COVID-19 in patients with rheumatological diseases in the Eastern Province of Saudi Arabia.

The severity of the 2019 coronavirus disease (COVID-19) and its effects remain unpredictable. Certain factors, such as obesity, hypertension, and type 2 diabetes mellitus, may increase the severity of the disease. Rheumatology experts suggest that patients with active autoimmune conditions and controlled autoimmune diseases on immunosuppressive therapy may be at higher risk of developing severe COVID-19. In this retrospective observational study, we aimed to examine the patterns of COVID-19 in patients with underlying rheumatological diseases and their association with disease severity and hospital outcomes. A total of 34 patients with underlying rheumatological diseases who tested positive for severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) by polymerase chain reaction (PCR) were included between March 2020 and April 2021 at King Fahd Hospital of the University. The study population consisted of 76.47% female and 23.53% male patients, with a mean age ranging from 20 to 40 years. Female gender (p=0.0001) and younger age (p=0.004) were associated with milder disease. The most frequent rheumatological disease was systemic lupus erythematosus (SLE) (38.24%), which was associated with a milder infection (p=0.045). Patients treated with mycophenolate mofetil (MMF) had a milder disease course (p=0.0037). Hypertension was significantly associated with severe COVID-19 disease (p=0.037). There was no significant relationship between SLE and the need for ICU admission. Patients on hydroxychloroquine and MMF tended to develop milder disease, and there was no association between the severity of the infection and the treatment with steroids.

COVID-19 and Malignancy: What is the Association? A Case Report and Review of the Literature.

Background: After more than two years since Coronavirus disease 2019 (COVID-19) was first identified as a global pandemic, we still observe a variety of clinical presentations. From asymptomatic carriers to severely ill patients. Most patients infected with COVID-19 present with respiratory symptoms. Objective: However, case reports of different presentations were published, none of them highlighted the potential of COVID-19 to facilitate the manifestation of hidden malignancy, particularly, gallbladder carcinoma. Case presentation: In this report, we present a case of a 77-year-old Saudi lady with multiple comorbidities, presented with an acute confusional state after one month of having asymptomatic COVID-19 infection. Significantly, she was completely functional prior to her presentation and did not manifest any symptoms such as weight loss or fever. Her clinical assessment demonstrated severe abdominal tenderness and guarding on palpation. Computed tomography scans of the abdomen showed perforated gallbladder cancer. Conclusion: Among multiple clinical presentations related to COVID-19 infection, gastrointestinal manifestations are the most common extrapulmonary symptoms, ranging from mild to more severe symptoms. Acute abdomen with perforated viscus should be kept in mind as a differential diagnosis when dealing with COVID-19 infected patients who present with severe abdominal pain. The current case report highlights one of unusual presentations of COVID-19 infection.

Clinical outcome of pre-operative blood transfusion for sickle cell disease patients in post-operative complications.

BACKGROUND: Preoperative blood transfusion for patients with sickle cell disease is a debatable topic and it can be lifesaving. Sickle cell disease patients are at high risk for vaso-occlusive crisis due to the large concentration of sickle hemoglobin (HgbS) in their blood. Despite the current extensive research into this disease, there is still no consensus over whether blood transfusion is a preferable preoperative modality among patients undergoing elective surgical procedures. METHOD: A retrospective observational study, which enrolled 204 patients with Sickle cell disease who underwent surgery at King Fahad Hospital of the University (KFHU) over the last five years. The primary objective was to determine whether there is evidence that preoperative blood transfusion for SCD patients undergoing surgical procedures will reduce postoperative complications related to SCD. RESULTS: A total of 204 patients were included, of which 30% had preoperative blood transfusion. Majority of patient 44% had undergone cholecystectomy. On multivariate logistic regression analysis, patients who did not undergo blood transfusion had significantly higher risk to develop post-operative SCD complications (OR = 3.07, P value = 0.002). In addition, they had significantly prolonged hospitalization (OR = 2.22, P value = 0.08). In contrast, patients who received blood transfusion had lower risk for developing post-operative SCD-related complications (OR = 1.87, P value = 0.29), and decrease in the duration of hospitalization by (OR = 0.49, P value = 0.045). CONCLUSION: Our study showed that patients who had not undergone preoperative blood transfusion had higher risk to develop postoperative complications and prolonged hospital stay compared to those who underwent blood transfusion.

Double CD38-/CD138- negative multiple myeloma.

The standard diagnosis of multiple myeloma by flow cytometry is based on selection of population of CD38+/CD138+ positives cells. As the result treatment with proteasome inhibitors, CD138 may be underexpressed on atypical plasma cells. Thus, in order to improve this strategy, recently new CD138-independent method, based on CD38 positivity of plasma cells was developed. We present an unusual case of CD138- negative multiple myeloma which had become double CD138-/CD38- negative after treatment with daratumumab by which we would like to illustrate potential pitfalls of both strategies.