Background: Very old patients represent the fastest-growing age subgroup among patients with intracerebral hemorrhage (ICH), which justifies studying age-specific prognostic behavior in this population. While systemic inflammatory indices are increasingly recognized for their prognostic potential in various conditions, their specific value in this rapidly expanding geriatric cohort remains unclear. This study aimed to evaluate whether specific indices, particularly the Monocyte-to-Albumin Ratio (MAR) and Systemic Inflammatory Response Index (SIRI), provide independent prognostic information for case-fatality in this population. Methods and findings: We conducted a retrospective observational cohort study of patients aged ≥65 years with spontaneous ICH admitted to a single tertiary emergency department between 2020 and 2025. Of 326 patients initially screened, 118 consecutive patients met inclusion criteria and constituted the cohort. Inflammatory indices were calculated from admission blood tests. Admission non-contrast cranial computed tomography scans were utilized to measure initial hematoma volume using the validated ABC/2 and ABC/2-derived compartmental methods. The primary outcome was 30-day all-cause case-fatality; secondary outcomes included 48-hour and 90-day case-fatality. Multivariable logistic and Cox regression models were adjusted for age, sex, hemorrhage type, and treatment type. Receiver operating characteristic (ROC) analysis was performed to assess predictive performance. Both MAR and SIRI were significantly higher in the deceased patient group at 30 days (p = 0.049 and p = 0.029, respectively). ROC analysis showed modest predictive value for 30-day case-fatality (MAR AUC = 0.606; SIRI AUC = 0.617). In multivariable analysis, MAR > 0.018 was independently associated with increased odds of 30-day (OR=3.57, 95% CI: 1.44–8.85) and 90-day case-fatality (OR=3.18, 95% CI: 1.28–7.92), while SIRI was not significant. Cox regression confirmed that patients with MAR ≤ 0.018 had a significantly lower 90-day case-fatality risk (HR = 0.44, 95% CI: 0.26–0.74). Multiple linear regression analysis identified MAR as the sole significant independent predictor of initial hematoma volume (p = 0.037), whereas other indices showed no such association. Furthermore, logistic regression confirmed that each one-unit (1 mL) increase in hemorrhage volume significantly elevated the odds of case-fatality by 9.8% (OR=1.098,95%CI:1.058–1.140,p < 0.001). Study limitations include its retrospective single-center design, and sample size constraints that limited multivariable modeling. Conclusions: In elderly patients with spontaneous ICH, admission MAR is independently associated with short- and medium-term case-fatality, whereas SIRI offers limited additional prognostic value. MAR may serve as a useful adjunctive marker for risk stratification, but its data-driven cut-offs and modest discrimination necessitate external validation and prospective assessment before clinical adoption.

Acute renal infarction (ARI) is a rarely encountered disease in emergency services, but is of particular importance owing to higher mortality and morbidity rates in the absence of early diagnosis and intervention. On the other hand, urolithiasis cases are admitted to emergency departments very frequently with the complaint of pain. ARI with non-specific symptoms or urolithiasis-like pain would increase the likelihood of being omitted in crowded emergency rooms. Previous studies reported supportive diagnostic role in ARI of increased serum lactate dehydrogenase and C-reactive protein levels and white blood cell count in the presence of hematuria; however, none mentioned D-dimer as a likely diagnostic or prognostic marker. We hereby present 2 case reports where a contrast-enhanced tomographic scan performed on the basis of suspicions raised by high serum D-dimer levels which established the definitive diagnosis ARI. Our aim was to emphasize that serum D-dimer may be used as a criterion for supporting or excluding the thromboembolic events, such as renal and mesenteric infarction.

