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Dias DA, Souza de Souza KF, Moslaves ISB, Buri MV, Basilio DCLS, Espinoça IT, Parisotto EB, Silva-Filho SE, Migliolo L, Jaques JAO, Franco DG, Chudzinski-Tavassi AM, Rita PHS, da Silva DB, Carollo CA, Toffoli-Kadri MC, Paredes-Gamero EJ. Identification of purinergic system components in the venom of Bothrops mattogrossensis and the inhibitory effect of specioside extracted from Tabebuia aurea. Purinergic Signal 2024:10.1007/s11302-024-10032-z. [PMID: 38958820 DOI: 10.1007/s11302-024-10032-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Accepted: 06/16/2024] [Indexed: 07/04/2024] Open
Abstract
Snake bites are a severe problem in the countryside of Brazil and are usually attributed to snakes of the genera Bothrops, Crotalus, and Lachesis. Snake venom can release ectoenzymes and nucleotidases that modulate the purinergic system. In addition to serum therapy against snake poisoning, medicinal plants with anti-inflammatory activities, such as Tabebuia aurea, is empirically applied in accidents that occur in difficult-to-access areas. This study aimed was to verify the presence and activity of nucleotidases in the crude venom of Bothrops mattogrossensis (BmtV) in vitro and characterize the modulation of purinergic components, myeloid differentiation, and inflammatory/oxidative stress markers by BmtV in vivo and in vitro. Moreover, our study assessed the inhibitory activities of specioside, an iridoid isolated from Tabebuia aurea, against the effects of BmtV. Proteomic analysis of venom content and nucleotidase activity confirm the presence of ectonucleotidase-like enzymes in BmtV. In in vivo experiments, BmtV altered purinergic component expression (P2X7 receptor, CD39 and CD73), increased neutrophil numbers in peripheral blood, and elevated oxidative stress/inflammatory parameters such as lipid peroxidation and myeloperoxidase activity. BmtV also decreased viability and increased spreading index and phagocytic activity on macrophages. Specioside inhibited nucleotidase activity, restored neutrophil numbers, and mediate the oxidative/inflammatory effects produced by BmtV. We highlight the effects produced by BmtV in purinergic system components, myeloid differentiation, and inflammatory/oxidative stress parameters, while specioside reduced the main BmtV-dependent effects.
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Affiliation(s)
- Dhébora Albuquerque Dias
- Faculdade de Ciências Farmacêuticas, Alimentos e Nutrição (FACFAN), Laboratório de Biologia Molecular e Culturas Celulares, Universidade Federal de Mato Grosso do Sul (UFMS), Av. Costa e Silva, s/n. Bairro Universitário, Campo Grande, MS, CEP: 79070-900, Brazil
| | | | - Iluska Senna Bonfá Moslaves
- Faculdade de Ciências Farmacêuticas, Alimentos e Nutrição (FACFAN), Laboratório de Biologia Molecular e Culturas Celulares, Universidade Federal de Mato Grosso do Sul (UFMS), Av. Costa e Silva, s/n. Bairro Universitário, Campo Grande, MS, CEP: 79070-900, Brazil
| | - Marcus Vinicius Buri
- Centre of Excellence in New Target Discovery-CENTD, Butantan Institute, São Paulo, SP, Brazil
| | - Denise Caroline Luiz Soares Basilio
- Faculdade de Ciências Farmacêuticas, Alimentos e Nutrição (FACFAN), Laboratório de Biologia Molecular e Culturas Celulares, Universidade Federal de Mato Grosso do Sul (UFMS), Av. Costa e Silva, s/n. Bairro Universitário, Campo Grande, MS, CEP: 79070-900, Brazil
| | - Isabelly Teixeira Espinoça
- Faculdade de Ciências Farmacêuticas, Alimentos e Nutrição (FACFAN), Laboratório de Biologia Molecular e Culturas Celulares, Universidade Federal de Mato Grosso do Sul (UFMS), Av. Costa e Silva, s/n. Bairro Universitário, Campo Grande, MS, CEP: 79070-900, Brazil
| | - Eduardo Benedetti Parisotto
- Faculdade de Ciências Farmacêuticas, Alimentos e Nutrição (FACFAN), Laboratório de Biologia Molecular e Culturas Celulares, Universidade Federal de Mato Grosso do Sul (UFMS), Av. Costa e Silva, s/n. Bairro Universitário, Campo Grande, MS, CEP: 79070-900, Brazil
| | - Saulo Euclides Silva-Filho
- Faculdade de Ciências Farmacêuticas, Alimentos e Nutrição (FACFAN), Laboratório de Biologia Molecular e Culturas Celulares, Universidade Federal de Mato Grosso do Sul (UFMS), Av. Costa e Silva, s/n. Bairro Universitário, Campo Grande, MS, CEP: 79070-900, Brazil
| | - Ludovico Migliolo
- Programa de Pós-Graduação em Biotecnologia, Universidade Católica Dom Bosco, Campo Grande, MS, Brazil
| | | | - Daniel Guerra Franco
- Instituto de Biociências, Universidade Federal de Mato Grosso do Sul (UFMS), Campo Grande, MS, Brazil
| | - Ana Marisa Chudzinski-Tavassi
- Centre of Excellence in New Target Discovery-CENTD, Butantan Institute, São Paulo, SP, Brazil
- Development and Innovation Centre, Butantan Institute, São Paulo, SP, Brazil
| | | | - Denise Brentan da Silva
- Faculdade de Ciências Farmacêuticas, Alimentos e Nutrição (FACFAN), Laboratório de Biologia Molecular e Culturas Celulares, Universidade Federal de Mato Grosso do Sul (UFMS), Av. Costa e Silva, s/n. Bairro Universitário, Campo Grande, MS, CEP: 79070-900, Brazil
| | - Carlos Alexandre Carollo
- Faculdade de Ciências Farmacêuticas, Alimentos e Nutrição (FACFAN), Laboratório de Biologia Molecular e Culturas Celulares, Universidade Federal de Mato Grosso do Sul (UFMS), Av. Costa e Silva, s/n. Bairro Universitário, Campo Grande, MS, CEP: 79070-900, Brazil
| | - Mônica Cristina Toffoli-Kadri
- Faculdade de Ciências Farmacêuticas, Alimentos e Nutrição (FACFAN), Laboratório de Biologia Molecular e Culturas Celulares, Universidade Federal de Mato Grosso do Sul (UFMS), Av. Costa e Silva, s/n. Bairro Universitário, Campo Grande, MS, CEP: 79070-900, Brazil
| | - Edgar Julian Paredes-Gamero
- Faculdade de Ciências Farmacêuticas, Alimentos e Nutrição (FACFAN), Laboratório de Biologia Molecular e Culturas Celulares, Universidade Federal de Mato Grosso do Sul (UFMS), Av. Costa e Silva, s/n. Bairro Universitário, Campo Grande, MS, CEP: 79070-900, Brazil.
- Biochemistry Department, Federal University of São Paulo, São Paulo, SP, Brazil.
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Kumar R, Rathore AS. Snakebite Management: The Need of Reassessment, International Relations, and Effective Economic Measures to Reduce the Considerable SBE Burden. J Epidemiol Glob Health 2024:10.1007/s44197-024-00247-z. [PMID: 38856820 DOI: 10.1007/s44197-024-00247-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Accepted: 05/20/2024] [Indexed: 06/11/2024] Open
Abstract
The sole treatment for snakebite envenomation (SBE), the anti-snake venom (ASV), suffers from considerable drawbacks, including side effects and limited species specificity. Additionally, despite its existence for more than a century, uniform availability of good quality ASV does not yet exist. The present review describes the journey of a SBE victim and highlights the global crisis of SBE management. A detailed analysis of the current ASV market has also been presented along with the worldwide snake distribution. The current production of country specific licensed ASV throughout the globe along with their manufacturers has been examined at the snake species level. Furthermore, a detailed analysis of on-ground situation of SBE management in antivenom manufacturing countries has been done using the most recent literature. Additionally, the export and import of different ASVs have been discussed in terms of procurement policies of individual countries, their shortcomings, along with the possible solution at the species level. It is interesting to note that in most countries, the existence of ASV is really either neglected or overstated, implying that it is there but unsuitable for use, or that it is not present but can be obtained from other countries. This highlights the urgent need of significant reassessment and international collaborations not just for development and production, but also for procurement, distribution, availability, and awareness. A PROMISE (Practical ROutes for Managing Indigenous Snakebite Envenoming) approach has also been introduced, offering simple, economical, and easy to adopt steps to efficiently alleviate the worldwide SBE burden.
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Affiliation(s)
- Ramesh Kumar
- Department of Chemical Engineering, Indian Institute of Technology Delhi, Hauz Khas, New Delhi, India
| | - Anurag S Rathore
- Department of Chemical Engineering, Indian Institute of Technology Delhi, Hauz Khas, New Delhi, India.
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Bisneto PF, Vilhena da Silva Neto A, Mota Cordeiro JS, Monteiro WM, de Almeida Gonçalves Sachett J. Does Covid-19 influence the dynamics of envenomation by animals in a country strongly affected by both conditions? Epidemiological data from Brazil. Toxicon 2024; 244:107776. [PMID: 38795850 DOI: 10.1016/j.toxicon.2024.107776] [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: 12/08/2023] [Revised: 05/20/2024] [Accepted: 05/21/2024] [Indexed: 05/28/2024]
Abstract
The impact of Covid-19 on envenomations by venomous animals in countries heavily affected by both conditions has not been quantified yet. Brazil shows high incidence of envenomations by scorpions, spiders and snakes and was heavily affected by waves of Covid-19. To determine how the pandemic impacted the epidemiology of envenomations by those three groups of venomous animals, we used online databases from two surveillance sources on number of cases and mortality. During the years before and during the pandemic, scorpion stings typically occurred in adults of both sexes in urban zones in the Southeast and Northeast regions. Spider bites occurred mainly in the South region, in adults of both sexes in urban zone. Snakebites affected mainly rural adult men in the Amazon. Between 2007 and 2021, overall incidence of cases by scorpions, spiders and snakes decreased after the beginning of the pandemic, snakebites did not show changes after the pandemic started in Brazil, but cases by scorpions and spiders decreased. No changes in the incidence of deaths were observed. On national level, Covid-19 affected some demographic, clinical and epidemiological aspects in cases by scorpions, spiders and snakes.
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Affiliation(s)
- Pedro Ferreira Bisneto
- Fundação de Medicina Tropical Doutor Heitor Vieira Dourado, Programa de Pós-Graduação em Medicina Tropical, Manaus, Amazonas, Brazil; Fundação de Medicina Tropical Doutor Heitor Vieira Dourado, Diretoria de Ensino e Pesquisa, Manaus, Amazonas, Brazil.
| | - Alexandre Vilhena da Silva Neto
- Fundação de Medicina Tropical Doutor Heitor Vieira Dourado, Diretoria de Ensino e Pesquisa, Manaus, Amazonas, Brazil; Escola Superior de Ciências da Saúde, Universidade do Estado do Amazonas, Manaus, Amazonas, Brazil
| | - Jady Shayenne Mota Cordeiro
- Fundação de Medicina Tropical Doutor Heitor Vieira Dourado, Programa de Pós-Graduação em Medicina Tropical, Manaus, Amazonas, Brazil
| | - Wuelton Marcelo Monteiro
- Fundação de Medicina Tropical Doutor Heitor Vieira Dourado, Programa de Pós-Graduação em Medicina Tropical, Manaus, Amazonas, Brazil; Fundação de Medicina Tropical Doutor Heitor Vieira Dourado, Diretoria de Ensino e Pesquisa, Manaus, Amazonas, Brazil; Escola Superior de Ciências da Saúde, Universidade do Estado do Amazonas, Manaus, Amazonas, Brazil
| | - Jacqueline de Almeida Gonçalves Sachett
- Fundação de Medicina Tropical Doutor Heitor Vieira Dourado, Programa de Pós-Graduação em Medicina Tropical, Manaus, Amazonas, Brazil; Fundação de Medicina Tropical Doutor Heitor Vieira Dourado, Diretoria de Ensino e Pesquisa, Manaus, Amazonas, Brazil; Escola Superior de Ciências da Saúde, Universidade do Estado do Amazonas, Manaus, Amazonas, Brazil
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Chowdhury MAW, Müller J, Ghose A, Amin R, Sayeed AA, Kuch U, Faiz MA. Combining species distribution models and big datasets may provide finer assessments of snakebite impacts. PLoS Negl Trop Dis 2024; 18:e0012161. [PMID: 38768190 PMCID: PMC11142713 DOI: 10.1371/journal.pntd.0012161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Revised: 05/31/2024] [Accepted: 04/22/2024] [Indexed: 05/22/2024] Open
Abstract
BACKGROUND Snakebite is a major poverty-related neglected tropical disease. An integrated scientific approach is needed to understand the dynamics of this important health issue. Our objective was to estimate snakebite occurrence in a tropical area by using a blend of ecological modelling and robust statistical analysis. METHODS The present study used climatic, environmental, and human population density data to determine the area with snakebite occurrence-probability for the first time in Bangladesh. We also analysed a large, 16-year dataset of hospitalized snakebite cases to reveal the epidemiology of snakebite in the south-eastern zone of the country. FINDINGS Our results show that cobra bite is the most commonly occurring venomous snakebite in humans (around ~12% of the total yearly snakebite records), and men are more frequently bitten than women (2/3 of human victims are men). Most bites occur during the rainy season for cobra and green pit viper, while krait bites are not restricted to any particular season. As snakebite incidents are closely related to climate conditions, we can model snakebite risk using temperature and precipitation variables. Whereas there is a lack of snakebite reports from several parts of the study area in official records, our models predict that the entire study area is favourable for snakebite incidents. Based on the combined evidence we estimate that about 200,000 snakebite events occur every year in the south-eastern part of Bangladesh alone. Considering future global climate change, our model projections show that snakebite incidence in Bangladesh might not significantly decrease in the future (- 2070-); however, the distribution of probabilities might change, with a predicted increase of snakebite incidence in the hilly areas of the country. CONCLUSIONS Using climatic data to predict snakebite incidence in Bangladesh allowed us to provide estimations of the total annual number of snakebite cases in the study area. As in most countries, the scarcity of accurate epidemiological data in official records might have masked the real magnitude of this problem. Our analysis suggests that the problem of snakebite envenoming in Bangladesh might be worse than currently perceived. A long-term sustainable snakebite program plan should be designed and institutionalized, considering climatic, geographical and human demographic variables, to obtain better data and facilitate the implementation of accurate snakebite management programs for this country.
