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Background: The world urgently requires surrogate markers to diagnose COVID-19 and predict its progression. The severity is not easily predicted via currently used biomarkers. Critical COVID‐19 patients need to be screened for hyperinflammation to improve mortality but expensive cytokine measurement is not routinely conducted in most laboratories. The neutrophil-to-lymphocyte ratio (NLR) is a novel biomarker in patients with various diseases. We evaluated the diagnostic and prognostic accuracy of the NLR in COVID-19 patients. Methods: We searched for relevant articles in seven databases. The quantitative analysis was conducted if at least two studies were evaluating the NLR role in COVID-19. Results: We included 8,120 individuals, including 7,482 COVID-19 patients, from 32 articles. Patients with COVID-19 had significantly higher levels of NLR compared to negative individuals. Advanced COVID-19 stages had significantly higher levels of NLR than earlier stages. Expert Opinion: We found significantly higher levels of NLR in advanced stages compared to earlier stages of COVID-19 with good accuracy to diagnose and predict the disease outcome, especially mortality prediction. A close evaluation of critical SARS-CoV-2 patients and efficient early management are essential measures to decrease mortality. NLR could help in assessing the resource allocation in severe COVID-19 patients even in restricted settings.

Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) has emerged in China. There are no available vaccines or antiviral drugs for COVID-19 patients. Herein, we represented possible therapeutic agents that may stand as a potential therapy against COVID-19.We searched PubMed, Google Scholar, and clinicaltrials.gov for relevant papers. We showed some agents with potentially favorable efficacy, acceptable safety as well as good pharmacokinetic profiles. Several therapies are under assessment to evaluate their efficacy and safety for COVID-19. However, some drugs were withdrawn due to their side effects after demonstrating some clinical efficacy. Indeed, the most effective therapies could be organ function support, convalescent plasma, anticoagulants, and immune as well as antiviral therapies, especially anti-influenza drugs due to the similarities between respiratory viruses regarding viral entry, uncoating, and replication. We encourage giving more attention to favipiravir, remdesivir, and measles vaccine.A combination, at least dual or even triple therapy, of the aforementioned efficacious and safe therapies is greatly recommended for COVID-19. Further, patients should have a routine assessment for their coagulation and bleeding profiles as well as their inflammatory and cytokine concentrations.

Background Male breast cancer (MBC) is usually diagnosed at late stages and therefore has a worse prognosis than female breast cancer (FBC). MBC is also more likely to have lymph node (LN) involvement than FBC. Materials and Methods We sought to determine the prognostic role of the examined lymph node (LN), negative LN (NLN), and positive LN counts and the LN ratio (LNR), defined as (positive LNs/ENLs), on the survival rate among MBC patients. We performed a large population-based study using the data from the Surveillance, Epidemiology, and End Results program. Results Older age, black race, stage IV disease, ≤ 1 NLN, and a > 31.3% LNR were significantly associated with worse survival across all prediction models. Moreover, we demonstrated a decreased risk of mortality in MBC patients across the MBC-specific survival model (hazard ratio, 0.98; 95% confidence interval, 0.96-0.998; P = .03) and 10-year MBC-specific survival model (hazard ratio, 0.98; 95% confidence interval, 0.96-0.999; P = .04). Conclusion MBC has had an augmented incidence over the years. We found several independent predictors of MBC survival, including age, race, stage, NLNs, and the LNR. We strongly suggest adding the NLN count and/or LNR into the current staging system. Further studies are needed to provide information on the mechanisms underlying the association between the NLN count and MBC survival and the LNR and MBC survival.

Background Our study aimed to compare three different percutaneous coronary intervention (PCI) approaches: culprit-only (COR) and complete (CR) revascularization – categorizing into immediate (ICR) or staged (SCR). Methods We searched 13 databases for randomized controlled trials. Articles were included if they compared at least two strategies. To have more studies in each analysis, an adjusted analysis was performed using person-years to incorporate follow-up durations and obtain pooled rate ratios (RR), with their corresponding 95% confidence interval. Results Thirteen trials were included with a population of 2830 patients. COR significantly increased major adverse cardiac event (MACE) (adjusted RR 1.67, 95% CI: 1.27–2.19) and repeat revascularization (2.12, 1.67–2.69), which was driven by repeat PCI, without any difference in all-cause mortality and myocardial infarction (MI) compared to CR. When categorizing CR into SCR and ICR, the trend repeated with COR increased MACE (1.99, 1.53–2.6 for ICR), cardiovascular mortality (2.06, 1.07–3.96 for ICR), MI for ICR (1.72, 1.04–2.86), repeat revascularization and repeat PCI for both ICR and SCR. Non-cardiovascular mortality, stroke, nephropathy, re-hospitalization, stent thrombosis and bleeding were similar among all approaches. Conclusions In MVD-STEMI patients, CR is better than COR in terms of MACE, cardiovascular mortality, repeat revascularization with no difference in safety outcomes. There was a trend towards to a reduction of cardiovascular mortality and MI in ICR compared to SCR when each matched with COR; even though there is no statistically significant difference between ICR and SCR when compared together.

