Hemophagocytic lymphohistiocytosis is a rare and potentially fatal disorder caused by immune dysregulation. It can occur as a primary genetic disease or secondarily due to various causes including infections, malignancies or autoimmune diseases. In this case report, we present two cases of Hemophagocytic lymphohistiocytosis which were secondary to typhoid and dengue fever. While primary disease occurs predominantly in infants, secondary hemophagocytic lymphohistiocytosis can occur in any age group. Both primary and secondary hemophagocytic lymphohistiocytosis are characterised by fever, hepatosplenomegaly, pancytopenia and multiorgan dysfunction. But unusual persistence of fever and other organ involvement should need further workup for hemophagocytic lymphohistiocytosis. Secondary hemophagocytic lymphohistiocytosis may resolve on treating the underlying disorder. But severe cases need treatment with immunosuppressive/immunomodulation therapy to prevent morbidity. Early clinical suspicion, prompt diagnosis and treatment of hemophagocytic lymphohistiocytosis are essential to prevent deleterious effects to health.

IntroductionSerum total lactate dehydrogenase (LDH) activity was elevated and showed a positive correlation with disease severity and outcome in severe COVID-19 disease. However, it is still unknown whether the relative abundance or calculated activity of any LDH isoenzyme is predominately increased in COVID-19 subjects.MethodsTwenty-two consecutive patients suffered from moderate or severe COVID-19 pneumonia were recruited into this study who showed enhanced total LDH activity. The ratio of LDH isoenzyme activities was further investigated using gel electrophoresis (Hydragel®, Sebia) with densitometric evaluation. Calculated activity values of these isoenzymes were correlated with routine laboratory parameters, the degree of lung parenchymal affection based on chest CT and clinical outcome.ResultsTotal LDH activity was raised in the range of 272-2141 U/L and significantly correlated with calculated LDH-3 and LDH-4 activities (r=0.765, P=0.0001; and r=0.783, P=0.0001, respectively). In contrast, the relative abundance of neither LDH isoenzyme was exclusively abnormal in COVID-19 patients. Calculated activity of LDH-3 and LDH-4 demonstrated a modest but statistically significant association with serum ferritin (r=0.437, P=0.042; r=0.505, P=0.016, respectively). When the relationship between the severity of pulmonary affection by SARS-CoV-2 infection and relative abundance of LDH isoenzymes was studied, a larger ratio of mid-zone fractions was observed in the presence of ≥ 50% lung parenchymal involvement. Finally, regardless of LDH isoenzyme pattern, abnormal relative ratio of LDH-4 and higher calculated LDH-3 and LDH-4 activity values were detected in subjects with unfavorable outcome.ConclusionNo characteristic profile of LDH isoenzymes can be detected in COVID-19 pneumonia, however, elevated activities of LDH-3 and LDH-4 are associated with worse clinical outcomes.

ContextCirculating microRNAs (miR) have revolutionized the field of molecular biology owing to their potential as a diagnostic as well as a prognostic biomarker of cardiovascular disease and dysfunctions. The present study aims to identify the circulating miR-126 and -122 as an independent risk predictors of coronary artery disease cases.Methods and materialBlood samples were collected from coronary artery disease cases (n=100) and non-CAD cases (n=100). Serum RNA was isolated by Trizol method. MiR levels were measured by quantitative real-time polymerase chain reaction with the specific primer probe set.ResultsMiR-126 levels were significantly down-regulated in CAD cases compared to non-CAD cases (controls) (80.0% vs. 39.0%, χ2=14.95, p<0.001). The level of miR-122 was significantly up-regulated in CAD cases in comparison to its non-CAD variant (14.0% vs. 63.0%, χ2=21.23, p<0.001). Multivariate analysis found chest pain (OR=37.07, 95% CI=3.21-169.04, p=0.017) and miR-126 (OR=0.01, 95% CI=0.00-0.63, p=0.030) as independent risk predictors of CAD.ConclusionThe results of our study show the potential of circulating miR-126 as a novel non-invasive biomarker in the risk prediction of CAD. Further unraveling of the role of miR-122 and miR-126 in the pathogenesis and progression of CAD will add to our understanding of the disease process leading to a new diagnostic approach.HighlightsMir-122 and -126 significantly differentiate non CAD cases from angiographically proven CAD casesChest pain and miR-126 might work as an independent risk predictor of coronary artery disease

Direct to consumer laboratory testing has the potential for self-empowerment of patients. However, the Direct to consumer laboratory testing (DTCT) uses loopholes which are related to the particular situation of healthcare: While advertisements and claims for medical usefulness are very high regulated in healthcare, essentially no regulations safeguard the consumers in DTCT. The same is true for the quality of testing services since quality regulations are only mandatory in healthcare. Another problem is the lack of medical interpretation of test results. Besides being very risky for the consumers, healthcare professionals relying on test results obtained by DTCT must be aware about the risks of these data.