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Affiliation(s)
- Mohammad Abdul Wahed Chowdhury
- Department of Zoology, University of Chittagong, Chattogram, Bangladesh
- Museum für Naturkunde, Leibniz-Institut für Evolutions- und Biodiversitätsforschung, Berlin, Germany
- Institut für Biologie, Humboldt-Universität zu Berlin, Berlin, Germany
- Venom Research Centre, Department of Medicine, Chittagong Medical College, Chattogram, Bangladesh
| | - Johannes Müller
- Museum für Naturkunde, Leibniz-Institut für Evolutions- und Biodiversitätsforschung, Berlin, Germany
- Institut für Biologie, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Aniruddha Ghose
- Venom Research Centre, Department of Medicine, Chittagong Medical College, Chattogram, Bangladesh
- Department of Medicine, Chittagong Medical College, Chattogram, Bangladesh
| | - Robed Amin
- Venom Research Centre, Department of Medicine, Chittagong Medical College, Chattogram, Bangladesh
- Directorate General of Health Services, Ministry of Health and Family Welfare, Dhaka, Bangladesh
| | - Abdullah Abu Sayeed
- Venom Research Centre, Department of Medicine, Chittagong Medical College, Chattogram, Bangladesh
- Department of Medicine, Chittagong Medical College, Chattogram, Bangladesh
| | - Ulrich Kuch
- Venom Research Centre, Department of Medicine, Chittagong Medical College, Chattogram, Bangladesh
- Institute of Occupational Medicine, Social Medicine and Environmental Medicine, Goethe University, Frankfurt am Main, Germany
| | - Mohammad Abul Faiz
- Venom Research Centre, Department of Medicine, Chittagong Medical College, Chattogram, Bangladesh
- Dev Care Foundation, Chattogram, Bangladesh
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5
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Machado Marinho AC, Chapeaurouge A, Dutra BM, Quintela BCSF, Pereira SS, Fernandes CFC. The role of venom proteomics and single-domain antibodies for antivenoms: Progress in snake envenoming treatment. Drug Discov Today 2024; 29:103967. [PMID: 38555033 DOI: 10.1016/j.drudis.2024.103967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Revised: 03/14/2024] [Accepted: 03/26/2024] [Indexed: 04/02/2024]
Abstract
Single-domain antibodies (sdAbs) hold promise for developing new biopharmaceuticals to treat neglected tropical diseases (NTDs), including snakebites, which are severe and occur frequently. In addition, limitations of conventional snakebite treatments, especially in terms of local action, and the global antivenom crisis incentivize the use of this biotechnological tool to design next-generation snakebite antivenoms. Conventional antivenoms for snakebite treatment are usually composed of immunoglobulin G or F(ab')2 fragments derived from the plasma of immunized animals. sdAbs, the smallest antigen-binding fragments, are derived from the variable domains of camelid heavy-chain antibodies. sdAbs may have some advantages over conventional antivenoms for local toxicity, such as better penetration into tissues due to their small size, and high solubility and affinity for venom antigens due to their unique antigen-binding loops and ability to access cryptic epitopes. We present an overview of current antivenom therapy in the context of sdAb development for toxin neutralization. Furthermore, strategies are presented for identifying snake venom's major toxins as well as for developing antisnake toxin sdAbs by employing proteomic tools for toxin neutralization.
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Affiliation(s)
- Anna Carolina Machado Marinho
- Laboratório Multiusuário de Pesquisa e Desenvolvimento, Fundação Oswaldo Cruz Ceará, FIOCRUZ CE, Eusébio-CE, Brazil; Programa de Pós-Graduação em Ciências Farmacêuticas, Universidade Federal do Ceará, UFC, Fortaleza, Brazil
| | - Alexander Chapeaurouge
- Laboratório Multiusuário de Pesquisa e Desenvolvimento, Fundação Oswaldo Cruz Ceará, FIOCRUZ CE, Eusébio-CE, Brazil
| | - Brunheld Maia Dutra
- Laboratório Multiusuário de Pesquisa e Desenvolvimento, Fundação Oswaldo Cruz Ceará, FIOCRUZ CE, Eusébio-CE, Brazil
| | - Barbara Cibelle S F Quintela
- Laboratório Multiusuário de Pesquisa e Desenvolvimento, Fundação Oswaldo Cruz Ceará, FIOCRUZ CE, Eusébio-CE, Brazil
| | - Soraya S Pereira
- Laboratório de Engenharia de Anticorpos, Fundação Oswaldo Cruz Rondônia, FIOCRUZ RO, Porto Velho-RO, Brazil
| | - Carla Freire C Fernandes
- Laboratório Multiusuário de Pesquisa e Desenvolvimento, Fundação Oswaldo Cruz Ceará, FIOCRUZ CE, Eusébio-CE, Brazil; Programa de Pós-Graduação em Ciências Farmacêuticas, Universidade Federal do Ceará, UFC, Fortaleza, Brazil
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6
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Knudsen C, Belfakir SB, Degnegaard P, Jürgensen JA, Haack AM, Friis RUW, Dam SH, Laustsen AH, Ross GMS. Multiplex lateral flow assay development for snake venom detection in biological matrices. Sci Rep 2024; 14:2567. [PMID: 38296989 PMCID: PMC10831076 DOI: 10.1038/s41598-024-51971-2] [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: 10/25/2023] [Accepted: 01/11/2024] [Indexed: 02/02/2024] Open
Abstract
Bothrops and Lachesis are two of Brazil's medically most relevant snake genera, causing tens of thousands of bites annually. Fortunately, Brazil has good accessibility to high-quality antivenoms at the genus and inter-genus level, enabling the treatment of many of these envenomings. However, the optimal use of these treatments requires that the snake species responsible for the bite is determined. Currently, physicians use a syndromic approach to diagnose snakebite, which can be difficult for medical personnel with limited training in clinical snakebite management. In this work, we have developed a novel monoclonal antibody-based multiplex lateral flow assay for differentiating Bothrops and Lachesis venoms within 15 min. The test can be read by the naked eye or (semi)-quantitatively by a smartphone supported by a 3D-printed attachment for controlling lighting conditions. The LFA can detect Bothrops and Lachesis venoms in spiked plasma and urine matrices at concentrations spanning six orders of magnitude. The LFA has detection limits of 10-50 ng/mL in spiked plasma and urine, and 50-500 ng/mL in spiked sera, for B. atrox and L. muta venoms. This test could potentially support medical personnel in correctly diagnosing snakebite envenomings at the point-of-care in Brazil, which may help improve patient outcomes and save lives.
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Affiliation(s)
- Cecilie Knudsen
- VenomAid Diagnostics, 2800, Kongens Lyngby, Denmark.
- Department of Biotechnology and Biomedicine, Technical University of Denmark, 2800, Kongens Lyngby, Denmark.
| | - Selma B Belfakir
- VenomAid Diagnostics, 2800, Kongens Lyngby, Denmark.
- Department of Biotechnology and Biomedicine, Technical University of Denmark, 2800, Kongens Lyngby, Denmark.
| | | | - Jonas A Jürgensen
- VenomAid Diagnostics, 2800, Kongens Lyngby, Denmark
- Department of Biotechnology and Biomedicine, Technical University of Denmark, 2800, Kongens Lyngby, Denmark
| | - Aleksander M Haack
- VenomAid Diagnostics, 2800, Kongens Lyngby, Denmark
- Department of Biotechnology and Biomedicine, Technical University of Denmark, 2800, Kongens Lyngby, Denmark
| | - Rasmus U W Friis
- VenomAid Diagnostics, 2800, Kongens Lyngby, Denmark
- Department of Biotechnology and Biomedicine, Technical University of Denmark, 2800, Kongens Lyngby, Denmark
| | - Søren H Dam
- VenomAid Diagnostics, 2800, Kongens Lyngby, Denmark
- Department of Biotechnology and Biomedicine, Technical University of Denmark, 2800, Kongens Lyngby, Denmark
| | - Andreas H Laustsen
- VenomAid Diagnostics, 2800, Kongens Lyngby, Denmark
- Department of Biotechnology and Biomedicine, Technical University of Denmark, 2800, Kongens Lyngby, Denmark
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Kono IS, Pandolfi VCF, Marchi MNAD, Freitas N, Freire RL. Unveiling the secrets of snakes: Analysis of environmental, socioeconomic, and spatial factors associated with snakebite risk in Paraná, Southern Brazil. Toxicon 2024; 237:107552. [PMID: 38065257 DOI: 10.1016/j.toxicon.2023.107552] [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: 10/09/2023] [Revised: 11/29/2023] [Accepted: 12/03/2023] [Indexed: 12/24/2023]
Abstract
The state of Paraná is home to three out of the five medically significant snake genera in Brazil and lacks of snakebite epidemiology studies. This study aimed to ascertain the spatial, environmental, and socioeconomic factors associated with snakebite risk by analyzing notification data of cases in the state of Paraná. Notification and socioeconomic data were gathered from the online platforms of the National System of Notifiable Diseases (SINAN) and the Brazilian Institute of Geography and Statistics (IBGE). Land cover and land use maps were obtained from the Mapbiomas platform in raster format and subsequently converted into vectors using QGis software. The proportions of land use and land cover in square kilometers (km2) were then calculated. All acquired data were tabulated using Microsoft Excel 365 software. For spatial analysis, GeoDa software version 1.20 was utilized to calculate the Global and Local Moran indices, assessing spatial correlations. Between 2007 and 2021, 12,877 notifications were recorded, with an average incidence of 8.22/100,000 inhabitants in the state, 8166 (63.41%) caused by Bothrops, 1534 (11.91%) caused by Crotalus, 56 (0.43%) caused by Micrurus. 1703 (13.22%) caused by non-venomous snake species, and the remaining cases did not have the identified causative species. The incidents caused by Bothrops and Crotalus showed different distribution patterns. Spatial analysis revealed that key factors contributing to snakebite risk included the presence of native forests, mangroves, apicuns, and monospecific planted forests. The population group at the highest risk comprised rural residents and workers. Furthermore, the absence of basic sanitation and proper garbage collection and disposal exhibited positive correlations with snakebites. Conversely, intensive farming practices with substantial mechanization and pastures demonstrated negative spatial correlations. This study has enabled the identification of the primary factors associated with snakebite risk, facilitating more targeted efforts to prevent snakebite accidents among vulnerable populations.
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Affiliation(s)
- Isabelli Sayuri Kono
- Departamento de Medicina Veterinária Preventiva, Universidade Estadual de Londrina, Londrina, 86057970, Paraná, Brazil.
| | | | - Melca Niceia Altoé de Marchi
- Departamento de Ciências Agrárias e Ambientais, Universidade Estadual de Santa Cruz, Ilhéus, 45662900, Bahia, Brazil.
| | - Nicolas Freitas
- Departamento de Geociências, Universidade Estadual de Londrina, Londrina, 86057970, Paraná, Brazil.
| | - Roberta Lemos Freire
- Departamento de Medicina Veterinária Preventiva, Universidade Estadual de Londrina, Londrina, 86057970, Paraná, Brazil.
