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Manini AF

@maninialex.bsky.social
107 followers 109 following 2K posts

Professor @MountSinaiNYC, views my own. Director and Founder of Mount Sinai RESPOND Center. icahn.mssm.edu/about/departments/em… See more youtu.be/NJpBa3tDVB4

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Manini AF @maninialex.bsky.social · 15/06/2026
The dashboard update is a reminder that the overdose epidemic is not a static problem. Drug markets evolve, chemistry evolves, and surveillance must evolve alongside them. Data are the flashlight; the dark corners keep moving. #AddictionScience
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Manini AF @maninialex.bsky.social · 15/06/2026
For researchers, clinicians, and policymakers, the value of this dataset is scale. More than 2,500 comprehensively tested overdose cases create opportunities to identify regional patterns, emerging compounds, and evolving clinical risks. #OverdoseData
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Manini AF @maninialex.bsky.social · 15/06/2026
One of the most striking observations over the past several years is the disappearance of heroin from many overdose samples while fentanyl continues to dominate. The illicit opioid market has undergone a remarkable transformation in a very short period of time. #SyntheticOpioids
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Manini AF @maninialex.bsky.social · 15/06/2026
Clinically, the findings reinforce what many frontline providers are seeing: overdose presentations are increasingly driven by multiple substances, not a single drug. Management decisions become more complex when opioids, stimulants, sedatives, and adulterants overlap. #EmergencyToxicology
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Manini AF @maninialex.bsky.social · 15/06/2026
Public health lesson: overdose surveillance cannot rely solely on death certificates, law enforcement seizures, or self-report. Near real-time clinical toxicology data provide an early warning system for emerging threats before they become national headlines. #PublicHealthSurveillance
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Manini AF @maninialex.bsky.social · 15/06/2026
Recent media coverage has focused on the emergence of veterinary sedatives, designer benzodiazepines, and novel synthetic opioids in the illicit drug supply. The dashboard moves us from anecdotes to measured toxicology #DrugSupply
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Manini AF @maninialex.bsky.social · 15/06/2026
The CDC Fentalog Dashboard has been updated to include >2,500 nonfatal suspected opioid overdose cases with advanced toxicology testing from EDs across the U.S. #medsky 🧵 www.cdc.gov/overdose-pre...
cdc.gov
The Fentalog Study: A Subset of Nonfatal Suspected Opioid-Involved Overdoses with Toxicology Testing
View substances detected in samples from patients experiencing a suspected opioid-involved overdose.
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Manini AF @maninialex.bsky.social · 11/03/2026
Mount Sinai has 13 departments nationally in the top 10 🔗 www.mountsinai.org/about/newsro...
mountsinai.org
Icahn School of Medicine at Mount Sinai Remains Among Top Institutions for NIH Funding
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Manini AF @maninialex.bsky.social · 11/03/2026
3 RESPOND Center faculty appear on the list 🔗 icahn.mssm.edu/about/depart... #EmergencyMedicine #NIH #TeamScience
icahn.mssm.edu
RESPOND Center | Icahn School of Medicine
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Manini AF @maninialex.bsky.social · 11/03/2026
New Blue Ridge rankings! 📊 Always humbling to see these rankings; much gratitude for the team behind the numbers. 🔗 brimr.org/brimr-rankin... Proud to see Icahn School of Medicine at Mount Sinai rise to #6 nationally in EM NIH funding (from #7). 🚀 @medsky.social @mountsinainyc.bsky.social
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Manini AF @maninialex.bsky.social · 02/02/2026
The positivity of the novel orphine substance N-propionitrile chlorphine, or "Cychlorphine" in fatal drug overdoses has increased since mid-2025 when the Chinese government placed nitazene analogues under generic control, per CFSRE www.cfsre.org/nps-discover...
