparative analysis of clinical and biological characteristics of COVID-19 patients: A retrospective cohort study

BackgroundCoronavirus disease (COVID-19), caused by a betacoronavirus, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has rapidly evolved into a pandemic since it was first reported in December 2019. thus, SARS-CoV-2 has become a major global public health issue. ObjectiveThe objective of this work is to compare demographics, comorbidities, clinical symptoms, biology and imaging findings between severe and non-severe COVID-19 patients and to identify clinical and biological risk factors and biomarkers for the development of severe COVID-19 as well as predictive thresholds for severity in order to best rationalize management and decrease the morbidity and mortality caused by this condition. Patients and methodsThis is a single-center retrospective study, from June 25 to December 31, 2021, on 521 patients at the level of the unit COVID-19 of the central laboratory of the Mohammed VI University Hospital Center Oujda, then classified into two groups according to the severity of the disease. ResultsOut of a total of 521 patients, a severe group including 336 cases (64.5%) and a non-severe group with 185 cases (35.5%). Hypertension, diabetes and obesity were noted in the majority of patients. Severe COVID-19 cases had higher C-reactive protein, procalcitonin, D-dimer, ferritin, elevated white blood cell count, and lower lymphocyte count than non-severe cases with a significant difference between the two groups. The areas under the curve (AUC) for C-reactive protein, procalcitonin and D-dimer were 0.886, 0.708, and 0.736 respectively. The optimal thresholds predictive of severity were 105 mg/l for C-reactive protein, 0.13 ng/ml for procalcitonin, 7420/μl for white blood cell count, and 0.55 mg/l for D-dimer. ConclusionComparison of the proportion of clinical, biological and radiological data between severe and non-severe cases of COVID-19, as well as identification of biomarkers for the development of severe form in the present study, will allow optimal streamlining of management with rapid triage of patients.

Role of bilirubin in the prognosis of coronary artery disease and its relationship with cardiovascular risk factors: a meta-analysis

BackgroundBilirubin is a heme catabolism product with antioxidant, anti-inflammatory, and anti-apoptotic properties and is implicated in the prognosis of several diseases. This study evaluates the prognostic role of bilirubin in coronary artery disease (CAD) patients.MethodsAfter identifying studies from the literature, meta-analyses were performed to achieve a) overall estimates of serum total bilirubin levels in patients with myocardial infarction (MI), non-MI CAD and healthy individuals; b) odds ratios (OR) of adverse outcomes between higher and lower total bilirubin levels; c) standardized mean difference (SMD) in total bilirubin levels in patients with high vs low CAD severity; and d) correlation between disease severity and total bilirubin. Metaregression analyses were performed to examine the relationship between cardiovascular risk factors and increasing quantiles of total bilirubin levels.ResultsForty-three studies were identified. Pooled serum total bilirubin levels were 0.72 mg/dl [95% confidence interval (CI): 0.60, 0.83] in MI patients; 0.65 mg/dl [95% CI: 0.60, 0.69] in non-MI CAD patients; and 0.66 mg/dl [95% CI: 0.56, 0.75] in healthy individuals. Higher total bilirubin levels were associated with greater odds of adverse outcomes in MI patients (OR: 1.08 [95% CI: 0.99, 1.18]) but lower odds in non-MI CAD patients (OR: 0.80 [95%CI: 0.73, 0.88]). Compared to non-severe cases, total bilirubin levels were higher in patients with severe MI (SMD 0.96 [95% CI: − 0.10, 2.01]; p = 0.074) but were lower in severe non-MI CAD patients (SMD − 0.30 [95%CI: − 0.56, − 0.03]; p = 0.02). Total bilirubin levels correlated positively with MI severity (r = 0.41 [95% CI: 0.24, 0.59]; p < 0.01) but correlated negatively with non-MI CAD severity (r = − 0.17 [95% CI: − 0.48, 0.14]; p = 0.28). Female sex was inversely associated with increasing quantiles of bilirubin (meta-regression coefficient: − 8.164 [− 14.531, − 1.769]; p = 0.016) in MI patients.ConclusionPrognostic role of bilirubin for CAD appears complicated, as different odds are observed for MI and non-MI CAD patients which weakens the case of causal involvement of bilirubin in CAD etiology or prognosis.

Comparison of clinical severity, genotype and toxin gene expression of binary toxin-producing Clostridioides difficile clinical isolates in Japan.

