Systemic Toxicity after Rattlesnake Envenomation in Patients Using Angiotensin Converting Enzyme Inhibitors: A North American Snakebite Registry Study.

Background: Some North American rattlesnake venoms and angiotensin converting enzyme inhibitor (ACEI) medications each increase bradykinin levels in humans, with clinical effects attributable to bradykinin described in exposed populations. Influence of ACEI exposure on persons with snake envenomation has not been studied. We used data from the ACMT North American Snakebite Registry (NASBR) to determine if use of ACEI medications at the time of rattlesnake envenomation is associated with increased rate of systemic toxicity.

Successful Amendment of an Existing Hepatitis B Screening Programme by a Guideline Recommended Hepatitis D Screening in the Primary Care Setting.

Background: Despite European guidelines recommending anti-hepatitis D virus (HDV) screening for all hepatitis B surface antigen (HBsAg)-positive cases, screening rates remain insufficient.

Aims: We analysed anti-HDV screening rates in primary care and implemented prospective HDV screening in HBsAg-positive cases identified in the preventive medical examination from the age of 35 ("Check-Up 35+").

Methods: From 2012 to 2021, we reviewed anti-HDV and HDV RNA test rates in HBsAg-positive patients at 11 sites of a large German laboratory group.

A Case Report of Crotalidae Immune F(ab')-associated Coagulopathy Recurrence in a Preschool-age Child.

Introduction: Pit viper envenomation may cause coagulopathy. The coagulopathy has been treated with crotalidae polyvalent immune fragment antigen-binding (Fab) ovine antivenom for the last few decades in the United States and usually corrects the acute coagulopathy within hours. Days after receiving Fab, coagulopathy may recur in approximately half of the patients.

Compartment Syndrome after Crotalid Envenomation in the United States: A Review of the North American Snakebite Registry from 2013 to 2021 on Behalf of the ToxIC Snakebite Study Group.

Introduction: Compartment syndrome (CS) is a rare but serious complication after crotalid envenomation in the United States. Few data are available regarding the epidemiology and management of these cases. Significant controversy and misunderstanding over best practices, including measurement of compartment pressures and use of fasciotomy, exist for this syndrome.

Late hemotoxicity following North American rattlesnake envenomation treated with crotalidae immune F(ab') (equine) antivenom and crotalidae immune polyvalent Fab (ovine) antivenom reported to the North American Snakebite Sub-registry.

Introduction: Late hemotoxicity is common following rattlesnake envenomation treated with crotalidae immune polyvalent Fab (ovine) (FabAV). Initial clinical trials showed crotalidae immune F(ab')2 (equine) (Fab2AV) to be superior to FabAV in preventing late hemotoxicity, but this effect has not been demonstrated in broader populations. This study investigated late hemotoxicity in patients receiving Fab2AV or FabAV after rattlesnake envenomation.

Effects of a CB Subtype Selective Agonist ABK5-1 on Cytokine Production in Microglia.

Background And Objectives: Neuroinflammation is closely associated with various diseases including neuropathic pain. Microglia are immune cells in the central nervous system which are the main players of immunity and inflammation. Since microglia are activated by nerve injury, and they produce proinflammatory mediators to cause neuropathic pain, targeting activated microglia is considered to be a strategy for treating neuropathic pain.

Characterization of Subtype Selective Cannabinoid CB Receptor Agonists as Potential Anti-Inflammatory Agents.

Activation of the CB receptor has been shown to have anti-inflammatory and antinociceptive effects without causing psychoactive effects. Previously, we reported that the compound ethyl 2(2-(-(2,3-dimethylphenyl) phenylsulfonamido)acetamido)benzoate (ABK5) is a CB subtype selective agonist with anti-inflammatory and antinociceptive effects. In the present study, we tested four ABK5 derivatives, ABK5-1, ABK5-2, ABK5-5, and ABK5-6, to analyze the structure of ABK5 to obtain CB-selective agonists with higher affinity and efficacy.

Anti-inflammatory and antinociceptive effects of the selective cannabinoid CB receptor agonist ABK5.

Cannabinoid receptors are a potential target for anti-inflammatory and pain therapeutics. There are two subtypes, CB and CB, and Δ-tetrahydrocannabinol activates both of them, providing an analgesic effect but also psychoactive side effects. The psychoactive side effects are considered to be caused by activation of CB, but not CB.

Unwitting adult marijuana poisoning: a case series.

Study Purpose: With increasing state legalization, marijuana use has become commonplace throughout much of the United States. Existing literature on unintentional exposure focuses primarily on children.We report on a cluster of adults with unwitting marijuana exposure.

