Riverside Community Hospital

BackgroundThe common recommendation for hypoglycemia treatment, oral ingestion of 15 g of simple carbohydrates and glucose recheck in 15 min, was predominantly based on expert opinion, and two small-sized studies of intravenous insulin-induced hypoglycemia in people living with type 1 diabetes mellitus (T1D). The evidence for “15 grams/15 minutes” treatment for people living with type 2 diabetes mellitus (T2D) needs to be explored. The objective of this systematic review is to determine which oral carbohydrate treatments were studied in adults living with T2D for timely resolution of hypoglycemia events.MethodsMedline, Embase, Scopus, and Cochrane Central Register of Controlled Trials were searched from January 1990 to 24 March 2025, for full-text studies of oral treatment for hypoglycemia in T2D. Two authors screened the results and extracted data. Inclusion criteria included age > = 18 years with T2D, treated with a defined quantity of simple carbohydrates, and reported hypoglycemia event resolution as a defined time of first glucose recheck after treatment completion. Exclusion criteria included non-oral route of hypoglycemia treatment. The Newcastle-Ottawa scale was used for risk of bias assessment.ResultsThree studies were included, which reported on 152 insulin-treated adults who experienced 366 hypoglycemia events. None of these three studies presented if the participants were or were not on sulfonylurea concurrently, nor did they present a breakdown of the types of insulin(s) (long-acting versus rapid-acting) for the participants. All studies had different oral hypoglycemia treatments and various glucose recheck times. Hence, data synthesis was not possible. There was near 100% hypoglycemia resolution with 15 g carbohydrates at 30-minute recheck in a study of mild hypoglycemia in hospitalized people living with type 2 diabetes. An at-home study showed 95% hypoglycemia resolution with 30 g carbohydrates at 10-minute recheck, although rebound hyperglycemia became a concern. The studies had low risk of bias.ConclusionThree studies provided a very limited evidence base for hypoglycemia treatment in T2D. Future studies are encouraged to identify and analyze people living with T2D who are treated with sulfonylurea, with or without insulin therapy, to reflect hypoglycemia treatment over the breadth of T2D pharmacotherapy.Clinical trial numberNot applicable.Trial registrationProspero registration number CRD420251032322. No amendments. Study protocol can be obtained by sending a written request to the corresponding author.Supplementary InformationThe online version contains supplementary material available at 10.1186/s12902-025-02144-3.

Introduction Spinal dural arteriovenous fistulas (SDAVFs) are rare vascular malformations involving an abnormal connection between a dural artery and a medullary vein, leading to venous hypertension and progressive myelopathy. Literature estimates an annual incidence of 5‐10 cases per million, with a strong male predominance between 50‐70 years old (∼80%), with women accounting for only 20% of cases. SDAVFs in octogenarian females are extraordinarily rare, with no current literature implicating horseback riding as a potential trigger. This case presents a patient with a proposed novel mechanism for acquired SDAVF through equestrian activity. Case Presentation An 81‐year‐old woman with hypertension and hypothyroidism presented with distal leg paresthesias progressing over three weeks to flaccid bilateral lower extremity paralysis, urinary retention, and constipation. She denied back or neuropathic pain. At baseline, she was independent with all instrumental activities of daily living and had recently taken up horseback riding. Initial lumbar spine MRI showed multilevel degenerative disc disease and foraminal narrowing. She was discharged to a skilled nursing facility with a presumed diagnosis of lumbar radiculopathy. On re‐presentation 2 weeks later, neurological exam revealed 0/5 strength in the lower extremities, areflexia, a T12‐L1 sensory level, mute plantar responses, and persistent sphincter dysfunction. Thoracic spine MRI showed long‐segment T2 hyperintensity, cord expansion, and serpentine flow voids. Digital subtraction angiography confirmed a SDAVF at the right T12 intercostal artery. She underwent Onyx‐18 embolization, with minimal motor recovery and persistent urinary retention. Due to incomplete response, she underwent T11‐L1 laminoplasty with direct surgical ligation and nBCA glue embolization of a residual extradural component. Following surgery, she regained movement in the hips, knees, and feet, though sphincter dysfunction persisted. She remains in rehabilitation with slow but measurable improvement. Discussion SDAVFs are acquired lesions often associated with dural sinus thrombosis, trauma, or prior surgery. In this patient, none of these risk factors were present. Her only recent physical change was picking up horseback riding as a new hobby in the last year, which introduced repetitive axial spinal stress. With her history of hypertension weakening the arterial walls and the introduction of axial spinal stress from horseback riding, it could have contributed to the formation of the abnormal connection between arteries and veins that characterizes a SDAVF.This may have triggered angiogenic pathways, particularly vascular endothelial growth factor (VEGF), leading to abnormal arteriovenous shunt formation. Additional mediators such as FGF and IL‐6 could have contributed to endothelial injury and neovascularization. No prior literature has linked equestrian activity with SDAVF, making this a novel etiologic consideration. The delay in diagnosis reflects the overlap of symptoms with more common conditions like lumbar stenosis. Clinicians should consider SDAVF in elderly patients with progressive myelopathy and sphincter dysfunction even if the etiology does not follow medical norms for SDAVF's. Conclusion This case raises the novel hypothesis of horseback riding as a potential mechanical trigger for angiogenesis. Early diagnosis is critical to prevent irreversible deficits. The patient's partial recovery highlights the need for a high index of suspicion and the benefits of a timely, multimodal therapeutic approach.

