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Background: Recurrent depressive disorder (RDD) is mainly manifested as a low mood, negative and pessimistic mood, and often presents suicidal tendencies when severe. This study reports on a patient with RDD who experienced rat poison poisoning occurring tongue biting. The patient's psychiatric symptoms improved after receiving emergency management and subsequent combined medical care., Case Presentation: The patient was a 51-year-old female with RDD complicated with rat poison poisoning. Tongue bite occurred on the third day of hospitalization. She received emergency treatment. Depression, anxiety and suicide risk assessment, safety management and caregiver-health education were conducted on the day of admission and before discharge. At the follow-up after discharge, the risk of suicide was reduced., Conclusions: Suicide in patients with RDD is characterized by repetition and complexity. The occurrence of clinical cases involving tongue bite after gastric lavage is rare. Suicide assessment and emergency management play an auxiliary role in the treatment of patients with recurrent depressive disorder., (© 2024. The Author(s).)

We report the case of a 49-year-old woman who suffered an envenomation from a greater weever during a seaside vacation along the Aegean coast in Izmir, Türkiye. Following the incident, she experienced intense pain and sought treatment at an emergency department, where she received analgesics and cold compresses. Unfortunately, this approach failed to alleviate her pain, which persisted for approximately 24 hours. On the twelfth day, with symptoms worsening and the emergence of a larger wound than the one sustained on the day of the incident, she visited the University Hospital for further care, where she received periodic wound cleaning and a six-week antibiotic treatment regimen for possible osteomyelitis after suspicious findings on her Magnetic Resonance Imaging. The standard treatment for piscine envenomation involves hot water immersion to neutralize thermolabile toxins, providing pain relief and preventing subsequent complications. The water temperature should be between 40 and 45 degrees Celsius, and the affected body part should be immersed for at least 60 minutes. This case underscores the critical nature of hot water immersion in managing envenomation, a step which, if omitted, can result in extended pain duration and the evolution of a wound requiring over five months to heal.

Envenomations are the 23rd most common reason for calls to US poison control centers, with over 35,000 incidents reported annually. Snake bites account for over 20% of those calls, while marine envenomations are likely underreported at 3% to 4%. 1 While these types of envenomations may not be encountered on a daily basis for many physicians, the different types of envenomations warrant unique management strategies based on the offending creature and symptom presentation. This text serves as a review of the epidemiology, clinical presentations, and management of endemic North American species of snakes and marine vertebrate and invertebrate envenomations., Competing Interests: Disclosure The authors declare that they do not have a current financial relationship with any non-eligible entities (commercial interests) that may have a direct interest in the subject matter of the continuing medical education program., (Copyright © 2024 Elsevier Inc. All rights reserved.)

This text serves to familiarize readers with animal bites and attacks. Topics include appropriate management of animal bite wounds, postexposure prophylaxis for possible rabies exposures, and unique infectious diseases transmitted through animal vectors. Large mammal attacks are discussed, in addition to the management of smaller animal attacks and exposures., Competing Interests: Disclosure The authors have no conflicts of interest to declare. The authors have no financial interest to report. All authors attest that this submission is original and not under review at any other publication entity., (Copyright © 2024 Elsevier Inc. All rights reserved.)

With the surge in the human coastal population and the increasing frequency of human activities along the coast, cases of marine envenomation, particularly jellyfish envenomation, have notably risen. Jellyfish stings can induce a spectrum of symptoms that vary in severity, encompassing skin injuries, acute systemic venom effects, delayed indirect sequelae, and even fatality, causing significant distress to patients. Among these manifestations, the occurrence of skin lesions following jellyfish stings is prevalent and substantial. These lesions are characterized by evident blister formation, development of bullae, subcutaneous hemorrhage, erythema, papules, wheal, ecchymosis, and ulceration or skin necrosis. Local cutaneous manifestations may persist for several weeks or even months after the initial sting. Despite aggressive treatment, many skin injuries still result in significant pigmentation or scarring after recovery. To address this issue effectively, it is imperative to conduct comprehensive evidence-based medical research, elucidate various components within jellyfish venom, and elucidate its pathogenic mechanism to develop targeted treatment programs. This article aims to review the skin symptoms, pathophysiology, and management of jellyfish stings. Such considerations can provide comprehensive guidance to medical professionals and the public and minimize the harm caused by jellyfish stings.

Traumatic auricular avulsion is a rare and deforming injury. Classically, repair has required microvascular anastomosis. In this publication, we report two separate cases of pediatric auricular avulsion from dog bites. In both cases, the ear was cleaned and surgically reattached. Adjunctive therapies included hyperbaric oxygen and nitroglycerin ointment. There was complete graft take for one patient and 90% graft take for the second, both achieving satisfactory aesthetic outcome. These unique cases highlight the benefits of surgical reattachment of the avulsed portion of the ear followed by hyperbaric oxygen therapy and nitroglycerin ointment.

