The aim of this study was to evaluate the role of the prognostic nutritional index in predicting in-hospital mortality among patients with acute ischemic stroke.

Characterization of Suicide, Suicidal Ideation, and Self-harm Attempts: A Pre-hospital Descriptive Study - European Archives of Medical Research

In the 21st century, disasters (particularly earthquakes, which remain the leading cause of death) continue to be among the foremost issues requiring global emergency response. While the impact of advancing technologies on the environmental and human damage caused by earthquakes is still a subject of debate, search and rescue (SAR) teams and emergency departments (ED), specifically emergency physicians (EPs), play a crucial role in the most acute management of the effects of these earthquakes on human life. This study aims to examine the injury dynamics of two catastrophic earthquakes that occurred in Turkey 24 years apart from the perspective of EPs, utilizing archival records from the SAR teams in which EPs served. This study is a cross-sectional investigation analyzing the injury and SAR dynamics of casualties, based on the archives of SAR teams that included 12 EPs, during the 1999 Marmara and 2023 Kahramanmaraş (Maraş) earthquakes (groups). In this study, a total of 160 injured individuals who were rescued alive from the rubble were included, with 26.3% (n = 42) from the Maraş group and 73.8% (n = 118) from the Marmara group. Identification of the injured was achieved in 54.8% (n = 23) of the Maraş group and 88.1% (n = 104) of the Marmara group, with an overall identification rate of 79.4% (n = 127) (p < 0.001). The most common injuries among the injured were lower extremity injuries (53.1%, n = 85) and upper extremity injuries (49.4%, n = 79), with the most frequent scenario being the extraction of two individuals from the same location (33.8%, n=54). The most common interventions provided to the injured were intravenous fluid therapy (63.8%, n =102) and oxygen support (57.5%, n =92). The rate of intubation at the scene was 16.1% (n = 19) in the Marmara group and 4.8% (n = 2) in the Maraş group (p < 0.05). Additionally, cardiopulmonary resuscitation (CPR) was administered at the scene in 13.6% (n = 16) of the Marmara group, compared to 2.4% (n = 1) in the Maraş group (p < 0.05). When examining the challenges encountered during SAR operations, the most frequent issue in the Maraş group was identification, affecting 57.1% of the cases (p < 0.001), whereas the most common issue in the Marmara group was entrapment, occurring in 50.0% of cases (p < 0.001). Lighting difficulties were observed at similar rates in both earthquakes (19.0% in Maraş, 19.5% in Marmara; p = 1.000). Additionally, weather conditions posed a challenge in 11.9% of cases in the Maraş group, whereas this issue was not encountered in the Marmara group (p < 0.001). The 24 years of experience and expertise gained by EPs who served in Türkiye in these operations constitute a valuable global resource. Disseminating this knowledge is crucial not only for managing earthquakes but also for preparing for other catastrophic events that could cause widespread destruction. Harnessing this accumulated experience can significantly enhance knowledge-sharing and the development of more effective preparedness strategies.

Acute pancreatitis (AP) is a disease that poses significant health risks with potential severe outcomes. Identifying markers for severity can aid in early intervention and improve prognoses. This study, conducted in the emergency department, investigates the QRS–T angle as a potential indicator of severity in patients with acute pancreatitis. This retrospective study included 367 patients diagnosed with AP, classified as either mild acute pancreatitis or severe acute pancreatitis based on Ranson criteria. The QRS–T angle was measured using standard 12-lead electrocardiogram, and the data were analyzed to compare the QRS–T angles between the mild acute pancreatitis and severe acute pancreatitis groups. This research adhered to the guidelines outlined in the Strengthening the Reporting of Observational Studies in Epidemiology statement. The study included 367 patients, 94% (n = 345) had mild pancreatitis while 6% (n = 22) had severe pancreatitis. Severe cases had a significantly higher median age (P < .001) and higher rates of hypertension and diabetes mellitus (P = .027, P = .011). Severe cases also had higher Ranson scores (3 [IQR 3–3.25] vs 1 [IQR 1–2], P < .001) and longer hospital stays (6 [IQR 2.75–11.5] days vs 3 [2–5] days, P = .029). Additionally, severe pancreatitis group showed higher QRS–T angle (P < .001), higher rates of abnormal QRS angles (31.8% vs 10.1%, P = .002), and QRS–T angles (31.8% vs 8.1%, P < .001). The QRS–T angle may serve as a valuable clinical tool for differentiating between mild and severe forms of acute pancreatitis. This could potentially help clinicians in stratifying patients according to their risk and tailoring their management accordingly.

Smartwatches equipped with photoplethysmography (PPG) sensors are increasingly used for arrhythmia detection, yet their diagnostic accuracy in asymptomatic patients presenting to the emergency department (ED) remains underexplored. This study aimed to evaluate the performance of PPG-equipped smartwatches in detecting arrhythmias among asymptomatic patients and compare smartwatch-generated alerts with standard 12-lead electrocardiograms (ECG). This retrospective observational study included 523 asymptomatic patients who presented to a tertiary care ED over a one-year period with smartwatch-generated arrhythmia alerts. All patients underwent a standard 12-lead ECG upon arrival. Arrhythmias were categorized as atrial fibrillation (AF), sinus bradycardia, bundle branch block (BBB), or ischemic changes. Diagnostic metrics including sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and overall accuracy were calculated for each condition. Misclassification rates were analyzed to assess smartwatch limitations. Of the patients, 35.27% had abnormalities detected by ECG, including AF (18.2%), sinus bradycardia (10.9%), BBB (17.5%), and ischemic changes (25.5%). For AF, smartwatches demonstrated a sensitivity of 53.85%, specificity of 69.06%, PPV of 28.87%, and NPV of 86.52%, with an overall accuracy of 66.18%. Detection rates were lower for sinus bradycardia (sensitivity 30.36%) and ischemic changes (sensitivity 4.88%). Misclassification rates were particularly high for ischemic changes (95.7%), sinus bradycardia (70%), and BBB (75%). While smartwatches exhibit moderate utility for AF detection, their limited accuracy for other arrhythmias underscores the need for algorithmic improvements. Despite these limitations, smartwatches may serve as supplementary tools to encourage early medical attention in asymptomatic patients.