Snake Antivenom Research Articles

Nationwide and long-term epidemiological research of snakebite envenomation in Taiwan during 2002-2014 based on the use of snake antivenoms: A study utilizing National Health Insurance Database.

In Taiwan, six venomous snake species with medical importance have been found; however, long-term epidemiological data of snakebite envenomation (SBE) is lacking. This study aimed to explore the epidemiology of SBE based on the distribution and use of different antivenoms in different parts of Taiwan to facilitate the development of prevention strategies and resource allocation. This retrospective study was conducted using the Taiwan National Health Insurance Research Database from 2002 to 2014. A total of 12,542 patients were treated with antivenoms. The directly standardized cumulative incidence was 3.6 cases per 100,000 individuals based on the 2000 World Standard Population. The incidence of SBEs peaked in the summer (35.9%). The relative risk (RR) of male patients versus female patients was 2.5 (p < 0.0001). The RRs of patients aged 18-64 and ≥65 years versus those aged <18 years were 6.0 (p < 0.0001) and 14.3 (p < 0.0001), respectively. Furthermore, the RR of eastern Taiwan versus northern Taiwan was 6.8 (p < 0.0001). The RR of agricultural workers versus laborers was 5.5 (p < 0.0001). Compared with patients envenomed by Trimeresurus stejnegeri stejnegeri or Protobothrops mucrosquamatus, those envenomed by Naja atra or Bungarus multicinctus multicinctus were more likely to occur in central (adjusted odds ratio [aOR] = 2.6, p < 0.0001) or southern (aOR = 3.2, p < 0.0001) Taiwan, but less frequently among agricultural workers (aOR = 0.6, p < 0.0001). The overall case-fatality rate was 0.11%. Among Asian countries, Taiwan had low incidence and case-fatality rates of SBE. Risk factors included male gender, old age, summer season, being in eastern Taiwan, and being an agricultural worker. Differences of the epidemiological findings between snake species should be focused on when developing strategies for snakebite prevention.

Production and evaluation of monovalent anti-snake immunoglobulins from chicken egg yolk using Ghanaian puff adder (Bitis arietans) Venom: Isolation, purification, and neutralization efficacy

Snakebites are rampant in Ghana, especially among the farmers, herdsmen, military recruits, hunters, and rural dwellers, and the antisnake venoms (ASV) use to treat these bites are not locally produced but rather imported, which come with a high cost, lack of constant supply and low specificity. The study was therefore aimed at isolating, purifying, and evaluating the efficacy of monovalent ASV from chicken egg yolk using puff adder (Bitis arietans) venom from Ghana. The major pathophysiological properties of the venom and the efficacy of the locally produced ASV were evaluated. The results showed that the snake venom (LD50 of 0.85 mg/kg body weight) had anticoagulant, haemorrhagic, and edematic activities in mice which were effectively neutralized using the purified egg yolk immunoglobulin Y (IgY), with two distinct molecular weight bands (∼70 and 25 kDa). The cross-neutralization studies also showed that the venom/IgY mixture (2.55 mg/kg body weight: 90 mg/kg body weight) offered 100% protection to the animals with ED50 of IgY being 22.66 mg/kg body weight. However, the applied dose (11.36 mg/kg body weight) of the available polyvalent ASV offered 25% protection compared with the 62% protection of the IgY at the same dose. The findings showed successful isolation and purification of a Ghanaian monovalent ASV with a better neutralization efficacy compared with the clinically available polyvalent drug.

