Objective To determine the prevalence of benzodiazepine use in adults aged 65 and older at two West Virginia academic medical centers as phase one of a benzodiazepine deprescribing strategy. Design Cross-sectional Setting Two academic hospitals in West Virginia with 107,504 hospitalized adults age 65 and older from the years 2010 to 2018 with information on admission medication use. Measurements Use of benzodiazepines based on presence on the admission medication list. Demographics, select co-morbidities, and laboratory tests were also recorded. Results The prevalence of benzodiazepine use was 13.5% and use remained relatively constant with increasing age over 65, even in those over age 89. Conclusion Efforts aimed at assessing the true need for benzodiazepine use and deprescribing need to be employed, particularly with advancing age.

Background: Immunosuppressed patients are at an increased risk for developing odontogenic and orofacial infections, which can present with atypical processes and features that may mimic rare but life-threatening infections such as Ludwig’s angina. Differentiating cellulitis from a deep neck space infection is often challenging in this population in acute settings due to a broad differential diagnosis and blunted inflammatory responses. This diagnostic uncertainty complicates acute risk stratification and may delay recognition of conditions requiring early airway evaluation and intervention. Case Presentation: We present the case of a 28-year-old male with chronic myelogenous leukemia on immunosuppression with dasatinib who developed unilateral facial swelling and severe odontogenic pain that was refractory to empiric antibiotic therapy. The patient’s presentation with rapid clinical progression, early trismus, submandibular involvement, and floor-of-mouth tenderness raised significant concern for evolving Ludwig’s angina. Laboratory evaluation demonstrated elevated inflammatory markers, including erythrocyte sedimentation rate and C-reactive protein, further complicating early assessment. Imaging was promptly obtained to determine the nature of the infection, and the patient was admitted for intravenous antibiotic therapy and airway monitoring. Clinical improvement ensued. Conclusions: This case highlights the diagnostic overlap between facial cellulitis and Ludwig’s angina and underscores the importance of prompt imaging, airway monitoring, and clinical vigilance for risk stratification of immunocompromised patients in the acute setting to prevent life-threatening complications.

Hypertension is common in hospitalized patients and is most often asymptomatic. While there are no guidelines for management of such patients, aggressive blood pressure treatment, including the use of intravenous antihypertensives, is often undertaken. While evidence of benefit is lacking, emerging data suggest that treatment of asymptomatic hypertension in the inpatient setting is associated with adverse outcomes, including acute kidney injury and ischemic stroke. In addition, the intensification of a preexisting antihypertensive regimen at hospital discharge significantly increases the risk of readmission without significant improvement in outpatient hypertension control. Such a combination of a common problem with the demonstrable benefit of a less aggressive approach offers considerable opportunity to improve patient care. This review article will discuss the existent literature and a specific case and make suggestions for improvement of practice.

Acute ST-segment elevation (STE) on electrocardiogram (EKG) is very frequently associated with myocardial infarction, which requires prompt diagnosis and treatment. However, there are multiple other causes of acute STE, both cardiac and noncardiac. Here we describe a unique case of acute inferior and lateral STE caused by osteomyelitis and abscess of the lower cervical vertebrae.