The hypothalamic–pituitary–adrenal axis is a tightly regulated system that represents one of the body’s mechanisms for responding to acute and chronic stress. Prolonged stress and/or inadequate regulation of the stress system can lead to a condition of chronic hypercortisolism or, in some cases, a blunted cortisol response to stress, contributing to insulin resistance, increased adiposity and type 2 diabetes mellitus. Moreover, acute and chronic stress can exacerbate or worsen metabolic conditions by supporting an inflammatory state and a tight relationship between stress, inflammation and adipose tissue has been reported and has been a growing subject of interest in recent years. We reviewed and summarized the evidence supporting hypothalamic–pituitary–adrenal axis dysregulation as an important biological link between stress, obesity, inflammation and type 2 diabetes mellitus. Furthermore, we emphasized the possible role of infectious-related stress such as SarsCov2 infection in adrenal axis dysregulation, insulin resistance and diabetes in a bidirectional link. Understanding and better defining the links between stress and obesity or diabetes could contribute to further definition of the pathogenesis and the management of stress-related complications, in which the HPA axis dysregulation has a primary role.

Introduction: Cardiac arrests are traditionally classified according to the setting in which they occur, including out-of-hospital cardiac arrest (OHCA) and in-hospital cardiac arrest (IHCA). However, cardiac arrests that occur in the emergency department (EDCA) could constitute a third category, due to the peculiar characteristics of the emergency department (ED). In recent years, the need to study EDCAs separately from other intra-hospital events has emerged. The aim of this study was to describe the characteristics and outcomes of a cohort of patients experiencing EDCA in an Italian hospital over a 14-year period. Methods: This was a single-centre retrospective observational study conducted in the ED of the Santa Croce e Carle Hospital in Cuneo, Italy. All adult patients who experienced EDCA between 1 January 2010 and 30 June 2023 were included. OHCA patients, those arriving in the ED with on-going resuscitation measures, patients with EDCA not undergoing resuscitation, and patients with post-traumatic cardiac arrest were excluded from the study. The main outcome of the study was survival at hospital discharge with a favourable neurological outcome. Results: 350 cases of EDCA were included. The median age was 78 (63–85) years, and the median Charlson Comorbidity Index score was 5 (3–6). A total of 35 patients (10%) survived to hospital discharge with a cerebral performance category (CPC) Score of 1–2; survival in the ED was 28.3%. The causes of cardiac arrests were identified in 212 cases (60.6%) and included coronary thrombosis (35%), hypoxia (22%), hypovolemia (17%), pulmonary embolism (11%), metabolic (8%), cardiac tamponade (4%), toxins (2%) and hypothermia (1%). Variables associated with survival with a favourable neurological outcome were young age, a lower Charlson Comorbidity Index, coronary thrombosis as the primary EDCA cause, and shockable presenting rhythm; however, only the latter was associated with the outcome in a multivariate age-weighted model. Conclusions: In a cohort of patients with EDCA over a period of more than a decade, the most frequent cause identified was coronary thrombosis; 10% of patients survived with a good neurological status, and the only factor associated with the best prognosis was presenting a shockable rhythm. EDCA should be considered an independent category in order to fully understand its characteristics and outcomes.

Background: Behavioural cues observed during emergency department (ED) triage may provide additional information on patient acuity. We conducted an exploratory pilot study to investigate whether mobile phone use observed during ED triage was associated with hospital admission. Methods: We performed a retrospective, single-centre study including all adult ED attendances between 1 January 2019 and 30 June 2025. Demographics, triage category, mobile phone use documented by nursing staff during waiting time, and hospital admission were extracted from the electronic health record. The primary outcome was hospital admission, with a secondary analysis restricted to low-priority triage categories. Results: Among 423,267 ED visits, the overall admission rate was 20.9%. Mobile phone use was documented in 171 patients (0.04%), of whom 4.7% were admitted (p < 0.001). In low-priority patients (n = 336,160), admission was 4.5% among those using a phone compared with 13.2% overall (p = 0.001). Conclusions: Mobile phone use observed during ED triage was associated with lower hospital admission rates and may represent a simple behavioural adjunct to conventional triage assessment.

Dear Editor, We read with great interest the Educational Paper by Colantoni and colleagues recently published in Emergency Care Journal.1 We particularly appreciated the attention paid to the potential role of Geriatric Emergency Departments —an entity not yet well defined in Italy. The increasing number of older patients with multimorbidity and/or frailty attending EDs represents an emerging challenge, and the training of Emergency Physicians (EPs) alone may not always be sufficient to address their complex needs.