Fatal injection of ranitidine: a case report

ABSTRACT: INTRODUCTION: Ranitidine hydrochloride (Zantac(R)), a histamine-2-receptor antagonist, is a widely used medication with an excellent safety record. Anaphylactic reaction to ranitidine is an extremely rare event and a related death has never been described in the literature. CASE PRESENTATION: We present the clinical history, histological and toxicological data of a 51-year-old man with negative anamnesis for allergic events, who died suddenly after the intravenous administration of one phial of Zantac(R) 50 mg prescribed as a routine post-surgical prophylaxis for stress ulcer. CONCLUSION: Although the incidence of anaphylactic reactions related to ranitidine is low, caution needs to be exercised on administration of this drug. In addition, further study is needed to define strategies for the prevention of adverse drug reactions in hospitalized patients

Sudden unexpected death in epilepsy genetics: Molecular diagnostics and prevention.

Epidemiologic studies clearly document the public health burden of sudden unexpected death in epilepsy (SUDEP). Clinical and experimental studies have uncovered dynamic cardiorespiratory dysfunction, both interictally and at the time of sudden death due to epilepsy. Genetic analyses in humans and in model systems have facilitated our current molecular understanding of SUDEP. Many discoveries have been informed by progress in the field of sudden cardiac death and sudden infant death syndrome. It is becoming apparent that SUDEP genomic complexity parallels that of sudden cardiac death, and that there is a pauci1ty of analytically useful postmortem material. Because many challenges remain, future progress in SUDEP research, molecular diagnostics, and prevention rests in international, collaborative, and transdisciplinary dialogue in human and experimental translational research of sudden death

Weak effect of urbanization on bdelloid rotifers living in lichens

Human activities have an overwhelming impact on the natural environment, leading to a deep biodiversity crisis whose effects range from genes to ecosystems. Here, we analysed the effect of such anthropogenic impacts on bdelloid rotifers (Rotifera Bdelloidea), for whom these effects are poorly understood. We targeted bdelloid rotifers living in lichen patches across urbanization gradients in Flanders and Brussels (Belgium). Urbanization was measured as the percentage of built-up area (BU) across different spatial scales, at circles from 50 to 3200 m of radius around the lichen. Urbanization effects on biodiversity were assessed on abundance, species richness and community-weighted mean body size of bdelloid rotifers, as well as on genetic diversity of a mitochondrial marker (cytochrome c oxidase subunit I) of one of the most common and widespread bdelloid species, Adineta vaga. Overall, no negative effect of urbanization was found at any diversity level and any spatial scale. Counterintuitively, the BU area quantified at the largest spatial scale had a positive effect on abundance. These results leave open the question of whether negative effects of urbanization are present for bdelloid rotifers, if they are mediated by other unexplored drivers, or if such effects are only visible at even larger spatial scales

Clinical interpretation of genetic variants in arrhythmogenic right ventricular cardiomyopathy

Arrhythmogenic right ventricular cardiomyopathy is an inherited cardiac entity characterized by right ventricular, or biventricular, fibrofatty replacement of myocardium. Structural alterations may lead to sudden cardiac death, mainly in young males during exercise. Autosomal dominant pattern of inheritance is reported in most parts of pathogenic genetic variations identified. Currently, 13 genes have been associated with the disease but nearly 40 % of clinically diagnosed cases remain without a genetic diagnosis. New genetic technologies allow further genetic analysis, generating a significant amount of genetic data in novel genes, which is often classified as of ambiguous significance. We focus on genetic advances of arrhythmogenic right ventricular cardiomyopathy, helping clinicians to interpret and translate genetic data into clinical practice

Genetic analysis, in silico prediction, and family segregation in long QT syndrome

The heritable cardiovascular disorder long QT syndrome (LQTS), characterized by prolongation of the QT interval on electrocardiogram, carries a high risk of sudden cardiac death. We sought to add new data to the existing knowledge of genetic mutations contributing to LQTS to both expand our understanding of its genetic basis and assess the value of genetic testing in clinical decision-making. Direct sequencing of the five major contributing genes, KCNQ1, KCNH2, SCN5A, KCNE1, and KCNE2, was performed in a cohort of 115 non-related LQTS patients. Pathogenicity of the variants was analyzed using family segregation, allele frequency from public databases, conservation analysis, and Condel and Provean in silico predictors. Phenotype-genotype correlations were analyzed statistically. Sequencing identified 36 previously described and 18 novel mutations. In 51.3% of the index cases, mutations were found, mostly in KCNQ1, KCNH2, and SCN5A; 5.2% of cases had multiple mutations. Pathogenicity analysis revealed 39 mutations as likely pathogenic, 12 as VUS, and 3 as non-pathogenic. Clinical analysis revealed that 75.6% of patients with QTc≥500 ms were genetically confirmed. Our results support the use of genetic testing of KCNQ1, KCNH2, and SCN5A as part of the diagnosis of LQTS and to help identify relatives at risk of SCD. Further, the genetic tools appear more valuable as disease severity increases. However, the identification of genetic variations in the clinical investigation of single patients using bioinformatic tools can produce erroneous conclusions regarding pathogenicity. Therefore segregation studies are key to determining causality

