Background/Objectives: Digital self-triage tools may support patient-flow management in crowded emergency departments (EDs), but their agreement with established professional triage systems requires prospective validation. We evaluated the agreement and classification performance of a locally developed mobile self-triage application, structured according to Manchester Triage System (MTS)-related urgency logic, compared with professional MTS assessment in adult ED patients. Methods: This prospective, observational, single-center agreement study included 2274 consecutive, hemodynamically stable adult walk-in patients who used a tablet-based application covering 11 predefined presenting complaints and subsequently underwent a single, blinded professional MTS assessment, which served as the prespecified comparator. Of 3244 initial registrations, 970 (29.9%) were excluded because their complaints were not covered by the predefined pathways. MTS Categories 2-3 were classified as urgent. Results: Exact agreement occurred in 968 patients (42.6%); 1161 patients (51.1%) were overtriaged and 145 (6.3%) were undertriaged. The application showed 93.9% sensitivity, 28.7% specificity, 61.1% positive predictive value, and 79.8% negative predictive value for identifying professional MTS-defined urgent cases. Agreement was slight by unweighted kappa (κ = 0.198), fair by quadratically weighted kappa (κw = 0.278), and the prevalence- and bias-adjusted kappa for binary urgent/non-urgent classification was 0.28. Overtriage exceeded 70% for headache and low back pain, and these complaints were the strongest independent predictors of overtriage; higher self-reported pain intensity was strongly associated with overtriage. Conclusions: The application demonstrated a conservative classification profile with high sensitivity and a low undertriage rate but frequent overtriage that would inflate the apparent urgent caseload if the tool were used unsupervised; it should be considered an adjunct to, rather than a replacement for, professional triage. Findings apply to stable adult walk-in patients whose complaints matched the predefined categories and may not generalize to the broader ED population.

We developed a fast-dissolving nanofibrous film based on cyclodextrin (hydroxypropyl-β-cyclodextrin) inclusion complexes (ICs) incorporating a triple drug combination of acetylsalicylic acid (Aspirin), paracetamol, and caffeine (APC). The combination of these three drugs constitutes a multimodal analgesic widely used for the treatment of acute pain conditions, such as headache and migraine. Herein, the electrospun HPβCD/APC-IC nanofibrous film was fabricated with a total drug loading of ∼10 % (w/w), comprising ∼4.4/4.4/1.2 % (w/w) of each component (A/P/C), thereby matching the drug ratio found in the commercial analgesic formulation, Excedrin. 2D NMR (ROESY) analysis confirmed the IC formation between HPβCD and both acetylsalicylic acid and paracetamol. The powder form of HPβCD/APC-IC was also prepared as a control sample. XRD and DSC analyses revealed the amorphization of all three drug components within both the HPβCD/APC-IC nanofiber and powder forms. The HPβCD/APC-IC nanofibrous films exhibited significantly enhanced dissolution and disintegration performance in aqueous medium, along with improved drug release profiles, compared to their powder counterparts. HPβCD/APC-IC nanofibers demonstrate strong potential as a fast-dissolving drug delivery system, offering a promising alternative to conventional tablet dosage forms of this triple-drug combination.

Elecoglipron (AZD5004) is an oral small-molecule glucagon-like peptide-1 (GLP-1) receptor agonist administered once daily without food or fluid restriction, in development for weight management in people living with obesity or overweight and type 2 diabetes. We assessed the efficacy, safety, and tolerability of elecoglipron versus placebo in participants with obesity or overweight and at least one weight-related condition without diabetes.

Myelin oligodendrocyte glycoprotein (MOG) antibody-associated disorder (MOGAD) is a central nervous system demyelinating disease in children, frequently induced by infection. We report the case of a 9-year-10-month-old boy with a 13-day fever and headache. He was admitted to our hospital for fever of unknown origin. He was diagnosed with bronchopneumonia via chest X-ray and encephalitis via cranial magnetic resonance imaging (MRI) and laboratory tests, which revealed increased white blood cells (WBC) (67 × 106/L) and a high proportion of segmented granulocytes (31%) in cerebrospinal fluid (CSF). Further examination showed positive serum MOG-immunoglobulin G (IgG). After treatment with high-dose methylprednisolone (20 mg/kg/day, 3 days) and gamma globulin (400 mg/kg/day, 5 days), the patient's temperature returned to normal with decreased CSF WBC count (11 × 106/L) and segmented granulocytes (5%). No abnormal bacterial growth was found in CSF. Oral methylprednisolone (32 mg/day), calcitriol soft capsules (1 capsule/day), and calcium carbonate D3 tablets (1 tablet/day) were prescribed after discharge, with a follow-up examination 1 week later. We present a rare case of a child with fever of unknown origin, diagnosed with MOG-IgG-associated encephalitis, bronchopneumonia, and MOG-IgG seropositivity despite negative infection screening. This report offers new insights into atypical MOGAD and a reference for MOGAD diagnosis and treatment in children. It highlights the importance of conducting MOG-IgG tests in children with encephalitis and bronchopneumonia despite negative infection screening.

Migraines represent one of the most prevalent and debilitating neurological disorders. In terms of quality-of-life impairment and the degree of disability incurred, severe migraine attacks align with the World Health Organization (WHO) level 7 disability, comparable to conditions such as tetraparesis, psychosis, and dementia. The severity of migraine attacks is influenced not only by the intensity of the headache but also by the severity of accompanying non-pain symptoms, which include nausea, vomiting, photophobia, phonophobia, dizziness, and cognitive impairment, as well as the frequency of recurrence. The presence of nausea or vomiting during a migraine attack is indicative of migraine-associated gastroparesis, which adversely affects the bioavailability and efficacy of oral medications. Consequently, these factors contribute to the limited effectiveness of standard tablet formulations in aborting migraine attacks. This article explores contemporary approaches to treating migraine attacks and new criteria for assessing therapeutic efficacy. Particular emphasis is placed on the effectiveness of orally disintegrating tablets (ODT) of rizatriptan compared with sumatriptan and zolmitriptan. Optimal management of a migraine attack necessitates an individualized approach that considers the severity of the condition, the spectrum of clinical manifestations, and the selection of an appropriate pharmaceutical formulation. Strong evidence supports the assertion that rizatriptan 10 mg ODT (Kaporiza) is one of the most rapid, effective, and convenient options for the abortive treatment of migraine attacks in the majority of patients.

Systemic lupus erythematosus (SLE) is a chronic, inflammatory, autoimmune disorder involving multiple systems. A 18-year-old female patient presented with complaints of headache, weakness, and tingling sensation in the left upper limb and lower limb. On magnetic resonance imaging (MRI), acute nonhemorrhagic infarct in right thalamo-capsular region was seen. The patient gave a history of malar rash and intermittent joint pains for which she had taken nonspecific treatment. Antineutrophilic antibody (ANA) by innumoflourescence and ANA blot was suggestive of SLE. Hence, the patient had central nervous system vasculitis and stroke due to SLE. The patient was started on antiplatelet therapy, tablet prednisolone 40 mg once daily, and tablet warfarin 5 mg once daily. The patient was readmitted after 2 weeks with menorrhagia and deranged INR. Tablet Warfarin was with-held, fresh frozen plasma transfusions were given. Repeat MRI did not show any new changes. Patient was given tablet nicoumalone and three doses of injection cyclophosphamide 800 mg. Hemiplegia has improved by 90%, her menstrual cycles are now regular.