Antibacterial and antioxidant potentials of selected anti-ophidic plants from Assam, India: Bioassay-guided fractionation and HR-LCMS assisted identification of potential bioactive compounds

Shewanella infection of snake bites: a twelve-year retrospective study

Management of pediatric snake bites: Are we doing too much?

Venomous snake bites can constitute medical emergencies, and without immediate care may be life-threatening. This study describes the characteristics and management of patients suffering from snake bite injuries (SNIs) in the Jerusalem area. A retrospective analysis of all patients who were admitted to the Hadassah Medical Center emergency departments (EDs) due to SNIs between 1 January 2004 and 31 March 2018 was conducted. During this period, 104 patients were diagnosed with SNIs, of whom 32 (30.7%) were children. Overall, 74 (71.1%) patients were treated with antivenom, 43 (41.3%) were admitted to intensive care units, and 9 (8.6%) required treatment with vasopressors. No mortality was recorded. On ED admission, none of the adult patients presented with an altered mental state compared to 15.6% of the children (p < 0.00001). Cardiovascular symptoms were observed in 18.8% and 5.5% of the children and adults, respectively. Fang marks appeared in all of the children. These findings underscore the severity of SNIs and the differences in clinical presentation between children and adults in the Jerusalem region.

The chronic wounds that develop following snake bites may display a spectrum of histological features that could be correlated with the type of venom injected. The pathological changes may provide useful information for the management of chronic wounds that develop following snake bites. This study intends to assess the histopathological changes seen in chronic wounds following Daboia russelii (Russell’s viper), Hypnale species (Hump nosed viper) and Naja naja (Cobra) bites and wounds of non snake bite aetiology. Inflammatory cells were seen in snake bite and non snake bite wounds. An intense mixed cellular inflammatory cell presence around the vessels could be seen. More lymphocytes and plasma cells were seen in wounds following snake bite and presence of more eosinophils was detected in wounds with other aetiology. Haemorrhagic areas in the dermis were seen in tissue samples taken from Naja naja and Hypnale species bite wounds. Vascular proliferation was predominant in all chronic wounds following snake bite. Granulation tissues were also more in chronic wounds following snake bites than the wounds of other aetiology. Among these three snake bites, haemorrhage was present mainly in Naja naja and Hypnale bite wounds compared to Daboia russelii.

BackgroundIndia is a thickly populated country; apart from having biodiversity among people, climate does change from place to place. Western Ghats of South India harbors variety of plantations and diverse creatures. Agriculture is the primary occupation of the people and some tribes living in these regions. Here majority are callous/ ignorant in employing neither advanced farming techniques nor safety precautions, hence are exposed to bites and stings by animals. Of these, snake bites cause significant mortality and morbidity. Proper care for some of these individuals is out of reach. Identification of offending snake, snake bite injury or findings of envenomation is a key not only for the administration of antisnake venom but also for the victim to realize that he needs an expert care. Unless he believes it to be a critical snake bite and not a thorn prick, scorpion sting or a spider bite he will not approach a health care provider. To know about these dangerous signs that may help the victim to realize it as a case of snake bite, current study is employed on fatal cases in this region.Methods60 fatal snakebite cases were studied retrospectively for 5 years with an objective to know the socio-demography, latency and pattern of injuries in rural Southern India.ResultsMost of the victims were males, in the age group of 31-50 years and were at risk of snake bites while farming. Large sample of subjects approached traditional therapists and were deprived of essential care in the critical first few hours after snake bite. Fang marks (90%), local ecchymoses (50%) and internal hemorrhage (28.3%), were the frequent demonstrable signs appreciated at autopsy.ConclusionSnakebite is a neglected, endemic, occupational (farming) disease of the poor and there is need for National Snakebite Prevention Programme for curtailing this menace.

India has reported one of the highest snake bite mortality rates in the world. It is estimated that over 5 million persons per year are bitten by snakes of whom, over 1,00,000 survivors develop severe sequelae due to local wound complications. The adoption of harmful first aid practices like use of tourniquets or cutting and sucking the snake bite marks further complicates wound management. National Snake Bite Protocol has been issued in 2007, with technical support from WHO to institute proper management of snake bites. However, there is no evidence based guidelines for local wound management in snake envenomation. The local tissue problems at the bite site were effectively managed by timely administration of anti-snake venom and other supportive management in majority of patients. Cribari et al have graded the local signs of envenomation. Local tissue complications are most frequently seen with bite from Viperidae. Cytotoxic enzymes in viper venom cause proteolysis, lipolysis, blisters, necrosis and gangrene. Surgical management of snake bite has a significant role in preventing late sequelae and permanent disability due to snake bite wounds. The aim of surgical intervention will be radical removal of all devitalized tissues, followed by reconstructive procedures using skin grafts and flaps, to minimize functional loss and maximize rehabilitation. This paper explores the pathology of a snake bite wound and compiles the accepted guidelines for wound management and also the do’s and don’ts pertaining to the bite areas following a snake bite.

