Nicolau syndrome, also known as livedo-like dermatitis or embolia cutis medicamentosa, is a rare complication following the intramuscular or intra-articular injection of various drugs.

The C-reactive protein (CRP) velocity (CRPv) is an indicator of the change in CRP over time. In individuals with sepsis, the second values of CRP and CRPv have been shown to have more importance than the first CRP value measured at admission. This study examined the importance of CRPv for mortality among individuals who were hospitalized in the intensive care unit (ICU). The study was conducted between January 2021 and December 2022. CRPv was calculated according to the change in the second CRP value compared to the first. The median age of the patients was 79 years (interquartile range (IQR), 69–85 years), and 53.2 % were male. The in-hospital mortality rate was 45.5 %. The presence of diabetes increased the odds of mortality by 2.17 times (confidence interval (CI): 1.06–4.4, p=0.032). Each increase in CRPv by 1 mg/dl/hour increased the odds of mortality by 1.07 times (CI: 1.01–1.14, p=0.015), while each one-point increase in the Sequential Organ Failure Assessment (SOFA) score increased the odds of mortality by 1.21 times (CI: 1.07–1.35, p=0.002). The SOFA score had the highest area under the curve (AUC) value for in-hospital mortality (AUC = 0.699 p=7, its sensitivity in predicting mortality was 46.7 %, and its specificity was 85.1 %. The AUC value of CRPv in predicting mortality was 0.629 (p=0.006). When CRPv was >0.75, its sensitivity in predicting mortality was 68.2 %, and its specificity was 57 %. CRPv performed well in predicting mortality and had satisfactory discriminative ability. Additionally, diabetes, SOFA score, and CRPv elevation were significant risk factors for mortality.

Objective: This study aimed to assess the performance of the CURB-65, the quick COVID-19 severity index (qCSI), and the Brescia-COVID respiratory severity scale (BCRSS) scores in predicting ICU (intensive care unit) hospitalization and in-hospital mortality in emergently hospitalized patients with COVID-19 pneumonia. Materials and Methods: We retrospectively reviewed the emergently hospitalized 258 patients with COVID-19 pneumonia consecutively. The required sample size was calculated to compare the areas under the two ROC (receiver operating characteristic) curves (AUC) using the MedCalc 20.0 program (MedCalc Software Ltd., Ostend, Belgium). In addition, we actualized ROC analyses of the CURB-65, the qCSI, and the BCRSS scores and compared the ROC curves of these three scores. Results: The median age of the patients was 73, and 63.6% (n=164) were male. Of 258 patients, 29.5% (n=76) were hospitalized in the intensive care unit (ICU), and 15.9% (n=41) died. The CURB-65 and the qCSI scores predicted ICU admission at a moderate level (p ≤ 0.001; AUC values were 0.743 and 0.723, respectively). However, the predictive effect of the BCRSS score for ICU admission was lower (p ≤ 0.001; AUC value was 0.667). The CURB-65 predicted in-hospital mortality at a moderate level (p ≤ 0.001; AUC value was 0.762). However, the predictive effect of the qCSI and the BCRSS scores for in-hospital mortality were lower (p ≤ 0.001 and p= 0.012, respectively; AUC values were 0.655 and 0.612, respectively). Conclusion: The CURB-65 score predicted ICU hospitalization and in-hospital mortality better than the qCSI and the BCRSS scores. Also, the qCSI score predicted ICU admission better than the BCRSS score.The predictive effect of the BCRSS score was the lowest. We recommend future studies to evaluate the value and utility of COVID-19 risk classification models. Keywords: COVID-19, CURB-65, scoring systems

