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   Table of Contents - Current issue
October-December 2022
Volume 47 | Issue 4
Page Nos. 233-325

Online since Thursday, March 9, 2023

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Prognostic value of neutrophil/lymphocyte ratio, lymphocyte/monocyte ratio, lactate dehydrogenase, and mean platelet volume in the diagnosis of patients with diffuse large B-cell lymphoma p. 233
Mehmet Bakirtas, Semih Basci, Burcu Aslan Candır, BaharUncu Ulu, Samet Yaman, Tuğçe Nur Yiğenoğlu, Mehmet Sinan Dal, MerihKızıl Çakar, Fevzi Altuntaş
Background Diffuse large B-cell lymphoma (DLBCL), a heterogeneous type of lymphoma, encompasses various biologic abnormalities and numerous morphologic variants, showing several clinical findings and responses to treatments. Lactate dehydrogenase (LDH) is a well-established diagnostic and prognostic marker for DLBCL, and neutrophil/lymphocyte ratio (NLR), lymphocyte-to-monocyte ratio (LMR), and mean platelet volume (MPV) have been shown to have prognostic values in several malignancies. Objectives In the study, we examined the prognostic value of LMR, NLR, LDH, and MPV in the stage and prognosis of DLBCL by analyzing the data of patients treated with rituximab-based chemotherapies. Patients and methods A total of 188 patients diagnosed as having DLBCL between January 2012 and January 2020 were selected. DLBCL stages were categorized as early and late, international prognostic index was categorized as below and above 4, and the treatment response was categorized as responders and nonresponders. NLR, LMR, LDH, MPV, and other factors predicting these outcomes were analyzed. Results Logistic regression analysis showed that the factors influencing stage of DLBCL were NLR [P=0.009, odds ratio (OR)=1.220, 95% confidence interval (CI): 1.050–1.417] and LDH (P=0.001, OR=0.286, 95% CI: 0.146–0.561). The factor influencing international prognostic index score was LMR (P=0.001, OR=6.226, 95% CI: 2.092–18.533). Factors influencing response were R-CHOP treatment (P=0.001, OR=0.181, 95% CI: 0.068–0.478) and stage (P=0.005, OR=18.306, 95% CI: 2.383–140.607). Conclusion The pretreatment LMR, NLR, LDH, and MPV values may affect the stage and prognosis of DLBCL, which showed influences on the treatment response.
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Predictive value of neutrophil-to-lymphocyte, lymphocyte-to-monocyte, and platelet-to-lymphocyte ratios in adult and pediatric acute lymphoblastic leukemia patients p. 239
Mariam K Youssef, Rania A Radwan, Sara M Makkeyah, Sara I Taha
Background Methods used for prognostication of acute lymphoblastic leukemia (ALL) are expensive; discovering low-cost prognostic factors is challenging. Objectives This study aimed to explore the prognostic role of baseline neutrophil-to-lymphocyte (NLR), lymphocyte-to-monocyte (LMR), and platelet-to-lymphocyte (PLR) ratios in predicting the response to end of induction chemotherapy in ALL patients. Patients and methods We included 44 adult patients and 47 pediatric patients who were newly diagnosed with ALL. All participants were subjected to a full history taking and a thorough medical examination. Laboratory investigations included complete blood count (CBC) with differential count analysis, with calculation of NLR, LMR, and PLR; bone marrow examination; conventional cytogenetic analysis; and immunophenotyping. Patients were followed until the end of the induction phase, and their response to treatment was assessed. Results Among the adult patients, 63.6% showed complete remission at the end of induction; their baseline CBC showed significantly lower NLR (P=0.001) and higher LMR (P=0.013). On the other hand, 66% of the pediatric patients showed good response to induction chemotherapy; their baseline CBC showed significantly lower NLR (P<0.001), greater LMR (P=0.0134), and lower PLR (P=0.017). NLR more than or equal to 1, LMR less than or equal to 2.846, and PLR more than or equal to 39.1 were able to discriminate adult patients who will respond to induction chemotherapy, similarly NLR more than or equal to 1, LMR less than or equal to 3.286, and PLR more than or equal to 10 among pediatric patients. Conclusion Our research discovered that the rise in NLR and PLR, together with the decline of LMR at ALL diagnosis, could predict future resistance to the routinely used induction protocols, and the need for intensification regimens.
