COVID‐19‐another influential event impacts on laboratory medicine management

BackgroundBefore public health emergencies became a major challenge worldwide, the scope of laboratory management was only related to developing, maintaining, improving, and sustaining the quality of accurate laboratory results for improved clinical outcomes. Indeed, quality management is an especially important aspect and has achieved great milestones during the development of clinical laboratories.Current statusHowever, since the coronavirus disease 2019 (COVID‐19) pandemic continues to be a threat worldwide, previous management mode inside the separate laboratory could not cater to the demand of the COVID‐19 public health emergency. Among emerging new issues, the prominent challenges during the period of COVID‐19 pandemic are rapid‐launched laboratory‐developed tests (LDTs) for urgent clinical application, rapid expansion of testing capabilities, laboratory medicine resources, and personnel shortages. These related issues are now impacting on clinical laboratory and need to be effectively addressed.ConclusionDifferent from traditional views of laboratory medicine management that focus on separate laboratories, present clinical laboratory management must be multidimensional mode which should consider consolidation of the efficient network of regional clinical laboratories and reasonable planning of laboratories resources from the view of overall strategy. Based on relevant research and our experience, in this review, we retrospect the history trajectory of laboratory medicine management, and also, we provide existing and other feasible recommended management strategies for laboratory medicine in future.     

Stent thrombosis during COVID‐19 pandemic: A case series

The coronavirus disease 2019 (COVID‐19) pandemic originated from Wuhan, China, in late 2019. In addition to the respiratory system, COVID‐19 also affects other organ systems. The disease can lead to cardiovascular complications such as myocarditis, acute myocardial infarction, acute heart failure, and venous thromboembolism; patients with COVID‐19 experience more thrombotic events than non‐COVID‐19 patients. A 50‐year‐old male cigarette smoker presented to the emergency department (ED) with typical chest pain. His electrocardiography (ECG) showed an anterior STEMI. He developed multiple episodes of ventricular fibrillation (VF) and received defibrillator shocks. His angiogram showed thrombotic severe in‐stent restenosis (ISR) of the left anterior descending (LAD) artery stents. A 70‐year‐old diabetic hypertensive woman presented to the ED with dyspnea and chest pain. The patient had undergone angioplasty two times beforehand, and a fresh angiogram revealed severe thrombotic ISR of LAD stents and another far midpart lesion after the stents. She underwent successful percutaneous coronary intervention (PCI). A 54‐year‐old man presented to the ED with typical chest pain commencing an hour beforehand. He had undergone angioplasty about 10 years earlier. The patient received the Oxford/AstraZeneca COVID‐19 vaccine 36 h before developing chest pain. The ECG revealed an infero‐posterior STEMI, and the angiogram depicted thrombotic occluded ISR in the RCA. The patient underwent successful PCI. Patients with COVID‐19 or even with COVID‐19 vaccination experience stent thrombosis due to a hypercoagulable state. Hence, we need standard guidelines to prevent stent thrombosis.     

The effect of smoking on COVID‐19–linked biomarkers in hospitalized patients with COVID‐19

BackgroundThe coronavirus pandemic, an infection (coronavirus disease 2019—COVID‐19), caused by severe acute respiratory disease coronavirus 2 (SARS‐CoV‐2), continues to have a strong influence worldwide. Although smoking is a major known risk factor for respiratory infectious disease, the effects of smoking on COVID‐19 are unclear. In this study, we aimed to evaluate the relationship between smoking and important hematologic (lymphocyte count, neutrophil count, platelet count, neutrophil‐lymphocyte ratio [NLR], platelet‐lymphocyte ratio [PLR]), inflammatory, and biochemical biomarkers in the prognosis of hospitalized patients with COVID‐19.MethodsIn a COVID‐19 pandemic hospital between June and August 2020, 200 adult patients aged over 18 years were hospitalized with COVID‐19 inflammatory and hematologic biomarkers at their first admission and smoking data were selected for this study.ResultsThe rate of smokers was much higher among men (91.5%) than in women (8.5%) (p = 0.001). Neutrophil counts were evaluated and was significantly higher in current smokers (p < 0.001) and ex‐smokers (p = 0.001), and NLR (p = 0.008) and ferritin (p = 0.004) levels were higher than in never smokers. The saturation of patients had a negative significant linear correlation of NLR, PLR, and pack years of smoking. Compared with never smokers, current smokers had higher neutrophil counts (OR = 0.828 [0.750–0.915]; p = 0.041), NLR values (OR = 0.948 [0.910–0.987]; p = 0.009), and CRP levels (OR = 0.994 [0.990–0.999]; p = 0.019).ConclusionSerum neutrophil, NLR, and ferritin levels, which are widely used in determining the prognosis of COVID‐19, were found higher in current smokers/ex‐smokers. These results support the view that a poor prognosis of COVID‐19 is associated with smoking.     

