Alpha-gal syndrome (AGS) is an immunoglobulin E-mediated sensitivity to galactose-alpha-1,3-galactose ("alpha-gal"), an oligosaccharide found in non-primate, mammalian-derived foods and products as well as some plant-based ingredients. Sensitization to alpha-gal is most commonly caused by a tick bite. Once sensitized, individuals experience delayed allergic reactions, typically 2-8 h after exposure to mammalian foods and other alpha-gal containing products. Symptoms range from urticaria to anaphylaxis and differ from exposure to exposure in the same individual, distinguishing AGS from other IgE-mediated food allergies. Recognition of AGS has grown since 2008, when patients receiving the anticancer drug, cetuximab, experienced severe reactions later linked to alpha-gal. In 2009, 24 cases were documented when patients endorsed anaphylaxis and urticaria several hours after eating meat. Today, an estimated 15,000 new cases occur annually in the United States, with many more suspected due to testing limitations and limited awareness among affected individuals and healthcare professionals. AGS has been diagnosed on every continent except Antarctica though there is not a global estimate of AGS prevalence at this time. Given the varying types and severities of sensitivity of this IgE-mediated food allergy, registered dietitian nutritionists (RDNs) are vital members of the care team. This mini review provides an overview of AGS for nutrition professionals that are responsible for delivering medical nutrition therapy, nutrition education, and nutrition counseling across clinical, community, and food service settings.

Scorpionism has emerged as a growing public health concern in Brazil, characterized by increasing incidence and geographic expansion. Despite this trend, studies integrating climatic drivers and advanced time-series modeling remain limited. This study aims to analyze the temporal dynamics, spatial diffusion, and climate-disease relationships of scorpion sting incidence in Brazil using a nationwide dataset from 2007 to 2025. Monthly scorpion sting data from SINAN/DATASUS were combined with high-resolution climatic variables from the TerraClimate dataset. Descriptive statistics, seasonal analysis, and lagged correlation were applied to explore temporal patterns. A distributed lag non-linear model (DLNM) was used to quantify the non-linear and delayed effects of temperature and precipitation on scorpion sting incidence. The results revealed a pronounced non-linear increase in scorpionism, with a structural breakpoint around 2011 indicating accelerated expansion. Seasonal patterns showed higher incidence between September and November. Lag analysis demonstrated that temperature had the strongest association with incidence, peaking at a one-month lag (r ≈ 0.57), while precipitation exhibited weaker but delayed effects. DLNM results confirmed significant non-linear and lag-dependent relationships, with elevated temperatures associated with increased risk at short lag periods. Scorpionism in Brazil is a climate-sensitive and dynamically evolving epidemiological system, driven by the interaction of environmental variability and urban expansion. These findings highlight the need for integrated, climate-informed public health strategies and predictive modeling approaches to mitigate future risk.

Sleep bruxism (SB) is a motor activity characterized by repetitive masticatory muscle contractions during sleep, commonly associated with tooth damage and jaw pain or headache. Pharmacological management strategies targeting its central nervous system-related mechanisms remain limited. This study aimed to evaluate whether a low dose of a central muscle relaxant, cyclobenzaprine, reduces SB-related muscle activity, maximum voluntary bite force and self-reported bruxism awareness. A randomized, double-blind, placebo-controlled, crossover clinical trial was conducted. Twenty participants underwent baseline SB motor activity recordings followed by two intervention phases consisting of 5 mg of cyclobenzaprine or placebo for three consecutive nights. Masticatory muscle activity during sleep was quantified using portable surface electromyography. Maximum voluntary bite force was measured using a bite force-recording device. Self-reported outcomes related to SB and secondary effects (e.g., dry mouth) were collected each morning. Comparison of cyclobenzaprine to placebo and baseline nights failed to show a difference in mean frequency of masticatory muscle activity during sleep and maximum voluntary bite force. No self-reported differences were observed for SB awareness. Few secondary effects were identified between cyclobenzaprine use and placebo; a significant increase in perception of tolerable dry mouth upon awakening (p = 0.034) and a marginally statistically significant reduction in the perceived leg movements during sleep (p = 0.046). In conclusion, low-dose cyclobenzaprine was not effective in modifying SB-related muscle activity or masticatory muscle force, suggesting limited clinical utility for SB. Future studies using higher doses of cyclobenzaprine are warranted before ruling out its clinical utility, within a safety profile.

The standard Douglass ternary binding model (TBM) for three-body equilibria assumes a well-mixed, three-dimensional solution. When applied to bispecific T-cell engagers (BiTEs), however, the productive trimeric complex forms not in bulk solution but within a nanoscale membrane synapse with finite receptor copy numbers. We present a generalization of the TBM to membrane-confined systems that replaces the macroscopic bulk volume with a coarse-grained reactive contact volume defined by synapse geometry and microvillus topology, and extends the deterministic equilibrium to a stochastic description via the chemical master equation. The framework preserves the original algebra while restoring its representational capacity for the regime in which therapeutic activity occurs. A key finding is that conventional bulk mapping places the system in the affinity-limited regime, where antigen density is mathematically inert and the TBM predicts identical dose-response regardless of target expression. Membrane confinement shifts effective antigen concentration by six orders of magnitude-from ∼ 10 - 3 nM to ∼ 10 3 nM-restoring antigen density as a governing variable for trimer formation. Using blinatumomab (anti-CD19 BiTE) as a case study, we introduce the absolute formation dose d N * : the drug concentration required to produce a fixed number of ternary complexes sufficient for T-cell activation. This metric replaces the conventional T F 50 , which normalizes each cell line to its own maximum, erasing the density dependence that confinement rescues. For NALM-6 and HAL-01 cell lines (CD19 density ratio ≈ 2.5), the framework predicts a corresponding ≈ 2.5 -fold difference in required dose-a prediction structurally invisible to the bulk formulation.

