Evaluation of lymphocyte count, T-cell subsets and neutrophil-to-lymphocyte ratio as early predictors for severity and outcome of COVID-19 disease-a report from a highly complex hospital in Brazil

ABSTRACT Introduction: Lymphopenia is a laboratory marker of poor prognosis and severity of disease in the SARS-CoV-2 infection. This study aims to describe the immune profile of a Brazilian population. Methods: A total of 121 consecutive patients with severe acute respiratory syndrome (SARS) were analyzed between April and June 2020. Routine peripheral blood counts and multiparametric flow cytometry were performed on admission to assess lymphocytes and subsets (CD3, CD4, CD8). Demographic, clinical and laboratory data were collected from hospital sources. Results: The total of 116 patients included 63 (54.3%) males; 76 (62.8%) COVID-19 patients were divided, based on clinical characteristics and mechanical ventilation (MV) use, into moderate (n = 41; no MV) and severe (n = 35; MV) groups. The control group (n = 40) was comprised of patients with SARS of different etiologies. All patients had lymphopenia, with overall lymphocyte counts and their subsets considerably lower in severe patients, when compared to the moderate and controls. Patients with a high neutrophil-to-lymphocyte ratio (> 15.2) and T-cell lymphopenia (CD3 < 593 cells/μL, CD4 < 326 cells/μL, CD8 < 121 cells/μL) had a higher risk of being intubated and progressing to death. A total of 39 patients (95.1%) in the moderate group and 54.3% (n = 19) in the severe group were discharged; 28 patients died. Conclusion: Laboratory assessment of the neutrophil/lymphocyte ratio and T-cell subsets may be predictive of mortality and may be useful for stratifying COVID-19 patients.

Survival benefit of pediatric-based regimen for adults with acute lymphoblastic leukemia: A single-center retrospective cohort

ABSTRACT Introduction: Improving survival of Acute Lymphoblastic Leukemia (ALL) in adult patients has been a challenge. Despite intensive chemotherapy treatment, overall survival is poor. However, several studies demonstrate that young adult patients have better survival when treated with pediatric-based intensive regimens. Considering these results, We decided to treat newly diagnosed ALL patients according to age and risk factors. The goal of this study was to describe the results of this intensive chemotherapy treatment approach for ALL adult patients diagnosed at our institution. Methods: Fifty-eight ALL patients, diagnosed from 2004 to 2013, were included in the analysis. Patients were assigned to either the St. Jude Total Therapy XIIIB high-risk arm (St Jude) or the CALGB 8811 (CALGB). The Kaplan-Meier survival curve was used for the survival analyses and the Cox proportional hazard regression, for multivariable analysis. Results: The overall survival was 22.9% at 10 years. The St. Jude improved survival, compared to the CALGB (p = 0.007), with 32.6% vs. 7.4% survival rate at 10 years. However, no survival benefit was found for patients younger than 20 years old (p = 0.32). The multivariable analysis demonstrated that undetectable minimal residual disease (MRD) and hematopoietic stem cell transplantation (HSCT) had beneficial impact on survival (p = 0.0007 and p = 0.004, respectively). Conclusion: ALL is a disease of poor prognosis for adults. The joint effort to standardize treatment and seek solutions is the way to start improving this scenario.

Evaluation of lymphocyte count, T-cell subsets and neutrophil-to-lymphocyte ratio as early predictors for severity and outcome of COVID-19 disease-a report from a highly complex hospital in Brazil.

INTRODUCTION: Lymphopenia is a laboratory marker of poor prognosis and severity of disease in the SARS-CoV-2 infection. This study aims to describe the immune profile of a Brazilian population. METHODS: A total of 121 consecutive patients with severe acute respiratory syndrome (SARS) were analyzed between April and June 2020. Routine peripheral blood counts and multiparametric flow cytometry were performed on admission to assess lymphocytes and subsets (CD3, CD4, CD8). Demographic, clinical and laboratory data were collected from hospital sources. RESULTS: The total of 116 patients included 63 (54.3%) males; 76 (62.8%) COVID-19 patients were divided, based on clinical characteristics and mechanical ventilation (MV) use, into moderate (n = 41; no MV) and severe (n = 35; MV) groups. The control group (n = 40) was comprised of patients with SARS of different etiologies. All patients had lymphopenia, with overall lymphocyte counts and their subsets considerably lower in severe patients, when compared to the moderate and controls. Patients with a high neutrophil-to-lymphocyte ratio (> 15.2) and T-cell lymphopenia (CD3 < 593 cells/µL, CD4 < 326 cells/µL, CD8 < 121 cells/µL) had a higher risk of being intubated and progressing to death. A total of 39 patients (95.1%) in the moderate group and 54.3% (n = 19) in the severe group were discharged; 28 patients died. CONCLUSION: Laboratory assessment of the neutrophil/lymphocyte ratio and T-cell subsets may be predictive of mortality and may be useful for stratifying COVID-19 patients.

