Bilirubin/Albumin Ratio for Predicting Acute Bilirubin-induced Neurologic Dysfunction

Objective: The aim of this study was to evaluate the bilirubin albumin (B/A) ratio in comparison with total serum bilirubin (TSB) for predicting acute bilirubin-induced neurologic dysfunction (BIND). Methods: Fifty two term and near term neonates requiring phototherapy and exchange transfusion for severe hyperbilirubinemia in Children's Medical Center, Tehran, Iran, during September 2007 to September 2008, were evaluated. Serum albumin and bilirubin were measured at admission. All neonates were evaluated for acute BIND based on clinical findings. Findings: Acute BIND developed in 5 (3.8%) neonates. B/A ratio in patients with BIND was significantly higher than in patients without BIND (P<0.001). Receiver operation characteristics (ROC) analysis identified a TSB cut off value of 25 mg/dL [area under the curve (AUC) 0.945] with a sensitivity of 100% and specificity of 85%. Also, according to the ROC curve, B/A ratio cut off value for predicting acute BIND was 8 (bil mg/al g) (AUC 0.957) with sensitivity of 100% and specificity of 94%. Conclusion: Based on our results, we suggest using B/A ratio in conjunction with TSB. This can improve the specificity and prevent unnecessary invasive therapy such as exchange transfusion in icteric neonates

A Review of SARS-CoV-2 Genetic and Structure: Hot Cellular Targets for Virus Entry: Genetic and structure of COVID-19

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) uses several molecules such as angiotensin-converting enzyme 2 (ACE2), cluster of differentiation 26 (CD26), Ezrin, and Neuropilin-1 (NRP-1) for viral entry. In this review, the entire structural and genomic combination and the mechanism of virus entry, are discussed. This study might be useful for further drug design studies. SARS-CoV-2 neutralization allows the immune system to fight the virus before its entry. COVID-19 enters the host bloodstream by infecting endothelial cells via a cluster of differentiation 147 (CD147). SARS-CoV-2 not only uses ACE2 for its entry but also affects ACE-2 and its enzymatic activity on Ang II and bradykinin, it also imbalances the RAAS and bradykinin system and elevates the inflammation. High levels of bradykinin, cause nonproductive cough as the result of fluid extravasation and leukocyte recruitment to the lung. Accordingly, we suggest replicase transcriptase complex (RTC) and specific non-structural proteins (Nsps) such as Nsp7,8, Nsp10, Nsp12, and Nsp16 are perfect targets of study because RTC and Nsps are the golden elements in the maintenance of COVID-19 appearance and masking. Base on this evidence COVID-19 uses various receptors for its entry and it might block these receptors' activity to evade the immune system and spread to other cells. *Corresponding Authors: Elham Rajaei, Email: [email protected];&nbsp;ORCID: https://orcid.org/0000-0002-8231-0138 Please cite this article as: Torabizadeh M, Ghobadi Dana V, Aghapour SA, Zibara K, Deris Zayeri Z, Rajaei E. A Review of SARS-CoV-2 Genetic and Structure: Hot Cellular Targets for Virus Entry. Arch Med Lab Sci. 2021;7:1-9 (e15). https://doi.org/10.22037/amls.v7.3421

Clues of HLAs, metabolic SNPs, and epigenetic factors in T cell-mediated drug hypersensitivity reactions

Drug hypersensitivities are common reactions due to immunologic responses. They are of utmost importance because they may generate severe and fatal outcomes. Some drugs may cause Adverse Drug Reactions (ADRs), such as drug hypersensitivity reactions (DHRs), which can occur due to the interaction of intact drugs or their metabolites with Human Leukocyte Antigens (HLAs) and T cell receptors (TCRs). This type develops over a period of 24–72 h after exposure and is classified as type IV of DHRs. Acute generalized exanthematic pustulosis (AGEP), Stevens-Johnson syndrome (SJS)/toxic epidermal necrolysis (TEN) and drug reaction with eosinophilia and systemic symptoms (DRESS) are types of Severe Cutaneous Adverse Reactions (SCARs). In this review, we aim to discuss the types of ADRs, the mechanisms involved in their development, and the role of immunogenetic factors, such as HLAs in type IV DHRs, single-nucleotide polymorphisms (SNPs), and some epigenetic modifications, e.g., DNA/histone methylation in a variety of genes and their promoters which may predispose subjects to DHRs. In conclusion, development of promising novel in vitro or in vivo diagnostic and prognostic markers is essential for identifying susceptible subjects or providing treatment protocols to work up patients with drug allergies as personalized medicine