Zahorec index or Neutrophil-to-lymphocyte ratio, valid biomarker of inflammation and immune response to infection, cancer and surgery.

BACKGROUND: For many years, the physicians are searching for easily measurable marker of immune response to the stress and inflammation. More than, 20 years ago Zahorec (2001) proposed neutrophil-to-lymphocyte ratio (NLR) as an easy available and valid biomarker of inflammation, stress, and activation of immune system. METHODS: In this narrative review we focused on the utility of neutrophil-to-lymphocyte ratio (Zahorec's index) in clinical practice of general medicine (inflammation and infection), intensive medicine (sepsis), oncology (prediction of prognosis in cancer of solid organs), surgery and perioperative medicine (diagnosis of complications, and prediction of clinical outcome). RESULTS AND CONCLUSION: We provide many evidences of clinical research which confirm that Neutrophil-to-lymphocyte ratio is a very sensitive marker of inflammation, stress reliable and valid parameter in everyday clinical practice. NLR (Zahorec index) is an effective tool for diagnosis of infection and severity of disease of variable etiologies. NLR reflect the grade of inflammation in cancer disease, which has a significant impact on the prognosis of cancer patients. Zahorec index should be used routinely in emergency medicine, surgery and perioperative medicine as a marker of the severity of affliction, infection, and complications in general. NLR may help physicians in decision making process for early diagnosis and therapy. NLR should be investigated frequently in acute states (sepsis, shock, peritonitis, stroke, trauma) on a daily basis, in subacute states few times per week (during hospital stay), and few times per year in chronic disease (cancer, diabetes mellitus, ischemic heart disease, psychiatry disorders). NLR has a deep biological sense connecting together function of three suprasystems: immune, endocrinne and autonomous nervous system (Tab. 2, Fig. 3, Ref. 86).

Occurrence of butyrylcholinesterase polymorphisms in patients undergoing surgery in Slovakia.

Background: Post-operative residual curarization is a persisting problem, characterized by muscle fatigue, exhaustion or paresis, caused by the use of neuromuscular blocking agents with prolonged postoperative effect. Genetically, determined changes in cholinesterase activity can be a major reason for persistent muscle blockade after administration of muscle relaxants. Methods: Regarding the subsistence of polymorphisms in the plasma cholinesterase gene causing change in enzyme activity and metabolism of applied drugs, we investigated the frequency of two polymorphisms known to reduce its activity significantly in patients undergoing surgery. Results: Primary results show a relatively high occurrence of plasma cholinesterase K risk allele (18.75%). Conclusion: Characterization of the lacking information about genetic background of changes in plasma cholinesterase activity within Slovakia may allow for easier decision-making in clinical practice when selecting alternative neuromuscular blocking and also reversal agents.

Full recovery of lung tissue after severe viral pneumonia H1N1: A case report with 10 years follow-up.

RATIONALE: World healthcare frequently faced severe viral pneumonia cases in the last decades, due to pandemic situations such as H1N1, MERS-CoV, and SARS-COVID-19. PATIENT CONCERNS: The impact of viral infection on lung structure, lung function, and overall mortality was significant. The quality of life and assumed life expectancy was decreased with the supposed development of lung fibrosis in involved survived patients. DIAGNOSES: We described the course and treatment of severe pneumonia H1N1 in a 30-year-old patient. INTERVENTIONS: Patient was included in a study regarding the therapeutic efficacy of selenium ClinicalTrials.gov ID: NCT02026856 with 10 years follow-up with concurrently documented X-ray lung examinations and final histology of lung tissue after sudden death. OUTCOMES: All sequential examinations and histological findings show a healing trend with the final full recovery of lung tissue.

Improvement of mortality prediction accuracy in critically ill patients through combination of SOFA and APACHE II score with markers of stress haematopoiesis.

INTRODUCTION: In critically ill patients nucleated red blood cells (NRBC) and immature granulocytes (IG) appear in the peripheral blood as the consequence of stress haematopoesis. The aim of this retrospective study was to evaluate the diagnostic value of NRBC and IG and to propose a model of improved mortality prediction including these parameters in the assessment of critically ill patients. METHODS: The study included 338 critically ill adult patients hospitalized at Department of Anaesthesiology and Intensive Medicine, Louis Pasteur University Hospital in Kosice. As NRBC positive patients were considered patients with peripheral NRBC > 0.01 × 109 /L and IG positivity as >0.03 × 109 /L. Apache II index was calculated 24 hours after admission and Systemic Organ Failure Assessment (SOFA) on the day with the worst clinical condition. RESULTS: NRBC positivity was found in 27.6% of patients. The mortality of NRBC positive patients was 48.38%, significantly higher than 23.7% of NRBC negative patients. IG positivity was 79.0% and their mortality was also higher as compared with that of IG negative patients (69.3% vs 33.8%). Three regression models predicting mortality including stress haematopoiesis markers, APACHE II, SOFA scores and age had sufficient level of sensitivity and specificity. CONCLUSION: The presence of NRBC in the peripheral blood and the IG increase are available early risk predictors of mortality in critically ill patients. Regression models designed by combination of SOFA, APACHE II, and the new haematological parameters increase the accuracy and effectivity of diagnostic process in predicting prognosis and risk of mortality with high sensitivity and specificity.

