Utility of Differential White Cell Count and Cell Population Data for Ruling Out COVID-19 Infection in Patients With Community-Acquired Pneumonia

Introduction: The main aim of this study was to assess the utility of differential white cell count and cell population data (CPD) for the detection of COVID-19 in patients admitted for community-acquired pneumonia (CAP) of different etiologies. Methods: This was a multicenter, observational, prospective study of adults aged ≥18 years admitted to three teaching hospitals in Spain from November 2019 to November 2021 with a diagnosis of CAP. At baseline, a Sysmex XN-20 analyzer was used to obtain detailed information related to the activation status and functional activity of white cells. Results: The sample was split into derivation and validation cohorts of 1065 and 717 patients, respectively. In the derivation cohort, COVID-19 was confirmed in 791 patients and ruled out in 274 patients, with mean ages of 62.13 (14.37) and 65.42 (16.62) years, respectively (p<0.001). There were significant differences in all CPD parameters except MO-Y. The multivariate prediction model showed that lower NE-X, NE-WY, LY-Z, LY-WY, MO-WX, MO-WY, and MO-Z values and neutrophil-to-lymphocyte ratio were related to COVID-19 etiology with an AUC of 0.819 (0.790, 0.846). No significant differences were found comparing this model to another including biomarkers (p=0.18). Conclusions: Abnormalities in white blood cell morphology based on a few cell population data values as well as NLR were able to accurately identify COVID-19 etiology. Moreover, systemic inflammation biomarkers currently used were unable to improve the predictive ability. We conclude that new peripheral blood biomarkers can help determine the etiology of CAP fast and inexpensively. (AU)

Gene mutations in acute promyelocytic leukemia early death in patients treated with arsenic trioxide alone

Purpose APL patients have recurrent alterations in FLT3, WT1, NRAS and KRAS. Gene mutations have a strong potential for involvement in pathogenesis and may have potential effects on the clinical manifestations. Gene mutations may even be associated with early death (ED) in APL patients. However, there is little published information on mutations in APL patients and whether they are attributed to early death. Methods In this study, we retrospectively analyzed the clinical data and gene mutations of 134 de novo APL patients. We detected the gene mutations by next-generation sequencing (NGS) to investigate the genetic predictors of early death in APL patients. According to the number of gene mutations per patient, the 134 APL patients were divided into three groups. All patients received arsenic trioxide (ATO) alone as induction therapy. The clinical data and gene mutations were compared and analyzed. Results A total of 134 APL patients were involved in the study. The clinical data of sex, WBC, PT, and DD, UA, and LDH level were significantly different between the three groups (P = 0.000, P = 0.000, P = 0.009, P = 0.020, P = 0.030, P = 0.001 and P = 0.014, respectively). Meanwhile, among them, the Sanz risk stratification and early death rate were significantly different (P = 0.001). The early death rate was 10.4%, and the median time to early death was 6.6 days (range 2–15 days). For the next-generation sequencing, a mean of 1.28 ± 1.06 mutations per patient was detected (range: 0–5). The univariate and the multivariate regression analysis showed that age > 50[HR = 1.666, CI (1.027–2.702), P = 0.039], high WBC count [HR = 4.702, CI (1.026–21.543), P = 0.046] and low ALB levels [HR = 4.547, CI (1.088–18.995), P = 0.038] were independent risk factors for early death in APL patients (AU)

Association of severity of allergic rhinitis with neutrophil-to-lymphocyte, eosinophil-to-neutrophil, and eosinophil-to-lymphocyte ratios in adults

Background: Allergic rhinitis (AR) is characterized by chronic inflammation of the nasal mucosa. T-helper 2 lymphocytes, neutrophils, and eosinophils play an active role during the late-phase immune response after exposure to allergen. Objective: We aimed to investigate the usefulness of inflammatory parameters of neutro-phil-to-lymphocyte ratio (NLR), eosinophil-to-neutrophil ratio (ENR), and eosinophil-to- lymphocyte ratio (ELR) as markers for distinction between intermittent and persistent allergic rhinitis. Material and Methods: This was a double-center, retrospective study. Patients were enrolled after diagnosed with AR according to the Allergic Rhinitis and Its Impact on Asthma guidelines. Individuals with an active infection were excluded. A cohort of healthy subjects acted as a control group. NLR, ENR, and ELR were calculated using the results obtained from the patients’ complete blood count. Descriptive statistical analysis was performed for all studied variables. Results: In all, 205 AR patients and 49 healthy individuals were included. AR patients had significantly higher levels of absolute eosinophils, ENR, and ELR, and significantly lower levels of NLR than the healthy controls (P < 0.05). A total of 160 (78%) patients with persistent AR had significantly higher levels of absolute eosinophils, ENR, and ELR, and significantly lower levels of NLR than patients with intermittent AR (P < 0.05) Conclusion: Currently, classification of severity of AR is based on the patient’s anamnesis. It has been shown in this study that serum eosinophil levels in persistent AR patients could be used as traceable parameters in evaluating severity of the disease by looking at the proportions of ENR and ELR. We anticipate that in the future this issue would be supported by a larger number of studies (AU)