A Nepalese bipolar case amidst risk and protective factors during COVID‐19 pandemic

Bipolar disorder is a chronic and recurring psychiatric illness. Emphasis on enhancing key protective factors like social support systems and promoting this to minimize risk factors like non‐compliance is one of the key strategies tied to enhance overall psychological, intellectual, and emotional health for symptoms remission and relapse prevention even during adverse situations like the COVID‐19 crisis. We intend here to point out implication of the dynamics of the protective and risk factors for bipolar mood through a 23‐year patient from eastern Nepal, which is largely harmonious in its multi‐ethnic, multilingual and multicultural social composition. This attribute of social cohesiveness and compassion is evident in this case report. When disturbed and ill, neighbors from native semi‐urban Nepalese society did support even in the times of crisis of COVID‐19 pandemic. The support of other people including neighbors is a key factor for the short‐term and long‐term management of bipolar mood.     

COVID‐19‐associated mucormycosis involving the maxilla

It is important to increase the awareness and knowledge of head and neck surgeons about the recent surge of craniofacial mucormycosis in COVID‐19 patients because early diagnosis and appropriate treatment are essential to improve the outcomes. Here, we describe clinical features, treatment protocols, and outcomes of treatment in eight patients with COVID‐19‐associated mucormycosis in the maxilla. Consistent with the findings of previous studies, our experience in the management of these eight patients shows that early administration of amphotericin B and prompt aggressive surgery are essential for optimal control of the disease.     

Bell's palsy after Sputnik V COVID‐19 (Gam‐COVID‐Vac) vaccination

A possible association between Bell''s palsy and COVID‐19 vaccination has been suggested previously. Here, we report two cases of facial nerve hemiparalysis following the Sputnik V COVID‐19 vaccination in a 27‐year‐old female patient and a 58‐year‐old male patient who were both clinically diagnosed with Bell''s palsy.     

Subacute thyroiditis following COVID‐19 vaccination

Physicians should be alert about the possibility of subacute thyroiditis (SAT) being induced by COVID‐19 vaccination. SAT may present with anterior neck pain, extended fever or palpitation in recently vaccinated patients, which should not be easily dismissed as expected post‐vaccination flu‐like symptoms, thereby, facilitating in time diagnosis and treatment.     

Lichen planus flare following COVID‐19 vaccination: A case report

We report the third case of cutaneous lichen planus (LP) following COVID‐19 BNT162b2 vaccination in a 59‐year‐old woman with previous LP. The reactivation of LP in patients with dormant LP suggests a possible vaccine‐induced immune dysregulation. We suggest that the already described vaccine‐induced upregulation of Th1 response may play a relevant role in LP reactivation, through an increase in inflammatory cytokines involved in the pathogenesis of LP. Interestingly, LP has already been associated with vaccinations and viral infections including COVID‐19 disease. However, the exact mechanism underlying LP (re)activation after Pfizer‐BiotNtech COVID‐19 vaccination is still widely unknown and needs to be further investigated.     

