Differences In Lymphocyte Counts Research Articles

A causal link between circulating leukocytes and three major urologic cancers: a mendelian randomization investigation.

This study aimed to explore the influence of serum leukocytes on urologic cancers (UC) using observation-based investigations. In the present study, Mendelian randomization (MR) was employed to assess the link between leukocyte count (LC) and the risk of UC development. Five LC and three major UC patient prognoses were obtained for MR analysis from genome-wide association studies (GWAS). Furthermore, in order to evaluate reverse causality, bidirectional studies were conducted. Finally, a sensitivity analysis using multiple methods was carried out. There was no significant correlation found in the genetic assessment of differential LC between the co-occurrence of bladder cancer (BCA) and renal cell carcinoma (RCC). Conversely, an individual 1-standard deviation (SD) rise in neutrophil count was strongly linked to a 9.3% elevation in prostate cancer (PCA) risk ([odd ratio]OR = 1.093, 95% [confidence interval]CI = 0.864-1.383, p = 0.002). Reverse MR analysis suggested that PCA was unlikely to cause changes in neutrophil count. Additional sensitivity studies revealed that the outcomes of all MR evaluations were similar, and there was no horizontal pleiotropy. Primary MR analysis using inverse-variance weighted (IVW) revealed that differential lymphocyte count significantly influenced RCC risk (OR = 1.162, 95%CI = 0.918-1.470, p = 0.001). Moreover, altered basophil count also affected BCA risk (OR = 1.249, 95% CI = 0.904-1.725, p = 0.018). Nonetheless, these causal associations were not significant in the sensitivity analysis. In summary, the results revealed that increased neutrophil counts represent a significant PCA risk factor. The current research indicates a significant relationship between immune cell activity and the cause of UC.

Sunscreen compound benzophenone-3 and its relationship with white blood cell counts.

Evidence from animal models suggests a role for the organic ultraviolet filter benzophenone-3's (BP-3) on white blood cells (WBCs). However, BP-3's effect on WBCs in humans is unknown. We used National Health and Nutrition Examination Survey data from 2003 to 2016. We included participants>6 years with data on urinary BP-3, urinary creatinine, and WBC count. Quintiles of urinary creatinine-normalized BP-3 (CnBP-3) levels were used in linear regression models adjusting for age, gender, race, body mass index (BMI), smoking status, education level, family income to poverty threshold ratio, survey cycle, and season. Of the 16959 participants, 8564 (50.5%) were females, 6602 (38.9%) were White, and 3870 (22.8%) were Black. The mean (standard deviation) age was 37.6 (22.7) years, BMI was 26.8 (7.40) kg/m2, WBC count was 7.22 (2.53) × 109/L, neutrophil count was 4.15 (1.86) × 109/L, and lymphocyte count was 2.25 (1.33) × 109/L and median (interquartile range) of CnBP-3 was 12.1 (44.9) µg/gm. The highest quintile of CnBP-3 was associated with significantly lower WBC and neutrophil counts compared to the lowest quintile of CnBP-3 (Δ quintiles=-137×106/L, 95% CI: -249 to -24, p=0.02 and=-177×106/L, 95% CI: -323 to -30, p=0.02, respectively). In contrast, we did not observe a difference in lymphocyte count between the lowest and highest quintiles of CnBP-3 in unadjusted or adjusted analyses. We found an inverse relationship between BP-3 levels and WBC and neutrophil counts, and not with lymphocyte count. Further research is needed to confirm our findings.

Effect of Pneumocystis jirovecii pneumonia prophylaxis on hematologic toxicity in patients receiving chemoradiation for primary brain tumors.

Diffuse gliomas are managed with radiation and temozolomide; however, this therapy often results in hematologic toxicities. Patients undergoing chemoradiation also risk contracting Pneumocystis jirovecii pneumonia (PJP), and frequently receive prophylaxis against PJP during treatment. Independent of chemoradiation, some PJP prophylaxis drugs have the potential to cause myelosuppression, which could require cessation of chemotherapy. Here, we evaluate differences in the frequency of hematologic toxicities during chemoradiation when patients receive PJP prophylaxis. This retrospective chart review evaluated patients with primary brain tumors treated with radiation and concurrent temozolomide. Analyses were performed to assess the effect of the type of PJP prophylaxis on risk for neutropenia, lymphopenia, or thrombocytopenia and the severity of these adverse effects as defined using the Common Terminology Criteria for Adverse Events. Of the 217 patients included in this analysis, 144 received trimethoprim-sulfamethoxazole (TMP/SMX) and 69 received pentamidine. Of the patients who received TMP/SMX, 15.3% developed an absolute neutrophil count < 1500 cells/µL compared with 7.2% of patients receiving pentamidine (p = 0.10). Platelet count < 100,000/µL occurred in 18.1% of patients who received TMP/SMX and 20.3% of patients who received pentamidine (p = 0.70). No significant differences in lymphocyte counts between therapies were seen. Severity of hematologic toxicities were similar between PJP prophylaxis groups. These findings suggest that the type of PJP prophylaxis does not significantly affect the risk for hematologic toxicity in brain tumor patients receiving radiation and temozolomide. Additional studies are merited to evaluate the higher rate of neutropenia in patients on TMP/SMX observed in this study.

