Emergency Care Journal is the official Journal of the Academy of Emergency Medicine and Care (AcEMC). The journal is an international, peer-reviewed journal dedicated to improve the quality of care by publishing contributions on acute medical care and related medical specialties. The journal welcomes submissions from international contributors and researchers of all specialties involved in acute medical conditions. Emergency Care Journal publishes Original Articles, Review Articles, Opinion Reports, Case Reports, Images in Emergency, Letters to the Editors, Commentaries, Book Reviews, Editorials and other educational information related to the practice, teaching, and environment of emergency medicine. In addition to general topics, ECJ also publishes articles on out-of-hospital emergency medical services, pediatric emergency medicine, injury and disease prevention, health policy and ethics, disaster management, toxicology, and related topics. Although most of published research is clinical, there is also strong interest for basic science research pertinent to emergency medicine, thus including all clinical, diagnostics and therapeutic areas of medicine involved in the emergency care management. This journal does not apply charge for publication to Authors as it is fully supported by institutional funds (Academy of Emergency Medicine and Care).
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Delirium in the emergency department: science or ritual? Rethinking diagnostic pathways in emergency delirium management
Section: Mini Reviews Categories: Newsletter Keywords: Array, Array, Array, Array, Array, Array Delirium is an acute disturbance of attention and awareness that develops over a short period and typically fluctuates in severity. It may affect up to one-quarter of older adults presenting to the Emergency Department (ED) and is associated with increased mortality, prolonged hospital stays, and increased healthcare costs. Despite its clinical importance, delirium is frequently underrecognized, as it may manifest with subtle or nonspecific symptoms. When delirium is suspected, prompt and systematic evaluation is critical for identifying underlying etiologies, which may include infections, metabolic disturbances, structural brain pathology, or adverse drug effects. This article is hence aimed to provide a critical overview of the English-language literature published between the years 2020 and 2025 on laboratory investigations and diagnostic workup of delirium in older patients presenting to the ED.
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Evolution of simulation-based training in Italian emergency medicine residency programs: results from a national longitudinal survey (2022–2024)
Section: Original Articles Categories: Newsletter Keywords: Array, Array, Array, Array, Array Simulation-Based Education (SBE) is increasingly recognized as a key component of Emergency Medicine (EM) training. In Italy, where EM residency programs are relatively recent, national initiatives have been developed to promote and standardize the use of simulation within postgraduate training. A national survey was conducted among all Italian EM residency programs in 2022 and repeated in 2024 to assess changes in the use of simulation-based education. The survey explored the frequency and duration of simulation activities, available infrastructure, instructor qualifications, and the integration of simulation into training and assessment. Response rates were high in both years (91% in 2022 and 84% in 2024). The proportion of programs offering simulation-based training increased from 45% to 57%. High-fidelity simulation showed a moderate increase, while procedural skills remained the main focus of simulation activities. Crisis Resource Management (CRM) and non-technical skills training were reported in a minority of programs. The number of certified simulation facilitators increased, although access to simulation centers remained uneven. Simulation was rarely used for assessment purposes. Simulation-based education in Italian EM residency programs is gradually expanding, although important disparities remain in access to infrastructure and trained faculty. Future efforts should focus on strengthening faculty development, improving access to simulation resources, and integrating simulation more systematically into curricula and assessment processes.
