Journal of Acute Disease
Issue 14,2025 Table of Contents
2025(14):1-9.
DOI: 10.4103/jad.jad_96_24
Abstract:
Objective: To study the clinical profiles of children with febrile seizures, comparing those with single episodes to recurrent cases, and identify predictors of recurrence. In addition, to develop a scoring system to predict recurrence after the first febrile seizure, and identify modifiable risk factors to mitigate recurrence risks.
Methods: This cross-sectional study included children aged 6 months to 5 years with typical febrile seizures, seen as inpatients or outpatients of the Department of Pediatrics at a tertiary care teaching hospital. Data were collected via parent interviews, physical exams, and laboratory tests. The questionnaire covered demographics, antenatal, natal, and postnatal events, seizure history, family history, immunization, daycare attendance, and fever management. Clinical evaluations ruled out central nervous system infections and fever causes were diagnosed per ICD-10 at discharge. Laboratory tests assessed anemia, dyselectrolytemia, and hypoglycemia. Data were analyzed in SPSS Version 25 using descriptive statistics, t-tests, Chi-square tests, and odds ratios with 95% confidence intervals (CI), with significance set at P<0.05.
Results: 451 children were included in this study. Low birth weight (OR=2.60, 95% CI=1.12-6.33, P=0.026), age at first episode>2 months (OR=0.28, 95% CI=0.16-0.48, P=0.001), family history of febrile seizure (OR=5.21, 95% CI=2.92-9.28, P=0.001), no intermittent prophylaxis (OR=15.25, 95% CI=7.05- 32.90, P=0.001), treatment for fever (OR=0.26, 95% CI=0.13- 0.51) and low socioeconomic status (OR=5.87, 95% CI=3.32- 10.38) were significantly associated with recurrent febrile seizures. Conclusions: Low birth weight, age at first episode ≤12 months, family history of febrile seizure, no intermittent prophylaxis, inadequate treatment for fever and low socioeconomic status were significant risk factors for having recurrent febrile seizures in children aged from 6 months to 5 years.
Objective: To study the clinical profiles of children with febrile seizures, comparing those with single episodes to recurrent cases, and identify predictors of recurrence. In addition, to develop a scoring system to predict recurrence after the first febrile seizure, and identify modifiable risk factors to mitigate recurrence risks.
Methods: This cross-sectional study included children aged 6 months to 5 years with typical febrile seizures, seen as inpatients or outpatients of the Department of Pediatrics at a tertiary care teaching hospital. Data were collected via parent interviews, physical exams, and laboratory tests. The questionnaire covered demographics, antenatal, natal, and postnatal events, seizure history, family history, immunization, daycare attendance, and fever management. Clinical evaluations ruled out central nervous system infections and fever causes were diagnosed per ICD-10 at discharge. Laboratory tests assessed anemia, dyselectrolytemia, and hypoglycemia. Data were analyzed in SPSS Version 25 using descriptive statistics, t-tests, Chi-square tests, and odds ratios with 95% confidence intervals (CI), with significance set at P<0.05.
Results: 451 children were included in this study. Low birth weight (OR=2.60, 95% CI=1.12-6.33, P=0.026), age at first episode>2 months (OR=0.28, 95% CI=0.16-0.48, P=0.001), family history of febrile seizure (OR=5.21, 95% CI=2.92-9.28, P=0.001), no intermittent prophylaxis (OR=15.25, 95% CI=7.05- 32.90, P=0.001), treatment for fever (OR=0.26, 95% CI=0.13- 0.51) and low socioeconomic status (OR=5.87, 95% CI=3.32- 10.38) were significantly associated with recurrent febrile seizures. Conclusions: Low birth weight, age at first episode ≤12 months, family history of febrile seizure, no intermittent prophylaxis, inadequate treatment for fever and low socioeconomic status were significant risk factors for having recurrent febrile seizures in children aged from 6 months to 5 years.
2025(14):1-3.
DOI: 10.4103/jad.jad_102_24
Abstract:
Rationale: Cholera is an acute diarrheal disease caused by the ingestion of food or water contaminated by Vibrio cholerae. It threatens global health and signifies a lack of proper access to clean water and sanitation. If not treated properly, cholera causes severe watery diarrhea that can lead to hypovolemic shock.
Patient’s Concern: A 23-year-old male patient was admitted with severe diarrhea with a frequency of fifteen to twenty loose, watery stools and was severely dehydrated. The patient developed severe bradycardia with a positive serum troponin level and no chest pain. Initial electrocardiogram on the day of admission was sinus tachycardia with a heart rate of 120 beats/min on the third day of admission, the patient developed bradycardia with a heart rate of 45 beats/min with a prolonged QT interval of 550 msec (corrected QT interval 476 msec).
Diagnosis: Cholera with sinus bradycardia with prolonged QT interval.
Interventions: Based on the clinical situation and the inferior vena cava status determined by ultrasound, a thorough fluid resuscitation using crystalloids was performed. The patient was then administered antibiotics: oral doxycycline 300 mg STAT and intravenous ciprofloxacin 15 mg/kg twice daily for three days.
Outcomes: After 5 days of adequate hydration and antimicrobial treatment, diarrhea was resolved and heart rate improved with no electrocardiogram abnormalities.
Lessons: This case report highlights the importance of timely diagnosis and managing severe diarrhea in cholera patients to prevent morbidity and mortality. Public awareness regarding cholera and its complications is necessary for the betterment of the community.
Rationale: Cholera is an acute diarrheal disease caused by the ingestion of food or water contaminated by Vibrio cholerae. It threatens global health and signifies a lack of proper access to clean water and sanitation. If not treated properly, cholera causes severe watery diarrhea that can lead to hypovolemic shock.
Patient’s Concern: A 23-year-old male patient was admitted with severe diarrhea with a frequency of fifteen to twenty loose, watery stools and was severely dehydrated. The patient developed severe bradycardia with a positive serum troponin level and no chest pain. Initial electrocardiogram on the day of admission was sinus tachycardia with a heart rate of 120 beats/min on the third day of admission, the patient developed bradycardia with a heart rate of 45 beats/min with a prolonged QT interval of 550 msec (corrected QT interval 476 msec).
Diagnosis: Cholera with sinus bradycardia with prolonged QT interval.
Interventions: Based on the clinical situation and the inferior vena cava status determined by ultrasound, a thorough fluid resuscitation using crystalloids was performed. The patient was then administered antibiotics: oral doxycycline 300 mg STAT and intravenous ciprofloxacin 15 mg/kg twice daily for three days.
Outcomes: After 5 days of adequate hydration and antimicrobial treatment, diarrhea was resolved and heart rate improved with no electrocardiogram abnormalities.
Lessons: This case report highlights the importance of timely diagnosis and managing severe diarrhea in cholera patients to prevent morbidity and mortality. Public awareness regarding cholera and its complications is necessary for the betterment of the community.
2025(14):1-3.
DOI: 10.4103/jad.jad_4_25
Abstract:
Rationale: Advances in sleep research have introduced medications like lemborexant, a dual orexin receptor antagonist. While effective for regulating sleep, overdoses are a concern, especially in suicide attempts. However, limited data exist on lemborexant overdose, prompting this case report to elucidate its clinical course.