Envenomation by marine animals poses a significant health concern globally, affecting both local residents and tourists in coastal regions. The primary objective of this review is to critically evaluate the existing scientific literature to determine the most effective first-aid treatment for envenomations caused by marine animals, specifically whether hot-water immersion (HWI) or ice-pack treatment (IPT) provides the best immediate care. This comprehensive review covers a wide range of marine envenomations, from jellyfish stings to stingray injuries. While our focus is primarily on the efficacy of HWI and IPT, we also explore the role of cold-water treatment as a result of its relevance and similarity to ice-pack applications. In addition, we examine other treatments mentioned in the literature, such as medications or vinegar, and highlight their findings where applicable. To provide a clear and structured overview, we summarised the articles in separate tables. These tables categorise the type of research conducted, the marine species studied, the region of origin of the marine species, and the key findings of each study. Our analysis of the available evidence indicates a general consensus in the scientific community on the effectiveness of HWI or IPT for envenomation by marine animals. However, when treating those injuries, it is crucial to consider all factors since there is no universally superior treatment due to the diverse nature of marine habitats.

Abstract: Patients who have experienced animal or human bites may present for care in a number of settings with a variety of injuries requiring different approaches to treatment and management. Because animal and human bites range in severity and can result in a host of sequelae, their evaluation and management can be complex. In caring for patients with an animal or human bite, NPs must consider the many factors relevant to such an injury., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

Background: Dog bite injuries are a preventable yet common cause of animal related hospitalisation. Dog bites in metropolitan areas have been well characterised however there is limited information regarding dog bites in regional areas. This study sought to describe the demographics, clinical presentation and short-term outcomes of patients presenting with dog bite related injuries to Broome Regional Hospital (BRH)., Methods: A retrospective cohort study examined all dog bite related injuries presenting to BRH Emergency Department (ED) between July 1st 2021 - June 30th 2023, with the terms "dog" AND "bitten OR bite" in ED triage note. Chart review was performed to extract demographics, clinical presentation and short-term outcomes of dog bite related injuries., Results: After exclusions, 207 patients were identified during the 2-year study period; approximately four dog-bites per week. Median age was 32 (IQR: 32, range 1-97 years old) with 46 % of patients being female. Residents of the Kimberley represented 78 % of presentations for dog bites. Dogs that belonged to or were known to patients were involved in 74 % of cases. The lower limb below the knee (42 %) was most commonly bitten, followed by the distal upper limb (30.5 %) and then face (13 %). Most patients presented on the same-day (67 %), were treated with antibiotics (79 %) and 83 % were discharged on the day of presentation. There were 43 (23 %) patients who required repair in the ED or operating theatre. Thirty-three patients were admitted to BRH. Seven patients required transfer for subspecialty tertiary level care., Conclusion: Dog-bite trauma is common and consumes significant health resources associated with ED presentations, hospital admissions, theatre usage and transfer in severe cases. A multifaceted approach encompassing education, engineering, and enforcement is required to prevent dog bites., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Crown Copyright © 2024. Published by Elsevier Ltd. All rights reserved.)

Mammal bites account for over 5 million visits to Emergency Departments (EDs) annually. Nurse Practitioners (NPs) need to stay abreast of current guidelines, changes to antibiotic regimens that are now most effective, and understand in what circumstances collaboration with other specialists is indicated. It is not enough to care for the wound, itself, but rather understand in what presentations additional care may be needed despite the fact that there is no clear evidence at the time of evaluation of the need for advanced care. Additionally, NPs should understand what resources are available within their community for wound care that may exceed the scope and ability of the facility in which they practice. Health departments may need to be utilized in the care of ED patients who present with wounds that are suspicious for rabies. Finally understanding what constitutes a high, medium, and low risk bite will aide NPs in delivering optimal care within the communities they serve while also minimizing patient morbidity., Competing Interests: Disclosure: The author reports no conflicts of interest., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

Background: Stay-at-home injunction during COVID-19 pandemic led to new dynamics in households and increased the risk of domestic accidents involving pets. The aim of the study was to demonstrate an increase of facial dog bites in children during first lockdown period in France, compared to the same period in 2018 and 2019. Secondary objective was to investigate the demographics and circumstances in which dog bites occurred., Methods: A retrospective multicentric study was conducted nationwide. Patients under 18 years old managed in fifteen oral and maxillofacial surgery departments for a dog bite were included., Results: Eighty-seven patients were included. A significant increase of the number of children managed for facial dog bite was noticed in 2020 (p=0.0005). The male-to-female ratio was significantly reversed in 2020 with more bites in girls than boys (p=0.02). In 2020, children were mostly bitten to cheeks (28.6 %), lips-and-chin region (26.2 %), and eyelids (23.8 %). Severe bites increased in 2020, in comparison with 2018 and 2019. Dog bites occurring while petting or playing significantly increased in 2020 (31 %) (p=0.03)., Conclusion: The process leading to bites is highly dependent on the balance of dog-owner relationship. This was strongly disrupted during COVID-19 pandemic, resulting in the increase of dog bites in households. Regarding dog bites, face is the most vulnerable area in children. Its injury has lots of esthetic and functional consequences and maxillofacial surgeons have a key role to play in their prevention. Reminders of some of these management and prevention strategies are presented in this article., Competing Interests: Declaration of Competing Interest None, (Copyright © 2023 Elsevier Masson SAS. All rights reserved.)