Prehospital team composition and mortality: a scoping review
Section: Reviews Categories: Newsletter Keywords: Array, Array, Array, Array, Array Emergency Medical Services (EMS) operate with heterogeneous team configurations, yet the impact of prehospital staffing models on patient mortality remains uncertain. Existing evidence suggests that survival differences may reflect system-level factors rather than the intrinsic superiority of specific professional roles. The aim of the present study was to map and synthesize the available evidence on the association between EMS team composition and mortality outcomes in prehospital care. A scoping review was conducted in accordance with PRISMA-ScR guidelines. PubMed, CINAHL, Web of Science, ProQuest, and Scopus were searched through July 2025. Peer-reviewed studies published from 2000 onwards that reported mortality outcomes in relation to defined prehospital team configurations were included. Two reviewers independently screened studies and extracted data, with disagreements resolved by a third reviewer. Twenty-five studies were included, encompassing diverse EMS systems across Asia, Europe, the Americas, and Oceania. Mortality outcomes varied substantially according to clinical severity, system maturity, dispatch accuracy, and prehospital time intervals. Physician-staffed teams demonstrated selective mortality benefits in high-acuity trauma and traumatic out-of-hospital cardiac arrest. Nurse–paramedic and advanced paramedic teams frequently achieved comparable survival outcomes in mixed emergencies and medical conditions when supported by robust training and standardized protocols. Across all models, emergency nurses contributed substantially to early assessment, physiological stabilization, clinical decision-making, and safety processes. System heterogeneity emerged as a dominant determinant of observed outcomes. No single EMS staffing model consistently outperforms others across all clinical contexts. Mortality outcomes appear to be shaped by the interaction between team competence and system organization rather than by professional composition alone. Future research should prioritize standardized quality indicators, intermediate outcomes, and comparative designs to support evidence-informed EMS workforce planning.
Evidence-based pathways to modernise emergency nursing in Italy: autonomy, accountability, and outcomes
Section: Educational Papers Categories: Newsletter Keywords: Array, Array, Array, Array, Array, Array, Array Italian emergency nursing has not evolved in step with rising Emergency Department (ED) demand and increasing clinical complexity, contributing to overcrowding, delays, burnout, and inappropriate ED use. This paper synthesizes European models and evidence to outline a modernization agenda centred on professional autonomy, accountability, and outcomes. We propose implementing Advanced Nurse Practitioners to manage low- to moderate-acuity presentations through urgent care pathways, supported by master’s education and a clear scope of practice with audit. For prehospital care, we recommend an advanced practice profile for out-of-hospital emergency nurses enabling assessment, protocolised treatments, non-conveyance decisions, and activation of general practitioner and community services when chronic-care pathways are appropriate. System levers include adoption of a validated national triage system with training and recertification, reconfiguration of night-time demand via alternative community access and telehealth, and investment in nurse-led research networks and university pathways. Finally, competencies and responsibilities should be linked to contractual recognition, remuneration, and sustainable rostering. These actions aim to reduce inappropriate ED attendance, shorten call-to-treatment times, improve patient safety, and strengthen workforce retention, aligning Italy with European standards in emergency care.
Acute ischaemic colitis after initiation of tirzepatide in an elderly patient with type 2 diabetes
Section: Case Reports Categories: Newsletter Keywords: Array, Array, Array, Array Tirzepatide, a dual GLP-1/GIP receptor agonist, is increasingly used for the treatment of type 2 diabetes and obesity. While gastrointestinal side effects such as nausea and diarrhoea are common, reports of ischemic colitis potentially associated with tirzepatide are extremely rare. Understanding potential mechanisms is critical for early recognition and management. We report the case of a 77-yearold woman with type 2 diabetes, severe obesity, and cardiovascular comorbidities, who developed acute onset abdominal pain and rectal bleeding two days after her second dose of tirzepatide. On admission, laboratory evaluation showed leucocytosis and elevated Creactive protein. Abdominal CT demonstrated segmental left-sided colitis with diverticulosis. Rectosigmoidoscopy revealed hyperaemic, oedematous, friable mucosa with superficial ulcerations in the sigmoid colon. Histology was consistent with erosive colitis with features suggestive of ischemic injury. Infectious workup was negative. The patient was promptly started on intravenous metronidazole, fluid resuscitation, and pantoprazole. Clinical symptoms resolved over the subsequent days, and laboratory markers improved. This case highlights a potential association between tirzepatide therapy and ischemic colitis. Mechanisms may include delayed gastrointestinal motility, increased intraluminal pressure, relative hypovolemia, and possible neuroenteric microvascular modulation. Clinicians should be aware of this rare but serious complication, particularly in patients with cardiovascular comorbidities.