Early decrease in blood lymphocyte count is associated with poor prognosis in COVID-19 patients: a retrospective cohort study

BackgroundPrevious studies have declared that baseline lymphocyte count is associated with COVID-19-related death. However, whether dynamic lymphocyte change over time affects prognosis in COVID-19 patients is unknown. This study aims to investigate the significance of lymphocyte count during the progression of the disease in COVID-19 patients.MethodsThe retrospective cohort study recruited COVID-19 patients at the First People’s Hospital of Jiangxia District in Wuhan from January 7, 2020, to February 28, 2020. The demographics, medical histories, results of the blood routine test, and patients’ outcomes were collected. We utilized a generalized additive mixed model to compare trends in lymphocyte count over time among survivors and non-survivors, with an adjustment for potential confounders. The statistical analysis used R software and EmpowerStats. Significance was determined at a P-value of less than 0.05 (two-sided).ResultsA total of 532 patients were included in the study. Overall, there were 29/532 in-hospital deaths (5.45%). Lymphocytes declined over time in the non-survivor group and increased in the survivor group in the first 10 days of hospitalization. Within 10 days after admission, lymphocyte count increased in the survivor group and decreased in the non-survivor group. The difference in lymphocyte counts between survivors and non-survivors increased by an average of 0.0732 × 109/L daily. After adjusting for several covariables, the increasing value remained at 0.0731 × 109/L per day.ConclusionIn the early stage, lymphocyte count can dynamically reflect the pathophysiological changes in COVID-19 patients. An early decrease in lymphocyte count is associated with mortality in COVID-19 patients.

The Multi-Strain Probiotic OMNi-BiOTiC® Active Reduces the Duration of Acute Upper Respiratory Disease in Older People: A Double-Blind, Randomised, Controlled Clinical Trial.

Immunosenescence is the adverse change in the human immune function during aging, leaving older people more prone to an increased risk of infections and morbidity. Acute upper respiratory tract infections (URTIs) are very common among older people, often resulting in continued morbidity and mortality. Therefore, approaches, such as consuming probiotics, that shorten the duration or even reduce the incidence of URTIs in older people are being studied. The aim of this study was to determine the effects of a multi-strain probiotic OMNi-BiOTiC® Active, which contains 11 live probiotic strains, on the incidence, duration, and severity of URTIs in older people. In this randomized double-blinded placebo-controlled study, 95 participants, with an average age of 70.9 years in the probiotic group and 69.6 years in the placebo group, were randomly allocated to two groups: 1010 cfu per day of the multi-strain probiotic intervention OMNi-BiOTiC® Active (49) or placebo (46). The incidence of URTIs in older people after 12 weeks supplementation with OMNi-BiOTiC® showed no statistically significant difference between the two groups (p = 0.5244). However, the duration of the URTI infections was statistically significantly different between the groups (p = 0.011). The participants that consumed the probiotic had an average duration of illness of 3.1 ± 1.6 days, whilst participants that received the placebo had symptoms for an average of 6.0 ± 3.8 days (p = 0.011). Statistically significant differences in lymphocyte counts in both groups after supplementation (p = 0.035 for the probiotic group and p = 0.029 for the placebo group) and between both groups were found (p = 0.009). Statistically significant differences in eosinophil (p = 0.002) and basophil counts (p = 0.001) in the probiotic groups before and after supplementation with probiotics were also found. Supplementation with the multi-strain probiotic OMNi-BiOTiC® Active may benefit older people with URTIs. Larger randomised controlled clinical trials are warranted. Clinical Trial Registration; identifier NCT05879393.

Pre-existing Immunocompromised Status as a Preventer of Mortality in COVID-19 Patients: Friend or Foe?

