Modulatory Activities of Plant Extracts on Jellyfish Cytotoxicity.

INTRODUCTION: The potential efficacy of selected plant extracts to counteract the dermal toxicity of jellyfish envenomation was investigated using an in vitro cell culture model. METHODS: We studied plant extracts from Carica papaya, Ananas comosus, and Bouvardia ternifolia, known for their antivenom properties, in pairwise combinations with tissue homogenates of the jellyfish Pelagia noctiluca, Phyllorhiza punctata, and Cassiopea andromeda, to evaluate modulations of jellyfish cytotoxic effects. L929 mouse fibroblasts were incubated with pairwise jellyfish/plant extract combinations and examined by MTT assay (3-[4,5-dimethylthiazol-2-yl]-2,5-diphenyltetrazolium bromide). RESULTS: C papaya and A comosus significantly lowered the cytotoxicity of P noctiluca and P punctata but induced a slight worsening of C andromeda cytotoxicity. Conversely, B ternifolia was protective against P punctata, ineffective against P noctiluca, and worsened C andromeda cytotoxicity. CONCLUSIONS: Data showed species-specific and contrasting effects of plant extracts, suggesting that those containing protease activities, namely A comosus and C papaya, are more effective in lowering the cytotoxicity of jellyfish venom containing toxic peptidic factors such as phospholipase A. However, all examined plants require further investigation in vivo to evaluate their ability to counteract jellyfish injury to the skin.

Delayed Allergic Reactions to Jellyfish Stings: Usefulness of Ultrasonographic Evaluation.

Jellyfish stings often cause immediate local skin reactions, and, less frequently, the affected individuals may develop delayed allergic reactions days or months after the sting. Here, we present 4 such cases. In all cases, color Doppler ultrasonography was performed at the time of diagnosis, and in 3 of the cases, clinical follow-ups with ultrasonographic evaluations were performed. Ultrasonography initially showed dermal thickening with decreased echogenicity that progressively normalized during follow-up. Ultrasonography was useful in quantifying inflammation by measuring the thickness of the dermis and was more precise than standard clinical follow-up of cutaneous lesions in these cases.

Pain from bluebottle jellyfish stings.

An 11-year-old girl presented to the emergency department with severe pain after a jellyfish sting at a New South Wales beach. Bluebottle (Physalia) jellyfish was deemed the most likely cause considering her geographical location. The Australian Resuscitation Council Guideline (2010) suggests immersing in water as hot as can be tolerated for 20 min for treating pain from jellyfish stings. This guideline was written based on past case reports, books and randomised controlled trials (RCTs). We performed a search to assess the most current evidence for relief of pain from Bluebottle jellyfish stings, which yielded two systematic reviews and seven RCTs. Both systematic reviews had similar conclusions, with one of the RCTs used in both reviews showing the most relevance to our presenting patient in terms of demographics, location and jellyfish type. This journal club article is an appraisal of this RCT by Loten et al. and the validity of its conclusion that hot water immersion is most effective for the relief of pain from Bluebottle stings.

Anaphylaxis: a history with emphasis on food allergy.

In the century since Paul Portier and Charles Richet described their landmark findings of severe fatal reactions in dogs re-exposed to venom after vaccination with sea anemone venom, treatment for anaphylaxis continues to evolve. The incidence of anaphylaxis continues to be difficult to measure. Underreporting due to patients not seeking medical care as well as failure to identify anaphylaxis affects our understanding of the magnitude of the disease. Treatment with intramuscular epinephrine continues to be the recommended first-line therapy, although studies indicate that education of both the patients and the medical community is needed. Adverse food reactions continue to be the leading cause of anaphylaxis presenting for emergency care. Current therapy for food-induced anaphylaxis is built on the foundation of strict dietary avoidance, rapid access to injectable epinephrine, and education to recognize signs and symptoms of anaphylaxis. Investigation into therapy with oral and sublingual immunotherapy as well as other modalities holds hope for improved treatment of food-induced anaphylaxis.

Water envenomations and stings.

Marine envenomations are an important part of sports medicine. Marine sport is practiced widely, and many aquatic envenomations require quick recognition and timely action to ensure the safety and recovery of victims. Even a basic knowledge of treatments of various envenomations could help clinicians be more effective in acute treatment. The purpose of this article is to review known literature and expand on recent progress in the field of aquatic envenomations.

SCUBA medicine: a first-responder's guide to diving injuries.

Self-contained underwater breathing apparatus (SCUBA) diving is an ever-growing sport, and despite a myriad of technological advances to improve safety, it remains dangerous. Providers of medical care for SCUBA divers must have an understanding of diving physiology and potential medical problems that can occur. SCUBA diving also can take participants to remote areas, so being properly prepared for potential emergencies can make a significant difference. The following is a review of diving physiology and the medical problems that can occur in SCUBA divers, along with some suggestions as to how to prepare for a SCUBA excursion.

Epidemiology of jellyfish stings presented to an American urban emergency department.

