1
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Sulaeman SJ, Graudins A. Evolution in the choice of therapies used to treat latrodectism: Redback spider antivenom or standard analgesic medications. Nothing to rave about. Emerg Med Australas 2023. [PMID: 36807536 DOI: 10.1111/1742-6723.14182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2022] [Revised: 01/05/2023] [Accepted: 01/25/2023] [Indexed: 02/21/2023]
Abstract
OBJECTIVES Redback spider (RBS) antivenom (RBSAV) use appears to have decreased since the results of the RAVE-2 antivenom efficacy study were released. The aims of this study were to assess change in RBSAV use over time and compare responses to treatment for antivenom and other analgesics. METHODS Retrospective audit of RBS bite referrals to a toxicology unit, from January 2010 to January 2022. Data included demographics, pain severity, treatment (analgesia or RBSAV), response to treatment, re-presentation rate, adverse events, change in antivenom use over time. RESULTS Of 270 presentations, 157 with moderate or severe pain were included (RBSAV n = 51, analgesia n = 106). Median age was 39 years, n = 81 (51%) female. Those receiving antivenom were more likely to report severe pain n = 46/51 (84%) versus n = 68/106 (58%) (P = 0.006). Eighty-three percent of antivenom doses were administered between 2010 and 2013. Analgesia-only group received various combinations of paracetamol, NSAIDs, and opioids. In those receiving RBSAV, 17/48 (35%), 26/48 (54%), 5/48 (10%) reported a partial, complete or no reduction in pain, respectively, versus 30/77 (39%), 43/77 (58%) and 4/77 (5%), for analgesia-only group. Post-treatment pain was not recorded in three RBSAV and 28 analgesia-only patients. Pain reduction was no different for intravenous and intramuscular antivenom. Re-presentation for ongoing pain was more common in the analgesia-only group, 16/106 (15%) versus 1/51 (2%) for antivenom (P = 0.013). CONCLUSION Antivenom use fell over the study period. There was no difference in pain relief between RBSAV and analgesia-only groups. RBSAV, regardless of route of administration, was no better than standard analgesics in pain reduction in the present study.
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Affiliation(s)
- Siba J Sulaeman
- Monash Toxicology Unit, Emergency Service, Dandenong Hospital, Monash Health, Melbourne, Victoria, Australia
| | - Andis Graudins
- Monash Toxicology Unit, Emergency Service, Dandenong Hospital, Monash Health, Melbourne, Victoria, Australia.,Department of Medicine, Clinical Sciences at Monash Health, Monash University, Melbourne, Victoria, Australia
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2
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Malaque CMS, Novaes CTG, Piorelli RO, Risk JY, Murad JC, Lara AN, Virgulino CC, Miyaji KT, Santoro ML. Impact of antivenom administration on the evolution of cutaneous lesions in loxoscelism: A prospective observational study. PLoS Negl Trop Dis 2022; 16:e0010842. [PMID: 36240248 PMCID: PMC9604982 DOI: 10.1371/journal.pntd.0010842] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Revised: 10/26/2022] [Accepted: 09/23/2022] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Spiders of the genus Loxosceles are distributed throughout tropical and temperate regions worldwide. Loxosceles spp. bites may evolve to necrosis, with or without intravascular hemolysis. There is no consensus regarding the best treatment to prevent necrosis. The objective of this study was to evaluate the factors associated with the development of necrosis and the impact that antivenom administration has on the evolution of cutaneous loxoscelism. METHODOLOGY/PRINCIPAL FINDINGS This was a prospective observational study carried out at a referral center for envenoming. Over a 6-year period, we included 146 patients with a presumptive or definitive diagnosis of loxoscelism. Depending on the symptom severity, a polyvalent anti-arachnid antivenom was administered or not-in 74 cases (50.7%) and 72 cases (49.3%), respectively. Cutaneous and systemic manifestations were assessed at admission and weekly thereafter. Adverse reactions to the antivenom were also evaluated. Cutaneous loxoscelism was observed in 141 cases (96.6%), and the spider was identified in 29 (19.9%). The mean time from bite to antivenom administration was 41.6 ± 27.4 h. After discharge, 130 patients (90.9%) were treated with corticosteroids, antihistamines and analgesics being prescribed as needed. The probability of developing necrosis was significantly lower among the patients who were admitted earlier, as well as among those who received antivenom (p = 0.0245). Among the 74 patients receiving antivenom, early and delayed adverse reactions occurred in seven (9.5%) and four (5.4%), respectively. Local infection was observed only in three (2.3%) of the 128 patients for whom that information was available. CONCLUSIONS/SIGNIFICANCE Necrosis after a Loxosceles sp. bite appears to more common when hospital admission is delayed or when antivenom is not administered. In addition, the administration of a polyvalent anti-arachnid antivenom appears to be safe, with a relatively low rate of adverse reactions.