Prognostic value of neutrophil-to-lymphocyte ratio in advanced cancer patients receiving immunotherapy

Background The prognostic value of neutrophil-to-lymphocyte ratio (NLR) has been extensively studied in cancer patients. However, the performance of NLR as an early marker of efficacy of immune checkpoint inhibitors (ICI) is still understudied. We studied the utility of NLR at baseline (bNLR), before the second dose of immunotherapy (NLR2) and the NLR trend for predicting efficacy outcomes. Methods We included all patients with advanced cancer treated with ICI from June 2013 to April 2019 at La Paz University Hospital, Madrid (Spain). We examined bNLR, NLR2 and NLR trend and explored the association with progression-free survival (PFS) at 6 months, median PFS and overall survival (OS). Results We included 211 patients. PFS and OS were significantly longer in the low bNLR group than in the high bNLR group [HR 0.71 (95% CI 0.60–0.84) and HR: 0.66 (95% CI 0.55–0.79), respectively]. Regarding NLR2, patients with low NLR2 had significantly longer PFS and OS than patients with high NLR2 [HR 0.67 (95% CI 0.57–0.79) and HR: 0.60 (95% CI 0.50–0.72), respectively]. Finally, for NLR trend, PFS and OS for patients with NLR trend < 1 were significantly longer than those patients with NLR trend ≥ 1 [HR 0.59 (95% CI 0.43–0.82) and HR 0.63 (95% CI 0.44–0.90), respectively]. At the multivariate analysis for PFS and OS, bNLR, NLR2 and NLR trend were all independent prognostic factors for PFS and OS. Conclusions bNLR, NLR2 and NLR trends are independent prognostic factors for survival in patients on immunotherapy. The dynamics of NLR in patients on immunotherapy is a promising marker that needs further investigation (AU)

Characterization of severe asthma in the pediatric population

Introduction and objectives Relationship between the causal mechanisms of pediatric severe asthma and severity of symptoms would be helpful for developing personalized strategies for treatment and prevention. Materials and methods For this study, 698 medical histories of asthmatics between 6 and 18 years of age were reviewed in a period of 2 years. Variables analyzed were: age, sex, ethnicity, perinatological history, allergy history, asthma predictive index (API), exposure to tobacco, heavy traffic or epithelium, lung function, age of onset of symptoms, hospitalization admissions/PICU, systemic corticosteroids, daily symptoms control, device prescribe for daily control, and adherence. Results A total of 86 children with severe asthma were included (12.3%). Mean age 13.3 +/− 1.86 years, sex ratio1:1, mean age of symptom onset 2.765 +/− 3.06 years, mean IgE 1076.18KU / L +/− 1136, mean eosinophils 604c / mcl +/− 511.9, mean of FEV1 93.15% +/− 16.3. Evidently, 70 children (81.4%) had positive API, 68 (79.1%) rhinitis, 34 (39.5%) atopic dermatitis. 73 (83.9%) sensitized to inhalants and 56 (65.1%) to dermatophagoides, 39 (45.3%) passive smokers, 19 (22.1%) exposure to heavy traffic; 55 (64%) showed symptoms with exercise, 35 (40.7%) had audible wheezing. The mean systemic corticosteroid cycles/year was 3.63 +/− 3.23, mean PICU admissions 0.36 +/− 0.83, mean hospital admissions 4.31 +/− 5.3, average emergency room visits/year 19.44 +/− 16.28. 38 (56.7%) had good adherence, 44 (51%) used an MDI device and 39 (45.3%) used dry powder. Conclusions Children with severe asthma meet the following criteria: premature, positive API, rhinitis, atopic dermatitis, high IgE, eosinophilia, passive smokers, exposure to heavy traffic, decreased lung function, and low adherence to controller medication (AU)

