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Haplo-diploid sex determination in the parasitoid wasp, Nasonia vitripennis (Walker), allows females to adjust their brood sex ratios. Females influence whether ova are fertilized, producing diploid females, or remain unfertilized, producing haploid males. Females appear to adjust their brood sex ratios to minimize 'local mate competition,' i.e., competition among sons for mates. Because mating occurs between siblings, females may optimize mating opportunities for their offspring by producing only enough sons to inseminate daughters when ovipositing alone, and producing more sons when superparasitism is likely. Although widely accepted, this hypothesis makes no assumptions about gamete limitation in either sex. Because sperm are used to produce daughters, repeated oviposition could reduce sperm supplies, causing females to produce more sons. In contrast, if egg-limited females produce smaller broods, they might use fewer sperm, making sperm limitation less likely. To investigate whether repeated oviposition and female fertility influence gamete limitation within females, we created two treatments of six mated female wasps, which each received a series of six hosts at intervals of 24 or 48 h. All females produced at least one mixed-sex brood (63 total broods; 3,696 offspring). As expected, if females became sperm-limited, in both treatments, brood sex ratios became increasingly male-biased with increasing host number. Interhost interval did not affect brood size, total offspring number, or sex ratio, indicating females did not become egg limited. Our results support earlier studies showing sperm depletion affects sex allocation in N. vitripennis¸ and could limit adaptive sex ratio manipulation in these parasitoid wasps.
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Avispas , Animales , Femenino , Masculino , Reproducción , Semen , Razón de Masculinidad , EspermatozoidesRESUMEN
Aim We aim to describe differences in stroke risk factors, subtypes and outcomes in a multi-ethnic Irish Stroke population. Gaining an insight into prevalent risk factors and subtypes in ethnic groups may help target prevention efforts. Methods We retrospectively identified patients originally not of Irish ethnicity (ONIE) admitted to the acute stroke unit between 2016 and 2018 through surname recognition (N=44). Country of origin was confirmed on chart review. The presumed native Irish (PNI) patients admitted over the same time frame were used as a comparison group (N=437). Data was collected on stroke subtype, comorbidities, outcomes and socioeconomic factors. Results Patients ONIE made up 9.1% of all stroke unit admissions. Male gender was more common accounting for 33 of 44 (75%) patients ONIE and 251 of 437 (57.4%) PNI (p = 0.02). Overall ONIE were younger than PNI patients (mean age 57.5 [SD 13.0] vs 69.6yr [SD 13.2], p <0.001). Patients ONIE also recorded higher rates of intracranial haemorrhage(ICH) (N = 15 [34.1%] vs N=51 [11.7%], p <0.01). Conclusion Our study demonstrates that stroke patients ONIE have a different stroke subtype and demographic profile compared to Irish patients. Patients ONIE are more likely to be young, male with higher rates of ICH.
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Etnicidad , Accidente Cerebrovascular , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Factores de Riesgo , Accidente Cerebrovascular/epidemiología , Accidente Cerebrovascular/etiología , Población BlancaRESUMEN
The HIV Mothering Study (n = 72) was a prospective, observational, cohort study exploring psychosocial experiences and needs of WLWHIV in pregnancy and postpartum. We performed quantitative analysis of determinants of loneliness (UCLA Loneliness Scale) and lower perceived social support (SS) (Medical Outcomes Study-Social Support Survey). The hypothesized determinants included: age, years with HIV, racism (Everyday Discrimination Scale), depression (Edinburgh Postnatal Depression Scale [EPDS]), nadir CD4 (<200â cells/µL), tertiary vs. community HIV care, and marital status. The median age was 33 (IQR = 30-37); 65.3% were African/Caribbean/Black. Multivariable analyses revealed associations between marital status and perceived social support (ß = -16.48, p < 0.0001), and this association was also seen with change over time (p = 0.02). Variables associated with SS that did not change over time were: income, EDS racism, EPDS score. Significant associations with loneliness were seen with the same variables associated with SS. Variables associated with loneliness that also changed over time were: EDS Racism (ß = 0.22, p = 0.0005, and over time p = 0.003), and EPDS score (ß = 0.74, p < 0.0001), and over time (p = 0.0211). Variables associated with loneliness but that did not change over time were: marital status and income. This analysis provides clinicians with prenatal risk factors which may be associated with increase loneliness and lower SS during pregnancy and postpartum: marital status, income, racism and depression.