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Affiliation(s)
| | | | | | - Jose Y. Risk
- Hospital Vital Brazil, Instituto Butantan, São Paulo, Brazil
| | | | - Amanda N. Lara
- Hospital Vital Brazil, Instituto Butantan, São Paulo, Brazil
| | | | - Karina T. Miyaji
- Departamento de Moléstias Infecciosas e Parasitárias, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Marcelo L. Santoro
- Laboratório de Fisiopatologia, Instituto Butantan, São Paulo, Brazil
- Escola Superior do Instituto Butantan (ESIB), Instituto Butantan, São Paulo, Brazil
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3
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Dooley E, Agrawal R. Toddler with priapism as a result of redback spider latrodectism. J Paediatr Child Health 2022; 58:705-706. [PMID: 34118101 DOI: 10.1111/jpc.15615] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Revised: 05/08/2021] [Accepted: 05/17/2021] [Indexed: 11/27/2022]
Affiliation(s)
- Elizabeth Dooley
- Department of General Medicine, Women's and Children's Hospital, Adelaide, South Australia, Australia
| | - Rishi Agrawal
- Department of General Medicine, Women's and Children's Hospital, Adelaide, South Australia, Australia
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4
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Fairbrother SL, Borland ML. Re: Redback spider bites in children in South Australia: A 10-year review of antivenom effectiveness. Emerg Med Australas 2022. [PMID: 35132788 DOI: 10.1111/1742-6723.13934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Susan L Fairbrother
- Emergency Department, Perth Children's Hospital, Perth, Western Australia, Australia
| | - Meredith L Borland
- Emergency Department, Perth Children's Hospital, Perth, Western Australia, Australia.,Divisions of Emergency Medicine and Paediatrics, The University of Western Australia Faculty of Medicine, Dentistry and Health Sciences, Perth, Western Australia, Australia
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5
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Cocks J. Response to Re: Redback spider bites in children in South Australia: A 10-year review of antivenom effectiveness. Emerg Med Australas 2021; 34:298-299. [PMID: 34962056 DOI: 10.1111/1742-6723.13922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Accepted: 12/09/2021] [Indexed: 11/27/2022]
Affiliation(s)
- Jane Cocks
- Paediatric Emergency Department, Women's and Children's Hospital, Adelaide, South Australia, Australia
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6
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Downes MA, Lovett CJ, Berling I, Isbister GK. Re: Redback spider bites in children in South Australia: A 10-year review of antivenom effectiveness. Emerg Med Australas 2021; 34:297-298. [PMID: 34962066 DOI: 10.1111/1742-6723.13923] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Accepted: 12/09/2021] [Indexed: 12/01/2022]
Affiliation(s)
- Michael A Downes
- Department of Clinical Toxicology, Calvary Mater Newcastle, Newcastle, New South Wales, Australia.,School of Medicine and Public Health, University of Newcastle, Newcastle, New South Wales, Australia
| | - Caitlyn J Lovett
- Department of Clinical Toxicology, Calvary Mater Newcastle, Newcastle, New South Wales, Australia.,Emergency Department, John Hunter Hospital, Newcastle, New South Wales, Australia
| | - Ingrid Berling
- Department of Clinical Toxicology, Calvary Mater Newcastle, Newcastle, New South Wales, Australia.,School of Medicine and Public Health, University of Newcastle, Newcastle, New South Wales, Australia
| | - Geoffrey K Isbister
- Department of Clinical Toxicology, Calvary Mater Newcastle, Newcastle, New South Wales, Australia.,School of Medicine and Public Health, University of Newcastle, Newcastle, New South Wales, Australia
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7
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Venomous Snake and Spider Bites in Pregnancy. Obstet Gynecol Surv 2021; 76:760-767. [PMID: 34942652 DOI: 10.1097/ogx.0000000000000959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Importance Venomous snake and spider bites are relatively rare in the Unites States and even more so in the pregnant population. However, the impact of a venomous bite, also known as an envenomation, can be serious in a pregnant patient. Thus, providers in endemic and high-risk areas must be familiar with the management of envenomation in the pregnant population. Objective The purpose of this article is to review the current literature on the most common snake and spider envenomations in the United States, the effects of envenomation on maternal and fetal health, and the management of envenomation in pregnancy. Evidence Acquisition Original research articles, review articles, and guidelines on snake and spider envenomation were reviewed. Results Snake envenomation carries higher risks of maternal morbidity and fetal morbidity and mortality than spider envenomation. Although the data are limited, current literature suggests that both snake and spider antivenom can be used in the pregnant population without significant adverse outcomes. However, the risks of an adverse hypersensitivity reaction with antivenom administration should be weighed carefully with the benefits. Conclusions and Relevance The use of antivenom therapy in the symptomatic envenomated pregnant population is likely safe with the appropriate monitoring and follow-up. Knowledge of the indications for antivenom therapy and proper escalation of care are vital to optimizing maternal and fetal outcomes. More research is needed to determine the effects of both envenomation and antivenom therapy on the pregnant patient and their fetus.
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8
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Jenkins TP, Ahmadi S, Bittenbinder MA, Stewart TK, Akgun DE, Hale M, Nasrabadi NN, Wolff DS, Vonk FJ, Kool J, Laustsen AH. Terrestrial venomous animals, the envenomings they cause, and treatment perspectives in the Middle East and North Africa. PLoS Negl Trop Dis 2021; 15:e0009880. [PMID: 34855751 PMCID: PMC8638997 DOI: 10.1371/journal.pntd.0009880] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
The Middle East and Northern Africa, collectively known as the MENA region, are inhabited by a plethora of venomous animals that cause up to 420,000 bites and stings each year. To understand the resultant health burden and the key variables affecting it, this review describes the epidemiology of snake, scorpion, and spider envenomings primarily based on heterogenous hospital data in the MENA region and the pathologies associated with their venoms. In addition, we discuss the venom composition and the key medically relevant toxins of these venomous animals, and, finally, the antivenoms that are currently in use to counteract them. Unlike Asia and sub-Saharan Africa, scorpion stings are significantly more common (approximately 350,000 cases/year) than snakebites (approximately 70,000 cases/year) and present the most significant contributor to the overall health burden of envenomings, with spider bites being negligible. However, this review also indicates that there is a substantial lack of high-quality envenoming data available for the MENA region, rendering many of these estimates speculative. Our understanding of the venoms and the toxins they contain is also incomplete, but already presents clear trends. For instance, the majority of snake venoms contain snake venom metalloproteinases, while sodium channel-binding toxins and potassium channel-binding toxins are the scorpion toxins that cause most health-related challenges. There also currently exist a plethora of antivenoms, yet only few are clinically validated, and their high cost and limited availability present a substantial health challenge. Yet, some of the insights presented in this review might help direct future research and policy efforts toward the appropriate prioritization of efforts and aid the development of future therapeutic solutions, such as next-generation antivenoms.
