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Posttraumatic headaches (PTHs) frequently occur following mild traumatic brain injury and may occasionally present with features of trigeminal autonomic cephalalgias (TACs). PTH-TAC is characterized by unilateral craniofacial pain and autonomic symptoms and can be significantly debilitating. Management of this headache subtype can be particularly challenging as it can be refractory to medical therapies. Currently, there is a paucity of evidence on the optimum medical management for this condition. This case series evaluated the effectiveness of nerve blocks in managing PTH with TAC features, highlighting their therapeutic potential for this debilitating headache phenotype. In this retrospective study, we identified 4 patients seen at St. Michael's clinic from January 2021 to December 2023. We identified 4 patients meeting the International Classification of Headache Disorders diagnostic criteria for PTH, presenting with TAC features. They initially failed medical management and later underwent anesthetic nerve block procedures, including occipital, supraorbital, and supratrochlear nerve blocks. Clinical outcomes, including changes in headache frequency, pain intensity using a standard 11-point Numeric Rating Scale (NRS-11), where 0 indicates no pain, and 10 indicates the worst pain imaginable., and autonomic symptoms, were documented over a 2 month follow-up period. All patients demonstrated significant improvement, with reductions in headache intensity and frequency > 50% in 2 cases and near-complete resolution in 2 cases recorded at the 2 month follow-up. Associated autonomic symptoms, including nasal congestion, tearing, and periorbital pain, also showed marked improvement. No significant adverse effects were reported during or after the procedure. This is a small case series with a limited follow-up period (2 months). Nerve blocks represent a potentially safe and effective intervention for PTH with TAC-like features, providing both rapid and sustained relief for patients with refractory symptoms. However, we need larger prospective cohort studies with extended follow-up periods to confirm the findings of this small case series. Such studies will help standardize evidence-based treatment protocols for this challenging subset of headaches.

Anti-neutrophil cytoplasmic antibody-associated vasculitis (AAV) is a group of small-vessel necrotizing vasculitides with minimal immune complex deposition. Hypertrophic cranial pachymeningitis, a rare complication of AAV, is characterized by focal/diffuse dural thickening and fibrosis, causing neurological dysfunction such as headache and optic nerve injury. While AAV-associated hypertrophic cranial pachymeningitis is well documented, reports of concurrent spinal dural involvement remain scarce. This case highlights the rare co-occurrence of cranial and spinal dural involvement in AAV, providing new clinical evidence to expand the understanding of AAV-related dural manifestations and improve diagnostic awareness among clinicians. A 57-year-old male presented with fever, headache, otalgia, and hearing loss, and was diagnosed with granulomatosis with polyangiitis based on positive anti-proteinase 3 antibodies (664.3), cytoplasmic anti-neutrophil cytoplasmic antibody (1:10). Symptoms resolved with glucocorticoids, disease-modifying antirheumatic drugs, and anti-infective therapy. He later developed recurrent headache and lumbodorsal pain. Thoracic magnetic resonance imaging (MRI) revealed a T10 to 12 epidural lesion, which was surgically resected. Pathology confirmed epidural vasculitis with necrotic/fibrous tissue, granulation, and inflammatory cell infiltration. Methylprednisolone and cyclophosphamide relieved back pain, but headaches persisted. Cranial MRI showed dural thickening in the cerebellar, posterior fossa, and foramen magnum regions, consistent with pachymeningitis. Cerebrospinal fluid analysis showed elevated mononuclear cells (35.00 × 106/L), nucleated cells (40.00 × 106/L), and protein (1.49 g/L), with negative cultures. The final diagnosis was granulomatosis with polyangiitis complicated by concurrent cranial and spinal dural involvement. Initial management included glucocorticoids, disease-modifying antirheumatic drugs, and anti-infective therapy, which resolved the patient's fever, otalgia, and hearing loss. Surgical resection was performed for the T10 to 12 epidural lesion, followed by immunosuppressive therapy with methylprednisolone and cyclophosphamide. After adjustment of the treatment regimen, the patient's headache improved. Initial therapy resolved the patient's fever, otalgia, and hearing loss. Surgical resection combined with immunosuppressive therapy relieved lumbodorsal pain but failed to resolve headaches initially; cranial MRI confirmed pachymeningitis, and cerebrospinal fluid analysis indicated inflammatory changes. After adjustment of the treatment regimen, the patient's headache improved, and he has remained clinically stable during follow-up. This case demonstrates that AAV can involve both cranial and spinal dura mater. Clinicians should consider dural involvement in AAV patients presenting with lumbodorsal pain.

