Neutrophil Respiratory Burst: an immunological indicator of post stroke infection.

Stroke is long known to be followed by a series of immunosuppressive events, and infections might be a cause of death after an acute insult of stroke. The aim of our work was to assess the percentage of neutrophils showing spontaneous oxidative burst in patients with acute ischemic stroke. The study included 30 patients with acute cerebral infarction subjected to the following: magnetic resonance imaging of the brain immediately on admission, and blood sampling on day one of admission (baseline) and after 3 days of admission. Blood samples were used for the assessment of: differential leucocyte count and percentage of neutrophils showing spontaneous oxidative burst, performed by flow cytometry. Thirty age and gender matched controls were also recruited. Neutrophil respiratory burst percentage was significantly lower in stroke patients in comparison to controls (P < 0.001), and stroke patients had significantly lower neutrophil respiratory burst percent on day 3 of admission compared to the baseline (P < 0.001). Stroke-induced immune alterations including impairment of the first-line defense performed by neutrophils against bacteria. The hypothesis that these changes enhance susceptibility to acquired infections is supported by our observation that oxidative burst in neutrophils was more impaired in patients with stroke who exhibited subsequent stroke-associated infections.

The interplay between tumor necrosis factor alpha, disease activity, and depressive symptoms among Egyptian female patients with systemic lupus erythematosus.

One of the most remarkable presentations of systemic lupus erythematosus (SLE) is depression. Our aim was to elucidate the potential relationship between disease activity, depressive symptoms, and tumor necrosis factor alpha (TNF-α) in patients with SLE. Sixty female patients with SLE and thirty comparable healthy controls were recruited. According to systemic lupus erythematosus disease activity index, patients were subdivided into two similar groups; active and inactive. Complete clinical and laboratory assessments were done to authenticate the diagnosis of SLE and outline its activity. All participants were assessed using the Beck depression Inventory (BDI) to diagnose and determine the severity of depressive symptoms. TNF-α level was assessed using Enzyme linked immunosorbent assay technique. Using BDI, patients with SLE activity showed higher prevalence of depression 19 (63.3%) compared to those with inactive SLE and control groups (P < 0.001). TNF-α level was markedly elevated amongst patients with active SLE in comparison to inactive and control groups (P <0.001). TNF-α differentiated SLE patients into with and without depression at cut-off value (>360 ng/l) (AUC = 0.726; P=0.0008; 95% CI 1.3-2.7). Multivariable regression analysis for prediction of depression revealed that TNF-α was the only independent predictor of depression (P= 0.011). In conclusion, patients with increased SLE activity are more prone to depression especially, moderate to severe degree. TNF-α level could be of significance in predilection of depression and SLE activity in patients with SLE. Hence, future studies are essential to test the treatment modalities targeting TNF-α in those patients.

Neutrophil/lymphocyte ratio and lymphocyte/monocyte ratio in ulcerative colitis as non-invasive biomarkers of disease activity and severity.

BACKGROUND: Apart from endoscopic interventions, readily attainable cost-effective biomarkers for ulcerative colitis (UC) assessment are required. For this purpose, we evaluated differential leucocytic ratio, mainly neutrophil-lymphocyte ratio (NLR) and lymphocyte-monocyte ratio (LMR) as simple available indicators of disease activity in patients with ulcerative colitis. METHODS: Study conducted on 80 UC patients who were classified into two groups of 40 each according to Mayo score and colonoscopic findings. Group 1 (active UC) and group 2 (inactive UC). Another 40 group-matched healthy participants were enrolled. White blood cell count, NLR, LMR, C-reactive protein, and Erythrocyte sedimentation rate were measured and recorded. RESULTS: Significant elevation of NLR was observed in active UC group compared to inactive UC and controls (2.63 ± 0.43, 1.64 ± 0.25, 1.44 ± 0.19 respectively; p < 0.0001). The optimal NLR cut-off value for active UC was > 1.91, with a sensitivity and a specificity of 90% and 90% respectively. The mean LMRs of active UC was significantly lower compared with inactive UC patients and controls (2.25 ± 0.51, 3.58 ± 0.76, 3.64 ± 0.49 respectively; p < 0.0001). The cut-off value of LMR for determining the disease activity was ≤ 2.88 with a sensitivity of 90% and a specificity of 90%. NLR, LMR, and CRP were found to be significant independent markers for discriminating disease activity (p = 0.000). Besides, NLR was significantly higher in patients with pancolitis and positively correlated with endoscopically severe disease. CONCLUSION: NLRs and LMRs are simple non-invasive affordable independent markers of disease activity in UC.