Patient’s Concern: A 91-year-old Japanese woman with multiple comorbidities, including insomnia and chronic kidney disease, was admitted after ingesting 315 mg of lemborexant in a suicide attempt.
Diagnosis: Lemborexant overdose.
Interventions: Supportive care with 500 mL of Ringer’s acetate solution at the emergency room.
Outcomes: She gradually regained full consciousness with no residual deficits. Due to persistent suicidal ideation, she was transferred to a psychiatric hospital after seven days of supportive care.
Lessons: A review of four lemborexant overdose cases managed at our hospital revealed that overdoses primarily induce altered consciousness and are unlikely to cause organ dysfunction. Supportive care is generally sufficient for management. However, given the limited data, further case accumulation is needed to enhance clinical understanding.
Rationale: Advances in sleep research have introduced medications like lemborexant, a dual orexin receptor antagonist. While effective for regulating sleep, overdoses are a concern, especially in suicide attempts. However, limited data exist on lemborexant overdose, prompting this case report to elucidate its clinical course.
Patient’s Concern: A 91-year-old Japanese woman with multiple comorbidities, including insomnia and chronic kidney disease, was admitted after ingesting 315 mg of lemborexant in a suicide attempt.
Diagnosis: Lemborexant overdose.
Interventions: Supportive care with 500 mL of Ringer’s acetate solution at the emergency room.
Outcomes: She gradually regained full consciousness with no residual deficits. Due to persistent suicidal ideation, she was transferred to a psychiatric hospital after seven days of supportive care.
Lessons: A review of four lemborexant overdose cases managed at our hospital revealed that overdoses primarily induce altered consciousness and are unlikely to cause organ dysfunction. Supportive care is generally sufficient for management. However, given the limited data, further case accumulation is needed to enhance clinical understanding.
Alireza Mirahmadizadeh
,
Maryam Janfada
,
Alireza Heiran
,
Amir Askarinejad
,
Mohammad
Javad Moradian
,
Afshan Javadi
,
Leila Kasraian
,
Andishe Hamedi
2025(14):1-6.
DOI: 10.4103/jad.jad_111_24
Abstract:
Objective: To determine the causes of COVID-19 deaths at home.
Methods: This descriptive cross-sectional study was conducted on confirmed COVID-19 deaths, which were confirmed to occur at home using the “Electronic Death Registration System (EDRS)” database, from February 20, 2020, to September 23, 2021, in the Fars province, south of Iran. A semi-structured, face-to-face survey consisting of 29 items was filled by the family caregivers, and the information was confirmed based on medical records.
Results: One hundred and ninety-three deaths were included, with 60.1% male and 39.9% female. More than 75% of cases had at least one comorbid condition. Death was unexpected for 65.8% of the families and 45.1% of the deceased cases had been medically managed at home during the disease. According to the family caregivers’ opinion, the most frequent causes of death at home in their COVID-19 patients were early discharge/release from the hospital (28.5%), physician's reassurance to continue home quarantine/supportive care (14.5%), hopeless/oldest-old patient (11.9%), and family/relative recommendation to not to hospitalize their patient due to fears, myths, etc. (8.8%).
Conclusions: In family caregivers’ belief, deaths at home might be related to healthcare system preparedness, physicians’ knowledge, and public education and empowerment.
Objective: To determine the causes of COVID-19 deaths at home.
Methods: This descriptive cross-sectional study was conducted on confirmed COVID-19 deaths, which were confirmed to occur at home using the “Electronic Death Registration System (EDRS)” database, from February 20, 2020, to September 23, 2021, in the Fars province, south of Iran. A semi-structured, face-to-face survey consisting of 29 items was filled by the family caregivers, and the information was confirmed based on medical records.
Results: One hundred and ninety-three deaths were included, with 60.1% male and 39.9% female. More than 75% of cases had at least one comorbid condition. Death was unexpected for 65.8% of the families and 45.1% of the deceased cases had been medically managed at home during the disease. According to the family caregivers’ opinion, the most frequent causes of death at home in their COVID-19 patients were early discharge/release from the hospital (28.5%), physician's reassurance to continue home quarantine/supportive care (14.5%), hopeless/oldest-old patient (11.9%), and family/relative recommendation to not to hospitalize their patient due to fears, myths, etc. (8.8%).
Conclusions: In family caregivers’ belief, deaths at home might be related to healthcare system preparedness, physicians’ knowledge, and public education and empowerment.
Vahab Hassan Kaviar
,
Zahra Farshadzadeh
,
Azar Dokht Khosravi
,
Mohammad Hossein
Haddadi
,
Somayeh Karamolahi
,
Marzieh Hashemian
,
Nazanin Omidi
,
Moloudsadat Motahar
,
Nourkhoda Sadeghifard
,
Saeed Khoshnood
,
Fatemeh Shahi
2025(14):1-12.
DOI: 10.4103/jad.jad_104_24
Abstract:
Objective: To investigate the pattern of antibiotic resistance and biofilm production capabilities of clinical Acinetobacter baumannii (A. baumannii) isolates in this study.
Methods: A. baumannii isolates were collected from Tehran Imam Khomeini Hospital in this cross-sectional study, and the minimum inhibitory concentrations for 16 antibiotics were determined using Vitek2® systems. All isolates were analyzed for biofilm production, then presence of biofilm-associated genes, and classⅠand Ⅱ integron genes.
Results: 60 non-replicate A. baumannii isolates were included in this study. The resistance rates reached 100% for aztreonam, cefepime, ceftazidime, ciprofloxacin, piperacillin-tazobactam, piperacillin, ticarcillin, and trimethoprim-sulfamethoxazole. A. baumannii isolates were most sensitive to colistin and rifampicin being the most effective treatments. Multi-drug resistant and extensively drug-resistant isolates accounted for 83.3% and 16.7%, respectively. Of the isolates, 91.6% formed biofilms, categorized as 10% strong, 31.6% moderate, and 50% weak. No correlation was found between antibiotic resistance and biofilm formation. The genes csuE, abaI, and ompA were prevalent, but their distribution was similar across biofilm categories. A relationship between Int1 and biofilm production was noted.
Conclusions: The high rates of antibiotic resistance and biofilmformation, alongside the presence of integrons including class ⅠandⅡ, underscore the necessity for ongoing monitoring of A.baumannii. Notably, class Ⅰintegron presence was significantly linked to biofilm formation. Further research is needed to explore the connection between antibiotic resistance and biofilm production in A. baumannii.
Objective: To investigate the pattern of antibiotic resistance and biofilm production capabilities of clinical Acinetobacter baumannii (A. baumannii) isolates in this study.
Methods: A. baumannii isolates were collected from Tehran Imam Khomeini Hospital in this cross-sectional study, and the minimum inhibitory concentrations for 16 antibiotics were determined using Vitek2® systems. All isolates were analyzed for biofilm production, then presence of biofilm-associated genes, and classⅠand Ⅱ integron genes.
