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1.
World J Gastroenterol ; 26(39): 6087-6097, 2020 Oct 21.
Artículo en Inglés | MEDLINE | ID: mdl-33132657

RESUMEN

BACKGROUND: The coronavirus disease 2019 (COVID-19) is spreading rapidly around the world. Most critically ill patients have organ injury, including acute respiratory distress syndrome, acute kidney injury, cardiac injury, or liver dysfunction. However, few studies on acute gastrointestinal injury (AGI) have been reported in critically ill patients with COVID-19. AIM: To investigate the prevalence and outcomes of AGI in critically ill patients with COVID-19. METHODS: In this retrospective study, demographic data, laboratory parameters, AGI grades, clinical severity and outcomes were collected. The primary endpoints were AGI incidence and 28-d mortality. RESULTS: From February 10 to March 10 2020, 83 critically ill patients out of 1314 patients with COVID-19 were enrolled. Seventy-two (86.7%) patients had AGI during hospital stay, of these patients, 30 had AGI grade I, 35 had AGI grade II, 5 had AGI grade III, and 2 had AGI grade IV. The incidence of AGI grade II and above was 50.6%. Forty (48.2%) patients died within 28 days of admission. Multiple organ dysfunction syndrome developed in 58 (69.9%) patients, and septic shock in 16 (19.3%) patients. Patients with worse AGI grades had worse clinical variables, a higher incidence of septic shock and 28-d mortality. Sequential organ failure assessment (SOFA) scores (95%CI: 1.374-2.860; P < 0.001), white blood cell (WBC) counts (95%CI: 1.037-1.379; P = 0.014), and duration of mechanical ventilation (MV) (95%CI: 1.020-1.340; P = 0.025) were risk factors for the development of AGI grade II and above. CONCLUSION: The incidence of AGI was 86.7%, and hospital mortality was 48.2% in critically ill patients with COVID-19. SOFA scores, WBC counts, and duration of MV were risk factors for the development of AGI grade II and above. Patients with worse AGI grades had a higher incidence of septic shock and 28-d mortality.


Asunto(s)
Infecciones por Coronavirus/fisiopatología , Enfermedades Gastrointestinales/fisiopatología , Mortalidad Hospitalaria , Neumonía Viral/fisiopatología , Lesión Renal Aguda/epidemiología , Anciano , Betacoronavirus , China/epidemiología , Infecciones por Coronavirus/epidemiología , Enfermedad Crítica , Femenino , Enfermedades Gastrointestinales/epidemiología , Humanos , Incidencia , Recuento de Leucocitos , Hepatopatías/epidemiología , Masculino , Persona de Mediana Edad , Mortalidad , Insuficiencia Multiorgánica/epidemiología , Puntuaciones en la Disfunción de Órganos , Pandemias , Neumonía Viral/epidemiología , Prevalencia , Respiración Artificial/estadística & datos numéricos , Síndrome de Dificultad Respiratoria del Adulto/epidemiología , Estudios Retrospectivos , Factores de Riesgo , Índice de Severidad de la Enfermedad , Choque Séptico/epidemiología
2.
Monaldi Arch Chest Dis ; 90(4)2020 Nov 09.
Artículo en Inglés | MEDLINE | ID: mdl-33169598

RESUMEN

COVID-19 is a pandemic with over 5 million cases worldwide. The disease has imposed a huge burden on health resources. Evaluation of clinical and epidemiological profiles of such patients can help in understanding and managing the outbreak more efficiently. This study was a prospective observational analysis of 200 diagnosed COVID-19 patients admitted to a tertiary care center from 20th march to 8th May 2020. All these patients were positive for COVID-19 by an oro-nasopharyngeal swab-rtPCR based testing. Analyses of demographic factors, clinical characteristics, comorbidities, laboratory parameters, and the outcomes were performed. The mean age of the population was 40 years with a slight male predominance (116 patients out of 200, 58%). A majority of the patients (147, 73.5 %) were symptomatic, with fever being the most common symptom (109, 54.5%), followed by cough (91, 45.5%). An older age, presence of symptoms and their duration, leukocytosis, a high quick SOFA score, a high modified SOFA score, need for ventilator support, an AST level more than 3 times the upper limit of normal (ULN), and a serum creatinine level of 2 mg/dl or greater were at a significantly higher risk of ICU admission and mortality. Presence of diabetes mellitus, AST > three times ULN, serum creatinine 2 mg/dl or higher, and a qSOFA score of 1 or higher were all associated with significantly greater odds of critical care requirement. Triage and severity assessment helps in deciding the requirement for a hospital stay and ICU admission for COVID-19 which can easily be done using clinical and laboratory parameters. A mild, moderate and severe category approach with defined criteria and treatment guidelines will help in judicious utilization of health-care resources, especially for developing countries like India.   *Other members of the Safdarjung Hospital COVID-19 working group: Balvinder Singh (Microbiology), MK Sen (Pulmonary Medicine), Shibdas Chakrabarti (Pulmonary Medicine), NK Gupta (Pulmonary medicine), AJ Mahendran (Pulmonary Medicine), Ramesh Meena (Medicine), G Usha (Anaesthesiology), Santvana Kohli (Anaesthesiology), Sahil Diwan (Anaesthesiology), Rushika Saksena (Microbiology), Vikramjeet Dutta (Microbiology), Anupam Kr Anveshi (Microbiology).


