Acute diarrhea is a relevant public health problem and a leading cause of outpatient visits and emergency department (ED) admissions worldwide. This narrative review is intended to provide a guideline-based approach to support the management of acute diarrhea in the ED, a unique setting where physicians must manage a high volume of patients. Due to the limited availability of rapid diagnostic tests, most decisions are made empirically at the time of presentation based on clinical judgment. Hence, it is important to provide clinicians clear and practical decision-making rules to help distinguish among patients who can be safely discharged, those requiring etiological diagnosis or empiric antibiotic therapy, and those who need hospitalization. In most cases, acute diarrhea has a viral etiology, and the habitual use of antibiotics should be discouraged. However, antibiotic therapy may be appropriate for patients with severe disease, symptoms and signs suggestive of invasive bacterial infection, or those at high risk for complications. Azithromycin or a fluoroquinolone are the antibiotics of choice, depending on local susceptibility patterns and the patient’s travel history.
Sepsis-associated acute kidney injury (SA-AKI) is a frequent and severe complication of critical illness and is increasingly recognized as a contributor to remote organ dysfunction, including the brain. Experimental and clinical data suggest that SA-AKI may exacerbate neurological injury through systemic inflammation, blood–brain barrier disruption, impaired cerebral autoregulation, and altered osmotic and metabolic homeostasis, providing a biological basis for a kidney–brain axis in sepsis. Continuous renal replacement therapy (CRRT) is the preferred renal replacement modality in patients with, or at risk of, hemodynamic instability and is central to the management of severe SA-AKI. Beyond its established role in solute and fluid control, CRRT may influence kidney and brain pathophysiology by modulating the inflammatory burden, acid–base balance, and hemodynamics; however, evidence for organ-protective effects remains inconsistent, and optimal prescription strategies remain undefined. This review synthesizes clinical and preclinical evidence examining the impact of CRRT on renal and neurological outcomes in SA-AKI, with a specific focus on treatment timing, intensity, and fluid management. We integrate mechanistic insights to highlight potential pathways linking CRRT prescription to kidney and brain injury, identify critical gaps in current knowledge, particularly regarding neurological and renal outcomes, and propose priorities for future research aimed at optimizing CRRT strategies in sepsis-associated multi-organ dysfunction.
Background: The impact of short-term exposure to desert dust days on upper respiratory tract infections (URTI) remains unclear. This study aimed to investigate the association of desert dust days, particulate matter (PM10, PM2.5) levels, and meteorological parameters (temperature, humidity, and pressure) on emergency department visits due to URTI. Methods: A retrospective study was conducted using data from a tertiary hospital in Gaziantep, Turkey, between 2013 and 2023. Patients diagnosed with URTI based on International Classification of Diseases, Tenth Revision (ICD-10) codes were included. Environmental data were obtained from national meteorology and air quality databases. Dust storm days were identified using Aerosol Optical Depth (AOD) values from Aerosol Robotic Network (AERONET) satellite data. Generalized Additive Models (GAM) with negative binomial distribution were used to assess association between environmental variables and URTI visits, adjusting for temporal lag effects and potential confounders. Results: A total of 690,608 URTI-related emergency visits were recorded, with 2.4% of days identified as dust storm days. PM10 levels and temperature were significantly higher, pressure and humidity lower, on dust storm days. PM10 was associated with a small but statistically significant increase in URTI visits (Incidence Rate Ratio (IRR) = 1.001, p < 0.001), particularly with a 4-day lag (IRR = 1.001, p = 0.029). Increases in temperature and humidity were linked to fewer URTI visits, while increased pressure showed a slight positive association. Dust days themselves had no significant direct association on URTI visits (IRR = 1.006, p = 0.941). Conclusions: While desert dust days alter environmental conditions, they do not directly increase URTI-related emergency visits. However, elevated PM10 levels contribute modestly to increased URTI cases, especially with a time-lag effect. Meteorological conditions, particularly higher temperatures and humidity, appear protective, whereas increased pressure slightly elevates URTI risk. These findings highlight the complex and time-dependent nature of environmental influences on respiratory health.
