Routine Laboratory Research Articles

Predictive value of procalcitonin for early atrial fibrillation recurrence post-cardioversion at the emergency department

Abstract Funding Acknowledgements None. Background Cardioversion of acute atrial fibrillation (AF) in the emergency department (ED) has been shown to be a safe and effective treatment strategy that allows direct discharge from the ED thereby reducing avoidable hospitalizations. However, early AF recurrence may present a limitation, thereby necessitating the identification of predictors of AF recurrence post-ED cardioversion. Methods 117 patients with acute AF (first detected or recurrent paroxysmal) of <48 hours duration, managed by pharmacological (PC) or electrical cardioversion (EC) at the ED were prospectively enrolled upon ED presentation. Clinical, echocardiography, routine laboratory and NT-proBNP and procalcitonin assessments were performed upon presentation. We investigated the utility of inflammatory biomarker procalcitonin as predictor of acute success of cardioversion and early AF recurrence up to 30 days post-cardioversion. Results Study group consisted of 50% males, of mean(±SD) age 67±12years, 41% with first episode and 59% with paroxysmal AF, left ventricular ejection fraction (LVEF) 54±7% and left atrial diameter (LAD) 39±5mm. Median (IQR) creatinine, NTproBNP, hsTroponinT and procalcitonin were: 0.9(0.8-1.1)mg/dl, 517(137-1454)pg/ml, 11.8(6.7-19)pg/ml and 0.03(0.02-0.05)pg/ml, respectively. Of the total group, 59% had paroxysmal and 41% first-episode AF, whereas 70% received EC and 30% PC. Acute cardioversion success was achieved in 81%, while sinus rhythm was maintained in 84% at 8 days and in 86% in 30 days post-cardioversion. In univariate regression analysis, lower procalcitonin levels were associated with higher acute cardioversion success [HR, 95%CI: 0.208(0.050-0.863), p=0.031] as well as lower risk of AF recurrence at 8 days [HR, 95%CI: 0.142(0.028-0.730), p=0.019] and 30 days post-cardioversion [HR, 95%CI: 0.190(0.044-0.818), p=0.026]. Predictive value of procalcitonin was maintained after adjustment for LAD in multivariate regression (all p<0.05). Conclusions In acute AF managed by cardioversion in the ED, procalcitonin, a marker of inflammatory stimulation, may predict acute non-response as well as early AF recurrence up to 30 days post-cardioversion.

Molecular surveillance of carbapenem-resistant Enterobacterales in two nearby tertiary hospitals to identify regional spread of high-risk clones in Germany, 2019–2020

Understanding the transmission dynamics of carbapenem-resistant Enterobacterales (CRE) is critical to addressing the escalating global threat of antimicrobial resistance (AMR). Although hospital transmission of CRE has been extensively studied, information on community transmission is lacking. This study aims to identify genomic clusters of CRE from two nearby institutions that may be indicative of community or inter-facility transmission. CRE isolates between 1st of January 2019 and 31st of December 2020 from two tertiary hospitals, detected in the respective routine microbiology laboratories, were collected and characterized by short-read whole genome sequencing. A total of 272 CRE were collected, with Enterobacter cloacae complex (71/192, 37%) predominant in Heidelberg and Escherichia coli (19/80, 24%) in Mannheim. The most common carbapenem resistance gene, blaOXA-48, was detected in 38% of CRE from both centres. Several putative transmission clusters were found, including 6 clusters of E. cloacae complex, 5 clusters of Klebsiella pneumoniae, 4 clusters of Citrobacter freundii, and 2 clusters each of Escherichia coli and K. aerogenes. No clusters involved isolates from both study centres, except for an ST22 C. freundii cluster. Globally circulating clones were identified between the two centres for ST131 E. coli, ST66 E. hormaechei and ST22 C. freundii. This study found no widespread transmission clusters among isolates from both centres, suggesting a hospital-specific clonal structure. This suggests that CRE clusters involving both institutions may indicate emerging or circulating clones in the community, highlighting the need for intersectoral surveillance and data sharing.