L-lactate in acute mesenteric ischemia: toward integrated diagnostic and therapeutic stratification
Section: Letters to the Editor Categories: Newsletter Keywords: Array, Array, Array Dear Editor, We read with great interest the article entitled “L-lactate in acute mesenteric ischemia: a reliable biomarker for diagnosis and prognosis?”.1 The authors provide valuable insight into the prognostic role of preoperative L-lactate levels in patients with Acute Mesenteric Ischemia (AMI), a condition associated with substantial diagnostic challenges and high mortality. Identifying reliable biomarkers for early risk stratification is of undeniable clinical importance. Nevertheless, we believe that several additional aspects could further enhance the clinical impact and scientific depth of this important study. [...]
Section: Images in Emergency Categories: Newsletter Keywords: Array, Array, Array, Array A 77-year-old man presented to the emergency department with sudden right periorbital swelling following nose blowing. His medical history was unremarkable. On clinical examination, his vital signs were normal, the right eyelid was closed due to swelling and there was crepitus of the upper and lower eyelids. The patient underwent a Computed Tomography (CT) scan of the maxillofacial region.
Motivation and resilience in emergency medicine: from burnout to work–life balance
Section: Educational Papers Categories: Newsletter Keywords: Array, Array, Array, Array, Array, Array A multidisciplinary narrative analysis of the scientific literature was conducted to examine the factors influencing motivation among active emergency physicians and medical students considering a career in emergency medicine. Drawing from psychology, sociology, neuroscience, medical education, and healthcare organization, this analysis synthesizes findings across disciplines to identify intrinsic and extrinsic determinants of motivation. Scientific literature consistently highlights that intrinsic drivers (such as vocation, competence, and professional fulfilment) and structured training enhance motivation, whereas overcrowding, chaotic work conditions, and limited support systems reduce it. The paper organizes these findings into clear thematic categories and outlines recurrent patterns emerging across studies. Understanding these motivational mechanisms is essential for improving workforce sustainability, professional well-being and quality of emergency care.
Section: Images in Emergency Categories: Newsletter Keywords: Array, Array, Array, Array, Array An 85-year-old female patient with a medical history significant for hypertension, chronic kidney disease, renal artery stenosis, Sjogren syndrome, and hypothyroidism presented to the emergency department with sudden severe dyspnea. Physical examination revealed a blood pressure of 130/80 mmHg and a heart rate of 120 bpm. The electrocardiogram showed sinus tachycardia. Pointof- care Ultrasound (US) documented a moderate bilateral pleural effusion, normal cardiac function, and a collapsible inferior vena cava. Compression US excluded lower extremity deep vein thrombosis. An arterial blood gas showed lactic acidosis (pH 7.31, lactates 36 mg/dL – normal value < 15) and a severe respiratory failure (PaO2/FiO2 ratio of 167). Enhanced Computed Tomography (CT) of the thorax was performed.
A pulmonary arteriovenous shunt hypoxemia and recurrent bleeding in the emergency department: a case report
Section: Case Reports Categories: Newsletter Keywords: Array, Array, Array We report the case of a 62-year-old male with a long-standing history of Hereditary Hemorrhagic Telangiectasia (HHT, Rendu-Osler- Weber syndrome) complicated by multiple Pulmonary Arteriovenous Malformations (PAVMs), chronic anemia from recurrent gastrointestinal bleeding, and permanent atrial fibrillation. He presented to the Emergency Department (ED) with acute dyspnea and atrial fibrillation with rapid ventricular response. Despite high-flow oxygen therapy, severe hypoxemia persisted due to right-to-left shunt physiology. A prompt blood transfusion increased the oxygen delivery, contributing to transient clinical stabilization; however, the PaO2/FiO2 ratio remained severely reduced, confirming persistent impairment of oxygenation. After multidisciplinary evaluation, he underwent a successful embolization of one PAVMs, with overall clinical improvement. Because of high bleeding risk, long-term oral anticoagulation was avoided and left atrial appendage closure was proposed but declined by the patient. This case highlights the complexity of managing shunt hypoxia and anticoagulation in HHT patients with PAVMs presenting with acute dyspnea to the ED.