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8
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Schneider MC, Min KD, Romijn PC, De Morais NB, Montebello L, Manrique Rocha S, Sciancalepore S, Hamrick PN, Uieda W, Câmara VDM, Luiz RR, Belotto A. Fifty Years of the National Rabies Control Program in Brazil under the One Health Perspective. Pathogens 2023; 12:1342. [PMID: 38003806 PMCID: PMC10674250 DOI: 10.3390/pathogens12111342] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2023] [Revised: 11/04/2023] [Accepted: 11/09/2023] [Indexed: 11/26/2023] Open
Abstract
In 1973, the National Rabies Program was created in Brazil through an agreement between the Ministry of Health and Agriculture. Since its beginning, it developed integrated action through access to free post-exposure prophylaxis (PEP) for people at risk, dog vaccination campaigns, a joint surveillance system, and awareness. This study aims to describe human rabies in Brazil under the One Health perspective in recent decades, including achievements in the control of dog-mediated cases and challenges in human cases transmitted by wild animals. This paper also explores possible drivers of human rabies in the Northeast Region with half of the cases. The first part of this study was descriptive, presenting data and examples by periods. Statistical analysis was performed in the last period (2010-2022) to explore possible drivers. Dog-mediated human cases decreased from 147 to 0, and dog cases decreased from 4500 to 7. A major challenge is now human cases transmitted by wild animals (bats, non-human primates, and wild canids). Most current human cases occur in municipalities with a tropical and subtropical moist broadleaf forest biome and a Gini index higher than 0.5. In the multivariable analysis, an association with temperature was estimated (OR = 1.739; CI95% = 1.181-2.744), and primary healthcare coverage (OR = 0.947; CI95% = 0.915-0.987) was identified as a protector. It is possible to significantly reduce the number of dog-mediated human rabies cases through the efforts presented. However, Brazil has wildlife variants of the rabies virus circulating. The association of human cases with higher temperatures in the Northeast is a concern with climate change. To reduce human cases transmitted by wild animals, it is important to continue distributing free PEP, especially in remote at-risk areas in the Amazon Region, and to increase awareness.
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Affiliation(s)
- Maria Cristina Schneider
- Department of Global Health, School of Health, Georgetown University, Washington, DC 20007, USA
- Institute of Collective Health Studies, Federal University of Rio de Janeiro, Rio de Janeiro 24220-900, Brazil; (V.d.M.C.); (R.R.L.)
- PAHO/WHO (Ret.), Washington, DC 20037, USA;
| | - Kyung-Duk Min
- College of Veterinary Medicine, Chungbuk National University, Chungbuk 28644, Republic of Korea;
| | | | | | - Lucia Montebello
- Secretaria de Vigilancia em Saúde e Ambiente, Ministry of Health, Brasilia 70723-040, Brazil; (L.M.); (S.M.R.)
| | - Silene Manrique Rocha
- Secretaria de Vigilancia em Saúde e Ambiente, Ministry of Health, Brasilia 70723-040, Brazil; (L.M.); (S.M.R.)
| | | | | | - Wilson Uieda
- Department of Zoology and Botany, São Paulo State University (Ret.), Sao Paulo 05508-090, Brazil;
| | - Volney de Magalhães Câmara
- Institute of Collective Health Studies, Federal University of Rio de Janeiro, Rio de Janeiro 24220-900, Brazil; (V.d.M.C.); (R.R.L.)
| | - Ronir Raggio Luiz
- Institute of Collective Health Studies, Federal University of Rio de Janeiro, Rio de Janeiro 24220-900, Brazil; (V.d.M.C.); (R.R.L.)
| | - Albino Belotto
- PAHO/WHO, Washington, DC 20037, USA; (S.S.); (A.B.)
- FUNASA (Fundacao SESP)/Ministry of Health (Ret.), Brasilia 70070-040, Brazil
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9
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Duque BR, Bruno SF, Ferreira V, Guedes TB, Machado C, Hamdan B. Venomous snakes of medical importance in the Brazilian state of Rio de Janeiro: habitat and taxonomy against ophidism. BRAZ J BIOL 2023; 83:e272811. [PMID: 37909585 DOI: 10.1590/1519-6984.272811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Accepted: 08/19/2023] [Indexed: 11/03/2023] Open
Abstract
Snakebite envenoming is a major global health problem that kills or disables half a million people in the world's poorest countries. Identifying the biting snake and its habitat use is key to understanding snakebite eco-epidemiology and optimizing its clinical management. To prevent and combat the neglected snakebite disease, we characterize the morphology, geographic distribution, habitat use, and snakebites of medically important venomous snakes in the state of Rio de Janeiro (Brazil). Despite Philodryas spp. not being considered of medical importance by the Brazilian Ministry of Health, we also explore their data once the bites may require medical intervention, may cause death, and their consequences are underestimated. Methods: We assessed taxonomy and geographic data from specimens housed in scientific collections, the literature, and the Notifiable Diseases Information System. Our data revealed fragility in the morphological characters recommended to distinguish Bothrops jararaca from B. jararacussu, identify the subspecies of Crotalus durissus and distinguish the species of Philodryas. To help identify these species, we present an identification key to the venomous snake species from Rio de Janeiro based on the morphological data collected. We record the genera Bothrops and Micrurus in all mesoregions of the state. Here, we provide the first record of C. durissus in the Serrana region, supporting the hypothesis of geographic expansion of the species in the state. The crotalic antivenom must not be missing in Médio Paraíba, Centro-Sul Fluminense, and Serrana, where the rattlesnake C. durissus occurs. Bothrops bilineatus and Lachesis muta have historical records presented for the first time herein. However, these species are likely endangered or extinct in the state. There were 7,483 snakebites reported between 2001 and 2019, with an annual average of 393.8 cases. The Bothrops genus is responsible for the majority of accidents. The highest number of cases occurred in the Serrana region, the largest pole of family agriculture in Rio de Janeiro. We improve the identification of venomous snake species, better delimit their distribution, and update the number of cases of snakebites, thus providing greater precision in the attention to this problem in Rio de Janeiro. We emphasize the importance of clinical studies to test using bothropic-crotalic antivenom and heparin in all mesoregions to treat B. jararacussu envenomation; and mechanical ventilation, atropine, and anticholinesterases in the emergency health centers in the Metropolitana and Norte Fluminense regions due to the occurrence of the coral M. lemniscatus in these areas.
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Affiliation(s)
- B R Duque
- Instituto Vital Brazil - IVB, Laboratório de Coleções Biológicas e Biodiversidade, Diretoria Científica, Niterói, RJ, Brasil
- Universidade Federal do Estado do Rio de Janeiro - UNIRIO, Programa de Pós-graduação em Ecoturismo e Conservação, Rio de Janeiro, RJ, Brasil
| | - S F Bruno
- Universidade Federal Fluminense - UFF, Faculdade de Veterinária, Niterói, RJ, Brasil
| | - V Ferreira
- Instituto Vital Brazil - IVB, Laboratório de Coleções Biológicas e Biodiversidade, Diretoria Científica, Niterói, RJ, Brasil
| | - T B Guedes
- Universidade Estadual de Campinas - UNICAMP, Instituto de Biologia, Departamento de Biologia Animal, Campinas, SP, Brasil
- University of Gothenburg, Gothenburg Global Biodiversity Center - GGBC, Department of Biological and Environmental Sciences, Göteborg, Sweden
| | - C Machado
- Instituto Vital Brazil - IVB, Laboratório de Coleções Biológicas e Biodiversidade, Diretoria Científica, Niterói, RJ, Brasil
| | - B Hamdan
- Instituto Vital Brazil - IVB, Laboratório de Coleções Biológicas e Biodiversidade, Diretoria Científica, Niterói, RJ, Brasil
- Universidade Federal do Rio de Janeiro - UFRJ, Instituto de Bioquímica Médica Leopoldo de Meis, Laboratório de Hemostase e Venenos, Rio de Janeiro, RJ, Brasil
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10
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Araújo SCM, Câmara JT, Guedes TB. Snakebites in Northeastern Brazil: accessing clinical-epidemiological profile as a strategy to deal with Neglected Tropical Diseases. Rev Soc Bras Med Trop 2023; 56:e02242023. [PMID: 37820102 PMCID: PMC10561396 DOI: 10.1590/0037-8682-0224-2023] [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: 05/15/2023] [Accepted: 08/23/2023] [Indexed: 10/13/2023] Open
Abstract
BACKGROUND Brazil ranks first in the number of snakebites in South America. A detailed analysis of these cases is required to improve the public health planning. In this study, we retrospectively examined the clinical and epidemiological profiles of snakebites in Maranhão between January 2009 and December 2019. METHODS Data were obtained from the compulsory notification forms provided by the Health Department of Maranhão. RESULTS A total of 17,658 cases were recorded during the study period. Most of the bites were from snakes belonging to the genus Bothrops. Medical care was mostly within three hours after the bite. Most cases were classified as mild and most victims recovered; however, 139 deaths were recorded. Most bites occurred among people aged 20-39 years, mainly among rural workers. The most frequent local clinical manifestations were pain, edema, and ecchymosis. The most common systemic clinical manifestations include neuroparalysis, vagal syndrome, and myolysis. Most snakebites occurred between January and March. The municipalities with the highest number of notifications were Buriticupu (936 cases), Arame (705 cases), and Grajaú (627 cases). CONCLUSIONS The clinical profile of snakebites in Maranhão is similar to that observed in other states of Northeast Brazil. However, we found that some systemic manifestations are not compatible with the etiology of snakebites, which leads us to believe that the problem could be the lack of knowledge of the health professionals at the site of envenomation, who may not be ready for attendance, and an important lack of health centers with snake antivenom to treat snakebites.
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Affiliation(s)
- Sâmia Caroline Melo Araújo
- Universidade Estadual do Maranhão, Programa de Pós-Graduação em Biodiversidade, Ambiente e Saúde, Caxias, MA, Brasil
| | - Joseneide Teixeira Câmara
- Universidade Estadual do Maranhão, Programa de Pós-Graduação em Biodiversidade, Ambiente e Saúde, Caxias, MA, Brasil
| | - Thaís B. Guedes
- Universidade Estadual de Campinas, Instituto de Biologia, Departamento de Biologia Animal, Campinas, SP, Brasil
- Gothenburg Global Biodiversity Center, University of Gothenburg, Department of Biological and Environmental Sciences, Göteborg, Sweden
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11
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da Silva WRGB, de Siqueira Santos L, Lira D, de Oliveira Luna KP, Fook SML, Alves RRN. Who are the most affected by Bothrops snakebite envenoming in Brazil? A Clinical-epidemiological profile study among the regions of the country. PLoS Negl Trop Dis 2023; 17:e0011708. [PMID: 37856557 PMCID: PMC10617728 DOI: 10.1371/journal.pntd.0011708] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 10/31/2023] [Accepted: 10/03/2023] [Indexed: 10/21/2023] Open
Abstract
Snakebite envenoming represents an important Neglected Tropical Disease (NTD) that mainly affects tropical and subtropical developing countries according to the World Health Organization (WHO). As a priority issue in the tropics, it is estimated that accidental encounter between snakes and humans is the leading cause of morbidity and mortality among all NTDs in the world. In Brazil, an extremely diverse country with continental dimensions, snakebite envenoming is the second leading cause of reported human envenoming. Treating the disease has been an unprecedented challenge for Brazilian Health Systems for decades. Despite access to Antivenom therapy and distributing it free of charge across the country, Brazil faces numerous issues regarding the notification process and accurate treatment targeting for at-risk populations. Thus, this study aimed to identify the temporal epidemiological dynamics of accidents caused by Bothrops snakes in Brazil, the country's major group of venomous snakes, based on secondary information from the online database provided by The Brazilian Notifiable Diseases Information System (SINAN). For this purpose, reported Bothrops snakebites between 2012 and 2021 were counted, then the data were analyzed. We looked at the frequency, occurrence, mortality rates, case fatality rate (CFR), age and gender distribution, and the time lapse between the incident and the initiation of Antivenom therapy. The data were also organized considering regional variations of the country. Throughout the studied period, a total of 202,604 cases of envenoming caused by Bothrops spp. were notified, resulting in 766 fatalities. These accidents were found to occur in variable proportions across different regions in Brazil, with notable concentrations observed in the North, Northeast, and Southeast regions. The epidemiological profile of patients varied greatly between the regions, revealing that snake envenoming is much more a social, economic, and ecological problem than a medical one. In conclusion, our study provides an overview of the clinical and epidemiological profile of envenoming by Bothrops snakes in Brazil. Notably, this is the first study to present such information in a country as vast and diverse as Brazil, encompassing a comparative analysis of its regions using SINAN data, that proves to be a very useful national tool to improve the control and management of envenoming.
