Improving the Diagnosis of Dermatitis Herpetiformis Using the Intraepithelial Lymphogram.

Dermatitis herpetiformis is a cutaneous manifestation of celiac disease. Phenotyping of intraepithelial lymphocytes in the small bowel mucosa can strengthen the diagnosis of celiac disease when it is not clear-cut. We aim to evaluate the usefulness of the intraepithelial lymphogram to confirm dermatitis herpetiformis in equivocal cases. We performed a retrospective multicenter study on patients diagnosed with dermatitis herpetiformis and collected data from the intraepithelial lymphogram assessed by flow cytometry. A total of 36 patients were analyzed in relation to the severity of intestinal damage (18 had non-atrophic mucosa) at baseline (N = 28) and/or after the adoption of a gluten-free diet (median follow-up of three years, N = 16). We observed that patients with atrophy more often had positive celiac serology (p = 0.019), celiac clinical symptoms (p = 0.018), and iron-deficiency anemia (p = 0.018), but the severity of skin damage was similar in both groups (p = 0.79). At baseline, increased TCRγδ+ cells were present in 94% of patients with atrophy and 67% with non-atrophic lesions (p = 0.13). After a gluten-free diet, increased TCRγδ+ cells persisted in 100% and 63% of cases, respectively (p = 0.21). We concluded that increased TCRγδ+ cells may be helpful in confirming the diagnosis of dermatitis herpetiformis in equivocal cases, even in patients who were started on a gluten-free diet.

Serological response to COVID-19 pneumonia and increasing severity over 18 months in a prospective cohort of hospitalized patients.

In this study, we present an 18-month serological follow-up of 294 patients with COVID-19 pneumonia. The aim was to assess the dynamics of serological response and its correlation with clinical worsening, as well as to describe clinical worsening determinants. Results of the study showed an early immunoglobulin M response, which clearly diminished starting at 4 months, but nonetheless, a small group of patients remained positive. As for immunoglobulin G, levels were higher up to 6 months in patients who presented clinical worsening during hospitalization. High titers of the immunoglobulin were maintained in all patients during follow-up, which would indicate that humoral immunity due to infection is long-lasting. Male sex, presence of myalgias and extensive radiological affectation were significantly correlated with clinical worsening.

Coeliac Disease in Elderly Patients: Value of Coeliac Lymphogram for Diagnosis.

(1) Background: Although a meta-analysis reported that the sensitivity of CD3+ TCRγδ+ cells for coeliac disease diagnosis was >93%, a recent study has suggested that sensitivity decreased to 65% in elderly patients. (2) Aim: To evaluate whether the sensitivity of intraepithelial lymphocyte cytometric patterns for coeliac disease diagnosis changes with advanced age. (3) Methods: We performed a multicentre study including 127 coeliac disease patients ≥ 50 years: 87 with baseline cytometry (45 aged 50-59 years; 23 aged 60-69 years; 19 aged ≥ 70 years), 16 also with a follow-up cytometry (on a gluten-free diet); and 40 with only follow-up cytometry. (4) Results: In Marsh 3 patients, a sensitivity of 94.7%, 88.9% and 86.7% was observed for each age group using a cut-off value of TCRγδ+ >10% (p = 0.27); and a sensitivity of 84.2%, 83.4% and 53.3% for a cut-off value >14% (p = 0.02; 50-69 vs. ≥70 years), with difference between applying a cut-off of 10% or 14% (p = 0.008). The TCRγδ+ count in the ≥70 years group was lower than in the other groups (p = 0.014). (5) Conclusion: In coeliac patients ≥ 70 years, the TCRγδ+ count decreases and the cut-off point of >10% is more accurate than >14%.

Cambio de linaje de leucemia linfática aguda (LLA) a leucemia mieloide aguda (LMA): Reporte de un caso / Lineage switch from acute lympheal leukemia (ALL) to acute myeloid leukemia (AML): Report of a case

Introducción: La Leucemia Linfática Aguda (LLA) representa la enfermedad maligna pediátrica más frecuente, que representa al menos el 25% de los casos de cáncer infantil. El cambio de linaje de Leucemia Linfática Aguda a Leucemia Mieloide Aguda (LMA) representa aproximadamente 6 a 9% de los casos recidivados, y se observa con mayor frecuencia en pacientes infantiles. Reporte de caso: un paciente de varón de 9 años con Diagnóstico inicial de LLA- B de Muy Alto Riesgo, recae con LMA tras 1 año 9 meses de recibir tratamiento con Quimioterapia y radioterapia profiláctica. Conclusión: Existen diferentes mecanismos que podrían explicar el cambio de linaje entre leucemia linfática aguda a leucemia mieloide aguda; en nuestro paciente podríamos hablar de posibles factores que influenciaron en el cambio de linaje: progenitores bipolares, selección clonal, Quimioterapia.