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Depresión/etiología , Infecciones por VIH/psicología , Soledad/psicología , Madres/psicología , Apoyo Social , Adulto , Recuento de Linfocito CD4 , Femenino , Infecciones por VIH/inmunología , Humanos , Renta , Estado Civil , Ontario , Periodo Posparto , Embarazo , Estudios Prospectivos , Escalas de Valoración Psiquiátrica , Racismo , Factores de RiesgoRESUMEN
Chronic hepatitis C virus (HCV) infection is the most common blood-borne infection in the USA. Estimating prevalence is critical for monitoring diagnosis, treatment, and cure and for allocating resources. Surveillance data reported to the New York City (NYC) Health Department, 2000-2015, were used to estimate HCV prevalence in NYC in 2015. The numbers who died, out-migrated or whose last RNA test was negative were removed from the count of people reported with HCV. A simulation model was used to remove estimates of people whose infection spontaneously cleared or was cured and to add an estimate of people unaware of infection. The surveillance-based HCV prevalence in NYC in 2015 overall was 1.4% (95% certainty level (CL) 1.2-1.6%; n ≈ 116 000, 95% CL ≈99 000-135 000) and among adults aged ⩾20 years was 1.8% (95% CL 1.5-2.0%, n ≈ 115 000, 95% CL ≈99 000-134 000), lower than the 2010 estimate among adults aged ⩾20 years of 2.4% (n ≈ 147 000). Contributors to the decrease in HCV prevalence from 2010 to 2015 include both the availability of highly effective treatment and also deaths among an ageing population. The 2015 estimate can be used to set NYC-specific HCV screening and treatment targets and monitor progress towards HCV elimination.
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Hepatitis C Crónica/epidemiología , Adulto , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Ciudad de Nueva York/epidemiología , Vigilancia de la Población , PrevalenciaRESUMEN
In 2016, imported Zika virus (ZIKV) infections and the presence of a potentially competent mosquito vector (Aedes albopictus) implied that ZIKV transmission in New York City (NYC) was possible. The NYC Department of Health and Mental Hygiene developed contingency plans for a urosurvey to rule out ongoing local transmission as quickly as possible if a locally acquired case of confirmed ZIKV infection was suspected. We identified tools to (1) rapidly estimate the population living in any given 150-m radius (i.e. within the typical flight distance of an Aedes mosquito) and (2) calculate the sample size needed to test and rule out the further local transmission. As we expected near-zero ZIKV prevalence, methods relying on the normal approximation to the binomial distribution were inappropriate. Instead, we assumed a hypergeometric distribution, 10 missed cases at maximum, a urine assay sensitivity of 92.6% and 100% specificity. Three suspected example risk areas were evaluated with estimated population sizes of 479-4,453, corresponding to a minimum of 133-1244 urine samples. This planning exercise improved our capacity for ruling out local transmission of an emerging infection in a dense, urban environment where all residents in a suspected risk area cannot be feasibly sampled.
