Adult-Onset Still disease (AODS) is rare condition that can be the cause behind high fever,rashes and joint aches in adult patients. Being a rare condition often times it is overlooked as an improbable condition. It’s prevalence is estimated at 1 in 100.000. AODS generally presents itself in young adults, however in our case the patient was a lactating mother.Yamaguchi criteria remains as the diagnostic criteria for AODS. Our case report aims to demonstrate the diagnostic process and subsequent treatment of this rarely encountered condition.

Early risk stratification of critically ill patients is essential for facilitating timely interventions in the emergency department (ED). This study assessed whether point-of-care ultrasound (POCUS) parameters – specifically, left ventricular ejection fraction (EF) and inferior vena cava (IVC) collapsibility – contribute prognostic value to established early warning scores, including the rapid emergency medicine score, Modified Early Warning Score (MEWS), and Hypotension, Oxygen saturation, low Temperature, ECG changes, Loss of independence (HOTEL) score, in predicting 6-month mortality. In this prospective, single-center study, 59 nontraumatic adult patients admitted to the ED critical care unit between October 2022 and October 2023 were enrolled. Demographic characteristics, vital signs, and clinical scores (rapid emergency medicine score, MEWS, HOTEL, glasgow coma scale, and Alert, Voice, Pain, Unresponsive [AVPU]) were documented at admission, alongside single-time bedside ultrasound measurements of EF and IVC collapsibility. The primary outcome was 6-month mortality. Six-month mortality was observed in 27 patients (45.8%). Non-survivors exhibited significantly lower systolic blood pressure (median 110 vs 142 mm Hg; P = .021) and elevated respiratory rates (median 22 vs 20 breaths/min; P = .021). Additionally, levels of consciousness were reduced (median glasgow coma scale 13 vs 15; P = .002; AVPU P = .003). The MEWS (median 4 vs 2; P = .004) and HOTEL (median 2 vs 1; p<0.001) scores were notably higher in the mortality cohort. Logistic regression analysis identified HOTEL (OR 4.23; 95% confidence interval 1.80–9.95; P = .001) and MEWS (OR 1.57; 95% confidence interval 1.17–2.12; P = .003) as independent predictors of mortality, whereas EF and IVC collapsibility did not reach statistical significance ( P = .307 and P = .084, respectively). It is evident that traditional physiological scoring systems, such as the MEWS and HOTEL, continue to serve as reliable instruments for predicting long-term mortality in critically ill patients in the ED. Single-time measurements of EF and IVC collapsibility at admission did not provide additional prognostic value beyond these scores. Future larger, multicentre studies may help to further clarify whether integrated or repeated point-of-care ultrasound (POCUS) assessments could have a role in risk stratification.

Background: Evidence comparing different non–vitamin K antagonist oral anticoagulants (NOACs) in terms of intracranial hemorrhage (ICH) characteristics and clinical outcomes is limited. Aim: This study aimed to identify factors associated with mortality and morbidity in geriatric patients receiving different NOACs presenting to the emergency department with intracranial hemorrhage. Methods: This multicenter retrospective observational study. Geriatric patients (aged ≥ 65 years) who presented to the emergency department with ICH while receiving NOAC therapy were included. Clinical characteristics were extracted from electronic medical records. The primary outcome was in-hospital mortality, while secondary outcomes included hemorrhage volume, intraventricular hemorrhage, intensive care unit admission, and the effect of four-factor prothrombin complex concentrate administration. Statistical analyses were performed using the chi-square or Fisher’s exact tests for categorical variables and the Mann–Whitney U or t-test for continuous variables, with p < 0.05 considered statistically significant. Results: A total of 47 patients were included; 57.4% ( n = 27) were female and 42.6% ( n = 20) were male. No significant association was observed between NOAC type and in-hospital mortality ( p = 0.533). Intraventricular hemorrhage was significantly more frequent in the rivaroxaban group than in the apixaban group (42.9% vs. 9.5%, p = 0.014). Intraventricular hemorrhage (52.6% vs. 4.2%, p < 0.001) and atrial fibrillation (90.5% vs. 57.7%, p = 0.012) were significantly more common in the mortality group compared with the survival group. Conclusion: NOAC type was not associated with in-hospital mortality; however, intraventricular hemorrhage occurred more frequently in patients receiving rivaroxaban and was significantly associated with mortality.

