Snakebite Research Articles

The Composition and Biochemical Properties of Strophantus (Apocynaceae), with a Focus on S. sarmentosus

The genus Strophantus belongs to the Apocynaceae family of flowering plants which grows primarily in tropical Africa. The plants are widely used in traditional herbal medicine. S. sarmentosus, in particular, is used for the treatment of, e.g., joint pain and rheumatoid arthritis, wound infections, head lice, diarrhea, snake bite, and eye conditions. Despite its widespread use, dedicated research characterizing its bioactive plant components is scarce. Investigations have focused mainly on its cardenolides because of their cardioactivity and historical use as cardiotonic. There are also studies concerning the antibacterial, antioxidant, and anti-inflammatory activity of plant extracts. This review summarizes the present knowledge surrounding the biochemical and analytical research on Strophantus, in general, and S. sarmentosus, in particular, and describes the current state of the field based on the available scientific literature.

Hemocoagulation Conditions Associated with Venom-Induced Consumption Coagulopathy due to Snakebite in Humans

Highlights:1. This review comprehensively highlighted aspects of hematologic abnormalities in snakebites, a topic that remains understudied globally.2. This review contributes insights into the field of snakebite research and improves the management of snakebites by examining the diverse effects of different types of snakebites on hemocoagulation status. Abstract Snakebite remains an underreported health hazard worldwide. The most common effects of snakebite envenomation globally are hematological disorders, with venom-induced consumption coagulopathy (VICC) being the most prevalent and significant condition. This review aimed to explore the hematological aspects of snakebite, with a focus on snakebite-induced consumption coagulopathy. We conducted a systematic review according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines through a search across several databases, namely PubMed, ScienceDirect, and Google Scholar. The inclusion criteria for this review were studies on snakebite envenomation in humans with a discussion of relevant cases. Additionally, the included studies were conducted between 2010 and 2023 and published in the English language. Studies on animal models were excluded. We used the keywords “venom-induced consumption coagulopathy AND snake" in the search. The critical appraisal was performed using the Joanna Briggs Institute (JBI) Critical Appraisal Checklist for Case Reports and the Mixed Methods Appraisal Tool (MMAT). The findings were presented as a qualitative synthesis of 14 articles covering 316 patients and various snakebite types. The studies on snakebite came from various countries, but mostly from Sri Lanka. The snake types exhibited variation, with certain species existing only in specific areas. The subjects fell into different age groups, from children to the elderly. The majority of the subjects were male. The subjects' youngest age was 6 years old, while the oldest was 70 years old. Prothrombin time (PT) and activated partial thromboplastin time (APTT) were the most discussed variables. Some of the studies demonstrated an increase in PT and APTT, although other studies reported contrasting findings. In conclusion, certain types of snakebite have a different impact on the hemocoagulation status.

Dr. Himmatrao Bawaskar: Transforming Rural Healthcare Through Scientific Inquiry and Advocacy.

Dr. Himmatrao Bawaskar, a distinguished figure in Indian healthcare, has made significant contributions to medical research and public health, particularly in rural areas. Born in 1951 in Maharashtra, his journey from a rural upbringing to receiving one of the highest civilian awards of the Government ofIndia, the Padma Shri, reflects his dedication to the field of medicine and public health. Dr. Bawaskar's groundbreaking research on scorpion stings, notably the use of prazosin, has revolutionized treatment protocols, significantly reducing mortality rates. Beyond scorpion stings, his work spans diverse medical areas, including snake bites and cardiovascular diseases. Moreover, Dr. Bawaskar's advocacy for ethical practices and healthcare reform underscores his commitment to improving healthcare outcomes. His legacy serves as an inspiration for future generations of healthcare professionals and policymakers, emphasizing the transformative power of dedication, compassion, and scientific inquiry in addressing critical healthcare challenges.

Preclinical testing of expired antivenoms and its uses in real-world experience: a systematic review

IntroductionLimited access to antivenoms is a global challenge in treating snakebite envenoming. In emergency situations where non-expired antivenoms are not readily available, expired antivenoms may be used to save lives...

