First Report of Hb Youngstown in Capillary Electrophoresis and Overlapping Hb Analysis Findings with Hb Rush.

Hb Youngstown [HBB:c.305A > C] is a rare unstable hemoglobin caused by the substitution of glutamic acid with alanine at codon 101 of the Beta globin chain. It causes hemolytic anemia in the heterozygous state. This is a case of a six-year-old Chinese-Javanese girl with heterozygous Hb Youngstown and clinical features of chronic hemolysis and iron overload. Hb Youngstown appears at the S window near to 4.6 minutes on high-performance liquid chromatography (HPLC) and can form a hybrid tetramer on alkaline gel electrophoresis seen as two distinct bands cathodal to A and close to F. For the first time, Hb Youngstown is captured with capillary electrophoresis (CE) and shown to be eluted at zone 8. Clinical presentation and Hb analysis results of this heterozygous Hb Youngstown overlap with heterozygous Hb Rush. They can only be differentiated at molecular level by Beta globin gene sequencing or intact mass spectrometry.

The genome sequence of great wood-rush, Luzula sylvatica (Huds) Gaudin.

We present a genome assembly from an individual specimen of Luzula sylvatica (great wood-rush; Tracheophyta; Magnoliopsida; Poales; Juncaceae). The genome sequence is 444.5 megabases in span. Most of the assembly is scaffolded into 6 chromosomal pseudomolecules. The mitochondrial and plastid genome assemblies have lengths of 633.36 kilobases and 201.32 kilobases in length, respectively.

Venom immunotherapy in clinical practice: comparison of two ultra-rush protocols.

Summary: Background. Ultra-rush venom immunotherapy protocols have shown to be a safe and effective approach to prevent the occurrence of systemic reactions after hymenoptera stings. The aim was to describe our experience with two ultra-rush protocols - a five-step with 1 µg starting dose and a six-step with 0.1 µg starting dose, as well as to compare their safety profile. Methods. This is a retrospective study of all the patients who underwent VIT with honey bee or wasp venom between January 2008 and December 2021, in our department. Results. A total of 110 patients was included, with 109 patients (99%) completing the protocol. A total of 63 (57%) patients had no local or systemic reactions. Most systemic reactions occurred with 20 µg or higher doses (24, 83%). There were no documented grade IV systemic reactions (Mueller grading). No differences were found in local or systemic reactions regarding sex, atopy, ß-blocker medication, the severity of the index reaction, ID test positivity, levels of total IgE, specific IgE and tryptase (all p > 0.05). Younger age, treatment with bee VIT or being a beekeeper were associated with more systemic reactions (p = 0.035, 0.006 and 0.047, respectively). No statistical differences in the number of local and systemic reactions were found when comparing both protocols (p = 1.000). Conclusions. Ultra-rush protocols are safe and effective, but systemic reactions are to be expected, especially with honeybee. Our data supports that ACE inhibitors do not compromise safety. Beginning with 1 µg is safe and can save time and resources.

Use of Point-of-Care Ultrasound to Diagnose a Ruptured Splenic Hemangioma.

An 89-year-old female presented to the emergency department (ED) with hypotension and altered mental status. The patient had no external signs of trauma or hemorrhage and no abdominal tenderness on examination. The patient remained hypotensive after initial fluid resuscitation, and laboratory testing revealed a significant anemia. Point-of-care ultrasound (POCUS) was used to perform a rapid ultrasound in shock (RUSH) exam in an attempt to uncover the etiology of undifferentiated hypotension. The exam displayed free fluid in the right upper quadrant and the left upper quadrant exam demonstrated a large splenic lesion with mixed echogenicity. Subsequent computed tomography (CT) of the abdomen and pelvis with intravenous contrast suggested a ruptured hemorrhagic splenic cyst, and the patient underwent an emergent splenectomy for hemorrhage control. Operative pathologic examination revealed the cystic lesion to be a splenic hemangioma. This case report highlights the utility of the Rapid Ultrasound for Shock and Hypotension (RUSH) protocol when evaluating patients with undifferentiated nontraumatic shock, and a rare cause of spontaneous intra-abdominal hemorrhage.

