Medicine and Pharmacology

Abstract: Background/Objectives: Frozen triage narratives may contain prognostic information not captured by urgency categories or vital signs. We evaluated their incremental value for hospital admission and subsequent critical outcomes among adults assigned Emergency Severity Index (ESI) levels 3-5. Methods: This single-center retrospective study used routine electronic records from 1 April 2025 to 30 June 2026. Models were developed using 51,735 visits (4852 admissions) in April-December 2025 and evaluated without refitting in 40,433 visits in January-June 2026. Hospital admission included accepted interhospital inpatient transfers. Separate models predicted index-hospital ICU transfer or death among completed, observable episodes, including 285 development events. ESI-only, structured, text-only and combined logistic models were compared using discrimination, calibration and patient-cluster bootstrap intervals. Grouped cross-validation and fixed model variants assessed overfitting and source-quality sensitivity. Results: Temporal evaluation included 3517 admissions (8.70%). Adding text increased admission AUROC from 0.763 to 0.835 (95% CI 0.828-0.841) and average precision from 0.246 to 0.340. The combined model had a calibration slope of 1.083 and observed-to-expected ratio of 0.982. Among 39,697 secondary-analysis visits, 177 had ICU transfer or death (0.446%); combined AUROC was 0.924 (95% CI 0.908-0.940) and average precision 0.076. Text gains persisted without the seven measured fields or their missingness indicators. Conclusions: Frozen triage text added predictive information in a later calendar period. Admission prediction estimates recorded disposition rather than medical necessity. Low critical-outcome precision, incomplete follow-up exclusions and single-center design preclude clinical deployment without further validation. No specific research funding or registration identifier was reported.

Abstract: Background: Acute pulmonary embolism (PE) is a major cause of cardiovascular morbidity and mortality. Right ventricular dysfunction (RVD) reflects the hemodynamic consequences of acute pulmonary arterial obstruction and is an important prognostic marker in patients with PE. However, data regarding the prevalence, clinical correlates, and prognostic significance of RVD remain limited in sub-Saharan Africa, particularly in Somalia, where diagnostic and critical care resources are constrained. Objective: To determine the prevalence and clinical correlates of RVD among adults with acute PE and to assess its association with in-hospital mortality at a tertiary referral hospital in Mogadishu, Somalia. Methods: This retrospective cohort study included adults aged ≥18 years with acute PE confirmed by computed tomography pulmonary angiography (CTPA) who were admitted to Mogadishu Somali–Türkiye Recep Tayyip Erdoğan Training and Research Hospital between January 2020 and December 2023. RVD was defined as structural or functional right ventricular impairment documented on transthoracic echocardiography or CTPA. Demographic, clinical, comorbidity, imaging, treatment, and outcome data were extracted from medical records. Associations were assessed using chi-square or Fisher’s exact tests, as appropriate. Multivariable logistic regression was used to identify independent predictors of in-hospital mortality. Results: Among 293 patients, the mean age was 59.2 years, and 201 patients (68.6%) were female. RVD was identified in 110 patients (37.5%). Compared with patients without RVD, those with RVD had higher prevalences of hypertension (46.4% vs. 34.4%; p=0.042) and pre-existing heart failure (19.1% vs. 9.8%; p=0.024). Patients with RVD were more likely to require intensive care admission (92.7% vs. 59.0%; p<0.001) and to present with hypoxemia (91.8% vs. 58.5%; p<0.001) and syncope (12.7% vs. 1.6%; p<0.001). Active malignancy was more frequent among patients with RVD, although the difference was not statistically significant (12.7% vs. 6.6%; p=0.081). Overall, 51 patients (17.4%) died during hospitalization. Mortality was significantly higher among patients with RVD than among those without RVD (29.1% vs. 10.4%; p<0.001). After adjustment for age, sex, hypertension, diabetes mellitus, hypoxemia, and intensive care admission, RVD remained independently associated with in-hospital mortality (adjusted odds ratio [aOR], 2.55; 95% confidence interval [CI], 1.30–5.04; p=0.007). Conclusions: RVD was present in more than one-third of Somali adults hospitalized with acute PE and was independently associated with a more than two-fold increase in the odds of in-hospital mortality. Routine assessment of right ventricular function may improve early risk stratification and support prioritization of intensive care resources in resource-limited settings.

