Methotrexate (MTX) is an important drug for rheumatic and non-rheumatic disease therapy. MTX has been associated with many adverse effects ranging from asymptomatic transaminase elevation to fibrotic tissue formation and fatal hepatic necrosis due to oxidative stress. Concerns regarding potential liver toxicity have led to the avoidance of medication, termination, or advice for inquiries in clinical care. The protective and therapeutic effects of a new generation anti-angina drug, ranolazine (RAN), on MTX-induced liver damage were investigated by evaluating its antioxidant mechanism in rats. Thirty-two female Wistar Albino rats were randomly assigned to Control, RAN, prophylaxis, and treatment groups (n=8/group). Liver function enzymes, histopathological assessment and serum biochemical parameters were examined. Malondialdehyde (MDA), superoxide dismutase (SOD), catalase (CAT), and reduced glutathione (GSH) were also measured in liver tissue. MTX administration caused mononuclear inflammation, vascular congestion, ductal proliferation, vacuolization, and fibrosis as evaluated using Roening grading and increases in aspartate aminotransferase, alanine aminotransferase, alkaline phosphatase, and lactate dehydrogenase levels ( p <0.05) in the blood, which is compatible with hepatocyte damage in the blood and increased MDA levels in the tissue. Histopathologically, vascular congestion and ductal proliferation, and biochemically, MDA and SOD levels and serum biochemical parameters, significantly decreased in the RAN+MTX and MTX+RAN groups ( p 0.05). According to our results, RAN may be a potential hepatoprotective agent against MTX-induced liver injury.

Background and Objectives: Diabetic ketoacidosis (DKA) is a life-threatening acute metabolic complication of diabetes. Early identification of patients at high risk of mortality is crucial for optimal management. This study evaluated the prognostic association of the red blood cell distribution width-to-albumin ratio (RAR) and other laboratory biomarkers with in-hospital mortality and intensive care unit (ICU) admission in adult patients with DKA. Materials and Methods: In this retrospective single-center study, 86 adults hospitalized with DKA after emergency department admission between January 2021 and January 2026 were included. Demographic, laboratory, and clinical data were analyzed. The discriminatory performance of RAR, blood urea nitrogen-to-albumin ratio (BAR), and Red blood cell distribution width (RDW) for in-hospital mortality was assessed using receiver operating characteristic (ROC) analysis. Associations with in-hospital mortality were examined using logistic regression. Results: In-hospital mortality was 11.6%, and 79.1% of patients required ICU admission. Non-survivors had significantly higher inflammatory and metabolic biomarkers and lower albumin and pH. RAR showed the numerically highest Area Under the Curve (AUC) among the evaluated indices (AUC: 0.826, 95% Confidence interval (CI): 0.691–0.962), compared with BAR (AUC: 0.803, 95% CI: 0.632–0.973) and RDW (AUC: 0.713, 95% CI: 0.547–0.879). In the exploratory multivariable analysis, age (OR: 1.06), lactate (OR: 1.31), pH (OR: 0.002), albumin (OR: 0.28), and RAR (OR: 1.98) were associated with in-hospital mortality. Conclusions: RAR was associated with in-hospital mortality in adults with DKA and had the numerically highest AUC among the evaluated indices. However, these findings are exploratory, do not establish superior discrimination over other biomarkers, and require validation in larger, independent cohorts.

Objective: The aim of this study was to evaluate whether Hemoglobin, Albumin, Lymphocyte, and Platelet (HALP) scores, the Systemic Immune-Inflammation Index (SII), and the Systemic Inflammatory Response Index (SIRI) can predict intensive care unit (ICU) or inpatient admissions in pediatric diabetic ketoacidosis (DKA) cases and to determine their sensitivity and specificity. Methods: This retrospective study included 39 pediatric patients (<18 years) diagnosed with DKA (pH < 7.3, HCO₃ < 15). HALP, SII, SIRI, and urine ketone values were collected from medical records. Statistical analyses included ROC curve analysis, correlation tests, and appropriate parametric or non-parametric comparisons to evaluate associations with 30-day outcomes. Results: The median age was 13 years (IQR: 8–15), 56.4% were male, and 64.1% required ICU monitoring. ICU patients had significantly lower pH (p = 0.005) and HCO₃ (p = 0.012) and significantly higher monocyte, SII, and SIRI values (all p ≤ 0.018). ROC analysis showed SIRI had the highest predictive power for ICU admission (cut-off: 3911; sensitivity: 76%; specificity: 85.7%), followed by SII. HALP scores did not demonstrate any value in assessingdisease severity for predicting ICU admission (AUC = 0.25). Conclusion: SIRI and SII are reliable predictors of ICU admission in pediatric DKA. HALP scores do not predict ICU admission and should not be considered a marker of disease severity. Incorporating SIRI and SII into clinical decision-making may improve early risk stratification. Prospective multicenter studies are warranted to validate these results.

Background/Objectives: Portal vein thrombosis (PVT) is a clinically significant condition in which early risk stratification remains challenging, particularly in emergency settings where rapid decision-making is required. This study aimed to evaluate the prognostic value of the Systemic Immune-Inflammation Index (SII), Systemic Inflammation Response Index (SIRI), and the Model for End-Stage Liver Disease (MELD) score in predicting the need for intensive care in patients with PVT. Methods: A retrospective analysis was conducted on adult patients (>18 years) diagnosed with PVT in the emergency department between January 2018 and December 2024. A total of 29 patients meeting the inclusion and exclusion criteria were included. Demographic characteristics, laboratory parameters, Intensive Care Unit (ICU) admission status, and 90-day mortality were analyzed. The sensitivity and specificity of MELD, SII, and SIRI for predicting ICU admission were calculated. Non-normally distributed variables were expressed as median (interquartile range, IQR) and compared using the Mann–Whitney U test. Results: The mean age of patients was 60.5 ± 16.2 years, and 18/29 (62.1%) were male. ICU admission was required in 9/29 (31.0%) of cases. MELD score (median 18.7 [11.0–21.9] vs. 7.9 [6.7–13.5], p = 0.003), bilirubin (median 2.4 [1.0–4.2] vs. 0.7 [0.4–1.1], p = 0.016), and SIRI (median 6.4 [2.3–21.3] vs. 1.4 [0.6–9.3], p = 0.038) were significantly higher in ICU-admitted patients. MELD score showed 66.7% sensitivity and 95% specificity, while SIRI had 88.9% sensitivity and 55% specificity for ICU prediction. Conclusions: MELD score, bilirubin, and SIRI are significantly associated with ICU admission in PVT patients. Their integration into emergency department protocols may assist in early risk stratification and resource allocation.