Objective: To investigate the association between derangement of the serum iron profile and in-hospital mortality of adult patients diagnosed with sepsis using Sepsis-3 criteria, and to assess its potential role in improving diagnostic and prognostic accuracy. Methods: This prospective observational study (May 2023-October 2024) was conducted in the emergency and medical ward. Serum iron profile and Sequential Organ Failure Assessment (SOFA) scores were assessed on admission. Clinical outcomes were tracked; associations with serum iron profile were determined using Student's t-test and chi-square test. Results: One hundred fifty adult Sepsis-3 patients were recruited. 58 Patients (38.7%) died during hospitalization. Mean ferritin for deceased patients was 929.0±310.0µg/L, and was significantly higher than 417.0±311.0µg/L for survivors (P<.001). A serum ferritin value of 700µg/L strongly predicted in-hospital mortality (69.9% mortality above this threshold). The odds ratio was 23.2 (95% CI: 9.2–58.3) for ferritin above 700µg/L, indicating likelihood of death 23.2 times higher in patients with serum ferritin above 700µg/L. With SOFA, the odds ratio was 3.7, highlighting ferritin as a stronger individual predictor. Conclusions: Serum ferritin level is an independent predictor of in-hospital mortality in sepsis. Monitoring ferritin levels can enhance early risk stratification, facilitate timely intervention, and improve outcomes.

Objective: To address the critical impact of smoke inhalation lung injury on burn patient prognosis and the lack of animal models simulating varying injury severity, we established a graded rat model to facilitate research into its pathological mechanisms and treatments. Methods: Eighteen male Wistar rats were divided into a control group and groups exposed to smoke for 5, 10, 15, 30 minutes (n=3 per group). A custom smoke chamber and specific materials (50 g pine wood chips + 10 mL kerosene) were used. Post-exposure assessments included lung function, lung coefficient (wet weight), histopathology (H&E staining), and leukocyte count and IL-6 levels in alveolar lavage fluid. Results: Lung function declined significantly in all exposure groups versus controls, with progressive worsening over time. The lung coefficient increased significantly in the 15- and 30-minute groups. Histology revealed intact structure at 5 and 10 minutes, alveolar rupture and neutrophil infiltration at 15 minutes, and hyaline membranes at 30 minutes. Leukocyte count and IL-6 levels rose markedly after 15 and 30 minutes of exposure. Statistical comparisons confirmed progressive injury severity with longer exposure. Conclusions: Graded rat models of mild, moderate, and severe inhalation lung injury were successfully established following 5, 15, and 30 minutes of smoke exposure, respectively. Injury and inflammation intensified significantly with exposure duration, providing a valuable foundation for further research.

Rationale: Atrial fibrillation is a common perioperative arrhythmia, especially in elderly patients. Although a good amount of literature exists on the perioperative management of patients with pre-existing atrial fibrillation, information on managing a case with first-detected atrial fibrillation on the day of scheduled elective surgery is scarce. Although non-cardiac surgery guidelines in patients with cardiac diseases are well-established, this dilemma is not entirely answered. Patient’s concern: A 75-year-old male patient, anemic with suspected carcinoma and planned for diagnostic cystoscopy and biopsy, presented with irregularly irregular heart rate and palpitation on the morning of scheduled surgery. Diagnosis: First-detected atrial fibrillation with first ventricular rate. Interventions: Intravenous diltiazem 10 mg was given to control ventricular rate, followed by balanced general anesthesia for the intervention. Outcomes: Patient responded to diltiazem; heart rate was controlled. General anesthesia was uneventful except for two brief episodes of hypotension. Atrial fibrillation reverted to sinus rhythm spontaneously the next day. Lessons: The case highlights the dilemma faced in the decision-making based on existing guidelines and successful management of such a rare incident.