Fully automated detection and differentiation of pandemic and endemic coronaviruses (NL63, 229E, HKU1, OC43 and SARS-CoV-2) on the hologic panther fusion.

The hologic panther fusion (PF) platform provides fully automated CE marked diagnostics for respiratory viruses, including the recently discovered severe acute respiratory syndrome-coronavirus 2 (SARS-CoV-2) by a transcription mediated amplification (TMA) assay, but not for the endemic human coronaviruses (hCoV). Therefore, a laboratory developed test (LDT) comprising a multiplexed reverse transcription polymerase chain reaction (RT-PCR) protocol that detects and differentiates the four hCoV NL63, 229E, HKU1, and OC43 was adapted on the PF. The novel CE marked Aptima SARS-CoV-2 TMA and the LDT for hCoV were validated with 321 diagnostic specimens from the upper and lower respiratory tract in comparison to two SARS-CoV-2 RT-PCRs (PF E-gene RT-PCR and genesig RT-PCR, 157 specimens) or the R-GENE hCoV/hParaFlu RT-PCR (164 specimens), respectively.

When It Comes to Snakebites, Kids Are Little Adults: a Comparison of Adults and Children with Rattlesnake Bites.

Background: Rattlesnake envenomations are a significant cause of morbidity in the USA. While pediatric rattlesnake envenomations are relatively common, data comparing adult and pediatric patients with rattlesnake envenomations remain limited.

Methods: This multi-center retrospective study used the North American Snakebite Registry (NASBR), a sub-registry of the Toxicology Investigator's Consortium (ToxIC).

Case Report of Complete Radiological Response of a Thalamic Glioblastoma After Treatment With Proton Therapy Followed by Temozolomide and Tumor-Treating Fields.

Glioblastoma (GBM) is the most common and aggressive primary brain tumor in adults. We present a case of a 42-year-old male patient presenting with headache and vomiting. Imaging demonstrated obstructive hydrocephalus and a ring-enhancing lesion in the right posterior thalamus.

Stakeholder perceptions and scientific evidence linking wildfire mitigation treatments to societal outcomes.

A number of watershed partnerships have emerged in the western US to address the impacts of wildfire through investing in wildfire mitigation activities. To motivate collective action and design effective risk mitigation programs, these stakeholders draw on evidence linking wildfire mitigation to outcomes of interest. To advance knowledge in this area, we 1) assessed the strength of existing scientific evidence linking wildfire mitigation treatments with societal outcomes and 2) measured the importance of this evidence to watershed partnerships in the western US.

Yogaman: An Inexpensive, Anatomically-detailed Chest Tube Placement Trainer.

Introduction: Opportunities for chest tube placement in emergency medicine training programs have decreased, making competence development and maintenance with live patients problematic. Available trainers are expensive and may require costly maintenance.

Methods: We constructed an anatomically-detailed model using a Halloween skeleton thorax, dress form torso, and yoga mat.

Assessing the Effect of a Medical Toxicologist in the Care of Rattlesnake-envenomated Patients.

Background: Rattlesnake envenomation is an important problem in the United States, and the management of these envenomations can be complex. Despite these complexities, however, the majority of such cases are managed without the involvement of a medical toxicologist. The primary objective of this study was to evaluate the impact of a medical toxicology service (MTS) on the length of stay (LOS) of such patients.

Return on investment from fuel treatments to reduce severe wildfire and erosion in a watershed investment program in Colorado.

A small but growing number of watershed investment programs in the western United States focus on wildfire risk reduction to municipal water supplies. This paper used return on investment (ROI) analysis to quantify how the amounts and placement of fuel treatment interventions would reduce sediment loading to the Strontia Springs Reservoir in the Upper South Platte River watershed southwest of Denver, Colorado following an extreme fire event. We simulated various extents of fuel mitigation activities under two placement strategies: (a) a strategic treatment prioritization map and (b) accessibility.

Several Human Liver Cell Expressed Apolipoproteins Complement HCV Virus Production with Varying Efficacy Conferring Differential Specific Infectivity to Released Viruses.

Apolipoprotein E (ApoE), an exchangeable apolipoprotein, is necessary for production of infectious Hepatitis C virus (HCV) particles. However, ApoE is not the only liver-expressed apolipoprotein and the role of other apolipoproteins for production of infectious HCV progeny is incompletely defined. Therefore, we quantified mRNA expression of human apolipoproteins in primary human hepatocytes.