Myasthenia gravis (MG) is a rare autoimmune disease characterized by fatigable weakness of the voluntary muscles and can exacerbate to life-threatening myasthenic crisis (MC), requiring intensive ...care treatment. Routine laboratory parameters are a cost-effective and widely available method for estimating the clinical outcomes of several diseases, but so far, such parameters have not been established to detect disease progression in MG.
We conducted a retrospective analysis of selected laboratory parameters related to inflammation and hemogram for MG patients with MC compared to MG patients without MC. To identify potential risk factors for MC, we applied time-varying Cox regression for time to MC and, as a sensitivity analysis, generalized estimating equations logistic regression for the occurrence of MC at the next patient visit.
15 of the 58 examined MG patients suffered at least one MC. There was no notable difference in the occurrence of MC by antibody status or sex. Both regression models showed that higher counts of basophils (per 0.01 unit increase: HR = 1.32, 95% CI = 1.02-1.70), neutrophils (per 1 unit increase: HR = 1.40, 95% CI = 1.14-1.72), potentially leukocytes (per 1 unit increase: HR = 1.15, 95% CI = 0.99-1.34), and platelets (per 100 units increase: HR = 1.54, 95% CI = 0.99-2.38) may indicate increased risk for a myasthenic crisis.
This pilot study provides proof of the concept that increased counts of basophils, neutrophils, leukocytes, and platelets may be associated with a higher risk of developing MC in patients with MG.
Background:
In clinical practice, distinguishing disease activity in patients with rheumatological illnesses is challenging.
Objectives:
We aimed to investigate clinical associations of ...hemogram-derived indices, namely: red cell distribution width (RDW), mean platelet volume (MPV), neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), lymphocyte-to-monocyte ratio (LMR), and systemic immune-inflammation index (SII) with disease activity in patients with rheumatoid arthritis (RA), systemic lupus erythematosus (SLE), and ankylosing spondylitis (AS).
Methods:
In 250 patients with rheumatological disease and 100 healthy age-matched controls, we investigated disease activity scores and indicators and evaluated their association with hemogram-derived indices values.
Results:
Compared with the control group, RDW, MPV, and PLR significantly increased (P < .001) in the three studied disorders (RA, SLE, and AS), but LMR dramatically decreased. SII was considerably higher in RA and AS patients compared with controls but not in SLE patients. On the other hand, NLR rose dramatically in SLE patients compared with controls (P = .043), but did not change much in RA and AS patients (P > .05). RDW and MPV showed significant changes (P < .001) in the three studied diseases (RA, SLE, and AS) according to disease activity. They significantly increased across worsening activity scores. Only in the SLE group, PLR was significantly increased with disease activity (P < .001), while LMR showed a significant decrease (P = .016).
Conclusions:
Clinicians must pay close attention to complete blood count (CBC) analysis and its various derived ratios to better characterize the activity of rheumatological disorders and anticipate the disease course and prognosis.
COVID-19 disease is caused by SARS-CoV-2 which can trigger acute respiratory syndrome, which presents with dense alveolar and interstitial infiltrates and pulmonary edema, causing severe hypoxemia ...and significant alteration to pulmonary mechanics with reduced pulmonary compliance. The photobiomodulation technique alters cellular and molecular metabolism, showing promising results regarding the reduction of acute pulmonary inflammation.
To compare the photomodulation technique using near-infrared LED to conventional respiratory physiotherapy treatment in patients with COVID-19 in reversing acute conditions, reducing hospitalization time, and decreasing the need for oxygen therapy.
The cohort was comprised of 30 patients undergoing COVID-19 treatment who were divided and allocated into two equal groups randomly: the LED group (LED), treated with infrared LED at 940 nm and conventional therapy, and the control group (CON), who received conventional treatment (antibiotic therapy for preventing superimposed bacterial infections, and physiotherapy) with LED irradiation off. Phototherapy used a vest with an array of 300 LEDs (940 nm) mounted on a 36 cm × 58 cm area and positioned in the patient's anterior thoracic and abdominal regions. The total power was 6 W, with 15 min irradiation time. Cardiopulmonary functions and blood count were monitored before and after treatment. The patients were treated daily for 7 days. Statistical analysis was conducted using a two-tailed unpaired Student's t-test at a significance level of α = 0.05.