Comments on Methanol poisoning during COVID-19 pandemic: a multicenter study of northern Iran
Section: Letters to the Editor Categories: Newsletter Keywords: Array, Array, Array, Array, Array Dear Editor, We read with great interest the article by Divsalar et al. on methanol poisoning during the COVID-19 pandemic in northern Iran.1 The topic is clinically important, as misinformation and restricted access to regulated alcohol during public health crises have repeatedly precipitated large methanol outbreaks.2-5 The authors provide valuable multicenter data; however, several methodological and interpretative aspects merit further consideration. [...]
The impact of online training of patients with repeated clinical calls on the number of repeated ambulance service requests in the pre-hospital Emergency in Iran
Section: Original Articles Categories: Newsletter Keywords: Array, Array, Array, Array Frequent ambulance service requests are one of the common problems in medical emergency centers. This study aimed to determine the impact of online training of patients with repeated clinical calls on the number of ambulance service requests in the pre-hospital emergency and incident management center (Emergency Medicine Services, EMS) in Iran. This semi-experimental study was conducted on 63 patients who repeatedly contacted the EMS. Patients were divided into five groups based on their needs and the type of disease. Then, each group separately received online training for one month. Data were collected using a checklist and analyzed using SPSS 18 software. P-values less than 0.05 were considered significant. According to the results, the number of people with frequent calls decreased from 63 patients before the study to 40 people, but this difference was not statistically significant. However, the number of repeated ambulance requests decreased significantly from 173 calls to 101 calls (p<0.05). According to the results, the use of patient education in the EMS reduces repeated ambulance requests.
Potential and limitations of large language models in acute chest pain triage. Response to Evaluating the predictive accuracy of ChatGPT in risk stratification for chest pain in the emergency department
Section: Letters to the Editor Categories: Newsletter Keywords: Array, Array, Array, Array, Array Dear Editor-in-Chief, We were especially interested to find out about this recently published article by Malalan et al., which discussed the evaluation of ChatGPT 4.0 as a clinical decision-support tool for predicting Major Adverse Cardiac Events (MACE) in patients presenting with chest pain to the Emergency Department (ED).<!-- [if supportFields]> ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"aWRt25DG","properties":{"formattedCitation":"\\super 1\\nosupersub{}","plainCitation":"1","noteIndex":0},"citationItems":[{"id":209,"uris":["http://zotero.org/users/local/OhmpEGKW/items/ACJKH5BV"],"itemData":{"id":209,"type":"article-journal","abstract":"Chest pain is a frequent cause of emergency department (ED) visits, yet accurately assessing the risk of major adverse cardiac events (MACE) remains challenging. This study evaluated the potential of ChatGPT 4.0 as a clinical decision-support tool for predicting MACE in patients with chest pain. We conducted a prospective observational study at the Rovereto Hospital ED from March to August 2024, analyzing 178 patients. ChatGPT received patient data in three sequential phases: initial clinical history and ECG, first troponin test, and second troponin test. Its predictive performance improved with additional data, with the area under the receiver operating characteristic curve (AUROC) increasing from 0.699 in the first phase to 0.776 after the second troponin test (p=0.039). However, ChatGPT misclassified several MACE cases as non-urgent, raising concerns about sensitivity and risk stratification. While ChatGPT demonstrated potential in identifying MACE cases, its current performance does not support routine ED implementation. Further refinements in AI-based models are needed to improve real-time risk assessment and ensure safer, more reliable clinical integration.","container-title":"Emergency Care Journal","DOI":"10.4081/ecj.2025.13829","ISSN":"2282-2054","issue":"3","journalAbbreviation":"Emerg Care J","license":"http://creativecommons.org/licenses/by-nc/4.0","source":"DOI.org (Crossref)","title":"Evaluating the predictive accuracy of ChatGPT in risk stratification for chest pain in the emergency department","URL":"https://www.pagepressjournals.org/ecj/article/view/13829","volume":"21","author":[{"family":"Malalan","given":"Fabio"},{"family":"Zaboli","given":"Arian"},{"family":"Fiore","given":"Armando"},{"family":"Fanton","given":"Nicola"},{"family":"Sponga","given":"Laura"},{"family":"Zaia","given":"Barbara"},{"family":"Mantelli","given":"Giovanni"},{"family":"Barberi","given":"Caterina"},{"family":"Pisani","given":"Paola"},{"family":"Giorio","given":"Laura"},{"family":"Turcato","given":"Gianni"}],"accessed":{"date-parts":[["2026",3,8]]},"issued":{"date-parts":[["2025",6,6]]}}}],"schema":"https://github.com/citation-style-language/schema/raw/master/csl-citation.json"} <![endif]-->1<!