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Nachshon A, Bazer R, Dagan G, Firman S. Peripheral Nerve Block to Treat Pain Caused by Daboia palaestinae Envenomation. A A Pract 2024; 18:e01744. [PMID: 38557929 DOI: 10.1213/xaa.0000000000001744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2024]
Abstract
Snakebite pain can be challenging to control. We describe our experience managing intolerable pain after conventional treatment failed. A 35-year-old man, presented after a viper snakebite, suffering from intolerable pain in the affected extremity. He had no significant past medical history. All attempts to control the pain conventionally were unsuccessful. Treatment with a supraclavicular nerve block resulted in immediate relief. After the block receded, only a dull pain remained, which later disappeared without recurrence. This experience illustrates the need for personalized pain treatment to avoid subsequent complications.
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Affiliation(s)
- Akiva Nachshon
- From the General Intensive Care Unit, Department of Anesthesiology, Critical Care and Pain Medicine, Hadassah Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Rashit Bazer
- Department of Anesthesiology, Critical Care and Pain Medicine, Hadassah Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Gil Dagan
- Department of Cardiology, Hadassah Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Shimon Firman
- From the General Intensive Care Unit, Department of Anesthesiology, Critical Care and Pain Medicine, Hadassah Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
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2
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Arestakesyan H, LeFevre N, Posnack N, Sarian A, Grigoryan V, Ayvazyan N, Voskanyan A, Sarvazyan N, Karabekian Z. Changes in attachment and metabolic activity of rat neonatal cardiomyocytes and nonmyocytes caused by Macrovipera lebetina obtusa venom. Toxicol In Vitro 2024; 95:105755. [PMID: 38061605 DOI: 10.1016/j.tiv.2023.105755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Revised: 11/03/2023] [Accepted: 11/30/2023] [Indexed: 12/17/2023]
Abstract
The Caucasian viper Macrovipera lebetina obtusa (MLO) is one of the most prevalent and venomous snakes in the Caucasus and the surrounding regions, yet the effects of MLO venom on cardiac function remain largely unknown. We examined the influence of MLO venom (crude and with inhibited metalloproteinases and phospholipase A2) on attachment and metabolic activity of rat neonatal cardiomyocytes (CM) and nonmyocytes (nCM), assessed at 1 and 24 h. After exposing both CM and nCM to varying concentrations of MLO venom, we observed immediate cytotoxic effects at a concentration of 100 μg/ml, causing detachment from the culture substrate. At lower MLO venom concentrations both cell types detached in a dose-dependent manner. Inhibition of MLO venom metalloproteinases significantly improved CM and nCM attachment after 1-hour exposure. At 24-hour exposure to metalloproteinases inhibited venom statistically significant enhancement was observed only in nCM attachment. However, metabolic activity of CM and nCM did not decrease upon exposure to the lower dose of the venom. Moreover, we demonstrated that metalloproteinases and phospholipases A2 are not the components of the MLO venom that change metabolic activity of both CM and nCM. These results provide a valuable platform to study the impact of MLO venom on prey cardiac function. They also call for further exploration of individual venom components for pharmaceutical purposes.
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Affiliation(s)
- Hovhannes Arestakesyan
- Orbeli Institute of Physiology, National Academy of Sciences, 22 Orbeli Bros. St., Yerevan 0028, Armenia; Department of Pharmacology and Physiology, School of Medicine and Health Sciences, The George Washington University, Washington, DC 20037, USA
| | - Narine LeFevre
- Department of Pharmacology and Physiology, School of Medicine and Health Sciences, The George Washington University, Washington, DC 20037, USA
| | - Nikki Posnack
- Department of Pharmacology and Physiology, School of Medicine and Health Sciences, The George Washington University, Washington, DC 20037, USA; Children's National Heart Institute, Sheikh Zayed Institute of Pediatric Surgical Innovation, Washington, DC 20010, USA
| | - Arni Sarian
- Orbeli Institute of Physiology, National Academy of Sciences, 22 Orbeli Bros. St., Yerevan 0028, Armenia
| | - Vahan Grigoryan
- Orbeli Institute of Physiology, National Academy of Sciences, 22 Orbeli Bros. St., Yerevan 0028, Armenia
| | - Naira Ayvazyan
- Orbeli Institute of Physiology, National Academy of Sciences, 22 Orbeli Bros. St., Yerevan 0028, Armenia
| | - Armen Voskanyan
- Orbeli Institute of Physiology, National Academy of Sciences, 22 Orbeli Bros. St., Yerevan 0028, Armenia
| | - Narine Sarvazyan
- Orbeli Institute of Physiology, National Academy of Sciences, 22 Orbeli Bros. St., Yerevan 0028, Armenia; Department of Pharmacology and Physiology, School of Medicine and Health Sciences, The George Washington University, Washington, DC 20037, USA
| | - Zaruhi Karabekian
- Orbeli Institute of Physiology, National Academy of Sciences, 22 Orbeli Bros. St., Yerevan 0028, Armenia; Department of Pharmacology and Physiology, School of Medicine and Health Sciences, The George Washington University, Washington, DC 20037, USA.
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3
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Yahaya SNB, Khan AHKY, Sankala HA. A Case of Cobra Bite Complicated with Basilar Artery Occlusion. J Emerg Trauma Shock 2023; 16:185-188. [PMID: 38292282 PMCID: PMC10824211 DOI: 10.4103/jets.jets_23_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2023] [Revised: 03/29/2023] [Accepted: 04/17/2023] [Indexed: 02/01/2024] Open
Abstract
Snakebite is one of the most common complaints related to wilderness medicine. Venomous snakebite manifestation is divided into local and systemic envenomation. For the Elapidae group, the most feared complication is respiratory muscle paralysis due to neurotransmitter malfunction at the neuromuscular junction level which leads to respiratory insufficiency. However, there is a lack of evidence or case report incidence to suggest that it can potentially associate with the development of stroke disorder. We present a rare case of massive posterior circulation infarct in a middle-aged gentleman following a cobra bite. He was brought to our center few hours later following the bite and antivenom was administered. He improved shortly after receiving it. However, he had an abrupt drop in his conscious level several hours later. Noncontrast-enhanced computed tomography (NCCT) brain was performed immediately, but stroke disorder was excluded prematurely. Repeated NCCT imaging which was done 12 h apart showed massive posterior circulation infarction with hydrocephalus. He succumbed to death 3 days later. Given its rarity, the evolution of his clinical condition warrants clinician's early suspicion of potential stroke-related complications that can occur following a cobra bite.
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Affiliation(s)
| | - Abdul Hanif Khan Yusof Khan
- Department of Neurology, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Malaysia
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Nielsen VG. Novel Toxicodynamic Model of Subcutaneous Envenomation to Characterize Snake Venom Coagulopathies and Assess the Efficacy of Site-Directed Inorganic Antivenoms. Int J Mol Sci 2023; 24:13939. [PMID: 37762243 PMCID: PMC10530349 DOI: 10.3390/ijms241813939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Revised: 08/31/2023] [Accepted: 09/03/2023] [Indexed: 09/29/2023] Open
Abstract
Venomous snake bite adversely affects millions of people yearly, but few animal models allow for the determination of toxicodynamic timelines with hemotoxic venoms to characterize the onset and severity of coagulopathy or assess novel, site-directed antivenom strategies. Thus, the goals of this investigation were to create a rabbit model of subcutaneous envenomation to assess venom toxicodynamics and efficacy of ruthenium-based antivenom administration. New Zealand White rabbits were sedated with midazolam via the ear vein and had viscoelastic measurements of whole blood and/or plasmatic coagulation kinetics obtained from ear artery samples. Venoms derived from Crotalus scutulatus scutulatus, Bothrops moojeni, or Calloselasma rhodostoma were injected subcutaneously, and changes in coagulation were determined over three hours and compared to samples obtained prior to envenomation. Other rabbits had ruthenium-based antivenoms injected five minutes after venom injection. Viscoelastic analyses demonstrated diverse toxicodynamic patterns of coagulopathy consistent with the molecular composition of the proteomes of the venoms tested. The antivenoms tested attenuated venom-mediated coagulopathy. A novel rabbit model can be used to characterize the onset and severity of envenomation by diverse proteomes and to assess site-directed antivenoms. Future investigation is planned involving other medically important venoms and antivenom development.
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Affiliation(s)
- Vance G Nielsen
- Department of Anesthesiology, The University of Arizona College of Medicine, Tucson, AZ 85724, USA
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Kalpana S, Ravi S, Muthu T. Acute Demyelination Following Snake Bite - An Unusual Complication. Indian J Pediatr 2023; 90:846. [PMID: 37249832 DOI: 10.1007/s12098-023-04655-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Accepted: 05/02/2023] [Indexed: 05/31/2023]
Affiliation(s)
- Sivasambo Kalpana
- Department of Pediatric Medicine, Government Vellore Medical College, Adukamparai, Tamil Nadu, India.
| | - Suwethaa Ravi
- Department of Pediatric Medicine, Government Vellore Medical College, Adukamparai, Tamil Nadu, India
| | - T Muthu
- Department of Neurology, Government Vellore Medical College, Adukamparai, Tamil Nadu, India
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6
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Soopairin S, Patikorn C, Taychakhoonavudh S. Antivenom preclinical efficacy testing against Asian snakes and their availability in Asia: A systematic review. PLoS One 2023; 18:e0288723. [PMID: 37467278 DOI: 10.1371/journal.pone.0288723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2023] [Accepted: 07/04/2023] [Indexed: 07/21/2023] Open
Abstract
BACKGROUND Cross-neutralizing strategy has been applied to improve access to antivenoms, a key to reducing mortality and disability of snakebite envenoming. However, preclinical studies have been conducted to identify antivenoms' cross-neutralizing ability when clinical studies may not be considered ethical. Therefore, this study aimed to identify and summarize scattered evidence regarding the preclinical efficacy of antivenoms against Asian snakes. METHODOLOGY/PRINCIPLE FINDINGS In this systematic review, we searched for articles published until May 30, 2022, in PubMed, Scopus, Web of Science, and Embase. Preclinical studies that reported the available antivenoms' neutralizing ability against Asian snake lethality were included. Quality assessment was performed using the Systematic Review Centre for Laboratory animal Experimentation's risk of bias tool and the adapted the Animal Research Reporting In Vivo Experiments guidelines. The availability of effective antivenoms against Asian snakes was analyzed by comparing data from included studies with snakebite-information and data platforms developed by the World Health Organization. Fifty-two studies were included. Most studies assessed the antivenom efficacy against snakes from Southeast Asia (58%), followed by South Asia (35%) and East Asia (19%). Twenty-two (49%) medically important snakes had antivenom(s) with confirmed neutralizing ability. Situation analyses of the availability of effective antivenoms in Asia demonstrated that locally produced antivenoms did not cover all medically important snakes in each country. Among countries without local antivenom production, preclinical studies were conducted only in Bangladesh, Sri Lanka, and Malaysia. Risk of bias assessment was limited in some domains because of unreported data. CONCLUSIONS/SIGNIFICANCE Cross-neutralizing of antivenoms against some medically important snakes in Asia was confirmed. This strategy may improve access to geographically effective antivenoms and bypass investment in novel antivenom development, especially in countries without local antivenom production. A database should be developed to aid the development of a snakebite-information system.