Introduction: Acute Lymphatic Leukemia (ALL) represents the most frequent pediatric malignant disease, representing at least 25% of childhood cancer cases. Lineage switch from Acute Lymphatic Leukemia to Acute Myeloid Leukemia (AML) represents approximately 6 to 9% of recurrent cases, and is observed more frequently in children. Case report: a 9-year-old male patient with an Initial Diagnosis of Very High Risk ALL-B, relapses with AML after 1 year 9 months of receiving treatment with chemotherapy and prophylactic radiotherapy. Conclusion: Thereare different mechanisms that could explain the Lineage switch between acute lymphocytic leukemia to acute myeloid leukemia; in our patient we could talk about possible factors that influenced the Lineage switch: bipolar progenitors, clonal selection, chemotherapy.

Method To Determine MgO and MgOHCl in Chloride Molten Salts.

A commercial blend of mainly carnallite (KCl·MgCl2·6H2O) is considered as a next-generation heat transfer fluid in solar thermal plants. Corrosive properties of MgCl2 hydrates must be addressed at the operating temperatures of 500-720 °C. For successful chemical monitoring of the carnallite heat transfer fluid, an experimental method was developed to separate and titrate for MgO and MgOHCl from solid carnallite. This new method was assessed for error and accuracy. The method's relative error for MgOHCl was -7.0% for a mass fraction of 9.0 wt % MgOHCl in the carnallite salt. The method's relative error for MgO was less than +1.0% for a mass fraction of 12.0 wt % MgO in the carnallite salt. Titration results were used to track changes in the MgOHCl concentration in carnallite salt through the carnallite's dehydration and purification.

Gamma delta+ intraepithelial lymphocytes and coeliac lymphogram in a diagnostic approach to coeliac disease in patients with seronegative villous atrophy.

BACKGROUND: The causes of seronegative villous atrophy can be grouped as coeliac or noncoeliac related. There is no consensus on how to approach subjects with seronegative coeliac disease. AIM: To evaluate the accuracy of both an increase in CD3+ T-cell receptor gamma delta+ (TCRγδ+ ) intraepithelial lymphocytes and coeliac lymphogram for the diagnosis of coeliac disease in patients with seronegative villous atrophy. METHODS: Sixty-seven consecutive patients with seronegative villous atrophy were included. Duodenal biopsies to assess TCRγδ+ and CD3- by flow cytometry were performed at the index endoscopy. Coeliac lymphogram was defined as an increase in TCRγδ+ plus a decrease in CD3- intraepithelial lymphocytes. Sensitivity, specificity and Fagan's nomogram were calculated. RESULTS: Coeliac disease was diagnosed in 37 patients and noncoeliac villous atrophy in 30. Coeliac patients were younger (39 ± 3 vs 55 ± 3 years; P = 0.001), more often showed HLA-DQ2/8 (97.6% vs 61%; P = 0.002) and had a more severe histology (61% vs 32% Marsh 3b-c; P = 0.055), as compared to noncoeliac ones. Coeliac lymphogram was associated with a sensitivity of 87% (CI, 73.7-95) and specificity of 96.7% (82.7-99.9), whereas evaluating only TCRγδ+ yielded a sensitivity of 91.3% (79.2-97.6) and specificity of 83.3% (65.3-94.3). Among patients with a pre-test coeliac disease probability of 30%, post-test probabilities were 92% and 5% for positive and negative coeliac lymphogram, and 70% and 4% for positive and negative TCRγδ+ . CONCLUSIONS: Coeliac lymphogram was associated with a high level of diagnostic evidence either against or in favour of coeliac disease in patients with seronegative villous atrophy.

Purification strategy and effect of impurities on corrosivity of dehydrated carnallite for thermal solar applications.

This paper presents a purification method for dehydrated carnallite (DC)-a commercial ternary MgCl2-KCl-NaCl salt-for concentrating solar power (CSP) applications based on a thermal and chemical treatment using the reduction power of Mg. The purification is effective at reducing MgOH+ by an order of magnitude-from around 5 wt% in non-treated salt to less than 0.5 wt% in post-purification salt. The corresponding decrease in the measured corrosion rate of Haynes 230 at 800 °C from >3200 µm per year to around 40 µm per year indicates that soluble MgOH+ is indeed correlated to corrosion. The addition of elemental Mg serves as both a scavenger of impurities and corrosion potential control, which are considered the primary mechanisms for corrosion mitigation.

Comparison of lymphocyte isolation methods for endoscopic biopsy specimens from the colonic mucosa.

An ideal method of immune cell isolation should provide maximum cell yield without disturbing functional properties. Intestinal endoscopic biopsies, in contrast to surgical samples, allow the study of all disease stages but have the drawback of a minimum amount of tissue available, making protocol optimization mandatory. We compared for the first time two methods of separation of colonic epithelium and five methods of lamina propria cell isolation for colonic biopsy specimens (mechanical, enzymatic and organ culture protocols). Lymphocyte number, viability and phenotype (CD45+, CD103+, CD3+, CD4+, CD8+, CD19+, CD16-56+) were analyzed by flow cytometry. Neither of the two epithelial detachment protocols achieved proper epithelial separation, though the high intensity ion chelation method was more accurate. Maximum cell yield of lamina propria lymphocytes without phenotypic modification was obtained with overnight smooth enzymatic digestion. High dose collagenase incubation caused a marked decrease in CD4+ lymphocytes of the lamina propria as compared to low enzymatic method (p=0.004). Mechanical and biopsy culture are not advisable methods because of the low cell yield, and phenotypic alterations and high contamination rate, respectively.