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Cortactin: A novel prognostic marker in chronic myeloid leukemia p. 249
Mostafa K El-Razzaz, Tamer M Ahmed, Deena S Eissa, NourElhoda H Abdalla, Mohammed A Shaheen, Haydi S Mohamed
Background Chronic myeloid leukemia (CML) is a clonal myeloproliferative disease characterized by leukocytosis and an accumulation of granulocytes and their precursors. Cortactin is an actin-binding protein substrate of Src kinase. High cortactin expression in many hematological malignancies has been correlated with adverse prognostic factors. Aim The aim of our study was to measure cortactin levels in patients with CML at diagnosis and correlate such levels with other prognostic factors. Patients and methods This is a case–control study that was executed at hematology unit, Ain-Shams University Hospital during the period between January 2021 and October 2021. The study included 25 newly diagnosed patients with chronic phase CML and 25 healthy controls. Accelerated phase and blast crisis were excluded from the study. Results Cortactin level at diagnosis was higher in the patients group compared with the control group (71.04 ± 20.04 vs. 36.8 ± 11.6%, P<0.001). Cortactin level was significantly higher in patients who did not achieve complete hematological remission (CHR) at 3 months in comparison with those who achieved CHR (88.49 ± 8.02 vs. 61.23 ± 17.98, P<0.001). Patients who failed to attain CHR at 3 months had a significantly worse prognostic score at diagnosis using Sokal, Hasford, and ELTS scores (P=0.016, 0.035, and 0.009, respectively), but this did not apply to EUTOS score (P=0.089). Conclusion Higher cortactin levels are associated with delayed CHR in newly diagnosed patients with chronic phase CML, and it can be used as a prognostic marker for patients with CML at diagnosis.
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Simple prognostic markers in patients with hematological malignancies and coronavirus disease 2019 infection: Single-center experience p. 255
Nahed M Rakha, Dalia Abdel E Mohammed, Noha B Hassan, Nour El Hoda H Abdalla
Background Coronavirus disease 2019 (COVID-19) pandemic rapidly spread from China to other countries. The clinical features of patients with COVID-19 have revealed a number of potential biochemical markers associated with in-hospital mortality. Numerous studies have proposed the use of hematological markers that seem to associate with increased severity and mortality in patients with COVID-19. Aim To evaluate the prognostic value of some hematological parameters and inflammatory biomarker effect on overall survival (OS) and mortality on patients with hematological malignancies infected with COVID-19. Patients and methods A cross-sectional study of 50 adult Egyptian patients with different hematological malignancies were recruited from Clinical Hematology Department, Ain Shams University Hospital, over the period from December 2020 to October 2021. Results The mean of neutrophil-to-monocyte ratio (NMR) was 0–110 and median interquartile range 7.40 (3.0–16.67)×103/µl and there is significant correlation between NMR and OS with P value of 0.031, there is significant correlation between OS of those patients and D-dimer, ferritin, hematocrit, and red-blood cell count. Conclusion There are simple, easy, and rapid tests such as the NMR, inflammatory biomarkers (ferritin and D-dimer), and some hematological parameters (hematocrit and red blood cell) that have prognostic value on OS and mortality on patients with hematological malignancies infected with COVID-19.
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Determination of hematological response to iron and folic acid supplementation among the expectant mothers attending Kakamega County Referral Hospital, Kenya p. 262
Kirui Dennis, Dominic Marera, Tom Were
Background Despite iron and folic acid supplementation program among expectant mothers while attending antenatal care clinic at Kakamega County, the rates of maternal and fetal morbidity and mortality due to anemia complications are still high. Aim First, we determined changes in hematological profiles following iron and folic acid supplementation. Second, we determined association between hematological changes with demographic and clinical characteristics in response to iron and folic acid supplementation. Patients and methods Full hemogram and reticulocyte profiles of 127 expectant mothers were determined at baseline and endpoint after 1 month of iron and folic acid supplementation. Full hemogram profiles were measured using a Maxim 3010 fully automated hematology analyzer, whereas reticulocyte profiles were examined microscopically at ×100 magnification. Demographic data were collected using pretested structured questionnaires. Results The end point measures of red blood cells, hemoglobin (Hb), hematocrit, mean cell volume, reticulocyte count, reticulocyte production index, and absolute reticulocyte number among the anemic mothers were significantly higher relative to baseline levels. Among nonanemic mothers, Hb and mean cell volume levels differed significantly between baseline and end point of the study. The change in erythropoietic response and adequate Hb response was significantly associated with adherence to iron and folic acid supplement. Conclusion Hematological profiles significantly changed especially among anemic mothers following iron and folic acid supplementation. Adherence to supplement is associated with positive erythropoietic response and adequate Hb response.