Results: 60 non-replicate A. baumannii isolates were included in this study. The resistance rates reached 100% for aztreonam, cefepime, ceftazidime, ciprofloxacin, piperacillin-tazobactam, piperacillin, ticarcillin, and trimethoprim-sulfamethoxazole. A. baumannii isolates were most sensitive to colistin and rifampicin being the most effective treatments. Multi-drug resistant and extensively drug-resistant isolates accounted for 83.3% and 16.7%, respectively. Of the isolates, 91.6% formed biofilms, categorized as 10% strong, 31.6% moderate, and 50% weak. No correlation was found between antibiotic resistance and biofilm formation. The genes csuE, abaI, and ompA were prevalent, but their distribution was similar across biofilm categories. A relationship between Int1 and biofilm production was noted.
Conclusions: The high rates of antibiotic resistance and biofilmformation, alongside the presence of integrons including class ⅠandⅡ, underscore the necessity for ongoing monitoring of A.baumannii. Notably, class Ⅰintegron presence was significantly linked to biofilm formation. Further research is needed to explore the connection between antibiotic resistance and biofilm production in A. baumannii.
2025(14):1-4.
DOI: 10.4103/jad.jad_16_25
Abstract:
2025(14):1-6.
DOI: 10.4103/jad.jad_94_24
Abstract:
Objective: To investigate the diagnostic value of the neutrophil/ lymphocyte ratio, which has not been studied sufficiently to determine the cause of acute gastroenteritis worldwide. Methods: The prospective, observational study included patients diagnosed with acute gastroenteritis who were treated at Dışkapı Yıldırım Beyazıt Application and Research Center, Emergency Medicine Clinic between 1 September 2020 and 31 May 2021.
Demographic characteristics, as well as neutrophil count, lymphocyte count, white blood cell count, and the neutrophil-to lymphocyte ratio, were compared across the viral, bacterial, and parasitic acute gastroenteritis groups.
Results: A total of 168 acute gastroenteritis patients, 31 of whom had parasitic, 39 bacterial and 98 viral etiologies, were included in this study. Neutrophil/lymphocyte ratio was 2.73 (4.03) in the viral acute gastroenteritis group, 4.58 (8.61) in the bacterial acute gastroenteritis group, and 4.52 (5.49) in the parasite acute gastroenteritis group. A statistically significant difference was found among the groups regarding neutrophil/lymphocyte ratio (P=0.022). However, post-hoc analysis revealed no statistically significant differences in the neutrophil-to-lymphocyte ratio among the groups (P>0.05).
Conclusions: Neutrophil/lymphocyte ratio alone cannot distinguish etiological causes in patients admitted to the Emergency Medicine Clinic diagnosed with acute gastroenteritis.
Objective: To investigate the diagnostic value of the neutrophil/ lymphocyte ratio, which has not been studied sufficiently to determine the cause of acute gastroenteritis worldwide. Methods: The prospective, observational study included patients diagnosed with acute gastroenteritis who were treated at Dışkapı Yıldırım Beyazıt Application and Research Center, Emergency Medicine Clinic between 1 September 2020 and 31 May 2021.
Demographic characteristics, as well as neutrophil count, lymphocyte count, white blood cell count, and the neutrophil-to lymphocyte ratio, were compared across the viral, bacterial, and parasitic acute gastroenteritis groups.
Results: A total of 168 acute gastroenteritis patients, 31 of whom had parasitic, 39 bacterial and 98 viral etiologies, were included in this study. Neutrophil/lymphocyte ratio was 2.73 (4.03) in the viral acute gastroenteritis group, 4.58 (8.61) in the bacterial acute gastroenteritis group, and 4.52 (5.49) in the parasite acute gastroenteritis group. A statistically significant difference was found among the groups regarding neutrophil/lymphocyte ratio (P=0.022). However, post-hoc analysis revealed no statistically significant differences in the neutrophil-to-lymphocyte ratio among the groups (P>0.05).
Conclusions: Neutrophil/lymphocyte ratio alone cannot distinguish etiological causes in patients admitted to the Emergency Medicine Clinic diagnosed with acute gastroenteritis.
2025(14):1-3.
DOI: 10.4103/jad.jad_12_25
Abstract:
Rationale: Abdominal pain is a common complaint with a broad differential diagnosis, including both intra-abdominal and abdominal wall pathologies. While visceral causes are frequently considered, abdominal wall conditions are often overlooked, leading to diagnostic delays. Among them, umbilical abscesses are rare but require distinction from urachal abscesses due to differences in management.
Patient’s concern: A 46-year-old woman presented with a one week history of periumbilical pain unresponsive to analgesics.
Diagnosis: Physical examination revealed localized tenderness and a positive Carnett’s sign. Computed tomographic images identified an umbilical abscess without evidence of urachal remnants, ruling out a urachal abscess.
Interventions: The patient underwent abscess drainage and received cefalexin (1500 mg/day) for 28 days.
Outcomes: The abscess resolved completely without recurrence.
Lessons: Umbilical abscesses are rare and may be mistaken for urachal abscesses. A thorough clinical evaluation, including Carnett’s sign and imaging studies, is crucial for accurate diagnosis. Prompt differentiation facilitates appropriate management and prevents unnecessary interventions.
Rationale: Abdominal pain is a common complaint with a broad differential diagnosis, including both intra-abdominal and abdominal wall pathologies. While visceral causes are frequently considered, abdominal wall conditions are often overlooked, leading to diagnostic delays. Among them, umbilical abscesses are rare but require distinction from urachal abscesses due to differences in management.
Patient’s concern: A 46-year-old woman presented with a one week history of periumbilical pain unresponsive to analgesics.
Diagnosis: Physical examination revealed localized tenderness and a positive Carnett’s sign. Computed tomographic images identified an umbilical abscess without evidence of urachal remnants, ruling out a urachal abscess.
Interventions: The patient underwent abscess drainage and received cefalexin (1500 mg/day) for 28 days.
Outcomes: The abscess resolved completely without recurrence.
Lessons: Umbilical abscesses are rare and may be mistaken for urachal abscesses. A thorough clinical evaluation, including Carnett’s sign and imaging studies, is crucial for accurate diagnosis. Prompt differentiation facilitates appropriate management and prevents unnecessary interventions.
9 IgA vasculitis in an adult diabetic male with rapidly progressive glomerulonephritis: A case study
2025, 14(14):1-4.
DOI: 10.4103/jad.jad_110_24
Abstract:
Rationale: IgA vasculitis or Henoch-Schonlein purpura is an immune complex mediated small vessel vasculitis characterized by clinical triad of arthritis, palpable purpura and gastrointestinal symptoms. It is commonly seen in children below 10-year-old, though adults may be affected.
Patient’s Concern: A 40-year-old man with type-2 diabetes mellitus presented with fever, melena, palpable purpuric rash and hematuria with acute kidney injury, associated with nephrotic range proteinuria. Skin biopsy revealed leukocytoclastic vasculitis and renal biopsy showed IgA deposits in the mesangium and capillary loops with fibro cellular crescents confirming the diagnosis of IgA vasculitis with crescentic rapidly progressive glomerulonephritis.