Background/Objectives: Warfarin-associated intracranial hemorrhage (WA-ICH) remains one of the most devastating anticoagulant-related emergencies, particularly among older adults, with substantial morbidity and mortality. Although current guidelines recommend that reversal strategies should be guided primarily by bleeding severity and clinical presentation rather than the international normalized ratio (INR) alone, real-world treatment decisions often continue to rely on INR thresholds. This study investigated whether INR is an adequate determinant for four-factor prothrombin complex concentrate (4F-PCC) administration in geriatric patients with non-traumatic WA-ICH. Methods: In this multicenter retrospective cohort study, consecutive patients aged ≥65 years presenting with non-traumatic WA-ICH to five tertiary-care centers in Turkey were evaluated. Patients were categorized according to reversal strategy into a 4F-PCC group (n = 30) and a heterogeneous non-PCC management group (n = 30), which included supportive care, intravenous vitamin K, FFP, combinations of these approaches, or no specific reversal treatment. Subgroup analyses were performed using multiple INR thresholds to examine the relationship between INR levels, treatment allocation, and in-hospital mortality. The primary outcome was all-cause in-hospital mortality. Results: Patients who received 4F-PCC had higher admission INR values than those managed without PCC, whereas admission Glasgow Coma Scale (GCS) was similar between treatment groups. Admission GCS was substantially lower among non-survivors than survivors. In the revised Firth-penalized logistic regression model, higher admission GCS was independently associated with lower odds of in-hospital mortality (aOR 0.37 per 1-point increase; 95% CI 0.10–0.62; p < 0.001), whereas 4F-PCC administration and admission INR values were not independently associated with mortality. Conclusions: Higher admission INR was associated with 4F-PCC administration and was not independently associated with mortality, whereas admission GCS was independently associated with in-hospital mortality. These findings support consideration of neurological, radiological, and laboratory information together rather than interpretation of admission INR in isolation. Given the retrospective design, small sample size, baseline differences in anticoagulation intensity, and potential residual confounding, the findings should be considered hypothesis-generating.

This study compared the performance of the Glasgow-Blatchford Score (GBS), AIMS65, and the pre-endoscopic Rockall score in predicting clinical outcomes in patients aged ≥ 65 years receiving warfarin who presented with upper gastrointestinal bleeding (UGIB). In this multicenter retrospective study, geriatric patients presenting to the emergency departments of tertiary care hospitals over a 3-year period were evaluated. The primary outcome was in-hospital mortality, while secondary outcomes included RBC transfusion requirement and intensive care unit (ICU) admission. Predictive performance was assessed using receiver operating characteristic (ROC) curve analysis, and pairwise comparisons of correlated ROC curves were performed using the DeLong test with Bonferroni adjustment. A total of 126 patients were included. AIMS65 demonstrated the highest AUC for predicting in-hospital mortality (AUC = 0.815, 95% CI: 0.723–0.887), with significantly better discrimination than the pre-endoscopic Rockall score (DeLong p = 0.0005). GBS showed the highest AUC for predicting transfusion requirement (AUC = 0.655, 95% CI: 0.564–0.739, p = 0.002) and ICU admission (AUC = 0.739, 95% CI: 0.652–0.815, p < 0.001). GBS significantly outperformed AIMS65 for predicting transfusion requirement (p = 0.0023), whereas no other pairwise differences were statistically significant. These findings indicate that the three scoring systems demonstrated different patterns of predictive performance across the evaluated clinical outcomes, with AIMS65 showing the strongest discrimination for in-hospital mortality and GBS showing the strongest numerical discrimination for RBC transfusion requirement and ICU admission.

Acute respiratory distress syndrome(ARDS) is a critical condition which compromises with the respiratory functions.Aim of this study is to present the management of ARDS case in the emergency department. This is a case report of a patient who was admitted to an emergency department.We did not apply any statistical methods. A 41-year-old female patient with no medical history was admitted to the emergency department as an outpatient with complaints of shortness of breath and palpitations. After a physical examination,it was first though that the patient was simply experiencing an anxiety episode.However oxygen saturation was measured as 35 % and further investigation of the patient revealed ARDS as the cause of these symptoms.Patient was admitted to the ICU unit. Even though anxiety can be common,it can be dangerous to dismiss other clinical and potentially lethal pathologies when searching for the cause of respiratory distress.Physical examination and vital signs should be evaluated together to reach a potential diagnosis.