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Affiliation(s)
- Sutinee Soopairin
- Department of Social and Administrative Pharmacy, Faculty of Pharmaceutical Sciences, Chulalongkorn University, Bangkok, Thailand
| | - Chanthawat Patikorn
- Department of Social and Administrative Pharmacy, Faculty of Pharmaceutical Sciences, Chulalongkorn University, Bangkok, Thailand
| | - Suthira Taychakhoonavudh
- Department of Social and Administrative Pharmacy, Faculty of Pharmaceutical Sciences, Chulalongkorn University, Bangkok, Thailand
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Gopal G, Muralidar S, Prakash D, Kamalakkannan A, Indhuprakash ST, Thirumalai D, Ambi SV. The concept of Big Four: Road map from snakebite epidemiology to antivenom efficacy. Int J Biol Macromol 2023; 242:124771. [PMID: 37169043 DOI: 10.1016/j.ijbiomac.2023.124771] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Revised: 05/02/2023] [Accepted: 05/03/2023] [Indexed: 05/13/2023]
Abstract
Snake envenomation is a life-threatening disease caused by the injection of venom toxins from the venomous snake bite. Snakebite is often defined as the occupational or domestic hazard mostly affecting the rural population. India experiences a high number of envenoming cases and fatality due to the nation's diversity in inhabiting venomous snakes. The Indian Big Four snakes namely Russell's viper (Daboia russelii), spectacled cobra (Naja naja), common krait (Bungarus caeruleus), and saw-scaled viper (Echis carinatus) are responsible for majority of the snake envenoming cases and death. The demographic characteristics including occupation, stringent snake habitat management, poor healthcare facilities and ignorance of the rural victims are the primary influencers of high mortality. Biogeographic venom variation greatly influences the clinical pathologies of snake envenomation. The current antivenoms against the Big Four snakes are found to be less immunogenic against the venom toxins emphasizing the necessity of alternative approaches for antivenom generation. This review summarizes the burden of snake envenomation in India by the Big Four snakes including the geographic distribution of snake species and biogeographic venom variation. We have provided comprehensive information on snake venom proteomics that has aided the better understanding of venom induced pathological features, summarized the impact of current polyvalent antivenom therapy highlighting the need for potential antivenom treatment for the effective management of snakebites.
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Affiliation(s)
- Gayathri Gopal
- Biopharmaceutical Research Lab, Anusandhan Kendra-1, SASTRA Deemed-to-be-University, Thanjavur 613401, Tamil Nadu, India; School of Chemical and Biotechnology, SASTRA Deemed-to-be-University, Thanjavur 613401, Tamil Nadu, India
| | - Shibi Muralidar
- Biopharmaceutical Research Lab, Anusandhan Kendra-1, SASTRA Deemed-to-be-University, Thanjavur 613401, Tamil Nadu, India; School of Chemical and Biotechnology, SASTRA Deemed-to-be-University, Thanjavur 613401, Tamil Nadu, India
| | - Diwahar Prakash
- Biopharmaceutical Research Lab, Anusandhan Kendra-1, SASTRA Deemed-to-be-University, Thanjavur 613401, Tamil Nadu, India; School of Chemical and Biotechnology, SASTRA Deemed-to-be-University, Thanjavur 613401, Tamil Nadu, India
| | - Abishek Kamalakkannan
- Biopharmaceutical Research Lab, Anusandhan Kendra-1, SASTRA Deemed-to-be-University, Thanjavur 613401, Tamil Nadu, India; School of Chemical and Biotechnology, SASTRA Deemed-to-be-University, Thanjavur 613401, Tamil Nadu, India
| | - Srichandrasekar Thuthikkadu Indhuprakash
- Biopharmaceutical Research Lab, Anusandhan Kendra-1, SASTRA Deemed-to-be-University, Thanjavur 613401, Tamil Nadu, India; School of Chemical and Biotechnology, SASTRA Deemed-to-be-University, Thanjavur 613401, Tamil Nadu, India
| | - Diraviyam Thirumalai
- Biopharmaceutical Research Lab, Anusandhan Kendra-1, SASTRA Deemed-to-be-University, Thanjavur 613401, Tamil Nadu, India; School of Chemical and Biotechnology, SASTRA Deemed-to-be-University, Thanjavur 613401, Tamil Nadu, India
| | - Senthil Visaga Ambi
- Biopharmaceutical Research Lab, Anusandhan Kendra-1, SASTRA Deemed-to-be-University, Thanjavur 613401, Tamil Nadu, India; School of Chemical and Biotechnology, SASTRA Deemed-to-be-University, Thanjavur 613401, Tamil Nadu, India.
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Naveen A, Sahu MR, Mohanty MK, Padhi KS, Patnaik A. Fatal intracranial bleedings in a viper bite: A case report. Chin J Traumatol 2023; 26:121-124. [PMID: 36180309 PMCID: PMC10071319 DOI: 10.1016/j.cjtee.2022.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Revised: 08/09/2022] [Accepted: 08/28/2022] [Indexed: 02/04/2023] Open
Abstract
Viper bite envenomation represents a significant occupational hazard among agricultural workers in India. The viper bite envenomation is usually suspected when a patient presents with predominant local symptoms at the bitten site, including pain, swelling, and necrosis. Further, systemic findings such as diffuse intravascular coagulation, hypotension, and shock may alert physicians of viper bite envenomation rather than a neurotoxic snake bite. However, cerebral complications are rare in viper bites but may potentially fatal. Central nervous system involvement in a viper bite is either due to neurotoxins or hemorrhagins present in the venom, which may induce cerebral thrombosis, ischemia, infarction, and hemorrhage. Here we present a case of a previously healthy adult male who succumbed to extensive subarachnoid, intracerebral, and intraventricular hemorrhages involving bilateral cerebral hemispheres following viper snake bite envenomation. This report highlights the importance of anticipating cerebral complications in viper bite envenomation, a rare occurrence. It also emphasizes the need for early antisnake venom administration to prevent and control systemic envenomation and its complications.
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Affiliation(s)
- Alagarasan Naveen
- Department of Forensic Medicine & Toxicology, All India Institute of Medical Sciences (AIIMS), Bhubaneswar, Odisha, India
| | - Manas Ranjan Sahu
- Department of Forensic Medicine & Toxicology, All India Institute of Medical Sciences (AIIMS), Bhubaneswar, Odisha, India.
| | - Manoj Kumar Mohanty
- Department of Forensic Medicine & Toxicology, All India Institute of Medical Sciences (AIIMS), Bhubaneswar, Odisha, India
| | - Kimi Soumya Padhi
- Department of Forensic Medicine & Toxicology, All India Institute of Medical Sciences (AIIMS), Bhubaneswar, Odisha, India
| | - Ashis Patnaik
- Department of Neurosurgery, All India Institute of Medical Sciences (AIIMS), Bhubaneswar, Odisha, India
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9
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Osipov A, Utkin Y. What Are the Neurotoxins in Hemotoxic Snake Venoms? Int J Mol Sci 2023; 24:ijms24032919. [PMID: 36769242 PMCID: PMC9917609 DOI: 10.3390/ijms24032919] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Revised: 01/10/2023] [Accepted: 01/30/2023] [Indexed: 02/05/2023] Open
Abstract
Snake venoms as tools for hunting are primarily aimed at the most vital systems of the prey, especially the nervous and circulatory systems. In general, snakes of the Elapidae family produce neurotoxic venoms comprising of toxins targeting the nervous system, while snakes of the Viperidae family and most rear-fanged snakes produce hemotoxic venoms directed mainly on blood coagulation. However, it is not all so clear. Some bites by viperids results in neurotoxic signs and it is now known that hemotoxic venoms do contain neurotoxic components. For example, viperid phospholipases A2 may manifest pre- or/and postsynaptic activity and be involved in pain and analgesia. There are other neurotoxins belonging to diverse families ranging from large multi-subunit proteins (e.g., C-type lectin-like proteins) to short peptide neurotoxins (e.g., waglerins and azemiopsin), which are found in hemotoxic venoms. Other neurotoxins from hemotoxic venoms include baptides, crotamine, cysteine-rich secretory proteins, Kunitz-type protease inhibitors, sarafotoxins and three-finger toxins. Some of these toxins exhibit postsynaptic activity, while others affect the functioning of voltage-dependent ion channels. This review represents the first attempt to systematize data on the neurotoxins from "non-neurotoxic" snake venom. The structural and functional characteristic of these neurotoxins affecting diverse targets in the nervous system are considered.
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Romo E, Torres M, Martin-Solano S. Current situation of snakebites envenomation in the Neotropics: Biotechnology, a versatile tool in the production of antivenoms. BIONATURA 2022. [DOI: 10.21931/rb/2022.07.04.54] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Snakebite envenomation is a neglected tropical disease that affects millions of people around the world with a great impact on health and the economy. Unfortunately, public health programs do not include this kind of disease as a priority in their social programs. Cases of snakebite envenomations in the Neotropics are inaccurate due to inadequate disease management from medical records to the choice of treatments. Victims of snakebite envenomation are primarily found in impoverished agricultural areas where remote conditions limit the availability of antivenom. Antivenom serum is the only Food and Drug Administration-approved treatment used up to date. However, it has several disadvantages in terms of safety and effectiveness. This review provides a comprehensive insight dealing with the current epidemiological status of snakebites in the Neotropics and technologies employed in antivenom production. Also, modern biotechnological tools such as transcriptomic, proteomic, immunogenic, high-density peptide microarray and epitope mapping are highlighted for producing new-generation antivenom sera. These results allow us to propose strategic solutions in the Public Health Sector for managing this disease.
Keywords: antivenom, biotechnology, neglected tropical disease, omics, recombinant antibody.
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Affiliation(s)
- Elizabeth Romo
- Carrera de Ingeniería en Biotecnología, Departamento de Ciencias de la Vida y la Agricultura, Universidad de las Fuerzas Armadas-ESPE, Sangolquí, Ecuador
| | - Marbel Torres
- Carrera de Ingeniería en Biotecnología, Departamento de Ciencias de la Vida y la Agricultura, Universidad de las Fuerzas Armadas-ESPE, Sangolquí, Ecuador, Grupo de Investigación en Sanidad Animal y Humana (GISAH), Carrera de Ingeniería en Biotecnología, Departamento de Ciencias de la Vida y la Agricultura, Universidad de las Fuerzas Armadas-ESPE, Immunology and Virology Laboratory, Nanoscience and Nanotechnology Center, Universidad de las Fuerzas Armadas, ESPE, Sangolquí, Ecuador
| | - Sarah Martin-Solano
- Carrera de Ingeniería en Biotecnología, Departamento de Ciencias de la Vida y la Agricultura, Universidad de las Fuerzas Armadas-ESPE, Sangolquí, Ecuador, Grupo de Investigación en Sanidad Animal y Humana (GISAH), Carrera de Ingeniería en Biotecnología, Departamento de Ciencias de la Vida y la Agricultura, Universidad de las Fuerzas Armadas-ESPE, Grupo de Investigación en Biodiversidad, Zoonosis y Salud Pública, Universidad Central del Ecuador
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Hung WH, Sung J, Chen WY, Chiu LT, Yip HT, Wei JCC, Hung YM, Chang R. Risk of stroke with antivenom usage after venomous snakebite in Taiwan: a population-based cohort study. QJM 2022; 115:587-595. [PMID: 34613415 DOI: 10.1093/qjmed/hcab259] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2021] [Revised: 09/03/2021] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND AND PURPOSE Stroke is a rare complication of snakebites, but may lead to serious sequelae. We aimed to explore the relationship between venomous snakebite and the risk for acute stroke, in a nationwide population-based cohort study. METHODS This retrospective cohort study used claims data between 1 January 2000 and 31 December 2012, from the Taiwan National Health Insurance Research Database. The study included data of patients aged 18 years or older with venomous snakebite (n = 535), matched for propensity score with controls without venomous snakebite (n = 2140). The follow-up period was the duration from the initial diagnosis of venomous snakebite and administration of antivenom to the date of an acute stroke, or until 31 December 2013. The competing risk model was used to estimate the hazard ratio (HR) and 95% confidence intervals (CIs) of stroke, ischemic stroke and hemorrhagic stroke, after adjusting for demographic and other possible stroke risk factors. RESULTS The adjusted HR for the venomous snakebite group compared with the control group was 2.68 for hemorrhagic stroke (95% CI = 1.35-5.33). Stratified analysis showed that the older age group (>65 years old) had a higher risk of hemorrhagic stroke. A 2.72-fold significant increase in the risk for hemorrhagic stroke was observed following venomous snakebite with antivenom usage (95% CI = 1.41-5.26). CONCLUSION Venomous snakebite is associated with an increased risk of hemorrhagic stroke after the use of antivenom. Further study of the underlying mechanism is warranted.