Abstract: Although pressure bandage immobilisation (PBI) stopped systemic venom absorption in animal experiments, the real-world utility of PBI for snake bites in humans is incompletely defined. PBI is often applied for extended periods in rural Australia where snake bites are common. We describe a case of a man with taipan envenomation who required an above knee amputation after 12 hours of PBI. We hypothesise that this was the result of overzealous PBI application leading to a compartment syndrome and tissue ischaemia. The potential harms of PBI necessitate further research to define the incremental advantage of PBI in snakebites over immobilisation alone.

Abstract: Acute gastrointestinal bleeding is a serious emergency condition which without prompt and accurate diagnosis can lead to severe hemorrhagic shock and death. The initial diagnosis relies on a clinical assessment of the bleeding site. If symptoms such as hematemesis and melena are present, an esophagogastroduodenoscopy (EGD) is typically the first diagnostic procedure. In cases of massive rectal bleeding, a computed tomography scan with angiography (CTA) is often used to identify the source and cause of the bleeding. multiphasic CTA is the definitive first-line diagnostic standard, enabling prompt diagnosis and crucial pre-procedural planning for endovascular management in massive cystojejunal bleeding.

Abstract: Severe traumatic brain injury is a leading cause of death and disability worldwide. The optimal role of invasive intracranial pressure and cerebral perfusion pressure monitoring compared with non‑invasive clinical and imaging‑based management remains uncertain, particularly in low‑resource settings. The objective of this study was to design and evaluate new diagnostic and treatment algorithms for adult patients with severe TBI. A quasi‑experimental study was carried out between January 2010 and December 2024. Patients were assigned to two groups: Group I received continuous invasive ICP and CPP monitoring together with clinical and CT monitoring; Group II received only clinical and CT monitoring. The primary outcome was functional status at one-year post‑discharge according to the Glasgow Outcome Scale (GOS). A total of 250 patients were included: 145 (58%) in Group I and 105 (42%) in Group II. In Group I, the most frequent outcome was GOS V (good recovery), whereas in Group II, GOS I (death) predominated. Satisfactory recovery was achieved in 104/145 patients (71.72%) in Group I vs. 65/105 (61.90%) in Group II. Mortality was 39/145 (26.9%) in Group I vs. 44/105 (41.9%) in Group II (difference 15.0 percentage points; p ≤ 0.05). Continuous invasive ICP and CPP monitoring, was associated with significantly lower mortality and higher rates of satisfactory recovery compared with clinical and imaging‑based management alone. These findings support the use of invasive neuromonitoring where resources permit, while the non‑invasive algorithm may serve as an alternative in low‑resource settings.

