Hematology, immunology and clinical chemistry profiles of COVID-19 patients: Systematic review

Background: COVID-19 is an emerging novel viral infection that first emerged in December 2019 and was officially pronounced as a ‘pandemic’ by March 2020. One of the strategies to control the spread of COVID-19 disease is expanding laboratory diagnosis services. So far, the molecular biology-based real-time polymerase chain reaction (RT-PCR) method is the only recommended laboratory test to diagnose the disease. However, during COVID-19 infection, hematology, immunology, and clinical chemistry test profile changes might also assist in diagnosing the disease. Objective: The objective of this systematic review was “assessment of routine hematology, immunology, and clinical chemistry test profile changes among COVID-19 RT-PCR laboratory tests positive individuals”, which, before such tests are carried out, might suggest the occurrence of COVID-19 infection. Material and methods: The systematic review was done to assess general epidemiology, routine clinical chemistry and hematology/ immunohematology tests done in association with COVID-19 diagnosed cases. Online published articles were searched using PubMed, Hinari, AGORA and Google Scholar search engines, based on the following inclusion criteria: articles on COVID-19 that focus on human coronavirus diseases, their epidemiology, laboratory diagnosis of such diseases, the RT-PCR test, and additional routine laboratory tests. Exclusion criteria included articles that discuss the RT-PCR method only, imaging diagnostic methods, and those that focus on specific groups (such as COVID-19 among diabetes patients, cancer patients and so on). Accordingly, a total of 75 research articles were identified. Of these, 29 papers were selected for systematic review. Results: From the collected 29 articles on routine clinical chemistry tests, it was concluded that in confirmed COVID-19 cases, aminotransferase enzymes – alanine transaminase (ALT) and aspartate transaminase (AST) – bilirubin, creatine kinase (CK), troponin, lactate dehydrogenase (LDH), creatine  and ferritin values were relatively high, whereas the albumin value was reduced. In the hematology/immunohematology tests, total white blood cell (WBC) counts, neutrophil counts, erythrocyte sedimentation rates (ESR), C-reactive protein (CRP) and prothrombin time (PT) increased, whereas lymphocyte counts, platelet counts, and cluster of differentiation 4 (CD4) and cluster of differentiation 8 (CD8) counts decreased. In addition, neutrophil-lymphocyte (N-L) ratios increased, whereas lymphocyte-C-reactive protein (L-C) ratios decreased. Conclusions: For those individuals with signs and symptoms of COVID-19, leukocytosis with neutrophilia and lymphopenia, high N-L and low L-C ratios, mild increases in aminotransferase and creatinine values with increased CK, troponin and ferritin levels, might be considered as “routine laboratory test results that are supportive of occurrence COVID-19 disease”. Further large-scale studies are required to strengthen the present findings. [Ethiop. J. Health Dev. 2020; 34(3):226-231] Key words: COVID-19, clinical chemistry, hematology, immunohematology test

Assessment of Two Years’ Sputum Smear Results among Tuberculosis Suspected Patients in Gambella Regional Hospital, Western Ethiopia

Background. Determining burden of pulmonary tuberculosis (PTb) may be associated with success of directly observed theraphy (DOT) services in high PTb areas, such as Gambella, Ethiopia. Objective. To assess burden of sputum smear positive SSP-PTb reports in Gambella Regional Hospital, in two consecutive years: mid 2013 to 2015. Methods. From March 2013 to February 2015, PTb suspected patients’ sputum Acid Fast Bacilli test results were collected from laboratory registration book of Gambella Regional Hospital, western Ethiopia. Results. Of the total 3064 results, the proportions of males and individuals whose age is between 16 and 25 years were 1823 (59.5%) and 1046 (34.1%), respectively. Majority of samples were coming from newly PTb suspected patients (2587, or 84.4%); and of them, SSP-PTb cases were 9.9%. The overall SSP-PTb cases decreased by 2.1% in March 2014 to February 2015 as compared to March 2013 to Feburary 2014. Meanwhile, AFB smear negative cases were significantly associated with being male [1.384 (1.064–1.801)] and being of age group 16–25 years [1.517 (1.007–2.287)]. Conclusion. In Gambella region, although the distribution of AFB smear results had no significant yearly variations and the overall burden of SSP cases was decreased, still a lot of work needs to be undertaken on the PTb prevention and control program

