Management Of Snakebite Envenoming Research Articles

Prevention & management of snakebite envenomation: A qualitative study on perspectives & practices in Maharashtra & Odisha.

Background & objectives Snakebite envenoming (SBE) is a major public health concern, with India bearing the highest global burden of SBE-related deaths. SBE is concentrated in rural and tribal regions of India, where the knowledge, attitude and behaviour of the dwelling communities largely influence mortality and morbidity. Understanding these factors is crucial to designing effective SBE prevention and management strategies. The present study's objective was to document the perspectives of community members and practices in selected blocks of Maharashtra and Odisha States regarding SBE prevention, first aid and health-seeking behaviour. Methods Between March and April 2022, 28 focus group discussions (FGDs) were conducted. Study sites included Shahapur block in Thane district, Aheri block in Gadchiroli district of Maharashtra, and Khordha block in Khordha district, Kasipur block in Rayagada district of Odisha. Separate FGDs were held for males (n=14) and females (n=14), involving about 8-16 participants above 18 yr. All discussions were audio recorded, and a grounded theory approach was employed to identify key themes from the translated transcripts. Results The findings of this study revealed a variety of perspectives and practices determining the SBE burden at the study sites. The findings included insufficient knowledge about snake species and their nature of toxicity, use of non-scientific first aid techniques, inaccessible health care and reliance on traditional healers, non-utilization of prevention methods, varied cultural beliefs and practices, and differential treatments based on gender. The findings have been collated in two simplistic frameworks; barriers to effective prevention and barriers to effective management. Interpretation & conclusions SBE burden results from a complex interplay between socioeconomic, cultural, and demographic factors, necessitating a collaborative inter-sectoral effort for adequate control. Through crucial regional inputs and the barriers to prevention and management models, this study provides critical insights and priority intervention areas to strengthen India's upcoming National Action Plan for Prevention and Control of Snakebite Envenoming (NAPSE) in all high-burden States.

Improving the Snakebite Envenoming First Aid Treatment of Farmers in Rural Areas of Indonesia: An Educational Intervention Program

Introduction: Snakebite Envenoming (SBE) cases are a worldwide health problem. Farmers have a big risk of becoming victims of SBE. SBE management is an issue that needs to be resolved due to a lack of information regarding the appropriate management of SBE. This study aimed to analyze the effectiveness of educational intervention programs on the knowledge, attitude, practice, and self-efficacy of farmers toward SBE management. Methods: The design of this study was a non-blinded cluster randomized controlled trial design, applied to 80 farmers in six subdistricts from rural areas of Indonesia. A multistage sampling was used to select participants. Data collection tools included a three-part questionnaire that consisted of demographics, knowledge, self-efficacy, and an observation checklist for SBE first aid practices for farmers. Education and training sessions were carried out for eight weeks for the intervention group by providing eight sessions of education and training activities. The effectiveness of the intervention was analyzed using a dependent t-test, and analysis of covariance (ANCOVA) with p<0.05 was considered significant. Results: The results of this study showed that there were significant differences in knowledge, attitude, practice, and self-efficacy (p<0.05) of farmers in SBE first aid before and after the program. The intervention group showed better results compared to the control group after the follow-up. Conclusion: The educational intervention programs using the digital health education method with snakebite first aid applications have proven positive effect in increasing knowledge, attitudes, practices, and self-efficacy of SBE first aid among farmers.

Comprehensive Review of Epidemiology and Treatment of Snakebite Envenomation in West Africa: Case of Benin.

Snakebite envenomation (SBE) constitutes a public health, social, and economic problem affecting poor communities in intertropical and subtropical regions. This review sought to synthesize literature on snakebite envenomation in Benin to highlight research perspectives and strategies for better management of the menace. A literature search performed in multidisciplinary electronic databases showed that the prevalence of SBE is high in Benin, but the incidences, associated morbidities, and mortalities are greatly underestimated. Most snake envenomations are by Echis ocellatus in Northern Benin during the rainy season. Adults involved in agricultural activities are the most affected. The absence of antivenin serum in the most affected areas explains the preference for alternative and traditional medicine as the first-line treatment for SBE in Benin. In conclusion, it would be imperative to revitalize the snakebite reporting system in order to have better epidemiological data and to develop a sustainable national strategy for the control and management of snakebite envenomation.