The emerging Clostridioides difficile strain BI/NAP1/027 has been reported to be associated with more severe clinical symptoms and higher mortality rates, thought in part due to production of a novel binary toxin alongside conventional A and B toxins. However, recent studies suggest that this may not always be the case. Therefore, the purpose of this report was to investigate the correlation between clinical severity and microbiological characteristics of CDT-producing C. difficile isolates in Japan. Eight Japanese isolates of CDT producing C. difficile were investigated using genotyping, cytotoxic activity assays and toxin gene expression. Correlation with clinical severity was performed retrospectively using the patient record. Three of eight patients were assessed as having severe C. difficile infection (CDI). PCR ribotyping resolved six ribotypes including ribotype 027. No specific genes were identified determining severe compared with non-severe cases. Positive correlation of expression levels of tcdA, tcdB and cdtB were observed although these expression levels were not correlated with cytotoxicity. CDI severity index neither correlated with toxin gene expression level nor cytotoxicity. These data indicate that the possession of the CDT gene and toxin gene expression levels may not relate to C. difficile cytotoxicity or clinical severity.

SARS-CoV-2 Infection in Filipino Children: An Interim Report from the SALVACION Registry

Background: The COVID-19 pandemic continues to afflict nations worldwide. The Philippines is no exception which has recorded more than 3 million cases as of December 2021 with children comprising 12% of total cases. Since the start of the pandemic, the Pediatric Infectious Disease Society of the Philippines (PIDSP) has been collecting data nationwide, through an online pediatric COVID-19 registry (SALVACION registry), to provide a better understanding of COVID-19 in children in the local setting. Methods: This was an ambispective cohort study of pediatric COVID-19 cases in the Philippines reported from March 2020 to December 2021. Data on clinical features, laboratory findings, disease severity, and treatment outcomes were voluntarily reported by physicians across the country. This study was approved by the Department of Health Single Joint Research Ethics Board. Results: As of December 30, 2021, there were 2,127 cases reported in the registry, with a median age of 5 years (interquartile range: 1-13 years) and mostly mild (41.9%) or moderate (24.5%) in severity. The top symptoms reported were fever (57.9%), cough (42.7%), coryza/colds (29.4%), anorexia (25.2%), and difficulty of breathing (23.1%). The most common comorbidities were hematologic-oncologic diseases (7.4%), neurologic diseases (7.0%) and surgical conditions (4.4%), while the most common coinfections were sepsis (6.3%), dengue fever (4.8%) and healthcare-associated pneumonia (2.1%). Significantly higher median CRP, procalcitonin, D-dimer, ferritin, transaminases and lactate dehydrogenase were seen among severe/critical cases compared to non-severe cases. There was a high frequency of antibiotic use (58%). Most cases recovered, although 172 deaths were reported with an 8.6% case fatality rate. The most common comorbidities in those who died were neurologic (15.7%), cardiac (12.8%) and hematologic (11.6%) diseases. Conclusion: Children across all age groups are susceptible to COVID-19 and most cases are mild or moderate in severity. Among severe and critical cases, the most common comorbidities were neurologic, hematologic-oncologic and cardiac diseases. Most patients recovered with supportive management.

Evaluation of prognostic markers in patients infected with SARS-CoV-2

Abstract Prognostic markers are the biomarkers used to measure the disease progression and patient outcome regardless of treatment in coronavirus disease 2019 (COVID-19). This study aimed to analyze laboratory parameters as prognostic markers for the early identification of disease severity. In this study, 165 patients attending Sukraraj Tropical and Infectious Disease Hospital with COVID-19 were enrolled and divided into severe and non-severe groups. The demographic data, underlying co-morbidities, and laboratory findings were analyzed and compared between severe and non-severe cases. The correlation between the disease criticality and laboratory parameters was analyzed. Cut-off values of parameters for severe patients were speculated through the receiver operating characteristics (ROC) curve, and regression analysis was performed to determine the risk factors. Patients with severe COVID-19 infection had significantly higher absolute neutrophil count, neutrophil–lymphocyte ratio (NLR), platelet–lymphocyte ratio (PLR), ferritin, positive carbohydrate reactive protein (CRP), glucose, urea, creatinine, and aspartate aminotransferase, while lower absolute lymphocyte count, absolute eosinophil count (AEC), and red blood cell count in comparison to non-severe infection. ROC analysis gave a cut-off value (sensitivity, specificity) of age, AEC, NLR, PLR, and ferritin as 47.5 years (70.2, 64.7%), 335 cells/mm3 (74, 67%) 3.3 (68.4, 63.7%), 129 (77.2, 51%), and 241 ng/mL (74.0%, 65.0%) respectively. Risk factor analysis showed higher age, low AEC, high ferritin, and positive CRP as independent risk factors associated with severe COVID-19 infection. Hematological and inflammatory markers, including novel NLR and PLR, should be assessed to aid clinicians in the early identification of severe cases, prioritization of cases, and effective management to decrease the mortality of COVID-19 patients.

