COVID like illness versus COVID-19 (CLIC STUDY) – Clinical profile and outcome

Background: In December 2019, several cases of acute respiratory illness were detected in Wuhan city of China. This SARS-CoV-2 has been rapidly spreading worldwide ever since. SARS-CoV-2 has the potential to damage the vital organs such as lung, heart, liver, and kidney, and infection poses a considerable risk to patients by the high prevalence of pneumonia. Aims and Objectives: The objectives of the study are as follows: (1) To study clinical profile and biochemical markers in SARI patients. (2) To compare the clinical profile and biochemical markers between SARS-CoV-2 positive and negative patients and their outcomes. Materials and Methods: The present study is a hospital-based prospective cross-sectional study conducted on a total of 350 patients (150 SARI+200 COVID-19) in Bengaluru during the study period from June 2020 to May 2021. Results: Diabetes mellitus was present in 30% of SARI and 42% in COVID-19 patients (P=0.03). Leukocytosis (Total Leukocyte Count [TLC] >11000 cells/mm3) was more common among SARI patients than COVID-19 patients (49.3% vs. 24.3%). Leukopenia (TLC <4000 cells/mm3) was significantly more common in COVID-19 patients than in SARI patients (10.2% vs. 3.6%, P<0.001). Conclusion: COVID-19 infection is more common in patients with comorbidities such as diabetes mellitus and hypertension than SARI. Leukopenia was more common in COVID-19 patients whereas leukocytosis was more common in SARI patients.

Hematological and biochemical parameters of premature kids of goats subjected to different dexamethasone protocols

ABSTRACT: Corticosteroid therapy has been used for ruminants to allow lung maturation and the birth of premature babies. However, when considering laboratory analyses of these animals, very little data is available regarding hematological and biochemical patterns, especially for premature goats, and the effects of corticotherapy on these parameters are unknown. In this context, the objective of this study was to evaluate the hematological and biochemical parameters during the first hours of life of premature kids from goats subjected to different dexamethasone protocols. For this, the goats were divided into four groups: group I, goats that received 20 mg of dexamethasone at 139 days of gestation; group II, 2 mg of dexamethasone from the 133rd to 136th day of gestation, 4 mg from the 137th to 139th, and 20 mg on the 140th; group III, 16 mg of dexamethasone from the 139th day, with repeated doses every 12 h until elective surgery; and group IV, goats that received 4, 8, 16, and 20 mg of dexamethasone at 137, 138, 139, and 140 days of gestation, respectively. Blood samples were obtained at birth (T0h) and after 1 (T1h), 12 (T12h), 24 (T24h), and 48 h (T48h) of life for hemogram and serum biochemistry assessment of urea, creatinine, total protein (PT), and gamma-glutamyltransferase (GGT). PT levels and GGT activity were lower at birth in all groups and rose after colostrum ingestion. The creatinine values for all the experimental groups did not differ between T0h and T1h; however, they decreased in the subsequent moments. Except for group I, urea concentrations were higher at T48h than at T1h. The red blood cell, hemoglobin, hematocrit, and mean corpuscular hemoglobin counts decreased over time. The total leukocyte count behaved differently in different experimental groups, and was influenced by the levels of dexamethasone, mainly due to the change in the counts of segmented neutrophils and lymphocytes. It was concluded that significant changes in the hematological and biochemical parameters occur in the first hours of life of premature kids, and that the treatment of goats with dexamethasone can affect these parameters in a dose-dependent manner.