Objective COVID-19 has been negatively impacted by a number of comorbidities. Aside from that, some conditions or treatments that cause immunosuppression can alter the course of the disease, leading to worse outcomes. The primary goal of this study is to compare the clinical presentation, laboratory analysis, radiological findings, and outcomes of patients with COVID-19 with and without immunosuppression. Materials and methods The study includes patients with pre-existing immunosuppression and COVID-19 infection who were admitted and received inpatient treatmentat Marmara University Hospital, Istanbul, Pulmonary Medicine ward between April 2020 and June 2020. Data on demographics, epidemiology, clinical course, laboratory analysis, radiological findings, length of hospital stay, morbidity, and mortality were collected from all patients. Results The study group consisted of 23 patients who had pre-existing immunosuppression, and the control group consisted of207 immunocompetent patients, making a total of 230 patients. Significant differences in lymphocyte count, ROX (respiratory-rate oxygenation) index on Day 0, and fibrinogen levels were discovered between the two groups. SARI (severe acute respiratory infection) was more common in the control group than in the study group (p<0.022), but there was no difference in mortality. Conclusion The mean number and percentage of lymphocytes were lower in immunocompromised COVID-19 patients at the time of diagnosis. Higher ROX index values and a lower risk of developing SARI could explain the hypothesis that these patients may be benefitingfrom a pre-existing corticosteroid regimen. Additional research with larger numbers of patients may be beneficial in drawing a more definitive conclusion.

Effects of pegylated recombinant human granulocyte colony-stimulating factor on lymphocytes and white blood cells of patients with malignant tumor.

We investigated the effect of pegylated recombinant human granulocyte colony-stimulating factor (PEG-rhG-CSF) on lymphocytes and white blood cells of patients with malignant tumors. After PEG-rhG-CSF treatment, the count of lymphocytes increased in 66 cases, remained unchanged in 2 cases, and decreased in 20 cases. The difference in lymphocyte count before and after treatment was statistically significant (P < 0.001). White blood cell changes were positively correlated with lymphocyte changes (r = 0.36, P = 0.001). In the subgroup with increased white blood cells (n = 80), there were 62 cases with increased lymphocytes, 1 case with unchanged lymphocytes, and 17 cases with decreased lymphocytes after PEG-rhG-CSF treatment. There was significant difference in the count of lymphocytes and white blood cells (P < 0.001). In the subgroup with 6 mg of PEG-rhG-CSF (n = 66) and the subgroup with 3 mg of PEG-rhG-CSF (n = 22), the changes of white blood cell and lymphocyte counts before and after treatment were statistically significant (P < 0.001). The two were positively correlated in the 6 mg PEG-rhG-CSF subgroup, with correlation coefficient r = 0.34 (P = 0.002). PEG-rhG-CSF can increase the count of lymphocytes and white blood cells in patients with malignant tumors, and the increase of lymphocytes is positively correlated with the increase of white blood cells.

Comparison of Biochemical and Hematological Parameters Among COVID-19 Patients With and Without Vaccination in a Tertiary Care Hospital: A Retrospective

Background: The availability of the COVID-19 vaccine during the pandemic has changed the disease course in the entire world. The current study aimed to compare various hematological parameters among COVID-19 patients with and without vaccination. Methods: The present retrospective study included 26 vaccinated and 26 non-vaccinated COVID-19 patients. Various clinical and biochemical parameters of RT-PCR-positive patients were collected. The values are expressed in Mean±SD or median values IQR. Mann-Whitney U test was used for comparison between the groups. Results: Among the vaccinated individuals, 17 cases (65.4%) were asymptomatic, one patient (3.8%) had moderate, eight cases (30.8%) had mild COVID-19 infection and all 26 patients were completely recovered. Among non-vaccinated COVID-19 patients, 25 cases (96.2%) had severe, one case (3.8%) had moderate COVID-19, and 16 patients (61.5%) recovered but ten cases succumbed to COVID-19. There were statistically significant differences in SpO2, total leucocyte count, and differential counts of neutrophils, lymphocytes, eosinophils, monocytes, and basophils between vaccinated and non-vaccinated patients (P&lt;0.001). The neutrophil/lymphocyte ratio was found to be at a higher level (P&lt;0.01) among non-vaccinated patients [10.9(4.28-23.63)] compared to vaccinated [1.55(1.09-2.28)]. The blood urea, total and direct bilirubin, serum glutamic oxaloacetic transaminase (SGOT), serum glutamic pyruvic transaminase (SGPT), and inflammatory markers, like C-reactive protein (CRP), D-dimer, ferritin, and lactate dehydrogenase (LDH) were highly elevated in non-vaccinated patients (P&lt;0.001). Moreover, lower values of total protein, serum albumin, and albumin and globulin (A/G) ratio were noted in the non-vaccinated compared to vaccinated individuals (P&lt;0.001). Conclusion: Vaccinated patients had milder disease with fewer derangements of hematological parameters compared to non-vaccinated patients. It can be concluded that vaccine has played a vital role during the COVID-19 pandemic in reducing mortality.

