Neutrophil to Lymphocyte Ratio and Serum Biomarkers : A Potential Tool for Prediction of Clinically Relevant Cerebral Vasospasm after Aneurysmal Subarachnoid Hemorrhage

Objective@#: Subarachnoid hemorrhage (SAH) is a condition characterized by bleeding in the subarachnoid space, often resulting from the rupture of a cerebral aneurysm. Delayed cerebral ischemia caused by vasospasm is a significant cause of mortality and morbidity in SAH patients, and inflammatory markers such as systemic inflammatory response index (SIRI), systemic inflammatory index (SII), neutrophil-to-lymphocyte ratio (NLR), and derived NLR (dNLR) have shown potential in predicting clinical vasospasm and outcomes in SAH patients. This article aims to investigate the relationship between inflammatory markers and cerebral vasospasm after aneurysmatic SAH (aSAH) and evaluate the predictive value of various indices, including SIRI, SII, NLR, and dNLR, in predicting clinical vasospasm. @*Methods@#: A retrospective analysis was performed on a cohort of 96 patients who met the inclusion criteria out of a total of 139 patients admitted Trakya University Hospital with a confirmed diagnosis of aSAH between January 2013 and December 2021. Diagnostic procedures, neurological examinations, and laboratory tests were performed to assess the patients' condition. The Student’s t-test compared age variables, while the chi-square test compared categorical variables between the non-vasospasm (NVS) and vasospasm (VS) groups. Receiver operating characteristic (ROC) curve analyses were used to evaluate the diagnostic accuracy of laboratory parameters, calculating the area under the ROC curve, cut-off values, sensitivity, and specificity. A significance level of p<0.05 was considered statistically significant. @*Results@#: The study included 96 patients divided into two groups : NVS and VS. Various laboratory parameters, such as NLR, SII, and dNLR, were measured daily for 15 days, and statistically significant differences were found in NLR on 7 days, with specific cut-off values identified for each day. SII showed a significant difference on day 9, while dNLR had significant differences on days 2, 4, and 9. Graphs depicting the values of these markers for each day are provided. @*Conclusion@#: Neuroinflammatory biomarkers, when used alongside radiology and scoring scales, can aid in predicting prognosis, determining severity and treatment decisions for aSAH, and further studies with larger patient groups are needed to gain more insights.

Analysis of various potential prognostic markers and survival data in clear cell renal cell carcinoma

ABSTRACT Purpose Clear cell renal cell cancers frequently harbor Von Hippel-Lindau gene mutations, leading to stabilization of the hypoxia-inducible factors (HIFs) and their target genes. In this study, we investigated the relationship between vascular endothelial growth factor (VEGF), HIF-1α, HIF-2α, p53 positivity, microvessel density, and Ki-67 rates with prognostic histopathologic factors (Fuhrman nuclear grade, stage, and sarcomatoid differentiation) and survival in clear cell renal cell carcinomas. Material and Methods Seventy-two nephrectomy specimens diagnosed as clear cell renal cell carcinoma between 2000 and 2012 were reevaluated. Immunohistochemically VEGF, HIF-1α, HIF-2α, p53, CD34 (for microvessel density evaluation), and Ki-67 antibodies were applied to the tumor areas. The relationships of these antibodies with prognostic factors and survival rates were evaluated with statistical analyses. Results Mean survival time was 105.6 months in patients with ccRCC. Patients with high expression of VEGF, HIF-1α and HIF-2α positivity, a high Ki-67 proliferation index, and a high microvessel density evaluation score had a shorter survival time (p<0.05). Conclusions Our findings supported that with the use of these immunohistochemical markers, prognosis of renal cell carcinoma may be predicted at the first step of patient management. New treatment modalities targeted to HIF-1α and HIF-2α might be planned as well as VEGF-targeted therapies in the management of clear cell renal cell carcinomas.

Effect of the Pruritus on the Quality of Life: A Preliminary Study

BACKGROUND: Pruritus affects the quality of life (QoL) in the patients. However, little is known of the impacts of itching on the QoL in the literature. OBJECTIVE: In this study, a questionnaire eliciting specific responses about pruritus was used to determine the effect of itching and its severity on QoL in chronic pruritic patients. METHODS: One hundred ten adult patients with chronic pruritus were surveyed. Once itch severity had been self-reported by patients, together with Skindex-29, they have been given the 18-item Pruritus-related Life Quality Index (PLQI) questionnaire, which was used to generated the new index. RESULTS: Significant correlations have been found between the pruritus severity score of participants and their total Skindex-29 (p<0.001) with its function, emotion and symptom subscale scores (p<0.001 for each). Also, significant correlations were evident between total PLQI (p<0.001) and its psychosocial negativities, difficulties in everyday activities and social live subscale scores (p<0.001 for each). In particular, the emotion subscale of Skindex-29 (p=0.02) and psychosocial negativity subscale of PLQI (p=0.02) were significantly high in psychopathologic patients. A highly positive statistical correlation between Skindex-29 and PLQI scales was evident (r=0.845, p<0.001). For reliability, Cronbach's coefficient a coefficients were 0.931 for the Skindex-29 scale and 0.918 for the PLQI scale. CONCLUSION: The results demonstrate that chronic pruritus appreciably reduces the QoL. PLQI could be used in the development of new questionnaires for determining the QoL of patients with chronic itch.

