[Download Hindi Provoked
Luther Lazaro
The 2023 worldwide total of 69 confirmed unprovoked cases is in line with the most recent five-year (2018-2022) average of 63 incidents annually. There were 14 confirmed shark-related fatalities this year, ten of which are assigned as unprovoked. This number is higher than the five-year annual global average of six unprovoked fatalities per year. Three of the unprovoked fatalities were due to bites from white sharks on surfers in Australia.
Annual fluctuations in shark-human interactions are expected. While the number of fatalities in 2023 was considerably higher than in 2022, there have been years in the past (2011) in which fatalities were also higher. The 2023 uptick in fatalities due to white sharks may reflect stochastic year-to-year variation, but it might also be the consequence of the increasing number of white sharks seen at aggregation sites near beaches that are popular with surfers (particularly in Australia). Year-to-year variability in oceanographic conditions influences the local abundance of sharks in the water, while weather patterns and economic conditions impact human activities along coastlines.
Consistent with long-term trends, the United States recorded the most unprovoked shark bites in 2023, with 36 confirmed cases. This is slightly lower than the 41 incidents recorded in 2022. The 36 cases represent 52% of the worldwide total.
New Caledonia reported three unprovoked bites, one of which was fatal. Egypt reported two unprovoked bites, including one fatality. The Bahamas and Mexico each reported one fatal unprovoked bite for 2023. Brazil reported three bites, none of which were fatal. South Africa reported two bites, neither of which were fatal. Costa Rica, Colombia, New Zealand, Seychelles, the Galapagos Islands and the Turks and Caicos Islands each reported single non-fatal incidents for 2023.
The total number of unprovoked shark bites worldwide remains extremely low. Fatalities saw an increase over the past year. Most of the fatalities in 2023 were due to white shark bites (three in Australia, one in California).
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Study selection: Prospective cohort studies and randomized trials of patients with a first episode of symptomatic VTE provoked by a transient risk factor and treated for at least 3 months were identified.
Data extraction: Number of patients and recurrent VTE during the 0- to 12-month and 0- to 24-month intervals after stopping therapy, study design, and provoking risk factor characteristics were extracted.
Data synthesis: Annualized recurrence rates were calculated and pooled across studies. At 24 months, the rate of recurrence was 3.3% per patient-year (11 studies, 2268 patients) for all patients with a transient risk factor, 0.7% per patient-year (3 studies, 248 patients) in the subgroup with a surgical factor, and 4.2% per patient-year (3 studies, 509 patients) in the subgroup with a nonsurgical factor. In the same studies, the rate of recurrence after unprovoked VTE was 7.4% per patient-year. The rate ratio for a nonsurgical compared with a surgical factor was 3.0 and for unprovoked thrombosis compared with a nonsurgical factor was 1.8 at 24 months.
Conclusions: The risk of recurrence is low if VTE is provoked by surgery, intermediate if provoked by a nonsurgical risk factor, and high if unprovoked. These risks affect whether patients with VTE should undergo short-term vs indefinite treatment.