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Affiliation(s)
- Timothy P Jenkins
- Department of Biotechnology and Biomedicine, Technical University of Denmark, Kongens Lyngby, Denmark
| | - Shirin Ahmadi
- Department of Biotechnology and Biomedicine, Technical University of Denmark, Kongens Lyngby, Denmark
| | - Matyas A Bittenbinder
- Naturalis Biodiversity Center, Leiden, the Netherlands
- Amsterdam Institute for Molecular and Life Sciences, Division of BioAnalytical Chemistry, Department of Chemistry and Pharmaceutical Sciences, Faculty of Sciences, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
- Centre for Analytical Sciences Amsterdam (CASA), Amsterdam, the Netherlands
| | - Trenton K Stewart
- Department of Biotechnology and Biomedicine, Technical University of Denmark, Kongens Lyngby, Denmark
| | - Dilber E Akgun
- Department of Biomedical Engineering, Faculty of Engineering and Architecture, Eskişehir Osmangazi University, Eskişehir, Turkey
| | - Melissa Hale
- Department of Biotechnology and Biomedicine, Technical University of Denmark, Kongens Lyngby, Denmark
| | - Nafiseh N Nasrabadi
- Pharmaceutical Sciences Research Centre, Student Research Commitee, School of Pharmacy, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Department of Venomous Animals and Antivenom Production, Razi Vaccine, and Serum Research Institute, Karaj, Iran
| | - Darian S Wolff
- Department of Biotechnology and Biomedicine, Technical University of Denmark, Kongens Lyngby, Denmark
| | - Freek J Vonk
- Naturalis Biodiversity Center, Leiden, the Netherlands
- Amsterdam Institute for Molecular and Life Sciences, Division of BioAnalytical Chemistry, Department of Chemistry and Pharmaceutical Sciences, Faculty of Sciences, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Jeroen Kool
- Amsterdam Institute for Molecular and Life Sciences, Division of BioAnalytical Chemistry, Department of Chemistry and Pharmaceutical Sciences, Faculty of Sciences, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
- Centre for Analytical Sciences Amsterdam (CASA), Amsterdam, the Netherlands
| | - Andreas H Laustsen
- Department of Biotechnology and Biomedicine, Technical University of Denmark, Kongens Lyngby, Denmark
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9
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Cocks J, Chu S, Gamage L, Rossaye S, Schutz J, Soon AWC. Redback spider bites in children in South Australia: A 10-year review of antivenom effectiveness. Emerg Med Australas 2021; 34:230-236. [PMID: 34558205 DOI: 10.1111/1742-6723.13869] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Accepted: 08/28/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To describe the South Australian paediatric redback spider bite experience and to examine the hypothesis that redback antivenom (RBAV) treatment in children is clinically effective. METHODS Retrospective chart review of all children under 18 years of age presenting to the EDs of the three major paediatric or mixed hospitals in Adelaide, South Australia, with a discharge diagnosis of redback spider envenomation between 1 January 2010 and 31 March 2020. The main outcome measures include: patient and bite demographics; presenting symptoms and signs; treatment provided; clinical effects at 2 h post RBAV administration on pain, diaphoresis, blood pressure, heart rate and systemic features; overall clinical impression of RBAV effectiveness and resolution of symptoms prior to discharge. RESULTS There were 256 patient encounters involving 235 patients. Latrodectism was described in one-third (34%) of the cases. Sixty-one patients received RBAV and in 57 (93%) patients the RBAV had good clinical effect. Two hours post RBAV administration, pain resolved in 71%, hypertension resolved in 62%, diaphoresis resolved in 43% and tachycardia resolved in 82%. There were no cases of urticaria or anaphylaxis and one case of serum sickness. CONCLUSIONS This retrospective review of redback spider envenomation in South Australian children over a 10-year period has demonstrated clinical effectiveness of RBAV in paediatric patients across all age groups, observed in both clinician perceived results and measurable outcomes. RBAV remains an effective treatment for redback envenomation in children.
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Affiliation(s)
- Jane Cocks
- Paediatric Emergency Department, Women's and Children's Hospital, Adelaide, South Australia, Australia
| | - Simon Chu
- Emergency Department, Lyell McEwin Hospital, Adelaide, South Australia, Australia
| | - Lalith Gamage
- Paediatric Emergency Department, Women's and Children's Hospital, Adelaide, South Australia, Australia
| | - Sasha Rossaye
- Paediatric Emergency Department, Women's and Children's Hospital, Adelaide, South Australia, Australia
| | - Jacquie Schutz
- Paediatric Emergency Department, Women's and Children's Hospital, Adelaide, South Australia, Australia
| | - Aun Woon Cindy Soon
- Paediatric Emergency Department, Flinders Medical Centre, Adelaide, South Australia, Australia
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10
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Savu AN, Schoenbrunner AR, Politi R, Janis JE. Practical Review of the Management of Animal Bites. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2021; 9:e3778. [PMID: 34522565 PMCID: PMC8432645 DOI: 10.1097/gox.0000000000003778] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Accepted: 07/01/2021] [Indexed: 11/26/2022]
Abstract
Animal bites are common worldwide. Due to the plethora of animals, there are diverse pathogens with specific associated risks and treatment algorithms. It is crucial to understand these to develop and execute appropriate management plans. This practical review was designed to amalgamate the most common bites worldwide and synthesize data to help guide treatment plans. METHODS A PubMed literature search was performed focusing on the major animal bites. High-level studies were preferred and analyzed but lower-level studies were also used if high-level studies did not exist. RESULTS The tables presented in this article cover the pertinent information regarding the incidence, common presentation, initial treatment, and potential complications associated with bites from dogs, cats, horses, rodents, snakes, marine life, and spiders. Many of the pathogens associated with the bites are treatable with various and somewhat common antimicrobials, though some are less easy to access. Basic irrigation, debridement, and wound culture are common to almost every animal and should be the first step in treatment. CONCLUSIONS Based on the current studies, the most important factor in treating animal bites is timely presentation to a medical facility and/or physician. It is critical that the offending animal be accurately identified to help guide medical and surgical algorithms, including specific antimicrobial treatment guided by the most commonly presenting pathogens specific to certain animals.
