Assessment of Some Haematological, Coagulation and Immune Parameters among Male Oil Refinery Workers in Port Harcourt, Nigeria

Aim: The aim of this study was to assess the levels of some hematological, coagulation and immune parameters among male oil refinery workers in Port Harcourt, Nigeria. Study Design: This study is a cross-sectional study. Place and Duration of Study: Rivers State University Teaching Hospital (RSUTH), Port Harcourt, Shell Petroleum Development Company of Nigeria Limited and Modular Oil Refinery, Rivers State, between January 2021 and September 2021. Methodology: A total of one hundred (100) subjects (50 oil and gas workers as test subjects and 50 non-oil and gas workers as control subjects), were enrolled in the study. The convenient sampling technique was employed in the study. Venous blood samples were collected from all subjects and tested for Prothrombin Time (PT), Activated Partial Thromboplastin Time (APTT), Fibrinogen concentration, Full Blood Count (FBC) (Haemoglobin (Hb), Packed Cell Volume (PCV), Total White Blood Cell (WBC) count, Lymphocyte, Neutrophils, monocytes and Platelet Count), CD4 cell count, CD3 cell count and CD8 cell count. Data generated were analyzed statistically using Graph-Pad Prism, Version 8.0.2. Results: There was statistically significant decrease (P<.001) in Prothrombin time (PT) (11.55±0.73s), International Normalized Ratio (INR) (0.85±0.05), Fibrinogen (202.4±27.4mg/dl), Platelet count (185.6±37.1(103/μl)) and Neutrophils (46.6±6.4%) in oil refinery workers exposed to gas flare, while there was a statistical significant increase in APTT (31.8±4.15s), Hb (13.7±1.0g/dl), PCV (41.1±3.2%), Monocytes (8.4±3.0%) in subjects exposed to gas flare over control subjects with Prothrombin time(12.23±0.82s), INR(0.90±0.06), Fibrinogen(252.0±57.0mg/dl), platelet count(213.3±49.5(103/μl)) and Neutrophils(52.6±11.7%). Other parameters showed no statistical significant difference at P<.05 in both test and control subjects. Comparison of the mean ± standard deviation of the studied parameters in test subjects based on age using Analysis of Variance showed no statistically significant difference in all parameters at P<.05. Also, Comparison of the mean ± standard deviation of the studied parameters in test subjects based on duration of Exposure using Analysis of Variance showed a significant decrease in CD8 cells as the years of exposure increase (2-5years exposure = 865±319, 6-10years exposure = 579±288, 11-20 years exposure = 591± 286, F- Value = 3.869, P- Value = 0.0278). Conclusion: In conclusion, based on the findings, some haematogical, coagulation and immune parameters increased while others decreased in male oil refinery workers and duration of exposure can also be considered as a risk factor and age was considered not a risk factor as to cause any aberrations in the studied parameters.

Effect of Haemoglobin Variants on Glycemic Indices

Haemoglobin genotypes have been known to be linked with groups of diseases such as diabetes. The aim of this study is to assess the impact of haemoglobin variants on glycemic indices (fasting blood glucose and glycated haemoglobin) in subjects in Bayelsa State, Nigeria. A total of 150subjects were enrolled for the study with AA group = 99 subjects and AS group = 51 subjects. 4mls of blood was collected into EDTA bottle for each subject and was assayed for Hb electrophoresis and glycated haemoglobin (HbA1C) using electrophoretic method and automated CLOVER A1c Analyser respectively. 2mls was collected into fluoride oxalate bottle for spectrophotometric analysis of fasting blood glucose (FBG). Results revealed that there were no significant differences in the FBG and HbA1C mean levels of the two studied groups (AA and AS). This study has shown that AA and AS blood genotypes may not have any impact on FBG and HbA1C glycemic parameters.

