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Black Widow

Disney's president of marketing Asad Ayaz said that after Black Widow was delayed from its original May 2020 release date, the marketing team paused their campaign for the film. Once they began working towards a new release date in 2021, they were able to use character looks and story points that they had not revealed in the initial campaign to build a new approach to the film. Ayaz explained that they did not want it to feel like they had returned to the same marketing campaign, which focused on the Black Widow symbol and her black costume. The marketing team differentiated the new campaign by featuring the character's white costume from the film instead, and by focusing on her legacy as an Avenger.[159] The campaign featured 30 brands, including co-branded opportunities with GEICO, Ziploc, BMW, and Synchrony Bank. Additional custom partnerships occurred with Fandango, YouTube, Roku, TikTok, Amazon, a Twitter E3 gaming sponsorship, and announcements, posters, and collectibles for the various premium theater experiences such as IMAX.[5]

Black Widow

In September 2020, Barbie released two Black Widow dolls featuring the black and white outfits worn by Romanoff in the film.[160] Marvel released another trailer for the film in April 2021, which Austen Goslin at Polygon felt was a new "final" trailer for the film's new release date. He said it only had a few new scenes in it but provided the best look yet at Taskmaster. Goslin highlighted the Russian-inspired version of The Avengers theme music used at the end of the trailer.[161] Germain Lussier of io9 also highlighted the use of The Avengers theme, feeling that the music combined with footage from previous MCU films as well as flashback moments of Natasha and her family made the trailer feel more epic than the previous final trailer. Lussier said it was a trailer that "gets you excited for the return" of MCU films.[162] Ethan Anderton of /Film said the "epic" free-falling fight with Taskmaster showcased in the trailer "looks like a sequence unlike any other" in the MCU.[163] The trailer received over 70 million views in its first 24 hours.[164] On July 5, Moneymaker: Behind the Black Widow, a half-hour documentary special centered on Johansson's stunt double Heidi Moneymaker, premiered on ESPN+ as part of ESPN's E60 series. The special was directed by Martin Khodabakhshian and narrated by Johansson. A subsequent, eight-minute version of the special aired on ESPN's Outside the Lines on July 10.[165][166] An episode of the series Marvel Studios: Legends was released on July 7, exploring Black Widow using footage from her previous MCU appearances.[167]

The black widow spider species, also known by its biological nomenclature as the Latrodectus species is one of more than 40,000 different species of spiders. Clinically, it is one of most significant species of spiders worldwide. Within the United States, it is responsible for most of the clinically significant envenomation among all species of spiders. There are more than 30 different types of black widow spiders worldwide; however, not all species are as relevant due to their separation from human habitat. The Black Widow, or Latrodectus mactans, is easily identified by its characteristic shiny black body and strikingly red hourglass-shaped marking on the abdomen. This activity reviews the pathophysiology and presentation of a black widow spider bite and highlights the role of the interprofessional team in its management.

Objectives:Identify the toxins associated with a black widow spider bite.Review the presentation of a black widow spider bite.Summarize the treatment and management options available for black widow spider bite.Describe interprofessional team strategies for improving care abd outcomes in patients with a black widow spider bite.Access free multiple choice questions on this topic.

The black widow spider species, also known by its biological nomenclature as the Latrodectus species is one of more than 40,000 different species of spiders. Clinically, it is one of most significant species of spiders worldwide. Within the United States, it is responsible for most of the clinically significant envenomation among all species of spiders. There are more than 30 different types of black widow spiders worldwide; however, not all species are as relevant due to their separation from human habitat.[1][2]

Approximately 2600 Latrodectus-species exposures are reported to the National Poison Data System (NPDS) each year. Black widow spiders thrive in warmer climates, and except in Antarctica, exist on every continent. The 2 species most commonly implicated in envenomation within the United States are the Latrodectus mactans, or the southern black widow spider, and the Latrodectus hesperus, or the western black widow spider. Southern widow spiders are primarily located in the southeastern United States (including southern Ohio and Maryland). The western black widow spider is located along the western half of the United States, ranging from Canada to the north and extending southward to Mexico. Additional species in the United States include the Latrodectus variolus found in Eastern states, including New England; the Latrodectus bishopi, also found in the Southern states; and the Latrodectus geometricus, which is the brown widow found in the far Western states. The primary habitat of the black widow spider is outdoors where they are found in firewood, garages, gardening equipment, trash, outdoor equipment, outhouses, and on outdoor furniture. Exposures rise in spring months and continue to increase as the summer progresses into autumn.[4][5]

