Saturday, December 27, 2025
Sunday, December 21, 2025
Prewar Populations and size in square kilometers of Frontline Towns
Sloviansk: 105,000. 63km
Kramatorsk: 147,000 48km
Druzhkivka: 54,000 23km
Konstantinivka: 67,000 33km
Pokrovsk: 60,000 23km
Bakhmut: 75,000 40km
Lyman: 25,000
Chasiv Yar: 12,000 10km
Kurakhove: 5,000 7km
Siversk: 12,000 10km
Saturday, December 6, 2025
“Healthcare Resilience is NATO’s Missing 8th Pillar” - EuroMaidan article by Swedish Nonprofit Founder Jonas Hard
“The NATO alliance lists seven baseline requirements for national resilience: energy, communications, transport, food, water, government continuity, and population movement.” Jonas Hard, founder of nonprofit 1 for Ukraine, advocates for adding Healthcare Resilience as an 8th pillar. He describes hospital conditions 40km from the front, in Kharkiv, as well as an underground hospital under construction structure there.
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Saturday, November 29, 2025
TQ post
Application of Hemostatic Tourniquet on Wounded Extremities in Modern "Trench" Warfare: The View of a Vascular Surgeon
Who needs a tourniquet? And who does not? Lessons learned from a review of tourniquet use in the Russo-Ukrainian war
https://journals.lww.com/jtrauma/fulltext/2024/08001/who_needs_a_tourniquet__and_who_does_not__lessons.11.aspectEffect of prehospital tourniquets on resuscitation in extremity arterial trauma
Lessons learned from the war in Ukraine for the anesthesiologist and intensivist: A scoping review
https://www.sciencedirect.com/science/article/abs/pii/S2352556824000675?via%3Dihub
Picture: Overlooking monsoonal forest-savannah boundary zone in Sierra Leone. The local population has used fire to manage this landscape, for subsistence agriculture, for thousands of years.
The grass-uplands/forested lowlands combo reminds me of native-managed parts of the Klamath Mountains in California, where wildfires are currently returning the land to a balanced state.
We’re about to burn the slope below the viewpoint; some of the clinic staff will plant dryland rice under the palms during the monsoon. The area was brushed several weeks ago and allowed to cure during the height of the dry season. Now that green-up has begun, the area can be burned safely, without fire running too hot through the grass zone on the ridge, and destroying the bean crop there. The ridge grass is highly fire-and-drought adapted, with deep, massive roots. It responds well to light-moderate burning; new growth provides graze for cattle and game animals.
There are frequent strong storms and outflows this time of year, but that doesn’t seem to concern the local farmers. “Fires do damage if they’re lit in February, when it’s too dry”, says one of our medics, Bakar. Indeed, earlier this year a fire destroyed a bean crop, and last year one burned a nomadic Fula village while the inhabitants were away. If the culprit for either fire were found, they would have been fined by the Chief (likely in goats or chickens).
This place burns a lot like the Southern Rough in the US Southeast- under high humidity conditions, with pretty good fire behavior in a “seven-year Rough”, for example. In fact, I highly suspect our Southeast Fire Culture was imported from West Africa, via the Gullah people and the slave trade.
We’ve been getting some early monsoonal rains and the slash is damp, so we light at the bottom of the slope in order to create enough momentum to get decent consumption. The head fire has flame lengths of 5-15’, but the soil and vegetation is moist and it doesn’t get hot enough to damage the palm roots. The fire even climbs into most of the trees and harmlessly consumes the dead lower fronds that can host palm snakes and other dangerous vipers. We use oily palm kernel fibers as an initial fire starter. Then we drop dots of fire into receptive fuels along the road, using long, flammable bundles of split stalks. Five groups of farmers are burning adjacent farms at once today, and they coordinate with tonal shouts as they light.
Land plots are held by families, with new allocations made by the Chief. Traditional land management practices seem to be sustainable for the landscape, given the length of time any given parcel has been under successful cultivation.
