Hasan Can Guven

BACKGROUND: Acute pancreatitis is an important cause of morbidity and mortality among patients presenting to the emergency department with abdominal pain. OBJECTIVES: In this study, we aimed to compare the diagnostic performance of the Bedside Index for Severity in Acute Pancreatitis (BISAP) and Emergency Department SpO2, Age, and Systemic Inflammatory Response Syndrome (ED-SAS) score for predicting severe acute pancreatitis (SAP) in older patients diagnosed with acute pancreatitis in the emergency department. The predictive performances of inflammatory markers, including the neutrophil-to-lymphocyte ratio, systemic immune-inflammation index (SII), systemic inflammation response index (SIRI), and pan-immune-inflammation value, were also evaluated. DESIGN AND SETTING: This retrospective cohort study was conducted at a tertiary hospital in Türkiye. METHODS: Factors associated with SAP were evaluated using univariate and multivariate binary logistic regression analyses; odds ratios with 95% confidence intervals were calculated. RESULTS: The study included 400 older patients with acute pancreatitis (SAP group, n = 80; non-SAP group, n = 320). The neutrophil-to-lymphocyte ratio, SII, SIRI, pan-immune-inflammation value, ED-SAS score, and BISAP showed good discrimination for SAP, yielding area under the receiver operating characteristic curve values of 0.82, 0.83, 0.85, 0.86, 0.81, and 0.82, respectively. In the multivariate analysis, an SII of > 5796.25 (odds ratio, 13.59), SIRI of > 11.79 (odds ratio, 7.57), ED-SAS score of > 1 (odds ratio, 5.41), and BISAP of > 1 (odds ratio, 2.91) remained independently associated with SAP. CONCLUSION: The SII, SIRI, ED-SAS score, and BISAP may support early risk stratification for SAP in geriatric pancreatitis. These parameters should be interpreted alongside clinical assessment rather than used as stand-alone diagnostic criteria.

Patients presenting with suspected acute coronary syndrome (ACS) in the emergency department (ED) require rapid and accurate electrocardiographic (ECG) evaluation. This study aims to assess conventional ECG markers for diagnosing non-ST-elevation ACS (NSTE-ACS) in patients with chest discomfort and right bundle branch block (RBBB). A nested case–control design was employed to compare patients with RBBB admitted to the ED for suspected cardiac ischemia, focusing on those who developed NSTE-ACS versus those who did not. The sample consisted of 352 patients with suspected ACS and RBBB identified on ECG. Among them, 88 were diagnosed with NSTE-ACS. In the presence of RBBB, ST-segment elevation on the isoelectric line and/or positive T-waves on the ECG were significantly associated with the diagnosis of NSTE-ACS (p < 0.05). In patients who developed NSTE-ACS, the likelihood of an isoelectric ST-segment was 3.48 (95% CI 2.07–5.82) times higher, the likelihood of positive T-waves was 4.16 (95% CI 2.51–6.91) times higher, and the combination of an isoelectric ST-segment with positive T-waves was 4.81 (95% CI 2.28–8.25) times higher (p < 0.05). In addition, ST-segment depression and non-negative T-waves were significantly more frequent in patients who developed NSTE-ACS, with odds ratios of 5.78 (95% CI 3–11.3), compared to those who did not (p < 0.05). The odds ratios for ST-segment and T-wave changes were 2.81 and 3.47, respectively, with an 80% correct classification rate for predicting NSTE-ACS. Clinicians should closely monitor the presence of an isoelectric ST-segment and positive T-waves in patients with RBBB to assess for potential cardiac ischemia. Graphical abstract

Aim: It is very important to determine the diagnosis of strangulation quickly and with high accuracy in patients presenting with incarcerated hernia. Early diagnosis of strangulation reduces the rate of bowel resection. The objective of our study was to assess the effectiveness and consistency of recently established indices, namely neutrophil lymphocyte ratio (NLR), the systemic immune-inflammation index (SII), systemic inflammation response index (SIRI), and pan-immune-inflammation value (PIV) in predicting the occurrence of strangulation in incarcerated hernias. Material and Methods: Our study included patients over the age of 18 who presented to the emergency department with abdominal pain between 01.01.2020 and 01.01.2023 and were diagnosed with incarcerated inguinal hernia according to the examination results. There were two groups of patients with strangulated inguinal hernia (SIH) and non-strangulated inguinal hernia (NSIH). Receiver Operating Characteristic (ROC) analysis was used to define the cut-off in diagnostic value values. Results: A total of 128 patients (39 SIH and 89 NSIH) were enrolled. Neutrophil lymphocyte ratio, There was determined to be acceptable diagnostic power for SIH detection using SII, SIRI, and PIV (AUC:0.738-0.765). Conclusion: Biomarkers such as SII, SIRI, PIV and NLR can be utilized for prediction SIH in incarcerated hernias.