The venom of the black widow spider is a combination of biologically active proteins, peptides, and proteases. The primary toxin found in the venom of the black widow is alpha-Latrotoxin. It binds irreversibly to the protein receptors on presynaptic neurons and creates calcium ([Ca2+])-permeable channels within the lipid bilayers. This influx of [Ca2+] ions results in massive exocytosis of neurotransmitters, including acetylcholine, dopamine, norepinephrine, epinephrine, and glutamate. It is this release of neurotransmitters which leads to the characteristic symptomatology of pain, muscle rigidity, vomiting, and sweating.[6]

Some patients may progress to latrodectism. Latrodectism refers to the systemic manifestations of a widow bite. Symptoms include diffuse muscle rigidity and cramping, tenderness and burning around the bite, truncal and abdominal tenderness, nausea, and vomiting. The diffuse pain associated with latrodectism spreads contiguously from the bite site. In other words, if the bite occurs on the ankle, the pain will progress proximally along the leg, and then to the adjacent extremity, abdomen, chest, and back. All extremities can be involved.

The diagnosis of black widow envenomation is almost exclusively clinically established. Visualizing the bite along with its associated symptoms and obtaining a detailed history will allow accurate diagnosis. To officially confirm the diagnosis, the patient must bring in the spider after witnessing the bite. An entomologist, medical toxicologist, or another qualified specialist must then identify the spider. However, this is not necessary, and it should not be recommended to patients to capture, harm, or handle the spider. [7][8]

In a large case series involving 23,409 exposures to black widow venom, Monte et al. found that 65% of patients presented with minor clinical effects, 33.5% moderate effects (longer duration of symptoms, treatment required) and 1.4% with major effects (life-threatening). Of the 9872 cases with at least minor effects, the most common symptoms of envenomation were dermal irritation (58.7%), erythema (28.6%), pain (17.9%), edema (13.6%) and abdominal pain (9.7%). Lab values are generally non-specific but may show an elevated white blood cell count, hematuria, and elevated liver enzymes. Other rare manifestations include rhabdomyolysis and myocarditis resulting in elevated creatine kinase and myoglobin in the blood and urine.

The initial management for all cases of black widow envenomation includes local wound management and tetanus prophylaxis. Calcium gluconate and methocarbamol have been shown to be ineffective and are no longer recommended.

Black widow spider antivenom is safe and highly effective in most patients. It is effective in relieving symptoms, reducing the need for additional therapy, and decreasing admission rates. Typically, after administration and a brief period of observation, patients recover fully and can go home without complication. However, the antivenom has been associated with several severe allergic reactions that have led to precautionary assessment before antivenom administration. Most experts would recommend administration of antivenom to patients without a history of asthma or atopy, whose symptoms are not effectively treated with analgesics.[2][6]

The differential for black widow spider envenomation includes bites from other arthropods, as well as other causes of tachycardia, hypertension, muscle spasm, abdominal, back and chest pain. Other invertebrate envenomations or bites to consider include scorpion stings, as well as those from other spider species, namely the tarantula or brown recluse. With regard to abdominal pain, the practitioner must always consider other sources of acute abdominal pain, including but not limited to appendicitis, trauma, or other causes of acute abdominal pain. Back pain from muscle spasm or other etiology should be similarly considered. Regarding chest pain, especially as black widow bites can rarely cause troponin elevation, the practitioner must include acute coronary syndromes or myocarditis on their differential.

The prognosis for black widow bites is good. Most pain and systemic symptomatology are self-limited. Although patients may encounter long-term pain or muscle spasms after black widow bites, this phenomenon is rare. Similarly, systemic toxicity, including abdominal pain and autonomic dysfunction, is usually temporary. Recovery is usually complete within 24 to 48 hours. Finally, administration of anti-venom with a subsequent anaphylactic reaction is, as with most anaphylactic reactions, rare and usually a transient condition. Most patients can, and should, expect a full recovery after black widow envenomation. 041b061a72


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