For the people, however, social and climate challenges abound. Rapacious exploitation by foreigners remains the norm, just as it was in colonial days. Diamonds and gold continue to flow from the area into foreign hands. The local population has little to show in return for allowing mining concessions; mainly pits, tailings piles, and polluted streams, broken infrastructure-construction promises, and a handful of shiny cars and overseas-college-educations for the children of corrupt ministers.
Climate change affects the population directly and indirectly. Increasingly unpredictable monsoonal rains cause crop failures- either due to too much rain, too little, or poor precipitation timing. The southward expansion of the Sahara creates population pressures that flow south into Sierra Leone. Range fences arent a thing here, and nomadic Fula cattle-herders come into conflict with settled farming groups like the Kono people when cattle destroy crops. Climate issues in Burkina Faso, Mali, and Niger fuel political instability and create fertile ground for Islamists, various flavors of autocrats, and Russian influence. Sierra Leone social media (just beginning to penetrate widely into rural areas) is heavily targeted by propaganda from these groups.
Idyllic, peaceful and picturesque as village life might look on the surface, most young people don’t opt to continue their parents’ life experience of hard work, uncertain crop yields, low life expectancies, and high rates of child stunting (~60%+) and mortality (1 in 9 die before age 5). Youth flock to the cities, in search of education, work, and employment. Some succeed; most enter the vast ranks of the Sierra Leonean unemployed youth. Not a small number numb their frustrations with drugs like Kush (a dangerous mixture of marijuana, opiates, and various toxic substances). Others leave family, marriages, and children and dissapear to Guinea or the Ivory Coast for “jobs”, never to be seen again.
Schooling is another major pressure for the average Sierra Leonean, living on $1-3/day. Whether in the city or village, universal “free” schooling isn’t actually free. Paying for school fees, teachers’ salaries, books and uniforms doesn’t amount to much per child by American standards. But, combined with crop failures and food insecurity, it is more than enough to lock farmers into a cycle of poverty, unscrupulous lending practices, and poor access to capital.
Back at our burn, cumulus clouds are forming and starting to shade the sun. Most people in the area are behind on burning this year due to rainy weather, and there are concerns about crop failure. But our fire has already reached the top of the target area, and the results look ok.
“Does fire ever burn too hot here if you let the fuel build up for too many years?” I ask Bakar. “Yes, then it damages the soil and nothing grows.” Bakar’s tone indicates that he thinks I’m not too bright for asking a question with such an obvious answer. Funny how one group of people steals billions of dollars in resources and labor from another, then winds up wasting billions on mega fire suppression. Too bad we didn’t listen to the indigenous voices with generations of fire management knowledge last century, instead of embarking on 100 years of misguided total fire suppression.
Air Attack Last Night
Movement of shaheds (red), cruise missiles (blue) and ballistic missiles (yellow) during last night’s attack on Ukraine.
🇺🇦 “On the night of 29.11.25, according to the Air Force report, the Defense Forces destroyed from the launched strike means:
⚠️ 558/596 strike, imitation, and reconnaissance UAVs were shot down or suppressed by electronic warfare.
The enemy used:
(350×) UAVs of the "Geran-2" / "Shahed-136" type;
(246×) UAVs of the "Gerbera" / "Parody" / "Molniya" types.
🚀 1/5 aeroballistic hypersonic Kh-47M2 "Kinzhal" missiles;
☄ 4/4 ballistic missiles 9M723 OTRK "Iskander-M" / KN-23;
❗️ 12/23 cruise missiles Kh-101 / 9M727/729 "Iskander-K";
❗️ 2/4 guided aviation missiles Kh-59/69;
A total of 558/596 UAVs (94%) were neutralized.
A total of 19/36 missile weapons, 52% of those launched, were neutralized.”