Eosinophil: a central player in modulating pathological complexity in asthma

Eosinophils are the major inflammatory cells which play a crucial role in the development of allergic and non-allergic asthma phenotypes. Eosinophilic asthma is the most heterogeneous phenotype where activated eosinophils are reported to be significantly associated with asthma severity. Activated eosinophils display an array of cell adhesion molecules that not only act as an activation marker, suitable for assessing severity, but also secrete several tissue factors, cytokines and chemokines which modulate the clinical severity. Eosinophil activations are also strictly associated with activation of other hetero cellular populations like neutrophils, macrophages, mast cells, and platelets which culminate in the onset and progression of abnormal phenotypes such as bronchoconstriction, allergic response, fibrosis instigated by tissue inflammation, epithelial injury, and oxidative stress. During the activated state, eosinophils release several potent toxic signaling molecules such as major basic proteins, eosinophil peroxidase, eosinophil cationic protein (ECP), and lipid mediators, rendering tissue damage and subsequently leading to allergic manifestation. The tissue mediators render a more complex manifestation of a severe phenotype by activating prominent signaling cross-talk. Here, in the current review with the help of search engines of PubMed, Medline, etc, we have tried to shed light and explore some of the potent determinants regulating eosinophil activation leading to asthma phenotype (AU)

Repeteability of circulating eosinophil measures and inhaled corticosteroids effect in bronchiectasis. A post hoc analysis of a randomized clinical trial / Repetibilidad de las mediciones de eosinófilos circulantes y el efecto de los corticosteroides inhalados en las bronquiectasias. Un análisis a posteriori de un ensayo clínico aleatorizado

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Relevance of TH2 markers in the assessment and therapeutic management of severe allergic asthma: a real-life perspective

BACKGROUND: Although blood eosinophils are currently recognized as the main clinical marker of TH2-type inflammation, their relevance in identifying asthma severity remains a matter of debate. METHODS: Our retrospective real-life study on severe asthmatics included in the NEONet Italian database aimed to investigate the relevance of blood eosinophil count and fractional exhaled nitric oxide (FeNO) in the clinical assessment of severe asthma and their role as potential predictors of responsiveness to anti-IgE therapy. The cut-off values chosen were 300 eosinophils/mm3 and FeNO of 30 ppm. RESULTS: We evaluated 132 adult patients. No significant differences were observed between the groups (high and low baseline eosinophil counts) in terms of demographic data, total IgE, lung function, patient-reported outcomes, or nasal comorbidities. The Asthma Control Test score and Asthma Quality of Life Questionnaire scores were poorer in patients with FeNO ≥30 ppb than in patients with FeNO <30 ppb. In the high FeNO subgroup, more frequent hospital admissions and a higher number of working days lost in the previous year were registered. A combined score including both eosinophils and FeNO did not improve the accuracy of the individual parameters. In the high-eosinophil subgroup, the proportion of responders to omalizumab was greater and increased at each follow-up time point. CONCLUSIONS: Our findings show that blood eosinophil count is not an unequivocal marker of asthma severity, whereas a higher FeNO level is associated with more frequent hospital admissions and more working days lost. Blood eosinophils seem to act as a predictor of response to omalizumab

ANTECEDENTES: Aunque los eosinófilos en la sangre actualmente son reconocidos como el principal marcador clínico de la inflamación Th2, su relevancia en la identificación de la gravedad del asma sigue siendo un tema de debate. MÉTODOS: Nuestro estudio retrospectivo de la vida real sobre asmáticos graves, incluido en la base de datos italiana de NEONet, tuvo como objetivo investigar la relevancia del recuento de eosinófilos en sangre y el FeNO en la evaluación clínica del asma grave y su función como posible factor predictivo de la capacidad de respuesta al tratamiento con anti-IgE. Como valores de corte se eligieron 300 eosinófilos/mm3en sangre y 30 ppm para FeNO. RESULTADOS: En total se evaluaron 132 pacientes adultos. No se pudieron observar diferencias significativas entre los grupos de eosinófilos basales altos y bajos, en términos de datos demográficos, IgE total, función pulmonar, resultados informados por el paciente (PRO) o comorbilidades nasales. Los pacientes con ≥ FeNO 30 ppb mostraron una puntuación de ACT peor y una puntuación AQLQ más baja en comparación con los de FeNO <30 ppb. En el subgrupo de FeNO alto, se registraron ingresos hospitalarios con más frecuencia y un mayor número de días de trabajo perdidos en el último año. Una puntuación combinada que incluye tanto a los eosinófilos como el FeNO no mejoró la precisión de los parámetros individuales. En el subgrupo de eosinófilos altos, la proporción de pacientes que respondieron al tratamiento con omalizumab fue mayor y aumentó significativamente en cada punto de tiempo de seguimiento. CONCLUSIONES: De acuerdo con nuestros hallazgos, los eosinófilos en sangre no representan un marcador unívoco de la gravedad del asma, mientras que un nivel más alto de FeNO se asocia con más ingresos hospitalarios y más días de trabajo perdidos. Los eosinófilos de la sangre parecen actuar como predictores de la respuesta del tratamiento al omalizumab