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Affiliation(s)
- Andrei N. Savu
- From the Ohio State College of Medicine, The Ohio State University, Columbus, Ohio
| | - Anna R. Schoenbrunner
- Department of Plastic and Reconstructive Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio
- The University of Virginia School of Medicine, The University of Virginia, Charlottesville, Va
| | - Rachel Politi
- Department of Plastic and Reconstructive Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio
- The University of Virginia School of Medicine, The University of Virginia, Charlottesville, Va
| | - Jeffrey E. Janis
- The University of Virginia School of Medicine, The University of Virginia, Charlottesville, Va
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11
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Duran LH, Rymer TL, Wilson DT. Variation in venom composition in the Australian funnel-web spiders Hadronyche valida. Toxicon X 2020; 8:100063. [PMID: 33305257 PMCID: PMC7711288 DOI: 10.1016/j.toxcx.2020.100063] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 10/29/2020] [Accepted: 11/19/2020] [Indexed: 12/31/2022] Open
Abstract
Mygalomorph venom properties and active components, which have importance in medicine, agronomy, venomics, ecology and evolution, have been widely studied, but only a small fraction have been characterised. Several studies have shown inter-individual variation in the composition of venom peptides based on ontogeny, sexual dimorphism, season and diet. However, intra-individual variation in venom composition, which could play a key role in the evolution, diversification and function of toxins, is poorly understood. In this study, we demonstrate significant intra- and inter-individual variation in venom composition in the Australian funnel-web spider Hadronyche valida, highlighting that individuals show different venom profiles over time. Fourteen (four juvenile and ten adult females) funnel-web spiders, maintained under the same environmental conditions and diet, were milked a total of four times, one month apart. We then used reversed-phase high performance liquid chromatography/electrospray ionisation mass spectrometry to generate venom fingerprints containing the retention time and molecular weights of the different toxin components in the venom. Across all individuals, we documented a combined total of 83 individual venom components. Only 20% of these components were shared between individuals. Individuals showed variation in the composition of venom peptides, with some components consistently present over time, while others were only present at specific times. When individuals were grouped using the Jaccard clustering index and Kernel Principal Component Analysis, spiders formed two distinct clusters, most likely due to their origin or time of collection. This study contributes to the understanding of variation in venom composition at different levels (intra-individual, and intra- and inter-specific) and considers some of the mechanisms of selection that may contribute to venom diversification within arachnids. In addition, inter-specific variation in venom composition can be highly useful as a chemotaxonomic marker to identify funnel-web species.
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Affiliation(s)
- Linda Hernández Duran
- College of Science and Engineering, James Cook University, P. O. Box 6811, Cairns, QLD, 4870, Australia
- Centre for Tropical Environmental and Sustainability Sciences, James Cook University, P. O. Box 6811, Cairns, QLD, 4870, Australia
| | - Tasmin Lee Rymer
- College of Science and Engineering, James Cook University, P. O. Box 6811, Cairns, QLD, 4870, Australia
- Centre for Tropical Environmental and Sustainability Sciences, James Cook University, P. O. Box 6811, Cairns, QLD, 4870, Australia
| | - David Thomas Wilson
- Centre for Molecular Therapeutics, Australian Institute for Tropical Health and Medicine, James Cook University, Cairns, QLD, 4878, Australia
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12
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Walker K, Tan SI, Fatovich D, Watkins G, Stephenson M, Ting J, Whittome R, Wang W, Knott J. Research capacity of Australian and New Zealand emergency medicine departments. Int J Emerg Med 2020; 13:16. [PMID: 32293255 PMCID: PMC7161130 DOI: 10.1186/s12245-020-00275-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Accepted: 03/31/2020] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Large, multicentre studies are required in emergency medicine to advance clinical care and improve patient outcomes. The Australasian College for Emergency Medicine clinical trials network is available to researchers to assist with facilitating large, multicentre research. However, there is no current information about the research capacity of emergency departments (EDs) in Australia and New Zealand. METHODS All EDs accredited for emergency medicine training in Australia and New Zealand were eligible to participate. Research leads or ED directors were invited via email and telephone to complete a survey. Data were collected regarding the presence of a research lead; their research experience; available research resources including colleagues, funding, departmental paid research time; publications; and research culture. RESULTS One hundred and twelve responses were received on behalf of 122 (84%) sites (10 satellite plus main) from a possible 143 sites with all types of hospitals and regions represented. Research leads were identified at 66 (59%) sites; 32 (29%) had a director of emergency medicine research. A wide range of research was underway. Ninety-six sites (66%) contributed data to multicentre projects. Twenty-one centres (17%) were highly productive with multiple resources (skilled colleagues, funding, staffing), a positive research culture and high-volume output. Sixty to seventy centres (50-58%) had limited resources, experienced an unsupportive research culture and authored manuscripts infrequently. Paid time for research directors was associated with increased research outputs. DISCUSSION ACEM sites have the capacity to undertake large multicentre studies with a varied network of sites and researchers. While some sites are well equipped for research, the majority of EDs had minimal research output.
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Affiliation(s)
- Katie Walker
- Emergency Department, Cabrini, 183 Wattletree Rd, Malvern, Melbourne, Victoria, 3144, Australia. .,Health Services, Monash University, Melbourne, Victoria, 3004, Australia.