cfsre.org
Increase in Fatal Overdoses Linked to Novel Synthetic Opioid N-Propionitrile Chlorphine (Cychlorphine)
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Manini AF @maninialex.bsky.social · 14/01/2026
Perhaps counterintuitive: xylazine-positive patients had lower ICU admission rates and fewer early cardiopulmonary events. That complicates the narrative and should temper reflexive assumptions about severity. #ClinicalToxicology Thread 5/🧵
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Manini AF @maninialex.bsky.social · 14/01/2026
Clinical pearl: opioid overdose + unexpected bradycardia should raise suspicion for xylazine exposure. Naloxone still treats opioid toxicity, but it will not reverse alpha-2 agonism. Expect atypical physiology. #medsky Thread 4/🧵
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Manini AF @maninialex.bsky.social · 14/01/2026
This aligns with recent mainstream media reporting on “tranq” moving from street-level anecdotes to measurable clinical patterns, but adds rigor: analytically confirmed serum testing across 10 institutions, not police seizures or hearsay. #PublicHealth medicalxpress.com/news/2026-01... Thread 3/🧵
medicalxpress.com
Abnormally slow heart rate associated with xylazine-fentanyl overdose
Researchers have identified bradycardia—an abnormally low heart rate—as a symptom of xylazine-opioid overdose. This breakthrough finding from the Icahn School of Medicine at Mount Sinai may help emerg...
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Manini AF @maninialex.bsky.social · 14/01/2026
Key signal: xylazine detection clustered in the Northeast and was independently associated with bradycardia on arrival. Not hypotension. Not hypoxia. A specific physiologic fingerprint worth noticing. #EmergencyMedicine Thread 2/🧵
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Manini AF @maninialex.bsky.social · 14/01/2026
Our new paper out in Addiction from the multicenter Fentalog Study examines who is more likely to have xylazine detected in non-fatal opioid overdose presenting to the ED. This is patient-level toxicosurveillance. #Xylazine #medsky onlinelibrary.wiley.com/doi/10.1111/... Thread 1/🧵
onlinelibrary.wiley.com
Clinical factors linked to xylazine exposure in emergency department patients with illicit opioid overdose
Background and aims Xylazine, an alpha-2 agonist used in veterinary anesthesia, is increasingly detected in the illicit opioid supply but little is known about the patient level factors associated w...
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Manini AF @maninialex.bsky.social · 12/01/2026
Clinically, the data argue against single-agent mental models of overdose. Airway risk, withdrawal trajectories, and naloxone response increasingly reflect mixed pharmacology rather than pure opioid toxicity. Practice needs to catch up. #EmergencyMedicine www.cdc.gov/overdose-pre...
cdc.gov
The Fentalog Study: A Subset of Nonfatal Suspected Opioid-Involved Overdoses with Toxicology Testing
View substances detected in samples from patients experiencing a suspected opioid-involved overdose.
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Manini AF @maninialex.bsky.social · 12/01/2026
From a public health perspective, the Fentalog Study reinforces a core lesson: mortality curves flatten only when surveillance, toxicology, and policy move faster than the supply chain. Static dashboards miss dynamic epidemics. #medsky
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Manini AF @maninialex.bsky.social · 12/01/2026
This aligns uncomfortably well with recent media coverage highlighting xylazine and novel fentanyl analogs appearing in unexpected regions, long after they are entrenched in local drug markets. Signal detection is lagging consequence. #HealthJournalism www.ndtv.com/world-news/s...
ndtv.com
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Manini AF @maninialex.bsky.social · 12/01/2026
The updated CDC Fentalog Study dashboard is a sobering reminder that the opioid supply is no longer just “fentanyl.” Polysubstance exposure is now the rule, not the exception, and surveillance must evolve accordingly. #PublicHealth 🧵 www.cdc.gov/overdose-pre...
cdc.gov
The Fentalog Study: A Subset of Nonfatal Suspected Opioid-Involved Overdoses with Toxicology Testing
View substances detected in samples from patients experiencing a suspected opioid-involved overdose.