Abstract: Background Prehospital invasive ventilation is used across a range of critically ill adult patients, yet reported practices, monitoring approaches, and clinical outcomes vary considerably be-tween systems. Existing literature has focused largely on airway management, and the overall landscape of evidence regarding invasive ventilation strategies in the prehospital setting remains unclear. This scoping review aimed to map the extent and nature of the literature on prehospital invasive ventilation in adults, describe the clinical contexts in which it is applied, and identify knowledge gaps. Methods This scoping review was conducted according to Joanna Briggs Institute methodology and PRISMA-ScR guidelines. MEDLINE (via PubMed), Embase, and the Cochrane Library were searched from inception to the date of search. Studies were eligible if they included adult patients (≥18 years) receiving invasive ventilation in a prehospital setting. Random-ized and non-randomized controlled trials and observational studies were included. Two reviewers independently screened studies, charted data, and summarized findings de-scriptively. Results A total of 3,461 records were identified, of which 25 studies met inclusion criteria. Nine studies evaluated out-of-hospital cardiac arrest, ten focused on trauma, one examined sep-tic shock, and five included mixed populations. Across clinical contexts, deviations from recommended ventilation targets—particularly hyperventilation and inconsistent appli-cation of lung-protective tidal volumes—were common. Mechanical ventilation generally improved physiological parameters compared with manual ventilation, but consistent benefits in survival or neurological outcomes were not demonstrated. Capnogra-phy-guided ventilation and real-time feedback systems improved adherence to ventilation targets. Evidence was predominantly observational and heterogeneous in design and re-porting. Conclusion Prehospital invasive ventilation in adults is characterized by substantial variability in practice and limited high-quality comparative evidence. Ventilation quality and monitor-ing may be more important than ventilation modality alone. Prospective controlled studies and standardized reporting of prehospital ventilation practices are needed to create evi-dence-based recommendations.

Abstract: Background: Large language models (LLMs) are seeing more use in clinical decision support and medical education, though how well they perform in arterial blood gas (ABG) interpretation is still not fully understood. Few studies have looked at whether model accuracy changes between English and non-English prompts. This study compared ABG interpretation performance of GPT-4o and Gemini 1.5 Pro in English and Turkish. Methods: We conducted a cross-sectional evaluation with 100 open ended questions covering ABG physiology, pathophysiology, and clinical application. Each question was presented to four configurations: GPT-4o and Gemini 1.5 Pro in English and Turkish. Two independent assessors scored responses using a 14-dimension rubric (0–2 points per dimension, maximum 28 points). We used Kruskal-Wallis and Friedman tests with Bonferroni correction for statistical comparisons, and Cohen’s kappa for inter-rater reliability. Hallucination rates and Winter formula accuracy served as secondary outcomes. Results: Mean total scores were: GPT-4o English 22.36 ± 2.11/28 (79.9%); GPT-4o Turkish 21.28 ± 2.54/28 (76.0%); Gemini 1.5 Pro English 19.81 ± 3.52/28 (70.7%); and Gemini 1.5 Pro Turkish 17.52 ± 3.26/28 (62.6%). Kruskal-Wallis H = 109.87, p < 0.001; all six pairwise comparisons remained significant after Bonferroni correction. All four models showed progressive score decline across parts (Friedman p < 0.001 each). English outperformed Turkish within both model families. Cohen’s kappa = 0.91. Hallucination rates were 4%, 7%, 18%, and 25%; Winter formula accuracy was 96%, 88%, 75%, and 63%, respectively. Conclusions: GPT-4o outperformed Gemini 1.5 Pro in both languages, and English prompts yielded higher scores than Turkish prompts. Performance deteriorated with increasing clinical complexity. These findings support continued human oversight for LLM use in ABG-related tasks, particularly in non-English settings and complex cases.

Abstract: Introduction Trauma remains a leading cause of morbidity and mortality in the United States and places a substantial economic burden on the healthcare system. Although simulation-based training has been associated with improved trauma team performance and patient outcomes, whether emergency medicine simulation fellowship programs are associated with differences in trauma mortality remains unknown. This study examined whether counties with emergency medicine simulation fellowship programs differ in trauma mortality rates compared with counties without such programs. Methods County-level trauma mortality data (2021–2023) were obtained from the CDC WONDER Multiple Cause of Death database. The database was queried by county, year, and external cause of death. Trauma-related deaths were identified using ICD-10 external cause-of-death codes corresponding to blunt and penetrating injuries, excluding suicide. Counties with emergency medicine simulation fellowship programs were identified through publicly-available fellowship directories and classified according to the presence or absence of a simulation fellowship program. Trauma mortality rates were calculated by dividing the total number of trauma-related deaths by the cumulative county population for counties with and without simulation fellowship programs. The two mortality rates were compared using the rate ratio, 95% confidence interval, and P value calculated with the MedCalc online statistical calculator. Results Trauma mortality was 8.0 per 100,000 population in counties with emergency medicine simulation fellowship programs compared with 3.3 per 100,000 population in counties without fellowship programs (rate ratio, 2.45; P<0.0001). Conclusion Contrary to our hypothesis, counties with emergency medicine simulation fellowship programs demonstrated higher trauma mortality rates. Because these programs are predominantly located in urban counties, these findings may reflect greater injury severity and higher emergency department volume rather than effects of the fellowship programs themselves. These factors should be considered when interpreting the association between emergency medicine simulation fellowship programs and trauma-related mortality.