| | - Shijie Ian Tan
- Emergency Department, Cabrini, 183 Wattletree Rd, Malvern, Melbourne, Victoria, 3144, Australia.,Faculty of Medicine, Nursing and Health Sciences, Monash University, Building 15, 27 Rainforest Walk, Clayton Campus, Wellington Rd, Clayton, Victoria, 3800, Australia.,Ng Teng Fong General Hospital, 1 Jurong East Street 21, Singapore, 609606, Singapore
| | - Daniel Fatovich
- Department of Emergency Medicine, Royal Perth Hospital, GPO Box X2213, Perth, 6001, Western Australia.,Centre for Clinical Research in Emergency Medicine, Harry Perkins Institute of Medical Research, University of Western Australia, Perth, 6001, Australia
| | - Gina Watkins
- Emergency Department, Sutherland Hospital, Caringbah, Sydney, NSW, 2229, Australia.,School of Medicine, University of New South Wales, Sydney, New South Wales, 2052, Australia
| | - Melanie Stephenson
- Emergency Department, Cabrini, 183 Wattletree Rd, Malvern, Melbourne, Victoria, 3144, Australia.,Health Services, Monash University, Melbourne, Victoria, 3004, Australia.,Emergency Department, Austin Hospital, Heidelberg, Victoria, 3084, Australia
| | - Joseph Ting
- Mater Hospital, Raymond Terrace, South Brisbane, Queensland, 4101, Australia.,Ipswich Hospital, Chelmsford Ave, Ipswich, Queensland, 4305, Australia.,School of Public Health and Social Work, Queensland University of Technology, 2 George St, Brisbane City, Queensland, 4000, Australia
| | - Richard Whittome
- Australasian College for Emergency Medicine, West Melbourne, Victoria, 3003, Australia
| | - Wei Wang
- Cabrini Institute, 154 Wattletree Rd, Malvern, Victoria, 3144, Australia.,Faculty of Medicine, Nursing and Health Sciences, Monash University, 553 St Kilda Rd, Melbourne, Victoria, 3004, Australia
| | - Jonathan Knott
- Emergency Department, Royal Melbourne Hospital, 300 Grattan St, Parkville, Victoria, 3050, Australia.,Melbourne Medical School, University of Melbourne, Grattan Street, Melbourne, Victoria, 3010, Australia
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13
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Porras-Villamil JF, Olivera MJ, Hinestroza-Ruiz ÁC, López-Moreno GA. Envenomation by an arachnid (Latrodectus or Steatoda): Case report involving a woman and her female dog. CASE REPORTS 2020. [DOI: 10.15446/cr.v6n1.79718] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Introduction: Accidents involving spiders bites usually cause mild medical reactions that lead to local symptoms and, less commonly, systemic effects. The most medically significant spiders belong to the genera Latrodectus and Loxosceles. This paper presents a posible case of steatodism in a young woman and her pet.Case description: 26-year-old female patient, who reports a clinical history characterized by paresthesia, malaise, fever, diarrea and a painful papule in the left cheek after being bitten by a spider. Immediately after being bit, the patient hit the spider with the back of her hand and it fell to the ground, where her dog swallowed it. The dog presented with vomiting and general discomfort after ingestion. Symptomatic therapy was given for comfort, and neither the patient nor the dog required antivenin therapy. Both evolved favorably.Discussion: The relevance of this case is the involvement of two mammals (a human and her dog) due to the accidental contact with a spider, possibly of the genus Latrodectus or Steatoda.Conclusion: Two possible cases of steatodism are described. Since spider bites are a relatively frequent reason for medical consultation in Colombia, it is important to diagnose and manage them properly.
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14
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Graudins A. Therapeutic trends in the treatment of barbiturate poisoning: The ‘Scandinavian method’. Emerg Med Australas 2019; 31:893-894. [DOI: 10.1111/1742-6723.13360] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Accepted: 07/03/2019] [Indexed: 11/27/2022]
Affiliation(s)
- Andis Graudins
- Department of Emergency MedicineMonash Health Melbourne Victoria Australia
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15
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Dart RC, Bush SP, Heard K, Arnold TC, Sutter M, Campagne D, Holstege CP, Seifert SA, Lo JC, Quan D, Borron S, Meurer DA, Burnham RI, McNally J, Garcia-Ubbelohde W, Anderson VE. The Efficacy of Antivenin Latrodectus (Black Widow) Equine Immune F(abʹ)2 Versus Placebo in the Treatment of Latrodectism: A Randomized, Double-Blind, Placebo-Controlled, Clinical Trial. Ann Emerg Med 2019; 74:439-449. [DOI: 10.1016/j.annemergmed.2019.02.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Revised: 01/26/2019] [Accepted: 02/05/2019] [Indexed: 10/27/2022]
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16
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Ryan NM, James R, Downes MA, Isbister GK. Low-dose ketamine provides poor analgesia for pain in redback spider envenoming. Br J Clin Pharmacol 2019; 85:2423-2427. [PMID: 31269538 DOI: 10.1111/bcp.14052] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Revised: 05/24/2019] [Accepted: 06/18/2019] [Indexed: 12/26/2022] Open
Abstract
Redback spider envenoming causes severe pain lasting several days. A recent clinical trial found that antivenom is not effective. We investigated ketamine for pain in redback spider envenoming. Ten adult patients with severe pain from redback spider envenoming were administered 15 mg intravenous ketamine after standard analgesia, then up to 4 oral doses of ketamine 25- 50 mg. Three patients had a clinically significant improvement in pain compared to baseline after intravenous ketamine. Five patients had a minimal decrease in pain and 2 had no improvement. Eight patients received oral ketamine: 4 doses in 5 and 2 doses in 3. At 24 h, 3/6 patients assessed had clinically significant improvement in pain and 4/5 patients assessed at 48 h, had clinically significant improvement in pain. Six patients reported side effects, including dissociation (4) and hallucinations (2). Five patients required rescue opioids and 2 were readmitted to hospital. We found that ketamine provided no additional pain relief in redback spider envenoming, compared to standard analgesia, and resulted in unacceptable adverse effects.
