Total Lymphocyte Research Articles

Asymptomatic Apical Periodontitis Lesions and Their Association With Systemic Inflammatory Burden: A Preliminary Prospective Clinical Study.

Background: Apical periodontitis (AP) is an inflammatory disorder of the periapical tissues caused by the persistence of a microbial infection within the root canal system of the affected tooth. Clinically, it is symptomatic or asymptomatic depending on several factors such as the type of microorganisms, bacterial load, immunological reaction, and local tissue mediators. Chronic or asymptomatic infections may initiate and modulate intravascular accumulation of inflammatory cells resulting in endothelial dysfunction which subsequently represents a possible systemic inflammatory burden. Aim: The present study aimed to evaluate the relationship between asymptomatic AP and systemic inflammatory burden by assessing the levels of chronic inflammatory cells. Methodology: A total of 25 patients diagnosed with asymptomatic AP who showed a negative response to the pulp sensitivity test with no history of any systemic diseases were included in this preliminary prospective observational study. Blood samples were collected at each phase of the study, and a complete hemogram was carried out. All hematological parameters were recorded before and after root canal therapy and they were analyzed for statistical significance at p <.05 using IBMSPSSStatistics for Windows, Version 21 (Released 2012; IBM Corp., Armonk, New York, United States). Results: Evaluation of the mean total leukocyte count (TLC), lymphocyte, and eosinophil cell count showed a significant reduction in the number of cells before and after root canal therapy treatment respectively (p<.05). One-way analysis of variance also revealed statistical significance at p < .05 with a weak positive correlation between the TLC, lymphocyte, and eosinophil count before and after treatment. Conclusion: The present study showed that systemically healthy individuals with asymptomatic AP had increased inflammatory burden in the circulation, and thus, it is essential to identify and quantify the risk associated. It was evident that complete healing of the asymptomatic AP lesions results in an overall reduction of systemic inflammatory cells ultimately reducing the burden and risk of associated systemic inflammatory diseases.

Development and Validation of a Three-Parameter Scoring System for Monitoring HIV/AIDS Patients in Low-Resource Settings Using Hematological Parameters.

This study aimed to test the validity of a composite score using complete blood count (CBC) for monitoring HIV patients receiving antiretroviral therapy (ART) in the absence of viral load and CD4 count. This retrospective cohort study analyzed the laboratory data of 82 HIV patients who had pre- and post-treatment viral load, CD4 count, and CBC data. Pre- and post-treatment data were pooled to analyze the correlation of CBC parameters with Polymerase Chain Reaction (PCR) ranks and their performance in indicating a CD4 count<200 cells/mm3 using the Operating Characteristics Curve (ROC), with the determination of cutoffs. A score combining the significant parameters was tested to predict a CD4 count of <200. Total lymphocyte count (TLC), percentage (TLP), and hemoglobin concentration (Hb) were the most significant parameters, showing negative correlations with PCR (Spearman's Rho = -0.357 to -0.242). The risk of acquired immunodeficiency syndrome (AIDS) was independently associated with TLC<1345 cells/mm3 (OR=2.92), TLP<29.07% (OR=3.53), and Hb<10.55 mg/dL (OR=3.60). A combined score of 2-3 indicated a CD4 count<200 with an odds ratio of 8.3-86.7. The proposed 3-parameter score combining the use of TLC, TLP, and Hb, is an affordable and practical approach that may have clinical utility in monitoring HIV patients receiving ART in low-resource settings.

Differences peripheral of blood in HIV patients with and without cognitive disorders at “Prof. Dr. IGNG Ngoerah” Hospital

Background and objective. The prevalence of mild neurocognitive Disorder (MND) has increased after using antiretroviral therapy (ARV), which is around 51.5%. Inflammation plays an essential role in the neurodegenerative state of HIV patients. Peripheral blood images can assess increased macrophage activation by evaluating the number of leukocytes, neutrophils, total lymphocytes, hemoglobin, platelets, platelets, and neutrophil-lymphocyte ratio (NLR) to determine the condition of systemic inflammation in HIV patients with cognitive impairment. This study to know differences in the appearance of peripheral blood in HIV patients with and without cognitive impairment. Method. Observational analytic study with a cross-sectional design on 44 HIV patients who were outpatients at the polyclinic Voluntary Counseling and Testing (VCT) at Prof Dr. IGNG Ngoerah Denpasar Hospital. Subjects were divided into 2 groups based on cognitive status assessed using the MoCA-INA questionnaire. The peripheral blood images considered were the average levels of leukocytes, neutrophils, lymphocytes, hemoglobin, hematocrit, platelets, and the ratio of neutrophils to lymphocytes. Results. 31-40 years old, male, with &gt;9 years of education, has a CD4 count &gt;200, and has received ARV therapy &gt;1 year. The Shapiro-Wilk normality test performed on both groups showed that the data were normally distributed with p&gt;0.05. Bivariate analysis using an independent t-test with a 95% confidence level (α=0.05) found significant differences in mean leukocyte, neutrophil, lymphocyte, and neutrophil-lymphocyte ratios (p&lt;0.05) between groups of HIV patients with cognitive impairment and no cognitive impairment. Conclusion. Inflammatory markers from the peripheral blood picture are increased in HIV-infected persons.