Asunto(s)
Infecciones por Coronavirus/sangre , Infecciones por Coronavirus/fisiopatología , Neumonía Viral/sangre , Neumonía Viral/fisiopatología , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Alanina Transaminasa/sangre , Anemia/sangre , Aspartato Aminotransferasas/sangre , Betacoronavirus , Niño , Preescolar , Comorbilidad , Enfermedad de la Arteria Coronaria/epidemiología , Infecciones por Coronavirus/mortalidad , Infecciones por Coronavirus/terapia , Tos/fisiopatología , Creatinina/sangre , Diabetes Mellitus/epidemiología , Femenino , Fiebre/fisiopatología , Humanos , Hipertensión/epidemiología , Hipoxia/fisiopatología , India/epidemiología , Lactante , Recién Nacido , Unidades de Cuidados Intensivos , Tiempo de Internación , Recuento de Leucocitos , Leucocitosis/sangre , Linfopenia/sangre , Linfopenia/fisiopatología , Masculino , Persona de Mediana Edad , Mialgia/fisiopatología , Puntuaciones en la Disfunción de Órganos , Pandemias , Faringitis/fisiopatología , Recuento de Plaquetas , Neumonía Viral/mortalidad , Neumonía Viral/terapia , Estudios Prospectivos , Respiración Artificial , Taquipnea/fisiopatología , Centros de Atención Terciaria , Factores de Tiempo , Tuberculosis/epidemiología , Adulto Joven
3.
Virulence ; 11(1): 1569-1581, 2020 12.
Artículo en Inglés | MEDLINE | ID: mdl-33172355

RESUMEN

A pandemic designated as Coronavirus Disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is spreading worldwide. Up to date, there is no efficient biomarker for the timely prediction of the disease progression in patients. To analyze the inflammatory profiles of COVID-19 patients and demonstrate their implications for the illness progression of COVID-19. Retrospective analysis of 3,265 confirmed COVID-19 cases hospitalized between 10 January 2020, and 26 March 2020 in three medical centers in Wuhan, China. Patients were diagnosed as COVID-19 and hospitalized in Leishenshan Hospital, Zhongnan Hospital of Wuhan University and The Seventh Hospital of Wuhan, China. Univariable and multivariable logistic regression models were used to determine the possible risk factors for disease progression. Moreover, cutoff values, the sensitivity and specificity of inflammatory parameters for disease progression were determined by MedCalc Version 19.2.0. Age (95%CI, 1.017 to 1.048; P < 0.001), serum amyloid A protein (SAA) (95%CI, 1.216 to 1.396; P < 0.001) and erythrocyte sedimentation rate (ESR) (95%CI, 1.006 to 1.045; P < 0.001) were likely the risk factors for the disease progression. The Area under the curve (AUC) of SAA for the progression of COVID-19 was 0.923, with the best predictive cutoff value of SAA of 12.4 mg/L, with a sensitivity of 83.9% and a specificity of 97.67%. SAA-containing parameters are novel promising ones for predicting disease progression in COVID-19.


Asunto(s)
Betacoronavirus/aislamiento & purificación , Infecciones por Coronavirus/diagnóstico , Neumonía Viral/diagnóstico , Anciano , Área Bajo la Curva , Betacoronavirus/genética , Biomarcadores , Sedimentación Sanguínea , Proteína C-Reactiva/análisis , China , Estudios de Cohortes , Progresión de la Enfermedad , Femenino , Humanos , Laringe/virología , Recuento de Leucocitos , Modelos Logísticos , Masculino , Persona de Mediana Edad , Pandemias , Valor Predictivo de las Pruebas , ARN Viral/aislamiento & purificación , Reacción en Cadena en Tiempo Real de la Polimerasa , Estudios Retrospectivos , Factores de Riesgo , Sensibilidad y Especificidad , Proteína Amiloide A Sérica/análisis
4.
Sci Rep ; 10(1): 17458, 2020 10 15.
Artículo en Inglés | MEDLINE | ID: mdl-33060704

RESUMEN

We aim to study the association of hyperlipidemia and statin use with COVID-19 severity. We analysed a retrospective cohort of 717 patients admitted to a tertiary centre in Singapore for COVID-19 infection. Clinical outcomes of interest were oxygen saturation ≤ 94% requiring supplemental oxygen, intensive-care unit (ICU) admission, invasive mechanical-ventilation and death. Patients on long term dyslipidaemia medications (statins, fibrates or ezetimibe) were considered to have dyslipidaemia. Logistic regression models were used to study the association between dyslipidaemia and clinical outcomes adjusted for age, gender and ethnicity. Statin treatment effect was determined, in a nested case-control design, through logistic treatment models with 1:3 propensity matching for age, gender and ethnicity. All statistical tests were two-sided, and statistical significance was taken as p < 0.05. One hundred fifty-six (21.8%) patients had dyslipidaemia and 97% of these were on statins. Logistic treatment models showed a lower chance of ICU admission for statin users when compared to non-statin users (ATET: Coeff (risk difference): - 0.12 (- 0.23, - 0.01); p = 0.028). There were no other significant differences in other outcomes. Statin use was independently associated with lower ICU admission. This supports current practice to continue prescription of statins in COVID-19 patients.


Asunto(s)
Infecciones por Coronavirus/patología , Dislipidemias/tratamiento farmacológico , Inhibidores de Hidroximetilglutaril-CoA Reductasas/uso terapéutico , Neumonía Viral/patología , Anciano , Betacoronavirus/aislamiento & purificación , Estudios de Casos y Controles , Infecciones por Coronavirus/complicaciones , Infecciones por Coronavirus/virología , Dislipidemias/complicaciones , Dislipidemias/patología , Femenino , Humanos , Inmunidad Innata , Unidades de Cuidados Intensivos , Recuento de Leucocitos , Modelos Logísticos , Masculino , Persona de Mediana Edad , Pandemias , Neumonía Viral/complicaciones , Neumonía Viral/virología , Estudios Retrospectivos , Índice de Severidad de la Enfermedad
5.
Annu Int Conf IEEE Eng Med Biol Soc ; 2020: 1816-1819, 2020 07.
Artículo en Inglés | MEDLINE | ID: mdl-33018352

RESUMEN

The measure of White Blood Cells (WBC) in the blood is an important indicator of pathological conditions. Computer vision based methods for differential counting of WBC are increasing due to their advantages over traditional methods. However, most of these methods are proposed for single WBC images which are pre-processed, and do not generalize for raw microscopic images with multiple WBC. Moreover, they do not have the capability to detect the absence of WBC in the images. This paper proposes an image processing algorithm based on K-Means clustering to detect the presence of WBC in raw microscopic images and to localize them, and a VGG-16 classifier to classify those cells with a classification accuracy of 95.89%.