Laboratory Methods for COVID-19 Diagnosis

Coronaviruses are a group of related RNA viruses that cause disease in mammals and birds. Covid-19 infection occurs due to an RNA virus which is single-stranded, called SARS-CoV-2; this virus is similar to SARS-CoV. This review throws light on the available laboratory techniques used for testing coronavirus. Certain challenges are encountered during the development of a diagnostic test for a novel pathogen, which depends on sensitivity of the method, that is, the potential in detecting very low pathogen level for early laboratory diagnosis, produce little or no interference with other strains of the virus, and produce results rapidly. Since the time of incubation and clinical manifestation of the infection are relatively the same with SARS, the widespread and effect of COVID-19 globally serve as the basis why the development of quick and reliable laboratory methods are necessary. Samples that could be collected for covid-19 testing includes blood (especially for screening purpose), nasal and throat swab. Currently, the gold standard method for laboratory diagnosis of Covid-19 infection is RT-PCR, which serves as a confirmatory method for Covid-19 testing. EIA and SVN laboratory techniques are other techniques used in detecting the viral infection. In addition, Rapid Diagnostic Testing (RDT) are currently developed for point-of-care testing, and often used as a screening method of Covid-19 infections. Early detection of the virus remains the primary focus for the treatment and control of SARS-CoV-2 infections. Therefore, this review was aimed at the available laboratory methods used in the diagnosis for coronavirus infection.

Inflammatory Markers in Workers Occupationally Exposed to Petrol and Petroleum Products

Place and Duration of Study: Sample: Abia State University Teaching Hospital, Aba, Abia State and Laboratory Department, JAROS Inspection Services Limited, Port Harcourt, Rivers State, between April 2018 and June 2018. Methodology: A total of 204 samples comprising of 123 auto-mechanics and 81 non -auto-mechanics were assayed. Detailed information of the bio-data of the subjects including age, gender, medical history, health information and lifestyle were obtained from each participant. Blood samples were collected from for the analysis of inflammation markers, IL-6, TNF-α and CRP were determined using standard methods and techniques. The effect of age and duration of exposure on the inflammation parameters were considered. Statistical Analysis System (SAS), STAT 15.1, developed by SAS Institute, North Carolina State University, USA was used for statistical analysis. Data were presented as Mean ± SEM, comparison of means of groups that are more than two was done using Analysis of Variance (ANOVA), and the Tukey test of multiple comparison was used to test for variance within and across groups. Results: There was significant increase in the means of IL-6, TNF-α and CRP in the exposed subjects (p <0.05) compared with the control subjects There was no significant difference (p >0.05) in the means of IL-6, TNF-α and C-reactive protein (CRP) between the age groups of the exposed and the control subjects. Similarly, there was no significant difference between the groups, based on duration of exposure. This suggests that the toxic effect does not depend on the age or duration of exposure but on other factors for the automechanics in Aba. Conclusion: This study shows that the exposure of automechanics may significantly increase the serum IL-6 TNF-α and Hs-CRP levels. Increase in the serum levels of the inflammation markers is predictive of the danger of future pathology in automechanics compared with non automechanics in Aba metropolis. Age and duration did not influence significant variation in the automechanics.

Convalescent Plasma for COVID-19- is it Time to Say Goodbye? A Single-Center, Retrospective, Observational Study from Northern India

