Objective: The authors investigated the value of novel inflammatory markers, systemic immune-inflammation index and C-reactive protein to albumin ratio (CAR), to predict in-hospital mortality in pa...

Vertigo or dizziness (VDS) are common reasons for emergency department (ED) visits and pose significant challenges in the early identification of acute ischemic stroke (AIS). The TriAGe + score was developed to predict AIS in patients presenting with VDS without relying on neuroimaging; however, its diagnostic accuracy compared with ABCD-based scores remains uncertain. This study aims to evaluate the efficacy of the TriAGe + score in distinguishing central ischemic causes from peripheral etiologies in patients with VDS and to compare its predictive accuracy for AIS, including posterior circulation infarctions (PCIs), with that of the ABCD2, ABCD3, and ABCD3-I scores. This retrospective cohort study evaluated 1,138 patients who presented to a tertiary ED with VDS complaints between January 2023 and July 2024. After applying the exclusion criteria, 886 patients were included. All patients underwent diffusion-weighted magnetic resonance imaging within 72 h for diagnostic confirmation. On the basis of the imaging results, 210 patients were diagnosed with AIS, while 676 patients without findings consistent with AIS were considered the control group. The predictive performance of the TriAGe + and ABCD scores was evaluated in both groups via logistic regression and receiver operating characteristic (ROC) analyses. PCIs accounted for 74.3% of all AIS cases. The TriAGe + score demonstrated greater diagnostic accuracy than did the ABCD scores in the ROC analysis among all patients (AUC = 0.979; 95% confidence interval [CI]: 0.967–0.987). For the diagnosis of AIS in all patients, the TriAGe + score had a cutoff value of > 7, with a sensitivity of 91% and a specificity of 91.3%. In patients without focal weakness or sensory loss, the TriAGe + score remained a strong predictor of AIS, with a cutoff value of 5, yielding a sensitivity of 97.5% and a specificity of 80.9% (AUC = 0.950; 95% CI: 0.932–0.964). The TriAGe + score is useful in the diagnosis of AIS in patients presenting to the ED with VDS complaints. It outperforms ABCD scores in sensitivity and specificity, particularly in cases without focal neurological deficits. Implementing the TriAGE + score may optimize neuroimaging use, reduce healthcare costs, and improve ED efficiency by assisting clinicians in prioritizing high-risk patients. Not applicable.

Background/Objectives: This study investigated whether serum salusin-α and salusin-β levels could support the diagnosis and prognosis of confirmed acute pulmonary embolism (APE) cases. Methods: A prospective observational study was conducted including 57 patients diagnosed with APE using computed tomography pulmonary angiography (CTPA) and 30 control participants without any acute or chronic disease. APE patients were categorized based on the Pulmonary Artery Obstruction Index (PAOI) into low (≤20) and high (>20) thrombus burden groups. Serum salusin-α and salusin-β levels were measured at diagnosis using an enzyme-linked immunosorbent assay. Associations with PAOI and Pulmonary Embolism Severity Index (PESI) scores were analyzed. Results: Salusin-α and salusin-β levels were markedly reduced in APE patients versus controls (p < 0.001). In multivariate analysis, salusin-α remained independently associated with APE (p = 0.042), whereas salusin-β was not significant. A receiver operating characteristic analysis showed good diagnostic performance for salusin-α (AUC = 0.799; sensitivity = 89.5%; specificity = 46.7%). Neither peptide correlated with PAOI or PESI. At a 305.85 pg/mL cut-off, salusin-α yielded a positive predictive value of 76.1% and a negative predictive value of 70% in this cohort. Conclusions: The findings suggest that salusin-α has high sensitivity in detecting acute pulmonary embolism and may serve as a supportive diagnostic marker in emergency settings. Although its specificity is limited, it could contribute to guiding additional testing. While salusin-β showed no significant diagnostic value, the potential role of salusin peptides in prognostic evaluation requires further exploration.

Introduction: Chronic constipation is prevalent in the geriatric population. Undiagnosed and untreated constipation can lead to complications and decreased health-related quality of life. The aim of this study was to compare the therapeutic effectiveness of senna alone with a combination of bisacodyl and senna in patients diagnosed with chronic constipation. Materials and Method: This prospective, multicenter, double-blind, randomized controlled trial included patients aged 65 years and older who presented to the emergency department with chronic constipation, diagnosed according to the Rome IV criteria, between July and October 2023. Patients were randomly assigned to either the senna group (20 mg sennoside B) or the senna + bisacodyl group (3 mg sennoside B + 5 mg bisacodyl). Participants took the drugs twice daily for 28 days. The Constipation Scoring System and Patient Assessment of Constipation Quality of Life scores were calculated before and after treatment for each patient. Results: The study included 105 patients, with 54 in the senna group and 51 in the senna + bisacodyl group. There was a statistically higher need for dose reduction because of drug side effects in the senna + bisacodyl group compared with the senna group (p=0.026). Following treatment, the senna group had a higher score on the Constipation Scoring System and Patient Assessment of Constipation Quality of Life compared with the senna + bisacodyl group, and the difference was statistically significant (p<0.001, p=0.012). Conclusion: In geriatric patients, short-term treatment of chronic constipation with senna is more effective than senna+bisacodyl regarding constipation severity and quality of life. Keywords: Aged; Bisacodyl; Constipation; Quality of Life; Sennosides.

PATHOS Score as a Predictor of In-Hospital Mortality in Patients with Acute Cardiogenic Pulmonary Edema Presenting to the Emergency Department - Gazi Medical Journal