Ethylene Glycol Poisoning: A Case Study of a 71-Year-Old Male with a History of Alcohol Abuse and Suicide Attempts.

A 71-year-old male with a history of alcohol abuse and multiple suicide attempts was brought to the emergency department in an unconscious state. Initial assessment revealed profound obtundation and malnutrition. Laboratory findings demonstrated a significant anion gap metabolic acidosis with a high osmolar gap, suggestive of possible toxic alcohol ingestion. Despite negative serum alcohol levels, ethylene glycol poisoning was confirmed with a level of 226. Treatment included fluid resuscitation, bicarbonate therapy, and fomepizole administration. However, due to progressive multi-organ failure, continuous veno-venous hemodialysis was initiated. Despite interventions, the patient deteriorated rapidly, leading to a decision for hospice care, ultimately resulting in death. Ethylene glycol poisoning presents significant challenges in management, with potential complications including renal failure and multi-organ dysfunction. Fomepizole remains the cornerstone of treatment, but additional therapies such as ethanol administration were considered but ultimately deemed unnecessary due to associated risks. This case highlights the complexity and severity of ethylene glycol poisoning, emphasizing the need for early recognition and aggressive management strategies.

Cardiac Catheterization and Outcomes for Elderly Patients Hospitalized With Heart Failure.

Background: Heart failure affects over 6 million people in the United States (US) with limited evidence to support the use of cardiac catheterization. The benefit of its use remains mostly as expert opinion. This study intends to assess the benefits and risks of cardiac catheterization in elderly patients admitted for heart failure. Methods: This was a retrospective study using data from the National Inpatient Sample, including admissions 65 years and older hospitalized for heart failure, between 2008 and 2016. The outcomes analyzed were in-hospital mortality, total hospital costs, and length of stay. Results: After controlling for covariates, cardiac catheterization was found to have a protective association with mortality (OR 0.87, 95% CI 0.833-0.912, P < .0001), an increased hospital length of stay by 2.88 days (95% CI: 2.84-2.92 days, P < .0001) and approximately $16 255 increase in cost. Conclusions: Cardiac catheterization was associated with decreased in-hospital mortality, longer length of stay and higher total costs in admissions with heart failure aged 65 years or older.

The Synthesis, Structure, and Luminescent Properties of TmMgB5O10 Crystals.

TmMgB5O10 spontaneous crystals were synthesized via the flux-growth technique from a K2Mo3O10-based solvent. The crystal structure of the compound was solved and refined within the space group P21/n. The first principles calculations of the electronic structure reveal that TmMg-pentaborate with an ideal not defected crystal structure is an insulator with an indirect energy band gap of approximately 6.37 eV. Differential scanning calorimetry measurements and powder X-ray diffraction studies of heat-treated solids show that TmMgB5O10 is an incongruent melting compound. A characteristic band of the Tm3+ cation corresponding to the 3H6 → 1D2 transition is observed in the photoluminescence excitation spectra of TmMg-borate. The as-obtained crystals exhibit intense blue emission with the emission peaks centered at 455, 479, 667, and 753 nm. The most intensive band corresponds to the 1D2 → 3F4 transition. TmMgB5O10 solids demonstrate the thermal stability of photoluminescence.

New Series of Red-Light Phosphor Ca9-xZnxGd0.9(PO4)7:0.1Eu3+ (x = 0-1).

In this study, a new series of phosphors, Ca9−xZnxGd0.9(PO4)7:0.1Eu3+ (x = 0.00−1.00, step dx 0.05), was synthesized, consisting of centro- and non-centrosymmetric phases with ß-Ca3(PO4)2-type structure. Crystal structures with space groups R3c (0.00 ≤ x < 0.35) and R3¯c (x > 0.8) were determined using X-ray powder diffraction and the method of optical second harmonic generation. In the region 0.35 ≤ x ≤ 0.75, phases R3c and R3¯c were present simultaneously. Refinement of the Ca8ZnGd(PO4)7 crystal structure with the Rietveld method showed that 71% of Gd3+ ions are in M3 sites and 29% are in M1 sites. A luminescent spectroscopy study of Ca9−xZnxGd0.9(PO4)7:0.1Eu3+ indicated the energy transfer from the crystalline host to the Gd3+ and Eu3+ luminescent centers. The maximum Eu3+ luminescence intensity corresponds to the composition with x = 1.

Co-Doping Effect of Mn2+ and Eu3+ on Luminescence in Strontiowhitlockite Phosphors.