Scorpionfish are among the most venomous creatures found in American and Caribbean seas. Their envenomation is responsible for considerable morbidity and socioeconomic burden associated with marine animal injuries. Avoiding physical contact with scorpionfish through proper identification prevails as the chief prevention method for stings. This article discusses common features of scorpionfish as well as the clinical presentation and treatment options following exposure to its toxins.

Introduction: The dermatological effects of box jellyfish envenomation among stinging victims in Thailand are not well reported, particularly concerning chronic effects. For first aid, different recommendations indicate the necessity for the removal of tentacles in life-threatening situations. This study aimed to describe the dermatological effects of box jellyfish envenomation and propose recommendations regarding first aid for victims in urgent care or life-threatening situations., Methods: Surveillance systems and Toxic Jellyfish Networks were established to improve detection and investigation. The networks investigated all severe victims of jellyfish envenomation. A retrospective study was conducted, and victims of stinging by box jellyfish investigated from 1999 to 2021 were included., Results: One hundred and twenty-four victims were recorded. The majority of victims were males (55%), tourists (69%), and Thai nationals (49%). Direct contact had more severe consequences than indirect contact. Dermatological effects included edema, erythematous caterpillar track-like rash, blistering, bullae, papular eruption, necrosis, digital gangrene, recurrent dermatitis, dermal hypersensitivity, numbness, lichenification, hyperpigmentation, keloids, and scarring. Suffering and healing continued from several weeks to many years. Victims with multiple-tentacle box jellyfish stings had papular eruptions and greater severity of skin issues. All fatally envenomed victims collapsed within a few minutes and received incorrect/no first aid. The proposed first aid for life-threatening box jellyfish stings is continuous irrigation of the wound with vinegar for at least 30 s and initiation of cardiopulmonary resuscitation if there is no respiration or heartbeat. Tentacles often detach spontaneously, and removal is not always necessary, thus saving time., Conclusions: The findings provide input for improving diagnosis and treatment guidelines., (Copyright © 2023 Wilderness Medical Society. Published by Elsevier Inc. All rights reserved.)

Introduction. The objective of this study is to describe the characteristics of dog bite injuries in children seen at a children's hospital in Bolivia. Population and methods. This was an observational, retrospective study in patients seen between 2017 and 2021. Results. A total of 769 patients were studied. Dog bite injuries accounted for 5.6% of emergency visits and 0.8% of hospitalizations. They were more frequent in children younger than 5 years (55.1%), in whom the following were observed: greater injury severity (p = 0.008), history of animal provocation (p = 0.048), known attacking animal (p < 0.036), domestic accident (p = 0.021), greater frequency of post-exposure prophylaxis with anti-rabies serum (p = 0.005), and maxillofacial area as the main region involved (p < 0.001). There were 3 deaths due to human rabies and 1 due to hypovolemic shock. Conclusion. Dog bite injuries are a frequent cause of visit to the emergency department and hospitalization in pediatrics and have specific characteristics in children younger than 5 years., (Sociedad Argentina de Pediatría.)

Animal bites are a significant burden to health care systems worldwide. In the United States, dog bites account for an average of 337,000 emergency visits and generate medical costs of up to $2 billion per year. Most animal bites in adults and children are from a dog, and most bite patients are children who have been bitten by animals known to them. Dog bites may cause crush and soft-tissue avulsion, whereas cat bites usually cause deeper puncture-type wounds. Children most often present with dog bites on the head and neck, and adolescents and adults usually present with dog bites on the extremities and hands. Bite wounds should be examined, cleaned, and irrigated with warm water or normal saline solution, and any foreign bodies and devitalized tissue should be removed. Neurovascular function (e.g., pulses, sensation) and range and movement of adjacent joints should be examined and documented. Antibiotic prophylaxis, with amoxicillin/clavulanate as the first-line choice, should be considered for all bites, particularly for those at increased risk of infection. Imaging and laboratory studies are usually not required unless there is suspicion of a retained foreign body, damage to underlying structures, infection, or extensive injury. Primary closure of bite wounds may be performed if there is low risk of infection. The need for tetanus vaccination and rabies postexposure prophylaxis should be evaluated for each patient; bites that do not break the skin generally do not require rabies postexposure prophylaxis.