Biochemical and immuno-hematological test availability during the COVID-19 pandemic: The case of private diagnostic laboratories in Addis Ababa, Ethiopia

AbstractBackground: Since the emergence of COVID-19 (SARS-CoV-2) in China, in December 2019, the pandemic has continued to be a major public health threat. According to the World Health Organization, on March 02, 2021, there were113,989,973 confirmed cases of COVID-19 globally, and 2,531,542 reported deaths. In Ethiopia on the same period, there were159,072 confirmed cases and 2,365 reported deaths. Efforts have been made in Ethiopia to make COVID-19 Biochemical and immuno-hematological tests available; however, the role of private diagnostic laboratories with this perspective has not been assessed. This study aims to address the role of private diagnostic laboratories as service providers of various laboratory tests that can help with the management of COVID-19 patients. Materials and methods: A cross-sectional survey was carried out with seven standalone laboratories in Addis Ababa. A questionnaire and observation checklists – adopted from the World Health Organization, were used to prepare a structured questionnaire and on-site evaluations of the availability of biochemical and immuno-hematological tests in the city. The data collection tool also assessed whether the diagnostic laboratories had back-up instruments for common biochemical and immuno-hematological tests. The data entry and analysis were conducted using SPSS software version 20. Results: Among the 7 private diagnostic laboratories participated in this study majority of them have professionals who are males (N=20/33, 60.6%). Most of the laboratory professionals in the private laboratories had Bachelor of Science degrees in medical laboratory sciences (15/33, 45.5%). Almost all of them provide organ function tests including liver and renal functions. However, some important tests like D-dimer were not available. All the laboratories claimed that they had adequate stock for conducting hematological tests, although none had GeneXpert® MTB/RIF assays for detection Mycobacterium tuberculosis and testing for rifampin resistance. Conclusions: Private diagnostic laboratories that offer clients most clinical chemistry, hematological and immuno-hematological tests are to be welcomed, particularly during the COVID-19 pandemic, when public health diagnostic laboratories could be overburdened, and the stock of reagents might be low or unavailable. There should be a means to strengthen public-private partnerships and both patients and clinicians could benefit a lot by availing diagnostics as needed. Further detailed study is required to understand the role of private diagnostic laboratories during outbreaks and pandemics situation. [Ethiop. J. Health Dev. 2021; 35(1):3-8] Key words: Private laboratory, biochemical tests, hematological tests, COVID-1

Evaluation of Laboratory Performance, Associated Factors and Staff Awareness Towards Achieving Turnaround Time in Tertiary Hospitals, Ethiopia

BACKGROUND: WHO recommends that each laboratory should establish turnaround time (TAT) to monitor and evaluate performance throughout processes. The status of established TAT was not yet assessed in Ethiopian Armed Force Comprehensive Specialized Hospital. The aim of this study was to evaluate the laboratory performance and associated factors towards achieving TAT in clinical chemistry and hematology tests at Armed Force Comprehensive Specialized Hospital, Addis Ababa, Ethiopia.METHODS: Hospital-based cross-sectional study was conducted from April 2019 to June 2019. Standardized questionnaire was designed to collected data on awareness of laboratory staffs about TAT. The data was entered, cleaned and analyzed using SPSS version 24.0 Software. Logistic regression analysis was done to find out statistically significant association and strength of association between dependent and independent variables at pvalue <0.05.RESULT: A total of 422 test results were systematically selected with 100% response rates. Of these, 253(59.9%) were chemistry tests. From the expected < 90min TAT clinical chemistry tests, only 41(16.2%) and from < 60min TAT time for hematology tests, 37(21.9%) met the target. The laboratory TAT was affected by factors including high work load, laboratory information system problem, power interruption and sample collection time. Moreover, the level of knowledge, attitude and practices of laboratory staffs towards laboratory TAT were 60%, 85.7% and62.9% respectively.CONCLUSION: Overall achievement of clinical Chemistry and hematology tests TAT was poor. The finding might reflect other public hospital situation in Addis Ababa. Thus, additional large scale studies need to conduct