Post-treatment, the LED group showed a reduction in hospital discharge time and a statistically significant improvement for the following cardiopulmonary functions: Partial Oxygen Saturation, Tidal Volume, Maximum Inspiratory, and Expiratory Pressures, Respiratory Frequency, Heart Rate, and Systolic Blood Pressure (p < 0.05). Regarding blood count, it was observed that post-treatment, the LED group presented with significant differences in the count of leukocytes, neutrophils, and lymphocytes.
Photobiomodulation therapy can be used as a complement to conventional treatment of COVID-19, promoting the improvement of cardiopulmonary functions, and minimization of respiratory symptoms.
•A vest with an array of infrared LEDs was used for treatment of COVID-19 patients.•Photobiomodulation with infrared LED reduced hospitalization time for COVID-19.•Infrared LED photobiomodulation promotes improvement of cardiopulmonary functions.•Minimized symptoms of COVID-19 patients.•Photobiomodulation therapy can be used as an adjunct in the treatment in COVID-19.
This study identified the main clinical and laboratorial alterations of Anaplasma phagocytophilum naturally infected horses that were treated using oxytetracycline as the only medicine, totalizing 5 ...treatments. It was evaluated six horses presenting clinical symptoms with a definitive diagnostic by direct observation of blood smears or PCR. All he animals showed alterations on hematology and serum biochemistry, compatible to an acute infection. During the treatment, it was seen that the values of almost all the evaluated parameters returned to normal. Animals diagnosed with acute infection presented hypoalbuminemia, hyperglobulinemia and diminished values of ALT and AST. The use of oxytetracycline in equines must be done with caution due to the risk of myositis and diarrhea and is necessary the biochemistry profile follow up to avoid any problems during the treatment.
O presente trabalho identificou as principais alterações clínicas e laboratoriais de equinos naturalmente infectados por Anaplasma phagocytophilum e tratado utilizando-se oxitetraciclina de longa ação como único medicamento, num total de cinco aplicações. Foram avaliados seis equinos com infecção natural pelo agente Anaplasma phagocytophilum apresentando sintomatologia clínica e com diagnóstico definitivo realizado por meio de exame direto de esfregaço sanguíneo e PCR. Os animais apresentaram alterações nos valores hematimétricos e bioquímicos antes do tratamento, compatíveis com infeções de caráter agudo. Ao longo do tratamento observou-se melhora clínica e retorno aos valores de referência para a maioria dos parâmetros avaliados. Os animais com infecção aguda diagnosticada pela presença de inclusão intracitoplasmática ou PCR apresentaram hipoalbuminemia, hiperglobulinemia e diminuição nas concentrações de ALT e AST no momento do diagnóstico retornando aos valores de referência após o tratamento. A utilização de oxitetraciclina de longa ação em equinos deve ser realizada com muita cautela devido aos riscos de miosite e diarreias e se faz necessário o acompanhamento laboratorial, do perfil bioquímico destes animais, a fim de se evitar quaisquer problemas ao longo do tratamento.
Postpartum uterine infections of dairy cows promote a local and systemic inflammation and interfere with reproductive efficiency. The aim of this study was to evaluate the effect of steroid hormones ...including progesterone (P4) and estradiol (E2) on the systemic inflammatory response of cows after being challenged with an intrauterine infusion of lipopolysaccharide (LPS). For this, a hemogram and serum dosage of haptoglobin (Hp) in eight primiparous Gir cows ovariectomized were performed on day (day 0) and after 24 h (day +1). Four cows (n = 4) were challenged (day 0) with 20 mL of 0.9% NaCl + 12.5 μg/kg LPS, and four cows (n = 4) were challenged (day 0) with 20 mL of 0.9% NaCl. For this, the study was divided in four experimental groups as: (1) Control group: without any hormonal treatment before day 0; (2) Group 24 h - E2: 1 mg of estradiol benzoate 24 h before (day −1); (3) Group 24 h - P4: 2.0 g of P4 device 24 h before (day −1); (4) Group 14 d - P4: 2.0 g of P4 device 14 days before (day −14). In the systemic response to LPS, there was an increase in Hp (control group; 24 h - P4 group; 14 d - P4 group), and on day +1 the Hp of 14 d - P4 group was higher when compared to the other groups. On day 0, the 14 d - P4 group had an increase in circulating leukocytes and lymphocytes cells than the control group (P < 0.01). On day +1 after LPS-challenge the 14 d - P4 group showed a decrease in circulating lymphocytes, eosinophils, and monocytes (P < 0.05). A neutrophilia with left shift in the two treatments with P4 (day +1), in addition to a thrombocytopenia and lower platelets compared to the 24 h - E2 group (P < 0.05) (day 0) were recorded. It was concluded that ovariectomized cows challenged with LPS, previously submitted to steroid hormones induce a systemic inflammatory response. Also, the systemic response is more intense after previous prolonged exposure to P4 and less intense after exposure to E2. This study provided important information relating the effect of ovarian steroids on the systemic inflammatory response of cows challenged with intrauterine LPS.