Neutralizing Effect of Solanum dasyphyllum Schumach. &Thonn Extract against Naja nigricollis Venom-induced Toxicity

Background: Clinical treatments for snakebite envenomation typically involve the administration of antivenom, which can lead to various side effects. However, due to the limitations of conventional antivenoms in effectively treating snakebite envenomation, scientists are now exploring alternative sources for potential antivenom compounds, particularly those derived from plants. Solanum dasyphyllum belongs to the Solanaceae family. This plant has been found to possess several beneficial properties, including neuromuscular, anti-poisoning, and antispasmodic effects. Aim of the Study: This study aimed to investigate the phytochemical constituents and the In-vivo detoxifying effect of S. dasyphyllum extract against N. nigricollis-induced toxicity. Materials and Methods: Phytochemical screening and anticoagulant assays were conducted using standard procedures. The neutralizing and detoxifying effects of S. dasyphyllum were investigated in-vivo using locally bred adult Swiss mice. The neutralizing effect was evaluated in mice by administering a mixture of N. nigricollis venom and methanol leaf extract of S. dasyphyllum (100-400 mg/kg). The detoxifying effect was investigated by administering S. dasyphyllum via the intramuscular route 10 minutes after inoculation with N. nigricollis venom through the intraperitoneal route. Results: The results of phytochemical screening revealed the presence of tannins, cardiac glycosides, saponins, flavonoids, and alkaloids, and the absence of anthraquinone and starch. The results of the clotting time of human blood treated with N. nigricollis venom showed a significant reduction in the clotting time with an increase in the concentration of methanol leaf extract of S. dasyphyllum. Additionally, the mortality of the mice that were pre-treated with N. nigricollis venom before injected with various doses of plant extract and those that were co-administered with the venom and plant extract significantly lower compared to mice administered with the venom alone. S. dasyphyllum significantly reduced the extent of lipid peroxidation and the activity of the enzyme acetylcholinesterase compared to the untreated group. Conclusions: S. dasyphyllum possesses antivenom activity against N. nigricollis, and this result further supports the ethnomedical use of the plant in the treatment of snakebite envenomation.

Morphological state of lungs of rats under the influence of Vipera berus berus venom

About 5.4 million snake bite cases are registered worldwide every year. About half of them cause 81,000-138,000 deaths or disabled 400,000 people. Despite this, this problem is neglected in many countries in Asia, Africa and Latin America. It is believed that death from snakebites is associated with poverty since the lack of proper access to medical facilities in such sections of the population causes the development of fatal complications. The purpose of the study is to study the morphological state of rats' lungs under exposure to Vipera berus berus venom. Experimental studies were carried out on white, non-linear male rats. Animals were conditionally divided into control and experimental groups, ten individuals each. Experimental rats were injected intraperitoneally with a semi-lethal dose (LD50) (1.576 mg/g-1) of Vipera berus berus venom in a physiological solution. Animals of the control group were injected intraperitoneally with only a physiological solution. Rats were removed from the experiment 24 hours after exposure to the poison and anaesthetized by cervical dislocation. Lung tissue samples were taken for microscopic examination. Fixation of the material and preparation of paraffin blocks were carried out according to generally accepted methods. Staining of histological preparations of the lungs was carried out with hematoxylin and eosin, according to Masson, and the PAS+"Hale" reaction was carried out according to the Mowry method. Histological preparations were studied using an SEO SСAN light microscope. The toxic effect of Vipera berus berus venom caused significant changes in the vascular, stromal and parenchymal components, which was confirmed by histological, histochemical and morphometric data. In the lungs of experimental animals, the vascular bed is primarily restructured, forming coagulopathies and thrombosis. The development of DIC syndrome and haemorrhages accompanies an increase in the permeability of the vessel wall. Inflammatory phenomena are found in the bronchi and respiratory departments' walls. There is a remodelling of the respiratory department components, with the formation of significant areas of dis- and atelectasis and zones of emphysema, which is confirmed morphometrically.