The Prognostic and Predictive Value of Pre-Treatment Total Lymphocyte Count in HPV+ Oropharyngeal Carcinoma Receiving Definitive (Chemo-) Radiation

Evidence of prognostic importance of pre-radiotherapy (RT) total lymphocyte counts (TLC) and interaction with addition of cisplatin (CRT) in HPV-positive oropharyngeal carcinoma (HPV+OPC) is conflicting. Recent data suggest patients with high TLC may not benefit from the addition of chemotherapy (Price et al, JCO 2022). We assess the prognostic and predictive value of TLC in a large single center HPV+OCP cohort. All HPV+OPC patients treated at a single academic center with definitive RT/CRT between 2005-2018 were included. Pre-treatment TLC up to 6 weeks prior to RT start were considered. Multivariable analysis (MVA) was applied to assess the prognostic importance of TLC (continuous variable), adjusted for age, gender, performance status, TNM-8 stage, and smoking status in the CRT and RT subgroups. The actuarial rates of locoregional control (LRC), distant control (DC), and overall survival (OS) were calculated using Kaplan-Meier and competing risk methods, stratified by low vs high TLC (determined using Contal and O'Quigley method for optimal cutoff). Among 1153 eligible patients, 707 (61%) were treated with CRT. Median age was 59.7 (range 22.7-92.2) years. 526 patients were (46%) TNM-8 stage I, 366 (32%) stage II and 261 (23%) stage III. Median TLC was 1.6 x 109/L (range 0.1-8.5). Median follow-up was 5.5 years. On MVA, TLC was prognostic for patients receiving CRT (OS [adjusted hazard ration (aHR) 0.55 (0.38-0.79), p = 0.002], DC [aHR 0.57 (0.37-0.88), p = 0.011], LRC [aHR 0.57 (0.36-0.89), p = 0.014]) but not RT (OS [aHR 1.04 (0.82-1.31), p = 0.74], LRC [aHR 1.26 (0.86-1.85), p = 0.23], DC [aHR 0.87 (0.64-1.19), p = 0.4)]. The optimal TLC cut-off for OS with CRT was 1.9 x 109/L. Low vs high TLC patients receiving CRT had significantly inferior 5-year DC (87% vs 93%, p = 0.017) and OS (84% vs 90%, p = 0.026). The benefit of higher TLC was most evident in stage II disease (table 1). CRT vs RT improved OS for stage II/III disease at high and low TLC. Pre-treatment TLC is prognostic in a large cohort of HPV+OPC patients receiving CRT but not RT alone. Further investigation of the interaction of cisplatin and immune response during RT is warranted. The omission of chemotherapy based on TLC is not supported.

The Association of Chemoradiation Induced Lymphopenia with Racial Disparity and Its Prognostic Impact on Survival for Anal Cancer

While the association between chemoradiation induced lymphopenia (CIL) and poor overall survival (OS) is established in multiple solid malignancies, it has not been studied in anal cancer. Racial and socioeconomic disparities as potential predictors of lymphopenia have not been reported. We hypothesize that race and socioeconomic status is associated with increased incidence of severe CIL, which can predict worse overall survival for patients with anal cancer. A cohort of 75 patients treated with definitive chemoradiation (CRT) for squamous cell anal cancer from January 2014 to December 2020 was reviewed. Total lymphocyte counts (TLC) at baseline and TLC nadir at 1 month post-CRT were analyzed. Logistic regression was used to identify associations between race, gender, ethnicity, median household income by zip code, marital status, baseline hematopoietic cell counts, and post-CRT Grade 3+ lymphopenia (TLC <0.5k/μL). Kaplan-Meier method and Cox regression model were used to perform survival analysis. Of the 75 patients identified, mean age was 66.9 years and median follow-up time was 37.1 months. There were 63 females, 53 non-Hispanic whites, 22 minorities (12 Blacks, 9 Hispanics, 1 Asians) Radiation dose ranged from 41.4 Gray to 56 Gray. At 1 month post CRT, 85.3% developed lymphopenia (G1 9.3%, G2 26.7%, G3 37.3%, G4 12.0%). On multivariate logistic regression, non-white race demonstrated a trend to have more Grade 3+ lymphopenia (OR = 3.5, p = 0.07). On univariate Cox regression, poorer overall survival was associated with race (HR 3.7, p = 0.04), baseline white blood count (HR 1.3, p = 0.04), baseline hemoglobin (HR 0.6, p = 0.04), and post-CRT Grade 3+ lymphopenia (HR 5.8, p = 0.03). On multivariate Cox regression, only post-CRT Grade 3+ lymphopenia was associated with worse OS (HR 7.5, p = 0.049). 5-year OS significantly differed between patients with and without post-CRT Grade 3+ lymphopenia (62.3% vs 94.7%, P = 0.01). Lymphopenia is commonly observed after chemoradiation for anal cancer. Racial disparity is associated with severe lymphopenia induced by chemoradiation, which is a robust predictor of poor survival in anal cancer. More attention to lymphopenia induced by chemoradiation for anal cancer is needed, particularly in racial minorities.