Detection of Biofilm Production and Antibiotic Susceptibility Pattern among Clinically Isolated Staphylococcus aureus.

The increasing antibiotic resistance and the ability to form biofilms in medical devices have become the leading cause of severe infections associated with Staphylococcus aureus (S. aureus). Since the bacteria living in biofilms can exhibit 10- to 1,000-fold increase in antibiotic resistance and implicate chronic infectious diseases, the detection of S. aureus ability to form biofilms is of great importance for managing, minimizing, and effectively treating infections caused by it. This study aimed to compare the tube and tissue culture methods to detect biofilm production and antibiotic susceptibility in MRSA and MSSA. The S. aureus isolates were identified by the examination of the colony morphology, Gram staining, and various biochemical tests. Antimicrobial susceptibility testing of all isolates was performed by the modified Kirby-Bauer disc diffusion method as recommended by CLSI guidelines. MRSA screening was performed phenotypically using a cefoxitin disc (30 µg). Isolates were tested for inducible resistance using the D-test, and two phenotypic methods detected biofilm formation. Among 982 nonrepeated clinical specimens, S. aureus was isolated from 103 (10.48%). Among 103 clinical isolates of S. aureus, 54 (52.42%) isolates were MRSA, and 49 (47.57%) were MSSA. Among 54 MRSA isolates, the inducible MLSB phenotype was observed in 23/54 (42.59%) with a positive D-test. By TCP method, 26 (48.1%) MRSA isolates were strong biofilm producers, whereas, among all MSSA isolates, only 6 (12.2%) were strong biofilm producers. MRSA showed strong biofilm production in comparison with MSSA. The TCP method is a recommended reliable method to detect the biofilm among S. aureus isolates, and the TM method could be useful for the screening of biofilm production in S. aureus in the routine clinical laboratory.

Are shortened aPTT values always to be attributed only to preanalytical problems?

It has been recognized that shortened activated partial thromboplastin time (aPTT) may be caused by various preanalytical conditions. As coagulation Factor VIII is included in the invitro intrinsic coagulation cascade measured by aPTT, we hypothesized that the shortened aPTT could be a result of elevated FVIII activity. We aimed to inspect the connection of elevated FVIII with shortened aPTT, and the possible effect inflammation has on routine laboratory parameters. 40 patients from various hospital departments with aPTT measurement below the lower limit of the reference interval (<23.0 s) were included in the study. To compare the obtained results with aPTT measurements in the non-inflammatory state, samples from 25 volunteers (laboratory personnel) were collected. White blood cell count, C-reactive protein, aPTT, and FVIII values were measured in the control group. Only two samples among 40 patients with shortened aPTT (5 %) were clotted. Out of the remaining 38, 26 had FVIII activity above 150 % (upper limit of a reference interval), median value of 194 % (IQR: 143-243 %). Seven samples in the control group had shortened aPTT results (36 %). However, all coagulation samples were clot and hemolysis-free. Multiple regression identified only FVIII activity as an independent variable in predicting aPTT values (p=0.001). Our results support the thesis that shortened aPTT is rarely a consequence of preanalytical problems. Elevated FVIII activity causes shortened aPTT, not only in theinflammatory state but also in individuals with concentration of inflammatory markers within reference intervals.

Risk and timing of isotretinoin-related laboratory disturbances: a population-based study.

