Methemoglobinemia is a rare but clinically important condition that should be considered among differential diagnosis' in cyanosis. The conventional treatments of methemoglobinemia are high flow oxygen and methylene blue therapies. We present a 52-year-old male patient who admitted to emergency room with severe cyanosis and dyspnea after he was exposed to paint thinner and zinc phosphate solution. The patient was diagnosed with methemoglobinemia with a MetHb level of 49.1mm/Hg in his arterial blood gas test. Patient's symptoms and increased MetHb levels were resistant to high flow oxygen and methylene blue therapies so hyperbaric oxygen therapy (HBO) as an alternative treatment was initiated and the patient was cured promptly. In this case presentation, we aim to discuss the alternative treatment modalities in methemoglobinemia patients with persistent hypoxia and cyanosis, who are unresponsive to standard methylene blue treatment.

Background and Objectives: Contrast-induced nephropathy (CIN), is acute renal damage due to contrast agents. This study is conducted to evaluate serum and renal heterodimeric nuclear transcription factor (HIF)-2 alpha levels and its tissue expression in contrast-induced nephropathy, and in N-acetyl cysteine (NAC)-and Sildenafil-treated rat models. Materials/Methods: This randomized, controlled, interventional animal study was conducted on Wistar rats. Rats (n = 36) were randomly assigned to four groups: control (n = 9), CIN group (n = 9), CIN + NAC group (n = 9), and sildenafil (n = 9). The rat model was used to form iohexol-originated CIN. During the modeling, prophylactic treatment was performed at the 24th and 48th h. After 48 h of modeling, blood, urine, and tissue samples were obtained for biochemical analyses. HIF-2-α levels were measured in renal tissue, serum, and urine samples. Renal sections were also performed for histopathologic and immunohistochemical evaluations of renal injury and HIF-2-α expression. Results: In the CIN model, HIF-2α levels and other biochemical parameters were significantly increased (p < 0.01). Both sildenafil and NAC efficiently decreased renal damage due to contrast agents, as shown in histopathologic examinations (p < 0.05). Similarly, after treatment with sildenafil and NAC, HIF-2α levels were significantly decreased (p < 0.05). Conclusions: The current study shows that serum and tissue HIF-2α levels decrease in CIN. Besides, the levels and tissue expression of HIF-2α decrease with both NAC and sildenafil treatments. With further studies, HIF-2α can be investigated as a biomarker of CIN and can be used in the follow-up of patients with CIN.

Background: Accurate burn size and depth assessment at first contact guides fluid resuscitation, referral, and operative planning, yet both tasks show meaningful inter-clinician variability. General-purpose multimodal large language models may offer scalable, image-based decision support in emergency care, but prospective benchmarking against clinicians and a robust reference standard remains limited. Methods: We conducted a prospective, single-centre diagnostic accuracy and agreement study in a tertiary emergency department (22 July–8 September 2025). Consecutive acute burn presentations (< 24 h) were screened; protocol-conformant cases contributed standardized three-view photographs per anatomically distinct burn region. A multimodal large language model generated region-level estimates of total body surface area (TBSA) contribution and burn depth class. Eighteen emergency physicians independently rated the same images and minimal metadata, blinded to model and reference outputs. A three-member expert panel served as the reference standard by consensus. The primary endpoint was non-inferiority of the model versus the physician median for region-level absolute TBSA error relative to the panel, with a pre-specified margin of 3 percentage points, using patient-level cluster bootstrap for inference. Secondary endpoints included TBSA agreement and depth agreement (quadratic-weighted kappa). Results: Of 413 screened presentations, 52 patients were enrolled, yielding 64 analyzable burn region-cases (35 pediatric, 29 adult). The model’s mean absolute TBSA error versus the panel was 1.40 percentage points (median 1.00); 87.5% of cases were within ± 3 percentage points and 98.4% within ± 5. The physician median had a mean absolute error of 0.89 percentage points (median 0.75). The paired non-inferiority analysis met the pre-specified criterion (Hodges–Lehmann median Δ = 0.25; one-sided 95% upper bound = 0.50), indicating the model was non-inferior to physicians for TBSA estimation. In contrast, depth agreement versus the panel was slight for the model (quadratic-weighted kappa 0.14), with systematic underestimation of deeper burns, while physician consensus showed substantially higher agreement (quadratic-weighted kappa 0.65). Conclusions: In this prospective emergency department evaluation, a general-purpose multimodal model achieved non-inferior performance to emergency physicians for region-level TBSA estimation but performed substantially worse for burn depth classification. These findings support a narrowly defined adjunct role for TBSA estimation, while depth-dependent decisions should remain clinician-led and require further method development and external validation.

