Hematological Parameters in COVID-19 Patients: Association with Severity of the Disease

The novel coronavirus (COVID-19) produced severe acute respiratory coronavirus syndrome (SARS-CoV-2; formerly known as 2019-nCoV) and has mild to fatal symptoms. This study aimed to investigate the different blood markers in confirmed positive COVID-19 individuals and see how they associated with the severity of the condition. A cross-sectional study was conducted from September 2020 to March 2021 on seventy-six (20 female and 56 male) Iraqi patients unvaccinated against COVID-19. The mean age of the study subjects was (47.00±13.31; 43.86±14.27) for males and females, respectively. 68.42% of the cases with mild illness, 14.47% with moderate illness, and 17.10% were severely ill. The severity of COVID-19 was assessed by several hematological parameters, including white blood cell (WBC) count, derived indicators such as neutrophils to lymphocyte ratio (NLR) and IL6, C-reactive protein (CRP), D-dimer, and S-ferritin. The results showed that lymphocyte count was lower in severely ill patients compared to patients with mild and moderate symptoms, with a significant difference between the three groups (2.274.83). Additionally, the NLR results showed a significant rise (11.56±1.23) in severe COVID-19. The results of the present study indicated that serum levels of IL6, CRP, and S-ferritin revealed significant differences (41.20±6.23 pg/ml), (50.66±12.55 mg/l), and (454.60±95.69 ng/ml) at (P≤0.05) in sever ill compared with mild and moderately ill patients respectively. The results indicated a highly significant positive correlation between IL6 and severity of COVID-19 infection at P<0.01. Furthermore, a positive connection is seen in Neutrophil, CRP, and NLR (0.229, 0.264, and 0.277) at (P≤0.05) respectively.

A pilot study using flash continuous glucose monitoring in patients with type-2 diabetes on multiple anti-diabetic agents during Ramadan

BACKGROUND

This study aims to examine the incidence of hypoglycaemia, based on activity, during Ramadan in patients with type 2 diabetes mellitus who were on were on three or more anti-diabetic medications.

METHODS

Type 2 diabetes patients who fasted during Ramadan and were on three or more anti-diabetic medications were studied for two weeks using flash glucose monitoring. The patients were asked to document all episodes of hypoglycaemia and were classified as active or sedentary according to their daytime activity.

RESULTS

The study included 16 patients of whom 10 were active and 6 were sedentary. There were 13 males and 3 females; mean age was 53.4 ± 6.4 years; mean diabetes duration was 15 ± 5.9 years, and mean HbA1C was 7.9 ± 1.3%. Over the two weeks; there were 7.9 episodes of hypoglycaemia recorded per patient; 50% of which were asymptomatic. There was no difference at baseline in age, BMI, HBA1C, diabetes duration, and anti-diabetic medications between the active and sedentary groups. The active group had better glucose control; median blood glucose was (7.1 (5.1-8.5) vs 10.6 (9.6-11.5) mmol p < 0.01), mean estimated HBA1C was (6.2 ± 1.2% vs 8.3 ± 1.0%; p = 0.047). The active group had more episodes of hypoglycaemia compared to the sedentary group (11.6 vs 1.8 hypo episode per patient/two weeks; p = 0.019); most of which were asymptomatic.

CONCLUSION

Patients with type 2 diabetes mellitus who are on three or more anti-diabetic medications should be warned about the increased risk of asymptomatic hypoglycaemia during Ramadan. Anti-diabetic medication adjustments during Ramadan should take into account the degree of activity. Flash glucose monitoring system can help patients to fast safely during Ramadan and detect asymptomatic hypoglycaemia.

Pattern of Diffuse Large B cell Lymphoma (DLBCL) in Aden, Yemen

DLBCL is part of aggressive lymphomas with limited survival in the absence of effective treatment.

AIM

The aim of this study was to determine the frequency and the pattern of presentation of DLBCL in patients diagnosed in Aden.

METHODS AND MATERIAL

It was conducted prospectively in Aden, at Al-Amal Oncology Unit of Al-Gamhouria Modern General Hospital. All patients confirmed to have NHL by histopathology were selected from Jan. 1st to Dec. 31st, 2009. They were clinically examined and investigated for clinical staging and classification.

