Management Of Venomous Snakebites Research Articles

Penguatan Kapasitas Kader Petani dalam Penanganan Gigitan Ular Berbisa di Wilayah Antirogo

Venomous snakebites represent a significant health problem in agricultural areas, particularly in Antirogo Village, Jember Regency. Insufficient knowledge and skills in preventing and managing venomous snakebites increase the risk for farmers in this area. The Saung Tani Cekatan program aims to enhance the knowledge and preparedness of CEKATAN cadres in handling venomous snakebites. This program involves 30 CEKATAN cadres who receive training through educational methods using mobile applications and PowerPoint presentations, as well as demonstration methods. The activities were conducted in Antirogo Village, Jember Regency. The evaluation was carried out using pretest and posttest questionnaires consisting of closed-ended questions regarding the prevention and management of snakebites. The results showed an increase in the percentage of respondents who answered questions correctly: question 1 (53.3%), question 2 (76.6%), question 3 (86.6%), question 4 (66.6%), question 5 (70%), question 6 (83.3%), question 7 (90%), question 8 (96.6%), question 9 (96.6%), question 10 (100%), question 11 (96.6%), question 12 (100%), question 13 (90%), question 14 (100%), question 15 (56.6%), and question 16 (90%). In conclusion, the Saung Tani Cekatan empowerment program effectively increases cadre knowledge regarding preparedness and management of venomous snakebites in the Antirogo area. This program can be expanded to other agricultural sectors using similar methods.

Karakteristik Pendertia Snakebite Disertai Gangguan Hemodinamik dan Asidosis Respiratorik pada Pasien Anak dan Dewasa

Snakebite or snakebite is a defense mechanism for snakes and can become a medical emergency. Snakebites are a significant cause of morbidity and mortality worldwide, especially in South and Southeast Asia, sub-Saharan Africa and Latin America. The snakebite can be life-threatening if it has a neurotoxic, cytotoxic and hemotoxic effect. Complications from snakebite include hemodynamic disturbances and respiratory acidosis. International online databases (PubMed and Google Scholar) were used to search for articles in this systematic review. A total of 24 related research articles indexed by Scopus have been published in the last ten years. This research is a literature systematic review. Research sources were taken in the last 10 years from 2012 to 2022, taken from PubMed and Google Scholar. After exclusion, 24 articles and studies that met the exclusion and inclusion criteria were considered for systematic review. Of all the journals reviewed, there are many that explain snake bite associated with hemodynamic disturbances and respiratory acidosis. Snakebite is proven to provide long-term complications in the form of hemodynamic disturbances around the bite site. Another complication that has been proven to occur in snakeibite victims is cardiac shock, especially impaired cardiac return. Pathophysiology, symptoms, and diagnosis of snakebite in pediatric and adult patients are the same. The majority of journals discuss heart disorders and infections, necrosis of muscles and bones related to venomous snake bites. Hemodynamic disturbances and respiratory acidosis are complications that can occur in snakebite victims. There are similarities in symptoms and management of venomous snake bites in children and adults.

Knowledge on prevention, diagnosis and treatment of snakebite envenoming among doctors in snakebite-dense regions in Sri Lanka.

Sri Lanka is one of the highest envenoming reporting countries globally with >80000 snakebites per year. Among other factors, knowledge of snakebite among doctors predominantly determines patient outcomes. Using a pretested 72-item self-administered questionnaire, we assessed knowledge on identifying common snake species, signs of envenoming and management of venomous snakebites among 280 doctors working in eight state hospitals in regions where snakebite prevalence is highest in Sri Lanka. Visually, 92.1% correctly identified a cobra and 74.3% identified a Russell's viper, but only 30% could identify a hump-nosed viper (HNV). Syndromic identification of snakes was best for the krait (71.8%) followed by the cobra (59.6%), but poor for the HNV (30%). The median knowledge scores of pictorial and syndromic snake identification, indoor preventive measures and indications of antivenom were <75% of the maximum score. Apart from 62.5% who expected the victim to bring the snake along to the hospital, most doctors selected the correct options of pre-hospital care. The duration of work experience did not influence the competency of syndromic identification. Utilisation of local guidelines was associated with better knowledge in antivenom usage (odds ratio 2.22 [95% confidence interval 1.04 to 5.36]; p=0.03). Specific deficiencies of core knowledge in snakebite management exist among doctors working in snakebite prevalent regions.