Perceptions and awareness of snakebite envenoming in hilly areas of Madikeri: A cross sectional study

Abstract Background: Snake bite is one of the neglected public health problems in many tropical and subtropical countries. Wrong perception and practice of unproven traditional methods about snakes and snakebites may increase mortality due to snakebite envenoming. Objective: The objective is to assess the knowledge, attitude and practice regarding snakes and snakebites among the rural population in the Kodagu district. Materials and Methods: A community-based cross-sectional study was conducted between August-2021 and October-2021 in the rural field-practice area of Bhagamandala Primary Health Centre. Systematic random sampling was incorporated into the study to select the study participants. Data were collected using a predesigned and pretested questionnaire. Data entry was done in Microsoft Excel and was analyzed using STATA (16.1), StataCorp, College Station, Texas, USA. Results: Out of 1284 participants, the majority 964 (75.07%) of participants identified spectacled cobra correctly and 1142 (88.94%) correctly identified it as venomous. About 1228 (95.64%) participants had correct knowledge regarding Anti-Snake venom being an effective treatment for snake bites and the overall knowledge regarding snake bites was adequate among only 380 (29.60%) of the study population. Whereas, 188 (14.64%) of them even considered visiting a local quack or faith healer after a Snakebite. Conclusions: In our study, the overall knowledge regarding snake bites was adequate among 29.60% of the study population. The knowledge regarding the venemosity of snakes was good, but identification was poor. The participants had correct knowledge about ASV and its availability. The harmful practices such as visiting traditional healers and applying native medicine are still seen in 14.64% of participants.

Clinico-Epidemiological Study of Snake Bite Presenting to the Emergency Department of a Tertiary Care Hospital

Snakebite is an acute, life-threatening condition which is most commonly faced by the rural population of tropical countries. About 1.2 million deaths related to snake bites are reported from the Indian subcontinent adding a major part to the global burden towards snake bite mortality. Maharashtra reported the highest number of snake bite cases in the year 2019. A retrospective study was carried out at the emergency department from April 1st, 2020 to June 30th, 2021. Data regarding demographic factors, clinical features, complications, details of treatment received and outcomes of the snake bite victims were recorded. A total of 103 patients with snake bites were admitted, 71.84% were males, and the mean age group was 31.68 years. 26% of the cases were reported during the month of June, and 68% of the bites were reported between 12:00 pm to 12:00 am. 62.14% had bites over their lower limbs, and 31.07% of them were farmers. 47.57% had local pain. 59.22% were dry bites out of which 17.47% received an incomplete dose of Antisnakevenom (ASV) from referring hospitals. 17.47% manifested with neurological symptoms. Our study suggested that farmers, children, women and labourers are the most vulnerable groups affected. There is still a lack of knowledge among healthcare workers regarding the use of ASV.

Frequency, Presentation, Management and Outcome of Snake Bite in Children at DGKMC &amp; Hospital, D.G Khan.

Objective: To evaluate the frequency, common presentation, anti-snake venom (ASV) related management and outcome of snake bite cases in admitted children at a tertiary care hospital. Study Design: Case-series study. Setting: Department of Pediatric, Dera Ghazi Khan Medical College (DGKMC) &amp; Hospital. Period: 1st March 2021 to 31st August 2021. Material &amp; Methods: During the study period, all children presenting with snake bite were included. All cases were observed for their presentation, classified according to signs and symptoms, and managed through ASV as needed. Results: During the study period, a total of 52 patients of snake bite admitted in paediatric medical ward of DGKMC &amp; Hospital. There were 37 (71.2%) male and 15 (28.8%) female. Overall, mean age of the children was 6.1±3.1 years. Maximum number of snake bite cases were reported during May, June and July as 15 (28.8%), 13 (25.0%) and 8 (15.4%) respectively. In the presentation, 29 (55.8%) patients presented with local symptoms only while remaining 23 (44.2%) presented with local as well as systemic symptoms. In the management, 3 (5.8%) cases did not require any ASV vial, 35 (67.3%) needed initial doses only. Fourteen (26.9%) cases required initial as well as maintenance doses. In terms of outcome, 49 (94.2%) children were discharged successfully, 1 (1.9%) expired and 2 (3.8%) got left against medical advice (LAMA). Conclusion: Snake bite was a common pediatric medical emergency at our institute. Most children presented with hemotoxic symptoms and needed ASV for resolution of symptoms. Prognosis is good with timely and judicious management of snake bite.

