Microbiology
Abdolreza Javadi; Shahriar Dabiri; Manzumeh Shamsi Meymandi; Mohammad Hashemi-Bahremani; Hussein Soleimantabar; Bahram Dabiri; Houman Vosough; Maryam Gheidi Sharan; Farnoosh Sedaghati
Abstract
Background & Objective: Coronavirus disease 2019 (COVID-19) is progressively spreading, and many researchers have focused on the prognostic value of laboratory analyses. This study reviewed routine blood parameters, upper respiratory viral load, and chest imaging in recovered and expired COVID-19 ...
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Background & Objective: Coronavirus disease 2019 (COVID-19) is progressively spreading, and many researchers have focused on the prognostic value of laboratory analyses. This study reviewed routine blood parameters, upper respiratory viral load, and chest imaging in recovered and expired COVID-19 patients and evaluated possible correlations.Methods: In this retrograde study, 138 COVID-19 cases were enrolled. Chest tomography scores of patients, routine hematologic and biochemical parameters, and respiratory viral loads were measured. Furthermore, their correlation with severity of disease and the outcome was investigated during a week of admission.Results: The mean age of participants was 58.6±16; 36.2% of whom were diagnosed as critical, 8.7% expired, and 46% showed less than 50% lung opacity. The expiring rate was only correlated to the severity of illness and viral load. During admission, hemoglobin concentration was decreased in critical patients (from 11.49±0.27 to 10.59±0.36, P=0.042) and also among CT-scan scoring groups (P=0.000), while neutrophils (P=0.04), WBC (P=0.03), and platelets (P=0.000) count were increased. In patients with more than 50% lung opacity, leukocyte counts were decreased, but neutrophil and platelets counts showed raise (all P<0.05), while other hematologic parameters did not change. CRP and LDH demonstrated no increase based on the severity of the illness, RT-PCR viral loads and/or outcome. However, both CRP and LDH were increased in patients with more than 50% lobal opacity (CRP: 69.3±9.9 to 1021.1±7.5 and LDH:589.5±93.2 to 1128.6±15.81, P<0.05).Conclusion: We found that hemoglobin, white blood cells, neutrophil, lymphocytes, and platelets count together with chest tomography score might be beneficial for expedition the diagnosis, assessmen the severity of the disease, and outcome in the hospitalized cases, while CRP and LDH might be considered as the consequence of lung involvement.
Microbiology
Alireza Abdollahi; Samaneh Salarvand; Vahid Mehrtash; Bita Jafarzadeh; Mohammadreza Salehi; Reza Ghalehtaki; Saeed Nateghi
Abstract
Background & Objective: COVID-19 reverse transcription-polymerase chain reaction (RT-PCR) has been a reference test for diagnosing a disease since the very beginning of the pandemic. COVID-19 serology tests have also been developed and used to estimate the prevalence of individuals who have already ...
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Background & Objective: COVID-19 reverse transcription-polymerase chain reaction (RT-PCR) has been a reference test for diagnosing a disease since the very beginning of the pandemic. COVID-19 serology tests have also been developed and used to estimate the prevalence of individuals who have already been infected. We aimed to evaluate the performance of serology tests for the diagnosis of patients who had been referred to medical centers with acute symptoms.Methods: In this cross-sectional study, 80 individuals suspected of COVID-19 who had been referred to Imam Khomeini Hospital Complex, Tehran, Iran, were examined. Upper respiratory tract specimens for RT-PCR and blood samples for COVID-19 IgM and IgG antibody level tests were collected and the results were compared. Results: The overall proportion in agreement, the agreement between positive results, and the agreement between negative results when comparing RT-PCR and IgM serology test were 40% (kappa = -0.006, P = 0.9), 32%, and 66.6%, respectively, and when comparing RT-PCR and IgG serology test were 46% (kappa = -0.006, P = 0.94), 43.5%, and 55.5%, respectively.Conclusion: The absence of a gold standard method for the diagnosis of COVID-19 makes it very challenging to determine the true sensitivity and specificity of different methods. The study results revealed no agreement between the two methods; so the RT-PCR test for upper respiratory tract specimen cannot be replaced with COVID-19 serology test for the diagnosis of patients with acute symptoms.
