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Background: The current coronavirus disease 2019 (COVID-19) pandemic began in Ireland with the first confirmed positive case in March 2020. In the early stages of the pandemic clinicians and researchers in two affiliated Dublin hospitals identified the need for a COVID-19 biobanking initiative to support and enhance research into the disease. Through large scale analysis of clinical, regional, and genetic characteristics of COVID-19 patients, biobanks have helped identify, and so protect, at risk patient groups The STTAR Bioresource has been created to collect and store data and linked biological samples from patients with SARS-CoV-2 infection and healthy and disease controls. Aim: The primary objective of this study is to build a biobank, to understand the clinical characteristics and natural history of COVID-19 infection with the long-term goal of research into improved disease understanding, diagnostic tests and treatments. Methods: This is a prospective dual-site cohort study across two tertiary acute university teaching hospitals. Patients are recruited from inpatient wards or outpatient clinics. Patients with confirmed COVID-19 infection as well as healthy and specific disease control groups are recruited. Biological samples are collected and a case report form detailing demographic and medical background is entered into the bespoke secure online Dendrite database. Impact: The results of this study will be used to inform national and international strategy on health service provision and disease management related to COVID-19. In common with other biobanks, study end points evolve over time as new research questions emerge. They currently include patient survival, occurrence of severe complications of the disease or its therapy, occurrence of persistent symptoms following recovery from the acute illness and vaccine responses.

Objective: To examine the impact of a clinical toxicology service on toxicology patients admitted to an intensive care departmentMethods: The authors performed a retrospective chart audit of all pa...

The synthesis of a highly twisted chrysene derivative incorporating two electron deficient o‐carboranyl groups is reported. The molecule exhibits a complex, excitation‐dependent photoluminescence, including aggregation‐induced emission (AIE) with good quantum efficiency and an exceptionally long singlet excited state lifetime. Through a combination of detailed optical studies and theoretical calculations, the excited state species are identified, including an unusual excimer induced by the presence of o‐carborane. This is the first time that o‐carborane has been shown to induce excimer formation ab initio, as well as the first observation of excimer emission by a chrysene‐based small molecule in solution. Bis‐o‐carboranyl chrysene is thus an initial member of a new family of o‐carboranyl phenacenes exhibiting a novel architecture for highly‐efficient multi‐luminescent fluorophores.

Corals and humans represent two extremely disparate metazoan lineages and are therefore useful for comparative evolutionary studies. Two lipid-based molecules that are central to human immunity, platelet-activating factor (PAF) and Lyso-PAF were recently identified in scleractinian corals. To identify processes in corals that involve these molecules, PAF and Lyso-PAF biosynthesis was quantified in conditions known to stimulate PAF production in mammals (tissue growth and exposure to elevated levels of ultraviolet light) and in conditions unique to corals (competing with neighbouring colonies over benthic space). Similar to observations in mammals, PAF production was higher in regions of active tissue growth and increased when corals were exposed to elevated levels of ultraviolet light. PAF production also increased when corals were attacked by the stinging cells of a neighbouring colony, though only the attacked coral exhibited an increase in PAF. This reaction was observed in adjacent areas of the colony, indicating that this response is coordinated across multiple polyps including those not directly subject to the stress. PAF and Lyso-PAF are involved in coral stress responses that are both shared with mammals and unique to the ecology of cnidarians.

Holobionts are assemblages of microbial symbionts and their macrobial host. As extant representatives of some of the oldest macro-organisms, corals and algae are important for understanding how holobionts develop and interact with one another. Using untargeted metabolomics, we show that non-self interactions altered the coral metabolome more than self-interactions (i.e. different or same genus, respectively). Platelet activating factor (PAF) and Lyso-PAF, central inflammatory modulators in mammals, were major lipid components of the coral holobionts. When corals were damaged during competitive interactions with algae, PAF increased along with expression of the gene encoding Lyso-PAF acetyltransferase; the protein responsible for converting Lyso-PAF to PAF. This shows that self and non-self recognition among some of the oldest extant holobionts involve bioactive lipids identical to those in highly derived taxa like humans. This further strengthens the hypothesis that major players of the immune response evolved during the pre-Cambrian.