Analysis of regulatory T lymphocytes in patients with traumatic brain injury

In recent years, traumatic brain injury (TBI) has been one of the most urgent medical and social problems due to its prevalence, predominantly affecting young people of working age, causing high mortality, disability and economic costs for treatment and subsequent rehabilitation of patients. At present, the role of patients’ immune system in evolving neuroinflammation after traumatic brain injury has been proven. Treg cell populations represent an important factor determining the outcome of the disease due to promoting induction of immunological tolerance, being a significant component of immunoregulation. As a result of our study, we found a decrease in the relative content of Treg within the total lymphocyte pool of peripheral blood, which has the CD3+CD4+CD25bright phenotype in patients of the 3rd and 4th groups, in comparison with the data from control group. Moreover, a decreased relative content of Tregs (CD4+CD25+T cells) was revealed which is due to the degree of brain tissue damage and, as a result, their migration to suppress inflammation due to production of anti-inflammatory cytokines (TGF-â, IL-10). The Treg population is heterogeneous, thus prompting us for analysis of the Treg subpopulations profile based on the expression of CD45R0 and CD62L. When assessing subpopulations of regulatory T lymphocytes within CD45Ro and CD62L, significant changes were found only in patients with brain contusion. The changes were revealed within the pool of “naive” T regulatory lymphocytes with the CD3+CD4+CD25brightCD39+ Treg phenotype, capable of producing a wide range of cytokines specific for Th1, Th2, Th17, in patients with mild, moderate and severe TBI. Meanwhile, the level of highly active CD3+CD4+CD25brightCD73+ Tregs was significantly reduced in patients with moderate and severe TBI. These changes indicate an imbalance in immunoregulatory processes resulting from extensive damage to brain tissues.

Immune and cytokine alterations and RNA-sequencing analysis in gestational tissues from pregnant women after recovery from COVID-19

BackgroundCOVID-19 is a global pandemic. Understanding the immune responses in pregnant women recovering from COVID-19 may suggest new therapeutic approaches.MethodsWe performed a cross-sectional study between March 1, 2020, and September 1, 2020. Participants were assigned into the convalescent COVID-19 group if they had a previous COVID-19 infection during pregnancy or the healthy control group. RNA-Seq was performed on human umbilical cord mesenchymal stem cells (hUMSCs) and human amniotic mesenchymal stem cells (hAMSCs). Immunohistochemical staining, cytokine testing, lymphocyte subset analysis, RNA-Seq, and functional analyses were performed on the placental and umbilical cord blood (UCB) and compared between the two groups.ResultsA total of 40 pregnant women were enrolled, with 13 in the convalescent group and 27 in the control group. There were 1024, 46, and 32 differentially expressed genes (DEGs) identified in the placental tissue, hUMSCs, and hAMSCs between the convalescent and control groups, respectively. Enrichment analysis showed those DEGs were associated with immune homeostasis, antiviral activity, cell proliferation, and tissue repair. Levels of IL-6, TNF-α, total lymphocyte counts, B lymphocytes, Tregs percentages, and IFN-γ expressing CD4+ and CD8+ T cells were statistically different between two groups (p ≤ 0.05). ACE2 and TMPRSS2 expressed on the placenta were not different between the two groups (p > 0.05).ConclusionMultiple changes in immune responses occurred in the placental tissue, hUMSCs, and hAMSCs after maternal recovery from COVID-19, which might imply their protective roles against COVID-19 infection.