Abstract: Background: Undifferentiated chest pain is one of the most common reasons for emergency medical service (EMS) activation, yet its aetiological spectrum remains poorly characterised in the prehospital setting. Furthermore, no clinical prediction model has been specifically developed to identify patients at risk of significant coronary lesions using only information available before hospital arrival. This study aimed to describe the aetiologies of undifferentiated prehospital chest pain and develop a proof-of-concept clinical prediction model. Methods: We conducted a retrospective, single-centre study including 409 consecutive patients managed by the Orléans Mobile Intensive Care Unit (MICU) for undifferentiated chest pain between January and June 2024. Predictors of significant coronary lesions requiring coronary revascularisation were identified using multivariable logistic regression. Model performance was assessed by discrimination and calibration, and internally validated using 1000 bootstrap resamples. Results: Cardiological aetiologies accounted for 19% of cases, including 53 patients (13%) with significant coronary lesions. Four independent predictors were identified: age (OR 6.7–8.9 according to category), male sex (OR 2.2), typical chest pain (OR 6.6), and a positive family history of cardiovascular disease (OR 3.4). These variables were combined to develop the HATS (History, Age, Typical chest pain, Sex) model. The model demonstrated good discrimination (AUC 0.81), excellent calibration (Hosmer–Lemeshow P=0.88), and satisfactory internal validity after bootstrap validation. Conclusions: This study characterises the aetiological spectrum of undifferentiated prehospital chest pain and proposes the HATS model as a proof-of-concept clinical prediction tool. Prospective multicentre external validation is required before routine clinical implementation.

Abstract: Background: Procedural sedation and analgesia (PSA) is commonly used for shoulder dislocation reduction in emergency departments (EDs), but it requires monitoring resources and may be associated with sedation-related adverse events. Ultrasound-guided regional anesthesia (UGRA), particularly low-volume superior trunk (ST) block, has emerged as a potential alternative. However, little is known about how this technically demanding technique can be implemented and adopted in routine ED practice. This study aimed to describe the implementation and clinical adoption of low-volume ultrasound-guided ST block for shoulder reduction in a specialized ED over a six-year period. Methods: This retrospective single-center observational cohort study included all consecutive patients undergoing shoulder reduction in a specialized orthopedic ED between February 2018 and February 2024. Patients were managed according to routine clinical practice using either UGRA or PSA, with treatment choice determined by the treating physician. The primary objective was to describe the implementation and clinical adoption of low-volume ST block in routine practice. Additional analyses assessed temporal trends in technique utilization, local anesthetic volume, provider distribution, and ED length of stay. Results: A total of 206 patients were included (124 UGRA; 82 PSA). The use of UGRA increased progressively during the study period, whereas PSA decreased accordingly (p < 0.001). Most UGRA procedures were performed by a small group of experienced physicians, reflecting the gradual adoption of the technique in routine clinical practice. Local anesthetic volumes decreased significantly over time (p < 0.001), with most blocks ultimately performed using approximately 4-5 mL. Successful shoulder reduction was achieved in all patients. No conversion from UGRA to PSA was necessary. No clinically documented respiratory complications related to UGRA were identified in the medical records, although diaphragmatic function was not systematically assessed. Conclusions: This retrospective implementation analysis demonstrates that low-volume ultrasound-guided ST block was increasingly integrated into routine ED practice. The findings primarily describe the implementation and progressive adoption of a technically demanding regional anesthesia technique in a real-world setting. Prospective studies are warranted to further evaluate clinical effectiveness, patient-reported outcomes, and respiratory effects using standardized study protocols.