On February 2, 2011, Tropical Cyclone Yasi, the largest cyclone to cross the Australian coast and a system the size of Hurricane Katrina, threatened the city of Cairns. As a result, the Cairns Base Hospital (CBH) and Cairns Private Hospital (CPH) were both evacuated, the hospitals were closed, and an alternate emergency medical center was established in a sports stadium 15 km from the Cairns central business district. This article describes the events around the evacuation of 356 patients, staff, and relatives to Brisbane (approximately 1,700 km away by road), closure of the hospitals, and the provision of a temporary emergency medical center for 28 hours during the height of the cyclone. Our experience highlights the need for adequate and exercised hospital evacuation plans; the need for clear command and control with identified decision-makers; early decision-making on when to evacuate; having good communication systems with redundancy; ensuring that patients are adequately identified and tracked and have their medications and notes; ensuring adequate staff, medications, and oxygen for holding patients; and planning in detail the alternate medical facility safety and its role, function, and equipment.

OBJECTIVE: The purpose of this study is to assess the current evidence regarding the safety and effectiveness of the various embolic materials used in varicoceles embolization. METHODS: A systematic review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. Databases were searched for clinical studies that investigated the clinical outcomes of embolization treatment for the management of testicular varicoceles. Study methodological quality was analyzed. RESULTS: 23 retrospective and 7 prospective clinical studies were identified with a total of 3505 patients. Technical success rates appear to be above 90% for all embolic materials without any significant differences. In terms of recurrence rates, glue (N = 251) appeared to have the lowest and sclerosants alone (N = 728) the highest recurrence rates which were 4.2% (11–3.08%, SD: 5.9) and 11.03% (18.8–5.15%, SD: 6.06) within an average follow up (f/u) of 16.13 and 25.48 months respectively. Coils alone (N = 898) had an average recurrence rate of 9.1% (17.8–1.4%; SD: 5.79) and a mean f/u of 39.3 months. After an average of 12 months of f/u, the addition of sclerosants (N = 1628) as an adjunct to coils did not improve recurrence rates (8.44%, 16.5–5.1%; SD: 3.4). No differences were reported regarding the safety profile of the various embolic materials. CONCLUSION: Despite the heterogeneity of the included studies, preliminary evidence supports the safe and effective use of the various embolic materials currently used for the management of varicoceles. At 1 year, glue appears to be the most effective in preventing recurrence with coils being the second most effective. The addition of sclerosants to the coil embolization did not appear to have an impact on recurrence rates. Further research is required to elucidate the cost-effectiveness of these approaches. ADVANCES IN KNOWLEDGE: Varicocele embolization appears to be a safe and effective technique regardless of the embolic agent. Addition of a sclerosant agent to coil embolization does not appear to improve outcomes.

[Extract] I congratulate Isbister and colleagues for performing a first aid randomised controlled trial on box jelly fish stings (a rarity in toxinology). The result is at variance with other studies on this topic (although they mainly involved North American jelly fish stings). I agree with the authors and the accompanying editorial that the major weakness in the study was the up to 4-hour delay for treatment with hot water. Unlike the earlier bluebottle stings first aid study performed on the beach, this study is performed in the emergency department of the Royal Darwin Hospital, when the pain severity was lessening. Pain severity was the primary study outcome: 25% of the study group had pain scores of less than 26 (hot water) or 20 (ice), which is minimal pain. Only 10% of the study group received opioid analgesia, compared with the results obtained by Currie and Jacups in a 14-year prospective observational study of box jelly fish stings in Darwin, where 48% of patients received analgesia, including 30% of patients receiving narcotic analgesia.

[Extract] To the Editor: We read with interest the report of 12 hospital presentations related to the use of naltrexone implants. The accompanying editorial highlights how the rigorous scrutiny required to evaluate the efficacy and safety of this procedure is lacking. Regrettably, this study is likely to distort rather than inform the debate. Lintzeris and colleagues only identified patients with naltrexone implants who were referred to the Drug and Alcohol Consultation–Liaison services, not all patients presenting to the study hospitals. Additionally, the authors did not follow the methodology of chart reviews, as recommended by Gilbert and colleagues. Four of the 12 patients clearly had problems unrelated to their naltrexone implants. There was no attempt to identify the number of naltrexone implantations performed (ie, the denominator), nor was there any attempt to compare the naltrexone group with others being treated with agents such as methadone or buprenorphine.

The title compounds are synthesized starting from 4,10-dichlorochrysene (I) by C—H borylation followed by substitution of firstly 2,8-positions affording derivatives (V) and secondly 4,10-positions (VII).