Objective: To evaluate the association between the Geriatric Nutritional Risk Index (GNRI) at ICU admission and mortality in patients with heart failure complicated by sepsis, a high-risk population in which the prognostic value of this validated malnutrition risk assessment tool remains underexplored. Methods: Patients with heart failure and sepsis were identified from the Medical Information Mart for Intensive Care (MIMIC-Ⅳ) database and stratified into four GNRI groups. The primary endpoints were 28-day and 365-day all-cause mortality. Survival analysis used Kaplan-Meier curves and Cox proportional hazards models. Linearity was assessed using restricted cubic splines (RCS), while GNRI’s predictive performance was evaluated using receiver operating characteristic (ROC) curves. Results: Altogether, 1 713 patients with heart failure complicated by sepsis were identified in the present study. Kaplan-Meier analysis revealed 28-day mortality rates of 40.44% (high-risk) vs. 25.27% (no-risk) (P<.001), with a similar trend for 365-day mortality (63.75% vs. 43.96%, P<.001). RCS confirmed a linear inverse relationship between GNRI and mortality. Cox regression demonstrated that each unit GNRI increase reduced 28-day (hazard ratio [HR], 0.99; 95% confidence interval [ CI] 0.98–1.00) and 365-day mortality risk (HR, 0.98; 95% CI 0.98–0.99). ROC analysis indicated a moderate predictive value of GNRI for 28-day all-cause mortality (AUC=0.58, sensitivity=66.61%, specificity=45.62%, P<.001) and 365-day all-cause mortality (AUC=0.60, sensitivity=66.52%, specificity=51.28%, P<.001). Furthermore, the addition of GNRI significantly enhanced the predictive performance of the SAPSⅡ (AUC increased from 0.69 to 0.70, P=.02), SOFA (AUC increased from 0.73 to 0.74, P=.02), and LODS (AUC increased from 0.67 to 0.68, P=.03) scores, with these improvements achieving statistical significance. Conclusions: Admission GNRI is an independent risk factor for in-hospital mortality in ICU patients with heart failure complicated by sepsis. GNRI scores serve as a valuable prognostic indicator for assessing mortality risk in this patient population.

Rationale: Nitrite, a common meat preservative, can cause life-threatening methemoglobinemia. Patient’s concern: Two men (52 and 60 years) developed sudden cyanosis, dizziness, and nausea 10–20 minutes after consuming pork skin jelly from a local deli. Diagnosis: Acquired methemoglobinemia (methemoglobin 50.7% and 37.2%); jelly contained 420 mg/kg nitrite (GB 2760-2014 limit: 30 mg/kg). Interventions: High-flow oxygen and intravenous 1% methylene blue 1–2 mg/kg in 20 mL 5% glucose over 15 minutes. Outcomes: Cyanosis was relieved within 30 minutes; methemoglobin became normalized within 2 hours. Both recovered fully and were discharged on June 24, 2024. Lessons: Sudden cyanosis after meat consumption requires immediate hospitalization, methemoglobin testing, and methylene blue treatment; food residue analysis confirms diagnosis, while supplier monitoring and record-keeping prevent recurrence.

Rationale: Infected urinomas are rare complications of urinary tract obstruction and may mimic renal abscess or pyonephrosis. Presentation as a palpable flank mass is highly unusual. Patient’s concern: An 84-year-old man with fever, flank pain, and a firm right flank mass. Imaging revealed an acute multiloculated infected urinoma communicating with the proximal ureter, associated with a ureteric calculus. Diagnosis: Infected urinoma. Interventions: He was treated with antibiotics, percutaneous drainage, and nephrostomy. Outcomes: Recurrence occurred three months later due to unresolved obstruction, requiring repeat drainage. Definitive surgical management was deferred due to advanced age and comorbidities, highlighting challenges in high-risk patients. Lessons: This case highlights the importance of considering urinoma in the differential diagnosis of flank masses, the complementary roles of multimodal imaging for accurate diagnosis, and the importance of definitive management of urinary obstruction to prevent recurrence.