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Low leukocyte count in Langya henipavirus and severity of infection: A brief report p. 270
Rujittika Mungmunpuntipantip, Viroj Wiwanitkit
Aim The aim is to determine the leukocyte count in Langya henipavirus infection. Background The ‘Langya henipavirus’ is a brand new viral pathogen that first appeared in 2022. In the Chinese cities where this new virus was discovered, a big population was found with this infection. Despite the fact that the particular mode of transmission is unknown, zoonosis looks to be a possibility. Clinical medicine has little knowledge of the clinical symptoms of a recent infection. Methods The authors look into the signs of Langya henipavirus infections, including a low leukocyte count. Results Although the actual source of the new disease’s white blood cell dysfunction is unknown, a range of immunological or nonimmunological variables could be involved. Conclusion A low leukocyte count, according to current studies, can signal a severe infection. More research is required to validate this finding.
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Tyrosine kinase inhibitors reduce myeloid-derived suppressor cells in patients with chronic myeloid leukemia with better outcome p. 272
Youmna Refaat, Youseria A Rahman, Mostafa F Mohammed Saleh, Douaa M Sayed, Mona H Elzohri
Background and objectives Myeloid-derived suppressor cells (MDSCs) are increased in several hematologic malignancies. We looked at the effect of imatinib and nilotinib (tyrosine kinase inhibitors) on MDSCs in patients with chronic myeloid leukemia (CML) and how those cells could affect prognosis in CML. Patients and methods A randomized controlled trial was conducted that enrolled 103 patients with newly diagnosed chronic phase CML who were randomly subgrouped into group I, which included patients treated with oral imatinib (n=58) 400 mg/day, and group II, which included patients treated with oral nilotinib (n=45) 600 mg/day. Follow-up of BCR/ABL transcript was measured by quantitative PCR every 3 months. Moreover, detection of the percentages of granulocytic-MDSCs and monocytic (M-MDSCs) in the peripheral blood (HLA-DR/CD11b//CD33/CD14) by flow cytometry was done at baseline and during follow-up. Results Both groups had insignificant difference regarding baseline laboratory and clinical data. Both groups showed significant reduction in MDSCs but with insignificant differences between both of them. Patients did not achieve major molecular response (MMR) and had significantly higher M-MDSCs at baseline. Moreover, baseline M-MDSCs were a predictor for MMR (odds ratio=0.78, 95% confidence interval=0.66–0.93) and for loss of MRR (odds ratio=2.17, 95% confidence interval=1.22–3.87). For prediction of MMR, baseline M-MDSCs had 89.2% accuracy at cutoff point less than 8.9% and had 89.5% accuracy for prediction of loss of MMR at a cutoff point more than 8.5%. Conclusion Both imatinib and nilotinib are effective in reducing MDSCs in patients with CML. Baseline M-MDSCs are predictors of MMR and loss of response in patients with CML. The study was registered on clinicaltrials.gov with NCT03214718.