-- [if supportFields]><![endif]--> This novel study examines an innovative application of Large Language Models (LLMs) in a critical and time-sensitive clinical setting. With 178 patients, the authors conducted and have succeeded in a prospective observational study, where it evaluated ChatGPT’s score at three successive stages of patient evaluation — initial clinical history and ECG, first troponin test, and second troponin test. The results showed an encouraging pattern with ChatGPT’s predictive accuracy (Area Under the ROC curve) improving steadily from 0.699 to 0.776 (p=0.039) with the addition of clinical data. The model also showed some high negative predictive value, encouraging the possibility of targeting low-risk patients who could avoid avoidable hospitalisation. [...]
The prognostic role of procalcitonin in predicting mortality after early cholecystectomy in patients with acute calculous cholecystitis
Section: Original Articles Keywords: Array, Array, Array, Array, Array Recent studies have shown that Procalcitonin (PCT) can predict severity, difficult laparoscopic cholecystectomy, open conversion, and post-operative morbidity after Early Cholecystectomy (EC) in patients with Acute Calculous Cholecystitis (ACC). However, these studies are limited by their small sample sizes and lack of statistical power. The present study is a post-hoc analysis of a large prospective study (the S.P.Ri.M.A.C.C. study) to evaluate the value of PCT, as a predictor for mortality after EC. The S.P.Ri.M.A.C.C. study is an observational multicentre prospective study endorsed by the World Society of Emergency Surgery (WSES). 1253 patients from 79 locations in 19 countries were enrolled between September 1, 2021, and September 1, 2022. In this post-hoc analyses, patients with incomplete information regarding PCT value were excluded. The Receiving Operating Characteristic (ROC) curve and Area Under the Curve (AUC) were used to study the diagnostic ability of PCT. Exact logistic regression model was used to define the Odds Ratio (OR). 612 patients were included in this post-hoc analysis. The AUC of the PCT value as a continuous variable in predicting 30-day mortality was 0.926 (95% CI 0.874-0.978). The best cut-off in predicting 30-day mortality was 4 ng/mL with a sensitivity of 90.9% (95% CI 58.7%-99.8%) and a specificity of 88% (95% CI 85.1%-90.5%). The negative predicting value for mortality was 99.8% (95%CI 98.9%-100%), while the positive predicting value was 12.2% (95%CI 6.01%- 21.3%). Patients with a PCT≥4 ng/mL had 72.19 (95%CI 10.01-3175.90) times higher odds to die after EC than patients with a PCT<4 ng/ml. The present study demonstrated the prognostic value of pre-operative PCT in predicting 30-day mortality after EC in patients with ACC.
Ventricular fibrillation following accidental ingestion of aluminum cleaner containing hydrogen fluoride and sulfuric acid
Section: Case Reports Categories: Newsletter Keywords: Array, Array, Array, Array Subjects: Array, Array, Array, Array, Array Hydrogen Fluoride (HF) and sulfuric acid (H2SO4) are commonly used in household and commercial cleaning products but can pose significant health risks when managed improperly. This case report details the clinical management of a 53-year-old female who accidentally ingested an aluminum wheel cleaner containing HF and H2SO4. Despite initially spitting out the substance, she developed blood-tinged emesis, a brief syncopal episode, hypotension, and electrolyte disturbances. Despite prompt fluid resuscitation and electrolyte repletion, the patient experienced ventricular fibrillation approximately 9 hours after ingestion. Immediate chest compressions, defibrillation, and administration of calcium chloride restored normal rhythm without subsequent symptom recurrence. The case highlights the lethal potential of even minimal HF exposure and underscores the need for aggressive early intervention and close monitoring. In doing so, dispositions and outcomes for such patients may be improved.