Infected diabetic wounds represent one of the most severe complications of diabetes mellitus, with complex pathological mechanisms that present significant challenges in clinical management. Ferroptosis, an emerging form of iron-dependent programmed cell death driven by excessive lipid peroxidation, plays a critical role in the progression of infected diabetic wounds. This review systematically examines the central mechanisms of ferroptosis in infected diabetic wounds from three key perspectives: dysregulation of iron metabolism, accumulation of lipid peroxidation products, and impairment of the antioxidant defense system. Moreover, it analyzes the impact of ferroptosis on various cell types—fibroblasts, macrophages, vascular endothelial cells, and keratinocytes—during the impaired healing process. Based on these mechanistic insights, the review summarizes recent advances in ferroptosis-targeted therapeutic strategies for wound repair, including ferroptosis inhibitors, cell-based therapies, and innovative hydrogel materials with promising application potential. By integrating current knowledge on the role of ferroptosis in infected diabetic wounds and associated treatment approaches, this article aims to provide new perspectives and a solid theoretical foundation for future research and the comprehensive management of this challenging condition.

Objective: To compare the therapeutic efficacy of intravenous pantoprazole and famotidine for the treatment of epigastric pain in patients presenting to the emergency department. Methods: In this triple-blind randomized clinical trial, eligible patients presenting with epigastric pain were randomly assigned to receive intravenous pantoprazole or famotidine. Block randomization was used, and patients, treating physicians, and outcome assessors were blinded to treatment allocation. Pain intensity was assessed at baseline and at 30 and 60 minutes after drug administration. Results: Eighty patients were enrolled, with a mean age of 36.6 years (SD, 15.0), and 42.5% were male. Mean pain scores decreased significantly over time in both treatment groups. In the pantoprazole group, pain scores declined from 8.02±1.28 at baseline to 4.75±1.31 at 30 minutes and 1.62±1.29 at 60 minutes, whereas in the famotidine group scores decreased from 8.12±1.48 to 5.37±1.23 and 2.35±1.54, respectively. There was no significant difference in baseline pain scores between groups (P=.92). Pantoprazole resulted in greater pain reduction compared with famotidine at both 30 minutes (P=.04) and 60 minutes (P=.05). Conclusions: Both medications were effective in relieving epigastric pain; however, pantoprazole provided greater and more sustained pain reduction, supporting its preferential use in emergency settings.

Objective: Early sepsis can be treated if recognised early, but progression to severe sepsis and septic shock and multiple organ dysfunction syndrome substantially increases mortality. The objectives of our study were to assess morbidity and mortality of patients with sepsis and to compare the effectiveness of a simple bedside satisfiable Quick Sequential Organ Failure Assessment (qSOFA) score with National Early Warning Score (NEWS) in prognosticating sepsis. Methods: This prospective observational study was conducted among patients >18 years old presenting with sepsis at B.J. Medical College. The SOFA, qSOFA and NEWS scores were calculated. The effectiveness in predicting mortality was evaluated using receiver operating characteristic curve analysis. Results: A total of 200 patients were evaluated (56% male) with a mean age of 51.7 years. The mortality rate was 23%. Patients categorized under high risk according to SOFA score >8, qSOFA score of 2-3 and NEWS >7 had a mortality rate of 33.3%, 27.5% and 28.4%, respectively. AUC for mortality prediction was 0.695 using SOFA score, 0.665 using qSOFA and 0.725 using NEWS. At a cut off of 7.50, NEWS demonstrated a sensitivity of 97.8% with a specificity of 28.0% and outperformed both SOFA and qSOFA which yielded a sensitivity of 43.5% and 91.3% and a specificity of 77.9% and 27.9%, respectively. Conclusions: The NEWS score outperforms SOFA and qSOFA in predicting mortality among sepsis patients. However, qSOFA is more helpful in identifying high risk patients and performs better in intensive care setting.