Publications by authors named "Nathan Friedman"

Organ-on-a-chip (OoC) is a rapidly advancing technology with significant potential to revolutionize healthcare, drug discovery, and personalized medicine. OoC technologies offer cost-effective and ethical platforms that enable the acquisition of physiologically relevant data and enhance our understanding of human disease mechanisms and drug responsiveness. Over the past decade, numerous academic start-ups and spin-offs have sought to translate foundational research on OoC platforms from the lab bench to commercial and real-world applications.

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Despite the potential benefits of remote cognitive assessment for dementia, it is not appropriate for all clinical encounters. Our aim was to develop guidance on determining a patient's suitability for comprehensive remote cognitive diagnostic assessment for dementia. A multidisciplinary expert workgroup was convened under the auspices of the Canadian Consortium on Neurodegeneration in Aging.

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Article Synopsis
  • - Phenobarbital is a long-acting barbiturate used for treating alcohol withdrawal and epilepsy but can cause severe central nervous system depression in case of overdose.
  • - A case study of a 14-year-old girl showed that urinary alkalinization with sodium bicarbonate was used successfully for treating phenobarbital overdose, enhancing drug elimination.
  • - Despite the treatment increasing urinary excretion rates, there was no significant impact on the elimination half-life of the drug, indicating the need for further studies on the efficacy of urinary alkalinization in such cases.
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Background: The opioid overdose crisis is one of the worst public health crises ever to face the US and emerging evidence suggests its effects are compounded by the presence of drug adulterants. Here we report our efforts to characterize the adulterants present within the local fentanyl supply of San Diego County, obtained from undifferentiated drug samples seized by local law enforcement over the calendar year 2021.

Methods: Thirty-two participating local law enforcement agencies across San Diego submitted 4838 unknown individual illicit drug samples (total of 312 kg) to the San Diego County Sheriff's Department Regional Crime Laboratory for identification.

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Background: Opioid overdose is a major cause of mortality in the United States. In spite of efforts to increase naloxone availability, distribution to high-risk populations remains a challenge.

Objective: To assess the effects of multiple different naloxone distribution methods on patient obtainment of naloxone in the emergency department (ED) setting.

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Objectives: Rattlesnake envenomations are uncommon, and the majority occur in adults. Although Crotalidae equine immune F(ab') 2 antivenom (F(ab') 2 AV; trade name ANAVIP) was introduced in 2018, no pediatric specific studies of F(ab') 2 AV have been reported to date. The objective of this study was to evaluate the clinical performance and adverse effects of F(ab') 2 AV in children.

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We report a rare domestic case of exposure to tianeptine and use of a novel, extended-release, six-armed, star-shaped, drug delivery capsule. A 40-year-old male with a history of depression, anxiety, ethanol, opioid, cannabis, and tobacco use disorders presented to the emergency department (ED) from a substance abuse residential recovery treatment program after developing hypertension, tachycardia, and tremor for two day. He used an extended-release, six-armed, star-shaped, drug delivery device he purchased online, filling each arm with 15 mg of tianeptine (90 mg total).

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Patients that are taking Ayurvedic supplements have an increased risk of heavy metal toxicity. Lead, arsenic, and mercury are frequently identified in these supplements and can cause clinically significant toxicity. Clinicians should screen patients routinely for use of non-pharmaceutical medications and supplements.

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Human exposures to "fire color changing" agents containing copper salts (CS) are rare. We report the case of an intentional mixed CS ingestion with resulting corrosive gastrointestinal injury absent classic laboratory abnormalities. A 23-year-old male with a history of bipolar disorder presented to the emergency department two hours after intentional ingesting an unknown quantity of the fire colorant "Mystical Fire," which contains cupric sulfate (CuSO) and cupric chloride (CuCl).

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Ethanol remains one of the most frequently abused agents by adolescents, exceeding all others except for vaping nicotine, and use is rising. With increased ethanol use comes a greater risk for dependence and potential for alcohol withdrawal syndromes (AWS). Pediatric AWS is extremely rare and poorly characterized in the literature.