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Affiliation(s)
- Nicole M Ryan
- Clinical Toxicology Research Group, University of Newcastle, Newcastle, New South Wales, Australia
| | - Rosemary James
- Pharmacy Department, Calvary Mater Newcastle, Newcastle, New South Wales, Australia
| | - Michael A Downes
- Clinical Toxicology Research Group, University of Newcastle, Newcastle, New South Wales, Australia.,Department of Clinical Toxicology and Pharmacology, Calvary Mater Newcastle, Newcastle, New South Wales, Australia
| | - Geoffrey K Isbister
- Clinical Toxicology Research Group, University of Newcastle, Newcastle, New South Wales, Australia
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17
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Bryan SA, Vink CJ, Barratt BIP, Seddon PJ, van Heezik Y. Investigation of two new putative pheromone components of the invasive Australian redback spider, Latrodectus hasseltii, with potential applications for control. NEW ZEALAND JOURNAL OF ZOOLOGY 2018. [DOI: 10.1080/03014223.2018.1536067] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Stacey A. Bryan
- Department of Zoology, University of Otago, Dunedin, New Zealand
| | - Cor J. Vink
- Canterbury Museum, Christchurch, New Zealand
| | - Barbara I. P. Barratt
- Department of Botany, University of Otago, Dunedin, New Zealand
- AgResearch, Invermay Agricultural Centre, Mosgiel, New Zealand
| | - Philip J. Seddon
- Department of Zoology, University of Otago, Dunedin, New Zealand
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18
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[Surgical treatment of bites]. OPERATIVE ORTHOPADIE UND TRAUMATOLOGIE 2018; 30:321-341. [PMID: 30209521 DOI: 10.1007/s00064-018-0563-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/15/2018] [Revised: 05/21/2018] [Accepted: 06/07/2018] [Indexed: 01/14/2023]
Abstract
OBJECTIVE Thorough and profound debridement for acute bite injuries while sparing nerves, vessels and tendons. INDICATIONS Acute traumatic and late presented bite injuries. CONTRAINDICATIONS General contraindication for anesthesia or surgery. SURGICAL TECHNIQUE Extensive flabellate local anesthesia/general anesthesia, wound irrigation using 0.9% NaCl or antiseptic solutions, removal of avital tissues, wound debridement, wound edge excision, anew extensive irrigation, drainage if necessary, wound closure where applicable (except older or punctual deep injuries), bandage, elastic wrapping and immobilization. If necessary, plastic surgery with coverage of remaining defects. POSTOPERATIVE MANAGEMENT Immobilization with initially daily wound evaluation, removal of drainage/loop on postoperative day 2; if necessary, antibiotic therapy with amoxicillin and clavulanic acid in high-risk wounds (e.g., puncture wounds, joint or bone involvement, extensive soft tissue squeezing), suture removal on day 10-12 after surgery. RESULTS Of 142 bite injuries that were treated and retrospectively evaluated, 46% were caused by dogs and 32% by cats. Patients were on average 44 years old; 55% of all dog bites affected women, but 67% of all cat bites. In 48% of the cases, general anesthesia was necessary. The postoperative infection rate was 6.3%.
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20
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Mori S, Horita A, Ginnaga A, Miyatsu Y, Sawabe K, Matsumura T, Ato M, Yamamoto A, Shibayama K, Arai S, Yamagishi T, Takahashi M, Taki H, Hifumi T. Venom and Antivenom of the Redback Spider (Latrodectus hasseltii) in Japan. Part II. Experimental Production of Equine Antivenom against the Redback Spider. Jpn J Infect Dis 2017; 70:635-641. [PMID: 29093316 DOI: 10.7883/yoken.jjid.2017.125] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
This is the first report on large-scale experimental production of an equine antivenom against the redback spider (Latrodectus hasseltii) lived in Japan. We captured 10,000 redback spiders in Japan and prepared the toxoids of crude venom extract, mixed the toxoids with a mineral oil adjuvant, and immunized healthy horses repeatedly over a period of several weeks. Thereafter, we separated the horse plasma, purified the γ-globulin fraction, and stocked it as a purified antivenom concentrate. Consequently, we manufactured approximately 6,500 vials of a single-dose freeze-dried test lot from a portion of the purified γ-globulin fraction, equivalent to the extract derived from 520 spiders. This test lot had an antitoxin titer comparable to that of a similar drug commercially available overseas (a liquid preparation), and the other quality met all quality reference specifications based on the Minimum Requirements for Biological Products and other guidelines relevant to existing antivenom drug products in Japan.
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Affiliation(s)
- Shigemi Mori
- The Chemo-Sero-Therapeutic Research Institute (KAKETSUKEN)
| | - Akira Horita
- The Chemo-Sero-Therapeutic Research Institute (KAKETSUKEN)
| | | | | | | | | | - Manabu Ato
- National Institute of Infectious Diseases
| | | | | | | | | | | | | | - Toru Hifumi
- Kagawa University Hospital Emergency Medical Center
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21
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Dangerous arachnids-Fake news or reality? Toxicon 2017; 138:173-183. [PMID: 28866287 DOI: 10.1016/j.toxicon.2017.08.024] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2017] [Revised: 07/28/2017] [Accepted: 08/27/2017] [Indexed: 02/07/2023]
Abstract
The public perception of spiders and scorpions is skewed towards the potential harm they can inflict in humans, despite recent scientific evidence that arachnid venom components might be useful as bioinsecticides or even human therapeutics. Nevertheless, arachnids are becoming more popular as pets in Europe, America and Asia, raising the question for regulatory agencies in these regions as to whether they need to take measurements to protect their citizens. In order to decide upon the necessary regulatory steps, they first need to determine which arachnids are actually dangerous to humans. This review therefore provides an overview of the current literature on verified bites and stings from spiders and scorpions with the aim of assessing their potential danger for human health. As a guideline, we also provide a list of those arachnid genera that we consider as potentially dangerous, which includes 10 spider and 11 scorpion genera. The arachnid genera classified as dangerous comprise less than a quarter of all extant scorpion species and only 0.5% of all spiders species, with the actual number most likely being much lower than that, as not all species in those genera might turn out to pose an actual threat for humans. In conclusion, we found that only a small percentage of scorpions and a minute percentage of all spiders can be considered as potentially dangerous to humans. While in some countries of origin the high incidence of envenomations by dangerous arachnids can result in a serious problem to the health system, we assessed the risk that the same species pose when kept as pets under controlled maintenance conditions as significantly lower.