Amaç: Bu çalışmada akut skrotumlu hastalarda testis torsiyonu ve epididimo-orşit ayrımında pan immün inflamasyon değeri, sistemik immün inflamatuar indeks ve sistemik inflamasyon yanıt indeksinin tanısal değerini belirlemeyi amaçladık. Yöntemler: Bu retrospektif gözlemsel çalışma, acil servise testis ağrısı şikayetiyle başvuran 18 yaş ve üzeri erkek hastalar arasında gerçekleştirildi. Hastalar iki gruba ayrıldı: Ameliyat edilen testis torsiyonu grubu (n= 93); epididimo-orşit tedavisi gören epididimo-orşit grubu (n=125). Bulgular: Çalışmaya toplam 218 hasta (testis torsiyonu: 93, epididimo-orşit: 125) dahil edildi. Testis torsiyonu tespitinde Nötrofil/lenfosit oranı, sistemik immün-inflamatuar indeks ve sistemik inflamasyon yanıt indeksinin kabul edilebilir tanısal güce sahip olduğu bulundu (Eğri altındaki alan: sırasıyla 0,75, 0,77 ve 0,78). Pan immün inflamasyon değeri, belirlenen > 980,93 kesme noktasıyla (Eğri altındaki alan: 0,81, %95 Güven aralığı: 0,76-0,86, <0,001) TT'yi tespit etmede mükemmel bir tanısal güce sahipti. Sonuç: Acil serviste testis torsiyonu ve epididimo-orşit ayrımında ucuz, kolay ulaşılabilir ve hızlı sonuç üreten Pan immün inflamasyon değeri, sistemik immün inflamatuar indeks ve sistemik inflamasyon yanıt indeksinin kullanılması önerilebilir. Pan immün-inflamasyon değeri, testis torsiyonunu öngörmede diğer indekslere göre üstün bir indekstir.

Background: Acute pulmonary embolism (PE) is a disease with a serious prognosis and a high probability of death in the emergency department. Purpose: To investigate the prediction of PE-related mortality and intensive care admission (ICU) of Qanadli (Qscore), Bova, and simplified Pulmonary Embolism Severity Index (sPESI) scores. Material and Methods: This retrospective observational study consisted of all patients diagnosed with acute PE who were imaged under computed tomography pulmonary angiography (CTPA) for a total of 5 years between 1 June 2018 and 1 June 2023. The prediction of radiological and clinical scores for mortality and ICU admission was examined. Results: A total of 95 patients were analyzed. Patients who died and those who were admitted to the ICU had a significantly higher frequency of being found to have a high-risk (≥1) sPESI score ( P = 0.04 and P = 0.016, respectively). For mortality, the sPESI score was found to be significant; the sensitivity and specificity were observed as 54% and 66% (area under the curve [AUC]=0.670, 95% confidence interval [CI]=0.527–0.814; P = 0.020). For ICU admission, the sensitivity and specificity of the Qscore, sPESI, and Bova scores were 35%, 77%, and 58%, and 78%, 65%, and 84% respectively (AUC=0.626, 95% CI=0.511–0.740, P = 0.031; AUC=0.769, 95% CI=0.674–0.865, P < 0.001; and AUC=0.767, 95% CI=0.671–0.862, P < 0.001, respectively). Conclusion: It was found that the sPESI score was effective at predicting mortality in patients with acute PE. Qscore, sPESI, and Bova scores have been shown to be useful in predicting ICU admission.

Introduction: Acute appendicitis (AA) is the predominant condition responsible for acute abdominal pain across all age demographics. The purpose of this research is to determine if the hemoglobin, albumin, lymphocyte, and platelet (HALP) and modified HALP (m-HALP) scores differ between complicated and uncomplicated appendicitis in patients diagnosed with AA who have applied to the emergency department (ED). Additionally, this study aims to investigate whether HALP and m-HALP scores are superior to other biomarkers. Materials and methods: The retrospective analysis included adult patients, aged eighteen or older, who were diagnosed with AA, and sought treatment at the ED of a tertiary hospital. Patients were divided into two groups: complicated appendicitis (CA) and uncomplicated appendicitis (UCA). The cut-off in diagnostic value measurements was determined using the receiver operating characteristic analysis. Results: A total of 436 patients (CA: 126, UCA: 310) were included. Neutrophil-to-lymphocyte ratio (NLR), neutrophil-to-albumin ratio, systemic immune-inflammation index (SII), systemic inflammation response index (SIRI), and pan-immune inflammation value (PIV) were found to have acceptable diagnostic power in CA detection (area under the curve [AUC]: 0.735–0.783). In detecting UCA, HALP and m-HALP were of fair diagnostic power (AUC: 0.64, 0.68, respectively). Conclusions: In this study, we found that although PIV, SIRI, SII, and NLR had acceptable diagnostic values in distinguishing CA and UCA, HALP and m-HALP had fair diagnostic values.