Effect of vitamin E and zinc supplementation in pre and post partum period incrossbred cows on anti-oxidant, immunity status and performance of new borncalves

The present study was undertaken to investigate the effect of zinc (Zn) supplementation alone and its combination with vitamin E on growth, anti oxidant status and immunity status of new born calves of crossbred cows. The cows were supplemented with Zn @ 0 ppm (T0), Zn @ 80 ppm (T1) and Zn @80 ppm + 1000 IU α-tocopheryl acetate/d (T2) from 60 days prepartum up to 90 days postpartum. The fat, SNF, total solid, protein, Zn and Cu contents content of colostrum showed no effect of dietary treatments but α-tocopherol content was higher(P&lt;0.01) in group T2 as compared to other groups. Total immunoglobulin in colostrum of T2 group was 25.87% higher than control. There was no effect of dietary treatments on plasma Zn and Cu levels of calves, however α-tocopherol concentration at day 5 was higher (P&lt;0.05) in group T2 as compared to other groups. Status of antioxidant enzymes, lymphocyte proliferation index,total and differential leukocyte count was not affected by the treatments. Higher birth weight (P&lt;0.05) was obtained in groupT2 group as compared to other group. Calves from treatment groups showed lower incidence of morbidity and mortality due to calf scour and other infectious diseases compared to control

Analysis of CT signs, radiomic features and clinical characteristics for delta variant COVID-19 patients with different vaccination status

ObjectiveTo explore the characteristics of peripheral blood, high resolution computed tomography (HRCT) imaging and the radiomics signature (RadScore) in patients infected with delta variant virus under different coronavirus disease (COVID-19) vaccination status.Methods123 patients with delta variant virus infection collected from November 1, 2021 to March 1, 2022 were analyzed retrospectively. According to COVID-19 vaccination Status, they were divided into three groups: Unvaccinated group, partially vaccinated group and full vaccination group. The peripheral blood, chest HRCT manifestations and RadScore of each group were analyzed and compared.ResultsThe mean lymphocyte count 1.22 ± 0.49 × 10^9/L, CT score 7.29 ± 3.48, RadScore 0.75 ± 0.63 in the unvaccinated group; The mean lymphocyte count 1.55 ± 0.70 × 10^9/L, CT score 5.27 ± 2.72, RadScore 1.03 ± 0.46 in the partially vaccinated group; The mean lymphocyte count 1.87 ± 0.70 × 10^9/L, CT score 3.59 ± 3.14, RadScore 1.23 ± 0.29 in the fully vaccinated group. There were significant differences in lymphocyte count, CT score and RadScore among the three groups (all p < 0.05); Compared with the other two groups, the lung lesions in the unvaccinated group were more involved in multiple lobes, of which 26 cases involved the whole lung.ConclusionsThrough the analysis of clinical features, pulmonary imaging features and radiomics, we confirmed the positive effect of COVID-19 vaccine on pulmonary inflammatory symptoms and lymphocyte count (immune system) during delta mutant infection.

Is Renal Function Equally Impacted By Hypomethylating Agents during Acute Myelogenous Leukemia Induction Therapy?

Background: Hypomethylating agents (HMA), such as azacitidine (AZA) /decitabine (DAC) plus BCL2 inhibitors are increasingly used as acute myelogenous leukemia (AML) therapy. However, side effects such as neutropenic fever, tumor lysis syndrome and acute kidney injury (AKI) are described. Although AKI induced by HMAs is infrequent, severity can result in permanent renal damage. Previous reports suggest that kidneys clear more than 50% of AZA with renal tubular acidosis and electrolytes abnormalities developing after drug exposure. To date, it is unknown whether concurrent comorbid conditions increase risk of AKI in AML patients. This study aimed to evaluate renal function overtime in patients receiving a HMAs plus venetoclax to determine each agent's ability to induce AKI. Methods: A single center retrospective, descriptive study from January 2018 to March 2022 was conducted at Baylor St. Luke's Medical Center. Patients with a confirmed diagnosis of AML, who received at least 1 cycle of venetoclax and a HMA, who were not eligible for intensive chemotherapy were included. Primary objective was incidence of AKI in AZA vs DAC during first week induction. Given potential additive impact of BCL2 inhibition on renal function, secondary objective was a subgroup analysis of patients in AZA group receiving venetoclax ≤ or >14 days. Descriptive and paired-t-test comparing baseline and daily sequential creatinine and glomerular filtration rate (GFR) were analyzed using SAS. Results: 40 AML patients were included. 25/40 (62.5%) and 15/40 (37.5%) received AZA and DAC. Baseline patient characteristics were well balanced between groups, except for differential absolute lymphocyte count (ALC) expression [3.4 K/uL vs 1.3 K/uL, in AZA treated vs DAC, p=0.01]. Patients receiving AZA developed significantly higher incidence of AKI from day 1 to day7. DAC was associated with transient significant AKI detectable only during day 5 (Fig 1A). At last follow up, incidence of irreversible renal failure was observed in 1/40 (2.5%) of AML patients. In further subgroup analysis, we sought to understand the possible nephrotoxic BCL2- inhibitor effect while combining with AZA. Patients exposed >14 days of BCL2- inhibitors developed sustained AKI throughout day 3 to day 7 [p=<0.05 for all time points], as compared to those receiving ≤14 days. No detectable differences on incidence of diabetes, heart failure, infections, and use of diuretics were found in patients exposed or not to 14 days of BCL-2 inhibitor. Conclusions: Our study demonstrates more severe and sustained worsening renal function in patients exposed to AZA than those receiving DAC. While our report recapitulates similar previous observations, we describe an important synergistic BCL-2 inhibitor effect on renal function when combined with AZA. It would be interesting to investigate whether higher than expected ALC cooperates to induce renal damage via enhanced T-cell immunity. Figure 1View largeDownload PPTFigure 1View largeDownload PPT Close modal