Asunto(s)
Procesamiento de Imagen Asistido por Computador , Leucocitos , Algoritmos , Análisis por Conglomerados , Recuento de Leucocitos
6.
Medicine (Baltimore) ; 99(40): e22404, 2020 Oct 02.
Artículo en Inglés | MEDLINE | ID: mdl-33019416

RESUMEN

BACKGROUND: Systemic lupus erythematosus (SLE), known as lupus, is a chronic autoimmune disease and there is no cure for SLE. The western medication can improve syndromes to some extent; however, severe adverse drug reactions appear at the same time. Recently, it is confirmed that Chinese medicine also can have an excellent clinical efficacy on SLE. METHODS AND ANALYSIS: The following databases will be searched for relevant information before July 2020: PubMed, Embase, Cochrane Library, Web of Science, and China National Knowledge Infrastructure. MAJOR RESULTS: levels of total remission rate, SLEDAI. Secondary results: The laboratory index about C3 levels, Hb levels, white blood cell levels, and adverse event. Data will be collected independently by 2 researchers, and the risk of bias in meta analysis will be evaluated according to "Cochrane Handbook for Systematic Reviews of Interventions." All data analysis will be conducted using Review Manager V.5.3. and Stata V.12.0. RESULTS: The curative effect and safety of Chinese herbal compound prescription treatment for SLE patients will be evaluated systematically. CONCLUSION: The systematic review of this study will summarize the currently published evidence of Chinese herbal compound prescription treatment for SLE to further guide its promotion and application. ETHICS AND DISSEMINATION: The private information from individuals will not be published. This systematic review also will not involve endangering participant rights. Ethical approval is not required. The results may be published in a peer-reviewed journal or disseminated in relevant conferences. OPEN SCIENCE FRAMEWORK (OSF)REGISTRATION NUMBER:: https://osf.io/wvfrx/.


Asunto(s)
Medicamentos Herbarios Chinos/uso terapéutico , Lupus Eritematoso Sistémico/tratamiento farmacológico , Medicamentos Herbarios Chinos/administración & dosificación , Medicamentos Herbarios Chinos/efectos adversos , Hemoglobinas/análisis , Humanos , Recuento de Leucocitos , Ensayos Clínicos Controlados Aleatorios como Asunto , Inducción de Remisión , Proyectos de Investigación
7.
Clin Exp Rheumatol ; 38 Suppl 126(4): 195-202, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-33095147

RESUMEN

OBJECTIVES: Recently, the total area of the inflammatory infiltrate and the percentage of inflammatory infiltrate have been proposed as novel histopathological parameters to improve the stratification of patients with Sjögren's syndrome (SS) in clinical trials. Both these parameters provide a more accurate assessment of the extent of the infiltrate in minor salivary gland biopsies (MSGBs) and may overcome the bias related to the Focus score (FS). To date, however, only few studies have investigated their clinical value and feasibility. In this study we revised consecutive MSGBs obtained routinely in a real-life clinical setting and correlated the total area of the inflammatory infiltrate and the percentage of inflammatory infiltrate both with the other MSGB histopathological parameters and with patients' clinical features in order to explore their usefulness in SS diagnostic work-up. METHODS: We assessed the area of the inflammatory infiltrate and the percentage of the inflammatory infiltrate in consecutive MSGBs and correlated these parameters with the number of foci, the FS and the presence of ectopic lymphoid structures (ELS). We also correlated these additional parameters with patients' clinical and biological data. RESULTS: We revised 69 MSGB samples: 46 from patients with a diagnosis of SS and 23 from subjects with no SS. The total area of inflammatory infiltrate and the percentage of inflammatory infiltrate appeared significantly higher in patients fulfilling the ACR/EULAR classification criteria for SS and correlated significantly with both the number of foci (p<0.001) and the FS (p<0.001). Particularly, they correlated better with the ELS in MSGBs than the number of foci and the FS. When we limited the analysis to the 32/69 patients with a FS<1, both the total area of the inflammatory infiltrate (p=0.02) and the percentage of the inflammatory infiltrate (p=0.03), but not the number of foci (p=0.12) remained significantly higher in the 10/32 anti-Ro/SSA positive patients fulfilling the ACR/EULAR classification criteria. Finally, the total area of inflammatory infiltrate and the percentage of inflammatory infiltrate correlated significantly with several biological and haematological SS-related abnormalities including hypergammaglobulinaemia, C4 levels, total number of white blood cells and the number of circulating lymphocytes. CONCLUSIONS: The total area of the inflammatory infiltrate and the percentage of the inflammatory infiltrate in SS referral centres, and particularly for selected cases, may maximise the information on disease activity at tissue level, ultimately improving SS patients' assessment.