Using organ-on-a-chip technology to study haemorrhagic activities of snake venoms on endothelial tubules

Snakebite envenomation is a major public health issue which causes severe morbidity and mortality, affecting millions of people annually. Of a diverse range of clinical manifestations, local and systemic haemorrhage are of particular relevance, as this may result in ischemia, organ failure and even cardiovascular shock. Thus far, in vitro studies have failed to recapitulate the haemorrhagic effects observed in vivo. Here, we present an organ-on-a-chip approach to investigate the effects of four different snake venoms on a perfused microfluidic blood vessel model. We assess the effect of the venoms of four snake species on epithelial barrier function, cell viability, and contraction/delamination. Our findings reveal two different mechanisms by which the microvasculature is being affected, either by disruption of the endothelial cell membrane or by delamination of the endothelial cell monolayer from its matrix. The use of our blood vessel model may shed light on the key mechanisms by which tissue-damaging venoms exert their effects on the capillary vessels, which could be helpful for the development of effective treatments against snakebites.

Isolation, Characterization and Antibacterial Activity Study of Bioactive Compounds from Leaves of Cyphostemma cyphopetalum

Background:: Cyphostemma cyphopetalum is a herbaceous climber species within the Vitaceae family, found in various tropical and subtropical regions of Africa. It has a history of traditional use in Ethiopia for treating various health issues in humans and livestock, includ-ing snake bites, rabies, and eczema. Despite its reported ethnomedicinal uses, there is a lack of sufficient scientific literature regarding the isolation and characterization of its bioactive chem-ical compounds. Objective:: The objective of this work was to isolate bioactive compounds from the leaves of Cyphostemma cyphopetalum, characterize their chemical structures using FTIR and NMR spec-troscopy, and evaluate their antimicrobial activities. Methods:: Isolation was done using column chromatographic separation techniques. Spectro-scopic techniques, including Fourier transform infrared and nuclear magnetic resonance, were used for functional group identification and structural elucidation. Moreover, the paper disc dif-fusion bioassay method was used to evaluate the antibacterial activity of the isolated bioactive compounds. Results:: Three fractions were successfully isolated using chloroform with dichloromethane and chloroform with ethyl acetate as eluting solvents and silica gel as a stationary phase. After care-ful interpretation of the experimental results and comparison with the literature, the isolated fractions were constituted mainly by stigmasterol (fraction 1), β-sitosterol (fraction 2), and trans-resveratrol (fraction 3). The antibacterial activities of each isolated fraction were tested against Ralstonia solanacearum, a gram-negative bacterium, and Staphylococcus aureus, a gram-positive bacterial pathogen.Comparatively, the highest mean inhibitory value of 10.03 ± 0.13 mm was exhibited by fraction 2, which was followed by 6.25±0.05 mm inhibition activity recorded for fraction 1 against R. solanacearum, while fraction 3 did not exhibit any bacterial activity against both the strains. Conclusion:: We have successfully isolated and characterized three compounds (1-3) from leaves of C. cyphopetalum and evaluated their antibacterial activity. A maximum mean inhibi-tory value of 10.03 ± 0.13 mm was exhibited by compound 2 against R. solanacearum.

A randomized controlled trial and prospective cohort investigating antivenom for red-bellied black snake envenomation