Effectiveness of omalizumab in severe allergic asthma and nasal polyposis: a real-life study

BACKGROUND: Omalizumab is a human anti-IgE antibody approved for the treatment of severe allergic asthma (SAA). However, its effectiveness in SAA associated with chronic rhinosinusitis with nasal polyposis (CRSNP+) is less well documented. OBJECTIVE: The aim of this study was to evaluate the real-life effectiveness of omalizumab in patients with SAA and CRSNP+ who tolerated and did not tolerate aspirin. METHODS: We performed a retrospective, observational, multicenter, real-life study of patients with SAA and CRSNP+ treated with omalizumab for 6 months. Asthma outcome parameters (symptoms, number of salbutamol rescues/wk, number of moderate/severe exacerbations, Asthma Control Test score, and lung function), sinonasal outcome parameters (symptoms, number of episodes of acute rhinosinusitis, sinus computed tomography images, nasal polyps endoscopy score), and serum eosinophil levels were analyzed 6 months before and after treatment with omalizumab. RESULTS: Twenty-four adult patients were included (9 with documented aspirin intolerance). All respiratory parameters were significantly improved by the treatment. In parallel, a significant improvement was observed in sinonasal clinical outcomes and sinus computed tomography images, with no major effect on the nasal polyps endoscopy score. The serum eosinophil count decreased significantly after 6 months of treatment with omalizumab. CONCLUSION: Treatment of SAA with omalizumab improves the outcome of associated CRSNP+, thus supporting the concept of a "one airway disease"

ANTECEDENTES: El omalizumab es un anticuerpo anti-IgE humanizado aprobado para el tratamiento del asma alérgica grave (SAA), si bien su eficacia, cuando ésta se asocia a la rinosinusitis crónica con poliposis nasal (CRSNP+), está menos documentada. OBJETIVO: El objetivo de este estudio fue evaluar en "vida real" la eficacia de omalizumab en pacientes con SAA y CRSNP+ con o sin intolerancia a la Aspirina. MÉTODOS: Se realizó un estudio retrospectivo, observacional y multicéntrico, en vida real que incluyó pacientes con SAA y CRSNP+ que fueron tratados con omalizumab durante 6 meses. Las variables de eficacia en relación al asma (síntomas, número de inhalaciones de rescate de salbutamol por semana, número de exacerbaciones moderadas/graves, puntuación de la prueba de control del asma (ACT) y función pulmonar), y de la rinosinusitis (síntomas, número de rinosinusitis aguda, puntuación en tomografía computarizada, puntuación del tamaño de los pólipos en la endoscopia nasal) y el nivel de eosinófilos en sangre se analizaron antes y después de 6 meses de tratamiento con omalizumab. RESULTADOS: Se incluyeron veinticuatro pacientes adultos (nueve con una intolerancia a la Aspirina documentada). Todas las variables de eficacia en relación al asma mejoraron significativamente con el tratamiento. Paralelamente, las variables clínicas de eficacia en rinosinusitis y la puntuación de las imágenes tomográficas de los senos paranasales mejoraron significativamente, si bien no se observó un efecto relevante en la puntuación de los pólipos en la endoscopia nasal. El nivel de eosinófilos en sangre disminuyó significativamente después de 6 meses de tratamiento con omalizumab. CONCLUSIÓN: El tratamiento con omalizumab en pacientes con SAA induce paralelamente una mejoría clínica y radiológica de la CRSNP+ asociada, lo que apoya el concepto de una única enfermedad de las vías respiratorias

Clinical significance of neutrophil/lymphocyte ratio in patients with granulomatosis with polyangiitis / Significación clínica del ratio neutrófilos/linfocitos en pacientes con granulomatosis con poliangeítis

