In summary, MPV is decreased in adult patients with active lupus disease, and positively correlated with albumin, another biomarker of disease activity. Prospective studies are needed to evaluate the prognostic value of this biomarker.

Intradialytic hypotension is common complication in stage 5 chronic kidney disease patients on hemodialysis. Incidence ranges from 15 to 30%. These patients have levocarnitine deficiency. A randomized, placebo-controlled quadruple-blinded trial was designed to demonstrate the levocarnitine efficiency on intradialytic hypotension prevention. Patients were randomized into four groups, to receive levocarnitine or placebo. During the intervention period, levocarnitine and placebo was administered 0 and 30 min before each hemodialysis session, respectively. During the trial, 33 patients received 1188 hemodialysis sessions. We identified 239 (21.3%) intradialytic hypotension episodes. The intradialytic hypotension episodes were less frequent in the levocarnitine group (9.3%, 60 IH events) (P < 0.001). Hemodialysis is frequently perplexed by intradialytic hypotension episodes. Levocarnitine supplementation before each hemodialysis session efficiently diminishes the intradialytic hypotension episodes. This is a new application method that must be considered and explored.

In summary, MPV is decreased in adult patients with active lupus disease, and positively correlated with albumin, another biomarker of disease activity. Prospective studies are needed to evaluate the prognostic value of this biomarker.

No abstract

BackgroundNeutrophil-lymphocyte ratio (NLR) integrates the deleterious effects of neutrophilia and lymphopenia, and has been used as diagnostic and prognostic biomarker in various diseases (1). NLR was recently proposed as an inflammatory biomarker in systemic lupus erythematosus (SLE) (2).Objectives1. To compare the neutrophil count (NEU), lymphocyte count (LYM) and NLR between lupus patients with active disease and those with inactive disease. 2. To determine the diagnostic accuracy of these markers for detecting disease activity. 3. To compare the diagnostic accuracy of these markers.MethodsA retrospective comparative study. We compared two groups of lupus patients according to disease activity status (determined by Mex-SLEDAI). Subjects were age- and gender-matched. Normal distribution of the data was tested by the Shapiro-Wilk test. Comparisons between groups were performed by using Mann-Whitney U test. Associations between the variables were explored using Spearman's rho. A ROC curve was generated to determine the cutoff value in the NLR (and other markers) with the highest level of accuracy in identifying patients with active disease. Sensitivity and specificity were also calculated. Unless indicated otherwise, all results are expressed as median (25, 75%). A p-value below 0.05 was considered significant.ResultsWe included a total of 72 patients in this study, of whom 36 were classified as having active disease (34 females, aged 18-64 years), and 36 patients as having inactive disease (35 females, aged 20-53 years). Age and gender distributions were similar in the two groups. NEU was not significantly different between groups. LYM was comparatively lower in the group with active disease (963 [601.25, 1447.5] vs. 1540 [1110, 2030]). NLR was significantly higher in patients with active disease (4.784 [2.768, 6.885] vs. 2.306 [1.709, 4.605]). There were no significant relationships between NLR and Mex-SLEDAI, erythrosedimentation rate, serum albumin, or hemoglobin. ROC curve analysis for NLR showed an area under the curve (AUC) of 0.724 (95% CI 0.605-0.824, p=0.0002) with an optimal cutoff value of 2.42. Sensitivity and specificity were 82% and 55%, respectively. The AUC for predicting disease activity was 0.705 (95% CI 0.585-0.808, p=0.0012) for LYM. At a cutoff level of 993 cells/microliter, sensitivity and specificity were 62% and 80%, respectively. The pairwise comparison among the ROC curves showed no statistical difference (Fig. 1).ConclusionsNLR is not superior to LYM alone in differentiating disease activity in SLE. Therefore, NLR is probably not useful in clinical practice.ReferencesEur J Gastroenterol Hepatol. 2015 Jan;27(1):108.Acta Med Indones. 2013 Jul;45(3):170-4.AcknowledgementsWe would like to extend our gratitude to Drs. Jesús Alberto Cárdenas-de-la-Garza and Raymundo Vera-Pineda for their help.Disclosure of InterestNone declared

Malignant spinal cord compression syndrome (MSCCS) occurs in 2.5 to 5% of all oncological patients. In 20% of the cases, it is the initial manifestation. This syndrome is a rare event among germ cell tumors (GCT), occurring in only 1.7% of the patients. We present the case of a 24-year-old man who arrived at the emergency department with dysesthesia and paraparesis as well as urinary incontinence. Imaging studies showed an infiltrative lesion in the left testicle, pulmonary and hepatic metastatic disease, and a large retroperitoneal ganglionar conglomerate that infiltrated the spinal cord through the intervertebral foramina of the vertebra level T11 with displacement of the L1 vertebral body. A postoperative biopsy showed a pure embryonal carcinoma. In the initial approach of a young man who presents spinal cord compression, the presence of MSCCS associated with GCT should be considered as a possible cause. A high level of suspicion is required to achieve a timely diagnosis, to grant the patient the best possible outcome.

No abstract

No abstract