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Pruebas Diagnósticas de Rutina/métodos , Vigilancia de la Población/métodos , Orina/virología , Infección por el Virus Zika/epidemiología , Virus Zika/aislamiento & purificación , Humanos , Ciudad de Nueva York/epidemiología , Prevalencia , Muestreo , Sensibilidad y EspecificidadRESUMEN
Legionnaires' disease (LD) incidence in the USA has quadrupled since 2000. Health departments must detect LD outbreaks quickly to identify and remediate sources. We tested the performance of a system to prospectively detect simulated LD outbreaks in Allegheny County, Pennsylvania, USA. We generated three simulated LD outbreaks based on published outbreaks. After verifying no significant clusters existed in surveillance data during 2014-2016, we embedded simulated outbreak-associated cases into 2016, assigning simulated residences and report dates. We mimicked daily analyses in 2016 using the prospective space-time permutation scan statistic to detect clusters of ⩽30 and ⩽180 days using 365-day and 730-day baseline periods, respectively. We used recurrence interval (RI) thresholds of ⩾20, ⩾100 and ⩾365 days to define significant signals. We calculated sensitivity, specificity and positive and negative predictive values for daily analyses, separately for each embedded outbreak. Two large, simulated cooling tower-associated outbreaks were detected. As the RI threshold was increased, sensitivity and negative predictive value decreased, while positive predictive value and specificity increased. A small, simulated potable water-associated outbreak was not detected. Use of a RI threshold of ⩾100 days minimised time-to-detection while maximizing positive predictive value. Health departments should consider using this system to detect community-acquired LD outbreaks.
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Background Stroke is a leading cause of death. We looked at the causes (direct and indirect) of in-hospital mortality in a modern stroke unit over a two-year period. Methods We reviewed medical charts of stroke deaths in hospital from 2014-2015 inclusive. Data on stroke type, aetiology, age, length of stay, comorbidities, and documented cause of death were recorded. All patients were included. Results 518 patients were admitted acutely to the stroke service. Overall death rate was 7.5% (n=39). Of fatal strokes 29 (74%) were ischaemic. Average age 78.6 years. Mean survival was 26.4 days (range 1-154). 19 (49%) patients had atrial fibrillation. Forty-nine percent of deaths were due to pneumonia, and 33% were due to raised intracranial pressure. Discussion Mortality rate in our stroke service has decreased from 15% in 1997, and now appears dichotomised into early Secondary Stroke Related Cerebral Events (SSRCEs) and later infections.
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Accidente Cerebrovascular/mortalidad , Anciano , Mortalidad Hospitalaria , Humanos , Irlanda/epidemiología , Masculino , Estudios Retrospectivos , Accidente Cerebrovascular/complicacionesRESUMEN
Mycobacterium marinum, a bacterium found in freshwater and saltwater, can infect persons with direct exposure to fish or aquariums. During December 2013, the New York City Department of Health and Mental Hygiene learned of four suspected or confirmed M. marinum skin or soft tissue infections (SSTIs) among persons who purchased whole fish from Chinese markets. Ninety-eight case-patients with non-tuberculous mycobacteria (NTM) SSTIs were identified with onset June 2013-March 2014. Of these, 77 (79%) were female. The median age was 62 years (range 30-91). Whole genome sequencing of clinical isolates revealed two main clusters and marked genetic diversity. Environmental samples from distributors yielded NTM though not M. marinum. We compared 56 case-patients with 185 control subjects who shopped in Chinese markets, frequency-matched by age group and sex. Risk factors for infection included skin injury to the finger or hand (odds ratio [OR]: 15·5; 95% confidence interval [CI]: 6·9-37·3), hand injury while preparing fish or seafood (OR 8·3; 95% CI 3·8-19·1), and purchasing tilapia (OR 3·6; 95% CI 1·1-13·9) or whiting (OR 2·7; 95% CI 1·1-6·6). A definitive environmental outbreak source was not identified.
