This study revealed the utility of mean platelet volume (MPV) as a mortality marker in SARS-CoV-2 infection, as well as its connection with other inflammatory indicators such as procalcitonin (PCT) and neutrophil-lymphocyte ratio (NLR). A total of 1528 patients (853 males and 653 females; mean age: 64.33 ± 16.36 years; range, 18–100 years) were hospitalized with COVID-19 between March 2020 and December 2022. The patients' demographic and clinical information, including ward and critical care data, were gathered from their medical records. On the first and last days, the PCT, NLR, and MPV values of the patients, who were divided into groups based on their hospitalization and outcomes, were analyzed. When the relevant laboratory data from the first and last days were compared, each group was statistically significant (p < 0.05). There was a moderate association between the final MPV values and the PCT and NLR values of the patients admitted to the ward (r = 0.448 and r = 0.397, respectively, where p < 0.01). There was also a substantial and moderate correlation between the final MPV levels and the PCT and NLR values of patients admitted to the intensive care unit (r = 0.613 and r = 0.361, respectively, p < 0.01). When compared to the patients' outcomes, the MPV had greater specificity and AUC values than the PCT and NLR (94.4 %, 0.968, 80.6 %, 0.923, 81 %, 0.845, respectively). In patients hospitalized with COVID-19, the specificity of MPV values at the point of sickness severity and outcome was shown to be greater than PCT and NLR values, and MPV values may be a more accurate predictor of mortality than PCR and NLR.

Objective Bleeding originating from proximal to the ligament of Treitz is referred to as upper gastrointestinal tract (GI) bleeding. Upper GI bleeding is an important cause of morbidity and mortality and should be excluded in patients presenting with blood in the mouth, black stools or blood in the stool. Diagnosis of upper GI bleeding, prediction of prognosis and mortality, and early intervention are crucial in emergency departments. In this study, we aimed to determine the prognostic value of hemogram parameters, vital values and risk scores in patients hospitalized with upper GI bleeding from emergency department. Material and Method In this study, 259 patients aged 18 years and older who were admitted to Süleyman Demirel University Faculty of Medicine Emergency Department between January 2015 and January 2020 for upper GI bleeding were retrospectively evaluated. Vital signs, hemogram parameters such as hemoglobin, hematocrit, red cell distribution width (RDW), white blood cell (WBC), platelet, vital values and risk scores (Glasgow-Blacthford and AIMS65) at admission were recorded from hospital records. Then survival status was also investigated. Patients who were pregnant, had malignancy, hematologic disease, history of esophageal varices, patients who were discharged directly from the emergency department, patients who were referred, patients who left the emergency department by signing a refusal of treatment or without permission, and patients whose file data could not be accessed were not included in the study. Results A total of 259 patients (157 females, 102 males, mean age: 72.7±17 years) with non-variceal upper GI bleeding were included in the study. Patients who died had significantly higher age, shock index, pulse rate, neutrophil/lymphocyte ratio, RDW, Glasgow- Blatchford and AIMS65 scores (p:0.009; p<0.001; p:0.004; p:0.013; p:0.001; p<0.001; p<0.001; respectively) and lower mean arterial pressure (p:0.006). As a result of the ROC analysis, it was observed that AIMS65 score above the threshold of 2 had the highest sensitivity (82.5%) and RDW above the threshold of 16.5 had the highest specificity (62.6%) in predicting mortality in patients with upper GI bleeding. Conclusion