From a purple digit to left atrial appendage thrombus: the critical role of point-of-care transesophageal echocardiography in the emergency department: a case report
Section: Case Reports Categories: Newsletter Keywords: Array, Array, Array, Array Digital ischemia may be the initial manifestation of Left Atrial Appendage (LAA) thrombosis, even in the absence of atrial fibrillation. We report the case of a 79-year-old woman presenting to the Emergency Department (ED) with transient right-hand hyposthenia, paresthesia, and cyanosis ("purple digit"). The patient had known mitral stenosis and regurgitation but no history of atrial fibrillation. Although Transthoracic Echocardiography (TTE) identified MS and atrial dilatation, it failed to visualize the embolic source, a focused bedside Transesophageal Echocardiography (TEE) performed by emergency physicians revealed a large thrombus within the LAA. This finding identified the cardioembolic source for both her digital and concomitant Chronic cerebral ischemic events finding in brain computed tomography. Anticoagulation was promptly started after TEE performed leading to clinical improvement. This case underscores that in patients with structural heart disease, early TEE in the ED is essential to detect occult embolic sources missed by TTE and to guide appropriate stroke-prevention therapy.
Comments on Interpersonal skills training for the emergency department – exploring a mentalizing approach
Section: Letters to the Editor Categories: Newsletter Keywords: Array, Array, Array, Array, Array Dear Editor, We read with great interest and appreciation the brief report by Patrick et al.,1 which discusses the implementation of “mentalizing skills” as a training intervention for Emergency Department (ED) staff. We believe this work addresses a highly relevant issue in Emergency Medicine, highlighting relational competencies that are often overlooked in traditional training pathways. These skills are essential for managing the clinically and emotionally intense interactions typical in the ED. This article prompted us to consider how the concept of mentalization can provide a valuable framework for understanding deeper and less visible forms of moral distress in the context of Italian EDs. This understanding goes beyond simply addressing burnout and can be described as “moral erosion”.2,3 [...]
Comparison of low-cost interventions for pain during radial arterial blood gas sampling in the emergency department: a three-arm randomised controlled trial
Section: Original Articles Categories: Newsletter Keywords: Array, Array, Array, Array, Array This study evaluated the efficacy of topical anaesthesia and cryo-analgesia for pain management during radial Arterial Blood Gas (ABG) sampling, compared with standard care. An open-label, randomised controlled trial with blinded statistical analysis in a Thai emergency department (July–September 2024) included 126 adults requiring ABG sampling. Participants were randomised to receive topical anaesthesia (10% lidocaine spray), cryo-analgesia (cold pack), or standard care (2% chlorhexidine) two minutes prior to the procedure. The primary outcome was participant-reported pain, assessed via the Numeric Rating Scale (NRS) during the procedure and 30 seconds post-procedure. ANOVA determined significant differences in pain scores. Statistical significance was set at p<0.05. All 126 participants completed the study (42 participants per group). Mean NRS pain scores did not differ significantly among the groups during the procedure [F(2,123)=0.62, p=0.54] or 30 seconds post-procedure [F(2,123)=0.35, p=0.71] Cryo-analgesia achieved the highest first-attempt success rate (83.3%, p=0.42). No immediate complications occurred within 5 minutes. Neither topical anaesthesia nor cryo-analgesia provided superior pain management compared with standard care during radial ABG sampling. These findings represent an absence of evidence for superiority, rather than evidence of clinical equivalence.
Section: Case Reports Categories: Newsletter Keywords: Array, Array, Array A 59-year-old man presented with asthenia and dyspnoea. Admission ECG showed a type 1 Brugada pattern in leads V1–V2. The patient had no arrhythmic history and normal cardiac imaging. Laboratory tests revealed severe malignant hypercalcemia with renal dysfunction. After correction of calcium levels, the Brugada-like ECG changes completely resolved, and sodium-channel blocker testing was negative. This case illustrates malignant hypercalcemia as a reversible cause of Brugada phenocopy and underscores the importance of excluding metabolic disturbances before diagnosing Brugada syndrome and initiating risk stratification or devicebased therapies.