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Brotes de Enfermedades , Infecciones por Mycobacterium no Tuberculosas/epidemiología , Mycobacterium marinum/aislamiento & purificación , Enfermedades Cutáneas Bacterianas/epidemiología , Infecciones de los Tejidos Blandos/epidemiología , Adulto , Anciano , Anciano de 80 o más Años , Animales , Estudios de Casos y Controles , Femenino , Peces , Humanos , Incidencia , Masculino , Persona de Mediana Edad , Infecciones por Mycobacterium no Tuberculosas/microbiología , Ciudad de Nueva York/epidemiología , Enfermedades Cutáneas Bacterianas/microbiología , Infecciones de los Tejidos Blandos/microbiologíaRESUMEN
We used the winter of 2009-2010, which had minimal influenza circulation due to the earlier 2009 influenza A(H1N1) pandemic, to test the accuracy of ecological trend methods used to estimate influenza-related deaths and hospitalizations. We aggregated weekly counts of person-time, all-cause deaths, and hospitalizations for pneumonia/influenza and respiratory/circulatory conditions from seven healthcare systems. We predicted the incidence of the outcomes during the winter of 2009-2010 using three different methods: a cyclic (Serfling) regression model, a cyclic regression model with viral circulation data (virological regression), and an autoregressive, integrated moving average model with viral circulation data (ARIMAX). We compared predicted non-influenza incidence with actual winter incidence. All three models generally displayed high accuracy, with prediction errors for death ranging from -5% to -2%. For hospitalizations, errors ranged from -10% to -2% for pneumonia/influenza and from -3% to 0% for respiratory/circulatory. The Serfling and virological models consistently outperformed the ARIMAX model. The three methods tested could predict incidence of non-influenza deaths and hospitalizations during a winter with negligible influenza circulation. However, meaningful mis-estimation of the burden of influenza can still result with outcomes for which the contribution of influenza is low, such as all-cause mortality.
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Hospitalización/estadística & datos numéricos , Gripe Humana/epidemiología , Modelos Estadísticos , Neumonía Viral/epidemiología , Anciano , Anciano de 80 o más Años , Enfermedades Cardiovasculares/epidemiología , Enfermedades Cardiovasculares/mortalidad , Estudios de Cohortes , Femenino , Humanos , Incidencia , Subtipo H1N1 del Virus de la Influenza A , Gripe Humana/mortalidad , Masculino , Neumonía Viral/mortalidad , Enfermedades Respiratorias/epidemiología , Enfermedades Respiratorias/mortalidad , Estaciones del Año , Estados Unidos/epidemiologíaRESUMEN
PURPOSE: To evaluate reported ingested dose of paracetamol as a risk assessment tool in acute paracetamol overdose. METHODS: Data was retrospectively obtained from a clinical toxicology database linked to one Australian and two United Kingdom hospitals. Plasma paracetamol concentrations (PPCs) of adult patients presenting with acute single ingestion, non-staggered paracetamol deliberate self-poisoning between 2006 and 2012 were recorded and plotted on a treatment nomogram to determine accuracy of reported dose ingested as an indicator for antidotal treatment. PPC plotted on a treatment nomogram with a line intersecting a 4-h concentration of 100 mg/L [667 µmol/L] was considered an indication for antidotal treatment in the UK; the corresponding Australasian population utilised a line intersecting 150 mg/L [1000 µmol/L]. RESULTS: Of 1246 patients, 65.7 % were female and 88 % were from the UK. Fifty-two percent of patients reporting ingestion of ≥8 g paracetamol had a PPC above the 100 mg/L treatment line; PPV 52 % [95 % confidence interval (CI) 49 %, 55 %], sensitivity 81 % [95 %CI 78 %, 85 %]. Forty-four of patients reporting percent ingestion of ≥10 g had a PPC above the 150 mg/L treatment line; PPV 44 % [95 % CI 41 %, 49 %], sensitivity 85 % [95 % CI 78 %, 89 %], 72 % of patients reporting ingestion of ≥16 g had a PPC above the 100 mg/L treatment line; PPV 72 % [95% CI 67 %, 77 %], sensitivity 50 % [95 % CI 45 %, 54 %]. Overall, there was moderate correlation (R = 0.58) between reported paracetamol dose ingested and extrapolated 4-h PPC. CONCLUSIONS: There is a positive correlation between reported ingested dose of paracetamol and subsequent chance of a PPC being above a defined treatment line; however, ingested dose of paracetamol alone is a poor risk assessment tool in accurately determining need for treatment with an antidote.