Background: COVID-19 pandemic continues threatening the world with no effective treatment to tackle the menace. Till date, there is conflicting evidence on efficacy of CP in reducing COVID-19 related mortality. The objective of this study was to see disease progression and 7, 14 and 28-day mortality after CP therapy and analyze CP efficacy with/without Remdesivir. Materials and Methods: A retrospective single-centre observational study done from August 20, 2020, to 20 November 2020. Records of 294 COVID-19 patients with moderate to severe disease given CP therapy were analysed based on disease progression and length of hospital stay, further subcategorized on age, clinical profile, risk factors, ward/ICU, ventilatory support and co-administration of Remdesivir. Results: Lowest 7-day mortality rate was seen within age group 20-40 years (0%) and was highest in ≥61 years (24.3%). 87 patients on ventilatory support showed higher 28day mortality (48.28%) compared to non-ventilated (10.14%), (P<0.00001). Lesser 7-day mortality was seen in early CP therapy ≤3 days of admission (P=0.01). Patients requiring ICU admission showed higher 14 and 28-day mortality compared to ward P=0.001%). Median (IQR) length of hospital stay from CP transfusion was shorter, 4 (3 to 9) days in group 2 (CP only) compared to 7 (4 to 12) days in group1 (CP+Remdesivir ). Conclusion: CP therapy in ≤3 days of hospital admission in COVID-19 patients with moderate to severe infection not on ventilatory support showed reduction in mortality and length of hospital stay. Length of hospital stay was shorter in the CP-only group as compared to the CP+ Remdesivir group.

Overview of Adverse Events Associated with Anti-CD19 Chimeric Antigen Receptor T-Cell Therapy

Anti-CD19 chimeric antigen receptor (CAR) T-cells represent a novel immunotherapy that has shown remarkable success in the treatment of adult relapsed or refractory (R/R) B-cell non-Hodgkin's lymphoma, adult R/R mantle cell lymphoma, and R/R acute paediatric lymphoblastic leukaemia. One barrier to the widespread use of CAR T-cell therapy is toxicity, primarily cytokine release syndrome (CRS) with a variable grade of severity. The main manifestations of CRS are fever, hypotension, cytopenia, organ dysfunction among others. Neurological toxicities vary widely and range from headaches to encephalopathy. In addition, anti-CD19 CAR T-cell therapy provokes an array of less frequent events, such as coagulopathies, delayed cytopenia, and cardiovascular toxicities. In general, toxicities are usually reversible and resolve on their own in most cases, though severe cases may require intensive care and immunosuppressive therapy. Deaths due to CRS, neurologic toxicity and infectious complications have been reported, which highlights the gravity of these syndromes and the critical nature of appropriate intervention. In this paper, we look at all available FDA- and EMA-approved information about the pathophysiology, clinical manifestations, risk factor reviews of existing toxicity grading systems, current management strategies, and guidelines for anti-CD19 CAR T-cell toxicities. We also present new approaches, which are under investigation, to mitigate these adverse events.

Hypocholesterolemia and Statins in Multiple Myeloma

Statins are lipid-lowering agents. They also have immunomodulatory, anti-inflammatory, anti-angiogenic, and anti-proliferative functions. In this context, they are demonstrated to have beneficial effects on mortality in several malignancies including esophageal, breast, lung, liver, pancreatic, endometrial, and colorectal cancers. Multiple myeloma is considered as an incurable plasma cell disorder with current therapy; however due to the current knowledge about the correlation between cholesterol-lowering agents and myeloma; it’s suggested to have lower mortality rates for patients using statins. Patients with multiple myeloma usually have a low cholesterol level which is often underestimated by clinicians. Hereby we aimed to summarize the myeloma-hypocholesterolemia relationship and emphasize the importance of statins as an inexpensive and beneficial approach for these patients.

