Community-acquired pneumonia (CAP) poses a significant global health threat, particularly affecting vulnerable populations. Biomarkers and scoring systems play a crucial role in diagnosing, assessing severity, and guiding treatment decisions for CAP patients. Biomarkers like C reactive protein, procalcitonin, and the neutrophil-to-lymphocyte ratio aid in diagnosis and severity assessment, while scoring systems such as CURB-65 and Pneumonia Severity Index classify patients into risk categories. Emerging biomarkers (uremia, elevated respiratory rate, hypotension, and age ≥ 65) like serum amyloid A and S100 proteins show promise in predicting disease severity and prognosis. However, further research is needed to determine their precise roles and clinical utility in CAP management.

The incidence of acute pancreatitis (AP), a condition characterized by inflammation in the pancreas, has been increasing globally and is associated with several complications. This review elaborated on the etiology, clinical presentation, severity assessment, and treatment modalities of AP, mainly in the critical care setting. Patients with severe AP, as indicated by organ failure (>48 hours from onset), warrant treatment in the intensive care unit setting. The most common etiologies, biliary disease and alcohol consumption, and the advanced diagnostic tools used for the identification of the cause are highlighted. Different severity assessment tools are utilized for grading the severity of the disease, predicting patient outcomes, determining the associated risk, and guiding treatment decisions. The treatment interventions comprise various approaches, such as anti-infective therapy enteral nutrition, analgesics for pain, or minimally invasive surgical procedures, thereby demonstrating an evolving landscape of AP management. Furthermore, various complications such as necrosis, organ failure, and hemorrhage, necessitate disease monitoring and differential diagnosis and are crucial for optimal management of patients. Novel treatment modalities and advancements in multidisciplinary care emphasize the potential for reducing the burden of AP in critical care settings.

Objective: To assess the effects of L-carnitine on the outcomes of patients with moderate to severe coronavirus disease 2019 (COVID-19) in intensive care unit (ICU). Methods: This double-blind clinical trial was carried out in 2022-2023. 64 Patients with COVID-19 were selected from Amiralmomenin and Khansari hospitals in Arak, Iran. They were randomly assigned to the control and the L-carnitine treatment group via block randomization. Venous blood gases, disease severity, and levels of D-dimer, lactate dehydrogenase, ferritin, and C-reactive protein were daily assessed during the seven days of the intervention, and the length of ICU stay, the need for endotracheal intubation, and mortality rate were documented. Results: There were significant differences in length of ICU stay, the need for endotracheal intubation, and levels of D-dimer, lactate dehydrogenase, ferritin, APACHE II score, and C-reactive protein between the two groups (P<0.05). However, the groups did not significantly differ in mortality rate and venous blood gas indexes (P>0.05). Conclusions: L-carnitine can improve outcomes of patients with COVID-19. Therefore, it can be used as an adjuvant therapy for these patients. Trial registration: Iranian Registry of Clinical Trials identifier IRCT20141209020258N165.

Objective: To explore the predictive value of neutrophil-to-lymphocyte ratio (NLR) in in-hospital mortality in sepsis patients. Methods: A prospective observational cross-sectional study was conducted on 100 patients with septicemia. The data about the patient’s demography, medical history, general examination including pulse rate, blood pressure, etc, use of vasopressor support, need for renal replacement therapy, mechanical ventilation, outcome, and lab parameters including total lymphocyte count with neutrophil-to-lymphocyte ratio were recorded. And parameters between survivals and non-survivals were compared. Results: Out of 100 patients, 80% were from rural backgrounds. Most patients were 50 to 59 years old. 26 Patients were dead. The patients in the nonsurvivor group were older and more had a history of diabetes mellitus when compared with the survivor group. The non-survivor group had a higher NLR, APACHE II, and SOFA score. Conclusions: NLR is a readily available parameter and can be used as a good prognostic indicator for mortality in sepsis patients.

Objective: To explore expression level of interferon-stimulated genes PKR, OAS1, MX1, and ISG15 in peripheral blood mononuclear cells of COVID-19 patients. Methods: In this study, changes in the expression of four interferon-stimulated genes (ISGs), including PKR, OAS1, MX1, and ISG15, in peripheral blood mononuclear cells of 45 COVID-19 patients with different severities were evaluated by real-time PCR method. Results: OAS1, MX1, PKR, and ISG15 were differently expressed in COVID-19 patients with different severity. The results showed that the expression of OAS1, MX1, PKR, and ISG15 genes was significantly (P=0.001) lower in severe patients. Conclusions: Weak and defective IFN response and subsequent disruption of ISGs may be associated with COVID-19 severity.

