Is C-reactive protein-albumin ratio or neutrophil-lymphocyte ratio a better indicator to predict in-hospital mortality in traumatic brain injury?

BACKGROUND: Neutrophil-lymphocyte ratio (NLR) and C-reactive protein-albumin ratio (CAR) are simple and objective markers of inflammatory responses. However, there are no studies in the literature evaluating these two markers together in traumatic brain injury (TBI). Therefore, this study aimed to examine whether CAR or NLR is a better biomarker for predicting in-hospital mortality in patients with TBI. METHODS: A total of 257 consecutive patients admitted to the hospital between January 2016 and December 2021 were included in the study. The files of all patients aged >18 years with TBI were retrospectively reviewed. Clinical characteristics, Glasgow Coma Scale, and patient data during hospital stay were recorded. Definitive diagnosis was made using computed brain tomography. Routine blood tests were performed in the first 12-24 h of hospitalization. Laboratory results of patients with and without in-hospital mortality were comparatively analyzed. RESULTS: According to the Mann-Whitney U-test, median CRP, CAR, NLR, WBC, monocyte, neutrophil, RDW-CV, RDW-SD, and platelet values were significantly higher, whereas median albumin and RBC values were significantly lower in patients with in-hospital mortality. Student's t-test showed that the mean hemoglobin level was significantly lower in patients with in-hospital mortality compared to other patients. Univariate logistics regression model revealed that age, albumin, CRP, CAR, NLR, WBC, monocyte, neutrophil, RBC, RDW-CV, RDW-SD, and hemoglobin were the factors predicting mortality. However, in the multivariate logistic regression model, only age, albumin, CAR, and WBC were the factors predicting mortality. Areas under the curve were 0.891 for CAR (95% GA, 0.847-0.935), 0.759 for WBC (95% GA, 0.696-0.823), and 0.671 for NLR (95% GA, 0.598-0.744). CONCLUSION: The results of this study showed that CAR has better prognostic value than NLR in predicting in-hospital mortality in patients with TBI.

What is the restorative effect of VEGF inhibitor bevacuzimab against subarachnoid hemorrhage in an experimental model?

BACKGROUND: This study investigated the effect of vascular endothelial growth factor (VEGF) inhibitor bevacuzimab (BVZ) on the rabbit basilar artery using an experimental subarachnoid hemorrhage (SAH) model. METHODS: Eighteen adult male New-Zealand white rabbits were randomly divided into three groups: a control group (n = 6), SAH group (n = 6), and SAH+BVZ group (n = 6). Experimental SAH was created by injecting autologous arterial blood into the cisterna magna. In the treatment group, the subjects were administered a daily dose of 10 mg/kg, intravenous BVZ for 2 days after the SAH. Basilar artery diameters were measured with magnetic resonance angiography (MRA) 72 h after the SAH in all groups. After 72 h, whole brains, including the upper cervical region, were obtained from all the animals after perfusion and fixation of the animal. The wall thickness, luminal area, and the apoptosis at the basilar arteries were evaluated in all groups. RESULTS: BVZ significantly prevented SAH-induced vasospasm confirmed in vivo with MRA imaging with additional suppression of apoptosis on basilar artery wall. DISCUSSION: VEGF inhibition with BVZ has shown to have a vasospasm and apoptosis attenuating effect on basilar artery in a SAH model.

Effect of Age and Body Mass Index on Surgical Treatment Outcomes in Patients with Carpal Tunnel Syndrome.

AIM: To investigate the effect of age, diabetes mellitus, and body mass index (BMI) on the outcomes of carpal tunnel syndrome (CTS) surgery in patients with moderate CTS according to neurophysiological classification. MATERIAL AND METHODS: Postsurgical outcomes were evaluated via a nerve conduction study (NCS) six to nine months after the surgery. Patients were divided into two groups according to neurophysiological classification based on the findings of postsurgical NCS: patients with mild CTS (partial recovery) or normal NCS (complete recovery) were classified as surgical success, and patients with moderate to more severe CTS were defined as surgical failure. RESULTS: Forty-seven patients who underwent surgery for moderate CTS were included in the study. The mean age of the patients with surgical success (47.3 ± 10.9 years) was significantly lower than that of patients with surgical failure (54.3 ± 12.6 years; p=0.048). The mean BMI of the patients with surgical success (31.3 ± 4.03 kg/m2) was significantly lower than that of patients with surgical failure (36.75 ± 5.5 kg/m2; p < 0.001). Multivariate logistic regression analysis demonstrated that higher BMI (p=0.003) and older age (p=0.031) were independent prognostic factors for surgical failure. In addition, there was a statistically significant and strong correlation between postoperative CTS severity and BMI (rho=0.606, p < 0.001). CONCLUSION: Advanced age and high BMI negatively affect the success of surgical treatment in patients with CTS. Ensuring weight loss before surgery in CTS patients who have high BMI may increase the probability of treatment success.

Punica granatum L. Juice Attenuates Experimental Cerebral Vasospasm in the Rabbit Subarachnoid Hemorrhage Model: A Basilar Artery Morphometric Study and Apoptosis.

