Yasser’s COVID-19 Discrepancy phenomenon is a novel descriptive phenomenon that is always seen in all COVID-19 pneumonia. Initial dramatic improvement of the clinical status of COVID-19 pneumonic patient, not a simultaneously after the management, not a coincide with laboratory, radiological, and electrocardiographic workup. Further larger studies for the study medical regimen with considering of “Yasser’s COVID-19 Discrepancy phenomenon” is recommended.

1. Virtual International Conference on Microbiology& Immunology
November 16-18,2021
Paris, France

2. Elsayed
MB Bch, PGDip Cardiology (Middlesex
University, RILA)
Researcher and author
Critical Care Unit
Work: Egyptian Ministry of Health (MOH)
Damietta, Damietta Health Affairs

3. My greetings

4. Yasser's COVID-19 Discrepancy Phenomenon

5. Yasser's COVID-19 Discrepancy
Phenomenon
A Novel Phenomenon And Effective Regimen
Retrospective-Observational Study

6. Figure 1; Author caricaturing diagrammatic clarification for the improvement of the
clinical status vs. laboratory, radiological, and electrocardiographic workup

7. Learning objectives
• The study
• The COVID-19 chain
• Discovery and historical bit
• Understanding the phenomenon
• COVID-19 between suspicion and confirmation
• The analysis for the phenomenon
• Common laboratory tests in suspected COVID-19
• The study data and statistics
• The Effective used regimen
• Summary points in the management of Phenomenon
• Conclusion and Recommendations

8. Table 1- showing remarks of the study method and data.
Issue Definition
Title Yasser’s COVID-19 Discrepancy phenomenon; A
novel phenomenon and effective regimen
Estimated Enrollment 47 participants
Study Type Observational
Observational Model Case-only
Time Retrospective
Study Start Date Started on Jun 9, 2020
Estimated Study Completion
Date
Ended on May 8, 2021
Analytic method Comparative using percentage %

9. The COVID-19 Chain
Started from Diagnosis to
Recovery or Death

10. Figure 1: The essential role of laboratory diagnostics in severe acute respiratory syndrome coronavirus
2 (SARS-CoV-2) infection. RT-PCR; reverse transcription-polymerase chain reaction1. Lippi G, et al

11. Discovery

12. 1. History

13. • Discovery was accidental.

14. 2. Bases of
Yasser's COVID-19 Discrepancy Phenomenon

15. COVID-19 between the suspicion
and confirmation

16. Figure 2; Author caricaturing diagrammatic clarification for the improvement of the clinical status vs.
laboratory, radiological, and electrocardiographic workup.

17. Figure 3: Showing the balance of COVID-19 patients between laboratory suspicion and confirmatory tests.

18. • The analysis for this
phenomenon in the author's
interpretations are based on the
following;

19. 1. Precise clinical,
electrocardiographic, radiological,
and lab workup observation.

20. 2. I had been observing for
important wide-variety between the
clinical improvement and the
abnormal investigational workup.

21. 3. Generally, in medical diseases,
the clinical response is commonly
parallel to laboratory and
radiological improvement.

22. 4. So, there is a direct relationship
between clinical status and
laboratory workup

23. 5. There are deviations between the clinical response or
improvement and the improvement in both laboratory,
radiological, and electrocardiographic workup.

24. 6. Initial dramatic improvement of the
clinical status of COVID-19 pneumonic
patient, not a simultaneously after the
management, not a coincide with
laboratory, radiological, and
electrocardiographic workup.

25. 7. Unfortunately, no relevant studies
are taking into consideration the time
for identifying the relationship of the
improvement in clinical versus and
workup.

26. 8. These studies mostly signifying and
mention for both used drugs and
needed laboratory, radiological, and
work up with no focusing on the above
relationship between clinical status and
laboratory workup.

27. Common laboratory tests in suspected
COVID-19

28. Table 2: Common laboratory tests in the emergency setting of suspected COVID-19 infection.
Lab tests Abnormality in COVID-19 patients
Albumin Decreased
Lactate dehydrogenase Increased
Alanine aminotransferase Increased
Aspartate aminotransferase Increased
Total bilirubin Increased
Creatinine Increased
C-reactive protein Increased
Cardiac troponin Increased
Urea Predicted to be increased
Blood gas panel Predicted to have increased and decreased levels
Ferritin Increased
Procalcitonin Increased
IL-6 Increased
D-dimer Predicted to be increased
Modified from the International Federation of Clinical Chemistry and Laboratory Medicine (IFCC) list reaction1. Lippi G, et al (2021)

29. Table 3: Common clinical laboratory tests in the emergency setting of suspected COVID-19 infection with interpretations.
CRP, creactive protein; LDH, lactate dehydrogenase; MDW, monocyte volume distribution width.
Modified from the International Federation of Clinical Chemistry and Laboratory Medicine (IFCC) list1. Lippi G, et al (2021)

30. The study data and statistics

31. Eligibility criteria

32. • Inclusion criteria:
1. All cases with COVID-19 pneumonia.
2. Patients' ages started from 18 and up
to 75 years old.
• Exclusion criteria:
1. Non-COVID-19 pneumonia.
2. Non-COVID-19 infection.

33. Study limitations

34. • The only study limitation for the current
study was an absence of the confirmatory
tests for COVID-19 infections.