OBJECTIVE: To determine to neutrophil-to-lymphocyte ratio (NLR) in granulomatosis with polyangiitis (GPA) patients and to study its relation to disease manifestations and activity. METHODS: The study included 44 GPA patients and 44 matched age and sex controls. Full history taking, thorough clinical examination with more attention to ocular examination, laboratory and radiological investigations were considered. Disease activity was assessed using the Birmingham Vasculitis Activity Score (BVAS). RESULTS: The patients (21 males and 23 females) had a mean age of 45.66+/-7.24 years, disease duration 6.8+/-3.6 years and BVAS 50.1+/-14.3. All patients had a positive cytoplasmic anti-neutrophil cytoplasmic antibody (c-ANCA) while only 5 had a positive p-ANCA. The NLR was significantly increased in the GPA patients (5.1+/-2.4) compared to the control (1.5+/-0.8) (P<.0001). Ten patients with uveitis had a significantly higher NLR (6.5+/-1.9) compared to those without (4.7+/-2.4) (0.03) while those with proptosis (n=10), cutaneous manifestations (n=17) or ischemic heart disease (n=9) had a significantly lower NLR than those without (P=.0001, P=.017 and P=.046 respectively). The NLR did not significantly correlate with any of the patients' characteristics. The NLR inversely yet insignificantly correlated with the disease activity (r=-0.02, P=.93). CONCLUSION: The NLR may have a significant role in the pathogenesis of GPA, the development of uveitis or proptosis, cutaneous manifestations and ischemic heart disease. NLR may serve as a future potential companion to c-ANCA positivity in diagnosing and evaluating GPA and may play a role in the tissue-specific and clinical characteristics

OBJETIVO: Determinar el ratio neutrófilos/linfocitos (RNL) en pacientes con granulomatosis con poliangeítis (GP), y estudiar su relación con las manifestaciones y actividad de la enfermedad. MÉTODOS: El estudio incluyó a 44 pacientes con GP, y 44 controles pareados por edad y sexo. Se consideraron la historia clínica completa, la exploración minuciosa con especial atención al examen ocular, así como las pruebas de laboratorio y radiológicas. La actividad de la enfermedad se evaluó utilizando la clasificación Birmingham Vasculitis Activity Score (BVAS). RESULTADOS: Los pacientes (21 varones y 23 mujeres) tenían una edad media de 45,66+/-7,24 años, duración de la enfermedad de 6,8+/-3,6 años, y BVAS 50,1+/-14,3. Todos los pacientes tenían anticuerpos anticitoplasma de anti-neutrófilos positivos (c-ANCA), y únicamente 5 de ellos tenían p-ANCA positivo. El RNL se vio significativamente incrementado en los pacientes de GP (5,1+/-2,4) en comparación con el grupo control (1,5+/-0,8) (p < 0,0001). En 10 pacientes con uveítis se observó un RNL significativamente superior (6,5+/-1,9) en comparación con aquellos sin uveítis (4,7+/-2,4) (0,03), mientras que en aquellos con proptosis (n=10), manifestaciones cutáneas (n=17) o cardiopatía isquémica (n=9) se observó un RNL significativamente inferior al de aquellos sin dichas manifestaciones (p = 0,0001; p = 0,017 y p = 0,046, respectivamente). El RNL no guardó una correlación significativa con ninguna de las características de los pacientes. Sin embargo, el RNL guardó una correlación no significativa con la actividad de la enfermedad (r=-0,02; p = 0,93). CONCLUSIÓN: El RNL puede desempeñar un papel significativo en la patogenia de la GP, el desarrollo de uveítis o proptosis, manifestaciones cutáneas y cardiopatía isquémica. El RNL puede servir como futuro complemento potencial de la positividad de c-ANCA a la hora de diagnosticar y evaluar la GP, y jugar un papel con relación a sus características tisulares específicas y clínicas

Índice neutrófilo-linfocito como predictor de peritonitis en apendicitis aguda en niños / Neutrophil-to-lymphocyte ratio as a predictor of peritonitis in acute appendicitis in children

Introducción. El índice neutrófilo-linfocito (INL) se ha postulado como marcador inflamatorio en distintas patologías abdominales como la apendicitis aguda (AA). Sin embargo, existen pocos estudios que determinen su asociación con el grado de severidad de la AA. Este es el primer estudio que analiza la utilidad del INL como factor predictor de peritonitis en la AA en niños. Material y métodos. Estudio observacional retrospectivo en pacientes intervenidos de AA durante los años 2017 y 2018. Se distribuyeron en dos grupos según el diagnóstico intraoperatorio (AA no complicada y AA con peritonitis). Se analizaron variables demográficas y analíticas. Se definió el INL como el cociente entre los valores absolutos de neutrófilos y linfocitos. Se determinó mediante curvas ROC la sensibilidad y especificidad para el diagnóstico de peritonitis de distintos parámetros analíticos. Resultados. Se incluyeron un total de 398 pacientes (AA no complicada n= 342 y AA con peritonitis n=56), con una edad media de 10,5±2,9 años. El INL presentó un área bajo la curva (AUC) de 0,78, significativamente superior a la determinación de leucocitos (AUC 0,71; p=0,002) y de neutrófilos (AUC 0,74; p=0,009). No se observaron diferencias al compararlo con la determinación de la proteína C reactiva (AUC 0,79; p=0,598). Se estimó el punto de corte de INL>8,75 con una sensibilidad y especificidad de 75,0 y 72,2% respectivamente. Conclusión. El INL se postula como una herramienta útil para predecir la presencia de peritonitis en AA, y podría considerarse una alternativa a otras determinaciones de mayor coste como la proteína C reactiva