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Manini AF @maninialex.bsky.social · 14/08/2025
5/ Bottom line: fentanyl still rules, but the “other stuff” — novel benzos, veterinary sedatives, synthetic cannabinoids — is the stealthy threat changing overdose care. Full report: npsdiscovery.org #DrugTrends
npsdiscovery.org
NPS Discovery
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Manini AF @maninialex.bsky.social · 14/08/2025
4/ Clinically, this underscores why standard opioid panels miss the mark. LC-QTOF-MS detected >1,200 substances, catching dangerous adulterants missed by routine screens. Treatment must anticipate multi-drug toxicity. #EmergencyMedicine www.cdc.gov/overdose-pre...
cdc.gov
The Fentalog Study: A Subset of Nonfatal Suspected Opioid-Involved Overdoses with Toxicology Testing
View substances detected in samples from patients experiencing a suspected opioid-involved overdose.
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Manini AF @maninialex.bsky.social · 14/08/2025
3/ Public health takeaway: street drugs are increasingly poly-drug cocktails. Testing found opioids + stimulants + sedatives in the same patient; this complicates outreach, naloxone use, and treatment planning. #OverdosePrevention
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Manini AF @maninialex.bsky.social · 14/08/2025
2/ A related Fentalog publication last week in AEM noted how lab-made benzos are reshaping #overdose risk. Our data back it up: bromazolam is showing up in multiple cities — often alongside #fentanyl onlinelibrary.wiley.com/doi/10.1111/...
onlinelibrary.wiley.com
Benzodiazepine Co‐Exposure Among Patients Presenting to the Emergency Department With a Confirmed Opioid Overdose
Background Simultaneous exposure to both benzodiazepines and opioids can lead to synergistic respiratory depression, complicating overdose management. Our objective was to report on the detection of...
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Manini AF @maninialex.bsky.social · 14/08/2025
1/ 🚨 New TOXIC Fentalog quarterly report on multi-city toxicology testing shows fentanyl & other synthetic drugs dominate suspected overdose cases in US ERs. Findings offer a near real-time look at the street drug market. #medsky #PublicHealth 🧵 www.cfsre.org/nps-discover...
cfsre.org
ToxIC Fentalog Study Group - Quarterly NPS Report: Q2 2025
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Reposted by Manini AF
Toxicology Investigators Consortium (ToxIC) @toxicacmt.bsky.social · 28/07/2025
Publication: Black patients less likely than white patients to receive outpatient treatment referrals after #opioid #overdose ED visits, per ToxIC Fentalog study. Findings underscore need to address disparities in post-overdose care. ➡️ bit.ly/4l1hFE2 @jamanetworkopen.com @maninialex.bsky.social
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Reposted by Manini AF
Toxicology Investigators Consortium (ToxIC) @toxicacmt.bsky.social · 22/07/2025
🚨Publication Alert🚨 bit.ly/46U3nl6 #Xylazine found in 1 in 5 nonfatal #opioid #overdoses across 10 U.S. EDs, mostly alongside #fentanyl. Exposure highest in NE vs. rare in the West. Regional trends underscore need for targeted public health responses. #MedToxTuesday @maninialex.bsky.social
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Reposted by Manini AF
Toxicology Investigators Consortium (ToxIC) @toxicacmt.bsky.social · 07/07/2025
🚨Publication Alert🚨These findings focused on the presence of para-fluorofentanyl (PFF) point to important differences in OD response/treatment linked to fentanyl analogs w/ sex-specific effects that merit further investigation. 📖https://bit.ly/3Gv0gp3 @ziadkazzi.bsky.social @maninialex.bsky.social
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Reposted by Manini AF
JAMA Network Open @jamanetworkopen.com · 02/07/2025
Among patients with opioid overdose in emergency departments, Black patients received outpatient referrals less frequently than White patients, with rates of 5.7% versus 9.6%. ja.ma/44kiKjO
Disparities in Treatment and Referral After an Opioid Overdose Among Emergency Department Patients
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Manini AF @maninialex.bsky.social · 01/07/2025
July 1. Day One. - You will feel overwhelmed (That’s normal) - Courage isn't the absence of fear - Ask for help early and often - Nobody expects you to know everything - Efficiency comes with time - Trust the process 💙 Welcome. We’ve got your back. #InternYear #Medsky
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Reposted by Manini AF
Stand Up for Science! @standupforscience.net · 16/06/2025
🚨HUGE SCIENCE WIN ALERT🚨 NIH Grants to be restored en masse!!! Thank you Judge Young for standing up for science! #StandUpforScience #SummerFightforScience
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Reposted by Manini AF
Expose News @handle.invalid · 14/06/2025
Tianeptine, or ‘gas station heroin,’ can be addictive and cause serious side effects WASHINGTON (AP) — Health officials want you to think twice before buying one of those brightly colored little bottles often sold at gas stations, convenience stores and smoke shops. Sometimes called “gas station…
exposenews.xyz
Tianeptine, or ‘gas station heroin,’ can be addictive and cause serious side effects
WASHINGTON (AP) — Health officials want you to think twice before buying one of those brightly colored little bottles often sold at gas stations, convenience stores and smoke shops. Sometimes called “gas station heroin,” the products are usually marketed as energy shots or cognitive supplements but actually contain tianeptine, an unapproved drug that can be addictive and carries risks of serious side effects.
