Cathinone derivatives (bath salts) have emerged as the latest drugs of abuse. 3,4-methylenedioxypyrovalerone (MDPV) is the primary active ingredient in bath salts used in this country. This article presents the second reported cause of death by MDPV intoxication alone. In April 2011, a delusional man was emergently brought to a hospital, where he self-reported bath salt usage. He became agitated, developed ventricular tachycardia, hyperthermia, and died. Comprehensive alcohol and drug testing was performed. Using the alkaline drug screen, heart blood contained 0.7 mg/L MDPV and peripheral blood contained 1.0 mg/L MDPV. His bizarre behavior with life-threatening hyperthermia was consistent with an MDPV-induced excited delirium state. MDPV is not yet found by routine immunoassay toxicology screens. Testing for MDPV should be considered in cases with a history of polysubstance abuse with stimulant type drugs, report of acute onset of psychogenic symptoms, excited delirium syndrome, or presentation in a hyperthermic state.
California Verbal Learning Test-Children's Version (CVLT-C) indices have been shown to be sensitive to the neurocognitive effects of traumatic brain injury (TBI). The effects of TBI on the learning process were examined with a growth curve analysis of CVLT-C raw scores across the 5 learning trials. The sample with history of TBI comprised 86 children, ages 6-16 years, at a mean of 10.0 (SD=19.5) months postinjury; 37.2% had severe injury, 27.9% moderate, and 34.9% mild. The best-fit model for verbal learning was with a quadratic function. Greater TBI severity was associated with lower rate of acquisition and more gradual deceleration in the rate of acquisition. Intelligence test index scores, previously shown to be sensitive to severity of TBI, were positively correlated with rate of acquisition. Results provide evidence that the CVLT-C learning slope is not a simple linear function and further support for specific effects of TBI on verbal learning.
The Valsalva maneuver is used in clinical medicine for the diagnosis and/or treatment of various cardiovascular conditions. It can also be used in activities of daily living, such as defecation. Due to the cardiovascular effects produced during the Valsalva maneuver, it may be contraindicated in certain medical conditions and could be a trigger of sudden cardiac death. The incidence and prevalence of death following Valsalva maneuver in the presence of underlying cardiovascular disease, or "commode cardia," has not been examined. In 2012, the Wayne County Medical Examiner's Office (Detroit, MI) investigated 21 deaths that occurred on the toilet, fourteen of which were due to cardiovascular disease. In another 31 deaths in the bathroom due to cardiovascular disease, the possibility that the decedent defecated immediately prior to death could not be excluded. Hence, the incidence of commode cardia in this population ranges from 2.3 to 7.4% of all cardiovascular-related deaths.
Background Acute rheumatic fever triggered by pharyngeal and skin Group A Streptococcal infections (GAS) disproportionately affects indigenous Māori schoolchildren. This stepped-wedged study in Whakatāne, New Zealand compared whole-school-cluster allocated Streptococcus salivarius probiotic effectiveness on GAS pharyngeal prevalence (carriage and pharyngitis) following antibiotics, compared to antibiotics-alone for GAS positive children. Each of two clusters followed a sequence with a different Streptococcus salivarius exposure period over ten winter weeks in 2015. Method Both clusters had high Māori schoolchildren rolls (99% and 81%) at high risk of acute rheumatic fever. The parents/guardians of 60% of eligible schoolchildren consented. Schoolchildren had pharyngeal swabs and sore-throat questionnaires administered by external student-nurses, informing GAS prevalence (primary outcome) and pharyngitis (secondary outcome). GAS positive schoolchildren’s usual care was 10 days once-daily oral amoxicillin. One whole cluster then commenced S. salivarius daily for 30 days. The other initial control cluster had S. salivarius six weeks later, after both clusters were re-swabbed, and GAS positive schoolchildren treated. Student-nurses and laboratory scientists assessing outcomes were blinded to prior S. salivarius exposure. S. salivarius and control period findings were compared. Results Per-protocol efficacy, informed by study swabs, showed Odds of pharyngeal GAS prevalence reduced substantially, but not significantly 0.6 (95% CI 0.29–1.21) for added S. salivarius, (n 235) compared to antibiotics-alone (n 106). Subgroup analysis of 197 originally GAS negative schoolchildren’s swabs found significantly reduced Odds of GAS prevalence with S. salivarius 0.42 (95% CI 0.19–0.94). compared to controls (n 80). Intention to treat analysis utilizing study swabs showed S. salivarius effectively reduced GAS prevalence from 15.5–7.4%, Odds 0.52 (95% CI 0.28–0.97) (n 309) compared to antibiotics-alone (n 157). Intention to treat sub-analysis utilizing all swabs for 260 GAS negative schoolchildren, demonstrated S. salivarius effectiveness Odds 0.52 (95% CI 0.27-1.00) compared to 131 controls. GAS pharyngitis declined from 10/128 to 2/128 over three months Odds 0.19 (95%CI 0.04–0.87) following antibiotics and S. salivarius. Conclusion Whole-cluster S. salivarius probiotic, given after antibiotic treatment of schoolchildren with pharyngeal GAS, significantly reduces GAS pharyngeal prevalence, carriage, and pharyngitis, by limiting GAS negative schoolchildren acquiring Group A Streptococcus. Trial registration ACTRN12615000402549
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