Clinical Profile and Outcome of Snake Bite Patients from Tertiary Healthcare Center: In Sub-Himalayan Region: A Medical College-based Study.

Snake bite is an emergency in tropical and subtropical countries. It is a neglected disease and is most commonly seen in rural setups, where people are ignorant about the venomous snake bites. It results in increased mortality and morbidity because precious time is wasted, either in consulting traditional healers or waiting for the development of signs and symptoms of envenomation. Then only the patient is shifted to a health center. Here we studied the clinical profile, management, and outcome of snake bite patients. This study was done by retrieving the records of patients with snake bites admitted to the Department of Medicine, Indira Gandhi Medical College &amp; Hospital, Shimla, from 1st January 2017 through December 2019. The recorded data was entered in a precoded performa, and analysis was done with respect to various variables. We evaluated the records of 190 patients. The incidence of the bite was higher among females, 62.1% (n = 118). The commonest age group involved was 21-50 years, 70.1% (n = 34). In 55.8% (n = 106), the site of the bite was the upper limb. The daytime bite was present in 54.7% (n = 106). The maximum incidence of snake bites was found during the rainy season, 81.5% (n = 155). 28.4% (n = 54) of patients presented within 6 hours of the bite. Coagulopathy [whole blood clotting test (WBCT) of &gt;20 minutes] and neurotoxicity were seen in 77.9 and 7.9% of patients, respectively. Anti-snake venom (ASV) was given to 87.8% (n = 167) of patients. In 80% (n = 152) of the cases, hospital stay was up to 3 days. Mortality was seen in only two (1.05%) cases. There is a need to create awareness among the community, particularly in rural areas, about snake bite envenomation and early transportation of victims to the nearest health center. Training of health professionals is also needed to manage cases of snake bites efficiently and judiciously, thereby reducing morbidity and morbidity.

A cross sectional study of various types of acute poisoning; pharmacological management and their outcome in a tertiary care hospital

Background: Acute poisoning is a common and life-threatening crisis, leading to serious complications and death of patients. Poisoning may be due to self-consumption, accidental exposure of chemical compounds, medications and poisonous animal bites/stings. Aim of current study was to investigate the pattern of drug utilization, poisoning agents and outcome in patients with acute poisoning treated at a tertiary care teaching hospital, Vadodara, Gujarat. Methods: This prospective cross-sectional study was done on patients of acute poisoning admitted in emergency department, SSG Hospital during August 2021-March 2022. Results: 400 patients were enrolled during the study, from which 262 (65.50%) were male and 138 (34.50%) were female. Mean age of patients was 30.30 ± 13.79 years. The commonest mode of poisoning observed was Suicidal (66.25%). The most common cause of poisoning was due to Pesticides (33.25%), followed by venomous animal exposures (30.75%). Death was recorded in 53 (13.25%) patients with highest number seen in suicidal poisoning (14.34%) compared to accidental poisonings (11.19%). Mainly, multivitamins (19.03%), Antimicrobials (16.65%), Proton Pump Inhibitors (15.85%) and Antiemetics (11.10%) were prescribed. Antidotes used were Atropine (4.81%), Pralidoxime (4.46%) and Anti-snake venom (2.80%). Median number of drugs per patient was 8; range: 2-25. Conclusions: Pattern and magnitude of poisoning are multidimensional and demand multi-sectoral approach for facing this problem. Due to high incidence of snakebites, hospital stockpiles should be regularly checked for availability of antivenom. There is a need for stringent pesticide regulation laws, counselling and training programs to reduce incidence of poisonings and deaths due to it.