Uncertainty surrounds the optimal routine laboratory monitoring in acne patients treated with isotretinoin. Our aim was to evaluate the risk of mild and severe laboratory abnormalities in patients with acne starting isotretinoin versus oral antibiotic treatment. A global population-based retrospective cohort study assigned two groups of patients with acne-prescribed isotretinoin (n = 79,012) and oral antibiotics (n = 79,012). Comprehensive propensity-score matching was conducted. Compared to acne patients treated with oral antibiotics, those under isotretinoin demonstrated an increased risk of grade ≥3 hypertriglyceridemia (hazard ratio [HR], 7.85; 95% confidence interval [CI], 5.58-11.05; P < 0.001) and grade ≥3 elevated aspartate transaminase (AST) levels (HR, 1.45; 95% CI, 1.13-1.85; P = 0.003) within the initial 3 months of treatment. The absolute risk of these abnormalities among isotretinoin initiators was 0.4% and 0.2%, respectively. The risk difference of these findings was clinically marginal: 3 and 1 additional cases per 1,000 patients starting isotretinoin, respectively. There was no significant risk of grade ≥3 impairment in cholesterol, alanine transaminase, gamma-glutamyl transferase, or creatinine levels under isotretinoin. Most laboratory abnormalities were documented 1-3 months after drug initiation in time-stratified analysis. Isotretinoin is associated with a clinically marginal increased risk of severe hypertriglyceridemia and hypertransaminasemia. Routine blood testing should be performed 1-3 months after commencing therapy.

Enzymatic detection of α-hydroxybutyrate, an important marker of insulin resistance, and comparison with LC-MS/MS detection

AimThe metabolite α-hydroxybutyrate (α-HB) is an important marker of insulin resistance and impaired glucose tolerance allowing to identify patients at risk of developing diabetes and related metabolic disorders before any symptoms become apparent. At present, its exact quantification requires mass spectrometry (LC-MS), which is not compatible with routine laboratory use. Accordingly, a simple enzymatic-based method was assessed and its applicability and measuring accuracy compared with LC-MS was investigated. MethodsStandards, serum, and plasma samples containing α-HB were prepared with routine procedures and their α-HB contents measured with the XpressGT® enzymatic test kit photometrically or with LC-MS and multiple reaction monitoring. Resultsα-HB detection with XpressGT® yielded highly linear calibration curves and 102 % recovery of stocks added to commercial samples. Stability of the analyte in serum and plasma samples prepared with various anti-coagulants was >90 % after 46 h for several widely used preparations and recovery after 3 freeze-thaw cycles was ≥95 % with these anti-coagulants. A direct comparison of 75 samples indicated very good agreement of α-HB levels determined by both methods, 86 % of XpressGT® samples being within ±20 % of LC-MS values and even 93 % within ±20 % considering only samples above 30 μM concentration. ConclusionXpressGT®-based detection of α-HB is an easily applicable method which can be used for accurate and reliable quantification of the metabolite in clinical practice. Routine α-HB determination in patients at risk of developing diabetes would allow early establishment of preventive measures or pharmacological intervention reducing the risk for the onset of serious diabetes-related health problems.

LOWER PEAK ATRIAL LONGITUDINAL STRAIN VALUES ARE ASSOCIATED WITH OBESITY AND INSULIN RESISTANCE IN YOUNG PATIENTS WITH HYPERTENSION

Objective: The aim of the study was to compare features of left atrium remodeling in young patients with arterial hypertension (HTN) according to metabolic health status Design and method: We enrolled 83 young subjects (23 [21; 25] years, 87% males) with HTN diagnosed with office blood pressure (BP) measurement and 24-hours ambulatory BP monitoring according to ESC guidelines criteria (2018). Patients with diabetes mellitus and cardiovascular diseases were not included. We performed routine clinical examination and lab tests and two-dimensional speckle-tracking echocardiography. Patients were divided in two subgroups according to their relation to median of left atrial reservoir strain (LASr) in general population (Nielsen AB. et al., 2021. doi:10.1093/ehjci/jeab201). We estimated and compared main clinical characteristics of obesity and lipid and carbohydrates metabolism including HOMA-IR and non-insulin-based metabolic scores for insulin resistance in derived subgroups with T-test. Results: Groups had similar age, sex and BP structure. Subjects with LASr less than 39,4% (n = 48) had higher body mass index (27,2±5,0 vs 24,1±3,7, p=0,0041), waist circumference (93,4±14,0 vs 83,0±10,7, p=0,001) and waist-to-hips ratio (0,90±0,07 vs 0,84±0,07, p=0,0007). Characteristics of lipid metabolism also varied in 2 groups: in lower LASr subgroup triglycerides concentration was higher (1,53±1,06 vs 0,81±0,28, p=0,0005) and high density lipoproteins (HDL) was lower (1,18±0,28 vs 1,55±0,53, p=0,0003) while there was no significant difference in total cholesterol and low density lipoproteins levels. Fasting glucose and HOMA-IR did not differ between the groups but significant differences were observed for non-insulin-based metabolic scores: in lower LASr group METS-IR, TG/HDL ratio and TyG index were higher (41,6±9,25 vs 33,0±6,4, p&lt;0,0001; 3,38±2,94 vs 1,34±0,68, p=0,0004 and 8,55±0,60 vs 8,02±0,30, p&lt;0,0001, respectively). In reverse stepwise regression model for the general group LASr were independently associated with the level of left ventricular ejection fraction, DBP24h, METS-IR index, while the relationship with the HDL-C, SBP24h, relative wall thickness, E/e’ were lost (METS-IR index and HDL-C were included after checking the collinearity). Conclusions: young patients with HTN with lower LASr have worse metabolic status estimated with non-insulin-based metabolic scores and obesity characteristics.