DATA ANALYSIS

DATA ANALYSIS was conducted by the SPSS 18 program, using the Chi square, Fisher Exact, hypothesis test (Z-test) and student t-tests.

RESULTS

The frequency of DLBCL was 35%. In DLBCL, the median age was 51.5 years, with male to female ratio of 3.67:1. Clinically, most patients were nodal and B symptoms were present in 64.3% of them; weight loss and sweating were reported more than in the other subtypes of NHL. Investigations showed that 64.3% were anemic, 35.7% with high ESR and high β2 microglobulin, 21.4% with low albumin and high uric acid. Half of them presented in stage III and IV disease and according to the IPI scoring, 64.3% presented with intermediate to high risk disease. Comparison with other NHL subtypes was performed and showed that DLBCL is associated with aggressive pattern of presentation.

CONCLUSION

This study concluded that DLBCL is an aggressive NHL at presentation and needs immediate diagnosis and intervention to improve the outcome.

KEYWORDS

DLBCL, NHL, Lymphoma, Pattern, Aden, Aggressive.

The technical aspects and clinical significance of detecting extended-spectrum beta-lactamase-producing Enterobacteriaceae at a tertiary-care hospital in Kuwait

Extended-spectrum beta-lactamase (ESBL) production by Enterobacteriaceae is an emerging problem. This 3-year prospective study was undertaken to determine the prevalence of such enzymes among the clinically significant isolates of the Enterobacteriaceae family gathered from patients, and to evaluate the different techniques for their detection as well as their clinical significance. Members of the Enterobacteriaceae family isolated from blood, inhibited by the third-generation cephalosporins with minimum inhibitory concentrations (MICs) of < or =2 microg/ml and MIC < or =8 microg/ml and isolates from other sources inhibited by MIC < or =8 microg/ml were also investigated for ESBL production by VITEK2 and E test. Their clinical significance in septicemic patients was analyzed. Out of 3,215 isolates, 1018 (31.7%) were ESBL-producers by both VITEK2 and E test. Of these, 428 (42%) were Klebsiella pneumoniae and 376 (37.0%) were Escherichia coli with overall prevalence rates of 13.3% and 11.7%, respectively. There were a total of 184 septicemic patients infected by ESBL-producing Enterobacteriaceae out of which 134 (73%) needed modification of therapy; most (58%) of these patients were initially on third-generation cephalosporin therapy. A total of 58 (31.5%) patients were infected by ESBL-producing blood isolates which were inhibited by cefotaxime/ceftriaxone at MICs =8 microg/ml (within the susceptibility range). Resistance to both aminoglycosides and quinolones were significantly higher among ESBLproducing isolates compared to non-producers (P <0.05). This study highlights a high prevalence of ESBL-producing Enterobacteriaceae in a major tertiary teaching hospital in our country and demonstrates that almost a third of the ESBL-producing Enterobacteriaceae blood isolates would have been released as susceptible by routine susceptibility testing; a finding inimical to optimal therapeutic success.

The impact of problem-based pharmacotherapy training on the competence of rational prescribing of Yemen undergraduate students

OBJECTIVE

This study aims to reveal whether a short training course of problem-based pharmacotherapy teaching, based on the World Health Organization's (WHO's) Guide to Good Prescribing and the Yemen Essential Drug List and Standard Treatment Guidelines, will improve the competence of rational prescribing among medical and health assistant students in Yemen.

DESIGN

In a controlled pre/post-test study, 111 students from universities and health institutes participated on a voluntary basis. They were randomly separated into a study and a control group. Students of the study group were taught to generate standard first-choice drugs for asthma or diarrhoea. The students were then taught how to apply this set of first-choice drugs to specific patient problems, using the WHO six-step problem-solving approach.

RESULTS

Students from the study group performed significantly better than those from control in all problems presented and also when compared with the results of the pre-test. The results of the pre-test also show that teaching students all basic knowledge about drugs does not guarantee rational prescribing in Yemen.

CONCLUSION

It can be concluded from this study that proper training, i.e. 'immunising' future doctors using problem-based pharmacotherapy teaching, is an efficient way of teaching rational prescribing in Yemen.