Aim of the study. The neutrophilto-lymphocyte ratio (NLR) has been postulated as an inflammatory marker in several abdominal pathologies such as acute appendicitis (AA). However, there are few studies that determine its association with the degree of severity of AA. This is the first study that analyzes the usefulness of NLR as a predictor of peritonitis in children with AA. Methods. Retrospective observational study in patients treated of AA during the years 2017 and 2018. They were divided into two groups according to the intraoperative diagnosis (uncomplicated AA and AA with peritonitis). Demographic and analytical variables were analyzed. The NLR was defined as the quotient between the absolute values of neutrophils and lymphocytes. The sensitivity and specificity for the diagnosis of peritonitis of different analytical parameters were determined by ROC curves. Results. A total of 398 patients were included (uncomplicated AA n=342 and AA with peritonitis n=56), with a mean age of 10.5±2.9 years. The NLR had an area under the curve (AUC) of 0.78, significantly higher than the determination of leukocytes (AUC 0.71, p=0.002) and of neutrophils (AUC 0.74, p=0.009). No differences were observed when compared to the determination of C-reactive protein (AUC 0.79, p=0.598). A cut-off point of NLR>8.75 was estimated with a sensitivity and specificity of 75.0 and 72.2% respectively. Conclusions. The NLR is a useful tool to predict the presence of peritonitis in AA, and could be considered an alternative to other higher cost determinations such as C-reactive protein

Características del líquido sinovial en pacientes con artritis idiopática juvenil / Characteristics of synovial fluid in patients with juvenile idiopathic arthritis

Introducción: El análisis del líquido sinovial (LS) es una herramienta importante en el diagnóstico de pacientes con artritis idiopática juvenil (AIJ). Pacientes y métodos: Análisis retrospectivo de las características citológicas del LS obtenido de pacientes con AIJ en el periodo 2008-2016. Resultados: Se analizaron 102 LS de 59 pacientes. El 66% fueron mujeres y la forma clínica más frecuente fue la AIJ oligoarticular persistente (52,5%). La mediana de edad al inicio fue de 5 años (RIC 2,4-11,8). El LS generalmente era de características inflamatorias (mediana leucocitos 11.757/mm3; RIC 4.543-18.800) con predominio de polimorfonucleares (PMN, 61%; RIC 30-75). Ocho pacientes (14%) presentaron recuentos inferiores a 2.000 cél/mm3, con predominio de mononucleares (80%), mientras que 3 pacientes (5%) presentaron recuentos superiores a 50.000cél/mm3, con predominio de PMN (90%). No se encontraron diferencias en los recuentos celulares entre las distintas formas de AIJ. La mediana del recuento de leucocitos de pacientes positivos para ANA fue un 20% inferior a la de niños negativos para ANA (9.340 vs. 11.600/mm3; p = 0,23). La proporción de PMN en LS tendía a aumentar conforme se incrementaba la VSG (p < 0,001) y/o la PCR (p = 0,03). No existe correlación del índice JADAS-10 con el recuento en LS (p = 0,4). El LS en artrocentesis simultáneas de diferentes articulaciones mostró una correlación significativa (p = 0,001). Conclusiones: El LS de pacientes con AIJ generalmente tiene características inflamatorias, aunque un 19% presentó recuentos inferiores a 2.000 o superiores a 50.000cél/mm3. Los recuentos en pacientes positivos para ANA tendían a ser menores que en los negativos para ANA (no significativo). La proporción de PMN aumentaba con los reactantes