Hyperuricemia - consequences of not initiating therapy. Benefits and drawbacks of treatment.

Hyperuricemia, characterized by elevated levels of uric acid in the body, is associated with several health risks, including gout, urolithiasis and cardiovascular disease. Although treatment options are available, they can lead to hypersensitivity reactions, particularly with allopurinol therapy. This paper provides a comprehensive review of the consequences of hyperuricemia, the need for treatment and the potential adverse effects of allopurinol, illustrated by a case study. The study highlights the importance of careful consideration before initiating therapy, particularly in patients with comorbidities and concomitant medication. It emphasizes the need for vigilant monitoring and individualized treatment approaches to reduce adverse effects. In addition, genetic factors, particularly HLA-B*5801, play an important role in determining susceptibility to allopurinol hypersensitivity reactions. This paper highlights the importance of informed decision making in the management of hyperuricemia to optimize patient outcomes while minimizing the risks associated with treatment.

Managing systemic reactions and venom immunotherapy in vespid-venom allergy: observations from a retrospective study of Portuguese patients.

Summary: Background. Vespula spp. and Polistes spp. are relevant species in South Europe, with Vespa velutina nigrithorax (VVN) being considered a public health problem. We aimed to characterize a cohort of Portuguese patients referred for large local reaction (LLR) and/or systemic reaction (SR) to vespids. In patients treated with venom immunotherapy (VIT), induction protocol and frequency of adverse reactions were evaluated. Methods. Retrospective study including patients with LLR and SR to vespids referred to our Immunoallergology Department (2008-2022). Results. A total of 129 patients were evaluated, the majority were male adults (n = 77, 59.7%), from rural areas. From these, 51 patients had SR (Mueller classification: 7.8% grade I, 19.6% grade II, 37.3% grade III, 35.3% grade IV). We found no differences regarding the levels of total serum IgE, basal serum tryptase value, sIgE levels to the eliciting venom or their molecular components, regarding the severity of the SR that motivated the referral to our clinic. In the SR group, previous LLR Hymenoptera sting were reported in 15.7%. Thirty-eight patients (74.5%) initiated VIT: 22 with wasp venom, 14 with paper wasp venom and 2 with Vespa velutina venom. There was one mild systemic reaction, not requiring adrenaline and 4 LLR. Re-stings after VIT occurred in 16 patients, without any systemic or local reactions. Currently, eleven patients remain under VIT. Conclusions. Most vespid-venom allergic patients are male adults from rural areas. Sensitization to wasp venom was present in 52.9%, paper wasp in 33.3% and Vespa velutina in 13.7%. The frequency of adverse reactions during both induction and maintenance phases appears to be low. Despite a reduced sample size, our experience with VVN VIT, suggests its safety.

Rapid Ultrasonography for Shock and Hypotension Protocol Performed using Handheld Ultrasound Devices by Paramedics in a Moving Ambulance: Evaluation of Image Accuracy and Time in Motion.

INTRODUCTION: Handheld ultrasound (US) devices have become increasingly popular since the early 2000s due to their portability and affordability compared to conventional devices. The Rapid Ultrasonography for Shock and Hypotension (RUSH) protocol, introduced in 2009, has shown promising accuracy rates when performed with handheld devices. However, there are limited data on the accuracy of such examinations performed in a moving ambulance. This study aimed to assess the feasibility and accuracy of the RUSH protocol performed by paramedics using handheld US devices in a moving ambulance. OBJECTIVES: The study aimed to examine the performability of the RUSH protocol with handheld US devices in a moving ambulance and to evaluate the accuracy of diagnostic views obtained within an appropriate time frame. METHODS: A prospective study was conducted with paramedics who underwent theoretical and practical training in the RUSH protocol. The participants performed the protocol using a handheld US device in both stationary and moving ambulances. Various cardiac and abdominal views were obtained and evaluated for accuracy. The duration of the protocol performance was recorded for each participant. RESULTS: Nine paramedics completed the study, with 18 performances each in both stationary and moving ambulance groups. The accuracy of diagnostic views obtained during the RUSH protocol did not significantly differ between the stationary and moving groups. However, the duration of protocol performance was significantly shorter in the moving group compared to the stationary group. CONCLUSION: Paramedics demonstrated the ability to perform the RUSH protocol effectively using handheld US devices in both stationary and moving ambulances following standard theoretical and practical training. The findings suggest that ambulance movement does not significantly affect the accuracy of diagnostic views obtained during the protocol. Further studies with larger sample sizes are warranted to validate these findings and explore the potential benefits of prehospital US in dynamic environments.

