Background and Objectives: Traumatic brain injury (TBI) triggers oxidative stress, mitochondrial dysfunction, and sterile inflammation. Amantadine (ATD), a weak NMDA receptor antagonist, has shown neuroprotective potential, but its mechanistic basis remains unclear. This study examined whether ATD treatment is associated with changes in molecular and histological markers related to the HIF-1α/BNIP3L/HMGB1-mediated hypoxia–mitophagy–inflammation response in a rat TBI model. Materials and Methods: Thirty-two Wistar rats were assigned to four groups: sham, trauma, trauma + ATD (1 day), and trauma + ATD (7 days). TBI was induced using the impact-acceleration model, and ATD (45 mg/kg, i.p.) was administered post-injury. Oxidative stress indices (TOS, TAS, OSI), histopathology, inflammatory/apoptotic markers (CRP, TNF-α, Caspase-3), and gene expression (HIF-1α, BNIP3L, HMGB1) were evaluated. Results: ATD improved oxidative balance and histopathological integrity while reducing TNF-α, CRP, and Caspase-3 immunoreactivity. qPCR analysis showed lower HIF-1α, BNIP3L, and HMGB1 expression in ATD-treated groups, which is consistent with attenuation of hypoxia-related, mitochondrial stress-associated, and damage-associated molecular pattern-associated signaling after injury. Conclusions: In this experimental model, amantadine ameliorated oxidative, inflammatory, and apoptotic markers and was associated with reduced expression of HIF-1α, BNIP3L, and HMGB1. These findings support a mechanistic correlation between ATD treatment and suppression of secondary injury signatures; however, causal pathway relationships and functional neurological outcomes were not assessed.

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.

İntihar, dünya genelinde özellikle genç yaş grubunda önemli bir ölüm nedenidir ve acil tıp pratiğinde de intihar vakaları önemli bir yer kaplamaktadır. Bu çalışma ile bir üniversite hastanesi üçüncü basamak acil servisine başvuran intihar vakalarının klinik ve demografik özelliklerinin ortaya konması amaçlanmıştır. Erişkin acil servise 20/04/2015-20/04/2018 tarihleri arasında başvuran hastalar içinden intihar girişimi, kendine zarar verme amacı güden davranışlar (X01-X84, Y87, Z91.5) tanı kodlarından herhangi biri girilen hastaların dosyaları tarandı ve dosya bilgilerine eksiksiz olarak ulaşılabilen hastalar çalışmaya dahil edildi. Hastaların yaş, cinsiyet, başvuru tarihi, intihar girişiminde kullanılan yöntem ve hasta sonlanımları olgu rapor formlarına kaydedildi. Çalışmamıza 97 (%32.9) erkek, 198 (%67.1) kadın olmak üzere toplam 295 hasta dahil edildi. Yaş ortalaması erkek hastalarda 29.7±15.3 yıl, kadın hastalarda 25.0±12.2 yıl, tüm hasta grubunda 26.5±13.4 yıl olarak hesaplandı. Başvurulan yöntemlerin incelenmesinde en sık yönteminin 258 (%87.4) ile yüksek doz ilaç alımı olduğu görüldü. Vakalar sonlanımları açısından değerlendirildiğinde; 20 (%6.8)’si acil servisten 202 (%68.5)’si hastaneden olmak üzere toplam 222 (%75.3) hastanın taburcu edildiği, 19 (%6.4) hastanın başka kurumlara sevk edildiği, 10 (%3.4) hastanın hayatını kaybettiği, 44 (%14.9) hastanın ise tedavi reddi ile hastaneden ayrıldığı saptandı. Çalışmamızda intihar girişimi genç yaş ve kadın hastalarda daha sık gözlenmiştir. Daha önemli bir bulgu olarak da intihar girişiminin mevsimsel değişiklikler ile bağlantılı olmadığı görülmüştür.

Objectives: This pilot study aimed to evaluate the efficacy of the 4-h mean lactate clearance (LACclr) level as a predictive factor for in-hospital outcomes, 30-day mortality, and treatment success in patients with acute cardiogenic pulmonary edema (ACPE), a significant clinical form of acute heart failure (AHF). Methods: A total of 44 patients diagnosed with acute pulmonary edema were included in the study. The patients were divided into two groups based on lactate levels and negative outcomes, and lactate and LACclr levels and negative outcomes were analyzed using statistical tests such as Fisher’s exact test, Student’s t-test, Mann-Whitney U test, and Receiver operating characteristic (ROC) analysis. Results: The results indicated a statistically significant difference in the total hospitalization length of stay according to whether the patients had a negative outcome (intubation and in-hospital mortality) (p=0.033). Additionally, the area under the curve (AUC) value for 4-h mean LACclr was 0.795 in all patients, which was statistically significant in predicting 30-day mortality (p=0.033). The optimal cut-off value for the 4-h mean LACclr in predicting 30-day mortality was found to be 5.57 %, with 80 % sensitivity and 66.7 % specificity. The threshold to rule out 30-day mortality for all patients was 18.85 with 100 % sensitivity and 30.2 % specificity (AUC, 0.795 95 % CI [0.546–1.000], p=0.033). Conclusions: These findings suggest that the 4-h LACclr level, calculated within 4 h of emergency department (ED) presentation, can be used as a predictive indicator for needing intubation, in-hospital mortality, and 30-day mortality and to identify patients at higher risk for adverse outcomes.

OBJECTIVE: Bone marrow fibrosis in primary immune thrombocytopenia (ITP) has become a centre of attention since cases with fibrosis were reported during trombopoeitin receptor agonist therapies but, there have been few studies evaluating the fibrosis status of the patients at diagnosis. The aim of the study was to evaluate the impact of marrow fibrosis on especially response to treatment and prognosis in patients with ITP. MATERIAL AND METHODS: Bone marrow reticulin fiber grade, haemoglobin, platelets, age, sex, co-morbidities of the patients, hepatitis and autoimmune markers on admission, response, remission status and duration of remission and treatments were recorded from medical files of the patients and each parameter was evaluated for an association with reticular fiber grade in 53 patients with ITP. RESULTS: 79.3% of patients had marrow reticulin content grade 1 or more. No significant correlations were found between bone marrow reticular fiber grade and total blood count at diagnosis, response times to the first, second- and third-line treatment, platelet counts after treatment and time between two treatment lines, age, gender, presence of comorbidity and antinuclear antibody positivity and response rate and time. There was a significant and positive correlation between platelet count at diagnosis and age (p<0.05) and, there was a statistically significant and negative correlation between white blood and neutrophil count at diagnosis and age (p<0.05) CONCLUSIONS: For the first time, higher grade of fibrosis was found in patients with ITP. Prospective studies with follow-up bone marrow biopsies are needed to validate the link between ITP and autoimmune fibrosis.