Coronavirus disease 2019 (COVID-19) increases the risk of coagulopathy. Although the presence of antiphospholipid antibodies (aPLs) has been proposed as a possible mechanism of COVID-19-induced coagulopathy, its clinical significance remains uncertain. Therefore, this study aimed to evaluate the prevalence and clinical significance of aPLs among critically ill patients with COVID-19. This prospective observational study included 60 patients with COVID-19 admitted to intensive care units (ICU). The study outcomes included prevalence of aPLs, and a primary composite outcome of all-cause mortality and arterial or venous thrombosis between antiphospholipid-positive and antiphospholipid-negative patients during their ICU stay. Multiple logistic regression was used to assess the influence of aPLs on the primary composite outcome of mortality and thrombosis. A total of 60 critically ill patients were enrolled. Among them, 57 (95%) were men, with a mean age of 52.8 ± 12.2 years, and the majority were from Asia (68%). Twenty-two patients (37%) were found be antiphospholipid-positive; 21 of them were positive for lupus anticoagulant, whereas one patient was positive for anti-β2-glycoprotein IgG/IgM. The composite outcome of mortality and thrombosis during their ICU stay did not differ between antiphospholipid-positive and antiphospholipid-negative patients (4 [18%] vs. 6 [16%], adjusted odds ratio 0.98, 95% confidence interval 0.1–6.7; p value = 0.986). The presence of aPLs does not seem to affect the outcomes of critically ill patients with COVID-19 in terms of all-cause mortality and thrombosis. Therefore, clinicians may not screen critically ill patients with COVID-19 for aPLs unless deemed clinically appropriate.

Objective: To find the pattern of idiopathic thrombocytopenic purpura (ITP) (acute/chronic) and to describe presenting features and clinical characteristics of the disease in children below 14 years of age in a newly developed Arabian society.Method: This retrospective, descriptive study was carried out at the Pediatric Department of the Hamad General Hospital, Hamad Medical Corporation, Qatar. A total of 50 children below 14 years of age who were diagnosed with ITP during the period 2000-2005 were included.Results: Among the studied children (50), 62% were diagnosed with acute ITP and 38% with chronic ITP. Acute ITP was more prevalent in boys (64.5%) when compared with girls (35.5%), whereas for chronic ITP, nearly an equal distribution was found in boys (57.9%) and girls (42.1%). Preceding viral infection was common in both acute (71%) and chronic (63.2%) ITP cases; 68% of the children with ITP showed a platelet count below 20×10 9 /L at the time of presentation. Most of the studied children were treated with intravenous immunoglobulin (74%). Conclusions:The study revealed a high incidence of ITP among children in Qatar. The study findings are in line with other international reports. J Pediatr (Rio J). 2009;85(3):269-272:Idiopathic thrombocytopenic purpura, bleeding, steroids, platelet. ResumoObjetivo: Definir o padrão da púrpura trombocitopênica idiopática (PTI) (aguda/crônica), e descrever seus sintomas e características clínicas em crianças com menos de 14 anos de idade em uma sociedade árabe recentemente desenvolvida. Resultados: Das crianças estudadas (50), 62% foram diagnosticadas com PTI aguda e 38% com PTI crônica. A PTI aguda foi mais prevalente em meninos (64,5%) em comparação com meninas (35,5%), enquanto que a PTI crônica apresentou uma distribuição quase igual em meninos (57,9%) e meninas (42,1%). História de infecção viral foi comum em casos de PTI tanto aguda (71%) quanto crônica (63,2%); 68% das crianças com PTI apresentaram contagem de plaquetas abaixo de 20×10 9 /L ao diagnóstico. A maioria das crianças estudadas (74%) foi tratada com imunoglobulina intravenosa. Conclusões:O estudo revelou uma alta incidência de PTI entre as crianças no Catar. As descobertas do estudo são semelhantes às de outros relatos internacionais. IntroduçãoA púrpura trombocitopênica idiopática (PTI) em crianças geralmente é uma doença autolimitada cuja forma mais comum de apresentação consiste em breve história de púrpura e feridas em crianças de ambos os sexos com idade entre 2 e 10 anos 1 . A PTI pode ser aguda ou crônica. A forma aguda é mais comum em crianças com idade entre 2 e 6 anos, e 10 a 20% das crianças com PTI evoluem para a forma crônica. A PTI não parece estar relacionada a raça, estilo de vida, clima ou fatores ambientais 2 .Em crianças, a PTI aguda primária é idiopática e ocorre tipicamente em crianças jovens e anteriormente saudáveis depois de uma doença infecciosa 3 . Os primeiros sintomas de PTI podem aparecer em qualquer idade, e o distúrbio afeta o número total de plaquetas sanguineas, ma...

Introduction and aims-Among individuals with chronic HCV infection, approximately 30% of patients show persistently normal alanine aminotransferase (PNALT). Individuals with PNALT have been historically excluded from antiviral treatment. However, some studies have reported sudden worsening of disease in patients with PNALT, suggesting the need to treat individuals with PNALT. To evaluate this further, we compared fibrosis severity and response to treatment in patients with PNALT to patients with abnormal ALT. In addition, we investigated whether liver histology and schistosomiasis affect response to treatment differently in those with PNALT and abnormal ALT.