Diagnosis: IgA vasculitis with rapidly progressive glomerulonephritis.
Interventions: The patient was treated with pulse intravenous methylprednisolone 500 mg/day for 3 days with tapering doses of oral prednisolone and intravenous cyclophosphamide (0.5 gm/m 2body surface area) under the cover of intravenous antibiotics for diabetic foot ulcer.
Outcomes: Patient improved gradually with return to baseline creatinine after 3 months of follow up.
Lessons: Rapidly progressive glomerulonephritis is a rare manifestation of IgA vasculitis and warrants special care and early treatment. The incidence of rapidly progressive glomerulonephritis in IgA vasculitis is unknown. It carries a high risk of progression to chronic kidney disease and thus should be treated as soon as feasible after diagnosis.
Rationale: IgA vasculitis or Henoch-Schonlein purpura is an immune complex mediated small vessel vasculitis characterized by clinical triad of arthritis, palpable purpura and gastrointestinal symptoms. It is commonly seen in children below 10-year-old, though adults may be affected.
Patient’s Concern: A 40-year-old man with type-2 diabetes mellitus presented with fever, melena, palpable purpuric rash and hematuria with acute kidney injury, associated with nephrotic range proteinuria. Skin biopsy revealed leukocytoclastic vasculitis and renal biopsy showed IgA deposits in the mesangium and capillary loops with fibro cellular crescents confirming the diagnosis of IgA vasculitis with crescentic rapidly progressive glomerulonephritis.
Diagnosis: IgA vasculitis with rapidly progressive glomerulonephritis.
Interventions: The patient was treated with pulse intravenous methylprednisolone 500 mg/day for 3 days with tapering doses of oral prednisolone and intravenous cyclophosphamide (0.5 gm/m 2body surface area) under the cover of intravenous antibiotics for diabetic foot ulcer.
Outcomes: Patient improved gradually with return to baseline creatinine after 3 months of follow up.
Lessons: Rapidly progressive glomerulonephritis is a rare manifestation of IgA vasculitis and warrants special care and early treatment. The incidence of rapidly progressive glomerulonephritis in IgA vasculitis is unknown. It carries a high risk of progression to chronic kidney disease and thus should be treated as soon as feasible after diagnosis.
2025, 14(14):1-10.
DOI: 10.4103/jad.jad_115_24
Abstract:
Objective: To explore the current status of sepsis-associated acute kidney injury (SA-AKI) research and predict its future research directions.
Methods: The bibliometric overview of publications was conducted in the field of SA-AKI based on Web of Science Core Collection database from January 2013 to August 2023. This study employed software such as CiteSpace and VOSviewer to conduct bibliometric and visualization analysis of the included literature, including publication trends, geographic distribution characteristics, author contributions, citations, funding sources characteristics, and keyword clustering.
Results: A total of 6509 articles were analyzed, and the number of publications and citations increased from 2013 to 2022. The United States had the highest number of publications in SA AKI, while France was the country with the highest number of citations per publication. Keyword clustering analysis showed that the pathophysiology and definition of SA-AKI were the research focus, and the research hotspots were "machine learning", "vitamin C", "kinase", "hemodynamics", "renal microcirculation" and "mitochondria". Literature coupling analysis indicated that exploring the management and treatment of SA-AKI was the research frontier.
Conclusions: Over the past decade, SA-AKI research has shown a upward trend in terms of the number of publication. Research primarily focuses on exploring mechanisms and improving early warning systems. Mechanisms involve microcirculatory dysfunction, inflammation, and other pathophysiological factors. Future recommendations include continuing basic research, achieving clinical application of novel biomarkers, and prioritizing renal recovery mechanisms in treatment strategies.
Objective: To explore the current status of sepsis-associated acute kidney injury (SA-AKI) research and predict its future research directions.
Methods: The bibliometric overview of publications was conducted in the field of SA-AKI based on Web of Science Core Collection database from January 2013 to August 2023. This study employed software such as CiteSpace and VOSviewer to conduct bibliometric and visualization analysis of the included literature, including publication trends, geographic distribution characteristics, author contributions, citations, funding sources characteristics, and keyword clustering.
Results: A total of 6509 articles were analyzed, and the number of publications and citations increased from 2013 to 2022. The United States had the highest number of publications in SA AKI, while France was the country with the highest number of citations per publication. Keyword clustering analysis showed that the pathophysiology and definition of SA-AKI were the research focus, and the research hotspots were "machine learning", "vitamin C", "kinase", "hemodynamics", "renal microcirculation" and "mitochondria". Literature coupling analysis indicated that exploring the management and treatment of SA-AKI was the research frontier.
Conclusions: Over the past decade, SA-AKI research has shown a upward trend in terms of the number of publication. Research primarily focuses on exploring mechanisms and improving early warning systems. Mechanisms involve microcirculatory dysfunction, inflammation, and other pathophysiological factors. Future recommendations include continuing basic research, achieving clinical application of novel biomarkers, and prioritizing renal recovery mechanisms in treatment strategies.
Wei Gu
,
Shuo Wang
,
Ling Wang
,
Yang Liu
,
Chuanzhu Lv
,
Guoqiang Zhang
,
Yuefeng
Ma
,
Wei Guo
,
Society of Emergency Medicine of Chinese Medical Association
,
Emergency
Medicine Branch of Chinese Geriatrics Society
2025, 14(14):1.
DOI: 10.4103/jad.jad_65_25
Abstract:
Community-acquired pneumonia (CAP) in adults (≥18 years old) is the most common infectious disease encountered in emergency departments. Its clinical complexity and the need for prompt treatment decisions pose significant challenges for patient management. The physician-pharmacist collaborative management (PPCM) model, which optimizes drug therapy regimens through collaboration between physicians and clinical pharmacists, has demonstrated strong clinical value in practice. However, the lack of standardized national guidelines for the application of the PPCM model in emergency departments in China has hampered its widespread adoption. This guideline is developed based on evidence-based medicine and clinical practice experience, with a focus on the application of the PPCM model in the management of CAP in emergency settings. It outlines the significance of the PPCM model, its applicable scenarios, the respective roles of emergency physicians and clinical pharmacists, and its practical implementation in the antimicrobial treatment of CAP patients. In addition, the guideline proposes standardized implementation processes and clinical pathways. By promoting the PPCM model, the expert panel aims to standardize the use of antimicrobial agents in the emergency treatment of CAP, reduce the risk of antimicrobial resistance, and improve patient outcomes.
Community-acquired pneumonia (CAP) in adults (≥18 years old) is the most common infectious disease encountered in emergency departments. Its clinical complexity and the need for prompt treatment decisions pose significant challenges for patient management. The physician-pharmacist collaborative management (PPCM) model, which optimizes drug therapy regimens through collaboration between physicians and clinical pharmacists, has demonstrated strong clinical value in practice. However, the lack of standardized national guidelines for the application of the PPCM model in emergency departments in China has hampered its widespread adoption. This guideline is developed based on evidence-based medicine and clinical practice experience, with a focus on the application of the PPCM model in the management of CAP in emergency settings. It outlines the significance of the PPCM model, its applicable scenarios, the respective roles of emergency physicians and clinical pharmacists, and its practical implementation in the antimicrobial treatment of CAP patients. In addition, the guideline proposes standardized implementation processes and clinical pathways. By promoting the PPCM model, the expert panel aims to standardize the use of antimicrobial agents in the emergency treatment of CAP, reduce the risk of antimicrobial resistance, and improve patient outcomes.