The internet can be used for the sale of many drugs substances including anxiolytics and sedatives not regulated by government authorities. We describe a case of analytically confirmed severe phenibut toxicity necessitating intensive care unit (ICU) admission and management. The phenibut was purchased readily over the internet.

Objectives: To analyze emergency department (ED) presentations after naltrexone-accelerated detoxification. Methods: This was a retrospective cohort analysis of patient presentations to Sir Charles Gairdner Hospital Emergency Department over a six-month period (November 2000 to April 2001). Results: During the six-month study period, 42 patients presented to the ED after naltrexone-accelerated detoxification. This represented 7% of patients treated at a single clinic over the same period. Presentation occurred within 24 hours in 40% of cases and within 48 hours in 74%. Clinical features on presentation included gastrointestinal (GI) symptoms (vomiting, 60%; abdominal pain, 55%; diarrhea, 45%), central nervous system [CNS] symptoms (excessive drowsiness, 55%; agitation requiring sedation, 50%), and respiratory symptoms (tachypnea, 33%; respiratory difficulties, 19%). Gastrointestinal symptoms were managed adequately with supportive therapy in most cases (intravenous fluids; antiemetics). Agitation sometimes required large doses of intravenous benzodiazepines (up to 730 mg in 44 hours), one-to-one nursing, and security staff. Two of 14 patients presenting with predominantly CNS disturbance required intubation (14%). Mean in-hospital stay for all patients was 18 hours (range 1 to 92 hours). Conclusions: A few patients undergoing outpatient naltrexone-accelerated detoxification during a six-month period subsequently required ED management. The clinical features encountered in this group of patients can be subdivided into GI or CNS predominance, with different management strategies. Most presentations can be managed in the ED or an associated observation ward, but departmental resources must be available for one-to-one nursing and security personnel. Patients presenting with agitation should be sedated with benzodiazepines; large doses may be required. Close monitoring of respiratory function is mandatory, and advanced airway management may be required.

Interest in envenoming syndromes caused by Australian jellyfish has been intense since the deaths in early 2002 of two tourists in Queensland, attributed to the Irukandji syndrome. We review current knowledge of these envenoming syndromes, mechanisms of venom action and therapy, focusing on the deadly box jellyfish, Chironex fleckeri, and the array of jellyfish thought to cause the Irukandji syndrome. Current understanding of jellyfish venom activity is very limited, and many treatments are unproven and based on anecdote.

The application of a new benzannulation reaction for the regiocontrolled synthesis of functionalized chrysenes is reported. The initial benzannulation and the subsequent halogen displacement reactions are both highly regiospecific, which thereby enables the regiocontrolled synthesis of a variety of 4,10-disubstituted chrysenes from commercially available 1,5-dihydroxynaphthalene.

Introduction. Irukandji syndrome is because of envenoming by a number of small jellyfish. It results in a delayed onset of generalized pain, sweating hypertension, and tachycardia. There is no antivenom. Case report. A 44-year-old healthy male was stung while swimming in NE Australia. He rapidly developed Irukandji syndrome. He had a rapid deterioration in conscious level because of an intracerebral hemorrhage. He developed left ventricular failure with an elevated troponin (34 mcg/L, N < 0.4) requiring inotropic support. He progressed to brain death and died on day 13 poststing. Nematocysts recovered from the patient skin were consistent with a large Carukia barnesi. Discussion. This is the first case of a death because of Irukandji syndrome where the jellyfish Carukia barnesi has been demonstrated to the causative creature.

A 49-year-old man presented with verapamil toxicity complicated by hypotension and a junctional rhythm, in the context of deliberate self-poisoning with multiple drugs. The patient's hypotension normalised following the early use of high-dose insulin euglycaemic therapy (HIET), without the need for additional vasopressors; it recurred when HIET was prematurely stopped, and again stabilised when HIET was recommenced. Consideration should be given to the early use of HIET in treating severe calcium channel blocker toxicity, rather than as a last resort after other therapies have failed.

A 29‐year‐old woman presents shortly after a massive overdose of carbamazepine controlled‐release tablets. In anticipation of coma, she is electively intubated to safely enable gastrointestinal decontamination with nasogastric activated charcoal. She is admitted to the intensive care unit for ongoing supportive care, and further doses of activated charcoal are prescribed to enhance elimination of carbamazepine. Carbamazepine levels remain high and haemodialysis is carried out to further enhance elimination. Her coma resolves as levels fall, but clinical progress is complicated by anticholinergic delirium, ileus and bowel obstruction from charcoal concretions. She survives to medical discharge on day 12.