Azadirachta indica A. Juss.: Ethnobotanical knowledge, phytochemical studies, pharmacological aspects future prospects

Azadirachta indica, commonly known as Neem, it is a member of the Meliaceae family, a fast-growing evergreen popular tree found commonly in India, Africa and America. All parts of the neem tree, including the seeds, fruits, twigs, leaves, flowers, roots, and bark, have traditionally been used to treat inflammation, infections, fever, skin ailments, and dental diseases. Azadirachtin, nimbolinin, nimbin, nimbidin, nimbidol, salannin, and quercetin are all useful active chemicals extracted from various plant parts. The aim of this review article provides information mainly on various pharmacological activities like Antioxidant Activity, Anti-cancer, Anti-inflammatory, Anti-bacterial, Antiviral Activity, Antifungal Activity, Antihelmethic effects, Antidiabetic action, Wound healing effect, Activity against ulcer, Orodental protection, Contraceptive, Hepatoprotective activity, Immunomodulatory and Growth Promoting, Antinephrotoxicity Effect and Antisnake venom activity of neem plant and medicinal uses. Plant extracts function as both a reducing and capping agent. Neem is a well-known medicinal plant and has been studied for the biosynthesis of nanoparticles. A. indica possesses many phytochemicals that can reduce metal ions. The nanoparticles are reported to exhibit good antimicrobial, and antioxidant and cytotoxicity effects against MCF-7 and HeLa cells in vitro.

Selective sensory nerve blocks for effective pain management in the emergency department for a term pregnant cobra snake envenomation patient.

Sir, Snake bites with envenomation are a rare life-threatening emergency during pregnancy.[1] We report a case of a young full-term parturient who reported intense localized pain at the cobra (Naza Naza) bite site which was managed successfully by selective sensory nerve blocks. She subsequently underwent a caesarean section under spinal anaesthesia and had an uneventful post-partum course. A 26-year-old eight month pregnant patient presented to the emergency department (ED) post-cobra bite. The patient was taken to a local hospital within 30 min of the event. The bite mark was present on the right foot near the 4th toe [Figure 1]. There was minimal localized swelling but intense pain in the bite area. She had an episode of vomiting 45 min post-snake bite (suggesting the onset of systemic symptoms) and was administered 10 vials of anti-snake venom and referred to our tertiary care set-up.Figure 1: Distribution of superficial peroneal nerve (a); Probe placement for USG-guided block (b); USG image showing the superficial peroneal nerve (c); Snake bite mark on foot of the patient (d)When she presented to our ED 3h post-bite, the swelling had increased considerably and 10 more vials of anti-snake venom were infused. The investigations revealed leucocytosis with mild thrombocytopenia and anaemia. Local site pain was unbearable even after intravenous paracetamol and diclofenac. A superficial peroneal nerve and sural nerve blocks to cover the dorsolateral aspect of the foot was planned. The nerves were localized using a linear transducer (8–13 MHz) and a 3.5 ml of 0.75% ropivacaine was deposited. [Figures 1 and 2] Within 5 mins, the numeric rating scale (NRS) fall to 2 from the initial score of 10. At 10h, the patient reported an NRS score of 6, and the same blocks were repeated and effective pain relief was reported. The patient underwent a caesarean section under spinal anaesthesia at 18h post-admission given foetal distress. The baby was kept on nasal continuous positive airway pressure for 18h in view of respiratory distress and both of them were discharged in stable condition on the 3rd day of admission.Figure 2: Distribution of sural nerve (a); Probe placement for USG-guided block (b); USG image showing the sural nerve (c)Snake bites are rare in pregnancy but maternal mortality and foetal loss remain high.[1] An early presentation and rapidity of treatment with anti-snake venom probably led to a good outcome in this case. Acute localized moderate-to-severe pain is often documented as the first sign of a venomous snake bite (VSB).[2,3] The presynaptic and postsynaptic neurotoxins may directly interact with the nerve endings or indirectly cause severe pain secondary to ischemia due to local oedema.[1] Antivenom treatment fails to alleviate the local pain which may last for 48–72 h.[3] Weak opioids such as tramadol or paracetamol often provide inadequate analgesia.[4] Systemic opioids and non-steroidal anti-inflammatory drugs may be harmful to the foetus in term pregnancy. Furthermore, opioids can increase the risk of respiratory depression in neurotoxic envenomation cases as seen in cobra bite.[4] Untreated pain can have adverse consequences on foeto-maternal circulation.[5] In our case, the patient had intense pain with an NRS of 10 despite analgesics and responded well to nerve blocks. Declaration of patient consent The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient has given her consent for her images and other clinical information to be reported in the journal. The patient understands that her name and initials will not be published and due efforts will be made to conceal identity, but anonymity cannot be guaranteed. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.