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Affiliation(s)
- Weslley Ruan Guimarães Borges da Silva
- Department of Biology, Center of Biological and Health Sciences, Paraíba State University, Campina Grande, Paraíba, Brazil
- Graduate Program in Bioinformatics, Department of Biophysics and Pharmacology, Federal University of Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil
| | - Lucas de Siqueira Santos
- Graduate Program in Geodetic Sciences and Geoinformation Technologies, Department of Cartographic Engineering, Federal University of Pernambuco, Recife, Pernambuco, Brazil
| | - Derick Lira
- Department of Biology, Center of Biological and Health Sciences, Paraíba State University, Campina Grande, Paraíba, Brazil
- Graduate Program in Ecology and Conservation, Department of Biology, Paraíba State University, Campina Grande, Paraíba, Brazil
| | - Karla Patrícia de Oliveira Luna
- Department of Biology, Center of Biological and Health Sciences, Paraíba State University, Campina Grande, Paraíba, Brazil
- Graduate Program in Science Teaching and Mathematics Education, Department of Biology, Paraíba State University, Campina Grande, Paraíba, Brazil
- Graduate Program in Cellular and Molecular Biology, Department of Molecular Biology, Federal University of Paraiba, João Pessoa, Paraíba, Brazil
| | - Sayonara Maria Lia Fook
- Graduate Program in Public Health, Department of Pharmacy, State University of Paraíba, Campina Grande, Paraíba, Brazil
| | - Rômulo Romeu Nóbrega Alves
- Department of Biology, Center of Biological and Health Sciences, Paraíba State University, Campina Grande, Paraíba, Brazil
- Graduate Program in Ecology and Conservation, Department of Biology, Paraíba State University, Campina Grande, Paraíba, Brazil
- Graduate Program in Ethnobiology and Nature Conservation, Federal Rural University of Pernambuco, Recife, Pernambuco, Brazil
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12
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Knudsen C, Jürgensen JA, D Knudsen P, Oganesyan I, Harrison JA, Dam SH, Haack AM, Friis RUW, Vitved L, Belfakir SB, Ross GMS, Zenobi R, H Laustsen A. Prototyping of a lateral flow assay based on monoclonal antibodies for detection of Bothrops venoms. Anal Chim Acta 2023; 1272:341306. [PMID: 37355315 DOI: 10.1016/j.aca.2023.341306] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Accepted: 04/30/2023] [Indexed: 06/26/2023]
Abstract
BACKGROUND Brazil is home to a multitude of venomous snakes; perhaps the most medically relevant of which belong to the Bothrops genus. Bothrops spp. are responsible for roughly 70% of all snakebites in Brazil, and envenomings caused by their bites can be treated with three types of antivenom: bothropic antivenom, bothro-lachetic antivenom, and bothro-crotalic antivenom. The choice to administer antivenom depends on the severity of the envenoming, while the choice of antivenom depends on availability and on how certain the treating physician is that the patient was bitten by a bothropic snake. The diagnosis of a bothropic envenoming can be made based on expert identification of the dead snake or a photo thereof or based on a syndromic approach wherein the clinician examines the patient for characteristic manifestations of envenoming. This approach can be very effective but requires staff that has been trained in clinical snakebite management, which, unfortunately, far from all relevant staff has. RESULTS In this article, we describe a prototype of the first lateral flow assay (LFA) capable of detecting venoms from Brazilian Bothrops spp. The monoclonal antibodies for the assay were generated using hybridoma technology and screened in sandwich enzyme-linked immunosorbent assays (ELISAs) to identify Bothrops spp.-specific antibody sandwich pairs. The prototype LFA is able to detect venom from several Bothrops spp. The LFA has a limit of detection (LoD) of 9.5 ng/mL in urine, when read with a commercial reader, and a visual LoD of approximately 25 ng/mL. SIGNIFICANCE The work presented here serves as a proof of concept for a genus-specific venom detection kit that could support physicians in diagnosing Bothrops envenomings. Although further optimisation and testing is needed before the LFA can find clinical use, such a device could aid in decentralising antivenoms in the Brazilian Amazon and help ensure optimal snakebite management for even more victims of this highly neglected disease.
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Affiliation(s)
- Cecilie Knudsen
- Department of Biotechnology and Biomedicine, Technical University of Denmark, Kongens Lyngby, Denmark; BioPorto Diagnostics A/S, Hellerup, Denmark; VenomAid Diagnostics ApS, Kongens Lyngby, Denmark.
| | | | | | - Irina Oganesyan
- Department of Chemistry and Applied Biosciences, ETH Zürich, Zürich, Switzerland
| | - Julian A Harrison
- Department of Chemistry and Applied Biosciences, ETH Zürich, Zürich, Switzerland
| | - Søren H Dam
- Department of Biotechnology and Biomedicine, Technical University of Denmark, Kongens Lyngby, Denmark; VenomAid Diagnostics ApS, Kongens Lyngby, Denmark
| | - Aleksander M Haack
- Department of Biotechnology and Biomedicine, Technical University of Denmark, Kongens Lyngby, Denmark; VenomAid Diagnostics ApS, Kongens Lyngby, Denmark
| | - Rasmus U W Friis
- Department of Biotechnology and Biomedicine, Technical University of Denmark, Kongens Lyngby, Denmark; VenomAid Diagnostics ApS, Kongens Lyngby, Denmark
| | - Lars Vitved
- Cancer and Inflammation, Department of Molecular Medicine, University of Southern, Denmark
| | - Selma B Belfakir
- Department of Biotechnology and Biomedicine, Technical University of Denmark, Kongens Lyngby, Denmark; VenomAid Diagnostics ApS, Kongens Lyngby, Denmark
| | | | - Renato Zenobi
- Department of Chemistry and Applied Biosciences, ETH Zürich, Zürich, Switzerland
| | - Andreas H Laustsen
- Department of Biotechnology and Biomedicine, Technical University of Denmark, Kongens Lyngby, Denmark; VenomAid Diagnostics ApS, Kongens Lyngby, Denmark.
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Jesus LMG, Guedes JJM, Moura MR, Feio RN, Costa HC. Environmental drivers of tropical forest snake phenology: Insights from citizen science. Ecol Evol 2023; 13:e10305. [PMID: 37492463 PMCID: PMC10363785 DOI: 10.1002/ece3.10305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Revised: 05/18/2023] [Accepted: 06/26/2023] [Indexed: 07/27/2023] Open
Abstract
Museum specimens and citizen science initiatives are valuable sources of information on how anthropogenic activities affect biodiversity and how species respond to rapid global change. Although tropical regions harbor most of the planet's biodiversity, investigations on species' phenological changes are heavily biased toward temperate regions. Such unevenness in phenological research is also taxonomically biased, with reptiles being the least studied group among tetrapod species regarding animal phenology. Herein, we used long-term time-series data to investigate environmentally driven changes in the activity pattern of tropical forest snakes. We gathered natural history collection and citizen science data for 25 snake species (five venomous and 20 non-venomous) from an Atlantic Forest region in southeastern Brazil. Using circular mixed-effects models, we investigate whether snake activity patterns followed the variation in environmental variables over a decade. Our results show that the activity pattern of Atlantic Forest snakes was seasonal and largely driven by average temperature and relative humidity. Since snakes are ectothermic animals, they are particularly sensitive to temperature variations, especially at small scales. Moreover, relative humidity can affect snake's seasonal activities through physiological constraints and/or prey availability. Most specimens were registered during the rainy season, with highly venomous snakes (lanceheads and coral snakes) emerging as the most abundant taxa. We highlight the importance of citizen science and natural history collections in better understanding biodiversity. Furthermore, our data obtained from local collectors underscore the need for environmental education programs and collaboration between researchers and local decision-makers to raise awareness and reduce conflicts between people and snakes in the region.
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Affiliation(s)
- Letízia M. G. Jesus
- Museu de Zoologia João Moojen, Instituto de Ciências Biológicas e da SaúdeUniversidade Federal de ViçosaViçosaBrazil
- Programa de Pós‐Graduação em Biodiversidade e Conservação da Natureza, Instituto de Ciências BiológicasUniversidade Federal de Juiz de ForaJuiz de ForaBrazil
| | - Jhonny J. M. Guedes
- Programa de Pós‐Graduação em Ecologia e Evolução, Departamento de Ecologia, Campus SamambaiaUniversidade Federal de GoiásGoiâniaBrazil
| | - Mario R. Moura
- Departamento de Biologia AnimalUniversidade Estadual de CampinasCampinasBrazil
- Departamento de Ciências BiológicasUniversidade Federal da ParaíbaAreiaBrazil
| | - Renato N. Feio
- Museu de Zoologia João Moojen, Instituto de Ciências Biológicas e da SaúdeUniversidade Federal de ViçosaViçosaBrazil
| | - Henrique C. Costa
- Programa de Pós‐Graduação em Biodiversidade e Conservação da Natureza, Instituto de Ciências BiológicasUniversidade Federal de Juiz de ForaJuiz de ForaBrazil
- Departamento de Zoologia, Instituto de Ciências BiológicasUniversidade Federal de Juiz de ForaJuiz de ForaBrazil
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Moon Y, Kim C, Yoon S, Kang W. Identification of Risk Areas for Gloydius Snakebites in South Korea. Animals (Basel) 2023; 13:1959. [PMID: 37370469 DOI: 10.3390/ani13121959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2023] [Revised: 06/08/2023] [Accepted: 06/08/2023] [Indexed: 06/29/2023] Open
Abstract
Snakebites can pose a significant threat to human health as the destruction of natural habitats and increased human intrusion into ecosystems result in more frequent encounters with snakes. Mitigation measures for snakebites are particularly crucial for hiking trails where transportation of snakebite victims to medical facilities is challenging due to limited emergency resources and difficult access. This study employed a random forest-based species distribution model approach to investigate the potential habitats of Gloydius spp., specifically Gloydius saxatilis, Gloydius brevicaudus, and Gloydius ussuriensis, in South Korea and to assess the snakebite risk in national parks. Potential habitats of Gloydius spp. were identified and visualized by overlaying binary maps derived from species distribution models (SDMs) of each Gloydius spp. that corresponded to high-risk snakebite areas. In addition, hiking trails with high snakebite risk in the national parks were identified after demonstrating the statistical correlation between the potential habitat distribution of Gloydius spp. and the actual snakebite incidents in major regions of South Korea. The primary environmental variables determining Gloydius spp. habitat were the topographic position index, slope, and the annual average of the maximum and minimum temperatures. The potential habitat of G. saxatilis generally appeared in high-altitude mountainous areas, mostly in the eastern part of the study area. Favorable habitats for G. brevicaudus and G. ussuriensis were predominantly located in mountainous areas throughout the study area, with the exception of some high-altitude mountainous terrain in the east. The number of snakebite incidents per 10,000 people was significantly correlated with the area ratio of Gloydius spp. potential habitat (Spearman's rho = 0.638, p < 0.01). The proportion of snakebite risk areas among national parks in South Korea ranged from 18% to 57%. This study can support practical solutions to prevent injuries and fatalities among hikers due to snakebites by identifying areas with a high risk of snakebite accidents at the hiking-trail level.
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Affiliation(s)
- Youngjoo Moon
- Department of Forest Resources, Graduate School, Kookmin University, 77 Jeongneung-ro, Seongbuk-gu, Seoul 02707, Republic of Korea
| | - Chaewan Kim
- Department of Forest Resources, Graduate School, Kookmin University, 77 Jeongneung-ro, Seongbuk-gu, Seoul 02707, Republic of Korea
| | - Sungsoo Yoon
- Ecological Information Team, National Institute of Ecology, 1210 Geumgang-ro, Seocheon-gun 33657, Republic of Korea
| | - Wanmo Kang
- Department of Forest Environment and Systems, College of Science and Technology, Kookmin University, 77 Jeongneung-ro, Seongbuk-gu, Seoul 02707, Republic of Korea
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Isaacson JE, Ye JJ, Silva LL, Hernandes Rocha TA, de Andrade L, Scheidt JFHC, Wen FH, Sachett J, Monteiro WM, Staton CA, Vissoci JRN, Gerardo CJ. Antivenom access impacts severity of Brazilian snakebite envenoming: A geographic information system analysis. PLoS Negl Trop Dis 2023; 17:e0011305. [PMID: 37343007 PMCID: PMC10284398 DOI: 10.1371/journal.pntd.0011305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Accepted: 04/14/2023] [Indexed: 06/23/2023] Open
Abstract
BACKGROUND Snakebite envenoming (SBE) is a neglected tropical disease capable of causing both significant disability and death. The burden of SBE is especially high in low- and middle-income countries. The aim of this study was to perform a geospatial analysis evaluating the association of sociodemographics and access to care indicators on moderate and severe cases of SBE in Brazil. METHODS We conducted an ecological, cross-sectional study of SBE in Brazil from 2014 to 2019 using the open access National System Identification of Notifiable Diseases (SINAN) database. We then collected a set of indicators from the Brazil Census of 2010 and performed a Principal Component Analysis to create variables related to health, economics, occupation, education, infrastructure, and access to care. Next, a descriptive and exploratory spatial analysis was conducted to evaluate the geospatial association of moderate and severe events. These variables related to events were evaluated using Geographically Weighted Poisson Regression. T-values were plotted in choropleth maps and considered statistically significant when values were <-1.96 or >+1.96. RESULTS We found that the North region had the highest number of SBE cases by population (47.83/100,000), death rates (0.18/100,000), moderate and severe rates (22.96/100,000), and proportion of cases that took more than three hours to reach healthcare assistance (44.11%). The Northeast and Midwest had the next poorest indicators. Life expectancy, young population structure, inequality, electricity, occupation, and more than three hours to reach healthcare were positively associated with greater cases of moderate and severe events, while income, illiteracy, sanitation, and access to care were negatively associated. The remaining indicators showed a positive association in some areas of the country and a negative association in other areas. CONCLUSION Regional disparities in SBE incidence and rates of poor outcomes exist in Brazil, with the North region disproportionately affected. Multiple indicators were associated with rates of moderate and severe events, such as sociodemographic and health care indicators. Any approach to improving snakebite care must work to ensure the timeliness of antivenom administration.