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Affiliation(s)
- W-H Hung
- Division of Chest Medicine, Department of Internal Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - J Sung
- Department of Obstetrics and Gynecology, Kaohsiung Veterans General Hospitals, Kaohsiung, Taiwan
| | - W-Y Chen
- Department of Emergency Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - L-T Chiu
- Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan
| | - H-T Yip
- Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan
| | - J C-C Wei
- Shu-Zen Junior College of Medicine and Management, Kaohsiung, Taiwan
- Graduate Institute of Integrated Medicine, China Medical University, Taichung, Taiwan
- Division of Allergy, Immunology and Rheumatology, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - Y-M Hung
- Department of Obstetrics and Gynecology, Kaohsiung Veterans General Hospitals, Kaohsiung, Taiwan
- Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan
- School of Medicine, National Yang Ming University, Taipei, Taiwan
| | - R Chang
- Department of Emergency Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
- Department of Recreation and Sports Management, Tajen University, Pingtung, Taiwan
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12
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Kaeley N, Prasad H, Singhal A, Subhra Datta S, Galagali SS. Snakebite Causing Facial and Lingual Tremors: A Case Report. Cureus 2022; 14:e27798. [PMID: 36106299 PMCID: PMC9449249 DOI: 10.7759/cureus.27798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/08/2022] [Indexed: 11/05/2022] Open
Abstract
Snakebite is a significant public health problem causing around 2.7 envenomations and 138,000 deaths globally. History may sometimes be unclear or misleading, which can cause a delay in diagnosis. Neuroparalytic, hemotoxic, and myotoxic are the common snake bite manifestations. Neuroparalytic snake bites rarely cause involuntary movements. Here we report a case of a 26-year-old female patient who sustained a snake bite and developed tremors in the face and tongue. She improved with mechanical ventilation, anti-snake venom, atropine-neostigmine, and calcium gluconate. She was discharged after seven days of hospital stay and now maintaining regular follow-up in the outpatient clinic.
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13
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Ghosh R, León-Ruiz M, Das S, Dubey S, Benito-León J. Snakebite envenomation-induced posterior reversible encephalopathy syndrome presenting with Bálint syndrome. NEUROLOGÍA (ENGLISH EDITION) 2022:S2173-5808(22)00078-5. [DOI: 10.1016/j.nrleng.2022.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2022] [Accepted: 06/09/2022] [Indexed: 10/17/2022] Open
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Cerebral Complications of Snakebite Envenoming: Case Studies. Toxins (Basel) 2022; 14:toxins14070436. [PMID: 35878174 PMCID: PMC9320586 DOI: 10.3390/toxins14070436] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Revised: 06/21/2022] [Accepted: 06/24/2022] [Indexed: 02/01/2023] Open
Abstract
There are an estimated 5.4 million snakebite cases every year. People with snakebite envenoming suffer from severe complications, or even death. Although some review articles cover several topics of snakebite envenoming, a review of the cases regarding cerebral complications, especially rare syndromes, is lacking. Here, we overview 35 cases of snakebite by front-fanged snakes, including Bothrops, Daboia, Cerastes, Deinagkistrodon, Trimeresurus, and Crotalus in the Viperidae family; Bungarus and Naja in the Elapidae family, and Homoroselaps (rare cases) in the Lamprophiidae family. We also review three rare cases of snakebite by rear-fanged snakes, including Oxybelis and Leptodeira in the Colubridae family. In the cases of viper bites, most patients (17/24) were diagnosed with ischemic stroke and intracranial hemorrhage, leading to six deaths. We then discuss the potential underlying molecular mechanisms that cause these complications. In cases of elapid bites, neural, cardiac, and ophthalmic disorders are the main complications. Due to the small amount of venom injection and the inability to deep bite, all the rear-fanged snakebites did not develop any severe complications. To date, antivenom (AV) is the most effective therapy for snakebite envenoming. In the six cases of viper and elapid bites that did not receive AV, three cases (two by viper and one by elapid) resulted in death. This indicates that AV treatment is the key to survival after a venomous snakebite. Lastly, we also discuss several studies of therapeutic agents against snakebite-envenoming-induced complications, which could be potential adjuvants along with AV treatment. This article organizes the diagnosis of hemotoxic and neurotoxic envenoming, which may help ER doctors determine the treatment for unidentified snakebite.
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Martínez-Villota VA, Mera-Martínez PF, Portillo-Miño JD. Massive acute ischemic stroke after Bothrops spp. envenomation in southwestern Colombia: Case report and literature review. BIOMEDICA : REVISTA DEL INSTITUTO NACIONAL DE SALUD 2022; 42:9-17. [PMID: 35471166 PMCID: PMC9045098 DOI: 10.7705/biomedica.6114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Accepted: 09/20/2021] [Indexed: 06/14/2023]
Abstract
Bothrops spp. envenomation and its relationship with ischemic stroke has complex pathogenesis. Local effects such as edema, pain, redness, necrosis, and systemic manifestations like coagulation disorders, thrombosis, renal failure, and hemorrhage have been reported. Hemorrhagic stroke is a common neurological complication but ischemic stroke is poorly understood. We present here the case of a 50-year-old male with no comorbidities referred from a rural area in southwest Colombia with a Bothrops spp. snakebite on the left hand. On admission, the patient presented with a deterioration of consciousness and required mechanical ventilation assistance. The MRI showed multiple ischemic areas in the bilateral frontaltemporal and occipital regions. Two months later, the patient had a favorable resolution, although central paresis in the III and VI cranial nerves and positive Babinski's sign persisted. As already mentioned, the pathophysiology of ischemic stroke due to snakebite is complex but the procoagulant activity of the venom components, the hypovolemic shock, the endothelial damage, and the thromboinflammation can explain it, and although it rarely occurs, it should be considered as a complication of ophidian accidents caused by Bothrops spp.
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Affiliation(s)
- Viviana Alexandra Martínez-Villota
- Facultad de Medicina, Universidad Nacional de Colombia, Bogotá, D.C., Colombia; Departamento de Neurología, Hospital Universitario Departamental de Nariño, Pasto, Colombia.
| | - Paulo Francisco Mera-Martínez
- Facultad de Ciencias de la Salud, Universidad de Nariño, Pasto, Colombia; Departamento de Emergencias, Hospital Universitario Departamental de Nariño, Pasto, Colombia.
| | - José Darío Portillo-Miño
- Facultad de Ciencias de la Salud, Grupo de Investigación RIZHOME GROUP II, Fundación Universitaria San Martín, Pasto, Colombia; Grupo de Investigación en Infecciosas y Cáncer, Fundación Hospital San Pedro, Pasto, Colombia.
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Ghosh R, Maity A, Biswas U, Das S, Benito-León J. Lance-Adams syndrome: An unusual complication of snakebite envenomation. Toxicon 2022; 209:50-55. [DOI: 10.1016/j.toxicon.2022.02.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2021] [Revised: 02/07/2022] [Accepted: 02/08/2022] [Indexed: 11/26/2022]
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17
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OUEDRAOGO PV, TRAORE C, SAVADOGO AA, BAGBILA WPAH, GALBONI A, OUEDRAOGO A, SERE IS, MILLOGO A. [Cerebral-meningeal hemorrhage secondary to snakebite envenomation: about two cases at the Sourô Sanou Teaching Hospital in Bobo-Dioulasso, Burkina Faso]. MEDECINE TROPICALE ET SANTE INTERNATIONALE 2022; 2:MTSI.2022.131. [PMID: 35685837 PMCID: PMC9128486 DOI: 10.48327/mtsi.2022.131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Accepted: 01/04/2022] [Indexed: 11/12/2022]
Abstract
Background Envenomation by snakebite is a public health problem in developing countries. Neurovascular complications are uncommon. We report two cases of hemorrhagic stroke at the Sourô Sanou Teaching Hospital in Bobo-Dioulasso, which complicate an envenomation. Clinical description The first patient was a 60-year-old woman with no history, who had been admitted 2 hours after snakebite for gingivorrhagia and consciousness disorders. Clinical examination found coma (GCS 7/15) and tetraparesis. The second patient was a 50-year-old woman with no history, who had been admitted one week after snakebite with digestive bleeding. Clinical examination found right hemiplegia and meningeal syndrome. Both patients presented hemorrhagic stroke on brain CT-scan but hemostasis assessment was normal. They received polyvalent antivenom and symptomatic treatment. The outcome was favorable for survival but with sequelae like tetraparesis for first patient and hemiparesis for second patient. Discussion - Conclusion The hemorrhagic strokes are rare complications of snake envenomation. Venomous toxins can directly lead to the rupture of intracranial vessels apart of abnormalities of hemostasis. However, the morbidity and mortality related to envenomation by snake bite remains high in our environment.
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Affiliation(s)
- Pingdéwendé Victor OUEDRAOGO
- Centre hospitalier universitaire Sourô Sanou, Bobo-Dioulasso, Burkina Faso,Université Nazi Boni, Bobo-Dioulasso, Burkina Faso,*
| | - Catherine TRAORE
- Centre hospitalier universitaire Sourô Sanou, Bobo-Dioulasso, Burkina Faso,Université Nazi Boni, Bobo-Dioulasso, Burkina Faso
| | - Abdoul Aziz SAVADOGO
- Centre hospitalier universitaire Sourô Sanou, Bobo-Dioulasso, Burkina Faso,Université Nazi Boni, Bobo-Dioulasso, Burkina Faso
| | | | - Adama GALBONI
- Centre hospitalier universitaire Sourô Sanou, Bobo-Dioulasso, Burkina Faso
| | - Abaz OUEDRAOGO
- Centre hospitalier universitaire Sourô Sanou, Bobo-Dioulasso, Burkina Faso
| | | | - Athanase MILLOGO
- Centre hospitalier universitaire Sourô Sanou, Bobo-Dioulasso, Burkina Faso,Université Joseph Ky Zerbo, Ouagadougou, Bobo-Dioulasso, Burkina Faso
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18
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Valdés-Arellanes M, Ortega-Hernández G, Cervantes-Santos DM, Rendón-Barrón MJ, Madrigal-Santillán EO, Morales-González JA, Paniagua-Pérez R, Madrigal-Bujaidar E, Álvarez-González I. In vivo genotoxic and cytotoxic evaluation of venom obtained from the species of the snake ophryacus, cope, viperidae. TOXIN REV 2021. [DOI: 10.1080/15569543.2021.1975752] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- Mariel Valdés-Arellanes
- Laboratorio de Genética, Escuela Nacional de Ciencias Biológicas, Instituto Politécnico Nacional, Ciudad de México, México
| | - Gerardo Ortega-Hernández
- Laboratorio de Genética, Escuela Nacional de Ciencias Biológicas, Instituto Politécnico Nacional, Ciudad de México, México
| | - Doralí M. Cervantes-Santos
- Laboratorio de Genética, Escuela Nacional de Ciencias Biológicas, Instituto Politécnico Nacional, Ciudad de México, México
| | - Michael Joshue Rendón-Barrón
- Laboratorio de Genética, Escuela Nacional de Ciencias Biológicas, Instituto Politécnico Nacional, Ciudad de México, México
| | | | - José Antonio Morales-González
- Laboratorio de Medicina de Conservación, Escuela Superior de Medicina, Instituto Politécnico Nacional, Ciudad de México, México
| | | | - Eduardo Madrigal-Bujaidar
- Laboratorio de Genética, Escuela Nacional de Ciencias Biológicas, Instituto Politécnico Nacional, Ciudad de México, México
| | - Isela Álvarez-González
- Laboratorio de Genética, Escuela Nacional de Ciencias Biológicas, Instituto Politécnico Nacional, Ciudad de México, México
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Fonar G, Polis B, Sams DS, Levi A, Malka A, Bal N, Maltsev A, Elliott E, Samson AO. Modified Snake α-Neurotoxin Averts β-Amyloid Binding to α7 Nicotinic Acetylcholine Receptor and Reverses Cognitive Deficits in Alzheimer's Disease Mice. Mol Neurobiol 2021; 58:2322-2341. [PMID: 33417228 PMCID: PMC8018932 DOI: 10.1007/s12035-020-02270-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Accepted: 12/18/2020] [Indexed: 12/03/2022]
Abstract
Alzheimer's disease (AD) is the most common cause of senile dementia and one of the greatest medical, social, and economic challenges. According to a dominant theory, amyloid-β (Aβ) peptide is a key AD pathogenic factor. Aβ-soluble species interfere with synaptic functions, aggregate gradually, form plaques, and trigger neurodegeneration. The AD-associated pathology affects numerous systems, though the substantial loss of cholinergic neurons and α7 nicotinic receptors (α7AChR) is critical for the gradual cognitive decline. Aβ binds to α7AChR under various experimental settings; nevertheless, the functional significance of this interaction is ambiguous. Whereas the capability of low Aβ concentrations to activate α7AChR is functionally beneficial, extensive brain exposure to high Aβ concentrations diminishes α7AChR activity, contributes to the cholinergic deficits that characterize AD. Aβ and snake α-neurotoxins competitively bind to α7AChR. Accordingly, we designed a chemically modified α-cobratoxin (mToxin) to inhibit the interaction between Aβ and α7AChR. Subsequently, we examined mToxin in a set of original in silico, in vitro, ex vivo experiments, and in a murine AD model. We report that mToxin reversibly inhibits α7AChR, though it attenuates Aβ-induced synaptic transmission abnormalities, and upregulates pathways supporting long-term potentiation and reducing apoptosis. Remarkably, mToxin demonstrates no toxicity in brain slices and mice. Moreover, its chronic intracerebroventricular administration improves memory in AD-model animals. Our results point to unique mToxin neuroprotective properties, which might be tailored for the treatment of AD. Our methodology bridges the gaps in understanding Aβ-α7AChR interaction and represents a promising direction for further investigations and clinical development.
