Evaluation of peripheral lymphocyte subsets' alteration and IL6 serum level correlated with Severity and outcome in Corona virus disease 2019 (COVID-19)

Background: Coronavirus disease 2019 (COVID-19) has rapid spread worldwide and its pathogenesis is still not well understood. It's critical to identify the key immune inflammatory markers that may be correlated with COVID-19 severity. This study aimed to study the association of the peripheral lymphocyte subsets alteration and IL-6 serum level with disease severity and outcome in COVID-19. Methods: Samples from 30 COVID-19 patients were collected; one is EDTA anticoagulated for flowcytometric analysis of different lymphocyte subsets and the other for Interleukin-6 (IL6) serum level assessed by ELISA technique. Results: Absolute lymphocytic count (0.9 (0.5 - 1.4)× 103/µL) , CD4+ T cells (217 (135.6 - 445.5) cells/µL) , CD8+ T cells (160 (112 - 338) cells/µL) and natural killer (NK) cells (33.3 (18.2 - 99.5) cells/µL)  were significantly reduced in severe COVID-19 patients with significantly elevated IL-6 serum levels 90 (70-120) (pg/mL) in severe patients. Lower T lymphocytes and NK subset counts with higher IL-6 levels were significantly associated with higher mortality. However, B cell count was not associated with severity or mortality. Il-6 levels, CD4+ and CD8+ T cells counts were considered best predictors of disease severity and mortality according to ROC curve analysis (with AUC 0.842, 0.884 and 0.773 respectively). Conclusion:Peripheral lymphocyte subsets as CD4+ T cells, CD8+ T cells and NK cells were significantly reduced in severe COVID-19 patients. CD4+ T cell count was the most significant biomarker for disease severity .Serum IL-6 levels were higher in severe illness. So, IL-6 can serve as a significant predictor of COVID-19 severity. As regard mortality and relation with lymphocytic count and lymphocytic subsets, total lymphocytic count and all T lymphocyte subsets CD4+, CD8+ and CD56+ cells count can be used as a significant predictor of death in COVID-19 patients. However, CD19+ cells counts had no relation with death

Thyroid dysfunction and inflammatory biomarkers in chronic obstructive pulmonary disease: Relation to severity and exacerbation

Background: Thyroid dysfunction or non-thyroidal illness syndrome (NTIS) is frequently detected in chronic, systemic diseases. The systemic manifestations of chronic obstructive pulmonary disease (COPD) include a number of endocrine disorders. The severity of hypoxia and airway obstruction in COPD patients might cause alterations in thyroid function. The aim of this study is to assess serum levels of thyroid hormones and the inflammatory biomarkers; IL-6, TNF-α in COPD patients during stability and acute exacerbation of the disease, and also to assess the relation between severity of COPD and levels of thyroid hormones. Subjects and methods: Forty stable COPD patients and twenty COPD patients with acute exacerbation were included in this study as patient groups and twenty healthy age-matched non smoker subjects with normal pulmonary function as a control group. The diagnosis of COPD and acute exacerbation of COPD were established according to GOLD (2011) criteria. Stable COPD patients were further subdivided into Mild-to-moderate COPD patient group (FEV1 ⩾ 50% of predicted value, which included 14 patients) and Severe COPD patient group (FEV1 < 50% of predicted value, which included 26 patients). All enrolled patients were subjected to measurements of pulmonary function tests (FEV1%, FVC% and FEV1/FVC ratio), arterial blood gases (ABGs) (PaO2, PaCO2, pH), serum levels of thyroid hormones (TSH, total T3, total T4, free T3 and free T4) and the inflammatory biomarkers IL-6 and TNF-α on the first day of admission to RICU or first visit to the outpatient clinics. Results: There was a significant decrease in serum total T3 and free T3 levels in stable COPD patients when compared to control subjects. Also, there was a significant decrease in serum total T3, free T3, TSH levels and TT3/TT4 ratio in the COPD exacerbation patient group when compared to control subjects and when compared to stable COPD patients. There were no statistically significant differences in serum levels of total T4, free T4 between the studied groups. Regarding disease severity, serum total T3, free T3 levels and TT3/TT4 ratio were significantly decreased in severe COPD patients when compared to mild-to-moderate COPD patients. There were significant positive correlations between PaO2 and both serum total T3 and TT3/TT4 ratio in the stable COPD group. Serum IL-6 and TNF-α levels were significantly increased in both stable and exacerbation phase COPD patient groups when compared to control subjects. Conclusion: COPD is a systemic disease that may produce significant alterations in serum levels of thyroid hormones, especially in severe COPD patients and during exacerbation phases of COPD where NTIS is more evident. There was a significant decrease in serum total T3 and free T3 levels in stable COPD patients and this decrease was more significantly evident with a superadded significant decrease in serum TSH levels during the exacerbation phase of COPD. The hormonal alterations are especially related to severity of the disease and hypoxemia. Serum IL-6 and TNF-α levels were increased even in stable COPD and this rise is magnified with increased disease severity and during exacerbation phases of COPD

