Fang shape varies with ontogeny and sex in the venomous elapid snake Pseudonaja affinis.

A predator's preferred prey often changes over the course of its life as it grows from an inexperienced juvenile through to a sexually mature adult. For species with highly specialised feeding strategies, this may require its anatomy to change over the course of its life. The dugite (Pseudonaja affinis, Günther 1872) is a venomous snake from Australia that displays such a diet shift, with juveniles feeding on small reptiles, while adults mainly target mammals. We examined the morphology of fangs across both sexes and throughout ontogeny using geometric morphometrics and cross-sectional sharpness measurements of key functional regions on these teeth. This highlighted key differences in shape that likely relate to the varied properties of their adult and juvenile diet. We found that juveniles display a more robust and blunter fang, which likely relates to feeding on scaly lizard prey, whereas adults have slender fangs with sharper tips, which reflects their diet of softer mammalian prey. There were also differences between males and females, with male snakes having significantly more slender fangs than females, which might be an indication of niche partitioning between the sexes. Using snout-vent length as a proxy for age, we found that the ontogenetic shift in fang shape occurs when P. affinis is around 60 cm long, corresponding with previous studies that found this size to be the moment where these snakes switch from their juvenile to adult diet.

Chlamydophila pneumoniae infection among Basic Underwater Demolition/SEAL (BUD/S) candidates, Coronado, California, July 2008.

Community-acquired pneumonia can compromise readiness of recruits and service members operating in confined spaces. Often respiratory pathogens are implicated in outbreaks. In July 2008, 5 Basic Underwater Demolition/SEAL students entering an intense period of training at Naval Amphibious Base Coronado reported with clinical symptoms and chest radiographs consistent with pneumonia. Throat and nasal swabs were tested for respiratory pathogens. Molecular evidence indicated that they were infected with the atypical bacterium Chlamydophila pneumoniae. Thirty contemporaneous Basic Underwater Demolition/SEAL students were tested to determine the extent of C pneumoniae infection burden. Five additional cases were captured within this group. The 10 individuals diagnosed with C pneumoniae were treated with a course of azithromycin, Avelox (moxifloxacin hydrochloride), and doxycycline. The cases ended following the isolation of cases and prophylaxis with oral antibiotics. This work highlights the importance of rapid respiratory disease diagnoses to guide the clinical response following the emergence of respiratory infections among military trainees.

Tonsillectomy in the anticoagulated patient.

OBJECTIVES: The objectives of this study were to review perioperative bridging strategies for anticoagulated patients and to describe a novel bridging strategy for tonsillectomy in an anticoagulated patient that addresses both primary and secondary hemorrhage risks. METHODS: A literature review and a case report are presented. PubMed was reviewed for evidence-based recommendations on perioperative management of anticoagulated patients. A case report is detailed of a 28-year-old woman with antiphospholipid syndrome on warfarin for high risk of venous thrombosis who underwent tonsillectomy. A perioperative bridging strategy incorporating outpatient low-molecular weight heparin and inpatient unfractionated heparin was implemented to minimize risks of thrombosis and primary and secondary posttonsillectomy hemorrhage. RESULTS: Limited evidence supports a consensus on the best perioperative management of anticoagulated patients. Tonsillectomy in an anticoagulated patient has not been described previously. The patient in this case underwent successful tonsillectomy with no thrombosis or bleeding after 1 month of follow-up. CONCLUSIONS: Tonsillectomy can be done relatively safely in an anticoagulated patient at high risk for thrombosis. The perioperative bridging strategy should account for its unique risk of primary and secondary postoperative hemorrhage. A proposed algorithm for managing these competing risks is presented.

Late displacement of a Montgomery thyroplasty implant following endotracheal intubation.

OBJECTIVES: We document a late displacement of a thyroplasty implant following endotracheal intubation. METHODS: A 66-year-old man was referred to our clinic with a chief complaint of breathy dysphonia immediately following an elective inguinal hernia repair under general endotracheal anesthesia. The patient's medical history was significant for a medialization laryngoplasty with a Montgomery implant 14 years earlier. RESULTS: Examination and computed tomographic scanning of the neck confirmed displacement of the implant. The patient underwent revision medialization laryngoplasty with successful restoration of his voice quality. CONCLUSIONS: This case report illustrates a potential complication of endotracheal intubation in patients who have previously undergone vocal fold medialization procedures.

Review of pharmacological therapy for tinnitus.

This article provides a review of studies investigating the pharmacological treatment of tinnitus. Tinnitus continues to be a significant and costly health problem without a uniformly accepted treatment. A wide variety of studies exploring prescription, supplement, and vitamin therapies are assessed for efficacy of treatment and for establishing consistencies in symptom definition, assessment, and outcome measures. This review reveals no compelling evidence suggesting the efficacy of any pharmacological agent in the treatment of tinnitus. Analysis of prior investigations provides insight to appropriate methods for future work, which are outlined.