A 6 months retrospective observational study to assess the rationality and effectiveness of snake bite management in a tertiary care teaching hospital of rural Bengal, India

Background: Snake envenomation is a common life-threatening problem encountered all-over West Bengal particularly in the rural areas. There are a large number of patients attending the Emergency unit and being admitted to the Medicine ward, some in the intensive care unit (ICU) and intensive therapy unit (ITU) of the tertiary health care facilities. The objective of this study was to assess rationality and effectiveness of management of venomous snake bite following standard protocol – Standard treatment guidelines of Government of West Bengal and National snakebite management protocol of Government of India.Methods: This was a retrospective observational study of six months (May - October 2017) duration. Data were collected from the treatment records of patients admitted with history of snake bite in the Medicine ward, ICU and ITU of tertiary care teaching hospital of rural Bengal.Results: Of the 63 venomous bite patients, most (82.5 %) were diagnosed to have features of neurotoxic envenomation. All of them (100%) received anti-snake venom (ASV). There was no incidence of anaphylactic reaction as well as any serious adverse drug reaction following ASV administration. Two patients developed acute renal failure, needed haemodialysis. Overall percentage of mortality was 3.2%.Conclusions: The survival rate in venomous snake bite is found to be high in this institution. The practice of snake bite management is found to be adherent with standard protocol. A multicentric study of longer duration is suggested to draw a firm conclusion.

Prospective, consecutive case series of 158 snakebite patients treated at Savannakhet provincial hospital, Lao People's Democratic Republic with high incidence of anaphylactic shock to horse derived F(ab')2 antivenom

Snakebites are a seriously neglected public health problem in Lao PDR. Community-based cross-sectional surveys in two districts of Savannakhet province in Southern Laos revealed an incidence of up to 1105 snakebites per 100,000 persons per year. In contrast the number of snakebite patients treated in district and provincial hospitals are low. In order to improve health care for snakebite victims, antivenom was introduced to Savannakhet provincial hospital in July 2013 and medical staff has been trained in management of venomous snakebites at the same time. After the intervention the number of snakebite patients treated at the provincial hospital increased significantly from 4 patients in 2012 to 158 snakebite patients between July 2013 and November 2015. They were included into a prospective, consecutive case series. Median age was 32 years (range 1.5–70 years) and male-to-female ratio 2.2:1. Forty patients were bitten by Malayan pit vipers, 26 by green pit vipers, 24 by cobras, including 3 cases of venom ophthalmia, 5 by kraits, 8 by non-venomous species and in 55 cases the snake could not be identified. Forty-three out of 158 patients received horse derived F(ab')2 antivenom from Queen Saovabha Memorial Institute (QSMI) in Bangkok. Twenty-three patients (53%) developed early adverse reactions (EARs) within one hour after antivenom administration, including 13 patients (30%) with severe anaphylaxis. This extremely high rate of severe EARs turns the use of antivenom into a risky intervention. In contrast a retrospective chart review from Chulalongkorn University in Bangkok found only 3.5% early reactions including 1.2% severe anaphylactic reactions using the same antivenom from QSMI between 1997 and 2006. The reason for this enormous difference remains unclear. A better understanding of the aetiology and pathophysiology behind antivenom induced anaphylaxis is crucial in order to identify patients at risk and to improve safety of antivenom administration.

Counteraction of Bothrops snake venoms by Combretum leprosum root extract and arjunolic acid

Ethnopharmacological relevanceSerotherapy against snakebite is often unavailable in some regions over Brazil, where people make use of plants from folk medicine to deal with ophidic accidents. About 10% of Combretum species have some ethnopharmacological use, including treatment of snakebites. Materials and methodsWe evaluated the ability of the extract of Combretum leprosum and its component arjunolic acid to reduce some in vivo and in vitro effects of Bothrops jararacussu and Bothrops jararaca venoms. The protocols investigated include phospholipase, proteolytic, collagenase, hyaluronidase, procoagulant, hemorrhagic, edematogenic, myotoxic and lethal activities induced by these venoms in Swiss mice. ResultsOral pre-treatment with arjunolic acid reduced the Bothrops jararacussu lethality in up to 75%, while preincubation prevented the death of all the animals. Hemoconcentration effect of Bothrops jararacussu venom was confirmed two hours after i.p. injection, while preincubation with arjunolic acid preserved the hematocrit levels. Both Combretum leprosum extract and arjunolic acid abolished the myotoxic action of Bothrops jararacussu venom. Preincubation of Bothrops jararacussu venom with the extract or arjunolic acid prevented the increase of plasma creatine kinase activity in mice. The hemorrhagic activity of Bothrops jararaca crude venom was reduced down to about 90% and completely inhibited by preincubation with 10mg/kg or 100mg/kg Combretum leprosum extract, respectively, while the preincubation and the pretreatment with 30mg/kg of arjunolic acid reduced the venom hemorrhagic activity down to about 12% and 58%, respectively. The preincubation of the venom with both extract and 30mg/kg arjunolic acid significantly reduced the bleeding amount induced by Bothrops jararacussu venom. The extract of Combretum leprosum decreased the edema formation induced by Bothrops jararacussu venom both in preincubation and pretreatment, but not in posttreatment. Similarly, arjunolic acid preincubated with the venom abolished edema formation, while pre- and posttreatment have been partially effective. Some enzymatic activities of Bothrops jararacussu and Bothrops jararaca venoms, i.e. phospholipase A2, collagenase, proteolytic and hyaluronidase activities, were to some extent inhibited by the extract and arjunolic acid in a concentration-dependent manner. ConclusionsAltogether, our results show that Combretum leprosum extract can inhibit different activities of two important Brazilian snake venoms, giving support for its popular use in folk medicine in the management of venomous snakebites.