Introduction: Synovial fluid (SF) analysis is an important tool for the diagnosis of patients with juvenile idiopathic arthritis (JIA). Patients and methods: A retrospective analysis was carried out of cytological features of SF samples obtained from patients with JIA during the period 2008-2016. Results: A total of 102 SF samples from 59 patients were analysed. JIA was more common in females (66%). The most frequent form was persistent oligoarticular JIA (52.5%). The median age at onset was 5 years (IQR 2.4-11.8). SF usually showed an inflammatory pattern (median white blood cells count 11,757/ mm3; IQR 4,543-18,800), with a predominance of polymorphonuclear (PMN) cells (61%; IQR 30-75). Eight patients (14%) had white blood cells counts of less than 2,000 cells/mm3, with predominance of mononuclear cells (80%), whereas 3 patients (5%) had white blood cells counts higher than 50,000 cells/mm3, with a predominance of PMN cells (90%). Synovial white blood cells count did not show significant differences among the different forms of JIA. The median synovial white blood cells count in ANA-positive patients was 20% lower than in ANA-negative (9,340 vs. 11,600/mm3; P = .23). The proportion of PMN increased with increasing levels of ESR (P < .001) and/or CRP (P = .03). No significant correlation was found between JADAS-10 and synovial white blood cells count (P = .4). SF obtained from different joints in simultaneous arthrocentesis showed a significant correlation P = .001). Conclusion: SF from JIA patients usually had inflammatory characteristics, although 19% of the patients showed white blood cells counts below 2,000cells/mm3 or higher than 50,000 cells/mm3. SF cell count was non-significantly lower in ANA-positive patients, and the proportion of PMN increased with increasing levels of ESR/CRP

Valor pronóstico del recuento de leucocitos y plaquetas, en tumores testiculares de células germinales / Leukocyte and platelet counts as prognostic values of testicular germ cell tumors

Introduction: The immune system plays an essential role in the organism's response to cancer. Several hematological markers can influence prognosis and survival of patients. The objective of this study is to determine their prognostic value in testicular germ cell tumors. Material and methods: Retrospective cohort study on 164 patients with germ cell tumors. Clinical, analytical, histological and evolutionary data were collected. The absolute neutrophil and absolute platelet counts, neutrophil-lymphocyte (NLR), platelet-lymphocyte and lymphocyte-monocyte ratios were estimated at diagnosis. The association that these markers can have with the classic prognostic factors, as well as their effect on prognosis and survival, have been analyzed. Results: 17.7% had NLR > 4 and 14.6% ANC > 8000/μL. These patients presented higher percentages of residual disease and stage II-III tumors. Patients with elevated absolute neutrophil showed also higher percentages of progression and exitus. 7.3% presented absolute platelet > 400,000/μL. These patients obtained higher rates of residual disease, nonseminomatous and stage III tumors. 28.4% showed platelet-lymphocyte values > 150. This data was associated to higher percentages of residual disease, progression, stage II and III tumors and seminomatous tumors. 83.3% had a lymphocyte-monocyte > 3. These patients presented: higher tumor markers in normal range, decreased residual disease rates and higher percentages of stage I and II tumors. The mean survival time was shorter in patients with NLR > 4 and absolute neutrophil > 8000/μL. The ROC curves showed significance in the prediction of progression and values of lymphocyte-monocyte >3, and prediction of survival and values NLR > 4. Conclusion: Our results indicate that the analyzed hematological markers are associated with poor prognoses at diagnosis. Therefore, their use in daily clinical practice can be a valuable tool in the diagnosis and prognosis of patients with testicular germ cell tumors

Introducción: El sistema inmune ejerce un papel clave en la respuesta del organismo frente al cáncer. Existen diversos marcadores hematológicos que pueden influir en el pronóstico y supervivencia de los pacientes. El objetivo de este estudio es determinar su valor pronóstico en tumores testiculares de células germinales. Material y métodos: Estudio de cohortes retrospectivo sobre 164 pacientes con tumores testiculares de células germinales. Se recogieron datos clínicos, analíticos, histológicos y evolutivos. Se estimaron, al diagnóstico, el recuento total de neutrófilos y plaquetas, la ratio neutrófilo-linfocito (RN/L), plaqueta-linfocito(RP/L) y linfocito-monocito (RL/M). Se analizó la relación que estos marcadores pueden tener sobre los factores pronósticos clásicos, así como sobre el pronóstico y supervivencia. Resultados: Un 17,7% tuvieron una RN/L > 4 y un 14,6% un RNT > 8000/μL. Estos enfermos, presentaron mayor porcentaje de enfermedad residual y tumores en estadios II y III. Los enfermos con recuento total de neutrófilos elevado también tuvieron mayor porcentaje de progresión y éxitus. Un 7,3%, tenían un recuento total de plaquetas > 400000/μL. Estos enfermos tuvieron un mayor porcentaje de tumores no seminomatosos, de enfermedad residual y tumores en estadio III. El 28,4% mostraron valores RP/L>150, asociándose este dato a mayor porcentaje de tumores seminomatosos, enfermedad residual, estadios II y III y progresión. El 83,3% tuvieron una RL/M > 3. Estos enfermos presentaron: mayor porcentaje de marcadores tumorales en rango normal, menor porcentaje de enfermedad residual y mayor porcentaje de pacientes en estadio I y II. El tiempo medio de supervivencia fue menor en pacientes con RN/L > 4 y con recuento total de neutrófilos > 8.000/μL. Las curvas ROC mostraron significación en la predicción de progresión y valores de RL/M > 3, y predicción de supervivencia y valores RN/L > 4. Conclusión: Nuestros resultados indican que los marcadores hematológicos analizados se asocian situaciones de mal pronóstico en el momento del diagnóstico. Por tanto, su utilización en la práctica clínica diaria puede ser considerada como una herramienta más en el diagnóstico y pronóstico de pacientes con tumores testiculares de células germinales de testículo