The influence of mode of anaesthesia for caesarean delivery on neonatal Apgar scores in the Czech Republic and Slovakia: secondary analysis of the results of an international survey in 2015.

AIMS: The purpose of this international survey was to describe the impact of current practices and techniques of caesarean section on the neonatal Apgar score in the Czech Republic (CZE) and Slovakia (SVK). METHODS: All Czech and Slovak departments that provide obstetric anaesthesia were invited to participate in a one-month (November 2015) prospective study that monitored in details all peripartum anaesthetic practices, delivered by anaesthesiologists. Participating centers recorded all data on-line in the CLADE-IS database (Masaryk University, CZE). RESULTS AND DISCUSSIONS: We collected data of 10119 women who delivered 10226 newborns. A caesarean section was recorded in 25.1% of deliveries (CZE 23.2%; SVK 30%). General anaesthesia was used for caesarean section in 37.5% of the cases (CZE 40%, SVK 33%). There was no statistically significant difference in the Apgar score lower than 7 in the 1, 5 or 10 min in groups of general and regional anaesthesia for caesarean section, when only elective sections of in-term babies with birth weight over 2500 g were analyzed. We found no statistically significant differences in the Apgar score in newborns of women intubated for caesarean section in rocuronium (n=21; 2.2%) and suxamethonium (n=889; 93%). CONCLUSION: We found no difference in neonatal outcomes in groups of general and regional anaesthesia for caesarean section when only out-of-risk newborns were analyzed. The risk factors were identified as follows: an acute caesarean section, preterm babies, birth weight less than 2 500 g, born in perinatological center and multiple pregnancy - second baby. TRIAL REGISTRATION: ClinicalTrials.gov (ID: NCT02380586) https://clinicaltrials.gov/ct2/show/NCT02380586.

Selenium adjuvant therapy in septic patients selected according to Carrico index.

OBJECTIVES: The objective of this paper is to highlight the selected group of patients in which adjuvant therapy seems to have a more pronounced positive effect. DESIGN AND METHODS: 65 septic patients from the prospective observational study Se-AOX (2008-2012) (ClinicalTrials.gov Identifier: NCT02026856) were divided into a Se group, receiving sodium selenite in a continual infusion of 750µg/24h for 6 days, and a placebo group. They were subsequently divided into subgroups according to the initial Carrico index (CI) on the day of admission: CI>200 and CI<200. Dynamical changes in glutathione peroxidase (GPx), glutathione reductase (GR) and superoxide dismutase activities were recorded at two day intervals. Clinical parameters and mortality were compared. RESULTS: The CI increased in subgroup Se-CI<200 with negative correlation against subgroup Placebo-CI<200 during the last measuring period (p<0.02). GPx activity increased in selenium subgroups with negative correlation against placebo subgroups (p<0.01). SOD activity was elevated in all subgroups in comparison with values of healthy subjects. CONCLUSIONS: Adjuvant selenium therapy seems to be beneficial for a selected group of patients with acute lung injury. However, as is clear from the results discussed, this is not the case with persistent renal failure, as this leads to an inability to maintain synthetic renal function and ensure GPx synthesis.

[Acute multiple organ failure after endoscopic polypectomy]. / Akútne multiorgánové zlyhanie po kolonoskopii s polypektómiou.

BACKGROUND: Serious intraabdominal infections belong among life treating diseases. They are based on spreading infections from focal sources of inflammation in abdomen or damaged intestinal wall. METHODS AND RESULTS: Treatment strategies are surgical intervention, antimicrobial therapy, distributional shock treatment and accurate nutritional support (1). Glutamine and selenium supplementation may improve intestinal functions and restore antioxidant defence (2). Septic shock with multiple organ failure accompanied by serious catabolism and decrease of albumin had developed in a patient after endoscopic polypectomy. Infection source was not discovered by medical imaging examinations non surgical laparotomy. After distributive shock treatment, wide spectral antibiotics and enteral and parenteral nutrition the patients health improved. As adjuvant therapy intravenous supplementation was administered: glutamine in daily dose 2g and sodium selenite in continual infusion in daily dose 750 µg over 6 days. During intensive therapy, inflammatory markers decreased: C-reactive protein, procalcitonin, leukocyte count and neutrophils. Albumin levels increased. CONCLUSIONS: The paper describes therapeutic options during septic shock treatment and reversion possibilities in the catabolic phase of disease.Key words: colonoscopy, septic shock, multiorgan failure, enteral nutrition, parenteral nutrition.