Objective: To investigate the doses of antivenom administered to adult patients with severe brown snake envenoming. Design and setting: Review of charts from Western Australian adult teaching hospitals, December 1991 to December 2001. Patients: 35 patients with severe brown snake envenoming, defined prospectively as afibrinogenaemia (< 0.3 g/L) after a bite by a brown snake (genus Pseudonaja). Main outcome measure: The dose of antivenom required to neutralise venom, defined prospectively as the dose of antivenom given before the return of detectable fibrinogen levels. Results: Of 88 patients with brown snake envenoming admitted over the 10 years, at least 35 had severe envenoming. Afibrinogenaemia persisted for 10 hours (range, 1.4–68 hours) after the first dose of antivenom; in four patients afibrinogenaemia lasted more than 24 hours. The dose of antivenom given before venom neutralisation ranged from one to 23 ampoules. In two-thirds of cases, venom was neutralised with five ampoules, and 89% had venom neutralised with 10 ampoules. Two patients died, and another had serious bleeding complications. Another patient died during the study period from intracerebral haemorrhage, but did not have fibrinogen levels measured. Conclusions: Patients received initial doses of antivenom too small to neutralise circulating venom, and remained afibrinogenaemic for prolonged periods, with serious consequences. The authors now use 10 ampoules as an initial dose in severe brown

[Extract] We are concerned that a recent report announced that the Queensland Ambulance Service now treats patients with hypertension caused by Irukandji syndrome with sublingual glyceryl trinitrate, based on an uncontrolled, unrandomised, unblended "trial" of three patients. We believe the authors have made the justification for such treatment on questionable assumptions.

[Extract] The World Health Organization has declared snakebite a neglected tropical disease. Although Australia has many of the world's most venomous snakes, the annual rate of envenoming here is much lower than in some other regions. In Australia, rates of snakebite are higher in tropical areas — a prospective study in the Northern Territory estimated the rate of envenoming to be 7.6 per 100 000 people per year. Sadly, there were at least three snakebite deaths in Queensland in the summer of 2012–2013.

Objective: To evaluate whether applying pressure equivalent to that of pressure immobilisation bandages (PIB) causes release of additional venom from discharged jellyfish nematocysts. Design: In-vitro experiment - the venom beads released from electrically activated Chiropsalmus sp. nematocysts were viewed under direct microscopy before and after applying 40 mmHg pressure (replicating the pressure of PI B); and saline washings of discharged nematocysts before and after applying pressure were tested for toxicity (time to ventricular standstill after injecting into live prawns). Results: Applying 40 mmHg pressure caused the venom beads to visibly increase in size, consistent with pressure expressing further venom from the discharged nematocysts. First washings of the nematocyst shafts before compression produced ventricular standstill in prawns within 60 seconds (n =3); second washings did not produce standstill during 540 seconds of observation( n =3); and washings after applying 40 mmHg pressure showed a return of toxicity, with ventricular standstill in all prawns within 180 seconds (n =3). Conclusion: Discharged nematocysts are by no means empty and harmless. Applying pressure results in further release of nematocyst venom. The currently recommended practice of applying PIB in the initial treatment of patients stung by a jellyfish may exacerbate the envenomation, and thus should not be recommended.

An asymptomatic 18 month old child presents to the emergency department of a small district hospital shortly after ingesting two unidentified tablets. A small number of pharmaceuticals and illicit drugs may produce life threatening toxicity in a small child if ingested even in one or two dose units and the onset of toxicity may be delayed for some agents. Following risk assessment, a rational management plan is devised and the child is carefully monitored. The patient is observed overnight and discharged home the following day.

A teenager ingests 375 mg of glipizide and 14.5 g of melformin intentionally in a small country town. She presents to the local medical facility with symptoms and signs of hypoglycaemia. Using a risk assessment based approach, the management of suiphonylurea and metformin overdose is discussed. Sulphonylurea overdose invariably results in profound hypoglycaemia that requires resuscitation with IV dextrose and the use of octreotide as an antidote. Metfonnin overdose rarely causes problems.