Diagnostic and prognostic value of CRP/albumin and RDW/albumin ratios in young patients with acute coronary syndrome
Section: Original Articles Categories: Newsletter Keywords: Array, Array, Array, Array, Array Acute Coronary Syndrome (ACS) is a common cause of emergency department admissions and remains an important contributor to morbidity and mortality. Early identification of disease severity and prognosis is particularly important in young patients with ACS. This study aimed to evaluate the diagnostic and prognostic value of the C-reactive protein to Albumin Ratio (CAR) and red cell distribution width to Albumin Ratio (RAR) in young patients with ACS. This retrospective study included 210 patients younger than 50 years of age who were diagnosed with ACS in the emergency department between January 1, 2020, and December 31, 2022. Demographic characteristics, ACS type (unstable angina, NSTEMI, and STEMI), laboratory parameters, hospitalization data, and mortality outcomes were recorded. CAR and RAR values were calculated and analyzed in relation to ACS type and mortality. Of the 210 patients, 30 (14.3%) were female and the mean age was 43.14±5.03 years. CAR (p=0.002) and RAR (p<0.001) values were significantly associated with ACS type and were highest in the STEMI group. Mortality occurred in 7(3.4%) patients, and both CAR and RAR values were significantly higher in patients who died (CAR: 27.35±20.37, p<0.001; RAR: 6.06±3.15, p=0.009). In multivariate analysis, hospitalization duration and RAR were identified as independent predictors associated with ACS classification. ROC analysis demonstrated that both CAR and RAR showed good predictive performance for mortality. CAR and RAR appear to be useful inflammatory biomarkers that may assist in the clinical classification of ACS and in the early identification of mortality risk in young patients presenting with ACS.
Establishing a multidisciplinary pain clinic in Gaza: navigating humanitarian, coordination, and collaborative challenges in an active conflict area
Section: Original Articles Categories: Newsletter Keywords: Array, Array, Array, Array, Array, Array, Array, Array Subjects: Array, Array The prolonged humanitarian crisis in Gaza has overwhelmed hospital capacity, accompanied by the collapse of health infrastructure, severe physical exhaustion and starvation among local healthcare workers, and a total blockade restricting humanitarian access. Coordinating international Emergency Medical Teams (EMTs) in an active conflict zone poses substantial logistical, ethical, and cross-cultural challenges. To document the establishment process, humanitarian coordination challenges, and collaborative strategies of a Multidisciplinary Pain Clinic (MPC) initiated by the BSMI–Universitas Brawijaya EMT in Gaza, and to evaluate its clinical benefits for war-related pain and torture-associated conditions, with a focus on quality of life and functional recovery. A mixed descriptive approach was employed, incorporating systematic participatory observation, documentation of EMT coordination with local healthcare providers, field-based ethical analysis, and structured interprofessional reflection. The MPC integrated international specialists and local medical personnel operating in field tents under extreme resource constraints and persistent security threats. The MPC successfully implemented adaptive multimodal pain management strategies despite severe logistical disruptions caused by the blockade, ethical challenges related to scarce resource allocation, cross-cultural communication barriers, and widespread trauma among local healthcare workers. Clinical benefits included improved chronic pain control, enhanced mobility, and reduced psychological distress among war survivors and victims of detention-related torture. Key enabling strategies included on-site nerve block training to support sustainable local capacity, real-time adaptation of protocols to available resources, and culturally sensitive, trustbased collaboration. This experience demonstrates that effective EMT deployment in conflict settings requires operational flexibility, ethical sensitivity, and strong partnerships with local providers. Multidisciplinary pain clinics play a critical rehabilitative and dignity- restoring role for war victims, contributing meaningfully to quality-of-life improvement amid complex humanitarian crises.