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Augmented Berlin-Frankfurt-Munster versus GRAALL-2003 in young adults with Philadelphia-negative, B-cell acute lymphoblastic leukemia: A single-center experience p. 281
Fady E I Ghobrial, Heidi Elkerdawy, Mostafa Abdelhakiem, Shaimaa El-Ashwah
Background Acute lymphoblastic leukemia (ALL) is a heterogeneous group of diseases characterized by clonal proliferation of lymphoblasts. Improvement in the outcome of ALL in adolescents and young adult (AYA) patients remains one of the challenging problems in ALL treatment. Aim This study was conducted to compare the outcome of polychemotherapy regimens, augmented Berlin-Frankfurt-Munster (ABFM) regimen and GRAALL-2003, in Philadelphia-negative, B-cell ALL in AYA patients. Patients and methods A single-center retrospective study was performed on AYA patients with Philadelphia-negative, B-cell ALL who were diagnosed between 2013 and 2019. Results A total of 37 patients were included (27 males and 10 females) with a mean age of 22.3 years. Complete remission (CR) rate in the ABFM group was 94.1 versus 75% in the GRALL-2003 group (P=0.1). There was no statistically significant difference regarding relapse rate between both regimens (P=0.2). Regarding toxicities, there was no statistically significant difference between the two regimens apart from ICU admission rate, which was statistically significantly higher in the GRAALL-2003 group compared with the ABFM group (P=0.048); however, it had no influence on the overall survival. Conclusion The outcome of both polychemotherapy regimens, ABFM and GRAALL-2003, was comparable regarding CR rate, relapse rate, overall survival, and toxicity profile apart from a noticeable increased rate of ICU admission in GRAALL-2003 regimen, which makes ABFM regimen the more feasible option in treatment.
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Platelet/lymphocyte, neutrophil/lymphocyte, and red-cell distribution width/platelet ratios for assessment of hepatitis-C virus infection severity p. 288
Ghada M Abdelsalam, Hossam Hodeib, Tamer A Elbedewy, Loai M ElAhwal, Mohamed S Aboelnasr
Introduction Chronic hepatitis C is a global health problem with high cost, morbidity, and mortality. There is increasing need for noninvasive parameters to assess disease severity. Some parameters obtained from routine full-blood count are used as indicators for systemic inflammation. These include platelet/lymphocyte ratio (PLR), neutrophil/lymphocyte ratio (NLR), and red-cell distribution width-to-platelet ratio (RPR). The aim of the present study was to investigate the utility of these parameters in assessment of hepatitis-C virus disease severity. Patients and methods The study population included 180 participants who were divided into four groups. Group I included 90 healthy participants as control. Group II included 30 patients in sustained virus response after 6 months of treatment with direct-acting antiviral agents. Group III included 30 untreated noncirrhotic patients with chronic hepatitis C. Group IV included 30 untreated cirrhotic patients. All underwent thorough clinical evaluation and investigations, including PLR, NLR, RPR, aspartate aminotransferase to platelet-ratio index, and fibrosis index based on the 4 factors. Results NLR did not express significant difference among the studied groups (P=0.998). When moving from the first to the fourth group, PLR showed a gradual decrease being significantly lower in group IV (P<0.001), while RPR showed a gradual increase being significantly higher in group IV (P<0.001). Conclusion PLR and RPR were closely related to disease severity in patients with hepatitis-C virus-related liver disease. NLR was not correlated to disease severity in the same cohort.
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DNMT3A-448A>G nucleotide polymorphism and susceptibility to acute myeloid leukemia in a cohort of Egyptian patients p. 294
Essam H Elnoshokaty, Gamal T Ebid, Mohamed A Fahmy, Tarek M Shikhon, Rania M Gawdat
Background DNA-methyltransferase 3 A (DNMT3A) plays an important role in DNA methylation. Its mutation is the commonest mutated epigenetic regulator in acute myeloid leukemia (AML). However, the relation between DNMT3 polymorphism and AML risk in Egyptian patients is still unknown. Objectives To detect the frequency of DNMT3A-448A>G (rs 1550117) single nucleotide polymorphism in a cohort of adult Egyptian patients with AML and normal controls matched by age, sex, and ethnicity and to assess its effect on the susceptibility of AML. Patients and methods PCR-restriction fragment length polymorphism was the genotyping method used to assess DNMT3A polymorphism in the present case–control study. Results The frequency of the wild (GG), mutant heterozygous (AG), and mutant homozygous (AA) genotypes among patients and controls were 47.90 versus 47.70%, 46.50 versus49.20%, and 5.60 versus 3.10%, respectively (P=0.763, 0.505, and 0.462, respectively), whereas the frequency of A allele was 28.87 versus 27.69% P=0.829. The patients with DNMT3A mutant types (AG, AA, and carrier of the variant Allele of the DNMT3A) were not associated with the risk of AML (odds ratio: 0.548, 0.516, and 0.934; 95% confidence interval: 0.094–3.206, 0.088–3.014, and 0.556-1.60, respectively). Conclusion DNMT3A-448A>G (rs 1550117) polymorphism conferred no risk to AML in our studied Egyptian patients.