Background: Dog bite injuries are a common problem globally; however, little is known about the epidemiology of dog bite injury from a low-and-middle-income country like Pakistan. This study aims to determine the epidemiology of dog bite injuries among children and adults from a tertiary care hospital in Karachi, Pakistan., Methods: We conducted a cross-sectional study on dog bite patients visiting the emergency department from November 2015 to August 2016 of a major public tertiary care hospital. Data was collected using a structured questionnaire on demographic details, bite history, and management of dog bite victims. Descriptive analysis was reported. Chi-square test was applied to check the associations between age-specific dog bite cases and independent variables., Results: 2178 participants were included in the analysis. 715 (38.8%) were children less than 18 years old, and 1463 (61.2%) were adults over 18 years. A majority of the patients were males (1909, 87.7%). Results show that most dog bite injuries (2052, 94.2%) tend to occur outside the house by stray dogs biting without provocation. People aged 18 years and above (61.2%) and males (children: 84.6%, adults: 89.1%) tend to be bitten more often. Lower limbs are most frequently bitten (children: 69.5%, adults: 85.8%). Free-roaming stray dogs (children: 73.4%, adults: 74.9%) were involved in reported biting cases. Many of the patients did not receive appropriate first aid and instead just washed the wound with soap and water (children: 45.1%, adults: 43.7%). 99% of the victims received Tetanus toxoid, Rabies vaccine, and immunoglobulins while in the emergency department., Conclusion: There is a high burden of dog bite injuries from stray dogs in Karachi, Pakistan. Efforts should be made to create awareness among the general public on the risks of dog bites and on seeking appropriate first aid and medical attention for a dog bite injury., Competing Interests: Declaration of Competing Interest The author declares no competing interests., (Copyright © 2022. Published by Elsevier Ltd.)

Background: Animal and human bite injuries are a relevant health problem worldwide. With the increasing number of pets, bite injuries are becoming more frequent. Previous studies on animal and human bite injuries in Switzerland were completed several years ago. The aim of the present study was to provide a detailed overview of patients with bite injuries admitted to a tertiary emergency department in Switzerland in terms of demographics, injury patterns and treatment strategies., Methods: A 9-year cross-sectional analysis of patients presenting to the emergency department of Bern University Hospital in the period January 2013 to December 2021 following an animal or human bite injury., Results: A total of 829 patients with bite injuries were identified, including 70 for postexposure prophylaxis only. Their median age was 39 (IQR 27-54) years and 53.6% were female. Most patients were bitten by a dog (44.3%), followed by cats (31.5%) and humans (15.2%). Most bite injuries were mild (80.2%); severe injuries were mainly found in dog bites (28.3%). Most patients were treated within six hours after human (80.9%) or dog (61.6%) bites; after cat bites, patients often presented with a delay (74.5%) and signs of infection (73.6%). Human bite wounds were superficial in the majority of cases (95.7%), rarely showed signs of infection (5.2%) at the time of presentation and hospitalisation was never required., Conclusions: Our study provides a detailed overview of patients admitted to an emergency department of a tertiary Swiss University Hospital after an animal or human bite. In summary, bite injuries are common among patients who present to the emergency department. Therefore, primary and emergency care clinicians should be familiar with these injuries and their treatment strategies. The high risk of infection, particularly in cat bites, may warrant surgical debridement in the initial treatment of these patients. Prophylactic antibiotic therapy and close follow-up examinations are recommended in most cases.

Competing Interests: I have read and understood BMJ policy on declaration of interests and have no relevant interests to declare.

Younger children in particular are at risk of becoming victims of dog attacks due to their small size. Such a biting incident can fulfil various criminal offences. In order to be able to satisfy possible legal claims, the injuries should be documented by forensic medicine and thus be legally binding. Therefore, close cooperation between the treating surgeons and forensic experts is recommended. A retrospective analysis of the cases of dog bite injuries in children and adults treated by clinical forensic medicine at the University Medical Center Rostock was carried out under various aspects. Adult casualties were predominantly injured on the lower extremities. The children examined were predominantly bitten on the head, neck and face region as well as the upper extremities. Injury severity ranged from skin redness to severe substance defects with loss of body structures. The biting dog was known in about half of the cases. In order to avoid dog bites in children, parents as well as children should be trained in dealing with dogs., (© 2022. The Author(s).)

Competing Interests: Competing interests: The BMJ has judged that there are no disqualifying financial ties to commercial companies. The authors declare the following other interests: none. Further details of The BMJ policy on financial interests are here: https://www.bmj.com/about-bmj/resources-authors/forms-policies-and-checklists/declaration-competing-interests

Rabies is an infectious viral disease endemic worldwide and is fatal after the onset of clinical symptoms. In 99% of cases, dogs contribute to infectious viral transmission in humans. It causes approximately 10,000 deaths per year, mainly in Asia and Africa, with 95% of deaths occurring in Asia alone. Currently, the number of dog bite cases reported in Pakistan is alarming. Such cases are first seen mostly by general practitioners. The current narrative review was planned to assess the knowledge, attitude and practices of general practitioners as reported in the literature from different countries published between July 2016 and February 2021 regarding dog bite management. Articles were searched using Google, Google Scholar, Ovid, Eric and PubMed databases. Keywords used included rabies, dog bite, general practitioners, medical officers, knowledge, attitude and practices. A total of 7 studies comprising 875 participants were included. Because of the increasing human population, a growing number of dogs and a lack of concerted efforts for the control of disease, the burden of human deaths as a result of rabies will continue to escalate.

