Hematologic Evaluation of Children with COVID-19 Infection: Mortality Biomarkers.

BACKGROUND: In this study, we investigated the predictive value of routine coagulation parameters including D-dimer, Prothrombin Time (PT), International Normalized Ratio (INR), activated Partial Thromboplastin Time (aPTT) and Complete Blood Count (CBC) test parameters in children with COVID-19 infection. METHODS: Retrospective and observational study carried out in Abuzar Hospital, Ahvaz Jundishapur University of Medical Sciences (Ahvaz, Iran) included COVID-19 patients. RESULTS: Deceased patients (n = 5) compared to alive patients (n = 76) showed higher RDW (p = 0.005), PT (p = 0.005), INR (p = 0.004), PTT (p = 0.009), platelet count (p < 0.001), PLR (p < 0.001), and hospitalization time (p < 0.001). The area under the curve (AUC) of RDW was 0.85 (95% CI 0.75 - 0.96) which indicates its high power for mortality prediction in hospitalized children with COVID-19. We did not find significant differences in parameters in comparison between different severities. CONCLUSIONS: To our knowledge, our study is one of the few studies to evaluate routine coagulation tests and the CBC test parameters predictive value in children with COVID-19. RDW has the most power to predict the mortality of children with COVID-19, followed by PT, INR, aPTT, platelet count, PLR, and hospitalization time have a high power to predict the risk of death in patients.

Increased levels of advanced glycation end products positively correlate with iron overload and oxidative stress markers in patients with ß-thalassemia major.

The impaired biosynthesis of the ß-globin chain in ß-thalassemia leads to the accumulation of unpaired alpha globin chains, failure in hemoglobin formation, and iron overload due to frequent blood transfusion. Iron excess causes oxidative stress and massive tissue injuries. Advanced glycation end products (AGEs) are harmful agents, and their production accelerates in oxidative conditions. This study was conducted on 45 patients with major ß-thalassemia who received frequent blood transfusions and chelation therapy and were compared to 40 healthy subjects. Metabolic parameters including glycemic and iron indices, hepatic and renal functions tests, oxidative stress markers, and AGEs (carboxymethyl-lysine and pentosidine) levels were measured. All parameters were significantly increased in ß-thalassemia compared to the control except for glutathione levels. Blood glucose, iron, serum ferritin, non-transferrin-bound iron (NTBI), MDA, soluble form of low-density lipoprotein receptor, glutathione peroxidase, total reactive oxygen species (ROS), and AGE levels were significantly higher in the ß-thalassemia patients. Iron and ferritin showed a significant positive correlation with pentosidine (P < 0.01) but not with carboxymethyl-lysine. The NTBI was markedly increased in the ß-thalassemia patients, and its levels correlated significantly with both carboxymethyl-lysine and pentosidine (P < 0.05). Our findings confirm the oxidative status generated by the iron overload in ß-thalassemia major patients and highlight the enhanced formation of AGEs, which may play an important role in the pathogenesis of ß-thalassemia major.

Port implantation-related bloodstream infection caused by Wickerhamomyces myanmarensis: A case report.

Background and Purpose: Wickerhamomyces myanmarensis is a new opportunistic yeast previously named Pichai myanmarensis, which belongs to the order Saccharomycetales. Since its discovery, one environmental isolate of W. myanmarensis has been reported from Myanmar, and one clinical sample from Iran. Case Report: We report a case of bloodstream infection related to an implantable venous access port. W. myanmarensis was isolated from patient's blood after chemotherapy, which was meant to control and heal T-cell lymphoblastic lymphoma. Broth dilution minimum inhibitory concentrations were performed according to the CLSI M27-A3 document. The patient recovered with intravenous voriconazole and was discharged with the recommended prescription of oral voriconazole as a maintenance drug. Conclusion: So far, only one case of W. myanmarensis fungemia has been reported in the world in 2019. This is the second case of bloodstream infection with this yeast from a patient undergoing chemotherapy in Iran.

Sensory neural hearing loss in beta-thalassemia major patients treated with deferoxamine.

This study evaluated the incidence of sensory neural hearing loss (SNHL) in beta-thalassemia major patients treated with deferoxamine in Mofid Children's Hospital. Based on the patients' file review, this descriptive and cross-sectional study was performed in all thalassemia patients older than 5 years old who were treated with regular blood transfusion and deferoxamine pump injection during the year 2006. The first visit with the otolaryngologist was performed in all patients to demarcate the presence of cerumen, otitis, and congenital abnormalities of ears. Then pure tone audiometery in frequency ranges of 250-8000 Hz was performed. Data statistical analysis was done by Mann-Whitney, chi square, and Fisher tests. There were 67 patients over 5 years old in our study. Five patients (7.4%), including 2 boys and 3 girls, in the age range of 7-24 years (mean:17.8 +/- 6.6 years) had SNHL. Their hearing loss was bilateral and in the frequency range of 2000-4000 Hz, with a mean of 3200 +/- 836.66 Hz. There were no significant differences between SNHL and non-SNHL patients in age, sex, serum ferritin level, age of the first transfusion, starting age of deferoxamine infusion, or duration and dosage of deferoxamine therapy. It seems that SNHL is not directly related to the serum ferritin level or deferoxamine dosage and other factors, including genetic or constitutional characteristics, may be also related. On the other hand, this complication may occur with doses lower than 50 mg/kg/day of deferoxamine, so no dosage can be considered safe for this drug. Despite the results of this study, hearing evaluation of beta-thalassemia major patients by audiometry is recommended because of the importance of this complication and the consequent disabilities.

Clinical responses to rituximab in a case of neuroblastoma with refractory opsoclonus myoclonus ataxia syndrome.

Opsoclonus myoclonus ataxia syndrome (OMS) is a rare neurologic syndrome. In a high proportion of children, it is associated with neuroblastoma. The etiology of this condition is thought to be immune mediated. In children, immunotherapy with conventional treatments such as corticosteroids, intravenous immunoglobulin, adrenocorticotropic hormone, and even antiepileptic drugs has been tried. Recently rituximab has been used safely for refractory OMS in children with neuroblastoma. Our patient was a 3.5-year-old girl referred for ataxia and dancing eye movements starting since 1.5 years ago. She was diagnosed with neuroblastoma on imaging studies on admission. The OMS was refractory to surgical resection, chemotherapy, corticosteroids, and intravenous immunoglobulin. Patient received rituximab simultaneously with chemotherapy. The total severity score decreased by 61.1% after rituximab. Patient's ataxia markedly improved that she was able to walk independently after 6 months. Our case confirmed the clinical efficacy and safety of rituximab in a refractory case of OMS.