Indigenous poison healing traditions in Kerala

Prior to the emergence of modern medicine as a universal method for all diseases across cultures, and geography—specific methods of treatment existed in various regions. It is not to argue here that these cultural particularities in the treatment of diseases totally disappeared. Under the pressure of modern medicine, pre-modern methods reformed, reformulated and re-emerged as a hybrid system to survive and sustain. The history of snake poison healing in Kerala is sufficient for this argument. The modern and indigenous (consisting of textual and folk) poison healing methods have simultaneously been in existence in the state. The viṣavaidyam (poison treatment), an anti-snake venom treatment practiced by different sections of people with known herbs is plural in nature. However, Ayurveda takes second place in authority and hierarchy of treatments because of the textualization of the treatment methods. Other methods lack such authority. However, due to the presence of poisonous reptiles all over Kerala, the practice of different treatment methods by different castes and communities’ points to the inclusiveness of the poison healing system. In this paper, an attempt has been made to present an overview of the native poison healers and their healing systems in Kerala, with special attention to their traditions and present condition.

CORRELATION BETWEEN BITE TO NEEDLE TIME AND COMPLICATIONS IN SNAKE BITES

INTRODUCTION: The World Health Organization (WHO) estimates that 81,000–138,000 people die each year from snakebites worldwide,approximately half of global snake bite deaths,estimated at 100,000 per year,occur in India.The present study was carried to analyze correlation between the time delay in administering Anti Snake Venom (ASV) in patients with symptomatic evidence of snake bite and subsequent development of complication.MATERIAL:The study was carried out on forty patients admitted with snake bite in the Department of Medicine in Jhalawar Medical College. Detailed clinical history, clinical examination and investigations were carried out. ASV administered in symptomatic patients and bite-to-needle time was noted.And patients were followed for subsequent development of complications. OBSERVATION:Forty patients of snake bites became eligible for the study over a period of 5 months,15 patients (37.5%) had developed complications while remaining 25 patients (62.5%) were uncomplicated.The Chi square test was used to find the significance of the relationship between the timing of ASV administration after bite due to late arrival at hospital (bite to needle time) with subsequent development of complications. It was found to be significant at 5% level of significance (p&lt;0.05) (i.e.,p=0.04 at degree of freedom 2).CONCLUSIONS: In our study we came to a conclusion that the incidence and severity of post snake bite complications is directly proportional to Bite-to-needle time.To prevent this complication and reduce health care burden, timely arrival at health care centres and prompt administration of ASV is encouraged.

PRE-TREATMENT WITH LOW DOSE SUBCUTANEOUS ADRENALINE TO PREVENT ADVERSE REACTIONS TO ANTI SNAKE VENOM FOLLOWING SNAKE BITE

Aim and objective : To assess the efcacy of low dose subcutaneous adrenaline to prevent adverse reactions to Anti Snake Venom (ASV) in hospitalised patients following snake bite. Hospital Methods : ised patients following snake bite requiring ASV were randomised to receive either 0.25ml 1:1000 dilutions adrenaline subcutaneously or placebo as pre-treatment before ASV administration. Pregnants, age less than 12 years and more than 70 years, patients who received ASV in the past, history of adverse reactions to adrenaline, patients with obstructive airway disease, ischemic heart disease, stroke and patients who received ASV before hospital admission were excluded from the study. Results : 50 patients were included in the study. 26 patients received low dose subcutaneous adrenaline and 24 patients received placebo. 3 patients(11%) in adrenaline group and 13 patients(54%) in placebo group developed adverse reactions following ASV administration. Conclusion : 0.25ml 1:1000 dilutions subcutaneous adrenaline given immediately before ASV administration reduces incidence of adverse reactions to ASV

Saw scaled viper bite and envenomation in the subcutaneous plane.