Objectives: This study aimed to evaluate the clinical features, management, and outcomes of patients with animal bites presented to the pediatric emergency department of a tertiary center., Methods: Patients with ICD-10 code W54 (contact with dog) and W55 (contact with other mammals) between March 1 st , 2017, and July 1 st , 2021, were included in the study. Demographic characteristics of the patients, type of contacted animal, wound characteristics (muscle involvement, soft tissue defect, vascular injury, type of nerve injury, and Lackmann's classification), wound care measurements, tetanus prophylaxis, administration of rabies immunoglobulin and antibiotics, location of the injury, existing fractures, suturing, splinting, surgical consultations and hospitalization status were recorded., Results: Four hundred and nineteen incidents of animal bites (240 males and 179 females) occurred over a four-year period. 51% was due to a dog bite; 47% was by a cat. The median age was nine years (IQR: 5-14 years). Most bites (91.6%) involved only a single anatomical site. The extremities were the commonly involved part (right upper limb [35.3%], left upper limb [21.2%], right lower limb [12.6%], left lower limb [16%]). Head-neck and face injury ratio was 17.6%. Torso (5.7%) and genitalia (5.2%) were uncommonly involved. A consultation was requested from at least one surgical department for 8% of the patients. 97.1% of patients received a rabies vaccine. Most attacks were trivial and did not require hospitalization., Conclusion: Animal bites often cause minor injuries. However, multiple dog attacks can be seen related to a high number of stray animals in our country. Therefore, these patients may present with major traumas. Surgical intervention and hospitalization may be required. Emergency physicians play an essential role in acute management and rabies prophylaxis in these patients.

Introduction and Objective: Owning a dog or spending time around a dog have many benefits, but also pose a risk of being bitten or attacked. Currently, publications on dog bites and related factors come from both high-income countries and low- and middle-income countries. So far, no attempt has been made to assess this phenomenon in Poland. The aim of this study was to determine the number of such events and evaluate hospital medical assistance provided to dog bite victims in Poland in the period of 15 years between 2006-2020., Material and Methods: This cross-sectional study was based on the data from the Nationwide General Hospital Morbidity Study and cases with the code W54 (ICD-10) as the cause of hospitalization. As part of the analysis, victim demographical data, with an emphasis on city- and country-dwellers, as well as treatment variables were assessed., Results: Between 2006-2020, 4,145 cases of hospitalizations for dog bites were found, of which approx. 42% occurred in 2020 during the COVID-19 pandemic and lockdowns. Most of the victims were children aged 0-9, and this is especially common among boys living in the countryside. It was found that regardless of the place of residence, there was a systematic decrease in hospitalization of men as they were older. In women, however, the decrease in hospitalization concerned only the age groups 0-39. Among older women, the percentage of hospitalization increased, especially among rural women aged 60 and over., Conclusions: Hospital discharge records report a small number of dog bites. These are only the tip of the iceberg. The problem has a multi-factorial nature and requires epidemiological monitoring and further research on correlates and determinants, as well as preventive measures.

Arthropods, including insects and arachnids, significantly affect humans as vectors for infectious diseases. Arthropod bites and stings commonly cause minor, usually self-limited reactions; however, some species are associated with more severe complications. Spider bites are rarely life-threatening. There are two medically relevant spiders in the United States. Widow spider (Latrodectus) envenomation can cause muscle spasm and severe pain that should be treated with analgesics and benzodiazepines. Antivenom is not widely available in the United States but may be considered for severe, refractory cases. Recluse spider (Loxosceles) bites are often overdiagnosed, should be treated supportively, and only rarely cause skin necrosis. Centruroides scorpions are the only medically relevant genus in the United States. Envenomation causes neuromuscular and autonomic dysfunction, which should be treated with analgesics, benzodiazepines, supportive care, and, in severe cases, antivenom. Hymenoptera, specifically bees, wasps, hornets, and fire ants, account for the most arthropod-related deaths in humans, most commonly by severe allergic reactions to envenomation. In severe cases, patients are treated with analgesia, local wound care, and systemic glucocorticoids. Diptera include flies and mosquitoes. The direct effects of their bites are usually minor and treated symptomatically; however, they are vectors for numerous infectious diseases. Arthropod bite and sting prevention strategies include avoiding high-risk areas, covering exposed skin, and wearing permethrin-impregnated clothing. N,N-diethyl- m-toluamide (DEET) 20% to 50% is the most studied and widely recommended insect repellant.

Jellyfish are ubiquitous animals registering a high and increasing number of contacts with humans in coastal areas. These encounters result in a multitude of symptoms, ranging from mild erythema to death. This work aims to review the state-of-the-art regarding pathophysiology, diagnosis, treatment, and relevant clinical and forensic aspects of jellyfish stings. There are three major classes of jellyfish, causing various clinical scenarios. Most envenomations result in an erythematous lesion with morphological characteristics that may help identify the class of jellyfish responsible. In rare cases, the sting may result in delayed, persistent, or systemic symptoms. Lethal encounters have been described, but most of those cases happened in the Indo-Pacific region, where cubozoans, the deadliest jellyfish class, can be found. The diagnosis is mostly clinical but can be aided by dermoscopy, skin scrapings/sticky tape, confocal reflectance microscopy, immunological essays, among others. Treatment is currently based on preventing further envenomation, inactivating the venom, and alleviating local and systemic symptoms. However, the strategy used to achieve these effects remains under debate. Only one antivenom is currently used and covers merely one species ( Chironex fleckeri ). Other antivenoms have been produced experimentally but were not tested on human envenomation settings. The increased number of cases, especially due to climate changes, justifies further research in the study of clinical aspects of jellyfish envenoming.

