During the summer and fall of 2009, significant thrombotic events were observed in patients infected with the pandemic H1N1 influenza A virus. In a retrospective chart review of 119 individuals admitted to the hospital with H1N1 virus infection, 7 patients (5.9%) were found to have experienced thrombotic vascular events.

Anti-N-methyl-D-aspartate receptor (anti-NMDA-R) encephalitis is an immune-mediated syndrome that remains under-recognized despite a growing body of literature. This syndrome has been predominantly described in young females with a constellation of symptoms, including personality changes, autonomic dysfunction and neurologic decompensation. It is commonly associated with mature ovarian teratomas. We describe the classic presentation of anti-NMDA-R encephalitis in three dramatically different patients: Case A, a young woman with ovarian teratoma; Case B, the eldest case reported to date; and Case C, a young male with no identifiable tumor. We review the literature summarizing the differential diagnosis, investigative approach, treatment options and challenges inherent to this disorder. We advocate good supportive care, involvement of multiple health disciplines and use of immune-modulating therapies in patient management. These cases underscore the need for increased awareness and high diagnostic suspicion when approaching the patient with suspected viral encephalitis.

ED throughput for admitted medical patients improved with a quality improvement initiative involving education, goal setting and performance feedback.

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IMPORTANCE Severe obesity is a risk factor for major early complications after total hip arthroplasty (THA).OBJECTIVE To determine the association between surgeon experience with THA in patients with severe obesity and risk of complications.