Funnel-web spider bite: a systematic review of recorded clinical cases

The document attached has been archived with permission from the editor of the Medical Journal of Australia (09 January 2008). An external link to the publisher’s copy is included.Objective: To investigate species-specific envenoming rates and spectrum of severity of funnel-web spider bites, and the efficacy and adverse effects of funnel-web spider antivenom. Data sources: Cases were identified from a prospective study of spider bite presenting to four major hospitals and three state poisons information centres (1999–2003); museum records of spider specimens since 1926; NSW Poisons Information Centre database; MEDLINE and EMBASE search; clinical toxinology textbooks; the media; and the manufacturer’s reports of antivenom use. Data extraction: Patient age and sex, geographical location, month, expert identification of the spider, clinical effects and management; envenoming was classified as severe, mild–moderate or minor/local effects. Data synthesis: 198 potential funnel-web spider bites were identified: 138 were definite (spider expertly identified to species or genus), and 77 produced severe envenoming. All species-identified severe cases were attributed to one of six species restricted to NSW and southern Queensland. Rates of severe envenoming were: Hadronyche cerberea (75%), H. formidabilis (63%), Atrax robustus (17%), Hadronyche sp. 14 (17%), H. infensa (14%) and H. versuta (11%). Antivenom was used in 75 patients, including 22 children (median dose, 3 ampoules; range, 1–17), with a complete response in 97% of expertly identified cases. Three adverse reactions were reported, all in adults: two early allergic reactions (one mild and one with severe systemic effects requiring adrenaline), and one case of serum sickness. Conclusions: Severe funnel-web spider envenoming is confined to NSW and southern Queensland; tree-dwelling funnel webs (H. cerberea and H. formidabilis) have the highest envenoming rates. Funnel-web spider antivenom appears effective and safe; severe allergic reactions are uncommon.Geoffrey K Isbister, Michael R Gray, Corrine R Balit, Robert J Raven, Barrie J Stokes, Kate Porges, Alan S Tankel, Elizabeth Turner, Julian White and Malcolm McD Fishe

Ventricular Dysrhythmias Associated with Poisoning and Drug Overdose: A 10-Year Review of Statewide Poison Control Center Data from California

Background: Ventricular dysrhythmias are a serious consequence associated with drug overdose and chemical poisoning. The risk factors for the type of ventricular dysrhythmia and the outcomes by drug class are not well documented. Objective: The aim of this study was to determine the most common drugs and chemicals associated with ventricular dysrhythmias and their outcomes. Methods: We reviewed all human exposures reported to a statewide poison control system between 2002 and 2011 that had a documented ventricular dysrhythmia. Cases were differentiated into two groups by type of arrhythmia: (1) ventricular fibrillation and/or tachycardia (VT/VF); and (2) torsade de pointes (TdP). Results: Among the 300 potential cases identified, 148 cases met the inclusion criteria. Of these, 132 cases (89 %) experienced an episode of VT or VF, while the remaining 16 cases (11 %) had an episode of TdP. The most commonly involved therapeutic classes of drugs associated with VT/VF were antidepressants (33/132, 25 %), stimulants (33/132, 25 %), and diphenhydramine (16/132, 12.1 %). Those associated with TdP were antidepressants (4/16, 25 %), methadone (4/16, 25 %), and antiarrhythmics (3/16, 18.75 %). Drug exposures with the greatest risk of death in association with VT/VF were antidepressant exposure [odds ratio (OR) 1.71; 95 % confidence interval (CI) 0.705–4.181] and antiarrhythmic exposure (OR 1.75; 95 % CI 0.304–10.05), but neither association was statistically significant. Drug exposures with a statistically significant risk for TdP included methadone and antiarrhythmic drugs. Conclusions: Antidepressants and stimulants were the most common drugs associated with ventricular dysrhythmias. Patients with suspected poisonings by medications with a high risk of ventricular dysrhythmia warrant prompt ECG monitoring

Treasury Of Greek Mythology: Classic Stories Of Gods, Goddesses, Heroes And Monsters

The new National Geographic Treasury of Greek Mythology offers timeless stories of Greek myths in a beautiful new volume. Brought to life with lyrical text by award-winning author Donna Jo Napoli and stunning artwork by award-winning illustrator Christina Balit, the tales of gods and goddesses such as Zeus, Aphrodite, Apollo, and Athena and heroes and monsters such as Helen of Troy, Perseus, and Medusa will fascinate and engage children’s imaginations. National Geographic completes the book with embellishments of each story: sidebars for each god, goddess, hero, and monster link the myths to constellations, geography, history, and culture to help young readers connect the stories to real life events, people, and places. A family tree and a “cast of characters” profile page help make relationships between the characters clear, and a mapping feature adds to the fun and fascination. Resource notes and ample back matter directing readers to more information round out this luminous book. Sure to dazzle all those intrigued with the fantastic tales of Greek mythology and enchant new readers, this vibrant book will soon become a family keepsake

Treasury Of Egyptian Mythology, Classic Stories Of Gods, Goddesses, Monsters & Mortals

The new National Geographic Treasury of Egyptian Mythology is a stunning tableau of Egyptian myths, including those of pharaohs, queens, the boisterous Sun God Ra, and legendary creatures like the Sphinx. The lyrical storytelling of award-winning author Donna Jo Napoli dramatizes the timeless tales of ancient Egypt in the year when Angelina Jolie will make Cleopatra a multimedia star. And just like the popular National Geographic Treasury of Greek Mythology, the stories in this book will be beautifully illustrated to bring ancient characters vividly to life. The stories are embellished with sidebars that provide historical, cultural, and geographic context and a mapping feature that adds to the fun and fascination. Resource notes and ample back matter direct readers to discover more about ancient Egypt. With its attractive design and beautiful narrative, this accessible treasury stands out from all other mythology titles in the marketplace