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Manini AF @maninialex.bsky.social · 11/06/2025
6/ Over the long term, proactive surveillance could shift care from reactive triage to prediction and prevention—offering a model for future responses to dynamic drug crises. #overdoseprevention
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Manini AF @maninialex.bsky.social · 11/06/2025
5/ Collaboration within the Toxicology Investigators Consortium (ToxIC) ensures a national, multisite approach—boosting generalizability and helping track evolving overdose trends across diverse regions. #toxicology www.acmt.net/fentanyl-ana...
acmt.net
Fentanyl Analog Study
Fentanyl and its analogs (fentalogs) are increasingly contributing to opioid overdoses and deaths across the United States. Since 2017, ToxIC sites have reported multiple case data of such overdoses i...
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Manini AF @maninialex.bsky.social · 11/06/2025
4/ Clinically, this research will explore whether current naloxone dosing suffices against these potent synthetics. ED docs may need new protocols if higher or novel reversal agents prove necessary. #EDpreparedness
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Manini AF @maninialex.bsky.social · 11/06/2025
3/ From a public health lens: amid >108,000 overdose deaths in 2023 and 70 % opioid-related, this study aims to integrate real-time data into the CDC Fentalog Nonfatal OD dashboard—enabling region‑specific alerts and proactive intervention. #publichealthalert www.cdc.gov/overdose-pre...
cdc.gov
The Fentalog Study: A Subset of Nonfatal Suspected Opioid-Involved Overdoses with Toxicology Testing
View substances detected in samples from patients experiencing a suspected opioid-involved overdose.
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Manini AF @maninialex.bsky.social · 11/06/2025
2/ The work sports strong media resonance: outlets are highlighting how fentanyl analogues and ultra-potent nitazenes—often missed by standard tests—are fueling overdose spikes. #medsky #fentanylepidemic www1.racgp.org.au/newsgp/clini...
www1.racgp.org.au
newsGP - GPs warned amid ‘worrying spike’ in nitazenes
The ‘illicit and dangerous’ synthetic opioid has been found in fake pain medication, as GPs ramp up calls for pill testing to be expanded.
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Manini AF @maninialex.bsky.social · 11/06/2025
1/ Exciting news: Our team has been awarded a NIDA R01 grant to fund "Fentalog II", a continuation of our groundbreaking collaboration to detect novel fentanyl analogue overdoses in EDs across ten major hospitals over five years. #syntheticopioids #Medsky 🧵 www.mountsinai.org/about/newsro...
mountsinai.org
Mount Sinai Receives $3.8 Million Grant to Study New Synthetic Drugs and Opioid Overdoses in Emergency Departments to Prevent Deaths
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Manini AF @maninialex.bsky.social · 11/06/2025
7/ Clinicians: if your overdose patient is bradycardic, acidotic, or in shock and has a QTc ≥500 ms, think ECMO, not observation. #resus #ToxTwitter pubmed.ncbi.nlm.nih.gov/40492421/
pubmed.ncbi.nlm.nih.gov
Clinical Factors Associated With Ventricular Dysrhythmia in Emergency Department Patients With Severe QTc Prolongation After Drug Overdose - PubMed
In this large international data registry, we identified predictors of ventricular dysrhythmia in patients presenting to the ED after overdose in the setting of severe QTc prolongation.