Asunto(s)
Síndrome de Sjögren , Biopsia , Humanos , Hipergammaglobulinemia , Recuento de Leucocitos , Glándulas Salivales Menores , Síndrome de Sjögren/diagnóstico
8.
Int J Immunopathol Pharmacol ; 34: 2058738420966497, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-33076729

RESUMEN

Coronavirus disease 2019 (COVID-19), an acute respiratory infection, is largely associated with dysregulation and impairment of the immune system. This study investigated how the immune system changes were related to disease severity in COVID-19 patients. The frequencies of different immune cells and levels of pro- and anti-inflammatory cytokines in whole blood of participants were determined by flow cytometry and enzyme-linked immunosorbent assay, respectively. The values of other inflammatory agents were also studied. In the late recovery stage, unlike CD56high CD16+/- NK cells and monocytes, CD56low CD16+ NK cell numbers were increased (P < 0.0001-0.05). Th1, Th2, and Th17 cell percentages were significantly lower in patients than healthy control (P < 0.0001-0.05), while their frequencies were increased following disease recovery (P < 0.0001-0.05). The numbers of Tregs, activated CD4+ T cells, and exhausted CD8+ T cells were significantly decreased during a recovery (P < 0.0001-0.05). No significant change was observed in exhausted CD4+ T cell number during a recovery (P > 0.05). B cell showed an increased percentage in patients compared to healthy subjects (P < 0.0001-0.05), whereas its number was reduced following recovery (P < 0.0001-0.05). IL-1α, IL-1ß, IL-6, TNF-α, and IL-10 levels were significantly decreased in the late recovery stage (P < 0.0001-0.05). However, TGF-ß1 level was not significantly changed during the recovery (P > 0.05). Lymphocyte numbers in patients were significantly decreased (P < 0.001), unlike ESR value (P < 0.001). Lymphocyte number was negatively correlated to ESR value and Th2 number (P < 0.05), while its association with monocyte was significantly positive at the first day of recovery (P < 0.05). The immune system changes during the disease recovery to improve and regulate immune responses and thereby may associate with the reduction in disease severity.


Asunto(s)
Infecciones por Coronavirus/inmunología , Infecciones por Coronavirus/patología , Sistema Inmunológico/inmunología , Sistema Inmunológico/patología , Neumonía Viral/inmunología , Neumonía Viral/patología , Anciano , Anciano de 80 o más Años , Sedimentación Sanguínea , Estudios de Casos y Controles , Citocinas/metabolismo , Femenino , Citometría de Flujo , Humanos , Recuento de Leucocitos , Recuento de Linfocitos , Masculino , Persona de Mediana Edad , Pandemias , Recuperación de la Función , Linfocitos T/inmunología , Resultado del Tratamiento
9.
Hepatol Int ; 14(5): 723-732, 2020 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-33026573

RESUMEN

BACKGROUND: Coronavirus disease 2019 (COVID-19) has rapidly become a major international public health concern. This study was designed to evaluate the clinical characteristics and risk factors of COVID-19-associated liver injury. METHODS: A fraction of 657 COVID-19 patients were retrospectively analyzed. Clinical and laboratory data were derived from electronic medical records and compared between patients with or without liver injury. Multivariate logistic regression method was used to analyze the risk factors for liver injury. RESULTS: Among 657 patients, 303 (46.1%) patients had liver injury with higher rate in severe/critically ill patients [148/257 (57.6%)] than those in moderate cases [155/400 (38.8%)]. The incidence of liver injury was much higher in male [192/303 (63.4%)] than female [111/303 (36.6%)], and in severe/critical patients [148/303 (48.8%)] with percutaneous oxygen saturation ≤ 93% [89/279 (31.9%)] or peak body temperature ≥ 38.5 °C [185/301 (61.5%)] on admission. Liver injury-related inflammations included increased white blood cells, neutrophils and decreased lymphocytes. More patients with liver injury than without had increased serum IL-2R, TNFα, ferritin, hsCRP, PCT, ESR, γ-GT, and LDH. Multivariate regression analysis revealed that increasing odds of liver injury were related to male, higher serum hsCRP (≥ 10 mg/L), and neutrophil-to-lymphocyte ratio (NLR) (≥ 5). Moreover, more deceased patients (14/82 (17%)) had significantly elevated serum TBIL than discharged patients [25/532 (4.7%)]. CONCLUSION: Liver injury is a common complication in COVID-19 patients. The potential risk factors of liver injury include male, hsCRP and NLR score. A close monitor of liver function should be warned in COVID-19 patients, especially in severe/critical individuals.


Asunto(s)
Infecciones por Coronavirus , Citocinas/sangre , Insuficiencia Hepática , Recuento de Leucocitos/métodos , Pruebas de Función Hepática , Pandemias , Neumonía Viral , Betacoronavirus/aislamiento & purificación , China/epidemiología , Infecciones por Coronavirus/complicaciones , Infecciones por Coronavirus/mortalidad , Infecciones por Coronavirus/fisiopatología , Infecciones por Coronavirus/terapia , Enfermedad Crítica/epidemiología , Enfermedad Crítica/terapia , Femenino , Insuficiencia Hepática/sangre , Insuficiencia Hepática/epidemiología , Insuficiencia Hepática/virología , Humanos , Incidencia , Pruebas de Función Hepática/métodos , Pruebas de Función Hepática/estadística & datos numéricos , Masculino , Persona de Mediana Edad , Neumonía Viral/complicaciones , Neumonía Viral/mortalidad , Neumonía Viral/fisiopatología , Neumonía Viral/terapia , Estudios Retrospectivos , Factores de Riesgo , Factores Sexuales
10.
J Coll Physicians Surg Pak ; 30(9): 928-932, 2020 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-33036676

