Twelve-lead electrocardiogram (ECG) may provide prognostic information for in-hospital cardiac arrest (IHCA). This study aimed to identify post-arrest ECG features and their temporal changes associated with IHCA outcomes. This single-center retrospective study included patients experiencing IHCA between 2005 and 2022. Post-arrest ECGs were obtained within 48 h after an IHCA, admission ECGs upon hospital admission, and pre-arrest ECGs within 72 h before an IHCA. Multivariable logistic regression analyses were conducted to identify ECG features associated with neurologically intact survival. A total of 708 patients were included, with 131 (18.5%) achieving neurologically intact survival. The median age was 70.4 years (interquartile range: 59.2-82.6), and 362 (62.7%) patients were male. Four post-arrest ECG features were associated with survival: sinus rhythm (odds ratio [OR]: 1.81, 95% confidence interval [CI]: 1.11-2.93), QRS duration between 80 and 120 ms (OR: 1.91, 95% CI 1.19-3.08), low QRS voltage (OR: 0.50, 95% CI 0.25-0.99), and prolonged QTc (OR: 1.89, 95% CI 1.08-3.28). Comparing with admission ECGs, new-onset right bundle branch block (OR: 0.39, 95% CI 0.16-0.95) and increases in the number of leads with ST depression (OR: 0.85, 95% CI 0.77-0.94) on post-arrest ECGs were inversely associated with survival. Compared with pre-arrest ECGs, increases in the number of leads with ST depression (OR: 0.91, 95% CI 0.88-0.96) on post-arrest ECGs were also inversely associated with survival. Post-arrest ECGs may serve as a valuable prognostic tool for IHCA. Further exploration is warranted to determine whether incorporating these ECG features can enhance the performance of prediction models for IHCA outcomes.

Point-of-Care Ultrasound (POCUS), when used by experienced physicians, is a valuable diagnostic tool for the initial minutes of shock management and subsequent monitoring. It enables early diagnosis with high sensitivity (Sn) and specificity (Sp). Published protocols have advanced towards true multi-organ ultrasonographic exploration, with the RUSH (Rapid Ultrasound in Shock) protocol likely being the most well-known nowadays. Although there is no established order, cardiac evaluation, as well as vascular system assessments including intra- and extravascular volume, should be explored. Additionally, there are ultrasonographic evaluations particularly useful for diagnosing and monitoring response/tolerance to volume. Both the identification of B lines and the increase in left ventricular pressures bring us closer to a diagnosis of fluid overload in these patients. Velocity-time integral (VTI) of the left ventricle (LV) outflow tract (LVOT, LVOT) or right ventricular outflow tract (RVOT, RVOT) can be indicative of distributive shock if elevated, and help identifying volume responders through leg-raising manoeuvres or crystalloid bolus administration. Several index of the inferior vena cava (IVC) can also be helpful. In addition, different parameters to establish fluid responsiveness are being investigated at the carotid level. Venous congestion parameters have not yet been proven to identify volume responders but can identify patients with poor tolerance. Currently, it is essential that physicians treating critical patients use POCUS to enhance clinical outcomes.

Optimal duration of anticoagulant therapy for left ventricular thrombous (LVT) is unclear. The aim of this study is to evaluate effectiveness and safety of vitamin K antagonists (VKAs) up to 12 months in patients with LVT. Patients diagnosed with LVT between 2011 and 2023 and treated with VKAs until LVT resolution or up to 12 months were enrolled in a retrospective cohort study. Primary outcome included on-treatment LVT resolution, secondary outcomes acute ischemic stroke, myocardial infarction, peripheral embolism, and major and clinically relevant non-major bleedings during the 12-month follow-up. Ninety patients were included. Median age was 66 years and 78.9% were male. Mean time in therapeutic range was 61% and 32.9% of patients received VKA monotherapy, with the remaining concomitant antiplatelet treatment. The 3, 6, 12 months cumulative incidences of LVT resolution were 27% (95% confidence intervals -95%CI-, 18%-36%), 47% (95%CI 36%-57%), and 70% (95% CI 60%-79%), respectively. At Cox regression model, reduced left ventricular ejection fraction (Hazard Ratio 0.48; 95%CI 0.24-0.95) and left-ventricular aneurysms (Hazard Ratio 0.44; 95%CI 0.22-0.88) were associated with reduced LVT resolution. One patient developed an acute ischemic stroke and one an acute myocardial infarction. Two patients developed a major and four a clinically relevant non-major bleeding. Incidence of LVT resolution appeared to be higher at 12 than at 3 and 6 months of follow-up, and the rates of on-treatment acute arterial and bleeding events were low. Reduced left ventricular ejection fraction and left-ventricular aneurysm appeared to be associated with a lower rates of LVT resolution.