Investigation of the availability of tongue movements in Mallampati classification

To investigate the relation of Mallampati classification with a new alternative method suggested for use in the estimation of tongue movements. This study was conducted in the Department of Anesthesiology, Faculty of Medicine, Trakya University, Edirne, Turkey from April to October 2009. Two hundred and thirty patients were enrolled in this study. The modified Mallampati score [MMS] was devised by an anesthetist. To define tongue movements, horizontal and vertical lines were utilized. Horizontal lines passing through the mid points of the upper lip and mandible, and vertical lines passing through the right and left infraorbitale points were constituted on each subject. Subjects were asked to elevate, depress, and abduct [right-left] the tip of the tongue. The scores corresponding with the movements of the tongue were determined. Depression of the tip of the tongue [DTT] and elevation of the tip of the tongue [ETT] levels were significantly different between MMS 1, MMS 2, and MMS 3, MMS 4 groups [p=0.001]. The risk of being MMS 3 or MMS 4 for the groups that cannot reach the borderline for the DTT or ETT are 5.5 times and 5.4 times higher consequently than the groups that can reach the borderline. This new method can be combined with MMS classification, which requires clinical experience and knowledge in predicting difficult intubation

Evaluation of Handwashing Behaviors and Analysis of Hand Flora of Intensive Care Unit Nurses

PURPOSE: The aim of this study was to evaluate the handwashing behaviors of intensive care nurses based on personal statements, and to identify the microorganisms represented in the hand flora preshift and postshift. METHODS: This prospective study was performed with 60 intensive care nurses between January and December 2008, at a training and research hospital at a university in Turkey. Samples were taken from the hands of the nurses for bacteriological culture, using the bag-broth method, at the beginning and end of the shift. The samples were cultured aerobically and the colonies that grew were counted and identified. The nurses completed a self-report questionnaire, and their answers were evaluated. RESULTS: The frequency of handwashing by participants during each shift was 32.8 +/- 13.9. Overall, 65% of the nurses preferred alcohol-based antiseptic solutions for handwashing, 95% used paper towels to dry their hands, and 98.3-100% of the nurses washed their hands after performing care procedures. The Escherichia coli and coagulase negative Staphylococcus species were found to be at significantly higher levels in the postshift hand culture samples when compared to the preshift hand culture sample values. Enterobacter cloacae was the only species found in the postshift hand culture samples of the nurses. CONCLUSIONS: The number of colonies of the microorganisms in the hand flora of the nurses increased postshift. The handwashing behavior of intensive care nurses must be improved as they nurse critical patients.

Acinetobacter pneumonia: is the outcome different from the pneumonias caused by other agents

The principal aim of the present study was to determine whether Acinetobacter spp. Pneumonia differs from hospital-acquired pneumonias [HAPs] caused by other agents with respect to therapeutic success and survival rate. This study includes 140 adult patients diagnosed with HAPs caused by identified etiologic agents between March 2005 and February 2006. These patients were divided into two groups according to the agent responsible to their infection [Acinetobacter spp. [n=63] or non-Acinetobacter spp. [n= 77]]. The groups were compared in terms of risk factors, therapeutic success and six-week survival rates. Previous antibiotic use and the risk of aspiration were independent factors responsible for the development of Acinetobacter spp. pneumonia. Hypoalbuminemia, steroid use and the use of a mechanical ventilator were determined to be mortality-associated independent risk factors for Acinetobacter spp. pneumonia. The clinical success rate at the end of therapy was 41.6% and, at the sixth week, the survival rate was 35% among patients in whom Acinetobacter spp. was the causative agent. Conversely, in the control group, these values were 43 and 32%, respectively [P>0.05]. We found that the use of the appropriate antibiotics for the treatment of Acinetobacter spp. pneumonia was an important factor in survival [P <0.001]. The outcome of Acinetobacter spp. pneumonia do not differ from HAPs associated with non-Acinetobacter spp. in terms of therapeutic success and survival rates

Assessing the quality of randomized controlled trials from two leading cancer journals using the CONSORT statement

No study has been conducted on the scientific quality of randomized controlled trials [RCTs] in the cancer field. Our objective was to determine whether adherence to the Consolidated Standards for Reporting Trials [CONSORT] statement is associated with scientific properties of RCT reports from two leading cancer journals. We conducted an observational study of RCTs published between 2002 and 2004 in two leading cancer journals that did not endorse the CONSORT statement during that period. We determined the adherence rates with confidence intervals of 33 RCTs according to the 19 methodological items of the CONSORT statement. Each RCT was blindly assessed by three independent evaluators; then the evaluators examined all judgments sequentially and obtained a consensus regarding each methodological item of the CONSORT statement. The average adherence of these 33 RCTs to the 19 methodological items of the CONSORT statement was 79.3% [95% CI, 75.3-83.4%]. Most descriptors from the checklist were determined to be methodologically adequate except sequence generation [56.1%; 95% CI, 40.9-71.3%], allocation concealment [27.3%; 95% CI, 13.2-41.4%], implementation [7.6%; 95% CI, 0.0-15.4%], blinding [30.3%; 95% CI, 14.4-46.3%] and sample size [74.2%; 95% CI, 59.5-89.0%]. Of all CONSORT checklist items, randomization implementation was the most often omitted. Some key methodological items of the CONSORT statement seem poorly addressed in RCTs from these leading cancer journals. Thus researchers should be urged to conform to the CONSORT statement when reporting on RCTs, and the poorly addressed items of the CONSORT statement should be reevaluated for RCTs already reported