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Affiliation(s)
| | - Jinny Jing Ye
- Department of Emergency Medicine, Duke University School of Medicine, Durham, North Carolina, United States of America
| | - Lincoln Luís Silva
- Department of Emergency Medicine, Duke University School of Medicine, Durham, North Carolina, United States of America
- Post-Graduation Program in Biosciences and Physiopathology, State University of Maringá, Maringá, Paraná, Brazil
| | - Thiago Augusto Hernandes Rocha
- Department of Emergency Medicine, Duke University School of Medicine, Durham, North Carolina, United States of America
- Duke Global Health Institute, Durham, North Carolina, United States of America
| | - Luciano de Andrade
- Department of Medicine, State University of Maringá, Maringá, Paraná, Brazil
| | | | - Fan Hui Wen
- Antivenom Production Section, Butantan Institute, São Paulo, São Paulo, Brazil
| | - Jacqueline Sachett
- School of Health Sciences, University of Amazonas State, Manaus, Amazonas, Brazil
| | - Wuelton Marcelo Monteiro
- School of Health Sciences, University of Amazonas State, Manaus, Amazonas, Brazil
- Tropical Medicine Foundation Dr. Heitor Vieira Dourado, Manaus, Amazonas, Brazil
| | - Catherine Ann Staton
- Department of Emergency Medicine, Duke University School of Medicine, Durham, North Carolina, United States of America
- Duke Global Health Institute, Durham, North Carolina, United States of America
| | - Joao Ricardo Nickenig Vissoci
- Department of Emergency Medicine, Duke University School of Medicine, Durham, North Carolina, United States of America
- Duke Global Health Institute, Durham, North Carolina, United States of America
| | - Charles John Gerardo
- Department of Emergency Medicine, Duke University School of Medicine, Durham, North Carolina, United States of America
- Duke Global Health Institute, Durham, North Carolina, United States of America
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Vaiyapuri S, Kadam P, Chandrasekharuni G, Oliveira IS, Senthilkumaran S, Salim A, Patel K, de Almeida Gonçalves Sachett J, Pucca MB. Multifaceted community health education programs as powerful tools to mitigate snakebite-induced deaths, disabilities, and socioeconomic burden. Toxicon X 2023; 17:100147. [PMID: 36632238 PMCID: PMC9827049 DOI: 10.1016/j.toxcx.2022.100147] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 12/13/2022] [Accepted: 12/20/2022] [Indexed: 12/27/2022] Open
Abstract
Snakebite envenoming (SBE) predominantly affects rural impoverished communities that have limited access to immediate healthcare. These communities often hold numerous myths/misbeliefs about snakes and SBE. Moreover, healthcare professionals who practice in rural regions often work in unstable situations with limited medical infrastructure and therefore, lack sufficient knowledge/experience and confidence in the clinical management of SBE. Due to the lack of reliable statistics on the true burden of SBE, developing health policies for this condition by relevant authorities may be difficult. Hence, it is critical to improve awareness about SBE among rural communities, healthcare professionals and health authorities using robust multifaceted community health education approaches. Here, we describe the design, development, implementation, and impact of distinctive community health education approaches that we used in India and Brazil. A wide range of educational tools including information leaflets, posters, pocket guides, learning materials for healthcare professionals and short/long video documentaries were developed in local languages and used to engage with target communities through direct assemblies as well as mass/traditional and social media. Notably, we used diverse methods to determine the impact of our programs in improving awareness, treatment-seeking behaviour, and clinical practice. The people-centred approaches that we used were inclusive and highly impactful in instigating fundamental changes in the management of SBE among rural communities. The resources and approaches presented in this article can be easily adapted for wider use in other countries in order to collectively reduce SBE-induced deaths, disabilities and socioeconomic ramifications.
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Affiliation(s)
- Sakthivel Vaiyapuri
- School of Pharmacy, University of Reading, Reading, RG6 6UB, UK
- Corresponding author.
| | | | | | - Isadora S. Oliveira
- Department of Biomolecular Sciences, School of Pharmaceutical Sciences of Ribeirão Preto, University of São Paulo, Ribeirão Preto, Brazil
| | | | - Anika Salim
- School of Pharmacy, University of Reading, Reading, RG6 6UB, UK
| | - Ketan Patel
- School of Biological Sciences, University of Reading, Reading, RG6 6UB, UK
| | | | - Manuela B. Pucca
- Medical School, Federal University of Roraima, Boa Vista, Brazil
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Strand E, Murta F, Tupetz A, Barcenas L, Phillips AJ, Farias AS, Santos AC, Rocha GDS, Staton CA, Ramos FR, Machado VA, Wen FH, Vissoci JR, Sachett J, Monteiro W, Gerardo CJ. Perspectives on snakebite envenoming care needs across different sociocultural contexts and health systems: A comparative qualitative analysis among US and Brazilian health providers. Toxicon X 2023; 17:100143. [PMID: 36578905 PMCID: PMC9791583 DOI: 10.1016/j.toxcx.2022.100143] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Accepted: 11/25/2022] [Indexed: 12/13/2022] Open
Abstract
With the advancements in therapeutics and available treatment options, almost all deaths and permanent disabilities from snakebite envenoming (SBE) are preventable. The challenge lies in implementing these evidence-based treatments and practices across different settings and populations. This study aims to compare data on provider perceptions of SBE care across health systems and cultural contexts to inform potential implementation science approaches. We hypothesize different health systems and cultural contexts will influence specific perceived needs to provide adequate snakebite care within central tenets of care delivery (e.g., cost, access, human resources). We previously conducted exploratory descriptive studies in the US and Brazil in order to understand the experience, knowledge, and perceptions of health professionals treating SBE. In the US, in-depth interviews were performed with emergency physicians from January 2020 to March 2020. In BR, focus group discussions were conducted with health professionals from community health centers at the end of June 2021. The focus group discussions (BR) were originally analyzed through an inductive thematic analysis approach. We conducted a secondary qualitative analysis in which this codebook was then applied to the interviews (US) in a deductive content analysis. The analysis concluded in August 2022. Brazil participants were physicians (n=5) or nurses (n=20) from three municipalities in the State of Amazonas with an average of three years of professional experience. US participants were emergency physicians (n=16) with an average of 15 years of professional experience. Four main themes emerged: 1) barriers to adequate care on the patient and/or community side and 2) on the health system side, 3) perceived considerations for how to address SBE, and 4) identified needs for improving care. There were 25 subthemes within the four themes. These subthemes were largely the same across the Brazil and US data, but the rationale and content within each shared subtheme varied significantly. For example, the subtheme "role of health professionals in improving care" extended across Brazil and the US. Brazil emphasized the need for task-shifting and -sharing amongst health care disciplines, whereas the US suggested specialized approaches geared toward increasing access to toxicologists and other referral resources. Despite similar core barriers to adequate snakebite envenoming care and factors to consider when trying to improve care delivery, health professionals in different health systems and sociocultural contexts identified different needs. Accounting for, and understanding, these differences is crucial to the success of initiatives intended to strengthen snakebite envenoming care. Implementation science efforts, with explicit health professional input, should be applied to develop new and/or adapt existing evidence-based treatments and practices for SBE.
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Affiliation(s)
- Eleanor Strand
- Department of Emergency Medicine, Duke University School of Medicine, Durham, NC, United States
| | - Felipe Murta
- Escola Superior de Ciências da Saúde, Universidade do Estado do Amazonas, Manaus, Brazil
- Diretoria de Ensino e Pesquisa, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Brazil
- Programa de Pós-Graduação Em Enfermagem, Universidade Federal de Santa Catarina, Florianópolis, Brazil
| | - Anna Tupetz
- Department of Emergency Medicine, Duke University School of Medicine, Durham, NC, United States
| | - Loren Barcenas
- Department of Emergency Medicine, Duke University School of Medicine, Durham, NC, United States
| | - Ashley J. Phillips
- Department of Emergency Medicine, Duke University School of Medicine, Durham, NC, United States
| | - Altair Seabra Farias
- Escola Superior de Ciências da Saúde, Universidade do Estado do Amazonas, Manaus, Brazil
- Diretoria de Ensino e Pesquisa, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Brazil
| | - Alícia Cacau Santos
- Escola Superior de Ciências da Saúde, Universidade do Estado do Amazonas, Manaus, Brazil
- Diretoria de Ensino e Pesquisa, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Brazil
| | - Gisele dos Santos Rocha
- Escola Superior de Ciências da Saúde, Universidade do Estado do Amazonas, Manaus, Brazil
- Diretoria de Ensino e Pesquisa, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Brazil
| | - Catherine A. Staton
- Department of Emergency Medicine, Duke University School of Medicine, Durham, NC, United States
| | - Flávia Regina Ramos
- Escola Superior de Ciências da Saúde, Universidade do Estado do Amazonas, Manaus, Brazil
- Diretoria de Ensino e Pesquisa, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Brazil
- Programa de Pós-Graduação Em Enfermagem, Universidade Federal de Santa Catarina, Florianópolis, Brazil
| | - Vinícius Azevedo Machado
- Escola Superior de Ciências da Saúde, Universidade do Estado do Amazonas, Manaus, Brazil
- Diretoria de Ensino e Pesquisa, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Brazil
| | - Fan Hui Wen
- Instituto Butantan, São Paulo, São Paulo, Brazil
| | - João R.N. Vissoci
- Department of Emergency Medicine, Duke University School of Medicine, Durham, NC, United States
| | - Jacqueline Sachett
- Escola Superior de Ciências da Saúde, Universidade do Estado do Amazonas, Manaus, Brazil
- Programa de Pós-Graduação Em Enfermagem, Universidade Federal de Santa Catarina, Florianópolis, Brazil
- Diretoria de Ensino e Pesquisa, Fundação Alfredo da Matta, Manaus, Brazil
| | - Wuelton Monteiro
- Escola Superior de Ciências da Saúde, Universidade do Estado do Amazonas, Manaus, Brazil
- Diretoria de Ensino e Pesquisa, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Brazil
- Programa de Pós-Graduação Em Enfermagem, Universidade Federal de Santa Catarina, Florianópolis, Brazil
| | - Charles J. Gerardo
- Department of Emergency Medicine, Duke University School of Medicine, Durham, NC, United States
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Challenges and Opportunities in Clinical Diagnostic Routine of Envenomation Using Blood Plasma Proteomics. Toxins (Basel) 2023; 15:toxins15030180. [PMID: 36977071 PMCID: PMC10056359 DOI: 10.3390/toxins15030180] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Revised: 02/03/2023] [Accepted: 02/09/2023] [Indexed: 03/02/2023] Open
Abstract
Specific and sensitive tools for the diagnosis and monitoring of accidents by venomous animals are urgently needed. Several diagnostic and monitoring assays have been developed; however, they have not yet reached the clinic. This has resulted in late diagnoses, which represents one of the main causes of progression from mild to severe disease. Human blood is a protein-rich biological fluid that is routinely collected in hospital settings for diagnostic purposes, which can translate research progress from the laboratory to the clinic. Although it is a limited view, blood plasma proteins provide information about the clinical picture of envenomation. Proteome disturbances in response to envenomation by venomous animals have been identified, allowing mass spectrometry (MS)-based plasma proteomics to emerge as a tool in a range of clinical diagnostics and disease management that can be applied to cases of venomous animal envenomation. Here, we provide a review of the state of the art on routine laboratory diagnoses of envenomation by snakes, scorpions, bees, and spiders, as well as a review of the diagnostic methods and the challenges encountered. We present the state of the art on clinical proteomics as the standardization of procedures to be performed within and between research laboratories, favoring a more excellent peptide coverage of candidate proteins for biomarkers. Therefore, the selection of a sample type and method of preparation should be very specific and based on the discovery of biomarkers in specific approaches. However, the sample collection protocol (e.g., collection tube type) and the processing procedure of the sample (e.g., clotting temperature, time allowed for clotting, and anticoagulant used) are equally important to eliminate any bias.