Abstract: Stress hyperglycaemia affects more than half of critically ill patients within 48 hours of admission and predicts adverse outcomes. The classical mechanistic model attributes this phenomenon entirely to counter-regulatory hormones, inflammatory cytokines, and peripheral insulin resistance. Recent demonstration that red blood cells (RBCs) function as a primary glucose sink under chronic hypoxia, capable of redirecting up to 70% of systemic glucose disposal, demands a re-examination of stress hyperglycaemia mechanisms in patients exposed to the opposite condition: sustained moderate-to-severe hyperoxia delivered routinely in intensive care units. We propose that the band 3-anchored switch between deoxyhaemoglobin-driven glycolysis and oxidative-stress-driven pentose phosphate pathway activation operates symmetrically. ICU hyperoxia—through both acute conformational locking of glycolytic enzymes onto the band 3 N-terminus and chronic generation of oxidant-defensive, low-GLUT1 erythrocyte populations—silences the RBC glucose sink, contributing to systemic hyperglycaemia independent of hormonal and inflammatory pathways. We propose this as the hyperoxia paradox: while short-term hyperbaric oxygen ameliorates insulin resistance through extra-erythrocyte mechanisms, sustained moderate hyperoxia in critical illness imposes an erythrocyte-level metabolic cost not captured by current frameworks. We outline a measurable biomarker panel—the Red Cell Hypoxic Metabolic Index (RHMI)—comprising RBC GLUT1 abundance, ex vivo glucose uptake, intracellular 2,3-diphosphoglycerate, and methaemoglobin fraction, all feasible with existing critical-care laboratory infrastructure. This perspective generates testable predictions: (i) ICU hyperoxia exposure correlates dose-dependently with reduced RHMI; (ii) RHMI correlates inversely with glycaemic variability and insulin requirement; (iii) conservative oxygen targets should preserve erythrocyte glucose disposal capacity. The NIH-sponsored trial NCT04137692, currently testing therapeutic RBC exchange transfusion for GLUT1 deficiency syndrome, validates the broader concept that RBC glucose handling is a tractable therapeutic target. We argue that erythrocyte metabolic phenotyping should be incorporated into the next generation of critical care glycaemic control studies.

Abstract: Craniocerebral firearm injuries are associated with high mortality rates which increase in proportion to the damage to the brain and skull produced by the projectile, as a result of the kinetic energy dissipated during the projectile-tissue interaction. Ballistic factors that contribute to the brain injury are related to the ballistic behavior of the bullet (whether it yaws, tumbles, mushrooms or disintegrates following skull penetration) and its effects. While these injuries are complicated by the creation of bone fragments causing further damage to the brain tissue, the pressure waves generated intracranially as a result of the temporary cavitation phenomenon are the landmark of bullet penetration of the head. Because within the skull there is no mechanism of pressure relief as in other parts of the body during cavitation, the largely incompressible brain tissue sustains the pressure built up, transmitting the pressure wave and causing indirect bone fractures. Although cavitation occurs with low-velocity projectiles too, high-velocity projectiles are capable of high energy transfer secondary to bullet tumbling, mushrooming and often fragmentation, resulting in marked cavitation and more widespread tissue damage. The sudden increase in the intracranial pressure and the transient deformation of the brain tissue contributes to the development of diffuse brain edema and the cardiac and respiratory centers of the brainstem when not involved in the path of the bullet can still be affected indirectly by the pressure transmission with catastrophic results. Shotgun injuries to the head at close range cause extensive destruction of the brain involving a different mechanism, as the pellets enter the cranial cavity bunched together, thus acting as a single projectile of large diameter.

