Charles J. Gerardo

Duke University Health System

Author Statistics

Papers

Citation

H-Index

i-10 index

Research Trends

Author Order

Document Type

Co-Authors

João Ricardo Nickenig Vissoci

Duke Institute for Health Innovation

Eric J. Lavonas

Denver Health Medical Center

Scott M. Silvers

Mayo Clinic in Florida

Steven A. Godwin

Florida College

Sharon E. Mace

Cleveland Clinic

Susan B. Promes

Pennsylvania State University

Bernard Lo

Ottawa Hospital Research Institute

Richard D. Shih

Florida Atlantic University

Deborah B. Diercks

The University of Texas Southwestern Medical Center

Christian Tomaszewski

UC San Diego Health System

Cooperative Institutions

Duke University

146

Duke Medical Center

Duke University Hospital

Duke Institute for Health Innovation

Fundação de Medicina Tropical

Universidade do Estado do Amazonas

Escola Superior de Ciências da Saúde

American College of Emergency Physicians

University of Colorado Denver

University of North Carolina at Chapel Hill

Author Statistics

Papers

Citation

H-Index

i-10 index

Research Field

Injury prevalence and safety habits of boda boda drivers in Moshi, Tanzania: A mixed methods study

PLoS ONE (2018)

TuanDat Nguyen João Ricardo Nickenig Vissoci Treasure Joelson Msafiri Pesambili Michael M. Haglund

Traffic crashes are a major cause of global morbidity and mortality disproportionately affecting low- and middle-income countries (LMICs). Motorcycle taxi (boda boda) drivers are particularly vulnerable because they are exposed to traffic risks with limited safety equipment. This study aims to characterize injury prevalence and safety habits among boda boda drivers, as well as ways to improve road traffic safety in LMICs.A cross-sectional mixed methods study was conducted with 300 boda boda drivers between 24 March and 3 April 2014 in urban Moshi, Tanzania. A convenience sample of participants was drawn from 25 of 58 registered boda boda stands and 2 of 31 unregistered stands. Data were analyzed using R, and content thematic analysis was performed and agreed upon by three investigators. Logistic regression models were used to evaluate the association between boda boda characteristics and injury risk.In total, 300 drivers participated, of whom 148 (49.3%) had experienced a crash during their lifetime, and 114 (77.0%) sustained at least one injury. Only 27 of those injured (23.4%) were hospitalized. Of all participants, 220 (73.3%) reported consistent helmet usage, despite 285 participants (95.0%) agreeing that helmet usage reduces injury severity. From the 280 helmets observed, 231 (82.5%) were either damaged or fit improperly. Having a cracked helmet was associated with higher risk of being involved in a traffic crash. Owning a helmet with a proper fit was associated with reduced risk for a traffic crash (OR = 0.06) and road traffic injuries (OR = 0.07). A thematic analysis of boda boda drivers' suggestions to increase road safety identified four intervention areas: 1) roadway infrastructure and traffic regulation, 2) road user attitudes and safe driving behaviors, 3) education and training, and 4) law enforcement.Our study demonstrates boda boda drivers' safety behaviors and identifies four intervention areas that can be leveraged to increase overall road traffic safety. Unfortunately, while boda boda drivers are aware of ways to improve safety, adherence to safety habits remains low. Successful multi-sectoral interventions are needed to improve road safety for boda boda drivers in Tanzania.

Cross-sectional study

10.1371/journal.pone.0207570

Cite

Citations (27)

Oral varespladib for the treatment of snakebite envenoming in India and the USA (BRAVO): a phase II randomised clinical trial

BMJ Global Health (2024)

Charles J. Gerardo Rebecca W. Carter Surendra Kumar Farshad M. Shirazi Suneetha D. Kotehal

Introduction Snakebite envenoming (SBE) results in over 500 000 deaths or disabling injuries annually. Varespladib methyl, an oral inhibitor of secretory phospholipase A2, is a nearly ubiquitous component of snake venoms. We conducted a phase II clinical trial to assess efficacy and safety of oral varespladib methyl in patients bitten by venomous snakes. Methods This double-blind, randomised, placebo-controlled trial enrolled patients in emergency departments in India and the USA. Patients with SBE were randomly assigned (1:1) to receive varespladib methyl or placebo two times per day for 1 week. All patients received standard of care, including antivenom. The primary outcome was change in the composite Snakebite Severity Score (SSS) measuring the severity of envenoming, from baseline to the average composite SSS at 6 and 9 hours. Results Among 95 patients randomised August 2021 through November 2022, the most common snakebites were from Russell’s vipers (n=29), copperheads (n=18) and rattlesnakes (n=14). The SSS improved from baseline to the average at 6 and 9 hours by 1.1 (95% CI, 0.7 to 1.6) in the varespladib group versus 1.5 (95% CI, 1.0 to 2.0) in the placebo group (difference −0.4, 95% CI, −0.8 to 0.1, p=0.13). While key secondary outcomes were not statistically different by treatment group, benefit was seen in the prespecified subgroup initiating study drug within 5 hours of bite (n=37). For this early treatment group, clinically important differences were observed for illness severity over the first week, patient-reported function on days 3 and 7 and complete recovery. No death or treatment emergent serious adverse event occurred. Conclusion For emergency department treatment of snakebites, the addition of varespladib to antivenom did not find evidence of difference for the primary outcome based on the SSS. A potentially promising signal of benefit was observed in patients initiating treatment within 5 hours of snakebite.