Introduction Antivenom is first line treatment for snake envenomation worldwide, despite few placebo controlled clinical trials demonstrating effectiveness. We aimed to investigate whether early antivenom in red-bellied black snake (Pseudechis porphyriacus) bites would prevent systemic myotoxicity. Methods We undertook a multicentre randomized placebo-controlled trial of antivenom for red-bellied black snake bites with patients recruited from the Australian Snakebite Project (July 2014 to June 2020). In addition, we report all patients with red-bellied black snake bites during the same period, comparing the same outcomes. Patients over 2 years of age with definite red-bellied black snake bites and early systemic effects were randomized to receive 50 per cent glucose (placebo) or tiger snake antivenom within 6 hours post-bite, or in the cohort group received antivenom determined by the treating clinician. The primary outcome was the proportion of patients with myotoxicity (peak creatine kinase activity >1,000 U/L). Secondary outcomes were: area under the curve of total creatine kinase elevation over 48 hours, presence of venom post-antivenom, and adverse reactions. We analyzed both the randomized control trial patients and the combination of randomized control trial and cohort patients. Results Fifteen patients were recruited to the randomized controlled trial, and a cohort of 68 patients who were not randomized were included in the analysis. After treatment, two of seven patients given placebo had a peak creatine kinase activity >1,000 U/L versus none of the eight given antivenom (difference in favour of antivenom; 29 per cent; 95 per cent confidence interval:-18 per cent to +70 per cent; P = 0.2). The median area under the curve of total creatine kinase elevation over 48 hours in patients given placebo was 0 U/L*h (interquartile range: 0–124 U/L*h), which was not significantly different to those given antivenom: 197 U/L*h (interquartile range: 0–66,353 U/L*h; P = 0.26). Venom was not detected post-antivenom in six patients with measured venom concentrations given antivenom. Two patients given antivenom had immediate hypersensitivity reactions, one severe anaphylaxis, and another had serum sickness. Combining randomized and not randomized patients, three of 36 (8 per cent) administered antivenom less than 6 hours post-bite had a peak creatine kinase activity >1,000 U/L versus 17/47 (36 per cent) patients not receiving antivenom less than 6 hours post-bite (difference in favour of antivenom 29 per cent; 95 per cent confidence interval: 8 per cent to 44 per cent; P < 0.004). Overall, 13/36 (36 per cent) patients administered antivenom within 6 hours had hypersensitivity reactions, six severe anaphylaxis (17 per cent). Discussion We found that early antivenom was effective in red-bellied black snake bites, and only three patients need to be given antivenom within 6 hours to prevent myotoxicity in one (number needed to treat = 3). However, one in three patients administered antivenom developed a hypersensitivity reaction, and one in six had severe anaphylaxis. The major limitation of this study was the small number of patients recruited to the randomized controlled trial. Conclusion Administration of antivenom in red-bellied black snake envenomation within 6 hours post-bite appeared to decrease the proportion of patients with myotoxicity, but a third of patients had adverse reactions.

Study of the Antihypertensive Effect of Scorzonera undulata ssp. deliciosa in Albino Wistar Rats.

The study aimed to investigate the antihypertensive activity of Scorzonera undulata ssp. deliciosa. Scorzonera undulata ssp deliciosa, locally known as "Guiz", is used in traditional medicine in Morocco as a diuretic and mainly against snake bites. This study investigated the possible antihypertensive effect of the aqueous extract of Scorzonera undulata (AESU). In the present study, the antihypertensive activity of AESU was tested in normotensive and hypertensive rats Results: The results indicated that AESU decreased the systolic, diastolic, and mean arterial blood pressure in hypertensive rats. The data revealed that AESU exerted its antihypertensive effect through vasodilatory properties. Interestingly, the study demonstrated that the vasorelaxation ability of AESU might be mediated through receptor-operated calcium channels (ROCCs). However, AESU dhad effect on inhibiting ACE-2. The present study indicates the antihypertensive and vasorelaxant activities of AESU in hypertensive rats.

Photobiomodulation mitigates Bothrops jararacussu venom-induced damage in myoblast cells by enhancing myogenic factors and reducing cytokine production.

Photobiomodulation has exhibited promise in mitigating the local effects induced by Bothrops snakebite envenoming; however, the mechanisms underlying this protection are not yet fully understood. Herein, the effectiveness of photobiomodulation effects on regenerative response of C2C12 myoblast cells following exposure to Bothrops jararacussu venom (BjsuV), as well as the mechanisms involved was investigated. C2C12 myoblast cells were exposed to BjsuV (12.5 μg/mL) and irradiated once for 10 seconds with laser light of 660 nm (14.08 mW; 0.04 cm2; 352 mW/cm2) or 780 nm (17.6 mW; 0.04 cm2; 440 mW/ cm2) to provide energy densities of 3.52 and 4.4 J/cm2, and total energies of 0.1408 and 0.176 J, respectively. Cell migration was assessed through a wound-healing assay. The expression of MAPK p38-α, NF-Кβ, Myf5, Pax-7, MyoD, and myogenin proteins were assessed by western blotting analysis. In addition, interleukin IL1-β, IL-6, TNF-alfa and IL-10 levels were measured in the supernatant by ELISA. The PBM applied to C2C12 cells exposed to BjsuV promoted cell migration, increase the expression of myogenic factors (Pax7, MyF5, MyoD and myogenin), reduced the levels of proinflammatory cytokines, IL1-β, IL-6, TNF-alfa, and increased the levels of anti-inflammatory cytokine IL-10. In addition, PBM downregulates the expression of NF-kB, and had no effect on p38 MAKP. These data demonstrated that protection of the muscle cell by PBM seems to be related to the increase of myogenic factors as well as the modulation of inflammatory mediators. PBM therapy may offer a new therapeutic strategy to address the local effects of snakebite envenoming by promoting muscle regeneration and reducing the inflammatory process.