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Refractory splenectomized immune thrombocytopenic purpura: Does vincristine have a role after thrombopoietin receptor agonist failure? p. 299
Sawsan M Moeen, Ahmad F Thabet, Mohamed A Morad
Introduction The treatment options for patients with refractory splenectomized chronic immune thrombocytopenic purpura (ITP) are often unsatisfactory despite different lines of treatment, especially after thrombopoietin receptor agonist (TPO-RA) failure. Objective This study was done to assess the efficacy of vincristine in the treatment of patients with splenectomized chronic ITP who failed TPO-RA therapy as well as their 8-month follow-up following vincristine discontinuation. Patients and methods A total of 12 patients with splenectomized chronic ITP who failed to respond to TPO-RA were treated with vincristine 1–2 mg weekly for 6 weeks. Results The platelet count was evaluated during the treatment, and every 2 months for 8-month follow-up. The mean platelet count was significantly increased at the third, fourth, fifth, and sixth weeks during the treatment and persistently elevated during the second, fourth, and sixth months of follow-up when compared with the baseline platelet count, while decreasing at the 8-month follow-up, with no significant difference at their baseline. Conclusion Vincristine could be an effective treatment in patients with splenectomized ITP who failed to respond to TPO-RAs and in patients requiring a short-term increase in the platelet count.
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Telemedicine in patients with hematological diseases during the coronavirus disease 2019 (Covid-19) pandemic: Beneficial care or waste of time? p. 304
Rasha Rawi, Marwa Salah, Mervat Mattar, Noha M El Husseiny, Mohamed A Morad
Introduction Telemedicine (TM) is a method for follow-up of patients experiencing chronic morbidities, such as those with myeloproliferative neoplasms (MPNs) and thalassemia, particularly during the coronavirus disease 2019 (COVID-19) pandemic. Objective To assess medical services administrated to patients with MPNs and thalassemia after 6 months of online follow-up. Patients and methods During the COVID-19 pandemic, of 250 patients who were regularly following up in the hematology clinic, only 45 patients with MPNs and 30 patients with thalassemia were able to connect through the WhatsApp group. Six months later, a questionnaire was given to patients. We asked if COVID-19 affected their routine medical service and receipt of their treatment. Finally, did they attend the clinic despite TM service and why?Results Two patient groups were included. A total of 75 patients were included, comprising 56 (80%) females and 19 (20%) males. The median age was 51.2 (16–73) years in the MPN group and 29.5 (17–50) years in the thalassemia group. All patients with MPNs found the application easy to use, whereas 93.3% of patients with thalassemia found the application to be easy. TM consultations increased since the start of online follow-up for 41 patients, with no change in three and decreased in one patient. Seven patients had suspicious COVID symptoms, and four of them notified the consultant. During the follow-up, about 205 consultations and 300 laboratory results had been medically debated through WhatsApp groups or audio-visual calls. Conclusion Evidence supports that TM is a fast, safe, and effective tool to increase care and decrease morbidity for both patients with MPNs and adult patients with thalassemia during the pandemic time.