35. Table 4- Summary of the history, clinical, and management data for the study cases.

38. Age

39. • Age averages in the study; Mean: 50.08, Mode: 44,
Median: 48. The mean ±SD age was: 50.08 (14.9) years,
with male sex predominance (55.32%).

40. Sex and percentages
(%)

41. • Sex in the study: Male (M)
55.32% (26 cases) vs. Female (F)
44.68% (21 cases). (Figure 4).

42. Figure 4- Pie-chart showing the sex in the study

43. The mean days of improvement

44. The mean days of clinical versus leukocytosis, neutrophilia,
and lymphopenia improvement in the study showed
statistical significance (p-value is < 0.00001). The mean days
of clinical versus leukocytosis, neutrophilia, and lymphopenia
improvement (0.84 ±0.49, 13.05 ±6.44, 13.05 ±7.01, 13.05
±7.01). (Figure 5).

45. Figure 5- Bar chart showing the mean days of clinical versus leukocytosis,
neutrophilia, and lymphopenia improvement in the study.

46. The day of clinical versus CRP,
D-dimer, S. ferritin, and LDH
improvement in the study

47. The day of clinical versus CRP, D-dimer, s. ferritin, and
LDH improvement in the study showed statistical
significance (p-value is < 0.00001). The mean ±SD days
of clinical versus CRP, D-dimer, s. ferritin, and LDH
improvement (0.84 ±0.49, 12.2 ±3.25, 12.2 ±6.21, 12.3
±5.46, 20.92± 9.48). (Figure 6).

48. Figure 6- Bar chart showing the mean days of clinical versus CRP, D-dimer, s.
ferritin, and LDH improvement in the study.

49. The mean days of clinical
versus radiological and ECG
improvement in the study

50. The mean days of clinical versus radiological and
electrocardiographic improvement in the study showed
statistical significance (p-value is < 0.00001). The mean days
of clinical versus radiological and electrocardiographic
improvement (0.84 ±0.49, 15.74 ±5.25, 11.45 ±5.45). (Figure
7).

51. Figure 7- -Bar chart showing the mean days of clinical versus radiological and electrocardiographic improvement in
the study.

52. The Effective Used Regimen

53. • Cefotaxime; (1000 mg IV every 8hours)
• Azithromycin (500 mg PO single daily dose)
• Oseltamivir (75 mg PO twice daily only for 5 days)
• Paracetamol (500 mg IV every 8 hours as needed)
• SC enoxaparin 80 mg twice daily)
• Aspirin tablet (75 mg, once daily)
• Clopidogrel tablet (75 mg, once daily)
• Hydrocortisone sodium succinate (100 mg IV every 12 hours; was tapered with time) were
added.
• O2 inhalation by O2 cylinder (100%, by nasal cannula, 5L/min) was added on need.
• IVI fluids were sometimes given according to the clinical indications.
• Dose adjustment for some of the above drugs in hepatic impairment, renal impairment, cardiac,
hypertensive, and diabetic patients were applied.
• The patient was daily monitored for temperature, pulse, blood pressure, and O2 saturation.

54. Summary points
in the management of the
“Yasser's COVID-19 Discrepancy
Phenomenon”

55. • Generally, in medical diseases, the clinical response is commonly
parallel to laboratory and radiological improvement.
• So, there is a direct relationship between clinical status and
laboratory workup.
• But, the author revealed that there are deviations between the
clinical response or improvement and the improvement in both
laboratory, radiological, and electrocardiographic workup.
• Initial dramatic improvement of the clinical status of COVID-19
pneumonic patient, not a simultaneously after the management,
not a coincide with

56. laboratory, radiological, and ECG workup.
• Unfortunately, no relevant studies are taking into consideration
the time for identifying the relationship of the improvement in
clinical versus and workup.
• These studies mostly signifying and mention for both used drugs
and needed laboratory, radiological, and work up with no focusing
on the above relationship between clinical status and laboratory
workup.

57. Conclusion and
Recommendations

58. • Yasser’s COVID-19 Discrepancy phenomenon is a novel
descriptive phenomenon that is always seen in all COVID-
19 pneumonia.
• Initial dramatic improvement of the clinical status of
COVID-19 pneumonic patient, not a simultaneously after
the management, not a coincide with laboratory,
radiological, and electrocardiographic workup.
• Further larger studies for the study medical regimen
with considering of “Yasser’s COVID-19 Discrepancy
phenomenon” is recommended.

59. Acknowledgment

60. I wish to thank Ahmed Alghobary,
B.sc. for his technical support.

61. References

62. 1. Lippi G, Plebani M. The critical role of laboratory medicine during
coronavirus disease 2019 (COVID-19) and other viral outbreaks. Clin
Chem Lab Med. 2020 Jun 25;58(7):1063-1069. DOI: 10.1515/cclm-
2020-0240. PMID: 32191623.
2. Elsayed YMH. Yasser's COVID-19 Discrepancy Phenomenon: A
Novel Phenomenon and Effective Regimen; RetrospectiveObservational
Study. J Clinical Research and Reports, 2021;8(4):1-10.
DOI:10.31579/2690-1919/185
3. Elsayed YMH. A COVID-19 from Laboratory Suspicion to
Confirmatory Tests: Controversial Debatable. Int Arch Cardiovasc Dis
2021;5(2):1-6. DOI: 10.23937/2643-3966/1710042

63. Thank you