Assessment of Indigenous Knowledge on Using of Traditional Medicinal Plants to Cure Human Diseases in South Omo Zone Baka Dawla Ari District, Kure and Bitsmal South Ethiopia

This ethnobotanical study aims to investigate and document the indigenous knowledge on using traditional medicinal plants to cure human diseases in southern Ethiopia, south Omo zone Baka dawla Ari district at Kure and Bitsmal community. In this study, 77 plant species that belong to 68 genera and 35 plant families were identified by 110 local community members and 10 traditional healers of the study area to treat 32 human diseases. According to the analyzed result of the study three families (Lamiaceae, Solanaceae, and Fabaceae) are equally leading families each with nine species (11.69%) followed by Euphorbiaceae with five species (6.5%) and Asteraceae with four species (5.2%) in the study area. The result of this study also shows that most of the traditional medicines were taken in the mouth (oral) at 61.5% followed by topical (26,4%) and inhalation form (12.1%). The findings of this study show that most traditional plants were collected from the forest (45.5%) followed by the backyard (26%) and herbs are the most popular (59%) followed by shrubs (27%) plant habits. According to the result of this study, leaves are the dominant traditional medicinal plant parts used (55%) followed by roots (11.2%). preference ranking of medicinal plants in the study shows Solanum incanum ranked first indicating that it was the most effective in curing stomach pain followed by Verbena officinalis and the highest informant consensus factor value (0.57) was recorded by Malaria, Evil eye, snake bite, sudden disease categories.

Comparison of the intrageneric neutralization scope of monospecific, bispecific/monogeneric and polyspecific/monogeneric antisera raised in horses immunized with sub-Saharan African snake venoms.

Snakebite envenomation inflicts a high burden of mortality and morbidity in sub-Saharan Africa. Antivenoms are the mainstay in the therapy of envenomation, and there is an urgent need to develop antivenoms of broad neutralizing efficacy for this region. The venoms used as immunogens to manufacture snake antivenoms are normally selected considering their medical importance and availability. Additionally, their ability to induce antibody responses with high neutralizing capability should be considered, an issue that involves the immunization scheme and the animal species being immunized. Using the lethality neutralization assay in mice, we compared the intrageneric neutralization scope of antisera generated by immunization of horses with monospecific, bispecific/monogeneric, and polyspecific/monogeneric immunogens formulated with venoms of Bitis spp., Echis spp., Dendroaspis spp., spitting Naja spp. or non-spitting Naja spp. It was found that the antisera raised by all the immunogens were able to neutralize the homologous venoms and, with a single exception, the heterologous congeneric venoms (considering spitting and non-spitting Naja separately). In general, the polyspecific antisera of Bitis spp, Echis spp, and Dendroaspis spp gave the best neutralization profile against venoms of these genera. For spitting Naja venoms, there were no significant differences in the neutralizing ability between monospecific, bispecific and polyspecific antisera. A similar result was obtained in the case of non-spitting Naja venoms, except that polyspecific antiserum was more effective against the venoms of N. melanoleuca and N. nivea as compared to the monospecific antiserum. The use of polyspecific immunogens is the best alternative to produce monogeneric antivenoms with wide neutralizing coverage against venoms of sub-Saharan African snakes of the Bitis, Echis, Naja (non-spitting) and Dendroaspis genera. On the other hand, a monospecific immunogen composed of venom of Naja nigricollis is suitable to produce a monogeneric antivenom with wide neutralizing coverage against venoms of spitting Naja spp. These findings can be used in the design of antivenoms of wide neutralizing scope for sub-Saharan Africa.