Application of boosted trees to the prognosis prediction of COVID-19.

The precise prediction of COVID-19 prognosis remains a clinical challenge. In this regard, early identification of severe cases facilitates the triage and management of COVID-19 cases. The present paper aims to explore the prognosis of COVID-19 patients based on routine laboratory tests taken when patients are admitted. A data set including 1455 COVID-19 patients (727 male, 728 female) and their routine laboratory tests conducted upon hospital admission, age, Intensive Care Unit (ICU) admission, and outcome were gathered. The data set was randomly split into the train (75% of the data) and test data set (25% of the data). The explainable boosting machine (EBM) and extreme gradient boosting (XGBoost) were used for predicting the mortality and ICU admission of COVID-19 cases. Also, feature importance was extracted using EBM and XGBoost. The EBM and XGBoost achieved 86.38% and 88.56% accuracy in the test data set, respectively. In addition, EBM and XGBoost predicted the ICU admission with an accuracy of 89.37%, and 79.29% in the test data set for COVID-19 patients, respectively. Also, obtained models indicated that aspartate transaminase (AST), lymphocyte, blood urea nitrogen (BUN), and age are the most significant predictors of COVID-19 mortality. Furthermore, the lymphocyte count, AST, and BUN level were the most significant ICU admission predictors of COVID-19 patients. The current study indicated that both EBM and XGBoost could predict the ICU admission and mortality of COVID-19 cases based on routine hematological and clinical chemistry evaluation at the time of admission. Also, based on the results, AST, lymphocyte count, and BUN levels could be used as early predictors of COVID-19 prognosis.

Is there a risk for patients with the implementation of autovalidation in routine laboratory practice?

Is there a risk for patients with the implementation of autovalidation in routine laboratory practice?

Comparability study of different analytes, from Wantai Wan200+ instrument using routine laboratory assays

Comparability study of different analytes, from Wantai Wan200+ instrument using routine laboratory assays

Misclassification of Opisthorchis viverrini and Minute Intestinal Fluke Eggs by Routine Laboratory Staff Using Images from the Kato-Katz Method.

The Kato-Katz method is a commonly used diagnostic tool for helminth infections, particularly in field studies. This method can yield inaccurate results when samples contain eggs that are similar in appearance, such as Minute Intestinal Fluke (MIF) and Opisthorchis viverrini (OV) eggs. The close resemblance of eggs can be problematic and raises the possibility of false diagnoses. The objectives were to compare the diagnostic performance of the Kato-Katz method for accurately identifying MIF and OV and to provide evidence of possible misclassification. Methods: Based on questionnaire responses from 15 (young parasitologists and public health staff), the test comprised 50 MIF egg images and 50 OV egg images, for a total of 100 Google Form questionnaires. The morphology of MIF and OV eggs found size and shape similarity and found that the shoulder rims were small, while the OV egg found the knobs had disappeared. The opercular conjunction was apparent, the shoulder rims and miricidium were prominent. The average percentage of correctly classified infections was 61.6 ± 12.1%. The accuracy percentages for both public health staff and young parasitologists in identifying were found to be 59.0 ± 14.8 and 66.8 ± 2.8, respectively. There was no significant difference observed in both groups. These findings highlight the need for improving the accuracy of parasite identification. Preserving stool samples before the Kato-Katz method can help mitigate the potential degradation or distortion of parasite eggs. The incorrect classification of both eggs had an impact on treatment plans and the policy of parasite control programs.