Infectious‐mononucleosis‐like exanthema associated with COVID‐19 in a child

Cutaneous manifestations of childhood COVID‐19 differ from those of adults. Maculopapular rash is not specific and could be mistaken with other viral exanthema. A nasopharyngeal swab is strongly recommended to confirm the possible COVID‐19 diagnosis.     

The diagnostic value of platelet distribution width in patients with mild COVID‐19

COVID‐19 has a worldwide distribution; however, there is no effective diagnosis marker, especially for the mild‐type COVID‐19. The purpose of the current study was to identify parameters for mild‐type COVID‐19. We retrospectively analyzed a single‐center data of patients with mild COVID‐19. Forty patients diagnosed with COVID‐19 were enrolled. Peripheral blood indices between the admission and discharge times were collected and analyzed. The platelet distribution width (PDW) was shown to be an indicator of significant change. The receiver operating characteristic curve for PDW was 0.7; the sensitivity and specificity for PDW were 82.5% and 55.0%, respectively. Therefore, a potential diagnostic value of PDW for mild‐type COVID‐19 was demonstrated.     

Stevens‐Johnson Syndrome due to COVID‐19 vaccination

As public COVID‐19 vaccination programs are being implemented, it is possible that more rare and serious adverse effects such as Stevens‐Johnson syndrome (SJS) and toxic epidermal necrosis (TEN) may occur.     

COVID‐19 vaccine‐related new‐onset lichen planus

Coronavirus disease 2019 (COVID‐19) vaccines significantly impacted world health and well‐being. However, various adverse events have been observed following severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) vaccination. Cutaneous reactions have been prevalent following many vaccines, including COVID‐19 vaccines. Here, we present a case of new‐onset lichen planus in a patient who received the COVID‐19 vaccine at the same time as being infected with SARS‐CoV‐2. A 52‐year‐old woman presented to the clinic with extensive pruritic skin lesions. The eruptions had appeared a week after her second dose of the Sinopharm COVID‐19 vaccine. She mentioned a history of SARS‐CoV‐2 infection approximately 10 days following the first dose of her vaccine, causing a 1‐month delay in getting the second dose. Her past medical history was not significant. On examination, erythematous and squamous papules were demonstrated predominantly on the extremities, including inguinal and axillary folds. Moreover, desquamation of the lips was visible, and buccal lesions were also found. After consultation with a dermatologist, a skin biopsy was indicated for the patient, but she refused to undergo the procedure. Therefore, considering the typical appearance of the eruptions, lichen planus was suspected, for which she was treated with oral antihistamines and topical corticosteroids.     

Acute pancreatitis due to methanol toxicity during the COVID‐19 pandemic

Acute methanol poisoning may be associated with a variety of symptoms, such as abdominal pain, blurred vision, loss of consciousness, and acute pancreatitis. We present a 37‐year‐old man with acute pancreatitis due to methanol poisoning during the COVID‐19 pandemic.     

Rectus sheath hematoma in COVID‐19 patient: The importance of abdominal pain in the course of COVID‐19

We report herein a case of a 58‐year‐old woman with COVID‐19. During the hospitalization, the patient complained of acute abdominal pain, and abdominal CT revealed the rectus sheath hematoma (RSH). Since corticosteroids and anti‐coagulation are commonly administered in COVID‐19 patients, physicians should consider RSH as a possible diagnosis for acute abdominal pain.     