Introduction: Stingray envenomation is a marine injury suffered by ocean goers throughout the world. No prospective studies exist on the various outcomes associated with these injuries., Study Objective: The aim of this study was to perform a prospective, observational study of human stingray injuries to determine the natural history, acute and subacute complications, prevalence of medical evaluation, and categories of medical treatment., Methods: This study prospectively studied a population of subjects who were injured by stingrays at Seal Beach, California (USA) from July 2012 through September 2016 and did not immediately seek emergency department evaluation. Subjects described their initial injury and provided information on their symptoms, medical evaluations, and medical treatment for the injury at one week and one month after the injury. This information was reported as descriptive statistics., Results: A total of 393 participants were enrolled in the study; 313 (80%) of those completed the one-week follow-up interview and 279 (71%) participants completed both the one-week and one-month follow-up interviews. Overall, 234 (75%) injuries occurred to the foot. One hundred sixty-three (52%) patients had complete resolution of their pain within one week and 261 (94%) had either complete resolution or improvement of pain by one month. Sixty-eight (22%) subjects reported being evaluated by a physician and a total of 49 (17%) subjects reported antibiotic treatment for their wound. None of the subjects required parenteral antibiotics or hospital admission., Conclusion: The majority of stingray victims recover from stingray injury without requiring antibiotics. A subset of subjects will have on-going wound pain after one month. The need for parenteral antibiotics or hospital admission is rare.

Objective: To define the microbiologic characteristics of animal bites in tropical Australia and the appropriateness of current Australian antimicrobial guidelines for their management., Methods: This retrospective audit examined hospitalizations in tropical Australia after an animal bite or animal-associated penetrating injury between 2013 and 2020. The primary outcome was a composite of death, intensive care unit admission, amputation, quaternary center transfer, or unplanned rehospitalization., Results: A wide variety of animals were implicated, but snakes (734/1745, 42%), dogs (508/1745, 29%), and cats (153/1745, 9%) were the most common. Hospital presentation after 24 hours (odds ratio (OR) (95% confidence interval (CI)): 68.67 (42.10-112.01)) and a cat-related injury (OR (95% CI): 22.20 (11.18-44.08)) were independently associated with an increased risk of infection. A pathogen not covered by the relevant antimicrobial regimen recommended in Australian guidelines was identified in only 12/1745 (0.7%) cases. The primary outcome occurred in 107/1745 (6%) and was independently associated with tissue trauma (OR (95% CI): 9.29 (6.05-14.25), p<0.001), established deep infection at presentation (OR (95% CI): 2.95 (1.31-6.61), p=0.009) and hospital presentation after 24 hours (OR (95% CI): 1.77 (1.12-2.79), p=0.01)., Conclusions: A wide variety of animals bite humans in tropical Australia, but empiric antimicrobial regimens recommended in current national guidelines cover almost all the microbiologic isolates from the resulting wounds., (Copyright © 2022 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

Background: In Africa, rabies causes an estimated 24,000 human deaths annually. Mass dog vaccinations coupled with timely post-exposure prophylaxis (PEP) for dog-bite patients are the main interventions to eliminate human rabies deaths. A well-informed healthcare workforce and the availability and accessibility of rabies biologicals at health facilities are critical in reducing rabies deaths. We assessed awareness and knowledge regarding rabies and the management of rabies among healthcare workers, and PEP availability in rural eastern Kenya., Methodology: We interviewed 73 healthcare workers from 42 healthcare units in 13 wards in Makueni and Kibwezi West sub-counties, Makueni County, Kenya in November 2018. Data on demographics, years of work experience, knowledge of rabies, management of bite and rabies patients, and availability of rabies biologicals were collected and analyzed., Results: Rabies PEP vaccines were available in only 5 (12%) of 42 health facilities. None of the health facilities had rabies immunoglobulins in stock at the time of the study. PEP was primarily administered intramuscularly, with only 11% ( n = 8) of the healthcare workers and 17% (7/42) healthcare facilities aware of the dose-sparing intradermal route. Less than a quarter of the healthcare workers were aware of the World Health Organization categorization of bite wounds that guides the use of PEP. Eighteen percent ( n = 13) of healthcare workers reported they would administer PEP for category I exposures even though PEP is not recommended for this category of exposure. Only one of six respondents with acute encephalitis consultation considered rabies as a differential diagnosis highlighting the low index of suspicion for rabies., Conclusion: The availability and use of PEP for rabies was sub-optimal. We identified two urgent needs to support rabies elimination programmes: improving availability and access to PEP; and targeted training of the healthcare workers to improve awareness on bite wound management, judicious use of PEP including appropriate risk assessment following bites and the use of the dose-sparing intradermal route in facilities seeing multiple bite patients. Global and domestic funding plan that address these gaps in the human health sector is needed for efficient rabies elimination in Africa., Competing Interests: SD is an employee with Sanofi and may hold shares and/or stock options in the company. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Chuchu, Kitala, Bichanga, Ksee, Muturi, Mwatondo, Nasimiyu, Maritim, Mutono, Beyene, Druelles, Hampson and Thumbi.)