Migraine attacks are frequently accompanied by patient-reported "subjective" cognitive symptoms, but objective findings have been inconsistent. We used high-frequency, smartphone-based cognitive testing to assess within-person changes in subjective and objective cognition across migraine phases using daily diaries. Adults with migraine were recruited through social media. Eligible participants met ICHD-3 migraine criteria and had 3 to 22 monthly headache days. For 30 days, they completed daily smartphone-based reports on headache features, cognitive symptoms, and three smartphone-based objective cognitive tasks. Objective tests included Symbol Search (processing speed/visual search), Color Dots (visual working memory/attention), and Grid Memory (visuospatial working memory). Primary analyses contrasted assessments on current headache days (ictal) versus days with no headache (nonictal). When possible, non-ictal days were subclassified using information from adjacent days as pre-ictal, post-ictal, and interictal days. Outcomes included subjective cognition, reaction time (mean across correctly scored trials), accuracy, and a speed-accuracy composite (Reaction Time/Accuracy). Mixed-effects models adjusted for age, sex, and practice effects. The 139 eligible participants (84.9% female; mean age 38.2 years) contributed 3,014 person-days for ictal versus nonictal comparisons (2,097 nonictal; 917 ictal); for 1,828 person-days precise phase classification was possible. Subjective cognitive symptoms were worse on ictal days, with higher odds of more severe brain fog (OR=3.39, 95% CI 2.70-4.27) and task forgetting (OR=2.82, 95% CI 2.29-3.49). In adjusted models, reaction times were slower on ictal days for Symbol Search (reaction time ratio =1.043, 95% CI 1.028-1.059) and Color Dots (ratio=1.015, 95% CI 1.003-1.026) but not Grid Memory (reaction time ratio =1.006, 95% CI 0.985-1.028). Grid Memory accuracy was lower on ictal days (OR=0.867, 95% CI 0.823-0.914). In analyses based on phase, most nonictal phases showed faster reaction time and lower subjective symptom burden relative to ictal days, with limited differentiation among preictal, postictal, and interictal periods. In persons with migraine, daily smartphone assessments revealed subjective cognitive impairment on ictal vs nonictal days in brain fog and forgetfulness. Objective testing revealed slowing in processing speed and attention and modest differences in the accuracy of working-memory. High-frequency digital cognition appears feasible and may provide scalable functional endpoints for real-world monitoring and treatment evaluation.

This study evaluated the efficacy of a minimally invasive cervical procedure that combines percutaneous nucleoplasty, annuloplasty, and manual nucleotomy in patients with internal annular rupture or contained disc protrusion accompanied by cervicogenic symptoms. Seventeen patients presenting with cervical radiculopathy and associated complaints - such as headache, vertigo/tinnitus, or facial numbness - underwent treatment with the Disc-FX Mini technique. A control group of 15 individuals with similar clinical and radiological findings received conservative therapy. Pain intensity and functional status were assessed using the Visual Analogue Scale (VAS) and the Neck Disability Index (NDI) at baseline and during follow-up. Psychological examination was performed to exclude any psychological background of ailments. In the treated group, the mean VAS scores dropped from 8.1 ± 1.2 at baseline to 1.6 ± 1.0 at one year, while the NDI scores improved from 29.8 ± 6.8 to 7.6 ± 2.3. The control group showed smaller improvement (VAS from 7.5 ± 1.4 to 3.9 ± 1.2; NDI from 26.0 ± 9.6 to 12.1 ± 6.1). Of 13 patients reporting persistent or recurrent headache in the treatment group, 9 reported relief of these symptoms. Vertigo and other atypical symptoms subsided or markedly decreased in most cases. This combined percutaneous method may represent a safe and effective option for patients with cervicogenic symptoms who are unresponsive to conservative management. It potentially bridges the gap between ineffective conservative treatment and open surgery, particularly for patients with subtle imaging findings.