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22
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Abstract
Blood serum from immunized humans or animals (e.g., horses) contains relevant antibodies and has been used as serum therapy to treat many diseases or envenomation events. The effectiveness of blood serum was initially discovered in 1890 when Kitasato and von Behring observed the effectiveness of this type of therapy against diphtheria and tetanus. Serum therapies played an important role in the advancement of modern medicine prior to the development of penicillin and steroids. At present, several types of serum therapy remain in clinical use. However, some physicians have a limited understanding of the nature and the benefits of serum therapy and the factors that require particular attention. In this review, we set out to clarify the benefits, cautions, and potential applications of serum therapy in the context of conditions such as gas gangrene, diphtheria, botulism, and tetanus and bites from three snake species (mamushi, habu, and yamakagashi) and the redback spider. It is hoped that this review will help clinicians to learn about clinical serum therapies and become familiar with their applications.
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23
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Treatments for Latrodectism-A Systematic Review on Their Clinical Effectiveness. Toxins (Basel) 2017; 9:toxins9040148. [PMID: 28430165 PMCID: PMC5408222 DOI: 10.3390/toxins9040148] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2017] [Revised: 03/31/2017] [Accepted: 04/10/2017] [Indexed: 11/16/2022] Open
Abstract
Latrodectism or envenomation by widow-spiders is common and clinically significant worldwide. Alpha-latrotoxin is the mammalian-specific toxin in the venom that results in toxic effects observed in humans. Symptoms may be incapacitating and include severe pain that can persist for days. The management of mild to moderate latrodectism is primarily supportive while severe cases have variously been treated with intravenous calcium, muscle relaxants, widow-spider antivenom and analgesic opioids. The object of this systematic review is to examine the literature on the clinical effectiveness of past and current treatments for latrodectism. MEDLINE, EMBASE and Google Scholar were searched from 1946 to December 2016 to identify clinical studies on the treatment of latrodectism. Studies older than 40 years and not in English were not reviewed. There were only two full-publications and one abstract of placebo-controlled randomised trials on antivenom use for latrodectism. Another two randomised comparative trials compared the route of administration of antivenom for latrodectism. There were fourteen case series (including two abstracts), fourteen case reports and one letter investigating drug treatments for latrodectism with the majority of these also including antivenom for severe latrodectism. Antivenom with opioid analgesia is often the major treatment reported for latrodectism however; recent high quality evidence has cast doubt on the clinical effectiveness of this combination and suggests that other treatments need to be investigated.
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24
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Isbister GK, Palmer DJ, Weir RL, Currie BJ. Hot water immersion
v
icepacks for treating the pain of
Chironex fleckeri
stings: a randomised controlled trial. Med J Aust 2017; 206:258-261. [DOI: 10.5694/mja16.00990] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2016] [Accepted: 10/17/2016] [Indexed: 11/17/2022]
Affiliation(s)
- Geoffrey K Isbister
- University of Newcastle, Newcastle, NSW
- Calvary Mater Newcastle, Newcastle, NSW
| | | | - Rebecca L Weir
- Royal Darwin Hospital, Darwin, NT
- North East Health Wangaratta, Wangaratta, VIC
| | - Bart J Currie
- Menzies School of Health, Royal Darwin Hospital, Darwin, NT
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25
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Isbister GK, Buckley NA. Therapeutics in clinical toxicology: in the absence of strong evidence how do we choose between antidotes, supportive care and masterful inactivity. Br J Clin Pharmacol 2016; 81:408-11. [PMID: 26914603 DOI: 10.1111/bcp.12819] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2015] [Accepted: 11/03/2015] [Indexed: 12/13/2022] Open
Affiliation(s)
- Geoffrey K Isbister
- Clinical Toxicology Research Group, University of Newcastle, Newcastle, New South Wales.,NSW Poisons Information Centre, The Childrens Hospital Westmead, Sydney, New South Wales
| | - Nicholas A Buckley
- NSW Poisons Information Centre, The Childrens Hospital Westmead, Sydney, New South Wales.,Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
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26
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Buckley NA, Dawson AH, Juurlink DN, Isbister GK. Who gets antidotes? choosing the chosen few. Br J Clin Pharmacol 2016; 81:402-7. [PMID: 26816206 DOI: 10.1111/bcp.12894] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2015] [Revised: 01/25/2016] [Accepted: 01/26/2016] [Indexed: 12/25/2022] Open
Abstract
An understanding of mechanisms, potential benefits and risks of antidotes is essential for clinicians who manage poisoned patients. Of the dozens of antidotes currently available, only a few are regularly used. These include activated charcoal, acetylcysteine, naloxone, sodium bicarbonate, atropine, flumazenil, therapeutic antibodies and various vitamins. Even then, most are used in a minority of poisonings. There is little randomized trial evidence to support the use of most antidotes. Consequently, decisions about when to use them are often based on a mechanistic understanding of the poisoning and the expected influence of the antidote on the patient's clinical course. For some antidotes, such as atropine and insulin, the doses employed can be orders of magnitude higher than standard dosing. Importantly, most poisoned patients who reach hospital can recover with supportive care alone. In low risk patients, the routine use of even low risk antidotes such as activated charcoal is unwarranted. In more serious poisonings, decisions regarding antidote use are generally guided by a risk/benefit assessment based on low quality evidence.