Abstract: Background Non-massive hemoptysis is generally considered low-risk and manageable with conservative treatment. However, some patients progress to massive hemoptysis during follow-up. Identifying high-risk patients early in the emergency department matters for calibrating monitoring intensity, guiding timely intervention, and allocating acute care resources. This study aimed to identify clinical, laboratory, and radiological predictors of progression to massive hemoptysis within the first 72 hours in emergency department patients presenting with non-massive hemoptysis who were managed conservatively. Methods This prospective cohort study enrolled patients at a tertiary university hospital emergency department between November 2023 and June 2025. Adult patients presenting with non-massive hemoptysis were enrolled consecutively. The primary outcome was development of massive hemoptysis within 72 hours of admission. Patients were divided into two groups: those who developed massive hemoptysis within 72 hours and those who did not. Demographic, bleeding, laboratory, imaging, and bronchoscopy data were recorded for all patients. Multivariate logistic regression was used to identify independent predictors. Results Of 199 patients, 10.6% developed massive hemoptysis within the first 72 hours. On multivariate analysis, bright red hemoptysis (3.17-fold increase in risk), a cavity or mass on chest CT (7.13-fold increase in risk), and bleeding volume ≥20 mL in a single episode (3.3-fold increase in risk) were independent predictors of massive hemoptysis. Conclusion A meaningful proportion of patients presenting with non-massive hemoptysis go on to develop massive hemoptysis in the early period. Simple clinical and radiological parameters available at admission can support early risk stratification and inform decisions about monitoring intensity and timely intervention.

Abstract: Hemoptysis is a potentially life-threatening clinical emergency requiring rapid identification of the bleeding source to guide appropriate management. CT angiography is the primary imaging modality for evaluating hemoptysis, enabling characterization of underlying parenchymal disease, precise identification of arterial anatomy, and selection of candidates for endovascular intervention. This review describes the comprehensive spectrum of hemoptysis on CT angiography, including parenchymal abnormalities (e.g., tuberculosis and bronchiectasis), bronchial arterial anatomy, non-bronchial systemic and pulmonary arterial sources of hemorrhage, and vascular malformations. Careful evaluation of parenchymal disease, precise arterial source identification, and recognition of vascular pathology is crucial for optimizing diagnosis confirmation, risk stratification, and clinical decision-making. Embolization techniques, contraindications, and indications are also discussed.

Abstract: Abstract Background: Caffeine toxicity represents a growing public health challenge due to the widespread availability of highly potent formulations. Ingestions of 3–10 grams can be fatal, with serious toxicity occurring at plasma concentrations 15 mg/L or greater. This review provides a framework explaining its diverse clinical consequences. Methods: A comprehensive literature search was conducted across PubMed, Scopus, and Google Scholar using AI-assisted tools, prioritizing clinical, forensic, toxicokinetic, and molecular mechanism studies while excluding chronic moderate consumption. Results: Caffeine toxicity is dose-dependent, progressing from adenosine receptor antagonism to phosphodiesterase inhibition, intracellular calcium release, and GABA-A antagonism. In overdose, these mechanisms interact synergistically to cause severe neurological, cardiovascular, and metabolic complications. Furthermore, the CYP1A2 metabolic system becomes saturated, prolonging the elimination half-life up to 27 hours and causing a disproportionate rise in plasma concentrations. Interactions with drugs like mexiletine drastically reduce clearance. Conclusions: Severe poisoning stems from complex, synergistic molecular interactions. Hypokalemia serves as a promising, actionable clinical biomarker for severity assessment. When massive ingestions saturate endogenous detoxification, hemodialysis becomes essential for survival. Unregulated markets for pure caffeine require stricter regulatory interventions and intensified clinical surveillance.