Monoclonal antibodies (mAbs) targeting the Calcitonin Gene-Related Peptide (CGRP) pathway are safe and effective treatments for migraine prevention. However, the high cost of these novel therapies has led to reimbursement policies requiring patients to try multiple traditional preventives before access. Here, we evaluate the real-world effectiveness of onabotulinumtoxinA (BoNT-A) as first-line treatment and describe the sequential transition to anti-CGRP monoclonal antibodies in patients who did not achieve sufficient response, within the Polish chronic migraine treatment program. In this retrospective cohort study, we included 94 patients with chronic migraine who received BoNT-A treatment according to the PREEMPT protocol every 3-4 months for 12 months as first-line treatment. Headache diaries and documentation were used to evaluate reductions in monthly headache days (MHD) and MIDAS scores. Patients were divided into two subgroups based on their response after three BoNT-A administrations: insufficient response (&#x2264;&#x2009;50% reduction in MHD) and sufficient response (>&#x2009;50% reduction in MHD). We included 94 patients (93.62% female, age range 22-66 years). Following three BoNT-A injection cycles, 70 patients (74.47%) did not achieve the &#x2265;&#x2009;50% response threshold and were sequentially transitioned to fremanezumab per programme protocol. In the insufficient response group, MHD decreased from 18.26&#x2009;&#xb1;&#x2009;4.46 to 13.90&#x2009;&#xb1;&#x2009;4.64 days (t(69)&#x2009;=&#x2009;15.49, p&#x2009;<&#x2009;0.001), representing a 23.9% reduction, while MIDAS scores decreased from 93.77&#x2009;&#xb1;&#x2009;41.80 to 61.69&#x2009;&#xb1;&#x2009;35.56 (t(69)&#x2009;=&#x2009;10.22, p&#x2009;<&#x2009;0.001, 34.2% reduction). In the sufficient response group (n&#x2009;=&#x2009;24, 25.53%), MHD decreased from 17.83&#x2009;&#xb1;&#x2009;1.95 to 7.83&#x2009;&#xb1;&#x2009;1.83 days after 3 injections (56.1% reduction, t(23)&#x2009;=&#x2009;31.97, p&#x2009;<&#x2009;0.001), and further to 4.13&#x2009;&#xb1;&#x2009;1.77 days after 5 injections (76.7% reduction, t(22)&#x2009;=&#x2009;32.59, p&#x2009;<&#x2009;0.001). Pearson's correlation analysis revealed moderate positive correlation between MHD and MIDAS after 3 injections (r&#x2009;=&#x2009;0.392, p&#x2009;<&#x2009;0.001), which weakened substantially after 5 injections (r&#x2009;=&#x2009;0.082, p&#x2009;=&#x2009;0.691). Baseline MIDAS scores were numerically higher in the sufficient response group (116.62&#x2009;&#xb1;&#x2009;61.12 vs. 93.77&#x2009;&#xb1;&#x2009;41.80, t(92)&#x2009;=&#x2009;2.04, p&#x2009;=&#x2009;0.044); however, given the outcome-dependent nature of group allocation, this difference should not be interpreted causally or as a prognostic marker. For patients who did not experience sufficient improvement after the third BoNT-A administration, treatment was changed to fremanezumab. Our real-world data demonstrate that 74.47% of patients with chronic migraine did not achieve the &#x2265;&#x2009;50% MHD reduction threshold after three onabotulinumtoxinA injections, supporting the current Polish therapeutic algorithm that allows sequential transition to anti-CGRP monoclonal antibodies for insufficient responders.