Evaluation of vital values, shock index, neutrophil/ lymphocyte ratio, RDW, AIMS65 and Glasgow- Blatchford score in patients with upper GI bleeding admitted to the emergency department contributes to the emergency physician to predict prognosis, need for early treatment and mortality. WBC and platelet indices are thought to have no effect in predicting prognosis and mortality. Amaç Üst gastrointestinal sistem (GİS) kanamaları treitz ligamentinin proksimalinden kaynaklanan kanamalardır. Ağızdan kan gelmesi, dışkıda siyahlaşma veya dışkıda kan görülmesi şikâyeti ile başvuran hastalarda dışlanması gereken üst GİS kanaması önemli bir morbidite ve mortalite sebebidir. Acil servislerde üst GİS kanama tanısı, prognoz ve mortalitenin tahmin edilmesi ve erken müdahale oldukça önemlidir. Biz bu çalışmamızda acil servise varis dışı üst GİS kanama ile başvuran ve yatışı yapılan hastalarda hemogram değerleri, vital bulgular ve risk skorlamalarının prognostik değerini sorgulamayı amaçladık. Gereç ve Yöntem Çalışmamızda Süleyman Demirel Üniversitesi Tıp Fakültesi Acil Servisi’ne üst GİS kanama sebebiyle Ocak 2015 – Ocak 2020 tarihleri arasında başvuran 18 yaş ve üzeri hastalar dahil edilmiştir. Vital bulgular, hemoglobin, hemotokrit, eritrosit dağılım genişliği (RDW), beyaz kan hücresi (WBC), trombosit gibi hemogram parametreleri, vital değerler ve başvuru sırasındaki risk skorları (Glasgow-Blacthford ve AIMS65) hastane kayıtlarından kaydedilmiştir. Sonrasında hastaların sağkalım durumu incelenmiştir. Çalışmaya gebe olan, malignitesi olan, hematolojik hastalığı olan, özefagus varisi öyküsü olan, acil servisten direkt taburcu olan, sevk edilen, tedavi reddi imzalayarak veya izinsiz olarak acil servisi terk eden hastalar ile dosya verilerine ulaşılamayan hastalar dahil edilmemiştir. Bulgular Çalışmaya varis dışı üst GİS kanaması olan toplam 259 hasta (157 kadın, 102 erkek, ortalama yaş: 72,7±17 yıl) dahil edildi. Sağkalım durumu incelendiğinde ölen hastaların anlamlı derecede daha yüksek yaşa, şok indeksine, nabız sayısına, nötrofil/lenfosit oranına, RDW, Glasgow-Blatchford ve AIMS65 skorlarına sahip oldukları (p:0,009; p<0,001; p:0,004; p:0,013; p:0,001; p<0,001; p<0,001; sırasıyla), daha düşük ortalama arter basıncına sahip oldukları (p:0,006) görüldü. Yapılan ROC analizi sonucunda üst GİS kanamalı hastalarda mortalite tahmininde AIMS65 skorunun 2 eşik değerin üzerinde olması en yüksek sensitiviteye (%82,5) RDW’nin 16,5 eşik değerin üzerinde olması en yüksek spesifiteye (%62,6) sahip olduğu gözlendi. Sonuç Acil servise başvuran üst GİS kanamalı hastalarda vital değerler, şok indeksi, nötrofil/lenfosit oranı, RDW, AIMS65 ve Glasgow-Blatchford skorunun değerlendirilmesi acil servis hekimine prognoz, erken tedavi ihtiyacı ve mortaliteyi tahmin etmesinde katkı sağlamaktadır. WBC ve trombosit...

Özet: Covid-19, genellikle damlacık yoluyla bulaş gösterse de enfekte obje teması sonrasında, temas edilen bölgenin ağız, burun ve göz ile etkileşimi sonucunda da insandan insana geçmektedir. Kapalı ve kısıtlı alanlara sahip acil servisler, Covid-19 enfeksiyonu için oldukça risk barındırmaktadır. Acil servis işleyişinin mutlak suretle devam ediyor olması, diğer kritik hasta yönetimleriyle enfekte hasta süreçlerinin eş zamanlı yürütülmesi gerekliliğini doğurmuştur. Aynı zamanda Covid-19 hastalarının klinik başvuru çeşitliliğinin fazlaca varyasyon göstermesi hem çalışan, hem de enfekte olmayan hastalar adına riski artıran faktörlerdendir. Acil servislerin imkanları da göz önüne alınarak, çeşitli ihtiyaçların karşılanabilmesi adına bazı düzenlemelerin yapılması, enfekte hastalar için triaj, müşahede, resüsitasyon ve mümkünse görüntüleme alanlarının ayrılması, Covid-19’lu hastalar için hızlı yatış algoritmalarının düzenlenmesi gereklidir. Bu makalemizde acil servis içerisinde Covid-19 yönetimini tartışmayı amaçladık.