Diagnosis and management of venomous snakebites in Southeast Asia

Background: Globally, snake envenoming is an important medical problem. Various species from different parts of the world require a variety of diagnostic and therapeutic strategies. Objective: Review clinical manifestations, diagnosis, and management of venomous snakebites in Southeast Asia. Method: Relevant information was extracted from publications in the PUBMED database (up to June 2012) and the World Health Organization (WHO) website. Expert opinions of the authors were added when clinical trial evidence was lacking. Results: The clinical findings including local tissue damage, muscular weakness, coagulopathy, and renal injury were summarized. These data can be used to deduce the responsible snake species. The guide for the first aid, initial evaluation, follow-up observation, and antivenin administration was also suggested. Conclusion: It is critical to transport snakebite victims to hospitals as soon as possible for basic and advance life supports. Appropriate usage of antivenin is life-saving. However, a mode to prevent debilitating tissue necrosis remains to be defined. Keywords: Antivenin, diagnosis of snakebite, management of snakebite, Southeast Asia, venomous snakebite

Antiophidic activity of the extract of the Amazon plant Humirianthera ampla and constituents

Ethnopharmacological relevanceAlthough serotherapy against snakebite has been discovered more than one hundred years ago, antivenom is not available all over Brazil. The use of plants from folk medicine is common mainly in the Brazilian Amazon area. One of these plants is named Humirianthera ampla (HA). Materials and MethodsWe have investigated HA extract and constituents’ antiophidic activity in different experimental protocols against some Bothrops snake venoms (Bothrops jararacussu, Bothrops atrox and Bothrops jararaca). The protocols investigated include phospholipase, proteolytic, pro-coagulant, hemorrhagic, edematogenic and myotoxic activities induced by these venoms in Swiss mice. ResultsAll the venoms caused an increase in the rate of creatine kinase (CK) release from isolated muscles, indicating damage to the sarcolemma. The crude extract of HA decreased the myotoxic activity in a concentration-dependent fashion. The presence of HA 300μg/mL decreased up to 96% of Bothrops jararacussu and 94% of Bothrops atrox myotoxicity after 90min of exposure. In vivo myotoxicity of Bothrops atrox venom was decreased in 75% when the venom was preincubated with HA 500mg/kg. Similar results were observed with lupeol against Bothrops jararacussu and Bothrops atrox venoms. The hemorrhagic activity was evaluated by intradermal injection of Bothrops atrox venom. Preincubation and oral pre- and posttreatment with HA decreased hemorrhage by 100%, 45% and 45%, respectively. Bothrops atrox venom also induced formation of edema, which was significantly inhibited by pre- and posttreatment with HA. All the venoms showed extensive pro-coagulating properties, and these activities were inhibited by up to 90% with HA, which presented concentration-dependent inhibition. Finally, proteolytic and phospholipase activities of the venoms were all inhibited by increasing concentrations of HA, lupeol and sitosterol. The inhibition of these activities might help explain the actions against in vivo myotoxicity and the in vivo effects observed, i.e., edema, myotoxicity, pro-coagulation and hemorrhage. ConclusionsAltogether, our results give support for the popular use of HA extracts in cases of accidents with snakes, suggesting that it can be used as an adjunct in the management of venomous snakebites.

Management of venomous snakebites in dogs and cats in Brazil

Snake envenoming is a major problem both to veterinary and human medicine in tropical countries due to high incidence, severity, and sequelae. In Brazil, most envenomings involving animals are caused by Bothrops and Crotalus snakes; these are the highest risk to animals. This study reports on Bothrops and Crotalus envenomings in dogs, the main species responsible for epidemiology, pathogenesis, venom action, clinical signs, sequelae and complications, clinical pathology, necropsy findings, diagnosis, and treatment. Veterinarians must be capable of identifying the snake not only by observing its characteristics but also symptom evolution.

ENVIRONMENTAL EMERGENCIES

This article reviews the pearls and pitfalls of high-altitude sickness, decompression sickness, and barotrauma; new findings relevant to the near-drowning patient; continued controversies on hyperbaric oxygen for carbon monoxide poisoning; pitfalls in hypothermia management; and updates on the management of venomous snakebites.

Index to volume 2

Environmental exposures and emergencies are occurring more frequently owing to a greater interest in outdoor activities, and especially because of the public's interest in more extreme and challenging endeavors. The emergency physician should have current information relevant to potential environmental emergencies and how to handle them and should know where to obtain additional information on these areas. For a complete review of environmental topics relevant to emergency medicine, the following text is recommended: “Management of Wilderness and Environmental Emergencies, ed 2.” edited by colleagues in our specialty; Paul S. Auerbach and Edward C. Geehr.This article focuses on pearls and pitfalls of high-altitude sickness, decompression sickness, and barotrauma; new findings relevant to the near-drowning patient; continued controversies on hyperbaric oxygen for carbon monoxide poisoning; pitfalls in hypothermia management; and updates on the management of venomous snakebites.