Dear Editor, We present a 25-year-old man bitten by a saw scale viper on his left hand. The patient presented to a medical emergency 4 hours after the bite. On examination, there was swelling, edema, and cellulitis in the left hand up to the axilla [Figure 1]. On laboratory evaluation, his Hb was 120 g/L, with a normal white cell count (9.0 × 109/L) and platelet 152 × 109/L, with coagulation showing normal reading (PT 12 s, INR, 0.98, APPT 29 s) and serum creatinine (88.42 umol/L). His 20-min whole blood clotting test was normal. Viper venom contains serine proteases, metalloproteinases, C-type lectins, and phospholipases and shows both procoagulant and anticoagulant effects on the blood clotting mechanism resulting in defibrination syndrome.[1] Among the toxins of saw-scaled viper, phospholipase helps in the subcutaneous spread of venom by dissolving the cell membrane. In the present case, envenomation was in the subcutaneous plane causing swelling, edema, and cellulitis. There was no systemic manifestation of envenomation. In such a scenario question arises whether to give antisnake venom or not when there is no defibrination syndrome or systemic manifestation of envenomation. In our patient, there was no coagulopathy at the time of admission and 24 hours after envenomation. But given local envenomation, it is decided to give antisnake venom. We gave 150 mL of antisnake venom over 8 hours. After that swelling started subsiding and over the next 24 hours, there was a significant decrease in swelling, cellulitis, and edema [Figure 2]. Giving antisnake venom in a locally toxic situation is beneficial and works by creating a concentration gradient across the extracellular compartment and sucking out intracellular venom and subsequent decrease in swelling, cellulitis, and edema.[2] Whenever there is local envenomation at the site of the bite by viper without systemic manifestation antisnake venom should be given.Figure 1: Envenomation in the left hand with swelling, edema, and cellulitisFigure 2: Swelling, edema, and cellulitis subsided after antisnake venomConsent Taken from the patient. Declaration of patient consent The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.

The molecular mechanism of snake short-chain alpha-neurotoxin binding to muscle-type nicotinic acetylcholine receptors.

Bites by elapid snakes (e.g. cobras) can result in life-threatening paralysis caused by venom neurotoxins blocking neuromuscular nicotinic acetylcholine receptors. Here, we determine the cryo-EM structure of the muscle-type Torpedo receptor in complex with ScNtx, a recombinant short-chain α-neurotoxin. ScNtx is pinched between loop C on the principal subunit and a unique hairpin in loop F on the complementary subunit, thereby blocking access to the neurotransmitter binding site. ScNtx adopts a binding mode that is tilted toward the complementary subunit, forming a wider network of interactions than those seen in the long-chain α-Bungarotoxin complex. Certain mutations in ScNtx at the toxin-receptor interface eliminate inhibition of neuronal α7 nAChRs, but not of human muscle-type receptors. These observations explain why ScNtx binds more tightly to muscle-type receptors than neuronal receptors. Together, these data offer a framework for understanding subtype-specific actions of short-chain α-neurotoxins and inspire strategies for design of new snake antivenoms.