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Affiliation(s)
- Gennadiy Fonar
- Drug Discovery Laboratory, The Azrieli Faculty of Medicine, Bar-Ilan University, 1311502, Safed, Israel.
| | - Baruh Polis
- Drug Discovery Laboratory, The Azrieli Faculty of Medicine, Bar-Ilan University, 1311502, Safed, Israel
| | - Dev Sharan Sams
- Laboratory of Molecular and Behavioral Neuroscience, The Azrieli Faculty of Medicine, Bar-Ilan University, 1311502, Safed, Israel
| | - Almog Levi
- Drug Discovery Laboratory, The Azrieli Faculty of Medicine, Bar-Ilan University, 1311502, Safed, Israel
| | - Assaf Malka
- Drug Discovery Laboratory, The Azrieli Faculty of Medicine, Bar-Ilan University, 1311502, Safed, Israel
| | - Natalia Bal
- Institute of Higher Nervous Activity and Neurophysiology, Russian Academy of Sciences, Moscow, Russia
| | - Alexander Maltsev
- Institute of Higher Nervous Activity and Neurophysiology, Russian Academy of Sciences, Moscow, Russia
| | - Evan Elliott
- Laboratory of Molecular and Behavioral Neuroscience, The Azrieli Faculty of Medicine, Bar-Ilan University, 1311502, Safed, Israel
| | - Abraham O Samson
- Drug Discovery Laboratory, The Azrieli Faculty of Medicine, Bar-Ilan University, 1311502, Safed, Israel
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20
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Liblik K, Byun J, Saldarriaga C, Perez GE, Lopez-Santi R, Wyss FQ, Liprandi AS, Martinez-Sellés M, Farina JM, Mendoza I, Burgos LM, Baranchuk A. Snakebite Envenomation and Heart: Systematic Review. Curr Probl Cardiol 2021; 47:100861. [PMID: 33992425 DOI: 10.1016/j.cpcardiol.2021.100861] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 03/27/2021] [Indexed: 12/15/2022]
Abstract
Snakebite envenomation is a neglected tropical disease which can result in morbidity and mortality. Cardiac implications are poorly understood due to the low frequency of cardiotoxicity combined with a lack of robust information, as snakebites commonly occur in remote and rural areas. This review aims to assess cardiovascular implications of snakebite envenoming and proposes an algorithm for screening of cardiovascular manifestations. A systematic review was performed and 29 articles relating to cardiovascular involvement in snakebite envenomation were selected. Cardiovascular involvement seems to be rare and includes a wide spectrum of outcomes, such as myocardial infarction, ventricular dysfunction, hypotension, cardiac arrest, and myocarditis. In a significant proportion of the cases analyzed (24.39%), the cardiovascular manifestations had major consequences (cardiac arrest, myocardial infarction, malignant ventricular arrhythmias, or death). Clinical monitoring, physical examination, and early electrocardiogram should be considered as key measures to detect cardiovascular involvement in patients with evidence of systemic illness.
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Affiliation(s)
- Kiera Liblik
- Department of Medicine, Kingston Health Science Center, Queen's University, Kingston, Ontario, Canada
| | - Jin Byun
- Faculty of Health Sciences, Queen's University, Kingston, Ontario, Canada
| | - Clara Saldarriaga
- Department of Cardiology and Heart Failure Clinic, Cardiovascular Clinic Santa Maria, University of Antioquia, Medellín, Colombia
| | - Gonzalo E Perez
- Division of Cardiology, Clínica Olivos, Buenos Aires, Argentina
| | - Ricardo Lopez-Santi
- Division of Cardiology, Hospital Italiano de la Plata, Buenos Aires, Argentina
| | - Fernando Q Wyss
- Division of Cardiology, Clínica Olivos, Buenos Aires, Argentina
| | - Alvaro S Liprandi
- Guatemala Cardiovascular Services and Technology, Cardiosolutions, Guatemala City
| | | | - Juan M Farina
- Hospital General Universitario Gregorio Marañón, CIBERCV, Universidad Europea, Universidad Complutense, Madrid, Spain
| | - Ivan Mendoza
- Tropical Cardiology, Tropical Medicine Institute, Central University of Venezuela, Caracas, Venezuela
| | - Lucrecia M Burgos
- Department of Heart Failure, Pulmonary Hypertension and Heart Transplant, Instituto Cardiovascular de Buenos Aires, Buenos Aires, Argentina
| | - Adrian Baranchuk
- Division of Cardiology, Kingston Health Science Center, Queen's University, Kingston, Ontario, Canada.
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21
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Cook MA, Jagpal PS, Hnin Pwint K, San LL, Kyaw Thein SS, Pyone T, Thit WMM, Bradberry SM, Collins S. Systematic Review of Human Poisoning and Toxic Exposures in Myanmar. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18073576. [PMID: 33808312 PMCID: PMC8037674 DOI: 10.3390/ijerph18073576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Revised: 03/19/2021] [Accepted: 03/29/2021] [Indexed: 12/03/2022]
Abstract
The International Health Regulations (2005) promote national capacity in core institutions so that countries can better detect, respond to and recover from public health emergencies. In accordance with the ‘all hazards’ approach to public health risk, this systematic review examines poisoning and toxic exposures in Myanmar. A systematic literature search was undertaken to find articles pertaining to poisoning in Myanmar published between 1998 and 2020. A number of poisoning risks are identified in this review, including snakebites, heavy metals, drugs of abuse, agrochemicals and traditional medicine. Patterns of poisoning presented in the literature diverge from poisoning priorities reported in other lower-middle income countries in the region. The experience of professionals working in a Yangon-based poison treatment unit also indicate that frequently observed poisoning as a result of pharmaceuticals, methanol, and petroleum products was absent from the literature. Other notable gaps in the available research include assessments of the public health burden of poisoning through self-harm, household exposures to chemicals, paediatric risk and women’s occupational risk of poisoning. There is a limited amount of research available on poisoning outcomes and routes of exposure in Myanmar. Further investigation and research are warranted to provide a more complete assessment of poisoning risk and incidence.
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Affiliation(s)
- Meghan A. Cook
- Centre for Radiation, Chemical and Environmental Hazards, Public Health England, Didcot OX11 0RQ, UK;
- Correspondence:
| | - Pardeep S. Jagpal
- National Poisons Information Service, City Hospital, Birmingham B18 7QH, UK; (P.S.J.); (S.M.B.)
| | - Khin Hnin Pwint
- National Poisons Control Centre, Department of Medical Research, Yangon 11191, Myanmar; (K.H.P.); (L.L.S.); (S.S.K.T.)
| | - Lai Lai San
- National Poisons Control Centre, Department of Medical Research, Yangon 11191, Myanmar; (K.H.P.); (L.L.S.); (S.S.K.T.)
| | - Saint Saint Kyaw Thein
- National Poisons Control Centre, Department of Medical Research, Yangon 11191, Myanmar; (K.H.P.); (L.L.S.); (S.S.K.T.)
| | - Thidar Pyone
- Global Public Health, Public Health England, London SE1 8UG, UK;
| | - Win Moh Moh Thit
- Global Public Health, Public Health England, P.O. Box 638, Yangon, Myanmar;
| | - Sally M. Bradberry
- National Poisons Information Service, City Hospital, Birmingham B18 7QH, UK; (P.S.J.); (S.M.B.)
| | - Samuel Collins
- Centre for Radiation, Chemical and Environmental Hazards, Public Health England, Didcot OX11 0RQ, UK;
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22
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Akhtar B, Muhammad F, Sharif A, Anwar MI. Mechanistic insights of snake venom disintegrins in cancer treatment. Eur J Pharmacol 2021; 899:174022. [PMID: 33727054 DOI: 10.1016/j.ejphar.2021.174022] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2020] [Revised: 02/26/2021] [Accepted: 03/10/2021] [Indexed: 01/27/2023]
Abstract
Snake venoms are a potential source of various enzymatic and non-enzymatic compounds with a defensive role for the host. Various peptides with significant medicinal properties have been isolated and characterized from these venoms. Few of these are FDA approved. They inhibit tumor cells adhesion, migration, angiogenesis and metastasis by inhibiting integrins on transmembrane cellular surfaces. This plays important role in delaying tumor growth, neovascularization and development. Tumor targeting and smaller size make them ideal candidates as novel therapeutic agents for cancer treatment. This review is based on sources of these disintegrins, their targeting modality, classification and underlying anti-cancer potential.
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Affiliation(s)
- Bushra Akhtar
- Department of Pharmacy, University of Agriculture, Faisalabad, Pakistan.
| | - Faqir Muhammad
- Institute of Physiology and Pharmacology, University of Agriculture, Faisalabad, Pakistan
| | - Ali Sharif
- Institute of Pharmacy, Faculty of Pharmaceutical and Allied Health Sciences, Lahore College for Women University, Lahore, Pakistan
| | - Muhammad Irfan Anwar
- Department of Pathobiology, Faculty of Veterinary Sciences, Bahauddin Zakariya University, Multan, Pakistan
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23
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Fatal brain hemorrhage after Bothrops asper bite in the Catatumbo region of Colombia. ACTA ACUST UNITED AC 2020; 40:609-615. [PMID: 33275340 PMCID: PMC7808782 DOI: 10.7705/biomedica.5181] [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: 08/26/2019] [Indexed: 11/24/2022]
Abstract
Las mordeduras de serpientes son un problema de salud pública en regiones tropicales y subtropicales del mundo. Ocurren, especialmente, en trabajadores rurales, y son una importante fuente de discapacidad y mortalidad. Se presenta el caso de un hombre de 59 años, agricultor de la región del Catatumbo (Colombia), quien sufrió la mordedura de una serpiente Bothrops asper, la cual le produjo una hemorragia cerebral fatal. Se llama la atención sobre el grave trastorno hemorrágico en contraste con los leves cambios en el sitio de la mordedura, así como sobre la necesidad del tratamiento temprano de la intoxicación con el suero antiofídico, incluso, en ausencia de manifestaciones cutáneas significativas.
