Impact Of Severity Of Covid-19 On Haematological Parameters In Patients Reporting To Saidu Group Of Teaching Hospitals, Swat.

BACKGROUND: In 2019 novel coronavirus was discovered in Wuhan, China and declared pandemic by world health organization. The disease caused by this virus called coronavirus disease 2019 (COVID-19). Among the corona family the actual virus responsible for COVID-19 is Severe Acute Respiratory Syndrome Corona Virus 2 (SARS-CoV-2). Objective of the study was to determine the pattern of blood parameters in corona virus disease (COVID-19) positive cases and the association of these parameters with severity of COVID-19. METHODS: This cross-sectional descriptive study was conducted on 105 participants who were confirmed positive by SARS-CoV-2 through real-time reverse transcriptase PCR, both genders, and Pakistani nationals. The participants who were below 18 years age and missing data were excluded. Haemoglobin (Hb), total leukocyte count (TLC), neutrophil, lymphocyte, monocyte, basophil and eosinophil counts were calculated. Comparison of blood parameters was done among various severity classes of COVID-19 by running one way ANOVA. The level of significance was p≤0.05. RESULTS: The mean age of the participants was 50.6±6.26 years. Males were 78 (74.29%) and females were 27 (25.71%). In critical type COVID-19 the mean haemoglobin was least (10.21±1.07 g/dl) and highest in mild cases (15.76±1.16 g/dl) and these differences were highly statistically significant (p<0.001). TLC was highest in critical COVID cases (15.90±0.51x103 /µl) followed by moderate (12.44±0.65x103/µl). Similarly, neutrophil count was highest in critical (89±2.1) followed by severe (86±1.12). CONCLUSIONS: There is significant decrease in mean haemoglobin level and platelet count but increase in TLC in patients infected from COVID-19.

Hepatitis E virus-associated aplastic anaemia: the first case of its kind.

Here we report the case of a 32-year-old Pakistani male, who developed severe aplastic anaemia after a severe attack of acute hepatitis E virus (HEV) infection. His laboratory test values were not in normal ranges. The liver enzymes were elevated. Serologic and/or molecular-based tests for hepatitis A, B, C, D, G, transfusion transmitted virus (TTV) and B19 were negative, whereas anti-HEV IgM and HEV RNA polymerase chain reaction (PCR) was also detected in the patient sample. The patient received immunosuppressive therapy for 6 months; however, he did not show response to this kind of therapy. The results of our case clearly show the causative role of HEV in the development of aplastic anaemia that might not be ignored.

Occult hepatitis C virus infection and associated predictive factors: the Pakistan experience.

The aim of the present study was to determine the presence of HCV RNA in the liver biopsies of patients with abnormal liver tests but without detectable serum HCV RNA and anti-HCV antibodies in sera. Liver biopsies and whole blood of total 31 patients who were negative for anti-HCV antibodies with elevated liver function tests were received at Division of Molecular Diagnostics, University of the Punjab Pakistan from January 2002 to June 2009 for the detection of HCV RNA. HCV RNA status of the subjects was tested by reverse-transcription PCR and quantified using SmartCycler II real-time PCR. HCV genotyping was carried out in HCV RNA positive samples using molecular genotyping method. HCV RNA was found in liver-biopsy specimens from 23 (74.2%) of the total 31 patients negative for anti-HCV antibodies and undetectable serum HCV RNA. HCV RNA of both negative and positive polarity was found in the livers of 8 (25.8%) patients. Genotyping analysis showed that 65% patients were infected with HCV 3a, 17% with 3b, 13% with 1a and 4% patients were found with untypable genotype. In a multivariate logistic regression model, patients having previous history surgeries, male sex and age above 30 years were significantly associated with the presence of occult HCV infection (p<0.05). In conclusion, patients with elevated liver enzymes and negative HCV antibodies and negative serum RNA may have occult HCV infection and its chance increases with previous history of surgeries, in male sex and above 30 years of age.

Pattern and molecular epidemiology of Hepatitis B virus genotypes circulating in Pakistan.