Quantitative CT comparison between COVID-19 and mycoplasma pneumonia suspected as COVID-19: a longitudinal study

ObjectiveThe purpose of this study was to compare imaging features between COVID-19 and mycoplasma pneumonia (MP).Materials and methodsThe data of patients with mild COVID-19 and MP who underwent chest computed tomography (CT) examination from February 1, 2020 to April 17, 2020 were retrospectively analyzed. The Pneumonia-CT-LKM-PP model based on a deep learning algorithm was used to automatically quantify the number, volume, and involved lobes of pulmonary lesions, and longitudinal changes in quantitative parameters were assessed in three CT follow-ups.ResultsA total of 10 patients with mild COVID-19 and 13 patients with MP were included in this study. There was no difference in lymphocyte counts at baseline between the two groups (1.43 ± 0.45 vs. 1.44 ± 0.50, p = 0.279). C-reactive protein levels were significantly higher in MP group than in COVID-19 group (p < 0.05). The number, volume, and involved lobes of pulmonary lesions reached a peak in 7–14 days in the COVID-19 group, but there was no peak or declining trend over time in the MP group (p < 0.05).ConclusionBased on the longitudinal changes of quantitative CT, pulmonary lesions peaked at 7–14 days in patients with COVID-19, and this may be useful to distinguish COVID-19 from MP and evaluate curative effects and prognosis.

Effect of selenium and vitamin E supplementation on the metabolic status of dairy goats and respective goat kids in the peripartum period.

This study aimed to examine the effects of selenium (Se) and vitamin E (vitE) supplementation on blood cell counts and blood metabolite concentrations in goats and their kids. Fifteen Saanen goats (average age 6years of age; average initial body weight of 70 ± 10kg) and 21 ½ Saanen × ½ Pardo Alpine crossbred goat kids (average body weight of 3.70 ± 0.64kg) were used. Animals were distributed in a completely randomized design with five replicates per diet for mother goats and seven for goat kids and randomly assigned into three groups in the following diets: CON, control basal diet; Se, inclusion of 3.2mg of Se/kg DM; SevitE, inclusion of 3.2mg Se/kg DM and 1145IU/day vitE/kg DM. Effects of time were observed on red blood cells, hemoglobin, hematocrit, mean corpuscular volume, and mean corpuscular hemoglobin in goats and goat kids. Effects of time were observed on differential counts of leucocytes, lymphocytes, and monocytes in goat kids. Interaction was observed for high-density lipoprotein and total protein in goats and for triglycerides, beta-hydroxybutyrate (BHBA), and gamma-glutamyltransferase (GGT) in goat kids. Effects of time were observed on low-density lipoprotein, triglycerides, glucose, lactate, BHBA, non-esterified fatty acids (NEFA), creatinine, aspartate-aminotransferase, and GGT in goats and all blood metabolites in goat kids. Selenium, vitE, or association in the evaluated levels are not sufficient to change blood cell counts when supplied in diets for goats or goat kids. However, the effect of time or interaction between time and diets change the blood metabolite concentrations in the animals.