This study aimed to assess whether delivering Continuous Positive Airway Pressure (CPAP) through a Helmet interface (H-CPAP) reduces common carotid artery flow (CCAF), compared to breathing room air (RA) or using an oronasal mask (M-CPAP). This trial is an unblinded, randomized, controlled crossover trial. The primary outcome was CCAF, measured using Doppler ultrasound. The secondary outcome was mean arterial pressure (MAP). A convenient sample of adult healthy volunteers was enrolled. Subjects were enrolled and randomized to receive either H-CPAP or M-CPAP first at + 10 cmHO, followed by the alternate intervention, each for 5 min. CCAF, mean arterial pressure (MAP), heart rate (HR), respiratory rate (RR), oxygen saturation (SpO₂), and anxiety score (AS) were recorded at baseline (RA) and after 5 min under each CPAP condition. Results showed a significant 14% reduction in CCAF between RA and H-CPAP (p = 0.001) and a 13% reduction between M-CPAP and H-CPAP (p = 0.004), with no significant difference between RA and M-CPAP. MAP remained unchanged across treatments, suggesting that the reduction in cerebral perfusion observed with H-CPAP was independent of systemic blood pressure changes. Helmet CPAP significantly reduces CCAF compared to RA and M-CPAP. While H-CPAP may offer advantages in respiratory support, its effect on cerebral perfusion suggests caution in patients with impaired cerebral autoregulation, such as those with stroke.

Sodium-glucose co-transporter type-2 (SGLT2) inhibitors have been identified to have a crucial hepatoprotective role in patients with type 2 diabetes (T2DM) and metabolic-associated steatotic liver disease (MASLD). Thus, we aimed to assess the effect of SGLT2 inhibitors on hepatic steatosis in patients with T2DM and MASLD added to the standard of care (SOC) treatment. Our study was a single-arm clinical trial with trial no ISRCTN85961860. Thirty T2DM patients with MASLD were recruited from the outpatient endocrinology and diabetes clinic of the Internal Medicine Department at Kasr Al-Aini Hospital, Cairo University, Egypt. Our Patients received Empagliflozin 10 mg daily which was added to SOC treatment and followed up for 24 weeks. Magnetic resonance imaging proton density fat fraction (MRI-PDFF) was done at baseline and after 24 weeks to assess the percentage change in hepatic fat mass. Also changes in Fib-4 and NAFLD fibrosis scores were calculated. Our study showed a statistically significant decrease in the mean MRI-PDFF measurement of hepatic steatosis after 24 weeks of adding empagliflozin to SOC treatment (13.297 ± 7.15) compared to the mean at baseline (15.288 ± 8.72), P = 0.006 with overall percentage decrease about 13.16% of liver steatosis. There were significant decreases in BMI, fasting blood glucose, and Alanine transaminase, (P < 0.001, 0.03, 0.01) respectively. There were no significant differences in Fib-4 or NAFLD fibrosis scores. Adding empagliflozin 10 mg to the standard treatment in patients with diabetes and MASLD could reduce hepatic fat mass significantly after 24 weeks of treatment. Thus, adding SGLT2 inhibitors to the clinical practice guidelines could be a therapeutic agent for patients with MASLD and T2DM.