2025, 14(14):1-6.
DOI: 10.4103/jad.jad_84_24
Abstract:
Objective: To evaluate laboratory findings that predict bacterial meningitis in emergency service and their diagnostic effectiveness.
Methods: This retrospective cohort study analyzed data from patients presenting with meningitis symptoms at a referral hospital in Mersin, Turkey, between January 2019 and January 2022. Clinical findings and laboratory results, including leukocyte count, C-reactive protein (CRP), and procalcitonin levels in blood, were examined. Logistic regression, Chi square test, and receiver operating characteristics (ROC) curve analyses assessed the predictive value of these parameters.
Results: A total of 199 participants were included in the study; 99 patients were diagnosed with meningitis after lumbar puncture and 100 served as controls. Patients with meningitis exhibited significantly higher leukocyte counts (median: 11 890×103 / uL vs. 7 905×103 /uL, P<0.001) and CRP levels (median: 6.00 mg/dL vs. 0.95 mg/dL, P<0.001) compared to controls. Procalcitonin levels were significantly elevated in meningitis patients (median: 0.21 ng/mL vs. 0.10 ng/mL, P<0.001). Logistic regression identified albumin (OR=0.16, 95% CI=0.06-0.40), and CRP (OR=1.18, 95% CI=1.08-1.28) as independent predictors of meningitis. ROC analysis for CRP demonstrated a sensitivity of 80.6% and specificity of 70.0% at a cut-off value of 2.23 mg/dL (AUC=0.792).
Conclusions: Elevated albumin levels and CRP contents in the blood were significant predictors of meningitis in emergency service. Early identification of predictive markers may aid in timely lumbar puncture and management of atypical cases.
Objective: To evaluate laboratory findings that predict bacterial meningitis in emergency service and their diagnostic effectiveness.
Methods: This retrospective cohort study analyzed data from patients presenting with meningitis symptoms at a referral hospital in Mersin, Turkey, between January 2019 and January 2022. Clinical findings and laboratory results, including leukocyte count, C-reactive protein (CRP), and procalcitonin levels in blood, were examined. Logistic regression, Chi square test, and receiver operating characteristics (ROC) curve analyses assessed the predictive value of these parameters.
Results: A total of 199 participants were included in the study; 99 patients were diagnosed with meningitis after lumbar puncture and 100 served as controls. Patients with meningitis exhibited significantly higher leukocyte counts (median: 11 890×103 / uL vs. 7 905×103 /uL, P<0.001) and CRP levels (median: 6.00 mg/dL vs. 0.95 mg/dL, P<0.001) compared to controls. Procalcitonin levels were significantly elevated in meningitis patients (median: 0.21 ng/mL vs. 0.10 ng/mL, P<0.001). Logistic regression identified albumin (OR=0.16, 95% CI=0.06-0.40), and CRP (OR=1.18, 95% CI=1.08-1.28) as independent predictors of meningitis. ROC analysis for CRP demonstrated a sensitivity of 80.6% and specificity of 70.0% at a cut-off value of 2.23 mg/dL (AUC=0.792).
Conclusions: Elevated albumin levels and CRP contents in the blood were significant predictors of meningitis in emergency service. Early identification of predictive markers may aid in timely lumbar puncture and management of atypical cases.
2025, 14(14):1-5.
DOI: 10.4103/jad.jad_140_24
Abstract:
Rationale: Cavernous internal carotid artery dissection (ICAD) is a rare cause of cavernous sinus syndrome, presenting diagnostic challenges, particularly in resource-limited settings.
Patient’s concern: A 43-year-old man presented with sudden, painless left eye blindness, partial ptosis and reduced facial sensation. Examination revealed a relative afferent pupillary defect, anisocoria, mild ophthalmoplegia and a pale optic disc. Initial computed tomography imaging was unremarkable, and lumbar puncture suggested meningoencephalitis. Despite treatment, his condition deteriorated to complete ptosis and total ophthalmoplegia. Urgent magnetic resonance imaging and computed tomography angiography confirmed cavernous internal carotid artery dissection and multiple areas of infarction.
Diagnosis: Cavernous sinus syndrome secondary to cavernous ICAD with non-arteritic ischemic optic neuropathy, total ophthalmoplegia and trigeminal nerve palsy.
Interventions: The patient initially received treatment for meningoencephalitis. Upon confirming the diagnosis of ICAD, he declined surgical intervention.
Outcomes: Irreversible left eye blindness.
Lessons: This case highlights the progressive nature of cavernous ICAD, the critical role of advanced imaging in diagnosis, and the need for clinical vigilance in resource-limited settings for timely diagnosis and intervention.
Rationale: Cavernous internal carotid artery dissection (ICAD) is a rare cause of cavernous sinus syndrome, presenting diagnostic challenges, particularly in resource-limited settings.
Patient’s concern: A 43-year-old man presented with sudden, painless left eye blindness, partial ptosis and reduced facial sensation. Examination revealed a relative afferent pupillary defect, anisocoria, mild ophthalmoplegia and a pale optic disc. Initial computed tomography imaging was unremarkable, and lumbar puncture suggested meningoencephalitis. Despite treatment, his condition deteriorated to complete ptosis and total ophthalmoplegia. Urgent magnetic resonance imaging and computed tomography angiography confirmed cavernous internal carotid artery dissection and multiple areas of infarction.
Diagnosis: Cavernous sinus syndrome secondary to cavernous ICAD with non-arteritic ischemic optic neuropathy, total ophthalmoplegia and trigeminal nerve palsy.
Interventions: The patient initially received treatment for meningoencephalitis. Upon confirming the diagnosis of ICAD, he declined surgical intervention.
Outcomes: Irreversible left eye blindness.
Lessons: This case highlights the progressive nature of cavernous ICAD, the critical role of advanced imaging in diagnosis, and the need for clinical vigilance in resource-limited settings for timely diagnosis and intervention.
2025, 14(14):1-7.
DOI: 10.4103/jad.jad_64_25
Abstract:
Objective: To evaluate the effects of early bronchoalveolar lavage (BAL) on inflammatory response, oxidative stress, and clinical outcomes in older adult patients with severe pneumonia using generalized estimating equations (GEE).
Methods: Eighty-three older adult patients (≥60 years) hospitalized with severe pneumonia between August 2024 and December 2024 were enrolled and assigned to either a control group (n=47), which received standard therapy (including antimicrobials, expectorants, and mechanical ventilation), or an intervention group (n=36), which received additional BAL at 12 and 48 hours post-admission. Clinical efficacy and time to symptom improvement were compared between groups. Serum concentrations of inflammatory markers—interleukin (IL)-6, procalcitonin, and C-reactive protein (CRP)—and oxidative stress markers—superoxide dismutase and malondialdehyde (MDA)—were measured at baseline (T0) and at 24 (T1), 72 (T2), and 144 hours (T3) following admission. Intergroup differences were analyzed using GEE.
