anshuman singh
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Background
Renal cell carcinoma (RCC) is an aggressive cancer prevalent worldwide.
ObjectivesWe investigated whether preoperative serum levels of plateletcrit (PCT) can predict tumor stages and pathological grades in patients, who were operated on for T1-4, N0, and M0 RCC. Additionally, we compared it with neutrophil to lymphocyte ratio (NLR).
MethodsWe conducted a retrospective evaluation of 196 patients, who had undergone nephrectomy (radical or partial) for T1-4, N0, and M0 RCC at our hospital from January 2016 to December 2022. Based on their histopathology results, tumor stages (T) and WHO-ISUP grades (G) were identified. The patients were separated into two categories depending on their T-stage (T1 - T2 and T3 - T4) and pathological grade (G1 - 2 and G3 - 4). The study compared the NLR, PCT, and their combined values to determine their role in predicting aggressiveness based on pathological stage and grade of tumors.
ResultsThe mean cut-off values for NLR and PCT were found to be 2.108 and 0.273, for the high tumor stage and 2.237 and 0.252 for high-grade tumors, respectively. The statistical analysis showed that NLR (P = 0.031) and PCT (P = 0.006) were significant predictors of high tumor stage, while only PCT (P = 0.022) was a significant predictor of high WHO-ISUP grade. The combination of both NLR and PCT helps improve the sensitivity for detecting high-grade tumors.
ConclusionsNLR and PCT can be predictive markers of the tumor stage. However, only PCT can predict the tumor grade in patients with RCC. In addition, combining the PCT and NLR scores improved the predictive ability of each parameter, especially for identifying high-grade tumors.
Keywords: Platelets, Tumor Stage, Tumour Grade, NLR, Renal Cell Carcinoma, Mean Platelet Value -
BackgroundPain scores are used for acute pain management. The assessment of pain by the patient as well as the caregiver can be influenced by a variety of factors. The numeric rating scale (NRS) is widely used due to its easy application. The NRS requires abstract thinking by a patient to assign a score to correctly reflect analgesic needs, and its interpretation is subject to bias..ObjectivesThe study was done to validate a 4-point objective pain score (OPS) for the evaluation of acute postoperative pain and its comparison with the NRS..Patient andMethodsA total of 1021 paired readings of the OPS and NRS of 93 patients who underwent laparotomy and used patient-controlled analgesia were evaluated. Acute pain service (APS) personnel recorded the OPS and NRS. Rescue analgesia was divided into two incremental levels (level 1-paracetamol 1 g for NRS 2 - 5 and OPS 3, Level 2-Fentanyl 25 mcg for NRS ≥ 6 and OPS 1 and 2). In cases of disagreement between the two scores, an independent consultant decided the rescue analgesia..ResultsThe NRS and OPS agreed across the range of pain. There were 25 disagreements in 8 patients. On 24 occasions, rescue analgesia was increased from level 1 to 2, and one occasion it was decreased from level 2 to 1. On all 25 occasions, the decision to supplement analgesia went in favor of the OPS over the NRS. Besides these 25 disagreements, there were 17 occasions in which observer bias was possible for level 2 rescue analgesia..ConclusionsThe OPS is a good stand-alone pain score and is better than the NRS for defining mild and moderate pain. It may even be used to supplement NRS when it is indicative of mild or moderate pain..Keywords: Pain Assessment, Acute Pain Service, Postoperative Pain
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