Microbiology
Alireza Abdollahi; Samaneh Salarvand; Vahid Mehrtash; Bita Jafarzadeh; Reza Ghalehtaki; Saeed Nateghi
Abstract
Background & Objective: The prevalence of COVID-19 and its severity have been observed to be on a lower level in underdeveloped countries with poorer standards of hygiene. This disparity may be attributed to the higher seroprevalence of other viral diseases which can result in the presence of antibodies ...
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Background & Objective: The prevalence of COVID-19 and its severity have been observed to be on a lower level in underdeveloped countries with poorer standards of hygiene. This disparity may be attributed to the higher seroprevalence of other viral diseases which can result in the presence of antibodies protective against COVID-19. Two of the widespread diseases in such countries are infection to hepatitis A and E viruses (HAV and HEV). In the present study, we explored the relationship between the level of antibodies against these viruses and the susceptibility to COVID-19.Methods: Ninety patients were studied in two groups of controls and cases each consisting 45 individuals. The cases were patients with the clinical symptoms of COVID-19 and positive RT-PCR test results. The controls were individuals referred to the respiratory triage of Imam Khomeini Hospital Complex and were not demonstrating relevant clinical symptoms of COVID-19 and their RT-PCR test results were negative. Levels of HAV and HEV antibodies were measured and compared in these two groups.Results: The median of HAV antibody level was 13.6 (IQR=11.5-16.9) and 13.2 (IQR =10.7-14.7) in cases and controls, respectively, showing no statistically significant difference (P = 0.1). Likewise, the median of HEV antibody level was 6.7 (IQR=5.3-7.1) and 7.1 (IQR=6.3-7.5) in cases and controls, respectively, which again showed no statistically significant difference (P=0.41).Conclusion: The present study was carried out in a region with a relatively high prevalence of HAV and HEV infections. Contrary to our expectations, no statistically significant relationship was observed between the levels of antibodies against these viruses and the susceptibility to COVID-19. Further studies with larger sample sizes and in other countries are needed to come to a definite conclusion.
Infectious Diseases
Maryam Sarkardeh; Amin Dalili; Naser T Tayyebi Meibodi; Mostafa Izanlu; Seyed Javad Davari-Sani; Saeed Moghaddamzade; Mehdi Jamalinik; Seyed Javad Hosseini; Javad Koushki; Ali Abedia
Abstract
Novel coronavirus disease 2019 (COVID-19) as a potential health risk factor continues to spread throughout the world. Although common symptoms include headache and respiratory symptoms, some studies have suggested that COVID-19 may cause coagulation disorders and thrombolytic events, disrupt blood flow ...
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Novel coronavirus disease 2019 (COVID-19) as a potential health risk factor continues to spread throughout the world. Although common symptoms include headache and respiratory symptoms, some studies have suggested that COVID-19 may cause coagulation disorders and thrombolytic events, disrupt blood flow to the visceral organs, and cause some complications such as mesenteric ischemia. The authors reported four cases of acute mesenteric ischemia associated with COVID-19 confirmed in patients hospitalized in Imam Reza Hospital (a COVID-19 referral center in Mashhad University of Medical Sciences, Mashhad, Iran). The authors described the pathological findings that may be associated with this infection. The authors collected clinical data, imaging, microscopic, and operative findings of four patients with severe COVID-19 infection and evidence of intestinal necrosis. These four cases that all had severe COVID-19 pneumonia simultaneously showed intestinal necrosis during the infection process, indicating a relationship between coronavirus and mesenteric vascular events. Physicians should be aware of thrombosis symptoms in the digestive system in patients with severe COVID-19 disease.
Microbiology
Saeed Mirsadraee; Mihan Pourabdollah Toutkaboni; Mehrdad Bakhshayeshkaram; Mitra sadat Rezaei; Elham Askari; Sara Haseli; Nazanin Sadraee
Abstract
Background & Objective: Diagnosis of coronavirus disease 2019 (COVID-19) can be challenging, especially when the realtime quantitative reverse transcription polymerase chain reaction (RT-PCR) is not available or it is negative. In this study, we evaluated imaging and laboratory findings in a ...