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Bravo-Vega C, Renjifo-Ibañez C, Santos-Vega M, León Nuñez LJ, Angarita-Sierra T, Cordovez JM. A generalized framework for estimating snakebite underreporting using statistical models: A study in Colombia. PLoS Negl Trop Dis 2023; 17:e0011117. [PMID: 36745647 PMCID: PMC9934346 DOI: 10.1371/journal.pntd.0011117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Revised: 02/16/2023] [Accepted: 01/20/2023] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Snakebite envenoming is a neglected tropical disease affecting deprived populations, and its burden is underestimated in some regions where patients prefer using traditional medicine, case reporting systems are deficient, or health systems are inaccessible to at-risk populations. Thus, the development of strategies to optimize disease management is a major challenge. We propose a framework that can be used to estimate total snakebite incidence at a fine political scale. METHODOLOGY/PRINCIPAL FINDINGS First, we generated fine-scale snakebite risk maps based on the distribution of venomous snakes in Colombia. We then used a generalized mixed-effect model that estimates total snakebite incidence based on risk maps, poverty, and travel time to the nearest medical center. Finally, we calibrated our model with snakebite data in Colombia from 2010 to 2019 using the Markov-chain-Monte-Carlo algorithm. Our results suggest that 10.19% of total snakebite cases (532.26 yearly envenomings) are not reported and these snakebite victims do not seek medical attention, and that populations in the Orinoco and Amazonian regions are the most at-risk and show the highest percentage of underreporting. We also found that variables such as precipitation of the driest month and mean temperature of the warmest quarter influences the suitability of environments for venomous snakes rather than absolute temperature or rainfall. CONCLUSIONS/SIGNIFICANCE Our framework permits snakebite underreporting to be estimated using data on snakebite incidence and surveillance, presence locations for the most medically significant venomous snake species, and openly available information on population size, poverty, climate, land cover, roads, and the locations of medical centers. Thus, our algorithm could be used in other countries to estimate total snakebite incidence and improve disease management strategies; however, this framework does not serve as a replacement for a surveillance system, which should be made a priority in countries facing similar public health challenges.
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Affiliation(s)
- Carlos Bravo-Vega
- Grupo de investigación en Biología Matemática y Computacional (BIOMAC), Departamento de Ingeniería Biomédica, Universidad de los Andes, Bogotá, Colombia
- * E-mail:
| | | | - Mauricio Santos-Vega
- Grupo de investigación en Biología Matemática y Computacional (BIOMAC), Departamento de Ingeniería Biomédica, Universidad de los Andes, Bogotá, Colombia
- Facultad de Medicina, Universidad de los Andes, Bogotá, Colombia
| | - Leonardo Jose León Nuñez
- Observatorio de Salud Pública y epidemiología "José Felix Patiño", Universidad de los Andes, Bogotá, Colombia
| | - Teddy Angarita-Sierra
- Grupo de investigación Biodiversidad para la sociedad, Universidad Nacional de Colombia sede de La Paz, Cesar, Colombia
| | - Juan Manuel Cordovez
- Grupo de investigación en Biología Matemática y Computacional (BIOMAC), Departamento de Ingeniería Biomédica, Universidad de los Andes, Bogotá, Colombia
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20
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Ochoa C, Rai M, Babo Martins S, Alcoba G, Bolon I, Ruiz de Castañeda R, Sharma SK, Chappuis F, Ray N. Vulnerability to snakebite envenoming and access to healthcare in the Terai region of Nepal: a geospatial analysis. THE LANCET REGIONAL HEALTH. SOUTHEAST ASIA 2023; 9:100103. [PMID: 37383041 PMCID: PMC10306013 DOI: 10.1016/j.lansea.2022.100103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 10/07/2022] [Accepted: 10/21/2022] [Indexed: 06/30/2023]
Abstract
Background Snakebite envenoming is a neglected tropical disease that mainly affects poor populations in rural areas. In hyperendemic regions, prevention could partially reduce the constant risk, but the population still needs timely access to adequate treatment. In line with WHO's snakebite roadmap, we aim to understand snakebite vulnerability through modelling of risk and access to treatment, and propose plausible solutions to optimise resource allocation. Methods We combined snakebite-risk distribution rasters with travel-time accessibility analyses for the Terai region of Nepal, considering three vehicle types, two seasons, two snakebite syndromes, and uncertainty intervals. We proposed localised and generalised optimisation scenarios to improve snakebite treatment coverage for the population, focusing on the neurotoxic syndrome. Findings In the Terai, the neurotoxic syndrome is the main factor leading to high snakebite vulnerability. For the most common scenario of season, syndrome, and transport, an estimated 2.07 (15.3%) million rural people fall into the high vulnerability class. This ranges between 0.3 (2.29%) and 6.8 (50.43%) million people when considering the most optimistic and most pessimistic scenarios, respectively. If all health facilities treating snakebite envenoming could optimally treat both syndromes, treatment coverage of the rural population could increase from 65.93% to 93.74%, representing a difference of >3.8 million people. Interpretation This study is the first high-resolution analysis of snakebite vulnerability, accounting for uncertainties in both risk and travel speed. The results can help identify populations highly vulnerable to snakebite envenoming, optimise resource allocation, and support WHO's snakebite roadmap efforts. Funding Swiss National Science Foundation.
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Affiliation(s)
- Carlos Ochoa
- Institute of Global Health (IGH), Department of Community Health and Medicine, Faculty of Medicine, University of Geneva, Geneva, Switzerland
- Institute for Environmental Sciences (ISE), University of Geneva, Geneva, Switzerland
| | | | - Sara Babo Martins
- Institute of Global Health (IGH), Department of Community Health and Medicine, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Gabriel Alcoba
- Institute of Global Health (IGH), Department of Community Health and Medicine, Faculty of Medicine, University of Geneva, Geneva, Switzerland
- Médecins Sans Frontières (MSF), Neglected Tropical Diseases Working Group, Geneva, Switzerland
- Division of Tropical and Humanitarian Medicine, Geneva University Hospitals (HUG), Geneva, Switzerland
| | - Isabelle Bolon
- Institute of Global Health (IGH), Department of Community Health and Medicine, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Rafael Ruiz de Castañeda
- Institute of Global Health (IGH), Department of Community Health and Medicine, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | | | - François Chappuis
- Division of Tropical and Humanitarian Medicine, Geneva University Hospitals (HUG), Geneva, Switzerland
- Department of Community Health and Medicine, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Nicolas Ray
- Institute of Global Health (IGH), Department of Community Health and Medicine, Faculty of Medicine, University of Geneva, Geneva, Switzerland
- Institute for Environmental Sciences (ISE), University of Geneva, Geneva, Switzerland
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21
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Patiño RSP, Salazar-Valenzuela D, Robles-Loaiza AA, Santacruz-Ortega P, Almeida JR. A retrospective study of clinical and epidemiological characteristics of snakebite in Napo Province, Ecuadorian Amazon. Trans R Soc Trop Med Hyg 2023; 117:118-127. [PMID: 35917814 DOI: 10.1093/trstmh/trac071] [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: 03/22/2022] [Revised: 05/31/2022] [Accepted: 07/07/2022] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Snakebite envenoming remains a relevant public health problem in tropical and subtropical countries. In Ecuador, this is particularly true in an area of great diversity like the Amazon region. Nevertheless, there is scarce information about epidemiological and clinical characteristics of these accidents in this area. METHODS This was a descriptive and retrospective study of snakebite cases treated at a tertiary hospital in the Napo Province, Ecuadorian Amazon, from 2015 to 2019. We collected sociodemographic and snakebite-related information, clinical aspects and the use of antivenom and antibiotics from medical records. RESULTS Information from 133 snakebite accidents was reviewed in this time period. Reports of snakebite envenoming decreased over the years. In total, 67% of those bitten were from nearby indigenous communities, which were the most affected groups. When a species was identified, Bothrops atrox was responsible for the highest number of cases registered. Local clinical manifestations were more frequent than systemic signs, in keeping with the typical effects produced by bothropic venoms. Additionally, data showed that more antivenom vials were given than those suggested by the protocol of the Ecuadorian Ministry of Health, in proportion to the grade of severity. Finally, we identified a low incidence of adverse reactions with antivenom administration, as well as a frequent use of antibiotics. CONCLUSIONS The profile of snakebite accidents in the Napo Province is very similar to that described for other localities in the Amazon region of Ecuador and neighboring countries, with its challenges and limitations. Such aspects underlie the importance of establishing a robust and science-based public health program to respond to this frequent, but neglected, tropical disease.
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Affiliation(s)
- Ricardo S P Patiño
- Universidad Regional Amazónica Ikiam, Km 7 Via Muyuna, Tena, Napo 150150, Ecuador.,Escuela Superior Politécnica del Litoral (ESPOL), Centro Nacional de Acuicultura e Investigaciones Marinas (CENAIM), Guayaquil 090211, Ecuador
| | - David Salazar-Valenzuela
- Centro de Investigación de la Biodiversidad y Cambio Climático (BioCamb) e Ingeniería en Biodiversidad y Recursos Genéticos, Facultad de Ciencias de Medio Ambiente, Universidad Tecnológica Indoamérica, Quito 170103, Ecuador
| | | | - Paola Santacruz-Ortega
- Escola de Educação Permanente, Faculdade de Medicina, Universidade de São Paulo, São Paulo 05403010, Brasil
| | - José R Almeida
- Universidad Regional Amazónica Ikiam, Km 7 Via Muyuna, Tena, Napo 150150, Ecuador
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22
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Nascimento TP, Vilhena Silva-Neto A, Baia-da-Silva DC, da Silva Balieiro PC, Baleiro AADS, Sachett J, Brasileiro L, Sartim MA, Martinez-Espinosa FE, Wen FH, Pucca MB, Gerardo CJ, Sampaio VS, Ferreira de Aquino P, Monteiro WM. Pregnancy outcomes after snakebite envenomations: A retrospective cohort in the Brazilian Amazonia. PLoS Negl Trop Dis 2022; 16:e0010963. [PMID: 36469516 PMCID: PMC9754599 DOI: 10.1371/journal.pntd.0010963] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Revised: 12/15/2022] [Accepted: 11/18/2022] [Indexed: 12/12/2022] Open
Abstract
Snakebite envenomations (SBEs) in pregnant women can result in adverse maternal or neonatal effects, such as abortion, placental abruption, preterm labor, fetal malformations, and maternal, fetal or neonatal deaths. Despite the high incidence of SBEs in the Brazilian Amazon, there is no literature on the impact of SBEs on pregnancy outcomes. The objective of this study was to describe clinical epidemiology and outcomes associated with SBEs in women of childbearing age and pregnant women in the state of Amazonas, Western Brazilian Amazon, from 2007 to 2021. Information on the population was obtained from the Reporting Information System (SINAN), Mortality Information System (SIM) and Live Birth Information System (SINASC) for the period from 2007 to 2021. A total of 36,786 SBEs were reported, of which 3,297 (9%) involved women of childbearing age, and 274 (8.3%) involved pregnant women. Severity (7.9% in pregnant versus 8.7% in non-pregnant women) (P = 0.87) and case-fatality (0.4% in pregnant versus 0.3% in non-pregnant women) rates were similar between groups (P = 0.76). Pregnant women who suffered snakebites were at higher risk for fetal death (OR: 2.17, 95%CI: 1.74-2.67) and neonatal death (OR = 2.79, 95%CI: 2.26-3.40). This study had major limitations related to the completeness of the information on the pregnancy outcomes. Although SBE incidence in pregnant women is low in the Brazilian Amazon, SBEs increased the risk of fetal and neonatal deaths.