-Ukraine MOD”
Wednesday, November 26, 2025
Tuesday, November 18, 2025
Russia suspected of orchestrating railway damage in Poland
Saboteurs appear to have targeted a section of rail in Poland, which is used to transfer wartime supplies to Ukraine.
Guardian article:
Monday, November 17, 2025
Monday, November 10, 2025
Thursday, November 6, 2025
Wednesday, November 5, 2025
Thursday, February 27, 2025
The Orchestrated Circus Act: A Classical Autocrat's Distractionary Tactic, to Divide and Conquer
A recent news story about a mysterious Neo-Nazi Rally, which popped up, just as schools were letting out, outside Lincoln Heights, OH. The small town, which bills itself as the oldest self-governing Black Community north of the Mason-Dixon Line, was targeted with racist pamphlets and swastikas hung from highway overpasses. This dispicable stunt (whether genuine or engineered to incite political agitation), has justifiably led to an armed neighborhood watch in Lincoln Heights.
I don't have any particular background on this incident, beyond reading a few headlines. But it does bring to mind the sort of engineered circuisry that accompanied Putin's rise to power. During the late 1990's, Putin quite masterfully arranged acts of political violence, paying saboteurs on both sides. The result was a distrustful, agitated society, which had lost sight of the truth, and was prepared to back a strongman leader, against a fabricated enemy. See the link below for a Radio Free Europe article about deadly apartment bombings, allegedly orchestrated by Putin and the FSB.
Two Decades On, Smoldering Questions About The Russian President's Vault To Power
Trump Falsely Claims that US has spent $350 billion on the Ukraine War
Trump is blatantly lying. These people are giving honest assessments:
The war cost Ukraine $320 billion, of which $120 billion was paid by Ukrainians, and another 200 billion by the US and Europe , — -Zelensky
According to US federal government sources, Congress has passed five so-called 'supplemental appropriation acts' since the 2022 invasion, allocating $174.2 billion in funds for Ukraine.
Another US government tracker - which compiles data from over 20 oversight entities from across the government - puts the headline sum slightly higher at $182.8 billion. This is because the tracker also includes smaller donations made by other government agencies, such as the U.S. Agency for Global. Media (USAGM) or the Department of Justice (DOJ). Of this, $182.8 billion pot, only $83.4 billion has been disbursed, with the remaining $99,4 billion either not yet committed or not yet approved for payment.
Other estimates provided by the Berlin-based Kiel institute for the World Economy put the headline figure of total US assistance at 114.15 billion (119.76 billion).
This is because of the Kiel Institute's methodology, which only considers support directly given to Ukraine. It excludes things like money used to replenish US weapon stocks following donations to Kyiv, or funds spent to help neighbouring countries welcome Ukrainian refugees.
- Fact-checking President Trump's claims on US financial support to Ukraine
Monday, February 24, 2025
Sunday, February 23, 2025
Saturday, February 22, 2025
Kashyap Patel has been appointed as the new director of the FBI — he is known as a “loyal supporter” of Trump and a conservative radical.
The U.S. Senate confirmed him with a 51–49 vote. Democrats opposed the appointment, arguing that Patel would use his position to seek revenge against Trump’s political opponents. Republicans defended Trump’s nominee, claiming Patel would make the FBI more transparent.
The Washington Post previously reported that in 2024, Patel received a $25,000 fee from a Russian film company promoting pro-Russian and anti-Western views. Now, he will be responsible for countering Russian espionage operations in the United States.
Friday, February 21, 2025
A New Authoritarianism for the 21st Century: TRUMPISM
Ladies and gents, fresh and steaming, straight from the nether orifice of human ingenuity that brought you 20th-century crowd-pleasers such as Communism, Fascism, and Nazism….we are pleased to Introduce the greatest political scourge of the 21st century! Come one, come all, folks, feast your egos, nurture your prejudices, give in to your greed, your complacency, and your hatred! Competitive Authoritarianism has a catchy new name: TRUMPISM!!! And America, our City on a Hill, is leading thru way through the new century.
