High altitude illness in its most severe form can lead to high altitude cerebral edema (HACE). Current strategies have focused on prevention with graduated ascents, pharmacologic prophylaxis, and descent at first signs of symptoms. Little is understood regarding treatment with steroids and oxygenation being commonly utilized. Pre-clinical studies with turmeric derivatives have offered promise due to its anti-inflammatory and antioxidant properties, but they warrant validation clinically. Ongoing work is focused on better understanding the disease pathophysiology with an emphasis on the glymphatic system and venous outflow obstruction. This review highlights what is known regarding diagnosis, treatment, and prevention, while also introducing novel pathophysiology mechanisms warranting further investigation.

Citation: Rahimi MJ, Mirakhori F, Zelmanovich R, et al. Diagnostic Significance of Neutrophil to Lymphocyte Ratio in Recurrent Aphthous Stomatitis: A Systematic Review and Meta-Analysis. Dermatol Pract Concept. 2024;14(1):e2024046. DOI: https://doi.org/10.5826/dpc.1401a46 Accepted: August 14, 2023; Published: January 2024 Copyright: ©2024 Rahimi et al. This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial License (BY-NC-4.0), https://creativecommons.org/licenses/by-nc/4.0/, which permits unrestricted noncommercial use, distribution, and reproduction in any medium, provided the original authors and source are credited. Funding: None. Competing interests: None. Authorship: All authors have contributed significantly to this publication. Corresponding Author: Shokoufeh Khanzadeh, Student Research Committee, Tabriz University of Medical Sciences, Tabriz, Iran. Email: Khshokufeh7@gmail.com Introduction: Recurrent aphthous stomatitis (RAS) is a prevalent ulcerative condition affecting oral mucosa. Objectives: A systematic review and meta-analysis was performed to compare the level of neutrophil to lymphocyte ratio (NLR) between individuals with RAS and those who are healthy. Methods: A systematic search for relevant publications before June 21, 2022, was conducted using Web of Science, PubMed, and Scopus. The results were presented as the standardized mean difference (SMD) with a 95% confidence interval (CI), and a random-effects model was used to calculate pooled effects due to the presence of significant heterogeneity. Quality assessment was performed using the Newcastle-Ottawa scale. Results: Overall, 13 article with were included in the analysis. NLR was higher among patients with RAS compared to healthy controls (SMD = 0.50, 95% CI = -0.20 to 0.79, P = 0.001, I² = 91.5%). In the subgroup analysis based on the study design, it was found that retrospective studies showed higher levels of NLR in patients with RAS compared to healthy controls (SMD = 0.62, 95% CI= 0.16 to 1.08, P < 0.01), but these results were not applied to prospective studies (SMD = 0.35, 95% CI = -0.03 to 0.74, P < 0.07). Conclusion: Elevated neutrophil to lymphocyte ratio revealed crosstalk between systematic inflammation and RAS. Keywords : NLR, Recurrent aphthous stomatitis, Meta-analysis, Neutrophil to lymphocyte ratio, inflammation This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.