Circulating Interleukin-6 Levels and Timing of Acute Ischemic Stroke Onset.

Intravenous thrombolysis is the most widely available effective ischemic stroke treatment, but is approved only if given within 4.5 h from stroke onset. Many patients are not treated because stroke onset time is unknown.

The prevalence of pharmacogenetic testing in the United States.

It is unknown how many people in the US have had pharmacogenetic (PGx) testing and whether people want to be tested. We conducted a nationally representative survey of the general US adult population to determine the prevalence of adults that have had PGx testing using a validated confidential online survey, the Non-Medical Use of Prescription Drugs Program. A weighted logistic regression was used to test health characteristics associated with PGx testing and determine those who desire to be tested.

Toward an integrated resource for pharmacogenomics (PGx): Survey findings from the genomic medicine communities.

Purpose: Pharmacogenomics (PGx) is a critical component of precision health care that aims to improve drug efficacy and reduce adverse events. Terminologies and standards have not always aligned between PGx and broader genomic medicine communities, which is a barrier to PGx implementation. An updated assessment of community barriers, needs, and perspectives is critical to enable more standardized terminologies and interpretation frameworks.

Psychedelic Trips: Travel Within the United States to Use Psychedelic Drugs After Legalization.

Study Objective: Oregon and Colorado have legalized possession of natural psychedelic drugs. We assessed if travel to use psychedelics in decriminalized states is occurring and compared the use patterns of travelers with nontravelers.

Methods: The National Survey Investigating Hallucinogen Trends is a cross-sectional behavioral survey fielded from April to June 2024 to every US state.

Progress in Pharmacogenomics Implementation in the United States: Barrier Erosion and Remaining Challenges.

Barriers to incorporating pharmacogenetics into routine clinical practice in the United States are well documented. Initial surveys by the Clinical Pharmacogenetics Implementation Consortium (CPIC) in 2009 and 2010 identified barriers across four key domains that have hindered the widespread adoption of clinical pharmacogenetic testing. These are presented verbatim as: (i) absence of a definition of the processes required to interpret genotype information and to translate genetic information into clinical actions; (ii) need for recommended drug/gene pairs to implement clinically now; (iii) clinician resistance to consider pharmacogenetic information at the bedside; and (iv) concerns about test costs and reimbursement.

People entering opioid substance use treatment have low rates of naloxone knowledge and possession.

Background And Aims: Deaths from opioid overdose are increasing in the United States (US) and distribution of the opioid antagonist naloxone is one key strategy to reduce mortality. In this cross-sectional survey, we assess the association of high-risk behaviors with possession of naloxone and knowledge of where to find it.

Setting And Participants: 5663 adults entering treatment for opioid use disorder at facilities throughout the US during the calendar year 2022 were surveyed.

Elevated initial blood kynurenine is associated with increased odds of post-stroke infection: Kynurenine and post-stroke infection.

Objective: Post-stroke infection is a leading cause of acute ischemic stroke mortality. Tryptophan metabolites can modulate the immune response. This study assesses the association between tryptophan metabolism and post-stroke infection.

The Pharmacogenomics Global Research Network Implementation Working Group: global collaboration to advance pharmacogenetic implementation.

Pharmacogenetics promises to optimize treatment-related outcomes by informing optimal drug selection and dosing based on an individual's genotype in conjunction with other important clinical factors. Despite significant evidence of genetic associations with drug response, pharmacogenetic testing has not been widely implemented into clinical practice. Among the barriers to broad implementation are limited guidance for how to successfully integrate testing into clinical workflows and limited data on outcomes with pharmacogenetic implementation in clinical practice.

Functional differences in the mu opioid receptor SNP 118A>G are dependent on receptor splice-variant and agonist-specific recruitment of β-arrestin.

The OPRM1 gene codes for the mu opioid receptor (MOR) and polymorphisms are associated with complex patient clinical responses. The most studied single nucleotide polymorphism (SNP) in OPRM1 is adenine (A) substituted by guanine (G) at position 118 (118A>G, rs1799971) leading to a substitution of asparagine (Asn) for aspartic acid (Asp) at position 40 in the N terminus of the resulting protein. To date, no structural explanation for the associated clinical responses resulting from the 118A>G polymorphism has been proposed.

Clinical Effects of Psychedelic Substances Reported to United States Poison Centers: 2012 to 2022.