Flow Cytometric Analysis of Lymphocyte Subsets of Covid-19 Patients from A Single Centre in Turkey

Background:&#x0D; Lymphocyte counts have been shown to negatively correlate with the severity and different outcomes in Covid-19. The aim of this single centre study is to analyse the distribution of lymphocyte subsets in response to SARS-CoV-2 infection and its relation to the severity, course and prognosis of the disease.&#x0D; Methods:&#x0D; Blood samples were obtained from 67 consecutive patients between April 2020 and July 2020. Data on other laboratory parameters, and clinical course were collected retrospectively from patient files and patints were defined to have as severe or non-severe (mild/moderate) disease. Leukocyte subsets to be studied were identified by using flow cytometric analysis. Patients were allocated into 3 groups based on the day of blood sample collection for the flow cytometric analysis: Days 0-7, Days 8-14 and Days &gt;14 as Group I, Group II and Group III, respectively. In 10 available of 67 patients an additional flow cytometric analysis was done 7-10 days after the initial sampling.&#x0D; Results:&#x0D; Lower total lymphocyte, CD3 positive, CD4 positive and B-cell counts were identified in severe infection compared to non-severe infection group which were also correlated with high serum CRP, D-dimer and ferritin levels. NK and monocyte counts were not different between the two groups. Activation markers CD38 and HLA-DR on CD4 and CD8 positive lymphocytes also were not different in either group. &#x0D; Conclusion:&#x0D; CD3 and CD4 lymphopenia were lower in accordance with previous studies and were associated with severe disease. The expectancy of high activation markers was not met. Future studies with detailed subgroup analyses at different time-points, and immune profiling after vaccination as well as during new infection in vaccinated patients will shed more light on our general knowledge of the immune response to COVID-19 and viruses in general.

Immuno-endocrine alterations and oxidative stress induced by commercial formulations of pesticides in the tegu lizard (Salvator merianae)

Recent research has shown the risk of environmental contamination by pesticides in Argentina. Salvator merianae is considered as “sentinel species” for monitoring their effects. We intended to investigate growth, immunological and endocrine functions, and oxidative stress in S. merianae exposed to two commercial brands of the herbicide glyphosate: Roundup and Panzer Gold, as well as, to two insecticides: chlorpyrifos, and cypermethrin. Our results showed a higher increase in growth in animals exposed to Roundup and chlorpyrifos and a lower increase in those exposed to Panzer Gold. Higher total leukocyte and lymphocyte count values were observed in lizards exposed to Panzer Gold. The heterophils/lymphocytes ratio decreased in all treated animals. Regarding lobularity index, natural antibodies titers, and complement system activity values, lizards exposed to cypermethrin had higher values. Low corticosterone levels were observed in animals exposed to Roundup. Our results reveal different toxic effects of pesticides contributing to the knowledge of the pesticides’ potential deleterious impact in the habitat of S. merianae.

Immunological Impact of Fermented Soybean Condiments Produced from Indigenous Fermenters

Several studies have shown that most condiments consumed in Nigeria today are fortified with chemicals that alter the nature and stripped the natural immunological adjuvants designed by nature to protect the body system. Several condiments have been developed from fermented foods in order to control this ugly situation but there is still controversial thought in the choice of microorganism to be used in order to produce a non-toxic condiment with an improved immunological function. The aim of this study was to evaluate the toxicity, nutritive value and immunological impact of fermented soybean condiments. Soybean (Glycine max) sample was fermented with indigenous microorganisms isolated from 7 days old fermented soybean sample; this was oven-dried, pulverized and packaged in a cleaned sterile screw capped container. The immunological impact, pro-inflammatory and anti-inflammatory activities were determined using in vivo and instrumentation techniques. Lactobacillus plantarum strain ZS 2058 (L), Bacillus subtilis strain 168 (B) and Saccharomyces cerevisiae strain YJM555 (Y) were the indigenous microbes used both singly and in consortium for the production of light to dark brown condiments with water activity ranging from 0.27 – 0.37 for the fermented soybean in the plate and 0.22 - 0.36 for the fermented soybean wrapped with Thaumatococcus danielli leaves (called Uma in Igbo and Ewe eran in Yoruba). There was pronounced delay type hypersensitivity (DTH) and significant (P&lt;0.05) elevation of lymphocyte population, rosette counts, antibody titers, phagocytic indices, total lymphocytes and malondialdehyde (MDA) values, of which pronounced activities were mostly seen on those condiments prepared with consortium of the organisms (BLY). Therefore condiments produced from fermentation of soybean using indigenous B, L, Y, BL and BLY are recommended as this would enhance its immunological impact and also safe, and those fermented in plastic plates using BLY were most efficient, preferable and acceptable.