A Multivariate Model for Predicting the Progress of COVID-19 Using Clinical Data besides Chest CT Scan

Objective. Computed tomography (CT) scan is a method to predict the progression and prognosis of COVID-19. It is not sufficient merely to measure the prognosis of COVID-19 without other clinical methods. The purpose of this study was to investigate the association between the CT scan and clinical laboratory indicators as well as clinical manifestations. Method. A total of 335 patients were enrolled from January 26, 2020, to February 26, 2020, in Shandong province and Huanggang city. Demographic and clinical characteristics, laboratory variables, and the data from the CT scans were collected for analysis. Scatter plot analysis and correlation analysis were used to calculate the relationship between CT evaluation and other indicators. Multivariable linear regression analysis was used to establish a model for diagnostic and prognostic prediction. Age, CRP, LDH, and lymphocyte counts as independent variables were selected to develop a predictive model, and the results from the CT scans to reflect the degree of lung injury were taken as the dependent variable. Result. The median age was 44 years (IQR: 34–56); among them, 188 (56%) were male. Severe patients were older (56 vs. 40, P &lt; 0.001 ). There were statistically significant differences in lymphocyte counts, platelet counts, C-reactive protein (CRP), lactate dehydrogenase (LDH), procalcitonin (PCT), and creatine kinase (CK) between the general patients and severe patients. We found that, without effective antiviral treatment, mild patients had a 6-day interval from symptom onset to CRP elevation, but in severe patients, CRP started to increase from day 2. Lung injury score from a chest CT scan and incidence of acute respiratory distress syndrome (ARDS) were significantly higher in severe patients than in mild patients. Lung injury score from a chest CT scan was closely correlated with CRP (rs = 0.704, P &lt; 0.01 ), and they reflected the severity of the disease. The receiver operating curve (ROC) value of the injury score from the chest CT scan was 0.854 (95% CI: 0.808–0.901), and the area under the curve (AUC) value of CRP was 0.823 (95% CI: 0.769–0.878). Conclusion. The results from CRP and chest CT scans were indicators of the severity of COVID-19. Combining patient age, CRP, LDH, and lymphocyte counts, we developed a model that could help to predict lung injury/function of patients with COVID-19.

Association Between COVID-19 Outcomes and Patient Characteristics: A Study in an Inner-City Community Hospital.

BackgroundIt has been shown that certain hematological conditions, such as lymphopenia and thrombocytopenia, are associated with increased severity and mortality from severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. However, a majority of the previous data came from large institutional centers with high academic output. We aimed to explore the association between patient’s characteristics, hematological parameters, and outcomes in admitted persons with coronavirus disease 2019 (COVID-19) at our community hospital in an inner city.MethodsThis study is a retrospective chart review designed to evaluate the potential associations between demographic and clinical characteristics of our patient population and their outcomes when testing positive for SARS-CoV-2. The study population included patients hospitalized in the Saint Francis Medical Center from January 2020 to September 2020. This pilot study included 50 out of the 275 hospitalized patients with a confirmed SARS-CoV-2 infection during this timeframe. Data collection from the patient’s chart included age, sex, comorbidities, admission complete blood cell count, and use of Remdesivir, steroids, and plasma. The primary outcome was all-cause in-hospital mortality. Secondary outcomes included the need for mechanical ventilation and ICU admission.ResultsIn this pilot study, there was an overall mortality rate of 32% (16 out of 50 patients). Charlson Comorbidity Index (CCI) of 3 points or above was present in 87.5% of the patients in the mortality group versus 41.1% in patients who survived (p = 0.0021). There was no statistically significant difference in mortality between males and females after adjusting for other variables with an odds ratio (OR) of 0.19 (95% CI 0.02-1.80, p = 0.09). There were no statically significant differences in mortality between Caucasians, non-Hispanic, Black, and Latinx patients (p = 0.466). Admission platelets were lower in the mortality group with a mean of 157.7 ± 43.23 (Thou/ul) versus 250.06 ± 93.95 (Thou/ul) in the survivors (p = 0.0005). Admission white blood cell count in the mortality group was lower than the survivor group with an average of 5.93 ± 2.58 (Thou/ul) versus 9.3 ± 4.14 (Thou/ul) (p = 0.0039), respectively. The plasma D-dimer level of 3 mg/L fibrinogen equivalent unit (FEU) or higher was associated with increased mortality. There was no association of C-reactive protein (CRP) with mortality (p = 0.93 and p = 0.54, respectively); however, the CRP level revealed an association with ICU admission (p = 0.03). The use of steroids, Remdesivir, and plasma did not have a statistically significant effect on mortality, ICU admission, or sepsis in our study.ConclusionIn this study, older age, higher CCI, and plasma D-dimer level of 3 mg/L FEU or higher were associated with higher mortality among COVID-19 patients. White blood cell count and platelet count were significantly lower in the mortality group in comparison to the survivor group. However, there was no statistical difference in lymphocyte count between the mortality group and the survivor group. COVID-19 patients with thrombocytopenia or serum CRP level of 15 mg/dL or higher were more likely to be admitted to ICU.

Use of radiological tests in COVID-19 positive child cases: Is chest computed tomography necessary?