We’ll have new villains, new heroes, new propaganda, and, best of all, a whole new World War!
Stay tuned and enjoy the show, folks!
Turning America into a Competitive Authoritarian State
Robber baron government
Undermining Rule of Law
McCarthyism 2.0
Purging civil service and military of the opposition, Prosecuting the opposition, Press suppression
Institutions Weaponized against the opposition
Shock and Awe, Speed in dismantling checks and balances
Making friends with dictators, and foes out of liberal democracies
Thursday, February 20, 2025
Wednesday, February 19, 2025
Tuesday, February 18, 2025
Monday, February 17, 2025
CAVALIER Study: Prehospital Calcium and Vasopressin for Hypovolemic Shock Following Traumatic Injury
"About
The CAlcium and VAsopressin following Injury Early Resuscitation (CAVALIER) Trial is a proposed 4 year, double-blind, mutli-center, prehospital and early in hospital phase randomized trial designed to determine the efficacy and safety of prehospital calcium and early in hospital vasopressin in patients at risk of hemorrhagic shock.
Full description
Resuscitation strategies for the acutely injured patient in hemorrhagic shock have evolved. Patients benefit from receiving less crystalloid in favor of blood transfusions with balanced ratios of plasma and platelets or whole blood resuscitation. These resuscitation practices are termed Damage Control Resuscitation and have been incorporated into resuscitation protocols in Level I trauma centers across the country. Damage Control Resuscitation represents standard practice for military and civilian trauma. Despite these changes, deaths from traumatic hemorrhage continue to occur in the first hours following trauma center arrival, underscoring the importance of early, novel interventions.
Hypocalcemia following traumatic injury is exceedingly common following severe traumatic injury in patients at risk of hemorrhagic shock. During hemorrhagic shock resuscitation, pathways reliant upon calcium such as platelet function, intrinsic and extrinsic hemostasis, and cardiac contractility are disrupted. Citrate containing transfusion products are known to further reduce calcium levels through chelation during trauma resuscitation. Hypocalcemia has consistently been shown to be independently associated with the risk of large volume blood transfusion and mortality. Current management practices include calcium replacement during the in hospital phase of care in patients receiving blood products. Early calcium replacement in patients at risk of hemorrhage and hypocalcemia may mitigate coagulopathy, maintain hemostasis, improve hemodynamics and outcomes, and may reduce complications attributable to hemorrhagic shock.
Arginine vasopressin is a physiologic hormone released by the posterior pituitary in response to hypotension and is commonly used as a vasopressor for critically ill patients for the treatment of hypotension due to multiple causes including sepsis. Prolonged hemorrhagic shock has the potential to alter systemic vasomotor tone which can progress to refractory/recalcitrant hypotension. Patients receiving resuscitation for hemorrhage are at risk of vasopressin deficiency. Vasopressin may improve hemostasis by enhancing platelet function and augmenting clot formation. Vasopressin infusion soon after injury in patients in hemorrhagic shock has been demonstrated to be safe and result in a reduction in blood transfusion requirements and a lower incidence of deep venous thrombosis.
Whole blood, red cells, and blood components are a precious and limited resource. Trauma resuscitation adjuncts such as early calcium and vasopressin may provide benefit when transfusion products are limited and may provide additional benefit even when transfusion capabilities remain robust. Due to their action on coagulation and hemodynamic cascades in the injured patient, these resuscitation adjuncts have the potential to interact and provide additive benefit to the injured patient. However, safety and efficacy of prehospital calcium and early in hospital vasopressin remain inadequately characterized. Enrolled patients may participate in the prehospital phase (calcium), in-hospital phase (vasopressin), or both. The aims of the CAlcium and VAsopressin following Injury Early Resuscitation (CAVALIER) trial are to determine the efficacy and safety of prehospital calcium supplementation and early in hospital vasopressin infusion as compared to standard care resuscitation in patients at risk of hemorrhagic shock and to appropriately characterize any additive effect of both resuscitation adjunct interventions."