Percutaneous intramedullary screw or rush pin fixation of unstable ankle fractures in patients with fragile soft tissue - retrospective study of 80 cases.

INTRODUCTION: The standard surgical procedure for unstable ankle fractures is fixation of the lateral malleolus with a plate and screws. This method has a high risk of complications, especially among patients with fragile skin conditions. The aim of this study was to estimate the re-operation rates and identify complications in patients with an unstable ankle fracture, surgically treated with an intramedullary screw or rush pin. MATERIALS AND METHODS: We identified all patients who were surgically treated with either a 3.5-mm screw or rush pin at Aarhus University Hospital, Denmark, from 2012 to 2018. Major complications were re-operations within three months. We included 80 patients, of which 55 (69%) were treated with a 3.5-mm intramedullary screw and 25 (31%) with a rush pin. The majority of the study population was female (59) and the mean age was 75 (range 24 to 100) years. Of the 80 patients included, 41 patients had more than 2 comorbidities. RESULTS: Three patients underwent re-operation within three months due to either fracture displacement or hardware cutout. Radiographs obtained after six weeks showed that nine patients had loss of reduction. Additionally, four patients had superficial wound infections and six patients had delayed wound healing. CONCLUSIONS: Intramedullary fixation of distal fibula fractures with either a screw or rush pin has low re-operation rates. However, the high proportion of patients with radiological loss of reduction is concerning.

Inhibition of Autophagy Alters Intracellular Transport of APP Resulting in Increased APP Processing.

Alzheimer's disease (AD) pathology is characterized by amyloid beta (Aß) plaques and dysfunctional autophagy. Aß is generated by sequential proteolytic cleavage of amyloid precursor protein (APP), and the site of intracellular APP processing is highly debated, which may include autophagosomes. Here, we investigated the involvement of autophagy, including the role of ATG9 in APP intracellular trafficking and processing by applying the RUSH system, which allows studying the transport of fluorescently labeled mCherry-APP-EGFP in a systematic way, starting from the endoplasmic reticulum. HeLa cells, expressing the RUSH mCherry-APP-EGFP system, were investigated by live cell imaging, immunofluorescence, and Western blot. We found that mCherry-APP-EGFP passed through the Golgi faster in ATG9 knockout cells. Furthermore, ATG9 deletion shifted mCherry-APP-EGFP from early endosomes and lysosomes toward the plasma membrane concomitant with reduced endocytosis. Importantly, this alteration in mCherry-APP-EGFP transport resulted in increased secreted mCherry-soluble APP and C-terminal fragment-EGFP. These effects were also phenocopied by pharmacological inhibition of ULK1, indicating that autophagy is regulating the intracellular trafficking and processing of APP. These findings contribute to the understanding of the role of autophagy in APP metabolism and could potentially have implications for new therapeutic approaches for AD.

Teaching Medical Students Rapid Ultrasound for shock and hypotension (RUSH): learning outcomes and clinical performance in a proof-of-concept study.

