Arrowhead Regional Medical Center (ARMC) is a teaching hospital located in Colton, California, within Southern California's Inland Empire. ARMC is owned and operated by the County of San Bernardino. The emergency department (ED) at ARMC is the second busiest ED in the state of California. The hospital operates ten different residency training programs.In the most recent year with available data, the hospital had 24,441 admissions, performed 6,483 inpatient and 5,367 outpatient surgeries, and 254,000 outpatient visits. Arrowhead Regional Medical Center is accredited by the American Osteopathic Association's Healthcare Facilities Accreditation Program, the Centers for Medicare and Medicaid Services, and is certified by the American College of Surgeons as a Level II trauma center.
BACKGROUND:Melatonin, an anti-inflammatory-antioxidant neurohormone, is considered for the treatment of neonatal hypoxic-ischemic-encephalopathy. However, its effects on the developing cardiopulmonary system are poorly defined. We investigated how postnatal melatonin administration alters cardiopulmonary structure, function, and responses to acute hypoxia in newborn lambs. METHODS:Twenty term-newborn lambs received melatonin (0.25 mg kg-1, n = 9) or vehicle (n = 11) daily from birth to day 5. Echocardiography was performed in 15 lambs (7 melatonin; 8 vehicle; day 5). On day-6, five lambs per group underwent 30-min of hypoxia followed by euthanasia. Cardiovascular physiology, morphology, cardiomyocyte size, gene expression, and lung morphology were analyzed. RESULTS:At normoxia, melatonin-treated lambs showed normal systemic function but altered cardiac hemodynamics and morphology compared to vehicle-treated lambs. During hypoxia, melatonin-treated lambs exhibited a blunted sympatho-circulatory response, with no increase in mean pulmonary arterial pressure and cardiac output. Additionally, heart weight and cardiomyocyte cross-sectional area were reduced, and pulmonary arteriole density increased. Gene expressions showed reduced cardiomyocyte markers in the right ventricle and left atrium but increased protective gene expression in the left ventricle. CONCLUSIONS:Postnatal melatonin triggers notable cardiopulmonary remodeling, reducing physiological flexibility to respond to hypoxic stress, highlighting the need to weigh its therapeutic benefits against potential cardiovascular risks. IMPACT:This study examined the effects of melatonin treatment on the cardiopulmonary system during the early neonatal period in lambs, when endogenous melatonin production is limited. Melatonin induces significant cardiopulmonary remodeling in newborn lambs, characterized by reduced heart weight and ventricular cardiomyocyte size, increased pulmonary arteriole density, and altered cardiac chamber gene expression. While these changes maintain normal cardiovascular function at normoxic-baseline, they compromise the system's ability to respond to acute hypoxia, revealing a diminished physiological flexibility. The study highlights the need to balance melatonin's therapeutic promise with caution regarding its potential developmental consequences on the cardiopulmonary system.
BACKGROUND Nitrous oxide (N₂O) deactivates vitamin B12 and, when inhaled regularly, can lead to vitamin B12 deficiency, resulting in temporary or permanent peripheral neuropathy. This case report describes a young adult with N₂O-induced B12 deficiency, whose neurological symptoms were initially misattributed to a distracting traumatic injury from a motor vehicle collision (MVC). CASE REPORT We present a case of a previously healthy 24-year-old man who presented with low back pain and bilateral leg paresthesia that began 2 days after being a passenger in an MVC. There was no head trauma, loss of consciousness, or bowel or bladder dysfunction. Examination revealed an apraxic gait with a positive Romberg sign, while motor strength and sensation remained intact. Laboratory tests showed severely low vitamin B12 level. Diagnostic challenges included misattributing the symptoms to trauma from the MVC. MRI of the lumbar spine and CT scans of the head and spine were unremarkable. Follow-up questioning revealed recreational N₂O inhalation, which was sporadic over the preceding year and most recently occurred on the same night following the MVC. Intramuscular B12 provided rapid improvement in gait and paresthesias, thereby also offering support for a diagnosis of vitamin B12 deficiency secondary to N2O use rather than the initially presumed traumatic etiology. The patient was discharged within 24 hours without requiring admission. CONCLUSIONS This case underscores the importance of considering N₂O use in patients with unexplained neurological deficits, along with obtaining directed social history and serum B12 levels when this differential diagnosis is plausible. Early recognition, supplementation, and counseling can prevent lasting deficits.
Background:Hospital-onset urinary tract infections (HOUTIs), including catheter-associated (CAUTI) and non-catheter-associated UTI (non-CAUTI), remain a significant source of morbidity and healthcare burden. While CAUTI prevention strategies are well established, non-CAUTIs lack standardized definitions, surveillance protocols, and targeted interventions. To address this gap, consensus recommendations identifying prevention strategies for HOUTIs in adult patients were developed. Methods:A panel of 17 experts in infectious diseases, infection prevention and control, healthcare epidemiology and quality improvement, clinical microbiology, urology, urogynecology, and nursing, participated in a modified Delphi process. An online anonymized survey based on a systematic literature review was completed, before meeting to determine consensus on HOUTI prevention strategies. A further anonymous online survey was shared to finalize recommendations. Thresholds of ≥15/17 panel members in agreement (≥88%) for strong consensus and ≥13/17 (≥76%) for moderate consensus were prospectively set for all statements. Results:Strong consensus was reached on 37 statements spanning surveillance, intervention selection, strategies and maintenance, related care interventions, specimens and cultures, provider training, and outcome assessment. Key topics-particularly those focused on non-CAUTI HOUTI prevention-were identified as important priorities requiring further exploration and research. Conclusions:These recommendations offer the foundation for a structured, scalable framework to reduce the burden of all HOUTIs, while also defining future research priorities. By harmonizing established CAUTI best practices with existing literature, and bridging current evidence gaps for non-CAUTI prevention and management with expert consensus, these recommendations provide a road map for improved prevention strategies for all HOUTIs.
Abstract Atypical parathyroid tumors are variants of parathyroid adenomas that may present with features of parathyroid carcinoma due to their size, biochemical profile, and atypical features that are typically associated with carcinomas. We report a case of a 75-year-old female presenting with chest pain, hypercalcemia, and severely elevated parathyroid hormone level. Intraoperatively, a 40-g gland was found displacing adjacent structures, raising concern for malignancy. The parathyroid lesion was determined to be an atypical parathyroid tumor. This case highlights the diagnostic challenge in distinguishing atypical parathyroid tumors and highlights the importance of advanced imaging in surgical planning and management of atypical presentations of primary hyperparathyroidism.
