Varun Vohra

: Centipedes are among the largest terrestrial arthropods. Modified walking appendages called forcipules are connected to venom glands and used for predation and defense. Centipede envenomations in humans are relatively rarely reported; however, they can produce clinically significant effects. Most clinical cases are attributed to the genus Scolopendra . Scolopendra dehaani ( S. dehaani ), the giant Vietnamese centipede, is the largest of the Asian centipedes. A paucity of clinical literature exists on envenomation by S. dehaani , originally considered a subspecies of Scolopendra subspinipes but now identified as an independent species. A 55-year-old man was envenomated on his left index finger by S. dehaani and reported excruciating pain with progressive erythema and edema. He required multiple doses of opioids and a parenteral antihistamine with gradual, yet incomplete, symptom improvement. The centipede was morphologically identified as S. dehaani . Three months post-envenomation, the patient reported residual numbness and swelling and a relatively limited range of motion in the affected finger.

Background: Bupropion is a common cause of drug-induced seizures, but evidence guiding prophylactic therapy is limited. No prospective head-to-head comparison of phenobarbital and benzodiazepines for symptomatic bupropion overdose has been reported. Methods: We performed a 6-month prospective observational cohort study of patients with symptomatic bupropion overdose. Patients were grouped by receipt of seizure prophylaxis versus no prophylaxis, with agent-specific exploratory analyses for phenobarbital and lorazepam. Baseline characteristics and clinical outcomes were summarized using descriptive statistics. Continuous variables were assessed for normality using Shapiro-Wilk testing and summarized as median and interquartile range (IQR) when non-normally distributed. Categorical outcomes were compared using two-tailed Fisher exact tests with statistical significance defined as p < 0.05. Exploratory logistic regression evaluated seizure odds by prophylaxis group with and without adjustment for initial heart rate. Results: Fifty-five patients were enrolled: 39 received prophylaxis and 16 who did not receive recommended prophylaxis and served as controls. The prophylaxis agents used were phenobarbital in 20 patients, lorazepam in 12, other benzodiazepines in 6, and combined phenobarbital plus lorazepam in 1. Initial heart rate was 114 bpm (IQR 97–133.5) in the prophylaxis group versus 109 bpm (IQR 103.5–117.8) in controls. Reported ingestion dose was 2.70 g (IQR 1.39–5.18) versus 1.80 g (IQR 0.98–7.13), respectively. Three patients had a documented seizure history and were in the prophylaxis group, none of which experienced a seizure. Overall seizure incidence was lower with prophylaxis but did not reach statistical significance (1/39 [2.6%] vs 3/16 [18.8%]; p = 0.069). Proconvulsant co-ingestions were similar between groups (12/39 [30.8%] vs 7/16 [43.8%]; p = 0.370). Among patients with known ingestion ≥3 g, seizures occurred in 0/10 phenobarbital-treated patients, 1/4 lorazepam-treated patients, and 3/5 controls; phenobarbital differed from control (p = 0.022), whereas lorazepam did not (p = 0.524), and phenobarbital did not differ significantly from lorazepam (p = 0.286). Among patients with initial heart rate ≥120 bpm, seizures occurred in 0/7 phenobarbital-treated patients, 1/6 lorazepam-treated patients, and 3/4 controls; phenobarbital differed from control (p = 0.024), whereas lorazepam did not (p = 0.190) and phenobarbital did not differ significantly from lorazepam (p = 0.462). Exploratory logistic regression adjusted for initial heart rate found higher seizure odds in controls than in prophylaxis patients (OR 26.86, 95% CI 1.21–598.08; p = 0.038); initial heart rate showed a nonsignificant trend (OR 1.08 per bpm; p = 0.070). Conclusions: In this interim cohort, phenobarbital was associated with fewer seizures than no prophylaxis in higher-risk subgroups. However, direct phenobarbital-lorazepam comparisons were not statistically different. Findings remain hypothesis-generating given the small sample, observational design, statistical fragility, sparse seizure events, wide regression confidence intervals, and potential reporting bias. Background: Bromadiolone is a long-acting anticoagulant rodenticide that can cause severe and prolonged coagulopathy in humans, while clinical data from low- and middle-income countries remain limited. This study aimed to describe the clinical characteristics, laboratory findings, management strategies, and outcomes of patients with bromadiolone poisoning treated at an emergency center in Vietnam, and to identify factors associated with severe outcomes. We conducted a retrospective observational study of adult patients with confirmed bromadiolone poisoning admitted to the Emergency Center of Thai Nguyen Medical University Hospital, Vietnam, between February 2021 and August 2024. Demographic data, exposure characteristics, clinical manifestations, laboratory parameters, treatment details, and outcomes were extracted from medical records. Severe outcome was defined as major bleeding, international normalized ratio (INR) ≥ 5, requirement for blood product transfusion, or death. A total of 33 patients were included, with a median age of 46 years; 60.6% were male, and suicidal ingestion accounted for 66.7% of cases. Severe outcomes occurred in 7 patients (21.2%). Patients with severe outcomes presented significantly later after exposure (median 48 vs. 5.5 h, p = 0.001) and had markedly higher admission INR values. Bleeding manifestations and blood product transfusion were observed exclusively in the severe outcome group, and no in-hospital deaths occurred. In conclusion, bromadiolone poisoning is associated with substantial morbidity due to prolonged coagulopathy. Delayed hospital presentation and severe coagulopathy at admission are strongly associated with adverse outcomes, highlighting the importance of early recognition and appropriate vitamin K therapy in resource-limited settings. Methods: This retrospective observational study was conducted at the Emergency Center of Thai Nguyen Medical University Hospital, Thai Nguyen, Vietnam. Study population: All consecutive adult patients diagnosed with bromadiolone poisoning and admitted between February 2021 and August 2024 were eligible. Inclusion criteria: Exclusion criteria: Data collection Data extracted from medical records included: Results: Baseline characteristics: Thirty-three patients with bromadiolone poisoning were included. The median age was 46 years (IQR 27), and 20 patients (60.6%) were male. Suicidal ingestion was the most common exposure intent, accounting for 22 cases (66.7%). The median time from exposure to hospital presentation was 7 h (IQR 20), and the median estimated ingestion dose was 1 mg (IQR 4). Conclusions: Bromadiolone poisoning is a serious clinical condition associated with prolonged coagulopathy and a substantial risk of severe bleeding. Delayed hospital presentation and severe coagulopathy at admission are strongly associated with adverse outcomes. Early diagnosis, close monitoring of coagulation parameters, and appropriate vitamin K therapy are essential to improve outcomes, particularly in low- and middle-income countries. Background: Amiodarone is an antiarrhythmic drug used to treat life-threatening cardiac dysrhythmias, but its use is limited by multiorgan toxicity. Large-scale age-stratified data on clinical outcomes remain limited. The National Poison Data System (NPDS) is a national database of over 81 million de-identified case records from all 53 U.S. poison centers. The objective of this study was to describe amiodarone exposures reported to U.S. poison centers.

The Morbidity and Mortality Weekly Report (MMWR) Series is prepared by the Centers for Disease Control and Prevention (CDC).