•The bilateral flank ovariectomy surgery reduces progesterone (P4) levels in cows.•Intrauterine infusion (iu) of lipopolysaccharide (LPS) promotes endometrial inflammation.•The intensity of the systemic inflammatory response to the iu LPS challenge is dependent on P4 and estradiol (E2).•The systemic response is more intense in previous prolonged exposure to P4.•The systemic response is less intense in previous exposure to E2.
Amaç: Bu çalışmanın amacı ektopik gebelik ve düşük tehdidi mevcut olan hastaların hemogram parametrelerini, normal intrauterin gebeliği olan hastalar ile karşılaştırmak, bu parametrelerin ektopik ...gebelik erken tanısında ve düşük tehdidi ayrımında kullanılabilirliğini araştırmaktır.
Gereç ve Yöntem: Çalışmamız Ocak 2016-Ocak 2019 tarihleri arasında hastanemizde ektopik gebelik tanısı ile medikal ya da cerrahi yolla tedavi edilmiş (n:50), ve düşük tehdidi tanısı ile hospitalize edilmiş hastalar (n:50) ile normal intrauterin gebeliği mevcut olan hastalar (n:50) arasında retrospektif bir araştırma olarak planlandı. Tüm hastaların preoperatif ve hastaneye yatış hemogram kan parametreleri dosyalarından elde edildi. Tüm gruplarda sosyodemografik veriler, tam kan sayımı kaydedildi. Nötrofil lenfosit oranı (NLR), trombosit lenfosit oranı (PLR), lenfosit monosit oranı (LMR) hesaplandı.
Bulgular: Düşük tehdidi ve ektopik gebeliklerde lenfosit sayısı, kontrol grubuna göre daha yüksek olarak saptandı. PDW, ektopik gebeliklerde kontrol grubuna göre anlamlı düzeyde düşük saptandı. Monosit değerleri, düşük tehdidi grubunda kontrol grubuna göre anlamlı olarak daha yüksek bulundu. Düşük tehdidinde PLR kontrol grubuna göre anlamlı olarak daha düşük saptandı.
Sonuç: PDW değerlerinin düşük bulunması ektopik gebelikte mikroçevreyi değiştirerek gebeliğin implantasyonu bozmakla suçlanmaktadır. Mevcut çalışmada PDW değerlerinin ektopik gebelikte düşük bulunması nedeni ile bu parametre kullanılarak, erken tanısında faydalı olabilir.