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Background & Objective: Diagnosis of coronavirus disease 2019 (COVID-19) can be challenging, especially when the realtime quantitative reverse transcription polymerase chain reaction (RT-PCR) is not available or it is negative. In this study, we evaluated imaging and laboratory findings in a group of patients with a multidisciplinary diagnosis of COVID-19 pneumonia. Methods: A total of 163 patients with a clinical diagnosis of COVID-19 pneumonia admitted to a specialised respiratory centre in Tehran, Iran were enrolled in this study. The distribution and characteristics of presenting radiological and laboratory findings were evaluated and the relationship to the outcome was investigated. Results: RTPCR was positive in 92 patients. The diagnosis of COVID-19 in RT-PCR negative patients was made on clinical and radiological grounds (n=71). Also, 24 (14.7%) patients died. The common computed tomography (CT) scan findings included ground-glass (94%) and consolidating opacification (12%), mainly in the lower lobes (90%). Peripheral and central lung changes were observed in 90% and 52% of patients, respectively. Lymphopenia, positive CRP, and raised LDH were present in 32%, 65%, and 96% of cases, respectively. A raised LDH of >500U/L was the best predictor of death in these patients (R2=0.6623; OR=24.4). Other markers of outcome were male gender, age (>50 years), lymphopenia, and severe CXR changes. Conclusion: Diagnosis of COVID-19 can be challenging, and a multidisciplinary approach is often needed. Whilst RT-PCR is the standard diagnostic test, a negative test should be interpreted with caution. Blood tests and imaging can be useful in the diagnosis, monitoring, and risk assessment in patients with COVID-19.
Biochemistry
Ahmad Raesi; Ebrahim Saedi Dezaki; Hamideh Moosapour; Farzaneh Saeidifard; Zahra Habibi; Fereidoun Rahmani; Soleiman Kheiri; Elham Taheri
Abstract
Background & Objective: Previous studies have addressed the electrolyte abnormalitiessuch as hypocalcemiain COVID-19 patients. We aimed to compare the laboratory findings especially the electrolyte levels amongCOVID-19 patients and healthy controls and evaluate their prognostic values. Materials ...
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Background & Objective: Previous studies have addressed the electrolyte abnormalitiessuch as hypocalcemiain COVID-19 patients. We aimed to compare the laboratory findings especially the electrolyte levels amongCOVID-19 patients and healthy controls and evaluate their prognostic values. Materials and Methods: This case-control study included 91 COVID-19 patients and 169 healthy individuals. Their laboratory parameters including electrolytes, albumin, liver enzymes, complete blood count, vitamin D, and parathyroid hormone (PTH) were compared. We also analyzed the association between these markers and the major outcomes including severity, mortality and hospitalization. Results: Among patients with COVID-19, 59.3% of the patients had hypocalcemia on admission while in control group only 32.5% had low calcium level (OR=3.02, 95% CI: 1.79-5.13, p <0.001). The rates of death and ICU admission were significantly higher among the patients in hypocalcemic group than those of eucalcemic group (85.7% vs 14.3% and 33.3% Vs 9.1%, respectively). However, there was no significant difference in the mean PTH and vitamin D levels between the two groups. In terms of the severity of the infection, 74.1% of patients in hypocalcemic group had a severe infection while 24.3% of the patients in eucalcemic group were diagnosed with severe infection (OR=8.89, 95% CI: 3.38-23.37, p <0.001). Conclusion: Patients with COVID-19 had considerable laboratory abnormalities including hypocalcemia. The hypocalcemia was also associated with worse major clinical outcomes and higher mortality risk.
Diagnostic Pathology
Alireza Abdollahi; Ali Labbaf; Mahboobeh Mafinejad; Maryam Sotoodeh-Anvari; Farid Azmoodeh-Ardalan
Abstract
Background & Objective: The world is facing COVID-19 pandemic, and medical education system and consequently the evaluation of students at different levels have been overshadowed. Residency students are among those affected. In the present study, we aim to share our experiences regarding holding ...
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Background & Objective: The world is facing COVID-19 pandemic, and medical education system and consequently the evaluation of students at different levels have been overshadowed. Residency students are among those affected. In the present study, we aim to share our experiences regarding holding exams for pathology residents before and during the pandemic.Methods: This cross-sectional study was carried out in Tehran University of Medical Sciences. The online exam, which consisted of 30 multiple-choice questions, was designed and held in April 2020 to evaluate pathology residents. To assess the quality of the exam, indices such as the number of questions, highest and lowest scores, the average score, the standard deviation, the variance, Cronbach’s alpha reliability coefficient, standard error of measurement, discrimination index, difficulty index, number/percentage of questions on three difficulty levels of easy, normal, hard were reviewed and analyzed.Results and Discussion: The average score of the participants in the January exam which was held in the university’s exam center was 16.23 (±5.03), while the average score in the online exam which was held after the onset of the pandemic was 20.86 (±5.18). The average discrimination indices in the first and second exams were 0.36 and 0.38, respectively, and the average difficulty indices in the first and second exams were 0.54 and 0.70, respectively. We found the administration of this online examination would be a positive experience. By sharing it, we hope to pave the way for similar ventures in the other departments.
