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Background and Aims: Patient initiated transport refusal during Emergency Medical Service (EMS) opioid overdose encounters has become an endemic problem. This study aimed to quantify circumstantial and environmental factors which predict refusal of further care., Design: In this cross-sectional analysis, a case definition for opioid overdose was applied retrospectively to EMS encounters. Selected cases had sociodemographic and situational/incident variables extracted using patient information and free text searches of case narratives. 50 unique binary variables were used to build a logistic model., Setting: Prehospital EMS overdose encounters in Washington, DC, USA, from July 2017 to July 2023., Participants: Of EMS encounters in the study timeframe, 14 587 cases were selected as opioid overdoses., Measurements: Predicted probability for covariates was the outcome variable. Model performance was assessed using Stratified K-Fold Cross-Validation and scored with positive predictive value, sensitivity and F1. Prediction accuracy and McFadden's pseudo-R squared are also determined., Findings: The model achieved a predictive accuracy of 78% with a high positive predictive value (0.83) and moderate sensitivity (0.68). Bystander type influenced the refusal outcome, with decreased refusal probability associated with family (nondescript) (-28%) and parents (-16%), while presence of a girlfriend increased it (+28%). Negative situational factors like noted physical trauma (-62%), poor weather (-14%) and lack of housing (-14%) decreased refusal probability. Characteristics of the emergency response team, like a prior crew member encounter (+20%) or crew experience <1 year (-36%), had a variable association with transport., Conclusions: Refusal of emergency transport for opioid overdose cases in Washington, DC, USA, has expanded by 43.8% since 2017. Several social, environmental and systematic factors can predict this refusal. Logistic regression models can be used to quantify broad categories of behavior in surveillance medical research., (© 2024 Society for the Study of Addiction.)

To better connect non-emergent 911 callers to appropriate care, Washington, DC, routed low-acuity callers to nurses. Nurses could provide non-emergent transportation to a health centre, recommend self-care or return callers to the traditional 911 system. Over about one year, 6,053 callers were randomized (1:1) to receive a business-as-usual response (n control  = 3,023) or further triage (n treatment  = 3,030). We report on seven of nine outcomes, which were pre-registered ( https://osf.io/xderw ). The proportion of calls resulting in an ambulance dispatch dropped from 97% to 56% (β = -1.216 (-1.324, -1.108), P < 0.001), and those resulting in an ambulance transport dropped from 73% to 45% (β = -3.376 (-3.615, -3.137), P < 0.001). Among those callers who were Medicaid beneficiaries, within 24 hours, the proportion of calls resulting in an emergency department visit for issues classified as non-emergent or primary care physician (PCP) treatable dropped from 29.5% to 25.1% (β = -0.230 (-0.391, -0.069), P < 0.001), and the proportion resulting in the caller visiting a PCP rose from 2.5% to 8.2% (β = 1.252 (0.889, 1.615), P < 0.001). Over the longer time span of six months, we failed to detect evidence of impacts on emergency department visits, PCP visits or Medicaid expenditures. From a safety perspective, 13 callers randomized to treatment were eventually diagnosed with a time-sensitive illness, all of whom were quickly triaged to an ambulance response. These short-term effects suggest that nurse-led triage of non-emergent calls can safely connect callers to more appropriate, timely care., (© 2024. This is a U.S. Government work and not under copyright protection in the US; foreign copyright protection may apply.)

Background: A 30-year-old immunocompetent male with an unremarkable medical history presented with 2 months of lower abdominal bloating and loose, bloody, mucoid bowel movements. He was clinically suspected to have IBD. Due to the progression of his symptoms, he ultimately required hospitalization for further investigation and care., Investigations: Full medical history and physical examination, routine blood analyses, stool studies, hepatitis serologic tests, abdominal CT, colonoscopy, PCR analysis and light microscopy and immunoperoxidase staining of colonic biopsy samples., Diagnosis: Epstein-Barr virus (EBV)-associated lymphoproliferative disorder with diffuse colonic involvement (EBV colitis) in an immunocompetent adult., Management: Inpatient supportive care.

The prozone phenomenon in syphilis testing refers to a false negative response resulting from overwhelming antibody titers which interfere with the proper formation of the antigen-antibody lattice network necessary to visualize a positive flocculation test. This prozone effect in syphilis testing can be expected in cases of disproportionately high antibody titers, such as secondary syphilis, or with human immunodeficiency virus (HIV) coinfection. Clinicians need to remain familiar with the protean manifestations of syphilis to be able to exclude the prozone phenomenon.

Primary human immunodeficiency virus type 1 (HIV-1) infection (acute retroviral syndrome) has been well characterized as a mononucleosis-like illness. Manifestations of HIV-1 infection such as pharyngitis, fever, morbilliform rash, myalgias, arthralgias, nausea, headache, emesis, and lymphadenopathy have been reported. Acute rhabdomyolysis has been reported as part of the acute retroviral syndrome on 11 different occasions. We report the case of a primary HIV-1 infection with acute rhabdomyolysis and review critically the other case reports.

Our laboratory previously reported in situ hybridization analyses showing varicella-zoster virus (VZV)-specific RNA transcripts in latently infected human trigeminal ganglia. These transcripts were found exclusively in non-neuronal cells and emanated from at least three separate regions of the VZV genome, those encompassing restriction fragments BamHI-EY, EcoRI-B, and BamHI-J. Extending these in situ studies, we now report that VZV RNAs colinear with open reading frames (ORFs) 29 and 62 are demonstrable in non-neuronal cells; however, neither VZV RNA colinear with ORF 28 nor antisense RNAs of ORFs 29 and 62 are detected. Northern hybridization analyses of poly(A)+ RNA from human trigeminal ganglion pools also reveal VZV-specific transcripts corresponding to ORFs 29 and 62, but not those of ORFs 28 or 61. The ORF 29- and 62-specific transcripts are similar to those expressed in productive infection, with regard to size and polyadenylation. The cumulative findings suggest that VZV latency is characterized by selected expression of multiple genes, which appear to include some but not all putative immediate-early and early genes.