A new series of Sr-based phosphates, Sr9-xMnxEu(PO4)7, were synthesized using the high-temperature solid-state method in air. It was found that these compounds have the same structure as strontiowhitlockite, which is a ß-Ca3(PO4)2 (or ß-TCP) structure. The concentration of Mn2+ ions required to form a pure strontiowhitlockite phase was determined. An unusual partial reduction of Eu3+ to Eu2+ in air was observed and confirmed by photoluminescence (PL) and electron spin resonance (ESR) spectra measurements. The PL spectra recorded under 370 nm excitation showed transitions of both 4f5d-4f Eu2+ and 4f-4f Eu3+. The total integral intensity of the PL spectra, monitored at 395 nm, decreased with increasing Mn2+ concentration due to quenching effect of Eu3+ by the Mn2+ levels. The temperature dependence of Eu2+ photoluminescence in a Sr9-xMnxEu(PO4)7 host was investigated. The conditions for the reduction of Eu3+ to Eu2+ in air were discussed.

Bright UV-C Phosphors with Excellent Thermal Stability-Y1-xScxPO4 Solid Solutions.

The structural and luminescence properties of undoped Y1-xScxPO4 solid solutions have been studied. An intense thermally stable emission with fast decay (τ1/e ~ 10-7 s) and a band position varying from 5.21 to 5.94 eV depending on the Sc/Y ratio is detected and ascribed to the 2p O-3d Sc self-trapped excitons. The quantum yield of the UV-C emission, also depending on the Sc/Y ratio, reaches 34% for the solid solution with x = 0.5 at 300 K. It is shown by a combined analysis of theoretical and experimental data that the formation of Sc clusters occurs in the solid solutions studied. The clusters facilitate the creation of energy wells at the conduction band bottom, which enables deep localization of electronic excitations and the creation of luminescence centers characterized by high quantum yield and thermal stability of the UV-C emission.

Disparities in colonoscopy utilization for lower gastrointestinal bleeding in rural vs urban settings in the United States.

BACKGROUND: Lower gastrointestinal bleeds (LGIB) is a very common inpatient condition in the United States. Gastrointestinal bleeds have a variety of presentations, from minor bleeding to severe hemorrhage and shock. Although previous studies investigated the efficacy of colonoscopy in hospitalized patients with LGIB, there is limited research that discusses disparities in colonoscopy utilization in patients with LGIB in urban and rural settings. AIM: To investigate the difference in utilization of colonoscopy in lower gastrointestinal bleeding between patients hospitalized in urban and rural hospitals. METHODS: This is a retrospective cohort study of 157748 patients using National Inpatient Sample data and the Healthcare Cost and Utilization Project provided by the Agency for Healthcare Research and Quality. It includes patients 18 years and older hospitalized with LGIB admitted between 2010 and 2016. This study does not differentiate between acute and chronic LGIB and both are included in this study. The primary outcome measure of this study was the utilization of colonoscopy among patients in rural and urban hospitals admitted for lower gastrointestinal bleeds; the secondary outcome measures were in-hospital mortality, length of stay, and costs involved in those receiving colonoscopy for LGIB. Statistical analyses were all performed using STATA software. Logistic regression was used to analyze the utilization of colonoscopy and mortality, and a generalized linear model was used to analyze the length of stay and cost. RESULTS: Our study found that 37.9% of LGIB patients at rural hospitals compared to approximately 45.1% at urban hospitals received colonoscopy, (OR = 0.730, 95%CI: 0.705-0.7, P > 0.0001). After controlling for covariates, colonoscopies were found to have a protective association with lower in-hospital mortality (OR = 0.498, 95%CI: 0.446-0.557, P < 0.0001), but a longer length of stay by 0.72 d (95%CI: 0.677-0.759 d, P < 0.0001) and approximately $2199 in increased costs. CONCLUSION: Although there was a lower percentage of LGIB patients that received colonoscopies in rural hospitals compared to urban hospitals, patients in both urban and rural hospitals with LGIB undergoing colonoscopy had decreased in-hospital mortality. In both settings, benefit came at a cost of extended stay, and higher total costs.

K5Eu1-xTbx(MoO4)4 Phosphors for Solid-State Lighting Applications: Aperiodic Structures and the Tb3+ → Eu3+ Energy Transfer.