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Long C, Liu M, Tian H, Li Y, Wu F, Mwangi J, Lu Q, Mohamed Abd El-Aziz T, Lai R, Shen C. Potential Role of Platelet-Activating C-Type Lectin-Like Proteins in Viper Envenomation Induced Thrombotic Microangiopathy Symptom. Toxins (Basel) 2020; 12:E749. [PMID: 33260875 PMCID: PMC7760373 DOI: 10.3390/toxins12120749] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Revised: 11/11/2020] [Accepted: 11/20/2020] [Indexed: 12/12/2022] Open
Abstract
Envenomation by viperid snakes may lead to severe bleeding, consumption coagulopathy, and thrombotic microangiopathy symptoms. The exact etiology or toxins responsible for thrombotic microangiopathy symptoms after snake envenomation remain obscure. Snake C-type lectin-like proteins (snaclecs) are one of the main non-enzymatic protein constituents in viper venoms, of which a majority are considered as modulators of thrombosis and hemostasis. In this study, we demonstrated that two snaclecs (mucetin and stejnulxin), isolated and identified from Protobothrops mucrosquamatus and Trimeresurus stejnegeri venoms, directly induced platelet degranulation and clot-retraction in vitro, and microvascular thrombosis has been confirmed in various organs in vivo. These snaclecs reduced cerebral blood flow and impaired motor balance and spatial memories in mice, which partially represent the thrombotic microangiopathy symptoms in some snakebite patients. The functional blocking of these snaclecs with antibodies alleviated the viper venom induced platelet activation and thrombotic microangiopathy-like symptoms. Understanding the pathophysiology of thrombotic microangiopathy associated with snake envenoming may lead to emerging therapeutic strategies.
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Affiliation(s)
- Chengbo Long
- Key Laboratory of Bioactive Peptides of Yunnan Province/Key Laboratory of Animal Models and Human, Disease Mechanisms of Chinese Academy of Sciences, Kunming Institute of Zoology, KIZ/CUHK Joint Laboratory of Bioresources and Molecular Research in Common Diseases, Kunming Institute of Zoology, Chinese Academy of Sciences, Kunming 650223, China; (C.L.); (H.T.); (F.W.); (J.M.); (Q.L.); (R.L.)
- School of Life Sciences, University of Chinese Academy of Sciences, Beijing 100009, China
| | - Ming Liu
- Department of Molecular and Cell Biology, School of Life Sciences, University of Science and Technology of China, Hefei 230027, China;
| | - Huiwen Tian
- Key Laboratory of Bioactive Peptides of Yunnan Province/Key Laboratory of Animal Models and Human, Disease Mechanisms of Chinese Academy of Sciences, Kunming Institute of Zoology, KIZ/CUHK Joint Laboratory of Bioresources and Molecular Research in Common Diseases, Kunming Institute of Zoology, Chinese Academy of Sciences, Kunming 650223, China; (C.L.); (H.T.); (F.W.); (J.M.); (Q.L.); (R.L.)
| | - Ya Li
- Key Laboratory of Laboratory Medicine of Yunnan Province/Department of Clinical Laboratory, the First Affiliated Hospital of Kunming Medical University, Kunming 650032, China;
| | - Feilong Wu
- Key Laboratory of Bioactive Peptides of Yunnan Province/Key Laboratory of Animal Models and Human, Disease Mechanisms of Chinese Academy of Sciences, Kunming Institute of Zoology, KIZ/CUHK Joint Laboratory of Bioresources and Molecular Research in Common Diseases, Kunming Institute of Zoology, Chinese Academy of Sciences, Kunming 650223, China; (C.L.); (H.T.); (F.W.); (J.M.); (Q.L.); (R.L.)
- School of Life Sciences, University of Chinese Academy of Sciences, Beijing 100009, China
| | - James Mwangi
- Key Laboratory of Bioactive Peptides of Yunnan Province/Key Laboratory of Animal Models and Human, Disease Mechanisms of Chinese Academy of Sciences, Kunming Institute of Zoology, KIZ/CUHK Joint Laboratory of Bioresources and Molecular Research in Common Diseases, Kunming Institute of Zoology, Chinese Academy of Sciences, Kunming 650223, China; (C.L.); (H.T.); (F.W.); (J.M.); (Q.L.); (R.L.)
- School of Life Sciences, University of Chinese Academy of Sciences, Beijing 100009, China
| | - Qiumin Lu
- Key Laboratory of Bioactive Peptides of Yunnan Province/Key Laboratory of Animal Models and Human, Disease Mechanisms of Chinese Academy of Sciences, Kunming Institute of Zoology, KIZ/CUHK Joint Laboratory of Bioresources and Molecular Research in Common Diseases, Kunming Institute of Zoology, Chinese Academy of Sciences, Kunming 650223, China; (C.L.); (H.T.); (F.W.); (J.M.); (Q.L.); (R.L.)
- Key Laboratory of Cardiovascular Disease of Yunnan Province, Kunming 650051, China
| | - Tarek Mohamed Abd El-Aziz
- Department of Cellular and Integrative Physiology, University of Texas Health Science Center at San Antonio, San Antonio, TX 78229-3900, USA;
- Zoology Department, Faculty of Science, Minia University, El-Minia 61519, Egypt
| | - Ren Lai
- Key Laboratory of Bioactive Peptides of Yunnan Province/Key Laboratory of Animal Models and Human, Disease Mechanisms of Chinese Academy of Sciences, Kunming Institute of Zoology, KIZ/CUHK Joint Laboratory of Bioresources and Molecular Research in Common Diseases, Kunming Institute of Zoology, Chinese Academy of Sciences, Kunming 650223, China; (C.L.); (H.T.); (F.W.); (J.M.); (Q.L.); (R.L.)
- Sino-African Joint Research Center, CAS, Kunming Institute of Zoology, Kunming 650223, China
| | - Chuanbin Shen
- Key Laboratory of Bioactive Peptides of Yunnan Province/Key Laboratory of Animal Models and Human, Disease Mechanisms of Chinese Academy of Sciences, Kunming Institute of Zoology, KIZ/CUHK Joint Laboratory of Bioresources and Molecular Research in Common Diseases, Kunming Institute of Zoology, Chinese Academy of Sciences, Kunming 650223, China; (C.L.); (H.T.); (F.W.); (J.M.); (Q.L.); (R.L.)
- Department of Laboratory Medicine, LKSKI-Keenan Research Centre for Biomedical Science, St. Michael’s Hospital, University of Toronto, Toronto, ON M5B 1W8, Canada
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Lazaro RP. Complex Regional Pain Syndrome Following Snakebite: A Putatively Rare Complication of Envenomation and Review of the Literature. Int Med Case Rep J 2020; 13:603-607. [PMID: 33204179 PMCID: PMC7667582 DOI: 10.2147/imcrj.s275591] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Accepted: 10/28/2020] [Indexed: 01/15/2023] Open
Abstract
Background Complex regional pain syndrome (CRPS) following snakebite is considered rare. Only four cases have been reported in the world literature. The present case is the first in the United States. We felt the need to report this case to bring attention to health-care providers that CRPS is probably an under-recognized complication of snakebite. Case Presentation A 44-year-old right-handed man developed signs and symptoms of complex regional pain syndrome (CRPS) in the left upper extremity following a bite by a cat-eyed snake (genus Leptodeira), a slightly venomous snake that belongs to the Colubridae (colubrids) family. The man did not develop muscle weakness or hematologic complications at that time. However, in subsequent years, he developed sporadic jerking of the upper extremities without alteration in consciousness or electroencephalographic abnormalities. These movements tended to occur during emotional tension and exacerbation of pain, and decreased in frequency when the subject was distracted. This is the fifth case of snakebite-induced CRPS described in the world literature (Nepal, Turkey, Korea, and Norway), the first reported in the United States, and the first induced by a slightly venomous snake. Conclusion With closer attention to the presence of indicators of sympathetic nerve dysfunction in association with allodynia, it is probable that cases of persistent pain following snakebite might have been instances of CRPS.
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Alberto-Silva C, Franzin CS, Gilio JM, Bonfim RS, Querobino SM. Toxicological effects of bioactive peptide fractions obtained from Bothrops jararaca snake venom on the structure and function of mouse seminiferous epithelium. J Venom Anim Toxins Incl Trop Dis 2020; 26:e20200007. [PMID: 32636877 PMCID: PMC7315626 DOI: 10.1590/1678-9199-jvatitd-2020-0007] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Background: Pathogenesis of Bothrops envenomations is complex and despite numerous studies on the effects of this snake venom on various biological systems, relatively little is known about such effects on the male reproductive system. In the present study, the toxicological outcomes of the low molecular weight fraction (LMWF) of B. jararaca snake venom - containing a range of bioactive peptides - were investigated on the dynamics and structure of the seminiferous epithelium and 15P-1 Sertoli cells viability. Methods: LMWF (5 µg/dose per testis) venom was administered in male Swiss mice by intratesticular (i.t.) injection. Seven days after this procedure, the testes were collected for morphological and morphometric evaluation, distribution of claudin-1 in the seminiferous epithelium by immunohistochemical analyses of testes, and the nitric oxide (NO) levels were evaluated in the total extract of the testis protein. In addition, the toxicological effects of LMWF and crude venom (CV) were analyzed on the 15P-1 Sertoli cell culture. Results: LMWF induced changes in the structure and function of the seminiferous epithelium without altering claudin-1 distribution. LMWF effects were characterized especially by lost cells in the adluminal compartment of epithelium (spermatocytes in pachytene, preleptotene spermatocytes, zygotene spermatocytes, and round spermatid) and different stages of the seminiferous epithelium cycle. LMWF also increased the NO levels in the total extract of the testis protein and was not cytotoxic in concentrations and time tested in the present study. However, CV showed cytotoxicity at 10 μg/mL from 6 to 48 h of treatment. Conclusions: The major finding of the present study was that the LMWF inhibited spermatozoa production; principally in the spermiogenesis stage without altering claudin-1 distribution in the basal compartment. Moreover, NO increased by LMWF induce open of complexes junctions and release the germ cells of the adluminal compartment to the seminiferous tubule.
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Affiliation(s)
- Carlos Alberto-Silva
- Natural and Humanities Sciences Center, Experimental Morphophysiology Laboratory, Federal University of ABC (UFABC), São Bernardo do Campo, SP, Brazil
| | - Celline Sampaio Franzin
- Natural and Humanities Sciences Center, Experimental Morphophysiology Laboratory, Federal University of ABC (UFABC), São Bernardo do Campo, SP, Brazil
| | - Joyce Meire Gilio
- Department of Biophysics, Federal University of São Paulo (Unifesp), São Paulo, SP, Brazil
| | - Rodrigo Simão Bonfim
- Natural and Humanities Sciences Center, Experimental Morphophysiology Laboratory, Federal University of ABC (UFABC), São Bernardo do Campo, SP, Brazil
| | - Samyr Machado Querobino
- Natural and Humanities Sciences Center, Experimental Morphophysiology Laboratory, Federal University of ABC (UFABC), São Bernardo do Campo, SP, Brazil.,Center for Health and Biological Sciences, Minas Gerais State University (UEMG), Passos, MG, Brazil
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Huang TI, Hsieh CL. Effect of Traditional Chinese Medicine on Long-Term Outcomes of Snakebite in Taiwan. Toxins (Basel) 2020; 12:E132. [PMID: 32093388 PMCID: PMC7076781 DOI: 10.3390/toxins12020132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Revised: 02/17/2020] [Accepted: 02/18/2020] [Indexed: 11/16/2022] Open
Abstract
Herein, we review the characteristics of the six predominant venomous snakes in Taiwan and the effects of traditional Chinese medicine on the long-term outcomes of snakebite venom. We electronically searched databases, including PubMed, ClinicalKey, China National Knowledge Infrastructure, National Digital Library of Theses and Dissertations in Taiwan, and Airiti Library, from their inception to November 2019 by using the following Medical Subject Headings' keywords: snakebite, long-term, chronic, Chinese medicine, CAM, herb, and Taiwan. The most common long-term effects of snakebite envenomation include "migraine-like syndrome", brain injuries caused by hypoxia or intracranial hemorrhage, and chronic kidney disease. In addition, hypopituitarism is also worth mentioning. Traditional Chinese medicine can potentially be used in a complementary or alternative treatment for these effects, but additional studies are needed.