Abstract: Background: Standard sepsis risk stratification relies on static scores and single time-point biomarkers, failing to capture the temporal complexity of the host response. The dynamic interplay between immune dysregulation and metabolic distress remains poorly integrated into clinical phenotyping. We hypothesized that early longitudinal trajectories of these domains could reveal distinct immunometabolic phenotypes predicting intensive care unit-acquired infection (ICU-AI) and mortality. Methods: This multicenter retrospective study leveraged high-granularity data from the Medical Information Mart for Intensive Care IV (MIMIC-IV) and the eICU Collaborative Research Database (eICU-CRD), enrolling adult patients with a diagnosis of sepsis identified by the International Classification of Diseases (ICD) coding. We employed unsupervised latent class growth modeling (LCGM) to identify phenotypes based on 72-hour serial measurements of core immunometabolic indices, including lymphocyte, neutrophil, and platelet counts, lactate, and the lactate dehydrogenase-to-albumin ratio (LAR). Associations with the primary outcome (ICU-AI) and secondary outcomes (28-day mortality and a composite of ICU-AI/death) were quantified using multivariable Fine-Gray competing-risk models and multivariable logistic regression. We assessed the incremental prognostic value of trajectory phenotypes beyond a baseline model comprising age and sequential organ failure assessment (SOFA) scores. Results: We identified three reproducible immunometabolic trajectory phenotypes, each exhibiting distinct temporal profiles of inflammation and organ function. Trajectory 3 (“Rapid Recovery”) demonstrated swift normalization of biomarkers and favorable outcomes. In contrast, Trajectory 2—characterized by distinct “Immunometabolic Paralysis” (persistent lymphopenia paired with sustained hyperlactatemia and elevated LAR)—conferred the poorest prognosis. Compared to the Rapid Recovery phenotype, Trajectory 2 was associated with a more than two-fold increase in ICU-AI risk and significantly higher 28-day mortality. Integrating trajectory phenotypes into baseline severity models significantly enhanced predictive accuracy and demonstrated superior net benefit in decision curve analysis (DCA). Conclusion: Early 72-hour trajectories of routine biomarkers identify a distinct “Immunometabolic Paralysis” phenotype characterized by sustained metabolic stress and immunosuppression. This dynamic classification outperforms static severity scores in predicting ICU-AI. By distinguishing patients with entrenched dysregulation from those with rapid recovery, this approach offers a scalable framework for risk stratification and predictive enrichment in future trials of immunomodulatory or metabolic therapies.

Abstract: Background and Objectives: Suspected bacterial infection is one of the leading presentations to the Emergency Department (ED) and is still associated with considerable morbidity and mortality. There is increasing evidence that biological sex may influence host immune responses, disease manifestations, therapeutic requirements, and clinical outcomes in infectious diseases. However, sex-specific differences among patients who present to the ED with suspected infection remain incompletely defined. This study, therefore, aimed to assess demographic characteristics, clinical presentation, and clinical management as well as short-term outcomes related to sex among these patients. Materials and Methods: Our single-center retrospective observational study included consecutive adults patients (n= 213) presented with suspected acute bacterial infection to the Emergency Department between June 2025 and August 2025. Results: Female patients were significantly older than male patients (72.13 ± 15.26 vs. 64.25 ± 13.66 years, p < 0.001). Cardiovascular disease and urinary tract infections were more frequently observed among women, whereas men presented significantly higher diastolic blood pressure values at admission (p = 0.004). Vasopressor therapy was more commonly required in female patients compared to males (26.0% vs. 13.3%, p = 0.019). No significant sex-related differences were identified regarding ICU admission or in-hospital mortality. Conclusions: ED patients with suspected bacterial infection demonstrate sex-related differences in age, comorbidities, infection source, and treatment requirements. Female patients were older and more frequently required vasopressor therapy. On the other hand, male patients had higher diastolic blood pressure and presented more frequently with respiratory infections. Short-term outcomes, including ICU admission and in-hospital mortality, were similar for both sexes. These findings highlight the importance of considering sex-specific characteristics in the early assessment and management of suspected infection in the Emergency Department.

