Xylazine in the Opioid Epidemic: A Systematic Review of Case Reports and Clinical Implications

Introduction and objectives: The opioid overdose epidemic is exacerbated by the emergence of Xylazine as an illicit drug adulterant. Xylazine, a veterinary sedative, can potentiate opioid effects while also causing toxic and potentially fatal side effects. This systematic review aims to assess the impact of Xylazine use and overdoses within the opioid epidemic context.Method: A systematic search was conducted following PRISMA guidelines to identify relevant case reports, and case series related to Xylazine use. A comprehensive literature search included databases like Web of Science, PubMed, Embase, and Google Scholar, utilizing keywords and Medical Subject Headings (MeSH) terms related to Xylazine. Thirty-four articles met the inclusion criteria for this review. Results: Intravenous (IV) administration was a common route for Xylazine use among various methods, including subcutaneous (SC), intramuscular (IM), and inhalation, with overall doses ranging from 40 mg to 4300 mg. The average dose in fatal cases was 1,200 mg, compared to 525 mg in non-fatal cases. Concurrent administration of other drugs, primarily opioids, occurred in 28 cases (47.5%). Intoxication was identified as a notable concern in 32 out of 34 studies, and treatments varied, with the majority experiencing positive outcomes. Withdrawal symptoms were documented in one case study, but the low number of cases with withdrawal symptoms may be attributed to factors such as a limited number of cases or individual variation. Naloxone was administered in eight cases (13.6%), and all patients recovered, although it should not be misconstrued as an antidote for Xylazine intoxication. Of the 59 cases, 21 (35.6%) resulted in fatal outcomes, with 17 involving Xylazine use in conjunction with other drugs. The IV route was a common factor in six out of the 21 fatal cases (28.6%). Conclusion: This review highlights the clinical challenges associated with Xylazine use and its co-administration with other substances, particularly opioids. Intoxication was identified as a major concern, and treatments varied across the studies, including supportive care, naloxone, and other medications. Further research is needed to explore the epidemiology and clinical implications of Xylazine use. Understanding the motivations and circumstances leading to Xylazine use, as well as its effects on users, is essential for developing effective psychosocial support and treatment interventions to address this public health crisis

Bus travel time prediction using support vector machines for high variance conditions

Real-time bus travel time prediction has been an interesting problem since past decade, especially in India. Popular methods for travel time prediction include time series analysis, regression methods, Kalman filter method and Artificial Neural Network (ANN) method. Reported studies using these methods did not consider the high variance situations arising from the varying traffic and weather conditions, which is very common under heterogeneous and lane-less traffic conditions such as the one in India. The aim of the present study is to analyse the variance in bus travel time and predict the travel time accurately under such conditions. Literature shows that Support Vector Machines (SVM) technique is capable of performing well under such conditions and hence is used in this study. In the present study, nu-Support Vector Regression (SVR) using linear kernel function was selected. Two models were developed, namely spatial SVM and temporal SVM, to predict bus travel time. It was observed that in high mean and variance sections, temporal models are performing better than spatial. An algorithm to dynamically choose between the spatial and temporal SVM models, based on the current travel time, was also developed. The unique features of the present study are the traffic system under consideration having high variability and the variables used as input for prediction being obtained from Global Positioning System (GPS) units alone. The adopted scheme was implemented using data collected from GPS fitted public transport buses in Chennai (India). The performance of the proposed method was compared with available methods that were reported under similar traffic conditions and the results showed a clear improvement

Bridging science and spirituality: the intersection of religion and public health in the COVID-19 pandemic

BackgroundThe COVID-19 pandemic has had global impacts on social interactions and religious activities, leading to a complex relationship between religion and public health policies. This article reviews impact of the COVID-19 pandemic on religious activities and beliefs in relation to the spread of the virus, as well as the potential of religious leaders and faith communities in mitigating the impact of the pandemic through public health measures and community engagement.MethodsA literature review was conducted using PubMed and Google Scholar, with search terms including “religion,” “COVID-19,” “pandemic,” “coronavirus,” and “spirituality.” We included English articles published between January 2020 and September 2022, focusing on intersection of religion and COVID-19.ResultsWe identified two main themes emerging, with the selected 32 studies divided in 15 studies focused on the relationship between religious practices, beliefs, and the spread of COVID-19, while 17 studies explored the role of religious leaders and faith communities in coping with and mitigating the impact of COVID-19. Religious activities were found to correlate with virus spread, particularly in early days of the pandemic. The relationship between religiosity and adherence to government guidelines was mixed, with some studies suggesting increased religiosity contributed to misconceptions about the virus and resistance to restrictions. Religious beliefs were also associated with vaccine hesitancy, particularly conservative religious beliefs. On the other hand, religious leaders and communities played a crucial role in adapting to COVID-19 measures, maintaining a sense of belonging, fostering emotional resilience, and upholding compliance with public health measures. The importance of collaboration between religious leaders, institutions, and public health officials in addressing the pandemic was emphasized.ConclusionsThis review highlights the essential role of religious leaders, faith-based organizations, and faith communities in promoting education, preparedness, and response efforts during the COVID-19 pandemic. Engaging with religious leaders and communities can improve pandemic control and prevention efforts. Collaboration between religious leaders, governments, and healthcare professionals is necessary to combat vaccine hesitancy and ensure successful COVID-19 vaccination campaigns. The insights from this review can guide future research, policy development, and public health interventions to minimize the impact of the pandemic and improve outcomes for individuals and communities affected

Predictive factors indicating comorbid psychotic disorders among hospitalized individuals with encephalitis.

Predictive factors indicating comorbid psychotic disorders among hospitalized individuals with encephalitis.</p

Variations in demographic characteristics, comorbid conditions, and clinical outcomes among hospitalized individuals with encephalitis with comorbid psychotic disorders.

Variations in demographic characteristics, comorbid conditions, and clinical outcomes among hospitalized individuals with encephalitis with comorbid psychotic disorders.</p