ObjectiveThis study aimed to correlate the radiographic findings of the coronavirus disease 2019 (COVID‐19) positive children with their clinical and laboratory findings and discuss the frequency and necessity of chest computed tomography (CT) used for the radiological imaging in paediatric patients with COVID‐19 infection.Materials and methodsSixty‐nine paediatric inpatient cases were retrospectively analysed using their clinical, laboratory and imaging features. The National Public Health Guide was used in the diagnosis and treatment of paediatric patients. COVID‐19 infections for all patients were confirmed by the COVID‐19 nucleic acid test using a pharyngeal swab.ResultsThe median age of the patients was 11 years [3‐15]. The most common clinical symptoms were fever (40.6%) and cough (33.3%). When the laboratory findings of patients were examined, the median white blood cell (WBC) count was 5.8/mm3 (4.8‐8.05/mm3), median lymphocyte count was 2.3/mm3 (1.7‐3.55/mm3) and median C‐reactive protein (CRP) level was 2.3/mm3 (1‐2.1/mm3). All patients had chest radiographs (CRXs), while only 44.9% of the patients underwent a chest CT. The 8.7% of CXRs and 12.8% of chest CT findings were found as pathological. Ground‐glass opacity was the most frequent finding. In the tomography group, the count of lymphocytes was lower, and creatine kinase (CK) and lactate dehydrogenase (LDH) levels were significantly higher. The patients with pathological tomography findings demonstrated no statistically significant difference in lymphocyte count and CK and LDH levels; however, their CRP value was significantly higher.ConclusionIn this study, it is emphasised that chest CT should be requested by considering the underlying diseases and severity of clinical findings in paediatric patients. In this way, unnecessary chest CT could be prevented in the paediatric population.

Leukocyte differential and reactive lymphocyte counts from Sysmex XN analyzer in the evaluation of SARS-CoV-2 infection

Background Leukocyte differential present certain features in COVID 19 patients. RE-LYMP (reactive lymphocytes) is an extended inflammation parameter (EIP) reported by XN analyzer (Sysmex Corporation, Kobe, Japan) reflect the activation of lymphocytes triggered by infections. We aimed to assess the clinical utility of these parameters as biomarkers for the rapid detection of COVID 19. Methods The study group included 200 COVID 19 and 167 patients with other infections at admission. Differences of leukocyte differential, neutrophil/lymphocyte ratio (NLR) and EIP among groups were assessed with the Kruskal-Wallis test; parameters statiscally different in the groups were tested with Receiver operating characteristic (ROC) curve analysis to assess their diagnostic performance in distinguishing SARS-CoV-2 infections. The reliability of the selected parameters was evaluated in a validation group of 347 patients (160 COVID 19 and 187 other infections). Results NLR performed well to discard viral infections, area under curve (AUC) 0.988 (95%CI 0.973 − 0.991) and RE-LYMP was useful to distinguish COVID 19 and bacterial infections AUC 0.920 (95%CI 0.884 − 0.948); the two conditions NLR> 3.3 RE-LYMP> 0.6% was applied to the validation group and 153 out of 160 COVID 19 patients were correctly distinguished (95.6%). Conclusions Early diagnosis of SARS-CoV-2 infection is critical for better caring of patients and to reduce the threat of nosocomial infection for professionals. Leukocyte differential and RE-LYMPH could assist in a preliminary differential diagnosis of the disease.

The Lymphocyte Depletion in Patients with Acute Ischemic Stroke Associated with Poor Neurologic Outcome.

PurposeInflammation plays an important role and is involved in all stages of acute ischemic stroke. One of these stages involves the recruitment of leukocytes from the peripheral circulation into the ischemic tissue. Lymphocytes as a subtype of leukocytes are important mediators and can become a predictor of neurological outcome. Several studies have been conducted regarding the correlation between differential lymphocyte counts and acute ischemic stroke. Most of these studies analyzed lymphocyte ratio to other leukocyte subtypes such as neutrophils and monocytes. This study specifically observed the role of lymphocytes as an indicator of the inflammatory response in patients with acute ischemic stroke. This study aimed to observe the correlation among risk factors, infarct location, leukocyte counts, lymphocyte value and neurologic output in acute ischemic stroke patients.Patients and MethodsWe observed and analyzed 193 patients’ data from medical record which met the inclusion and exclusion criteria with a diagnosis of acute ischemic stroke at the Department of Neurology of Dr. Hasan Sadikin General Bandung. Data were then analysed using appropriate statistical tests.ResultsMost patients have more than one risk factor with a leukocyte count of less than 10,000 cell/mm3. Infarct was mostly located in subcortical area (basal ganglia), with moderate average NIHSS values at admission and at discharge. The number of lymphocytes decreased in the subject group with more than 10,000 cell/mm3 leukocytes. Subsequently, data were analyzed using Spearman’s test and there was a correlation between NIHSS on admission and lymphocyte depletion.ConclusionThe lymphocyte depletion in patients with leukocytosis is a predictor of poor NIHSS.

