We aimed to determine the levels of follicular helper T (Tfh) and follicular regulatory T (Tfr) cells in COVID-19 patients and determine whether their levels correlated with disease severity and presence of hyperglycemia. This study was carried out in 34 hospitalized COVID-19 patients and 20 healthy controls. Levels of total circulating Tfh, inducible T-cell costimulator (ICOS)+ activated Tfh, and Tfr cells were assessed in all participants by flow cytometry. Total CD4+CXCR5+ Tfh cells and ICOS+Foxp3-activated Tfh cells increased and ICOS+Foxp3+ Tfr cells decreased in COVID-19 patients, especially in diabetic patients and those with severe disease. Activated ICOS+ Tfh cells were directly correlated with lactate dehydrogenase, D-dimer, ferritin, and respiratory rate and inversely correlated with the partial pressure of carbon dioxide. COVID-19 is associated with marked activation of Tfh cells and a profound drop in Tfr cells, especially in severe and diabetic patients. Future studies on expanded cohorts of patients are needed to clarify the relationship between SARS-CoV-2 and acute-onset diabetes.

Objective: Non Hodgkin Lymphomas (NHL)s are a group of malignancies which affect the lymphatic system. A significant proportion of NHL patients experience either relapse or failure of treatment which is called refractory disease. Relapsed or refractory NHL usually have poor prognosis due to shortage of randomized trials comparing efficacy of different treatment protocols to define the optimal salvage chemotherapy regimen in these cases. In this study, we are trying to define the best salvage chemotherapy regimen with low toxicity and better quality of life for patients by comparing outcome of 2 salvage chemotherapy regimens GDP & DHAP. Patients and methods: 100 patients diagnosed as relapsed or refractory NHL were randomly assigned to receive either Gemcitabine, Dexamethasone and Cisplatin (GDP) or Dexamethasone, Cytarabine and Cysplatin (DHAP) for 4 to 6 cycles. Primary endpoints of the study were overall survival and progression free survival. Secondary endpoints were response to treatment, toxicity profile of each regimen, and quality of life assessment. Results: The overall response rate was 70% in GDP group & 64% in DHAP group with no statistically significant difference between them (p-value 0.5). There was no significant difference between both groups regarding toxicity profile except in febrile neutropenia episodes which was much less in GDP group (p-value 0.04). Quality of life was better in GDP group than DHAP with significant difference (p-value < 0.05). There was no statistical significant difference between both groups regarding OS or PFS. Conclusion: GDP is as effective as DHAP for relapsed or refractory lymphoma with less toxicity and better quality of life.

Objective/Background: Chronic lymphocytic leukemia is one of the commonest leukemias affecting adults. CD39 inhibits T-cell and Natural killer (NK) cell responses by hydrolyzing adenosine triphosphate and adenosine diphosphate, suppressing the immune system. We investigated expression of CD39 on CD4+ T Lymphocytes in chronic lymphocytic leukemia (CLL) patients and its relationship with deletion 6q, its association with disease stage and survival. Methods: Thirty CLL patients and 20 matched controls were included in the study. Bone marrow studies with immunophenotyping, CD39, CD38, and ZAP-70, and detection of del 6q by FISH were performed. Results: CD39+ CD4+ T helper cells in CLL patients were significantly expressed compared with the controls (p < .001). Levels of CD39+ CD4+ T cells were significantly expressed in high risk CLL patients. Del 6q was detected in 63.3% of patients and it correlated with CD39, CD38, and ZAP-70, and advanced stage disease. There was a significant relation between response to treatment and CD39 expression and del 6q, also there was a significant difference in overall survival (OS) between patients with and without Del 6q. Conclusion: CD39 expression on CD4+ Tcells and del 6q act as prognostic markers in CLL. Blocking or inhibition of CD39 may be a target for new immune therapy for CLL.

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Aim: This study was designed to assess the impact of sofosbuvir/daclatasvir on vitamin D and iron status in chronic HCV patients (CHC). Methods: Sixty-five CHC patients registered for sofosbuvir/daclatasvir based regimen were recruited. Serum vitamin D, total iron, total iron binding capacity, and serum hepcidin were measured prior the treatment and 12 weeks after the stoppage of the treatment. Transferrin saturation was calculated. Results: The present study showed that a great majority of CHC patients had vitamin D deficiency or insufficiency, high total serum iron, and high transferrin saturation. Vitamin D was negatively correlated ALT. 12 weeks after completion of treatment, patients who had vitamin D deficiency or insufficiency reduced and the median value of vitamin D significantly increased compared to the pretreatment value. Total serum iron, transferrin saturation tended to decrease, however, there were no significant differences. The number of patients who had concurrently vitamin D deficiency or insufficiency and high transferrin saturation was reduced. Serum hepcidin significantly increased 12 weeks after completion of the antiviral therapy. Despite there were no significant correlations between hepcidin and total serum iron, vitamin D, and transferrin saturation before treatment, a significant positive correlation between hepcidin and serum iron and a significant negative correlation between hepcidin and vitamin D were noted after treatment. Conclusion: CHC is associated with vitamin D deficiency and iron overload, which could be attributed to reduced hepcidin level. Treatment with sofosbuvir/daclatasvir increases hepcidin and thereby reduces iron level and its harmful effect on the liver, thus increases vitamin D.