This paper describes the influence of sintering conditions and Eu3+/Tb3+ content on the structure and luminescent properties of K5Eu1-xTbx(MoO4)4 (KETMO). KETMO samples were synthesized under two different heating and cooling conditions. A K5Tb(MoO4)4 (KTMO) colorless transparent single crystal was grown by the Czochralski technique. A continuous range of solid solutions with a trigonal palmierite-type structure (α-phase, space group R3̅m) were presented only for the high-temperature (HT or α-) KETMO (0 ≤ x ≤ 1) prepared at 1123 K followed by quenching to liquid nitrogen temperature. The reversibility of the ß â†” α phase transition for KTMO was revealed by a differential scanning calorimetry (DSC) study. The low-temperature (LT)LT-K5Eu0.6Tb0.4(MoO4)4 structure was refined in the C2/m space group. Additional extra reflections besides the reflections of the basic palmierite-type R-subcell were present in synchrotron X-ray diffraction (XRD) patterns of LT-KTMO. LT-KTMO was refined as an incommensurately modulated structure with (3 + 1)D superspace group C2/m(0ß0)00 and the modulation vector q = 0.684b*. The luminescent properties of KETMO prepared at different conditions were studied and related to their structures. The luminescence spectra of KTMO samples were represented by a group of narrow lines ascribed to 5D4 → 7FJ (J = 3-6) Tb3+ transitions with the most intense emission line at 547 nm. The KTMO single crystal demonstrated the highest luminescence intensity, which was ∼20 times higher than that of LT-KTMO. The quantum yield λex = 481 nm for the KTMO single crystal was measured as 50%. The intensity of the 5D4 → 7F5 Tb3+ transition increased with the increase of x from 0.2 to 1 for LT and HT-KETMO. Emission spectra of KETMO samples with x = 0.2-0.9 at λex = 377 nm exhibited an intense red emission at ∼615 nm due to the 5D0 → 7F2 Eu3+ transition, thus indicating an efficient energy transfer from Tb3+ to Eu3+.

The role of anionic heterovalent [PO4]3- → [GeO4]4- substitution on the luminescence properties of inorganic phosphors with the ß-Ca3(PO4)2-type structure: new data based on accurate crystal structure refinement.

A series of solid-solution phosphate germanates Ca8+0.5xZnEu(PO4)7-x(GeO4)x (x = 0, 0.2, 0, 4, 0.6, 0.8, 1) with the ß-Ca3(PO4)2-type structure were synthesized by solid-state reactions. The limit of existence of a single-phase solid solution was determined by X-ray diffraction patterns and it was found at x = 0.8. The heterovalent tetrahedral [PO4]3- → [GeO4]4- substitution requires a charge compensation according to the scheme: [PO4]3- + ½ □ → [GeO4]4- + ½ Ca2+. The additional amount of Ca2+ ions in the crystal structure was detected at the M4 site during Rietveld refinement. It was shown that in ß-Ca3(PO4)2-type compounds, charge balancing is not provided by the randomly distributed oxygen vacancies but only by the partial occupancy of the M4 site. The presence of Ca2+ at the M4 site leads to a polar structure with the space group R3c which was confirmed by an SHG test for all single-phase samples. It was shown that the Ge4+ ions preferably occupy the T3 site in the structure, which is connected through common oxygen with the cationic M1-M5 sites. The analysis of the similarity of the previously reported Ca9La(GeO4)0.75(PO4)6 compound reveals an unexpectedly high value. The same structural similarity evaluation of the studied compound Ca8.1EuZn(PO4)6.8(GeO4)0.2 in the present work with the initial model gives a very small value, which indicates a good match between the initial and under-consideration structures. The luminescence properties of Eu3+ were investigated from the point of view of crystal structures and anionic substitutions. The integral intensity increased linearly with the [PO4]3- → [GeO4]4- substitution. It can be concluded that the anionic substitution on Ge4+ can improve the luminescence characteristics. The present study includes new data on the anionic substitution based on accurate crystal structure refinement.

Salt Consumption and Myocardial Infarction: Is Limited Salt Intake Beneficial?