Elgvandringer i grenseland med følger for skogbruk, jakt og rovdyr

Forvaltning av elg i områder med en delvis trekkende elgbestand byr på utfordringer, fordi kostnadene i form av beiteskader på skogen og goder i form av elgjakt ofte berører forskjellige grunneiere. Dette blir ytterligere komplisert når elgtrekket går på tvers av forvaltningsinndelinger eller til og med over riksgrensen. GRENSEVILT har studert samspillet mellom elg, ulv, skogbruk og jakt i nordre Finnskogen, et stort barskogsområde som er delt av riksgrensen. For å berenge størrelsenpå elgbestanden og beskrive den romlige fordelingen av elg for vintrene 2019/20 og 2020/21, samt somrene 2020 og 2021,har vi gjennomført elgmøkktellinger over et areal på mer enn 3500 km2. Vi ønsket også å studere hvordan elgtrekket påvirker ulvens områdebruk, beitepå furu, og jaktuttaket. Derfor har vived hjelp av GPS-halsbånd analysert områdebruken til fire ulveflokker i samme område. Dessuten gjennomførte vi på våren 2021 en stor beitetakst som kombinerte den norke Solbraa-og den svenske Äbin-metoden. Til slutt har vi sammenstilt jaktdata fra norske vald og svenske älgjaktområder for jaktårene 2019/20 og 2020/21.Vi beregnet elgens tetthet for tidsserien vinter 2019/20, sommer 2020, vinter 2020/21, og sommer 2021 til henholdsvis 1,18, 1,37, 1,01, og 1,70dyr/km2. Om sommeren var elgen noksåjevnt fordelt over hele studieområdet, og om vinteren stod elgen mer konsentrert i de snøfattige områdene, mens det var lite elgi de nordlige, snørike områdene. Til tross for at elgens fordeling endret seg mellom sommer og vinter, opprettholdt ulveflokkene de samme revirgrensene gjennom hele året. Derimot tilpasset de sine aktivitetsområder innenfor revirgrensene til endringen i elgfordelingen. Elgens vinterkonsentrasjonsområder var kjennetegnet ved et større beitetrykk på furu. Skader på produksjontrær var mest hyppig langs dalbunnen og i områder med mye lauvkratt, men vi fant ikke noe tydelig sammenheng mellom skadegrad og elgens vinterfordeling. Elgens effekt på skogbruk målt med den norske Solbraa-metoden viste at beitegraden på furu var stort sett liten. Den svenske Äbin-metoden tegnet et helt motsatt bilde, og bedømmetskadegraden på de samme prøveflatenesomsvært alvorlig. Jaktuttaket i jaktområdene gjenspeilet fordelingen av elg sommerstid i Norge, men ikke i Sverige, der det ble skutt mest elg i områdene med lavest sommertetthet. De hardest beskattede jaktområdene i Sverige hadde en lavere elgtetthet vinteren etter jakt. Vi fant ikke noensammenheng mellom beite-eller skadegrad på furu og jaktuttak i jaktområdene. I den østlige delen av studieområdet som har et stort innslag av trekkelg som oppholder seg på norsk side på sommeren og under jakta, men trekker til Sverige når snøen hoper seg opp lenger nord, var det en tydelig mismatch i forvaltningen av elg mellom de to landene. Mens man i Sverige satset på et høyt jaktuttak for å få bukt med beiteskader,og i tillegg beskattet trekkelg ved januarjakt,sparte man på avskytingen på norsk side fordi beitegraden ikke var bekymringverdigog elgens sommerbestand også ble utsatt for ulvens uttak i tillegg til vinterjakt på svensk side .Vi foreslår en bedre samordning av elgforvaltningen på tvers av riksgrensen. Det krever dialog og samarbeid mellom rettighetshaverne. Et felles elgforvaltningsområde som strekker seg over grensen og dekker trekkelgens helårsområde hadde gjort et slikt samarbeid enklere. Dessuten foreslår vi en samordning av beitetakstmetoden og en felles trafikklysmodell som baserer seg på tetthet av uskadde produksjonstrær heller enn beite-eller skadegraden

Scots pine for fika : the role of local moose density in determining browsing damages to pine across commercial forests in Sweden

By browsing on young Scots pine (Pinus sylvestris), moose (Alces alces) can cause significant damage to commercial forests. The National Forest Agency monitors browsing damage and moose faecal pellet groups annually on pre-defined plots throughout Sweden. Here, we investigated the relationship between moose pellet groups and the proportion of pine trees with fresh (< 1 year) browsing damages. We used mixed-effects logistic regression models with proportion of damaged stems as response and moose pellet group density, presence of other deer pellet groups, Scots pine and birch (Betula spp.) numbers, and site productivity as predictors. We used data collected nationwide and did analyses first for the whole of Sweden and secondly for each separate region by subdividing the same dataset. Overall, the results were consistent across the regions and for Sweden as a whole, with some differences. We found that moose pellet group density was positively correlated with damage in every region and was especially important in explaining damage levels in the north of Sweden. Presence of other ungulates was positively related to pine damage in the Southern region only, and it is unclear to what extent their effect on young pine trees is direct through browsing or indirect through competition. Contrary to recent studies, pine abundance had a secondary role in explaining browsing damage. Instead, browsing damage was positively associated to site productivity and number of birch trees, the latter with a systematic higher importance than moose local density. Plots where birch is abundant might be attractive to moose and therefore indirectly lead to increased browsing damage on pine. Given the consistent positive association found between moose pellet groups and level of damage, we conclude that moose pellet counts on browsing survey plots are an important add-on for the adaptive management of moose and forests. However, pellet count should be made more systematically and should not be limited to young forest stands to properly capture moose density