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The association between anemia and hypovitaminosis D p. 308
Raed A Alharbi
Background Hypovitaminosis D (deficiency and insufficiency) and anemia are both known as major public health concerns globally. A suboptimal level of vitamin D has been suggested to be a potential trigger player for reduced hemoglobin levels, thus increasing the risk of anemia. Objective The purpose of this study was to determine the prevalence of hypovitaminosis D and anemia, as well as the relationship between the two. Patients and methods Demographic and laboratory data were collected and analyzed (Pearson’s correlation and multivariate logistic regressions) using IBM Statistical Package for SPSS, and graphical data visualization was performed using the R programming language and R-based Rstudio. Results The overall prevalence of vitamin D deficiency was 75% (n=302), whereas insufficiency and sufficiency were 19.7 and 4.5%, respectively. Vitamin D deficiency was most prevalent in the 30–49-year age group (n=155, 81%), whereas it was least prevalent in the 50–69-year age group (n=63, 65%). A significant positive Pearson’s correlation was found between vitamin D concentration and hemoglobin at the 0.05 level (r=0.133 and P=0.05) and between vitamin D concentration and the patient’s age in years at the 0.01 level (r=0.157 and P=0.01). Anemia was found to be prevalent in 36% of the population. Normocytic anemia was the most prevalent type, followed by microcytic anemia. Conclusion The role of hypovitaminosis D as a risk factor for anemia is unknown, and thus multiple longitudinal and interventional studies are recommended to establish an association between vitamin D deficiency and anemia.
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Pattern of HLA types in renal transplant patients in Sohag Governorate: A cross-sectional study p. 316
Emad A M Yossef, Eman M Salama, Ahmad M M A Elsharif
Objective This study aimed to assess the pattern of HLA types in Egyptian renal transplant patients in the Sohag governorate. Materials and methods A retrospective chart review was conducted on all patients and their donors, who were scheduled to undergo renal transplantation at Sohag University Hospital through the period from January 2010 to December 2019. We retrieved the following data from eligible patients’ files: age of the recipient and donor, gender of the recipient and donor, consanguinity, blood group, cross-matching, HLA classes A and B, and DR alleles. Results Overall, a total of 26 recipients (70.3%) and 25 donors (67.6%) had HLA-A alleles, while 22 recipients (59.5%) and 26 donors (70.3%) had HLA-B alleles. In terms of the pattern of HLA-A distribution among recipients, the most frequent alleles were A*01/02 (8.1%), A*02/23 (5.4%), A*02/32 (5.4%), and A*02 (5.4%). On the other hand, the most frequent HLA-A alleles in the donors’ group were A*01/02 (5.4%), A*02/03 (5.4%), and A*26/68 (5.4%). Regarding HLA-B allele distribution, all recipients had different alleles. While B*41/52 was the most frequent allele in the donors’ group. All recipients, except two patients, had HLA-DR alleles, most commonly DR*11/13 (13.5%) and DR*13/15 (8.1%). Negative cross-matching was present in 59.5% of the cases. Among female recipients, only A*13/15 and B*27/51/53 alleles were detected. Conclusion In conclusion, our findings were very similar to the results from other local and global studies. Different populations and ethnicities are the main dependent variables of the major differences in terms of HLA allele distribution.
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Interrelationship between G-6-PD-deficiency frequency and accumulated number of coronavirus disease 2019 cases: An observation from provinces in a highly endemic area in Indochina p. 321
Rujittika Mungmunpuntipantip, Viroj Wiwanitkit, Pathum Sookaromdee
Background The relationship between coronavirus disease 2019 (COVID-19) incidence and genetic background is an important clinical issue. A relationship has been proposed between COVID-19 and congenital hereditary blood disorder. Methods The authors report on a link between G-6-PD deficiency frequency and COVID-19 prevalence in an endemic area of a tropical Indochina country where G-6-PD deficiency is common. Results The scattergram can illustrate the descriptive distribution of both researched parameters based on the original data. There is no evident pattern of association between G-6-PD-deficient carrier frequency and COVID-19 incidence in the dual axis image. Conclusions In the research scenario, there was no significant link between G-6-PD insufficiency frequency and COVID-19 incidence, according to the data.
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Unwelcome guests in monocytes: Peripheral blood histoplasmosis p. 323
Asish Rath, Ganesh K Vishwanathan
Disseminated histoplasmosis is a serious and life-threatening opportunistic infection in patients with HIV/AIDS. An early diagnosis and appropriate therapy can save lives. The diagnosis predominantly relies on clinical suspicion, radiological investigations, and histopathology. Rarely, Histoplasma can be identified in peripheral blood monocytes or neutrophils. However, a careful peripheral blood smear examination is needed and can result in an early diagnosis. We present a case of a 28-year old young man suffering from HIV/AIDS, who could be diagnosed with disseminated histoplasmosis with a careful peripheral blood smear examination.
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