Abstract PO-048: Baseline blood DNA methylation-based immune profiles are associated with survival outcomes in head and neck cancer patients on immune checkpoint therapy

Abstract Background: Standard-of-care anti-PD-1 therapy does not provide long-lasting benefits for most patients with recurrent/metastatic (R/M) head and neck squamous cell carcinoma (HNSCC). A current biomarker of potential response, PD-ligand-1 combined proportion score, has limitations due to the heterogeneity and availability of tumor samples. The development of peripheral blood-based biomarkers offers a contemporary noninvasive sample for immunotherapy response. DNA methylation-based immune cell deconvolution provides opportunities for developing blood-based biomarkers to predict immunotherapy response outcomes in HNSCC. Methods: Our study is an ongoing prospective multi-center study aimed at identifying blood DNA methylation biomarkers of therapy response in patients with R/M HNSCC undergoing standard-of-care, FDA-approved anti-PD-1 therapy. DNA isolated from these samples underwent bisulfite conversion and methylation profiling using the Illumina EPIC microarray. Peripheral blood immune profiles were generated using cellular deconvolution. 58 consecutive R/M HNSCC patients with anti-PD-1 monotherapy were included (4/31/23). We investigated 47 immune variables for relation with progression-free survival (PFS) and overall survival (OS) using Cox proportional-hazard models adjusted for age, sex, and a marker for corticosteroid exposure (NDMI). Immune variables were treated as continuous and binary predictors in the models. A data-based statistical cutpoint (surv_cutpoint) was used to dichotomize the immune variables. Differences between the baseline immune profiles of patients who received anti-PD-1 monotherapy with durable clinical benefit for at least one year (Benefit group) and patients who experienced progression or death within 100 days (Non-benefit group) from the start of therapy were modeled using linear regression, adjusted for age, sex, and NDMI. A p-value &amp;lt; 0.05 was used as the cut-off for statistical significance. Results: In 58 patients with R/M HNSCC who received only anti-PD-1 therapy for this preliminary analysis, a granulocytic myeloid-derived suppressor cell (gMDSC) score was consistently associated with PFS as a continuous (HR: 1.27) and a binary variable (HR: 2.70). Several immune profiling variables were significantly associated with PFS and OS as a binary variable. Consistently, baseline neutrophil proportion (PFS HR 3.62; OS HR: 4.67), total T cell count (PFS HR 0.32; OS HR: 0.25), total lymphocyte proportion (PFS HR 0.36; OS HR: 0.27), lymphocyte to monocyte ratio (PFS HR 0.43; OS HR: 0.32), monocyte count (PFS HR 2.50; OS HR: 2.84), and total CD4T cell count (PFS HR 0.37; OS HR: 0.38) were associated with PFS and OS. A significantly lower gMDSC score was observed in the Benefit group compared to the Non-benefit group. Conclusion: DNA methylation-based immune profiling in peripheral blood at baseline identifies clinically relevant biomarkers of benefit from anti-PD-1 therapy. Our results promise the potential development of new blood-based DNA methylation biomarkers to predict immunotherapy response before treatment. Citation Format: Ze Zhang, Kartik Sehgal, Keisuke Shirai, Rondi Butler, Min Kyung Lee, Annette Molinaro, John Wiencke, Devin Koestler, Hannah Stolrow, Geat Ramush, Lucas Salas, Robert Haddad, Karl Kelsey, Brock Christensen. Baseline blood DNA methylation-based immune profiles are associated with survival outcomes in head and neck cancer patients on immune checkpoint therapy [abstract]. In: Proceedings of the AACR-AHNS Head and Neck Cancer Conference: Innovating through Basic, Clinical, and Translational Research; 2023 Jul 7-8; Montreal, QC, Canada. Philadelphia (PA): AACR; Clin Cancer Res 2023;29(18_Suppl):Abstract nr PO-048.

The prognostic nutritional index (PNI) is independently associated with 90-day and 12-month mortality after metastatic spinal tumor surgery.

Estimatedpostoperative survival is an important consideration during the decision-making process for patients with spinal metastases. Nutritional status has been associated with poor outcomes and limited survival in the general cancer population. The objective of this study was to evaluate the predictive utility of the prognostic nutritional index (PNI) for postoperative mortality after spinal metastasis surgery. A total of 139 patients who underwent oncologic surgery for spinal metastases between April 2012 and August 2022 and had a minimum 90-day follow-up were included. PNI was calculated using preoperative serum albumin and total lymphocyte count, with PNI < 40 defined as low. The mean PNI of our cohort was 43 (standard deviation: 7.7). The primary endpoint was 90-day mortality, and the secondary endpoint was 12-month mortality. Multivariate logistic regression analyses were performed. The 90-day mortality was 27% (37/139), and the 12-month mortality was 56% (51/91). After controlling for age, ECOG performance status, total psoas muscle cross-sectional area (TPA), and primary cancer site, thePNI was associated with 90-daymortality [odds ratio 0.86 (95% confidence interval 0.79-0.94); p = 0.001]. After controlling for ECOG performance status and primary cancer site, the PNI was associated with 12-month mortality [OR 0.89 (95% CI 0.82-0.97); p = 0.008]. Patients with a low PNI had a 50% mortality rate at 90days and an 84% mortality rate at 12months. The PNI was independently associated with 90-day and 12-month mortality after metastatic spinal tumor surgery, independent of performance status, TPA, and primary cancer site.

