Credibility of the Neutrophil-to-Lymphocyte Count Ratio in Severe Traumatic Brain Injury

Traumatic brain injury (TBI) is one of the leading causes of morbidity and mortality worldwide. The consequences of a TBI generate the activation and accumulation of inflammatory cells. The peak number of neutrophils entering into an injured brain is observed after 24 h; however, cells infiltrate within 5 min of closed brain injury. Neutrophils release toxic molecules including free radicals, proinflammatory cytokines, and proteases that advance secondary damage. Regulatory T cells impair T cell infiltration into the central nervous system and elevate reactive astrogliosis and interferon-γ gene expression, probably inducing the process of healing. Therefore, the neutrophil-to-lymphocyte ratio (NLR) may be a low-cost, objective, and available predictor of inflammation as well as a marker of secondary injury associated with neutrophil activation. Recent studies have documented that an NLR value on admission might be effective for predicting outcome and mortality in severe brain injury patients.

SPO2/FIO2 RATIO AND TRIAGE SCORE IN PREDICTING OUTCOME OF CRITICALLY ILL CHILDREN

Introduction: Non-invasive nature of pulse oximetry allows much affordable, rapid assessment of degree of hypoxemia and helps in identication of the patients at risk. Mortality in a pediatric intensive care unit (PICU) depends on the severity of illness. A good scoring system for identifying the severity of illness can help to prioritize care. Triage is sorting out of patients, the main objective of which is early patient assessment to obviate harmful delay in the management. Aims And Objectives: To predict the outcome of critically ill children in pediatric ICU by using the Triage scoring system and Spo2/Fio2(SF) ratio. Materials And Methods: A hospital based prospective observational study done at Navodaya Medical College Hospital & Research Centre during January 2020 to June 2021 for a period of 18 months. A total of 125 children were studied. Data is described in terms of mean (+SD), frequencies (number of cases) and percentages. Statistical analysis was done using SPSS software version 26. Results: Out of 125 children studied, 8 died. Except temperature, all other variables showed signicant association with mortality (p <0.001). Mortality was 0%, 4.88%, 28.57%, 75%, 25% and 50% for scores of 0, 1, 2, 3, 4 and 5 respectively. Children of score 3 or more had signicant high mortality. Among the 113 subjects who survived, mean SpO2/FiO2 ratio is 340 and among 12 subjects who died, SpO2/FiO2 ratio is 184. SpO2/FiO2 ratio is less among the children who died and can predict mortality. Conclusions: Many deaths in under ve children occurring in hospitals can be prevented if triage is followed, if any sick children are identied soon on their arrival and treatment is started immediately. SpO2/FiO2 ratio is a non-invasive and reliable tool for hypoxemia screening and predicting outcome among patients admitted to the ED.

Multimodal CT Imaging Characteristics in Predicting Prognosis of Wake-Up Stroke

Background: Multimodal CT imaging can evaluate cerebral hemodynamics and stroke etiology, playing an important role in predicting prognosis. This study aimed to summarize the comprehensive image characteristics of wake-up stroke (WUS), and to explore its value in prognostication.Methods: WUS patients with anterior circulation large vessel occlusion were recruited into this prospective study. According to the 90-day modified Rankin Scale (mRS), all patients were divided into good outcome (mRS 0–2) or bad (mRS 3–6). Baseline clinical information, multimodal CT imaging characteristics including NECT ASPECTS, clot burden score (CBS), collateral score, volume of penumbra and ischemic core on perfusion were compared. Multivariate logistic regression analysis was further used to analyze predictive factors for good prognosis. Area under curve (AUC) was calculated from the receiver operating characteristic (ROC) curve to assess prognostic value.Results: Forty WUS were analyzed in this study, with 20 (50%) achieving good outcome. Upon univariable analysis, the good outcome group demonstrated higher ASPECTS, higher CBS, higher rate of good collateral filling and lower penumbra volume when compared with the poor outcome group. Upon logistic regression analysis, poor outcome significantly correlated with penumbra volume (OR: 1.023, 95% CI = 1.003–1.043) and collateral score (OR: 0.140, 95% CI = 0.030–0.664). AUC was 0.715 for penumbra volume (95% CI, 0.550–0.846) and 0.825 for good collaterals (95% CI, 0.672–0.927) in predicting outcome.Conclusions:Penumbra volume and collateral score are the most relevant baseline imaging characters in predicting outcome of WUS patients. These imaging characteristics might be instructive to treatment selection. As the small sample size of current study, further studies with larger sample size are needed to confirm these observations.

The role of urine metabolomics among newborn infants with hypoxic ishaemic encephalopathy: a literature review

Background: Perinatal asphyxia (PA) which may result in hypoxic ischaemic encephalopathy (HIE) affects four million neonates worldwide and accounts for the death of one million of affected babies. The science of metabolomics has become an area of growing interest in neonatal research, with a potential role in identifying useful biomarkers that can accurately predict injury severity in perinatal asphyxia and HIE. The aim of this review is to look at the evidence of the usefulness of urine metabolomics in predicting outcome in PA/HIE. Methods: The key words used in the advanced search ‘urine metabolomics’ AND ‘perinatal asphyxia’ OR ‘hypoxic ischaemic encephalopathy’, yielded 13 articles. Results: Of the selected thirteen studies, 38% (n = 5) were human studies, 31% (n= 4) were animal studies and 31% (n = 4) were review articles. The studies confirmed the involvement of known pathways in the development of PA/HIE, primarily the Krebs cycle evidenced by accumulation of TCA cycle intermediates (citrate, α-ketoglutarate, succinate) and anaerobic pathways indicated by increased lactate. Other pathways involved include amino acid and carbohydrate pathways. Conclusion: Metabolomic studies so far are promising in highlighting potential biomarker profiles in PA/HIE. Further research is necessary to further clarify the role of identified metabolites in predicting outcome and prognosis in neonates affected by PA/HIE.