This operative video report demonstrates two cases of endoscopic fenestration for enlarging symptomatic thalamic cysts causing obstructive hydrocephalus. A literature review of 29 cases (1987-2026)1-17 reveals hydrocephalus present in the majority of cases. Common presentations include headache, gait disturbance, and cognitive changes. The first case involves a 62-year-old female with progressive proprioceptive deficits and imbalance due to a 2.5 cm right thalamic cyst protruding into the third ventricle. The second case involves a 59-year-old female presenting with altered mental status and headaches from an enlarging right thalamic cyst. In both cases, a frontal transcortical endoscopic approach was utilized to fenestrate the cysts into the lateral and third ventricles in combination with an endoscopic third ventriculostomy. To ensure precise access, two separate trajectories were employed: one providing a straight-line path to the cyst wall and another to the floor of the third ventricle. Fenestration was achieved using blunt dissection and Fogarty balloon dilation, followed by further enlargement with alligator clamps. Postoperatively, both patients experienced complete resolution of symptoms and mass effect. These cases illustrate that while benign thalamic neuroepithelial cysts are rarely symptomatic10, they can be effectively treated with endoscopic fenestration. While treatment approaches in the literature vary, endoscopic or microsurgical fenestration remains the most common intervention. This technique, utilizing a high-resolution rigid endoscope coupled with stereotactic navigation and preoperative trajectory planning, allows for safe and effective treatment of these deep cystic lesions.

Introduction Laparoscopic cholecystectomy is the standard treatment for symptomatic cholelithiasis. Although 3D laparoscopy may improve depth perception, its effects on efficiency, ergonomics, and complication rates in comparison to 2D systems remain unclear. Methods In this prospective, single-blinded, randomized comparative study, 100 patients underwent elective laparoscopic cholecystectomy at the Department of General and Minimal Access Surgery in a tertiary care teaching hospital in North India. Patients were randomized equally to 3D (Group A) or 2D laparoscopy (Group B). Exclusion criteria included prior major abdominal surgery, coagulopathy, or pregnancy. Total performance time, surgeon's subjective depth perception (scale 1-5), strain scores (eye, wrist/hand, neck/back, dizziness/headache), intraoperative complications, conversion rates, and hospital stay were documented through surgical records and postoperative questionnaires. Results The total performance time was significantly shorter in the 3D group (46 min) compared to the 2D group (50 min; p=0.0074). The median depth perception score was higher in the 3D group (5.0 vs. 2.0; p<0.001). Wrist/hand strain was lower in the 3D group (median 2.0 vs. 3.0; p=0.0117), while eye strain (4.0 vs. 3.0; p=0.0021) and dizziness/headache (4.0 vs. 2.0; p<0.001) were greater. There were no significant differences in neck/back strain (p=0.81), rates of gallbladder rupture (10% vs. 12%; p=0.76), liver bed bleeding (10% vs. 14%; p=0.76), biliary injury (none), conversion rates (2% in both), or hospital stay (2.06 days each; p=0.78). Conclusions 3D laparoscopy enhances operative efficiency and depth perception while reducing wrist/hand strain. However, increased eye strain and dizziness warrant further technological optimization to improve the overall ergonomic profile for surgeons.

Cystic echinococcosis (CE), caused by Echinococcus granulosus sensu lato and other Echinococcus species, is a neglected tropical disease that predominantly affects the liver and lungs, with central nervous system involvement being rare but potentially severe. Data on cerebral CE in Afghanistan remain limited, resulting in insufficient characterization of its clinical and management patterns. This study describes seven patients (aged 7-45 years) with isolated cerebral CE and a history of livestock exposure or CE in family members. Lesions were located in the frontal, parietal, or temporal lobes. Headache was present in all patients (100%), followed by seizures (85.7%) and focal neurological deficits (28.6%). All patients underwent complete surgical cystectomy, followed by a three-month course of albendazole. Short-term outcomes were favorable, with resolution of headache in all cases and seizure control achieved in the majority (83.3%). These findings highlight the occurrence of cerebral CE in different regions of Afghanistan, and demonstrate a favorable early clinical response to the combined surgical and medical treatment approach.