Compendium of medically important snakes, venom activity and clinical presentations in Ghana.

Snake bite envenoming (SBE) is one neglected tropical disease that has not received the needed attention. The sequelae of burdensome disability and mortality impact the socioeconomic life of communities adversely with little documentation of SBE in health facility records in Ghana. This study details SBE and snake distribution, habits/habitats, type of venom expressed and clinical manifestations. We conducted a structured thematic desk review of peer reviewed papers, books and reports from repositories including PubMed, World Health Organization (WHO) and Women's & Children's Hospital (WCH) Clinical Toxinology Resources using bibliographic software EndNote and search engine Google Scholar with the following key words; snakes, medical importance, snake bites, venom and venom type, envenomation, symptoms and signs, vaccines, venom expenditure, strike behaviour and venom-metering + Ghana, West Africa, Africa, World. We also reviewed data from the District Health Information Management System (DHIMS) of the Ghana Health Service (GHS). Outcome variables were organized as follows: common name (s), species, habitat/habit, species-specific toxin, clinical manifestation, antivenom availability, WHO category. Snake bites and SBE were grouped by the activity of the expressed venom into neurotoxic, cardiotoxic, haemorrhagic, cytotoxic, myotoxic, nephrotoxic and procoagulants. Neurotoxic snake bites were largely due to elapids. Expressed venoms with cardiotoxic, haemorrhagic, nephrotoxic and procoagulant activities principally belonged to the family Viperidae. Snakes with venoms showing myotoxic activity were largely alien to Ghana and the West African sub-region. Venoms showing cytotoxic activity are expressed by a wide range of snakes though more prevalent among the Viperidae family. Snakes with neurotoxic and haemorrhagic venom activities are prevalent across all the agro-ecological zones in Ghana. Understanding the characteristics of snakes and their venoms is useful in the management of SBE. The distribution of snakes by their expressed venoms across the agro-ecological zones is also instructive to species identification and diagnosis of SBE.

Approach to the diagnosis and management of snakebite envenomation in South Africa in humans: Special patient groups and surgical aspects.

This article explores the management of snakebite to vulnerable patient groups, namely children and pregnant women as well as providing detail on the current best practice when caring for venom ophthalmia and surgical wounds resulting from snakebite. Finally, the optimal free-to-use medical record for accurate documentation of snakebite incidents is provided for use by South African practitioners.

Embryonated eggs as an alternative to animals in the determination of median lethal dose (LD50) in bitis venom

Determination of median lethal dose (LD50) is a vital tool adopted by the World Health Organization for pre-clinical assessment of products for use in the management of snakebite envenoming, a condition which is now included among the list of Neglected Tropical Diseases in 2017. The current trend in the determination of LD50 involves the use of laboratory animals, tens or even hundreds of animals are sacrificed to achieve this goal. This study aimed to find reliable alternatives to this sacrificing of laboratory animals for research purposes. This study investigated the comparative similarities or differences in results obtained from the use of laboratory animals and embryonated eggs in the determination of LD50 in snake venom research. The median lethal dose (LD50) was determined using female mice using the up and down method and Probit method as well as embryonated eggs. There was no statistical difference in the LD50 of the venom of Bitis arietans obtained by the up and down method and that of the conventional probit analysis (p≤0.05) (0.325 mg/kg [probit] and 0.351 mg/kg [up and down] respectively). There was also no statistical difference in the LD50 of the venom of Bitis arietans by the up and down method, conventional probit method, and by the use of embryonated eggs (p≤0.05) (0.325 mg/kg [probit], 0.351 mg/kg [up and down], and 0.392 mg/kg [embryonated eggs). The three methods used produced values of LD50 that were within the range reported on the Australian snake and venom database of 2007. The results suggest embryonated eggs can conveniently replace the use of laboratory animals in the determination of LD50 in snake venom research to ease the ethical challenges posed by excessive use of laboratory animals in snake venom research.

Approach to the diagnosis and management of snakebite envenomation in South Africa in humans.

Snake bite management is largely driven by expert opinion and consensus, however there are a few large retrospective studies and RCT's that have improved the quality of medical guidance currently available. South African snakes are different in the venomous potential and it behooves the hospital provider and the average medical practitioner to know the current best practice concepts concerning assessment, treatment and antivenom use. The recent SASS meeting in July 2022 provided an update and national consensus from which this Hospital Care document is derived.