INTRODUCTION: Sodium is an essential mineral that plays a crucial role in the maintenance of normal cellular homeostasis, regulation of fluid and electrolytes, and blood pressure (BP). Due to the presence of sodium in a variety of regularly consumed food products, the deficiency of sodium is extremely unlikely. On the other hand, excess intake of dietary sodium is observed in many populations as it is generally used in most food products. Existing guidelines recommend lowering salt consumption for better cardiovascular health; these dietary sodium intake recommendations are not reassuring as the evolving studies show evidence that there is a higher risk of cardiovascular disease (CVD) with low sodium consumption. The aim of this study was to identify the association between salt consumption and myocardial infarction (MI). METHODS: The National Health and Nutrition Examination Survey (NHANES) data between 2017- 2018 was analyzed to examine the association between sodium intake (use in daily meal preparation) and reported history of MI. Logistic regression was used to assess for significant differences between the groups and calculated odds ratios while adjusting for confounders. RESULTS: A total of 4626 participants were included in the study, with a mean age of 66 ± 11 years in those with a history of MI (n = 212). Amongst these participants, those with salt consumption "Occasionally used" or "Very often used" were less likely to have suffered from MI than those who "Never used" salt in meal preparation. Multivariable logistic regression was performed to control for confounders. "Occasionally used" compared to "Never used" odds ratio was 0.5227 (95% confidence interval (CI); 0.3053-0.9009 p = 0.0184) and "Very often used" compared to "Never used" odds ratio was 0.5033 (95% CI; 0.2892-0.8799 p = 0.0152). CONCLUSION: After adjusting for confounders, the participants that used salt more liberally during meal preparation were less likely to have MI than those who minimally or never used salt in meal preparation.

Differences in nicotine dependence, smoke exposure and consumer characteristics between smokers of machine-injected roll-your-own cigarettes and factory-made cigarettes.

BACKGROUND: Consumption of machine-injected roll-your-own (RYO) filtered cigarettes made from pipe tobacco increased almost 7-fold from 2008 to 2011 in the United States. METHODS: We used data from the Pennsylvania Adult Smoking Study to compare the differences in sociodemographic, smoking topography, nicotine dependence, and cotinine levels between 280 smokers using factory made (FM) cigarettes and 68 smokers using RYO cigarettes. RESULTS: RYO smokers were older (41 vs. 37, P = 0.053), had significantly lower levels of income (P < 0.001) and education (P = 0.007), and were less likely to be fully employed (P = 0.009). RYO smokers consumed more cigarettes per day [CPD] (21 vs. 15, P < 0.001), and had a higher mean score on the Fagerström Test for Cigarette/Nicotine Dependence (5.2 vs. 4.1, P < 0.001). The main reasons for choosing RYO cigarettes were the lower cost (68%) and believed they are less harmful (12%). The average cost per pack of FM cigarettes was $5.74 vs. $1.13 for RYO. In multiple regression analyses, RYO smokers had significantly lower cotinine levels across all levels of CPD. Among smokers of king-size cigarettes, mean interpuff interval (P < 0.05) and total smoke duration (P < 0.01) per cigarette was significantly greater in RYO smokers. In laboratory measurements, RYO cigarettes contained more tobacco by weight than FM cigarettes, but weight varied by both tobacco and cigarette tube brands. CONCLUSIONS: Machine-injected RYO cigarettes made from pipe tobacco are cheaper than FM cigarettes but may have higher abuse liability. Smokers who might otherwise reduce their cigarette consumption or quit altogether may continue to smoke RYO cigarettes due to their affordability.

Septic Arthritis in the Temporomandibular Joint.

UNLABELLED: Septic arthritis of the temporomandibular joint (TMJ) is a rare event that has only been reported a few dozen times worldwide. This case is remarkable for septic arthritis of the TMJ joint in an otherwise healthy male. CASE REPORT: A 24-year-old male presented to the emergency department with periauricular swelling, erythema, fever, myalgia's and generalized joint pain. He had previously sought medical attention and was placed on ciprofloxacin. However, he developed facial swelling and a rash and had to discontinue the antibiotic. On physical exam the patient had a large swelling and tenderness in his left periauricular area, with erythema and deviation of the right mandible which limited his ability to open the mouth. A computed tomography showed mild asymmetric soft tissue swelling in the left pharyngeal region but did not show joint effusion. Subsequent magnetic resonance imaging did show effusion of the joint space. The effusion was drained, and the synovial fluid was submitted for gram stain, culture, and sensitivity. The cultures grew menthicillin sensitive Staphyloccocus Aureus. The patient was discharged to complete a two week course of intravenous (IV) Ceftriaxone and IV Vancomycin via home infusion. CONCLUSION: Septic Arthritis of the TMJ is a rare event with very specific clinical symptoms. Due to the low sensitivity of the computed tomography scan, magnetic resonance imaging should be considered when computed tomography scan is negative for TMJ effusion.

A widened pulse pressure: a potential valuable prognostic indicator of mortality in patients with sepsis.