The continuously mutating nature of Hepatitis B virus (HBV) is responsible for the emergence of varying genotypes in different regions of the world affecting the disease outcome. The objective of the current study was to find out the pattern of HBV genotypes circulating in Pakistan. HBV genotypes were determined in HBV chronic patients of different age and gender from all the four different geographical regions (provinces) of Pakistan for a period of 2 years (2007-2009). Out of the total 3137 consecutive patients, 300 (175; 58.3% males and 125; 41.7% females) were randomly selected for HBV genotype A through H determination using molecular genotyping methods. Total 269 (89.6%) isolates were successfully genotyped where as 31 (10.3%) samples failed to generate a type-specific PCR band and were found untypable. Out of the successfully genotyped samples, 43 (14.3%) were with type A, 54 (18%) were with type B, 83 (27.6%) were with type C, 39 (13%) were with type D, 2 (0.6%) were with type E, 4 (1.3%) were with genotype F and total 44 (14.6%) were with mixed HBV infections. Of the mixed genotype infection cases, 16 were with genotypes A/D, 9 were B/C, six were A/D/F, five were with genotypes A/F, two were with A/B/D and B/E and one each for A/C as well as A/E genotypes. Four common genotypes of HBV found worldwide (A, B, C & D) were isolated from Pakistan along with uncommon genotypes E and F for the first time in Pakistan. Overall Genotype C is the most prevalent genotype. Genotypes B and C are predominant in Punjab & Balochistan and Khyber Pakhtoonkhwa, respectively whereas genotype A in Sindh.

False positivity of serological tests for hepatitis C virus.

BACKGROUND: Hepatitis C virus infection is now one the common infection in Pakistan. Patients are routinely screened by antibody assays. Objective of this study was to assess the viremia in patients labelled as anti-HCV positive by ELISA. METHODS: It this retrospective study patients labelled as anti HCV positive by ELISA were assessed for HCV RNA by polymerase chain reaction. The 254 HCV positive cases which were analysed by MEIA method on AxSYM System were selected for RNA extraction by RT-PCR upon Cepheid thermal cycler using TaqMan technology and subsequent for amplification. RESULTS: Out of 254 anti HCV positive by ELISA, viremia was shown in 211 patients; the remaining 43 (16.92%) samples were false positive. CONCLUSION: Out of a total 254 anti HCV positive patients, 211 had viremia by RT-PCR. The false positivity noted was 16.9%.

High prevalence of hepatitis C virus infection in the largest province of Pakistan.

OBJECTIVE: To estimate the prevalence and spectrum of hepatitis C virus (HCV) infection in the general population of Pakistan. METHODS: A total of 6817 blood samples were collected randomly from apparently healthy people in the Punjab, Pakistan from March 1999 to April 2001 and September 2006 to August 2007. Detailed socioeconomic information for each participant was recorded. All the samples were tested for anti-HCV antibodies and all seropositive samples were further tested for HCV RNA by polymerase chain reaction (PCR). RESULTS: Of the total 6817 serum samples tested, 998 (14.63%) were positive for anti-HCV antibodies. HCV RNA PCR was detected in 494 (49.50%) anti-HCV-positive samples. The prevalence of anti-HCV antibodies were significantly higher in males (15.09%) than in females (12.3%) (P < 0.009). A significant difference was also noted in the anti-HCV prevalence rate among different age groups tested (P < 0.01). In a multivariate logistic regression analysis, injected drug use (adjusted OR 6.6 [95%CI 4.1-9.9]), blood transfusion (adjusted OR 5.9 [95%CI 2.9-12.3]), pricked with a needle (adjusted OR 2.2 [95%CI 1.6-3.1]), re-use of syringes (adjusted OR 1.7 [95%CI 0.8-3.6]) and being over 35 years old (adjusted OR 1.3 [95%CI 0.9-1.9]) were independent risk factors for HCV infection. CONCLUSION: The study showed a high seroprevalence of anti-HCV antibodies in a general and apparently healthy population of the Punjab province of Pakistan. Drug injection, blood transfusion and needle stuck were the factors most strongly associated with HCV infection.