Ultrasound of the scrotum plays a crucial role in assessing acute scrotal conditions in the Emergency Department. Although the Emergency Physician and Intensivist have shared responsibility for the care of the critically ill patient, the Emergency Physician typically uses Point-of-care Ultrasound in a broader range of applications than the intensivist to include advanced abdominal, obstetric, testicular, musculoskeletal, and ocular ultrasonography. Acute scrotum refers to the sudden onset of scrotal erythema, swelling, or pain, and it is not a rare condition in the Emergency Department. Prompt intervention is required in cases of testicular torsion or rupture, and ultrasound of the scrotum has high utility for emergency physicians seeing acute scrotal complaints with any frequency. However, the incidence of acute scrotum incidence is low compared to other disease states requiring ultrasound diagnosis. This presents a problem when considering ultrasound training of Emergency Physicians for ultrasound of the scrotum in a Point-of-care perspective. With this narrative review, we will attempt to raise the awareness of emergency medicine doctors to the importance of ultrasound of the scrotum in the Emergency Department. We will also discuss educational aspects in testicular ultrasound and the use of contrast-enhanced ultrasound. Finally, we propose an algorithm for action.

Malignant Peritoneal Mesothelioma (MPM) is a rare and aggressive cancer originating in the mesothelial serosal membranes, often associated with pleural mesothelioma. Its diagnosis is challenging due to its nonspecific symptoms, such as abdominal distension, pain, weight loss, and ascites, which overlap with other abdominal conditions. This case study details a 64-year-old male patient with a complex clinical presentation, initially misdiagnosed with seronegative celiac disease, before ultimately being diagnosed with MPM through video-laparoscopy. Despite extensive workup-including CT, PET scans, and colonoscopy-the diagnosis was delayed until peritoneal nodules were identified. MPM remains difficult to detect, often identified at advanced stages, with a poor prognosis and a median survival of less than 1 year post-diagnosis. This case underscores the importance of a comprehensive diagnostic approach, particularly in patients with nonspecific abdominal symptoms, to improve early detection and treatment outcomes for MPM.

Behçet's disease (BD) is a multifaceted disorder of undetermined etiology. Distinct clinical manifestations exhibit varying prevalences, with mucocutaneous and ocular presentations being the most prevalent in the BD population. The aim of this study was to assess musculoskeletal (MSK) manifestations and their effect on health-related quality of life (HRQoL) of life in individuals with BD. We asked patients with BD to complete an online survey. The survey had many questions focused on demographic, clinical, and therapeutic data, as well as the Nordic musculoskeletal questionnaire and the short form-36 (SF-36). There was a total of 185 BD patients, mostly females (54.6%), with a mean age of 33.81 years. The most prevalent clinical manifestation was recurrent oral aphthosis (95.1%), followed by ocular involvement (72.4%). Most of the study patients (85.4%) reported MSK manifestations in the last 6 months. These manifestations included mainly the lower back (69%) and neck (67%), followed by the left and right knees (62% and 60%, respectively), while the least affected areas of the body were the right elbow (37%), and the right ankle and foot (7%). The age at disease onset (p = 0.007) showed a statistically significant difference between those with MSK manifestations and those without. Patients exhibiting MSK manifestations demonstrated statistically significant lower scores of all SF-36 domains compared to those without such manifestations. MSK manifestations are prevalent and adversely affect HRQoL among BD patients. Therefore, early identification and treatment are strongly recommended.

Idiopathic Systemic Capillary Leak Syndrome (ISCLS) is a poorly understood paroxysmal permeability disorder. This study aimed to characterize the clinical features and severity markers of ISCLS in critically and non-critically ill patients. We analyzed prospectively and retrospectively collected data on ISCLS cases from the Italian IRIS-CLS Registry (January 1995-December 2023). A total of 124 acute episodes were identified in 32 patients; 61 episodes in 26 patients having complete records were included in the analysis. Monoclonal gammopathy was found in 20/23 adults but was absent in all three pediatric patients, who exhibited IgA deficiency instead. At admission, patients presented with hypotension (systolic arterial pressure 87 mmHg [80-105]), tachycardia (110 bpm [96-130]), and hemoconcentration (hematocrit 57% [48-62.7]). ICU admission was required in 70.5%, and cardiac involvement occurred in 49.2% of episodes. Fluid volume infused correlated positively with rhabdomyolysis severity, and the need for renal replacement therapy was more frequent in patients receiving ≥ 3 L. No pharmacologic treatment was effective during the crises. Mortality was 9.8% per episode, and the day-1 Sequential Organ Failure Assessment score was a predictor of death (p = 0.0181). Immunoglobulin prophylaxis reduced attack frequency from 0.67 (0.4-1.07) to 0.4 (0.1-0.52) per year (p = 0.033). Two adults (8.7%) developed multiple myeloma during follow-up. This study provides a comprehensive overview of ISCLS in both critically and non-critically ill patients. We highlight clinical-biochemical-instrumental red-flags and emphasize the need for increased awareness and early recognition since effective treatments for acute shock remain elusive.