Antineutrophil cytoplasmic antibody (ANCA)-associated pachymeningitis is a rare inflammatory disorder of the dura mater that may occur in isolation or as part of systemic vasculitis. The clinical features and outcomes of proteinase 3 (PR3)- and myeloperoxidase (MPO)-ANCA-associated pachymeningitis remain poorly defined. We aimed to synthesize clinical presentation, investigations, and treatment outcomes to improve diagnosis and guide management. A systematic review was conducted in accordance with PRISMA guidelines. PubMed, Embase, and Scopus were searched to June 15, 2023. Eligible studies were case reports or series of patients with imaging-confirmed pachymeningitis and positive ANCA serology. Individual patient data were extracted, including demographics, clinical features, pathology, and outcomes. We identified 230 patients from 177 reports, including 108 MPO-ANCA-positive, 71 PR3-ANCA-positive, and 3 dual MPO/PR3-positive cases; 46 ANCA-positive cases had unspecified antigen specificity, and 2 were ELISA-negative but ANCA IIF-positive. Median age was 60 years; 53% were male. Headache and cranial neuropathies-particularly hearing loss, visual impairment, and diplopia-were predominant. Systemic involvement was present in 89% of cases, primarily affecting the ear, nose, throat, lungs, orbits and kidneys. Imaging often showed tentorium/falx, middle cranial fossa, and frontal convexities involvement. Inflammatory markers were raised in >&#x2009;90%, and cerebrospinal fluid pleocytosis in 50%. Typical pathological features such as granulomas, vasculitis, or necrosis were documented in 66% of biopsied patients. At a median 9-month follow-up, mortality rate was 3.9% and relapse rate 23.5%. Rituximab (25%) was associated with lower rates of refractory disease. PR3- and MPO-ANCA-associated pachymeningitis typically presents with headache and cranial neuropathies, usually with systemic involvement. Relapse and incomplete recovery remain common despite treatment, underscoring the need for early recognition, targeted immunotherapy, and long-term follow-up.

A phase&#xa0;4, prospective, open-label study of low-sodium oxybate (LXB) in narcolepsy (type&#xa0;1 [NT1] or 2 [NT2]) or idiopathic hypersomnia included novel symptom outcomes important to patients (Jazz DUET; NCT05875974; registered 16 May&#xa0;2023). Primary results from the narcolepsy cohort, including LXB effectiveness (nighttime sleep/daytime symptoms/overall disease severity) and safety are reported here. DUET included screening, 8-day baseline (BL; off-LXB), 2-8-week LXB dose titration/optimization, 2-week stable-dose, 8-day end-of-treatment (EOT; on-LXB), and safety follow-up periods. At BL and EOT, participants underwent nocturnal polysomnography (PSG) and completed Epworth Sleepiness Scale (ESS; primary endpoint), Narcolepsy Severity Scale (NSS [NT1]; NSS-2 [NT2]), and Patient Global Impression of Severity (PGI-S) and Change (PGI-C); eDiaries for sleep quality and cataplexy (NT1 only) were completed daily for 8&#xa0;days before PSGs. Least-squares mean (LSM) changes were adjusted for BL values. Thirty-four participants completed the study and were analyzed (NT1, n&#x2009;=&#x2009;16; NT2, n&#x2009;=&#x2009;18); LSM (SE) change in ESS score (BL to EOT),&#x2009;-&#x2009;7.7 (0.9), P&#x2009;<&#x2009;0.0001. At EOT versus BL, transitions to lighter stages of sleep decreased (LSM [SE]&#x2009;-&#x2009;13.1 [2.9], P&#x2009;<&#x2009;0.0001), N3 duration increased (45.0 [8.8] min, P&#x2009;<&#x2009;0.0001), and nocturnal awakenings decreased (-&#x2009;3.2 [0.9], P&#x2009;=&#x2009;0.0013). LSM [SE] changes in NSS and NSS-2 scores were&#x2009;-&#x2009;19.7 (2.7) and -&#x2009;11.3 (1.6). Most participants reported improved sleep quality and overall narcolepsy disease and fewer cataplexy attacks. Treatment-emergent adverse events were consistent with the known LXB safety profile. DUET study results demonstrated novel nighttime sleep/daytime symptom improvements in participants with narcolepsy treated with open-label LXB. ClinicalTrials.gov identifier, NCT05875974. Low-sodium oxybate (LXB; Xywav&#xae;), a medication that contains calcium, magnesium, potassium, and sodium oxybates, is approved for treating excessive daytime sleepiness or cataplexy (sudden muscle weakness) in people aged 7&#xa0;years and older with narcolepsy. LXB is also approved for treating idiopathic hypersomnia in adults. The DUET (Develop hypersomnia Understanding by Evaluating low-sodium oxybate Treatment) study tested sleep and daytime symptoms in people with narcolepsy who took LXB. Before starting LXB, people in the study completed tests to measure their symptoms and sleep patterns. Then they started taking LXB. Study doctors adjusted LXB doses over 2&#x2013;8&#xa0;weeks to find the best dosage for each person. After the best dosage was found, people took that dosage for 2 more weeks. At the end of the study, people took the tests again while taking LXB. The study looked at changes in test findings before and after taking the best dosage of LXB. People took LXB for 5&#x2013;12&#xa0;weeks. Fifty-five people with narcolepsy started taking LXB. After LXB treatment, people had less daytime sleepiness. They had fewer sleep disruptions, like transitions from deeper to lighter stages. They got about 45&#xa0;min more of deep sleep at night. They also woke up less frequently at night. After LXB treatment, most people said their overall narcolepsy disease was better. The most common side effects were nausea, dizziness, headache, drowsiness, and vomiting. People with narcolepsy who took LXB had less daytime sleepiness and less disrupted nighttime sleep than before taking LXB.