INTRODUCTION: Cnidarian, or jellyfish, stings are a common malady in tropical Emergency Departments. There are limited studies examining cnidarian stings in the United States. The team investigated the epidemiology and treatments for jellyfish stings presenting to an urban emergency department (ED) in Honolulu, Hawai'i. METHODS: The team performed a retrospective chart analysis of stings presented between 2000 and 2008. A total of 116 patients were identified. Charts were reviewed for patient demographics, incident characteristics, patient arrival condition, and treatments given in the emergency department. RESULTS: The median age was 24 years (range 9-85). Of patients 58% were men, 64% were Hawai'i non-residents, and 23 % arrived between the hours of 10pm and 2 am. Emergency Medical System transported 64%, and 65% arrived with normal vital signs. Twenty-four different types of IV/PO medications were administered and patients received up to 5 different medications per visit. Intravenous medications were given to 64%. All patients were eventually discharged home from the ED. DISCUSSION: Risk factors for cnidarian stings include being men, being a Hawai'i non-resident, and nighttime ocean activities. Stings were treated with various medications and routes suggesting that there is no current standard of care for stings. This study suggests that there is a need for public health interventions tailored to tourists. Prevention and education of home treatment could decrease the cost of health care by decreasing ambulance transports and total number of ED visits for a non-urgent disease.

'To swim or not to swim': the impact of jellyfish stings causing Irukandji Syndrome in Tropical Queensland.

AIM: This manuscript presents both demographic and descriptive data related to a distressing clinical condition known as Irukandji syndrome. Chart audit and observation data were collected to explore trends in patient characteristics and to review the current practices surrounding the management of the syndrome by advanced practice ED nurses. BACKGROUND: Irukandji syndrome, a known health emergency in northern Australia, causes severe symptoms such as muscle pains, nausea and vomiting, headache and chest pain causing clinical challenges for emergency nurses. Little is written about this condition from a nursing perspective. DESIGN: A mixed methods case study approach. METHODS: Data were collected by observation and chart audit from 186 patients diagnosed with Irukandji syndrome between 2001-2007. RESULTS: Of the 186 patients, 44.1% were local residents and 58.6% were men. Median age of the patients was 27 years (range 16-77). There was a time trend with a greater number of stings occurring out at the Great Barrier Reef than at mainland beaches (p < 0.001). Important results were found regarding waiting times for pain management and intuitive rather than documented assessment practices of advanced practice nursing staff. CONCLUSION: Irukandji syndrome causes severe emotional distress and acute pain, however, people continue to swim in marine sting environments and fail to make use of available protective clothing such as body suits. Local residents continue to be stung regardless of the educational information available suggesting a review of the current public education campaign is required. RELEVANCE TO CLINICAL PRACTICE: Nurses failed to document assessment processes limiting adequately the ability to assess trends in the patient's condition effectively and treat symptoms efficiently. It is, therefore, timely to review the critical role that assessment plays in clinical care.

18ß-Glycyrrhetinic Acid Improves Cardiac Diastolic Function by Attenuating Intracellular Calcium Overload.

Ranolazine, a late sodium current inhibitor, has been demonstrated to be effective on heart failure. 18ß-glycyrrhetinic acid (18ß-GA) has the similar inhibitory effect on late sodium currents. However, its effect on diastolic function is still unknown. This study aimed to determine whether 18ß-GA can improve the diastolic function and to explore the underlying mechanisms. Eighty male Sprague Dawley (SD) rats of Langendorff model were randomly divided into the following groups: group A, normal cardiac perfusion group; group B, ischemia-reperfusion group; group C, ischemia-reperfusion with anemoniasulcata toxin II (ATX-II); group D, ranolazine group; and group E, 18ß-GA group with four different concentrations. Furthermore, a pressure-overloaded rat model induced by trans-aortic constriction (TAC) was established. Echocardiography and hemodynamics were used to evaluate diastolic function at 14th day after TAC. Changes of free intracellular calcium (Ca2+) concentration was indirectly detected by laser scanning confocal microscope to confirm the inhibition of late sodium currents. With the intervention of ATX-II on ischemia reperfusion injury group, 5 µmol/L ranolazine, and 5, 10, 20, 40 µmol/L 18ß-GA could improve ATX-II-induced cardiac diastolic dysfunction. 630 mg/kg glycyrrhizin tablets could improve cardiac diastolic function in the pressure-overloaded rats. 18ß-GA and ranolazine had similar effects on reducing the free calcium in cardiomyocytes. The study demonstrates that 18ß-GA and glycyrrhizin could improve diastolic dysfunction induced by ischemia-reperfusion injury in Langendorff-perfused rat hearts and pressure-overloaded rats. The mechanism may be attributed to the inhibition of enhanced late sodium currents.

Epidemiology of jellyfish stings reported to summer health centres in the Salento peninsula (Italy).

BACKGROUND: The presence of jellyfish along coasts constitutes a potentially serious public health problem because of the toxic effects of contact with them. OBJECTIVE: To determine the epidemiology of jellyfish stings in the Province of Lecce, Italy, in 2007. METHODS: The study involved the gathering and processing of data on patients seeking medical treatment at summer first aid centres and hospitals along the coast of Salento following contact with jellyfish. RESULTS: In 2007, 446 bathers sought medical assistance following contact with jellyfish. The spatial distribution indicates a greater frequency of stings sustained along the Adriatic coast, while the time analysis shows patterns related to wind direction. Most of the injuries were seen in persons aged between 1 and 10 years and in females. In 24% of cases, injuries were sustained to several parts of the body, while single injuries were mainly to the lower limbs (33%). In 4.9% of cases, there were complications, including one case of anaphylactic shock. CONCLUSION: In the light of the significant level of medical assistance provided, there is a need to identify suitable strategies that will guarantee the best response in terms of both prevention and treatment.