Assessment of renal function and electrolytes in patients with thyroid dysfunction in Addis Ababa, Ethiopia: a cross sectional study

Introduction: studies demonstrated that abnormal thyroid functions may result in decreased or increased kidney size, kidney weight, and affect renal functions. In this regard, studies on the association of abnormal thyroid functions and renal function tests are scarcely found in Ethiopia. Objective: to assess renal function and electrolytes in patients with thyroid dysfunction, in Addis Ababa, Ethiopia. Methods: cross sectional study was conducted from March 21/2015-May 27/2015 at Arsho Advanced Medical Laboratory. During the study period, 71 patients with thyroid dysfunction were eligible, and socio demographic data collected by structured questionnaire. Then blood sample was collected for thyroid function tests, renal function and blood electrolyte analysis. The collected data was analyzed by SPSS version 20. ANOVA and binary logistic regression were employed to evaluate the mean deference and associations of thyroid hormone with renal function and electrolyte balances. Results: among the renal function tests, serum uric acid, and creatinine mean values were significantly decreased in hyperthyroid patients; whereas, eGFR mean value was significantly increased in hyperthyroid study patients (P<0.05). Meanwhile, from the electrolyte measurements made, only the mean serum sodium value was significantly increased in hyperthyroid study participants. Binary logistic regression analysis on the association of thyroid dysfunction with electrolyte balance and renal function tests indicated that serum sodium, creatinine, eGFR values and hyperthyroidism have a statistical significant association at AOR 95% CI of 0.141(0.033-0.593, P=0.008); 16.236(3.481-75.739, P=0.001), and 13.797(3.261-58.67, P=0.001) respectively. Conclusion: the current study reveals, thyroid abnormalities may lead to renal function alterations and also may disturb electrolyte balance. Knowledge of this significant association has worthwhile value for clinicians, to manage their patients' optimally.The Pan African Medical Journal 2016;2

Prevalence of intestinal parasites versus knowledge, attitude and practices (KAPs) with special emphasis to Schistosoma mansoni among individuals who have river water contact in Addiremets town, Western Tigray, Ethiopia.

BACKGROUND:Intestinal parasite infections are major public health problems in resource-limited countries that adversely affect the well-being of millions. Among these, intestinal schistosomiasis is a serious public health problem in tropical and sub-tropical countries. METHODS:A Community based cross sectional study was conducted from February to April 2017 in Addiremets town, Ethiopia. Socio-demographic associated risk factors and knowledge, attitude and practices of individuals regarding intestinal parasite infection including schistosomiasis were collected from 411 study participants using pretested structured questionnaires. From each study participant, a fresh stool sample was collected and direct microscopy, formol-ether concentration and Kato- Katz techniques were performed. Snails were checked and collected from the nearby study area river. The collected data was entered and analyzed using SPSS version 20. Bi-variant and multiple logistic regressions were used for correlation analysis. A P <0.05 was considered as statistically significant. RESULT:The overall intestinal parasite prevalence was 51.3% (211/411). The most prevalent parasites were S. mansoni 26.3%(108/411) and Hookworm 23.1%(95/411). The prevalence of intestinal parasites among males and females were 54.1%(131/242) and 47.3%(80/169) respectively. The highest proportion of parasite infection was reported among the age group of 5-9 year old participants, at 70.6%(36/51). The prevalence of S. mansoni was 26.3% (108/411) with mean infection intensity of 218 eggs per gram (range: 24 to 1728). Among study participants, 94.4% had good knowledge while 35.9% of them had poor practices towards intestinal parasite and Schistosomes infection prevention. CONCLUSION:High prevalence of intestinal parasitic infection was observed in Addiremets town and the most common parasites identified were S. mansoni and Hookworm. Most study participants had light infection intensity of Schistosomiasis, Ascariasis and Hookworm infection. Majority of the participants in the study area had good knowledge and positive attitude about intestinal parasitic infection and schistosomiasis control. Shells of Biomphalaria species, Bulinus species and Physa species were collected from the Mytsaeda river shore