Recommendations for quality assurance in multiparametric flow cytometry: first consensus of the Brazilian Group of Flow Cytometry (GBCFLUX) / Recomendações para garantia da qualidade em citometria de fluxo multiparamétrica: primeiro consenso do Grupo Brasileiro de Citometria de Fluxo (GBCFLUX)

ABSTRACT The Brazilian Group of Flow Cytometry (Grupo Brasileiro de Citometria de Fluxo [GBCFLUX]), founded on April 24, 2010, is composed of experts in flow cytometry (FC) area who have the common objective of contributing to technical and scientific advances in Brazilian clinical and research laboratories. Among GBCFLUX working groups, the Quality Control (QC) subcommittee is responsible for discussing data in the literature and contributes to the quality assurance of the pre-analytical, analytical and post-analytical process in FC. The QC subcommittee's actions began through meetings and lectures, in which data from the literature were reviewed and discussed with all participating members of the GBCFLUX. In a second step, it was decided to draw up a text of technical and scientific consensus recommendations, informative and educative, for dissemination to all FC working groups in Brazil. To this effect, a questionnaire with objective responses was designed and sent to 35 recognized Brazilian institutions, in order to evaluate the QC profile of these institutions. Thus, the QC technical-scientific recommendations, which will be described in this updating article, are intended to ensure the process quality, technical standardization, and reproducibility of results in FC.

RESUMO O Grupo Brasileiro de Citometria de Fluxo (GBCFLUX), fundado em 24 de abril de 2010, é composto por especialistas da área de citometria de fluxo (CF) que possuem o objetivo comum de contribuir para avanços técnico-científicos em laboratórios clínicos e de pesquisa brasileiros. Entre os grupos de trabalho do GBCFLUX, o subcomitê de Controle de Qualidade (CQ) é responsável por discutir dados da literatura e contribuir para a garantia da qualidade do processo pré-analítico, analítico e pós-analítico em CF. As ações do subcomitê de CQ iniciaram-se por meio de reuniões e palestras, nas quais dados da literatura foram revisados e discutidos com todos os membros participantes do GBCFLUX. Em uma segunda etapa, definiu-se elaborar um texto de recomendações consensuais técnicocientíficas, informativas e educativas para divulgação a todos os grupos que trabalham com CF no Brasil. Para tanto, foi elaborado um questionário com respostas objetivas, sendo enviado para 35 instituições brasileiras cadastradas, com a finalidade de avaliar o perfil de CQ dessas instituições. Dessa forma, as recomendações técnico-científicas de CQ que serão descritas neste artigo de atualização têm o objetivo de contribuir para a garantia da qualidade do processo, a padronização técnica e a reprodutibilidade dos resultados em CF.

Paroxysmal nocturnal hemoglobinuria clone in 103 Brazilian patients: diagnosis and classification

Background: Paroxysmal nocturnal hemoglobinuria is an acquired chronic hemolytic ane- mia, which often manifests as peripheral blood cytopenias and thrombosis. Objective: The aim of this study is to describe a Brazilian population of paroxysmal nocturnal hemoglobinuria patients. Methods: One hundred and three paroxysmal nocturnal hemoglobinuria cases were retrospectively reviewed and the clinical presentation, thrombosis, survival, and clone size were assessed. Diagnosis was established by flow cytometry. Results: Fifty-two male and 51 female patients with a median age of 24.1 years (5.5-62 years) were studied. Clinical symptoms included hemoglobinuria (18.4%), infection (46.6%) and thrombosis (16.5%), and 80.6% had pancytopenia. Patients were classified as classic parox- ysmal nocturnal hemoglobinuria (10), paroxysmal nocturnal hemoglobinuria with aplastic anemia (39), and paroxysmal nocturnal hemoglobinuria with subclinical features and aplas- tic anemia (54). There were significant differences in terms of median age, size of clone, clinical symptoms, and peripheral blood cell counts between the three subcategories. The clone size in erythrocytes and granulocytes were respectively 0.04% (range: 0-18%) and 7.3% (range: 0.3-68.7%) in patients with subclinical features and aplastic anemia, 15.8% (range: 0-99.7%) and 63.0% (range: 1.7-99.8%) in patients with aplastic anemia alone, and 82.2% (range: 0-99.85%) and 98.0% (81.3-100.0%) in Classic disease. Statistical differences were identified for platelets (p-value = 0.001), lactate dehydrogenase (p-value = 0.002) and the clone size (p-value < 0.001) in patients who suffered thrombotic events compared to those who did not. Overall survival was 81.7%, with patients with subclinical features and aplastic anemia having lower overall survival (76.5%). Conclusion: This retrospective review of 103 patients over an 11-year period represents the largest collection of paroxysmal...

