Convalescent plasma as an adjunctive treatment for severe and critically ill COVID-19

Introduction: The historical treatment of convalescent plasma was successful against RNA viruses. However, the significance of COVID-19 convalescent plasma therapy has not been clinically proven consistently in most studies and the available data showed contradictory results so far. Our study aims to evaluate the role of convalescent plasma therapy as an adjunctive treatment for severe and critically ill COVID-19 patients.

Methods: This study was an open-label, non-randomized comparative clinical trial that was conducted at Dr. Kariadi Hospital, Semarang, Indonesia. This study sample are hospitalized severe and critically ill COVID-19 patients were assigned with a 2:1 ratio to receive convalescent plasma and local standard of care. The primary outcome was the clinical status 30 days after the intervention

Results: A total of 73 patients received convalescent plasma and 38 patients received local standards of care. Both of the groups had similar clinical ordinal scales (median was 5, p=0.65), while patients in the study groups had significantly higher SOFA scores and P/F ratio. The control group had a worse overall mortality rate (61.1% vs 18.4%) with a hazard ratio of 3.5 (95%CI, 2.1-5.9) compared to the study group. From the subgroup analysis, we found that patients in the study group without mechanical ventilation support had the best survival rate compared to other groups HR: 0.0047 (95%CI, 0.01-0.19). The clinical outcome 7 days after convalescent plasma infusion was also significantly improved in the study group (median baseline & day-7, 5 & 3, p<0.001). From the multivariate analysis of therapeutic variables, convalescent plasma was the most significant variable for survival outcome (OR=0.089, 95%CI, 0.029-0.27; p<0.001). There was one case of anaphylactic shock and was excluded.

Conclusions: The convalescent plasma administration significantly improved clinical outcomes and overall survival rates compared to those who received local standards of care.

Type of anemia correlate with ferritin levels in patients with Chronic Kidney Disease (CKD): a cross sectional study

Background: Anemia is the most common complication due to CKD. Normocytic normochromic is the most common type of anemia in CKD is, but there is also some microcytic hypochromic. Clinical examination such as erythrocyte indices examination and monitoring serum ferritin levels can help diagnose anemia in CKD. The purpose of this study is to determine the correlation between erythrocyte indices and ferritin levels in CKD patients in the hemodialysis unit of PKU Hospital Bantul.

Methods: This research involved 50 CKD patients at PKU Hospital Bantul. Blood samples were taken to check ferritin levels and erythrocyte indices consisting of mean corpuscular volume (MCV), mean corpuscular hemoglobin (MCH) and mean corpuscular hemoglobin concentration (MCHC). This study was conducted by cross-sectional study design. Data were analyzed using SPSS version 20 for Windows.

Results: The average hemoglobin level was 8.46±1.31 g/dL in males and 7.92±0.90 g/dL in females. Most of the hematological profile was predominant in male patients such as in MCV (89.36±6.72 fl), MCH (29.12±2.76 pg), and MCHC (32.95±0.96 g/dL). However, the average ferritin level (352.51±544.74 ng/mL) was predominant in female patients (399.99±680.96 ng/mL). There was a significant correlation between MCH and ferritin levels (r = 0.364; p = 0.009) and MCHC with ferritin levels (r = 0.295; p = 0.038). However, there was no significant correlation between MCV and ferritin levels (r = -0.059, p = 0.683).

Conclusion: There is a significant correlation between MCH and MCHC levels with ferritin levels. In addition, the patients had normal MCV, MCH, and MCHC values with normocytic normochromic anemia. 

A rare case of porokeratosis mibelli in 3-year-old boy

Introduction: Porokeratosis mibelli is a rare, chronic, and slowly progressive genodermatotic characterized by abnormality of keratinization. The clinical manifestations are hyperkeratotic papules or plaques surrounded by a thread-like elevated border that widens centrifugally. Rarity of this case means the science behind it is underdeveloped. Thus, we present this case as an educational vehicle and to further develop the body of knowledge surrounding this disease.

Case report: We reported a 3 years old boy, suspect of porokeratosis mibelli. His mother complained of a few reddish spots and patches that sometimes itchy, healed into white and brownish patches with atrophic centers in the last 5 months before admission. Physical examination: few lesions on the back, waist, left side of buttock, back of the neck, and lateral upper left arm. Hypopigmented and hyperpigmented patches with atrophic centers, and erythematous plaques with central erosion were found. No abnormality of internal organs or laboratory findings. Histopathology examination showed epidermis contains of invagination rete malpighia filled keratin. Slightly thinned stratum germinativum with corneum contains basket weave pattern. Topical therapy with 1% 5-fluorourasil cream twice daily showed mild improvement after 10 days.

Conclusion: Although clinical examinations of the lesions on this patient did not fit the criteria of porokeratosis mibelli, however, the results of histopathology examination supported the diagnosis. Treatment with 1% 5-fluorourasil cream showed slow but progressive healing on the patient