The mouse model of tick-mediated Borrelia burgdorferi sensu lato (Bbsl) challenge is integral to the preclinical evaluation of Lyme disease vaccines. The standard measure of vaccine efficacy is the recovery of viable spirochetes from different mouse tissues, monitored weekly for a month post challenge. Serological tests (ELISA and Western blots) with B. burgdorferi lysates, recombinant proteins, or peptides are often used as alternative or confirmatory readouts. While there are several reports suggesting that culture positivity and serology are strongly correlated, a systematic study addressing this issue is lacking. In this report, we took advantage of available data sets from large cohorts of naive and OspA actively and passively immunized mice that had been challenged with Ixodes scapularis nymphs carrying Bbsl strain B31, euthanized 3 weeks later, then assessed for culture positivity across different tissue types (ear, skin, ankle, bladder, and heart) and seropositivity using an OspC and DbpB 2-plex microsphere immunoassay (MIA) and a vmp-like sequence C6 monoplex MIA. Our results demonstrate a 96.5%-97% agreement between culture positivity and seroconversion using the OspC/DbpB and C6 MIAs, suggesting that serology provides a near-perfect readout of disseminated spirochetal infection. While some instances of culture and serological discordance could be attributed to technical errors, others likely reflect aspects of infectivity/immunological dynamics, including the possibility of abortive (non-sterilizing) B. burgdorferi infections. We conclude that serological testing provides a highly accurate and practical measure of disseminated B. burgdorferi infection in mouse models, crucial for the efficient preclinical assessment of Lyme disease vaccines.

Human rabies is a fatal viral encephalitis that presents a profound diagnostic challenge in the absence of a known history of animal exposure. We report the case of a 9-year-old boy from Morocco who presented with fever, seizures, psychomotor agitation, hypersalivation and hydrophobia, despite no reported history of an animal bite or scratch. Brain magnetic resonance imaging (MRI) served as a critical diagnostic tool, strongly suggesting rabies encephalitis by revealing classic bilateral symmetric grey matter hyperintensities in the thalami and temporal lobes. Concurrently, MRI revealed an atypical and rare macrovascular finding: extensive cerebral venous sinus thrombosis of the right transverse and sigmoid sinuses, which likely accounted for additional asymmetric white matter changes. A nuchal skin biopsy analyzed via reverse transcription polymerase chain reaction confirmed the presence of rabies virus RNA. Despite aggressive neurocritical care and therapeutic anticoagulation, the patient's condition deteriorated, and he passed away on day 9 of admission. This case underscores the dual role of MRI in acute encephalitis: guiding early etiological diagnosis of rabies and identifying concurrent, clinically significant macrovascular complications like cerebral venous sinus thrombosis.

Brown spider (Loxosceles) envenomation is a critical public health issue in Brazil, the systemic cutaneous-hemolytic form of which represents a rare but life-threatening complication. This manifestation is primarily driven by sphingomyelinase D, a potent toxin that triggers a complex cascade of direct erythrocyte membrane disruption and complement-mediated destruction. While systemic cases are more frequently documented in younger populations, reports in octogenarians are exceptionally rare, posing significant diagnostic and therapeutic challenges. This study details a rare case of cutaneous-hemolytic loxoscelism in an 82-year-old woman. Initially misdiagnosed with a primary skin infection, the patient presented four days post-injury with a 6-cm necrotic lesion, fever, and anemia. Laboratory evaluation confirmed a significant hemoglobin drop, elevated lactate dehydrogenase, and a strongly positive direct antiglobulin test (4+), indicating immune-mediated hemolysis. Management included specific antivenom and high-dose corticosteroid therapy (prednisone), leading to clinical stabilization without the need for blood transfusion. The patient was monitored in the intensive care unit with conservative wound management. This report emphasizes that prompt recognition and multidisciplinary intervention are vital for favorable outcomes in rare, high-risk geriatric presentations with prominent synergy between toxic effects and immune dysregulation.

Crimean-Congo hemorrhagic fever (CCHF) remains a major tick-borne zoonotic infection and a persistent public health challenge in Central Asia. Kazakhstan is among the endemic countries, where natural foci of CCHF are concentrated predominantly in the southern regions. This study evaluated the long-term epidemiological trends, regional distribution, seasonality, and risk factors associated with CCHF in Kazakhstan. A retrospective analysis of national surveillance data from 1980 to 2023 was conducted, complemented by detailed epidemiological and entomological investigations in the Turkestan region and the city of Shymkent during 2011-2023. Laboratory-confirmed cases, tick bite-related healthcare visits, entomological surveillance data, demographic characteristics, and epidemiological risk factors were analyzed. The results demonstrated cyclic fluctuations in CCHF incidence, with epidemic peaks occurring every 4-6 years and pronounced spring-summer seasonality, with the highest incidence observed in June and July. Long-term average annual incidence in endemic southern regions exceeded the national average by 2.67-fold. A total of 50,671 tick bite-related healthcare visits were registered during 2011-2023, while their incidence declined over time. Analysis of 94 laboratory-confirmed cases identified adults aged 18-40 years as the most affected group. Tick bites and livestock-related activities were the principal risk factors. These findings support the strengthening of integrated surveillance, vector control, laboratory diagnostics, and One Health-based prevention strategies in endemic regions.