Pulmonary Sarcoidosis and Immune Dysregulation: A Pilot Study on Possible Correlation.

Sarcoidosis is a systemic inflammatory disease characterized by an altered inflammatory response. The aim of this study was to evaluate whether immune system alterations detected by lymphocyte typing in peripheral blood correlate with the severity of sarcoidosis, calculated according to two separate severity scores proposed by Wasfi in 2006 and Hamzeh in 2010. Eighty-one patients were recruited, and clinical data and laboratory tests at the time of diagnosis were obtained in order to assess the severity index score and investigate any statistically significant correlation with the cytofluorimetry data. Our data demonstrated that none of the two scores show an association with the level of total lymphocytes or lymphocyte subclasses. First of all, the sample taken into consideration is small. The assessment was performed only at disease onset and not during the disease. Furthermore, the severity scores do not take into account disease activity (measured by PET/CT or gallium scintigraphy). Lymphocyte subpopulation values at the time of diagnosis do not appear to correlate with disease severity at onset.

Serum Interferon Gamma (IFN-ɣ) Levels and Hematological Indices in Patients with HIV-MTB Co-Infection in North-Eastern Nigeria

Introduction: The dual epidemic of human immunodeficiency virus (HIV) infection and Mycobacterium tuberculosis (MTB) poses significant health challenges, particularly in sub-Saharan Africa. Understanding the immune response and hematological changes in HIV-MTB co-infection is crucial for better management of affected individuals. Objectives: This study aimed to evaluate the serum levels of IFN-ɣ and hematological indices in patients with HIV-MTB co-infection in North-Eastern Nigeria, as well as explore any potential relationships between these factors. Methods: A total of 88 participants were enrolled in the study, including 44 antiretroviral therapy-naive patients with HIV-MTB co-infection (study group) and 44 HIV mono-infected individuals as controls. Data on personal biodata and clinical details were collected using an interviewer-administered questionnaire. Blood samples were obtained from each participant and analyzed for IFN-ɣ levels using ELISA and hematological indices using an automated hematology analyzer. Statistical analysis, including Mann-Whitney U test, independent samples t-test, and Pearson's correlation analysis, was conducted to compare the study and control groups and assess the relationship between IFN-ɣ levels and hematological parameters. Results: Serum IFN-ɣ was insignificantly increased in the study group compared to the control group (p=0.093). The WBC count was also significantly reduced in the study group compared to the control group (p=0.038). The HGB, HCT, MCV and MCH were significantly reduced in the study group compared to the control group (p=0.001, 0.001, 0.002 and 0.001) respectively. Participants with HIV-TB co-infection have insignificantly increased serum IFN-ɣ levels, low total WBC, lymphocyte and monocyte counts compared to those with HIV mono-infection. In conclusion, participants with HIV-TB co-infection have insignificant increased serum IFN-ɣ levels, low total WBC, and lymphocyte and monocyte counts compared to those with HIV mono-infection. There was no correlation of IFN-ɣ with any of the haematological indices.

The role of inflammatory processes and zinc levels in prostatic enlargement among Iraqi samples.

This study aimed to investigate the role of inflammatory processes in benign prostatic enlargement among men with elevated prostate-specific antigen (PSA) levels without a history of prostatic disease. Additionally, we aimed to examine the influence of serum zinc levels on prostate volume. We investigated the associations between systemic inflammatory markers, serum PSA, and serum zinc levels in 48 men without a history of prostatic disease, aged between 60-72 years, and 30 healthy men in the same age range. Data collection occurred between 1/2/2022 to 1/10/2022. The results are presented as mean values ± standard error (SE), and statistical significance was determined at p≤0.05. The levels of sIL-8 (P: 44.295±1.002, C: 1.404±0.2562), IL-6 (P: 7.406±0.5632, C: 4.468±0.830), CRP (P: 14.765±0.565, C: 6.267±0.538), increased significantly in patients with high PSA, while zinc levels (P: 92.305±2.8235, C: 114.565±8.861) decreased in the patient group. Regarding white blood cell (WBC) parameters, patients exhibited a significant increase in WBC total count (P: 12995.00±488.47, C: 7713.333±777.778), neutrophil % (P: 69.450±1.619, C: 51.200±1.826), lymphocyte % (P: 39.50±2.024, C: 30.867±1.268), and NLR (2.013±0.105). Conversely, there were no significant differences in eosinophil % (P: 3.450±0.4558, C: 3.267±0.5297), basophil % (P: 0.300±0.105, C: 0.267±1182), or monocyte % (P: 3.450±0.4558, C: 3.267±0.5297) between the two groups. In men without known prostatic illness, increased PSA was linked to markers of systemic inflammation. The results indicate the role of inflammatory processes in increasing the size of the prostate gland, as evidenced by the increased levels of immune markers like white blood cells and interleukins, along with the influence of zinc. Future research is required to determine how these markers relate to the development and incidence of prostate cancer.