Despite efforts to mitigate high opioid prescription frequencies, previous research showed minimal change within emergency departments (ED) in the United States, and a few studies investigate prescription provider types. Thus, our primary objective was to assess opioid prescribing rates by differing healthcare team members using data from the National Hospital Ambulatory Medical Care Survey (NHAMCS). Using the 2019-2021 NHAMCS, we calculated the overall opioid prescription rate during ED visits by provider type. Next, we estimated opioid prescription rates by provider type annually and determined differences by year using design-based X tests and regression models. From 2019 through 2021, 7428 of 50,548 visits involved opioids, representing 15.62% of all ED visits. During this timeframe, 16.59% of total encounters with opioid prescriptions were among attending/consulting physicians. This was followed by physician assistants (13.91%), nurse practitioners (10.67%), and residents (7.28%). Compared to 2019, opioid prescribing rates showed no significant changes; however, resident physicians showed a significant decrease, and RNs showed a significant increase. From our analysis, opioid prescribing rates in the ED were highest among attending/consulting physicians, and rates among physician assistants and nurse practitioners were higher than 10%. Resident physicians had a significant decrease in opioid prescriptions, while RNs had an increase-likely due to new laws enacted during this timeframe. Removing barriers to alternative pain management for acute and long-term care may lessen rates of opioid prescriptions-including patient and provider training, physical therapists inclusion, and osteopathic manipulative therapy incorporation.

Toxicological and epidemiological studies suggest that new-generation nicotine delivery products will reduce the harmful exposures associated with combustible cigarettes and toxic forms of smokeless tobacco products. However, enhanced study designs are needed to support epidemiological research that was more appropriate when the ways of consuming nicotine were limited and methods to assess causality in less than decades were unavailable. Given their different perspectives and scientific capabilities, progress in THR requires deeper and transparent engagement between industry scientists and those in academia that rigorously applies conflicts of interest norms.

Emergency doctors are really superheroes; they are not just for resuscitating people from cardiac arrests and performing emergency tracheotomies but also for being capable of holding their breath for a very long time, living in a blender and taking care of many simultaneous issues. That is an absurd feature that others practitioners do not really realize, and it is not acknowledged and valorized sufficiently.

Loneliness is a major concern for public health in contemporary societies. Older adults are particularly vulnerable to loneliness because of their reduced social connections following life changes, such as retirement. Loneliness is often investigated and discussed together with social isolation. While social isolation implies an actual lack of social connections, loneliness implies a perceived deficit of social relations regardless of the real amount of social contacts. However, since living alone may lead to loneliness, individuals can experience both loneliness and social isolation together. Loneliness is not an inevitable consequence of aging and can be tackled with various interventions that can be classified into individual- and group-based formats and can be conducted either in-person or online. In terms of contents, interventions for lonely older adults vary widely, from psychological therapies to contacts with nature and pet company. Although many lonely patients are seen in primary care settings, they are often hospitalized through emergency departments. Social prescriptions, which are more and more perceived as an important add-on to clinical treatments, are non-medical interventions designed to help patients to improve their health by linking traditional clinical practice with social activities and support services within the community. Health- and social-integrated care in the community has become a major priority among older adults to ensure their continuity and quality of care. A European model for welfare systems should be framed by a full integration of care across health and social services. Investing in integrated community care should improve the broad efficiency of the European welfare systems.