Phytochemicals, bioactivity, and ethnopharmacological potential of selected indigenous plants

The coastal regions of Africa are endowed with indigenous wild fruit plants rich in nutritional and medicinal phytochemicals and micronutrients. South African wild fruit plants complement the diet and health needs of rural poor households by providing vital dietary nutrients and remedies for various health concerns, and alleviating food insecurity. Milk plum, Natal plum, wild custard apple, and wild medlar medicinal plants are found mainly in the coastal provinces of South Africa. Studies have established that these plants are good sources of vitamins, essential elements, and bioactive phytocompounds such as flavonoids, phenolic acids, and terpenoids, which demonstrate significant antioxidant, antimicrobial and anti-inflammatory activities. The plants studied possess anti-epileptic, antiplasmodial, and snake antivenom qualities. Here we highlight the views of different reports on ethnopharmacological relevance, phytochemistry, and bioactivity of the selected South African indigenous medicinal plants. We found a research gap in the phytochemical composition and phytopharmacological activity evaluation of Carissa macrocarpa and Englerophytum magalismontanum.Significance: South African indigenous medicinal plants augment the dietary and other health needs of the rural populace. The phytochemistry and phytopharmacological activities of C. macrocarpa and E. magalismontanum have been only partially studied, hence the need for further studies to examine their worth and possible use in cosmetic product enrichment.

Vasculotoxic Snake Bite: Infusion Antisnake Venom Therapy versus Bolus Antisnake Venom Therapy at Tertiary Care Centre

The problem of snake bites is widespread throughout the world and particularly in tropical regions. In India, snake bites are found to be one of the leading causes of mortalities and morbidities. According to statistics, approximately 35 000 to 50 000 fatal bites occur every year in India. However, snake bites are usually prevalent in rainy season. Burden of snake-bite has been documented by many investigators recently, with the consequences of snake bite being explored. Identifying chronic impairments and associated socioeconomic costs is an important part of assessing snakebite burden, however, providing significant data on these respect is difficult. Aim: To study infusion antisnake venom therapy versus bolus antisnake venom therapy in vasculotoxic snake bite at tertiary healthcare care. Material and methods: The current study was an observational study. During the study, four different anti-snake venom regimens were used to treat patients with vasculotoxic snake bites by comparing clinical manifestations, laboratory investigations, the amount of anti-snake venom required, the incidence of complications, and the outcomes. Results: In the present study, demographic data showed significant preponderance of snakebite amongst farmers (n=44). However, the drill was followed by housewives (n=29), students (n=17), teachers (n=4) and shopkeepers (n=3) amongst the reported cases respectively. Conclusion: study concludes that not only proper regimens but also the modality of treatment for the patients of viperine vasculotoxic snake bite is equally important. In order to decrease the morbidity and mortality of snake bite patients, it is imperative to make ASV available universally in areas with high snake bite incidences and to adequately train health care providers about snake bite treatment.

Overview of Snakebite Cases in a Hospital Situated in the Rural Area of Navsari District of Gujarat, India

Background: Snakebite envenoming is a greatly underreported neglected tropical disease (NTD) responsible for up to 138,000 deaths and 400,000 permanently disabled victims worldwide every year. More than a third of the global deaths, about 46,000 annually, are estimated to occur in India with not much known about other aspects of burden or risk factors in the country. Objective: To gather evidence on the burden and epidemiological aspects for snakebite in rural pocket of Navsari district of South Gujarat, India. Materials &amp; Methods: a structured data collection tool was developed &amp; patients hospitalized due to snakebite from year 2009 to 2020 were studied. Results: Total 1108 lab confirmed patients of snakebite were admitted to the Hospital for the mentioned period out of which 239 (21.6%) patients had bite of poisonous snakes. Majority i.e. 55.7% of the snake bite cases were seen amongst men. Most of the cases were reported during the monsoon season. Local pain at the site of bite was reported by 100% of cases admitted. 24 (2.2 %) cases had developed complications. Cellulitis and Respiratory distress were major complications that were found. Conclusion: Less bite to hospitalization time, awareness about snake bite and its consequences amongst community, availability and appropriate use of Anti Snake Venom, close monitoring of patients, availability of ventilator support are key measures that needs to be in practice in any institution. Keywords: Snake Bite, Anti Snake Venom, Monsoon season, South Gujarat

Decomplexation proteomic analysis and purity assessment of a biologic for snakebite envenoming: Philippine Cobra Antivenom.