Results: Compared with the control group, the intervention group demonstrated significantly lower Clinical Pulmonary Infection Score, Acute Physiology and Chronic Health Evaluation 栻 score, Murray Lung Injury Score, duration of lung inflammation, and length of hospital stay (all P<0.05). GEE analyses indicated that the intervention group exhibited significantly reduced levels of IL- 6, procalcitonin, CRP, and MDA (all P<0.05), and significantly increased superoxide dismutase levels (P<0.05).
Conclusions: Early administration of BAL significantly mitigates systemic inflammation and oxidative stress, while improving clinical outcomes in older adult patients with severe pneumonia. These findings support further investigation of broader clinical application of early BAL in this population.
Objective: To evaluate the effects of early bronchoalveolar lavage (BAL) on inflammatory response, oxidative stress, and clinical outcomes in older adult patients with severe pneumonia using generalized estimating equations (GEE).
Methods: Eighty-three older adult patients (≥60 years) hospitalized with severe pneumonia between August 2024 and December 2024 were enrolled and assigned to either a control group (n=47), which received standard therapy (including antimicrobials, expectorants, and mechanical ventilation), or an intervention group (n=36), which received additional BAL at 12 and 48 hours post-admission. Clinical efficacy and time to symptom improvement were compared between groups. Serum concentrations of inflammatory markers—interleukin (IL)-6, procalcitonin, and C-reactive protein (CRP)—and oxidative stress markers—superoxide dismutase and malondialdehyde (MDA)—were measured at baseline (T0) and at 24 (T1), 72 (T2), and 144 hours (T3) following admission. Intergroup differences were analyzed using GEE.
Results: Compared with the control group, the intervention group demonstrated significantly lower Clinical Pulmonary Infection Score, Acute Physiology and Chronic Health Evaluation 栻 score, Murray Lung Injury Score, duration of lung inflammation, and length of hospital stay (all P<0.05). GEE analyses indicated that the intervention group exhibited significantly reduced levels of IL- 6, procalcitonin, CRP, and MDA (all P<0.05), and significantly increased superoxide dismutase levels (P<0.05).
Conclusions: Early administration of BAL significantly mitigates systemic inflammation and oxidative stress, while improving clinical outcomes in older adult patients with severe pneumonia. These findings support further investigation of broader clinical application of early BAL in this population.
Yaxin Xiong
,
Jiuyue Sun
,
Yu Song
,
Jia Xu
,
Yingfei Zhi
,
Yuan Gao
,
Huaming Li
,
Mingyan Zhao
,
Xianglin Meng
2025(14):1.
DOI: 10.4103/jad.jad_88_25
Abstract:
Objective: To investigate the infulence of the International Normalized Ratio (INR) on the prognosis of patients with acute coronary syndrome (ACS) admitted to intensive care units (ICUs).
Methods: A retrospective analysis was conducted on ACS patients from the MIMIC-桇 2.0 database, who were admitted to ICUs for the first time between 2008 and 2019 and met the study criteria. The association between the initial INR upon admission and the prognosis of ACS patients was assessed using a restricted cubic spline model at a continuous level. Based on the restricted cubic spline (RCS) curve, patients were stratified into three groups, and a multivariate Cox regression model was applied to analyze the effect of INR on the prognosis of ACS patients.
Results: When INR was 曑1.0, the mortality risk gradually decreased with increasing INR levels; when INR ranged between 1.0 and 1.5, the mortality risk rose significantly with further elevation of INR; when INR exceeded 1.5, the mortality risk stabilized at a persistently high level, with minimal fluctuations observed despite substantial changes in INR values. Multivariate Cox regression analysis also demonstrated that patients in the medium (1.0-1.5) and high (>1.5) INR groups exhibited significantly higher mortality risks compared to those in the low (曑1.0) INR group.
Conclusions: Fluctuations in the INR among patients with ACS admitted to the ICU are associated with an increased risk of mortality and adversely affect patient prognosis.
Objective: To investigate the infulence of the International Normalized Ratio (INR) on the prognosis of patients with acute coronary syndrome (ACS) admitted to intensive care units (ICUs).
Methods: A retrospective analysis was conducted on ACS patients from the MIMIC-桇 2.0 database, who were admitted to ICUs for the first time between 2008 and 2019 and met the study criteria. The association between the initial INR upon admission and the prognosis of ACS patients was assessed using a restricted cubic spline model at a continuous level. Based on the restricted cubic spline (RCS) curve, patients were stratified into three groups, and a multivariate Cox regression model was applied to analyze the effect of INR on the prognosis of ACS patients.
Results: When INR was 曑1.0, the mortality risk gradually decreased with increasing INR levels; when INR ranged between 1.0 and 1.5, the mortality risk rose significantly with further elevation of INR; when INR exceeded 1.5, the mortality risk stabilized at a persistently high level, with minimal fluctuations observed despite substantial changes in INR values. Multivariate Cox regression analysis also demonstrated that patients in the medium (1.0-1.5) and high (>1.5) INR groups exhibited significantly higher mortality risks compared to those in the low (曑1.0) INR group.
Conclusions: Fluctuations in the INR among patients with ACS admitted to the ICU are associated with an increased risk of mortality and adversely affect patient prognosis.
2025(14):1.
DOI: 10.4103/jad.jad_96_25
Abstract:
Objective: To systematically evaluate the global research landscape of artificial intelligence (AI) applications in sepsis management to identify evolutionary patterns and inform evidence-based clinical decision-making.
Methods: We extracted 1 100 publications from the Web of Science Core Collection (1985-2024), employing Excel, CiteSpace, and VOSviewer for quantitative analysis of national contributions, institutional collaborations, author networks, and keyword evolution.
Results: Our findings reveal exponential growth in publication output since 2017 (annual growth rate: 56.3%), driven by advancements in machine learning and interdisciplinary integration. China and the United States emerged as dominant contributors, collectively accounting for over 60% of total publications. The top three institutions were Harvard University, University of California System and Emory University. Keywords co-occurrence and cluster analysis identified research hotspots such as AI-driven prediction models, immune infiltration, precision medicine and single-cell sequencing. Keywords were categorized into five clusters: clinical management of sepsis, pathological mechanism and biomarkers, complications and monitoring, AI-based research, and diagnostic criteria.
Conclusions: The publications interest in the application of AI in sepsis management is continuously increasing, especially in aspects such as the immune mechanism of sepsis, critical care management, and treatment plans. Moreover, there is great potential for research in precision medicine and single-cell sequencing. Future research should focus more on the application of AI in the prediction and precise intervention of sepsis.
Objective: To systematically evaluate the global research landscape of artificial intelligence (AI) applications in sepsis management to identify evolutionary patterns and inform evidence-based clinical decision-making.
Methods: We extracted 1 100 publications from the Web of Science Core Collection (1985-2024), employing Excel, CiteSpace, and VOSviewer for quantitative analysis of national contributions, institutional collaborations, author networks, and keyword evolution.