Retrospective Evaluation of Clinical and Clinicopathologic Findings, Case Management, and Outcome for Dogs and Cats Exposed to Micrurus fulvius (Eastern Coral Snake): 92 Cases (2021-2022).

This retrospective, observational study describes the clinical findings, case management trends, and outcomes of 83 dogs and nine cats exposed to eastern coral snakes in a university teaching hospital setting. The medical records of dogs and cats that received antivenom following coral snake exposure were reviewed. Data collected included signalment, time to antivenom administration, physical and laboratory characteristics at presentation, clinical course during hospitalization, length of hospitalization, and survival to discharge. The mean time from presentation to coral snake antivenom administration was 2.26 ± 1.46 h. Excluding cases where the owner declined in-hospital care, the mean hospitalization time for dogs and cats was 50.8 h and 34 h, respectively. The mean number of antivenom vials was 1.29 (1-4). Gastrointestinal signs (vomiting and ptyalism) occurred in 42.2% (35/83) of dogs and 33.3% (3/9) of cats. Peripheral neurologic system deficits (ataxia, paresis to plegia, absent reflexes, and hypoventilation) were noted in 19.6% (18/92) of dogs and cats. Hemolysis was also common in 37.9% (25/66) of dogs but was not observed in cats. Mechanical ventilation (MV) was indicated in 12% (10/83) of dogs but no cats. Acute kidney injury (AKI), while rare, was a common cause of euthanasia at 20% (2/5) and was the most common complication during MV at 44.4% (4/9). Pigmenturia/hemolysis occurred in 88.9% (8/9) of MV cases and in all cases with AKI. Despite delays in antivenom administration by several hours, dogs and cats with coral snake exposure have low mortality rates (6% of dogs (5/83) and 0% of cats). Gastrointestinal signs were common but were not predictive of progression to neurological signs. Thus, differentiating between coral snake exposure and envenomation before the onset of neurological signs remains challenging.

#2781 Renal cortical necrosis—a rare cause of acute kidney injury

Abstract Background and Aims Renal cortical necrosis (RCN) is a rare and catastrophic cause of acute kidney injury (AKI). It is characterized by ischemic destruction of all the elements of renal cortex due to marked reduction in renal arterial perfusion of renal cortex due to vascular spasm and microvascular injury. It can be patchy or diffuse depending upon the cause and extent of hypoperfusion. Snake bite is rare cause of RCN. Incidence of RCN following snake bite has been reported to be as high as in 25% of the bitten patients to &amp;lt;1%. Lack or delay in receiving anti snake venom (ASV) has been observed to be a contributing factor in development of RCN following snake bite. Method A 45-year-old female had an unknown bite on foot while returning to home at twilight. She had intense pain at site of bite with slight ooze of blood. Overnight she had vomiting and pain abdomen. Subsequently she developed progressive fall in urine output and dyspnoea. After about 36 hours of bite at the time of admission in hospital she had anuria, prolonged whole blood clotting time, tachypnoea, hypoxemia and required oxygen (O2) to maintain normal O2 saturation. She was given two doses of polyvalent ASV 6 hours apart which corrected her coagulation defect. Investigations showed: haemoglobin—9 gm/dl, total leucocyte count—18700/mcl, platelet—1.15 lakh/mcl, blood urea—88 mg/dl and serum creatinine—10.5 mg/dl. She was managed with haemodialysis and supportive care. Even after 3 weeks of onset of AKI, she had anuria so a kidney biopsy was done. Results kidney biopsy on light microscopy examination showed 9 glomeruli; 8 revealing global tuft necrosis along with necrosis of adjacent tubules and vasculature and necrotic process affected around 60% of sampled cortical area consistent with cortical necrosis (Fig. 1). She was continued with haemodialysis support and urine output and pre-dialysis serum creatinine were monitored. Her urine output after 3 months of onset of AKI is around one litre per day but her pre-dialysis serum creatinine stays in the range of 9-10 mg/dl and so she continues to receive biweekly haemodialysis. Conclusion In our index case, there was delay in getting ASV which may have contributed to development of RCN. So, early treatment of snake bite is important to prevent this catastrophic complication.