Índices neutrófilo-linfocito y plaqueta-linfocito como marcadores biológicos de interés en la enfermedad renal / Neutrophil-to-lymphocyte and platelet-to-lymphocyte ratios as biological markers of interest in kidney disease

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Survey of opinion of Spanish physicians on the role of eosinophils in asthma and other diseases

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Impact of low dose chlorine inhalation in healthy humans: a pilot study

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Aumento en los recuentos de leucocitos y neutrófilos durante las primeras 18 semanas de tratamiento con clozapina en pacientes ingresadas en una unidad de cuidados psiquiátricos prolongados / Increase in white cell and neutrophil counts during the first eighteen weeks of treatment with clozapine in patients admitted to a long-term psychiatric care inpatient unit

Material y métodos. Se estudió una muestra de mujeres ingresadas en nuestra UCPP y en tratamiento con clozapina. Se estudió la variación de los recuentos de leucocitos y neutrófilos durante las primeras 18 semanas de tratamiento, la aparición de leucopenia, neutropenia y agranulocitosis, así como la influencia de los fármacos empleados de forma concomitante. Resultados y conclusiones. Se obtuvo una tasa de incidencia de neutropenia de 1,82% (IC 95%: 0,05-10,13) y ningún caso de leucopenia ni agranulocitosis (0%). En el análisis cuantitativo de leucocitos y neutrófilos durante las 18 semanas de tratamiento, se observó un aumento hasta la semana 3-4, tendiendo después a la estabilización de las cifras alcanzadas, pero manteniendo siempre cifras superiores a las de los valores iniciales. Estas diferencias resultaron estadísticamente significativas para los leucocitos en el ANOVA de medidas repetidas con la corrección de Greenhouse-Geisser F (11,47, 37)=2,114 (p=0,011), ŋ2P=0,038. También resultó significativo para los neutrófilos el ANOVA con la corrección de Greenhouse-Geisser F (10,33, 37)=3,312 (p=0,0002), y el MANOVA F (18, 37)=2,693 (p=0,005), ŋ2P=0,567). La influencia de los fármacos estudiados de forma concomitante (litio, valproico y biperideno) no resultó globalmente significativa (MANOVA) sobre el aumento hallado en los leucocitos y neutrófilos

Introduction. Clozapine is an antipsychotic drug that has shown to be more effective than other antipsychotics in the treatment of schizophrenia, but its use is limited due to its side effects, particularly by the risk of causing agranulocytosis. A study was made on the variations in white cell and neutrophil counts in patients treated with clozapine in a Long-term Psychiatric Unit. Methods. A retrospective observational study was conducted with a sample of women of our long-term psychiatric care unit who had been treated with clozapine. A study was made on the variations in white cell and neutrophil counts during the first 18 weeks of treatment, as well as the onset of leukopenia, neutropenia, agranulocytosis, and the influence of concomitant drugs. Results and conclusions. The study included 55 patients on treatment with clozapine. The incidence rate of neutropenia was 1.82% (95% CI; 0.05-10.13). The incidence rate of leukopenia and agranulocytosis was 0%. An increase in white cell and neutrophil counts from baseline to week 3-4 was observed. Only small variations were observed after this time, but the counts remained higher than the initial values. These changes were statistically significant in the white cell count: One-way repeated ANOVA with Greenhouse-Geisser correction F (11.47, 37) = 2.114 (P= .011); and in neutrophils: One-way repeated ANOVA with Greenhouse-Geisser correction F (10.3, 37)=3.312 (P=.0002), and MANOVA F (18, 37)=2.693 (P=.005), ŋ2P=0.567. The influence of concomitant drugs (lithium, valproic and biperiden) was not significant on the overall increase found in white cells or neutrophils (MANOVA)

Is the Blood Eosinophil Count a Useful Biomarker in COPD? The devil is in the Details / ¿Es el recuento de eosinófilos un biomarcador útil en la EPOC? El problema está en los detalles

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