Trends of Coagulation Parameters in Human Immunodeficiency Virus Patients.

Background and Objectives: HIV disease is recognized to cause inconsistencies in coagulation via various pathways during infection. Some studies have indicated that HIV-infected patients are prone to developing thrombocytopenia, thrombosis, or autoantibodies that may cause difficulties in diagnosis. This study is intended to measure the trend of coagulation parameters in Sudanese patients with HIV. Materials and Methods: A cross-sectional study was carried out in patients with HIV admitted to the Sudan National AIDS Program (SNAP) from January 2018 to December 2019. Prothrombin time (PT), partial thromboplastin time (PTT), thrombin time (TT), D-dimer (DD), hemoglobin (HB), total lymphocyte count (TLC), platelet count (PLT), and a disintegrin and metalloproteinase with thrombospondin type 1 motif, member 13 (ADAMTS13), were evaluated among HIV Sudanese patients. Results: Out of the 44 HIV patients included, 6 (13.6%) were found to have thrombotic thrombocytopenic purpura-like events and 12 (27.2%) had antiphospholipid antibodies, of whom 8 (66.6%) showed anticardiolipin antibody (1gG (75%) and IgM (25%)) and 4 showed lupus anticoagulants. The HB, TLC, and PLT values were found to be significantly lower in HIV patients than in control (p = 0.000, 0.000, and 0.050, respectively). The PT and ADAMTS13 values showed no significant difference between HIV patients and control (p = 0.613 and 0.266, respectively). The PTT, TT, and DD values were found to be augmented in HIV patients versus the control (p = 0.000). Conclusions: Thrombotic thrombocytopenic purpura-like events among HIV Sudanese patients were explored. In addition, antiphospholipid antibodies were strikingly seen in these patients. Additional research is anticipated to confirm these diagnoses.

Potential Therapeutic Target and Vaccines for SARS-CoV-2.

The coronavirus has become the most interesting virus for scientists because of the recently emerging deadly SARS-CoV-2. This study aimed to understand the behavior of SARS-CoV-2 through the comparative genomic analysis with the closest one among the seven species of coronavirus that infect humans. The genomes of coronavirus species that infect humans were retrieved from NCBI, and then subjected to comparative genomic analysis using different bioinformatics tools. The study revealed that SARS-CoV-2 is the most similar to SARS-CoV among the coronavirus species. The core genes were shared by the two genomes, but there were some genes, found in one of them but not in both, such as ORF8, which is found in SARS-CoV-2. The ORF8 protein of SARS-CoV-2 could be considered as a good therapeutic target for stopping viral transmission, as it was predicted to be a transmembrane protein, which is responsible for interspecies transmission. This is supported by the molecular interaction of ORF8 with both the ORF7 protein, which contains a transmembrane domain that is essential to retaining the protein in the Golgi compartment, and the S protein, which facilitates the entry of the coronavirus into host cells. ORF1ab, ORF1a, ORF8, and S proteins of SARS-CoV-2 could be immunogenic and capable of evoking an immune response, which means that these four proteins could be considered a potential vaccine source. Overall, SARS-CoV-2 is most related to SARS-CoV. ORF8 could be considered a potential therapeutic target for stopping viral transmission, and ORF1ab, ORF1a, ORF8, and the S proteins of SARS-CoV-2 could be utilized as a potential vaccine source.

A rare haematological disorder in a Sudanese child: Evans syndrome, case report and literature review.

Evans syndrome is a condition in which autoimmune-mediated red blood cells and platelet destruction happens consecutively. It may be associated with a reduction in neutrophil count as a result of immune neutropenia. No sex preference is known and it presents in all ages and any ethnic cohort. Generally, this syndrome tends to be chronic and is characterised by remission and exacerbation. We document a case of the immune-mediated disease associated with Epstein-Barr virus infection in an 8-year-old boy from eastern Sudan who presented with both immune thrombocytopenia purpura and autoimmune haemolytic anaemia. Complete blood count and peripheral blood picture revealed features consistent with immune haemolytic anaemia (rouleaux formation and spherocytes) and thrombocytopenia. Direct anti-human globulin test and indirect anti-human globulin test were positive. Evans syndrome is a potentially life-threatening condition due to the concomitant existence with antiplatelet and anti-erythrocyte antibodies distinguished by a positive antiglobulin test and possibly linked to other autoimmune or lymphoproliferative diseases.

Neonatal polycythaemia.