RESUMEN

OBJECTIVE: To investigate the association ​of white blood cell (WBC) counts, neutrophil, platelets, lymphocyte counts, C-reactive protein (CRP), neutrophil / lymphocyte ratio (NLR), derived NLR ratio (d-NLR), and platelet / lymphocyte ratio (PLR) at the time of first admission for mortality caused by COVID-19. STUDY DESIGN:  Descritive, analytical study. PLACE AND DURATION OF STUDY: Department of Emergency Medicine, Sakarya University Training and Research Hospital, Turkey from  March 2020 to  May 2020. METHODOLOGY: One hundred and sixty-nine patients with the diagnosis of Covid-19 were retrospectively reviewed. Patients were divided into two groups as survivors and non-survivors. Inclusion criteria were age ≥18 years, RT-PCR test positivity, hospitalisation. Patients with missing data were excluded. Data regarding age, gender, WBC counts, neutrophil, platelets, and lymphocyte, CRP, NLR, d-NLR, PLR and comorbid conditions were analysed for mortality. All tests were done with a two-sided significance of 5%. For each endpoint, the absolute and relative effects and their corresponding 95% confidence interval  were calculated. RESULTS: There was a statistically significant association between neutrophil, lymphocyte, CRP, NLR, d-NLR and PLR values (p=0.005, p<0.001, p<0.001, p<0.001, p<0.001, and p<0.001, respectively) with mortality status of the patients. The cutoff values calculated by this analysis were 67.50 years for age, 5.12 K / µl for neutrophil, 1.12 K / µl for lymphocyte, 67.78 mg / dl for CRP, 3.9 for NLR, 2.55 for d-NLR, and 148.85 for PLR. CONCLUSION: Altered neutrophil and lymphocyte counts, NLR, d-NLR, PLR, and CRP values can be used as early predictors of mortality in Covid-19 patients. Key Words: Covid-19, Mortality, Emergency, NLR, d-NLR, PLR.


Asunto(s)
Infecciones por Coronavirus/mortalidad , Servicio de Urgencia en Hospital/estadística & datos numéricos , Neumonía Viral/mortalidad , Anciano , Anciano de 80 o más Años , Betacoronavirus , Proteína C-Reactiva/análisis , Infecciones por Coronavirus/sangre , Femenino , Humanos , Recuento de Leucocitos , Recuento de Linfocitos , Linfocitos , Masculino , Persona de Mediana Edad , Neutrófilos , Pandemias , Recuento de Plaquetas , Neumonía Viral/sangre
11.
Front Immunol ; 11: 2063, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-33013872

RESUMEN

Background: Cases of excessive neutrophil counts in the blood in severe coronavirus disease (COVID-19) patients have drawn significant attention. Neutrophil infiltration was also noted on the pathological findings from autopsies. It is urgent to clarify the pathogenesis of neutrophils leading to severe pneumonia in COVID-19. Methods: A retrospective analysis was performed on 55 COVID-19 patients classified as mild (n = 22), moderate (n = 25), and severe (n = 8) according to the Guidelines released by the National Health Commission of China. Trends relating leukocyte counts and lungs examined by chest CT scan were quantified by Bayesian inference. Transcriptional signatures of host immune cells of four COVID19 patients were analyzed by RNA sequencing of lung specimens and BALF. Results: Neutrophilia occurred in 6 of 8 severe patients at 7-19 days after symptom onset, coinciding with lesion progression. Increasing neutrophil counts paralleled lesion CT values (slope: 0.8 and 0.3-1.2), reflecting neutrophilia-induced lung injury in severe patients. Transcriptome analysis revealed that neutrophil activation was correlated with 17 neutrophil extracellular trap (NET)-associated genes in COVID-19 patients, which was related to innate immunity and interacted with T/NK/B cells, as supported by a protein-protein interaction network analysis. Conclusion: Excessive neutrophils and associated NETs could explain the pathogenesis of lung injury in COVID-19 pneumonia.


Asunto(s)
Betacoronavirus/genética , Infecciones por Coronavirus/inmunología , Trampas Extracelulares/genética , Activación Neutrófila/genética , Neutrófilos/inmunología , Neumonía Viral/inmunología , Adulto , Anciano , Teorema de Bayes , Infecciones por Coronavirus/virología , Femenino , Humanos , Recuento de Leucocitos , Lesión Pulmonar/inmunología , Lesión Pulmonar/patología , Masculino , Persona de Mediana Edad , Infiltración Neutrófila/inmunología , Pandemias , Neumonía Viral/virología , Mapas de Interacción de Proteínas/inmunología , ARN Viral/genética , Estudios Retrospectivos , Transcriptoma
12.
Zhongguo Shi Yan Xue Ye Xue Za Zhi ; 28(5): 1563-1569, 2020 Oct.
Artículo en Chino | MEDLINE | ID: mdl-33067955

RESUMEN

OBJECTIVE: To explore the influence of lymphocyte / monocyte ratio (LMR), LMR/lactate dehydrogenase (LDH) ratio on the prognosis of patients with diffuse large B-cell lymphoma. METHODS: Clinical data of 107 newly diagnosed patients with DLBCL, including age, sex, stage, B symptoms, IPI score, ECOG score, absolute lymphocyte count, absolute value of monocytes, the ratio of lymphocyte to monocyte(LMR), LDH, LMR/LDH, and SUVmax detected by FDG-PET/CT were analyzed. The best cut-off points of LMR and LMR/LDH were determined by receiver operating characteristics (ROC) curve; the chi-square test was used to analyze the correlation of clinical factors with LMR and LMR/LDH; Spearman correlation analysis was used to determine the correlation between serum LDH level and SUVmax; the Kaplan-Meier protocol was used to compare the overall survival (OS) rate and progression-free survival (PFS) rate between LMR and LMR/LDH groups; the Cox proportional risk model was used to carry out the multivariate analysis of prognostic factors. RESULTS: The optimal limit value for LMR and LMR/LDH (%) determined by ROC curve was 2.535 (P<0.05) and 0.35% (P<0.01) respectively. Patients with an LMR<2.535 had a higher incidence of advanced Ann Arbor stage, B symptoms, higher IPI score, higher ECOG score, and elevated LDH level, while patients with LMR/LDH 0.35% had the same trend as patients with LMR <2.535. A significant positive correlation between serum LDH and SUVmax was observed by Spearman correlation analysis (P<0.001). K-M survival analysis showed that the PFS rate and OS rate in high LMR group were significantly better than that in the low LMR group (P<0.05). K-M analysis showed that the PFS rate and OS rate in high LMR/LDH group were statistical significantly better than that in low LMR/LDH group (P<0.05). Multivariate COX analysis showed that the predictive value in LMR/LDH was much better than single LMR, which may be an independent prognostic factor for patients with DLBCL. CONCLUSION: At the initial diagnosis, high LMR/LDH suggests that DLBCL patient is a better prognosis.


