Platelet-to-lymphocyte ratio as a prognostic biomarker for COVID-19 severity: a single center retrospective data analysis and systematic review with meta-analysis of 187 studies

INTRODUCTION: This study aims to evaluate the prognostic value of the platelet-to-lymphocyte ratio in determining the severity and mortality of adults hospitalized for COVID-19 using retrospective data and a meta-analysis of previous studies on the platelet-to-lymphocyte ratio worldwide. MATERIAL AND METHODS: A retrospective study was conducted at the Kırdar City Hospital (Istanbul, Turkey) and included 521 COVID-19 patients. A systematic literature search of EMBASE, MEDLINE, the Cochrane Central Register of Controlled Trials (CENTRAL), and Google Scholar databases was performed for relevant trials relating to the PLR ratio in COVID-19 published before April 12, 2023. RESULTS: In the retrospective part of the study, PLR values were found to predict COVID-19 severity at admission with an AUC of 0.61 (SE = 0.03; 95% CI: 0.56 to 0.65; p = 0.0003) as well as survival status in a statistically significant fashion with an AUC of 0.59 (SE = 0.03; 95% CI: 0.55 to 0.64; p = 0.0004). Results of our meta-analysis showed a significant relationship between PLR and COVID-19 severity, with a pooled standardized mean difference (SMD) of 1.34 (95% CI: 1.13 to 1.55; p < 0 .001), and that PLR was significantly lower among patients who survived compared to deceased patients (SMD = –1.32; 95% CI: 1.57 to –1.07; p < 0.001). CONCLUSIONS: PLR is a valid, readily available marker that can distinguish COVID-19 individuals with distinct progression and survival outcomes

Electrochemical activation and inhibition of neuromuscular systems through modulation of ion concentrations with ion-selective membranes

Conventional functional electrical stimulation aims to restore functional motor activity of patients with disabilities resulting from spinal cord injury or neurological disorders. However, intervention with functional electrical stimulation in neurological diseases lacks an effective implantable method that suppresses unwanted nerve signals. We have developed an electrochemical method to activate and inhibit a nerve by electrically modulating ion concentrations in situ along the nerve. Using ion-selective membranes to achieve different excitability states of the nerve, we observe either a reduction of the electrical threshold for stimulation by up to approximately 40%, or voluntary, reversible inhibition of nerve signal propagation. This low-threshold electrochemical stimulation method is applicable in current implantable neuroprosthetic devices, whereas the on-demand nerve-blocking mechanism could offer effective clinical intervention in disease states caused by uncontrolled nerve activation, such as epilepsy and chronic pain syndromes.Massachusetts Institute of Technology. Faculty Discretionary Research FundNational Institutes of Health (U.S.) (Award UL1 RR 025758)Harvard Catalyst (Grant

A Rare Cause of Headache

A 45-year-old man presented with headache for two days. He described the quality of headache as throbbing, and it was unilateral. There was no history of fever, vomiting, blurred vision, ear discharge or trauma, no relevant past medical or drug history and no family history of note. On examination, he was afebrile with pulse 76/min, regular, blood pressure of 130/80mmHg. His pupils and speech appeared normal. There were no papilledema, sensory deficit, focal neurological deficit or signs of meningeal irritation. Hyperdensity of right transverse sinus (Figure 1) and superior sagittal sinus was identified on unenhanced computed tomography (CT). Magnetic resonance venography (MRV) demonstrated lack of flow in right transverse sinus (Figure 2) and superior sagittal sinus

Posterior fascicular ventricular tachycardia: A rare cause of tachycardia

A 13-year male patient with a history of tachycardia attacks was diagnosed to have left posterior fascicular ventricular tachycardia (VT) according to the electrocardiogram (ECG) obtained at the emergency service. This diagnosis was confirmed with advanced electrophysiological studies and the case was diagnosed by genetic evaluation, which was performed to reveal the underlying cause, to have Brugada type 2 syndrome that might be associated with sudden cardiac death. Underlying causes should be evaluated, although idiopathic VTs generally have a good prognosis

Can we recognize severe community-acquired pneumonia without pneumonia severity index? Use of modified qSOFA with procalcitonin

Objective: The aim of this study is to analyze the diagnostic value of Quick Sequential Organ Failure Assessment (qSOFA), modified qSOFA, National Early Warning Score (NEWS) and NEWS + Lactate (NEWS + L) scores in the detection of severe community-acquired pneumonia (CAP). Methods: This research is a retrospective cohort study. Patients admitted to the Emergency Department (ED) with the diagnosis of CAP were divided into severe and mild pneumonia regarding their Pneumonia Severity Index (PSI) scores. The accuracies of lactate, procalcitonin (PCT) values, NEWS and qSOFA scores, as well as score combinations (NEWS + L and qSOFA + PCT) in predicting patients with severe CAP were analyzed. Results: Median qSOFA value in the severe CAP group (0 [IQR 0–1]) was found to be higher than median qSOFA value (0 [IQR 0-0]) in the mild CAP group (p < 0.001). The rate of qSOFA positivity (qSOFA ≥ 2) was significantly higher in the severe CAP group (17.1%, n = 21) compared to the mild CAP group (1.3%, n = 1) (p < 0.001). Median qSOFA + PCT for the severe CAP group (2 [IQR 1–2]) was higher than the mild CAP group (1 [IQR 0–1]) (p < 0.001). Mean NEWS score for severe CAP (4.95 ± 3.09) was found to be 1.69 (95% CI 0.92–2.46) higher than mean NEWS score of the mild CAP group (3.26 ± 2.39) (p < 0.001). The severe CAP NEWS + L score (6.97 ± 3.71) was higher than the mild CAP NEWS + L score (4.94 ± 2.48) (p < 0.001). Blood lactate level was not significant in the evaluation of severe CAP (p = 0.221). PCT (AUROC = 0.685 [95% CI 0.610–0.760]; p = 0.038), NEWS score (AUROC = 0.658 95% CI [0.582–0.733]; p < 0.001), qSOFA (AUROC = 0.686) were calculated to have adequate accuracy for the detection of severe CAP. [95% CI 0.613–0.759]; p = 0.037), NEWS + L score (AUROC = 0.665 [95% CI 0.589–0.740]; p = 0.038). The qSOFA + PCT score (AUROC = 0.758 [95% 0.691–0.825]; p = 0.034) was also found to be a highly accurate predictor of severe CAP. Conclusion: In this study, we found a combination of qSOFA and PCT to be the most reliable method of detecting severe CAP