Early risk stratification may support emergency department (ED) decision-making for patients hospitalized with heart failure (HF), yet commonly used tools may perform differently across clinically relevant outcomes. We conducted a retrospective observational cohort study using MIMIC-IV (v3.1) linked to MIMIC-IV-ED (2011–2019). Adult ED encounters with HF International Classification of Diseases-9/10 codes from the ED diagnosis table that were linkable to an inpatient admission were included. The primary analytic cohort was restricted to complete-case encounters with sufficient data to compute both Acute Decompensated Heart Failure National Registry (ADHERE) CART and Get With The Guidelines–Heart Failure (GWTG-HF). The primary outcome was 30-day all-cause mortality; secondary outcomes were intensive care unit (ICU) admission within 24 hours after ED disposition, any ICU admission, acute kidney injury (AKI; Kidney Disease Improving Global Outcomes creatinine criteria), and hospital/ICU length of stay. Associations were evaluated using univariable logistic regression. Discrimination was assessed by area under the receiver operating characteristic curve (bootstrap 95% confidence intervals [CI]s) and compared using DeLong test. Calibration was assessed with patient-level 10-fold cross-validated calibration intercept/slope and calibration curves. Among 5508 eligible encounters, 4812 had complete data for both scores and constituted the analytic cohort. Thirty-day mortality occurred in 317/4812 (6.6%). ICU admission within 24 hours after ED disposition occurred in 822/4812 (17.1%), any ICU admission in 1098/4812 (22.8%), and AKI in 1373/4810 (28.5%). GWTG-HF was associated with higher 30-day mortality (odds ratio 2.3 per 10 points, 95% CI 2.1–2.6); ADHERE CART also showed higher odds across strata (group 4 vs 1 odds ratio 5.2, 95% CI 3.1–8.8). Mortality discrimination was higher for GWTG-HF than ADHERE (area under the receiver operating characteristic curve 0.75 vs 0.64; difference 0.10; P < .001), with near-ideal calibration for both. In ED patients hospitalized with HF, GWTG-HF more reliably stratified 30-day mortality risk than ADHERE CART, while both scores showed limited utility for ICU utilization and AKI, supporting outcome-specific and dynamic risk assessment.

Objective: There are scales to decide hospitalization or follow up in patients presenting to the emergency department after suicide attempt. Modified SAD PERSONS scale (MSPS) is the scaling system for adult suicide generated using the initials of 10 major demographic risk factor in the literature. The aim of our study is to investigate the reliability of the MSPS patients who are evaluated in the emergency department after suicide attempt for deciding admission or discharging of patients in our population. Material-Method: Patients admitted to our emergency department with suicide attempts was evaluated by MSPS. All patients were evaluated by MSPS also consulted to a psychiatrist concurrently. MSPS suggestions are compared with psychiatry decisions. All data were inputted into SPSS analyzed statistically. Results: There were 205 patients totaly and 147of them were female. Psychiatrics decide hospitalization for 95% of patients MSPS score higher than 8. 131 patients MSPS score less than 6 are evaluated by psyhiatrics and 5 (3.8%) of them were decided for hospitalization. MSPS has sensitivity 90%, specificity 84%, positive predictive value 67%, negative predictive value 96% for deciding hospitalization when compared with psychiatric evaluation. Conclusion: Giving the decision of discharging or hospitalization of patients presenting in the emergency department after suicide attempt is a serious dilemmas for doctors working in the emergency department. There is a need for objective evaluation of such patients of in the emergency department. Although MSPS does not meet all of the requirements but can be used in the emergency department.

Van, Türkiye’s eastern border province, is a major transit corridor for irregular migrants and lies on the Balkan route for drug trafficking. This study describes the clinical and radiological features of body packer cases presenting to an emergency department in this critical border region. This retrospective case series included all 13 confirmed body packer patients who presented to the University of Health Sciences, Van Training and Research Hospital Emergency Department between January 2021 and November 2025. Data on demographics, clinical presentation, imaging findings, and management were extracted from medical records. Eleven patients (84.6%) were refugees or irregular migrants; all 13 were brought by law enforcement, with no voluntary self-presentations. The median age was 33 years, and 12 were male. The concealed substances were predominantly methamphetamines (69.2%), followed by opioids (15.4%) and cocaine (15.4%). Seven patients (53.8%) were asymptomatic. CT imaging, used in all cases, showed a 100% detection rate. A key finding was the observation of two patients with rectal packet clustering and marked bladder distension, both reporting deliberate avoidance of defecation and urination—a behavioral cue for high-risk screening. The single female patient had multiluminal concealment (rectal and vaginal). No toxicity or mortality occurred; median hospital stay was 3 days. Body packing among migrants in Van is an under-recognized phenomenon at the intersection of migration, trafficking, and substance use vulnerability. The small number of detected cases, all law-enforcement-driven, suggests a significant underestimation of the true burden. The predominance of methamphetamines suggests a significant stimulant trafficking trend. Border-region emergency departments must implement risk-based screening strategies, integrate addiction services, and adopt trauma-informed care frameworks to address the complex needs of this vulnerable population.