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Affiliation(s)
- Thaís P. Nascimento
- Leônidas & Maria Deane Institute, Oswaldo Cruz Foundation, Manaus, Amazonas, Brazil
| | - Alexandre Vilhena Silva-Neto
- Amazonas State University, Manaus, Amazonas, Brazil
- Dr. Heitor Vieira Dourado Tropical Medicine Foundation, Manaus, Amazonas, Brazil
| | - Djane Clarys Baia-da-Silva
- Leônidas & Maria Deane Institute, Oswaldo Cruz Foundation, Manaus, Amazonas, Brazil
- Amazonas State University, Manaus, Amazonas, Brazil
- Dr. Heitor Vieira Dourado Tropical Medicine Foundation, Manaus, Amazonas, Brazil
- Amazonas Federal University, Manaus, Amazonas, Brazil
| | | | | | - Jacqueline Sachett
- Amazonas State University, Manaus, Amazonas, Brazil
- Butantan Institute, São Paulo, Brazil
| | - Lisele Brasileiro
- Amazonas State University, Manaus, Amazonas, Brazil
- Dr. Heitor Vieira Dourado Tropical Medicine Foundation, Manaus, Amazonas, Brazil
| | - Marco A. Sartim
- Amazonas State University, Manaus, Amazonas, Brazil
- Dr. Heitor Vieira Dourado Tropical Medicine Foundation, Manaus, Amazonas, Brazil
| | - Flor Ernestina Martinez-Espinosa
- Leônidas & Maria Deane Institute, Oswaldo Cruz Foundation, Manaus, Amazonas, Brazil
- Dr. Heitor Vieira Dourado Tropical Medicine Foundation, Manaus, Amazonas, Brazil
| | | | | | - Charles J. Gerardo
- Department of Emergency Medicine, Duke University School of Medicine, Durham, North Carolina, United States of America
| | - Vanderson S. Sampaio
- Dr. Heitor Vieira Dourado Tropical Medicine Foundation, Manaus, Amazonas, Brazil
| | | | - Wuelton M. Monteiro
- Amazonas State University, Manaus, Amazonas, Brazil
- Dr. Heitor Vieira Dourado Tropical Medicine Foundation, Manaus, Amazonas, Brazil
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23
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Ediriweera DS, de Silva T, Kasturiratne A, de Silva HJ, Diggle P. Geographically regulated designs of incidence surveys can match the precision of classical survey designs whilst requiring smaller sample sizes: the case of snakebite envenoming in Sri Lanka. BMJ Glob Health 2022; 7:bmjgh-2022-009500. [PMID: 36220306 PMCID: PMC9557310 DOI: 10.1136/bmjgh-2022-009500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Accepted: 09/24/2022] [Indexed: 11/16/2022] Open
Abstract
Background Snakebite envenoming is a neglected tropical disease. Data from the worst affected countries are limited because conducting epidemiological surveys is challenging. We assessed the utility of inhibitory geostatistical design with close pairs (ICP) to estimate snakebite envenoming incidence. Methods The National Snakebite Survey (NSS) in Sri Lanka adopted a multistage cluster sampling design, based on population distribution, targeting 1% of the country’s population. Using a simulation-based study, we assessed predictive efficiency of ICP against a classical survey design at different fractions of the original sample size of the NSS. We also assessed travel distance, time taken to complete the survey, and sensitivity and specificity for detecting high-risk areas for snake envenoming, when using these methods. Results A classical survey design with 33% of the original NSS sample size was able to yield a similar predictive efficiency. ICP yielded the same at 25% of the NSS sample size, a 25% reduction in sample size compared with a classical survey design. ICP showed >80% sensitivity and specificity for detecting high-risk areas of envenoming when the sampling fraction was >20%. When ICP was adopted with 25% of the original NSS sample size, travel distance was reduced by >40% and time to conduct the survey was reduced by >75%. Conclusions This study showed that snakebite envenoming incidence can be estimated by adopting an ICP design with similar precision at a lower sample size than a classical design. This would substantially save resources and time taken to conduct epidemiological surveys and may be suited for low-resource settings.
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Affiliation(s)
| | - Tiloka de Silva
- Department of Decision Sciences, Faculty of Business, University of Moratuwa, Moratuwa, Sri Lanka
| | | | | | - Peter Diggle
- Centre for Health Informatics, Computing and Statistics, Lancaster University, Lancaster, UK
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24
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Bibliometric Analysis of Literature in Snake Venom-Related Research Worldwide (1933–2022). Animals (Basel) 2022; 12:ani12162058. [PMID: 36009648 PMCID: PMC9405337 DOI: 10.3390/ani12162058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 08/03/2022] [Accepted: 08/09/2022] [Indexed: 11/29/2022] Open
Abstract
Simple Summary Around the world, snake envenomation poses a serious health risk. Proteins with pharmacological effects are present in snake venom. Recent studies elaborate snake venom and its potential application, including as a cancer drug and antibacterial substances. Our study aimed to analyze the global profile of the literature in snake venom research from documents indexed in the Scopus database between 1933 and 2022. In total, 2999 documents were published with Brazil showing the highest productivity. Antivenom, proteomics, and transcriptomics are emerging as hot topics on a global scale. The present study offers a distinctive overview of snake venom research conducted worldwide. Abstract Snake envenomation is a severe economic and health concern affecting countries worldwide. Snake venom carries a wide variety of small peptides and proteins with various immunological and pharmacological properties. A few key research areas related to snake venom, including its applications in treating cancer and eradicating antibiotic-resistant bacteria, have been gaining significant attention in recent years. The goal of the current study was to analyze the global profile of literature in snake venom research. This study presents a bibliometric review of snake venom-related research documents indexed in the Scopus database between 1933 and 2022. The overall number of documents published on a global scale was 2999, with an average annual production of 34 documents. Brazil produced the highest number of documents (n = 729), followed by the United States (n = 548), Australia (n = 240), and Costa Rica (n = 235). Since 1963, the number of publications has been steadily increasing globally. At a worldwide level, antivenom, proteomics, and transcriptomics are growing hot issues for research in this field. The current research provides a unique overview of snake venom research at global level from 1933 through 2022, and it may be beneficial in guiding future research.
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25
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Ochoa C, Pittavino M, Babo Martins S, Alcoba G, Bolon I, Ruiz de Castañeda R, Joost S, Sharma SK, Chappuis F, Ray N. Estimating and predicting snakebite risk in the Terai region of Nepal through a high-resolution geospatial and One Health approach. Sci Rep 2021; 11:23868. [PMID: 34903803 PMCID: PMC8668914 DOI: 10.1038/s41598-021-03301-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Accepted: 12/01/2021] [Indexed: 11/09/2022] Open
Abstract
Most efforts to understand snakebite burden in Nepal have been localized to relatively small areas and focused on humans through epidemiological studies. We present the outcomes of a geospatial analysis of the factors influencing snakebite risk in humans and animals, based on both a national-scale multi-cluster random survey and, environmental, climatic, and socio-economic gridded data for the Terai region of Nepal. The resulting Integrated Nested Laplace Approximation models highlight the importance of poverty as a fundamental risk-increasing factor, augmenting the snakebite odds in humans by 63.9 times. For animals, the minimum temperature of the coldest month was the most influential covariate, increasing the snakebite odds 23.4 times. Several risk hotspots were identified along the Terai, helping to visualize at multiple administrative levels the estimated population numbers exposed to different probability risk thresholds in 1 year. These analyses and findings could be replicable in other countries and for other diseases.
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Affiliation(s)
- Carlos Ochoa
- Institute of Global Health (IGH), Department of Community Health and Medicine, Faculty of Medicine, University of Geneva, Chemin des Mines 9, 1202, Geneva, Switzerland.
- Institute for Environmental Sciences (ISE), University of Geneva, Geneva, Switzerland.
| | - Marta Pittavino
- Research Center for Statistics (RCS), Geneva School of Economics and Management (GSEM), University of Geneva, Geneva, Switzerland
| | - Sara Babo Martins
- Institute of Global Health (IGH), Department of Community Health and Medicine, Faculty of Medicine, University of Geneva, Chemin des Mines 9, 1202, Geneva, Switzerland
| | - Gabriel Alcoba
- Institute of Global Health (IGH), Department of Community Health and Medicine, Faculty of Medicine, University of Geneva, Chemin des Mines 9, 1202, Geneva, Switzerland
- Médecins Sans Frontières (MSF), Geneva, Switzerland
- Division of Tropical and Humanitarian Medicine, Geneva University Hospitals (HUG), Geneva, Switzerland
| | - Isabelle Bolon
- Institute of Global Health (IGH), Department of Community Health and Medicine, Faculty of Medicine, University of Geneva, Chemin des Mines 9, 1202, Geneva, Switzerland
| | - Rafael Ruiz de Castañeda
- Institute of Global Health (IGH), Department of Community Health and Medicine, Faculty of Medicine, University of Geneva, Chemin des Mines 9, 1202, Geneva, Switzerland
| | - Stéphane Joost
- Laboratory of Geographic Information Systems (LASIG), School of Architecture, Civil and Environmental Engineering (ENAC), École Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland
| | | | - François Chappuis
- Division of Tropical and Humanitarian Medicine, Geneva University Hospitals (HUG), Geneva, Switzerland
- Department of Community Health and Medicine, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Nicolas Ray
- Institute of Global Health (IGH), Department of Community Health and Medicine, Faculty of Medicine, University of Geneva, Chemin des Mines 9, 1202, Geneva, Switzerland
- Institute for Environmental Sciences (ISE), University of Geneva, Geneva, Switzerland
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Maciel FV, Ramos Pinto ÊK, Valério Souza NM, Gonçalves de Abreu TA, Ortolani PL, Fortes-Dias CL, Garrido Cavalcante WL. Varespladib (LY315920) prevents neuromuscular blockage and myotoxicity induced by crotoxin on mouse neuromuscular preparations. Toxicon 2021; 202:40-45. [PMID: 34562493 DOI: 10.1016/j.toxicon.2021.09.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Revised: 09/15/2021] [Accepted: 09/20/2021] [Indexed: 12/26/2022]
Abstract
Varespladib (LY315920) is a synthetic phospholipase A2 (PLA2) inhibitor that has been demonstrating antiophidic potential against snake venoms that present PLA2 neurotoxins. In this study, we evaluate the capacity of Varespladib to inhibit the neuromuscular effects of crotoxin (CTX), the main toxic component of Crotalus durissus terrificus snake venom, and its PLA2 subunit (CB). We performed a myographic study to compare the neuromuscular effects of CTX or CB and the mixture of these substances plus Varespladib in mice phrenic nerve-diaphragm muscle preparations. CTX (5 μg/mL), CB (20 μg/mL), or toxin-inhibitor mixtures pre-incubated with different concentration ratios of Varespladib (1:0.25; 1:0.5; 1:1; w/w) were added to the preparations and maintained throughout the experimentation period. Myotoxicity was assessed by light microscopic analysis of diaphragm muscle after myographic study. CTX and CB blocked the nerve-evoked twitches, and only CTX induced histological alterations in diaphragm muscle. Pre-incubation with Varespladib abolished the muscle-paralyzing activity of CTX and CB, and also the muscle-damaging activity of CTX. These findings emphasize the clinical potential of Varespladib in mitigating the toxic effects of C. d. terrificus snakebites and as a research tool to advance the knowledge of the mechanism of action of snake toxins.
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Affiliation(s)
- Fernanda Valadares Maciel
- Department of Pharmacology, Institute of Biological Science, Federal University of Minas Gerais (UFMG), Brazil
| | - Êmylle Karoline Ramos Pinto
- Department of Pharmacology, Institute of Biological Science, Federal University of Minas Gerais (UFMG), Brazil
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Isaacson JE, Joiner AP, Kozhumam AS, Caruzzo NM, de Andrade L, Iora PH, Costa DB, Vissoci BM, Sartori MLL, Rocha TAH, Vissoci JRN. Emergency Care Sensitive Conditions in Brazil: A Geographic Information System Approach to Timely Hospital Access. LANCET REGIONAL HEALTH. AMERICAS 2021; 4:100063. [PMID: 36776707 PMCID: PMC9903578 DOI: 10.1016/j.lana.2021.100063] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Revised: 07/26/2021] [Accepted: 08/20/2021] [Indexed: 11/16/2022]
Abstract
Background The benefits of treatment for many conditions are time dependent. The burden of these emergency care sensitive conditions (ECSCs) is especially high in low- and middle-income countries. Our objective was to analyze geospatial trends in ECSCs and characterize regional disparities in access to emergency care in Brazil. Methods From publicly available datasets, we extracted data on patients assigned an ECSC-related ICD-10 code and on the country's emergency facilities from 2015-2019. Using ArcGIS, OpenStreetMap, and WorldPop, we created catchment areas corresponding to 180 minutes of driving distance from each hospital. We then used ArcGIS to characterize space-time trends in ECSC admissions and to complete an Origin-Destination analysis to determine the path from household to closest hospital. Findings There were 1362 municipalities flagged as "hot spots," areas with a high volume of ECSCs. Of those, 69.7% were more than 180 minutes (171 km) from the closest emergency facility. These municipalities were primarily located in the states of Minas Gerais, Bahia, Espiríto Santo, Tocantins, and Amapá. In the North region, only 69.1% of the population resided within 180 minutes of an emergency hospital. Interpretations Significant geographical barriers to accessing emergency care exist in certain areas of Brazil, especially in peri-urban areas and the North region. One limitation of this approach is that geolocation was not possible in some areas and thus we are likely underestimating the burden of inadequate access. Subsequent work should evaluate ECSC mortality data. Funding This study was funded by the Duke Global Health Institute Artificial Intelligence Pilot Project.