Crocodile bites are one of the most powerful bites of any creature. Bite wounds are usually deep, with severe tissue damage, frequently contaminated with unusual microorganisms, and are difficult to treat. This case report describes the treatment of a middle-aged man admitted after a crocodile attack to the left distal end of humerus, elbow and proximal forearm. He was successfully treated with empirical broad-spectrum antibiotics and repeated wound debridement. The patient was discharged after nine days of intensive care at a level 1 trauma unit, good outcomes were seen eight months later.

Objectives: Bite wounds are a common cause of trauma in cats; nevertheless, large-scale studies of this trauma in cats are lacking. The aims of the present study were to characterise the clinical and clinicopathological findings in these cats, to assess the association of these variables and therapeutic measures with survival, and to assess the association between the animal trauma triage (ATT) score and severity of injuries score (SS) at presentation with survival., Methods: The medical records of cats presented to a veterinary teaching hospital and two large referral clinics were reviewed retrospectively., Results: The study included 72 cats diagnosed with canine bite wounds (with the dog attacks having been witnessed). Seventy-one percent of cats suffered multiple injuries, and there was a significant association between the number of injured body areas and survival, and between severity of injury and survival ( P  = 0.02 and P  = 0.012, respectively). The median ATT scores and SSs for non-survivors were significantly higher compared with survivors ( P <0.0001). There was a strong and significant correlation between ATT scores and SSs ( r  = 0.704, P  <0.0001). Total protein and albumin were significantly lower and alanine aminotransferase significantly higher in non-survivors compared with survivors ( P  ⩽0.032). Fifty percent of cats were treated conservatively, 32% by local surgical debridement and 18% of cats required an exploratory procedure. Cats undergoing more aggressive treatments were significantly less likely to survive ( P  = 0.029). Fifty-seven cats (79%) survived to discharge., Conclusions and Relevance: Cats sustaining canine bite wounds have a good overall prognosis for survival to discharge. High ATT score, high SS, multiple body area injuries, penetrating injuries, radiographic evidence of vertebral body fractures and body wall abnormalities, as well as hypoproteinaemia and elevated alanine aminotransferase, are negative predictors of survival.

Jellies, more commonly known as jellyfish, are a common cause of stings in oceans throughout the world. Most stings result in immediate painful skin reactions that can be treated with hot water immersion and careful removal of adherent tentacles. Rarely, certain jellyfish species can cause life-threatening systemic reactions that must be treated promptly and monitored in the acute care setting. Wearing a full-body stinger suit or applying a sting-inhibiting lotion are common strategies that may reduce the risk for jellyfish injuries. Avoidance of waters during jellyfish season is prudent in regions that harbor more dangerous species of jellyfish, particularly along the Australian and Indo-Pacific coastlines.

An increasing presence on many beaches worldwide, jellyfish are a diverse group of Cnidarians equipped with stinging cells termed cnidocytes. Though few of the over 10,000 species are dangerous to humans, and most that are produce no more than a painful sting, some jellyfish can produce systemic symptoms and even death. Chironex fleckeri, the Australian box jellyfish, has a venom potent enough to kill in less than 10 minutes, and for which there is an antivenom of debatable efficacy. Stings from Carukia barnesi can cause Irukandji syndrome, characterised by severe pain and hypertension. Jellyfish stings have also been associated with Guillain-Barre syndrome and anaphylaxis. Though optimal treatment of stings remains controversial, after removal from the water and addressing any immediate life threats, the tentacles should be removed and the area washed, with seawater being the best choice due to its low likelihood of inducing further cnidocyte discharge. Hot water immersion may be beneficial for pain control for non-tropical jellyfish stings, and cold packs for tropical stings. In general, there is no consensus for the optimal treatment of jellyfish stings, and so further research is needed into species-specific guidelines and whether there are any overarching rules.

Captive nonhuman primates frequently experience bite wounds inflicted by conspecifics; however, few studies evaluate wound management in these animals. This study evaluates bite wound management in 35 captive ring-tailed lemurs (RTL, Lemur catta ) held within five British zoological institutions between 2015 and 2019. Treatments for 152 bite incidents resulting in 211 bite wounds were summarized. Treatment efficacy and potential risk factors for bite wound complications were evaluated for correlations with outcomes. Treatments in the first 48 hours included analgesia alone (54/152; 35.5%); analgesia and antimicrobials (42/152; 27.6%); no treatment (26/152; 17.1%); analgesia, antimicrobials, and wound management under anesthesia (24/152; 15.8%); and antimicrobials alone (6/152; 3.9%). Poor outcomes were observed in RTL in association with 20.4% of wounds (43/211): signs of pain (SOP) after 48 hours were the most common (30/211; 14.2%), followed by signs of infection (SOI, 16/211; 7.6%), wound dehiscence (7/211; 3.3%), and abnormal function or behavior at day 30 (4/ 211; 1.9%). Poor outcomes were more likely with severe bite wounds and bite wounds to the hand or limb (thoracic or pelvic, excluding the hand or foot). Specifically, SOP were more likely to be observed with severe wounds and solitary wounds, and SOI were more likely to be observed with wounds not treated with early antimicrobials. When SOI occurred, most resolved with antimicrobial treatment alone. Early analgesia is recommended for RTL with bite wounds. If SOP persist, multimodal analgesia should be administered. Clinicians should consider withholding antimicrobials for RTL with bite wounds of mild and moderate severity until SOI are observed.