[Extract] Irukandji syndrome is a distressing array of symptoms following a jellyfish sting.1 Generally, symptoms develop 20–60 min after the sting, and include back pain, nausea, abdominal cramps, sweating, hypertension, tachycardia and a feeling of impending doom.1–3 The sting usually leaves only mild local signs. In a series of 116 cases presenting to Cairns Base Hospital in one year, 64% required hospital admission and there was one death.2 Patients suffer severe pain, as demonstrated by the adult patients in this series requiring a mean dose equivalent to 42mg of morphine.2 There have been case reports of patients developing life-threatening cardiac failure requiring intubation and inotropic support.3 In Huynh’s series, 22% had evidence of myocardial injury, with an elevated troponin.2 Reports of Irukandji syndrome have come from Australia, Hawaii, Florida, French West Indies, Bon Air, Caribbean, Timor Leste and Papua New Guinea.1 The syndrome may well occur in many other parts of the world, but not be recognized.

Early assessment and management of poisoning constitutes a core emergency medicine competency. Medical and psychiatric emergencies coexist; the acute poisoning is a dynamic medical illness that represents an acute exacerbation of a chronic underlying psychosocial disorder. The emergency physician must use an approach that ensures early decisions address potentially time critical interventions, while allowing management to be tailored to the individual patient's needs in that particular medical setting. This article outlines a rationale approach to the management of the poisoned patient that emphasises the importance of early risk assessment. Ideally, this approach should be used in the setting of a health system designed to optimise the medical and psychosocial care of the poisoned patient.

[Extract] To The Editor: During a national multicentre study of snake bites — the Australian Snakebite Project (ASP), involving over 40 hospitals — we have recently noted a high rate of early allergic reactions following the administration of tiger snake antivenom in Australia. People with suspected or definite snake envenoming are recruited to ASP, and laboratory and clinical data and serial blood samples are collected to measure venom and antivenom concentrations.

[Extract] Paracetamol is one of the most common agents involved in deliberate self-poisoning in Australia. N-Acetylcysteine (NAC; Parvolex, Mayne Pharma Pty Ltd, Parkville, Vic) is the specific antidote, and its administration is recommended to all patients judged to be at risk of developing hepatotoxicity following paracetamol overdose. The standard administration regimen in Australia is a dose of 300 mg/kg given by staged intravenous infusion in 5% dextrose solution (150mg/kg over 15–60 minutes, followed by 50 mg/kg over 4 hours, followed by 100 mg/kg over 16 hours). This is how staff in Australia routinely calculate doses of NAC for infusion.

(1) To identify the causative jellyfish species by examining skin scrapings in patients presenting to Cairns Base Hospital with marine stings, and (2) to describe clinical outcomes of those with Irukandji syndrome and those in whom nematocysts were identified from skin scrapings.(1) A retrospective case series of 128 patients, identified from Cairns Base Hospital emergency department records with discharge diagnoses of marine stings between 1 July 2001 and 30 June 2002. (2) A prospective study of skin scrapings from 50 patients presenting with marine stings from the same period.Number of patients with Irukandji syndrome, their opioid requirements and cardiac findings (where available); identification of causative species from nematocysts isolated from skin scrapings.116 patients retrospectively identified with marine stings had Irukandji syndrome. Of 50 patients who had skin scrapings, 39 had nematocysts consistent with Carukia barnesi. Symptoms experienced ranged from local pain alone to severe Irukandji syndrome with elevated troponin I levels, changes on electrocardiogram, cardiac dysfunction on echocardiography, and high opioid dose requirements. One patient had an unidentified cnidome on his skin scraping. He developed severe Irukandji syndrome and subsequently died from its complications.This is the first published report of Carukia barnesi being successfully identified from skin scrapings. Most patients with identifiable cnidomes experiencing Irukandji syndrome were stung by Carukia barnesi, which we show causes a wide range of illness, including cardiac dysfunction. Our finding of a cnidome not consistent with Carukia barnesi in the setting of Irukandji syndrome makes it possible that other species of jellyfish may also cause this syndrome.

Objective: To determine the effect of temperature on lethality of venom from Chironex fleckeri (the potentially fatal box jellyfish). Design: Venom extracted from nematocysts of mature Chironex fleckeri specimens was exposed to temperatures between 4°C and 58°C for periods of two, five or 20 minutes, and then injected into freshwater crayfish (Cherax quadricarinatus) to assess lethality. Main outcome measure: Venom lethality, assessed as time to cardiac standstill in crayfish after intramuscular injection. Results: Venom lethality was significantly affected by both temperature (F7,34 = 21915; P < 0.0001) and time of exposure (F2,34 = 9907; P < 0.0001). No significant loss of lethality was seen after exposure to temperatures ≤ 39°C, even after 20 minutes' exposure. At temperatures ≥ 43°C, venom lost its lethality more rapidly the longer the exposure time. Venom was non-lethal after exposure to 48°C for 20 minutes, 53°C for five minutes, and 58°C for two minutes. Conclusion: Exposure to heat dramatically reduces the lethality of extracted C. fleckeri venom. Although heat application may be of limited use in treating C. fleckeri envenoming because of the speed of symptom onset, its use in other box-jellyfish envenomings, such as Irukandji syndrome, requires investigation.