Abstract: Trauma is defined as an injury caused by external mechanical forces ranging from physical, chemical, biochemical, or physchological. The Injury Severity Score (ISS) is established on the Abbreviated Injury Scale (AIS). Advanced Trauma Life Support (ATLS) contains basic procedures for securing the airway, establishing and maintaining hemodynamic stability, and adequately assessing injuries based on diagnostic tests. The damage control strategy is a multidisciplinary approach to the polytraumatized patient, including Damage control resuscitation and Damage control surgery. In the emergency room management of a polytraumatized patient, several critical steps are taken to guarantee comprehensive care: all clothing and jewelry are removed from the patient, monitoring devices are placed, circulatory status is evaluated, blood typing and cross-matching are done, and possibly, the transfusion of blood and blood products is initiated. The Initial Hemorrhage Management Steps are: controlling the bleed source, maintaining permissive hypotension and adequate fluid resuscitation, providing coagulation support and treating/reversing trauma-induced coagulopathy. Supportive perfusion therapy provides maintenance of adequate pH, which, together with maintaining body temperature above 36℃. The shift to directed therapy based on standard coagulation tests and point-of-care methods (viscoelastic haemostatic assays), should be done as soon as possible. Substitution therapy is selected with the aim to correct the identified hemostasis disorder associated with trauma.

Abstract: Accidental foreign body ingestion is a common and often harmless event in childhood, especially among very young children, who naturally explore their surroundings by putting objects in their mouths. However, certain objects whose ingestion carries a risk of complications, sometimes potentially life-threatening. Being aware of these is particularly important, as their removal must be performed as soon as possible in a specialized center. Among these, button batteries, magnets, sharp objects, and coins require special attention. The location of the object is also important in determining the degree of urgency. Since symptoms may be absent initially or are completely nonspecific, the medical history is crucial, as prompt and correct management is particularly important. In the absence of a clear medical history, the diagnosis is often based on a high degree of suspicion. Therefore, this article aims to analyze the situations when a foreign body ingestion constitutes an emergency and to present the appropriate diagnostic and therapeutic approach in specific cases. Preventive measures are important in avoiding these life-threatening situations, and therefore, parents and caregivers must be informed and take steps to keep children from accessing dangerous objects.

Abstract: Background/Objectives: In male trauma patients suspected of having a pelvic fracture with urethral injury (PFUI), repeated urethral catheterization attempts can cause additional injury. Since 2021, our institution has been performing simultaneous percutaneous cystostomy using a guidewire and anterograde urethral Foley catheter insertion during pelvic angiography in patients with suspected PFUI. We aimed to analyze the characteristics and clinical course of this patient group. Methods: We retrospectively analyzed male trauma patients who were admitted to our emergency department between January 2021 and December 2025, and who underwent the aforementioned interventional procedure after standard Foley catheterization failed because of a pelvic fracture-associated urethral injury. The age, mechanism of injury, injury severity score (ISS), abbreviated injury scale, type of pelvic fracture, use of pelvic angiography, time from emergency room arrival to Foley catheterization, and administration of additional urological treatments were investigated. Results: Among 492 male patients with pelvic fractures, 11 underwent the procedure because of PFUI (age: 57.8 ± 13.9 years, ISS: 20.2 ± 9.6). Pelvic crushing was the most common injury mechanism, and pelvic angiography was performed in 81.8% of cases. The mean time from emergency room arrival to interventional Foley catheterization was 283 ± 250 min. Three patients required additional urological treatment after the acute phase, and all underwent endoscopic internal urethrotomy for urethral stricture. Conclusions: In cases in which hemodynamically unstable PFUI is suspected and initial urethral catheterization is difficult, Foley catheter insertion via interventional radiology may represent an alternative to conventional primary endoscopic realignment and suprapubic cystostomy.