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Affiliation(s)
- Teng-I Huang
- Department of Chinese Medicine, China Medical University Hospital, Taichung 40447, Taiwan;
| | - Ching-Liang Hsieh
- Department of Chinese Medicine, China Medical University Hospital, Taichung 40447, Taiwan;
- Chinese Medicine Research Center, China Medical University, Taichung 40402, Taiwan
- Graduate Institute of Acupuncture Science, College of Chinese Medicine, China Medical University, Taichung 40402, Taiwan
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Snake C-Type Lectins Potentially Contribute to the Prey Immobilization in Protobothrops mucrosquamatus and Trimeresurus stejnegeri Venoms. Toxins (Basel) 2020; 12:toxins12020105. [PMID: 32041262 PMCID: PMC7076790 DOI: 10.3390/toxins12020105] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2019] [Revised: 01/31/2020] [Accepted: 02/02/2020] [Indexed: 12/18/2022] Open
Abstract
Snake venoms contain components selected to immobilize prey. The venoms from Elapidae mainly contain neurotoxins, which are critical for rapid prey paralysis, while the venoms from Viperidae and Colubridae may contain fewer neurotoxins but are likely to induce circulatory disorders. Here, we show that the venoms from Protobothrops mucrosquamatus and Trimeresurus stejnegeri are comparable to those of Naja atra in prey immobilization. Further studies indicate that snake C-type lectin-like proteins (snaclecs), which are one of the main nonenzymatic components in viper venoms, are responsible for rapid prey immobilization. Snaclecs (mucetin and stejnulxin) from the venoms of P. mucrosquamatus and T. stejnegeri induce the aggregation of both mammalian platelets and avian thrombocytes, leading to acute cerebral ischemia, and reduced animal locomotor activity and exploration in the open field test. Viper venoms in the absence of snaclecs fail to aggregate platelets and thrombocytes, and thus show an attenuated ability to cause cerebral ischemia and immobilization of their prey. This work provides novel insights into the prey immobilization mechanism of Viperidae snakes and the understanding of viper envenomation-induced cerebral infarction.
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Pérez-Gómez AS, Monteiro WM, João GAP, Sousa JDDB, Safe IP, Damian MM, Sachett JAG, Silva IMD. Hemorrhagic stroke following viper bites and delayed antivenom administration: three case reports from the Western Brazilian Amazon. Rev Soc Bras Med Trop 2019; 52:e20190115. [PMID: 31340373 DOI: 10.1590/0037-8682-0115-2019] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2019] [Accepted: 04/15/2019] [Indexed: 02/02/2023] Open
Abstract
Snakebites were included by the World Health Organization in their list of neglected diseases. In Latin America, most snakebites are caused by species of the Viperidae family, notably by the genus Bothrops. Bothrops atrox accounts for 90% of the cases of envenoming in the Brazilian Amazon. In this report, we present a series of three cases of snakebites that evolved with hemorrhagic stroke due to delays in the access to antivenom in the Brazilian Amazon, being fundamental for diagnosis to validate the clinical suspicion and make decisions that would improve the treatment and prognosis of the patients.
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Affiliation(s)
- Aline Stephanie Pérez-Gómez
- Fundação de Medicina Tropical Doutor Heitor Vieira Dourado, Manaus, AM, Brasil.,Escola Superior de Ciências da Saúde, Universidade do Estado do Amazonas, Manaus, AM, Brasil
| | - Wuelton Marcelo Monteiro
- Fundação de Medicina Tropical Doutor Heitor Vieira Dourado, Manaus, AM, Brasil.,Escola Superior de Ciências da Saúde, Universidade do Estado do Amazonas, Manaus, AM, Brasil
| | - Guilherme Augusto Pivoto João
- Fundação de Medicina Tropical Doutor Heitor Vieira Dourado, Manaus, AM, Brasil.,Escola Superior de Ciências da Saúde, Universidade do Estado do Amazonas, Manaus, AM, Brasil
| | - Jose Diego de Brito Sousa
- Fundação de Medicina Tropical Doutor Heitor Vieira Dourado, Manaus, AM, Brasil.,Escola Superior de Ciências da Saúde, Universidade do Estado do Amazonas, Manaus, AM, Brasil
| | - Izabella Picinin Safe
- Fundação de Medicina Tropical Doutor Heitor Vieira Dourado, Manaus, AM, Brasil.,Escola Superior de Ciências da Saúde, Universidade do Estado do Amazonas, Manaus, AM, Brasil
| | - Marcia Melo Damian
- Fundação de Medicina Tropical Doutor Heitor Vieira Dourado, Manaus, AM, Brasil.,Escola Superior de Ciências da Saúde, Universidade do Estado do Amazonas, Manaus, AM, Brasil
| | - Jacqueline Almeida Gonçalves Sachett
- Fundação de Medicina Tropical Doutor Heitor Vieira Dourado, Manaus, AM, Brasil.,Escola Superior de Ciências da Saúde, Universidade do Estado do Amazonas, Manaus, AM, Brasil.,Fundação Hospital Adriano Jorge, Manaus, AM, Brasil
| | - Iran Mendonça da Silva
- Fundação de Medicina Tropical Doutor Heitor Vieira Dourado, Manaus, AM, Brasil.,Escola Superior de Ciências da Saúde, Universidade do Estado do Amazonas, Manaus, AM, Brasil
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Abraham A K, John L. Hemotoxic Snakebite Presenting with Bilateral Blindness Due to Ischemic Occipital Infarcts. Indian J Crit Care Med 2019; 23:99-101. [PMID: 31086455 PMCID: PMC6487605 DOI: 10.5005/jp-journals-10071-23125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Cerebrovascular complications are rare following a Viperidae snake envenomation, let alone ischemic ones. This catastrophic hemorrhaging cascade is widely known to cause a wide array of manifestations. Its manifestations can range from skin bleeds to fatal intracranial or organ hemorrhages. Our patient had cortical blindness secondary to an ischemic occipital infarct following a hemotoxic snakebite - a seemingly distinct oxymoron. The physician should be mindful of the fact that a hemotoxic snakebite can deceptively bring in ischemic attacks as well. Toxic vasculitis, thrombotic angiopathies, widespread vasospasm and endothelial damage are believed to shoulder a part of the disease process that can bring about tissue ischemia. Key Messages Hemotoxic snake envenomation can have devastating effects. Apart from dealing with the threat of coagulopathy, the physician must also be alert to the ironical ischemic aftermath that can equally bring in misery. Our patient had one such complication-bilateral cortical blindness resulting from bilateral occipital ischemic infarcts. The physician must be aware that a hemotoxic snakebite can even instigate ischemic dilemmas, i.e. cerebrovascular infarcts, as well. How to cite this article Kodiatte Abraham A, Livingston J. Hemotoxic Snakebite Presenting with Bilateral Blindness Due to Ischemic Occipital Infarcts. Indian J of Crit Care Med 2019;23(2): 99-101.
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Affiliation(s)
- Kodiatte Abraham A
- Department of Medicine, Christian Medical College and Hospital, Ludhiana, Punjab, India
| | - Livingston John
- Department of Cardiology, Christian Medical College and Hospital, Ludhiana, Punjab, India
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Al-Sadawi M, Mohamadpour M, Zhyvotovska A, Ahmad T, Schechter J, Soliman Y, McFarlane SI. Cerebrovascular Accident and Snake Envenomation: A Scoping Study. INTERNATIONAL JOURNAL OF CLINICAL RESEARCH & TRIALS 2019; 4:133. [PMID: 31528777 PMCID: PMC6746409 DOI: 10.15344/2456-8007/2019/133] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
BACKGROUND Snake envenomation is associated with serious complications including infections, bleeding and, in rare occasions, thrombosis. Previous work by our group examined the association of snakebite and acute myocardial infarction. In this systematic review we aim to assess the clinical characteristics and outcomes of acute cerebrovascular accidents that are reported to be extremely rare complications of snake envenomation. METHODS We performed a literature search for reports on stroke associated with snake envenomation between Jan 1995 to Oct 2018, and summarized their characteristics. RESULTS Eighty-three published cases were reviewed. 66.3% of the cases were younger than 50 years of age. The mean time for the onset of the symptoms is 23.8±10.9 hours after exposure. 77.1% of the cases found to have ischemic stroke, 20.5% with intra-cranial hemorrhage and both infarction and hemorrhage in 2.4%. Mortality was reported in 16.9% with mean time between onset of the symptoms and death is 4.2 days. CONCLUSION Stroke secondary to snake envenomation is a rare but serious complication. Once stroke is suspected, initiating appropriate management is crucial in reducing morbidity and mortality associated with this potentially fatal complication of snake envenomation.
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Affiliation(s)
- Mohammed Al-Sadawi
- Department of Internal Medicine, Division of Cardiovascular
Disease, State University of New York, Downstate Medical Center, Brooklyn, NY 11203,
USA
| | - Maliheh Mohamadpour
- Department of Internal Medicine, Division of Cardiovascular
Disease, State University of New York, Downstate Medical Center, Brooklyn, NY 11203,
USA
| | - Angelina Zhyvotovska
- Department of Internal Medicine, Division of Cardiovascular
Disease, State University of New York, Downstate Medical Center, Brooklyn, NY 11203,
USA
| | - Tahir Ahmad
- Department of Internal Medicine, Division of Cardiovascular
Disease, State University of New York, Downstate Medical Center, Brooklyn, NY 11203,
USA,Department of Emergency Medicine State University of New
York, Downstate Medical Center, Brooklyn, New York, USA
| | - Joshua Schechter
- Department of Emergency Medicine State University of New
York, Downstate Medical Center, Brooklyn, New York, USA
| | - Yasmin Soliman
- Department of Internal Medicine, Division of Cardiovascular
Disease, State University of New York, Downstate Medical Center, Brooklyn, NY 11203,
USA
| | - Samy I. McFarlane
- Department of Internal Medicine, Division of Cardiovascular
Disease, State University of New York, Downstate Medical Center, Brooklyn, NY 11203,
USA,Corresponding Author: Prof. Samy I.
McFarlane, Divisions of Cardiovascular Disease,and Endocrinology, Department of
Internal Medicine, State University of New York, Downstate Medical Center,
Brooklyn, New York,11203, USA, Tel: 718-270-6707, Fax: 718-270-4488;
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Munawar A, Ali SA, Akrem A, Betzel C. Snake Venom Peptides: Tools of Biodiscovery. Toxins (Basel) 2018; 10:toxins10110474. [PMID: 30441876 PMCID: PMC6266942 DOI: 10.3390/toxins10110474] [Citation(s) in RCA: 53] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2018] [Revised: 10/30/2018] [Accepted: 11/07/2018] [Indexed: 01/09/2023] Open
Abstract
Nature endowed snakes with a lethal secretion known as venom, which has been fine-tuned over millions of years of evolution. Snakes utilize venom to subdue their prey and to survive in their natural habitat. Venom is known to be a very poisonous mixture, consisting of a variety of molecules, such as carbohydrates, nucleosides, amino acids, lipids, proteins and peptides. Proteins and peptides are the major constituents of the dry weight of snake venoms and are of main interest for scientific investigations as well as for various pharmacological applications. Snake venoms contain enzymatic and non-enzymatic proteins and peptides, which are grouped into different families based on their structure and function. Members of a single family display significant similarities in their primary, secondary and tertiary structures, but in many cases have distinct pharmacological functions and different bioactivities. The functional specificity of peptides belonging to the same family can be attributed to subtle variations in their amino acid sequences. Currently, complementary tools and techniques are utilized to isolate and characterize the peptides, and study their potential applications as molecular probes, and possible templates for drug discovery and design investigations.