Coronavirus: A Laboratory Perspective

COVID-19 is a virus of the species of the Family coronaviridae known as as SARS-COV-2. This virus is easily contracted and/transmitted from an infected person to another healthy individual and has continued to spread rapidly. The aim of this review is to identify laboratory methods used in the diagnosis of COVID-19 infection. COVID-19 test are aimed at detecting active infection, or past infection, or an immunization so as to treat and curb the further spread of the virus. The initial viral detection is typically carried out with the upper respiratory tract (URT) sample. Repeated testing is particularly helpful and essential if a patient has a clinical appearance of viral pneumonia, radiographic results consistent with pneumonia and/or a history of potential exposure. The Centre of Disease Control and Prevention, CDC recommends the collection of specimens from the lower respiratory tract, upper respiratory tract, and the blood. The lower respiratory tract sample includes; the sputum, broncheoalveolar lavage, bronchial wash, tracheal aspirate, and pleural fluid. The upper respiratory tract specimens include; the nasopharyngeal swab, and oropharyngeal swab (NP/OP swabs). Some laboratory techniques developed and in use for the detection of Covid-19 are; nucleic acid amplification tests (NAATs), antibody detection, and viral antigen detection. The role of the laboratory assay in diagnosis of COVID-19 infection or disease cannot be under-estimated, timing and site of specimen collected must be followed by adequate professional training to ensure result accuracy. This review provides information on available laboratory techniques for the diagnosis of the viral infection and their potential merits and limitations.

Informed Consent in Transfusion Medicine: An Ethical Obligation Or a Legal Compulsion to Avert Liabilities for Negligence to the Health Care Provider

Blood transfusion is oftentimes life-saving but associated with risks which ought to be disclosed by the health care provider as an ethical obligation and legal requirement. The practice of informed consent to transfusion medicine is quite new and few studies have comprehensively x-rayed its historical, ethical and legal implications with an in depth consideration of professional negligence using decided cases by the adversarial and arbitration systems. PubMed, PubMed Central, Google Scholar, African Journal on Line (AJOL) electronic databases were searched using combined keywords like; “Blood transfusion and informed consent” “informed choice to transfusion medicine practice”, “consent in transfusion medicine”, “health care giver and consent to transfusion therapy”, “transfusion consent and the health care seeker”, “liability and informed consent to transfusion” and “contemporary issues in medical negligence”. Relatedly, printed materials were considered. The 91 studies that met the inclusion criteria were considered with highlights showing that, informed consent to medical treatment generally is an age long practice running from roman civilization to the present but its advocated practice in transfusion medicine a recent event. The practice is also generally low in comparison with informed consent taken for other treatments in similar settings. The consequences of dereliction including infamous conduct amongst professionals or negligence with direct and vicarious liabilities in adversary systems has been set in precedent judgments. These in addition to the present day patient-centered care model as global best practice and quality in health care delivery is compelling for health care providers to imbibe the practice not as a form of defensive medicine but a repertoire to quality and responsive Medicare service.

Survival in Patients with Acute Lymphoblastic Leukemia and COVID-19 in Mexico

Aims: To determine the survival of patients with acute lymphoblastic leukemia and COVID-19. Study Design: Prospective, analytical and relational. Place and Duration of Study: Hematology department, Hospital of Specialties, High Specialty Medical Unit, National Medical Center "Gral. Manuel Avila Camacho", Puebla, Mexico, during the period June 2020-April 2021 Methodology: Patients aged 15 to 64 years, both sexes, with acute lymphoblastic leukemia and a confirmed diagnosis of COVID-19 by PCR. The variables included were; sex, age (groups: 15-20; 21-29; 30-39; 40-49; 50-59; and 60-64), comorbidities, general treatment and hematological treatment response. Survival was determined for the diagnosis of COVID-19 for 11 months, using the Kaplan Meier estimator and the Log-Rak test; Cox regression model (univariate and multivariate); as well as Chi square and V-Cramer with a 95% confidence interval and using the statistical program SPSS Ver. 25. Results: The study consisted of 20 patients, of which 33.3% were women, with an average age of 37.75 ± 11.63 years; The men registered an age of 28.50 ± 18.05 years. Overall survival was 50%, with a lower limit of 101.3 and an upper limit of 242.5 days, with a mean of 171.9 days; and median at 17 days. No significant differences were found in survival regarding sex, comorbidities, general treatment and hematological response. However, mortality in patients with comorbidities was higher (p = 0.051). Conclusion: Survival in patients with acute lymphoblastic leukemia and COVID-19 is low, due to complications that increase mortality, mainly owing to hematological suppression, and even more so with the presence of comorbidities.