Clinical scores and blood biomarkers for early risk assessment of patients presenting to the emergency department – Critical review

The use of an accurate and well-validated triage system in the emergency department is pivotal for early risk stratification of medical patients. For this purpose different clinical scores, such as the Manchester Triage Score, are widely propagated. Prognostic blood biomarkers mirroring physiopathological changes in different organ systems and severity of disease provide additional prognostic information. Also, nursing scores have been developed for early prediction of post-acute care needs. Still, there is no well-validated initial triage score integrating this information on clinical status, biomarker, prognosis and nursing care needs for a more overall assessment of patients. Such an integral score will help to estimate early initial treatment priority, decide site of care and predict post-acute care needs, and thereby optimise management of undifferentiated patients. The aim of this current review is to critically summarise potential and limitations of present clinical risk scores and blood biomarkers that have been used in recent studies in the emergency department setting for early patient assessment. Particularly, we focused on the following biomarkers from different organ systems: proadrenomedullin, C-reactive protein and procalcitonin as markers of infection/vasodilation; high-sensitivity troponin T assay and natriuretic peptides as cardiac dysfunction markers; copeptin and cortisol as markers of stress; plasma neutrophil gelatinase-associated lipocalin, the soluble form of urokinase-type plasminogen activator and urea as markers of kidney dysfunction; thyroid hormones and proEndothelin-1 as a marker of endothelial activation and lactate as a marker of organ dysfunction. Despite the promising role of clinical scores and biomarkers from different pathophysiological concepts, no conclusive clinical trial has yet looked at different biomarkers in a large and comprehensive patient population. In addition, it remains unclear whether the use of scores and biomarkers has the potential to improve clinical outcome of patients as randomised trials are largely lacking

Pitfall Prayer Marks: Recognition and Appropriate Treatment: A Case report and Review of Literature

Prayer marks are asymptomatic callosities resulting from repeated, extended pressure, and friction exerted on bony prominences when praying on hard ground. A 41-year-old woman with ulcerative colitis treated with infliximab was referred to our clinic due to skin changes on her feet that were suspected to be drug eruptions. The patient presented several asymptomatic, hyperpigmented, and hyperkeratotic plaques over the lateral malleoli suggesting that the lesions had a mechanical cause. Further exploration revealed that the patient, a practicing Muslim, prays in a sitting position called "Julus" several times a day. After color marking, the lesions over the lateral feet left a precise imprint on the underlay when the patient was asked to imitate the praying posture-thus proving the origin of the skin lesions. We searched the database on July 31, 2019 using the terms «prayer marks» OR «prayer nodules» OR "prayer callosities." Only electronically available publications were reviewed. Recognition of prayer marks is important to avoid misdiagnosis, performance of unnecessary diagnostic procedures, and to enhance the intercultural competence of clinicians who practice in multicultural societies

Firefly: The Case for a Holistic Understanding of the Global Structure and Dynamics of the Sun and the Heliosphere

This white paper is on the HMCS Firefly mission concept study. Firefly focuses on the global structure and dynamics of the Sun's interior, the generation of solar magnetic fields, the deciphering of the solar cycle, the conditions leading to the explosive activity, and the structure and dynamics of the corona as it drives the heliosphere