The dynamic beauty care sector in the Middle East is on an upward trend in the UAE; however, concerns persist about the side effects of this industry, attributed to chemical exposure, which is believed to contribute to skin problems and other health issues. In the UAE, there is a lack of data on consumer usage, awareness, and the health effects associated with it. This study presents the results of an online survey administered to 461 female subjects in the United Arab Emirates as part of a cross-sectional study. The survey consisted of 55 questions on product use, knowledge, attitudes, safety measures, and potential adverse health effects. Descriptive statistics and logistic regression analysis were applied to identify predictors of adverse reactions. Among the 461 participants, most were aged 18-29&#xa0;years (55.7%) and university educated (68.3%). The application of scent and makeup was almost widespread, as 91.5% of users applied scented products daily, and 100% of users mentioned cosmetics, 36.4% of respondents reported health problems caused by the use of these products, with the most common issues being persistent respiratory problems (16.3%), headaches (15.8%), and skin irritation (11.9%). Knowledge of fragrance safety was moderate, with only 43.8% recognizing that fragrances contain complex chemical mixtures. The study demonstrated daily cosmetic use in 75.1% of individuals who frequently perform allergy tests, and limited safety practices in 6.7% of these individuals. While allergy testing was protective, logistic regression analysis revealed that younger age, higher education, a history of allergies, and frequent product use were predictors of adverse events. This has led to the association of widespread use of fragrances and cosmetics amongst women in the UAE with major respiratory and dermatological problems.

Spinal cerebrospinal fluid (CSF) leak is a disabling and often misdiagnosed condition characterised by CSF hypovolemia. Associated neurological symptoms are diverse and often leave individuals bed-bound due to their orthostatic nature. Prior literature describing the difficulties in diagnosis, treatment, and ongoing impact of CSF leak is, thus far, confined to Europe and North America. This study provides a novel account of lived experiences of spinal CSF leak in Australia and Aotearoa New Zealand (NZ). An online survey exploring symptoms, diagnosis, treatment, and effect on daily life of a person's "first" CSF leak was designed with consumer involvement. Responses were received from May to August 2025. Open-text responses were analysed using thematic analysis. In total, 106 surveys were completed. Over 70 symptoms were reported; the most common were orthostatic headache (95.3%), neck pain (85.8%), and brain fog (79.2%). Most people considered their diagnosis (73.6%) and treatment (65.3%) difficult, underscored by limited clinician awareness and access to care, leaving individuals to self-advocate. Amongst symptomatic participants (73.6%), median EuroQol Visual Analogue Scale score was 40 (interquartile range 25-64; indicating low health-related quality-of-life) and mean Headache Impact Test-6 score was 69&#x2009;&#xb1;&#x2009;5 (indicating severe impact). Other challenges identified included navigating change to social identity and daily functioning. The spinal CSF leak experience in Australia and NZ is comparable to reports from other high-income countries, highlighting the global need to increase awareness of spinal CSF leak, support timely diagnostic, referral and treatment pathways, and mitigate its impact on quality of life.