BACKGROUND: Point-of-care ultrasound (POCUS) is a critical diagnostic tool in various medical settings, yet its instruction in medical education is inconsistent. The Rapid Ultrasound for Shock and Hypotension (RUSH) protocol is a comprehensive diagnostic tool, but its complexity poses challenges for teaching and learning. This study evaluates the effectiveness of a single-day training in RUSH for medical students by assessing their performance in clinical scenarios. METHODS: In this prospective single-center observational proof-of-concept study, 16 medical students from Saarland University Medical Center underwent a single-day training in RUSH, followed by evaluations in clinical settings and on a high-fidelity simulator. Performance was assessed using a standardized scoring tool and time to complete the RUSH exam. Knowledge gain was measured with pre- and post-training written exams, and diagnostic performance was evaluated with an objective structured clinical examination (OSCE). RESULTS: Students demonstrated high performance in RUSH exam views across patients (median performance: 85-87%) and improved scanning times, although not statistically significant. They performed better on simulators than on live patients. Written exam scores significantly improved post-training, suggesting a gain in theoretical knowledge. However, more than a third of students could not complete the RUSH exam within five minutes on live patients. CONCLUSIONS: Single-day RUSH training improved medical students' theoretical knowledge and simulator performance but translating these skills to clinical settings proved challenging. The findings suggest that while short-term training can be beneficial, it may not suffice for clinical proficiency. This study underscores the need for structured and possibly longitudinal training programs to ensure skill retention and clinical applicability.

Genetic associations with dementia-related proteinopathy: Application of item response theory.

INTRODUCTION: Although dementia-related proteinopathy has a strong negative impact on public health, and is highly heritable, understanding of the related genetic architecture is incomplete. METHODS: We applied multidimensional generalized partial credit modeling (GPCM) to test genetic associations with dementia-related proteinopathies. Data were analyzed to identify candidate single nucleotide variants for the following proteinopathies: Aß, tau, α-synuclein, and TDP-43. RESULTS: Final included data comprised 966 participants with neuropathologic and WGS data. Three continuous latent outcomes were constructed, corresponding to TDP-43-, Aß/Tau-, and α-synuclein-related neuropathology endophenotype scores. This approach helped validate known genotype/phenotype associations: for example, TMEM106B and GRN were risk alleles for TDP-43 pathology; and GBA for α-synuclein/Lewy bodies. Novel suggestive proteinopathy-linked alleles were also discovered, including several (SDHAF1, TMEM68, and ARHGEF28) with colocalization analyses and/or high degrees of biologic credibility. DISCUSSION: A novel methodology using GPCM enabled insights into gene candidates for driving misfolded proteinopathies. HIGHLIGHTS: Latent factor scores for proteinopathies were estimated using a generalized partial credit model. The three latent continuous scores corresponded well with proteinopathy severity. Novel genes associated with proteinopathies were identified. Several genes had high degrees of biologic credibility for dementia risk factors.

Spatial-Temporal Mapping Reveals the Golgi as the Major Processing Site for the Pathogenic Swedish APP Mutation: Familial APP Mutant Shifts the Major APP Processing Site.

Alzheimer's disease is associated with increased levels of amyloid beta (Aß) generated by sequential intracellular cleavage of amyloid precursor protein (APP) by membrane-bound secretases. However, the spatial and temporal APP cleavage events along the trafficking pathways are poorly defined. Here, we use the Retention Using Selective Hooks (RUSH) to compare in real time the anterograde trafficking and temporal cleavage events of wild-type APP (APPwt) with the pathogenic Swedish APP (APPswe) and the disease-protective Icelandic APP (APPice). The analyses revealed differences in the trafficking profiles and processing between APPwt and the APP familial mutations. While APPwt was predominantly processed by the ß-secretase, BACE1, following Golgi transport to the early endosomes, the transit of APPswe through the Golgi was prolonged and associated with enhanced amyloidogenic APP processing and Aß secretion. A 20°C block in cargo exit from the Golgi confirmed ß- and γ-secretase processing of APPswe in the Golgi. Inhibition of the ß-secretase, BACE1, restored APPswe anterograde trafficking profile to that of APPwt. APPice was transported rapidly through the Golgi to the early endosomes with low levels of Aß production. This study has revealed different intracellular locations for the preferential cleavage of APPwt and APPswe and Aß production, and the Golgi as the major processing site for APPswe, findings relevant to understand the molecular basis of Alzheimer's disease.

Solar urticaria: clinical characteristics, treatment effectiveness, long-term prognosis, and QOL status in 29 patients.

