Background The Coronavirus 2019 is a pandemic that has spread worldwide, threatening human health. The main cause of death in patients with COVID-19 is a systemic pro-inflammatory mechanism that quickly progresses to acute respiratory distress syndrome. Hematological ratios as affordable indicators of inflammatory response were studied in COVID-19 patients. The study aimed to study the importance of the blood cell indexes of the systemic inflammatory response, as the Aggregate Index of Systemic Inflammation (AISI), neutrophils lymphocyte to platelet ratio (NLPR), systemic immune-inflammation index (SII) and, systemic inflammation response index (SIRI) in predicting intensive care unit (ICU) admission of COVID-19 patients. Methods 495 COVID-19 patients managed in four tertiary centers; divided into non-ICU and ICU groups. Results Total leucocyte count (TLC), AISI, NLPR, SII, and SIRI were more elevated in the ICU group (P < 0.001 for all except AMC P = 0.006), while this group had less absolute lymphocyte count (ALC) (P = 0.047). We estimated the optimal cut-off values of the hematological ratio; AISI (729), NLPR (0.0195), SII (1346), and SIRI (2.5). SII had the highest specificity (95.6%), while NLPR had the highest sensitivity (61.3%). Age, AISI, CRP, D-dimer, and oxygen aid were the independent predictors for ICU admission in COVID-19 in multivariate logistic regression. Conclusion AISI is a predictor for severity and ICU admission in COVID-19 patients, SII is a predictor of survival, while NLPR and SIRI have an additive role that needs further evaluation.

Introduction Coronaviruses belong to a large family that leads to respiratory infection of various severity. Hematological ratios are indicators of inflammatory response widely used in viral pneumonia with affordability in developing countries. Purpose Study the role of the neutrophil lymphocyte ratio (NLR), derived NLR ratio (d-NLR), platelet lymphocyte ratio (PLR), and lymphocyte monocyte ratio (LMR) in predicting the outcome of COVID-19 Egyptian patients. Methods A retrospective study on 496 COVID-19 Egyptian patients, managed in four tertiary centers, grouped into non-severe, severe, and critical. Patients’ laboratory assessment including total leucocyte count (TLC), absolute neutrophil count (ANC), absolute lymphocyte count (ALC), absolute monocyte count (AMC), NLR, d-NLR, LMR and, PLR were reported as well as C reactive protein (CRP), D-dimer and serum ferritin. Results TLC, ANC, AMC, NLR, d-NLR and, PLR were highest in the critical group ( p <0.001 for all except AMC p =0.033), while this group had the least ALC and LMR ( p =0.049 and <0.001, respectively). Higher CRP and d-dimer levels were reported in the critical group ( p <0.001). At the same time, higher ferritin was found in the severe group more than the critical and non-severe groups ( p <0.001, p =0.005, respectively). We calculated the optimal cut-off values of the hematological ratio; NLR (3.5), d-NLR (2.86), PLR (192), and LMR (3). D-NLR had the highest specificity (89.19%), while NLR had the highest sensitivity (71.38%). By univariate logistic regression, age, DM, HTN, cardiovascular diseases, COPD, NLR, d-NLR, LMR and PLR, CRP, steroid, oxygen aids, and mechanical ventilation were associated with the severity of COVID-19. Still, only age, NLR, CRP, and oxygen aid were independent predictors in multivariate logistic regression. Conclusion NLR is a predictor for severity in COVID-19. LMR, d-NLR, and PLR may assist in risk stratification.

Background The novel severe acute respiratory syndrome coronavirus (SARS-CoV-2) causes COVID-19, a recent infectious disease that aggravates the underlying pathophysiology of hyperglycemia in diabetic individuals. This study aimed to detect how diabetes mellitus (DM) affected COVID-19 patients’ morbidity and mortality, and the incidence of neonset DM. Patients and Methods The present study was a cross-sectional study done at Aswan Isolation Hospitals, Egypt. It comprised 200 individuals who had been tested positive for COVID-19. They were divided into two groups: group 1 (pre-existing diabetes = 143 patients) and group 2 (new-onset diabetes = 57 patients), and all patients were subjected to general examinations, hospital stay duration, and investigations, such as (complete blood count, urea, creatinine, HBA1c, fasting, postprandial, and random blood sugar, D-Dimer, ferritin, C-reactive protein, PCR for SARS COV-2 RNA, and CT chest. Results The current study consisted of 94 males and 106 females. According to disease severity, they were 96 (48.0%) critical cases, 57 (28.5%) severe cases, and 47 (23.5%) non-severe cases. The incidence of new-onset DM in COVID-19 patients was 28.5% (57 new cases), with a mortality rate of 42.0% (84 cases). Regarding glycemic control, we found a significant difference in fasting blood sugar (FBS) between the two groups, with a significant increase of FBS in the dead group than in the survived group. We also found a significant age difference in critical than in severe and non-severe groups, with a high mortality rate in older patients. Inflammatory markers, such as ferritin, CRP, and D-dimer, were higher in critical than in severe and non-severe groups. Conclusion The prevalence of new-onset DM is significant among hospitalized COVID-19 patients. Older patients were more prone to disease severity with high mortality rate. Inflammatory markers such as CRP and ferritin were significantly related to the COVID-19 severity and outcome.

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Paraphenylenediamine (PPD) is a commonly used xenobiotic in hair dying, causing deleterious outcomes in acute poisoning. Although many epidemiological studies and case reports explained their clinical presentations and fatal consequences, no studies have evaluated the early determinants of adverse outcomes. Therefore, the present study aimed to assess the initial predictors of acute PPD poisoning adverse outcomes, focusing on the discriminatory accuracy of the Rapid Emergency Medicine Score (REMS) and Sequential Organ Failure Assessment (SOFA) score. A retrospective cohort study included all acute PPD-poisoned patients admitted to three Egyptian emergency hospitals from January 2020 to January 2022. Data was gathered on admission, including demographics, toxicological, clinical, scoring systems, and laboratory investigations. Patients were categorized according to their outcomes (mortality and complications). Ninety-seven patients with acute PPD poisoning were included, with a median age of 23 years, female predominance (60.8%), and suicidal intention (95.9%). Out of all patients, 25.77% died, and 43.29% had complicated outcomes. Respiratory failure was the primary cause of fatalities (10.30%), while acute renal failure (38.14%) was a chief cause of complications. The delay time till hospitalization, abnormal electrocardiogram, initial creatine phosphokinase, bicarbonate level, REMS, and SOFA scores were the significant determinants for adverse outcomes. The REMS exhibited the highest odds ratio (OR = 1.91 [95% confidence interval (CI): 1.41–2.60], p < 0.001) and had the best discriminatory power with the area under the curve (AUC) = 0.918 and overall accuracy of 91.8% in predicting mortality. However, the SOFA score had the highest odds ratio (OR = 4.97 [95% CI: 1.16–21.21], p = 0.001) and only yielded a significant prediction for complicated sequels with AUC = 0.913 and overall accuracy of 84.7%. The REMS is a simple clinical score that accurately predicts mortality, whereas the SOFA score is more practicable for anticipating complications in acute PPD-poisoned patients.