The clinical and immunological characteristics of COVID-19 patients with delayed SARS-CoV-2 virus clearance.

The outbreak of coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has posed a great threat to human health. Some severe COVID-19 patients still carried detectable levels of SARS-CoV-2 even after prolonged intensive care unit treatment. However, the immunological features of these COVID-19 patients with delayed virus clearance (CDVC) are still unclear. We retrospectively reviewed the clinical and immunological data of 13 CDVC cases, who were admitted into one hospital in Wuhan from February to April 2020. These data were also compared to those of perished (n = 9) and recovered (n = 52) cases. The expression of the exhaustion marker PD-1 on circulating T cells of these patients was measured by flow cytometry. High levels of serum interleukin-6 (IL-6), IL-1β, IL-8, as well as other inflammatory mediators, were seen in CDVC cases. Severe lymphopenia was observed in CDVC patients with the counts of total lymphocytes (0.9 × 109 /L), CD4+ T cells (0.35 × 109 /L), and CD8+ T cells (0.28 × 109 /L) below their corresponding lower limits of normal range. Similar to the perished group, CDVC cases have higher percentages of CD25+ Foxp3+ regulatory T cells (Treg) in circulation. Moreover, enhanced expression of the exhaustion marker PD-1 on CCR7- CD45RA+ effector, CCR7+ CD45RA- central memory, and CCR7- CD45RA- effector memory CD4+ and CD8+ T cells were also observed in CDVC cases. CDVC patients still have SARS-CoV-2 and these cases manifest with severe clinical symptoms due to persistent inflammation. Augmentation of the frequency of circulating Treg, severe lymphopenia, and functional exhaustion of T cells might lead to inefficient clearance of SARS-CoV-2. Therefore, enhancing lymphocyte counts and reversing T-cell exhaustion might be key methods to boost immune responses and eliminate SARS-CoV-2 in CDVC patients.

ASSESSING STROKE PATIENTS' TREATMENT AND PROGNOSIS TO ENHANCE THERAPEUTIC STRATEGIES

Background: Stroke is the second leading cause of death and disability worldwide. Global stroke rates rise with age. Socioeconomic factors make low- and middle-income youth more susceptible to stroke. Objectives: This study assessed many strokes incidence and predictive factors in Pakistan. Methodology: Stroke cases were studied at Peshawar Postgraduate Hospital. The study comprised consenting patients with recent first-time or recurrent strokes without secondary causes. Results: Our study found that strokes are more common in men (88%) and those over 63. The satisfied income group (72%) and urban population (60%) were the most affected. Ischemic type affected 84% of these cases. Anatomical MRI data shows that a stroke can impact any brain region. Hypertension (55%), with a mean blood pressure of 136/84 and 109/67mm Hg in male and female patients, respectively, was the main risk factor for stroke. Stroke victims' lipid levels were mostly normal. Aspiration pneumonia occurred in 19% of stroke patients. Blood chemistry assays for haemoglobin, total lymphocyte count, blood urea, alkaline phosphatase, and random blood sugar showed significant alterations. 28%, 47%, and 5% of patients' prescription regimens had minor, major, and severe interactions, respectively. Conclusion: Our study found that urban Khyber Pakhtoon Khwa inhabitants have a higher stroke risk than rural residents. These patients had mostly ischemic strokes. This paper summarizes stroke demographics, kinds, and interactions to help discover effective treatments for this potentially fatal disorder.

Exploration and improvement of QuantiFERON-TB assay in patients with indeterminate results in clinical practice: A head-to-head study