Results: Our findings reveal exponential growth in publication output since 2017 (annual growth rate: 56.3%), driven by advancements in machine learning and interdisciplinary integration. China and the United States emerged as dominant contributors, collectively accounting for over 60% of total publications. The top three institutions were Harvard University, University of California System and Emory University. Keywords co-occurrence and cluster analysis identified research hotspots such as AI-driven prediction models, immune infiltration, precision medicine and single-cell sequencing. Keywords were categorized into five clusters: clinical management of sepsis, pathological mechanism and biomarkers, complications and monitoring, AI-based research, and diagnostic criteria.
Conclusions: The publications interest in the application of AI in sepsis management is continuously increasing, especially in aspects such as the immune mechanism of sepsis, critical care management, and treatment plans. Moreover, there is great potential for research in precision medicine and single-cell sequencing. Future research should focus more on the application of AI in the prediction and precise intervention of sepsis.
2025(14):1.
DOI: 10.4103/jad.jad_93_25
Abstract:
Objective: To evaluate the association between serum levels of macrophage inflammatory protein-1 (MIP-1β) and disease severity as well as 28-day mortality in sepsis patients.
Methods: The retrospective study included adult patients with sepsis who were admitted to the emergency department. Demographic characteristics and laboratory parameters measured within 3 hours of admission were compared, including MIP-1β, lactate, procalcitonin, C-reactive protein, Acute Physiology and Chronic Health Evaluation 栻 (APACHE 栻) score, and Sequential Organ Failure Assessment score.
Results: The study included a total of 202 sepsis patients, who were stratified by 28-day outcomes into 61 survivors and 141 non-survivors. MIP-1β levels were significantly higher in the non-survivor group [(196.08v.s.10.75) pg/mL] than in the survivor group [(125.48v.s.4.70) pg/mL, P<.05]. The areas under the receiver operating characteristic curves (AUC) for predicting 28-day mortality were 0.712 for MIP-1β, 0.599 for lactate, and 0.766 for APACHE 栻 score. MIP-1β levels showed a positive correlation with lactate (r=0.172). Binary logistic regression identified MIP-1 β (OR=1.02, 95% CI: 1.01-1.03, P=.001), APACHE 栻 score (OR=1.16, 95% CI: 1.08-1.24, P<.001), and lactate (OR=1.45, 95% CI: 1.08-1.95, P=.01) as independent risk factors for 28-day mortality in sepsis patients.
Conclusions: MIP-1β demonstrates high sensitivity and specificity in predicting poor outcomes in sepsis. MIP-1β, APACHE 栻 score, and lactate are independent risk factors for 28-day mortality in these patients.
Objective: To evaluate the association between serum levels of macrophage inflammatory protein-1 (MIP-1β) and disease severity as well as 28-day mortality in sepsis patients.
Methods: The retrospective study included adult patients with sepsis who were admitted to the emergency department. Demographic characteristics and laboratory parameters measured within 3 hours of admission were compared, including MIP-1β, lactate, procalcitonin, C-reactive protein, Acute Physiology and Chronic Health Evaluation 栻 (APACHE 栻) score, and Sequential Organ Failure Assessment score.
Results: The study included a total of 202 sepsis patients, who were stratified by 28-day outcomes into 61 survivors and 141 non-survivors. MIP-1β levels were significantly higher in the non-survivor group [(196.08v.s.10.75) pg/mL] than in the survivor group [(125.48v.s.4.70) pg/mL, P<.05]. The areas under the receiver operating characteristic curves (AUC) for predicting 28-day mortality were 0.712 for MIP-1β, 0.599 for lactate, and 0.766 for APACHE 栻 score. MIP-1β levels showed a positive correlation with lactate (r=0.172). Binary logistic regression identified MIP-1 β (OR=1.02, 95% CI: 1.01-1.03, P=.001), APACHE 栻 score (OR=1.16, 95% CI: 1.08-1.24, P<.001), and lactate (OR=1.45, 95% CI: 1.08-1.95, P=.01) as independent risk factors for 28-day mortality in sepsis patients.
Conclusions: MIP-1β demonstrates high sensitivity and specificity in predicting poor outcomes in sepsis. MIP-1β, APACHE 栻 score, and lactate are independent risk factors for 28-day mortality in these patients.
2025, 14(14):1.
DOI: 10.4103/jad.jad_142_24
Abstract:
Rationale: Although traditionally linked to myocardial dysfunction, left ventricular (LV) thrombus with preserved systolic function presents a distinct diagnostic challenge, necessitating its consideration in all cardioembolic strokes.
Patient’s Concern: A 50-year-old woman with diabetes experienced sudden unresponsiveness accompanied by significant right upper limb weakness. Remarkably, her clinical history was devoid of symptoms suggestive of ischemic or arrhythmic cardiac events.
Diagnosis: Advanced neuroimaging identified acute bilateral medial thalamic and paramedian midbrain infarctions. Transthoracic echocardiography revealed an unexpectedly large, mobile LV thrombus, coexisting with normal systolic function (ejection fraction: 60%).
Interventions: Immediate anticoagulation with low molecular weight heparin was initiated, followed by oral warfarin titrated to an international normalized ratio of 2.0-3.0. Physical therapy was implemented to address residual motor deficits.
Outcomes: Three months post-intervention, the patient demonstrated marked neurological improvement (right upper limb power: 3/5) and complete thrombus resolution, confirmed by follow-up echocardiography.
Lessons: This case highlights that LV thrombus is a rare but critical consideration in embolic stroke of uncertain origin, even with normal cardiac function. It underscores the necessity of prompt echocardiography and early anticoagulation to achieve optimal outcomes.
Rationale: Although traditionally linked to myocardial dysfunction, left ventricular (LV) thrombus with preserved systolic function presents a distinct diagnostic challenge, necessitating its consideration in all cardioembolic strokes.
Patient’s Concern: A 50-year-old woman with diabetes experienced sudden unresponsiveness accompanied by significant right upper limb weakness. Remarkably, her clinical history was devoid of symptoms suggestive of ischemic or arrhythmic cardiac events.
Diagnosis: Advanced neuroimaging identified acute bilateral medial thalamic and paramedian midbrain infarctions. Transthoracic echocardiography revealed an unexpectedly large, mobile LV thrombus, coexisting with normal systolic function (ejection fraction: 60%).
Interventions: Immediate anticoagulation with low molecular weight heparin was initiated, followed by oral warfarin titrated to an international normalized ratio of 2.0-3.0. Physical therapy was implemented to address residual motor deficits.
Outcomes: Three months post-intervention, the patient demonstrated marked neurological improvement (right upper limb power: 3/5) and complete thrombus resolution, confirmed by follow-up echocardiography.
Lessons: This case highlights that LV thrombus is a rare but critical consideration in embolic stroke of uncertain origin, even with normal cardiac function. It underscores the necessity of prompt echocardiography and early anticoagulation to achieve optimal outcomes.
