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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">I read the article by Efe et al&#46;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">1</span></a> entitled &#8220;Calcific aortic stenosis and its correlation with a novel inflammatory marker&#44; the lymphocyte&#47;monocyte ratio&#8221; published in the <span class="elsevierStyleItalic">Portuguese Journal of Cardiology</span>&#46; The authors aimed to assess the correlation between severity of calcific aortic stenosis and the lymphocyte-to-monocyte ratio &#40;LMR&#41; in adult patients&#46; They reported that there was a statistically significant inverse relationship between severity of calcific aortic stenosis and LMR values in patients compared with healthy controls&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">The LMR is calculated as the ratio of lymphocyte count to monocyte count from a whole blood count&#44; which is a commonly used&#44; automated&#44; cheap and easily accessible laboratory test in clinical practice&#46; Similarly to the neutrophil-to-lymphocyte ratio&#44; the LMR may also be used as an indicator of systemic inflammation in several diseases such as malignancy or cardiovascular disease&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">2</span></a> However&#44; the lymphocyte count is affected by gender&#44; age&#44; race&#44; time of sampling&#44; physical and psychological stress&#44; pregnancy&#44; drugs &#40;cephalosporin&#44; chemotherapy&#44; steroids&#41;&#44; tuberculosis&#44; viral infections&#44; smoking&#44; presence of anti-lymphocyte autoantibodies and procedures such as splenectomy&#46;<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">3&#44;4</span></a> Standardization of procedures in LMR analysis is vital for reducing variations in results from different laboratories&#46; Different methods of sample collection&#44; processing and analysis&#44; as well as the time of collection&#44; instruments and types of equipment used for the complete blood count&#44; can cause variations in lymphocyte counts&#46; Circadian or diurnal variation of lymphocyte levels &#8211; variation in T cell counts at different time points during the day in the same person &#8211; is another factor affecting fluctuations in lymphocyte count&#44; which can reach up to 20&#37;&#46; Finally&#44; strenuous physical activity may also be an influential factor in variations in lymphocyte count&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">3</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">In conclusion&#44; I think that the results of LMR analysis would be more reliable if based on prospective research into technical and methodological aspects&#44; as well as physiological and pathological conditions&#46; It would thus be easier to understand whether there is a strong correlation between LMR and severity of calcific aortic stenosis&#46;</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflicts of interest</span><p id="par0020" class="elsevierStylePara elsevierViewall">The author has no conflicts of interest to declare&#46;</p></span></span>"
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Letter to the Editor
Methodology, as well as physiological and pathological conditions, can affect analysis of the lymphocyte-to-monocyte ratio
A metodologia assim como as condições fisiológica e patológica podem afetar a análise da relação linfócitos/monócitos
Mustafa Gülgün
Gulhane Traning and Research Hospital, Pediatric Cardiology, Ankara, Turkey
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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">I read the article by Efe et al&#46;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">1</span></a> entitled &#8220;Calcific aortic stenosis and its correlation with a novel inflammatory marker&#44; the lymphocyte&#47;monocyte ratio&#8221; published in the <span class="elsevierStyleItalic">Portuguese Journal of Cardiology</span>&#46; The authors aimed to assess the correlation between severity of calcific aortic stenosis and the lymphocyte-to-monocyte ratio &#40;LMR&#41; in adult patients&#46; They reported that there was a statistically significant inverse relationship between severity of calcific aortic stenosis and LMR values in patients compared with healthy controls&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">The LMR is calculated as the ratio of lymphocyte count to monocyte count from a whole blood count&#44; which is a commonly used&#44; automated&#44; cheap and easily accessible laboratory test in clinical practice&#46; Similarly to the neutrophil-to-lymphocyte ratio&#44; the LMR may also be used as an indicator of systemic inflammation in several diseases such as malignancy or cardiovascular disease&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">2</span></a> However&#44; the lymphocyte count is affected by gender&#44; age&#44; race&#44; time of sampling&#44; physical and psychological stress&#44; pregnancy&#44; drugs &#40;cephalosporin&#44; chemotherapy&#44; steroids&#41;&#44; tuberculosis&#44; viral infections&#44; smoking&#44; presence of anti-lymphocyte autoantibodies and procedures such as splenectomy&#46;<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">3&#44;4</span></a> Standardization of procedures in LMR analysis is vital for reducing variations in results from different laboratories&#46; Different methods of sample collection&#44; processing and analysis&#44; as well as the time of collection&#44; instruments and types of equipment used for the complete blood count&#44; can cause variations in lymphocyte counts&#46; Circadian or diurnal variation of lymphocyte levels &#8211; variation in T cell counts at different time points during the day in the same person &#8211; is another factor affecting fluctuations in lymphocyte count&#44; which can reach up to 20&#37;&#46; Finally&#44; strenuous physical activity may also be an influential factor in variations in lymphocyte count&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">3</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">In conclusion&#44; I think that the results of LMR analysis would be more reliable if based on prospective research into technical and methodological aspects&#44; as well as physiological and pathological conditions&#46; It would thus be easier to understand whether there is a strong correlation between LMR and severity of calcific aortic stenosis&#46;</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflicts of interest</span><p id="par0020" class="elsevierStylePara elsevierViewall">The author has no conflicts of interest to declare&#46;</p></span></span>"
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