Evaluation of physio-biochemical criteria in maize inbred lines and their F1 hybrids grown under water-deficit conditions

Since the application of deficit water became a dominant tactic in crop irrigation, developing and surveying newly adapted genotypes should be adopted. In this study, we determined the physio-biochemical activities of 21 maize genotypes under 100 % and 70 % crop evapotranspiration irrigation conditions (normal and deficit irrigation, respectively) in sandy soil to determine which activities can identify drought-tolerant, high-yield genotypes. The experimental design was arranged in randomized complete blocks with three replicates. Results showed that the drought-tolerant parents and hybrids had the highest relative water content (RWC), membrane stability index (MSI), chlorophyll a and b (Chl. a, b), total chlorophyll (total Chl.), chlorophyll a/b ratio (Chl. a/b), chlorophyll stability index (CSI), proline, phenolic content, superoxide dismutase (SOD), catalase (CAT) and peroxidase (POD) levels. They also had the lowest malondialdehyde (MDA) content. The physio-biochemical traits were positively correlated with more tolerant inbred lines and hybrids that displayed a high yield under both irrigation treatments. Furthermore, maize parents that performed well under the 100 % and 70 % evapotranspiration levels were capable of producing high-performance hybrids under both conditions. Accordingly, the hybrids P1 x P6, P2 x P5, and P4 x P6 gave a high performance in sandy soil under both conditions, based on yield attributes estimation. It could be concluded that physio-biochemical traits can be used as effective selection criteria at the silking stage of maize plants to identify high-yield inbred lines and hybrids under stress and normal conditions. These findings will undoubtedly aid maize breeders in rapidly improving and developing new drought-tolerant varieties

Global economic burden of unmet surgical need for appendicitis

Background There is a substantial gap in provision of adequate surgical care in many low- and middle-income countries. This study aimed to identify the economic burden of unmet surgical need for the common condition of appendicitis. Methods Data on the incidence of appendicitis from 170 countries and two different approaches were used to estimate numbers of patients who do not receive surgery: as a fixed proportion of the total unmet surgical need per country (approach 1); and based on country income status (approach 2). Indirect costs with current levels of access and local quality, and those if quality were at the standards of high-income countries, were estimated. A human capital approach was applied, focusing on the economic burden resulting from premature death and absenteeism. Results Excess mortality was 4185 per 100 000 cases of appendicitis using approach 1 and 3448 per 100 000 using approach 2. The economic burden of continuing current levels of access and local quality was US $92 492 million using approach 1 and$73 141 million using approach 2. The economic burden of not providing surgical care to the standards of high-income countries was $95 004 million using approach 1 and$75 666 million using approach 2. The largest share of these costs resulted from premature death (97.7 per cent) and lack of access (97.0 per cent) in contrast to lack of quality. Conclusion For a comparatively non-complex emergency condition such as appendicitis, increasing access to care should be prioritized. Although improving quality of care should not be neglected, increasing provision of care at current standards could reduce societal costs substantially

Global economic burden of unmet surgical need for appendicitis

Background There is a substantial gap in provision of adequate surgical care in many low- and middle-income countries. This study aimed to identify the economic burden of unmet surgical need for the common condition of appendicitis. Methods Data on the incidence of appendicitis from 170 countries and two different approaches were used to estimate numbers of patients who do not receive surgery: as a fixed proportion of the total unmet surgical need per country (approach 1); and based on country income status (approach 2). Indirect costs with current levels of access and local quality, and those if quality were at the standards of high-income countries, were estimated. A human capital approach was applied, focusing on the economic burden resulting from premature death and absenteeism. Results Excess mortality was 4185 per 100 000 cases of appendicitis using approach 1 and 3448 per 100 000 using approach 2. The economic burden of continuing current levels of access and local quality was US $92 492 million using approach 1 and$73 141 million using approach 2. The economic burden of not providing surgical care to the standards of high-income countries was $95 004 million using approach 1 and$75 666 million using approach 2. The largest share of these costs resulted from premature death (97.7 per cent) and lack of access (97.0 per cent) in contrast to lack of quality. Conclusion For a comparatively non-complex emergency condition such as appendicitis, increasing access to care should be prioritized. Although improving quality of care should not be neglected, increasing provision of care at current standards could reduce societal costs substantially