Comparing Clinician Estimates versus a Statistical Tool for Predicting Risk of Death within 45 Days of Admission for Cancer Patients.

While clinical practice guidelines recommend that oncologists discuss goals of care with patients who have advanced cancer, it is estimated that less than 20% of individuals admitted to the hospital with high-risk cancers have end-of-life discussions with their providers. While there has been interest in developing models for mortality prediction to trigger such discussions, few studies have compared how such models compare with clinical judgment to determine a patient's mortality risk. This study is a prospective analysis of 1,069 solid tumor medical oncology hospital admissions (n = 911 unique patients) from February 7 to June 7, 2022, at Memorial Sloan Kettering Cancer Center. Electronic surveys were sent to hospitalists, advanced practice providers, and medical oncologists the first afternoon following a hospital admission and they were asked to estimate the probability that the patient would die within 45 days. Provider estimates of mortality were compared with those from a predictive model developed using a supervised machine learning methodology, and incorporated routine laboratory, demographic, biometric, and admission data. Area under the receiver operating characteristic curve (AUC), calibration and decision curves were compared between clinician estimates and the model predictions. Within 45 days following hospital admission, 229 (25%) of 911 patients died. The model performed better than the clinician estimates (AUC 0.834 vs. 0.753, p < 0.0001). Integrating clinician predictions with the model's estimates further increased the AUC to 0.853 (p < 0.0001). Clinicians overestimated risk whereas the model was extremely well-calibrated. The model demonstrated net benefit over a wide range of threshold probabilities. The inpatient prognosis at admission model is a robust tool to assist clinical providers in evaluating mortality risk, and it has recently been implemented in the electronic medical record at our institution to improve end-of-life care planning for hospitalized cancer patients.

Analyzing HALP and PNI scores as prognostic factors in metastatic head and neck cancers

ObjectiveThis study investigates the prognostic significance of Hemoglobin, Albumin, Lymphocyte, Platelet (HALP) score and Prognostic Nutritional Index (PNI) in metastatic head and neck cancers. MethodsRetrospective analysis was conducted on data obtained from January 2014 to June 2022 for 68 patients using rigorous statistical methods. HALP and PNI scores, derived from routine laboratory parameters, were categorized into low and high groups using respective median values. Prognostic significance was determined through Kaplan–Meier survival analyses and Cox proportional hazards regression using IBM SPSS Statistics. ResultsOf the 68 patients (80.9% male, median age 57), 39 (57.4%) had laryngeal cancer. When stratified by low and high HALP scores, the median overall survival (OS) was 5.9 and 16.4 months, respectively (P < 0.001), while the median progression-free survival (PFS) was 5.7 months and 8.2 months, respectively (P: 0.016). In the low and high PNI score groups, the median OS was 7 and 13.2 months (P < 0.001), with median PFS of 5.6 months and 8.2 months (P: 0.002), respectively. In the multivariate analysis, while the HALP score did not reach statistical significance in terms of PFS, the PNI score and age groups were found to be statistically significant. In terms of OS, higher HALP score and PNI scores were significantly associated with longer OS. ConclusionIn this study, the HALP score and PNI score were found to be a prognostic factor in patients with metastatic head and neck cancer.

Comparison between a new point-of-care HbA1c test and a routine laboratory method

Comparison between a new point-of-care HbA1c test and a routine laboratory method

Quid de la détection des anticorps anti-TIF1γ dans les dermatomyosites ?