Learning From Biological and Computational Machines: Importance of SARS-CoV-2 Genomic Surveillance, Mutations and Risk Stratification

The global coronavirus disease 2019 (COVID-19) pandemic has demonstrated the range of disease severity and pathogen genomic diversity emanating from a singular virus (severe acute respiratory syndrome coronavirus 2, SARS-CoV-2). This diversity in disease manifestations and genomic mutations has challenged healthcare management and resource allocation during the pandemic, especially for countries such as India with a bigger population base. Here, we undertake a combinatorial approach toward scrutinizing the diagnostic and genomic diversity to extract meaningful information from the chaos of COVID-19 in the Indian context. Using methods of statistical correlation, machine learning (ML), and genomic sequencing on a clinically comprehensive patient dataset with corresponding with/without respiratory support samples, we highlight specific significant diagnostic parameters and ML models for assessing the risk of developing severe COVID-19. This information is further contextualized in the backdrop of SARS-CoV-2 genomic features in the cohort for pathogen genomic evolution monitoring. Analysis of the patient demographic features and symptoms revealed that age, breathlessness, and cough were significantly associated with severe disease; at the same time, we found no severe patient reporting absence of physical symptoms. Observing the trends in biochemical/biophysical diagnostic parameters, we noted that the respiratory rate, total leukocyte count (TLC), blood urea levels, and C-reactive protein (CRP) levels were directly correlated with the probability of developing severe disease. Out of five different ML algorithms tested to predict patient severity, the multi-layer perceptron-based model performed the best, with a receiver operating characteristic (ROC) score of 0.96 and an F1 score of 0.791. The SARS-CoV-2 genomic analysis highlighted a set of mutations with global frequency flips and future inculcation into variants of concern (VOCs) and variants of interest (VOIs), which can be further monitored and annotated for functional significance. In summary, our findings highlight the importance of SARS-CoV-2 genomic surveillance and statistical analysis of clinical data to develop a risk assessment ML model.

Atypical Kawasaki disease in an early infant, a diagnostic challenge: Case report

A 4.5-month-old girl presented to us with continuous fever for 10 days and loose stools for 2 days. She received short courses of multiple oral antibiotics during this period however, was not relieved. Initial investigations were suggestive of urinary tract infection for which broad spectrum antibiotics were started. However, fever persisted even after 72 h of antibiotics. Blood counts showed persistently high total leukocyte count and increasing platelet count, along with high C-reactive protein. Consequently, a diagnosis of Kawasaki disease (KD) was suspected, which was supported by echocardiographic findings. After she received intravenous immunoglobulins, her fever subsided and lab parameters showed significant improvement. This case highlights an unusual presentation of KD in an uncommonly young age group without much clinical pointers except for persistent fever.

Chorioptes texanus causing mange in goats: comparison of two therapeutic protocols

Out of 34 caprine dermatological cases examined, 12 were detected positive for Chorioptes texanus. Pruritus, alopecia, crusts, thickening, wrinkling, cracks and fissures on legs, axillae, inguinal region and perineal region were the symptoms noticed in caprine chorioptic mange. In affected animals, reduction in haemoglobin concentration and per cent lymphocytes were noticed, along with elevation in the values of the total leukocyte count, per cent neutrophils and per cent monocytes. Values of serum glucose, zinc and copper were normal. All the 12 cases were treated with ivermectin at 10 days interval till two consecutive skin scrapings were negative for mites. In addition, all goats were treated with vitamin A supplements throughout the period. Six goats were treated topically with permethrin spray while other six animals were treated topically with lime sulphur spray. Both treatment protocols caused recovery of the animals from clinical symptoms, however, a skin scraping after 1 year revealed the presence of mites.

Haemato-biochemical changes in tuberculosis infected and healthy Asian elephants (Elephas maximus) from South India

Tuberculosis is known to be a disease of elephants for the past 2000 years. The main causative agent isolated from reported tuberculosis (TB) cases were Mycobacterium tuberculosis. The study focuses on the haematological and serum biochemical changes in the blood of TB infected Asian elephants (Elephas maximus). Twelve apparently healthy elephants and twelve TB infected elephants (confirmed by trunk wash smear positive for acid fast bacilli) were selected for the study. Neonates, pregnant elephants and elephants in musth were not included in the study. The study animals were subjected to haematological and serum biochemical evaluation. The data were analysed statistically. The results showed a significant increase in total leukocyte count, lymphocyte count, monocyte count, thrombocyte count and ESR in TB affected animals compared with apparently healthy animals. Serum creatinine, total bilirubin, direct bilirubin, globulin was significantly high in TB affected animals compared with healthy controls. Assessment of haematological and serum biochemical parameters in TB affected elephants aid in diagnosis and tracking of the infection