Introduction: Solar urticaria (SU), a relatively rare skin inflammatory and photosensitivity disease, is often resistant to standard urticaria treatment. Quality of life (QOL) among SU patients has not been extensively explored. This study was performed to clarify the clinical features and effectiveness of therapies (e.g., hardening therapy) for SU and to determine QOL among SU patients. Methods: The authors examined the characteristics, treatments, and QOL statuses of 29 Japanese SU patients using medical records and a questionnaire approach. Results: Among 29 patients, H1 antihistamine therapy (H1) was effective in 22 (75.8%) patients. H2 antihistamine therapy (H2) was effective in three of seven (42.9%) patients. Ultraviolet radiation A (UVA) hardening therapy was effective in eight of nine (88.9%) patients. Visible light (VL) hardening therapy was ineffective in three of three patients. In one patient who underwent both UVA and VL hardening therapy, only UVA hardening therapy was effective. In the questionnaire, 18 patients (90%) reported some improvement compared with disease onset (four had complete remission, six had completed treatment although mild symptoms persisted, and eight were receiving treatment with moderate symptoms), whereas two patients reported exacerbation. Patients in complete remission had a mean disease duration of 4 years, whereas patients not in remission had a mean disease duration of 8.8 years. The mean Dermatology Life Quality Index (DLQI) score for the current status was 7.4. There was a correlation between DLQI and symptom/treatment status. However, neither DLQI and action spectra nor DLQI and treatments exhibited significant differences. Discussion: The questionnaire revealed current QOL status and long-term prognosis in SU patients. Compared with disease onset, most patients showed improvement when assessed for this study. Both H1 and H2 should be attempted for all SU patients. UVA hardening therapy may be an option for SU patients with an action spectrum that includes UVA.

Rush to Charge, Dead to Drive: Application of Deadline Rush Model to Electric Vehicle User's Charging Behavior.

OBJECTIVE: This work aims to estimate the portion of electric vehicle (EV) users who exhibit procrastination-like behavior, almost equivalent to an "empty" battery, before they decide to charge their vehicles. BACKGROUND: There is a human tendency to procrastinate when a deadline approaches. Human behavior in the presence of deadlines has been studied in different fields to evaluate individuals' performance or organizational efficiency and effectiveness. However, this phenomenon has not been investigated among EV users. METHOD: This study explores users' procrastination-like behavior among 69 Rhode Island public charging stations' data representing 70,611 charging events. The Deadline Rush Model is incorporated to model frequent users' charging profiles. To conduct a robust estimation, the Bayesian Mixture Model is implemented. RESULTS: With the selection of an informative prior, the Bayesian Mixture Model estimated that almost one-third of frequent users procrastinate charging. CONCLUSION: The majority of procrastination-like users have small battery sizes. Although procrastination-like users need to charge when they arrive at a location, that might not necessarily be true for a plug-in hybrid; thus, systematically, they can clog the system for other users whose needs are more pressing. Understanding unique and unexplored charging behaviors among EV users is beneficial to EV infrastructure stakeholders in reducing the adoption threshold by providing a reliable and ubiquitous charging network. APPLICATION: The findings identify a different kind of demand on the EV infrastructure than previously modeled and can directly influence future decision-making criteria in terms of planning to optimize to accommodate EV drivers with different charging behaviors.

Loss of the Golgi-localized v-ATPase subunit does not alter insulin granule formation or pancreatic islet ß-cell function.