Asunto(s)
L-Lactato Deshidrogenasa , Monocitos , Humanos , Recuento de Leucocitos , Linfocitos , Tomografía Computarizada por Tomografía de Emisión de Positrones , Pronóstico , Estudios Retrospectivos
13.
Pediatr Blood Cancer ; 67(12): e28745, 2020 12.
Artículo en Inglés | MEDLINE | ID: mdl-33009893

RESUMEN

Infection from severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), though mainly a respiratory disease, can impair many systems, including causing hematological complications. Lymphopenia and hypercoagulability have been reported in adults with coronavirus disease 2019 (COVID-19) and are considered markers of poor prognosis. This review summarizes the hematological findings in children with SARS-CoV-2 infection. The majority of infected children had a normal leukocyte count, while the most common white blood cell abnormality was leukopenia. Lymphopenia, which may be a marker of severe disease, was rarer in children than in adults, possibly due to their immature immune system or due to the less severe manifestation of COVID-19 in this age group. Age may have an impact, and in neonates and infants the most common abnormality was lymphocytosis. Abnormalities of red blood cells and platelets were uncommon. Anemia and hypercoagulability were reported mainly in children presenting the novel multisystem inflammatory syndrome (MIS) associated with SARS-CoV-2.


Asunto(s)
Anemia/sangre , Betacoronavirus/metabolismo , Infecciones por Coronavirus/sangre , Linfopenia/sangre , Pandemias , Neumonía Viral/sangre , Trombofilia/sangre , Adolescente , Anemia/epidemiología , Anemia/inmunología , Betacoronavirus/inmunología , Biomarcadores/sangre , Plaquetas/inmunología , Plaquetas/metabolismo , Niño , Preescolar , Infecciones por Coronavirus/epidemiología , Infecciones por Coronavirus/inmunología , Eritrocitos/inmunología , Eritrocitos/metabolismo , Femenino , Humanos , Lactante , Recién Nacido , Recuento de Leucocitos , Linfopenia/epidemiología , Linfopenia/inmunología , Masculino , Neumonía Viral/epidemiología , Neumonía Viral/inmunología , Trombofilia/epidemiología , Trombofilia/inmunología
14.
N Engl J Med ; 383(17): 1624-1634, 2020 10 22.
Artículo en Inglés | MEDLINE | ID: mdl-33085861

RESUMEN

BACKGROUND: Eosinophilic gastritis and duodenitis are characterized by gastrointestinal mucosal eosinophilia, chronic symptoms, impaired quality of life, and a lack of adequate treatments. Mast-cell activity may contribute to the pathogenesis of the conditions. AK002 (lirentelimab) is an anti-Siglec-8 antibody that depletes eosinophils and inhibits mast cells and that has shown potential in animal models as a treatment for eosinophilic gastritis and duodenitis. METHODS: In this phase 2 trial, we randomly assigned adults who had symptomatic eosinophilic gastritis, eosinophilic duodenitis, or both conditions in a 1:1:1 ratio to receive four monthly infusions of low-dose AK002, high-dose AK002, or placebo. The primary end point was the change in gastrointestinal eosinophil count from baseline to 2 weeks after the final dose; to maximize statistical power, we evaluated this end point in the placebo group as compared with the combined AK002 group. Secondary end points were treatment response (>30% reduction in total symptom score and >75% reduction in gastrointestinal eosinophil count) and the change in total symptom score. RESULTS: Of the 65 patients who underwent randomization, 43 were assigned to receive AK002 and 22 were assigned to receive placebo. The mean percentage change in gastrointestinal eosinophil count was -86% in the combined AK002 group, as compared with 9% in the placebo group (least-squares mean difference, -98 percentage points; 95% confidence interval [CI], -121 to -76; P<0.001). Treatment response occurred in 63% of the patients who received AK002 and in 5% of the patients who received placebo (difference, 58 percentage points; 95% CI, 36 to 74; P<0.001). The mean change in total symptom score was -48% with AK002 and -22% with placebo (least-squares mean difference, -26 percentage points; 95% CI, -44 to -9; P = 0.004). Adverse events associated with AK002 were similar to those with placebo, with the exception of higher percentages of patients having mild-to-moderate infusion-related reactions with AK002 (60% in the combined AK002 group and 23% in the placebo group). CONCLUSIONS: In patients with eosinophilic gastritis or duodenitis, AK002 reduced gastrointestinal eosinophils and symptoms. Infusion-related reactions were more common with AK002 than with placebo. (Funded by Allakos; ENIGMA ClinicalTrials.gov number, NCT03496571.).


Asunto(s)
Anticuerpos Monoclonales Humanizados/administración & dosificación , Duodenitis/tratamiento farmacológico , Enteritis/tratamiento farmacológico , Eosinofilia/tratamiento farmacológico , Eosinófilos , Gastritis/tratamiento farmacológico , Lectinas/antagonistas & inhibidores , Adolescente , Adulto , Anciano , Anticuerpos Monoclonales Humanizados/efectos adversos , Anticuerpos Monoclonales Humanizados/farmacología , Antígenos CD/inmunología , Antígenos de Diferenciación de Linfocitos B/inmunología , Relación Dosis-Respuesta a Droga , Método Doble Ciego , Duodenitis/complicaciones , Enteritis/complicaciones , Eosinofilia/complicaciones , Femenino , Gastritis/complicaciones , Tracto Gastrointestinal/inmunología , Humanos , Infusiones Intravenosas/efectos adversos , Lectinas/inmunología , Recuento de Leucocitos , Masculino , Persona de Mediana Edad , Adulto Joven
15.
Medicine (Baltimore) ; 99(43): e22215, 2020 Oct 23.
Artículo en Inglés | MEDLINE | ID: mdl-33120730