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Affiliation(s)
- Aisha Munawar
- Department of Chemistry, University of Engineering and Technology, Lahore 54890, Pakistan.
| | - Syed Abid Ali
- H.E. J. Research Institute of Chemistry, (ICCBS), University of Karachi, Karachi 75270, Pakistan.
| | - Ahmed Akrem
- Botany Division, Institute of Pure and Applied Biology, Bahauddin Zakariya University, Multan 60800, Pakistan.
| | - Christian Betzel
- Department of Chemistry, Institute of Biochemistry and Molecular Biology, University of Hamburg, 22607 Hamburg, Germany.
- Laboratory for Structural Biology of Infection and Inflammation, DESY, Build. 22a, Notkestr. 85, 22603 Hamburg, Germany.
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Silva LMG, Zamuner LF, David AC, dos Santos SA, de Carvalho PDTC, Zamuner SR. Photobiomodulation therapy on bothrops snake venom-induced local pathological effects: A systematic review. Toxicon 2018; 152:23-29. [DOI: 10.1016/j.toxicon.2018.07.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2018] [Revised: 06/25/2018] [Accepted: 07/05/2018] [Indexed: 01/28/2023]
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Nanobodies as novel therapeutic agents in envenomation. Biochim Biophys Acta Gen Subj 2018; 1862:2955-2965. [PMID: 30309831 DOI: 10.1016/j.bbagen.2018.08.019] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Revised: 08/27/2018] [Accepted: 08/29/2018] [Indexed: 12/11/2022]
Abstract
BACKGROUND An effective therapy against envenoming should be a priority in view of the high number scorpion stings and snakebites. Serum therapy is still widely applied to treat the envenomation victims; however this approach suffers from several shortcomings. The employment of monoclonal antibodies might be an outcome as these molecules are at the core of a variety of applications from protein structure determination to cancer treatment. The progress of activities in the twilight zone between genetic and antibody engineering have led to the development of a unique class of antibody fragments. These molecules possess several benefits and lack many possible disadvantages over classical antibodies. Within recombinant antibody formats, nanobodies or single domain antigen binding fragments derived from heavy chain only antibodies in camelids occupy a privileged position. SCOPE OF REVIEW In this paper we will briefly review the common methods of envenomation treatment and focus on details of various in vivo research activities that investigate the performance of recombinant, monoclonal nanobodies in venom neutralization. MAJOR CONCLUSIONS Nanobodies bind to their cognate target with high specificity and affinity, they can be produced in large quantities from microbial expression systems and are very robust even when challenged with harsh environmental conditions. Upon administering, they rapidly distribute throughout the body and seem to be well tolerated in humans posing low immunogenicity. GENERAL SIGNIFICANCE Scorpion and snake envenomation is a major issue in developing countries and nanobodies as a venom-neutralizing agent can be considered as a valuable and promising candidate in envenomation therapy.
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Fernandes FH, Bustos-Obregon E, Matias R, Dourado DM. Crotalus durissus sp. rattlesnake venom induces toxic injury in mouse sperm. Toxicon 2018; 153:17-18. [PMID: 30149042 DOI: 10.1016/j.toxicon.2018.08.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Revised: 08/14/2018] [Accepted: 08/19/2018] [Indexed: 11/19/2022]
Abstract
Accidents involving snakebites constitute a serious public health problem in many regions around the world. However, there are no study about a possible action of snake venom on the reproductive system. Herein we show that Crotalus durissus sp. (Linnaeus) rattlesnake venom (25 μg/kg of body weight) affected chromatin condensation, and increased the number of sperm with abnormal morphology and the sperm count. In conclusion, besides the known hazards of the C. durissus sp. venom to animal health, this study was the first to show its effect also on male germ cells.
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Affiliation(s)
- Fábio Henrique Fernandes
- São Paulo State University - UNESP, Medical School, Department of Pathology, Rubião Junior, 18618-000, Botucatu, São Paulo, Brazil.
| | | | - Rosemary Matias
- Anhanguera-Uniderp University, Environment and Regional Development, Postgraduate Program, R. Alexandre Herculano, 1400, 79037-280, Campo Grande, Mato Grosso do Sul, Brazil.
| | - Doroty Mesquita Dourado
- Anhanguera-Uniderp University, Laboratory of Toxinology and Medicinal Plants, R. Alexandre Herculano, 1400, 79037-280. Campo Grande, Mato Grosso do Sul, Brazil.
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Li M, Xie ZH, Yu AY, He DP. Increased Efficacy of Antivenom Combined with Hyperbaric Oxygen on Deinagkistrodon acutus Envenomation in Adult Rats. Chin Med J (Engl) 2018; 131:323-329. [PMID: 29363648 PMCID: PMC5798054 DOI: 10.4103/0366-6999.223840] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Snakebites are a neglected threat to global human health with a high morbidity rate. The present study explored the efficacy of antivenom with hyperbaric oxygen (HBO) intervention on snakebites, which could provide the experimental basis for clinical adjuvant therapy. METHODS Male Sprague-Dawley rats (n = 96) were randomized into four groups: the poison model was established by injecting Deinagkistrodon acutus (D. acutus) venom (0.8 LD50) via the caudal vein; the antivenom group was injected immediately with specific antivenom via the caudal vein after successful establishment of the envenomation model; and the antivenom + HBO group was exposed to HBO environment for 1 h once at predetermined periods of 0 h, 4 h, 12 h, and 23 h after antivenin administration. Each HBO time point had six rats; the control group was left untreated. The rats in the experimental group were euthanized at the corresponding time points after HBO therapy, and brain tissue and blood were harvested immediately. Hematoxylin and eosin (H&E) staining was used to investigate the pathological changes in the rat brain. Immunohistochemistry (IHC), real-time polymerase chain reaction (PCR), and Western blotting were used to detect the expression of Nestin mRNA and protein in the subventricular zone (SVZ) of the brain. The levels of coagulation function (prothrombin time, activated partial thromboplastin time [APTT], and fibrinogen) and oxidation/antioxidation index (malondialdehyde [MDA] and superoxide dismutase [SOD]) were analyzed. Data were analyzed using one-way analysis of variance. RESULTS The brain tissue from rats in the poison model was observed for pathological changes using H&E staining. Tissues showed edema, decreased cell number, and disordered arrangement in the SVZ in the snake venom group. The antivenom - HBO intervention significantly alleviated these observations and was more prominent in the antivenom + HBO group. The serum levels of SOD and MDA in the snake venom group were increased and the antivenom - HBO intervention further increased the SOD levels but significantly decreased the MDA levels; however, this was enhanced within 1 h after HBO administration (MDA: F = 5.540, P = 0.008, SOD: F = 7.361, P = 0.000). Activated partial thromboplastin time (APTT) was significantly abnormal after venom administration but improved after antivenom and was even more significant in the antivenom + HBO group 5 h after envenomation (F = 25.430, P = 0.000). Only a few nestin-positive cells were observed in the envenomation model. The expression levels were significant in the antivenom and antivenom + HBO groups within 1 and 5 h after envenomation and were more significant in the antivenom + HBO group as determined by IHC, real-time PCR, and Western blotting (P < 0.05). D. acutus envenomation has neurotoxic effects in the brain of rats. CONCLUSIONS Antivenin and HBO, respectively, induced a neuroprotective effect after D. acutus envenomation by attenuating brain edema, upregulating nestin expression in SVZ, and improving coagulopathy and oxidative stress. The intervention efficacy of antivenom with HBO was maximum within 5 h after envenomation and was more efficacious than antivenom alone.
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Affiliation(s)
- Mo Li
- Department of Emergency, The First Affiliated Hospital of Zunyi Medical College, Zunyi, Guizhou 563003, China
| | - Zhi-Hui Xie
- Department of Hyperbaric Oxygen, The First Affiliated Hospital of Zunyi Medical College, Zunyi, Guizhou 563003, China
| | - An-Yong Yu
- Department of Emergency, The First Affiliated Hospital of Zunyi Medical College, Zunyi, Guizhou 563003, China
| | - Dong-Po He
- Department of Emergency, The First Affiliated Hospital of Zunyi Medical College, Zunyi, Guizhou 563003, China
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Reis J. Environmental Risk Factors for Stroke and Cardiovascular Disease. ENCYCLOPEDIA OF CARDIOVASCULAR RESEARCH AND MEDICINE 2018. [PMCID: PMC7150018 DOI: 10.1016/b978-0-12-809657-4.64111-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Besides the classical individual stroke risk factors a new class has appeared, the environmental risk factors. After a review of the evidences demonstrating that air pollution is a potent risk factor (Part 1), we propose an update of other physical, chemical, and biological factors, now considered as risk factors (Part 2). One of the challenges is to precise their specific roles as they can be combined in their noxious impacts (traffic air pollution + noise + weather + infections). This knowledge has practical consequences; From now on, medical advices cannot be limited to individual recommendations but must also deal with environmental public health issues.
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Teixera LF, de Carvalho LH, de Castro OB, Bastos JSF, Néry NM, Oliveira GA, Kayano AM, Soares AM, Zuliani JP. Local and systemic effects of BdipTX-I, a Lys-49 phospholipase A2 isolated from Bothrops diporus snake venom. Toxicon 2018; 141:55-64. [DOI: 10.1016/j.toxicon.2017.11.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2017] [Revised: 11/17/2017] [Accepted: 11/18/2017] [Indexed: 11/24/2022]
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Silva de Oliveira S, Freitas-de-Sousa LA, Alves EC, de Lima Ferreira LC, da Silva IM, de Lacerda MVG, Fan HW, Moura-da-Silva AM, Monteiro WM. Fatal stroke after Bothrops snakebite in the Amazonas state, Brazil: A case report. Toxicon 2017; 138:102-106. [DOI: 10.1016/j.toxicon.2017.08.021] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2017] [Revised: 08/18/2017] [Accepted: 08/21/2017] [Indexed: 10/19/2022]
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Abstract
Snakebite envenoming is a neglected tropical disease that kills >100,000 people and maims >400,000 people every year. Impoverished populations living in the rural tropics are particularly vulnerable; snakebite envenoming perpetuates the cycle of poverty. Snake venoms are complex mixtures of proteins that exert a wide range of toxic actions. The high variability in snake venom composition is responsible for the various clinical manifestations in envenomings, ranging from local tissue damage to potentially life-threatening systemic effects. Intravenous administration of antivenom is the only specific treatment to counteract envenoming. Analgesics, ventilator support, fluid therapy, haemodialysis and antibiotic therapy are also used. Novel therapeutic alternatives based on recombinant antibody technologies and new toxin inhibitors are being explored. Confronting snakebite envenoming at a global level demands the implementation of an integrated intervention strategy involving the WHO, the research community, antivenom manufacturers, regulatory agencies, national and regional health authorities, professional health organizations, international funding agencies, advocacy groups and civil society institutions.