Antivenom

10.1136/bmjgh-2024-015985

Cite

Citations (3)

Hematologic Abnormalities and Bleeding in Copperhead Snakebite

Wilderness and Environmental Medicine (2014)

C. Scott Evans Weiying Drake Mariam Diskina Alexander T. Limkakeng Charles J. Gerardo

Prothrombin time

Hypofibrinogenemia

Antivenom

10.1016/j.wem.2013.12.018

Cite

Citations (8)

Association of a Network of Immunologic Response and Clinical Features With the Functional Recovery From Crotalinae Snakebite Envenoming

Frontiers in Immunology (2021)

Charles J. Gerardo Elizabeth Silvius Seth Schobel John Eppensteiner Lauren M McGowan

Background The immunologic pathways activated during snakebite envenoming (SBE) are poorly described, and their association with recovery is unclear. The immunologic response in SBE could inform a prognostic model to predict recovery. The purpose of this study was to develop pre- and post-antivenom prognostic models comprised of clinical features and immunologic cytokine data that are associated with recovery from SBE. Materials and Methods We performed a prospective cohort study in an academic medical center emergency department. We enrolled consecutive patients with Crotalinae SBE and obtained serum samples based on previously described criteria for the Surgical Critical Care Initiative (SC2i)(ClinicalTrials.gov Identifier: NCT02182180). We assessed a standard set of clinical variables and measured 35 unique cytokines using Luminex Cytokine 35-Plex Human Panel pre- and post-antivenom administration. The Patient-Specific Functional Scale (PSFS), a well-validated patient-reported outcome of functional recovery, was assessed at 0, 7, 14, 21 and 28 days and the area under the patient curve (PSFS AUPC) determined. We performed Bayesian Belief Network (BBN) modeling to represent relationships with a diagram composed of nodes and arcs. Each node represents a cytokine or clinical feature and each arc represents a joint-probability distribution (JPD). Results Twenty-eight SBE patients were enrolled. Preliminary results from 24 patients with clinical data, 9 patients with pre-antivenom and 11 patients with post-antivenom cytokine data are presented. The group was mostly female (82%) with a mean age of 38.1 (SD ± 9.8) years. In the pre-antivenom model, the variables most closely associated with the PSFS AUPC are predominantly clinical features. In the post-antivenom model, cytokines are more fully incorporated into the model. The variables most closely associated with the PSFS AUPC are age, antihistamines, white blood cell count (WBC), HGF, CCL5 and VEGF. The most influential variables are age, antihistamines and EGF. Both the pre- and post-antivenom models perform well with AUCs of 0.87 and 0.90 respectively. Discussion Pre- and post-antivenom networks of cytokines and clinical features were associated with functional recovery measured by the PSFS AUPC over 28 days. With additional data, we can identify prognostic models using immunologic and clinical variables to predict recovery from SBE.

10.3389/fimmu.2021.628113

Cite

Citations (1)

Response to carpenter and colleagues

Clinical Toxicology (2019)

Eric J. Lavonas Victoria E. Anderson Charles J. Gerardo

To the Editor,We agree with Dr. Carpenter et al. that dry bites should not be treated with antivenom. The inclusion criteria for the original trial was swelling due to copperhead envenomation [1].T...

Antivenom

Snake bites

10.1080/15563650.2018.1554816

Cite

Citations (0)

Clinical Policy: Critical Issues in the Initial Evaluation and Management of Patients Presenting to the Emergency Department in Early Pregnancy

Annals of Emergency Medicine (2017)

Sigrid A. Hahn Susan B. Promes Michael D. Brown Michael D. Brown Richard L. Byyny

10.1016/j.annemergmed.2016.11.002

Cite

Citations (69)

Clinical Policy for Well-Appearing Infants and Children Younger Than 2 Years of Age Presenting to the Emergency Department With Fever

Annals of Emergency Medicine (2016)

Sharon E. Mace Seth R. Gemme Jonathan H. Valente Barnet Eskin Katherine Bakes

Chest radiograph

10.1016/j.annemergmed.2016.01.042

Cite

Citations (21)

Scaling up antivenom for snakebite envenoming in the Brazilian Amazon: a cost-effectiveness analysis

The Lancet Regional Health - Americas (2023)

Armand Zimmerman Wuelton Marcelo Monteiro João Ricardo Nickenig Vissoci Emily R. Smith Thiago Augusto Hernandes Rocha

Snakebite envenoming (SBE) affects nearly three million people yearly, causing up to 180,000 deaths and 400,000 cases of permanent disability. Brazil's state of Amazonas is a global hotspot for SBE, with one of the highest annual incidence rates per 100,000 people, worldwide. Despite this burden, snake antivenom remains inaccessible to a large proportion of SBE victims in Amazonas. This study estimates the costs, and health and economic benefits of scaling up antivenom to community health centers (CHCs) and hospitals in the state.

Antivenom

10.1016/j.lana.2023.100651

Cite

Citations (3)

Clinical Policy: Critical Issues in the Diagnosis and Management of the Adult Psychiatric Patient in the Emergency Department

Annals of Emergency Medicine (2017)

Devorah J. Nazarian Joshua Broder Molly E.W. Thiessen Michael P. Wilson Leslie S. Zun

10.1016/j.annemergmed.2017.01.036

Cite

Citations (203)

162 Access to a Health Care Facility Impacts Mortality in Brazilian Snake Envenomation: A Geospatial Information Systems Analysis

Annals of Emergency Medicine (2017)

J.J. Ye João Ricardo Nickenig Vissoci Thiago Rocha Hernandes Nicole Toomey Catherine A. Staton

10.1016/j.annemergmed.2017.07.189

Cite

Citations (0)