INTRODUCTION: On October 6, 2022, Pomona Valley Hospital Medical Center (PVHMC) was notified of a nationwide synthetic oxytocin shortage. A policy was implemented to enforce a judicious use of this medication in labor and postpartum. This study aimed to assess the effect on clinical management and on patient and neonatal outcomes. METHODS: Data were collected via retrospective chart review from nursing and physician documentation on the labor and postpartum course. Inclusion criteria were patients who delivered at PVHMC from September 6 to November 7, 2022. Exclusion criteria were cesarean birth admissions. Patients were divided into groups based on whether they delivered before or after implementation of the policy. Data were compared using t-tests for continuous variables or the chi-squared analysis for categorical variables. RESULTS: Seven hundred nine patients met the criteria, with 342 delivering prior to and 367 delivering after implementation of the policy. The percentage of patients receiving misoprostol increased (32.8% versus 42.9%, P=.005). The percentage receiving synthetic oxytocin decreased (64.3% versus 31.1%, P<.001). Postpartum, the percentage of patients receiving synthetic oxytocin decreased (92.1% versus 52.6%, P<.001) whereas the percentage receiving misoprostol, methylergonovine, and tranexamic acid increased (21.9% versus 42.0%, P<.001; 17.5% versus 43.2%, P<.001; 14.0% versus 26.2%, P<.001). There was no significant difference in cesarean birth rates, quantitative blood loss, blood transfusion, or neonatal outcomes. CONCLUSIONS/IMPLICATIONS: In our population, labor and the postpartum period were managed safely and effectively with selective use of synthetic oxytocin. Understanding various management strategies allows institutions to adapt as availability of resources fluctuates.

A unique case involving a 65-year-old woman with recurrent hormone-positive, HER-2-negative breast cancer stage IV (T2N2M1) with known metastases to the bone presented with worsening dysphagia and esophageal wall thickening on imaging masquerading as achalasia. However, endosonography (EUS)-guided biopsy of the esophagus wall demonstrated metastatic breast cancer to the esophagus causing pseudoachalasia.

PurposeAlcohol use has been shown to affect injury patterns and risk of trauma. This study aims to characterize the epidemiologic characteristics of alcohol involved facial injuries presenting to US emergency departments.MethodsThis study reports a cross-sectional analysis of patients with facial injuries within the National Electronic Injury Surveillance System (NEISS). Demographics, disposition, and mechanism of injury were compared between facial injury patients with reported/suspected alcohol consumption prior to or during the time of injury (AIFI+) and facial injury patients with no alcohol consumption (AIFI-).ResultsA total of 37,777 facial injuries were reported within the NEISS. Out if these, 3,336 patients experienced an alcohol involved facial injury (AIFI+). AIFI + patients were younger than AIFI- patients (47 vs. 57, p < 0.001), more likely to be male (68.5% vs. 31.5%, p < 0.001), and more likely to be White (51.6% vs. 53.6%, p = 0.03). Patients with AIFI were less likely to be injured at home (41.5% vs. 45.5%, p < 0.001) and more likely to be injured in the street (8.5% vs. 4.5%, p < 0.001). Disposition differed with AIFI + patients less likely to be treated and released (78.8% vs. 83.3%, p < 0.001) and more likely to leave without being seen (3.8% vs. 1.8%, p < 0.001).ConclusionsOur study reports that AIFI + patients are younger, more likely to be injured on the street, and more likely to be injured by stairs than AIFI- patients. Additionally, patients with an AIFI + are more likely to leave the hospital without being seen.

The prognosis and treatment planning of glioblastoma multiforme (GBM) involves a holistic analysis of imaging, clinical, and molecular data. The correlation of imaging and molecular features has garnered much interest due to its potential to reduce the number of invasive procedures on a patient and resource utilization of the overall prognostic and treatment planning process. This article detects and characterizes the impact of tumor biomarkers (such as shape, texture, location, and the tissue surrounding the tumor) in detecting a prognostic mutation – the concurrent gain of 19 and 20 chromosomes, and proposes two novel ideas for this analysis. First, to address the challenges associated with the limited, diverse, and complex nature of medical data, this article proposes a novel generative model – the realistic radiogenomic design using disentanglement in generative adversarial networks (R2D2-GAN), designed to recreate highly subtle, unapparent manifestations of mutations in magnetic resonance imaging. It generates high-resolution, diverse data that captures the discriminatory visual features of the molecular markers while tackling the high diversity, unbalanced, and limited GBM data with rare mutations correlating with patient survival such as 19/20 co-gain. Second, this study proposes a quantitative metric called the synthetic image fidelity (SIF) score to evaluate the performance of GANs in learning visually unapparent prognostic features through the use of gradient-based model explanations. Results are compared with current methods.

Internal Jugular Vein Stenosis (IJVS) has been reported in the literature to be caused by extrinsic compression by styloid process, C1 transverse process, or both. Treatments under investigation for IJVS are internal jugular vein stenting or styloidectomy. We present a case of a patient successfully treated with C1 transverse process resection.