The Cause–Effect Dilemma of Hematologic Changes in COVID-19: One Year after the Start of the Pandemic

COVID-19 is a systemic infection that leads to multisystem affection, including hematological changes. On the other hand, the patients who have certain hematological diseases are more susceptible to COVID-19 infection. The aim of this review is to examine the wide spectrum of hematological changes that are reported to occur due to COVID-19 infection. Most of the studies over the past year mainly show that most of these changes are mainly non-specific, but are of prognostic value. On the other hand, the susceptibility of hematological patients to COVID-19 infection and complications remains questionable. Patients with certain hematological diseases (including malignancy) and those who are treated by aggressive immunosuppressive therapy have shown higher rates of COVID-19 infection and complications. On the other hand, for most of the patients suffering from other chronic hematological conditions, no evidence has shown a greater risk of infection, compared to the general population

Genotype and allele frequency distribution of <i>MTHFR C677T</i> in β-TM patients and controls.

<p>Genotype and allele frequency distribution of <i>MTHFR C677T</i> in β-TM patients and controls.</p

Detection of <i>MTHFR C677T</i> gene polymorphism.

<p>M: DNA molecular weight marker. Lane 5: PCR product before Hinf I RFLP at 198bp. Lanes 4&2: Wild type <i>CC</i>. Lane1: Heterozygous (<i>CT</i>). Lane 3: Homozygous (<i>TT</i>). RFLP Restriction Fragment Length Polymorphism</p

Impact of Genetic Polymorphism of <i>methylenetetrahydrofolate reductase C677T </i>on Development of Hyperhomocysteinemia and Related Oxidative Changes in Egyptian β-Thalassemia Major Patients

<div><p>Background</p><p>β-thalasemia major (β-TM) patients often suffer from various vascular complications together with increased oxidative stress. Hyperhomocysteinemia (Hhcy) has been defined as a risk factor for these complications. Genetic polymorphism of methylenetetrahydrofolate reductase <i>(MTHFR) C677T</i> has been shown to cause Hhcy particularly in individuals with low B-vitamins. However, the status of homocysteine (hcy) in β-TM has not yet been adequately defined.</p><p>Aim</p><p>To evaluate the genetic polymorphism of <i>MTHFR C677T</i> among β-TM patients and its prospective contribution to Hhcy and related oxidative changes.</p><p>Subjects and Methods</p><p>Genotyping for <i>MTHFR C677T</i> was done by PCR-RFLP technique. Plasma hcy, vitamin B12, folate, malondialdehyde (MDA), total antioxidant capacity (TAC), oxidized low density lipoprotein (oxLDL), total nitric oxide (NOx) and lipid profile were determined in 66 β-TM patients and 66 control subjects of matched age and sex.</p><p>Results</p><p>The prevalence of <i>MTHFR 677TT</i> genotype was significant among β-TM patients (12%) compared to (3%) controls (OR = 4.9, 95%CI:1.2–24.2,P = 0.03). A strong association between Hhcy and <i>MTHFR TT</i> genotype was observed (OR = 7.7, 95%CI:2.8–20.9) where all β-TM patients with <i>TT</i> genotype were hyperhomocystienemic (≥ 15 μmol/l) and having sub-optimal folate level than those with <i>CT</i> or <i>CC</i> genotypes. Hyperhomocystienemic patients have suffered from increased oxidative stress characterized by significant increase in plasma MDA and oxLDL, and a significant reduction of plasma TAC and total NOx. Lipid profile of those patients was severely affected indicated by reduction in HDL and HDL/LDL and elevation in atherogenic index as compared with <i>CC</i> genotype. Other measured parameters were not significantly different among β-TM patients with different <i>MTHFR</i> genotypes.</p><p>Conclusion</p><p>This study suggests that Egyptian β-TM patients with <i>MTHFR 677TT</i> genotype could be at increasing risk of developing Hhcy particularly with folate deficiency. This state of Hhcy may account potentially for most oxidative changes and atherogenic vascular complications frequently reported in β-TM patients.</p></div

Biochemical parameters of β-TM patients and controls.

<p>Biochemical parameters of β-TM patients and controls.</p

Demographic characteristics, hematological, and biochemical parameters of β-TM patients and controls.

<p>Demographic characteristics, hematological, and biochemical parameters of β-TM patients and controls.</p

Prevalence of hyperhomocysteinemia in β-TM patients according to their <i>MTHFR</i> genotypes.

<p>Prevalence of hyperhomocysteinemia in β-TM patients according to their <i>MTHFR</i> genotypes.</p

A guide for evaluation of online learning in medical education: a qualitative reflective analysis

Abstract Background With the strike of Covid-19, an unprecedented rapid shift to remote learning happened worldwide with a paradigm shift to online learning from an institutional adjuvant luxury package and learner choice into a forced solo choice. This raises the question of quality assurance. While some groups have already established standards for online courses, teaching and programs yet very little information is included on methodology of their development and very little emphasis is placed on the online learning experience. Nevertheless, no work has been done specifically for medical education institutions. Aim To develop a set of descriptors for best practice in online learning in medical education utilizing existing expertise and needs. Methods This work utilizes a qualitative multistage approach to identify the descriptors of best practice in online learning starting with a question guided focus group, thematic analysis, Delphi technique and an expert consensus session done simultaneously for triangulation. This was done involving 32 institution in 19 countries. Results This materialized into the development of a set of standards, indicators, and development of a checklist for each standard area. The standard areas identified were organizational capacity, educational effectiveness, and human resources each of which listed a number of standards. Expert consensus sessions identified the need for qualification of data and thus the development of indicators for best practice. Conclusion Standards are needed for online learning experience and their development and redesign is situational and needs to be enhanced methodologically in axes that are pertaining to the needs of the education community. Taking such axes into consideration by educators and institutions will lead to planning and implementing successful online learning activities, while taking them into consideration by the evaluators will help them conduct comprehensive audits and provide stakeholders with highly informative evaluation reports