RESUMEN

The Increasing prevalence of type 2 diabetes mellitus (T2DM) has been observed in younger adults. Insulin resistance [IR], decreased first-, second-phase insulin secretion, and glucose effectiveness (GE) (IR, first phase insulin secretion [FPIS], second phase insulin secretion [SPIS], and GE), denoted as diabetes factors (DF), are core for developing T2DM. A body of evidence has shown that inflammation contributes to the development of diabetes. In the present study, our goals were first, evaluate the relationships between white blood cell (WBC) count and, second, examine the relative tightness between the 4 DFs to WBC count. Thus, the pathophysiology of T2DM in Chinese young men could be more understood.21112 non-obese males between 18 to 27 years old were recruited (mean age: 24.3 ±â€Š0.017), including 1745 subjects with metabolic syndrome. DFs were calculated by the published equations by our groups as follows:The association between DFs and WBC count was analyzed using a simple correlation. The r-values of the simple correlation are regarded as the tightness of the relationships.Higher WBC, FPIS, SPIS, IR, age, BMI, blood pressure, FPG, TG, Cholesterol, low-density lipoprotein cholesterol and lower HDL-C and GE were observed in subjects with metabolic syndrome. A similar trend was seen across the quartiles of WBC levels. Among the 4 DFs, GE has the highest r-value (r = -0.093, P < .001), followed by IR (r = 0.067, P < .001), SPIS (r = 0.029, P < .001) and FPIS (r = 0.027, P < .001).Elevated WBC count is significantly associated with all the 4 DFs and the relative order of the tightness, from the highest to the lowest, are GE, IR, SPIS, and FPIS in Chinese young men.


Asunto(s)
Glucemia/análisis , Resistencia a la Insulina/fisiología , Secreción de Insulina/fisiología , Recuento de Leucocitos , Síndrome Metabólico/sangre , Adolescente , Adulto , Grupo de Ascendencia Continental Asiática , Presión Sanguínea , Índice de Masa Corporal , Colesterol/sangre , HDL-Colesterol , LDL-Colesterol , Diabetes Mellitus Tipo 2/sangre , Diabetes Mellitus Tipo 2/fisiopatología , Ayuno , Humanos , Masculino , Síndrome Metabólico/fisiopatología , Taiwán , Adulto Joven
17.
PLoS One ; 15(9): e0239318, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32970708

RESUMEN

BACKGROUND: Early risk stratification for guiding treatment priority in the emergency department (ED) is becoming increasingly important. Existing prediction models typically use demographics, vital signs and laboratory parameters. Laboratory-based models require blood testing, which may cause substantial delay. However, these delays can be prevented by the use of point-of-care testing (POCT), where results are readily available. We aimed to externally validate a laboratory-based model for mortality and subsequently assessed whether a POCT model yields comparable performance. METHODS: All adult patients visiting the ED of a university hospital between January 1st, 2012 and December 31st, 2016 were retrospectively reviewed for inclusion. Primary outcome was defined as 30-day mortality after ED presentation. We externally validated one existing prediction model including age, glucose, urea, sodium, haemoglobin, platelet count and white blood cell count. We assessed the predictive performance by discrimination, expressed as Area under the Curve (AUC). We compared the existing model to an equivalent model using predictors that are available with POCT (i.e. glucose, urea, sodium and haemoglobin). Additionally, we internally validated these models with bootstrapping. RESULTS: We included 34,437 patients of whom 1,942 (5.6%) died within 30 days. The AUC of the laboratory-based model was 0.794. We refitted this model to our ED population and found an AUC of 0.812, which decreased only slightly to 0.790 with only POCT parameters. CONCLUSIONS: Our POCT-model performs similar to existing laboratory-based models in identifying patients at high risk for mortality, with results available within minutes. Although the model needs further validation and evaluation, it shows the potential of POCT for early risk stratification in the ED.


Asunto(s)
Mortalidad Hospitalaria , Pruebas en el Punto de Atención , Adulto , Anciano , Área Bajo la Curva , Servicio de Urgencia en Hospital , Femenino , Hospitales Universitarios , Humanos , Recuento de Leucocitos , Masculino , Persona de Mediana Edad , Oportunidad Relativa , Recuento de Plaquetas , Curva ROC , Estudios Retrospectivos , Sodio/sangre , Urea/sangre
18.
Geriatr Gerontol Int ; 20(11): 1044-1049, 2020 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-32924229

RESUMEN

AIM: We aimed to describe the clinical characteristics, treatment and outcomes of patients with COVID-19 pneumonia, in particular older patients, admitted to tertiary and partner hospitals in Saitama, Japan. METHODS: We retrospectively reviewed the medical records of patients with COVID-19 pneumonia admitted to tertiary and partner hospitals in Saitama, Japan. Twenty-six patients with COVID-19 were categorized into two groups, i.e., older (≥75 years) and younger adults (≤74 years). We evaluated the clinical characteristics, comorbidities, symptoms, laboratory test results, treatments and outcomes of the patients. RESULTS: The majority of the older patients had comorbidities, such as dementia, cardiovascular disease and bone fractures. Comorbidities were significantly more frequent in older patients than younger patients. No association was found between age and body temperature or the incidence of respiratory failure. White blood cell count was significantly lower in older patients (P = 0.018) and the decrease in lymphocytes was greater in younger patients (P = 0.009). Computed tomography (CT) of all patients showed non-segmental, peripherally dominant ground-glass opacities consistent with COVID-19 pneumonia. In older patients, antiviral drugs, anticoagulants and anti-inflammatory drugs were administered on a compassionate use basis. The difference in mortality between the older and the younger patients was not statistically significant. CONCLUSIONS: In older patients, typical clinical symptoms and blood test changes were often absent; however, CT always contained typical findings of COVID-19, suggesting that CT may be a useful diagnostic tool. Our report illustrates that appropriate treatment, taking patient background into consideration, may improve their condition regardless of age. Geriatr Gerontol Int 2020; 20: 1044-1049.