#862 Prevalence and surrogate predictors of acute kidney injury in tropical infections in eastern India

Abstract Background and Aims Acute kidney injury (AKI) in tropical countries is strikingly different from the other countries with a temperate climate. The epidemiology of AKI is largely influenced by environmental factors and climatic conditions and differ significantly its outcome and the surrogate predictors are not much studied. 1. To observe the spectrum and estimate the prevalence of AKI in tropical infections. 2. To evaluate the outcome and surrogate predictor of tropical AKI. Method This was a tertiary level single centre prospective observational study. All patients admitted with tropical infections associated AKI (KDIGO) were enrolled in two years and underwent complete history taking, clinical examinations and necessary laboratory investigations according to situations.. All patients were followed up more than 6 month. All data recorded were analysed in suitable statistical tool. Univariate analysis is followed by multivariate analysis was done for predictors followed by hazards ratio and Neglekers test. Results Out of 132 patients with Tropical AKI M:F was 1.5:1. Mean age was 42.3 ± 14.4 year, About 35.6% had Malaria,31.1% Dengue, 17% Scrub typhus, 10.4% Leptospira, and 5.9% patients had Typhoid fever. Malaria was the most common causative factor followed by Dengue. study reflecting the high dengue incidence occurring in the months of August, September, October &amp; November. Among Malaria AKI (MAKI) 43.75% (21) had Falciparum malaria, 50% (24) had Vivax malaria and 6.25% (3) had dual infection. Out of 132 patients with Tropical AKI about 60% totally recovered at the time of discharge. 40% patients had Shock. Among them 60% Dengue AKI, 33.3% Malarial AKI 5 (21.7%) Scrub typhus, 4 (28.6%) Leptospira AKI &amp; 3 (37%) Typhoid AKI patients had Shock. About 23% patients required RRT. Among them 8 (25%) patients died, 5 (15.6%) patients had CKD progression compared to non-RRT group where only 3 (2.9%) patients died, and 2 (1.94%) patients had progression to CKD. Total 11 (8.1%) patients died during hospital stay and only 7 (6.2%) patients had progressed to CKD. The mean Hospital stay was 5.51 ± 3.8 days. S hock at presentation, requirement of ICU support ( in form of ionotropic and ventilatory support), Need of RRT, prolong hospital stay, late referral was the bad prognostic predictor in terms of death. Though not statistically significant, presence of anaemia, hyponatraemia, deranged liver function &amp; hypoalbuminemia were more in patients who died compared to survival group. Limitations: Small enrolments. non inclusion of all cause including snake bite, less biopsy in this study. Conclusion There are wide spectrum of tropical AKI with high mortality and morbidity. A greater awareness and early intervention is necessary for prompt diagnosis, treatment and favourable outcome.

Ethnomedicinal Plants of Betul District, Madhya Pradesh

The paper deals with ethnomedicinal information on 54 plant species (belonging to 33 families) collected from field survey amongst three tribes viz., Gond, Korku and Gaiki of Betul district, Madhya Pradesh. An analysis of data has indicated that eight plant species are employed as antidote to snake bite and scorpion sting, six to treat fever. five for rheumatism, four to treat cold, cough, skin diseases, as anthelmintic and tonic, and three for stomach diseases while two species to treat impotency, cuts, wounds and as diuretic. On the other hand, only single species has been referred for a number of other ailments like eye diseases, spermatorrhoea, spleen enlargement, tuberculosis, mouth sore, boil, asthma, liver disorder, toothache, bone fracture, abortifacient, antifertility, and in veterinary. Further, a comparison with the concerned literature has revealed that 23 ethnomedicinal uses of plants have not been reported earlier.