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Affiliation(s)
- Julia Elizabeth Isaacson
- Duke University School of Medicine, DUMC 3170, Durham, North Carolina, 27710, United States of America
| | - Anjni Patel Joiner
- Duke Global Health Institute, 310 Trent Drive, Durham, North Carolina, 27710, United States of America,Division of Emergency Medicine, Department of Surgery, Duke University Medical Center, 2301 Erwin Road, Durham, North Carolina, 27710, United States of America,Corresponding Author:
| | - Arthi Shankar Kozhumam
- Duke Global Health Institute, 310 Trent Drive, Durham, North Carolina, 27710, United States of America
| | - Nayara Malheiros Caruzzo
- Department of Physical Education, State University of Maringá, Av. Colombo, 5790 - Zona 7, Maringá - Paraná, 87020-900, Brazil
| | - Luciano de Andrade
- Department of Medicine, State University of Maringá, Av. Colombo, 5790 - Zona 7, Maringá - Paraná, 87020-900, Brazil
| | - Pedro Henrique Iora
- Department of Medicine, State University of Maringá, Av. Colombo, 5790 - Zona 7, Maringá - Paraná, 87020-900, Brazil
| | - Dalton Breno Costa
- Department of Psychology, Federal University of Health Sciences of Porto Alegre, R. Sarmento Leite, 245 - Centro Histórico, Porto Alegre - Rio Grande do Sul, 90050-170, Brazil
| | - Bianca Maria Vissoci
- Program for Health Sciences, State University of Maringá, Av. Colombo, 5790 - Zona 7, Maringá - Paraná, 87020-900, Brazil
| | - Marcos Luiggi Lemos Sartori
- Department of Computer Science, Pontifical Catholic University of Rio Grande do Sul, Av. Ipiranga, 6681 - Partenon, Porto Alegre - Rio Grande do Sul, 90619-900, Brazil
| | | | - Joao Ricardo Nickenig Vissoci
- Duke Global Health Institute, 310 Trent Drive, Durham, North Carolina, 27710, United States of America,Division of Emergency Medicine, Department of Surgery, Duke University Medical Center, 2301 Erwin Road, Durham, North Carolina, 27710, United States of America
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28
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Snakebites in Rural Areas of Brazil by Race: Indigenous the Most Exposed Group. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18179365. [PMID: 34501955 PMCID: PMC8431164 DOI: 10.3390/ijerph18179365] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/31/2021] [Revised: 08/28/2021] [Accepted: 09/03/2021] [Indexed: 01/02/2023]
Abstract
Animal stings are environmental hazards that threaten millions annually and cause a significant socioeconomic impact. Snakebite envenoming affects 2.7 million people globally every year, mostly the poorest and rural communities, with approximately 27,000 annual cases in Brazil. This study’s objective is to identify the most exposed racial group for snakebites in rural areas of Brazil and analyze possible differences in the outcome of an accident. A retrospective epidemiological study was conducted using a database of rural snakebite cases from Brazil’s Ministry of Health (2017). Descriptive analysis and a regression model were performed to examine the association of bad outcomes after a snakebite with several covariables. While mixed-race individuals presented the highest number of cases (61.79%), indigenous and white populations were the racial groups with the highest and lowest exposure rates (194.3 and 34.1 per 100,000 population, respectively). The fatality rate was 3.5 times higher in the indigenous population compared to the white population. In the multivariable model, the number of hours between the accident and health care received and the case classification suggested an association with a bad outcome. Snakebite is prominent in Brazil, particularly among indigenous groups. Antivenom is available in the Brazilian Health System; however, efforts need to be made for decentralization.
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Pintor AF, Ray N, Longbottom J, Bravo-Vega CA, Yousefi M, Murray KA, Ediriweera DS, Diggle PJ. Addressing the global snakebite crisis with geo-spatial analyses - Recent advances and future direction. Toxicon X 2021; 11:100076. [PMID: 34401744 PMCID: PMC8350508 DOI: 10.1016/j.toxcx.2021.100076] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Revised: 07/13/2021] [Accepted: 07/14/2021] [Indexed: 02/08/2023] Open
Abstract
Venomous snakebite is a neglected tropical disease that annually leads to hundreds of thousands of deaths or long-term physical and mental ailments across the developing world. Insufficient data on spatial variation in snakebite risk, incidence, human vulnerability, and accessibility of medical treatment contribute substantially to ineffective on-ground management. There is an urgent need to collect data, fill knowledge gaps and address on-ground management problems. The use of novel, and transdisciplinary approaches that take advantage of recent advances in spatio-temporal models, 'big data', high performance computing, and fine-scale spatial information can add value to snakebite management by strategically improving our understanding and mitigation capacity of snakebite. We review the background and recent advances on the topic of snakebite related geospatial analyses and suggest avenues for priority research that will have practical on-ground applications for snakebite management and mitigation. These include streamlined, targeted data collection on snake distributions, snakebites, envenomings, venom composition, health infrastructure, and antivenom accessibility along with fine-scale models of spatio-temporal variation in snakebite risk and incidence, intraspecific venom variation, and environmental change modifying human exposure. These measures could improve and 'future-proof' antivenom production methods, antivenom distribution and stockpiling systems, and human-wildlife conflict management practices, while simultaneously feeding into research on venom evolution, snake taxonomy, ecology, biogeography, and conservation.
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Affiliation(s)
- Anna F.V. Pintor
- Division of Data, Analytics and Delivery for Impact (DDI), World Health Organization, Geneva, Switzerland
- Australian Institute of Tropical Health and Medicine, Division of Tropical Health and Medicine, James Cook University, Cairns, Australia
| | - Nicolas Ray
- GeoHealth Group, Institute of Global Health, Faculty of Medicine, University of Geneva, Geneva, Switzerland
- Institute for Environmental Sciences, University of Geneva, Geneva, Switzerland
| | - Joshua Longbottom
- Department of Vector Biology, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
- Centre for Health Informatics, Computing and Statistics, Lancaster Medical School, Lancaster University, Lancaster, United Kingdom
| | - Carlos A. Bravo-Vega
- Research Group in Mathematical and Computational Biology (BIOMAC), Department of Biomedical Engineering, University of Los Andes, Bogotá, Colombia
| | - Masoud Yousefi
- School of Biology, College of Science, University of Tehran, Iran
| | - Kris A. Murray
- MRC Centre for Global Infectious Disease Analysis, Department of Infectious Disease Epidemiology, Imperial College London, UK
- MRC Unit the Gambia at London School of Hygiene and Tropical Medicine, Atlantic Blvd, Fajara, Gambia
| | - Dileepa S. Ediriweera
- Health Data Science Unit, Faculty of Medicine, University of Kelaniya, Ragama, Sri Lanka
| | - Peter J. Diggle
- Department of Vector Biology, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
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30
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Durso AM, Ruiz de Castañeda R, Montalcini C, Mondardini MR, Fernandez-Marques JL, Grey F, Müller MM, Uetz P, Marshall BM, Gray RJ, Smith CE, Becker D, Pingleton M, Louies J, Abegg AD, Akuboy J, Alcoba G, Daltry JC, Entiauspe-Neto OM, Freed P, de Freitas MA, Glaudas X, Huang S, Huang T, Kalki Y, Kojima Y, Laudisoit A, Limbu KP, Martínez-Fonseca JG, Mebert K, Rödel MO, Ruane S, Ruedi M, Schmitz A, Tatum SA, Tillack F, Visvanathan A, Wüster W, Bolon I. Citizen science and online data: Opportunities and challenges for snake ecology and action against snakebite. Toxicon X 2021; 9-10:100071. [PMID: 34278294 PMCID: PMC8264216 DOI: 10.1016/j.toxcx.2021.100071] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 06/10/2021] [Accepted: 06/15/2021] [Indexed: 12/03/2022] Open
Abstract
The secretive behavior and life history of snakes makes studying their biology, distribution, and the epidemiology of venomous snakebite challenging. One of the most useful, most versatile, and easiest to collect types of biological data are photographs, particularly those that are connected with geographic location and date-time metadata. Photos verify occurrence records, provide data on phenotypes and ecology, and are often used to illustrate new species descriptions, field guides and identification keys, as well as in training humans and computer vision algorithms to identify snakes. We scoured eleven online and two offline sources of snake photos in an attempt to collect as many photos of as many snake species as possible, and attempt to explain some of the inter-species variation in photograph quantity among global regions and taxonomic groups, and with regard to medical importance, human population density, and range size. We collected a total of 725,565 photos-between 1 and 48,696 photos of 3098 of the world's 3879 snake species (79.9%), leaving 781 "most wanted" species with no photos (20.1% of all currently-described species as of the December 2020 release of The Reptile Database). We provide a list of most wanted species sortable by family, continent, authority, and medical importance, and encourage snake photographers worldwide to submit photos and associated metadata, particularly of "missing" species, to the most permanent and useful online archives: The Reptile Database, iNaturalist, and HerpMapper.
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Affiliation(s)
- Andrew M. Durso
- Department of Biological Sciences, Florida Gulf Coast University, Ft. Myers, FL, USA
- Institute of Global Health, Department of Community Health and Medicine, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Rafael Ruiz de Castañeda
- Institute of Global Health, Department of Community Health and Medicine, Faculty of Medicine, University of Geneva, Geneva, Switzerland
- World Health Organization, Geneva, Switzerland
| | | | - M. Rosa Mondardini
- Citizen Science Center Zürich (ETH Zürich and University of Zürich), Zürich, Switzerland
| | | | | | | | - Peter Uetz
- The Reptile Database, Richmond, VA, USA
- Virginia Commonwealth University, Richmond, VA, USA
| | | | | | | | | | | | | | - Arthur D. Abegg
- Instituto Butantan, São Paulo, São Paulo, Brazil
- University of São Paulo, São Paulo, São Paulo, Brazil
| | - Jeannot Akuboy
- University of Kisangani, Kisangani, Democratic Republic of the Congo
| | | | - Jennifer C. Daltry
- Flora & Fauna International, Cambridge, England, UK
- Global Wildlife Conservation, Austin, TX, USA
| | | | - Paul Freed
- The Reptile Database, Richmond, VA, USA
- Reptile Database, Scotts Mills, OR, USA
| | | | - Xavier Glaudas
- University of the Witwatersrand, Johannesburg, South Africa
- Bangor University, Bangor, Wales, UK
| | - Song Huang
- Anhui Normal University, Wuhu, Anhui, China
| | | | - Yatin Kalki
- Madras Crocodile Bank Trust, Mahabalipuram, Tamil Nadu, India
| | | | | | | | | | - Konrad Mebert
- Global Biology, Birr, Switzerland
- Institute of Development, Ecology, Conservation & Cooperation, Rome, Italy
| | - Mark-Oliver Rödel
- Museum für Naturkunde - Leibniz Institute for Evolution and Biodiversity Science, Berlin, Germany
| | | | - Manuel Ruedi
- Museum d'Histoire naturelle Geneve, Geneva, Switzerland
| | | | | | - Frank Tillack
- Museum für Naturkunde - Leibniz Institute for Evolution and Biodiversity Science, Berlin, Germany
| | | | - Wolfgang Wüster
- Molecular Ecology and Fisheries Genetics Laboratory, School of Natural Sciences, Bangor University, Bangor, Wales, UK
| | - Isabelle Bolon
- Institute of Global Health, Department of Community Health and Medicine, Faculty of Medicine, University of Geneva, Geneva, Switzerland
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31
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Silva GM, Berto DH, Lima CA, Waitman KB, Lima CFG, Prezoto BC, Vieira ML, Rocha MMT, Gonçalves LRC, Andrade SA. Synergistic effect of serine protease inhibitors and a bothropic antivenom in reducing local hemorrhage and coagulopathy caused by Bothrops jararaca venom. Toxicon 2021; 199:87-93. [PMID: 34126124 DOI: 10.1016/j.toxicon.2021.06.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 06/05/2021] [Accepted: 06/10/2021] [Indexed: 01/11/2023]
Abstract
Snakebite accidents are a public health problem that affects the whole world, causing thousands of deaths and amputations each year. In Brazil, snakebite envenomations are caused mostly by snakes from the Bothrops genus. The local symptoms are characterized by pain, swelling, ecchymosis, and hemorrhages. Systemic disturbances can lead to necrosis and amputations. The present treatment consists of intravenous administration of bothropic antivenom, which is capable of reversing most of the systemic symptoms, while presenting limitations to treat the local effects, such as hemorrhage and to neutralize the snake venom serine protease (SVSP). In this context, we aimed to evaluate the activity of selective serine protease inhibitors (pepC and pepB) in combination with the bothropic antivenom in vivo. Further, we assessed their possible synergistic effect in the treatment of coagulopathy and hemorrhage induced by Bothrops jararaca venom. For this, we evaluated the in vivo activity in mouse models of local hemorrhage and a series of in vitro hemostasis assays. Our results showed that pepC and pepB, when combinated with the antivenom, increase its protective activity in vivo and decrease the hemostatic disturbances in vitro with high selectivity, possibly by inhibiting botropic proteases. These data suggest that the addition of serine protease inhibitor to the antivenom can improve its overall potential.
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Affiliation(s)
- G M Silva
- Laboratory of Pain and Signaling - Butantan Institute, São Paulo, Brazil.
| | - D H Berto
- Laboratory of Pain and Signaling - Butantan Institute, São Paulo, Brazil
| | - C A Lima
- Laboratory of Pain and Signaling - Butantan Institute, São Paulo, Brazil
| | - K B Waitman
- Laboratory of Pain and Signaling - Butantan Institute, São Paulo, Brazil
| | - C F G Lima
- Laboratory of Pain and Signaling - Butantan Institute, São Paulo, Brazil
| | - B C Prezoto
- Laboratory of Pharmacology - Butantan Institute, São Paulo, Brazil
| | - M L Vieira
- Department of Microbiology, Federal University of Minas Gerais (UFMG), Belo Horizonte, Brazil
| | - M M T Rocha
- Laboratory of Herpetology - Butantan Institute, São Paulo, Brazil
| | - L R C Gonçalves
- Laboratory of Pathophysiology - Butantan Institute, São Paulo, Brazil
| | - S A Andrade
- Laboratory of Pain and Signaling - Butantan Institute, São Paulo, Brazil
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