Pancreatic necrosis represents one of the most severe complications of acute pancreatitis (AP) and is linked to heightened risks of morbidity and mortality. Early recognition of this condition through simple and widely available biomarkers is particularly important in emergency departments, where immediate access to advanced imaging modalities may be limited. This study evaluated the diagnostic utility of the frontal QRS-T angle along with several inflammatory markers calculated from routine blood tests, including the systemic immune-inflammation index (SII), systemic inflammation response index (SIRI), and aggregate index of systemic inflammation (AISI), for predicting the presence of pancreatic necrosis. This retrospective study included adult patients diagnosed with AP in the emergency department between September 2022 and September 2024. Exclusion criteria were applied, and 227 patients were analyzed. Electrocardiographic (ECG) and laboratory data obtained upon admission were compared between patients with and without radiologically confirmed necrosis. Receiver operating characteristic curve analysis and logistic regression models were used to determine the diagnostic performance and independent predictors of necrosis. Pancreatic necrosis was present in 50 patients (22.0%). The frontal QRS-T angle (F-QRS-T) was significantly higher in patients with necrosis (113.64 ± 45.41° vs 54.63 ± 36.27°, P < .001) and showed the strongest predictive performance (area under the curve (AUC) = 0.838, 95% confidence interval (CI): 0.784–0.884), with 58.0% sensitivity and 92.7% specificity at a cutoff of 105°. Inflammatory indices SII (AUC = 0.703), SIRI (AUC = 0.658), and AISI (AUC = 0.809) were also significantly elevated in the necrosis group. In multivariate analysis, the F-QRS-T remained the most significant independent predictor of necrosis (odds ratio = 1.039, 95% CI: 1.024–1.055, P < .001), along with C-reactive protein, SII, SIRI, and AISI. The F-QRS-T and inflammatory indices are promising early markers for predicting pancreatic necrosis in AP. Their utility is particularly valuable in peripheral or resource-limited settings where computed tomography imaging is not readily available or contrast use is contraindicated. Integration of these parameters into a standardized necrosis risk score may aid in timely intervention and improve patient outcomes. Further prospective research is required to confirm and strengthen these observations.

Sepsis-induced acute lung injury (ALI) is a leading cause of mortality in intensive care, driven by inflammatory, apoptotic, and oxidative stress pathways. β-Hydroxy-β-methylbutyrate (HMB), a leucine metabolite, exhibits anti-inflammatory and antioxidant effects, but its role in septic lung injury remains unclear. Thirty-two male Wistar rats were randomized into four groups ( n = 8 each): Control, HMB (300 mg/kg), cecal ligation and puncture (CLP), and CLP + HMB. Lung tissues were analyzed histopathologically, nuclear factor kappa B p65 (NF-κB p65) and caspase 3 (Cas-3) expression was evaluated immunohistochemically, and mRNA expression of C/EBP homologous protein (CHOP), glucose-regulated protein 78 (GRP78), caspase 12 (Cas-12), B-cell lymphoma 2 (BCL-2), BCL-2-associated X protein (BAX), cytochrome C (Cyt-C), nuclear factor erythroid 2–related factor 2 (NRF2), and glutathione peroxidase 4 (GPX4) was measured at the molecular level. CLP induced upregulation of NF-κB p65, ER stress markers (CHOP, GRP78, Cas-12), and mitochondrial apoptotic proteins (BAX, Cyt-C, Cas-3), while downregulating BCL-2, NRF2, and GPX4 expression. HMB treatment reversed these expression changes and improved lung histopathology. HMB protects lungs in experimental sepsis by inhibiting NF-κB inflammation, reducing ER and mitochondrial apoptosis, and boosting antioxidant defenses via NRF2/GPX4. These findings support its potential as adjunct therapy for sepsis-induced ALI.