Background: Prostate cancer (PCa) is the third leading cause of death from cancer in the United States. We aimed to disclose the prognostic values of examined (dissected) lymph node (ELN), negative lymph node (NLN), and positive (metastatic) lymph node (PLN) counts and lymph node (LNs) ratio in PCa patients. Methods: We extracted data of PCa patients diagnosed between 2004 and 2015 from the Surveillance, Epidemiology, and End Results (SEER) program. We included patients with a histologically confirmed diagnosis having at least one ELN and with the PCa as the primary tumor only. Results: We have included 96,064 patients. Multivariable Cox proportional hazards regression modelsdisclosed that patients having more ELNs were associated with better survival. However, we demonstrated that patients having more PLNs were associated with worse survival. Additionally, older age, unmarried patients, with Gleason’s score of 8–10, T4 and M1 stages and those who received chemotherapy and/or radiation but did not receive surgery were significantly associated with worse PCa survival. Conclusions: We have disclosed several independent predictors affecting PCa patients including age, marital status, Gleason’s score, T and N stages, having received therapy, surgery, and ELN and PLN counts. Moreover, we demonstrated that patients with lower ELN and higher PLN counts were a high-risk group. We strongly recommend adding the ELN and/or PLN counts into consideration during patient staging/treatment.

Background Dengue is one of the most common infectious diseases. The aim of this study was to systematically review acute disseminated encephalomyelitis (ADEM) and to represent a new case. Methodology/Principal findings We searched for articles in nine databases for case reports, series or previous reviews reporting ADEM cases in human. We used Fisher’s exact and Mann-Whitney U tests. Classification trees were used to find the predictors of the disease outcomes. We combined findings using fixed- and random-effects models. A 13-year-old girl was admitted to the hospital due to fever. She has a urinary retention. The neurological examinations revealed that she became lethargic and quadriplegic. She had upper limbs weakness and lower limbs complete paraplegia. Her status gradually improved after the treatment. She was nearly intact with the proximal part of her legs had a mild weakness in discharge. The prevalence of ADEM among dengue patients was 0.4% [95% confidence intervals (95% CI) 0.1–2.5%], all neurological disorders among dengue was 2.6% [95% CI 1.8–3.8%], and ADEM among neurological disorders was 6.8% [95% CI 3.4–13%]. The most frequent manifestation of ADEM was altered sensorium/consciousness (58%), seizures and urination problems (35%), vision problems (31%), slurred speech (23%), walk problems (15%) then ataxia (12%). There was a significant difference between cases having complete recovery or bad outcomes in the onset day of neurological manifestations being earlier and in temperature being higher in cases having bad outcomes (p-value < 0.05). This was confirmed by classification trees which included these two variables. Conclusions/Significance The prevalence of ADEM among dengue and other dengue-related neurological disorders is not too rare. The high fever of ADEM cases at admission and earlier onset day of neurological manifestations are associated with the bad outcomes., Author summary We presented a 13-year-old girl of ADEM following dengue infection. She was totally alert and had a low grade of fever with no focal neurologic deficits, on admission. We revealed that the prevalence of either ADEM or all neurological disorders among dengue patients was not too rare. Moreover, we found that the most common manifestation of ADEM was altered sensorium/consciousness followed by seizures and urination problems then vision problems. These manifestations should be considered in the diagnosis and management of dengue-infected patients. Also, this requires shedding the light on the total global cases of ADEM from the annual incidence of dengue. The onset of ADEM can be early or late after dengue infection. Hence, clinicians should pay attention that it can be early or late that patients can forget about their fevers. Moreover, the onset day of neurological manifestations and patients’ temperature were significantly associated with the disease outcome.

Background Diffuse large B cell lymphoma (DLBCL) is the most common histological subtype of non-Hodgkin lymphoma (NHL), accounting for 25% of NHL subtypes. Usually associated with classic B-symptoms, such as fever, weight loss and night sweats in about 30% of patients, accompanied with elevated lactate dehydrogenase. Approximately in 25-40% of DLBCL cases, the disease arises from extra-nodal sites, such as stomach/gastrointestinal tract. Differences in clinical outcomes between extra-nodal and nodal site involvement suggest that both types should be considered as different entities. Our study aims to identify the role of primary nodal site as predictive tool for clinical and survival outcomes in patients with DLBCL. Methods Our study was based on data from the Surveillance, Epidemiology, and End Results program database. We used the Kaplan-Meier curve, log-rank test, and Cox proportional hazard regression models to examine predictors affecting the DLBCL survival. We used the multi-variable analysis to get overall survival (OS) as well as the disease-specific survival (DSS). Results From a total of 34,231 DLBCL patients were identified. The mean age was 61.3 years. The majority had multiple regions (M) lymph nodes (LNs) (18,044, 52.7%) followed by head, face and neck (HFN), intra-abdominal, intra-thoracic, axilla or arm (AA), inguinal or leg (IL) then pelvic LNs. Moreover, male, unmarried, black or Asian/Pacific Islander, older patients, advanced stages, and patients did not receive radiation and/or surgery were associated with a worse survival. We found a mean survival time of 61.07 months with OS and DSS of 39.1/54.1% only. The multiple regions, intra-abdominal, intrathoracic LNs were significantly associated with a worse survival. Conclusions DLBCL incidence has increased in the recent years. The multiple regions, intra-abdominal, intrathoracic LNs were significantly associated with a worse survival, suggesting that DLBCL nodal primary site can serve as a simple yet prognostic tool. Hence, we strongly encourage future studies to compare DLBCL patients' survival affected by these aggressive primary sites with other unfavorable predictors in IPI. Moreover, biomarkers, within these aggressive sites, may demonstrate their aggressive behaviors. Furthermore, more studies need to shed the light on the biological theory beyond these aggressive primary sites and to validate its reliability. Citation Format: Mohamed Gomaa Kamel, Fatma A. Abd-Elhay, Sara Morsy, Amr E. El-Qushayri, Khaled M. Elhusseiny, Muhammed K. Elfaituri, Ahmed M. Kamel, Sherief Ghozy, Nourin A. Sherif, Nguyen Tien Huy. The role of primary lymph node sites in survival and mortality prediction in DLBCL: A SEER population-based retrospective study [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2018; 2018 Apr 14-18; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2018;78(13 Suppl):Abstract nr 2215.