Accuracy of SCORTEN in predicting mortality in toxic epidermal necrolysis.

BACKGROUND: Toxic epidermal necrolysis (TEN) patients require multi-directional and multi-disciplinary treatment. In most cases, they are hospitalised at intensive care units and require multi-directional, burn-complication preventive care. Choosing the most appropriate treatment option might be troublesome even when predicting scores are used. SCORTEN is the most renowned prognostic score for TEN patients, however, there are some data indicating that the accuracy of this test may be limited. The credibility of not just the predicted mortality risk, but also componential laboratory results and clinical features subject to debate. The aim of this study was to evaluate the efficacy and credibility of SCORTEN in clinical practice, on proprietary material. METHODS: A retrospective analysis of 35 patients with diagnosed in histopathology TEN was performed. The inclusion criteria were as follows: day of submission before 5th day from the onset of the symptoms, full protocol of plasmaphereses and IVIGs according to our scheme. Our protocol includes cycle of plasmapheresis with frozen fresh plasma twice daily for the first 2 days following admission, and once daily for the subsequent 5 to 7 days. IVIGs were administered after the first two sessions of plasmapheresis, for 4 to 7 days. The dosage was calculated according to body weight, at 0.4 to 0.5 g/kg per dose. RESULTS: The sensitivity of SCORTEN for the analysed cohort was 100%, with a specificity of 24%. The estimated death was 41,9%, while the actual death rates were 12,5%. Our protocol improved the survival, OR = 26,57, RR = 6,34, p = 0,022. Decrease in mortality was caused by a combined treatment protocol we use- plasmaphereses with IVIGs. No independent risk factor was significant in death evaluation. CONCLUSION: Our data suggest that the scoring system for predicting death among TEN patients are reliable when they are high. New prognostic factors should be found to improve the evaluation of patients with low SCORTEN.

Immunomodulatory Treatment of Lyell's Syndrome: A Simultaneous Plasmapheresis and Intravenous Immunoglobulins Therapy.

Lyell's syndrome, or toxic epidermal necrolysis (TEN) is a rare but life-threatening condition. It manifests with blistering of skin and mucous due to subepidermal bullae and keratinocyte necrosis. In most cases, it is an immune response to drugs or their metabolites. The mortality in TEN is high despite optimal infection and wound control. There are no unequivocal treatment guidelines in TEN. Immunosuppressive treatment may increase the wound infection risk and mortality. The aim of the study was to evaluate a 10-year experience with immunomodulatory therapy in TEN. We perform a combination of plasmapheresis and intravenous immunoglobulins to control the disease. There were 35 patients in the group and we performed a post hoc evaluation. Twenty-eight patients received the full protocol and there were seven patients who did not complete the treatment (single therapy group). The mortality in the test group was 14.29%, and the difference reached statistical significance in comparison with the single therapy group (P < .05). Our protocol reduced the mortality risk five times. Our study proved that simultaneous plasmaphereses with intravenous immunoglobulins administration were safe and improved patients' outcome in TEN.

Microbiological Changes in Meat and Minced Meat from Beavers (Castor fiber L.) during Refrigerated and Frozen Storage.

This study aims to evaluate the microbiological status, pH, and water activity of European beaver meat to establish its shelf-life and microbiological safety. In this study, the microbiological profiles of meat and minced meat obtained from the carcasses of beavers were investigated. Microbial evaluation of the chilled meat was performed within 24 h after hunting, on the 7th day and 14th day, and the evaluation of the frozen meat was made during the 11th week of storage. Meat samples were analysed for total viable count (TVC), psychrotrophic bacteria count (PBC), Enterobacteriaceae count (EBC), Escherichiacoli count (EC), total staphylococcal count (TSC), lactic acid bacteria count (LABC) and total yeast and mould counts (TYMC). Tests for the presence of pathogenic bacteria from the genus Salmonella and Listeria were also performed. Additionally, the pH and water activity were determined. The initial amount of TVC was 4.94 log CFU/g in meat samples and 4.80 log CFU/g in minced meat. After 14 days of storage, the TVC increased to 8.33 in meat samples and 8.08 log CFU/g in minced meat. Pathogenic bacteria such as Listeria and Salmonella were not found in the beaver meat tested. The microbiological state of meat stored frozen for 11 weeks was comparable to the state found in meat stored refrigerated for seven days regarding the number of microorganisms.

Fatty Acid Profile in Fat Obtained from Edible Part of Land Snails Harvested in Poland.

INTRODUCTION: The objective was to determine the content of fatty acids in edible snail fat by snail species, collection site, and processing stage. MATERIAL AND METHODS: The research material comprised 180 edible fat samples from the three genera of edible snails collected in Poland: free-living Helix pomatia (HP) and two cultivated Cornu subspecies: C. aspersa maxima (CAM) and C. aspersum aspersum (CAA). All snails came from the Greater Poland and Lower Silesian Provinces: HP from their natural habitat and CAM and CAA from heliciculture farms. The studies focused on the raw meat, cooked meat, and frozen meat processing stages. Fatty acid (FA) profiles were determined by the gas chromatography method. RESULTS: Helix pomatia fat showed a higher saturated fatty acid (SFA) content, whereas the fat of Cornu genus snails had a higher unsaturated fatty acid (UFA) component, i.e. monounsaturated fatty acid (MUFA) and polyunsaturated fatty acid (PUFA). Thermal processing of snail meat increased all the determined SFA and decreased all the PUFA values, and increased the content of C18:1, C20:1, and C22:1 acids in the MUFA group. The material collection site had limited impact on FA content as differences were noted only in levels of C18:1, C18:2 n6, and C20:5. The differences pertained only to the fat of farmed snails of the Cornu genus. CONCLUSION: Due to the high content of UFA and a favourable ratio of n6:n3 acids and PUFA:SFA, snail fat can be regarded as nutritionally valuable.

Selenium, Copper, and Zinc Concentrations in the Raw and Processed Meat of Edible Land Snails Harvested in Poland.

INTRODUCTION: The objective of the present research was to carry out a comparative assessment of copper, zinc, and selenium concentrations in the meat of edible land snails collected in Poland (Helix pomatia, Cornu aspersum maxima, and Cornu aspersum aspersum), as well as to determine the effect of preliminary processing of Roman snails (Helix pomatia) on the content of the aforementioned elements. MATERIAL AND METHODS: In the first stage, determinations were made on unprocessed snail meat. In the second stage, the study focused on Roman snails and consisted in an additional evaluation of frozen meat after full processing. Zinc and copper contents were determined by flame atomic absorption spectrometry and the selenium content was established by graphite furnace atomic absorption spectrometry. RESULTS: The selenium content differed significantly among all three species. The copper content in Roman snails differed significantly from that in farmed snails. No significant difference in the zinc level was noted among the three snail species. The selenium content in raw and processed meat of Roman snails did not show any significant difference while the copper and zinc level was significantly higher in processed meat samples. CONCLUSION: The present research on the meat of edible snails showed different levels of selenium, copper, and zinc, depending on the species, collection site, and subjection to processing.