The objective of this study is to describe the clinical status, procedural interventions, and outcomes of critically ill patients with poisoning and snake bite injuries presenting to a tertiary-care emergency department for treatment with therapeutic plasmapheresis. Records of 20 patients who presented to our academic emergency department over a 2-year period and who underwent plasmapheresis for poisoning or snake bite were retrospectively reviewed. Plasmapheresis was performed using centrifugation technology via an intravenous antecubital venous or subclavian vein catheter access. Human albumin or fresh frozen plasma were used as replacement fluids. Data extracted from the patient record included demographic data, clinical status, and outcome measures. Sixteen patients underwent plasmapheresis because of toxicity from snake bite. Three patients were treated for drug poisoning (phenytoin, theophylline, bipyridene HCl) and one patient for mushroom poisoning. Haematologic parameters such as platelet count, PT, and INR resolved rapidly in victims of snake bite injuries after treatment with plasmapheresis. Loss of limbs did not occur in these cases. Seven patients required admission to the intensive care unit. One patient with mushroom poisoning died. Mean length of hospital stay was 14.3 days (range 3-28 days) for all cases. Plasmapheresis was a clinically effective and safe approach in the treatment of snake bite envenomation and other drug poisoning victims especially in the management of hematologic problems and in limb preservation/salvage strategies. In addition to established conventional therapies, emergency physicians should consider plasmapheresis among the therapeutic options in treatment strategies for selected toxicologic emergencies.

Approach and management of venomous snake bites: a guide for the primary care physician

Aim:Snakebite injuries are common in tropical India among those who are involved in outdoor activities. These injuries results in cellulitis, gangrene at the bite area, bleeding manifestations, compartment syndrome, regional lymphadenopathy, septicemia, hypotension, and disseminated intravascular coagulation (DIC) resulting in significant morbidity and mortality. The purpose of this study is to share our experience of multidisciplinary approach in the management of snakebite injuries of the extremities with various treatment modalities including hyperbaric oxygen (HBO) therapy, surgical debridement, and soft tissue reconstruction to provide an effective treatment for snake bite injuries.Methods:The study was conducted in the Department of Plastic Surgery, during the period October 2012–December 2014, wherein all the patients who were admitted with snakebite injuries were enrolled and the patients treated in plastic surgery department were included into the study. Out of total 766 patients, there were 323 patients treated with anti snake venom (ASV) and 29 died among the treated patients; 205 patients belonged to pediatric age group.Results:Out of 112 patients referred to Department of Plastic Surgery, 50 cases presented with cellulitis, 24 patients with compartment syndrome, and 38 patients were referred for the management of soft tissue cover over the extremities. Among 112 patients, 77 involved the lower extremity and 35 the upper extremity.Conclusion:Multidisciplinary approach including hyperbaric oxygen (HBO) therapy improves outcome in the management of snakebite injuries of the extremities.

Indonesia has a high biodiversity of snakes. Snake species that exist throughout Indonesia, consisting of venomous and non-venomous snakes. One of the dangers that can be posed by snakes is the bite of several types of deadly snakes. Snake bite cases recorded in Indonesia are quite high with not a few fatalities. Most of the deaths caused by snakebite occur due to errors in the handling procedure for the bite wound. This problem can be overcome one of them if we know how to classify snake bite wounds, whether venomous or non-venomous. In this study, a classification system for snake bite wound image was built using Regionprops feature extraction and Decision Tree algorithm. Snake bite images are classified as either venomous or non-venomous without knowing the kind of the snake. In Regionprops several features are used to help the process of feature extraction, including the number of centroids, area, distance, and eccentricity. Evaluation of the model that was built was found that the parameters of the number of centroids and the distance between centroids had the most significant influence in helping the classification of images of snakebite wounds with an accuracy of 97.14%, precision 92.85%, recall 91.42%, and F1 score 92.06%.