Hematological changes associated with COVID‐19 infection

BackgroundThe unresolved COVID‐19 pandemic considerably impacts the health services in Iraq and worldwide. Consecutive waves of mutated virus increased virus spread and further constrained health systems. Although molecular identification of the virus by polymerase chain reaction is the only recommended method in diagnosing COVID‐19 infection, radiological, biochemical, and hematological studies are substantially important in risk stratification, patient follow‐up, and outcome prediction.AimThis narrative review summarized the hematological changes including the blood indices, coagulative indicators, and other associated biochemical laboratory markers in different stages of COVID‐19 infection, highlighting the diagnostic and prognostic significance.MethodsLiterature search was conducted for multiple combinations of different hematological tests and manifestations with novel COVID‐19 using the following key words: “hematological,” “complete blood count,” “lymphopenia,” “blood indices,” “markers” "platelet" OR "thrombocytopenia" AND "COVID‐19," "coronavirus2019," "2019‐nCoV," OR "SARS‐CoV‐2." Articles written in the English language and conducted on human samples between December 2019 and January 2021 were included.ResultsHematological changes are not reported in asymptomatic or presymptomatic COVID‐19 patients. In nonsevere cases, hematological changes are subtle, included mainly lymphocytopenia (80.4%). In severe, critically ill patients and those with cytokine storm, neutrophilia, lymphocytopenia, elevated D‐dimer, prolonged PT, and reduced fibrinogen are predictors of disease progression and adverse outcome.ConclusionMonitoring hematological changes in patients with COVID‐19 can predict patients needing additional care and stratify the risk for severe course of the disease. More studies are required in Iraq to reflect the hematological changes in COVID‐19 as compared to global data.     

COVID‐19 in HIV‐positive patients: A systematic review of case reports and case series

IntroductionCoronavirus disease 2019 (COVID‐19) and acquired immune deficiency syndrome (AIDS) are two viral diseases for which there are currently no definitive treatments. Nowadays, because of the health system''s focus on the COVID‐19 epidemic, the control of human immunodeficiency virus (HIV) has received less attention. In this review, we will discuss the characteristics of COVID‐19 in HIV‐positive patients.Material and MethodsUsing the PRISMA guideline, the databases of Scopus, PubMed, and Web of Science were searched systematically from January 1, 2019 to February 24, 2021. The following keywords were used: “Human Immunodeficiency Virus,” “acquired immune deficiency syndrome,” “HIV,” “AIDS,” “COVID‐19,” “severe acute respiratory syndrome coronavirus 2,” “novel coronavirus,” “SARS‐CoV‐2,” “nCoV disease,” “SARS2,” and “2019‐nCoV disease.”ResultsTwenty‐one percent of studies were conducted in the USA (n = 13), 16% in China (n = 10), and 13% in Italy (n = 8), respectively. The majority of the patients were men (74.3%). Tenofovir disoproxil fumarate was used in 47.4% of patients, emtricitabine in 58.4%, and lamivudine in 34.8% to treat HIV. Symptoms of HIV patients with COVID‐19 included coughing (81.3%), fever (62.8%), and dyspnea (60%). Hydroxychloroquine (39.34%) and azithromycin (36.58%) were the common treatment options for COVID‐19. The total death rate in HIV‐positive patients with COVID‐19 was about 9%.ConclusionIn the current systematic review, we demonstrated that HIV‐positive patients co‐infected with COVID‐19 have high comorbidity of hypertension and diabetes mellitus. HIV/COVID‐19 co‐infection might have negatively influenced the HIV treatment and diagnosis, which indicates the need to regularly screen HIV patients in the COVID‐19 pandemic.     

Diabetic ketoacidosis mimicking COVID‐19 in an adolescent

Diabetic ketoacidosis (DKA) may be associated with nonspecific symptoms such as dyspnea, tachycardia, anorexia, and vomiting that are similar to COVID‐19. We describe an adolescent who was referred to the emergency department with the above symptoms and died after being discharged, regardless of the differential diagnosis and laboratory findings.     

Herpes‐like skin lesion after AstraZeneca vaccination for COVID‐19: A case report

Recurrent herpes simplex virus or varicella zoster virus infection should be considered as one of the rare complications after AstraZeneca vaccination for COVID‐19.     

Rituximab‐induced acute lympholysis and pancytopenia after COVID‐19 vaccination

Rituximab and COVID‐19 vaccine can cause massive hyperacute depletion of B cells and plasma cells, as well as subsequent cytokine release syndrome, coagulopathy, and pancytopenia. These effects differ from the adverse effects that have been reported for rituximab, and new guidelines regarding the timing of rituximab infusion and vaccination are urgently needed.