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Acetaminofén/sangre , Analgésicos no Narcóticos/sangre , Sobredosis de Droga/sangre , Autoinforme , Acetaminofén/administración & dosificación , Acetaminofén/envenenamiento , Acetilcisteína/uso terapéutico , Adulto , Analgésicos no Narcóticos/administración & dosificación , Analgésicos no Narcóticos/envenenamiento , Antídotos/uso terapéutico , Sobredosis de Droga/tratamiento farmacológico , Femenino , Humanos , Masculino , Riesgo , Adulto JovenRESUMEN
BACKGROUND: The rising prevalence of obesity and diabetes in Kuwait represents a significant challenge for the country's healthcare system. Diabetes care in Scotland has improved by adopting a system of managed clinical networks supported by a national informatics platform. In 2010, a Kuwait-Dundee collaboration was established with a view to transforming diabetes care in Kuwait. This paper describes the significant progress that has been made to date. METHODS: The Kuwait-Scotland eHealth Innovation Network (KSeHIN) is a partnership among health, education, industry and government. KSeHIN aims to deliver a package of clinical service development, education (including a formal postgraduate programme and continuing professional development) and research underpinned by a comprehensive informatics system. RESULTS: The informatics system includes a disease registry for children and adults with diabetes. At the patient level, the system provides an overview of clinical and operational data. At the population level, users view key performance indicators based on national standards of diabetes care established by KSeHIN. The national childhood registry (CODeR) accumulates approximately 300 children a year. The adult registry (KHN), implemented in four primary healthcare centres in 2013, has approximately 4000 registered patients, most of whom are not yet meeting national clinical targets. A credit-bearing postgraduate educational programme provides module-based teaching and workplace-based projects. In addition, a new clinical skills centre provides simulator-based training. Over 150 masters students from throughout Kuwait are enrolled and over 400 work-based projects have been completed to date. CONCLUSION: KSeHIN represents a successful collaboration between multiple stakeholders working across traditional boundaries. It is targeting patient outcomes, system performance and professional development to provide a sustainable transformation in the quality of diabetes healthcare for the growing population of Kuwaitis with diabetes in Kuwait.
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Diabetes Mellitus/epidemiología , Personal de Salud/educación , Informática Médica/organización & administración , Obesidad/epidemiología , Educación del Paciente como Asunto/métodos , Garantía de la Calidad de Atención de Salud/organización & administración , Adulto , Niño , Diabetes Mellitus/prevención & control , Diabetes Mellitus/terapia , Educación de Postgrado , Federación para Atención de Salud/organización & administración , Federación para Atención de Salud/normas , Humanos , Relaciones Interinstitucionales , Cooperación Internacional , Kuwait/epidemiología , Informática Médica/normas , Informática Médica/tendencias , Obesidad/complicaciones , Obesidad/terapia , Prevalencia , Garantía de la Calidad de Atención de Salud/métodos , Garantía de la Calidad de Atención de Salud/normas , Mejoramiento de la Calidad/organización & administración , Mejoramiento de la Calidad/normas , Sistema de Registros , Escocia/epidemiologíaRESUMEN
During December 2009, over 200 individuals reported gastrointestinal symptoms after dining at a North Carolina restaurant. An outbreak investigation included a case-control study of restaurant patrons, a secondary household transmission study, environmental assessment of the restaurant facilities and operations, and laboratory analysis of stool and food samples. Illness was primarily associated with consumption of steamed oysters (odds ratio 12, 95% confidence interval 4·8-28) and 20% (8/41 households) reported secondary cases, with a secondary attack rate of 14% among the 70 susceptible household contacts. Norovirus RNA was detected in 3/5 stool specimens from ill patrons; sequencing of RT-PCR products from two of these specimens identified identical genogroup II genotype 12 sequences. Final cooked temperatures of the steamed oysters were generally inadequate to inactivate norovirus, ranging from 21°C to 74°C. Undercooked contaminated oysters pose a similar risk for norovirus illness as raw oysters and household contacts are at risk for secondary infection.