The genus Scolopendra includes large centipedes that inhabit tropical regions of Southeast Asia and the Pacific Islands as well as South America and the Southwestern US. They are capable of inflicting a clinically significant venomous bite. These multilegged arthropods may enter tents or buildings at night in search of prey and tend to hide in bedding and clothing. Presentation and management are discussed., (2021.)

Dog bites are a significant public health problem among children. Primary prevention is important. A majority of the dog bites in children are in or around there own house and/or by a family dog. Therefore, parents should be educated how to handle dog and child. The consequences of dog bites can be dramatic, with on the long term scars, disability and posttraumatic stress disorder. Next to medical treatment it should be well considered if the safety of the child and society are endangered. All involved caregivers, as child health care practitioners and the family doctor, can be consulted to answer this question. Child Protection Services can be consulted if there may be safety issues of the child. Furthermore, it is important to consider behavioral examination of the dog. In the Netherlands, this can be done after reporting the matter to the police or on the initiative of the municipality.

Soft tissue injuries of the head and neck are a common reason for medical evaluation and treatment in pediatric populations with some unique and important considerations when compared with adults. The incidence and type of injuries continue to evolve with the adoption of new safety measures, technology advancements, and education of the general population. The goal of this article is to provide the reader with a thorough understanding of the evaluation and management of pediatric soft tissue trauma including the initial workup, physical examination, appropriateness of antimicrobial therapy, and setting for surgical repair. Additionally, the pediatric anesthetic considerations for evaluation and repair in regard to local anesthesia, sedation, and general anesthesia are described in detail. There is a focus on dog bites, perinatal injuries, and child abuse as these entities are distinctive to a pediatric population and have particular management recommendations. Lastly, application of the reconstructive ladder as it applies to children is supported with specific case examples and figures. Although there are many parallels to the management of soft tissue injury in adults, we will highlight the special situations that occur in pediatric populations, which are imperative for the facial plastic and reconstructive surgeon to understand., Competing Interests: None declared., (Thieme. All rights reserved.)

Less-lethal weapons and tactics are being increasingly used by law enforcement to minimize the reliance on more-lethal force. While these methods are designated as "less-lethal," they can cause morbidity and mortality when deployed. Knowledge of these weapons and tactics can help direct the workup and management of patients with injuries from these methods and can protect clinicians from secondary exposure and injuries. This issue reviews the most common less-lethal weapons and tactics used by law enforcement, describes their mechanism of action, and discusses associated common injury patterns. Recommendations are provided for the evaluation and management of these patients in the emergency department.

Background: Dog bite injuries cause significant preventable patient morbidity and health care expenditure in children. This study aimed to characterize the patient and healthcare burden related to pediatric dog bite injuries at a level 1 trauma center., Methods: This is a retrospective review of 356 pediatric patients who presented to Virginia Commonwealth University Pediatric Emergency Department between July 2007 and August 2017 after sustaining dog bite injuries. Demographic information, injury details, management, outcomes, and financial information were analyzed., Results: Most pediatric dog bite injuries afflicted male children (55.6%), ages 6 to 12 years (45.7%), by a household dog (36.2%). The most common offending breed was a pit bull or pit bull mix (53.0%). Infants and grade schoolers were more likely to sustain bites to the head/face (P = 0.001). Usual management consisted of primary repair (75.9%), whereas approximately 25% of the patients required advanced reconstructive techniques. Most patients healed uneventfully, but prolonged antibiotics, additional wound care, or procedures were necessary in 8.4% of the patients. Hospital charges per patient averaged US $8830.70 and tended to be higher in the younger age groups. Insurance status was statistically associated with use of conscious sedation, surgical consult placement, and surgical repair., Conclusions: Although most pediatric dog bite injuries in this study healed uneventfully from primary management in the emergency department, 25% required additional interventions. Furthermore, patient care for these injuries was associated with significant but potentially avoidable personal and financial burden to families. Our data reflect a need for safety education on animal care, behavior, and interaction., Competing Interests: Conflicts of interest and sources of funding: none declared., (Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.)

Stonefish are regarded as one of the most venomous fish in the world. Research on stonefish venom has chiefly focused on the in vitro and in vivo neurological, cardiovascular, cytotoxic and nociceptive effects of the venom. The last literature review on stonefish venom was published over a decade ago, and much has changed in the field since. In this review, we have generated a global map of the current distribution of all stonefish ( Synanceia ) species, presented a table of clinical case reports and provided up-to-date information about the development of polyspecific stonefish antivenom. We have also presented an overview of recent advancements in the biomolecular composition of stonefish venom, including the analysis of transcriptomic and proteomic data from Synanceia horrida venom gland. Moreover, this review highlights the need for further research on the composition and properties of stonefish venom, which may reveal novel molecules for drug discovery, development or other novel physiological uses.