Philippine Cobra Antivenom (PCAV) is the only snake antivenom manufactured in the Philippines. It is used clinically to treat envenoming caused by the Philippine Spitting Cobra (Naja philippinensis). While PCAV is effective pharmacologically, it is crucial to ensure the safety profile of this biologic that is derived from animal plasma. This study examined the composition purity of PCAV through a decomplexation proteomic approach, applying size-exclusion chromatography (SEC), sodium dodecyl sulfate-polyacrylamide gel electrophoresis (SDS-PAGE) and tandem mass spectrometry liquid chromatography-tandem mass spectrometry (LC-MS/MS). SDS-PAGE and SEC showed that the major protein in PCAV (constituting ∼80% of total proteins) is approximately 110 kDa, consistent with the F(ab')2 molecule. This protein is reducible into two subunits suggestive of the light and heavy chains of immunoglobulin G. LC-MS/MS further identified the proteins as equine immunoglobulins, representing the key therapeutic ingredient of this biologic product. However, protein impurities, including fibrinogens, alpha-2-macroglobulins, albumin, transferrin, fibronectin and plasminogen, were detected at ∼20% of the total antivenom proteins, unveiling a concern for hypersensitivity reactions. Together, the findings show that PCAV contains a favorable content of F(ab')2 for neutralization, while the antibody purification process awaits improvement to minimize the presence of protein impurities.

Fungal Orbital Cellulitis by Candida Albicans Following Snake Bite -A Rare Case

Fungal orbital cellulitis is extremely rare in immune-competent individuals. An ocular manifestation of snake bite is rare and orbital cellulitis following snake bite is one of the rarest entities. A 10 year old boy presented with periorbital edema with lid necrosis following snake bite on upper lid of the right eye. Patient was treated with intravenous empirical antibiotic along with anti-snake venom. The following day, the patient developed proptosis of the right eye. CT scan suggested orbital cellulitis. Microbiological examination confirmed Candida species. Patient was started on intravenous and topical antifungal agent with resultant decrease of proptosis. But, despite ocular improvement, the patient succumbed due to respiratory failure. The present case highlights fungal orbital cellulitis in immune-competent patient as one of the rarest manifestation of snake bite. Clinical suspicion and diagnosis by imaging and microbiological examination and immediate treatment are necessary while treating such patients.

Neuroparalytic Snake Bite Masquerading as Acute Abdominal Pain in Children

Background: Neurotoxic snakebite (usually by the krait) presents with abdominal colic and chest pain as a common premonitory sign of envenomation. Being a nocturnal snake, the time of unprovoked painless biting is usually at night and the victims are individuals sleeping on the ground. Thus, history is usually not forthcoming. Snakebite causes morbidity (neuroparalytic, myopathic, vasculopathic, venom-induced consumption coagulopathy, cardiotoxic, nephrotoxic, etc.), and mortality if not given timely treatment with anti-snake venom (ASV), the only specific treatment. Clinical Description: We present four children from a rural background who were admitted successively over a month during the last rainy season. They initially became symptomatic with acute abdominal pain from midnight to early morning time and developed neuroparalytic manifestations within a few hours. On exclusion of other causes by clinical evaluation, we suspected snakebite envenomation though there was no witnessing of the event or evidence of fang bites. Investigations to rule out commonly associated organ dysfunction were ordered. Management: All children were given supportive therapy. Three cases required mechanical ventilation. The first two received ASV relatively late as the suspicion of snakebite was not considered initially. In the third case, the administration of ASV was early and the hospital stay was shorter. The fourth case received ASV at a peripheral health center and was referred in case he required ventilator support. However, his neuroparalysis did not progress to respiratory failure and he was discharged the earliest. Conclusions: Clinicians should consider snakebite in children belonging to rural areas who present with acute abdominal pain during the rainy season, and monitor for signs of neurotoxicity and other clinical manifestations of snake envenomation. A high index of suspicion should be kept, as definitive treatment with ASV results in early recovery without any sequelae, and reduces mortality.