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Infecciones por Caliciviridae/epidemiología , Brotes de Enfermedades , Gastroenteritis/epidemiología , Norovirus/aislamiento & purificación , Ostreidae/virología , Mariscos/virología , Adulto , Animales , Infecciones por Caliciviridae/transmisión , Infecciones por Caliciviridae/virología , Estudios de Casos y Controles , Niño , Culinaria , Heces/virología , Femenino , Gastroenteritis/virología , Humanos , Masculino , North Carolina/epidemiología , ARN Viral/genética , Reacción en Cadena en Tiempo Real de la Polimerasa , Reacción en Cadena de la Polimerasa de Transcriptasa Inversa , Análisis de Secuencia de ARNRESUMEN
BACKGROUND: There is evidence of increasing use of the synthetic cathinone mephedrone (4-methylmethcathinone), particularly amongst clubbers. However, there have only two single case reports of mephedrone toxicity. The aim of this study is to report the pattern of clinical toxicity seen with mephedrone use. CASE SERIES: We describe 15 patients who presented to our Emergency Department following self-reported mephedrone use. Significant clinical features seen included agitation in 53.3%, tachycardia in 40%, systolic hypertension in 20% and seizures in 20%. Twenty per cent required treatment with benzodiazepines, predominantly for management of agitation. All patients were discharged with no sequelae. Previous user reports have suggested that mephedrone use is associated with cool/blue peripheries; this was not seen in any of the patients in our series. CONCLUSION: The pattern of toxicity seen with mephedrone in this series is similar to that seen with 1-benzylpiperazine which has recently been classified under UK and EU misuse of drugs legislation. On the basis of this, together with a recent confirmed mephedrone related death in Sweden, we feel that appropriate assessments should be undertaken to determine the legal status of mephedrone.
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Alcaloides/envenenamiento , Drogas de Diseño/envenenamiento , Metanfetamina/análogos & derivados , Psicotrópicos/envenenamiento , Adulto , Servicio de Urgencia en Hospital , Femenino , Escala de Coma de Glasgow , Humanos , Tiempo de Internación/estadística & datos numéricos , Masculino , Metanfetamina/envenenamiento , Estudios Retrospectivos , Reino UnidoRESUMEN
Objective: We sought to identify factors that influence Human Papillomavirus (HPV) vaccination rates in individuals at two higher education institutions in South Carolina (SC).Participants: We surveyed 1007 students with a mean age and standard deviation of 20.3 ± 3.3 from September 2018 to December 2018.Methods: Participants answered 13 questions, assessing HPV vaccination rates, demographics, and rationales for vaccination vs. non-vaccination.Results: Of 1007 respondents, 700 received HPV vaccination, 165 were unvaccinated, 75 received partial vaccination and 138 were uncertain. Commonalities in HPV vaccination existed between females (p = 0.037), individuals who received standard childhood vaccinations (p = 0.04), and those not native-born in SC (p < 0.001). Of non-vaccinated individuals, 37% "never thought about vaccination," 32% did not perceive a need for vaccination, and 31% reported vaccine safety as reasons for not receiving the vaccine.Conclusions: Promotion of HPV vaccination may benefit from targeting SC natives, males, and individuals who are under-vaccinated or unvaccinated.