It is generally accepted that sleep deprivation contributes to seizures. However, it is unclear whether a seizure occurring in the setting of sleep deprivation should be considered as provoked or not and whether this is influenced by seizure type and etiology. This information may have an important impact on epilepsy diagnosis and management. We prospectively analyzed the influence of sleep deprivation on the risk of seizure recurrence in patients with first-ever unprovoked seizures and compared the findings with patients with first-ever provoked seizures. Of 1026 patients with first-ever unprovoked seizures, 204 (20%) were associated with sleep deprivation. While the overall likelihood of seizure recurrence was slightly lower in sleep-deprived patients with first-ever seizures (log-rank p=0.03), sleep deprivation was not an independent predictor of seizure recurrence on multivariate analysis. Seizure recurrence following a first-ever unprovoked seizure associated with sleep deprivation was far more likely than for 174 patients with a provoked first-ever seizure (log-rank p
Confabulation is a mysterious adjunct of amnesia. It remains unexplained why some patients invent untrue stories in response to questions (provoked confabulations) or even spontaneously with no apparent motivation (spontaneous confabulations). Hypothesized mechanisms range from a desire to fill gaps in memory to a loss of the temporal context in memory. We examined the mechanisms of confabulations in 16 amnesic patients. Patients were classified as spontaneous confabulators if they ever acted according to their confabulations. Provoked confabulations were measured as the number of intrusions in a verbal learning test. We found a double dissociation between the two types of confabulations, indicating that they represent different disorders rather than different degrees of the same disorder. Confabulating patients did not show an increased tendency to fill gaps in memory as measured by the number of fake questions concerning nonexistent items that they answered. Neither type of confabulation correlated with a failure to store new information as gauged with recognition tasks; pure information storage was even found to be normal in some patients. However, we found a positive correlation between several measures of verbal learning and verbal fluency with provoked, but not spontaneous, confabulations. In contrast, spontaneous, but not provoked, confabulations were associated with an inability to recognize the temporal order of stored information as measured by the comparison of two runs of a continuous recognition task. We suggest that provoked confabulations depend on an amnesic subject's search in his deficient memory and are the trade-off for increased item recollection. Spontaneous confabulations appear to be based on a failure to recognize the temporal order of stored information, resulting in erroneous recollection of elements of memory that do not belong together.
The distinction between a provoked and an unprovoked clot is not always black-and-white. For example, if you have a clot several months after a major surgery, it may not be obvious whether the surgery led to the clot or not. Current treatment guidelines specify that a clot is considered to be provoked if it occurs within three months after a major transient risk factor, or two months after a minor one.
After three months, the treatment plan can vary. Some patients stop taking blood thinners, while others continue to take them over the long term. This decision is based on the risk of the patient having another clot versus the risk of bleeding caused by being on a blood thinner.
In general, an unprovoked clot is considered to be riskier than a provoked clot. Since unprovoked clots occur without any known precipitating factors, they could indicate an underlying tendency to form clots. Research has shown that patients with unprovoked clots have a high risk of having another clot in the future. Because of this, these patients are likely to be prescribed blood thinners for the long term to reduce their risk.
While unprovoked clots are considered to be riskier in general, clots that are provoked by a persistent (or long-term) risk factor are the riskiest of all, resulting in a very high risk of having another clot. For example, a patient with cancer who experiences a clot would usually be given long-term blood thinners, at least until their cancer goes into remission.
Beyond general treatment guidelines, there are some individual factors that can influence whether or not a particular patient gets long-term blood thinners. Even for a patient with a provoked clot, long-term blood thinners may still be preferred in some cases.
Imagine that you had a clot provoked by a major surgery. This is a transient risk factor, which would normally warrant taking blood thinners for only three months. However, if you were overweight or had other risk factors, for example, it might be worthwhile for you to take blood thinners for longer than three months to reduce the risk of future clots.
The location of a clot is also important. Blood clots in the lower legs are more common and less concerning than clots in other parts of the body. Studies have shown that people with a single unprovoked clot in the lower leg may not need long-term blood thinners, while those with a clot in another area (such as the thigh or arm) should be given blood thinners for a longer duration.
Another consideration is the risk of a fall. If a patient has a higher-than-average risk of falls, then they may be at increased risk of bleeding from taking blood thinners. This bleeding risk may be greater than the risk of another clot, so they may not be put on long-term blood thinners.
The North American Thrombosis Forum (NATF) is a 501(c)3 nonprofit organization incorporated by the Commonwealth of Massachusetts. NATF is dedicated to improving the lives of those affected by blood clots and related diseases. Through our comprehensive resources and innovative programming, we strive to educate patients and healthcare providers about thrombosis and its complications.
NATF provides the information and materials on this site for general information purposes only. You should not rely on the information provided as a substitute for professional medical advice, care, or treatment. This site is not designed to and does not provide medical advice, professional diagnosis, opinion, treatment, or services to you or any individual. If you believe you have a medical emergency, call 911 immediately.
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