BACKGROUND: Sepsis is one of the leading causes of death in the United States and the most common cause of death among critically ill patients in non-coronary intensive care units. Previous studies have showed pulse pressure (PP) to be a predictor of fluid responsiveness in patients with sepsis. Additionally, previous studies have correlated PP to cardiovascular risk factors and increase in mortality in end-stage renal disease patients. OBJECTIVES: To determine the correlation between PP and mortality in patients with sepsis. METHODS: A retrospective review was conducted on 5,003 patients admitted with the diagnosis of sepsis using ICD-9 codes during the time period from January 2010 to December 2014 at two community-based hospitals in central Pennsylvania. RESULTS: Our study findings showed significant decrease in the mortality when the PP was greater than 70 mmHg of patients with sepsis (p-value: 0.0003, odds ratio: 0.67, 95% confidence limit: 0.54-0.83). CONCLUSION: Based on our findings, we suggest that PP could be a valuable clinical tool in the early assessment of patients admitted with sepsis and could be used as a prognostic factor to assess and implement management therapy for the patients with sepsis.

Scrotal Swelling as a Complication of Hydrochlorothiazide Induced Acute Pancreatitis.

Background. Scrotal swelling is a rare complication of acute pancreatitis with few reported cases in the literature. In this case report, we present a 59-year-old male with hydrochlorothiazide induced pancreatitis who developed scrotal swelling. Case Presentation. A 59-year-old male presented to the emergency department with sharp epigastric abdominal pain that radiated to the back and chest. On physical examination, he had abdominal tenderness and distention with hypoactive bowel sounds. Computed tomography (CT) scan of the abdomen showed acute pancreatitis. The patient's condition deteriorated and he was admitted to the intensive care unit (ICU). After he improved and was transferred out of the ICU, the patient developed swelling of the scrotum and penis. Ultrasound (US) of the scrotum showed large hydrocele bilaterally with no varicoceles or testicular masses. Good blood flow was observed for both testicles. The swelling diminished over the next eight days with the addition of Lasix and the patient was discharged home in stable condition. Conclusion. Scrotal swelling is a rare complication of acute pancreatitis. It usually resolves spontaneously with conservative medical management such as diuretics and elevation of the legs.

A prediction model for Clostridium difficile recurrence.

BACKGROUND: Clostridium difficile infection (CDI) is a growing problem in the community and hospital setting. Its incidence has been on the rise over the past two decades, and it is quickly becoming a major concern for the health care system. High rate of recurrence is one of the major hurdles in the successful treatment of C. difficile infection. There have been few studies that have looked at patterns of recurrence. The studies currently available have shown a number of risk factors associated with C. difficile recurrence (CDR); however, there is little consensus on the impact of most of the identified risk factors. METHODS: Our study was a retrospective chart review of 198 patients diagnosed with CDI via Polymerase Chain Reaction (PCR) from February 2009 to Jun 2013. In our study, we decided to use a machine learning algorithm called the Random Forest (RF) to analyze all of the factors proposed to be associated with CDR. This model is capable of making predictions based on a large number of variables, and has outperformed numerous other models and statistical methods. RESULTS: We came up with a model that was able to accurately predict the CDR with a sensitivity of 83.3%, specificity of 63.1%, and area under curve of 82.6%. Like other similar studies that have used the RF model, we also had very impressive results. CONCLUSIONS: We hope that in the future, machine learning algorithms, such as the RF, will see a wider application.

Aeromonas hydrophila Sepsis Associated with Consumption of Raw Oysters.

Introduction. Aeromonas hydrophila is a gram negative bacillus that is native to aquatic environments that is increasingly reported in humans. This case is remarkable for A. hydrophila with an initial presentation of acute pancreatitis. Case Presentation. A 61-year-old male presented to the emergency department with nausea, vomiting, and abdominal pain for two days. His past medical history was significant for alcohol abuse. Initial laboratory examination showed an elevated white blood cell count, elevated lipase, and elevated liver function tests (LFT). Computer tomography (CT) showed peripancreatic inflammatory changes and retroperitoneal free fluid, suggestive of acute pancreatitis. The patient was treated with intravenous (IV) fluids and IV meropenem. After two days, the patient developed sepsis and respiratory failure and was intubated. Blood cultures were positive for Aeromonas hydrophila sensitive to ciprofloxacin which was added to his treatment. Additionally, it was discovered that this patient had recently vacationed in Florida where he consumed raw oysters. He was discharged home on the eighth day of the hospital admission. Conclusion. This is a rare case of A. hydrophila sepsis in an elderly patient with acute pancreatitis and a history of consumption of raw oysters. This case suggests that A. hydrophila can cause disseminated infection in immunocompetent individuals.