The purposes of the present experiment were to determine (a) whether an auditory model enhanced relative or absolute timing, (b) the extent to which the reduced frequency presentation of the auditory model resulted in enhanced retention, and (c) the degree to which executing the timing sequence was independent of the role of the effectors in carrying out the movement sequence. Participants (N = 45) were asked to alternately press two keys on a computer keyboard in an attempt to match the goal intervals presented on the computer monitor. Groups differed in terms of the frequency with which an auditory model (100, 50, or 0%) was presented. The results indicated that the auditory model (100% or 50% groups) enhanced relative timing performance and learning but not the learning of absolute timing. In addition, the 50% group did not appear to become dependent on the auditory model. However, significant decrements in performance were seen for the 100% group when the model was withdrawn. Last, participants were able to execute the timing sequences equally well when they reversed the hand used to execute the timing sequence. This was interpreted as strong evidence for the effector independence (Schmidt, 1975, 1988) and modularity of the timing sequence (Keele, Davidson,Hayes, 1998).

British and Australian medical teams working in Northern Iraq in 1991 providing primary care to refugees and the war wounded were subjected to a descriptive retrospective survey, 5 weeks after arriving in Iraq. The aim was to document different rates of diarrhea in British and Australian troops. The British, who were not taking daily doxycycline and did not enforce a plate- and hand-washing routine, experienced higher rates of diarrhea (69% of British troops compared with 36% of Australian troops), which was more severe and of a longer duration (p < 0.001) and resulted in twice as many days being lost (p < 0.001) in spite of the British team being half the size of the Australian contingent, and the region having enteropathogens with a high rate of antibiotic resistance. Vigorous hand- and plate-washing routines along with doxycycline prophylaxis appear to significantly reduce incapacitation from diarrhea in this military setting and have an important implication for operational effectiveness.

More than a million people became refugees when the Iraqi army, beaten but not broken in Gulf War, moved to crush the Kurdish independence movement in northern Iraq. As part of an international relief effort, the Australian Army mounted Operation Habitat, sending 75 specialised personnel to give aid to the refugees. As doctors in that group, we spent nearly two months among the Kurds, making friends and gaining valuable experience in refugee relief work.

[Extract] To the editor: The Guidelines for the management of acute coronary syndromes 20061 state: "Enoxaparin may be used in conjunction with fibrin-specific fibrinolytic agents in patients under the age of 75 years, provided they do not have significant renal dysfunction. An intravenous bolus dose of 30mg followed by a 1mg/kg subcutaneous injection every 12 hours in combination with tenecteplase is the most comprehensively studied therapy."

[Extract] To the Editor: We congratulate Nocera and colleagues on their article, which aptly demonstrates the logistical problems asso­ ciated with aeromedical rescue. In Cairns, Cairmed (the aeromedical retrieval service located at Cairns Base Hos­pital) performs around 260 missions yearly to rural and remote areas of far north Queensland. Successful retrieval work depends on forward planning, and to that end a supply of various antivenoms is kept in the hospital emergency department and is readily available to the deployed Cairmed team. In all retrievals of patients with animal stings or bites for which an antivenom is available, either polyvalent antivenom or the appropriate monovalent antivenom is carried.

[Extract] To the Editor: In 1964 the Journal published an article by Barnes which solved the mystery of a distressing illness that was affecting many Queensland beachgoers — Irukandji syndrome.1 In a remarkable piece of detective work, Barnes had captured a small (25 mm bell) jellyfish and demonstrated, by allowing it to sting himself, his 9-year-old son and the on-duty lifeguard, that this jellyfish caused Irukandji syndrome. All required inpatient care. This jellyfish was named Carukia barnesi in his honour, and has been known as the "Irukandji jellyfish". Many now believe that more than one jellyfish is responsible for Irukandji syndrome. Significantly, in the 40 years since Barnes' discovery, no other jellyfish causing Irukandji syndrome has been identified.