Haemato-biochemical and blood gas changes in bovines under multimodal anaesthesia

The study was conducted in six crossbred female cattle aged nine months to five years and weighing between 82-375 kg, to evaluate haematobiochemical and blood gas changes in during multimodal general anaesthesia. The animals were premedicated by intravenous administration of butorphanol (0.05mg/kg body weight) immediately followed by xylazine (0.02 mg/kg body weight). On achieving sedation, the animals were controlled in left lateral recumbency and induction of anaesthesia was carried out by intravenous administration of ketamine and midazolam at the dose rate of 4.0 and 0.2 mg/kg body weight respectively. Endotracheal intubation was performed and maintenance of general anaesthesia was carried out using isoflurane in 100% oxygen. The variation in total erythrocyte count, total leukocyte count, volume of packed red cells, platelet count and haemoglobin were non-significant before and after anaesthesia. A non-significant lymphocytopaenia with neutrophilia and mild variations in aspartate aminotransferase and alanine aminotransferase enzyme levels were also noticed. Blood pH reduced significantly (p<0.05) after induction of anaesthesia and returned to baseline values after recovery whereas PvCO2 (p<0.05) and base excess (p<0.01) values increased significantly after induction of anaesthesia. The blood bicarbonate did not alter significantly following induction of anaesthesia.

Application of a complete blood count to screening lethargic and anorectic cats for pancreatitis

Background Feline pancreatitis (FP) is an important health problem of cats. Its diagnostics is based on the combination of quantification of serum pancreatic lipase immunoreactivity (fPLI) and abdominal ultrasonography (AUS). These modalities allow for establishing highly specific diagnosis, however they are relatively expensive and time-consuming. On the other hand, a screening test of high sensitivity which would allow to rule out FP on the first visit without a considerable increase of costs would be clinically useful. To evaluate accuracy of nonspecific inflammatory biomarkers based on complete blood count (CBC) in diagnosing FP 73 client-owned cats with signs of lethargy and reduced appetite lasting for at least 2 days before presentation were enrolled in the cross-sectional study. They were examined with fPLI assay and AUS and classified as cats with very low risk of FP when fPLI ≤3.5 μg/L and AUS negative for FP, or as cats with increased risk of FP in the case of any other combination of results. Then, 7 various CBC measurements were measured in each cat and linked to the risk of FP using the multivariable logistic regression. Results Five CBC measurements turned out to be significantly associated with the risk of FP – total leukocyte count (WBC; crude odds ratio(ORcrude) = 12.2; CI 95%: 1.52, 98.5), total neutrophil count (ORcrude = 5.84; CI 95%: 1.22, 27.9), band neutrophil count (BNC; ORcrude = 6.67; CI 95%: 1.98, 22.4), neutrophil-to-lymphocyte ratio (ORcrude = 3.68; CI 95%: 1.25, 10.9), and eosinophil count (EC; ORcrude = 0.34; CI 95%: 0.12, 0.96). The model based on WBC, BNC, and EC proved to have at least fair diagnostic potential (area under ROC curve 82.7%; CI 95%: 72.8%, 92.5%). When WBC < 18 G/L, BNC < 0.27 G/L, and EC > 0.3 G/L was considered as a negative result, and any other combination as the positive result, the CBC model had high sensitivity (91.8%; CI 95%: 80.8%, 96.8%) at a relatively low specificity (58.3%; CI 95%: 38.8%, 75.5%). Conclusion The combination of three CBC measurements is an immediately available and fairly accurate screening method for identification of lethargic and anorectic cats with increased risk of FP.