Impact of bronchoalveolar lavage lymphocytosis on the effects of anti-inflammatory therapy in idiopathic non-specific interstitial pneumonia, idiopathic pleuroparenchymal fibroelastosis, and unclassifiable idiopathic interstitial pneumonia

BackgroundIdiopathic non-specific interstitial pneumonia (iNSIP), idiopathic pleuroparenchymal fibroelastosis (iPPFE), and unclassifiable idiopathic interstitial pneumonia (IIP) are IIPs with chronic fibrotic phenotypes, and unlike idiopathic pulmonary fibrosis, they have often been treated with anti-inflammatory drugs, including corticosteroids and immunosuppressants. However, the impact of bronchoalveolar lavage (BAL) lymphocytosis on the effects of anti-inflammatory therapy has never been evaluated. This study aimed to elucidate whether BAL lymphocytosis can be used to predict the efficacy of anti-inflammatory drugs for iNSIP, iPPFE, and unclassifiable IIP.MethodsJapanese patients diagnosed with iNSIP, iPPFE, and unclassifiable IIP by multidisciplinary discussion were identified using the nationwide registry. Eligible patients were stratified into four groups with and without BAL lymphocytosis and anti-inflammatory therapy to compare overall survival (OS) and changes in lung function. BAL lymphocytosis was defined as a lymphocyte differential count > 15%, and the cut-off was corroborated by survival classification and regression tree analysis.ResultsOverall, 186 patients (37 iNSIP, 16 iPPFE, and 133 unclassifiable IIP) were analyzed. Limited to patients treated with anti-inflammatory drugs (n = 123), patients with BAL lymphocytosis had a better prognosis [hazard ratio (HR), 0.26; 95% confidence interval (CI), 0.11–0.63; P = 0.003], higher slope of forced vital capacity (FVC) % predicted for 2 years, and longer OS (log-rank test, P = 0.012) than those without BAL lymphocytosis. On multivariate analysis, BAL lymphocytosis (HR 0.31; 95% CI 0.13–0.75; P = 0.009) was a prognostic factor for OS, along with age and FVC % predicted. Conversely, for patients managed without anti-inflammatory therapy (n = 63), the presence or absence of BAL lymphocytosis had no prognostic value.ConclusionsBAL lymphocytosis is associated with good outcomes in patients treated with anti-inflammatory drugs, but has no prognostic value when anti-inflammatory drugs are not used. BAL lymphocytosis may provide a predictive biomarker for identifying patients with iNSIP, iPPFE and unclassifiable IIP who are likely to benefit from anti-inflammatory drugs.

Improved osteosarcoma survival with addition of mifamurtide to conventional chemotherapy – Observational prospective single institution analysis

PurposeConventional osteosarcoma is an orphan disease. Current treatment approaches include combining a three drug chemotherapy schedule and surgery. The 3- and 5-year event-free survival (EFS) in localized disease is roughly 65 and 60%, respectively. The registration study of mifamurtide reported survival benefit, but some methodological controversies have been insufficient for FDA market authorization in contrast to EMA. Methodsprospective single centre survival analysis of a mifamurtide addition to conventional therapy in 23 patients over a 5.5 year enrolment period is reported and compared to a historical control of 26 patient with localized disease. Bias arising from observational methodology was addressed using Landmark analysis and time-dependent Cox models. Blood count dynamics were analysed during the treatment. ResultsThe adverse event profile was as expected with no dose limiting toxicities. There were no local relapses observed, one patient died in the first complete remission due to doxorubicin cardiotoxicity, one patient had pulmonary metastatic relapse. The observed 3- and 5-year EFS was 87.4% (CI 72.4–100%) and 87.4% (CI 72.4–100%), progression free survival (PFS) was 92.9% (CI 80.3–100%) and 92.9% (CI 80.3–100%), overall survival was 94.1% (CI 83.6–100) and 80.7% (CI 58.3–100), respectively. Comparison to the historical control showed statistically significant better PFS for mifamurtide patients (Landmark analysis; p = 0.044). Risk of progression was 5-times lower for the mifamurtide group (Cox model; HR 0.21, p = 0.136). Only subtle differences in lymphocyte counts were observed across treatment. Conclusionthe PFS benefit of mifamurtide is reported herein. The addition of mifamurtide could be considered as a best treatment option for localized osteosarcoma.