Background: Identifying immune cells involved in COVID-19 disease progression and predictors of poor outcomes is important to manage patients adequately. Methods: A prospective observational cohort study enrolled 53 mild non-hospitalized and 48 hospitalized confirmed COVID-19 patients to a tertiary hospital in Oman. Results: Hospitalized patients were older (58 years vs 36 years, p <0.001) and had more comorbid conditions like diabetes (65 % Vs 21% p<0.001). Hospitalized patients had significantly higher inflammatory markers (p<0.001); C-reactive protein (CRP) (114 vs 4 mg/L), Interleukin-6 (IL-6) (33 vs 3.71pg/ml), lactate dehydrogenase (LDH) (417 vs 214 U/L), ferritin (760 vs 196 ng/mL), fibrinogen (6 vs 3 g/L), D-dimer (1.0 vs 0.3 mcg/mL), disseminated intravascular coagulopathy (DIC) score (2 vs 0) and neutrophil/lymphocyte ratio (4 vs 1.1), (p<0.001). In multivariate regression analysis, statistically significant independent early predictors of ICU admission or death were higher levels of IL-6 (OR 1.03, p=0.03), frequency of large inflammatory monocytes (CD14+CD16+) (OR 1.117, p=0.010) and frequency of circulating naïve CD4+ T cells (CD27+CD28+CD45RA+CCR7+) (OR 0.476, p=0.03). Conclusion: IL-6, frequency of large inflammatory monocytes, and circulating naïve CD4 T cells can be used as independent immunological predictors of poor outcomes in COVID-19 patients to prioritize critical care and resources.

Objectives: Anaphylaxis is an acute, life-threatening allergic reaction involving multiple systems caused by the sudden release of mediators from mast cells. This study aims to assess the current practice of emergency management of adults and children diagnosed with anaphylaxis at the Royal Hospital, against the recommendations of the National Institute for Health and Clinical Excellence (NICE) guidelines. Methods: This is an observational study of all anaphylaxis cases which took place at the emergency department (ED) during a 5-year period. Results: Of 100 patients with a preliminary diagnosis of anaphylaxis, 49% were true-anaphylaxis cases based on the WAO definition. All the 49-patients with true-anaphylaxis received adrenaline intramuscularly at ED. 24 (48.9%) of them were referred to an immunologist: 8/24 (33.3%) were adults and 16/24 (66.6%) were children. 16-children were admitted, seen by an immunologist and received an adrenaline autoinjector when indicated. 25 of the 33 adult patients (75.7%) were discharged from the ED with no onward referral to a specialist. None of the adult patients received an adrenaline autoinjector prior to discharge from ED and no one had a tryptase level checked. Conclusion: The paediatric emergency department fulfilled all the criteria for anaphylaxis management in accordance with NICE guidelines except for measuring serum tryptase where appropriate. By contrast, the adult patients were discharged from ED without an adrenaline autoinjector as an interim measure until seen by an allergist or immunologist. Therefore, education is the best strategy to improve the management of this severe and possible fatal condition.