Background/Objectives: Pulmonary embolism (PE) remains a major cause of mortality, requiring rapid risk stratification. Widely used clinical tools such as the simplified Pulmonary Embolism Severity Index (sPESI) may not fully capture the disease’s inflammatory burden. This study aimed to evaluate the prognostic value of multiple inflammatory indices and to develop a clinically applicable nomogram integrating these indices with sPESI for mortality prediction in acute PE. Methods: This multicenter retrospective cohort study included 338 patients with acute PE. Ten inflammatory indices were calculated from admission laboratory data. The primary outcome was 12-month all-cause mortality; secondary outcomes were 30-day and 90-day mortality. Receiver operating characteristic analysis, multivariable Cox regression, and person-time analysis were performed. A composite inflammatory risk score (0–10) was developed, and a nomogram combining this score with sPESI was constructed. Internal validation used 1000 bootstrap resamples. Results: Overall mortality was 44.1%, with 41% of deaths occurring in the first 12 months. The red cell distribution width-to-albumin ratio (RAR) showed the highest discriminative performance (AUC = 0.755, 95% CI: 0.704–0.806). Each 1-point increase in the inflammatory risk score was independently associated with increased 30-day mortality (HR: 1.21, 95% CI: 1.10–1.34) and 90-day mortality (HR: 1.25, 95% CI: 1.15–1.36). The nomogram improved risk classification, particularly in patients with intermediate sPESI scores (1–2). The combined model achieved an AUC of 0.806 (95% CI: 0.761–0.851), with good calibration (Hosmer–Lemeshow p = 0.342). Platelet-to-lymphocyte ratio (PLR) did not show significant prognostic value. Conclusions: RAR is a strong, independent predictor of mortality in acute PE, providing incremental prognostic value beyond sPESI. The integrated nomogram enables more precise risk stratification and offers a practical, low-cost tool for bedside use.

Transfusion-related acute lung injury (TRALI) is a life-threatening complication occurring within 6–72 hours post-transfusion, marked by acute hypoxemia and bilateral pulmonary infiltrates. Delayed TRALI, presenting 6–72 hours after transfusion, is often underrecognized due to its temporal dissociation from the transfusion event. We report an 80-year-old woman with hypertension and atrial fibrillation who developed delayed TRALI 48 hours after receiving erythrocyte suspension for upper gastrointestinal bleeding. She exhibited dyspnoea, hypoxemia, and bilateral pulmonary oedema, without signs of volume overload or infection. Treatment included non-invasive ventilation and diuresis, resulting in rapid recovery. This case underscores the need to consider delayed TRALI in elderly patients with new respiratory symptoms post-transfusion. Early recognition and supportive care are vital, as delayed TRALI can lead to severe respiratory failure. Preventive measures, like using fresher blood units and male-donor plasma, may mitigate risk. Clinicians should maintain a high suspicion for TRALI in high-risk populations to enhance outcomes.

Background/Aims: Our study aimed to assess the abilities of emergency medicine, general surgery, and plastic surgery resident doctors in diagnosing, treating, and managing burn patients. Methods: We conducted a survey study between 04.05.2015 and 04.08.2015 at university hospitals and training and research hospitals in Ankara. We collected information on the age, gender, experience, and hospital of the doctors, as well as their training and approaches to treating burn cases. We evaluated their knowledge in various areas, including clinical approaches to 2nd and 3rd-degree burn cases, escharotomy localizations, intubation indications, bulla treatment, referral and hospitalization indications, identification of inhalation burns, and fluid resuscitation. Results: The average age of the participants was 29.3±2.4 years, and 65.7% were male. We found that doctors who had received advanced burn life support training had better approaches to burn cases (p

This case report describes a 49-year-old woman who developed ginseng-induced psychosis after using transdermal ginseng patches. Presenting with visual hallucinations, disorganized thoughts, and anxious behavior, she had no prior psychiatric history. Diagnostic tests, including brain imaging and EEG, were normal. The patient’s symptoms resolved after discontinuing the patches and receiving risperidone. Ginseng, commonly used for physical and mental fatigue, rarely causes psychosis. This case highlights the potential psychiatric side effects of herbal products, particularly transdermal forms, which lack regulatory oversight. Emergency physicians should consider herbal use in patients with psychotic symptoms, emphasizing the need for caution and regulation of such products.