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Manini AF @maninialex.bsky.social · 11/06/2025
6/ From a public health perspective, these findings underscore the hidden cardiovascular danger of common drugs like diphenhydramine, quetiapine, and loperamide in overdose. #poisonprevention #opioidepidemic
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Manini AF @maninialex.bsky.social · 11/06/2025
5/ QTc ≥500 ms alone isn’t the full picture. This paper gives clinicians a sharper triage lens: focus on the sickest patients, not just the longest intervals. #EDmedicine #riskstratification
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Manini AF @maninialex.bsky.social · 11/06/2025
4/ This work builds on growing public concern over OTC and Rx misuse. Years ago, @nytimes covered loperamide (“poor man’s methadone”) causing fatal arrhythmias. This study directly validates that risk. #medsky www.nytimes.com/2016/05/11/h...
nytimes.com
Addicts Who Can’t Find Painkillers Turn to Anti-Diarrhea Drugs (Published 2016)
The opioid epidemic has led to a form of drug abuse that few experts saw coming: the use of Imodium and other anti-diarrhea medications to get high.
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Manini AF @maninialex.bsky.social · 11/06/2025
3/ All three signs had strong associations with arrest, death, and ECMO need. Absence of all three? 98.2% NPV for dysrhythmia. #FOAMed #toxicology
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Manini AF @maninialex.bsky.social · 11/06/2025
2/ Only 3.8% of these patients developed ventricular dysrhythmias. But three simple ED findings—bradycardia, acidosis, and shock—were powerful red flags. #clinicaltox #ekgpearls
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Manini AF @maninialex.bsky.social · 11/06/2025
1/ Our new study in Academic Emergency Medicine analyzed 1,265 ED patients with severe QTc prolongation (≥500 ms) after drug overdose. What predicts dangerous ventricular dysrhythmias in this high-risk group? #cardiotoxins #overdose #Medsky 🧵 pubmed.ncbi.nlm.nih.gov/40492421/
pubmed.ncbi.nlm.nih.gov
Clinical Factors Associated With Ventricular Dysrhythmia in Emergency Department Patients With Severe QTc Prolongation After Drug Overdose - PubMed
In this large international data registry, we identified predictors of ventricular dysrhythmia in patients presenting to the ED after overdose in the setting of severe QTc prolongation.
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Reposted by Manini AF
Stand Up for Science! @standupforscience.net · 09/06/2025
“In an unusual act of public protest, more than 340 scientists and staff at the National Institutes of Health today released a statement charging NIH officials and their superiors with politicizing science.” www.science.org/content/arti... #StandUpForScience #BethesdaDeclaration
science.org
NIH staff and biomedical community sound alarm about agency politicization, funding slowdown
In test of NIH director’s support of dissent, NIH staff sign Bethesda Declaration urging reversal of grant cuts and freezes
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Manini AF @maninialex.bsky.social · 14/05/2025
Even he agrees with me! #medsky abcnews.go.com/amp/Health/r...
abcnews.go.com
RFK Jr. says people should not take medical advice from him, defends HHS cuts during House hearing
HHS Secretary Robert F. Kennedy Jr. is set to testify before two congressional committees on Wednesday.
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Manini AF @maninialex.bsky.social · 21/04/2025
Great primer and review of the landscape on Methadone for EM docs and emergency care providers #opioidcrisis #Medsky www.acepnow.com/article/libe...
acepnow.com
Liberate Methadone: An Introduction for the Emergency Medicine Physician - ACEP Now
ACEP Now offers real-time clinical news, news from the American College of Emergency Physicians, and news on practice trends and health care reform for the emergency medicine physician. ACEP Now is an...
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Manini AF @maninialex.bsky.social · 11/04/2025
6/ NIH doesn’t go silent without a reason. Two weeks of radio silence isn’t just a glitch—it’s a tremor. Pay attention.
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Manini AF @maninialex.bsky.social · 11/04/2025
5/ Bottom line: If you’re waiting on a reissue, planning a resubmission, or coaching a trainee—don’t assume timelines are stable. Now is the time to email your PO and ask if your anticipated FOA is still on track. Quiet weeks can signal loud changes.
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