Asunto(s)
Infecciones por Coronavirus , Enfermedades no Transmisibles/epidemiología , Pandemias , Neumonía Viral , Tomografía Computarizada por Rayos X , Factores de Edad , Anciano , Betacoronavirus , Comorbilidad , Infecciones por Coronavirus/sangre , Infecciones por Coronavirus/tratamiento farmacológico , Infecciones por Coronavirus/epidemiología , Infecciones por Coronavirus/fisiopatología , Infecciones por Coronavirus/terapia , Femenino , Hospitalización/estadística & datos numéricos , Humanos , Japón/epidemiología , Recuento de Leucocitos/métodos , Recuento de Leucocitos/estadística & datos numéricos , Masculino , Evaluación de Procesos y Resultados en Atención de Salud , Neumonía Viral/sangre , Neumonía Viral/diagnóstico , Neumonía Viral/epidemiología , Neumonía Viral/etiología , Neumonía Viral/fisiopatología , Neumonía Viral/terapia , Factores de Riesgo , Evaluación de Síntomas/métodos , Evaluación de Síntomas/estadística & datos numéricos , Centros de Atención Terciaria/estadística & datos numéricos , Tomografía Computarizada por Rayos X/métodos , Tomografía Computarizada por Rayos X/estadística & datos numéricos
19.
PLoS One ; 15(9): e0238177, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32881893

RESUMEN

INTRODUCTION: Renal hyperfiltration (RHF) has been found to be an independent predictor of adverse cardiovascular outcome. However, it remains uncertain whether it is precursor of chronic kidney disease (CKD) in a healthy population. MATERIALS AND METHODS: To determine relative risks and identify the predictor of incident proteinuria and decline of estimated glomerular filtration rate (eGFR) in subjects with RHF. A total of 55,992 subjects aged ≥20 years who underwent health check-up during 2004-2017 were included. Among them, 16,946 subjects who completed at least two health checkups were analyzed. RESULTS: A total of 949 (5.6%) subjects developed proteinuria and 98 (0.6%) subjects showed ≥ 30% of eGFR decline. The risk of incident proteinuria was significantly higher in those with RHF (RR: 1.644; 95% CI: 1.064-2.541). Those with RHF showed 8.720 fold (95% CI: 4.205-18.081) increased risk for ≥30% decline. ESR, CRP, and monocyte count showed reversed J shaped curve according to the increase of eGFR. The adjusted mean of monocyte count was significantly higher in participants with eGFR ≥90ml/min/1.73m2 or < 60ml/min/1.73m2 compared to that in patients with eGFR 75-89ml/min/1.73m2. Compared to subjects with the lowest tertile of monocyte and no RHF, those with the highest tertile of monocyte count in the RHF group had 3.314-fold (95% CI: 1.893-5.802) higher risk of incident proteinuria and 3.822-fold (95% CI, 1.327-11.006) risk of 30% eGFR decline. CONCLUSIONS: RHF had significantly increased risk of developing proteinuria and CKD in healthy subjects. Higher monocyte count might be used as a predictor of CKD in subjects with RHF.


Asunto(s)
Insuficiencia Renal Crónica/diagnóstico , Adulto , Proteína C-Reactiva/análisis , Estudios de Cohortes , Tasa de Filtración Glomerular , Humanos , Recuento de Leucocitos , Masculino , Persona de Mediana Edad , Modelos de Riesgos Proporcionales , Proteinuria/diagnóstico , Proteinuria/epidemiología , Factores de Riesgo , Adulto Joven
20.
PLoS One ; 15(9): e0238524, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32915806

RESUMEN

BACKGROUND: Markers of lung inflammation measured directly in expectorated sputum have the potential of improving the timing of antibiotic treatment in cystic fibrosis (CF). L-Lactate might be a marker of inflammation, as it is produced from glucose by polymorphonuclear neutrophils (PMNs) in CF lungs. We aimed to investigate changes in and associations between PMNs, glucose and L-lactate in sputum during antibiotic treatment. In addition, the effect of hemoglobin A1c and plasma glucose on these biomarkers were investigated. METHODS: We sampled non-induced sputum at day 0, 7, 14 and 42 in 27 chronically infected CF patients electively treated with 14 days of intravenous antibiotic. To analyze sputum samples, we used flowcytometry to count PMNs and colorimetric assays to estimate lactate and glucose. RESULTS: No changes in levels of PMNs, glucose and lactate were detected in sputum during the antibiotic treatment. Sputum PMNs were positively associated with both glucose (log coefficient = 0.20, p = 0.01) and L-lactate (log coefficient = 0.34, p<0.001). In multivariate analyses, hemoglobin A1c was negatively associated with sputum PMNs (log coefficient = -1.68, p<0.001) and plasma glucose was negatively associated with sputum glucose (log coefficient = -0.09, p = 0.02). CONCLUSIONS: In CF sputum PMNs, glucose and lactate were unchanged during elective antibiotic treatment. However, sputum PMNs were associated with both sputum glucose and sputum lactate. Surprisingly, hyperglycemia seemed to be associated with less PMNs infiltration and less glucose in CF sputum.


Asunto(s)
Fibrosis Quística/sangre , Glucosa/metabolismo , Ácido Láctico/metabolismo , Neutrófilos/metabolismo , Esputo/metabolismo , Adulto , Anciano , Antibacterianos/administración & dosificación , Antibacterianos/uso terapéutico , Biomarcadores/metabolismo , Glucemia/metabolismo , Fibrosis Quística/fisiopatología , Femenino , Hemoglobina A Glucada/metabolismo , Humanos , Inyecciones Intravenosas , Recuento de Leucocitos , Masculino , Análisis Multivariante , Pruebas de Función Respiratoria , Adulto Joven
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