In the field of critical care medicine, substantial research efforts have focused on identifying high-risk patient groups. This research has led to the development of diverse diagnostic tools, ranging from basic biomarkers to complex indexes and predictive algorithms that integrate multiple methods. Given the ever-evolving landscape of medicine, driven by rapid advancements, changing treatment strategies, and emerging diseases, the development and validation of diagnostic tools remains an ongoing and dynamic process. Specific changes in complete blood count components, such as neutrophils, lymphocytes, monocytes, and platelets, are key immune system responses influenced by various factors and crucial in systemic inflammation, injury, and stress. It has been reported that indices such as neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), systemic immune-inflammation index (SII), systemic inflammation response index (SIRI), and delta neutrophil index calculated using various ratios of these elements, are important predictors of various outcomes in conditions where the inflammatory process is at the forefront. In this narrative review, we concluded that NLR, PLR, SII, and SIRI show promise in predicting outcomes for different health conditions related to inflammation. While these tests are accessible, reliable, and cost-effective, their standalone predictive performance for a specific condition is limited.

The clinical policy of the Emergency Medicine Association of Türkiye (EMAT) provides guidance on the use of tranexamic acid (TXA) in emergency settings. TXA, an antifibrinolytic drug, is used to control bleeding by inhibiting plasminogen. Its applications have expanded from hemophilia and severe menstrual bleeding to include various forms of trauma and surgery-related bleeding. Despite its potential benefits, the use of TXA in emergency settings must be carefully evaluated due to its associated risks, including venous thromboembolism. This policy aimed to offer evidence-based recommendations on the indications and contraindications of TXA in different clinical scenarios encountered in the emergency departments. The guidelines were developed using the “Grading of Recommendations, Assessment, Development, and Evaluations” approach, incorporating systematic literature reviews, and expert consensus from the EMAT Research Committee. This document focuses on critical clinical questions regarding the efficacy and safety of TXA in situations such as gastrointestinal bleeding, multitrauma, traumatic brain injury, nontraumatic intracranial hemorrhage, hemoptysis, and epistaxis. By addressing these issues, the policy seeks to assist emergency physicians in making informed decisions about the use of TXA, ultimately aiming to improve the patient outcomes.

Angina bullosa haemorrhgica is a relatively uncommon condition characterized by blood-filled subepithelial lesions in the oral mucosa that is idiopathic and not caused by a systemic disease or a hemostatic abnormality. Middle-aged and elderly patients are usually affected and lesions heal spontaneously without scarring. A rapidly expanding hemorrhagic blister in the oropharynx can induce upper airway obstruction, so recognizing the lesion as soon as possible is essential. Because of its rarity, we wanted to highlight a 42-year-old male patient who presented with hemorrhagic bullae associated with insignificant local trauma in the oral mucosa and to emphasize that Angina bullosa haemorrhagica is a rare but recognizable lesion that clinicians should be aware of.

Objective: The primary outcome of this study is to evaluate the diagnostic performance of the initial delta neutrophil index (DNI) for early identification of severe acute pancreatitis (SAP). Material and Methods: All diagnoses and definitions were made according to the revised Atlanta classification. DNI (delta neutrophil index) was measured automatically using a hematology analyzer. The study included patients aged 18 years and older who were admitted with abdominal pain consistent with acute pancreatitis. The exclusion criteria encompassed patients with a known diagnosis of pancreatic malignancy, iatrogenic endoscopic pancreatitis, those presenting with abdominal trauma, and those experiencing exacerbation of chronic pancreatitis. Results: The median DNI for patients who developed SAP was 0.5 (0.29-1.1), while for non-severe patients, it was 0.2 (0.1-0.41). The difference between the two outcome groups was found to be statistically significant (p<0.001). The area under the curve (AUC) for DNI in predicting SAP was 0.727, with a 95% Confidence Interval (CI) of 0.628-0.825. At the optimal cut-off point, the sensitivity of DNI was determined to be 74.3%, with a 95% CI of 56.7%-87.5%. The specificity was calculated as 68.2% (95% CI=61.6%-74.3%). The positive likelihood ratio (LR+) was 2.34, with a 95% CI of 1.78-3.08, and the negative likelihood ratio (LR-) was 0.38, with a 95% CI of 0.21-0.67. Conclusion: Based on the results, the delta neutrophil index (DNI) shows promise as an essential inflammatory marker for the early diagnosis of SAP. While it may not demonstrate high performance as a standalone marker, our study indicates that DNI could serve as an independent predictor for this outcome. The significant difference observed in DNI values between patients who developed SAP and non-severe patients suggests its potential clinical significance in identifying severe acute pancreatitis cases at an early stage. Further investigations and validation studies are warranted to strengthen the reliability and generalizability of DNI as a diagnostic tool for SAP. Integrating DNI with other relevant clinical and laboratory parameters may enhance its diagnostic accuracy and contribute to more effective patient management strategies. With appropriate intervention and follow-up, the early identification of SAP using DNI may lead to improved patient outcomes and reduced complications, benefiting both the patients and the healthcare system.