Since 2009, more than 140 different synthetic cannabinoids (SC) have been identified in herbal mixtures consumed as recreational drugs. Knowledge of the acute toxicity of each individual compound remains sparse. Here we present a retrospective observational case series of patients presenting to emergency departments with analytically confirmed intake of JWH-210 as the only SC detected in serum samples. Cases were selected from a poison centre database from March 2011 to June 2014. In total, 22 patients were included (aged 12-25 years, median 17.5; 18 males 4 female). JWH-210 was identified in the serum samples in concentrations ranging from 0.18 to 90 ng/mL. Tachycardia, nausea, somnolence, hypokalemia, hypertension, restlessness, and/or agitation were most frequently reported. Diplopia, seizures, syncope, and ECG changes such as T-wave inversion and bradycardia were also noted. Acute adverse effects of JWH-210 typically include central nervous system depression or cerebral seizures, but also signs of sympathomimetic toxicity. Nausea was reported in 80% and typically shows a sudden onset shortly after inhalation, suggesting a central nervous effect possibly mediated by CB receptors. Cardiovascular effects are reported in up to 80% of the patients and might not only include alterations in blood pressure and heart rate, but also changes in the electrocardiogram (ECG). JWH-210 as a representative of a strong CB receptor agonist confirms previous reports about adverse effects of SC, but shows a distinct quantitative pattern of symptoms, compared to several other SC. Copyright © 2016 John Wiley & Sons, Ltd.

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This case illustrates that in the context of overdose, repaglinide can lead to prolonged hypoglycemia. We therefore recommend glucose monitoring and observation for 24 h in all patients who remain hypoglycemic or show symptoms of hypoglycemia for an unusually long period of time.

Background Lectures are still an important part of today’s medical education at many medical schools. The pediatric lecture series at the Center for Pediatrics, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, Germany had been evaluated poorly in recent terms. Methods To improve lecture quality and possibly evaluation results a combination of measures consisting of peer lecturer coaching, use of an audience response system, in depth analysis of the end of term evaluation results and changes to the exam itself were implemented. Results Peer lecturer coaching was performed successfully and both the audience response system evaluation as well as the end of term evaluation results improved significantly in the following term. Analysis of the students’ comments revealed more approval of lecture content and presentation after the organization of the lecture series was changed towards less lecturers and focus on less topics. Student-perceived high exam difficulty influenced the evaluation negatively. Conclusion The student-perceived exam difficulty can supersede the effects of different measures to improve lecture quality measured via evaluation. Whether better evaluation of the lecture series after different improvement measures was due to better match of the curriculum with the exam content or that an improved curriculum led to better exam performance remains to be elucidated.

mTOR inhibitors have a wide spectrum of therapeutic applications in adults and children. Little is known, however, about serious adverse effects in children undergoing mTOR inhibitor therapy. Oral ulcers are common and sometimes severe, but no other gastrointestinal involvement has been reported so far. Here we present a case of everolimus-associated perianal ulcers in an eight-month-old infant, 3 months after heart transplantation, which necessitated the drug's discontinuation. In a thorough series of diagnostic tests, we identified no other cause for the progressive perianal ulceration. The recognition and appropriate management of mTOR inhibitors' adverse effects in pediatric patients are essential and remain challenging.