Background . Early diagnosis of the mixed infection of ixodic tick-borne borreliosis and tick-borne encephalitis can be difficult without laboratory confirmation of the diagnosis. The aim. To assess ...clinical and laboratory predictors in patients for building the models of early differential diagnosis between mixed infection of erythema form of ixodic tick-borne borreliosis and febrile form of tick-borne encephalitis and monoinfection of erythema form of ixodic tick-borne borreliosis. Materials and methods. The clinical study included 26 patients with mixed infection of the erythema form of ixodic tick-borne borreliosis with tick-borne encephalitis (mean age – 46.7 years) and 30 patients with monoinfection of the erythema form of ixodic tick-borne borreliosis (mean age – 48.5 years). 59 clinical, epidemiological and laboratory parameters, including 6 leukocyte blood indices, standard and extended hemogram profiles were studied in these patients the first week of the disease. For statistical analysis, we used Pearson and Mann – Whitney goodness-of-fit tests, ROC analysis with calculation of the area under curve (AUC) and logistic regression. Results. Patients with mixed infection, compared to the patients with monoinfection, had increased odds of having febrile fever, weakness, headache and orbital pain; meningism symptoms occurred only in patients with mixed infection. Early predictors of a preliminary diagnosis of mixed infection were elevated values of fever (AUC = 0.87), intoxication syndrome score (AUC = 0.71), leukocyte count (AUC = 0.64) and neutrophils (AUC = 0.71) in the hemogram, levels of leukocyte intoxication index according to V.K. Ostrovsky (AUC = 0.67) and neutrophil-leukocyte index (AUC = 0.65), as well as a decrease in the number of platelets (AUC = 0.77), eosinophils (AUC = 0.72) and basophils (AUC = 0.79) in peripheral blood. Two prognostic models which included clinical and laboratory parameters demonstrated excellent prediction of mixed infection (AUC = 0.90 and AUC = 0.91). Conclusion. Early clinical and laboratory predictors have been established and models have been developed that make it possible, with excellent prognosis quality, to calculate in patients the probability of a preliminary diagnosis of mixed infection of the erythema form of ixodic tick-borne borreliosis with tick-borne encephalitis in comparison with borreliosis monoinfection.
Optimizing early breast cancer (BC) detection requires effective risk assessment tools. This retrospective study from Brazil showcases the efficacy of machine learning in discerning complex patterns ...within routine blood tests, presenting a globally accessible and cost-effective approach for risk evaluation. We analyzed complete blood count (CBC) tests from 396,848 women aged 40-70, who underwent breast imaging or biopsies within six months after their CBC test. Of these, 2861 (0.72%) were identified as cases: 1882 with BC confirmed by anatomopathological tests, and 979 with highly suspicious imaging (BI-RADS 5). The remaining 393,987 participants (99.28%), with BI-RADS 1 or 2 results, were classified as controls. The database was divided into modeling (including training and validation) and testing sets based on diagnostic certainty. The testing set comprised cases confirmed by anatomopathology and controls cancer-free for 4.5-6.5 years post-CBC. Our ridge regression model, incorporating neutrophil-lymphocyte ratio, red blood cells, and age, achieved an AUC of 0.64 (95% CI 0.64-0.65). We also demonstrate that these results are slightly better than those from a boosting machine learning model, LightGBM, plus having the benefit of being fully interpretable. Using the probabilistic output from this model, we divided the study population into four risk groups: high, moderate, average, and low risk, which obtained relative ratios of BC of 1.99, 1.32, 1.02, and 0.42, respectively. The aim of this stratification was to streamline prioritization, potentially improving the early detection of breast cancer, particularly in resource-limited environments. As a risk stratification tool, this model offers the potential for personalized breast cancer screening by prioritizing women based on their individual risk, thereby indicating a shift from a broad population strategy.
Background. It is difficult to confirm the diagnosis of the mixed infection of the erythema migrans form of Lyme borreliosis and tick-borne encephalitis at the onset of the disease because of delayed ...seroconversion.
Purpose. Assessment of hemogram predictors to develop a model for early diagnosis of the mixed infection of the erythema form of Lyme borreliosis and tick-borne encephalitis.
Materials and methods. The study involved 21 patients with the mixed infection of the erythema form of Lyme borreliosis and tick-borne encephalitis (Group 1) and 25 patients with the erythema form of borreliosis monoinfection (Group 2), who were hospitalized no later than the 7th day of the disease. The hemogram parameters, the leukocyte intoxication index and the body resistance index were analyzed. ROC analysis was used. The logistic regression model was developed using STATISTICA 12.0 modules.
Results. The Group 1 patients compared with Group 2 demonstrated significant increases in the levels of the leukocyte intoxication index, and neutrophils, but decreases in the levels of the body resistance index, eosinophils, basophils and platelets. The leukocyte intoxication index was a “very good” predictor of the mixed infection, and the body resistance index, the number of eosinophils, basophils, neutrophils and platelets in peripheral blood had a “good” predictive values. The model included the body resistance index, the number of eosinophils and basophils.
Conclusion. The developed model had a “very good” predictive value for the mixed infection early diagnosis of the erythema migrans form of Lyme borreliosis and tick-borne encephalitis.
