Peripheral vascular manifestation in patients receiving an amphetamine analog: A case series.

Amphetamine and its related derivatives and analogues (ADRA) are highly addictive central nervous system stimulants that are used commonly in the treatment of attention-deficit/hyperactivity disorder and narcolepsy. These medications are associated with many side effects but reports of peripheral arterial manifestations associated with ADRA usage are scarce. We retrospectively reviewed the records of 16 patients (median age 37 years (IQR 31-47), 13 females) referred to a single tertiary referral service while receiving ADRA. Follow-up was available for a median of 3 years (IQR 3-4.5). The most common presentation (62.5%) was mild vasospastic symptoms involving the upper, lower or both extremities. Six patients developed severe manifestations including tissue loss and the need for lower extremity amputation. Most patients (75%) refused to stop the medication during follow-up. Underlying rheumatologic disorders were found in 25% of the patients, and the presence of rheumatologic disease seemed to be associated with more severe vascular manifestations. In conclusion, it is important to search for ADRA usage as part of the differential diagnosis of digital ischemia.

Modeling tribal exposures to methyl mercury from fish consumption.

Exposure assessment and risk management considerations for tribal fish consumption are different than for the general U.S. population because of higher fish intake from subsistence fishing and/or from unique cultural practices. This research summarizes analyses of available data and methodologies for estimating tribal fish consumption exposures to methyl mercury (MeHg). Large MeHg fish tissue data sets from the Environmental Protections Agency's (EPA's) Office of Water, USGS's EMMMA program, and other data sources, were integrated, analyzed, and combined with fish intake (consumption) data for exposure analyses using EPA's SHEDS-Dietary model. Results were mapped with GIS tools to depict spatial distributions of the MeHg in fish tissues and fish consumption exposure patterns. Contribution analyses indicates the major sources for those exposures, such as type and length of fish, geographical distribution (water bodies), and dietary exposure patterns. Sensitivity analyses identify the key variables and exposure pathways. Our results show that MeHg exposure of tribal populations from fish are about 3 to 10 times higher than the US general population and that exposure poses potential health risks. The estimated risks would be reduced as much as 50%, especially for high percentiles, just by avoiding consumption of fish species with higher MeHg concentrations such as walleye and bowfin, even without changing total fish intake. These exposure assessment methods and tools can help inform decisions regarding meal sizes and frequency, types of fish and water bodies to avoid, and other factors to minimize exposures and potential health risks from contaminated fish on tribal lands.