Hematopathology
Anahita Nosrati
Abstract
Coronaviruses are considered to be one of the most significant human and animal pathogens. In late 2019, a new species of coronavirus was recognized as the cause of some pneumonia cases in Wuhan, China. The disease spread rapidly and made an epidemic in China and subsequently in almost all countries ...
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Coronaviruses are considered to be one of the most significant human and animal pathogens. In late 2019, a new species of coronavirus was recognized as the cause of some pneumonia cases in Wuhan, China. The disease spread rapidly and made an epidemic in China and subsequently in almost all countries in the world. In February 2020, the World Health Organization (WHO) named it as COVID-19 standing for Coronavirus 2019 (1). Due to being a pandemic issue, it is needed to discuss various aspects of this viral disease. Recently, Yan Zhang et al. reported a case of coagulopathy and antiphospholipid antibodies in the patient with severe COVID-19 infection (2). Thus, one of the serious complications of COVID-19 that should be taken into consideration is coagulopathy with possible anti-phospholipid antibodies syndrome in these patients. In this regard, some studies also claimed that COVID-19 could cause venous and arterial thromboembolism because of excessive inflammation, hypoxia, immobility, and diffuse intravascular coagulation (3). Antiphospholipid syndrome is a systemic autoimmune disease with vascular and hematologic complications as venous and arterial thrombosis or pregnancy morbidity (4). It is well known that infectious agents are one of the major stimulators of the antiphospholipid antibodies in vivo (5), thus, COVID-19 can be a possible cause of this phenomenon within its infection period and consequently, positive results of antiphospholipid antibodies detection are not unexpected.
Molecular Pathology
Alireza Abdollahi; Abbas Shakoori; Hoda Khoshnevis; Mohammad Arabzadeh; Seyed Ali Dehghan Manshadi; Esmaeil Mohammadnejad; Dorsa Ghasemi; Maryam Safari Aboksari; Shaban Alizadeh; Vahid Mehrtash; Arezoo Eftekhar-javadi; Masoomeh Safaei
Abstract
Background & Objective: A simple approach to prevent close contact in healthcare settings during the COVID-19 outbreak is to train patients to collect their own nasopharyngeal and oropharyngeal swabs and deliver them to medical laboratories to have them processed. The aim of our study ...
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Background & Objective: A simple approach to prevent close contact in healthcare settings during the COVID-19 outbreak is to train patients to collect their own nasopharyngeal and oropharyngeal swabs and deliver them to medical laboratories to have them processed. The aim of our study was to compare lab technician- with patient- collected oropharyngeal and nasopharyngeal samples for detection of the coronavirus disease 2019 (COVID 19) using rapid real-time polymerase chain reaction (rRT-PCR). Methods: Fifty adult patients with flu-like symptoms and radiologic findings compatible with atypical pneumonia who were admitted to the infectious diseases ward of Imam Khomeini Hospital Complex, Tehran, Iran, with a clinical diagnosis of COVID-19 from February 28 to April 27 of 2020 were randomly selected and entered in our study. Two sets of naso- and oropharyngeal swabs were collected, one set by a lab technician and the other by the patients, and the COVID-19 rRT-PCR test was performed. Results: Of 50 selected cases, in seven patients all collected naso- and oropharyngeal swabs tested positive, and in 22 patients all samples tested negative for COVID-19 in rRT-PCR. Discrepancies between rRT-PCR results of lab technician- and patient-collected swabs were observed in 12 nasopharyngeal and 13 oropharyngeal specimens. Positive lab technician-collected and negative patient-collected samples were observed in 10 and 5 nasopharyngeal and oropharyngeal specimens, respectively. Negative lab technician-collected and positive patient-collected samples were observed in two and seven nasopharyngeal and oropharyngeal specimens, respectively. The overall percentage of agreement among both nasopharyngeal and oropharyngeal swabs taken by a lab technician and patients was 76% with a kappa value of 0.49 (p =0.001). Conclusion: Based on our findings, lab technician-collected naso- and oropharyngeal swabs cannot be replaced by patient-collected ones with regard to COVID-19 rRT-PCR.