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Infecciones por Papillomavirus , Vacunas contra Papillomavirus , Estudiantes de Medicina , Femenino , Conocimientos, Actitudes y Práctica en Salud , Humanos , Masculino , Infecciones por Papillomavirus/prevención & control , South Carolina , Encuestas y Cuestionarios , Universidades , VacunaciónRESUMEN
OBJECTIVE: To investigate the reported association between exaggerated adrenarche (EA) and reduced foetal growth and to identify possible risk factors for future morbidity in Scottish children with clinical features of EA. DESIGN: Three-year prospective study. MEASUREMENTS: Auxology, blood pressure (BP), biochemical analysis of blood and urine, pelvic ultrasound in girls. RESULTS: Fifty-two patients were recruited of whom one girl had nonclassical congenital adrenal hyperplasia (17-OHP 17 nmol/l) and one had insufficient blood for analysis. The final cohort comprised 42 girls of mean (SD) age 7.7 (0.99) and eight boys of 8.8 (0.67) years. Mean (SD) birth weight was 3.27 (0.49) and 3.10 (0.76) kg in girls and boys respectively. Height/weight SDS were 1.13/1.69 in girls and 1.69/1.88 in boys. Mean systolic/diastolic BP was 107.8/60.4 (50th-75th centile) in girls and 115.5/63.9 (75th-91st centile) in boys. Uterine and ovarian development was prepubertal. Median serum dehydroepiandrosterone sulphate (DHEAS) was 2.1 and 4.1 mumol/l, androstenedione 3.1 and 3.8 nmol/l in girls and boys respectively, with DHEAS within the reference range/undetectable in 18/2 and androstenedione in 12/6 patients. Fasting insulin was 9.0 and 15.0 mU/l in girls and boys respectively, with concomitant low normal SHBG. Anti-Mullerian hormone (AMH) was 15.7 pmol/l in 27 girls, compared with 5.0 pmol/l in normal girls aged 5-8 years. CONCLUSIONS: Our Scottish EA cohort showed female predominance, no evidence of reduced foetal growth, a tendency to overweight with commensurate mild hyperinsulinaemia and modest elevation of serum androgens in some patients. We have found raised AMH levels in the girls, indicating advanced ovarian follicular development.
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Adrenarquia/fisiología , Andrógenos/sangre , Hormona Antimülleriana/sangre , Peso al Nacer , Niño , Femenino , Humanos , Hiperinsulinismo/etiología , Recién Nacido , Masculino , Folículo Ovárico/crecimiento & desarrollo , Pelvis/diagnóstico por imagen , Estudios Prospectivos , UltrasonografíaRESUMEN
Introduction: The majority of venomous snake exposures in the United States are due to snakes from the subfamily Crotalinae (pit vipers). There are three types of US pit vipers: rattlesnakes (Crotalus and Sisturus spp.) copperheads (Agkistrodon contortrix), and cottonmouths (Agkistrodon piscivorus) also known as water moccasins. Cottonmouth bites are reported less frequently than other pit viper envenomations, and data on cottonmouth envenomation are limited. Our objective was to describe the epidemiology, clinical manifestations, and management of cottonmouth envenomations using prospective data reported to the Toxicology Investigators Consortium's (ToxIC) North American Snakebite Registry (NASBR)Methods: Cottonmouth envenomation cases reported to NASBR for the period from January 1, 2013, through December 31, 2017 were reviewed. Variables collected included patient demographics, bite location, clinical manifestations, and management.Results: Thirty-one cottonmouth envenomations were reported. Most bites occurred in children aged 7-12 (39%). Most bites involved the lower extremity (72%). Intentional interaction with the snake occurred in three cases (10%). Swelling was the most reported clinical effect and occurred in all patients. Gastrointestinal symptoms were reported in 19% of patients, and 19% developed coagulopathy. Antivenom treatment was used in 84% of patients. Nineteen patients (61%) required hospital stays of >24 hours.Discussion: Our study represents the first systematic prospective data collection on cottonmouth bites. Our data demonstrate that cottonmouth envenomations cause primarily local effects and, occasionally, systemic toxicity. Our study also demonstrates that antivenom is often indicated for these envenomations per published guidelines and recommendations.Conclusions: Cottonmouth envenomations are relatively infrequent. However, they can cause significant local and systemic toxicity. Most cottonmouth envenomations in this series were treated with antivenom and were hospitalized beyond 24 hours.