- text quoted from full CAVALIER study website, click to link to website
Sunday, February 16, 2025
Chernobyl
Today Russia struck and damaged the enclosure that covers the radioactive 4th power unit with a shahed.
A Few Key Tech Lifelines offered to Ukraine in 2022
- Starlink provided service within days of the full-scale invasion, and donated hundred of terminals
- By detecting samples of Russian malware before the war began, Microsoft warned Ukraine about how the impending conflict could affect the country’s information systems.
- Amazon Web Services (AWS) and Microsoft migrated crucial Ukrainian government data to their cloud servers for safekeeping
- Google and Microsoft offered cybersecurity services.
- Airbus, the U.S.-based satellite manufacturer ICEYE, and the space technology companies Capella Space, HawkEye 360, and Maxar Technologies have all been providing invaluable battlefield imaging and data. The analytics company Palantir has been aggregating this data to paint a more complete picture of the war on the ground.
Saturday, February 15, 2025
"I Have Brought You Peace for Our Time"
Neville Chamberlain holds the Munich Agreement, a fateful 1938 decision to appease Hitler, who went on to seize most of Europe and murder millions of civilians.
“It’s certainly an innovative approach to a negotiation to make very major concessions even before they have started,” stated former Swedish Prime Minister Carl Bildt, who co-chairs the European Council on Foreign Relations. "Not even Chamberlain went that low in 1938."
Thursday, February 13, 2025
Ukraine War Developments: Gabbard, Russian Stocks, sanctions on oligarchs, "greatest betrayal of a European ally since Poland in 1945"
Today, the U.S. Senate confirmed Tulsi Gabbard as Director of National Intelligence.
She was voted in 52-48. As DNI, she will oversee 18 intelligence agencies with a budget of approximately $100 billion, and serve as Donald Trump’s top intelligence advisor.
Gabbard has consistently opposed U.S. support for Ukraine and has repeated Russian propaganda narratives, including claims about alleged biolabs in Ukraine. She has criticized President Joe Biden’s policies, accusing Democrats of prolonging the conflict and opposing U.S. arms shipments to Ukraine.
In 2022, Ukraine’s Center for Countering Disinformation stated that Gabbard was working for foreign audiences with Russian funding.
However, during her confirmation hearing on January 30, she called Russia a “strategic competitor” and stated that “Putin started the war against Ukraine.”
Sir Ed Davey, Liberal Democrat leader, speaks in UK Parliament:
Russian stocks soared today, after today's developments
In further news, the Ukrainian National Security and Defense Council imposed sanctions on Ukrainian oligarchs at a meeting on February 12. Those sanctioned included Poroshenko, Kolomoisky, Bogolyubov, Zhevago and Medvedchuk. All of them are accused of carrying out activities in the interests of the Russian Federation. Criminal cases have been opened for each episode, which are being investigated by law enforcement officers.
Sanctions against Poroshenko were reportedly imposed due to:
• a criminal case of high treason, when Poroshenko, in collusion with Medvedchuk and the Russian leadership, allowed Centrenergo to buy coal from the LDN. This deprived Ukraine of any chance of energy independence from the Russian Federation for a long time.
• Poroshenko's participation in the creation of the Party of Regions and his work in Yanukovych's government, when, as Minister of Foreign Affairs, he participated in the preparation of the Kharkiv Agreements.
• Cooperation with the Russian Federation: Owning assets in the Russian Federation – the Roshen factory in Lipetsk and Sevmorzavod in Crimea – Poroshenko was interested in continuing cooperation with the Russian Federation and stationing the Black Sea Fleet on the peninsula.
Sanctions against Kolomoisky and Bogolyubov were reportedly imposed because of:
• that in 2023 they were the founders and beneficiaries of the company Eclaris Group Limited. Through shell companies, it sold oil and gas to Gazprom subsidiaries, which paid taxes to the Russian budget, financing the war.
