A man bitten by a large coral snake (Micrurus lemniscatus helleri) in the Amazon basin of Ecuador developed persistent excruciating pain in the bitten arm. On admission to hospital less than 30 min later, he had a polymorphonuclear leucocytosis, thrombocytopenia and mildly prolonged prothrombin time/partial thromboplastin time. Not until 14 h after the bite did he develop the first signs of neurotoxicity. Despite treatment with specific antivenom 50 h after the bite, he required oxygen for respiratory failure 60 h, and 6 h of mechanical ventilation 72 h, after the bite. Over the next 38 h, he required two further intubations and periods of assisted ventilation before being airlifted to a tertiary referral hospital. Complications included bacterial pneumonia, pneumothorax, bronchial obstruction by mucus plugs and mild rhabdomyolysis. He was discharged from hospital 15 days after the bite with persistent limb weakness and urinary incontinence but eventually recovered. The interesting and unusual features of this case (severe local pain, very slow evolution of neurotoxic envenoming, persistent thrombocytopenia and mild coagulopathy) are discussed in the context of what is known of the composition of Micrurus venoms and the small clinical literature on envenoming from their bites.

Our objective was to conduct a randomized, investigator-blinded evaluation of the pediculicidal and ovicidal activity of a reduced application time (20 minutes) of Ovide (0.5% malathion) compared to Nix (1% permethrin) in a south Florida population infested with Pediculus humanus capitis. Either Ovide or Nix was applied according to the label instructions. However, Ovide application time was reduced to 20 minutes. At day 8, subjects with live lice were re-treated with the same product and procedure as on day 1. Ovicidal and pediculicidal efficacy were evaluated at days 8 and 15. A subject free of lice and viable eggs at day 15 was considered to be a treatment success. Percent efficacy was calculated using the number of subjects free of lice and viable eggs per total number of subjects treated. We found that a 20-minute application of Ovide was significantly more pediculicidal and ovicidal (98%) compared to Nix (55%) at day 15 (p < 0.0001). The percentage of Ovide subjects who required treatment at day 8 was half that of the Nix group. The reinfestation rate was 0% with Ovide and 33% with Nix. In conclusion, a 20-minute treatment with Ovide, instead of the approved 8- to 12-hour application, cured 40 of 41 subjects (98%), demonstrating superior efficacy to Nix. The poor efficacy of Nix confirms the resistance of head lice to permethrin in south Florida.

One hundred seventy-two subjects with head lice participated in a five-way, investigator-blinded, parallel-group, active-controlled study comparing 0.5% malathion gel (30, 60, and 90 minutes applications), Ovide Lotion (0.5% malathion), and Nix Crème Rinse (1% permethrin). All subjects were treated on day 1. Participants were reevaluated at day 8 +/- 1 and those with live lice were retreated with the same product, for the same duration as day 1. Cure, defined as the absence of live lice, was evaluated 14 +/- 2 days after the last treatment and 161 subjects completed the study according to the protocol. Compared to Nix, treatment success rates were statistically superior for all malathion gel and Ovide groups. Retreatment rate for Nix was 70%, which was statistically more than the malathion groups. The highest treatment success rates were observed for the 30-minute malathion gel (98% intent-to-treat and 100% per-protocol [PP]) and the 8 to 12 hour Ovide application (97% intent-to-treat and 100% PP). In conclusion, the 30-minute malathion gel, which contains the same ingredients and concentrations as Ovide, provides comparable efficacy, offers increased safety and is more cosmetically acceptable than Ovide.

No abstract

These results suggest that IDV-RTV-based regimens may be able to overcome IDV resistance. This underscores the importance of drug adherence, potency, and exposure in determining virologic responses to antiretroviral therapy.