Relationship between anthropometric and hemodynamic indexes in school children / Relação entre os indicadores antropométricos e hemidonâmicos em escolares

Cardiovascular diseases are the main cause of death in world population. Current analysis with 1074 schoolchildren in municipal schools of Cruzeiro do Oeste, Paraná State, Brazil, evaluated anthropometric indexes and blood pressure levels of schoolchildren and verified the relationship between Body Mass Index (BMI) and Waist Circumference (WC) with blood pressure (BP). Evaluations comprised weight and height for the calculation of BMI, waist circumference and arterial pressure. Chi-square test and Cramer's coefficient verified whether the variables were associated. High percentage of weight excess was reported, or rather, 16.6% of children were overweight; 9.8% were obese; 30.6% had high WC and 38.3% had high blood pressure. BMI and WC were associated with high BP. Overweight schoolchildren with central adiposity had a great trend of having high blood pressure.

As doenças cardiovasculares são a principal causa de morte na população. O estudo objetivou avaliar os indicadores antropométricos e os níveis pressóricos de escolares e verificar a relação entre esses indicadores: Índice de Massa Corporal (IMC) e Circunferência de Cintura (CC) com Pressão Arterial (PA). O estudo foi realizado com 1.074 escolares, em escolas municipais do município de Cruzeiro do Oeste, Estado do Paraná. As avaliações consistiram em medida de peso e estatura para o cálculo do Índice de Massa Corporal, da Circunferência da Cintura e da Pressão Arterial. Associações entre as variáveis foram verificadas utilizando do teste de qui-quadrado e pelo coeficiente de Cramer. Observou-se elevado percentual de excesso de peso, sendo sobrepeso de 16,6% e obeso 9,8%, 30,6% de CC alterada e 38,3% de escolares com medidas pressóricas elevadas. Tanto IMC como CC demonstraram associação com PA elevada. Os escolares com excesso de peso e adiposidade central apresentam maiores chances de elevar suas medidas pressóricas.

Prevalence of overweight/obesity and economical status of schoolchildren.

OBJECTIVE: To associate the nutritional status of elementary schoolchildren with their gender, age group, and economic status based on a cross-sectional study carried out at public schools in the municipality of Cruzeiro do Oeste, Southern Brazil. METHODS: The study was performed in 2010 including 939 schoolchildren aged six to ten years-old. The economical status of the families was classified based on a socioeconomic ranking questionnaire (Brazilian Association of Survey Companies), and the body mass index was calculated. Data were analyzed by descriptive statistics, and differences between independent groups were verified by Mann-Whitney and Kruskal-Wallis tests, while possible associations were verified by the chi-square test, being significant p<0.05. RESULTS: The prevalence of obesity in the sample was 8.0%, and overweight, 16.4%. No association was found between the socioeconomic and nutritional status or between the nutritional status and gender. CONCLUSIONS: A high prevalence of overweight and obesity was found in this study, indicating that children of both genders are affected regardless of their economical status and age.

Prevalência de sobrepeso/obesidade e nível econômico de escolares / Prevalence of overweight/obesity and economical status of schoolchildren / Prevalencia de sobrepeso/obesidad y nivel económico de escolares

OBJETIVO: Associar o estado nutricional com sexo, grupo etário e nível econômico de escolares do ensino fundamental por meio de um estudo transversal nas escolas municipais do município de Cruzeiro do Oeste, Paraná, Brasil. MÉTODOS: A pesquisa foi realizada em 2010 com 939 alunos com idades entre seis e dez anos. Para tanto, realizou-se a classificação do nível econômico das famílias por meio do questionário de ranking econômico (Associação Brasileira de Empresas de Pesquisa) e foi calculado o índice de massa corpórea. A análise dos dados foi realizada por estatística descritiva, e a verificação de diferenças entre grupos independentes pelos testes de Mann-Whitney e Kruskal-Wallis, bem como possíveis associações foram verificadas pelo teste do qui-quadrado. Para todos os procedimentos adotou-se o nível de significância de p<0,05. RESULTADOS: A prevalência de obesidade na amostra estudada foi de 8,0% e de sobrepeso, 16,4%. Não houve associação entre nível econômico e estado nutricional, assim como entre estado nutricional e sexo. CONCLUSÕES: A prevalência de sobrepeso e obesidade foi considerada alta, evidenciando que crianças de ambos os sexos são afetadas, independentemente de seus níveis econômicos e grupo etário.