Delayed Golgi export of proinsulin has recently been identified as an underlying mechanism leading to insulin granule loss and ß-cell secretory defects in type 2 diabetes (T2D). Because acidification of the Golgi lumen is critical for proinsulin sorting and delivery into the budding secretory granule, we reasoned that dysregulation of Golgi pH may contribute to proinsulin trafficking defects. In this report, we examined pH regulation of the Golgi and identified a partial alkalinization of the Golgi lumen in a diabetes model. To further explore this, we generated a ß-cell specific knockout (KO) of the v0a2 subunit of the v-ATPase pump, which anchors the v-ATPase to the Golgi membrane. Although loss of v0a2 partially neutralized Golgi pH and was accompanied by distension of the Golgi cisternae, proinsulin export from the Golgi and insulin granule formation were not affected. Furthermore, ß-cell function was well preserved. ß-cell v0a2 KO mice exhibited normal glucose tolerance in both sexes, no genotypic difference to diet-induced obesity, and normal insulin secretory responses. Collectively, our data demonstrate the v0a2 subunit contributes to ß-cell Golgi pH regulation but suggest that additional disturbances to Golgi structure and function contribute to proinsulin trafficking defects in diabetes.NEW & NOTEWORTHY Delayed proinsulin export from the Golgi in diabetic ß-cells contributes to decreased insulin granule formation, but the underlying mechanisms are not clear. Here, we explored if dysregulation of Golgi pH can alter Golgi function using ß-cell specific knockout (KO) of the Golgi-localized subunit of the v-ATPase, v0a2. We show that partial alkalinization of the Golgi dilates the cisternae, but does not affect proinsulin export, insulin granule formation, insulin secretion, or glucose homeostasis.

Test for abnormal niacin response syndrome in schizophrenia: reclaiming the oral route / Prueba de síndrome de respuesta a niacina anormal en pacientes con diagnóstico de esquizofrenia: reivindicando la vía oral.

Introduction: Although there is an abnormal presentation of Niacin Response Syndrome (ANRS) in schizophrenic patients (SZ) compared to subjects with other psychiatric illnesses and with healthy individuals. However, most of the literature is based on studies that have used tests of niacin topical administration, observing, on the other hand, less scientific production of its oral administration. The objective was to determine the sensitivity of the oral niacin test as a method of detecting ASRN in EZ. Methods: A non-randomized clinical trial was carried out. Two groups were formed, the experimental or SZ, with 21 patients diagnosed with schizophrenia according to DSM-IV-TR SZ or schizoaffective disorder, and the HC group, made up of 20 healthy controls. Both groups were exposed to an oral niacin test and clinical-semiological tools were applied to evaluate the NRS. Results: 90.5% of the SZ group presented ANRS. In contrast, no participant in the HC group presented ANRS (0%). Conclusions: Oral niacin administration was sensitive to the detection of ASRN in schizophrenia. Likewise, ASRN could be a gradual phenomenon and its prevalence could be dose-dependent, being lower the lower the dose of oral niacin used. Further trials with larger and randomized samples will be needed.

Introducción: En pacientes esquizofrénicos (EZ) existe un síndrome de respuesta a niacina (ASRN) anormal en comparación con sujetos con otras enfermedades psiquiátricas y con individuos sanos. Sin embargo, la mayor parte de la literatura se basa en estudios que han utilizado pruebas de niacina por vía tópica, observándose, en cambio, menor cantidad de ensayos utilizando su administración por vía oral, a pesar de existir algunas ventajas comparativas con el uso de esta última vía. El objetivo fue determinar la sensibilidad de la prueba de niacina por vía oral como método de detección del ASRN en EZ. Metodología: Se realizó un ensayo clínico no aleatorizado, conformando dos grupos, el grupo experimental o EZ, con 21 pacientes con diagnóstico de esquizofrenia según DSM-IV-TR SZ o trastorno esquizoafectivo, y el grupo CS, constituido por 20 controles sanos. Ambos grupos fueron expuestos a la prueba de niacina por vía oral y se aplicaron herramientas clínico-semiológicas para evaluar el SRN. Resultados: La prevalencia de ASRN fue del 90,5% en el grupo EZ, mientras que en el grupo CS fue nula (0%). Conclusiones: La administración oral de niacina fue sensible a la detección de ASRN en la esquizofrenia. Asimismo, la ASRN podría ser un fenómeno gradual y su prevalencia podría ser dosis-dependiente, siendo menor cuanto menor sea la dosis de niacina oral utilizada. Se necesitarán ensayos adicionales con muestras de mayor tamaño y aleatorizadas.

A comparative study of early functional outcomes in undisplaced neck of femur fracture treated with partially threaded and fully threaded cannulated screw fixation in patients above 60 years age.