BackgroundWe implemented the QuantiFERON-TB Gold In-Tube (QFT-GIT) based on peripheral blood mononuclear cells (QFT-PBMCs) and QFT Gold Plus (QFT-Plus) in patients with indeterminate results, and use Mit-Nil value to identify false negatives and impaired cellular immunity. MethodsOne hundred seventy-one out of 2480 patients who had a QFT-GIT test were prospectively recruited and classified as high Nil (n = 35), low Mit (n = 75) and control (n = 61) cohorts. Head-to-head comparisons, i.e., QFT-PBMCs vs. QFT-GIT in high Nil cohort, QFT-Plus vs. QFT-GIT in low Mit cohort, and QFT-PBMCs vs. QFT-GIT in controls, were performed. Lymphocyte subsets counts were conducted in low Mit and control cohorts. ResultsA significant reduction of positive rate only occurred in Mit-Nil < 6 IU/ml (p < 0.001). QFT-PBMCs yielded 100 % valid results and had a significant Nil decline in high Nil cohort (0.98 ± 1.06 vs. 9.55 ± 0.64 IU/ml, p < 0.0001), while correlated well with QFT-GIT for qualitative (Cohen’s k = 0.93) and quantitative (TB–Ag [R2 = 0.91] and Mit [R2 = 0.94]) analyses. QFT-Plus produced 61.3 % valid results and had a significant Mit increase in low Mit cohort (0.82 ± 0.95 vs. 0.17 ± 0.11 IU/ml, p < 0.0001). Mit-Nil value significantly correlated with lymphocyte subsets counts (R:0.49–0.56, p < 0.0001), separately corresponding to thresholds of 4.26, 5.33, 5.55 and 5.81 IU/ml for predicting decreased total lymphocyte, T lymphocyte, CD4+ and CD8+ cells. ConclusionsQFT that replacing whole blood with PBMCs should be recommended to handle high Nil samples, and QFT-Plus can declined the frequency of low Mit results. In addition, Mit-Nil < 6 and 5.81 IU/ml are potential thresholds to identify the risk of false negatives and impaired cellular immunity, respectively.

The Prognostic Nutritional Index in prediction of two-year mortality in patients undergoing Transcatheter Aortic Valve Replacement

Objective: Transcatheter aortic valve replacement (TAVR) is a minimally invasive procedure employed to treat aortic valve disease in patients who are ineligible for open-heart surgery. Undergoing TAVR patients generally include the elderly and frail. Malnutrition is associated with high morbidity and mortality in patients with undergoing TAVR. The aim of this study was to investigate the prognostic value of the prognostic nutritional index (PNI) for two-year survival after TAVR. Material and Methods: A cohort of 213 consecutive patients with severe aortic stenosis who underwent transcatheter aortic valve replacement between March 2019 and July 2021. The study population was divided into two groups according to the cut-off PNI level in a receiver operator characteristic (ROC) curve analysis. The two-year follow-up results of the patients were recorded retrospectively. PNI was defined according to the following formula: PNI = (10 x serum albumin [g/dl]) + (0.005 x total lymphocyte counts [1000/mcL]). Results: Mean age of the patients was 76.15, and 93 (43.7%) of them were males. Patients with low PNI (group 1) were significantly older. The mean PNI of group 1 was 43.17 ± 4.04 and the mean PNI of group 2 was 54.23 ± 4.30. Mortality at two-year was 32.6% in low PNI group and 10.7% in high PNI group. Hypertension and PNI were independent predictors of mortality after TAVR. In ROC curve analysis, PNI at a cut off value of 48.325 predicted the mortality after TAVR with 63.5% sensitivity and 70.1% specificity. Kaplan-Meier curves for two-year mortality between low and high PNI groups showed worse outcomes in patients with low PNI. Conclusion: PNI is a practical and useful nutritional index that predicts two-year mortality after TAVR.

The Association between Inflammatory and Nutritional Markers and Survival in Elderly Patients Operated for Lung Cancer

Aim: Today, there is an increase in cancer incidence and cancer-related deaths in the elderly population. This study aimed to evaluate the impact of neutrophil-to-lymphocyte ratio (NLR) and prognostic nutritional index (PNI) levels on the survival rate in elderly patients diagnosed with non-small cell lung cancer (NSCLC). Material and Methods: A total of 73 patients (aged ≥70 years) who operated for NSCLC between 2012 and 2018 were included in this study. Patient records were analyzed retrospectively. The NLR value was calculated with the blood neutrophil count/lymphocyte count formula. The cut-off value for NLR was considered as 2.5. The PNI value was calculated as 10 x serum albumin (g/dL) + 0.005 × total lymphocyte count (per millimeter). PNI values lower than 50 were considered as low. Results: The mean age of the patients was 74.15±3.23 years, 59 (80.8%) patients were male and 14 (19.2%) were female. No statistically significant relation of postoperative complication was noted with PNI (p=0.354) and NLR (p=0.483). Postoperative mortality was not significantly associated with PNI (p=0.188) and NLR (p=0.465). For patients with NLR &amp;lt;2.5, 1-, 3-, and 5-year survival rates were at 86.0%, 86.1%, and 78.3%, respectively, while these rates were at 76.9%, 65.2%, and 24.8%, respectively, for patients with NLR &amp;gt;2.5 (p=0.028). Conclusion: Results revealed a significant association of NLR with survival rates in elderly patients with NSCLC. NLR can be considered inexpensive, easily measurable, and reproducible marker that can be incorporated into routine clinical practice for guiding and optimizing treatment decisions in patients with NSCLC.