Inverse Associations of Infection and Metabolic Syndromes in Humans: A Cross-Sectional Study in Northeast Ethiopia

Background: Recent animal and retrospective human studies have demonstrated that Schistosoma mansoni infection may have potential to protect against development of metabolic syndromes. Thus, the aim of this study was to assess metabolic panel among S. mansoni egg positives and egg negatives in stool examinations. This study was a cross-sectional study, conducted involving 120 participants from S. mansoni endemic town (Kemise) and 61 from non-endemic town (Kombolcha), Northeast Ethiopia. Stool samples were collected and examined for S. mansoni and other helminths using Kato-Katz method. Furthermore, blood samples were collected and used for determination of blood sugar, lipid profile tests, insulin, and C-reactive protein. Data were analyzed using SPSS software version 20. Chi-square test, independent mean t-test, and logistic regression models were employed on data. P values less than .05 were considered as statistically significant. Results: S. mansoni infected participants (n = 41; all from Kemise) had significantly lower levels of fasting blood sugar, low prevalence of dyslipidemia (at least one or more abnormal lipid profile tests; total cholesterol, low-density lipoprotein cholesterol [LDL-C], high-density lipoprotein cholesterol [HDL-C], and triglycerides) as compared with controls (n = 79 in Kemise and 61 in Kombolcha). Moreover, logistic regression model indicated that with the adjusted odds ratios, there was significant inverse association between S. mansoni infection and impaired fasting glucose (adjusted odds ratio −0.181, 95% confidence interval: 0.042-0.774). Conclusions: Low fasting blood sugar and reduced prevalence of dyslipidemia in S. mansoni egg positive participants might suggest inverse association of S. mansoni infection and development of metabolic syndromes. Furthermore, large-scale studies are recommended to assess the role of S. mansoni egg and/or worm antigens in modulating the host metabolic profile and reducing the risk of metabolic syndromes, including diabetes mellitus and cardiovascular diseases

Human monocytes/macrophage inflammatory cytokine changes following in vivo and in vitro Schistomam manoni infection

Introduction: Epidemiological and animal studies indicate that helminth infections have positive effects due to their potential to protect against autoimmune diseases. Here, we aim to assess the effect of S. mansoni infection on immune modulation of human monocytes and their potential protection against autoimmune disease development both in vivo and in vitro. Materials and Methods: Monocytes were isolated from helminth-infected Ethiopians (MHIE), and from Dutch healthy volunteers (MHV). The MHV were stimulated in vitro with S. mansoni soluble egg antigens (SEA) or soluble worm antigens (SWA). In addition, phenotypical changes were studied directly, as well as after culturing for 6 days in the presence of human serum to obtain macrophages. Q-PCR, flow cytometry, multiplex bead immunoassay, and live-cell imaging were employed during analysis. Results: MHIE showed elevated transcripts of SOCS-1 and TNF-α compared to MHV. Similarly, MHV that were stimulated with SEA demonstrated enhanced levels of SOCS-1, IL-10, and IL-12 mRNA, compared to control MHV. Remarkably, the SEA-treated monocytes showed a much higher motility than control monocytes, a hallmark of a patrolling phenotype. Furthermore, in vitro cultured macrophages that were stimulated by SEA exhibited enhanced mRNA levels of SOCS-1, IL-10, TNF-α, IL-12 and TGF-β, compared to control macrophages. Conclusion: Macrophages from MHIE as well as SEA-treated MHV show an intermediate activation phenotype with both pro-inflammatory and anti-inflammatory characteristics in vitro. The observed pro-inflammatory properties might reflect a recent response of the cells due to contact with a pathogen, whereas the anti-inflammatory properties might contribute to helminth-induced protection against inflammatory diseases. Large-scale study is recommended to consolidate the findings of the present study