ISO 22870 lists specific requirements for the quality and competence of point-of-care testing (POCT), which are intended for medical laboratories in conjunction with ISO 15189. POCT characteristics include the availability of a large number of devices 24 h/day, a variety of analytical methods, clinical settings inside and outside the hospital, and general non-laboratory staff. ISO 22870 accreditation for adequate POCT management therefore poses a challenge for laboratory medicine, which is charged with leading and coordinating POCT with a multidisciplinary committee. La Paz University Hospital has a complex multitest and multisite network that has been accredited since 2017. In our experience, the particularly crucial areas for POCT accreditation are method performance verification, internal and external quality assurance, staff training and competency, and continuous improvement. ISO 22870 and ISO 15189 accreditation have led us to improve numerous areas regarding the total testing process and, consequently, our patients’ results.

BackgroundInterpretative commenting (IC) and reflective testing have recently generated interest because of their potential for adding value to Clinical laboratory testing. Physicians’ perception to this post-testing service in Nigeria is unknown. This study examined the practices and physician’s disposition regarding IC and reflective testing.MethodsThis cross-sectional study was conducted among 232 doctors working in public and private hospitals across eight purposively selected states in Nigeria. Doctors who have worked and/or currently working in a health facility within their state of residence and who consented to participating in this survey were given a structured questionnaire to fill and return.ResultsPaper-based reporting (213; 91.8%) was the most commonly practiced reporting method. One hundred and thirty-three (57.4%) doctors responded that interpretative comments were added to laboratory reports. “Free-handed text” (85/133; 63.9%) was the most commonly practiced form of IC; 184/232 (79.3%) and 166/232 (71.6%) doctors respectively considered comments on “potential implication of results” and “suggestions on further investigation” as the most “helpful” aspect of IC. Also, 192/232 (82.7%) doctors strongly agreed/agreed that IC influences patient’s management. Only 125 (53.7%) doctors responded that they welcomed reflective testing. Concerns about cost implications (68/107;63.6%) and delays in release of result (48/107; 44.9%) were among reasons for not supporting reflective testing.ConclusionNigerian doctors generally have a positive disposition towards addition of interpretative comments but less so concerning reflective testing. However, challenges such as lack of LIS, EQA schemes for IC and gaps in physicians’ education should be addressed to improve this aspect of laboratory services in Nigeria.

The RNA extraction is an important checkpoint for the detection of SARS-CoV-2 in swab samples, but it is a major barrier to available and rapid COVID-19 testing. In this study, we validated the extraction-free RT-qPCR method by heat-treatment as an accurate option to nucleic acid purification in Algerian population.

The Electronic Health Record (EHR) constitutes a complete information system useful for patient care, epidemiological studies and public health policies development.We describe the Integrating System of EHRs of the Autonomous City of Buenos Aires (CABA), established by Law 5669, of 2016.Although we consider the Integrating System of EHRs implemented by CABA very appropriate, we propose, first, that health services no longer store comprehensive EHRs. Instead, complete information would reside in one or several servers sheltered by civil society. Second, information would become integrated only when patients require it and grant access.The patient would now be in a position of strength (complete autonomy). Instead of asking for his data he would be asked for them. In this sense, the patient will have to exercise the emerging responsibility of reciprocity to the benefit of his own care and the care of others.

The Coronavirus disease 2019 (COVID-19) outbreak, caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), had emerged as a pandemic affecting almost all countries in the world in a short span after it was first reported in December. Clinical laboratory have a crucial role in mitigating this new pandemic. Timely and accurate diagnosis of COVID-19 is of paramount importance for detecting cases early and to prevent transmission. Clinical Laboratories have adopted different test modalities and processes to tackle this unprecedented situation with directives from regulatory bodies such as the WHO. The varying presentations, as well as complications attributed to comorbidities in COVID-19, have created hurdles in the management of these patients. Various clinical laboratory parameters have been investigated for their potential for diagnosis and prognosis of the disease, prediction of complications and monitoring of treatment response. Different routine and uncommon parameters have been shown to have the diagnostic and prognostic capacity. This update discusses the role of the laboratory in diagnosis, prognosis and monitoring of treatment response. Different methodologies for diagnostic testing as well as various clinical laboratory parameters having diagnostic and predictive powers have been discussed. This compilation organises relevant available information on various clinical laboratory parameters and their role in COVID-19 mitigating pandemic.