Introduction: Urinary tract infections (UTIs) remain a significant public health issue worldwide, particularly affecting the geriatric population with increased morbidity and mortality. Aging-related immune changes, comorbidities, and urogenital abnormalities contribute to the higher incidence and complexity of UTIs in elderly patients. Antimicrobial resistance, especially extended-spectrum beta-lactamase (ESBL) production and carbapenem resistance, poses a major challenge in managing UTIs in this group. Methods: This retrospective, multicenter study included 776 patients aged 65 and older, hospitalized with a diagnosis of urinary tract infection between January 2019 and August 2024. Clinical, laboratory, and microbiological data were collected and analyzed. Urine samples were obtained under sterile conditions and pathogens identified using conventional and automated systems. Antibiotic susceptibility testing was performed according to CLSI standards. Logistic regression analyses were conducted to identify factors associated with ESBL production, carbapenem resistance, and mortality. Results: Among the patients, the median age was 78.9 years, with 45.5% female. ESBL production was detected in 56.8% of E. coli isolates and carbapenem resistance in 1.2%. Klebsiella species exhibited higher carbapenem resistance (37.8%). Independent predictors of ESBL production included the presence of urogenital cancer and antibiotic use within the past three months. Carbapenem resistance was associated with recent hospitalization, absence of kidney stones, and infection with non-E. coli pathogens. Mortality was independently associated with intensive care admission at presentation, altered mental status, Gram-positive infections, and comorbidities such as chronic obstructive pulmonary disease and urinary incontinence. Discussion: Our findings suggest that urinary pathogens and resistance patterns in elderly patients are similar to those in younger adults reported in the literature, highlighting the need for age-specific awareness in empiric therapy. The identification of risk factors for multidrug-resistant organisms emphasizes the importance of targeted antibiotic stewardship, especially in high-risk geriatric populations. Multicenter data contribute to regional understanding of resistance trends, aiding clinicians in optimizing management strategies for elderly patients with UTIs. Conclusions: This study highlights that E. coli and Klebsiella species are the primary causes of UTIs in the elderly, with resistance patterns similar to those seen in younger adults. The findings also contribute important data on risk factors for ESBL production and carbapenem resistance, supported by a robust patient sample.

Purpose: Mucormycosis is a rapidly progressive angioinvasive fungal infection with limited large-scale outcome data. We aimed to describe the epidemiology, clinical spectrum, treatment strategies, and predictors of outcomes in adult patients with proven mucormycosis in Türkiye. Methods: We conducted a nationwide, retrospective study of 280 adults diagnosed with proven mucormycosis between 2004 and 2024 across 27 tertiary centers. Case definitions were applied according to the European Organization for Research and Treatment of Cancer and the Mycoses Study Group Education and Research Consortium. Clinical characteristics, antifungal management, surgical interventions, and outcomes were systematically analyzed. Results: The median age of the cohort was 60 years, and diabetes mellitus, frequently complicated by ketoacidosis, was the most common underlying condition. Rhino-orbital-cerebral disease represented the predominant clinical form, whereas pulmonary, gastrointestinal, and disseminated presentations were less frequent but carried less favorable prognoses. Liposomal amphotericin B was the main first-line therapy, often combined with surgery, although antifungal treatment was initiated at a median of five days after symptom onset. Ninety-day mortality was 42.1% by Kaplan–Meier estimation (crude 49.3%) and reached 49.3% (crude 55.0%) at 365 days. Crude mortality was lowest in patients who did not undergo surgery; however, this association was not significant in the time-dependent Cox regression analysis, suggesting confounding by baseline severity. Poor outcomes were associated with corticosteroid exposure, prolonged neutropenia, and neurological manifestations, while a history of sinusitis appeared to be associated with improved survival. Conclusion: In this multicenter study, survival was mainly determined by host-related factors rather than the choice of antifungal agent. Corticosteroid exposure, prolonged neutropenia, and neurological involvement independently predicted poor outcomes, whereas a prior history of sinusitis was linked to improved survival, likely reflecting earlier diagnosis and intervention. These findings reinforce the need for heightened clinical awareness, rapid recognition, and prompt multidisciplinary management to improve outcomes in patients with mucormycosis.

Aim: This study aimed to present the characteristics and poor prognostic factors of Crimean–Congo hemorrhagic fever (CCHF) patients. Materials & methods: Adult patients (>18 years) with CCHF were i... Plain language summary Crimean–Congo hemorrhagic fever is a disease caused by a virus that causes a high fever and bleeding. Unfortunately, there is no cure for this disease yet. It is important fo... Tweetable abstract De Ritis ratio (aspartate transaminase/alanine transaminase) increases in correlation with clinical severity in patients with Crimean–Congo hemorrhagic fever. If the De Ritis rat...