AbstractThe classification of idiopathic inflammatory myopathies (IBD) is evolving, with the consideration, in addition to clinicopathological criteria, of the presence of autoantibodies specific to myositis for the diagnosis and identification of clinical forms.The diagnosis of dermatomyositis (DM) is based on clinical, histological, imaging criteria and the demonstration of myositis-specific autoantibodies (MSA). Within these antibodies, anti-TIF1γ have a special place due to their high prevalence in juvenile DM and in cancer-associated DM. Anti-TIF1γ antibodies are present in 7-31% of adult DMs. DMs with anti-TIF1γ are associated with cancer in more than half of cases in adults (38-75%), whereas this is not the case in juvenile DMs. The role of the TIF1γ protein in the tumor process and of autoantibodies in the triggering of DM are the subject of numerous hypotheses, but without any definitive conclusion currently.Given the diagnostic and prognostic importance of the presence of anti-TIF1γ antibodies, it is essential to have reliable tests suitable for routine practice to characterize them. The reference technique, immunoprecipitation, is not suitable for the routine laboratory. Immunodots are practical but their performance is not optimal in terms of sensitivity and specificity. Elisa and the particle-based multi-analyte technology (PMAT)-type automated technique seem to present performances close to immunoprecipitation but with a practicability adapted to routine use.

SURVEY ON DETERMINATION OF ALBUMINURIA BY FAMILY PHYSICIANS

Objective: Albuminuria is an established marker of cardiovascular (CV) risk which has a role in pathogenesis of cardio-renal diseases, and it is questioned whether it should also be a therapy target. In all relevant guidelines it is listed as a routine laboratory method for all patients with hypertension and increased CV risk regardless they have diabetes or not. Croatian Hypertension League successfully negotiated with Croatian National Health Insurance company, and since last February determination of albumin-to-creatinine ratio - ACR is reimbursed for all patients with hypertension, and not only hospital specialist, but also family physicians (FP) are allowed to use this method. We announced this important novelty through our newsletters, website and media. The aim was to analyze how this method was implemented by family physicians in regular work. Design and method: A digital structured questionnaire was prepared and placed at the website of the Croatian Hypertension League. Using our regular monthly newsletter, we have invited FP, members of the League to participate in this survey. So far, 135 FP participated (83.7% women) from all parts of Croatia. Results: All physicians believe that determination of ACR is very important. Before this survey, 34% have not heard about this possibility, and from those who were informed 31% have not yet started. The most important reason was incapability of local laboratory (51%) followed by the answer that they have not had proper patient for these analyses (17.8%). When asked whether their laboratory provide them with values of estimated glomerular filtration rate, 51% answered negatively. Conclusions: Croatian Hypertension League made a big step forward enabling determination of ACR for all hypertensive patients by all physicians. However, there are still several gaps which should be eliminated. One is increasing awareness of FP and encouraging them to determine ACR more frequently, and the other one is to convince medical biochemistries to allow regular determination of ACR in all laboratories, but also of reporting eGFR. Survey, like this are very important and could be helpful in reaching final success, and we will use results for evidence-based negotiation with Croatian Biochemistry Chamber.

Determine of novel dependent score based on routine lab tests for accurate diagnosis of spontaneous bacterial peritonitis (SBP) in cirrhotic patients

Determine of novel dependent score based on routine lab tests for accurate diagnosis of spontaneous bacterial peritonitis (SBP) in cirrhotic patients

Endothelial dysfunction in breast cancer survivors on aromatase inhibitors: changes over time