OBJECTIVE: To associate the nutritional status of elementary schoolchildren with their gender, age group, and economic status based on a cross-sectional study carried out at public schools in the municipality of Cruzeiro do Oeste, Southern Brazil. METHODS: The study was performed in 2010 including 939 schoolchildren aged six to ten years-old. The economical status of the families was classified based on a socioeconomic ranking questionnaire (Brazilian Association of Survey Companies), and the body mass index was calculated. Data were analyzed by descriptive statistics, and differences between independent groups were verified by Mann-Whitney and Kruskal-Wallis tests, while possible associations were verified by the chi-square test, being significant p<0.05. RESULTS: The prevalence of obesity in the sample was 8.0%, and overweight, 16.4%. No association was found between the socioeconomic and nutritional status or between the nutritional status and gender. CONCLUSIONS: A high prevalence of overweight and obesity was found in this study, indicating that children of both genders are affected regardless of their economical status and age.

OBJETIVO: asociar el estado nutricional con el sexo, la franja de edad y el nivel socioeconómico de escolares de la enseñanza primaria, mediante estudio transversal en las escuelas municipales de la ciudad de Cruzeiro do Oeste (Paraná, Brasil). MÉTODOS: La investigación fue realizada en 2010, con 939 alumnos entre seis y diez años. Para eso, se realizó la clasificación del nivel económico de las familias mediante cuestionario de clasificación económica (Asociación Brasileña de Empresas de Investigación - ABEP) y se calculó el índice de masa corporal. El tratamiento estadístico se realizó por medio de los recursos de la estadística descriptiva y la verificación de diferencias entre grupos independientes por las Pruebas de Mann-Whitney y Kruskal-Wallis, así como posibles asociaciones fueron verificadas por la prueba de chi-cuadrado. Para todos los procedimientos se adoptó el nivel de significancia de p<0,05. RESULTADOS: La prevalencia de obesidad en la muestra estudiada fue de 8,0% y la de sobrepeso fue de 16,4%. No hubo asociación entre nivel económico y estado nutricional, así como entre estado nutricional y sexo. CONCLUSIONES: La prevalencia de sobrepeso y obesidad fue considerada alta, evidenciando que niños de ambos sexos son afectados, independiente de su nivel económico y franja de edad.

Prevalência e fatores associados ao excesso de peso em escolares / Overweight prevalence and factors associated with school-aged children / Prevalencia y factores asociados al sobrepeso en los escolares

O excesso de peso em escolares deve ser visto com atenção, pois a obesidade ou excesso de gordura corporal é comprovadamente fator de risco para a saúde humana. O estudo teve como objetivo verificar a prevalência e os fatores associados ao excesso de peso em escolares. Participaram 1.074 escolares de 6 a 10 anos, das escolas municipais do município de Cruzeiro do Oeste (PR). Foram coletadas informações antropométricas, sociodemográficas e comportamentos sedentários. A prevalência de excesso de peso para toda a amostra foi de 26,4% e não houve associação entre os sexos para as variáveis: idade, massa corporal, estatura, Índice de Massa Corporal (IMC) e nível econômico; fatores socioeconômicos e comportamentais não apresentaram associação entre os sexos com exceção da variável tempo em frente à televisão (TV). Escolares com hábito de assistir TV por mais de 4 horas por dia apresentaram 1,4 vezes mais chance de ter excesso de peso em relação àqueles que assistem menos de 4 horas diárias. Escolares com hábito de comer em frente à TV, computador (PC) ou Game apresentaram 34% mais chance de ter excesso de peso. Concluiu-se que deve ser dada atenção à prevalência de excesso de peso em escolares, voltadas à orientação nutricional e à atividade física.