Neonatal polycythaemia has multifactorial causes, and can be designated as active (increased foetal erythropoiesis) or passive (red blood cell transfusion) polycythaemia. Hematocrit estimated from capillary blood (regularly obtained through "heel sticks" in newborns) is normally the principal laboratory feature facility by which polycythaemia is recognszed. An unusually high proportion of haematocrit builds the risk of hyperviscosity, microcirculatory hypoperfusion, and in the long run multisystem organ dysfunction. A report enclosed in this short communication gives a brief review of neonatal polycythaemia, its causes, management and complications.

Hemostatic state augmented with platelet indices among Sudanese diabetic septic foot.

BACKGROUND: Diabetes mellitus is a very rampant metabolic disorder, particularly type II. It has many complications such as the septic foot. Diabetic septic foot (DSF) patients are at high risk for coagulation abnormalities as well as surgical hazards. Owing to the potential sequelae of coagulation and vascular abnormalities, this work aimed at studying the hemostatic state and platelet indices in diabetes type II patients with septic foot. METHODS: A case-control study was conducted during the period from July to September 2017 at Dr. Awaad medical center, Red Sea State, Sudan. 57 diabetic patients with septic foot, aged between 17 and 78 years along with 57 non-diabetic subjects as control were enrolled. Sociodemographic data were collected using a structured questionnaire. Venipuncture blood was taken with necessary safety measures. Diabetes profile, coagulation studies as well as platelet indices were estimated. Data was analyzed using SPSS version 24.0 for windows. Ethical approval was considered and written consent from each participant was obtained. RESULTS: The mean age of diabetic patients with septic foot and healthy controls were 48.49 ± 15.8 and 32.77 ± 14.0, respectively. The duration of the diabetes onset was 10.43 ± 9.5 years. Plasma prothrombin time (PT) value (12.61 ± 2.6 vs 13.67 ± 1.5, P < 0.009) was found to be significantly shorter in DSF compared to control. Plasma activated partial thromboplastin time (APTT) value was significant in diabetic septic foot (32.64 ± 5.2 vs 28.49 ± 4.13, P < 0.000), and thrombin time (TT) did not changed in DSF. Mean platelet volume (MPV), platelet distribution width (PDW), and platelet large cell ratio (P-LCR) values were significantly decreased in DSF compared to control (P < 0.013, 0.034, and 0.020, respectively). PDW values were positively correlated with PT, APTT, and D-Dimer (DD) (r = 0.28/p < 0.003, r = 0.29/p < 0.029, and r = 0.32/p < 0.016, respectively). FVIII activity (121.86 ± 174.4 vs 98.66 ± 31.83, P < 0.951) was insignificant with DSF, as the DD was also insignificant (P < 0.081). CONCLUSION: Diabetes mellitus is associated with prothrombotic tendency. Hypercoagulable state in DSF is indicated by shortened PT finding. PDW is a manifesting evidence that proves the presence of more reactive and aggregable platelets in DSF patients.

Natural regulatory anticoagulants proteins among Sudanese patients with dengue virus infection.

THE COAGULATION SYSTEM: Abnormalities in natural physiologic anticoagulants are observed in dengue infection. Laboratory values such as protein C (PC), protein S (PS), and antithrombin (AT) indicate this problem on the coagulation system in dengue. Recently, an interrelationship between dengue and the levels of natural anticoagulants has been observed. OBJECTIVE: The study conducted to find out the effect of dengue on the natural anticoagulant proteins. METHODS: A case-control study was conducted in Port Sudan Teaching Hospital from February 2013 to June 2014 for 334 cases of dengue caused by dengue virus, 217 (65%) males and 117 (35%) were females along with 101 cases of control 64 (63.4%) males and 37 (36.6%) were females. Laboratory-positive dengue cases were confirmed by immunoglobulin (Ig) M and IgG immune chromatography rapid test and the WHO criteria were used for classifying the dengue severity. Platelet count (PLT), plasma prothrombin time (PT), partial thromboplastin time (PTT), fibrinogen, D-dimer (DD), aspartate transaminase, alanine transaminase, PC, PS, and AT were performed. RESULTS: Of 334, 289 patients had dengue fever (DF) and 45 patients had dengue hemorrhagic fever (DHF). Thrombocytopenia was present in 279 (83.5%). PLT was found to be significantly low in the case of dengue (P < 0.000). There was a highly significant difference between the prolongations of PT and PTT in DF (P < 0.000). Prolongations of PT and PTT were significantly higher (90% and 76.2%, respectively) in DF than DHF patients (10% and 23.8%, respectively). PC and PS were significantly higher in DHF 100% and 80% than DF 89% and 57%, respectively. CONCLUSION: The findings of this study suggest that lower levels of these proteins in patients with dengue are attributed to disseminated intravascular coagulation.