Background/aim: Foot and ankle trauma represents a common reason for emergency department visits. While the majority of cases involve soft tissue injuries, radiographic imaging is frequently overutilized due to concerns about missed fractures, leading to increased costs and emergency department crowding. The Shetty test, a recently introduced clinical decision rule, may serve as a simpler alternative to established tools such as the Ottawa ankle rules. This study aimed to assess the diagnostic accuracy of the Shetty test and its potential role as a supportive tool within existing triage systems for patients presenting with foot and ankle trauma. Materials and methods: In this cross-sectional study, 229 adult patients with isolated foot or ankle trauma were evaluated in the emergency department. All participants underwent the Shetty test and standard radiographic imaging. The Shetty test was performed by trained emergency physicians prior to imaging; a positive result was defined as an inability to apply downward pressure due to pain. Diagnostic accuracy metrics—including sensitivity, specificity, positive predictive value, and negative predictive value—were calculated using radiographic findings as the reference standard. Results: Fractures were identified in 25.3% of cases. The Shetty test demonstrated a sensitivity of 77.6%, specificity of 60.8%, positive predictive value of 40.2%, and a high negative predictive value of 88.9%. Among patients with confirmed fractures, 77.6% had a positive test result. The test performed best in ruling out displaced and incomplete fractures, and results showed significant correlation with both physical findings and imaging outcomes. Conclusion: The Shetty test exhibited moderate sensitivity and specificity, alongside a high negative predictive value, supporting its use as a reliable rule-out tool for foot and ankle fractures. Its simplicity, ease of application, and diagnostic potential make it a promising triage adjunct to optimize emergency department resource use. Prospective multicenter validation is warranted before broad clinical adoption.

Background and Objectives: Various hematological and biochemical parameters, including derived indices such as the platelet-to-lymphocyte ratio (PLR) and neutrophil-to-lymphocyte ratio (NLR), have been investigated for prognostic assessment in cardiac arrest. The lactate-to-albumin ratio (LAR) may also predict mortality in critically ill patients. The primary objective of this study was to determine the prognostic value of hematological and biochemical parameters in predicting in-hospital mortality among patients who achieved ROSC following cardiac arrest. Materials and Methods: This retrospective cohort study was conducted in patients who experienced cardiac arrest. Laboratory parameters obtained at emergency department admission, including PLR, NLR, LAR, albumin and lactate, were recorded together with clinical outcomes, including return of spontaneous circulation (ROSC) and in-hospital mortality. The study examined the effectiveness of hematological and biochemical parameters in clinical ROSC prediction in patients experiencing both in-hospital and out-of-hospital cardiac arrest. The relationship between these parameters and in-hospital mortality in patients who achieved ROSC was also investigated. Results: During the study period, 505 patients were included, of whom 225 achieved ROSC and 168 died during hospitalization. LAR values were significantly higher in patients with in-hospital mortality (p < 0.001). For predicting in-hospital mortality after ROSC, LAR showed an AUC of 0.737 (95% CI: 0.661–0.812) and significantly outperformed lactate, PLR, and NLR (all p < 0.001). Adding LAR to the clinical model increased the AUC from 0.731 to 0.789 (ΔAUC = 0.058, p = 0.022). In multivariable analysis, higher LAR was independently associated with increased in-hospital mortality (aOR 1.61, 95% CI 1.21–2.16; p = 0.001). Conclusions: In patients who achieved ROSC after cardiac arrest, high initially recorded LAR levels were independently associated with in-hospital mortality. Although lower LAR values were associated with achievement of ROSC, the discriminative performance of LAR for predicting ROSC was insufficient to support its use as a standalone clinical predictor. However, the lack of standardized sampling times relative to cardiac arrest and ROSC limits the interpretation of LAR as a post-ROSC prognostic marker.

Kounis syndrome is defined as a coronary artery distortion due to hypersensitivity to various reasons such as drugs, environmental exposure, nutrients, coronary stents, etc. Diffuse alveolar hemorrhage is a life-threatening condition that clinically presents with hypoxemic respiratory distress, low hematocrit level, hemoptysis, and extensive pulmonary infiltration. Drugs involving pinaverium bromide as an active ingredient is frequently used for relieving gastrointestinal complaints. In this report, we present a case of a young female patient with Kounis syndrome accompanying diffuse alveolar hemorrhage admitted to our emergency department due to allergic reaction following Pinaverium Bromide intake.