Several studies have suggested the potential role of Magnesium Sulfate (MgSO₄) for the treatment of Atrial Fibrillation (AF) but, in clinical practice, the use of magnesium is not standardized although it is largely used for the treatment of supraventricular arrhythmias. Objectives. We evaluated the role of MgSO₄ infusion in association with flecainide in cardioversion of patients presenting in ED with symptomatic AF started less than 48 h before. We retrospectively searched for all patients presented in ED from 1 January 2019 to 31 December 2019 requiring pharmacological cardioversion with flecainide 2 mg/kg. Ninety-seven patients met these criteria, 46 received the administration of intravenous MgSO₄ 2 gr (Group A), and 51 did not (Group B). Among the 97 patients, the overall cardioversion rate was 85.6%, 91.3% in Group A and 80.4% in Group B. In 27 patients out of 97, the Flecainide was not administered because of spontaneous restoration of sinus rhythm of 9 pts (Group B) and 18 pts (Group A). We also found a statistical significance in the HR at the time of cardioversion between Group A (77.8 ± 19.1 bpm) and Group B (87 ± 21.7 bpm). No complications emerged. The association between MgSO₄ and Flecainide has not yielded statistically significant results. However, in consideration of its high safety profile, MgSO₄ administration may play a role in ED cardioversion of acute onset AF, reducing the need for antiarrhythmic medications and electrical cardioversion procedures, relieving symptoms reducing heart rate, and reducing the length of stay in the ED.

While the clinical impact of COVID-19 on adults has been massive, the majority of children develop pauci-symptomatic or even asymptomatic infection and only a minority of the latter develop a fatal outcome. The reasons of such differences are not yet established. We examined cytokines in sera and Th and B cell subpopulations in peripheral blood mononuclear cells (PBMC) from 40 children (<18 years old), evaluating the impact of COVID-19 infection during the pandemic’s first waves. We correlated our results with clinical symptoms and compared them to samples obtained from 16 infected adults and 7 healthy controls. While IL6 levels were lower in SARS-CoV-2⁺ children as compared to adult patients, the expression of other pro-inflammatory cytokines such as IFNγ and TNFα directly correlated with early age infection and symptoms. Th and B cell subsets were modified during pediatric infection differently with respect to adult patients and controls and within the pediatric group based on age. Low levels of IgD⁻ CD27⁺ memory B cells correlated with absent/mild symptoms. On the contrary, high levels of FoxP3⁺/CD25^high T-Regs associated with a moderate–severe clinical course in the childhood. These T and B cells subsets did not associate with severity in infected adults, with children showing a predominant expansion of immature B lymphocytes and natural regulatory T cells. This study shows differences in immunopathology of SARS-CoV-2 infection in children compared with adults. Moreover, these data could provide information that can drive vaccination endpoints for children.

Background: The growing use of Emergency Departments (EDs) by older adults highlights the need for early and accurate identification of clinical deterioration. Early Warning Scores (EWSs) are widely implemented tools based on standardized vital sign thresholds; however, their performance in elderly patients is inconsistent, likely reflecting the biological heterogeneity, multimorbidity, and reduced physiological reserve typical of this population. Objectives: This narrative review aims to summarize current evidence on the use of EWSs in adults aged ≥ 65 years presenting to the ED, with a specific focus on mortality and intensive care unit (ICU) admission, and to discuss their role within the evolving framework of personalized medicine. Sources: A narrative review of 36 clinical studies published between 2014 and 2025 was conducted. Content: Traditional scores such as National Early Warning Score (NEWS), National Early Warning Score 2 (NEWS2), Modified Early Warning Score (MEWS), VitalPAC Early Warning Score (ViEWS), Rapid Acute Physiology Score (RAPS) and Rapid Emergency Medicine Score (REMS) show variable and often reduced prognostic accuracy in older and frail patients. Evidence consistently suggests that applying uniform cut-off values fails to capture individual vulnerability in elderly patients. The integration of age, frailty, comorbidities, and baseline physiological status improves risk stratification. Second-generation tools—including Copeptin-NEWS, NEWS-L, suPAR-NEWS, OPERA, and RISE UP—as well as artificial intelligence-based models, represent emerging personalized approaches to clinical deterioration prediction. Implications: No single score currently provides reliable early risk prediction for all elderly ED patients. Moving beyond “one-size-fits-all” EWSs toward adaptive, person-centered models may better reflect the complexity of geriatric emergency care and improve prognostic accuracy.

Importance: Early warning scores (EWSs) are widely used tools to support triage and risk stratification in the emergency department (ED). However, data on their performance in identifying clinical deterioration among acutely ill adults aged 80 years or older are scarce. Objective: To evaluate and compare the performance of 5 EWSs for predicting short-term clinical deterioration in ED patients aged 80 years or older. Design, Setting, and Participants: This retrospective prognostic study included all consecutive nontrauma ED visits by patients aged 80 years or older between January 2015 and December 2024 at a large urban teaching hospital in Rome, Italy. Exposures: Physiologic parameters recorded at ED admission were used to calculate 5 EWSs: National Early Warning Score (NEWS), National Early Warning Score 2 (NEWS2), Modified Early Warning Score (MEWS), Rapid Emergency Medicine Score (REMS), and International Early Warning Score (IEWS). Main Outcomes and Measures: The primary outcome was clinical deterioration, defined as death or intensive care unit (ICU) admission within 24 hours of ED arrival. Discrimination was assessed by area under the receiver operating characteristic curve (AUROC), calibration by the Brier score, and age-related performance by spline regression. Comparative contributions of variables were analyzed using Shapley additive explanations (SHAP) values. Results: Among 50 645 patients (median age, 85 years [IQR, 82-88 years]; 54.6% females), 1233 (2.4%) experienced clinical deterioration. All EWSs demonstrated fair discrimination (AUROC range, 0.747 [IQR, 0.731-0.763] for MEWS to 0.782 [IQR, 0.767-0.798] for NEWS). Whereas NEWS achieved the highest AUROC, REMS had the best calibration (Brier score, 0.0220; 95% CI, 0.0208-0.0232). Discriminatory performance declined with increasing age beyond 90 years except for REMS, whose predictive accuracy improved among patients older than 94 years. For patients aged 87 years or older vs 80 to 86 years, oxygen supplementation (SHAP difference, 0.59), systolic blood pressure (SHAP difference, 0.32), and Glasgow Coma Scale score (SHAP difference, 0.40) were the strongest predictors of clinical deterioration. Conclusions and Relevance: In this prognostic study of EWSs conducted among ED patients aged 80 years or older, all scores provided acceptable short-term prognostic accuracy. REMS demonstrated the most consistent performance in patients aged 94 years or older, supporting its use for targeted risk stratification in this population.