The study revealed a high incidence of ITP among children in Qatar. The study findings are in line with other international reports.

In the era of new Hepatitis C Virus (HCV) therapy, and the detection of extrahepatic HCV reservoirs such as peripheral blood mononuclear cells and platelets, it is important to understand the factors underlying resistance to treatment. Detection and quantitation of HCV-RNA in platelets or leucocytes from patients under antiviral therapy is poorly studied and the limited studies generated contradictory results. Aim:To detect and quantify HCV-RNA in platelets, and to evaluate the relation between HCV-RNA in the serum and the kinetics of HCV-RNA in platelets, in response to treatment.Method: Viral kinetic was tested in 20 chronic HCV genotype4, during the course of therapy.Results: HCV-RNA was detected in sera of all infected patients. The baseline platelet viral load was significantly lower in responders compared to non-responders. Platelet viral load was also related to serum viral load (t=3.39, p=0.001), but not related to platelet count (t=-0.56, p=0.58). ROC curve analysis revealed that in general, platelet viral load at different time points was a better predictor of SVR compared to serum viral load.Conclusion: HCV RNA analysis in whole blood may be more sensitive than platelet-poor plasma, which might underestimate circulating viral load. Early eradication of viremia from platelets is associated with higher rates of SVR. Our data, reconfirm higher HCV-RNA levels in serum compared to platelets. Thrombocytopenia occurring during interferon-based therapy might be a manifestation of viral eradication rather than adverse effects. Our findings warrant testing the sensitivity of platelet viral load as a predictor of poor response.

Since the development and approval of new direct-acting antiviral (DAA) drugs, chronic hepatitis C virus (HCV) infection is now considered a curable disease. However, the emphasis on DAA therapies might disregard other preventive measures, and limits the strategy for a clinical cure rather than comprehensive disease control. The Qatar National plan for HCV control was launched in December 2014 to prioritize and proactively manage HCV with the ultimate aim of eliminating viral hepatitis. The plan is based on four pillars: primary prevention, early detection, clinical management, and continuous monitoring. This report describes the activities undertaken in Qatar to prepare for the programme and the early results of its initial phase, given the fact that countries with comprehensive HCV plans are providing better access to care and prevention.

Rare co-existance of disease or pathology Background: Chronic lymphocytic leukemia/small lymphocytic lymphoma (CLL/SLL) and mantle cell lymphoma (MCL) both have a common origin arising from mature CD5+ B-lymphocytes. Their distinction is crucial since MCL is a considerably more aggressive disease. Composite lymphoma consisting of CLL/SLL and MCL has been rarely reported. This type of composite lymphoma may be under-diagnosed as the 2 neoplasms have many features in common, both morphologically and immunophenotypically. Case Report: We report the case of a 57-year-old male patient who presented with a 4-month history of recurrent abdominal pain and distention with hepatosplenomegaly. Peripheral blood showed a high leukocytes count (46.7×10 3 /uL) with marked lymphocytosis of 35.0×10 3 /uL, mostly small mature-looking, with some showing nuclear irregularities, with approximately 3% prolymphocytes. Immunophenotyping by flow cytometry and immunohistochemistry revealed 2 immunophenotypically distinct abnormal CD5+monotypic B-cell populations. Fluorescence in situ hybridization (FISH) on peripheral blood demonstrated IGH/CCND1 rearrangement consistent with t(11;14) in 65% of cells analyzed. Accordingly, based on compilation of findings from morphology, flow cytometry, immunohistochemistry, and FISH, A diagnosis of composite lymphoma consisting of MCL; small cell variant and CLL/SLL was concluded. Conclusions: We describe a case of composite lymphoma of MCL (small cell variant) and CLL/SLL that emphasizes the crucial role of the multiparametric approach, including vigilant cyto-histopathologic examination, immunophenotyping by flow cytometry and immunohistochemistry, as well as genetic testing, to achieve the correct diagnosis.

Aggressive natural killer cell leukemia is an extraordinary rare aggressive malignant neoplasm of natural killer cells. Although its first recognition as a specific entity was approximately 20 years ago, this leukemia has not yet been satisfactorily characterized as fewer than 200 cases have been reported in the literature and up to our knowledge, this is the first case report in Qatar. Reaching a diagnosis of aggressive natural killer leukemia was a challenging experience, because in addition to being a rare entity, the relative scarcity of circulating neoplastic cells, failure to obtain an adequate aspirate sample sufficient to perform flow cytometric analysis, together with the absence of applicable method to prove NK clonality (as it lack specific clonal marker); our case had atypical confusing presentation of striking increase in bone marrow fibrosis that was misleading and complicated the case further. The bone marrow fibrosis encountered may be related to the neoplastic natural killer cells’ chemokine profile and it may raise the awareness for considering aggressive natural killer leukemia within the differential diagnosis of leukemia with heightened marrow fibrosis.