Correlation analysis between lactic, procalcitonin and disease severity in patients with imported malaria from Africa

Objective: To explore the clinical characteristics, the correlation between lactate, procalcitonin and disease severity of imported malaria from Africa. Methods: The clinical data of 186 patients with imported malaria were collected from January 1, 2018 to April 30, 2021 in the Guangzhou Eighth People's Hospital, Guangzhou Medical University. The general conditions, clinical symptoms, laboratory tests, treatment, and prognosis of the patients were analyzed retrospectively. Receiver operating characteristic (ROC) curves were drawn to evaluate the value of relevant indicators in predicting severe malaria. Results: A total of 186 patients were divided into severe cases (n=48) and non-severe cases (n=138) in this study, of which the mean age was (38.3±10.3) years, 169(90.9%) cases were male, 17(9.1%) cases were female. The main infection species was Plasmodium falciparum, in a total of 166 cases (89.2%). The severe cases were all falciparum malarias. Compared with the non-severe group, the lactic, procalcitonin, white blood cell count and neutrophil count of the severe group were all increased, the differences were all statistically significant (all P<0.01); the percentage of monocytes, red blood cell count, hemoglobin, hematocrit and platelet count were all decreased, the difference were all statistically significant (all P<0.01). The areas under the ROC curves (AUC)(95%CI) of lactate, procalcitonin, red blood cell count, hemoglobin, hematocrit and platelet count for predicting severe malaria was 0.753(0.663-0.844), 0.755(0.670-0.841), 0.782(0.700-0.864), 0.738(0.652-0.823), 0.760(0.676-0.844), 0.778(0.699-0.857), respectively (all P<0.01). When the Youden indexes were at their maximum, the best cut-off value of lactic was 2.29 mmol/L, with sensitivity in predicting of severe malaria was 56.3%, and the specificity was 93.5%; the best cut-off value of procalcitonin was 2.12 μg/L, with sensitivity in predicting of severe malaria was 77.1%, and the specificity was 68.1%. The fatality rate of severe malaria was 4.2% (2/48). Conclusions: Anemia and thrombocytopenia are common indicators for predicting the severity of malaria. Lactic and procalcitonin also have higher predictive value for severe malaria, which could help to identify severe malaria as early as possible, improve the cure rate and reduce the risk of death.

Recent Trends in Dengue Virus Infection; An Analysis of Virological, Clinical and Laboratory Profiles of Patients with Dengue Virus Infection in the Center for Clinical Management of Dengue Fever and Dengue Hemorrhagic Fever, Sri-Lanka

Background: Dengue is hyper-endemic with outbreaks around the country. Clinical presentation is influenced by presence of previous exposures to infection and circulating serotype. Changes in circulating serotype, frequently lead to outbreaks as well. Early identification of changes in circulating serotypes and clinical pattern is invaluable for outbreak prediction, control and efficient patient management. Objectives: Study aimed to describe demographic, clinical and laboratory parameters of dengue patients during the interepidemic period in Sri-Lanka, and to identify circulating serotypes and their association with clinical/laboratory parameters to understand future occurrence of dengue. Study design: Laboratory based cross-sectional study was conducted at National Arbovirus Diagnostic Laboratory, including 129 plasma samples tested positive by Dengue serotyping real-time PCR. All samples were also tested for secondary dengue. Results: Mean age was 20.8years and 41.8% belonged to 6-15years. Primary infection was noted in 56.9%.Majority had platelet &lt;50,000/ uL, leucopenia, ALT and AST above the upper limit of the normal (38.7%, 58.1%, 55, 8% and 71.3% respectively). DENV2 was 45.7% and DENV3 was 27.1%. Severe dengue was seen in 48.1% in DENV3 cases. Majority with DENV2 had platelets &lt; 50,000/uL (68.8%). Leucopenia (82.6%) was higher in DENV3. Primary and secondary infection for DENV2 was 43.9%&amp;54.8%. For DENV3 primary infections (22%) were higher than secondary infections (19.4%). Conclusion: Primary non-severe dengue cases of were predominant. Principal circulating serotype was DENV2 with cocirculation of DENV3 and1.DENV2 was more frequently associated with secondary-infection, thrombocytopenia and elevated AST while DENV3 was mostly associated with primary-infection, severe dengue, leucopenia and elevated ALT.