Seventy-six patients (30% children) were admitted to Fremantle Hospital over 10 years with suspected snake bite. Twenty-nine patients were definitely bitten, with 26 bites being witnessed. Of the 13 patients definitely envenomated, 11 had a coagulopathy although seven were asymptomatic; four other patients may have been envenomated. The dugite (Pseudonaja affinis) was probably responsible for most envenomations. Eleven of the 13 envenomated patients received antivenom (six brown snake, four polyvalent and one tiger snake antivenom). The patient envenomated by the tiger snake (Notechis ater occidentalis), a 13-year-old girl, was initially incorrectly treated with brown snake antivenom at a country hospital, and did not receive appropriate antivenom until 50 hours after the bite. She developed profound paralysis, rhabdomyolysis and renal failure, and required prolonged ventilation during her 53-day hospital admission, but survived without disability. Snake bite wounds should not be washed, so that venom can be identified from the wound. Attempts to kill snakes are dangerous, often leading to bites on the fingers. First aid measures of a pressure bandage and immobilisation, used in 13 of the 29 cases (45%), should be more widely publicised.

Around the world, snake bite injuries are still life threatening and require intensive care. The diagnose and treatment to toxic snake bites is the insufficient information, within the management of anti-toxin therapy, is not provided in clinical practice. In this comparative study, water extracts of Allium sativum, Allium cepa and Nigella sativa in different concentrations and heparin powder was used on human blood which is free from diseases. The common desert snake poison was used to compare the anti-coagulation time of the above plant extracts. Among three extracts Nigella sativa extract showed more time of coagulation of blood when treated with the snake poison. The results of the present study confirms the traditional medicinal use of selected plants and evidence for the best substances impact in the delay of blood clotting against snake bites of those plants. Further research is going on to isolate bioactive compounds.

PurposeOcular manifestations in snake-bite injuries are quite rare. However, the unusual presentations, diagnosis and their management can pose challenges when they present to the ophthalmologist. Early detection of these treatable conditions can prevent visual loss in these patients who are systemically unstable and are unaware of their ocular condition. To address this, a study was conducted with the aim of identifying the various ocular manifestations of snake bite in a tertiary care center.MethodsThis is a one-year institute-based prospective study report of 12 snake bite victims admitted to a tertiary hospital with ocular manifestations between June 2013 to June 2014, which provides data about the demographic characteristics, clinical profiles, ocular manifestations, and their outcomes.ResultsTwelve cases of snake bite with ocular manifestations were included of which six were viper bites, three were cobra bites and three were unknown bites. Six patients presented with bilateral acute angle closure glaucoma (50%), two patients had anterior uveitis (16.6%) of which one patient had concomitant optic neuritis. One patient had exudative retinal detachment (8.3%), one patient had thrombocytopenia with subconjunctival hemorrhage (8.3%) and two patients had external ophthalmoplegia (16.6%).ConclusionsBilateral angle closure glaucoma was the most common ocular manifestation followed by anterior uveitis and external ophthalmoplegia. Snake bite can result in significant ocular morbidity in a majority of patients but spontaneous recovery with anti-snake venom, steroids and conservative management results in good visual prognosis.

Abstract: Human toxin poisoning from a variety of sources, including plants, animals, and chemical compounds, is a major concern for global health. Snake envenomation is a common and possibly fatal kind of poisoning among these. In addition to covering other well-known toxin exposures, this page offers a thorough study of human poisoning episodes with a special focus on snake envenomation. The study begins by outlining the geographic distribution of venomous snake species and their effects on various populations. It next discusses the occurrence of snakebite incidents worldwide. It explores the complex structure of snake venom and clarifies the many impacts of its constituent parts on human physiology. The article investigates the corresponding clinical signs and medical care strategies by classifying venoms into hemotoxic, neurotoxic, and cytotoxic forms. The essay also looks into the socioeconomic effects of snakebite envenomation, highlighting how rural and low-income groups suffer disproportionately in areas with limited access to antivenom and medical care. It also emphasizes the efforts made by local programs and international health organizations to lessen the burden of morbidity and mortality associated with snakebite injuries. The article extends its focus beyond snake envenomation to include additional causes of human poisoning, such as plant toxins, chemical pollutants, and animal venoms. It provides prominent examples of poisoning occurrences produced by various compounds as well as an explanation of the mechanics of toxicity. The difficulties in diagnosing and treating such situations are also discussed, emphasizing the value of prompt and precise medical interventions.

Snake bite is a major occupational hazard globally. Immediate administration of antivenom is the standard regime for treatment. Snake bite wound can get deposited with the pathogenic microflora present in the buccal cavity of the snake. Hence, the present research study was performed to investigate anti-snake venom (ASV) efficacy against various bacteria. The antibacterial activity was measured by standard well diffusion method with American Type Culture Collection strains of gram positive and negative bacteria. ASV showed antibacterial effect against Staphylococcus species.