Study Objective: Psychedelic substances use is increasing in the United States (US). The approval of new psychedelic drugs and legalization of natural psychedelic substances will likely further increase exposures and subsequent adverse events. The study objective is to describe the clinical effects, therapies, and medical outcomes of patients with psychedelic exposures reported to US poison centers.

Clinical Pharmacogenetics Implementation Consortium Guideline (CPIC) for CYP2D6, ADRB1, ADRB2, ADRA2C, GRK4, and GRK5 Genotypes and Beta-Blocker Therapy.

Beta-blockers are widely used medications for a variety of indications, including heart failure, myocardial infarction, cardiac arrhythmias, and hypertension. Genetic variability in pharmacokinetic (e.g.

Sex Differences in the Blood Metabolome During Acute Response to Ischemic Stroke.

Females suffer greater lifetime risk of stroke and greater morbidity and mortality from stroke compared with males. This study's objective was to identify differences in metabolomic profiling of females and males with stroke and which differences were associated with neurological outcome. Females and males with acute ischemic stroke enrolled in the Emergency Medicine Specimen Bank at a comprehensive stroke center provided whole blood samples upon arrival for mass spectrometry-based metabolomics.

Recommendations for pharmacogenetic testing in clinical practice guidelines in the US.

Purpose: Pharmacogenetic testing can identify patients who may benefit from personalized drug treatment. However, clinical uptake of pharmacogenetic testing has been limited. Clinical practice guidelines recommend biomarker tests that the guideline authors deem to have demonstrated clinical utility, meaning that testing improves treatment outcomes.

Accessing and utilizing clinical and genomic data from an electronic health record data warehouse.

Electronic health records (EHRs) and linked biobanks have tremendous potential to advance biomedical research and ultimately improve the health of future generations. Repurposing EHR data for research is not without challenges, however. In this paper, we describe the processes and considerations necessary to successfully access and utilize a data warehouse for research.

Identification of Specific Recommendations for Prehospital Stroke Care Associated with Shorter Door-to-CT Times - an analysis of Get with the Guidelines-Stroke registry and prehospital data.

Objective: Full compliance with American Heart Association (AHA) recommendations for prehospital care of stroke patients remains low. This study aims to identify components of prehospital care associated with shorter door-to-CT times.

Methods: Data from a comprehensive stroke center's Get with the Guidelines-Stroke Registry was supplemented by prehospital medical records for ischemic stroke patients between January 1, 2018, and December 31, 2020.

Provider Perceptions of Oxygenation Strategies for Critically Ill Trauma Patients With and Without Moderate-to-Severe Traumatic Brain Injury.

Background: Hypoxia and hyperoxia (pulse oximetry [SpO2] > 96%) are associated with increased mortality in critically ill patients. However, provider practices regarding oxygenation in traumatic brain injury (TBI) patients are unknown. This study assesses views on oxygenation of critically ill trauma patients with and without TBI and how this varies between Neurological ICU (NeuroICU) and Surgical-Trauma ICU (STICU) providers.

Sex differences in acute ischemic stroke presentation are a matter of infarct location.

Introduction: Recognition of stroke by Emergency Medical Services (EMS) is critical to initiate rapid emergency department treatment. Most prehospital stroke screening tools rely heavily on presentation with the classic symptoms of facial droop, speech changes, unilateral weakness. However, women may be less likely to present with classic symptoms and may also have different distributions of stroke by anatomical location.

Fomepizole Therapy for Acetaminophen-Induced Liver Failure in an Infant.

Acetaminophen overdose is common in the pediatric population. N-acetylcysteine (NAC) is effective at preventing liver injury in most patients when started shortly after the overdose. Delays to therapy increase risk of hepatotoxicity and liver failure that may necessitate organ transplant.

A Multi-Omic Mosaic Model of Acetaminophen Induced Alanine Aminotransferase Elevation.

Background: Acetaminophen (APAP) is the most common cause liver injury following alcohol in US patients. Predicting liver injury and subsequent hepatic regeneration in patients taking therapeutic doses of APAP may be possible using new 'omic methods such as metabolomics and genomics. Multi'omic techniques increase our ability to find new mechanisms of injury and regeneration.

Total CroFab and Anavip Antivenom Vial Administration in US Rattlesnake Envenomations: 2019-2021.

Introduction: In 2018, Anavip became available for the treatment of rattlesnake envenomations in the USA. No comparisons between the treatment characteristics of patients have been made since Anavip and CroFab have both been widely available. The objective of this study was to compare the number of antivenom vials administered of CroFab and Anavip during the treatment of rattlesnake envenomations in the USA.