Overweight prevalence in school-aged children should be viewed carefully since obesity or excess of body fat has proven to be a risk factor for human health. The purpose of this study was to determine prevalence and factors associated with overweight in school-agedchildren. A number of 1074 school-aged children participated in this research from 6 to 10 years, from public schools in the municipality of Cruzeiro do Oeste, state of Paraná, Brazil. Anthropometric and sociodemographic data was collected as well as sedentary behaviorinformation. The prevalence of overweight for the entire sample was 26.4%, there was no association between the sexes for the variables: age, body mass, height, BMI (Body Mass Index) and economic level. Socio-economic status and behavioral factors were not associated with gender, except the variable time in front of the TV (television). School-aged children that have the habit of watching TV for more than 4 hours per day had 1.4 times more probability to be overweighed than those who watch less than 4 hours daily. School-aged children with the habit of eating in front of the TV, computer or playing games had 34% more chanceto be overweight. These results indicate that attention should be paid to the prevalence of overweight in school-aged children, focusing on nutrition education and physical activities.

El sobrepeso en escolares requiere atención pues, la obesidad o exceso de grasa corporal es comprobadamente factor de riesgo para la salud humana. El objetivo de este estudio fue determinar la prevalencia y los factores asociados con el sobrepeso en escolares. Participantes 1.074 escolares de 6 a 10 años, de las escuelas públicas del municipio de Cruzeiro do Oeste (PR). Fueron recolectadas informaciones antropométricas, sociodemográficas y comportamientos sedentarios. La prevalencia del sobrepeso para toda la muestra fue de 26,4%, no hubo asociación entre los sexos para las variables: edad, peso, talla, IMC (índice de masa corporal) y nivel económico; factores socioeconómicos yde comportamiento no se asociaron con el género, con excepción de la variable tiempo en frente de la TV. Los estudiantes con el hábito de ver la TV durante más de 4 horas por día, presentaron 1,4 veces más probabilidades de tener sobrepeso, en comparación con aquellos que ven TV menos de 4 horas diarias. Los estudiantes con el hábito de comer en frente de la TV, del ordenador (PC) o juegos, presentaron 34% más probabilidades de tener sobrepeso. Se concluye que se debe prestar atención a la prevalencia de sobrepeso en los escolares a escuela, orientada a la educación nutricional y a la actividad física.

Prevalência de llteração das medidas antropométricas em escolares / Prevalence of ntthropometric measurement alteration in school childeen

O sobrepeso e a obesidade estão entre os principais problemas de saúde pública. As medidas de índice de massa corporal (IMC) e circunferência da cintura (CC) têm sido ferramentas importantes para detectar o sobrepeso e obesidade. A medida da CC em crianças, além de apresentar relação com adiposidade da região central do corpo, apresenta associação com fatores de risco para Doenças Cardiovasculares (DCV). O objetivo do presente estudo foi associar as alterações antropométricas de IMC e CC e comparar as variáveis de acordo com os grupos etários em escolares de seis a dez anos de idade. O diagnóstico consistiu em avaliação antropométrica de 1074 escolares de 6 escolas de Cruzeiro do Oeste, PR. As medidas antropométricas utilizadas neste estudo foram: Peso, Estatura e Circunferência da Cintura. Apresentaram excesso de peso 26,4%, destas 9,8% são obesas. Entre as meninas 33,3%, apresentaram CC alterada e entre os meninos 27,9%, sem diferença significativa entre os gêneros sexuais.

Overweight and obesity are major public health problems. Measurementss of body mass index (BMI) and waist circumference (WC) have been important tools to detect overweight and obesity. WC measurement in children, besidespresenting a relationship with central adiposity of the body, is associated with risk factors of Cardiovascular Disease (CVD). The aim of this study was to associate anthropometric changes of BMI and WC and compare variables according to age groups in six- to ten-year-old school children. The diagnosis consisted of anthropometric measurements of 1074 students from six schools in Cruzeiro do Oeste, PR. The anthropometric measurements used in this study were: weight, height and waist circumference. Were overweight 26.4% were considered overweigh, and 9.8% of them were classified as obese. Among the girls,33.3% had altered CC, and among boys 27.9%. There was no significant difference between the genders.

Insuficiência renal aguda como manifestação inicial de linfoma de Burkitt renal / Acute renal failure as first clinical presentation of BurkittÆs renal lymphoma

Relatamos o caso de um jovem de 14 anos que procurou atendimento médico por edema e hipertensão, sendo insuficiência renal aguda secundária a linfoma de Burkitt renal diagnosticada após avaliação laboratorial, de imagem e biópsia de massa tumoral renal.

This case report is from a 14-year-old boy who had edema and hypertension due to a primary renal Burkitt's lymphoma, diagnosed through laboratory and image evaluation and kidney tumor biopsy.