Approach to the diagnosis and management of snakebite envenomation in South Africa in humans

Snakebites occur in the community, not in the Emergency Unit. As such it is important to understand the first-aid concepts and pre-hospital emergency care aspects of this neglected disease. This article will highlight the concepts for emergency care within the context of the current pre-hospital arena and in light of the recent South African Snakebite Symposium consensus meeting held in July 2022, where wilderness rescue, emergency medical services and other medical participants agreed through evidence review and consensus debate on the current best approaches to care of the snakebite victim outside the hospital environment.

Assessing knowledge and awareness regarding snakebite and management of snakebite envenoming in healthcare workers and the general population: A systematic review and meta-analysis.

Snakebite envenoming is a serious and life-threatening medical condition that predominantly affects people living in rural communities across Africa, Asia, and Latin America. As our climate changes, there is a growing concern that negative human-snake interactions will increase. Our ability to prevent and manage snakebite requires effective antivenoms as well as knowledge regarding the prevention and management of snakebite among healthcare workers and affected communities across the globe. This systematic review aims to assess existing levels of knowledge regarding snakebite prevention and management in both healthcare workers and affected communities. This review was conducted on studies reporting quantitative measurements to evaluate knowledge and practice regarding snakebite prevention and management published in major databases between 1 January 2000 and 31 December 2021. Random effects modelling was used to obtain the pooled proportion. Heterogeneity (I2) was tested, and sensitivity analyses performed. Out of 3,697 records, 16 studies from 12 countries assessing 7,640 participants were included. Four of the studies were ranked as good quality studies, 9 as fair, and 3 as poor. This study results demonstrated that 56% of the study population answered the knowledge question correctly (95% CI 48% to 63%, p < 0.001). High heterogeneity was observed (I2 = 97.29%), with marginal publication bias (Egger's regression test, p = 0.0814). Participants had relatively higher knowledge concerning use of antivenom as preferred treatment, followed by snakebite prevention, knowledge of signs and symptoms of snakebite, knowledge of first-aid, and knowledge of treatment. Participants had lower knowledge relating to types of snakes and the identification of snakes. Adequate knowledge about snakebites and its management among the general population and healthcare workers was 56%. Healthcare workers and communities across Asia showed higher relative knowledge compared to those in Africa and the Middle East. These data suggest that further education is needed in both the general population and among healthcare workers to ensure that appropriate preventative and patient management techniques are being utilised in snakebite endemic regions. Greater local awareness of the risks and appropriate management of snakebite is required to reduce the burden of snakebite mortality and morbidity.

Therapeutic Outcome of Quercetin Nanoparticles on Cerastes Cerastes Venom-Induced Hepatorenal Toxicity: A Preclinical Study

Aim: The objective of this study was to investigate the therapeutic potential of quercetin (QT) and QT-loaded poly(lactic-co-glycolic acid) nanoparticles (QT-NPs) on Cerastes cerastes venom-mediated inflammation, redox imbalance, hepatorenal tissue damage and local hemorrhage. Methods: The developed QT-NPs were first submitted to physicochemical characterization and then evaluated in the 'challenge then treat' and 'preincubation' models of envenoming. Results: QT-NPs efficiently alleviated hepatorenal toxicity, inflammation and redox imbalance and significantly attenuated venom-induced local hemorrhage. Interestingly, QT-NPs were significantly more efficient than free QT at 24h postenvenoming, pointing to the efficacy of this drug-delivery system. Conclusion: These findings highlight the therapeutic potential of QT-NPs on venom-induced toxicity and open up the avenue for their use in the management of snakebite envenoming.