In vivo neutralization of coral snake venoms with an oligoclonal nanobody mixture in a murine challenge model

Oligoclonal mixtures of broadly-neutralizing antibodies can neutralize complex compositions of similar and dissimilar antigens, making them versatile tools for the treatment of e.g., infectious diseases and animal envenomations. However, these biotherapeutics are complicated to develop due to their complex nature. In this work, we describe the application of various strategies for the discovery of cross-neutralizing nanobodies against key toxins in coral snake venoms using phage display technology. We prepare two oligoclonal mixtures of nanobodies and demonstrate their ability to neutralize the lethality induced by two North American coral snake venoms in mice, while individual nanobodies fail to do so. We thus show that an oligoclonal mixture of nanobodies can neutralize the lethality of venoms where the clinical syndrome is caused by more than one toxin family in a murine challenge model. The approaches described may find utility for the development of advanced biotherapeutics against snakebite envenomation and other pathologies where multi-epitope targeting is beneficial.

Combining species distribution models and big datasets may provide finer assessments of snakebite impacts.

Snakebite is a major poverty-related neglected tropical disease. An integrated scientific approach is needed to understand the dynamics of this important health issue. Our objective was to estimate snakebite occurrence in a tropical area by using a blend of ecological modelling and robust statistical analysis. The present study used climatic, environmental, and human population density data to determine the area with snakebite occurrence-probability for the first time in Bangladesh. We also analysed a large, 16-year dataset of hospitalized snakebite cases to reveal the epidemiology of snakebite in the south-eastern zone of the country. Our results show that cobra bite is the most commonly occurring venomous snakebite in humans (around ~12% of the total yearly snakebite records), and men are more frequently bitten than women (2/3 of human victims are men). Most bites occur during the rainy season for cobra and green pit viper, while krait bites are not restricted to any particular season. As snakebite incidents are closely related to climate conditions, we can model snakebite risk using temperature and precipitation variables. Whereas there is a lack of snakebite reports from several parts of the study area in official records, our models predict that the entire study area is favourable for snakebite incidents. Based on the combined evidence we estimate that about 200,000 snakebite events occur every year in the south-eastern part of Bangladesh alone. Considering future global climate change, our model projections show that snakebite incidence in Bangladesh might not significantly decrease in the future (- 2070-); however, the distribution of probabilities might change, with a predicted increase of snakebite incidence in the hilly areas of the country. Using climatic data to predict snakebite incidence in Bangladesh allowed us to provide estimations of the total annual number of snakebite cases in the study area. As in most countries, the scarcity of accurate epidemiological data in official records might have masked the real magnitude of this problem. Our analysis suggests that the problem of snakebite envenoming in Bangladesh might be worse than currently perceived. A long-term sustainable snakebite program plan should be designed and institutionalized, considering climatic, geographical and human demographic variables, to obtain better data and facilitate the implementation of accurate snakebite management programs for this country.

The effects of hyperbaric oxygen therapy on snake-bite-associated wounds in dogs.

To assess the effect of hyperbaric oxygen therapy (HBOT) on Crotalinae envenomation-induced wound swelling and severity and pain in dogs, and to describe the safety and complications of HBOT. Prospective, randomized, controlled, blinded study (2017-2021). University teaching hospital, private veterinary practice. Thirty-six client-owned dogs presenting within 24hours of a confirmed or suspected naturally occurring Crotalinae snake bite injury were enrolled between 2017 and 2021. In addition to the standard of care treatment, dogs received 2 interventions with either HBOT (n=19) or control (n=16) within 24hours of hospital admission. Dogs receiving HBOT were pressurized over 15 minutes (1psi/min), maintained at a target pressure of 2 atmosphere absolute (ATA) for 30 minutes, and decompressed over 15 minutes. Control dogs received 1 ATA for 1hour. Local wound swelling, wound severity score, and pain score were assessed at admission, before and after each intervention, and at hospital discharge. There was no significant difference in wound swelling (P=0.414), severity score (P=1.000), or pain score (P=0.689) between HBOT and control groups. Pain decreased significantly over time regardless of the study intervention (P<0.001). There were no major adverse effects associated with either study intervention. HBOT did not significantly alter the short-term recovery from Crotalinae envenomation in this study population. However, the study might be underpowered to detect a significant treatment effect.