• withdrawal of UAH 750 million from Privatbank.
The grounds for imposing sanctions against Zhevago reportedly were:
• his close ties with the Russian Federation, in particular, with the sanctioned Russian oligarch Alexei Fedorychev.
• crimes in the banking sector related to the withdrawal of UAH 500 million in credit funds from the Finance and Credit Bank.
• The Ferrexpo group of companies controlled by Zhevago cooperated with the Russian Federation until recently. For example, AvtoKraz exported trucks to Russia, and Rosava and Premiori exported tires, which were supplied to the so-called "LDNR" as early as 2022.
Sanctions against Medvedchuk have been imposed indefinitely - reportedly based on several old episodes, as well as new ones:
• collecting information about the Armed Forces of Ukraine for the benefit of the Russian Federation,
• blocking the launch of advanced cellular radio technologies in Ukraine
• his activities in the OPZH,
• anti-Ukrainian activities of its media resources,
• involving him in anti-Ukrainian propaganda in the Russian Federation. In 2024, the SBU terminated the activities of the media structure “Voice of Europe”, which was part of the pro-Russian project “Second Ukraine”. It was headed and financed by Medvedchuk, and coordinated by the 5th Service of the Russian FSB.
Wednesday, February 12, 2025
Ballistic Missile Impact in Kiev
Video shows damage from an unknown type of ballistic missile, which struck Kyiv on the morning of 12 Feb 2025.
Tuesday, February 11, 2025
Ukrainian MOD launches "Contract 18-24" voluntary army recruiting program
The program offers 18- to 24-year-olds the ability to join the military under a one-year contract, and the option to either reenlist after one year or return to civilian life.
The Ukrainian MoD will pay volunteers 200,000 UAH ($4,700) upon signing a one-year contract and an additional 800,000 UAH ($19,120) during their service in addition to a monthly salary of 120,000 UAH ($2,870). Volunteers will receive three months of training before deploying to the frontline.
The Ukrainian government will subsidize future mortgages, education, and medical care for volunteers and will permit volunteers to travel abroad after their one year of service.
The program also exempts volunteers from mobilization for 12 months after their one-year contract ends.
Ukrainian Defense Minister Rustem Umerov stated that the "Contract 18-24" program is part of Ukraine's ongoing efforts to create a professional military.
Monday, February 10, 2025
Ukraine: Reasons to Wear Eye Protection
Eye injury occurs in roughly 1/4 of blast injury victims. Most eye injuries are easily preventable, by using simple polycarbonate eye protection.
Here, the blast wave from a FAB-500 aerial bomb shatters nearby windows on 9 Feb 2025, in Kramatorsk.
Sunday, February 9, 2025
Saturday, February 8, 2025
Video: Ukrainian FPVs Hunt and Destroy Enemy Soldiers on a Golf Cart
This video shows modern FPV combat drone tactics
Elon Musk Retweets Debunked Russian Propaganda
Elon Musk has retweeted the fabricated piece of Russian propaganda below, on his X feed. The fake news story appears to have been designed by Russian disinformation network Matryoshka.
The fact that Musk retweeted it to his 216 million followers is a major coup for Matryoshka.
The fake video is designed appear to have been published on E! news. It falsely alleges that USAID sent US celebrities, including Angelina Jolie, to Ukraine to support the Ukrainian cause.
However, E! spokeman confirmed the video "is not authentic and did not originate from E! News". Ben Stiller, one of the actors named in the video, denied that his trip to Ukraine was funded by USAID, writing on X: "These are lies coming from Russian media. I completely self-funded my humanitarian trip to Ukraine. There was no funding from USAID and certainly no payment of any kind. 100 percent false." Darren Linvill, co-director of Clemson University's Media Forensics Hub, posted that the video has "every indication of being a Russian fabricated video planted and spread using familiar methods."
Elon Musk appears to have since deleted the post.