Background This study investigated the effect of Punica granatum L. (pomegranate) juice on the rabbit basilar artery in an experimental subarachnoid hemorrhage (SAH) model. Methods Eighteen adult male New Zealand white rabbits were randomly divided into three groups: a control group (n = 6), SAH group (n = 6), and SAH + treatment group (n = 6). Basilar artery diameter was measured with magnetic resonance angiography (MRA) in all groups at the beginning of the study. Experimental SAH was created by injecting autologous arterial blood into the cisterna magna. In the treatment group, the subjects were administered a daily dose of 30 ml/kg pomegranate juice via gastric gavage for 4 days after the SAH. The SAH group and SAH + treatment group underwent cerebral MRA after 72 hours. After a neurologic score assessment, all the animals were killed. The wall thickness and lumen area of the basilar artery were measured histometrically in all groups, and the apoptotic cell percentage in the artery was identified. The mean diameter of the basilar artery during MRA was measured. Results Pomegranate improved neurologic functions compared with the SAH group (p < 0.01). The mean basilar artery diameter on MRA in the SAH + treatment group was larger than in the SAH group and smaller than in the control group (p < 0.01 and p < 0.05, respectively). The mean vessel wall thickness value in the SAH + treatment group was lower than in the SAH group (p < 0.01), whereas there was no difference between the control and the SAH + treatment group (p > 0.05). The apoptotic cell rate in the SAH + treatment group was significantly lower than in the SAH group (p < 0.001). Evaluation of the basilar artery luminal area showed no difference between the three groups (p > 0.05). Discussion Pomegranate was shown to have a vasospasm- attenuating effect on the basilar artery in the rabbit SAH model for the first time in our study.

Metamizole Sodium Induces Neural Tube Defects in a Chick Embryo Model.

AIM: The aim of this study was to investigate the effects of metamizole sodium on neural tube development in the early stage chick embryo model that complies with the first month of embryonic development in mammals. MATERIAL AND METHODS: A total of 40 fertilized chicken eggs were divided into 4 equal groups. The eggs were incubated in the incubator at a temperature of 37.8±2°C with 60±5% humidity. Group A was the control, Group B was administered physiological saline, Group C was administered 30 mg/kg metamizole sodium (based on the therapeutic index range of it used in humans) and Group D was administered 90 mg/kg metamizole sodium. All embryos were removed from the egg at the 48th hour and morphologically and histologically examined. RESULTS: Normal development was seen and the neural tube was closed in 17 embryos in Groups A and B. A neural tube defect was seen in 2 embryos in group A and in 1 embryo in group B. A neural tube closure defect was seen in all embryos in group C and 9 embryos in group D. There was 1 dead embryo in Group D. CONCLUSION: Metamizole sodium was seen to produce a neural tube defect in the chicken embyro model.

The effect of flurbiprofen on the development of anencephaly in early stage chicken embryos.

OBJECTIVE: The study investigated the effect of flurbiprofen on the development of anencephaly in early stage chicken embryos. MATERIAL AND METHODS: We looked at four groups with a total of 36 embryos. There was a control group, a normal saline group, a normal-dose group and a high-dose group with ten, ten, eight and eight eggs with embryo respectively. RESULTS: Two embryos in the control group, studied with light microscopy at 48 h, were consistent with 28-29 hours' incubation in the Hamburger-Hamilton System. They had open neural tubes. The other embryos in this group were considered normal. One embryo in the normal saline group was on the occlusion stage at 48 h. One embryo showed an open neural tube. They were compatible with 28-29 hours' incubation in the Hamburger-Hamilton system. The remaining eight embryos showed normal development. In the normal dose group, one embryo showed underdevelopment of the embryonic disc and the embryo was dead. In four embryos, the neural tubes were open. One cranial malformation was found that was complicated with anencephaly in one embryo. In two embryos the neural tubes were closed, as they showed normal development, and they reached their expected stages according to the Hamburger-Hamilton classification. There was no malformation or growth retardation. Four experimental embryos were anencephalic in the high dose group, and three embryos had open neural tubes. One embryo exhibited both anencephaly and a neural tube closure defect. None of the embryos in this group showed normal development. CONCLUSIONS: Even the usual therapeutic doses of flurbiprofen increased the risk of neural tube defect. Flurbiprofen was found to significantly increase the risk of anencephaly. The provision of improved technical materials and studies with larger sample sizes will reveal the stage of morphological disruption during the development of embryos.

L'hermitte-Duclos disease in an elderly patient: A case report and review of the literature.

L'hermitte-Duclos disease (LDD) is an extremely rare cerebellar lesion of uncertain etiology. Occasionally, the patients with LDD may even have sudden neurological deterioration due to acute heniation as seen in the present case report. It is also imperative to distinguish this disease from other malignant lesion of the cerebellum and cerebellar malformations with its varied natural course of history and hence better ability to prognosticate such patients. Herein, we reported a successfully treated case of LDD following a long history of vaguely defined neurological complaints in an elderly patient and reviewed the literature.

The impact of antibiotic-impregnated catheters on ventriculoperitoneal shunt infection.

BACKGROUND/AIM: Ventriculoperitoneal shunt infections remain an important problem and result mainlyfrom perioperative colonization of shunt components by skin flora. Antibiotic-impregnated shunts have been designed to prevent such colonization. T'his study evaluates the incidence of shunt infection after the insertion of antibiotic-impregnated shunts in a population of children with hydrocephalus. MATERIALS AND METHODS: All pediatric patients who had undergone cerebrospinal fluid shunt insertion retrospectively were reviewed over a 6-year period between May 2004 and December 2010. The primary outcome measure was the rate of shunt infections. Patients were followed up with for an average of 26.2 months after shunt surgery, and shunt infections were evaluated. RESULTS: A total of 123 pediatric patients underwent 211 shunt placement procedures. Of these operations, 193 (91%) were performed with nonimpregnated catheters and 18 shunts (9%) were placed with antibiotic-impregnated shunt catheters. Of the patients with nonimpregnated catheters, 12 (6%) experienced shunt infection, whereas none of the patients with antibiotic-impregnated catheters experienced shunt infection within the 26.2-month follow-up period (P < 0.01). CONCLUSION: The antibiotic-impregnated catheters significantly reduced the incidence of shunt infection in children with hydrocephalus during the postoperative period. Antibiotic-impregnated catheters are effective devices to prevent perioperative colonization of shunt components.