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Affiliation(s)
- José María Gutiérrez
- Instituto Clodomiro Picado, Facultad de Microbiología, Universidad de Costa Rica, PO Box 11501-2060, San José, Costa Rica
| | - Juan J Calvete
- Instituto de Biomedicina de Valencia, Consejo Superior de Investigaciones Científicas (CSIC), Valencia, Spain
| | | | - Robert A Harrison
- Alistair Reid Venom Research Unit, Liverpool School of Tropical Medicine, Liverpool, UK
| | - David J Williams
- Charles Campbell Toxinology Centre, School of Medicine &Health Sciences, University of Papua New Guinea, Boroko, National Capital District, Papua New Guinea
- Australian Venom Research Unit, Department of Pharmacology and Therapeutics, University of Melbourne, Parkville, Victoria, Australia
| | - David A Warrell
- Nuffield Department of Clinical Medicine, John Radcliffe Hospital, University of Oxford, Oxford, UK
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Li J, Xiong Y, Sun S, Yu L, Huang C. Preparation of monoclonal antibodies against gamma-type phospholipase A 2 inhibitors and immunodetection of these proteins in snake blood. J Venom Anim Toxins Incl Trop Dis 2017; 23:37. [PMID: 28785278 PMCID: PMC5543733 DOI: 10.1186/s40409-017-0128-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Accepted: 07/25/2017] [Indexed: 12/04/2022] Open
Abstract
Background The gamma-type phospholipase A2 inhibitor (PLIγ) is a natural protein commonly found in snake serum, which can neutralize pathophysiological effects of snake venom phospholipases A2. Therefore, this protein is a potential candidate to the development of a novel antivenom. To the best of our knowledge, there is no antibody currently available for PLIγ identification and characterization. Methods Bioinformatics prediction of epitope using DNAStar software was performed based on the sequence of Sinonatrix annularis PLIγ (SaPLIγ). The best epitope 151CPVLRLSNRTHEANRNDLIKVA172 was chosen and synthesized, and then conjugated to keyhole limpet hemocyanin and bovine serum albumin for use as an immunogen and plate-coating antigen, respectively. Results Eighteen IgG anti-PLIγ mAb hybridoma cell strains were obtained, and all the mAbs had positive interaction with recombinant His6-PLIγ and natural SaPLIγ. Moreover, the mAb from 10E9 strain was also successfully used for the immunodetection of other snake serum PLIγs. cDNA sequence alignment of those PLIγs from different snake species showed that their epitope segments were highly homologous. Conclusions The successful preparation of anti-PLIγmAb is significant for further investigation on the relationship between the structure and function of PLIγs, as well as the interaction between PLIγs and PLA2s.
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Affiliation(s)
- Jingjing Li
- Department of Biochemistry, College of Basic Medical Science, Nanchang University, Nanchang, 330006 China
| | - Ying Xiong
- Second Affiliated Hospital to Nanchang University, Nanchang University, Nanchang, 330006 China
| | - Shimin Sun
- Department of Biochemistry, College of Basic Medical Science, Nanchang University, Nanchang, 330006 China
| | - Lehan Yu
- Department of Biochemistry, College of Basic Medical Science, Nanchang University, Nanchang, 330006 China
| | - Chunhong Huang
- Jiangxi Province Key Laboratory of Tumor Pathogens and Molecular Pathology, Nanchang University, 461 Bayi Avenue, Nanchang, 330006 China
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A Horned Viper Bite Victim with PRES. Case Rep Neurol Med 2017; 2017:1835796. [PMID: 28487791 PMCID: PMC5402235 DOI: 10.1155/2017/1835796] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2016] [Revised: 02/23/2017] [Accepted: 03/23/2017] [Indexed: 11/17/2022] Open
Abstract
Neurological complications of snake bites have been well documented in the literature as neuromuscular paralysis and cerebrovascular complications; posterior reversible encephalopathy syndrome was rarely described. A 23-year-old lady presented near full term of her pregnancy with a horned snake Cerastes cerastes bite; after successful delivery she started complaining of altered mental status and visual disturbance with ulceration over the site of the snake bite. On admission, the patient had Glasgow Coma Score of 12, blood pressure 130/80 mmHg, temperature 38°C, sinus tachycardia at 120 beats per minute, severe dehydration, and reduction in visual acuity to "hand motion" in both eyes with poor light projection and sluggish pupillary reactions. CT brain was not conclusive; MRI revealed features of PRES. Treatment was mostly supportive within one week; the patient regained consciousness; visual disturbance, however, persisted. This patient as well as the few previously described cases highlights PRES as a possible complication of snake bites.
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Eslamian L, Mobaiyen H, Bayat-Makoo Z, Piri R, Benisi R, Naghavi Behzad M. Snake bite in Northwest Iran: A retrospective study. JOURNAL OF ANALYTICAL RESEARCH IN CLINICAL MEDICINE 2016. [DOI: 10.15171/jarcm.2016.022] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
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Sharma M, Kalia S, Sharma S. An eleven year old boy with pain abdomen and early morning neuroparalytic syndrome. J Forensic Leg Med 2016; 42:79-81. [PMID: 27288565 DOI: 10.1016/j.jflm.2016.05.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2015] [Revised: 12/21/2015] [Accepted: 05/04/2016] [Indexed: 11/15/2022]
Abstract
An 11 year old boy presented with pain abdomen and tenderness all over body when he got up from sleep early in the morning and subsequently had one vomiting after 30 min. He had no other significant past medical history. The child was shifted to nearby health facility where he was managed as a case of acute abdomen on the basis of suggestive history and clinical findings. Within 2 h after the onset of clinical features suggestive of acute abdomen the patient went on to develop marked ptosis and flaccid quadriplegia. The young boy underwent a sequence of clinical tests which were noncontributory. Based on the clinical picture, a differential diagnosis of hypokalemic paralysis, botulism, Miller Fischer syndrome and EMNS were considered. Through exclusion, the most probable diagnosis for the symptoms was elapid envenomation hence he was started on anti-snake venom (ASV) with working diagnosis of EMNS. Within 2 h, he began to show improvement. This recovery with ASV suggests the possibility of elapid envenomation.
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Affiliation(s)
- Milap Sharma
- Department of Pediatrics, DRPGMC, Kangra, H.P., India.
| | - Shaurya Kalia
- Department of Pediatrics, DRPGMC, Kangra, H.P., India.
| | - Seema Sharma
- Department of Pediatrics, DRPGMC, Kangra, H.P., India.
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Chan YS, Cheung RCF, Xia L, Wong JH, Ng TB, Chan WY. Snake venom toxins: toxicity and medicinal applications. Appl Microbiol Biotechnol 2016; 100:6165-6181. [PMID: 27245678 DOI: 10.1007/s00253-016-7610-9] [Citation(s) in RCA: 77] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2016] [Revised: 05/01/2016] [Accepted: 05/03/2016] [Indexed: 11/25/2022]
Abstract
Snake venoms are complex mixtures of small molecules and peptides/proteins, and most of them display certain kinds of bioactivities. They include neurotoxic, cytotoxic, cardiotoxic, myotoxic, and many different enzymatic activities. Snake envenomation is a significant health issue as millions of snakebites are reported annually. A large number of people are injured and die due to snake venom poisoning. However, several fatal snake venom toxins have found potential uses as diagnostic tools, therapeutic agent, or drug leads. In this review, different non-enzymatically active snake venom toxins which have potential therapeutic properties such as antitumor, antimicrobial, anticoagulating, and analgesic activities will be discussed.
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Affiliation(s)
- Yau Sang Chan
- State Key Laboratory of Respiratory Disease for Allergy, School of Medicine, Shenzhen University, Nanhai Ave 3688, 518060, Shenzhen, Guangdong, China
| | - Randy Chi Fai Cheung
- School of Biomedical Sciences, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
| | - Lixin Xia
- State Key Laboratory of Respiratory Disease for Allergy, School of Medicine, Shenzhen University, Nanhai Ave 3688, 518060, Shenzhen, Guangdong, China.
| | - Jack Ho Wong
- School of Biomedical Sciences, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China.
| | - Tzi Bun Ng
- School of Biomedical Sciences, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China.
| | - Wai Yee Chan
- School of Biomedical Sciences, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China.
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Menon JC, Joseph JK, Jose MP, Punde D, Mazumdar DB, Bawaskar HS, Pillay VV, Mohapatra BN, Rajendiran C, Tanwar PD, Raut S, Ragunanthatan S, Tripathi S. Management protocol of venomous snakebite in India: a consensus statement. TOXIN REV 2016. [DOI: 10.1080/15569543.2016.1185735] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Praveen Kumar KV, Praveen Kumar S, Kasturi N, Ahuja S. Ocular Manifestations of Venomous Snake Bite over a One-year Period in a Tertiary Care Hospital. KOREAN JOURNAL OF OPHTHALMOLOGY 2015; 29:256-62. [PMID: 26240510 PMCID: PMC4520869 DOI: 10.3341/kjo.2015.29.4.256] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2015] [Accepted: 02/24/2015] [Indexed: 11/26/2022] Open
Abstract
Purpose Ocular manifestations in snake-bite injuries are quite rare. However, the unusual presentations, diagnosis and their management can pose challenges when they present to the ophthalmologist. Early detection of these treatable conditions can prevent visual loss in these patients who are systemically unstable and are unaware of their ocular condition. To address this, a study was conducted with the aim of identifying the various ocular manifestations of snake bite in a tertiary care center. Methods This is a one-year institute-based prospective study report of 12 snake bite victims admitted to a tertiary hospital with ocular manifestations between June 2013 to June 2014, which provides data about the demographic characteristics, clinical profiles, ocular manifestations, and their outcomes. Results Twelve cases of snake bite with ocular manifestations were included of which six were viper bites, three were cobra bites and three were unknown bites. Six patients presented with bilateral acute angle closure glaucoma (50%), two patients had anterior uveitis (16.6%) of which one patient had concomitant optic neuritis. One patient had exudative retinal detachment (8.3%), one patient had thrombocytopenia with subconjunctival hemorrhage (8.3%) and two patients had external ophthalmoplegia (16.6%). Conclusions Bilateral angle closure glaucoma was the most common ocular manifestation followed by anterior uveitis and external ophthalmoplegia. Snake bite can result in significant ocular morbidity in a majority of patients but spontaneous recovery with anti-snake venom, steroids and conservative management results in good visual prognosis.
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Affiliation(s)
- K V Praveen Kumar
- Department of Ophthalmology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - S Praveen Kumar
- Department of Ophthalmology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Nirupama Kasturi
- Department of Ophthalmology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Shashi Ahuja
- Department of Ophthalmology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
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Abstract
This review is on the pulmonary complications of snakebites, which can have fatal consequences. We identified three common themes as reported in the literature regarding envenomation: generalized neuromuscular paralysis affecting airway and respiratory muscles, pulmonary edema, and pulmonary hemorrhages or thrombosis due to coagulopathy. Respiratory paralysis and pulmonary edema can be due to either elapid or viper bites, whereas pulmonary complications of coagulopathy are exclusively reported with viper bites. The evidence for each complication, timeline of appearance, response to treatment, and details of pathophysiology are discussed.
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Affiliation(s)
- Ariaranee Gnanathasan
- From the The Department of Clinical Medicine, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka.
| | - Chaturaka Rodrigo
- From the The Department of Clinical Medicine, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka
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Del Brutto OH. The neglected strokes--cerebrovascular complications of neglected tropical diseases. Int J Stroke 2015; 10:E14-5. [PMID: 25598029 DOI: 10.1111/ijs.12414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- O H Del Brutto
- School of Medicine, Universidad Espíritu Santo, Guayaquil, Ecuador; Department of Neurological Sciences, Hospital-Clínica Kennedy, Guayaquil, Ecuador
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50
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Laines J, Segura Á, Villalta M, Herrera M, Vargas M, Alvarez G, Gutiérrez JM, León G. Toxicity of Bothrops sp snake venoms from Ecuador and preclinical assessment of the neutralizing efficacy of a polyspecific antivenom from Costa Rica. Toxicon 2014; 88:34-7. [DOI: 10.1016/j.toxicon.2014.06.008] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2014] [Revised: 06/09/2014] [Accepted: 06/11/2014] [Indexed: 11/29/2022]
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