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Affiliation(s)
- Nicholas A Buckley
- NSW Poisons Information Centre, The Childrens Hospital Westmead, Sydney, New South Wales.,Sydney Medical School, University of Sydney, Sydney, New South Wales.,Department of Clinical Toxicology, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Andrew H Dawson
- NSW Poisons Information Centre, The Childrens Hospital Westmead, Sydney, New South Wales.,Sydney Medical School, University of Sydney, Sydney, New South Wales.,Department of Clinical Toxicology, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - David N Juurlink
- Departments of Medicine, Paediatrics and Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
| | - Geoffrey K Isbister
- NSW Poisons Information Centre, The Childrens Hospital Westmead, Sydney, New South Wales.,Clinical Toxicology Research Group, University of Newcastle, Newcastle, New South Wales, Australia
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27
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Yan S, Wang X. Recent Advances in Research on Widow Spider Venoms and Toxins. Toxins (Basel) 2015; 7:5055-67. [PMID: 26633495 PMCID: PMC4690112 DOI: 10.3390/toxins7124862] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2015] [Revised: 11/02/2015] [Accepted: 11/16/2015] [Indexed: 01/29/2023] Open
Abstract
Widow spiders have received much attention due to the frequently reported human and animal injures caused by them. Elucidation of the molecular composition and action mechanism of the venoms and toxins has vast implications in the treatment of latrodectism and in the neurobiology and pharmaceutical research. In recent years, the studies of the widow spider venoms and the venom toxins, particularly the α-latrotoxin, have achieved many new advances; however, the mechanism of action of the venom toxins has not been completely clear. The widow spider is different from many other venomous animals in that it has toxic components not only in the venom glands but also in other parts of the adult spider body, newborn spiderlings, and even the eggs. More recently, the molecular basis for the toxicity outside the venom glands has been systematically investigated, with four proteinaceous toxic components being purified and preliminarily characterized, which has expanded our understanding of the widow spider toxins. This review presents a glance at the recent advances in the study on the venoms and toxins from the Latrodectus species.
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Affiliation(s)
- Shuai Yan
- Key Laboratory of Protein Chemistry and Developmental Biology of Ministry of Education, College of Life Sciences, Hunan Normal University, Changsha 410081, China.
| | - Xianchun Wang
- Key Laboratory of Protein Chemistry and Developmental Biology of Ministry of Education, College of Life Sciences, Hunan Normal University, Changsha 410081, China.
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28
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Maduwage K, Buckley NA, de Silva HJ, Lalloo DG, Isbister GK. Snake antivenom for snake venom induced consumption coagulopathy. Cochrane Database Syst Rev 2015; 2015:CD011428. [PMID: 26058967 PMCID: PMC11103661 DOI: 10.1002/14651858.cd011428.pub2] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Snake venom induced consumption coagulopathy is a major systemic effect of envenoming. Observational studies suggest that antivenom improves outcomes for venom induced consumption coagulopathy in some snakebites and not others. However, the effectiveness of snake antivenom in all cases of venom induced consumption coagulopathy is controversial. OBJECTIVES To assess the effect of snake antivenom as a treatment for venom induced consumption coagulopathy in people with snake bite. SEARCH METHODS The search was done on 30 January 2015. We searched the Cochrane Injuries Group's Specialised Register, the Cochrane Central Register of Controlled Trials (CENTRAL, The Cochrane Library), Ovid MEDLINE(R), Ovid MEDLINE(R) In-Process & Other Non-Indexed Citations, Ovid MEDLINE(R) Daily and Ovid OLDMEDLINE(R), Embase Classic+Embase (OvidSP), three other sources, clinical trials registers, and we also screened reference lists. SELECTION CRITERIA All completed, published or unpublished, randomised, controlled trials with a placebo or no treatment arm, where snake antivenom was administered for venom induced consumption coagulopathy in humans with snake bites. DATA COLLECTION AND ANALYSIS Two authors reviewed the identified trials and independently applied the selection criteria. MAIN RESULTS No studies met the inclusion criteria for this review. AUTHORS' CONCLUSIONS Randomised placebo-controlled trials are required to investigate the effectiveness of snake antivenom for clinically relevant outcomes in patients with venom induced consumption coagulopathy resulting from snake bite. Although ethically difficult, the routine administration of a treatment that has a significant risk of anaphylaxis cannot continue without strong evidence of benefit.
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Affiliation(s)
- Kalana Maduwage
- University of NewcastleSchool of Medicine and Public HealthC/O Calvary Mater NewcastleWaratahNSWAustralia2294
| | - Nick A Buckley
- University of SydneyDepartment of PharmacologyBlackburn Building D06Sydney Medical SchoolCamperdownNSWAustralia2006
| | | | - David G Lalloo
- Liverpool School of Tropical MedicineClinical Research GroupPembroke PlaceLiverpoolMerseysideUKL3 5QA
| | - Geoffrey K Isbister
- University of NewcastleSchool of Medicine and Public HealthC/O Calvary Mater NewcastleWaratahNSWAustralia2294
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29
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White J, Weinstein SA. Latrodectism and Effectiveness of Antivenom. Ann Emerg Med 2015; 65:123-4. [DOI: 10.1016/j.annemergmed.2014.08.022] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2014] [Revised: 08/05/2014] [Accepted: 08/05/2014] [Indexed: 11/27/2022]
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30
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Isbister GK, Page CB, Isbister GK, Buckley NA, Fatovich DM, Brown SGA. In reply. Ann Emerg Med 2014; 65:124-5. [PMID: 25529160 DOI: 10.1016/j.annemergmed.2014.08.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2014] [Revised: 08/18/2014] [Accepted: 08/18/2014] [Indexed: 10/24/2022]
Affiliation(s)
- Geoffrey K Isbister
- School of Medicine and Public Health, University of Newcastle and Department of Clinical Toxicology, Calvary Mater Newcastle, New South Wales, Australia
| | - Colin B Page
- School of Medicine and Public Health, University of Newcastle and Department of Clinical Toxicology, Calvary Mater Newcastle, New South Wales, Australia
| | - Geoffrey K Isbister
- New South Wales Poisons Information Centre, Sydney Children's Hospital Network, New South Wales, Australia; Clinical Pharmacology, Sydney Medical School, University of Sydney, New South Wales, Australia
| | - Nicholas A Buckley
- New South Wales Poisons Information Centre, Sydney Children's Hospital Network, New South Wales, Australia; Clinical Pharmacology, Sydney Medical School, University of Sydney, New South Wales, Australia
| | - Daniel M Fatovich
- Centre for Clinical Research in Emergency Medicine, Royal Perth Hospital, Harry Perkins Institute of Medical Research and the University of Western Australia, Perth, Australia
| | - Simon G A Brown
- Centre for Clinical Research in Emergency Medicine, Royal Perth Hospital, Harry Perkins Institute of Medical Research and the University of Western Australia, Perth, Australia
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