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Introduction: The puff adder (Bitis arietans) is a medically important snake species found across much of Africa, yet there is limited literature on the clinical features and pathophysiology of envenoming after a puff adder bite. Methods: We conducted a case-series study to describe the clinical features of patients with puff adder bites who were treated in two primary healthcare facilities in Kenya and complemented our case-series with a scoping review of all published cases of puff adder envenoming that contained sufficient clinical details to highlight the major features. Results: Between December 2020 and September 2021, 15 patients were admitted with a suspected puff adder bite (based on the patient's description of the biting snake or confirmed in patients who brought the dead snake or a picture of the biting snake for identification) at the Chemolingot and Mwingi sub-county hospitals in Baringo and Kitui counties, central Kenya. Common local and systemic features on admission included pain (n=15, 100%), swelling (n=14, 93%), and haemorrhage (n=9, 60%). Coagulopathy (n=2, 13%), blistering (n=1, 8%) and shock (n=1, 8%) were less common. In addition, we conducted a literature review and identified 23 studies with detailed descriptions of the clinical features of puff adder envenoming from 37 patients. Local features were common and consistent across cases—swelling (100%, n=37) and pain (95%, n=35). Systemic features were less consistent, with 10 (27%) patients exhibiting hypotension on admission, 10 (27%) patients reporting a fever, and 13 (35%) developing anaemia. Some complications were more common in patients with bites by captive snakes (amputations), compared to patients with bites by wild snakes (hypotension). Snake identification was easier and more accurate after bites by captive snakes, but more challenging for patients bitten in community settings. Conclusion: We combined clinical cases and a literature review to describe the common and less common clinical features of puff adder envenoming. Further clinical research incorporating serial laboratory assays of patients with definitively identified puff adder bites is crucial to better understand the pathophysiology of envenoming by this medically important snake species. Author summary: The puff adder is a medically important snake species found across much of Africa, yet the signs and symptoms of patients presenting with a puff adder bite have not been extensively described. We described the signs and symptoms of patients who were admitted with a puff adder bite in two primary healthcare facilities in Kenya and identified further published cases from the literature with sufficient details of the clinical presentation. Between December 2020 and September 2021, of the 15 patients admitted with a diagnosis of a puff adder bite at the Chemolingot and Mwingi sub-county hospitals, pain, swelling and haemorrhage were most common, while coagulopathy, blistering and shock were less common. From the 23 studies which described signs and symptoms from 37 patients, swelling and pain were most common, while hypotension, fever, and anaemia were less common. It was easier to objectively identify the biting snake after bites by a captive snake than after a bite in the community, and complications like amputations and hypotension followed the same pattern. Our study describes the common and less common clinical features of puff adder envenoming, but further clinical research incorporating serial laboratory assays of patients with definitively identified puff adder bites is crucial to better understand the pathophysiology of envenoming by this medically important snake species. [ABSTRACT FROM AUTHOR]

Pediatric acute myeloid leukemia (AML) exhibits distinct genetic characteristics, including unique driver alterations and mutations with prognostic and therapeutic significance. Emerging rare, recurrent genetic abnormalities and their associations with outcomes emphasize the need for high-throughput molecular diagnostic tools. Whole genome sequencing (WGS) reliably detects key AML biomarkers such as structural variants, mutations, and copy number alterations. Whole transcriptome sequencing (WTS) complements WGS by uncovering oncogene expression patterns, allele-specific expression, and gene expression signatures. In this study, we describe an integrated WGS and WTS clinical workflow for routine pediatric AML diagnosis and present a systematic evaluation of its application compared to conventional cytogenetics and standard molecular diagnostic methods. Our findings demonstrate that the integrated WGS and WTS (iWGS-WTS) approach improves the identification of clinically relevant genetic alterations, enhancing precise disease classification and risk assessment. Moreover, with advancements in workflow and bioinformatics pipelines, the testing turnaround time can be optimized to meet the demands of clinical decision-making, positioning iWGS-WTS as a practical and superior alternative to traditional diagnostic methods in pediatric AML management., Competing Interests: Additional Declarations: There is NO Competing Interest.

Diffuse pollution, globally affecting water quality by delivery of sediment, nutrients, pathogens and agro-chemicals from farmland, often has dominant flowpaths connecting to discrete channel delivery points, where field-edge mitigation can be optimally targeted. Accurate representation of field convergent flow paths (CFPs) can inform decisions on riparian mitigation planning. For three fields in Wexford, Ireland, we combined literature, catchment data, field-survey and spatial data methods to derive sediment and P exports (7.4-18.7 tonnes sediment/year and 0.9-6.9 kgP/year), runoff areas and watercourse delivery points (one to six CFPs per field). We moderated exports according to the ratio effective riparian buffer area: CFP contributing area and compared 3 mitigation levels. Low buffer to CFP area ratios highlighted limitations of narrow buffers for larger CFPs. Linear grass buffers (2 m, level 1) were predicted to retain 2-17% of sediment and 1-6% total P exports. Level 2, 5 m buffers targeting CFP delivery points to watercourses retained 4-38% of the sediment and 2-15% total P and improved cost-effectiveness two- to three- fold relative to level 1 (20-1761 Euros/tonne sediment and 650-5114 Euros/kgP for level 2). Level 3 scenarios (sediment traps and in-ditch filters; 49% and 33% retention of field sediment and P losses, respectively) improved cost-effectiveness (50-145 Euros/tonne sediment and 108-1498 Euros/kgP). Mitigation cost-effectiveness best informs policy and planning and landowner decisions by including surface runoff behaviour utilising spatial soil and topographic data, accompanied by walk-over ground truthing., Supplementary Information: The online version contains supplementary material available at 10.1007/s44288-025-00125-6., Competing Interests: Competing interestsThe authors declare no competing interests., (© The Author(s) 2025.)