BackgroundBreast cancer is estimated to comprise about 290,560 new cases in 2022. Aromatase inhibitors (AIs) are recommended as adjuvant treatment for estrogen-receptor positive (ER+) breast carcinoma in postmenopausal women, which includes approximately two-thirds of all women with breast cancer. AIs inhibit the peripheral conversion of androgens to estrogen by deactivation of the aromatase enzyme, leading to a reduction in serum estrogen level in postmenopausal women with ER+ breast carcinoma. Estrogen is known for its cardiovascular (CV) protective properties through a variety of mechanisms including vasodilation of blood vessels and inhibition of vascular injury resulting in the prevention of atherosclerosis. In clinical trials and prospective cohorts, the long-term use of AIs can increase the risk for hypertension and hyperlipidemia. Studies demonstrate mixed results as to the impact of AIs on actual CV events and overall survival.MethodsA single arm longitudinal study of 14 postmenopausal women with ER+ breast cancer prescribed adjuvant AIs at the University of Minnesota (UMN). Subjects with a history of known tobacco use, hypertension, hyperlipidemia, and diabetes were excluded to eliminate potential confounding factors. Participants underwent routine labs, blood pressure assessments, and vascular testing at baseline (prior to starting AIs) and at six months. Vascular assessment was performed using the EndoPAT 2000 and HDI/PulseWave CR-2000 Cardiovascular Profiling System and pulse contour analysis on two occasions as previously described. Vascular measurements were conducted by one trained vascular technician. Assessments were performed in triplicate, and the mean indices were used for analyses. All subjects were on an AI at the follow-up visit. The protocol was approved by the UMN Institutional Review Board and all participants were provided written informed consent. Baseline and follow-up characteristics were compared using Wilcoxon signed-rank tests. Analyses were performed using R version 3.6.1 (R Foundation for Statistical Computing, Vienna, Austria).ResultsAfter six months of AI treatment, EndoPAT® ratio declined to a median 1.12 (Q1: 0.85, Q3: 1.86; p = 0.045; Figure 1) and median estradiol levels decreased to 2 pg/mL (Q1: 2, Q3: 3; p=0.052). There was no evidence of association between change in EndoPAT® and change in estradiol level (p = 0.91). There were no statistically significant changes in small or large arterial elasticity.ConclusionsWe hypothesize that long-term use of AI can lead to persistent endothelial dysfunction, and further investigation is necessary. In our study, patients were on AI for approximately 5-10 years. As a result, we do not have data on whether these changes, such as EndoPAT® ratio and the elasticity of small and large arterial, are reversible with discontinuation of AI. These findings set the stage for a larger study to more conclusively determine the association between AI exposure and cardiovascular outcomes. Further studies should evaluate for multivariate associations withmodifiable risk factors for CV disease.

Gender disparities in lymphocyte counts and cytokine expression in COVID-19

Background: This study seeks to assess gender differences in the severity of COVID-19 infection, which have been noted in different regions during the early stages of the pandemic. Methods: A cross-sectional study conducted at Baquba Teaching Hospital in Diyala, Iraq, from October 1st to December 31st, 2020, included 132 confirmed COVID-19 patients. These patients underwent a comprehensive set of routine laboratory tests, including complete blood count, blood biochemistry, and D-dimer assessment. Statistical analysis was carried out using SPSS-20, with significance set at p &lt; 0.05. Results: The study included patients with a mean age of 45.61 (±11.32) years, predominantly male (63.0%), residing in urban areas (57.6%), and presenting with comorbidities (78.8%). All patients exhibited positive results on CT scans (100%) and CRP tests (100%). However, PCR testing confirmed COVID-19 infection in 87.2% of cases, with 12.8% testing negative. Among males, there was a significant increase in IL-6 and IL-10 levels (42.57 ± 7.64 pg/ml and 255.27 ± 21.03 pg/ml) compared to females (16.43 ± 4.19 pg/ml and 187.48 ± 20.35 pg/ml), with p-values &lt;0.001 and 0.003, respectively. Conversely, there was no significant difference in IFN-ɣ levels between males (165.73 ± 16.54 pg/ml) and females (176.12 ± 17.10 pg/ml), with a p-value of 0.105. However, lymphocyte levels were significantly lower in males (4.79 ± 0.85%) compared to females (14.01 ± 1.36%), with a p-value &lt;0.001. Conclusion: Overall, COVID-19 affects males more severely than females, with males showing weaker immune responses and higher levels of inflammatory cytokines like IL-6 and IL-10. While IFN-ɣ levels do not differ significantly between genders, males have lower lymphocyte counts compared to females.

Antiphospholipid Syndrome and Lupus Anticoagulant: Where do we stand today ?

Antiphospholipid Syndrome and Lupus Anticoagulant: Where do we stand today ?