Neutrophil-Lymphocyte ratio is associated with poor clinical outcome after mechanical thrombectomy in stroke in patients with COVID-19.

BACKGROUND: The neutrophil-lymphocyte ratio (NLR) is emerging as an important biomarker of acute physiologic stress in a myriad of medical conditions, and is a confirmed poor prognostic indicator in COVID-19. OBJECTIVE: We sought to describe the role of NLR in predicting poor outcome in COVID-19 patients undergoing mechanical thrombectomy for acute ischemic stroke. METHODS: We analyzed NLR in COVID-19 patients with large vessel occlusion (LVO) strokes enrolled into an international 12-center retrospective study of laboratory-confirmed COVID-19, consecutively admitted between March 1, 2020 and May 1, 2020. Increased NLR was defined as ≥7.2. Logistic regression models were generated. RESULTS: Incidence of LVO stroke was 38/6698 (.57%). Mean age of patients was 62 years (range 27-87), and mortality rate was 30%. Age, sex, and ethnicity were not predictive of mortality. Elevated NLR and poor vessel recanalization (Thrombolysis in Cerebral Infarction (TICI) score of 1 or 2a) synergistically predicted poor outcome (likelihood ratio 11.65, p = .003). Patients with NLR > 7.2 were 6.8 times more likely to die (OR 6.8, CI95% 1.2-38.6, p = .03) and almost 8 times more likely to require prolonged invasive mechanical ventilation (OR 7.8, CI95% 1.2-52.4, p = .03). In a multivariate analysis, NLR > 7.2 predicted poor outcome even when controlling for the effect of low TICI score on poor outcome (NLR p = .043, TICI p = .070). CONCLUSIONS: We show elevated NLR in LVO patients with COVID-19 portends significantly worse outcomes and increased mortality regardless of recanalization status. Severe neuro-inflammatory stress response related to COVID-19 may negate the potential benefits of successful thrombectomy.

Incidence, Characteristics and Outcomes of Large Vessel Stroke in COVID-19 Cohort: An International Multicenter Study.

BACKGROUND: While there are reports of acute ischemic stroke (AIS) in coronavirus disease 2019 (COVID-19) patients, the overall incidence of AIS and clinical characteristics of large vessel occlusion (LVO) remain unclear. OBJECTIVE: To attempt to establish incidence of AIS in COVID-19 patients in an international cohort. METHODS: A cross-sectional retrospective, multicenter study of consecutive patients admitted with AIS and COVID-19 was undertaken from March 1 to May 1, 2020 at 12 stroke centers from 4 countries. Out of those 12 centers, 9 centers admitted all types of strokes and data from those were used to calculate the incidence rate of AIS. Three centers exclusively transferred LVO stroke (LVOs) patients and were excluded only for the purposes of calculating the incidence of AIS. Detailed data were collected on consecutive LVOs in hospitalized patients who underwent mechanical thrombectomy (MT) across all 12 centers. RESULTS: Out of 6698 COVID-19 patients admitted to 9 stroke centers, the incidence of stroke was found to be 1.3% (interquartile range [IQR] 0.75%-1.7%). The median age of LVOs patients was 51 yr (IQR 50-75 yr), and in the US centers, African Americans comprised 28% of patients. Out of 66 LVOs, 10 patients (16%) were less than 50 yr of age. Among the LVOs eligible for MT, the average time from symptom onset to presentation was 558 min (IQR 82-695 min). A total of 21 (50%) patients were either discharged to home or discharged to acute rehabilitation facilities. CONCLUSION: LVO was predominant in patients with AIS and COVID-19 across 2 continents, occurring at a significantly younger age and affecting African Americans disproportionately in the USA.

Identification of a novel 80 kDa antigen associated with cell proliferation.

Exploiting the immunomasking method, a polyclonal antibody has been developed in mice for identification of a novel 80 kDa antigen (P80) in KB cells. The P80 was not detected in normal resting cells but was present in appreciable amount in malignant cells. In a comparative Western transfer the antisera to the immune complexes identified a 80 kDa peptide absent in normal cell extracts. When growth of KB cells were arrested by 48 h of serum starvation the P80 was not detected but after refeeding with serum containing medium, the P80 reappeared within 1 h. This result indicates that the P80 is associated with cell proliferation and appears early in the GI-S phase of the cell cycle.

Aetiological studies on hospital in-patients with acute diarrhoea in Calcutta.