Lipid Profile in Tuberculosis Patients with and without Human Immunodeficiency Virus Infection

Background. Understanding whether the preceding low lipid profile leads to active tuberculosis (TB) or active TB leads to low lipid profile is crucial. Methods. Lipid profile concentrations were determined from 159 study participants composed of 93 active TB patients [44 HIV coinfected (HIV+TB+) and 49 HIV negative (HIV−TB+)], 41 tuberculin skin test (TST) positive cases [17 HIV coinfected (HIV+TST+) and 24 HIV negative (HIV−TST+)], and 25 healthy controls (HIV−TST−). Cobas Integra 400 Plus was used to determine lipid profiles concentration level. Results. The concentrations of total cholesterol (TC), triglyceride (TG), low-density lipoprotein cholesterol (LDL-C), and high-density lipoprotein cholesterol (HDL-C) in HIV−TB+ patients were significantly lower compared to HIV−TST+ and to HIV−TST− individuals. Similarly, the concentrations of the TC, LDL-C, and HDL-C in HIV+TB+ were significantly lower compared to HIV−TB+ patients. After the 6 months of anti-TB treatment (ATT), the concentration levels of TC, LDL-C, and HDL-C in HIV−TB+ patients were higher compared to the baseline concentration levels, while they were not significantly different compared to that of HIV−TST+ concentration. Conclusion. The low concentration of lipid profiles in TB patients may be a consequence of the disease and significantly increased in TB patients after treatment

Genetic Diversity of Merozoite Surface Protein-1 and -2 Genes in Plasmodium falciparum Isolates among Asymptomatic Population in Boset and Badewacho Districts, Southern Ethiopia

Background. The genetic variation of Plasmodium falciparum has been studied to assess local malaria transmission genetic profile using evidence-based intervention measures. However, there are no known previous reports of P. falciparum polymorphism in Badewacho and Boset districts, Southern Ethiopia. The purpose of this study was to determine the genetic diversity of the merozoite surface protein-1 and -2 (msp-1 and msp-2) allelic families in P. falciparum isolates from an asymptomatic populations. Methods. This study was conducted from finger-prick blood samples spotted on 3 mm Whatman filter paper collected during a community-based cross-sectional study. Nested polymerase chain reaction amplification was used to type the allelic variants of msp-1 and msp-2. Results. From 669 asymptomatic study participants, a total of 50 samples positive for P. falciparum were included for molecular analysis. Of 50 positive samples, 43 P. falciparum isolates were successfully amplified for the msp-1 and msp-2 allelic families. A total of twelve different allele sizes (75–250 bp) were identified within the three allelic families of msp-1, whereas ten different allele sizes (250–500 bp) were detected within the two allelic families of msp-2. MAD20 had a higher allelic proportion, 65% among allelic families of msp-1, whereas the 3D7 allelic family 90.7% was higher in msp-2. A slightly higher frequency of polyclonal infection 53.5% was found in msp-2 allelic family, whereas a low proportion polyclonal infection 46.5% was found in msp-1 allelic family. The overall mean multiplicity of infection (MOI) for msp-1 and msp-2 was identical (MOI = 1.56). Correspondingly, the expected heterozygosity (He) value for msp-1 (He = 0.23) and msp-2 (He = 0.22) was almost similar. Conclusions. The findings of this study revealed low genetic diversity of the msp-1 and msp-2 allelic families in P. falciparum isolates. However, continued monitoring status of the local genetic diversity profile in the P. falciparum population is required to support current malaria control and elimination strategies