INTRODUCTION: Hematologic manifestations of Systemic Lupus Erythematosus (SLE) such as hemolytic anemia, leucopenia and thrombocytopenia are among the common causes of morbidity and hospitalization among patients. This is a case report of a patient presenting with refractory cytopenias.
CASE: The  patient  is  a  42-year-old  female,  diagnosed with  SLE,  having  met  the  Systemic  Lupus  Erythematosus  International  Collaboration  Clinics  Criteria  for  diagnosis Persistent  serositis  (pleural  effusion  and  ascites) and worsening of anemia prompted treatment with oral corticosteroid (prednisone 1.0 mg per kg per day) which showed improvement of shortness of breath and  pleural effusion. Cytopenias persisted despite increasing IV pulse steroid to 6.0  mkd  prednisone then further to 13 mkd prednisone.Rituximab given as 1.0 g infusion once every two weeks for two doses which resulted to improvement of anemia, thrombocytopenia and serositis. 
CONCLUSION: Hematologic manifestations may present as life threatening complications of lupus.Most cases are responsive  to  corticosteroid  therapy,however,in a few refractory cases,less used conventional treatment such as rituximab,may provide significant response.

Human ; Female ; Adult ; Serositis ; Prednisone ; Rituximab ; Leukopenia ; Lupus Erythematosus, Systemic ; Thrombocytopenia ; Lupus Erythematosus, Discoid ; Anemia, Hemolytic ; Pleural Effusion ; Adrenal Cortex Hormones ; Dyspnea

Introduction: White blood cell (WBC) count, from which neutrophil-to-lymphocyte count ratio (NLCR) can be derived, is commonly requested in the hospital setting among admitting patients with community acquired pneumonia (CAP). This study aims to establish the predictive value of WBC count and NLCR in classifying CAP which guides the clinicians in the choice of antibiotics and site-of-care. The researchers aim to evaluate the predictive value of WBC count and NLCR during consultation and admission in classifying patients with CAP based on the managementoriented risk stratification of the 2016 Philippine Clinical Practice Guidelines on CAP. Methods: This was a prospective cross-sectional study conducted in St. Luke’s Medical Center, Quezon City. Adult patients diagnosed with CAP were classified according to severity of infection based on the 2016 Philippine Clinical Practice Guidelines on CAP. WBC count of each patient was determined, and their corresponding NLCR was derived. The differences of WBC count and NLCR per risk were evaluated using chi-square and ANOVA test adjusted for the distribution of the outcome. Sensitivity and specificity of WBC and NLCR were determined for the following: (1) between CAP low risk (LR) versus CAP moderate risk (MR) and CAP high risk (HR) and (2) between CAP LR and CAP MR versus CAP HR. Receiver operating characteristic (ROC) curve was constructed to evaluate the sensitivity and specificity of WBC and NLCR in classifying. ROC curves displayed sensitivity versus 1-specificity such that area under the curve (AUC) ROC for WBC and NLCR. Results: Two hundred eighty (280) CAP patients from June 2016 until April 2017 were studied. Among the CAP patients, 69 (24.6%) were classified as LR, 172 (61.5%) were classified as MR, and 39 (13.9%) were classified as HR. The mean WBC count was 11,725.8 (±5,205.82)/ụl. The mean WBC per risk were as follows: 9,178/ụl for LR; 12,251/ụl for MR, and 13,916/ ụl for CAP HR. It showed that the higher the risk, the higher the mean of the WBC count (<0.00001). The mean NLCR was 8.9 (±8.4). The mean average of NLCR per risk were as follows: 5.4 for LR, 8.6 for MR, and 16.1 for HR. It showed that the higher the risk, the higher the NLCR (<0.00001). In predicting CAP patients with HR and MR from LR, the AUC of NLCR (0.700) was almost the same as that of the WBC count (0.698). In predicting CAP patients with HR from MR and LR, the AUC of NLCR (0.726) was higher than the WBC (0.621), indicating that NLCR is a fair predictive marker in distinguishing HR from MR and LR. Conclusion As the severity of CAP increases, the mean of the WBC count and NLCR increases. Between the two biomarkers, NLCR predicts CAP severity more than the WBC count. Furthermore, NLCR better predicts HR from MR and LR
Leukocyte Count

BACKGROUND

Coronavirus disease 2019 (COVID-19) has been associated with acute liver injury presenting as increased liver enzymes, specifically alanine aminotransferase (ALT) and aspartate aminotransferase (AST). There is limited data in the prevalence of liver injury in COVID 19. We aim to determine the prevalence of acute liver injury among COVID-19 patients admitted in a tertiary hospital in the Philippines.

