Envenomation From Flood-Related Fire Ant Rafting: A Cautionary Note.

BACKGROUND: Imported fire ants aggressively sting humans, leading to a variety of local and systemic effects. Fire ants display a behavioral adaptation to survive flooding, called "rafting," bringing humans into even more contact with fire ants. METHODS: To assess frequency of encounters with fire ant rafts, duck hunters on the website "Duck Hunter's Forum" were asked about their experiences with the ants while wading or boating in flooded areas. All members of the group received a brief explanation and asked to respond directly if they had had such an encounter. They were then asked to fill out a short 6-question survey. RESULTS: There were 2021 views of the thread about fire ant raft encounters, with 35 (1.7%) responses. Twenty-four (68.6%) said they had experienced encounters with fire ant rafts. Six responders described purposely or inadvertently physically touching the rafts with their body parts, boat, or a paddle, causing the ants to enter their boat or to climb directly onto the hunter(s). Five respondents were stung (number of stings from "a few" to 50), describing reactions to stings as "small pustules," "whelps," and "pimple-like, puss-filled whelps." CONCLUSIONS: These results confirm that fire ant rafts formed during flooding present a potential hazard to persons walking, wading, or boating in those areas. We suggest that these rafts are an under-appreciated health hazard. It is reasonable to assume that people in flooded areas occasionally contact these floating rafts and are stung multiple times. We provide preliminary prevention/protection recommendations for health professionals, to be shared with their patients and the general public.

Renin Angiotensin Aldosterone System Blockade: Little to No Rationale for ACE Inhibitor and ARB Combinations.

Our understanding of the complexities and inter-related pathways of the renin-angiotensin-aldosterone system continues to evolve. Which drugs to use, when, and how, are everyday questions faced by clinicians in the ambulatory setting. Combining these classes, for the purpose of enhancing renin-angiotensin-aldosterone system blockade and incremental blood pressure, nephroprotective, and cardioprotective effects, logically has emerged as an area for scientific inquiry and clinical use. Despite the lack of evidence on safety and efficacy in most disease states, dual therapy has been embraced as a treatment option. Most studies of angiotensin-converting enzyme (ACE) inhibitor and angiotensin receptor blocker (ARB) combination therapy in the treatment of hypertension have limitations. In contrast, combination ACE inhibitor-ARB therapy in systolic heart failure has been addressed in several large randomized controlled trials. Until recently, there has been limited and conflicting evidence for the use of combination therapy for the prevention or management of nephropathy. Based on the new evidence, combination ACE inhibitor-ARB therapy in the treatment and management of hypertension, heart failure, and nephropathy should be limited.