Friday, February 7, 2025
Thursday, February 6, 2025
Wednesday, February 5, 2025
Rabies in Wartime Ukraine
Rabies causes >59,000 deaths worldwide, mostly in Africa and Asia, according to WHO. Incidence in countries with domestic animal vaccination programs is far lower- for instance, 3 human deaths per year in the US. Ukraine remains the only country in Europe where rabies is widespread amongst animals, with natural foci present in Kharkiv, Lukhansk, Poltava, Sumy, Chernikhiv, Kirovohrad, and Khmelnitskiy. The main rabies reservoir amongst wild animals in Ukraine is foxes and other wild canids, such as racoon dogs. Dogs are, by far, the most common cause of bites to humans. Significant historical rabies outbreaks occurred in Ukraine in 1951, 1979, and 2007. Anecdotally, at the height of an outbreak, one might see neighbors with their morning coffee, chatting together at the mailbox, leaning on a precautionary shotgun. Like other other endemic diseases (e.g. hantavirus/”trench fever”, TB, HIV, etc), the spread of rabies is promoted by wartime disruptions. The full-scale invasion has led to an increase in the number of stray animals, and has disrupted programs that vaccinated wild and domestic animals. Fields left fallow due to UXO contamination and economic disruptions allow proliferation of rodents and associated predator species. The epidemiological picture in post-2014 Ukraine has been clouded by lack of reporting from occupied parts of the Donbas. The Ministry of Health of Ukraine has reported a substantial increase in rabies cases since 2022. In 2024, 369 communities reported having animals infected with confirmed rabies, compared with 190 communities in 2023. An average of 22,000 patients receive anti-rabies treatment annually in Ukraine.
Rabies can be transmitted by dogs, cats, bats, raccoons, skunks, and foxes, usually via saliva transfer during biting. Exposure is considered to be a bite that breaks the skin, or any contact between mucous membrane or broken skin and infected animal saliva. Racoons, skunks, and foxes that have bitten a human are presumed to be infected. Bat bites may go unnoticed by the patient. Rabid animals often act strangely. They may be agitated, vicious, weak, or paralyzed, make strange noises or flight patterns, and be unafraid of people. Nocturnal animals may be out during the day. Suspected rabid animals should be humanely euthanized in a way that preserves the brain, if possible, and removed by local health authorities.
After initial infection, the virus travels via the peripheral nervous system to the spinal cord and brain. The speed of progression depends on the amount of viral inoculum and proximity of the wound to the brain. The average incubation period is 1-2 months, but may last >1 year.
Pain or paresthesia may occur at the wound site. Initial global symptoms are flulike (fever, malaise, headache). This progresses within days to encephalitis (furious rabies, in 80%) or paralysis (dumb rabies, in 20%). Confusion, agitation, hallucinations, insomnia occur, along with excessive salivation. Attempts to drink cause painful spasms of the laryngeal and pharyngeal muscles (hydrophobia). In the paralytic form, ascending paralysis develops, without delirium and hydrophobia. Diagnosis is confirmed via skin biopsy or sometimes PCR. Treatment, once symptomatic rabies has developed, consists only of supportive and expectant care, including heavy sedation. Death usually occurs 3-10 days after onset of symptoms. Vaccination does not remove the need for post-exposure prophylaxis treatment, but it greatly simplifies it. Post-vaccination, titer checks every two years are recommended for those at risk of exposure.
If exposure occurs, prompt prophylaxis almost always prevents development of human rabies. The wound should be washed extremely thoroughly with soap and water, and deep punctures well-flushed with moderate pressure, using a syringe of soapy water. The patient should be evacuated immediately to a hospital that can do post-exposure prophylaxis. Prophylaxis consists of rabies vaccine and rabies immune globulin. 20 IU/kg of rabies IG is injected around the wound. In previously vaccinated patients, two booster doses of rabies vaccine is the only treatment needed.
* Clinical info was paraphrased from the Merck Manual
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