19 Oxygenation adjustment of ventilator combined with venovenous
extracorporeal membrane oxygenation
Chuanzhu Lv
,
Wei Guo
,
Xufeng Chen
,
Yong Mei
,
Jing Sun
,
Ling Wang
,
Yuguo Chen
,
Huadong Zhu
,
Yu Cao
,
Yanfan Chai
,
Emergency
Medicine Branch of Chinese Geriatrics Society
2025, 14(14):1.
DOI: 10.4103/jad.jad_123_25
Abstract:
In recent years, venovenous extracorporeal membrane oxygenation (VV-ECMO) has emerged as a critical intervention in the management of adult respiratory failure, with its clinical application expanding at a rapid pace annually. For critically ill patients receiving VV-ECMO support, achieving and maintaining a balance between oxygen supply and oxygen consumption is of paramount importance. Oxygen supply primarily relies on cardiac output and arterial oxygen content; notably, in patients under VV-ECMO support, arterial oxygen content is closely linked to the parameter configurations of both VV-ECMO and mechanical ventilators. Therefore, based on national and industrial needs, this document has been formulated by integrating the latest advancements and practical experience in this field from both domestic and international sources. Its core objectives are to standardize the adjustment of oxygen supply during the combined use of mechanical ventilators and VVECMO, provide unambiguous guidance for healthcare professionals, and ultimately enhance the success rate in the treatment of severe respiratory conditions.
In recent years, venovenous extracorporeal membrane oxygenation (VV-ECMO) has emerged as a critical intervention in the management of adult respiratory failure, with its clinical application expanding at a rapid pace annually. For critically ill patients receiving VV-ECMO support, achieving and maintaining a balance between oxygen supply and oxygen consumption is of paramount importance. Oxygen supply primarily relies on cardiac output and arterial oxygen content; notably, in patients under VV-ECMO support, arterial oxygen content is closely linked to the parameter configurations of both VV-ECMO and mechanical ventilators. Therefore, based on national and industrial needs, this document has been formulated by integrating the latest advancements and practical experience in this field from both domestic and international sources. Its core objectives are to standardize the adjustment of oxygen supply during the combined use of mechanical ventilators and VVECMO, provide unambiguous guidance for healthcare professionals, and ultimately enhance the success rate in the treatment of severe respiratory conditions.
Abhishek Mishra
,
Shalendra Singh
,
Sirisha Anne
,
Chandra Prakash Sharma
,
Shibu Sasidharan
,
Priya Taank
,
Anushree Mishra
2025(14):1.
DOI: 10.4103/jad.jad_2_25
Abstract:
Rationale: Acute appendicitis is a surgical emergency that can be difficult to diagnose, especially in females, due to a broad differential diagnosis. One of the conditions that may mimic or coexist with appendicitis is a ruptured ovarian cyst. However, distinguishing between the two is critical, as their management strategies differ significantly.
Patient concerns: A 23-year-old married woman with no known comorbidities presented with a one-day history of pain in her right iliac fossa.
Diagnosis: Abdominal ultrasonography confirmed an inflamed appendix; however, further pelvic scanning identified a ruptured right adnexal cyst. This indicated a case of acute appendicitis coexisting with a right adnexal cyst, resulting in hemoperitoneum.
Interventions: Laparoscopic appendectomy and deroofing of the cyst were performed, along with peritoneal lavage, and clot evacuation.
Outcomes: The patient was discharged one week after surgery.
Lessons: Clinicians should maintain a high index of suspicion for clinical variants of acute appendicitis, especially in female patients presenting with abdominal pain and a concurrent right hemorrhagic ovarian cyst.
Rationale: Acute appendicitis is a surgical emergency that can be difficult to diagnose, especially in females, due to a broad differential diagnosis. One of the conditions that may mimic or coexist with appendicitis is a ruptured ovarian cyst. However, distinguishing between the two is critical, as their management strategies differ significantly.
Patient concerns: A 23-year-old married woman with no known comorbidities presented with a one-day history of pain in her right iliac fossa.
Diagnosis: Abdominal ultrasonography confirmed an inflamed appendix; however, further pelvic scanning identified a ruptured right adnexal cyst. This indicated a case of acute appendicitis coexisting with a right adnexal cyst, resulting in hemoperitoneum.
Interventions: Laparoscopic appendectomy and deroofing of the cyst were performed, along with peritoneal lavage, and clot evacuation.
Outcomes: The patient was discharged one week after surgery.
Lessons: Clinicians should maintain a high index of suspicion for clinical variants of acute appendicitis, especially in female patients presenting with abdominal pain and a concurrent right hemorrhagic ovarian cyst.
2025(14):1.
DOI: 10.4103/jad.jad_99_25
Abstract:
Objective: To compare the diagnostic performance of DeepSeek-R1 and ChatGPT-4o in emergency department inpatients and explore their clinical practical value.
Methods: A retrospective study was conducted using clinical data from emergency department inpatients discharged in December 2024. Discharge diagnoses served as the gold standard. Patient data (age, symptoms, exams, tests) were input into DeepSeek-R1 and GPT-4o with the prompt: “What is the most likely diagnosis? ” Two physicians scored outputs (0–3) to assess accuracy and consistency.
Results: A total of 328 cases were analyzed. The mean scores for DeepSeek-R1 and ChatGPT-4o were 2.33±1.07 and 2.32±1.05, respectively, with no statistically significant difference (P=0.82). The Z-score was -0.232, indicating highly similar performance between the two models. However, the rate of accurate diagnoses was 66.5%. Diagnostic performance declined with increasing patient age.
Conclusions: DeepSeek-R1 and ChatGPT-4o demonstrated comparable diagnostic performance in emergency department settings, but the misdiagnosis risk remained high. Both models can serve as auxiliary tools to expand physicians' diagnostic considerations but should be integrated with clinical expertise for comprehensive judgment.
Objective: To compare the diagnostic performance of DeepSeek-R1 and ChatGPT-4o in emergency department inpatients and explore their clinical practical value.
Methods: A retrospective study was conducted using clinical data from emergency department inpatients discharged in December 2024. Discharge diagnoses served as the gold standard. Patient data (age, symptoms, exams, tests) were input into DeepSeek-R1 and GPT-4o with the prompt: “What is the most likely diagnosis? ” Two physicians scored outputs (0–3) to assess accuracy and consistency.
Results: A total of 328 cases were analyzed. The mean scores for DeepSeek-R1 and ChatGPT-4o were 2.33±1.07 and 2.32±1.05, respectively, with no statistically significant difference (P=0.82). The Z-score was -0.232, indicating highly similar performance between the two models. However, the rate of accurate diagnoses was 66.5%. Diagnostic performance declined with increasing patient age.
Conclusions: DeepSeek-R1 and ChatGPT-4o demonstrated comparable diagnostic performance in emergency department settings, but the misdiagnosis risk remained high. Both models can serve as auxiliary tools to expand physicians' diagnostic considerations but should be integrated with clinical expertise for comprehensive judgment.
2025(14):1.
DOI: 10.4103/jad.jad_41_2
Abstract:
Publication ethics
Academic misconduct statement
Mobile website
Journal of Acute Disease ® 2026 All Rights Reserved
Close