Objective: To compare the partially threaded versus fully threaded cannulated screw fixation methods in stable neck of femur fracture in terms of early functional outcomes in patients of age 60 and above. Methods: A randomized controlled trial was conducted at Orthopedic Unit-II, Mayo Hospital Lahore, Pakistan from July 2021 to July 2022. A total of 82 (41 in each group) patients of both genders, aged 60 or above were included. All patients had garden Type-I or II and were mobile before they fractured the femoral neck were included. In Group-A, cannulated screw fixation (cancellous screws 6 mm) was done using partially threaded screws while fully threaded screws (cancellous screws 6 mm) were used in Group-B. Patients were followed up at six weeks, three months and six months interval for "Radiographic Union Scale for Hip (RUSH)" and "Harris Hip score". Results: In a total of 82 (41 in each group) patients, 66 (80.5%) we male. At 6th week (p=0540) and 3rd month (p=0.653) postoperatively, no significant differences were seen between groups for Hip Harris score. However, at 6th month, functional outcome of Group-B patients was significantly better as compared to Group-A (p=0.038). Mean RUSH score in Group-A and in Group-B at 6th month postoperative was 25.45±2.73 and 30.52±2.39 (p<0.001). Conclusion: Fully threaded cannulated screw fixation is better in treating undisplaced neck of femur fracture as compared to partially threaded cannulated screw fixation in terms of early functional outcomes among the age group of 60 years and above.RCT Registration number: NCT05587660.

Out of the Blue: Methemoglobinemia Associated With the Use of Amyl Nitrite in Rush Poppers for Erectile Stimulation.

We report a clinical scenario involving a 51-year-old male patient with a history of prediabetes and gastritis who exhibited altered mental status following the consumption of poppers, a supplement containing nitrites, which is used for erectile stimulation. Shortly after the ingestion, the patient experienced convulsions, foaming at the mouth, and subsequently developed altered mental status and severe respiratory distress. The diagnosis of methemoglobinemia was confirmed based on elevated methemoglobin levels on venous blood gas analysis. Notably, the patient's blood had a chocolate-colored appearance upon admission, which is a characteristic finding in methemoglobinemia. Prompt recognition and management, including the administration of methylene blue, led to the resolution of symptoms. This case highlights the potential complications associated with the consumption of poppers and emphasizes the importance of early intervention.

Exercise-Induced Allergic Reactions in Children Desensitized to Hen's Eggs and Cow's Milk by Oral Immunotherapy.

BACKGROUND: Exercise-induced allergic reactions on desensitization (EIARDs) after successful in-hospital rush oral immunotherapy (OIT) for wheat allergy have been reported. However, the incidence rates of EIARDs after rush OIT for egg allergy and milk allergy have not been determined. OBJECTIVE: To determine the frequency of EIARDs and risk factors associated with rush OIT for egg and milk allergy. METHODS: This retrospective chart review, conducted in January 2020, enrolled 64 and 43 patients who underwent rush OIT for egg and milk allergy, respectively (in 2010 to 2014). In particular, 48 and 32 desensitized patients underwent exercise-provocation tests (Ex-P) after allergen administration (4,400 mg boiled egg white and 6,600 mg cow's milk protein, respectively). The EIARDs were determined by Ex-P or a suspicious event even after passing the Ex-P. Specific IgE levels to egg white, cow's milk, ovomucoid, casein, α-lactalbumin, and ß-lactoglobulin were analyzed using ImmunoCAP. RESULTS: At least one episode of EIARD was observed in 10 and 17 patients with egg and milk allergy (21% and 53%), respectively, which persisted for more than 5 years in one patient with egg allergy (2.1%) and 11 patients with milk allergy (34.4%) as of January 2020. We could not find background differences between the EIARD-positive and EIARD-negative groups, except that the egg white-specific IgE/total IgE ratio before rush OIT was significantly higher in patients with egg allergy with EIARD than in those without it. CONCLUSIONS: Exercise-induced allergic reactions on desensitization were more frequent and common in patients with milk allergy. Moreover, EIARDs to milk allergy were more likely to persist than those to egg allergy.