In-vitro and In-vivo Neutralization Activity of Methanol Extract of Adansonia digitata Fruit Pulp against Naja nigricollis Venom

Background: Adansonia digitata has been used as a traditional medicine to treat various diseases including snakebite envenomation. Objective: In this study, the protective and ameliorative potentials of crude methanol extract of Adansonia digitata fruit pulp against crude venom of Naja nigricollis in-vitro and in-vivo were investigated. Method: The dose-dependent inhibitory studies, pharmacological, histopathological and in vivo studies were conducted using standard methods. Result: The mean lethal dose of the crude methanolic extract of Adansonia digitata fruit pulp in Wistar rats was &gt; 5,000 mg/kg, while Naja nigricollis venom was 0.89 mg/kg. The anti-lethality effective concentration of the fruit pulp on Naja nigricollis venom was 92.52 mg/ml. Treatment significantly (&lt; 0.05) inhibited the activities of Naja nigricollis phospholipase A2 and dose-dependently reduced Naja nigricollis venom-induced paw oedema at 1-4 hours post-envenomation. In-vivo, treatment with 250 and 500 mg/kg of Adansonia digitata fruit pulp was protective against the clinical signs and mortality. Serum acetylcholinesterase activities were maintained in the group treated with normal saline and the ameliorative groups but decreased significantly (p &lt; 0.05) in other groups. Brain acetylcholinesterase was high in all the groups by day 1 but was reduced with increasing dose by day 2 in the ameliorative groups only. Adansonia digitata fruit pulp also preserved the histoarchitecture of the brain, heart, liver and spleen from venom-induced pathologies. Conclusion: Crude methanolic extract of Adansonia digitata fruit pulp possesses good protective and ameliorative neutralization effects on Naja nigricollis venom and could be promising in the management of snakebite envenomation.

Clinical Features and Management of Snakebite Envenoming in French Guiana.

The management of snakebite (SB) envenoming in French Guiana (FG) is based on symptomatic measures and antivenom (AV) administration (Antivipmyn Tri®; Instituto Bioclon—Mexico). Our study aimed to assess clinical manifestations, the efficacy, and safety of Antivipmyn Tri® in the management of SB. Our study is a prospective observational work. It was conducted in the Intensive Care Unit (ICU) of Cayenne General Hospital between 1 January 2016 and 31 December 2019. We included all patients hospitalized for SB envenoming. Our study contained three groups (without AV, three vials, and six vials Antivipmyn Tri®). During the study period, 133 patients were included. The main clinical symptoms were edema (98.5%), pain (97.7%), systemic hemorrhage (18%), blister (14.3%), and local hemorrhage (14.3%). AV was prescribed for 83 patients (62.3%), and 17 of them (20%) developed early adverse reactions. Biological parameters at admission showed defibrinogenation in 124 cases (93.2%), International Normalized Ratio (INR) > 2 in 104 cases (78.2%), and partial thromboplastin time (PTT) > 1.5 in 74 cases (55.6%). The time from SB to AV was 9:00 (5:22–20:40). The median time from SB to achieve a normal dosage of fibrinogen was 47:00 vs. 25:30, that of Factor II was 24:55 vs. 15:10, that of Factor V was 31:42 vs. 19:42, and that of Factor VIII was 21:30 vs. 10:20 in patients without and with AV, respectively, (p < 0.001 for all factors). Patients receiving Antivipmyn Tri® showed a reduction in the time to return to normal clotting tests, as compared to those who did not. We suggest assessing other antivenoms available in the region to compare their efficacy and safety with Antivipmyn Tri® in FG.

Prevalence and Management of Snake Bite Envenomation at the Regional Hospital Center of Sokodé (Togo)

Snakebite envenomation (SBE) is a public health issue in Africa, unfortunately neglected and underestimated. SBE is a medical emergency that can be devastating and lifethreatening. A retrospective study was performed from January 1, 2016 to December 31, 2016 in the general medicine department of the Regional Hospital Center (CHR), Sokodé. We included 91 SBE accounting for 5.7% of the whole hospitalizations in the general medicine department at the CHR of Sokodé. The median age of the patients was 34 [23.5-42] with male predominance (59%). Farming activities (75%) and walking (24%) were the most frequent activities when SBE happened, and they occurred mostly in rural areas (80%) during the dry season (56%). Echis genus (37%) belonging to the Viperidae family was the king of snake most often identified. Hospital admission time after a bite often exceeded 24 hours (44%). Clinical manifestations resulted in 76 cases of viper syndrome (83%) and 7 cases of dry bites (8%). Antivenom was administered in 84 cases (92%) within 12 hours (54%) after the bite with a minimum dose of 20 mL (43%). Observed complications were severe anemia (19 cases) and diffuse hemorrhage (32 cases). Case fatality rate was 9%. Antivenom is critical in cases of obvious SBE. High cost and poor access of antivenom, in addition to delayed care due to traditional treatment seeking behavior, are factors of poor prognosis.