Rationale: Synthetic cannabinoids are increasingly used as recreational drugs and have been associated with adverse cardiovascular effects. However, reports of synthetic cannabinoids accompanied by constrictive pericarditis are limited. Patient’s concern: A 28-year-old male with a history of synthetic cannabinoid (Bonzai) abuse presented with chest discomfort, dyspnea, and lower extremity edema. Investigations revealed reduced left ventricular ejection fraction, elevated inflammatory markers, low electrocardiogram voltages, and atrial fibrillation. Diagnosis: Chest spiral computerized tomography scan and chest X-ray demonstrated pericardial calcification. Cardiac magnetic resonance imaging and right heart catheterization were done to confirm the possibility of constrictive pericarditis. Based on the patient’s addiction history and exclusion of rheumatologic and infectious causes, it was supposed that constrictive pericarditis and cardiomyopathy may be accompanied by synthetic cannabinoid use. Interventions: The patient received standard medical therapy, including loop diuretics for cardiomyopathy and constrictive pericarditis. Catheter ablation was recommended for his rhythm control, and he was planned for close monitoring of clinical and echocardiographic response and evaluation of the need for surgical pericardiectomy in the future. Outcomes: After 6 months follow-up, echocardiographic exam revealed no significant improvement in ventricular function. However, due to the high surgical risk, the patient’s poor compliance, and the continuation of drug abuse, he was not a good candidate for surgery according to our heart team’s decision. Lessons: Synthetic cannabinoids can trigger constrictive pericarditis, and clinicians should consider them when evaluating patients with compatible symptoms and exposure history. Further research on the cardiovascular effects of synthetic cannabinoids is needed and public education on potential harms is warranted.

Rationale: Dengue fever is capable of inciting the formation of transient polyclonal antibodies directed at red blood cell antigens, resulting in complement-mediated hemolysis, leading to intravascular hemolysis and hemoglobinuria. Patient’s concern: A 12-year-old male patient who recovered from dengue fever a week ago had red blood cell agglutination, spherocytes, and engulfment of red blood cells (erythrophagocytosis) by monocytes and neutrophils on routine hematological peripheral blood smear. The unexpected blood smear results prompted the lab physicians to investigate autoimmune hemolytic anemia, which revealed a monospecific positive direct antiglobulin test for complement (C3d, C3b) and the presence of Donath-Landsteiner antibody. Diagnosis: Paroxysmal cold hemoglobinuria (PCH), secondary to dengue fever. Interventions: Oxygen supplements, antibiotics, intravenous immunoglobulins, steroid therapy, and packed cell transfusions were administered. Outcomes: The patient’s condition was improved following the therapy. Lessons: Post-dengue PCH is a rare complication that requires a thorough peripheral smear examination for erythrophagocytosis, as advanced hematology analyzers fail to detect such findings.

Scrotal trauma, though uncommon, can have severe consequences, and one such complication is testicular dislocation. This occurs when the testicle is displaced from its normal anatomical position within the scrotum due to a traumatic event. Understanding the mechanisms, diagnosis, and management of testicular dislocation is paramount in providing optimal care for affected individuals[1]. Traumatic incidents, such as sports injuries, motor vehicle accidents, or direct blows to the scrotum, can result in testicular trauma[2]. The condition demands immediate medical attention to prevent further complications, including vascular compromise and testicular ischemia. Diagnosing testicular dislocation involves a thorough physical examination and often necessitates imaging studies, such as ultrasound, to precisely determine the extent of the displacement and assess potential vascular compromise. Once diagnosed, prompt intervention is crucial to reposition the dislocated testicle and restore blood flow. Treatment options may include manual reduction or surgical intervention, depending on the severity of the dislocation and associated injuries[3]. Close monitoring in the post-treatment period is essential to identify and manage any complications promptly. Proper informed consent had been obtained from the patient. A 19-year-old male patient presented to the emergency department after a motorcycle collision with another vehicle. Despite the motorcycle collision accident, the patient exhibited a refusal to lie supine during examination. He maintained full consciousness, orientation, and cooperation, and his vital signs were within normal ranges. Physical examination revealed a painful swelling below the skin at the level of the right inguinal canal. While the left testis was palpable, the right testis could not be identified. Subsequent system examinations and investigations did not reveal any additional pathological findings. Laboratory tests indicated a leukocyte count of 15.3×10³/μL (normal: 4×10³-10×10³/μL), a hemoglobin level of 13.5 g/dL (normal: 10-15 g/dL), and a hematocrit of 40.3% (normal: 40%-54%). A computed tomography scan confirmed non-displaced fractures in both ischial columns (Figure 1A), along with a 32 mm diameter image consistent with the testis in the right inguinal region below the skin (Figure 1B). Further exploration in the operating room revealed the testis at the level of the external inguinal ring. The gubernacular cord was transected, and the testis, with normal blood supply and color, was successfully descended. Cord integrity was confirmed, and fixation of the right testis was performed. Following a two-day uneventful monitoring period, the patient was discharged without complications. In conclusion, testicular dislocation following scrotal trauma is a serious condition that requires a swift and accurate diagnosis, followed by appropriate intervention. Healthcare professionals must remain vigilant, considering the potential long-term consequences of untreated testicular dislocation, including infertility and chronic pain.