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  • - Capecitabine, an oral cancer medication, can cause toxicity from both regular use and overdoses, but an antidote called uridine triacetate is effective if given within 96 hours after exposure
  • - A study analyzed 81 cases of capecitabine exposures reported to a poison control center over 20 years, finding that most were managed at home, with only a small percentage showing severe symptoms
  • - The research highlights the need for better understanding of toxicity thresholds and more consistent treatment guidelines for handling capecitabine exposures, especially considering individual genetic differences.
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Background: The Komodo dragon (Varanus komodoensis) is the world's largest living lizard and exists in private captivity worldwide. Bites to humans are rare and have been proposed to be both infectious and venomous.

Case Report: A 43-year-old zookeeper was bitten on the leg by a Komodo dragon and suffered local tissue damage with no excessive bleeding or systemic symptoms to suggest envenomation.

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Introduction: Though acetaminophen overdoses are common, acetaminophen induced methemoglobinemia is rare and it is thought to be due to oxidative stress from reactive metabolites. However, few prior cases of sulfhemoglobinemia in the setting of acetaminophen overdose have been reported. We report a case of mixed methemoglobinemia and sulfhemoglobinemia in the setting of a large, isolated acetaminophen ingestion.

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Severe cases of hydrocarbon aspiration requiring Extracorporeal Membrane Oxygenation (ECMO) are rarely reported in pediatrics, and 90% of hospitalized patients have a relatively benign clinical course. We describe a 14 month-old female with accidental hydrocarbon ingestion and aspiration due to organic makeup brush cleaner that suffered severe ARDS and multiorgan failure, successfully managed with ECMO and surfactant. She was decannulated after a total of 72 hours on ECMO, extubated on hospital day 15 (HD 15), and discharged home in her normal state of health after one month in the hospital.

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Introduction: Pediatric organophosphate insecticide poisonings are rare in the United States, and life-threatening toxicity is rarely seen. We report 2 accidental ingestions of the organophosphate insecticide coumaphos that resulted in life-threatening symptoms.

Case Reports: A 7-year-old boy and 10-year-old girl both presented from home after accidental ingestion of 1 "spoonful" of coumaphos 20% liquid (Asuntol; Bayer de Mexico, S.

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The Southern Pacific rattlesnake (Crotalus helleri) is commonly encountered throughout Southern California. Typical toxicity includes tissue injury and hematologic toxicity. However, neurotoxicity is not commonly reported with rattlesnake envenomations, other than infrequently with select species, including the Mojave rattlesnake (Crotalus scutulatus scutulatus).

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Bromism is an unusual syndrome characterized by a variety of nervous system impairments such as ataxia, confusion, and delusions. Contemporaneous cases are rare as therapeutic use of bromide-containing medications has declined, but bromides can still be obtained as unregulated dietary supplements. Bromism from dietary supplements is not well-described.

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Objectives: Lithium is an uncommon pediatric exposure, and the effects of accidental or exploratory ingestions are not well characterized. This study examined the clinical effects and outcomes of unintentional lithium ingestions treated in a health care facility for patients up to 16 years old.

Methods: The database from a single-state Poison Control System was queried for all pediatric lithium exposures managed in a health care facility between January 2006 and December 2021.

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Article Synopsis
  • Most animal bites and stings are not harmful, but children may suffer more from venom effects due to their smaller size.
  • The review covers the epidemiology, pathophysiology, and clinical presentations of bites and stings from various creatures like spiders, bees, and snakes.
  • It provides evidence-based management recommendations while noting key differences in response between children and adults.
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A 46-year-old man presented with a painless mass on his dorsal right foot one week after striking it on a door. A traumatic hematoma was suspected, and needle aspiration of the mass is considered. However, point-of-care ultrasound performed by the emergency physician identified a pseudoaneurysm of the dorsalis pedis artery, a rare condition that can occur after minor trauma or iatrogenic intervention.

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Microfluidic technology has been extensively applied to model the functional units of human organs and tissues. Since vasculature is a key component of any functional tissue, a variety of techniques to mimic vasculature in vitro have been developed to address complex physiological and pathological processes in 3D tissues. Herein, we developed a novel, in vitro, microfluidic-based model to probe microvasculature growth into and across implanted porous membranes.

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