Bacterial enteropathogens and rotavirus were sought in 356 cases with acute diarrhoea admitted to the Infectious Diseases Hospital, Calcutta. One or more pathogens were isolated from 74.7% of the cases. Single enteropathogens could be detected from 66% and multiple enteropathogens from 8.7% of the patients. Vibrio cholerae biotype El Tor, rotavirus, V. parahaemolyticus, and enteropathogenic and enterotoxigenic Escherichia coli were the major pathogens detected. Rotavirus was detected from 7.6% of the cases. A higher rate of detection of rotavirus was seen in children younger than two years. Campylobacter jejuni could be isolated from the faeces of six (15%) of 40 cases either as a single pathogen or in association with V. cholerae biotype El Tor.

Placental hormones as possible markers in gynaecological cancer.

Two placental hormones (human chorionic gonadotropin and human chorionic somatotropin) were assayed in serum of patients bearing a wide variety of malignant tumours. The incidences of these hormones were found to be higher among female patients. Further studies revealed that the incidence was high in patients with malignant tumours of the gonads, breast, uterus and cervix. It was shown that these hormones are the products of tumour cells and that they are released in circulation. Studies on cervix cancer suggest that they may be useful aids in following the course of therapy.

A clinico-pathological study of cervical carcinoma through histopathology, SEM and tumour marker expression.

Carcinoma of the uterine cervix is the commonest tumour in India. Our study on the biological behaviour of cervical carcinoma was made with respect to oncofetoprotein expression, histopathology and scanning electron microscopy. A clinical picture was compared with the above three parameters to note the embryonic degeneration of the tumour. The objective of this study was to establish a new grading system of tumour pathology which might be an adjunct to clinical staging. This should be helpful for the formulation of different treatment protocols.

Stability of psychiatric diagnosis.

Eighty five charts of patients whose diagnoses have changed at least once between 1977 and 1981 (unstable) were compared with another randomly chosen charts where diagnosis during the subsequent admissions remained unchanged (stable). Seventy six percent of the changes occurred from one to the other diagnostic category and remained so. Seventy three percent of Schizophrenics, 77.5% of Manics, 45% of Depressives and only 31% the Neurotics retained their original diagnosis. More Schizophrenics became Manics rather than the reverse. No statistically significant differences were found regarding changes between the other diagnostic categories. Unstable group had lesser frequency of admissions before the index admission and were more often readmitted.

Enzymatic responses of transplanted tumour cells towards estrogen, progesterone and testosterone.

The influence of estrogen, progesterone and testosterone on the activities of alkaline and acid phosphatases, adenosine triphosphatase and succinate dehydrogenase were determined by cytochemical methods in sarcoma 180 and Ehrlich's carcinoma cells transplanted in male and female Swiss mice. The results revealed differential effects of the sex hormones on different enzymes which seemed to depend on the type of tumour cell studied and the sex of the host mice.

Enzymatic responses of transplanted tumour cells towards estrogen, progesterone and testosterone.

The influence of estrogen, progesterone and testosterone on the activities of alkaline and acid phosphatases, adenosine triphosphatase and succinate dehydrogenase were determined by cytochemical methods in sarcoma 180 and Ehrlich's carcinoma cells transplanted in male and female Swiss mice. The results revealed differential effects of the sex hormones on different enzymes which seemed to depend on the type of tumour cell studied and the sex of the host mice.

PIP: Cells of sarcoma 180 and of Ehrlich's carcinoma were maintained by serial transplantation in male and female Swiss mice. Either estrogen, progesterone, or testosterone were injected im at doses of 1 mg/mouse. Ascitic fluid was aspirated at intervals of 1, 3, 6, 24, and 48 hours following hormone injections. Enzyme activities were analyzed by subjective grading according to the intensity of staining reaction. Estrogen produced enhancement of alkaline phosphatase activity in both types of cells in both sexes of mice. Progesterone produced increased alkaline phosphatase activity in both types of cells from female hosts but an inhibitory effect in male hosts' cells. Testosterone produced no change in enzyme activity in tumor cells of female hosts but in male hosts it inhibited enzyme activity of sarcoma 180 cells and activated activity in carcinoma cells. The effect of all 3 hormones on acid phosphatase activity was activation. With adenosine triphosphatase, estrogen stimulated the activity in both types of tumor in both sexes. Progesterone stimulated cells from male hosts with little or no effect on cells from female hosts. This enzyme was resistant to testosterone. Succinate dehydrogenase activity under similar conditions was different. Estrogen reduced this activity and progesterone produced some inhibition of activity. Testosterone inhibited the sarcoma cells but had no effect on carcinoma cells of either sex. Others have shown that sex hormones affect the enzyme activities beyond the target tissues, particularly in the liver, kidney, and pancreas. Different responses of the enzymes seemed to depend on the endogenous hormonal status of the mice.