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Objective: Hemostatic abnormalities, including disseminated intravascular coagulation (DIC), are often cited as a common finding in patients following Loxosceles spider envenomation (ie, loxoscelism). The prevalence and severity of coagulopathy, however, particularly following L reclusa (ie, brown recluse) envenomation, is not well described. This study aimed to characterize coagulation laboratory parameters and coagulopathy in patients following L reclusa envenomation., Methods: We evaluated the coagulation laboratory parameters (eg, prothrombin time, partial thromboplastin time, coagulation factor activity levels, lupus anticoagulant [LA] testing) of 2 patients seen at our institution following brown recluse spider envenomation. We also comprehensively reviewed the literature for all reported cases of brown recluse spider envenomation and assessed patient demographics, clinical presentations, coagulation laboratory parameters, and outcomes., Results: We identified 2 patients with loxoscelism (1 cutaneous only, 1 systemic with hemolysis) with prolonged partial thromboplastin times but with normal clotting factor levels following envenomation. Literature review identified 263 patients: 12 patients had at least 1 prolonged clotting time, 31 reported a platelet count below 150 × 109/L, and there was clinical concern for DIC in 12 cases. The odds of death were statistically significantly higher in patients with clinical concern for DIC than in cases without concern for DIC or coagulopathy (odds ratio, 82.9 [95% CI, 12.6-433.8]; P < .001)., Conclusions: Following brown recluse spider envenomation, hemostatic perturbations are infrequent and clinical coagulopathy is uncommon, but the odds of death following a brown recluse spider bite are statistically significantly greater if DIC develops, even when compared to individuals with hemolysis without DIC., (© American Society for Clinical Pathology, 2025.)

Objective: Prolonged Exposure for Primary Care (PE-PC) leverages an opportunity to provide evidence-based posttraumatic stress disorder (PTSD) care in the PC setting where many veterans present for services and can greatly increase treatment access. However, such acute, short-term intervention may not be effective for all PTSD patients., Method: We analyzed data from a randomized clinical trial evaluating PE-PC to determine who may or may not benefit from PE-PC. We identified both PTSD symptom and general functioning trajectories for veterans with chronic PTSD in Veterans Administration primary care settings., Results: For PTSD symptoms, four trajectory patterns emerged, and for functional impairment, three emerged. Demographics, treatment expectancy, and credibility did not predict PTSD symptom or functional impairment trajectories. While baseline depression severity and functioning were initially predictive, only baseline PTSD symptoms were predictive of PTSD symptom trajectories once this variable was considered. Similarly, while baseline depression and PTSD severity were initially predictive of functional trajectories, only baseline function was predictive of function trajectories once this variable was included., Conclusion: PE-PC may be particularly appropriate and effective for veterans presenting to primary care with moderate PTSD symptoms or functional impairment. Replication and examination of trajectories in a larger effectiveness sample is warranted. (PsycInfo Database Record (c) 2025 APA, all rights reserved).