METHODS

The study is a single center, retrospective cohort of all COVID-19 patients with baseline AST and ALT admitted at St. Luke’s Medical Center - Quezon City from January 2020 to December 2021. The population was divided into those with normal liver enzymes, mild (AST and/or ALT 1-3 times ULN), and severe (AST and/or ALT >3x ULN) acute liver injury. Association of liver injury to clinical outcome, COVID 19 disease severity, and length of hospital stay were determined. Among those with elevated AST/ALT, comparison of the levels before and after treatment with hepatoprotective agents were evaluated.

RESULTS

Among the 669 patients included in the analysis, 448 (67%) developed liver injury of which 50 (7.5%) had severe liver injury and 398 (59.5%) developed mild liver injury. Chi squared analysis showed that acute liver injury (OR:2.64,CI:1.90-3.69, p < 0.01) was associated with COVID-19 severity. However, acute liver injury was not associated with clinical outcome (p = 0.347) and length of hospital stay (p = 0.317). There was no association between the use of hepatoprotective agents and changes in level of transaminases (p=0.087).

CONCLUSION

This study revealed that mild liver injury is commonly found in patients with COVID-19 infection. Severity of liver injury is significantly associated with COVID-19 severity, but not with clinical outcome and length of hospital stay. In this study, treatment with hepatoprotective agents did not lead to a decrease in liver enzymes. Further evaluation is needed to recognize those patients at higher risk of complications and identify effective therapies in providing better clinical outcomes.

Human ; Covid-19

INTRODUCTION

The development of pneumonia after cardiac surgery is a significant postoperative complication that may lead to worse clinical outcomes. We aimed to identify risk factors associated with it and determine its clinical impact in terms of in-hospital mortality and morbidity.

METHODS

This was a cross-sectional study among all adult patients who underwent cardiac surgery from 2014 to 2019 in a tertiary hospital in the Philippines. Baseline characteristics and risk factors for pneumonia were retrieved from medical records. Nosocomial pneumonia was based on the Centers for Disease Control and Prevention criteria. Odds ratios from logistic regression were computed to determine risk factors and clinical outcomes for pneumonia using STATA 15.0 (StataCorp, College Station, Texas).

RESULTS

Of 373 patients included, 104 (28%) acquired pneumonia. Most surgeries were ere coronary artery bypass grafting (71.58%). Age, sex, body mass index, diabetes, left ventricular/ renal dysfunction, chronic obstructive pulmonary disease/asthma, surgical urgency, surgical time, and smoking did not show association with pneumonia development. However, preoperative stay of >2 days was associated with 92.3% increased odds of having pneumonia (P = 0.009). Also, every additional hour on mechanical ventilation conferred 0.8% greater odds of acquiring pneumonia (P = 0.003). Patients who developed pneumonia had 3.9-times odds of mortality (95% confidence interval [CI], 1.51-9.89; P = 0.005), 3.8-times odds of prolonged hospitalization (95% CI, 1.81-7.90; P <0.001), 6.4-times odds of prolonged intensive care unit stay (95% CI, 3.59-11.35; P 0.001), and 9.5-times odds of postoperative reintubation (95% CI, 3.01-29.76; P <0.001), 6.4-times odds of prolonged intensive care unit stay (95% CI, 3.59–11.35; P <0.001), and 9.5-times odds of postoperative reintubation (95% CI, 3.01–29.76; P <0.001).

CONCLUSION

Among adult patients undergoing cardiac surgeries, prolonged preoperative hospital stay and prolonged mechanical ventilation were associated with an increased risk of nosocomial pneumonia. Those who developed pneumonia had worse outcomes with significantly increased in-hospital mortality, prolonged hospitalization/intensive care unit stay, and increased postoperative reintubation. Clinicians should therefore minimize delays in surgery and encourage timely liberation from mechanical ventilation after surgery.