Smallholder farmers' exposure to pesticide can be minimized by their hygiene behaviour during pesticide application. The aim of this study was to determine knowledge of the risks, hygiene habits and perceived health issues associated with pesticide mixing and application among smallholder farmers in Nigeria. A cross-sectional study was conducted on 162 smallholder farmers from Ibarapa North Local Government Area, using a validated structured questionnaire through a two-stage sampling method. Data were analyzed using descriptive statistics and chi-square test at p&#x2009;=&#x2009;0.05. Farmers' mean age was 42.4&#x2009;&#xb1;&#x2009;12.3 years, 85.0% were male while 32.9% had tertiary education. Most (95.1%) farmers acknowledged that pesticides affect human health and 63.1% read, understood and followed pesticides label. Notably, only 4.9% acknowledged that banned or restricted pesticides cannot be used. Respondents identified pesticide exposure routes as inhalation (74.7%), dermal (15.4%), oral (1.9%) and eye contact (0.6%). Mean knowledge score was 7.9&#x2009;&#xb1;&#x2009;2.7 and 54.3% had poor knowledge of pesticide risk. Majority of farmers had direct skin contact with pesticide (83.3%) while 21.3% wore pesticide contaminated farm cloth home. Respondents' use of personal protective equipment (PPE) during pesticide mixing and application were: goggles (10.1%), coverall (29.0%), head cover (22.9%) and gloves (41.8%). Additionally, unsafe disposal of empty pesticide containers on farm was common among the farmers (42.6%). Mean hygiene habit score was 5.8&#x2009;&#xb1;&#x2009;1.9 and 85.2% had unsafe hygiene habit. Respondents' (90.9%) who had poor knowledge of pesticide risk was significantly (p&#x2009;=&#x2009;0.025) higher among those who had unsafe hygiene habit during pesticide mixing and application. Reported symptoms by farmers included: dizziness&#x2009;>&#x2009;itchy eye&#x2009;>&#x2009;headache&#x2009;=&#x2009;skin irritation&#x2009;>&#x2009;nausea&#x2009;=&#x2009;coughing, during or after pesticide mixing and application. Farmers' knowledge about pesticide risk and safe hygiene habit was poor. Farmers' health may be at risk, hence appropriate hygiene habit and use of PPE should be strictly adhered to during pesticide mixing and application.

Cannabinoid hyperemesis syndrome (CHS) is characterized by intense nausea, abdominal pain, and cyclical vomiting following heavy, chronic cannabis use. With increases in cannabis legalization in the United States (U.S.), CHS is an emerging concern for cannabis users, medical professionals, and policymakers. This study is the first to examine a large, nation-wide sample of cannabis users to estimate CHS prevalence and identify risk factors and at-risk populations. Survey data were collected in the U.S. by the International Cannabis Policy Study in 2023. The prevalence of past-year CHS was calculated among participants reporting cannabis use. Logistic multilevel modeling was used to test a-priori hypotheses for factors associated with CHS. 10,255 participants (45.82% female, Mage = 39.46 years) were included in this study. Approximately 6% reported past-year CHS. Participants who were younger, male, Hispanic, or two or more races were more likely to experience CHS. Older age of first cannabis use, more frequent use of cannabis edibles and concentrates, riskier cannabis use patterns, and past-year alcohol use were associated with higher risk. Those who grew their own cannabis, used cannabis to manage symptoms of headaches/migraines or nausea/vomiting, or experienced bipolar disorder or psychosis/dissociative identity disorder were also more likely to report CHS. Those who used cannabis for lack of appetite or experienced depression were less likely to report CHS. There was no significant effect of state-legal cannabis. Ongoing surveillance, standardized definitions, and identification of underlying risk factors are essential to enhance public health awareness and accurate diagnosis.