Comparison between different methods of calculating Kt/V as the marker of adequacy of dialysis

Objectives: To compare different methods of calculating adequacy of hemodialysis in terms of Kt/V. Methods: This was an observational, quantitative study undertaken after the approval of Internal Review Board at the Hemodialysis Unit of Nephrology department, Mayo Hospital, Lahore from 1st December 2018 to 30th June 2019. Sixty hemodynamically stable patients of end stage renal disease undergoing hemodialysis for more than three months with age 18 to 70 years were included in the study by convenience non probability sampling. Critically ill patients with multiple co-morbidities like sepsis (i.e. total leukocyte count >11000 or <4000 x 109/L), ischemic heart disease, pace- makers, malignancies, cirrhosis etc were excluded. Patients who were not adherent to dialysis prescription or hemodynamically unstable were also excluded. One way ANOVA and Pearson’s correlation were used to find correlation between three methods of measuring Kt/V. Results: Mean ultrafiltration was 2.1+ 0.76 liter/session. Pre dialysis weight was 64.7 +14.7 kgs, mean post dialysis weight was 62.5 + 14.7 kgs. For every patient blood flow rate was 300 ml/m and dialysis flow rate was 500 ml/min. The mean values of Kt/V measured by Daugirdas formula was 1.35 ± 0.33, mean online clearance monitoring (OCM) value was 1.17 ± 0.29 and by normogram was 1.36 ± 0.33. There was positive significant correlation between values of Daugirdas formula, Normogram and online clearance monitoring (OCM) i.e. r = 0.897 (p-value < 0.001) measured by Pearson’s correlation and one way-ANOVA. Conclusion: Online clearance monitoring can be used for measuring adequacy of hemodialysis, but OCM slightly underestimates Kt/V as compared to Daugirdas formula and Normogram. doi: https://doi.org/10.12669/pjms.38.1.4281 How to cite this:Fazl-e-Mateen, Ahmad S, Elahi I, Anees M. Comparison between different methods of calculating Kt/V as the marker of adequacy of dialysis. Pak J Med Sci. 2022;38(1):167-171. doi: https://doi.org/10.12669/pjms.38.1.4281 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Toxicity Evaluation of Arsenic Nanoparticles on Growth, Biochemical, Hematological, and Physiological Parameters of Labeo rohita Juveniles

The present study aims to assess the induced nanotoxicity of arsenic nanoparticles (AsNPs) on different organs of fresh water fish Labeo rohita. AsNPs were synthesized by chemical reduction method using sodium arsenite as precursor, ice-cold sodium borohydride as reducing agent, and sodium hydroxide to adjust the solution pH. The synthesized AsNPs were characterized by UV-Vis spectroscopy, X-ray diffraction (XRD), and scanning electron microscopy (SEM) for optical, structural, and morphological investigations. The UV-Vis absorption peaks occurring at around 300 nm indicated the presence of AsNPs in colloidal sample. The rhombohedral crystalline nature and metallic purity of AsNPs with crystallite size of 30 ± 1 nm were confirmed by characteristic peaks of XRD pattern. The SEM micrograph revealed the almost spherical shape and 40 ± 10 nm average size prepared AsNPs. For assessment of induced nanotoxicity, juveniles of Labeo rohita (L. rohita) were exposed to three different concentrations of AsNPs (namely, 1, 10, and 20 mg/L) for 30 days (n = 15 per group), and the control fish was kept untreated. It was observed that the routine behavior activities (such as swimming, mutual interactions, and feed intake) were affected by AsNPs. The growth of AsNPs treated fish was found retarded as compared to the control fish. Total erythrocyte count, total leukocyte count, and hemoglobin and hematocrit values were low in the AsNPs treated fish. Immunobiochemical assays revealed that protein level was altered in the AsNPs treated fish. The levels of antioxidant enzymes catalase and superoxide dismutase were low in the treated fish. The histological alteration induced by AsNPs in liver, gills, and kidneys demonstrated the damage in form of glomerulus shrinkage, vacuolation, inflammation, necrosis, lamellar disorganization, and hemorrhage in comparison with untreated fish. The results of the present study indicate that AsNPs exposure causes behavior, growth, hematology, immunobiochemical, and histological shortcomings in L. rohita.