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Agkistrodon , Sistema de Registros , Mordeduras de Serpientes/epidemiología , Adolescente , Adulto , Factores de Edad , Anciano , Animales , Niño , Preescolar , Femenino , Hospitalización/estadística & datos numéricos , Humanos , Lactante , Masculino , Persona de Mediana Edad , América del Norte/epidemiología , Sistema de Registros/estadística & datos numéricos , Adulto JovenRESUMEN
The changes in relative efficacy of two incompatible behaviors was investigated during growth of the lobster, Homarus americanus. In larval and early juvenile stages, physiological and morphological factors favor use of the escape response over defensive behavior. In large animals, defensive behavior is preferred almost exclusively to escape behavior unless the claws are lost. The interaction of escape and defensive behavior is modified by neural and morphological factors, which are dependent on the stage in the life cycle of the organism.
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AIM: The feasibility of administering native glucagon-like peptide 1 (GLP-1) as GLP-1 Technosphere Inhalation Powder for diabetes therapy has been demonstrated in a rat model. METHODS: GLP-1 Technosphere Inhalation Powders containing 5, 10 and 15% GLP-1 were prepared and administered to healthy female Sprague-Dawley rats and to male Zucker diabetic obese rats. Rats received a single dose of GLP-1 Technosphere Powder by pulmonary insufflation. GLP-1 pharmacokinetic and pharmacodynamic responses were measured. RESULTS: Maximum circulating GLP-1 concentrations were achieved at approximately 10 min after dosing with detectable levels at 40 min. In a food consumption study, Sprague-Dawley rats receiving GLP-1 Technosphere Powder once-daily consumed less food than control rats for up to 24 h after dosing. Cumulative food consumption was decreased approximately 10% after 78 h. In an intraperitoneal glucose tolerance test, Zucker diabetic fatty rats receiving 2 mg GLP-1 Technosphere Powder (0.3 mg GLP-1) by pulmonary insufflation exhibited lower glucose concentrations and higher insulin concentrations than control rats. Pancreatic evaluations showed no differences in apoptotic index or cell proliferation of beta-cells. In addition, a dose-related increase in insulin expression within the pancreas was observed. CONCLUSIONS: These data demonstrate the feasibility of administering native GLP-1 as GLP-1 Technosphere Inhalation Powder for diabetes therapy.
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Glucemia/efectos de los fármacos , Péptido 1 Similar al Glucagón/farmacocinética , Hipoglucemiantes/farmacocinética , Fragmentos de Péptidos/farmacocinética , Administración por Inhalación , Animales , Glucemia/metabolismo , Sistemas de Liberación de Medicamentos , Femenino , Péptido 1 Similar al Glucagón/administración & dosificación , Hipoglucemiantes/administración & dosificación , Masculino , Fragmentos de Péptidos/administración & dosificación , Ratas , Ratas Sprague-Dawley , Ratas ZuckerRESUMEN
Our understanding of the long-term evolution of the Earth system is based on the assumption that terrestrial weathering rates should respond to, and hence help regulate, atmospheric CO2 and climate. Increased terrestrial weathering requires increased carbonate accumulation in marine sediments, which in turn is expected to result in a long-term deepening of the carbonate compensation depth (CCD). Here, we critically assess this long-term relationship between climate and carbon cycling. We generate a record of marine deep-sea carbonate abundance from selected late Paleocene through early Eocene time slices to reconstruct the position of the CCD. Although our data set allows for a modest CCD deepening, we find no statistically significant change in the CCD despite >3 °C global warming, highlighting the need for additional deep-sea constraints on carbonate accumulation. Using an Earth system model, we show that the impact of warming and increased weathering on the CCD can be obscured by the opposing influences of ocean circulation patterns and sedimentary respiration of organic matter. From our data synthesis and modeling, we suggest that observations of warming, declining δ13C and a relatively stable CCD can be broadly reproduced by mid-Paleogene increases in volcanic CO2 outgassing and weathering. However, remaining data-model discrepancies hint at missing processes in our model, most likely involving the preservation and burial of organic carbon. Our finding of a decoupling between the CCD and global marine carbonate burial rates means that considerable care is needed in attempting to use the CCD to directly gauge global carbonate burial rates and hence weathering rates.