&lt;em&gt;In vitro&lt;/em&gt; and &lt;em&gt;In vivo&lt;/em&gt; Neutralizing Activity of Uvaria Chamae Fractions on the Venoms of Naja Nigricollis in Albino Rat and Bovine Blood

This study was aimed at evaluating the effect of Uvaria chamae extract in protecting against Naja nigricollis envenomations. Uvaria chamae is a well-known medicinal plant in Nigeria traditional medicine for the management of snakebite. Freshly collected Uvaria chamae leaves and stems were air-dried, powdered and extracted in methanol. The median lethal dose of the extract was determined and further fractionated with n-hexane, n-butanol, and ethyl acetate. Each fraction was tested for neutralizing effect against venom-induced haemolytic, fibrinolytic, hemorrhagic, and cytotoxic activities. The result obtained showed significant (p<0.05) antihaemolytic activity of Uvaria chamae in n-butanol 31.40%, aqueous residue 39.60% and ethyl acetate 40.70% fractions when compared to positive controls, but in n-hexane, the activity 33% was not significantly (p>0.05) increased. Antifibrinolytic activity was significantly (p<0.05) increase in n-hexane 73.88%, n-butanol 72.22% and aqueous residue 72.22% fractions. Antihaemorrhagic significant (p<0.05) increase in all the concentrations of each fraction except for n-butanol and aqueous residues at 400 mg/kg; antihaemorrhagic effect was more at 100 and 200 mg/mL concentration following experimental envenomation. Uvaria chamae fractions were found to possess a high level of protection against Naja nigricollis venoms-induced lethality, compared to positive controls. The results apparently provide the pharmacological rationale for the use of the leaves of Uvaria chamae in the management of snakebite envenomation.

Toward improved antivenom management of snakebite envenomation in Southeast Asia: The Indonesian perspective

Toward improved antivenom management of snakebite envenomation in Southeast Asia: The Indonesian perspective

MOLECULAR DOCKING STUDIES OF SNAKE VENOM SERINE PROTEASE OF SHARP-NOSED PIT VIPER WITH HESPERETIN

Objective: The management of snake bite envenomation is a global challenge affecting millions of people. Immunotherapy is still regarded as the treatment of choice; however, their subsequent adverse effects restrict their potential use for therapy against snake venom poisoning. In recent years, more attention has been given to the exploration of indigenous medicinal plants for their outstanding benefits for the treatment of several diseases and disorders, including snake venom poisoning. Hesperetin is a naturally occurring compound derived from a flavanone glycoside, hesperidin and is obtained from various citrus fruits. It is known to possess significant inhibitory activity against snake venom serine proteases. The aim of our present study was to investigate the significant inhibitory action of hesperetin on thrombin-like serine protease from sharp-nosed pit viper (Deinagkistrodon acutus) snake venom.Methods: We have employed molecular docking analysis by implementing the state-of-the-art docking program to validate the hypothesis of the prospective inhibitory properties of hesperetin on thrombin-like serine proteases of snake venom. AutoDock 4.2, InterProSurf, MGLTools, and MTiAutoDock were utilized for the molecular docking analysis of thrombin-like serine protease obtained from the snake venom of sharp-nosed pit viper with the natural compound hesperetin.Results: The results generated from in silico based approach reveals the significant inhibitory role of hesperetin against thrombin-like snake venom proteases, which might lead to the drug designing of the inhibitors of snake venom serine proteases.Conclusion: The implementation of molecular docking analysis by the employment of state-of-the-art docking program supports the potential of inhibitory activity of naturally obtained hesperetin compound on thrombin-like serine proteases of snake venom. The generated in silico results suggests that the novel structure hesperetin - flavanone might act as a potent inhibitor of thrombin-like snake venom proteases, and unlocks the possibilities for designing drugs of the inhibitors of snake venom serine proteases. Moreover, the investigation of the novel compound obtained from natural sources for their inhibitory activity against snake venom serine proteases would lead to the discovery of newer inhibitory compound from a highly uninvestigated research arena.

Anaesthetic Management of Snake Bite Envenomation Complicated with Cellulitis for Fasciotomy

Anaesthetic Management of Snake Bite Envenomation Complicated with Cellulitis for Fasciotomy